Volar fracture dislocations of the second and third carpometacarpal joints associated with acute carpal tunnel syndrome. Volar fracture dislocation of the second and third metacarpal bases associated with acute carpal tunnel syndrome in a 17-year-old football player were treated with open reduction, via volar incision to decompress the carpal tunnel, and via a second dorsal incision for internal fixation of the fracture dislocations with Kirschner wire fixation and reinsertion of the avulsed extensor carpi radialis:longus tendon. Anatomic reduction by closed or open reduction is recommended to avoid leaving patients with a weak grip and pain over the site of the fracture.


Infection with Schistosoma mansoni in the Gezire area of the Sudan. A survey for schistosomiasis in a village in the Gezira area of the Sudan in 1973 showed that there has probably been a great increase in the incidence of S. mansoni infection in the last 25 years. Severe morbidity was uncommon in this sample but overt infection was associated with the symptoms of bloody diarrhoea, tiredness, and possibly abdominal pain, and with a reduced level of haemoglobin. Hepatosplenomegaly was common and schistosomiasis is considered to have contributed to this, although hyperendemic malaria must also have been important in its causation.


Patterns of acute renal failure in leptospirosis. The renal profile was studied in 61 patients having leptospirosis. Leptospira-induced acute renal failure conformed to one of two distinct clinical patterns, either oliguric on non-oliguric renal failure. The prognosis was excellent in the latter variety of renal failure and mortality was confined to patients with oliguric renal failure, where severe glomerular and widespread tubulo-interstitial lesions were invariably present. These patients had unfavourable prognostic features during life, such as prolonged oliguria and anuria, absence of a diruetic phase, persistent elevations in BUN and persistently low urea excretion. The prognostic significance of the age of the patients, hypotension and jaundice in relation to the occurrence and type of acute renal failure have been discussed. Retrospective observations indicate that both a vasculotoxic or haemorrhagic state and oliguric acute renal failure are important causes for mortality in human leptospiral infections.


Immunological response to tetanus toxoid during a schistosomal infection in mice. Mice infected with Schistosoma mansoni are unable to mount the same antibody response to tetanus toxoid as uninfected mice; the reduction in response does not occur during the prepatent period.


Viral DNA-synthesizing intermediate complex isolated during assembly of bacteriophage phi X174. A DNA protein complex that is a precursor of mature phi X174 phage was isolated. The complex sedimented with an S value of 50 in a sucrose gradient and contained phage DNA consisting of a replicative form molecule with an extended tail of single-stranded viral DNA. The viral-strand DNA ranged from one to two genomes in length. Proteins coded on the phi X174 genome as well as the host genome were associated with the viral DNA in the 50S precursor complex. Our results indicated that both viral DNA synthesis and cleavage of the growing viral-strand DNA occurred in the 50S complex.


Gene A product of phi X174 is required for site-specific endonucleolytic cleavage during single-stranded DNA synthesis in vivo. A functional gene A product of phi X174 was found to be required at the stage of single-stranded DNA synthesis. A precursor complex that synthesizes single-stranded DNA (50S complex [Fujisawa and Hayashi, 1976]) was isolated from cells infected with wild-type or with temperature-sensitive gene A mutant phage. Proper cleavage of the single-stranded viral DNA did not occur in cells infected with the temperature-sensitive gene A mutant under restrictive conditions. This resulted in (i) accumulation of linear viral DNA molecules of 2 units in length in the 50S complex and (ii) cessation of elongation of viral-strand DNA after one complete cycle of single-stranded DNA synthesis.


Nature of the molecular heterogeneity of human leukocyte interferon. The existence of two components of human leukocyte interferon has been recently reported. In the present study, the nature of this molecular heterogeneity was explored by affinity chromatography on immobilized micro- and macroligands, ion-exchange chromatography, and molecular sieving. Chromatography on a series of alkyl-agarose adsorbents shows, for the first time, the intrinsic hydrophobicity of human leukocyte interferon. Additionally, the separation of two interferon components is achieved by use of the alkyl-agarose as well as by the omega-aminoalkyl-agarose adsorbents. Clear-cut separation of the two components was also achieved by chromatography on BSA-CH-Sepharose and on DEAE-Bio Gel A. An important feature of these separations is that they do not require the use of denaturing conditions. The molecular weights of the leukocyte interferon components, as determined on Sephadex G-75, are quite similar or identical, approximately 26,000. Thus, the molecular heterogeneity of human leukocyte interferon can be attributed, at least in part, to differences in the hydrophobicity and ionic properties of its two components.


Phospholipid metabolism in Pseudomonas BAL-31 infected with lipid-containing bacteriophage PM2. Infection of Pseudomonas BAL-31 with the lipid-containing bacteriophage PM2 resulted in no detectable change in the rate of phosphatidylglycerol (PG) or phosphatidylethanolamine (PE) biosynthesis. An increase in the PG content of infected cultures was not seen until the cultures began to lyse, and this increase was in fact only a relative increase resulting from the extensive turnover of PE at the onset of culture lysis. Turnover studies revealed that the glycerol, phosphorus fatty acid, and ethanolamine moieties of PE turned over simultaneously at the time of lysis, and therefore made it unlikely that there was a PE to PG conversion during the latent period of the phage. The lipid found in the bacteriophage did not reflect a preferential selection for lipid synthesized before or after infection, but in fact reflected the composition of the host membrane at the time the phage were assembled. The use of a modified medium that allowed the cultivation of Pseudomonas BAL-31 as a prototroph and resulted in reliable lysis times of infected cultures led us to the conclusion that PM2 infection effects little change in host phospholipid metabolism, and that there is sufficient PG in the host cytoplasmic membrane to account for a full burst of phage. As a result of the reliable lysis times that we have achieved, we concluded that certain metabolic events, i.e., PE turnover, are lytic phenomena and must not be confused with events relevant to the biosynthesis and maturation of the phage.


Mutator mutations in bacteriophage T4 gene 32 (DNA unwinding protein). Bacteriophage T4 gene 32 encodes a DNA unwinding protein required for DNA replication, repair, and recombination. Gene 32 temperature-sensitive mutations enhance virtually all base pair substitution mutation rates.


Intermediates in adenovirus assembly.

Intermediates in adenovirus assembly. Three intermediates in adenovirus assembly have been defined; nuclear intermediates, young virions, and mature virions. The nuclear intermediates are fragile and heterogenous in size (550S-670S) and withstand separation on ficoll gradients but fall apart upon CsCl gradient centrifugation unless prefixed with glutaraldehyde. They contain both capsid and core structures, and the core structures are preferentially released during purification in CsCl. The precursor polypeptides pVI and pVII are present in the intermediates without any corresponding mature polypeptide. The young virions (Ishibashi and Maizel, 1974) are stable and preferentially confined to the nuclei after cell fractionation. They contain both uncleaved precursor polypeptides and their cleavage products. The mature virions accumulate in the cytoplasm during cell fractionation and contain the final mature polypeptides. Pulse-chase labeling kinetics, focusing on the precursor polypeptides, suggest that these three classes participate in assembly of adenovirus. Tryptic peptide maps establish that polypeptide pVI is the precursor of polypeptide VI, but only a small fraction of polypeptide 26K can in vivo account for polypeptide VIII.


Defective bud formation in human cells chronically infected with subacute sclerosing panencephalitis virus. Human prostate cells chronically infected with the Mantooth strain of subacute sclerosing panencephalitis (SSPE) virus multiply normally, fuse only occasionally to form giant cells, and yet have twisted intracytoplasmic nucleocapsids. These cells are able to support replication of vesicular stomatitis virus, although they release only small amounts of SSPE virus. To determine why carrier cells do not produce virus, they were examined with techniques for surface replication, freeze-fracturing, and immunoperoxidase labeling with SSPE antibody. The surface of carrier cells, like that of productive cells, is characterized by ridges crowned with viral antigens and devoid of the intramembrane particles revealed by freeze-fracture techniques. Since surface ridges form where nucleocapsids attach to the membrane, the shape and length of ridges are indicative of the shape and length of the underlying nucleocapsid. Whereas ridges on productive cells are serpentine in shape, those on carrier cells are typically straight or hairpin shaped, and the hairpin ridges are twice as long as serpentine ridges on productive cells. Furthermore, the spacing between ridges on carrier cells is never as small as that in productive infections, so that continuous sheets of viral membrane are never formed. The majority of carrier cells lack the round viral buds observed in productive cells but have, instead, many elongated processes attached to the cell surface. Each of these processes contains one or two hairpin ridges overlying hairpin-shaped nucleocapsids. These "hairpin buds" are restricted to a single region of the carrier cell surface, whereas viral buds are distributed over the entire surface of productive cells. Thus, there are several structural defects in carrier cells that depend on the specific interaction of a certain viral strain with a certain cell type. These defects prevent the deployment of viral antigen in some regions of the cell surface, the formation of nucleocapsids of normal length, the coiling of attached nucleocapsids, and the consolidation of sheets of viral membrane into spherical buds with the nucleocapsids coiled inside. These defects may account for the failure of carrier cells to shed infectious virus.


7-Methyl-guanosine and efficiency of RNA translation. Brome mosaic virus RNAs 3 and 4 were chemically modified to remove the terminal 7-methyl-guanosine (m7G) structure, and the modified RNAs were tested for their messenger activity in a cell-free system derived from wheat embryo. Amino acid incorporation and ribosome-binding data show that removal of m7G results in reduction, but not complete abolition, of the messenger activity of the RNA. This suggests that the function of m7G may be related to efficient translation of messenger RNA. Possible involvement of other structural factors in RNA translation is discussed.


Characterization of a temperature-sensitive, hexon transport mutant of type 5 adenovirus. Infection of KB cells at 39.5 degrees C with H5ts147, a temperature-sensitive (ts) mutant of type 5 adenovirus, resulted in the cytoplasmic accumulation of hexon antigen; all other virion proteins measured, however, were normally transported into the nucleus. Immunofluorescence techniques were used to study the intracellular location of viral proteins. Genetic studies revealed that H5ts147 was the single member of a nonoverlapping complementation group and occupied a unique locus on the adenovirus genetic map, distinct from mutants that failed to produce immunologically reactive hexons at 39.5 degrees C ("hexon-minus" mutants). Sedimentation studies of extracts of H5ts147-infected cells cultured and labeled at 39.5 degrees C revealed the production of 12S hexon capsomers (the native, trimeric structures), which were immunoprecipitable to the same extent as hexons synthesized in wild type (WT)-infected cells. In contrast, only 3.4S polypeptide chains were found in extracts of cells infected with the class of mutants unable to produce immunologically reactive hexon protein at 39.5 degrees C. Hexons synthesized in H5ts147-infected cells at 39.5 degrees C were capable of being assembled into virions, to the same extent as hexons synthesized in WT-infected cells, when the temperature was shifted down to the permissive temperature, 32 degrees C. Infectious virus production was initiated within 2 to 6 h after shift-down to 32 degrees C; de novo protein synthesis was required to allow this increase in viral titer. If ts147-infected cells were shifted up to 39.5 degrees C late in the viral multiplication cycle, viral production was arrested within 1 to 2 h. The kinetics of shutoff was similar to that of a WT-infected culture treated with cycloheximide at the time of shift-up. The P-VI nonvirion polypeptide, the precursor to virion protein VI, was unstable at 39.5 degrees C, whereas the hexon polypeptide was not degraded during the chase. It appears that there is a structural requirement for the transport of hexons into the nucleus more stringent than the acquisition of immunological reactivity and folding into the 12S form.


Utilization of early promotors in mutant far P85 of bacteriophage T4. We show that farP85 is a recessive mutant of T4 incapable of activating the delayed early promotors for genes 43 and 45 and that the farP85 mutation is in the same complementation group as the ts G1 mutation, which is located in the "modifier of transcription" (mot) gene.


Genome structure of incomplete particles of adenovirus. Incomplete particles arising during productive growth of adenovirus were separated from infectious particles by density gradient centrifugation. The DNA contained in particles of low density was characterized by restriction enzyme analysis and by electron microscopy and heteroduplexing techniques. The DNA is heterogeneous in length, ranging in size from 15% of the normal genome to full length. Many individual molecules contain long, inverted terminal repetitions, which consist of the sequences extending from the normal left-hand end of the viral genome inward; the normal right end sequences appear to be missing from these molecules. The region of the genome reiterated in these molecules is that which has been implicated in transformation of rat cells by adenovirus (Gallimore, Sharp, and Sambrook, 1974; Graham, van der Eb, and Heijneker, 1974). A model for adenovirus replication is presented that accounts for the aberrant structures observed.


Radiculitis distress as a mimic of renal pain. It is the experience of the urological author that radiculitis secondary to costovertebral joint derangement is the most common cause of lower abdominal pain. However, this pain is sometimes made worse when the patient is subjected to a flank incision for presumed renal disease, since the aftermath of a flank incision may be a downward pull on a rib owing to detachments of muscles attached to its superior surface. Emotional problems, too, befall many patients with radiculitis--despondency over delayed diagnoses or sensitivity at having been told their complaints are psychosomatic. Most often these difficulties disappear spontaneously once the pain is relieved. Definitive diagnosis requires orthopedic techniques. Unfortunately, few orthopedists are well versed or interested in the syndrome of renal pain. When they are, erroneous diagnosis can be corrected and a course of conservative or surgical treatment prescribed, with excellent results.


Evidence for a new mammalian organ: a preliminary report. During an investigation on the mechanisms by which mannitol increases renal blood flow, using an in vitro perfused rat kidney preparation, it was observed that an osmotic challenge (320 mOsm) was followed by the accumulation of chloride and calcium ions in the renal medulla. Although the chloride was derived from the perfusate, the source of calcium appeared to be localized in the renal sinus fatty tissue. A morphologic study of this area reveals the existence of a tissue complex, having the characteristics of a hitherto unrecognized organ or gland communicating with the renal parenchyma via a portal vascular system. The possible physiologic significance of this complex is discussed.


The use of tetrazolium to determine hydronephrotic damage in human kidneys. A study detailing an assay for evaluating hydronephrotic damage is presented. We used nitroblue tetrazolium, which is reduced by intact renal tissue. When marked hydronephrotic damage has occurred little evidence of tetrazolium reducing activity is present. The clinical application has been helpful in determining the extent of damage and the subsequent need for removal of the kidney in question. When the test indicated functioning renal tissue a repair of the obstruction was performed with subsequent improvement in function.


Experiences with 16 cases of pararenal pseudocyst. Pararenal pseudocysts developed after an operation, after blunt and penetrating trauma or after contiguous disease processes in 16 patients. Nephrectomy was necessary in 8 cases. Although the duration of the pseudocyst and the extent of conduit injury did to an extent determine fate of the kidney, the location of the encapsulated extravasate and its propensity for curtailment of urine formation appeared to be more significant factors. The cases were reviewed in light of the individualization in management required for the complex problems they present.


Sonography of the Page kidney.

Sonography of the Page kidney. We used sonography to investigate 3 patients with hypertension owing to a Page kidney phenomenon. In 2 cases a perinephric cystic collection was compressing the kidney, while in 1 case there was a large perinephric organized hematoma. When a Page kidney is suspected in a hypertensive patient sonography is a reasonable next step in the evaluation, after the excretory urogram, and may obviate the need for angiography.


Infusion pyelography in anuric patients. The spectrum for the use of retrograde pyelography in renal failure has been narrowed further by extending the facility of infusion urography to anuric patients. The latter study has helped greatly in sifting apart pre-renal and renal anuria patients from those with obstructive uropathy. In obstructive anuria infusion urography has proved comprehensive in influencing judgment about the exact site and nature of obstruction, in affixing laterality towards the better functioning renal unit and in deciding a suitable definitive operation or planned staged procedures.


Peripelvic extravasation, urinoma formation and tumor obstruction of the ureter. We report 4 cases of peripelvic extravasation caused by tumor obstruction of the ureter. A urinoma developed in 3 of the 4 cases. Review of the literature reveals only 5 previously reported cases of peripelvic extravasation secondary to tumor obstruction of the urinary tract. We discuss the mechanics of peripelvic extravasation and urinoma formation, and conclude that tumor obstruction of the ureter must be considered in all cases of peripelvic extravasation.


Six years of experience with retrograde biopsy of intraureteral carcinoma using the Dormia stone basket. To confirm the cause of a small defect of the ureter and to determine preoperatively the histological grade of ureteral carcinoma a new technique of intraureteral biopsy was attempted with a Dormia stone basket. Of 8 biopsies performed on 7 patients with ureteral or pelvioureteral carcinoma only 1 failed to produce a fragment of tissue. Histological diagnosis was made in each of the 7 patients and histological grading in 5. Four patients with non-malignant defects of the lower ureter also were biopsied with this technique to ascertain the feasibility of this biopsy on minimal filling defects. In each patient a tiny piece of tissue was removed. Histological diagnosis could be made in 3 cases.


Long-term results of cutaneous omento-ureterostomy. Six of 11 patients have had 2 to 7 1/2 years of followup evaluation after cutaneous omento-ureterostomy. Results were excellent in 3 cases and good in 1, while ureteral stomal stenosis developed in the 2 patients irradiated for bladder cancer. Complete prevention of cutaneous ureterostomy stoma stenosis remains unachieved but the use of a plastic meatal dilator seems useful.


External sphincterotomy: its effect on erections. External urethral sphincterotomy on 129 paraplegics had little effect on erections. In the 101 patients with post-injury erections only 2 had cessation of erectile capacity. Subjectively, 16 per cent had partial loss and 13 per cent had an increase. The remaining 69 per cent had no change. When the data were correlated with level and completeness of injury, age, time since injury, time since sphincterotomy, postoperative delayed hemorrhage and effect on leg and bladder spasms, no conclusions could be drawn concerning the etiology of altered erections.


Correlation between follicle stimulating hormone, luteinizing hormone, testosterone and 5-hydroxyindole acetic acid with sperm cell concentration. Plasma follicle stimulating hormone, luteinizing hormone, testosterone, urinary 5-hydroxyindole acetic acid and 17-ketosteroids were measured in patients seen at an infertility clinic. Plasma follicle stimulating hormone and luteinizing hormone levels, and urinary 5-hydroxyindole acetic acid levels were increased in patients with sperm concentrations less than 10 times 10(6) per ml. The results suggest that in patients with sperm counts less than 10 times 10(6) per ml. there is not only impaired spermatogenesis but also decreased Leydig cell function. Urinary 17-ketosteroid levels were not related to sperm cell concentration.


Extratesticular lipoma: report of 2 cases and a new classification. We report 2 cases of intrascrotal extratesticular lipoma and propose a new classification. If the possible anatomic sites of origin and the histology of this neoplasm are considered during dissection the tumor can be excised without unnecessary orchiectomy when the blood supply of the testicle can be preserved.


Outpatient needle aspiration biopsy of the prostate. The use of aspiration needle biopsy and needle biopsy of the prostate is described in 38 cases. Aspiration needle biopsy is a fast, safe and reliable procedure that requires no special equipment. It can be used as a preliminary office screening procedure in the diagnosis of carcinoma of the prostate.


A study of 48 cases of incidental carcinoma of the prostate followed 10 years or longer. We reviewed 48 cases of incidental carcinoma treated conservatively. Patients with poorly differentiated, multiple foci or with well differentiated, multiple foci had a poor prognosis, whereas those with well differentiated, few foci (1 to 3) had a good prognosis. We believe that patients with multiple foci (poorly or well differentiated) should be treated aggressively, either by radical prostatectomy or radiotherapy. However, we recommend conservative treatment for patients with well differentiated, few foci.


Factors influencing sexual activity after prostatectomy: a prospective study. Between 16 and 30 per cent of all prostatectomy patients become impotent after an operation for benign prostatic hyperplasia. Since the surgical technique does not seem to be the factor responsible for such a serious problem, more accentuated by the fact that this operation is becoming increasingly frequent with the increase in life expectancy, an assessment of 15 patients before and after prostatectomy is presented. With a statistical analysis of a structured interview (including a mini-Minnesota Multiphasic Personality Inventory test before and after the operation) 3 main differentiating factors emerged between the potent and the impotent group: 1) the level of anxiety exhibited by the patient, 2) whether the patients received an explanation about the surgery and its outcome prior to the operation and 3) the patient's general satisfaction with life.


Contribution to therapeutic decisions of ratios, absolute values and other measures of calcium, magnesium, urate or oxalate balance in stone formers. Investigation of multiple serum and urinary factors in 44 patients with calcium urinary stone disease confirmed a number of defects that have been described previously: elevation of mean serum calcium and uric acid above normal, and depression of mean serum magnesium. Urinary excretion of calcium and uric acid was increased and was increased and was probably related to food ingestion. Urinary magnesium also increased after eating but less than calcium, with the result that for most patients the magnesium to calcium x 100 ratio approached levels observed in stone formation. Urinary oxalate excretion was constant during the entire observation period and apparently was not affected by ingestion of a defined diet. Nine additional patients had persistent hypercalcemia owing to hyperparathyroidism (5 confirmed, 1 suspected), malignancy (2) and drug ingestion (1). Metabolic evaluation of patients with calcium urinary calculi continues to contribute to decisions regarding their best therapeutic regimen.


Pentolinium in the management of autonomic hyperreflexia. Patients with high spinal cord injuries frequently will develop a syndrome of autonomic hyperreflexia when stimulated by urological instrumentation. Severe sustained hypertension is the most hazardous component encountered during this reaction. Herein we report a series of patients exhibiting this condition who were managed safely and successfully by the use of the ganglionic blocking agent, pentolinium.


Hypoplasia of the major renal conduits.

Hypoplasia of the major renal conduits. An unusual case of a patient surviving a bilateral congenital anomaly of the major renal conduits is presented. Anatomical features of this case, considered with present embryological ideas in mind, support the concept of a continuum of disorders of the major renal conduits. The literature is reviewed and interesting microsurgical techniques with hypothermia enabling reconstruction of the collecting systems and renal preservation are discussed.


Simultaneous adrenal and multiple bilateral renal cysts. Benign cysts of the adrenal gland are rare. This is the first reported case of the simultaneous occurrence of an asymptomatic right adrenal cyst and bilateral multiple renal cysts. Excretory urograms with tomograms, renal aortography and ultrasound scanning were used to establish a non-invasive definitive diagnosis. There was no need for an operation since the lesions were benign.


A renal cause for massive retroperitoneal hemorrhage--renal angiomyolipoma. In any case of intra-abdominal trauma or hemorrhage a preoperative IVP is essential to determine the renal status. Preoperative catheter occlusion of the renal artery in these vascular tumors may be attempted to decrease blood loss. Stigmas of tuberous sclerosis should be sought in patients with vascular renal tumors, especially if they are bilateral. Conservation of renal tissue in tuberous sclerotic patients harboring renal angiomyolipomas is important.


[A case of psittacosis treated with rifampicin (author's transl)]. A 45-year-old male who had looked over pet-birds at a bird shop 11 days before, developed a high fever with chills. Without any response to cephalexin, he was admitted to the hospital, with the chief complaints of high fever and sever headache on the 8th day of illness. The chest X-ray films taken then revealed a fun-shaped ground glass-like shadow extending over S10 of the right lung. After the oral administration of 450 mg rifampicin on the 9th day of illness, he became a febrile within one day and was cured with the same daily doses for the following 10 days. Chlamydia was isolated from the peritoneal exudate of the mice inoculated with throat mucus of the patient taken prior to the administration of rifampicin. Complement fixation reaction for psittacosis was positive in a titer of 1 : 16 on the 11th day of illness and rose to 1 : 64 in a week.


[Studies on absorption and excretion of cyclacillin granules (vastcillin granules 'Takeda') (author's transl)]. Vastcillin granules 'Takeda', a cyclacillin (AC-PC) preparation for children were orally administered to nine children at a single dose of 10 mg/kg and its blood concentrations and urinary excretion were studied. From the results obtained, the following conclusions were obtained as to clinical dose and indications. (1) Absorption of AC-PC of Vastcillin granules is excellent . At 15 minutes after administration, 9.3 mcg/ml of AC-PC blood level was attained and its peak appeared 30 minutes after administration. The mean peak level was 17.6 mcg/ml.


[Studies on the disc method for the determination of bacterial sensitivity to ribostamycin (author's transl)]. The MICs of ribostamycin (RSM) were determined by the two-fold serial agar-dilution method of 109 bacterial strains of 20 species. The diameters of inhibition zones of these bacterial strains by the 50 mug RSM disc were also measured. The relation between the MIC and the diameter of the inhibition zone was found to be expressed as a primary regression line in all cases of the conventional method (cultured for about 16 hours), delayed assay method (cultured for about 24 hours) and rapid methods (5 approximately 6 hours and 3 approximately 4 hours culture methods). Thus, it was confirmed that the single-disc method can be employed for the susceptibility test of RSM. Subsequently, variations of MICs obtained by the disc-diffusion method were compared with those obtained by the serial agar-dilution method.


Detection of DNA polymerase activity in Chlamydia psittaci. DNA polymerase activities of intact and disrupted suspensions of the mature infectious, extracellular elementary bodies of the meningopneumonitis strain of Chlamydia psittaci were studied. Intact elementary bodies failed to incorporate labeled thymidine triphosphate (TTP), but homogenates of the organisms did incorporate TTP into the acid insoluble fraction; the reaction continued at a linear rate for 60 min and the newly synthesized DNA hybridized exclusively with DNA derived from C. psittaci elementary bodies. Synthesized DNA sedimented in 2 fractions in alkaline sucrose gradients, one in the 50S region and the other in the 10S region, corresponding to molecular weights of 2 X 10(7) and 5 X 10(5) daltons, respectively.


The endogenous secretin in chicken: minor physiological role in exocrine pancreatic secretion. The action of secretin (SN) on the exocrine pancreas in the chicken was studied in comparison with the rat and dog. Hydrochloric acid (0.1 N), pepton (5%) and olive oil were introduced into the small intestine of conscious chickens with chronic pancreatic fistula and caused the volume and protein output to increase slightly in about two-thirds of the chickens tested. The percent increase of the volume output in anesthetized chickens by HCl instillation was only one-tenth of that in the rat. Acid extracts of the intestinal mucosa (80 mg) from chickens when given intravenously to rats caused the volume of secretion from the rat pancreas to increase about twofold, whereas the extracts from the dogs' and rats' intestine increased the volume output 5.9 and 5.5 times respectively. The increase of pancreatic secretion in chickens by intravenous injection of commercial SN was about one-third of that in the rat. The present studies indicate that SN or a SN-like hormone may be present in the chicken, but it plays only a minor physiological role.


Effect of dantrolene sodium on excitation-contraction coupling of frog toe muscle. Dantrolene sodium (1.0 to 10.0 mug/ml) inhibited twitch tension, tetanus tension, and contracture induced by potassium and low concentration of caffeine in the frog toe muscles. The drug also inhibited rapid cooling contracture (RCC), i.e., contracture caused by rapidly cooling the muscle from room temperature to 0 degrees C after immersing it in Ringer's solution containing a subthreshold concentration of caffein. The drug also suppressed RCC in depolarized muscle fibres which were treated with high concentration of potassium. Comparing the effect of the drug on twitches augmented with nitrate and with caffeine, the former was more markedly inhibited than the latter. On the basis of these results, the possibility that the drug acts mainly by inhibiting the movement of "trigger calcium" which in turn releases calcium from the sarcoplasmic reticulum is discussed.


Interpretation of disaccharide-dependent electrical potential differences in the small intestine. The nature of maltose- and trehalose-induced electrical potential increments across everted small intestines of toads were investigated. A Michaelis-Menten-like relation was seen between the amplitude of PD increments (deltaPD) and the mucosal concentration of disaccharides over a wide range of concentration, but, at a higher concentration range, Lineweaver-Burk type plot of data always deviated from the linear line for the low and moderate concentration range. The extrapolation of the linear segment of the plots intercepted the ordinate at the same point as that of the line for the glucose-induced potential increments. Both the disaccharide- and the glucose-evoked potentials were not additive and were equally sensitive to phlorizin. Tris depressed the disaccharide-evoked potentials to about the same extent as that of inhibition of enzyme activities. The amplitude and time course of the disaccharide-induced potentials, however, could not be accounted for by the mucosal concentration of liberated glucose. These qualitative and quantitative characteristics were explained properly on the basis of a simple well-type local pool for liberated glucose assumed to exist at the brush border. In conclusion, a close functional linkage between brush border membrane disaccharidase activities and the electrogenic hexose transport is well reflected in the disaccharide-evoked potentials in the small intestine.


A mechanochemical model for the steady and transient contractions of the skeletal muscle. A mechanochemical model for muscle contraction was presented which consisted of three subsystems: the regulatory mechanism of contraction by Ca ion, the cross-bridge cycle coupled with actin-myosin interaction and the dynamics of contraction with an external load. It was assumed that both the rate constant of the cross-bridge cycle and the net force of the cross-bridge were linear functions of the sliding velocity. Most parameters in the model were determined from the experimental data, but several were estimated by simulation techniques. The model adequately described the force-load-velocity relation, the rates of energy and heat output as well as some basic mechanical properties of muscle. Not only the steady-state contraction but also the twitch response could be explained by the model. Time courses of tension and shortening during isometric and isotonic twitches were calculated by the model on a digital computer. The calculated curves agreed satisfactorily with the experimental ones obtained from the frog semitendinosus muscle. The rate of tension rise of the isometric twitch was shown to attain the peak at nearly the same time as does the calculated Ca concentration curve.


Effects of calcium ion on the rising phase of the action potential in rabbit sinoatrial node cells. To clarify the role of Ca ion in the rising phase of the sinoatrial (S-A) node action potential, the sigmoidal relationship between the maximum rate of rise of the action potential and the maximum diastolic potential was examined at various concentrations of Ca. The membrane potential was changed by applying a current across a single sucrose gap. The sigmoidal curve shifted toward the positive potential without a change in maximum value when the Ca concentration was increased from nominal "zero" to 10 mM. Therefore, it is concluded that Ca ion modifies the inactivation process of Na current which is responsible for the rapid rising phase of the S-A node action potential. The duration of the action potential and the maximum diastolic potential were decreased with an increase in Ca concentration. The observation that the overshoot of the action potential increased by 12 mV for a tenfold increase in concentration of Ca (within the range of 0.1-5.0 mM) suggests that the inward current of Ca ion may be responsible for the overshoot of the S-A node action potential.


Rauwolfia derivatives and breast cancer. During the course of a collaborative study initiated in investigate the relationship of breast cancer and the use of hormones, it was possible to study the possible relationship of rauwolfia derivatives, mainly reserpine, to breast cancer. Interviews were administered to breast cancer patients admitted to five hospitals in the Baltimore metropolitan area. The study of reserpine use was conducted for a period of approximately one and a half years and information on reserpine use was obtained on 164 breast cancer cases. Each case was matched with a control with respect to age, color, hospital of admission, and admission date. An additional set of controls was drawn from women residing in the same neighborhood as the cases. Neither reserpine, methyldopa, nor thiazides were found to be significantly associated with breast cancer. The exclusion from the analysis of hospital controls with a diagnosis of hypertensive disease and their matched cases did not significantly alter the results. Those cases who used reserpine, used more for longer periods of time than did the controls, however this was judged inconclusive due to a considerable amount of missing data. After comparison of these results with previously reported studies, it did not appear that reserpine was strongly associated with breast cancer. However, because of methodological problems and differences between the studies, a possible small overall relationship could not be definitely excluded.


[Adenoma of the ciliary epithelium of unusual structure and localisation (authors transl)]. The authors describe an adenoma of the ciliary epithelium of low degree of malignacy. The tumor is clinically and histologically remarkable because of its uncommom site behind the iris and the abundance of mucoid stroma. The clinical data, the course as well as the histological findings are described and compared with the rare similar cases in the literature. Electron microscopic data of this kind of tumor are reported for the first time. The tumor are characterised by basal membranes, microvilli, desmosomes, occasional melanin granules, a well differentiated RER and specially by the massive content of intracytoplasmatic filaments.


[Colloid bodies. A cause of vascular complications (author's transl)]. Optic disc colloid bodies are more common than previously supposed. They were noted to occur in 2.04% of unselected globes obtained at autopsy. Hemorrhages of the disc and juxtapapillary fundus are not infrequently found in association with disc colloid bodies. Superficial hemorrhages may be due to erosion of existing disc blood vessels by enlarging colloid bodies, on the other hand, juxtapapillary hemorrhages may occur from neovascularization induced by the colloid bodies. Ultrasound examination may be useful as an aid in diagnosing disc colloid bodies.


[The clinical misdiagnosis of chalazion (author's transl)]. Between 1966 and 1974, 1260 lidtumours were sent to the histological laboratory of the University Eye Hospital Hamburg. The clinical diagnosis "chalazion" in 138 cases could not be verified histologically in 33 cases. Other benign lesions were diagnosed 23 times and malignant lesions in 10 cases (4 times a Meibom's sebaceous cell carcinoma). The symptoms of all 7 Meibom's sebaceous cell carcinomatas diagnosed histologically during this time (the most common metastasizing lid-tumor in this series) were also analysed as they present the gravest diagnostic error for chalazia. Histologic examination of excised "chalazion"-material must be considered mandatory in all patients with a typical symptomatology, recurrence at the same site, high age, unilateral therapy-resistant keratoconjunctivities and involved regional lymphnodes.


[Diabetic retinopathy, problems of documentation and evaluation (author's transl)]. Follow-up studies of diabetic retinopathy cause difficulties through the altering numbers and figures of the retinal changes. If the various pictures of retinopathy are changed furthermore by coagulation, we have to distinguish, between spontaneous improvements or deteriorations and changes which are due to therapy. Follow-up studies with various evaluation methods have shown that the chosen criteria do not lead to corresponding judgements. The visual acuity seems to be the only criteria with decisive and relatively objective statements.


[The retinopathy of the childhood diabetic (author's transl)]. From investigations of 141 patients, diabetic since childhood, diabetic retinopathy (angiopathy), shows strikingly contrasting forms of progress: (a) thoroughly benign (retinopathia simplex; partly regressive); (b) malign (retinopathia proliferans and glomerulosclerosis). The tendency to progression of diabetic retino- and angiopathy appears to be hereditarily determined and is modified, later, only to a certain extent by environmental factors.


[Bilateral marked fundus changes with neovascularisation and subsequent detachment in association with thrombocythaemia (author's transl)]. Following radical hysterectomy a 65-year old patient developed massive preretinal vascular proliferation, similar in appearance to advanced proliferative diabetic retinopathy, which led to a traction detachment. Diabetes mellitus could not be established, and a thrombocyte count up to one million is discussed as a possible cause.


[Secondary disciform macular degeneration (author's transl)]. The disciform macular degeneration is in rare cases preceded by well-known diseases which have in common the destruction of the Bruch's membrane, recurrent haemorrhages with exudation from the choriocapillaris and later on ingrown of fibrovascular tissue into the subretinal space. The authors report on cases with chorioidal ruptures, vascularlike stripes and focal chorioiditis.


[Feeling of sand in the eyes and hormonal contraceptives (authors transl)]. By questionnaire forms the relation between the admission of taking antibaby pills and the subjective feeling of having sand in the eyes was checked. Out of 2201 patients from our group, aged between 9 and 84 years, 372 (16.9%) took hormonal contraceptives, 1812 (82.3%) denied the taking of contraceptives and 17 (0.8%) could not say. From the 372 patients who took hormonal contraceptives 37 (10%) complained of having the feeling of sand in the eyes, the other 335 (90%) denied having a feeling of sand in the eyes. The frequency of a subjective feeling of sand in the eyes was in the individual age groups independent of the subjective statement, of "take hormonal contraceptives" (chi2-test; P greater than 10%).


[Contusion and luxation of the eyeball with rupture of the optic fascicle in fronto-basal trauma (author's transl)]. A report is given of the pathological changes in two eyes which were enucleated because of anterior luxation with rupture of the orbital optic nerve two hours after a traffic accident with frontal head injury. In the first case there was rupture of the trabecular meshwork and Schlemm's canal, the ciliary body and epithelium of the pars plana, a giant retinal tear at the ora serrata and a retinal avulsion at the optic disc, a partial rupture of the peripheral and a complete one of the central lamina cribrosa with a longitudinal tear in the optic nerve which lead to a complete rupture of the orbital optic nerve together with its sheats 22 mm behind the globe. The lesions produced arised probably from a slightly oblique course of the frontal trauma with a suggested additional rotating force followed by a sudden anterior movement of the eye with subsequent luxation. In the second case there was a giant tear at the ora serrata and at the pars plana with dislocation of unpigmented epithelium of the pars plana over the ciliary body, a rupture of the optic fascicle behind the lamina cribrosa, and a rupture of the optic dura mater 16.5 mm behind the globe.


[The use of A-scan echography in the clinical diagnoses of persistent hyperplastic primary vitreous (PHPV) (AUTHOR'S TRANSL)]. In 15 eyes with PHPV (3 suspected cases) patterns of rudimentary hyaloid vessels were found by A-scan echography in 9 cases all under 7 years of age; although these vessels were seen ophthalmoscopically in only 1 case. This ultrasonographic finding appears to add an important contribution to the clinical diagnosis of PHPV, when the monolateral cataract is so dense as to observe other signs (elongated ciliary processes, retrolental fibrovascular tissue). It could also be demonstrated that the axial diameter of the lens remains smaller than that of the partner eye even when the cataract is intumescent with fattening of the anterior chamber. Contrary to our expectations, the axial length of the bulbus was increased in one third of the cases; while a relative microcornea was absent only in 2 eyes!


[Changes in the ocular muscles in progressive scleroderma (author's transl)]. One patient out of 13 with generalized scleroderma displayed related changes of ocular motility. Histologic examination of the external ocular muscles of one of our patients who had died, revealed a massive increase of the interstitial collagen, and various stages of muscular degeneration. These changes correspond closely with the histopathological findings in the myocardium.


[Experiments on the toxicity of intra-ocular administered Gentamycin (author's transl)]. The compatibility with Gentamycin solution used for irrigation of the anterior chamber of the eye was studied in experiments performed on rabbits. The degree of damage was measured by counting the number of the undestroyed cells of the corneal endothelium after perfusion. We compared the number of undestroyed cells after perfusion with 0.25% Gentamycin solution, 0.50% Gentamycin solution and Ringer solution. The result of these experiments showed a clear reduction of the endothelial cells using a 0.50% solution of Gentamycin. On the other hand there was not found any considerable difference between the number of cells using a 0.25% solution of Gentamycin or using Ringer solution. Using both solutions there was only a very slight degree of damage to be observed.


[Senile retinoschisis and cryocoagulation (author's transl)]. This is a report of experiences with the cryotherapy of senile retinoschisis. In spite of the prophylaxis retinal detachment occurred in 2 out of 30 eyes. The critical question, whether the prophylactic treatment is worthwhile or not, can be positively answered, when compared to the results of non treated retinoschisis (Shea et al., Okun and Cibis). A macular puckering was not seen.


[Iridoschisis (author's transl)].

[Iridoschisis (author's transl)]. The alterations characteristic for Iridoschisis (type I and II) are discussed in the light of our own observations. Iridoschisis must be differentiated from the essential progressive iris atrophy, from the dysgenesis mesodermalis corneae et iridis (Rieger), the Chandler syndrome and from the genuine polycoria. Because of the genetic inter-relationships between Iridoschisis, essential promalis corneae and iridis, a predisposition for the occurrence of these alterations has to be taken into account.


[Clinical contribution to Jaffe's syndrome (author's transl)]. The vitreo-retinal traction syndrome, described by Jaffe in 1967 represents a rare complication of idiopathic posterior vitreal detachment. In this vitreo-retinal disease process, which is ophthalmoscopically so characteristic and in the early phase so surprisingly symptom-free, and which only occurs in this form and to this extent following spontaneous intravitreal fibroplasia, we can discern 3 distinct stages, although transitional phases also occur. Vitreal and retinal changes occur which are developed to a varying extent in the 3 stages. Reported are 2 cases which were followed clinically through all 3 stages.


[A simple method to check alternating fixation in penalisation (author's transl)]. In addition to his glasses worn for penalisation, the patient receives spectacles with a red and green glass. Asked to fix the lamp of the examinator, the patient sees the light either red or green, according to which eye is fixing on the light.


[The bilateral paralysis of the abducens nerve. A contribution to industrial medical judgement (author's transl)]. After a brief statistical survey the anotomic basis is explained in a broad outline. In the description of a case with bilateral paralysis of the abducens nerve, the suffering of the patient in his working life is examined and the phenomenon of inacurrate depth projection, of "pointing past", is discussed. As a result the suitability for employment is more highly reduced for those suffering from bilateral paralysis of the abducens nerve, as compared to persons with one eye. During the report a 16 mm Color film was shown, showing the patient before and after the O'Connor operation. The possibility of keeping a progress or control report, of patients suffering from inacurrate depth perception, was demonstrated.


[Spastic entropion of the upperlid. A case observed in practice (author's transl)]. A 53-years-old patient was observed because of spastic entropion. This was incontestably a nonscarring rolling-inwards of the upper lid.


[Testing of macular function (author's transl)]. The readaptation time was used to test the function of the macula. After illumination of the macula with an ophthalmoscope the time was measured until the initial visual acuity was reached. Our findings are that the readaptation time of patients with degenerative lesions of the macula is significantly prolonged in comparison with normal controls. Furthermore the readaptation time in cases of exsudative-proliferative processes was longer than in cases of dry lesions of the macula. In clinical practice this method gives a good estimate of the functional state of the macula.


[Intraocular pressure in snorkling and diving (author's transl)]. The reactions of the intraocular pressure (i.o.p) in snorkling and scuba diving were studies on 29 healthy subjects. A patient with chronic glaucoma simplex was examined in a pressure tank. The results confirm the author's opinion, that a well compensated chronic glaucoma simplex with intact discs and fields does not exclude fitness to dive. However, a diver with narrow angel glaucoma risks sudden rise in i.o.p. and acute glaucoma while ascending to the surface. Persons, who are examined for fitness to dive, should be seen by an ophthalmologist, if they have a glaucoma or if they are hypermetropic and over 40 years of age.


[Two cases of external ophthalmomyasis (author's transl)]. After a brief survey of Hungarian references the author reports on two cases of ophthalmomyasis externa. The organism was shown to be present oestrus ovis in one instance. The treatment with carbon-tetrachloride might be considered as a new and efficacious therapy.


[A further modification of the Flieringa-ring (author's transl)]. A modified Flieringa-ring is demonstrated for the performance of a combined cataract-glaucoma surgery, by using a corneal incision and the Fronimopoulos modification of the Elliot trepanation.


[Angled micro-scissors for after-cataract surgery (author's transl)]. A report is given on new micro-scissors for after-cataract operations. Its shape permits a perfect direction of incision in the pupillary region not only form a temporally placed corneal incision but also from all other meridians without its handling being impeded by the orbital border or th nose of the patient. Especially in certain injury sequels and other postoperative conditions the scissors extend the operative possibilities.


[Reading aids for blind persons. Technical possibilities, practice up to now, and future development (author's transl)]. This report deals with electronic reading aids enabling patients with a visual acuity of less than 1/50 to read black-and-white-printed matter. A survey on experience with the Optacon from 1971 on is furnished and the chances of vocational training and the use of supplementary aids. The very handy Optacon (weight: 2 kg) consists of a miniature opto-electronic camera, and a tactile stimulator area consisting of 144 tiny metal rods. The development of another very useful instrument in the hands of the blind looks toward completion: The Braille-Converter. Its functions in short: A TV camera with an intermediate computer which transfers optical information into braille or spoken language.


[Etiology and final clinical cause for 1000 enucleations. (A clinico-pathologic study) (author's transl)]. From 1969-1974 1000 unselected enucleated globes have been examined histopathologically. 277 derive from the University Eye Hospital in Hamburg, 723 from various Eye Hospitals in northern and southern Germany. They originate from 589 men and 408 women, three times the sex was unknown. 86 globes had to be removed from children less than 15 years old. 6 groups of etiologies have been distinguished: trauma (308), histologically confirmed neoplastic disease (281), ocular manifestations of systemic diseases (diabetes mellitus, occlusions of central retinal vessels presumably following generalized vascular disease etc.: 128), "operative ocular disease" (164), primary inflammatory disease (71), miscellaneous (malformations, high myopia, pseudo-glioma and pseudo-melanoma: 48). The etiology "operative ocular disease" consists of 67 primary glaucomas (57 adults, 10 buphthalmus), 41 idiopathic cataracts (7 of these congenital) and 3 primary corneal dystrophies, as well as 53 cases of primary retinal detachment. Among the 281 neoplastic diseases, there are 238 primary intraocular malignant melanomas of the uvea, 18 retinoblastomas, 4 primary reticulumcellsarcomas of the retina, 2 choroidal nevi, 10 intraocular metastases and 9 orbital tumors. 16 enucleations among the 1000 enucleations have been performed for pseudo-gliomas (5 x Coats disease, 5 x persistent primary hyperplastic vitreous, 2 x retrolental fibroplasia, others 4 x). The manifestations of systemic disease are consisting of 68 central retinal vein-occlusions, 30 complications of diabetes mellitus and 10 central retinal artery occlusions as well as 20 other generalized diseases. A primary inflammatory disease led to enucleation 50 times due to an intraocular process, 5 times due to scleritis and 18 times as a consequence of keratitis (including 13 times herpes simplex). As the final clinical cause for enucleation the following categories have been elaborated: secondary glaucomas (416), clinical diagnosis of "tumor" (275), atrophy and phthisis bulbi (118), inflammation (112), acute trauma to 4 weeks after the accident (72), others (7). In conclusion the central role of rubeosis iridis leading to secondary angle closure glaucoma is emphasized. This process presents a challenge to ophthalmologic research. Finally the significance of early surgery for primary angle closure glaucomas and for complete restoration of the anterior chamber after trauma and any intraocular procedure is stressed.


[Auto-allo-keratoplasty (with special reference to chondrokeratoprosthesis procedure) (author's transl)]. Biological, rather then purely technical approach seems to be very essential to ensure better results in alloplasty of the cornea. The diseased corneal tissue (especially, after corneal burns) usually fails to accept a keratoprosthesis permanently. The cornea must, therefore, be biologically reconstructed by transplantation of autogenous tissue. Autogenous fascia lata, periosteum, sclera and auricular cartilage have been tried in the present work to surve the purpose. Autogenous sclera and cartilage proved to be best materials, the latter having an important advantage of being easily obtainable. Experimental studies (including hystological control) proved the method of "Chondrokeratoplasty" to be well founded. During the past four years the method has been used on the eyes of 18 patients with most severe corneal lesions unmanageable by the usual graft technique. The Keratoprosthesis must be buried under the cartilage disk until the adequate nutrition is developed and full vitality of the graft is achieved. Only then the cartilage disk is trephined in its centre and the optical part of the keratoprosthesis is exposed. Technically, the procedure is much simpler as compared to the procedure of odonto-keratoprosthesis by strampelly. The results seem to be highly encouraging. So far there was no extrusion after chondrokeratoprosthesis procedure.


[Facts for the muscle-reflex-hypothesis of squint. (The importance of asymmetry in the structure of the eyes for the pathogenesis of concomitant squint) (author's transl)]. Concomitant squint is regarded as result of a congenital dissymmetry in the structure of the eyes or of the oculomotor apparatus and of an insufficiency of the optomotor reflexes. Squint develops, when 1. the anomalies of the structure of the eye-muscles or of their insertions are so considerable that binocular vision cannot be maintained by fusional and convergence-reflexes; 2. the optomotor reflexes are too weak in order to compensate functionally even insignificant structural deviations of the extraocular muscles or 3. the optomotor reflex-mechanisms are disturbed to such a degree that binocular cooperation becomes impossible although the anatomical conditions are normal. Children with the symptoms of "potential squint" (ametropia, heterophoria, pseudo-ectopia of the macula) need special ophthalmological care. Using prisms early and operating in time one can stop the monocular vision becoming established.


[Pathogenesis and treatment of diabetic retinopathy (author's transl)]. The initial disorder leading to any kind of diabetic retinopathy is hypoxia. After exhaustion of the compensatory autoregulation (vasodilatation and increase of the volume flow), the blood-retina barrier breaks down, and parts of the central retinal capillary network fall out (pre-retinopathy). In the non-proliferative and pre-proliferative stage, either disturbance of permeability or occlusion of capillaries is the prevailing process. The stage and predominance of one of the two pathogenic factors, which eventually may be jointed by vascular proliferation, are decisive for the application of light coagulation. The plan of the procedure must be based upon fluorescence angiography. If all progressive changes are treated, and fluorescence angiographic controls are made in intervals of several weeks or months, according to the stage and form (primary exsudative or primary occlusive) of the retinopathy, this procedure is preferable to the coagulation of big retinal areas (retinal ablation), and a maximum of retina with normal vascularisation can be saved. Medical treatment comprising calcium phosphate, the vasoprotecting Doxium, and clofibrate as a depressor of the lipid level in the blood, play a secondary role. Finally, hypophysectomy could not maintain its place in modern treatment of diabetic retinopathy.


[Congenital grouped pigmentation of the retina (author's transl)]. In this disease entity we usually encounter black, sharply demarcated pigmented patches, occurring in groups and increasing in size toward the periphery. In the majority of cases the anomaly is unilateral (84%). The pigmentation may be found in one single sector (59%), in several separate sectors (27%) or distributed over the entire fundus (11%). Histology reveals pigment epithelial cells with hypertrophy and distinct irregularity in size and shape being arranged in one or two layers. Hyperpigmentation also exists with pigment granules of various size and distribution.


[A comport instrument for infrared examination of the eye (author's transl)]. A description is given of a comport infrared viewer recommended for clinical use in Ophthalmology. With this infrared viewer, an infrared slit lamp for advanced infrared diagnosis was developed.


[Application of infrared radiometry on the eye (author's transl)]. The non-contact determination of temperature by infrared radiometry allows the focal measuring of the surface temperature of the radiation source. In 119 patients the surface temperature in the middle of the cornea was measured by this method. The average temperatures were 33.50 degrees C (+/-0.91) in men and 33.74 degrees C (+/-0.91) in women. Further clinical testing is suggested first in diseases of the oculo-orbital region and secondly by means of a connected recorder to study the dynamic temperature reaction under the influence of different parameters.


[Contribution to the problem of optic nerve excavation (author's transl)]. To study opinions on the formation of optic nerve head excavation we had the opportunity of examining microscopic sections of the papilla of a 10-month-old baby who showed bilateral considerable border excavation without the presence of hydrophthalmus or increased intraocular pressure. The thickened lamina cribrosa showed centrally no perforations so that the nerve fibres had to avoid the unperforated parts of the lamina. According to the size and position of such unperforated laminar areas, types of excavation with various defects on the optic nerve head resulted. By coincidence of both components in the optic nerve stem (increased connective tissue growth, and formation of a small vascular bundle), considerable collections of mesenchyme could occur which then resulted in a spreading apart of the optic nerve fibres. As long as neuroglia formation has not filled the gaps in the nervous tissue originally, a secondary growth of glial tissue can follow an original connective tissue-caused defect formation. Hence the deposits of glia in the excavated optic nerve head would be not the cause, but rather the effect of defect formation.


[A rat holder for experimental fundus and anterior segment photography (author's transl)]. We conceived and manufactured a holder for rats. It is a useful little apparatus for some experiments on rats as well as for its fundus photography, angiographies included. The utility of our device is discussed and illustrated.


[Mycosis fungoides affecting the eye and internal organs (author's transl)]. In two patients with mycosis fungoides the following were found in the region of the eye: Infiltration of the eyelid (sometimes board-like), infiltrations and swellings of the connective tissue, orbital infiltrations (hard as a board) with secondary glaucoma, atrophy of the optic nerve, amaurosis, Descemet spots, cells in the aqueous humour, preretinal opacities of the vitreous body), intussusception of retinal vessels, grey infiltration of the retina.


[Therapy of recurring herpetic corneal lesions with Vidarabin (author's transl)]. Vidarabin (Dr. Thilo) is an effective virostatic agent in recurring herpetic corneal lesions.


[Malignancies in relatives of retinoblastoma patients (author's transl)]. In 14 out of 25 patients with retinoblastoma there was a family history of malignancies. Most of the malignant tumours had been carcinomas. In 2 families relatives died because of leukaemia; in these cases the tumour was a so-called diffuse retinoblastoma occurring in elder children. A third family with a retinoblastoma in one child and leukaemia in another is mentioned. This unusual coincidence of two tumourous conditions of which one might be of viral origin led to detailed electron microscopic examination of the retinoblastoma in one case; but there were no signs of reduplicating viruses.


[Corneal dermoid cysts with other abnormalities (author's transl)]. Out of 22 patients with corneal dermoids, 9 showed other abnormalities consistent with the 1st branchial arch syndrome. In 4 cases there was hare lip, divided jaw and /or cleft palate along-side other abnormalities which made impossible a sure classification into one of the recognised syndromes. It is assumed that the anomalies arise in the 5th and 6th intrauterine week. The corneal dermoids were always unilateral and in only one case confined in position to the cornea.


[Intravitreous cyst probably arising from ciliary body epithelium (author's transl)]. A description is given of a pigmented cyst situated within the anterior part of the vitreous body in the otherwise healthy eye of a girl aged 9 years.


[Operative refractive correction of keratoconus with a modified Passow cautery apparatus (author's transl)]. The thermokeratoplasty was developed by Gasset for treatment of keratoconus. The flattening of the cornea is induced by heat. Indications and contra-indications are discussed. This is a report on our first 10 cases which were treated with a modified Passow-cauter. The procedure is simple and harmless and it seems to restrict the range of indications for corneal transplantation.


[Late choroidal detachment after i.c. cryoextraction of the lens (author's transl)]. Eighty days after i.c. cryoextraction of the lens without any complications, intra- or postoperative, choroidal detachment was observed in a 68-year-old woman (hypertension, diabetes m..amaurosis of the right eye after central artery embolism). -Conventional decongestive drugs (Reparil, Tantum, Tanderil) had no effect. Within 6 days of treatment with microwaves, 2.5% Hydrocortisone and atropine eye-drops and Prednisolone (10 mg/die) internally there was complete regression of the detachment.


[Low-vision aids in visually handicapped children (author's transl)]. It is reported on 71 visually handicapped pupils. The visual acuity of 48 of these children could be tested with low-vision aids and the electronic television reading apparatus (Reinecker). With telescopic glasses (Zeiss, Keeler) 31 children had an average improvement of their visual acuity of two lines on a test board for near vision (Birkhäuser). With the reading apparatus 43 children showed an improvement of the visual acuity of 5 more lines. Only 3 to 21 pupils, who had been offered a regular use of the telescopic glasses, decided to have one. Finally our own experiences are compared with those of other authors.


[A contribution to the pseudo-LE-syndrome. Investigations of the cardiovascular system, abdominal organs, lymphatic system and drug histories (author's transl)]. 13 of 30 patients suffering from pseudo-LE-syndrome showed a usually reversible enlargement of the heart during the acute stage of the disease. In two patients carditis occurring in pseudo-LE-syndrome lead to congestive heart failure and an additional patient died in the acute stage of carditis. As opposed to Systemic Lupus Erythematosus hypertension did not occur in a higher frequency than normal. In five cases cardiac catheter examinations showed slight elevation of the end-diastolic pressure in the right ventricle, in two cases an abnormal high mean pressure in the right atrium and a systolic gradient at the pulmonic valve was found. -Scintigrams showed definite enlargement of the spleen and to a lesser degree enlargement of the liver was seen. Laparascopy showed multiple concretions after peritonitis. Lymphographic changes in the retroperitoneal lymph nodes and lymphatic ducts were not observed in contrast to rheumatic diseases. Drug histories in most cases discovered intake of Venopyronum dragees prior to onset of the disease. But recurrent attacks of the disease also occurred without further intake of the drug.


Renin, aldosterone and arterial pressure responses to acute beta-adrenergic receptor blockage in hypertensive patients. The effect of acute (intravenous) beta-adrenergic blockade with propranolol or pindolol on arterial pressure (BP), plasma renin activity (PRA), and plasma concentration of aldosterone (PA) was evaluated in 20 essential hypertensive men. BP, PRA and PA were determined during continuous recumbency over-night (8 p.m. to 6 a.m.) every 30 min. Two groups of patients were observed. Patients of group 1 exhibited a characteristic day-night rhythm of PRA with low values before midnight and large increases early in the morning. Conversely, no rhythm and very low PRA values were observed in patients of group II. BP was higher in group II than in group I. In group I following intravenous propranolol or pindolol, BP fell within minutes and levels as well as rhythms of PRA were converted to those of group II without treatment. In group II day-night profiles of PRA and BP remained unchanged. Rhythm and concentration of PA in the two groups were not influenced by either drug. In 4 patients of group I infusion of angiotensin II inhibitor did not lower BP. The observations suggest that in the two groups dissimilarities in rhythms of PRA as well as in BP responses to beta-blockade may reflect differences in neuro-adrenergic tone.


Influence of dehydrocholate sodium on the biliary reabsorption of sulfobromophtalein sodium from the rat biliary tree after retrograde intrabilary injection. Bilary re-excretion of sulfobromophthalein sodium (BSP) (1.2 mumol/rat) after retrograde intrabilary injection is markedly inhibited by dehydrocholate sodium (Decholin) given intravenously as a constant infusion (3.1 mumol/min/kg body weight) or as a bolus injection (24.8 mumol/rat) to rats. Most interestingly Decholin demonstrates the same inhibitory effects on the biliary re-excretion of BSP when it is administered by retrograde intrabiliary injection (24.8 mumol/rat) together with the dye. In contrast to the inhibition of biliary re-excretion of BSP its biliary reabsorption from the biliary tract seems to be rather increased: about 80-85% of 1.2 mumol BSP are reabsorbed in all sets of experiments with Decholin in comparison to about 65% to the control group. Combined with histological data it is suggested that reabosorption of BSP after retrograde intrabiliary injection occurs at the ductular site whereas re-excretion takes place at the cannalicular membrane of the hepatocyte.


Ultrastructural localization of concanavalin A in the perfused rat heart. Staining of the surface coat of heart capillaries and aorta was achieved by perfusing concanavalin A and phytohemagglutinin coupled to horseradish peroxidase through the rat heart. The binding of these lectins provides evidence for the presence of glycoproteins containing mannose, glucose, and N-acetylgalactosamine residues in the endothelial surface coat of rat aorta and heart capillaries. The binding of concanavalin A to capillary endothelium was further followed with radioautography of 125I-labeled concanavalin A in the in vitro perfused rat heart. Following the shorter time intervals of perfusion more than 80 per cent of labeled concanavalin A was releasable by alpha-methyl-D-mannoside and the radioautographic reaction was confined to the endothelial cell surface. Following 60 minutes of perfusion with concanavalin A there was translocation of part of the lectin to the extravascular space and evidence of endothelial cell swelling. A tentative estimate of the concanavalin A binding sites in capillary endothelium was determined to be approximately 5000 per sq. mum.


Lysosomal alterations in cultured macrophages exposed to anorexigenic and psychotropic drugs. Cultured rat macrophages were used for an in vitro study of drug-induced lipidosis. Cells were exposed for 24 hours to equimolar concentrations (5 X 10(-5) and 1 X 10(-4) M) of the following amphiphilic (amphipathic) cationic drugs: chlorphentermine, amitriptyline, 1-chloro-amitriptyline, iprindole, noxiptiline, chlorpromazine. In addition the less amphiphilic drug phentermine was used. Ultrastructurally, the cytologic changes essentially consisted of formation of multilamellated cytoplasmic inclusions, which possessed acid phosphatase activity. The abnormal inclusions are interpreted to result from intralysosomal accumulation of polar lipids. Under the present in vitro conditions all drugs except phentermine, had similar potencies to induce such lysosomal alterations, quite in contrast to the great quantitative differences previously observed under in vivo conditions. The present results lend further support to a concept that regards a pronounced amphiphilic (amphipathic) character to be responsible for the lipidosis-inducing action of various cationic compounds. Cultured macrophages are suggested as a useful tool to investigate this structure-activity relationship, which under in vivo conditions may be obscured by superimposed parameters such as drug metabolism.


Ultrastructural alterations of rat lung exposed to pyrolysis products of polytetrafluoroethylene (PTFE, Teflon). Ultrastructural changes of the lung tissues were evaluated in rats exposed to the pyrolysis products of Teflon at 380 degrees C., 400 degrees C;, and 450 degrees C., respectively, for 4 hours. At 450 degrees C. Teflon evolved numerous tiny particles (0.02 to 0.04 mum.), which were considered to be the toxic material, and at 550 degrees C., in addition to the tiny particles, large spherical particles (0.7 to 5.0 mum) were found. No particles were observed in the pyrolysis product produced at temperatures between 380 degrees C. and 425 degrees C. There were no clinical symptoms or lung alterations induced at temperatures below 425 degrees C colloidal carbon injected as a marker of increased vascular permeability did not pass through the alveolar capillary endothelium. At 450 degrees C. (approximate lethal temperature) rats revealed severe respiratory difficulty, pulmonary edema, hemorrhage, and necrosis of the tracheobronchial epithelium. The membranous pneumocytes appear to be vulnerable to the Teflon fume causing cytoplasmic swelling, bleb formation, fragmentation, and denudation. Similar changes were found in the endothelial cells, but to a much lesser extent. When Teflon fume generated at 450 degrees CnWAS FILTERED THROUGH A Millipore filter (pore size 0.2 mum.), rats revealed only slight degenerative changes in the superficial tracheobronchial epithelium, but no clinical signs.


Ultrastructural differences between rat inner medullary descending and ascending vasa recta;. The ultrastructure of rat inner medullary vasa recta was studied by both conventional transmission and freeze-fracture electron microscopy. The identify of descending and ascending vasa recta in the inner medulla was established by tracing outer medullary descending vasa recta and ascending vasa recta into the inner medulla, as well as by the incomplete carbon labeling technique to identify isolated descending vessels or loops. As in the outer medulla, descending vessels possess thick continuous endothelium with pinocytotic vesicles budding off the luminal and basal plasma membranes (more numerous in the latter location), but no fenestrae. Ascending vasa show thin, attenuated endothelium with numerous (500 to 800 A fenestrae bridged by 40 A thick fenestral diaphragms. Intercellular junctions in both vessels are zonulae occludens with usually one, and uncommonly two or three zones of outer leaflet membrane fusion. Intramembranous particles are numerous in endothelial plasma membranes of descending vasa recta; similar particles are much fewer in corresponding ascending vasa recta endothelial plasma membranes. The ultrastructural differences between descending vasa recta and ascending vasa recta may reflect markedly different permeability properties, particularly to macromolecules, and may be relevant to recent functional studies on rat inner medullary vasa recta.


Injury of the cell's respiratory system by heat and by formaldehyde. Thermokinetics and early molecular events. This is a study of the manner in which the respiratory system of the cell is injured either by elevated temperature or by exposure to diluted formaldehyde. Molecular mechanisms were identified by thermokinetic measurements. The rates at which respiratory failure developed in mouse liver slices in an injurious environment were measured at various temperatures. The data were fitted to the Arrhenius equation, and the effective activation energies of the injury processes were calculated. These data show that (1) the thermokinetics of injury to the cell's respiratory system, whether by thermal or chemical means, follows the Arrhenius law. (2) Thermal injury of the cell's respiratory system has a high activation energy, indicating that the critical, rate-determining event is a protein denaturation. Other mechanisms such as imbalance of metabolic reaction rates and thermal liquefaction of membrane lipids can be ruled out. (3) Repression of cell respiration by diluted formaldehyde has an activation energy compatible with a chemical reaction but low enough to exclude protein denaturation as a mechanism.


Ultrastructural and morphometric studies of platelets from cattle with the Chediak-Higashi syndrome. This study revealed that the lesions in platelets from cattle with the Chediak-Higashi syndrome (CHS) are not morphologically analogousto those present in the other granule-containing cells in cattle and other species with CHS.  There was no evidence of enlargement of the lysosomal granules in bovine CHS platelets...


Renewal of the terminal bronchiolar epithelium in the rat following exposure to NO2 or O3. Rats were exposed to either NO2 or O3 to determine whether nonciliated cells (Clara cells) could divide and differentiate into ciliated cells in the terminal bronchioles. Dividing cells were labeled with tritiated thymidine, visualized in the light and electron microscopes using autoradiographic techniques, and studied for up to 15 days after labeling. Electron microscopic autoradiography 1 hour after injection of tritiated thymidine showed that all labeled cells in the terminal bronchioles were nonciliated. However, 4 days after injection of tritiated thymidine, 67.8 per cent of the labeled cells were nonciliated and 32.2 per cent were ciliated. Light microscopic autoradiography showed that the new labeled ciliated cell population was stable for up to 15 days. These results indicate that nonciliated cells divide and the sister cells may form new ciliated and nonciliated cells. Thus, nonciliated cells can act as progenitor cells for the terminal bronchiolar epithelium.


Performance of an abdominal left ventricular assist device during induced tachycardias and dysrhythmias. Experiments were designed to assess the performance of an intracorporeal (abdominal) left ventricular assist device (ALVAD) in the presence of induced tachycardias, multiple premature ventricular contractions (PVC's), and ventricular fibrillation in calves. Performance criteria were the degree of left ventricular unloading and the per cent cardiac output assumed by the ALVAD. During synchronous pumping, left ventricular unloading was complete and the entire cardiac output was captured by the device. During induced tachycardias up to rates of 120 beats per minute, these degrees of performance were maintained. At rates in excess of 120 beats per minute, performance declined due to decreased biologic stroke volumes and prosthetic filling times. In the presence of induced PVC's, performance during synchronous pumping decreased because of erratic R-wave sensing. Left ventricular unloading was complete but irregular, and the total cardiac output was captured. When asynchronous pumping was utilized, mean left ventricular systolic pressures increased, but total cardiac output was still captured. During induced ventricular fibrillation, ALVAD actuation maintained cardiac outputs equal to control values for periods up to 5 1/2 hours. These experiments indicate that, during normal sinus rhythm, synchronous pumping is optimal; asynchronous pumping is optimal during complex dysrhythmias; and either can be utilized to support the circulation with varying degrees of left ventricular unloading.


Congenital aortic stenosis. Experience with 43 patients. Between September, 1967, and January, 1975, 43 patients underwent intracardiac repair for congenital aortic stenosis at the Buffalo Children's Hospital. The patients ranged in age from 2 days to 24 years, 6 of them being below one year of age. Valvular aortic stenosis was found in 21 cases (4 infants [Group I-A] and 17 older patients [Group I-B]), discrete subaortic membranous diaphragm in 11 (Group II); diffuse subvalvular muscular obstruction in 3 (Group III), supravalvular stenosis in 4 (Group IV), and multiple-level obstruction in 4 (2 infants [Group V-A] and 2 older patients [Group V-B]). Preoperatively, 58 per cent of the patients were symptomatic and 67 per cent had abnormal electrocardiograms. Associated congenital cardiac defects were found in 28 per cent of the cases. The over-all hospital mortality rate was 9 per cent (3 patients in Group I-A and one in Group V-A), with no deaths occurring in patients older than 3 months of age at the time of operation. Two late deaths occurred (Groups I-B and V-B). A complete heart block developed in one patient (Group III). The average intraoperative peak systolic left ventricular-aortic gradient decreased in all groups after repair but progressively increased in the late hemodynamic studies obtained in symptomatic patients. Six patients were reoperated upon for recurrent obstruction. Late results were evaluated on the basis of symptoms, electrocardiographic findings, valve function, and hemodynamic data. They showed excellent or satisfactory results in 59 per cent of the patients in Group I-B, in 45 per cent in Group II, in 66 per cent in Group III, and in 25 per cent in Group I-V. Results were fair or poor in Groups, I-A, V-A, and V-B. In children and adolescents, effective relief of the obstruction and of the symptoms can be obtained with minimal operative risk and minimal morbidity. In symptomatic infants, despite the high operative mortality rate, surgical intervention is indicated because of the poor prognosis.


The conduction system in simple, regular (D-), complete transposition with ventricular septal defect. This is a serial section study of the conduction system in 5 cases of complete (d-) transposition with ventricular septal defect (VSD) . In 3 of the cases with infracristal or intracristal VSD, the bundle lay in the posterior (inferior) wall on the left side of the defect. In the fourth case with infracristal VSD it was on the right side of this wall. In the case with a more distally situated VSD, the bundle branches skirted the anterior and distal walls of the defect. This study shows that in closure of the VSD in complete transposition, the posterior wall of the defect in some cases, and in others the anterior and distal walls of the defect are to be handled judiciously. The right side of this wall is probably safer to handle from the standpoint of block than the left side in most cases. His bundle recording during open-heart surgery may be indicated in large or unusually located VSD's to delineate the course of the conduction system and thereby to avoid atrioventricular (A-V) block.


Evaluating techniques of myocardial preservation for aortic valve replacement: operative risk. In a two-year period 105 patients underwent isolated aortic valve replacement without hospital death. Eighty-three patients were operated on using hypothermic ischemic arrest; 22 patients had coronary perfusion. The early postoperative cardiac performance and incidence of complications did not differ between groups, although cardiopulmonary bypass time was shorter in the ischemic arrest group. These data suggest that ischemic arrest is a satisfactory method for myocardial preservation. However, because of the low hospital mortality rate with either method, these results and those of others cannot be taken to indicate the superiority of any method of myocardial preservation.


A different approach for the total correction of tricuspid atresia. A new surgical procedure has been used successfully to correct tricuspid atresia in a 9-year-old girl. An external conduit containing a porcine aortic valve was positioned to lead from the right atrium to the underdeveloped right ventricle. The right ventricle was reconstructed with a large Dacron patch, thus providing a large cavity for the small hypoplastic right ventricle. The atrial and ventricular septal defects were closed. The patient made a satisfactory recovery and is doing well four months after the operation.


Complete repair of transposition of the great arteries with pulmonary atresia. In this series of 13 patients undergoing repair of transposition of the great arteries with ventricular septal defect and pulmonary atresia, the operative risk and postoperative complications were greater than for repair of either transposition of the great arteries with ventricular septal defect and pulmonary stenosis or pulmonary arterial atresia with ventricular defect. Nevertheless, 6 of the 8 survivors improved clinically. Because operative and late mortality and morbidity rates are related to persistent right ventricular hypertension caused primarily by restricted pulmonary arterial outflow, results should be improved by performance of a preliminary systemic-pulmonary artery shunt for patients with hypoplastic pulmonary arteries and by use of the Hancock prosthesis, which has yielded lower gradients at both the proximal and distal anastomoses of the conduit. These improvements and the relief from cyanosis, exercise intolerance, and other symptoms seem to justify the continued application of surgical correction of transposition of the great arteries when associated with pulmonary atresia.


Ventricular pacing with epigastric transdiaphragmatic electrodes. Long-term follow-up and comparison with other implantation methods. One hundred eighty-seven electrode systems were implanted in 158 consecutive patients--30 systems implanted by thoracotomy, 98 transvenous, and 52 epigastric transdiaphragmatic systems--and the long-term results were compared. With electrodes placed by thoracotomy there was a high rate of complication (76 per cent), prolonging the initial hospitalization (33 per cent) and necessitating frequent rehospitalizations (56 per cent). With transvenous electrodes the complication rate was 39 per cent (16 per cent during the first hospitalization, 28 per cent necessitating rehospitalization). With epigastric transdiaphragmatic electrodes these figures were, respectively, 15, 12, and 6 per cent. The most frequent complications with transvenous electrodes were displacement (15 per cent), ulcerations, and local infection; all were abolished when the epigastric approach was used. Threshold elevation was not more frequent with epigastric electrodes (sutured to the right ventricle) than with the other techniques. Four per cent of the epigastric electrodes caused complications severe enough to require another mode of pacing, contrasting with 18 and 26 per cent, respectively, for the transvenous and transthoracic electrodes.


A safe technique for closure of the recurrent patent ductus arteriosus. In an early series of 73 operations for patent ductus arteriosus, closure was by the triple ligation method. Over a short period, recurrence of patency was observed in 2 cases and after that the technique of division and suture rather than ligation became standard. For closure of the recurrent ductus, a modification of the usual technique is necessary to minimize danger of injury to the recurrent nerve and the great vessels. A safe method was devised which involves an intrapericardial approach to the superior aspect of the ductus and dissection inferiorly which avoids denudation of the aorta. This technique was used with satisfaction in 6 cases of recurrent patent ductus arteriosus.


Definitive surgical treatment of anomalous origin of left coronary artery. A new technical approach used successfully in a seven-month-old male infant. Anomalous origin of left coronary artery from the pulmonary artery is a very rare cardiac anomaly. Most patients with this defect die in the first year of life. Reconstructive surgery of the left coronary artery is the only saving measure in the management of this disease. A radical operation was successfully carried out in a seven-month-old boy by interposing a homologous saphenous vein (from his mother) between the aorta and left coronary artery. The operation was performed by use of deep hypothermia with surface cooling combined with limited cardiopulmonary bypass. The postoperative clinical course was uneventful and the patient relatively asymptomatic. Postoperative coronary angiograms revealed that the interposed homologous vein graft was patent, although it was slightly stenotic. Following the operation the patient showed good development and growth and has now reached 2 years of age. The purpose of this paper is to present the case by discussing our new operative technique.


A low-threshold, non-dislocating endocardial electrode. Threshold curves with large and small surface intracardiac pacemaker electrodes are compared. The 2 msec. impulse threshold with a 47 sq. mm. electrode was 3.6 v. (4.3 mA.) on the fourteenth postoperative day, when it reached its maximum, and 2.8 v. (3.1 mA.) one month after the operation. These values were 45 and 30 per cent lower with a 6 sq. mm. electrode. Thresholds increased by about 20 per cent when the impulse duration was shortened from 2 to 0.5 msec. The small surface electrode consumed about 35 per cent less current than the 47 sq. mm. one. A newly designed large area-small surface electrode with the shape of an open cage, seems to have the advantages of less increase in postoperative thresholds and good attachment to the endocardial wall.


Infection of cardiac suture line after ventricular aneurysmectomy. Report of two cases. Two cases of sepsis following ventricular aneurysmectomy are presented. In both, the source of sepsis was an infected caridac suture line in which Teflon felt strips were used to reinforce the closure. One patient had a pseudoaneurysm and a chronic empyema of the left side of the chest, and the second had a ventriculocutaneous fistula. Early operation with removal of the foreign body is warranted in this major complication of a ventricular aneurysmectomy.


Doppler ultrasonic flow detection as an adjunct in the diagnosis of patent ductus arteriosus in premature infants. Since ligation of a patent ductus arteriosus in the neonate with idiopathic respiratory distress syndrome seems to improve the clinical condition of the infant, we have attempted to identify those neonates earlier with the noninvasive Doppler ultrasonic technique, recording brachial arterial flow signals. Sixteen patients were studied. In the 5 with reversed brachial flow who were operated upon, ligation of a PDA resulted in improvement and postoperative correction of brachial flow reversal as evidenced by the Doppler ultrasonic technique.


Total correction of double-outlet ventricle with concordant atrioventricular relation, dextrocardia, pulmonary stenosis, and situs inversus. A case of successful surgical correction of double-outlet right ventricle with concordant atrioventricular relation, pulmonic stenosis, and situs inversus is described. Transposition of the great vessels was not present. Intracardiac repair with a Teflon tunnel conduit gave an excellent result. Proper resection of the subpulmonic obstructing fibromuscular band required no patch reconstruction of the outflow tract.


Effects of assisted ventilation on echocardiographic findings in two infants with patent ductus arteriosus. Echocardiography is a useful means of determining whether or not to ligate the patent ductus arteriosus (PDA) in premature infants with respiratory distress syndrome and PDA. The magnitude of the left-to-right ductal shunt can be gauged by measuring the diameter of the left atrium (LA) and aortic root (AO) echocardiographically and by determining the LA/AO ratio. An increase in this ratio during weaning from assisted ventilation is an indication for ligation of the PDA. We recently used this criterion in treating 2 infants with respiratory distress syndrome and PDA.


Fatal air embolism following gunshot wound of the lung. Air embolism following penetrating lung trauma has been reported infrequently and its existence is questioned. A death resulting from air embolism following a high-velocity gunshot wound is presented. Appropriate treatment and preventive measures are discussed.


Perfusion lung scan patterns in 100 patients with bronchogenic carcinoma. The relationship between size of the perfusion defect as seen by perfusion lung scan (PLS) and size of the mass lesion as seen radiologically was correlated with the presence of regional adenopathy in 100 consecutive patients with bronchogenic carcinoma. All patients underwent scanning before open thoracotomy or mediastinotomy and had histologic documentation of the disease. Each perfusion lung scan was classified as follows: (1) perfusion defect larger than the mass lesion. (2) perfusion defect of the same size as the mass lesion, or (3) no focal defect seen. Among patients with a larger perfusion defect 84 per cent were found to have regional lymph node involvements, whereas among patients in whom a larger defect was not present only 23 per cent had such extensions of the disease.


Pulmonary embolism: surgery in a hyperbaric chamber. A 20-year-old man with a known history of thrombophlebitis experienced massive pulmonary embolism with hypoxia and shock. Embolectomy was performed with hyperbaric oxygenation for cardiopulmonary support. Ligation of the inferior vena cava was required postoperatively to prevent further embolism. Hyperbaric oxygenation is an effective method of cardiopulmonary support for pulmonary embolectomy.


Postpneumonectomy empyema in pulmonary carcinoma patients. Treatment with antibiotic irrigation and closed-chest drainage. Seven patients with postpneumonectomy empyema who had had pulmonary carcinoma were treated with intrapleural antibiotic irrigation and closed-chest drainage. Two tubes were used to irrigate and drain the cavity. Although most patients had a bronchopleural or esophagopleural fistula, the treatment was successful in every case. Three of the 7 patients died of far-advanced carcinoma 1 to 2 years postoperatively, but none died of sequela of the empyema. In 3 patients with bronchopleural fistula, empyema recurred during the first postoperative year. However, it responded well to repeated irrigation and drainage. This simple, time-saving, and easily repeatable regimen proved to be both effective and also very comfortable for the patient. It has none of the disadvantages of open thoracic drainage or mutilating thoracoplasty.


A safe method of thoracentesis.

A safe method of thoracentesis. A simple and safe method for therapeutic and diagnostic thoracentesis is described. The application of this technique of thoracentesis may decrease the chance of injury to the lung during the procedure. The complete evacuation of the pleural cavity may reduce the chance of development of adhesions. Repeated aspirations and instillation of medications with the same system left in the thoracic cavity may also be possible.


Pulmonary artery conduits in infants younger than six months of age. Ten infants under 6 months of age with right ventricular-pulmonary artery discontinuity have undergone reparative operations. Five infants had either Type I or Type II truncus and 5 had pulmonary atersia with some discontinuity between right and left pulmonary arteries. There have been 4 survivors in each group. The one death in each category was due to pulmonary hypertension. The remaining 8 patients have low pulmonary vascular resistance. The survival rate after the reparative technique in infancy appears better than that with other forms of palliative treatment, such as banding of shunts, in these severly ill patients.


Arterial prosthesis of microporous expanded polytetrafluoroethylene for construction of aorta-pulmonary shunts. A new arterial prosthesis made of polytetrafluoroethylene (OTFE) was evaluated in 10 infants with complex cyanotic congenital heart disease. All grafts used were 4 mm. in diameter and varied in length from 0.8 to 6 cm. The grafts were anastomosed to the main pulmonary artery or its bifurcation in 8 infants and to the right and left pulmonary arteries in one each. There were two early deaths, one of which was related to shunt failure. The advantages of a shunt to the main pulmonary artery are obvious, and the intraoperative procedure is facilitated with the prosthesis. Follow-up averages 9 months in the 8 survivors, and the patients have nearly doubled their preoperative weight. A shunt murmur is present in each case and the children have mild-to-moderate cyanosis at rest. Repeat aortograms in 2 patients, 8 and 10 months postoperatively, show a smooth graft without luminal narrowing. The aortic oxygen saturations were 73 per cent. The PTFE graft and/or anastomoses will not grow with the growth of the child and therefore may not accommodate growth by increased flow. This may prove to be a limiting factor in its long-term use in fants. We reserve the use of these grafts for infants with complex cyanotic defects undergoing emergency surgery or in older children in whom a conventional shunt is not possible or a previous shunt has failed.


Anatomic correction of transposition of the great vessels. We present a new approach for anatomic correction of transposition of the great arteries. The two coronary arteries, with a piece of the aortic wall attached, are transposed to the posterior artery. The two aortic openings are closed with a patch. The aorta and pulmonary artery are transected, contraposed, ant then anastomosed. The interventricular septal defect is closed with a patch, through a right ventriculotomy approach, because the right ventricle is no longer part of the systemic circulation. Two patients, aged 3 months and 40 days weighing 4,200 and 3,700 grams, respectively, were operated upon with deep hypothermia and total circulatory arrest. There was good recovery from the operation, with normal cardiocirculatory conditions. Renal failure developed in the first patient, and she died on the third postoperative day. During this time the cardiocirculatory conditions were good. The second patient made an uneventful recovery. Hemodynamic studies 20 days after the operation showed complete correction of the malformation. Five and one-half months after the operation, he weighs 7,500 grams, and his development is very good. We believe that this operation will be reproducible by most cardiovascular septal defect and pulmonary hypertension.