[Echography of the vitreous body in case of aphakia and malignant aphakic glaucoma (author's transl)]. The senile destructions of the vitreous body which can be seen with the slit-lamp (formation of visible fibres, vacuoles and posterior vitreous detachment) cause, if sufficiently advanced, small echoblips visible at echographic examination. We reexamined aphakic patients who had no complications during cataract cryo-extraction. In aphakic eyes without postoperative vitreous prolapse into the anterior chamber the echograms usually consisted of uninterrupted series of small amplitude echoes in the vitreous area. In aphakic eyes with postoperative vitreous prolapse into the anterior chamber echo-free parts were found in the vitreous area and also parts showing closer placing of vitreous echoes. The echo-free parts may represent fluid-filled vacuoles. In malignant aphakic glaucomas, which could not be controlled otherwise, we succeeded inaspirating aqueous humour from these echo-free parts by punction. Echography facilitated, in this way, the punction of the trapped aqueous. Echography of the senile vitreous destructions approaches the limits of present ultrasonographic facilities; artefacts may occur, and technical improvements are desirable and possible.


[Computer tomography in ophthalmology (author's transl)]. The computer-aided tomography system (EMI-Scan) represents a new X-ray method in neuroradiology. Some cases of various space occupying retrobulbar orbit processes are presented, and it is demonstrated that this method is also well suited to the diagnosis of orbit diseases. Physicotechnical basis, technique of examination, the indication for computer tomography and the diagnostic possibilities are described.


[Computer tomography of the eye and the orbit (author's transl)]. Princips of computer tomography is demonstrated and the absorption coefficients of ocular and orbital tissue are calculated. The advantages and disadvantages of this procedure are discussed. 39 patients with ocular and orbital diseases were examined by computer tomography. The main indication was tumors, including metastases and diseases arising from ethmoidal cells. Vascular anomalies and tumors were better demonstrated by angiography. Dislocated lens, enlarged tumors of the choroid and prostheses (cerclage and orbital implants) are demonstrable. In contrast to echography, the computer tomography gives certainly better results in the posterior part of the orbit. Technical improvement of the apparatus could lead to a wider use in ophthalmology.


[On iris reposition in case of extraction of lens (author's transl)]. A description is given of a pair of iris retractors which avoid certain shortcomings of other instruments or of other methods of retracting the iris in connection with cryo-extraction, particularly in case where the pupil cannot be dilated or only insufficiently. This pair of iris retractors has proved useful. In addition, information is given about our own technique to achieve a round functional pupil, after complicated lens-extractions with vitreous prolapse, by peripheral iridotomy parallel to the limbus and discission of the body.


[Siderosis of the lens (author's transl)]. Incipient siderosis of the lens is reflected by an extremely fine granular, almost homogenous closely subcapsular brown discoloration between the anterior capsule of the lens and the epithelium. Advanced siderosis of the lens leads to subcapsular "rust spots" of varying size, especially in the region below the pupil; to increasing permeability cataract with protein breakdown and also to brown discoloration of the developing hollow spaces and clefts containing protein. In extensive siderosis of the lens, there was the following histological evidence of iron infiltration colour reactions: Between epithelium and capsule: (fusiformly) changed epithelia, intercellular substance formed by metaplasia of epithelia with connective tissue fibrillae (birefractive capsular cataract), in large, balloon-like epithelial cells freely occurring in the liquefied capsule, by decomposition of these cells in all fluid cavities containing protein (water clefts, etc.). On the other hand, there were no siderous granulations of protein: in normal epithelial cells of the lens, in unchanged fibres of the lens, in Wedl's cells and in Morgagni's or myelin droplets.


[Corneal pathology in rheumatoid arthritis and Sjögren-syndrome with special reference to "rheumatoid keratomalacia" (author's transl)]. The corneal pathology in rheumatoid arthritis and Sjögren's syndrome is described with emphasis on rheumatic keratomalacia. This particular disorder whether affecting the central and paracentral or the peripheral parts of the cornea is characterized by thinning of the corneal stroma, loss of epithelium, ulceration and eventually by corneal perforation. 7 cases are reported. Reduced tear production and simultaneous corticosteroid treatment seem to be the essential pathogenetic factors of this corneal disease. Therapeutic consequences and differential diagnosis are discussed.


[Combined contactoptical system (author's transl)]. The indications and the adaptation method of a combined contactoptical system called piggy-back system, are dealt with. This system comprises the adaptation of a soft contact lens on which is applied afterwards, a hard one. The optical and the therapeutic results obtained in 7 groups of patients (56 eyes) with astigmatism, aphakia, keratokonus, keratoplasty, injuries, chronic lesions of the epithelium, and hyposecretion of the tear fluid, are discussed together with the results of the adaptation of the lenses.


[Occurrence of diffusions shown by fluorescence angiography of the laser coagulation in animals (author's transl)]. Laser treated rat fundi were observed angiographically and with the fluorescence microscope for 3 months. Angiographically diffusions have been observable up to about one week post laser, fluorescence microscopically, however, for the whole observation time of 3 months. From the 2nd week, these diffusions were produced mainly by neovascularizations which angiographically were not visible. They started from the choroid and penetrated into the outer part of the retina.


[The action of pilocarpine on the metabolism of surviving lens epithelium and iris cells (author's transl)]. In tissue culture, lens epithelia and iris cells survive concentrations of 0.5 mg pilocarpine/100 ml TCM, even better those of 0.25 mg/100 ml. By means of the Warburg-method and Boehringer's Glukotest, the consumption of oxygen and glucose were measured without and with the addition of pilocarpine. The oxygen-uptake of the epithelia decreased to one third after addition of the drug, while it doubled in the iris cells. This reveals a compensating effect of the iris tissue protecting the epithelia. Pilocarpine inhibited the consumption of glucose in both tissues, but not significantly. Consequently, we are not dealing with a cataractogenuous substance. This gives new light upon Hockwin's so-called "Additions-katarakt".


[The clinical picture of retinopathia oxalogenica (author's transl)]. A presentation is given of the severe changes in the retina of a 26-year-old man caused by intraocular Calciumoxalate crystals with clinical, histological and polarizing optical findings. The stadia of the retinopathia oxalogenica are classified here.


[Alport-syndrom with participation of the cornea and alterations of ERG (author's transl)]. A description of a 26-year-old patient who had hearing difficulties, progressive nephropathy, and conus of the lens in both eyes is given. The ERG was below normal and the EOG remained normal. About the same time the nephropathy affliction occurred, a ringed abscess appeared in the left eye. Afterwards it healed with a scar, but half a year later the same affliction appeared in the right eye.


[Tuberous sclerosis with megalocornea and coloboma of the iris (author's transl)]. A mentally and physically retarded 4 1/2 year-old boy with epileptic seizures showed a megalocornea on both sides, a coloboma of the iris in the right eye and a white area at the temporal side of the disc in the left eye. At first a coloboma of the disc was suspected. By further controls at the age of 8 years a typical two diopters elevated nodular opaque white mass was seen in place of the white area in the left eye, in addition two flat tumours were also seen. In the right eye with coloboma of the iris there was also a flat area. Radiographically the right kidney showed two ureters with flat calyces. At the age of 8 years symmetrical face naevi occurred only under atropine medication, and showed at the age of 10 years the typical picture of Pringle's tumours.


[Reconstruction of the lacrimal canaliculi (author's transl)]. The different methods of reconstructing obliterated lacrimal canaliculi are described. At the Eye Clinic in Erlangen Henderson's method is prefered. Into a new canal between the lacrimal punctum and the lacrimal sac a tube of polyethylene is introduced and remains there for some weeks. About 60% of the reconstruction lacrimal canaliculi were still open after months and years.


[Rare ocular manifestations of Boeck's sarcoidosis (author's transl)]. The clinical and histological diagnosis of two patients having an unusual localisation of eyelid and orbita with sarcoidosis Besnier-Boeck-Schaumann is explained. The importance of a prompt excission of the sample for the diagnosis and initiation of therapy is emphasized.


[Intraocular cryptococcosis (author's transl)]. A 79-year-old female patient suffered from iridocyclitis of both eyes. In the fundus of the left eye equatorially a preretinal questionable granuloma (size 1/2 d.d.) was found; the first hint of a mycotic involvement. In the enucleated right bulbus, an abscess-like granulomatous focus with a diameter of 10 mm was found. Several round encapsulated cells having a diameter of 7 to 20 mu and looking like with Cryptococcus neoformans were microscopically demonstrable in the pus obtained from this abscess. Since the fungus could not be cultured, it may be assumed that a spontaneous healing occurred. The only known basic disease was a temporary uremia (330 mg0/0 urea and 7.0 mg0/0 creatinin). The role of amphotericin B therapy in this patient is discussed.


[Ophthalmic and orthoptic investigations in the kindergarten (author's transl)]. Recent observations of about 4000 children within the age of two to seven years are reported. It seems to be very useful to do all examinations such as visual acuity, cover-test and stereo-test in familial surroundings by experienced investigators. A survey of visual acuity, squint and stereopsis of all children is given in detail as well as an outline of the consequences of this study to the public health welfare.


[The exfoliation syndrome: source of the fibrillar material on the capsule (author's transl)]. A clinical case of unilateral capsular exfoliation syndrome was observed in the previously traumatized eye of a 22-year-old man with a drawn-down pupil. The distribution of material corresponded to the folds of the inner surface of contiguous iris. The periphery of the lens was free of deposits, as far as could be seen. These findings contradict previous theories on the source of the fibrillar material from the lens epithelium and indicate that it is derived from the iris pigment epithelium and not from within the lens capsule, although there is no question that a similar process involves the peripheral lens epithelium and capsule, the products of which probably do not reach the lens surface.


[Treatment of malignant lid tumours by intrapalpebral injection of urea (author's transl)]. 36 malignant tumours of the eyelids (basaliomas, basal-cell carcinomas and squamous-cell carcinomas) have been treated by intrapalpebral injections of a 5% to 25% solution of urea as recommended by E.D. Danopoulos. 1.5 to 3.0 ml of the solutions were injected around the tumours twice per week. Six malignant tumours disappeared completely after a treatment of eleven months; their largest initial diameter averaged 0.53 cm. Considering the protracted treatment, the uncertainty of success, without histological examination of the excised scar tissue, and finally because of the low rate of verified success, injections of dissolved urea around malignant tumours of the eye lids cannot replace radical excision.


[Eye involvement in plasmocytoma (author's transl)]. A description is given of a 37-year-old man, who suffered from a IgG myelom, diagnosed by internal medicine. The initial symptoms of the disease were grey-white, crystalline deposits in the cornea and recurring inflammation of the iris in both eyes. Only when a multiple recurring exophthalmos occurred, could the diagnosis be determined through an intensive internal examination. The continuing disease was still complicated by an insufficiency of the kidneys with hypertony and beginning retinopathia angiospastica.


[Micrometastasis of the uvea: a rare cause of uveal effusion (author's transl)]. A clinicopathological report is given on a case of spontaneous chorioideal detachment in a patient with metastatic carcinoma. Histological there was infiltration of the ciliary body and peripheral choroid and a large uveal effusion. Pain would seem to be a pathognomic sign of metastatic tumor in choroideal detachment caused by metastatic tumor.


[Electrolytic eye-lash epilation with the operating microscope (author's transl)]. A modified technique of epilation by electrolysis is reported. Epilation is hereby performed under the operating microscope. Contrary to the original method, with this technique the eyelash is firstly removed and then the hair canal is sounded with a fine wire under corresponding magnification. After the circuit is closed, white foam is formed and subsequently the hair papilla and the hair follicle are destroyed. The technique has several advantages compared to the original method: 1. It is relatively harmless to tissue. 2. Larger areas of abberant cilia may be epilated in one session as confluent necroses do not occur. 3. The risk of cilia again growing is reduced as the hair follicle and hair papilla are destroyed with high certainty.


[Spontaneous improvement of visual fusion by correction of minor anisometropia (author's transl)]. It is shown from two examples that spectacle correction of minor grades of anisometropia in children can be sufficient to allow them to fuse normally and to avoid asthenopic complaints caused by partial suppression of the image from one eye.


[A comparative trial between pilocarpine drops and ocusert-pilocarpine]. Ocusert P 20/P 40 was tested on 53 outpatients with glaucoma for 5 weeks. In 27 patients good results and compatibility could be seen. The therapy had to be stopped with 26 patients, due to bad compatibility in 16 patients, and due to insufficient effectiveness in 10 patients.


[Pilocarpine as a diagnostic agent for early recognition of a tendency to glaucoma. (Comparable results between Hollwich's pilocarpine-test and tonography) (author's transl)]. In a group of 20 patients Hollwich's pilocarpine-test and tonography were performed repeatedly at regular intervals, for diagnostic purposes. The results of the pilocarpine-test were compared with those of tonography. Hence it was shown, that the pilocarpine-test performed at the peak of the daily pressure curve, gives comparable results to tonography and hence can be useful when glaucoma suspicion exists in the eye-doctor's surgery.


[Ocular myiasis (author's transl)].

[Ocular myiasis (author's transl)]. One case of an extraocular myiasis is presented. It is reported on parasites, which cause an ocular myiasis, complications and treatments.


[Retinopathy and maculopathy in cystinosis (author's transl)]. Retinopathy and maculopathy combined with pseudoneuritis were observed in cystinosis. The disease was classified as a nephropathic process.


[Self-destruction by repeated introduction of foreign bodies into the eye (author's transl)]. There is an observation of a 30-year-old woman inserting foreign bodies into the left eye. Perhaps a grave psychiatric sign


[Ophthalmic-pharmacological complications (author's transl)]. The action of some drugs on the eye may lead to the occurrence of unforeseen ocular and extraocular reactions. Vincaleukoblastin (Velbe) provokes serious corneal lesions with a healing time of two weeks and a half. The local application of Neo-Synephrine eye drops (10%) and Mydrial-Atropine ointment may lead in the case of a pharmacogenetic disposition to disagreeable systemic effects. In one case of preparation for a cataract operation by akinesis and retrobulbar injection, Novocain was changed by mistake with Pilocarpinum hydrochloricum by the error of a pharmaceutical firm. This led to severe complications, which could by successfully treated with Chlorpromazine (Largactil). The knowledge of these clinical observations may be of greater usefulness in the preventation of untoward drug reactions.


[A soft, self-adhering contact lens for fundus examination (author's transl)]. A soft, self-adhering, biconcave silicone contact lens is presented. After surface anesthesia the lens can be placed on the cornea without additional contact fluid and a fundus area of about 35 degrees can be viewed. For vitreous surgery a modification with a flat or slightly convex surface is recommended.


[Retinoschisis and detachment (author's transl)]. Senile retinoschisis was found in 30 out of 315 pairs of eyes taken from cadavers. The retinal splitting occurred primarily as a result of the confluence of peripheral cystoid degeneration (Blessig's spaces or Iwanoff's cysts). There is no reason to suppose that two different forms of retinoschisis are present if the vessels are located in the inner layer. Based on reticular cystoid degeneration, there was only once case which could have represented another types of splitting. Here the vessels were located in the outer layer; the inner layer consisted only of the vitreous membrane. External spaces in the layer are the main causal factor for the development of retinoschisis detachment.


[A-scan-ultrasonography in unilateral optic nerve lesions (author's transl)]. With A-scan-ultrasonography it is possible to determine the time of transmission of ultrasound within the cross section of the distal optic nerve. In this way information regarding its thickness can be obtained. 156 patients with various unilateral optic nerve lesions were examined. Thickening of the affected nerve was found in the acute phase of neuritis nervi optici, trauma, optic nerve tumors and in papilloedema due to raised orbital or intracranial pressure. This investigation has proved a valuable aid in diagnosis in the following unilateral conditions: 1. Acute visual loss in the absence of significant fundus findings--an enlarged optic nerve ultrasonogram is an objective sign of a retrobulbar neuritis, or after injury, a haematoma. 2. Papilloedema--the optic nerve ultrasonogram gives information about the nerve. 3. Optic atrophy--an enlarged optic nerve ultrasonogram indicates an optic nerve or sheath tumor.


[Heterotopic fundus (author's transl)].

[Heterotopic fundus (author's transl)]. Fundus heterotopicus is the term used to describe a rare, non-hereditary curvature anomaly of the fundus in the non-myopic eye, which is characterized: 1. functionally, by a slowly increasing myopic-astigmatic refractive error, 2. by correctable bitemporal or binasal refractionscomata and 3. ophthalmoscopically by a posterior out-pouching of the nasal or temporal fundus portions, and including the optic disc and macula in the obliquely descending wall of the extasis.


[Traumatic palsies of the inferior oblique muscle (author's transl)]. The author discussed the increase in the frequency of traumatic paralyses of the ocular muscles, and reported 6 cases of inferior oblique muscle paresis caused by local blunt or sharp traumas (haematoma, contusion, rupture, incarceration) and one case of traumatic Brownian pseudo-paralysis. The localisation of the injuries in 3 cases was on the inferior temporal part and in the other 3 cases on the superior part of the bulbar conjunctiva. Atypical horizontal deviation and characteristic vertical deviation, torsion and torticollis were observed in the majority of cases. One patient recovered spontaneously. 3 patients became asymptomatic after correction by prisms and one after recession of contralateral superior rectus muscle. The symptoms remained unchanged in the case of a "blow out" fracture (in spite of operation) and a Brown's syndrome (without treatment).


[Aberrant reinnervation after oculomotor palsy with involvement of the ciliary muscle (author's transl)]. The clinical and electromyographic signs of the misdirection syndrome after oculomotor palsy are described. Besides the previously described findings we found an increase of intraocular pressure dependent on the direction of gaze. In three young patients (16-26 years), we were able to demonstrate an aberrant reinnervation of the ciliary muscle, which was responsible for an increasing myopia in adduction. These observations supplement the previous concept of the misdirection syndrome.


[Radionuclide dacryography in clinical practice and research (author's transl)]. Radionuclide dacryography (RND) has the following indications: 1. Localisation of obstructions in the lacrimal drainage system. 2. Judgement of relative tear obstruction. 3. Pre- and post-operative control of the function of lacrimal drainage in surgical and radiotherapy of the inner canthus region. 4. Investigations of tear secretion are described and own preliminary results are discussed. 5. Resorption of suitable marker substances clinically. First results of conjunctival resorption of pertechnetate are reported. 6. The possibility of testing in vivo radioactive drug delivery systems is shown by means of own investigations. 7. The absorbed radiation dose using RND is very low as compared to radiological methods, thus justifying repeated controls and investigations even in children.


[Intraarterial injection of Tolazolinhydrochlorid in retinal arterial occlusions. Our experiences with puncture of the carotid artery (author's transl)]. In partial and total retinal arterial occlusions we have been giving intracarotideal Tolazolinhydrochlorid since 1969. In the beginning we have prepared surgically the common carotid artery, at present this puncture is done percutanously. The author describes the surgical procedure and the results. A significant improvement of the visual acuity and of the visual field was present in the cases with intraarterial injection.


[Studies on the changes of transcortin-level in patients with glaucoma (author's transl)]. Changes in the plasma transcortin level were studied in patients with primary glaucoma, glaucoma and diabetes, diabetes mellitus compared with a control croup. It was found that the plasma transcortin level of the patients with or without glaucoma was significantly higher than that of the control values. Moreover, the analysis of the dissociation constant of transcortincorticosterone complex revealed that it is greater in patients with primary glaucoma than could be expected by the dilution ratio. Further studies are required to understand the mechanism of the changes occurring in plasma transcortin level in glaucoma.


[Relationships between hemopoiesis and peripheral blood counts in untreated and 32P-treated patients with polycythaemia vera (author's transl)]. The composition of the hemopoiesis was determined in iliac crest biopsies of 51 patients with polycythaemia vera. There was a good correlation between thrombopoiesis and thrombocytes and, to a minor degree also between erythropoiesis and erythrocytes in untreated patients as well as between granulopoiesis and granulocytes in 32P-treated patients. In patients with normal blood counts there existed no correlation between the bone marrow and the blood counts within smaller limits of the cell count. Histomorphometric analysis shows no difference either between untreated and 32P-treated patients or between patients with and without splenomegaly. This is an argument against a significant intrasplenic hemopoiesis or an intrasplenic cell pooling, or destruction (hypersplenism), respectively. The blood sinusoids are hyperplastic and distended. With increasing hyperplasia of the hemopoiesis the sinusoids become relatively smaller. So changes in vascularisation may be of importance in the infrequent transitions into myelofibrosis and/or leukemia.


[Insufficiency of the exocrine pancreas in Wilson's disease (author's transl)]. The function of the exocrine pancreas was examined by the secretin-pancreozymin-test in 3 patients with Wilson's disease. In all cases we found a partial insufficiency. At the time of investigation the patients were 6(7)/12, 11(6)/12 and 21 years old. The youngest one was examined before therapy with D-Penicillamin. We suppose that storage of copper in lysosomes causes a cytotoxic damage of the exocrine part of the pancreas requiring substitution therapy in advanced cases.


[Changes of erythrocyte membrane lipids in ethanol induced hyperlipidemia (Zieve's syndrome) (author's transl)]. In 11 patients with alcohol-induced hyperlipemia, of whom 6 showed a Zieve Syndrome increased phospholipids, triglycerides and total cholesterol were found in the red cells stromal. The gasliquid chromatographic analysis of the phospholipid fatty acids showed increased contents of saturated and monounsaturated fatty acids C 16-C 18 smaller contents of longchain highly unsaturated fatty acids. The changes in the fatty acid pattern mainly occurred in patients with Zieve Syndrome and could be important for the mechanism of the hemolytic anemia. Theses findings could be in connexion with vitamin E deficiency.


Biliary reabsorption of cholate sodium, glycocholate sodium, and taurocholate sodium from the rat biliary tree after retrograde intrabiliary injection. The results demonstrate the biliary reabsorption of 14C-cholate, 14C-glycocholate, and 14C-taurocholate from the rat biliary tree after retrograde intrabiliary injection. It could be shown that retrograde injection of these bile salts (20 nmol) in a total volume of 40 mul leads to significantly increased biliary reabsorption in contrast to the administration in a retrograde volume of only 20 mul. These differences in reabsorption may be explained by greater reabsorption at a more proximal site in the biliary tree. Furthermore 14C-glycocholate and 14C-taurocholate are reabsorbed to a lesser extent in contrast to 14C-cholate when bile flow was restarted at once after retrograde injection in a volume of 40 mul. It is speculated that conjugation of cholate to glycine and taurine has some effect on the extent of biliary reabsorption of this bile acid. Following the results presented in this paper one might hypothize that biliary reabsorption has an important influence on bile composition i.e. the biliary excretion of bile salts.


Lymphatic absorption and metabolism of orally administered testosterone undecanoate in man. [3H]-testosterone undecanoate ([3H]TU) was administered orally to 4 patients with a thoracic duct catheter after neck dissection surgery. Appearance of radioactivity in lymph, plasma and urine was measured at different times. Metabolites of TU in these fluids were investigated. Peak levels of radioactivity appeared simultaneously in lymph and plasma (2.5-5 h after administration) while the excretion in urine was highest approximately 2 h after the plasma and lymph peak. The main compounds appearing in the lymph were TU and 5alpha-dihydrotestosterone undecanoate (5alpha-DHTU), but 5beta-DHTU could not be detected. In plasma almost all metabolites were probably conjugated. During the first 24 h approximately 40% of the administered radioactivity was excreted in the urine. The total amount of radioactivity excreted in the urine during the first week was 45-48%. The predominant urinary metabolites were testosterone- and androsterone-glucuronide. The results indicate that TU is metabolized partly in the intestinal wall. The remaining TU and newly-formed 5alpha-DHTU, at least partly, are absorbed via the lymphatic system.


[Decrease of disaccharidase activity following application of bencyclan-hydrogenfumarate (author's transl)]. The disaccharidase activity of the small bowel mucosa of the rat is decreased by intraperitoneal application of Bencyclan-hydrogenfumarate. The doses applied were 10, 50 and 100 mg/kg body weight. The decrease rate after 100 mg/kg attained up to 50% of the control values. Furthermore, a reduction of villous height and an increase of the crypt depth has been observed in correlation with the enzyme activity decrease. Though functional and morphological alterations show a correlation, they cannot be explained by an antimetabolic-like effect because of the fact that the enzyme function recovers 72 h after application of the drug. Whilst our results do not sustain a cytostatic effect of Bencyclan-hydrogenfumarate, there is no doubt that the intraperitoneally applied drug influences the disaccharidase activity. These facts have to be considered in clinical therapy.


[DNA depolymerase activity in rat spleen following flight on the "Kosmos-605= satellite]. The activity of enzymes involved in DNA disintegration (acid and alkaline DNA-ases) was measured in the spleen of rats flown onboard the Cosmos-605 biosatellite for 22 days. The activity of alkaline DNA-ase remained unaltered whereas that of acid DNA-ase increased more than twice. The activity of acid DNA-ase returned to the normal 26 days postflight. The study of characteristic viscosity (eta) of native and denatured DNA showed that enzyme activation was not followed by degradation changes in the DNA molecule.


[Changes in human monosynaptic H-reflex during altitude decompression]. Test subjects exposed to altitude decompression without preliminary denitrogenization showed in 65-75% of cases stability or reduction of the amplitude of the H-response of a leg with subsequent painful sensations and in increase of the amplitude of the H-response in the other leg as long as they were raised to an altitude of 11,000 m. When bends developed in a leg the amplitude of the H-response in that leg decreased and in the opposite leg increased. During the descent and disappearance of painful sensations changes in the amplitude of the H-response were just the opposite. It is assumed that a decrease of the amplitude of the H-response during altitude decompression was associated with oxygen deficiency of nerve afferents and an increase--with the descending activating supraspinal effect.


[State of the human motor apparatus during prolonged exposure to a nitrogen-oxygen atmosphere at a pressure of 5 atm]. The state of the motor function of individuals who were pedalling a bicycle ergometer in an altitude chamber containing a nitrogen-oxygen atmosphere at 5.0 ata was studied. Maximum isometric force, precision of controlling movement and muscular tension, accuracy and velocity of movements were recorded. The maximum force, precision and velocity of movements varied phasically. The greatest changes were found on the 1st-3rd and 6--7th days of the exposure. These parameters returned to the normal when the atmosphere pressure was reduced to 1.0 ata. During exercises at an elevated pressure the muscular force, accuracy and velocity of movements decreased. During exercises at a normal pressure similar changes were less distinct and consistent.


[Effect on water metabolism of body posture relative to the gravity vector]. A combined effect of hypokinesia and body position at different angles to the gravity vector on the water content and rate of its metabolism was studied. It was shown that bed rest reduced total water losses and the rate of its metabolism. It was body position as related to the gravity vector rather than bed rest that influenced the total water content in the body.


[Recovery of muscle functions in rats following prolonged movement restraint]. Experiments were carried out to measure time and force parameters of isometric contractions and structural parameters of muscles of hind limbs of rats which were exposed to hypokinesia for 130 days and then were kept under surveillance for 3 months. During recovery certain functions of the contractile system returned to the normal. At the same time M. soleus displayed persistent changes that were indicative of atrophic developments. Unlike M. soleus where delayed contraction (due to an increase in the time of relaxation) was followed by losses in force, fast muscles (M. ext. digit. longus and M. plantaris) showed recovery of force parameters. They also exhibited delayed contraction due to an increase in the time of tension development and half-relaxation. These differences are associated with dissimilar function and structure of muscular fibers. On the whole, the pattern of recovery of the motor functions reflects responses to an increased load of the neuromuscular system of animals which are kept in large cages after prolonged hypokinesia.


[Prevention of decompression sickness as applied to conditions of multiple space walks]. Six 3-day experiments were carried out in an altitude chamber in which 6 test subjects took part. The experiments simulated repeated extra-vehicular activities--intensive work at an altitude of 10,000 m in a helmet or at an altitude of 40,000 m on a space suit pressurized at 200 mm Hg. It was demonstrated that altitude decompression could be prevented by desaturation--prolonged exposure to the hypobaric atmosphere (430 mm Hg) and 100% O2 or a 40% O2 and 60% N2 mixture. During the 3-day experiment the test subjects made seven 3--4 hour excursions, showing no symptoms of decompression disease.


[Human adrenal function during prolonged exposure to hyperbaric conditions (N2-02, 5 atm)]. Test subjects were exposed to a nitrogen-oxygen atmosphere at 5 ata, performing various activities. The adrenal function of the subjects was examined with respect to the catecholamine and corticosteroids excretion in the urine. During adaptation to the environment the excretion of catecholamines and corticosteroids varied phasically. After 3 days of the 7-day exposure to the hyperbaric atmosphere and during decompression the excretion of norepinephrine increased and that of corticosteroids, particularly 17-corticosteroids, decreased. The diurnal rhythm of the excretion changed though the life regimen of the test subjects remained unaltered. These variations can be considered as adaptive-protective responses of the human body.


[Comparative characteristics of electrocardiograms of overweight and normal weight flight personnel in conditions of moderate hypoxia]. Examination of electrocardiograms of pilots with normal and 10% excessive weight in a moderately hypoxic atmosphere showed that changes in the pulse rate, T voltage, systolic index were less expressed in obese subjects than in normal pilots. This can be attributed to the fact that obese subjects had reduced metabolism, minute oxygen consumption and compensatory capabilities of the cardiovascular system.


[Relation of human weight loss to the duration of space flight]. A formula describing weight losses in the first approximation during space mission was derived assuming that humans may adapt to space flight effects. The process depended on two parameters one of which characterized maximum body losses and another--time of adaptation. Weight estimates of Skylab crewmembers obtained with the aid of the formula were in good agreement with actual results. The typical time of adaptation was two days. Possible ways of constructing a more precise model of weight changes and its use to diagnose the status of crewmembers are discussed.


[Method of studying acceleration tolerance of pilots in flight conditions]. The following procedure was used to study the pilot's tolerance to acceleration inflight. Experiments were carried out in a specially equipped plane with a dual monitoring system. Inflight the pilot performed 3 dives, attaining 3.0, 5.0 and 6.0 g for 30 sec at an interval of 1-2 min and an onset rate of 0.4-0.6 g/sec. The control over the health state and performance of the pilot was maintained by the coach as well as with the aid of breathing rate, ECG, ear pulse rate recordings and cynematography of the pilot's face during exposure to acceleration. These methods were employed in experimental flights of a good number of pilots. The results show that the methods may well be used to better medical monitoring inflight and to identify subjects with decreased tolerance to acceleration.


[Mouse hematopoietic organs in hypokinesia]. The capacity of hemopoietic cells for colony-formation and the pattern of their differentiation during hypokinesia were studied. The absolute count of colony-forming units (CFU) decreased exponentially during 3 to 30 days. Bone marrow showed a change in the total cell count and a wave-like change in the absolute and relative count of CFU with a maximum on the 1st-3rd and 15th-45th days. Differentiating potentialities of CFU from the spleen and bone marrow were not altered towards erythro-, myelo- and thrombopoiesis. The cell structure of the peripheral blood changed, displaying lymphopenia, transient neutrophil leukocytosis, increase in the percentage content of large lymphocytes and stress-lymphocytes.


[Recovery of central vision after temporary blindness]. Recovery of spatial resolving capacity (acuity) of central vision after temporary blindness induced by prolonged (1.5, 3, 6 min) light adaptation to a sun or incandescence lamp (20, 40, 80 thous. lux) illuminated white screen was studied. The recovery time increased exponentially with an increase in energy light stimulation (product of brightness of the deadapting source by the time of action). A general formula describing the relationship between the time of recovery of acuity and brightness of the test table and energy of light stimulus was derived.


[Rabbit coronary vessels following a single irradiation of the heart region with a dose of 2400 rad]. The effect of ionizing radiation on the coronary vessels was studied on rabbits whose cardiac areas were irradiated at a dose of 2400 rads. This exposure led to dilatation and stricture of small vessels. The most significant changes were found in the system of the left coronary artery at an early post-irradiation period.


[Evaluation and application of quantitative indices of the work quality of an operator]. The paper gives assessment of quantitative parameters of the quality of the operators' activity involved in the spacecraft control. It discusses specific problems that can be solved using parameters characterizing the quality of the operator's activity during space flight, spacecraft development and operators' training.


Rabbit mortality survey.

Rabbit mortality survey. In a survey of mortality in 2224 rabbits of up to 12 weeks of age, drawn from 10 production units, neonatal mortality was important with 111 stillbirths and 175 deaths in the 1st week of life out of a total of 457 deaths in the whole survey. There was a low overall incidence of death from respiratory and enteric disease during the period of study.


Experimental induction of cervical lymphadenitis in guinea-pigs with group C streptococci. Streptococcal lymphadenitis with macroscopic abscesses was induced in guinea-pigs when an isolate of Lancefield's group C streptococci of guinea-pig origin was sprayed orally. The disease was also produced in guinea-pigs when another isolate was injected sublingually but not when it was sprayed orally. Treatment with prednisolone did not increase the susceptibility to the latter isolant when sprayed orally. Abscesses could not be induced in the cervical lymph nodes of guinea-pigs exposed by injecting group E streptococci sublingually, although the organism was isolated from the cervical lymph nodes 2 days after inoculation. Neither could abscesses be induced by injecting these streptococci sublingually in guinea-pigs treated with prednisolone.


Seizure resistance in albino gerbils.

Seizure resistance in albino gerbils. Albino gerbils (Meriones unguiculatus) and their agouti litter mates were tested once per week for 10-16 weeks for spontaneous epileptiform seizures when transferred to a novel environment. Only 16% of the albinos had seizures compared with 41% among the agoutis (P less than 0-05).


The distribution of enzymes in the skin of the domestic pig. On the basis of enzyme histochemical methods, the distribution and the activities of various enzymes in the skin of the domestic pig were investigated. The results are discussed in connection with the importance of the domestic pig as an experimental animal for dermatological research.


[Experiment with rats on a 22-day flight on the "Kosmos-605" biological satellite (objectives and methods)]. In 1974 a rat experiment was carried out onboard the Cosmos-605 biosatellite. Inflight Wistar rats were kept unrestrained in small cages. The cages were equipped with a feeder, water supply, light source and a ventilation device. The state of the animals was assessed with respect to their motor activity. The flight experiment was preceded by a number of preparatory runs and testinns that were completed with an end-to-end experiment in a biosatellite mockup. The flight experiment was paralleled by the ground-based synchroneous experiment which simulated almost entirely the flight profile. For each experiment rats were selected and trained during a month's observation. Postflight rats were exposed to clinical, physiological, morphological, cytochemical and biochemical investigations. Tissue examinations were performed on the 2nd-3rd day (20 rats) and 26-27th day (12 rats) after flight. Four rats were kept to study remote aftereffects.


The effects of age and anaesthetic on the blood picture of the cuis, Galea musteloides. Blood samples from 25 adult and 6 immature cuis were examined. There were slight differences in red cell parameters (RBC, Hb, PCV, MCV, MCH, & MCHC) between cuis and guinea-pigs. The total white cell count of cuis was much lower. The neutrophils of the cuis, as of the guinea-pig, had eosinophilic granules and were therefore termed pseudoeosinophils. Kurloff bodies were not present in mononuclear cells. There were more platelets in cuis blood compared with guinea-pig blood. The choice of anaesthetic did not influence any of the red cell parameters of the cuis, but may have affected the relative numbers of pseudoeosinophils, the platelet count and the percentage of reticulocytes. Immature animals had a lower erythrocyte count, a higher MCH and fewer platelets than adults.


An improved method for the production of experimental congestive heart failure in the guinea-pig. The method involves supravalvular aortic constriction, and a simple, efficient, aortic constrictor has been developed which gives highly predictable results. Mortality due to causes directly related to the surgical procedure was low.


Measurement of digestible and metabolizable energy of diets for rats. A balance method for the measurement of digestible and metabolizable energy in rats is described. Experimentally determined metabolizable energies of 2 diets for rats were closer to those values for metabolizable energy calculated from tabulated values for pigs rather than chickens. Some drawbacks in the use of tables of energy values to predict the energy of diets are discussed.


Effects of stress due to deprivation and transport in different genotypes of house mouse. The importance of various stress factors involved in boxing and transit of wild and laboratory mice on a 28 hour journey was studied. Transference from laboratory cage to transit box alone caused weight loss; under the best conditions the laboratory mice lost 5% of their initial weight and wild ones 8%. Deprivation of food resulted in absolute loss of weight; from this death ensued when 20% of initial weight was lost: the smaller wild mice died sooner than the larger laboratory ones. Water deprivation resulted in retarding recovery of weight lost; wild mice took longer to recover than laboratory ones. It also caused weight loss and, in conjunction with deprivation of food, poor condition and death. Transit itself affected percentage weight loss and wheat consumption; wild mice were affected differently from laboratory mice in both respects. Genotype is seen to be important not only in controlling initial weight and activity level, but also--and independently of weight--the total food requirement. In the light of these findings current literature giving guidance on shipment of small mammals is shown to be inadequate, and certain recommendations are given.


Effect of age and sex on histamine-induced gastric secretion in laboratory rats. The effect of age and sex on histamine-stimulated 24-hr gastric secretion was assessed in the rat. Secretion tests were done in rats of both sexes at 3, 6, 9, 12, 18, and 24 mo of age. The highest 24-hr volume and acid output of gastric secretion was found in both sexes in the 9-mo age group. When related to body weight the highest 24-hr gastric secretion and acid output was found in 6-mo-old males and in 9-mo-old females. This observation may have practical value when the rat is selected as an experimental tool for the study of gastric secretory function.


Reproductive performance and fertility testing in strain 13 and Hartley guinea pigs. A study to test the effects of certain experimental manipulation on the reproductive capacity of male guinea pigs required verifying the fertility of the male guinea pigs before and after manipulation. Methods of testing fertility were evaluated, and normal reproductive data from preexperimental and control groups were tabulated and analyzed. No data from the actual experiments were included. Virgin and proven fertile males were mated with 1 (1:1) or 2 (2:1) virgin or proven fertile females. Inbred (13/N Umm) and conventional (Mfi:CFDH-ML (DH) ) guinea pigs were used. Ninety-five percent of both groups of males were fertile. Eighty-four percent of both groups of females were fertile. Male guinea pigs previously proven fertile had the same subsequent fertility rate as virgin males. Over one-third of the conceptions did not take place during the first estrus cycle (16 da) during which the males and females were mated. Strain 13 and Hartley females had litters of approximately the same size (3.1 vs 3.0), but the neonatal mortality was statistically lower (P less than 0.001) in the Hartley stock (9.3%) than in the Strain 13 guinea pigs (28.4%).


Record-keeping for a colony of 15,000 mice without use of a computer. An economical and easy to learn method of record-keeping was developed which utilizes standard office supply 3 5 cards for cage cards and central office records. The method developed has been used to maintain all records of a mouse colony of 18 inbred strains and substrains for 9 yr. With this system, detailed pedigrees, postmortem data, tumor incidence, and average age are available in minutes.


Measurement of intestinal absorption in mice by a double-label radioisotope perfusion technic. The use of the standard chemical technic for measuring intestinal glucose absorption was compared with a new double-label radioisotope technic. Glucose absorption and water flux in the mouse small intestine were measured by both methods. The results indicated that the 2 approaches yield almost identical values. The radioisotope technic utilized [14C] polyethylene glycol to measure water flux and [3H] glucose. The technic was found to be reliable, rapid, and applicable to small samples and other substrates. It is particularly suited to absorption studies in small animals such as the mouse, where sample size is limited. The study also showed that the polyethylene glycol recovery rate from the mouse intestine was 97.8%, indicating that it is a valid absorption marker in this species.


Intracisternal virus-like particles in two guinea pig mammary adenocarcinomas. Virus-like particles were found in spontaneously arising mammary adenocarcinomas from 2 male guinea pigs. The type-B particles were 100 nm in diameter and budded from the apex of stalks into cisternae. Examination of normal and neoplastic tissues from other guinea pigs failed to reveal similar particles. A review of the literature revealed that of the 16 known cases of mammary adenocarcinomas in guinea pigs, 5 have occurred in male animals. The apparent propensity for spontaneous mammary adenocarcinomas in males of this species is discussed in relation to the possible etiologic agents responsible for them.


A restraining device and oral dosing technic for the chinchilla (Chinchilla laniger). A device, based on the principle of a cattle squeeze chute, was designed for restraining a chinchilla; and a cannula-tipped syringe was designed for introducing a solution into the animal's throat. The restraining device allows 1 person to conduct routine clinical procedures while the cannula-tipped syringe facilitates oral administration of liquids.


Blood and serum chemistry values of gnotobiotic beagles. Several blood and serum chemistry values were serially determined over a 2-yr period on 17 purebred beagle dogs from the same closed, inbred colony. Seven of these dogs were germfree, and 10 had a conventional bacterial flora. Seven of those with a conventional flora were confined in germfree-type isolators; 3 were housed in a routine manner in a conventional animal facility. The germfree dogs were found to have significantly lower red blood cell, white blood cell, neutrophil, and band cell counts lower levels of alpha-2 and gamma globulins, and higher amounts of cholesterol and alkaline phosphatase than the 2 sets of conventional dogs. In most other respects, the blood and serum chemistry values of the germfree dogs were similar to those of the conventional dogs and to previously reported values for normal beagles.


Effect of deworming medication on the microbial flora of the upper gastrointestinal tract of dogs. Control cultures were taken at laporatomy of the stomach or stomach remnant, jejunum, and ileum of 26 adult dogs, 8 of which had had gastric surgery 1 yr earlier. Two wk after the control cultures were taken, 17 of the 26 dogs, including all 8 which had had prior surgery, were treated with anthelmintics, niclosamide, dichlorophene, methylbenzene, and arecoline hydrobromide. Two wk after the anthelmintic treatment, or 4 wk after the control cultures were taken, the 26 dogs were recultured. Samples of microbial flora were obtained by direct needle aspiration employing anaerobic precautions. These samples were processed both quantitatively and qualitatively using both anaerobic and aerobic technics. The specific sites cultured were the lower stomach or stomach remnant, proximal jejunum 15 cm distal to the ligament of Treitz, and distal ileum 45 cm proximal to the ileocecal valve. Bacteria isolated were predominately facultative aerobes. No fungi were isolated. Cultivation of spirochetes was not attempted. The results showed that there was no significant qualitative or quantitative alteration of microbial flora caused by the anthelmintic treatment.


A system for inducing hyperthermia in sheep. A system that produces hyperthermia in pregnant sheep in a consistent and reproducible manner was designed. The experimental approach was through control of ambient temperature and relative humidity in a closed chamber; the sheep was unable to lose its metabolic heat in an environment of 42 degrees C and 75% relative humidity. This system resulted in a steady and progressive temperature rise of 2.5 degrees C in the maternal abdominal aorta in 120 +/- 17 min.


Koni, kona, kava. orange-beer culture of the Cook islands. The orange-beer culture of the Cook Islands is described. Island drinking customs were found to have cultlike forms, provide for social integration, and control drunken aggression.


Cerebral blood flow and its regional distribution in alcoholism and in Korsakoff's psychosis. The regional cerebral blood flow in alcoholics decreased with age. This reduction may be associated with the length of excessive drinking.


Effects of rate of drinking on human performance. Performance on tests of motor control and of central processing of information was more impaired in rapid drinkers than in slower drinkers.


Alcohol-induced taste aversion in golden hamsters. Multiple injections of alcohol were effective in producing substantial aversions to saccharin-flavored water in golden hamsters. A dose of 1.76 g of alcohol per kg produced a long-lasting aversion, whereas aversion produced by injections of 1.17 g per kg extinguished rapidly.


Alcoholics view group therapy. Process and goals. Alcoholics ranked certain elements of group therapy as more or less helpful, depending on the stage of therapy they were in.


Neighborhood reactions to a community-based treatment center for alcoholics. Survey data from residents of a neighborhood located near a controversial community-based treatment center for alcoholics were compared with data from a similar neighborhood with no treatment facility. The results suggest that neighborhood opposition to such facilities may not be as intense as is commonly thought.


Reconciling unidimensional and multidimensional models of patterns of drug use. Guttman-scale analyses and factor analyses seem to produce contradictory results in analyzing patterns of multiple drug use. Guttman-scale analyses usually show that drug use fits a unidimensional and cumulative model of involvement; factor analyses reject the unidimensional model. The two methods, however, can be reconciled. Guttman scaling is appropriate for discerning patterns of drug involvement, factor analysis for operationalizing degree of involvement within a specific pattern of use.


Women arrested for drunken driving in Boston. Social characteristics and circumstances of arrest. The social characteristics and circumstances of arrest of 73 women arrested for driving while intoxicated and referred to the Boston Alcohol Safety Action Project were examined. Driving while intoxicated was a necessary but not sufficient condition to accoutn for the arrests.


Effect of a negative stereotype on nurses' attitudes toward an alcoholic patient. Nurses' impressions of a hypothetical patient, labeled an alcoholic, were strongly influenced by their negative stereotypic views of alcoholics. Nurses responded more favorably to the same "patient" when he was not labeled an alcoholic even though the behavior of the patient was held constant.


Missouri statewide alcoholism treatment survey. Respondents to a statewide survey of alcoholism treatment services throught that prevention should be given prime priority consideration.


A.A. and group therapy for alcoholics. An application of the World Hypotheses Scale. The results of a study suggest that alcoholics with a preference for formistic thinking (as defined by Pepper's World Hypotheses) are more likely to benefit from participation in Alcholics Anonymous than from group therapy.


Personality traits and moods of alcoholics and heroin addicts. No differences in moods were found between alcoholics and drug addicts, but the alcoholics were significantly more neurotic than the addicts.


Evaluation of the randomized response technique in a drinking survey. A randomized response questionnaire elicited more positive responses from high-school students on an alcohol-related question than did  a self-report questionnaire.


Control orientation in women alcoholics. Women alcoholics had higher scores than women social drinkers (indicating greater external control orientation) on both the Internal-External Locus of Control Scale and a Locus of Drinking Control Scale.


Psychomotor and intellectual development after deep hypothermia and circulatory arrest in early infancy. Somatic, psychomotor, and intellectual development were studied in 11 patients who had total correction of congenital cardiac malformation in early infancy by the method of surface-induced deep hypothermia and circulatory arrest up to 43 minutes. Time between operation and re-evaluation ranged from 3 to 11 years (average 7 years). Somatic development was normal in all children. Psychomotor and intellectual behavior, measured by a battery of specially adapted test methods, failed to show a statistically significant difference when compared between the study group, a matched control group, and the normal population. Normal scores in psychomotor tests and normal intelligence quotients (I.Q.) were present in 8 patients; mental retardation was found in 2 patients: and unstable behavior, evident from different tests, was present in one. Except for the last case, in none of the patients was the method was found to be the primary cause of the abnormal behavior. Deep hypothermia and circulatory arrest in early infancy does not appear to have a negative influence on somatic, psychomotor, or intellectual development.


Acute clinical hypocalcemic myocardial depression during rapid blood transfusion and postoperative hemodialysis: a preventable complication. Despite experimental evidence that myocardial depression resulting from rapid transfusion of ACD blood (citrate binds ionic calcium) is avoidable by simultaneous calcium administration, most hypovolemic patients receive calcium either after transfusion or not at all. Similar iatrogenic hypocalcemic myocardial depression occurs in normovolemic patients with known myocardial damage who are dialyzed for acute uremia when ACD blood prime is used at high initial flow rates (350 c.c. per minute) and when dialysis is performed against low calcium dialysate (2.5 mEq. per liter or less). This study tests the hypotheses that (1) rapid transfusion of as little as one unit of CPD blood causes a significant reduction in ionized calcium, (2) the depressive effect of CPD blood is significant and similar to that of ACD blood, (3) rapid blood transfusion (ACD or CPD) is safe if calcium is given simultaneously, (4) addition of calcium to the extracorporeal heparinized blood prime used in dialysis prevents initial depression, and (5) hemodynamic instability during dialysis is prevented when the dialysate is normocalcemic. From the results of our study, we made the following conclusions: (1) Ionized calcium is reduced significantly by rapid transfusion of CPD blood; (2) acute myocardial depression noted with CPD blood is similar to that previously observed with ACD blood and is prevented during transfusion of either type of blood by simultaneous calcium administration; and (3) hemodialysis in patients who have had cardiac surgery is safe if calcium is added to blood prime and dialysate is made normocalcemic.


Preoperative assessment of esophageal pathology. Panmural esophagitis results in esophageal thickening and shortening and prevents adequate reduction of a hernia. Twenty patients with panmural esophagitis, treated by Belsey repair, have been followed up for more than 5 years; 9 of them remain asymptomatic and 11 have symptomatic reflux, 7 of whom have required further surgery. Belsey also has reported a 45 per cent recurrence rate in patients with this type of disease. Preoperative recognition of panmural esophagitis allows a planned surgical approach and the use of a surgical technique designed for the management of an irreducible hernia. The ability to predict these changes was studied in 124 patients, who were evaluated by history, radiology, endoscopy, and manometry prior to transthoracic hernia repair. The esophagus was inspected at operation to determine the presence of panmural changes. History was of no value in assessment. Radiologically, a large and irreducible hernia was associated with panmural changes, but these changes also occurred in the absence of ulceration. Manometric studies allowed accurate prediction of mural changes. Over 90 per cent of patients with panmural esophagitis have more than 40 per cent disordered motor activity (DMA) in the distal part of the esophagus, and 75 per cent of such patients have more than 60 per cent DMA. Combining these investigative data allowed the accurate prediction of panmural changes in 90 per cent of the 124 patients.


Management of acid-peptic esophageal strictures. Eighty-nine patients with benign acid-peptic strictures of the esophagus were evaluated. Of these, 56 patients were treated by dilatation and medical therapy, whereas 33 underwent operative therapy because medical therapy failed. Three patients, all psychotic and having post-emetic strictures, required resection of the stricture and a colon interposition. Twenty-nine patients underwent a Belsey or Nissen fundoplication combined with esophageal dilatation. Fourteen of 29 had an associated vagotomy and 15 did not. Two patients of this 29 had a poor result, one of whom had a post-emetic stricture. Although the patients having a concurrent vagotomy and pyloroplasty had the more severe disease,there was no significant difference between the results in the two groups. It is concluded that most patients with such esophageal strictures may be adequately treated without resecting the stricture and that the routine addition of a vagotomy and drainage procedure is probably not indicated.


Prosthetic reconstruction of the trachea and carina. Twenty-six patients with tracheal stenosis owing to benign stricture and malignancy have had airway reconstruction with a molded silicone rubber prosthesis. In 8 patients the distal trachea and carina were replaced with a bifurcated graft. One individual with respiratory insufficiency could not be weaned from the respirator and died in 3 weeks. Two other patients with malignancy died 15 and 18 months following operation from disseminated cancer. The remainder are living from 1 to 5 years postoperatively. Eighteen individuals have had the trachea reconstructed with a straight graft of silicone rubber. In 5 patients with long strictures the prosthesis was invaginated into the upper and lower ends of the trachea. Thirteen individuals had circumferential resection of the airway with end-to-end anastomosis of the graft to the trachea. There was one early death from erosion of the innominate artery and 5 late deaths unrelated to the prosthesis.


A hermetically sealed mercury cell pacemaker: advantages and early clinical results. Despite the known advantages of hermetic encapsulation of implanted pacemakers, only a few conventionally powered models are totally hermetically sealed, and most of them are not yet clinically available. This report describes the results with a mercury cell unit which has been in clinical use since 1970 and has been totally hermetically sealed since 1974. The lowered premature failure rate with the newer model substantiates the theoretical advantages of hermetic encapsulation. The rate behavior of the pulse generator, upon which our telephone follow-up system is based, is essentially the same for both models.


Permanent pervenous atrial sensing and pacing with a new J-shaped lead. We have developed a new J-shaped lead for atrial pacing. The lead has silicone rubber tines which become entangled in the trabeculae and thereby anchor the lead firmly in the left atrial appendage. Later, scar tissue forms around the tines, rather than around the electrode, so that there is no problem with either lead displacement or loss of sensing.


Aberrant left pulmonary artery presenting as a right paratracheal mass in an adult. Aberrant left pulmonary artery, or pulmonary sling, is a rare variation of the pulmonary vasculature, with only one previous report of the condition being recognized in an adult. In this report a second case recognized de novo in an adult is presented. Both of these adults were evaluated because of right paratracheal masses which required differentiation from pulmonary malignancies. The barium swallow shows a characteristic indentation of the anterior esophageal wall and the lateral tomogram demonstrates absence of the left pulmonary artery from its normal position in the left hilum. The pulmonary arteriogram is diagnostic and allows avoidance of more invasive diagnostic measures.


Chondrosarcoma simulating malignant atrial myxoma. A 69-year-old patient underwent removal of a left atrial tumor which was diagnosed clinically and pathologically as atrial myxoma. Fourteen, 18 and 22 months later, distant metastases were discovered. Two of the metastases were removed entirely and one partially. The metastatic tumors were also thought to be of myxomatous origin by light and electron microscopy. Only at autopsy was it demonstrated that the patient had a primary chondrosarcoma of the pelvis giving rise to widespread myxoid metastases to the heart and other sites.


Silent, chronic, massive pulmonary thromboembolism masquerading as bronchogenic carcinoma. A unique case is described of a 64-year-old white woman who had silent thromboembolic occlusion of the right pulmonary artery. Over the ensuing months, severe pulmonary hypertension developed, as manifested by marked dilatation and atherosclerosis of the right and left pulmonary arteries and severe right ventricular hypertrophy. Nevertheless, she remained fully ambulatory and felt generally well throughout this time. Eventually, however, the pulmonary arteries became so dilated that they compressed the recurrent laryngeal nerve as it looped under the aortic arch, and it was the resulting hoarseness that first caused the patient to seek medical attention. A work-up disclosed normal peripheral lung fields on x-ray study and a large dense right hilar mass. Accordingly, the patient was subjected to an exploratory thoracotomy on the reasonable but mistaken diagnosis of bronchogenic carcinoma. After the following operation, her condition deteriorated. She developed bronchopneumonia which, when superimposed on her already precariously reduced cardiopulmonary function, precipitated respiratory insufficiency. An independent stroke was the immediate cause of death.


A new method of producing pulsatile flow during cardiopulmonary bypass using a standard roller pump. A new method for producing pulsatile flow during cardiopulmonary bypass is described. The method requires only the addition of a dilated segment in the tubing which passes beneath the arc of a standard roller pump. Preliminary studies demonstrate that pulsatile flow and pressure with physiologic contours can be produced by this "bubble tube" system. Furthermore, the new tubing causes less hemolysis than standard pump tubing.


The Waterston anastomosis with no deaths in the neonate. The Waterston anastomosis has been performed with no deaths in 11 consecutive neonates during the past 24 months. Seven neonates had pulmonary atresia with either single ventricle or hypoplastic right ventricle, 3 had tetralogy of Fallot, and one had severe pulmonary stenosis with a normal right ventricle. Six neonates were one day old and only one was older than 7 days. All have obtained symptomatic and documented (increase Po2) benefit. This level of success is attributed to (1) minimal delay between the  recognition of cyanosis and operation (mean time between hospital admission and catheterization was 3 hours and between catheterization and operation, 4 hours); (2) correction of any base deficit prior to, during, and after operation; (3) accurate construction of the anastomosis to avoid excessive size, and (4) careful postoperative management of the pulmonary subsystem by experienced personnel. We have demonstrated that the high mortality rate previously reported for the Waterston anastomosis in the neonate can be markedly improved by an appropriate patient management program.


Surgical management of life-threatening coronary artery disease: experience in 18 consecutive patients with left main trunk or equivalent coronary artery obstruction associated with an obstructed or a nondominant right coronary artery. Eighteen patients with obstruction of the left main trunk or equivalent coronary artery associated with an obstructed or a nondominant right coronary artery were studied. All patients had coronary artery bypass surgery because of their symptoms and coronary anatomy. Five patients had coronary artery bypass without the use of preoperative elective intra-aortic balloon counterpulsation, and 3 of these patients had cardiac arrest prior to insertion of the grafts. The other 13 patients received elective intra-aortic balloon counterpulsation prior to induction of anesthesia and cannulation. None in this second group of patients developed any hypotensive episodes or cardiac arrest, and all have done well following the bypass operation. This experience suggests that the use of elective preoperative intra-aortic balloon assist in patients who have a very critical coronary artery obstruction is indicated in view of the high incidence of cardiac arrest observed in patients who did not receive the preoperative elective intra-aortic balloon support.


Homograft replacement of the trachea using immunosuppression. The experiments were divided into three-ring and five-ring autografts and allografts. In the animals receiving allografts, the trachea was exchanged between paired animals which were preoperatively immunosuppressed with Imuran (azathioprine) and postoperatively given Decadron (dexamethasone). Seven of the 14 dogs receiving a three-ring allograft survived until put to death months after the operation. Postmortem examination demonstrated a patent airway, but the cartilaginous rings were absent and the proximal and distal suture lines were approximated. By contrast, none of the dogs receiving the five-ring allografts survived beyond 29 days. In all, the cartilage had disappeared and the intervening fibrous tissue had collapsed and constricted the airway. On the other hand, in animals in which the trachea was simply transected and resutured over an area of seven to ten rings, leaving membranous portion intact, the trachea was entirely normal when the animals were put to death. It is concluded that tracheal replacement with an allograft is not feasible, even with immunosuppression. It is the blood supply to the grafted segment which precludes success.


Gunshot wounds of the esophagus.

Gunshot wounds of the esophagus. During a 4 year period between 1970 and 1974 there were eleven esophageal gunshot wounds representing 52 per cent of the total esophageal perforations. The increased incidence of esophageal gunshot wounds reflects the higher rate of civilian gunshot injuries. There were six perforations in the cervical portion of the esophagus and five in the thoracic portion, with three located above the aortic arch, one in the midesophagus, and one in the lower third. Symptoms are less diagnostic than in esophageal perforations from other causes because the gunshot wound tends to mask the complaints related to mediastinitis. The signs are similar. In 9 patients free air was present in the neck or mediastinum and in 10 patients the diagnosis was confirmed by barium swallow. Of the 2 patients without free air, one had a lateral thoracic wound and esophageal injury was not suspected; the diagnosis was made by drainage of oral feeding through a thoracostomy and confirmed by barium swallow. In the other patient the perforation was found during surgery for hemothorax. Primary repair with drainage was done in the group with cervical injuries. All survived with no serious complications. In the group with thoracic injuries, fistulas developed in 2 of 3 patients who had primary repair with drainage. Two patients with extensive injuries of the esophagus treated by defunctionalization did well but required a second procedure. It is concluded that gunshot wounds of the cervical esophagus, if treated promptly by suture and drainage, will do well. Thoracic injuries represent a more difficult problem and it is suggested that defunctionalization of the esophagus is the safest procedure, particularly if damage is extensive.


Effect of thoracotomy upon the carotid sinus control of regional hemodynamics in the dog. The effects of bilateral thoracotomy upon the operating characteristics of the carotid sinus reflex were examined in 11 vagotomized dogs. Pressure-flow relationships in the aorta, celiac, mesenteric, renal, and femoral arteries were studied as a function of pressure in the isolated carotid sinuses. These relationships were analyzed to give the carotid sinus reflex operating point values and sensitivities of pressure, flow, impedance, and power for each regional vascular bed. Following thoracotomy there was a significant fall in the closed-loop operating point pressure (CLOP) ( p less than 0.005). The operating point values and sensitivities for each regional flow and resistance together with the corresponding mean and oscillatory kinetic and pressure power were not significantly altered by thoracotomy. Renal characteristic impedance at the operating point significantly increased following thoracotomy (p less than 0.05), as did the aortic characteristic impedance for carotid sinus pressures (CSP) above the closed-loop operating point. The operating sensitivity of renal characteristic impedance was decreased (p less than 0.05). Possible mechanisms underlying these changes are discussed.


Anomalous origin of the right coronary artery from the pulmonary artery. Anomalous origin of a coronary artery from the pulmonary artery is a relatively rarer congenital anomaly which almost exclusively involves the left coronary artery. A previously healthy 25-year-old woman had a cardiopulmonary arrest. Following resuscitation, investigations revealed an even rarer anomaly, an anomalous right coronary artery arising from the pulmonary artery. Successful surgical repair was accomplished by reimplanting the right coronary artery into the aortic root. The patient is currently asymptomatic 2 years postoperatively. The pertinent literature is reviewed.


Glucocorticoid protection of the myocardial cell membrane and the reduction of edema in experimental acute myocardial ischemia. A possible protective effect of glucocorticoids on the ischemic myocardium was investigated in in situ dog hearts subjected to regional ischemia and in isolated rat hearts subjected to global ischemia. In the whole-animal preparation, the left anterior descending coronary artery (LAD) was occluded for 3 hours, or for 2 1/2 hours followed by 30 minutes of reperfusion. Dexamethasone phosphate was randomly administered (20 mg. per kilogram intravenously) after 15 minutes of ischemia. Its effects were studied on the following: (1) myocardial cell membrane integrity, using electron microscopic examination of tissue biopsies treated with colloidal lanthanum; (2) myocardial water content, measuring the wet/dry weight of myocardial tissue; (3) ischemic injury, by a count of fuchsinophilic cells at light microscopy. In isolated rat hearts, ischemia was produced by a 60 per cent reduction of coronary flow. Randomized hearts were perfused for 2 hours with dexamethasone, 15 mg. per milliliter in buffered salt solution. Study included determination of tissue water content and coronary vascular resistance. Lanthanum was confined to the extracellular spaces in normal dog myocardium, but it was found all intracellularly after 3 hours of ischemia or after reperfusion. This was associated with morphologic changes characteristic of irreversible cell injury. In the hearts treated with dexamethasone, lanthanum remained excluded from the cells, water content was less (p less than 0.005), and fuchsinophilia less severe (p less than 0.005). Likewise, water content was less (p less than 0.005) and the increase in coronary vascular resistance resulting from ischemia less severe (p less than 0.005) in the dexamethasone-treated isolated rat hearts. Thus dexamethasone administered in pharmacologic doses, early, appeared to stabilize the cell membrane, limit myocardial edema, and reduce the severity of injury, both during ischemia and upon reperfusion.


Cor triatriatum: masked by complex congenital cardiac anomalies. The radiographic, angiographic, hemodynamic, and surgical features of 2 cases of cor triatriatum complicated by other cardiac anomalies are presented. In the first case, the patient had tetralogy of Fallot, the scimitar syndrome, and left ventricular obstruction. In the second case the patient had truncus arteriosus. The first case was revealed only after augmentation of pulmonary flow by an aorta-pulmonary artery anastomosis. In the second case, the diagnosis was retrospectively suggested by certain angiographic and hemodynamic clues. The prospective diagnosis was made only after a modified Rastelli procedure for truncus arteriosus. The difficulties encountered in making the diagnosis in both cases are discussed. It is stressed that a high index of suspicion, thorough accumulation and examination of hemodynamic data, and excellent angiograms and plain film radiography are all necessary to an early diagnosis of cor triatriatum when the latter is complicated by other congenital heart anomalies.


Endocrine studies during the refeeding of young women with nutritional amenorrhea and infertility. Serial endocrine studies were performed during the refeeding of a group of nine young women who presented with amenorrhea associated with injudicious dieting. No significant psychopathology was disclosed by the Lanyon Psychological Screening Inventory in any of the patients, six of whom were single and three married and infertile. The mean weight before refeeding was 81.6% of the normal for height. The mean initial serum follicle-stimulating hormone concentration was within the limits of normal for young women of reproductive age, but the serum luteinizing hormone (LH) concentration and the vaginal maturation score were low. As weight was regained, the serum LH concentration increased (the pooled r for LH versus percent normal weight = 0.85) and the vaginal maturation score rose (the pooled r for vaginal maturation score versus percent normal weight = 0.93). When a mean weight of 96.6% of normal was reached after a mean of 5.3 (range, 2 to 11) months of refeeding, spontaneous menses occurred. The initial cycle was ovulatory in two instances and anovulatory in five, as determined by basal body temperature patterns, plasma progesterone concentrations, and endometrial biopsies. With continued weight gain, menstruation became regular and the three married patients conceived.


Hormones and preantral follicle growth in women. Studies of follicular morphology in biopsies of human ovarian tissue obtained from women with a syndrome of hypogonadotropic hypogonadism have been reviewed. Follicular maturation was consistent with that seen in ovarian tissues removed at postmortem examination of infants. Similarly, follicular maturation was inhibited in ovaries of women receiving oral contraceptive preparations consisting of a mixture of an estrogen and a progestogen. Considered together, ovarian morphology in these two states of relative gonadotropin deficiency suggests that initiation and progression of follicular maturation require adequate quantities of gonadotropins. The stimulatory effects of gonadotropin on preantral stages of follicular maturation are mediated by estrogen in rat ovaries. Failure to observe follicular maturation in ovaries of women with a congenital inability to synthesize estrogen in response to stimulation by gonadotropin suggests that the steroid may play a similar role in initiating follicular maturation in women.


Time study of effects of pregnant mare's serum gonadotropin on surface characteristics of granulosa cells in rat ovaries. A single injection of pregnant mare's serum gonadotropin (PMSG) into immature female rats was used to stimulate graafian follicle growth. The surface of granulosa cells in the growing follicles was examined at 12-hour intervals for 72 hours by scanning electron microscopy. Between 24 and 36 hours after injection of PMSG, microvillous processes appeared on the surface of the cells. These villous processes became fully developed at 48 hours and remained for at least 72 hours after PMSG injection. The significance of this PMSG-induced microvilli formation on granulosa cells is discussed.


Some questions related to melanocyte-stimulating hormone. A number of questions remain unsettled about the release of melanocyte-stimulating hormone (MSH) and about its function. Even though relatively few investigators are studying this area, some generalities have emerged during the last 10 years. It now seems that release of MSH from the pituitary is inhibited by a substance present in the hypothalamus. The structure of this physiologic inhibitor of MSH release may still not be considered an established entity but there is evidence for additional mechanisms capable of exerting a fine control on the release of MSH. Contrary to some opinions, the release of MSH does not always occur together with the release of ACTH, and the release of the two hormones can be dissociated in several laboratory and clinical situations. In addition, many studies have shown that the pituitary peptide, MSH, exerts behavioral and electroencephalographic effects in both the rat and man. The hypothalamic peptide Pro-Leu-Gly-NH2 (MIF-I) also has direct effects on the central nervous system that may include alleviation of the symptoms of Parkinson's disease.


The diagnosis and natural history of spinal cord arteriovenous malformations. The present study of 71 patients shows that the initial symptoms often cannot differentiate spinal cord arteriovenous malformation from other lesions causing cord dysfunction, but the picture at the time of presentation may suggest the diagnosis. Most patients are males with neurologic findings referable to the thoracolumbar area who present with gradually progressive pain, weadness, sensory distubance, and disturbance of micturition. Early impairment of micturition may help suggest this lesion because it is less likely to be an early complaint in patients with disk disease or tumor affecting the spinal cord. Symptoms occasionally vary with posture and exercise and menses. Most commonly there are combined upper motor neuron and lower motor neuron manifestations with nonradicular sensory deficit. The cerebrospinal fluid is abnormal in more than 75% of cases. The myelogram is positivie in 75 to 90% of cases and the angiogram is almost always diagnostic.


Intrasynovial injection of steroids uses and abuses. Intra-articular injection of steroids is a valuable method of treatment, but selection of the appropriate clinical setting is required to obtain maximal benefits and to minimize the complications. All intra-articular injections must be performed under strict aseptic technique. The rheumatoid patient with one or two joints that resist systemic therapy and the patient with an occasional osteoarthritic joint with an acute inflammation are amenable to this treatment. The patient who has acute attacks of tendinitis, pseudogout, or bursitis will obtain significant benefits. Selected patients with traumatic and acute gouty arthritis also may benefit. Repetitive injections appear to be contra-indicated as they may create an environment conducive to joint destruction.


Serum lipids in chronic renal failure.

Serum lipids in chronic renal failure. The serum lipids and lipoprotein patterns in 100 adult patients with nonnephrotic chronic renal failure were analyzed retrospectively. Hypertriglyceridemia was found in 43% of these patients. Forty-nine of the 100 had a normal lipoprotein pattern, whereas 42 had type IV hyperlipoproteinemia. This abnormal lipoprotein pattern could not be correlated with the degree of renal impairment, the type of renal disease, or with the patient's age, sex, weight, or diet.


Development of the aging cell surface: a freeze-fracture analysis of gap junctions between human embryo fibroblasts aging in culture. A brief note. Gap junctions have been identified between cells in late passage cultures of human embryo fibroblasts using techniques of freeze-fracture and electron microscopy. The junctions are sparsely distributed, which may suggest a decrease in electrotonic and metabolic coupling with increased age in culture.


Morphological changes in aging cell lines of Paramecium aurelia. II. Macronuclear alterations. Electron microscopic examination of aging P. aurelia showed that the macronucleus undergoes characteristic structural changes. The surface of the aging macronucleus was highly invaginated. Compared with young macronuclei, the chromatin bodies appeared to be smaller and condensed, and were fewer per unit area of the aging macronucleus. The nucleolar bodies also showed morphological alterations. In many aging macronuclei the nucleolar bodies appeared to be aggregated. Large ring-shaped or coiled loops of nucleoli were also observed. These changes in the ultrastructure of macronucleus in the aging paramecia suggest that the macronucleus in the aging cells is less active in the synthesis of macromolecules and transport of material to the cytoplasm.


[Aerodynamic analysis of a new sterile operating enclosure, and comparative bacteriologic testing between a conventional operating theatre and a sterile enclosure during sham operations (author's transl)]. An aerodynamic and bacteriological evaluation of a new sterile operating enclosure has been undertaken, comparing it with a conventional operating theatre under sham operating conditions with or without coincident use of either a surgical helmet or surgical face mask. Statistical analysis of these studies show the bacterial level in the sterile enclosure at the wound site is significantly lower than in ordinary operating theatre conditions whereas the use of a helmet with evacuating ducts effects these findings insignificantly.


[Pathogenesis and clinics of gastric stump carcinoma (author's transl)]. Statistics of postmortem examinations and retrospective long-term observations indicate a disposition of the resected stomach for the development of a primary carcinoma. The risk to develop a carcinoma after resection for peptic ulcer shows a two- to three-fold increase compared to gastric cancer mortality of the normal population. Because of the lack of typical symptoms for gastric stump cancer surgical treatment will occur late and the 5-years survival rate is only 1.38%. The cause of the increased cancer risk after gastric resection seems to be the atrophic gastritis in the gastric remnant which is found after a few years.


[Release of 14c-chloramphenicol in the rabbit femur implanted with polymethylmetacrylate (author's transl)]. In vitro studies and animal experiments were started for the purpose of following the migration of chloramphenicol marked with 14C from polymerised polymethylmetacrylate cylinders. Test-cylinders were submerged in a physiological saline solution and the 14C concentration followed over a period of 34 days. Two series were started with the cylinders being submerged at intervals of 5 and 40 min after the start of polymerisation. These in vitro studies showed that initially the migration of active substances marked with 14C from the plastic cylinders was extremely high but remained then constant over the whole test period. Over a period of at least 20 days a higher 14C migration was evident in those cylinders submerged in the elution 5 min after the start of polymerisation. In our in vivo studies we implanted test-cylinders into the femur of rabbits. The migration of active substances marked with 14C resulted in 14C-concentrations being present in the surrounding tissues. During the phase of exudation, depending on the operative process, the concentration increased and reached values that remained constant during the phase of recanalisation of the surrounding tissues over a period of up to 6 weeks. Thereafter the concentration of active substances fell. The max. concentration rates of active substances within the boundary layer were between 15 and 20 mug/g humidity weight. After 8 weeks we found concentration rates of approx. 1 mug/g humidity weight. On examining the 14C distribution within the implanted plastic cylinders we observed that in the course of time the boundary layer increased in thickness and a concentration gradient towards the centre had developed. The spread of diffusion gradually seized the deeper layers so that a long-lasting presence of active substances may be expected.


[Hydatid disease of liver and its complications (author's transl)]. This is a report on 121 cases of hydatid disease of liver. The alteration of the false cyst, explaining the most common complications of the disease, is discussed. Complications were present in 61 (50.41%) of our 121 patients: calcification in 13.22%, infection in 10.74%, perforation in bile ducts in 9.91%, thorax in 5.78% and abdominal cavity in 10.74% of our cases. Diagnostic importances of clinical findings, immunoelectrophoretic studies and radioisotopic liverscanning is emphasized. In 28 cases the complete excision of cysts were carried out, in 110 cases only removal of the hydatid membrane was performed. Other therapeutic methods are discussed. Of 108 treated patients 7 died postoperatively: they were all over 70 years old.


Division of posterior cricoid plate in young children with subglottic stenosis. Subglottic stenosis was corrected surgically in three young children. The key surgical maneuver is the anterior and posterior division of the cricoid cartilage. Endoscopic, xerographic and speech assessments have been done at intervals since decannulation. The anterior commissure is widened and the endolarynx deformed in two children examined. Radiographic studies indicated that increased airway diameters have been maintained to date. Speech has been adversely affected to some degree in all three patients.


Bifid epiglottis: a rare laryngeal anomaly. Two cases of bifid epiglottis are presented: one with an associated laryngeal cyst and another with an associated cricoid stenosis. The occurrence of multiple laryngeal anomalies in association with bifid epiglottis has not previously been described. The occurrence of an extra digit is noted to be statistically significant both in the current series and in a review of the literature. A brief review of the embryologic classification and staging by the Carnegie System, and the correlation of the time sequence of development of the epiglottis is presented. No correlation is made as to the mechanism of the origin of this laryngeal anomaly, as adequate embryologic knowledge of the development of the pharynx is not available at this time.


Patterns of anomalies in children with malformed ears. Sixteen children with anomalies of the auricle and/or middle ear who presented malformations of the face, mouth, upper airway, spine, limbs, heart, gastrointestinal (GI), and/or genitourinary (GU) systems, were described. While clusters of anomalies suggested syndromes such as the oculo-auriculo-vertebral syndrome of Goldenhar, hamifacial microsomia, mandibulo-facial dysostosis (Treacher Collins syndrome), Pierre Robin, Klippel-Feil, Moebius, Duane, and/or VATER syndromes, many children did not fit what are usually considered even minimal criteria for these syndromes. Several children had malformations which fit the description of more than one syndrome. The importance of investigating the children for unsuspected anomalies, especially of the GU system, was emphasized. Life threatening problems in this group consisted of airway problems, congenital heart disease, and major anomalies of the GI and GU systems. Better management of sucking, swallowing and airway problems might have decreased the early morbidity and mortality (3/16) in this group. Children with multiple defacing anomalies may not be mentally retarded so that aggressive management of their visceral anomalies and hearing problems, and early educational intervention are mandatory. Delay in development may be due to hearing loss, vestibular impairment, ataxia, the consequences of early malnutrition, and multiple hospitalizations rather than to mental retardation. A pessimistic attitude in infancy is unwarranted since it is impossible to predict which children will end up competitive individuals.


Recurrent meningitis secondary to idiopathic oval window CSF leak. Bacterial meningitis remains a life-threatening infection even in the present antibiotic era; thus, any abnormality which predisposes a patient to a recurrence of this serious disease, must be identified and corrected. This report describes the histroy of a 12-year old boy with a profound neurosensory hearing loss, a related absence of vestibular function and a Mondini-type of temporal bone dysplasia who developed recurrent episodes of meningitis which were due to an idiopathic cerebrospinal fluid otorrhea. Even though the meningitis was labyrinthogenic in origin, the patient did not experience the associated symptoms of hearing loss and/or vertigo since the affected inner ear was clinically unreactive. By surgically exploring the middle ear, the presence of a cerebrospinal fluid otorrhea was confirmed. The leak was observed to be coming from a defect in the stapes footplate, and it was controlled by firmly packing the inner ear vestibule with muscle. A remarkable similarity exists between the patient described above and the 15 previously reported cases of meningitis due to a spontaneous cerebrospinal fluid otorrhea. Generally, the problem occurred in young children, the average age being 6.4 years; male and female were equally afflicted. All 15 previously reported cases had a severe neurosensory hearing loss which was unilateral in 10 individuals and bilateral in the other five. In 11 of the case reports, the vestibular function was evaluated, and the labyrinth was noted to be unreactive in the affected ear. An associated congenital abnormality of the inner ear was described in 11 of the patients reviewed. Anatomically, in 13 cases, the leak was observed to be coming from the oval window area. Other affected sites included one report of a fissure of the promontory and one report of a defect in the roof of the eustachian tube. Multiple surgical procedures were required in 11 of the 15 patients in order to identify the exact source of the otorrhea and to seal it permanently. In three cases, the successful procedure was a middle ear exploration with stapedectomy and packing of the inner ear vestibule. Overall, a total of 36 operations was performed in the 15 patients reviewed. In conclusion, when the physician is confronted by a case of meningitis in a patient with a unilateral or bilateral total loss of hearing and vestibular function, the possible presence of an idiopathic cerebrospinal fluid leak should be considered, expecially if radiographic studies demonstrate a temporal bone dysplasia. In these selected cases, if the etiology of the meningitis is obscure, a middle ear exploration should be performed both for diagnostic purposes as a means to ascertain definitely the presence of a leak and for therapeutic purposes to seal it effectively.


Office otology follow-up.

Office otology follow-up. The validation of otological care in the previous quarter century has been based, by and large, on short-term follow-up information. The rapid variation in procedures introduced during this period indicates that there may be need for further consideration. Analyses based on relatively short duration have led the "acceptance" of a variety of diagnostic and treatment methods which have proven disappointing in some cases. To help avoid this invalid "acceptance," a review of patients with significant follow-up may result in a more critical evaluation of future procedural changes. This presentation will be in four parts: 1. History of the office structure. 2. Discussion of five long-term patients that illustrates and supports certain otological concepts. 3. A review of surgical care for chronic suppurative otitis media in 1968. 4. A review of patients treated for serous otitis media with myringotomy and tubal insertion in 1968.


Physician and patient-induced diseases in otolaryngology office practice. "Theragenic" diseases produce common ENT complaints. They are frequently and predictably induced by self or physician treatment. Fifteen percent of first office visits in various practice situations stem from therapeutically-induced disease. Self treatment by cotton tip applicator ear cleaning, nasal decongestants, mouth washes, and lozenges produce symptoms which mimic other etiologies. Prescription medications produce diseases with ENT symptoms which are based on pharmacologic toxicity, multiple drug therapy, drug intolerance, and occasional idiopathic hypersensitivity. The treatment of these diseases is simple and effective once their etiology is discovered.


Pharyngoesophageal dysphagia and gastroesophageal reflux. Pharyngoesophageal dysphagia occurred in 51.3 percent of 1,000 consecutive patients with gastroesophageal reflux. Aspiration, secondary to food obstruction, occurred in 30 percent of these patients, and some developed significant secondary respiratory symptoms. The site of obstruction was localized to the cricopharyngeus by timing the interval from swallow to obstruction. Cricopharyngeal incoordination was demonstrated in 20 of 52 patients studied by high speed esophageal manometry. Surgical correction of gastroesophageal reflux in patients with intractable reflux symptoms was shown to be effective in relieving pharyngoesophageal dysphagia in all but a small number of patients with very severe symptoms. In those with persistent dysphagia cricopharyngeal myotomy at a later stage was effective in giving relief.


Globus hystericus -- office evaluation by phychological testing with the MMPI. Ninety-nine patients, twenty-three men and seventy-six women, who complained of a lump in the throat were evaluated with the Minnesota Multiphasic Personality Inventory, which revealed that these patients had a higher than average score on the depression and the hypochondriasis scales. The intensity of this finding was greater in males. One must never overlook the possibility of a neurotic patient also having serious organic disease.