Respiratory mechanics during daily and alternate day corticosteroid therapy in asthma. Changes in lung mechanics were measured in asthmatic adults before and after a 10-day course of daily and a three-week course of alternate day adrenocortical steroid therapy. All patients improved after the 10 days of therapy. This response continued during the a.m. measurements on the alternate day regimen with further improvement through the afternoon of the treatment day. In the afternoon of the day off corticosteroid therapy there was a deterioration in flow rates.


Structural variations between pleural and peritoneal mesotheliomas produced in rats by the injection of crocidolite asbestos. The author studies the ultrastructure of pleural and peritoneal mesotheliomas caused in the rat by the intra-pleural or intra-peritoneal injection of 25 mg of crocidolite. In the peritoneum the tumour is made up chiefly of "connective" type tissue with rare "epithelial" cells. In the pleura, the "epithelial" cells predominate, constituting vast vegetating "papillomatous" zones or "adenomatous" territories. The author recalls Willis' concept, and feels that mesothelial tumours in the rat, caused by asbestos, represent one aspect of the family of mesenchymatous tumours, with their ability to behave differently according to their site.


Tumours in experimental animals following exposure to asbestos dust. The author summarises his research into experimental asbestos-related tumours. He notes in particular the inequality in carcinogenic power of different types of asbestos and the variations in the types of malignant tumour seen (carcinomas or mesotheliomas), according to the variety of asbestos used.


[Activity of blood somatomedin during childhood in normal subjects and in delayed growth]. A hundred sera from children, were used to evaluate normal levels of somatomedin activity and pathological levels. The results showed that the level of this activity in the blood, rises gradually during infancy, to reach normal adult reference level by postulate, equal to 1. Although the values are widely dispersed in each sample, the general phenomenon of their increase in infancy remains significant. The patients with somatotropin deficiency, have very low somatomedin values which become normal under the influence of injection of human growth hormone. A very unusual case is that of Laron's dwarfism with very high values of HGH in the plasma, and very low levels of somatomedin and, clinical and laboratory indifference to injections of exogenous HGH. The prospects of progress in the techniques of study of somatomedin will be of great service in the near future.


[Anatomopathologic study of 54 cases of diffuse pleural mesothelioma found in the harbor regions of Nantes, Saint-Nazaire and Lorient]. The study concerned the macroscopic and microscopic examination of 54 cases of diffuse malignant mesothelioma. Four points were felt to be of interest and worthy of emphasis: --the unilateral nature of the lesions, constant in this series; --the absence of involvement of other serous surfaces; --the tumour-like appearance of the disorder in 2/3 of cases and the appearance of a simple pachy-pleuritis in 1/3; --from a histological standpoint, despite the morphological flexibility of the classically accepted mesothelial cells, the homogenicity of our group, in which tumour morphology was much more epithelial than histiocytic or connective.


[Study of the specificity of action of cholesterol oxygen oxidoreductase on various sterols and related substances]. The authors studied the action of oxygen cholesterol oxidoreductase (E.C. 1.1.3.6) extracted from Nocardia erythropolis on different sterols following simultaneously:--the disappearance of the substrate by chromatography on thin layers of silic acid, the formation of hydrogen peroxide by Röschlau's reaction, changes in the absorption spectrum between 220 and 320 nm. The results obtained show that sterol oxidase presents a broad spectrum of activity. It catalyses the transformation into ketone of the secondary alcohol group at the 3 beta position of sterols which possess in the C17 position a lateral chain of at least two carbon atoms. In the other hand, the reaction does not take place if there exists in the C5 position, an H in the cis position or if two hydrogen atoms linked to carbon 4 are substituted. Finally, only oxidation products derived from sterols possess a double bond situated in the 4-5 or 5-6 position presenting an absorption band between 240 and 250 nm.


[The oncogenic effect of fibrous dust. Animal experiments and their relationship with human carcinogenesis]. The results after intraperitoneal injection of fibrous and granular dusts in rats suggest, that the fibrous shape of asbestos is the cause of its cancerogenicity. Fibrous dusts other than asbestos (for example glass fibers) may induce tumours, when their diameters are like that of asbestos and the fibres are invariable in tissue. It is supposed, that a fibre with a diameter less than 1 mum and a length greater than 3 mum has a cancerogenic effect. The interpretation of the experimental results considering the cancerogenesis in humans is discussed, especially concerning the effect of fibrous glass.


[Micromethod of diazepam determination in the blood by gas-liquid chromatography. Application in neonatal pharmacology]. We propose a micromethod of diazepam determination on 0,1 ml of whole blood. The extraction is made with n-heptane for the isolation of diazepam in presence of principal metabolites. For the usual concentrations, the precision is about 3 per cent; at the detection limite, 0,05 mug/ml, it is about 20 per cent. With this method we studied the pharmacokinetics of diazepam in neonate with convulsive diseases in comparison with electroencephalogram.


[Simple and totally automatic continuous flow technic for the determination of triglycerides in the blood]. The author describes a simple and entirely automatic technique for the estimation of triglycerides in human serum which, in acetic medium, are extracted by a mixture of nonane-isopropanol and saponified. The glycerol is oxidised into formaldehyde which is estimated by fluorimetry after Hantzsch' reaction. Successive stages are discussed together with the precision of the method. The results are in agreement with those obtained by Kessler and Lederer's method.


[Asbestosis with sarcoid-like pulmonary lesions. A propos of one anatomoclinical case report]. A report of a clinico-pathological case of asbestosis with special histological lesions. The latter had a granulomatous appearance, progressing to fibrosis with Schaumann bodies organised around bodies with a ferruginous covering, apparently due to asbestosis. The histogenesis of the lesions is discussed, together with the need to take a precise professional history. The usefulness of certain simple methods of analysis is mentioned.


[5 minutes incubation for the radioimmunologic determination of somatomammotrophic chorionic hormone]. A radioimmunoassay procedure for human chorionic somatomammotrophin in indiluted plasma has been developed in which the incubation lasts only five minutes rather than one half hour to four days in the previously described methods. The values obtained had excellent correlation (p less than or equal to 0,001) with those obtained by a two-hours technique. The intra-assay and inter-assay coefficients of variation are respectively 7 percent and 11 percent. Twenty women at term showed human chorionic somatomammotrophin values of 7.5 +/- 2.5 mug/ml plasma (mean +/- SD).


[Automatic microdetermination of serotinin in capillary blood]. The authors describe an automatic fluorimetric micromethod based on the reaction of condensation of serotonin with orthophthaldialdehyde forming a fluorescent compound. This precise and sensitive method permits estimation of serotonin on microsamples. The results obtained on capillary blood are identical to those obtained on venous blood.


[Enzymatic activity assays in the hepatic cell by mass fragmentography associated with gas-liquid chromatography]. The most generalized methods in enzymology are based on the quantitative assay of compounds, substrate or coenzyme, by spectrophotometry without any separation. Such a method is ruled out if the colorimetric reaction is not specific of the compound. In liver enzymology, aside the classical metabolic pathways, such assays are difficult to apply, especially when several metabolic steps are investigated. It is therefore necessary to use separative methods to isolate the metabolized substrate(s). For instance, the reductive catabolism of corticosterone leads to fourteen isomers (two dihydrocompounds, four tetrahydrocompounds and eight hexahydrocompounds) in which their respective productions are sex and age-linked. A position isomer of corticosterone, the 18-hydroxy-11-deoxy-corticosterone, follows the same reductive route. In adrenals some reduced metabolites arise from these two steroid hormones and are age dependent. When such metabolites are amenable to volatilization for gas chromatography, the interfacing of the gas chromatograph to the mass spectrometer allows to identify each compound introduced in the spectrometer. Among the ions produced by fragmentation of a compound or of a family of compounds, several specific fragments can be selected to be monitored along the chromatographic run leading to mass peaks which are quantitatively proportional to the amount of compounds, as far as other foreign molecules do not contribute fo fragment productions. These methods called mass fragmentography or multiple ion detection, or selected ion monitoring, allow with the help of all the resources of gas chromatography such the derivatization of studied molecules with heavy isotope labeled reagents to use the same unlabeled derivatized molecules as carriers and internal standards at once. This method allows to quantitate at the level of the picomolecule or less. Examples will be given with the study of the metabolism hormone steroids and xenobiotic compounds by the liver and adrenals in the animal and by isolated liver and adrenal cell cultures.


[Peripheral airway obstruction in the course of occupational exposure to asbestos]. Typically, the functional abnormalities in individuals exposed to asbestos dust take the form of a pulmonary fibrosis. Recently, several authors have stressed the early existence of small airways obstruction. In the present study, by measurement of closing volume, we have confirmed an obstructive factor in a certain number of exposed subjects, even if they were non-smokers, i.e. had no other apparent reason for small airways disease.


[Spectrofluorometric determination of furosemide in biological fluids. Application to pharmaco- and biokinetic studies]. The present report describes spectrofluorimetric methods for evaluation of furosemide (a sulfamide diuretic derived from anthranilic acid) in plasma or urine. The availability of these methods is discussed. These methods can be used for pharmacokinetic and pharmacological studies and sometimes resolution of therapeutic problems.


[Bacteroides fragilis. Its isolation and antibiotic sensitivity]. The authors chose the problem of the isolation of bacteroides fragilis in pathological samples to present a method of identification of strict anaerobic gram negative bacteria, suitable for use in a routine bacteriological laboratory. A selection of 20 strains led them to study the mean inhibitory concentration of these germs with regard to antibiotics. From this study, two groups were obtained: one of low activity, the other of greater activity in vitro, in which one may note certain tetracyclines, clindamycin and metronidazole.


[Topographical variations of pulmonary and pleural asbestos fiber concentrations in variously exposed subjects]. The authors study three groups of subjects with different exposures to asbestos dust. The lung content in asbestos fibres is measured by optical and electron microscopy, the latter technique revealing preferential concentration of asbestos fibres in the peripheral zones of the lung, in particular in individuals subject to a moderate degree of professional exposure.


[Urinary excretion of 17-ketosteroids studied by gas chromatography in the healthy adult: distribution of values]. The level of different urinary 17-ketosteroids were assayed using a method requiring an enzymatic hydrolysis and a solvolysis, a separation by gas-chromatography on OV 225 (cyanopropylsilicone) and a detection by flame ionisation. The method has been discuted. Statistical study of the results obtained in 89 healthy and ambulatory subjects (divided in 4 groups according to sex and age) has shown a log-normal distribution of urinary excretions.


Respiratory function and symptoms in urban office workers in relation to oxidant air pollution exposure. Similar populations of male and female office workers in San Francisco, which has little air pollution, and in Los Angeles, which experiences frequent photochemical smog episodes, were surveyed in an attempt to document excess respiratory symptoms and dysfunction in Los Angeles relatable to air pollution. Most results of forced expiratory tests, single-breath N2 tests, and questionnaire interviews did not differ significantly between cities. Los Angeles women reported nonpersistent cough and phlegm more often than did San Francisco women. Smokers in both cities showed increased functional abnormalities. These results suggested that Los Angeles oxidant exposure is far less significant than smoking as a risk factor in development of chronic respiratory disease in sedentary indoor workers in good general health. Oxidant exposure has not been ruled out as a significant risk to more heavily exposed on more highly susceptible persons.


Household aggregation of pulmonary function and chronic bronchitis. Persons from 148 randomly selected households in an urban community were screened in their homes using a modified British Medical Research Council respiratory disease questionnaire and a portable spirometer. Analysis showed a significant tendency for chronic bronchitis to aggregate within households. Significant aggregation was observed for 1-sec forced expiratory volume, when measured as the per cent of the predicted value or as a score calculated from the data. The 1-sec forced expiratory volume was significantly correlated between siblings, but less clearly so between spouses. Correlation of 1-sec forced expiratory volume between mother and child appeared to be confounded by maternal smoking habits, an effect most notable between mothers and male offspring. The 1-sec forced expiratory volume of fathers was significantly correlated with that of their children, especially female children, an effect that appeared to be independent of smoking habits.


Inhaled and oral salbutamol in exercise-induced asthma. Twenty-one asthmatic patients participated in a single blind, crossover study comparing the effects of aerosol and oral salbutamol (a beta-adrenergic bronchodilator), on exercise-induced bronchospasm. By both routes of administration, salbutamol (albuterol) produced significant bronchodilatation at rest, but only the aerosol effectively prevented post-exercise bronchospasm in most patients. Because exercise-induced bronchospasm is a common problem in children and adults with asthma, these observations are relevant to the drug therapy of these patients. The existence of separate mechanisms for bronchodilatation and the prevention of exercise-induced asthma is postulated. It is possible that differing tissue concentrations of salbutamol are responsible for the observed differences between the 2 routes of administration.


Frequency dependence of total respiratory resistance in early airway disease. Patients who develop frequency dependence of lung compliance will theoretically have frequency dependence of pulmonary resistance. We investigated the ability of the simpler, noninvasive measurement of frequency dependence of total respiratory resistance to identify subjects with frequency dependence of compliance. Ten healthy nonsmokers, 14 asymptomatic smokers, and 6 patients with obstructive airway disease were studied. Frequency dependence of total respiratory resistance was determined by the superimposed oscillating airflow technique at 3 to 9 cycles per sec, and frequency dependence of lung compliance was determined by measurements at 10 to 80 breaths per min. Spirometry, airway resistance, closing volume, and closing capacity were also measured. Frequency dependence of lung compliance and total respiratory resistance were closely correlated (P less than 0.001, r = 0.82), but closing volume, closing capacity, spirometry, and airway resistance could not be used to identify subjects with abnormal frequency dependence of lung compliance. Measurements of frequency dependence of total respiratory resistance and lung compliance, total respiratory resistance at 3 cycles per sec, and closing volume minus expiratory reserve volume were able to distinguish significantly between the smokers and the nonsmokers, but spirometry, closing volume, closing capacity, and airway resistance could not. These data indicate that in asymptomatic smokers and subjects with obstructive airway disease, frequency dependence of lung compliance can be predicted from measurements of frequency dependence of total respiratory resistance. These two tests appear to have equivalent sensitivity and selectivity in detecting the uneven time constants in the airways of asymptomatic smokers.


The response of asthmatic subjects to isoproterenol inhaled at differing lung volumes. Asthmatics are usually instructed to use pressurized bronchodilator aerosols by delivering a bolus of drug at the beginning of a full inspiration. Because airways are better dilated near total lung capacity, the delivery of the drug near the end of a full breath might allow better penetration of particles into the lung and greater bronchodilatation. To test this hypothesis, 13 asthmatic subjects inhaled 400 mug of isoproterenol at 20 per cent (low) and at 80 per cent (high) vital capacity. The studies were done on 2 separate days when the severity of asthma was the same. Forced vital capacity, 1-sec forced expiratory volume, specific airway conductance and maximal flow at 50 per cent of viral capacity were measured at frequent intervals after drug administration. Ten min after drug delivery, there was a significantly greater (P less than 0.05) improvement in 1-sec forced expiratory volume after the drug was inhaled at the high lung volume compared to the response after delivery at the low lung volume. The differences in forced vital capacity, specific conductance, and maximal flow at 50 per cent of vital capacity were not significant. We concluded that inhaling a bronchodilator drug at the end of a full inspiration causes relatively greater bronchodilatation than inhaling the same dose at the beginning of inspiration.


Inhaled atropine sulfate: dose response characteristics. Inhaled atropine sulfate is a bronchodilator in man, but its efficacy and optimal dosage are still unknown. In the current study, the dose-response characteristics of this agent were examined in 20 children with chronic perennial asthma, using maximal expiratory flow-volume curves. Inhaled drug was delivered in incremental doses of 0.005 to 0.1 mg per kg. A peak action of atropine on the maximal flow after exhalation of 50 per cent of the forced vital capacity was seen 1 hour after inhalation; significant bronchodilatation was observed for as long as 300 min, depending on the dose. A plateau was observed in the dose-response curve in the dose range, 0.05 to 0.1 mg per kg. Changes in the maximal expiratory flow after exhalation of 75 per cent of the forced vital capacity paralleled those in the maximal expiratory flow after exhalation of 50 per cent of the forced vital capacity. Specific conductance significantly increased, and the ratio of residual volume to total lung capacity significantly decreased in 10 patients examined. In no case could the observed increases in flows be explained by the patient's breathing at a higher lung volume. Considerable intersubject variation was found in the effects of a given dose of atropine. This may be explained by variations in baseline flows. It was concluded that atropine sulfate by inhalation is an effective bronchodilator in children with severe asthma and that reported variations in its efficacy may be related to inadequate dosage.


Carbon dioxide response lines in young adults: the limits of the normal response. Carbon dioxide responsiveness was determined in 126 normal, young adults. The mean +/- SE slope of the line relating PCO2 to minute volume of ventilation was 2.60 +/- 0.107 liter per min-mm Hg. Although a wide range of responses was noted, 80 percent of the subjects had a value for the slope between 1.5 and 5.0 liter per min - mm Hg, with 16.6 per cent having values lying below and 4 per cent above this range. Women were significantly less responsive than men. Low, but significant, correlations were found between the slope and vital capacity, and between the slope and maximal breathing capacity, but not between the slope and height, weight, age, or smoking habits. Additional findings included an increase in the slope with prolonged rebreathing, possibly due to a peripheral chemoreceptor effect; absence of metabolic acidosis during 4 min of rebreathing; excellent short-term reproducibility of results in 111 subjects; and good longer-term reproducibility in most of 10 subjects retested 9 to 24 months later.


Respiratory abnormalities and ventilatory capacity in a Papua New Guinea Island community. On Karkar Island, off the coast of Papua New Guinea, 87 per cent of the 1,026 resident adults of 3 villages were surveyed for respiratory abnormalities. The prevalence of abnormalities suggestive of chronic lung disease was similar for each sex and increased with age. After 35 years of age, the combined rates were: adventitious breath sounds, 29 per cent; positive loose cough sign, 33 per cent; chronic cough, 11 per cent; and shortness of breath on exertion, 12 per cent. All of these abnormalities were associated with an obstructive ventilatory defect. Smoking began in late adolescence and was established in more than 90 per cent of both sexes by 25 years of age. Most persons smoked a home-grown variety of Nicotiana tabacum. The nonsmoking group was too small to allow adequate comparison; but among smokers, inhalation was related to both respiratory abnormalities and reduced lung function. The prevalence of respiratory abnormalities appeared to be at least as high as in some developed western societies, despite the fact that smoking habits resembled those of cigar smokers elsewhere, and that atmospheric and occupational exposures were absent. Among persons more than 35 years of age, 4 per cent had a history of pulmonary tuberculosis, and 5 per cent showed evidence of localized lung disease in a 70-mm chest radiograph. The predominant condition resembled the chronic nonspecific lung disease of developed societies. Unless this population is unusually susceptible to the effect of cigar-type smoking, other etiologic factors must be considered. These might include repeated acute chest infections, the indirect effects of pulmonary tuberculosis, larval migrations of intestinal parasites, or impaired host response as a result of poor nutrition. A wide spectrum of severity coexisted with a uniform environment and smoking pattern, which suggests that individual susceptibility is important.


Bird breeder's hypersensitivity pneumonitis: progress studies of lung function after cessation of exposure to the provoking antigen. Lung function and immunologic studies have been performed in 9 patients with bird breeder's hypersensitivity pneumonitis at the time of diagnosis and at intervals from 8 to 30 months after they ceased exposure to the provoking antigen. All 9 patients had evidence of small airway obstruction at the time of diagnosis. Complete recovery of lung function occurred in 4 patients. The other 5 all had evidence of interstitial damage; 3 of them had progressive increase in the degree of airway obstruction, and one had progressive loss of elastic recoil. The patients were nonsmokers, and these progressive changes could not be explained by occult exposure to antigen because the tests of immunologic sensitivity to relevant avian antigens became negative. Neither the nature or degree of lung function abnormality nor the form of clinical presentation was related to the development of residual damage. The period of exposure to antigen after symptoms developed and the age of the patient appeared to be the most important factors determining recovery of lung function.


Study of the surface secretion of the bronchiole using radioautography. The purpose of the present study was to obtain further information regarding the chemical nature and cell of origin of the surface secretion of the bronchiole using radioautography after the injection of labeled leucine, glucosamine, galactose. Rat lungs were perfused with mammalian Ringer's solution with added albumin. A 10-min pulse of L-leucine labeled with hydrogen-3 was administered, followed by perfusion with nonradioactive solution for 15 min to 4 hours. Similar studies were performed with [3H] glucosamine and [3H] galactose. Heavy labeling of the Clara cells of bronchioles was obtained after injection of [3H] L-leucine. Labeling of alveolar wall cells was also obtained. Labeling of the surface of the bronchiole was much heavier than the labeling of the surface of the alveoli. No specific labeling of bronchiolar cells was obtained with [3H] glucosamine and [3H] galactose. The results provide added evidence for the protein nature of the surface layer of the bronchiole and for the Clara cell as its cell of origin.


Lung volumes and compliance in myasthenia gravis and reversible airway obstruction. A patient with myasthenia gravis, reversible airway obstruction, and a vertical chest wall pressure-volume curve was shown to inflate his lungs to 12 liter during the night. During the day, either spontaneously or after isoproterenol, his functional residual capacity decreased by more than 2 liter. The large lung volume changes occurred without a change in slope of the static pressure-volume curve of the lung above functional residual capacity. The changes in the position of this curve might be due to the the very slow filling and emptying of bullae or to unexplained alterations in the length-tension characteristics of the alveoli. The vertical pressure-volume curve of the chest wall suggested that, unlike other patients who have normal or decreased chest wall compliance, this patient's chest wal was not a factor that limited ventilation at high lung volumes.


Postoperative impairment of mucous transport in the lung. Impairment of mucous transport is considered significant to the postoperative development of atelectasis, but the association has never beed demonstrated in humans. Tantalum powder, which adheres to airway mucus, can be used to study mucociliary transport. The postoperative clearance of insufflated tantalum powder (mean diameter, 2.5 mum) was investigated in 25 patients. Eighteen patients underwent intra-abdominal vascular surgery and 7 undersent lower-extremity orthopedic procedures. At the completion of surgery, tantalum was insufflated into both lungs of each patient to outline a representative sample of airways from the trachea to the small bronchi. Tantalum clearance was evaluated from serial radiographs obtained immediately after  insufflation, at approximately 6, 18, 26, and 48 hours later, and thereafter whenever appropriate. In the 7 orthopedic patients, clearance of tantalum was progressive and usually complete within 48 hours. Atelectasis did not occur in this group. In 14 of the 18 patients who had abdominal surgery, mucociliary clearance was markedly abnormal in that tantalum was retained for up to 6 days. Pooling of tantalum-labeled mucus occurred in dependent bronchi in 16 of these 18 patients. Pooling preceded and always accompanied radiographically visible atelectasis. Lobar atelectasis occurred in 6 patients and segmental atelectasis in 8. Tantalum-labeled mucus moved peripherally in atelectatic lobes or segments and was retained in these bronchi until re-expansion took place. Thus, impaired ciliary function and mucous transport are associated with and implicated in postoperative pulmonary atelectasis.


Acute coccidioidal pleural effusion.

Acute coccidioidal pleural effusion. Acute coccidioidal pleural effusions were studied in 28 patients. Coccidioidal pleural effusion appeared to be secondary to direct spread of contigous parenchymal infection, rather than to hematogenous dissemination, in more than 90 per cent of these patients. Only 2 of 28 patients had the concomitant development of disseminated infection, and both patients possessed factors known to predispose to dissemination. Because of the excellent prognosis in most patients, therapy in patients with coccidioidal pleural effusion should be expectant. This is true even when substantial increases occur in complement fixation titers; such elevations were frequent in this series. Cultures of pleural  biopsy specimens were the most rewarding cultural source in this series, being positive in all 8 patients in whom such biopsy specimens were cultured. Dermal hypersensitivity, including erythema nodosum and erythema multiforme, was commin in patients whose clinical course was uncomplicated.


Idiopathic pulmonary hemosiderosis: evidence of capillary basement membrane abnormality. Electron microscopic examination of a lung biopsy obtained from a child in the active stage of idiopathic pulmonary hemosiderosis disclosed prominent changes in the basement membrane of alveolar capillaries. Review of the pertinent literature showed that a structural defect of lung capillary walls in this disease has been proposed in the past mainly on theoretic grounds but not adequately documented at the ultrastructural level. Concentric multilayering of pulmonary capillary basal lamina, one of the changes observed in our material, is a rare phenomenon in this location, although one that has been well described in extrapulmonary microcirculatory beds and is probably a nonspecific reaction to vascular injury. The conceptual difficulties attending a definition of idiopathic pulmonary hemosiderosis are breifly discussed.


High-dose ethambutol: its role in intermittent chemotherapy. A six-year study. The outcome of 81 patients receiving supervised ambulatory treatment with twice-weekly isoniazid and ethambutol is reported. The patients were divided into 2 groups, one of which received its entire outpatient treatment with isoniazid and ethambutol, the other receiving isoniazid and ethambutol after initial treatment with isoniazid and streptomycin. In both groups, there was a 100 per cent favorable response at completion of therapy and no relapes detected among those patients followed after treatment. We compared our results with other studies of intermittent-supervised therapy and concluded that twice-weekly isoniazid and ethambutol given up to 18 months after an adequate phase of daily treatment is a highly effective and well-tolerated regimen.


A comparison of pulmonary function in male smokers and nonsmokers. Results of certain tests of pulmonary function, including a questionnaire, single-breath N2 test of closing capacity, forced expiration, and diffusing capacity were significantly different in groups of male smokers and nonsmokers. The influence of age on these smoking-related changes of pulmonary function was evaluated. The analyses indicated that (1) some tests including number of symptoms; closing capacity, i.e., closing volume plus residual volume as a percentage of total lung capacity; residual volume as a percentage of total lung capacity; Phase III of the single-breath N2 test, and steady-state diffusing capacity (ml of CO/mm Hg - min) revealed significant differences between adjusted mean smoker and nonsmoker values but did not reveal differences associated with age. (2) Tests of forced expiration (1-sec forced expiratory volume/vital capapity, reciprocal of the maximal mid-expiratory flow, maximal flow at 50 per cent of vital capacity; and moments) however, revealed differences between smoker and nonsmoker means )adjusted and unadjusted), as well as increasing smoker-nonsmoker differences with increasing age. It is suggested that the first group of tests probably measured an all-or-none response that occurred with the onset of smoking and was not affected by duration of smoking. The second group of tests probably measured the effects of continued smoking and indicated increasing abnormality associated with longer exposure (years of smoking). Test showing age-related differences between smokers and nonsmokers may reflect cummulative, irreversible changes in pulmonary function to a greater extent than test that do not.


Lung function changes in smokers with normal conventional spirometry. The comparative ability to detect early abnormalities in smokers by commonly used lung function tests was studied. Sixty-five healthy male nonsmokers served as a reference group and provided standards for 1-sec forced expiratory volume, vital capacity, end-tidal spirometry, spirometric forced mid-and end-expiratory flows, single-breath diffusing capacity, static lung volumes (helium method), and single-breath N2 closing volume measurements, In the present series of 80 male smokers, the measurements of forced mid-expiratory flow and forced end-expiratory flow did not improve the ability of the more conventional indices, 1-sec forced expiratory volume and the ratio of 1-sec forced expiratory volume to vital capacity, to detect obstructive lung disease. In 71 smokers with normal 1-sec forced expiratory volume and ratio of 1-sec forced expiratory volume to vital capacity, the end-tidal spirometry, diffusing capacity, and residual volume indices revealed 14,20, and 21 per cent of abnormalities. respectively. The single-breath N2 closing volume test (Phase IV/vital capacity and slope of Phase III) detected the greatest number of subtle changes in lung function; this was abnormal in 32 per cent of smokers with normal conventional spirometry. In young or light smokers, Phase IV/vital capacity was more frequently increased than the slope of Phase III; an incerse trend was observed in older or heavier smokers. The single-breath N2 closing volume test also provided the greatest number of abnormal results when other indices were impaired in the same subjects.


Transit time analysis of the forced expiratory vital capacity in cystic fibrosis. Transit time analysis of the forced expiratory vital capacity maneuver was applied to 37 patients with cystic fibrosis 8 to 22 years of age. This analysis divides the vital capacity into segments of air and assigns a transit time to each segment. The characteristics of the distribution of these transit times are used as measurements of pulmonary function. The quantities were compared with the forced vital capacity, 1-sec forced expiratory volume, ratio of 1-sec forced expiratory volume to vital capacity, peak flow, forced expiratory flow during the middle half of the forced vital capacity, maximal expiratory flow at 25 per cent of the vital capacity, specific airway conductance, and arterial PO2 of these patients. The standard deviation of the transit times was the most frequently abnormal. The mean transit time had the largest range of values in terms of its own standard deviation, and it was the best single estimate of over-all lung function because it correlated almost equally with large and small airway function. The coefficient of cariance of transit times was specific in detecting abnormality of small airways and was as sensitive in the detection of minimal lung disease as the standard deviation of transit times.


The effect of lung volume on the ventilatory response to CO2 during resistive loading in normal subjects. The ventilatory response to CO2 during resistive loading was determined in normal subjects when the end-expiratory level was allowed to increase and when it was restored to that present in the unloaded state. Restoration of the end-expiratory level of that seen in the unloaded state, during the resistive loading, resulted in an increase in ventilatory response to CO2. The mechanism by which increases in lung volume affect the ventilatory response to CO2 is unknown; multiple factors are likely to be involved. It is suggested that an increase in end-expiratory level plays a major role in limiting the ventilatory response to CO2 during resistive loading and may also be an important factor in the reduced ventilatory response to CO2 that is seen clinically when there is obstruction to air flow.


Effects of cord factor on liver lipid: accumulation triglycerides. A single intraperitoneal injection of cord factor induced a remarkable increase in the amounts of triglycerides in liver. This effect was specific for cord factor among various lipid fractions of tuberclebacilli. Other lipid species of liver than triglycerides were not affected by cord factor injection. The accumulation of triglycerides became evident 16 to 24 hours after the cord factor injection and reached the maximum at 48 hours. As small a quantity as 12.5 mug of cord factor effectively induced the increase of triglycerides in liver.


Analysis of the causes of mortality from appendicitis. An analysis of 944 cases of acute appendicitis treated at the University of Kentucky Medical Center from 1966 to 1973 is presented. There were 12 deaths in this series, a mortality rate of 1.3 per cent, and the clinical presentation, operative and autopsy findings are discussed. It is significant that seven of the 12 patients had other serious illnesses that influenced the decision for operation and that operation was delayed over 48 hours in 50 percent. It is stressed that the need for early exploration in the patient suspected of having appendicitis is even more imperative in the individual with concomitant disease. Adequate but immediate preoperative preparation with fluids and electrolytes antibiotics and stabilization of renal, pulmonary and cardiac status is mandatory.


Surgical management of parathyroid disease. One hundred fifty patients who had operation for hyperparathyroidism at the National Institutes of Health are reviewed. The series is composed of several groups of patients, including 18 with normocalcemic hyperparathyroidism, 13 with hyperparathyroidism associated with MEA II, and 24 patients with a history of previous parathyroid operation. Selective venous catherization and radioimmunoassay of parathormone was carried out in 81 patients and was interpreted as being localizing in 65 cases. Following operation, six patients remained hypercalcemic. There were nine instances of permanent hypocalcemia and four cases in which permanent recurrent nerve injuries were experienced. The operative management of these patients is outlined in detail, stressing an approach which includes the surgeon, the internist and the pathologist. Based upon pathological evidence, the importance of identifying by frozen section four glands is emphasized.


Acute jejunogastric intussusception.

Acute jejunogastric intussusception. Our patient represents an example of acute retrograde jejunograstric intussusception with the additional finding of a bleeding jejunal ulcer in the intussusception. The ulcer may have been etiological in precipitating the intussusception, or a consequence of mucosal sloughing in the hemorrhagic intussusception. Early diagnosis and immediate surgical therapy resulted in an uneventful recovery.


Effect of antibiotics on the in vitro neutrophil chemotactic response. Polymorphonuclear neutrophilic leukocyte chemotaxis was examined in vitro in the presence of the following antibiotics: tetracycline, chloramphenicol, erythromycin, gentamicin, methicillin, sulfadiazine, cephalothin, oxacillin, nafcillin and clindamycin. Results indicate that high concentrations (1 mg/ml) of tetracycline, nafcillin, erythromycin and sulfadiazine inhibited the chemotactic response of neutrophils. Tetracycline produced an inhibition at concentrations as low as 1mug/ml. A stimulation of the neutrophil chemotactic response was observed in the presence of chloramphenicol in all concentrations. The results are discussed with particular emphasis on the implications to host immunity.


Perforation of the normal colon during barium contrast examination. Two cases of perforation of the normal colon during barium contrast examination are reported. Overdistention of the colon with air and barium contrast examination are reported. Overdistention of the colon with air and barium should be avoided in a patient with a competent ileocecal value. While rare, this complication can be life-threatening.


Spontaneous perforation of the extrahepatic bile ducts in infancy. An additional case of spontaneous perforation of the bile duct in infancy is reported. Review of the literature reveals a characteristic history and physical findings in all infants with this entity. Treatment should be prompt and should consist of simple drainage of the area of perforation. Recovery is to be expected in all those patients in whom bile is sterile.


Sepsis with a new species of Corynebacterium. Sepsis with a previously undescribed species of Corynebacterium was documented in four patients. All patients had predisposing illness at the time of infection, three patients having leukemia in relapse and one having a porencephalic cyst and a ventriculoatrial shunt. The isolates from blood cultures had a characteristic metallic sheen when grown on blood agar. They were resistant to most antibiotics tested, including the penicillins, but were uniformly sensitive to vancomycin. Common biochemical characteristics, the metallic sheen, and the unusual antibiotic sensitivity pattern suggest that these isolates comprise a new species or group of closely related species of Corynebacterium that is capable of infection in man.


Absence of complete homologous immunity in hepatitis B infection after massive exposure. Evidence from prospective studies of human cases of posttransfusion hepatitis observed among 299 cardiac surgery patients, and from each of three experimentally challenged chimpanzees, indicates that immunity to hepatitis B infection can be overcome by massive challenge doses. However, all cases of hepatitis in patients with prior immunity have been subclinical. Chimpanzees developed hepatitis and HBs antigenemia when challenged with hepatitis B virus that had an antigenic subtype identical to that used in the primary infection. This response provides evidence against the role of differences in antigenic composition of initial and challenge strains of virus as an explanation for incomplete homologous immunity.


Felty's syndrome: granulocyte-bound immunoglobulin G and splenectomy. A quantitative antiglobulin consumption technique was used to measure immunoglobulin G (IgG) present on human granulocytes. Granulocytes from 50 normal subjects had less than 20 X 10(-14) g IgG per cell. Patients with granulocytopenia due to bone-marrow failure, patients with IgG multiple myeloma, patients with splenomegaly, and patients with rheumatoid arthritis without granulocytopenia had granulocyte-bound IgG within the range of normal. Four patients with rheumatoid arthritis, splenomegaly, and severe granulocytopenia (Felty's syndrome) had granulocyte-bound IgG between 30 and 220 X 10(-14) g IgG per cell. One of these patients underwent splenectomy, after which his granulocyte-bound IgG fell to normal. Seven additional patients with Felty's syndrome who had previously undergone splenectomy had normal levels of granulocyte-bound IgG. Thus quantitation of granulocyte-bound IgG appears to be useful in defining patients with immunologically mediated granulocytopenia. Studies of patients with Felty's syndrome who have undergone splenectomy suggest that the spleen may produce this neutrophile-bound immunoglobulin.


Sicca syndrome and total lipodystrophy: a case in a fifteen-year-old female patient. A 15-year-old girl is described with the sicca syndrome of keratoconjunctivitis and xerostomia. There was no associated rheumatoid arthritis or other connective tissue disorder, but total lipodystrophy had been present since the age of 9 years. Marked hyperreactivity of the humoral immune system and suppression of cell-mediated immunity was shown. The association of sicca syndrome with total lipodystrophy has not previously been reported.


Menopause and risk of cardiovascular disease: the Framingham study. The relation of menopause to cardiovascular disease incidence was examined in women less than 55 years old from the cohort of 2873 women in the initial Framingham examination. Although the number of person-years of experience during the 20 years of observation was nearly the same for premenopausal and postmenopausal status, there were only 20 cardiovascular events among the premenopausal women in this age group whereas 70 events occurred among the postmenopausal women of the same age. In each specific age group studied incidence rates were lower in premenopausal than postmenopausal women. This was also true for coronary heart disease. Contrast for "hard" diagnoses of cardiovascular disease (excluding diagnoses of angina pectoris and intermittent claudication) was in the same direction. Although cholesterol and hemoglobin did rise somewhat more steeply in women undergoing the menopause, this greater incidence of cardiovascular disease in postmenopausal women could not be explained by the influence of the menopause on the usual cardiovascular risk factors.


Bradycardia with mitral valve prolapse: a potential mechanism of sudden death. Eleven members of a family with a high prevalence of mitral valve prolapse were investigated. Seven had documented sinus bradycardia, and five had mitral valve prolapse. Three patients with both mitral valve prolapse and bradycardia had recurrent syncope reproduced by simple head-up tilting, and in one patient this resulted in asystole. The hemodynamic response to isoproterenol and phenylephrine administration were normal. Supine plasma norepinephrine levels were normal in all three and increased appropriately in two of three patients after tilting. Atrial pacing studies documented marked prolongation of atrial-His intervals and inability to maintain 1:1 atrioventricular conduction when paced at a rate of 120/min. These findings were reversed by atropine. This family shows a close correlation between mitral valve prolapse and potentially lethal bradycardia. Excessive vagal tone is believed to be responsible for both bradycardia and sinus arrest, which in two patients was prevented by permanent demand pacing.


"e" Antigen, Dane particles, and serum DNA polymerase activity in HBsAg carriers. Sera of 103 carriers of hepatitis B surface antigen were assayed for e-antigen and anti-e. Twenty-four were e-antigen-positive, 31 anti-e-positive, and 48 had neither detectable (e-negative). Aminotransferases were elevated in 75% of the e-antigen-positive carriers compared with 25% of e-negative carriers (P less than 0.001) and 13% of anti-e-positive carriers (P less than 0.001). Serum DNA polymerase activity was significantly higher in the e-antigen-positive carriers than in carriers without e-antigen. Dane particles were shown in 10 of 12 carriers with e-antigen, compared with one of 12 e-negative carriers (P less than 0.0003) and none of 12 anti-e-positive carriers (P less than 0.00003). These results suggest that ongoing hepatitis B viral replication is more active in e-antigen-positive carriers than in carriers without e-antigen, a finding that may help explain the high prevalence of chronic active hepatitis described in these individuals.


Aerobic and anaerobic bacteria in diabetic foot ulcers. Twenty diabetic foot ulcers were cultured using optimal microbiologic techniques. Anaerobic bacteria coexisted with the more commonly recognized aerobic bacteria in 18 specimens. There were a total of 116 isolates with an average of 5.8 species per specimen (3.2 aerobes and 2.6 anaerobes). The principal isolates were Bacteroides species (sp.) (17 strains), peptococci (16), Proteus sp. (11), enterococci (9), Staphylococcus aureus (7), clostridia (7), and Escherichia coli (6). When antimicrobial therapy is indicated the selection of agents should consider the likelihood of a complex aerobic-anaerobic flora.


Chronic ulcerative colitis, skin necrosis, and cryofibrinogenemia. Necrotizing skin lesions developed in a man with chronic ulcerative colitis. No evidence of intrinsic disease of medium or small-sized vessels was found. A circulating cryofibrinogen was thought to be responsible for in situ thrombosis leading to skin infarctions. Sodium warfarin in a daily dose of 2.5 to 5 mg appears to have thwarted progression of developing lesions and the occurrence of new ones.


[Suppurative parietal endocarditides].

[Suppurative parietal endocarditides]. As opposed to acute or subacute orificial localizations, suppurative parietal endocarditis is a very rare entity (5 cases in 3,900 autopsies). More readily localized in the left heart and being generators of systemic emboli, they remain latent until anatomically verified. Two circumstances promote their occurrence : the focal point caused by the mural thrombus of a recent myocardial infarction ; septicemic infections with pulmonary localization and neighbouring thrombophlebitis within the context of intense depression of immunity.


[Multiple angioleiomyomas of both lungs. Probable hamartomatous tumors. Very late death due to respiratory insufficiency]. Case presentation : Multiple tumor nodules in both lungs, identified by biopsy and necropsy, in a 48 year old woman, 8 years after radiological discovery ; death due to respiratory failure after long tolerance ; peculiar angio-leiomyomatous type pulmonary tumors. This purely pulmonary tumor disease is difficult to understand ; the most probable hypothesis envisaged is that of hamartomatosis ; comparison with certain general dysplastic disease is possible, and in particular Bourneville's disease and lymphangio-myomatosis.


[Language in schizophrenic patients].

[Language in schizophrenic patients]. The author tries to analyze the results of research on schizophrenics language during the last thirty years. The almost permanent contradictions of these results leads the author to the conclusion that there is no evidence for a basic disturbance in schizophrenic language. Two hypothesis are proposed to explain the contradictory results 1) the exclusively clinical definition of schizophrenia is of minimal utility as a frame-work for psychometric and linguistic research programs. 2) psychometric and linguistic tests seem to have no reliability to elucidate a phenomenea as complex as the verbal expression of the schizophrenic.


[The hyperkinetic child. Psychopathological aspects (author's transl)]. The hyperkinetic syndrome, such as it is abundantly described in the literature of American authors, is clearly defined by the association in a young child, essentially at the beginning of schooling, of hyper-activity, psycho-motor instability, affective and learning disorders, emotional lability, immaturity, etc. It would appear that psycho-stimulants (in particular amphetamines) bring about a spectacular improvement in these children, representing a therapeutic test that confirms the diagnosis. In America, insistence is placed on the physiopathogeny of the disorders, and on the minimal cerebral dysfunction. This pathology, which, it would appear, does not seem to have been recognised in France, where the psychomotor instability is only one among many symptoms. We report here a synthetic clinical study of hyperkinetic children observed over a period of several years. They are particular in that they were seen at an early age (between 18 months and 4 years old). The psychopathological study of the early stages (which is usually missing in the literature) makes it possible to objectify a preliminary phase dominated by negative signs, of the "silent series": depressive and regressive tendencies, later hidden by agitation. We underline the importance of the early distorsion of the mother-child link, which appears to be a determining factor in the appearance of the hyperkinetic syndrome. These date (which tend to contradict many studies) lead one to reject the chemotherapy solution, and in particular psychostimulants for the greater majority of cases, and rather to intervene at an early stage, and ideally speaking preventively, to instigate above all a psychotherapy of the child and often of the mother (co-therapy), to restore a good level of communication, and the mother-child link. This in-depth approach should make it possible to avoid a purely symptomatic treatment, with its uncertain effects, and its often undersirable evolution.


[Paradoxical effects of iodine overload on thyroid function]. Any chronic iodine overload resulting from long term ingestion of a medication or the administration of a non-resorbable contrast medium, may result in a goitre with or without hypothyroidism, and in particular in patients with a past history of thyroid disease. By contrast, the administration of iodine is no longer indicated in the treatment of enedmic goitres since the hypothesis of an iodine deficiency in the pathogenesis of such goitres may be excluded in most countries, and in particular western countries, and the risk of the development of thyrotoxicosis in such patients is not negligeable. It would thus be desirable that iodine no longer be used in the composition of medications when its presence is not indispensalbe and where, furthermore, it may contribute to developement of an increasingly disturbing iatrogenic complication.


[Undifferentiated naso-pharyngeal carcinoma of the Schmincke-Regaud type. Apropos of 3 cases]. The authors present 3 cases of undifferentiared naso-pharyngeal carcinoma of the Schmincke-Regaud type. They study the anatomopathological, appearances, the geographic distribution, the background, the clinical expression and course, the immunological, virological and genetic factors of this very curious type of cancer the diagnosis and treatment of which remain difficult.


[Midline malignant granuloma and cyclophosphamide]. One case is presented whose characteristics features were breast hypertrophy, normal immune functions and the efficacy of cyclophosphamide alone : A complete remission is present 31 months after the granuloma started, after 7 and a half months of treatment by cyclophosphamide, 14 months after its interruption by the patient. It is proposed that lethal midline granuloma is a localised form of Wegener's granulomatosis ; between these extreme forms are the limited (pulomonary) form of Wegener's granulomatosis, and the lethal midline granuloma with cutaneous, glandular, digestive or urethrogenital involvements. Therapeutic is briefly reviewed and the efficacy of cyclophosphamide claimed.


[Fistula between a systemic artery and the pulmonary arterio-venous system. Apropos of a case. Review of the literature]. The authors present the case of a 19 year old man with a continuous murmurin the right latero-thoracic region, with no functional symptomatology. Complementary examination demonstrated the presence of an angiomatosis which had developed at the expense of the right internal and external mammary vessels, and communicating with the pulmonary arterio-venous system.


[Suicidal behavior and meterological conditions]. Six hundred and seventy five cases of attempted suicide observed in a resuscitation department were confronted with a certain number of biometeorological factors recorded daily: atmospheric pressure, air temperature, degree of insolation, precipitation, relative humidity, water vapour pressure, wind (speed and direction), hydrometeores, index of solar eruption, density of F2 layer. The confrontation is made for the two days before the intoxication and for the day when suicide is attempted. Parameters are then studied by statistical calculation (calculation of X2 and of the number of degrees of freedom). There does not seem to be any significant relationship, in spite of disconcerting series, between most meteorological factors and the number of attempted suicides observed. However, it is noted that no suicides were recorded during periods of solar eruption, and that there seems to be a marked correlation between suicide and winds, particularly according to their direction. Thus, winds charged with ionised particles seem to coincide with a high rate of self-destruction.


[Psychodynamic significance and scoring of "profile" and "silhouette" responses to Rorschach test in adults and minors]. "Profile" ou "silhouette" responses are rarely given at the Rorschach-test (4,87% of our 780 adults and minors; i.e. 7,17% for the adults and 2,56% for the minors). In 82% of our adults and in 50% of our minors, they are indicators of avoiding neurotic behaviour; in 18% of our adults and in 50% of our minors, we are dealing with contact difficulties or insufficiency complexes. These responses are generally unique in each Rorschach test. However 42% of our adults and 30% of our minors gave more than one of them. The VIIth plate holds the first place as a "stimulus" for "profile" or "silhouette" responses (46,22% of the adults and 40% of the minors). The other Rorschach-plates are, in a decreasing order: III, II, I, V and VI for the adults and VII, I, II, and IX for the minors. These responses suggested by the interpretation of the free border of the plates, are De-responses; when human beings are seen as wholes the Rorschach symbol will be G; if only their heads are perceived, it will be: D.


[Psychosomatic reflections].

[Psychosomatic reflections]. This paper resumes the philosophical analysis of the relationship between body and soul. Cartesian dualism is criticized according to the recent developments of the theory of information. The problem of causalities and somato-psychic or psycho-somatic interactions is also criticized. The conclusion aims at a multidisciplinary approach to the patient.


[Fa'a'mu and Fanau. Various traditional aspects and current problems of adoption and donation of children in French Polynesia]. The old polynesian custom of giving a child persits. One child in three or four is asked for and adopted (Fa'a'amu). It was not officially recognized, which had no disadvantage as it was between Maoris and inside enlarged polynesian families. But quick acculturation and urbanization, social and economical changes of the past ten years have changed all that. The contradiction between french law and tahitian traditional customs exposes these fa'a'amu children, with no legal statute and without judicial protection, to many drawbacks. First in their tahitian families because they get no family allowances. On the other hand some Europeans wishing to adopt children take often advantages, though it is illegal, of the generosity of the prolific tahitian women (no contraception in Tahiti) who seldom refuse giving children to a European, without understanding clearly that complete adoption (european model) cuts every tie with the biological family (Fanau). The illegal appropriation of these children sometimes leave them deprived of statute and legal protection in Europe (or America, or even Japan?). We have here an exemple of what happens when two cultures meet, whose customs and values are totally different.


[Late dyskinesia caused by neuroleptics. Survey on 1,660 psychiatric hospital patients]. Among 1 660 patients of 2 psychiatric hospitals (980 + 680), most of them chronically treated by neuroleptics, we found 120 tardive dyskinesia (7,2%). 64% were more of 50 years old. 85 of 923 women (9,1%), 36 of 737 men (4,8%), but most of the men are younger. In 67 cases oral dyskinesia is isolated, in 53 cases it is associated with choreic syndrom. 13 patients are free of neuroleptics for more than 6 months and the dyskinesia is probably irreversible (mean age = 74). The interest is double: 1. Practical: prevention by moderated and adapted prescription of neuroleptics, specially for long term treatments and oldest patients; anticholinergic correctors must be cautiously prescribed. 2. Theoretical: this human experimentation is a model of iatrogenic pathology for the study of mental illnesses, extrapyramidal troubles, and neuromediators...


[Short term effects of diets with high levels of dithiocarbamates on carbohydrate and lipid metabolism of rat liver]. The purpose of the work was to establish the eventual "metabolic toxicity" of pesticide-contaminated diets in the Rat. The liver metabolic response to various stimuli was compared in dithiocarbamate-fed animals and in non-contaminated ones. 112 weanling male Wistar CF rats were fed, during 15 days, with a demi-synthetic control diet. They were then divided into 4 lots:--the control group C, which went on to receive the same diet,--the nabame group N, the diet of which was supplemented with 275 ppm of the dithiocarbamate;--the thirame groupe R, receiving the control diet + 600 ppm thirame;--the zineb groupe Z, given the control diet + 3 600 ppm Zineb. The animals were fed with these diets during 14 days, their dithiocarbamate intake thus averaging 1/20 th of the per os LD 50/rat/day. At the end of this 2-week period, each of the 4 groups was divided into 4 sub-groups, all the animals were fasted overnight, then sacrified:--after no other treatment (sub-groups T);--30 minutes after an i.p. injection of 2.6 g/kg glucose (G);--after having been forced to walk in a restraint wheel for 50 minutes/hr during the 18 hrs of the night fast (sub-groups W);--after a 90 minutes exposure in a cold room (F). The weights of the animals, of their liver, heart, kidneys, adrenals and epididymal pads were recorded. In their liver, the following compounds were determined: water, proteins, total lipids, triglycerides, long-chain acyl-CoA, non-esterified fatty acids, total cholesterol, glycogen, glucose, alpha-glycerophosphate. The thirame rats had a lower food intake than the others and the smallest body weight, but their relative liver and kidneys weights were the highest. The nabame animals did not differ from the control ones but the zineb rats had the lightest epididymal fat pads. The primary effects of the dithiocarbamate diets on liver metabolism were apparently not the same in the 3 groups compared to the control ones: nabame and thirame increased glycogen, thirame increased the lipid compounds: long-chain actyl-CoA and triglycerides, where as zineb feeding resulted in an increase of glucose concentration and in a decrease of triglycerides and total lipids. Muscular exercise, or cold exposure, had the following effects compared to those they had in the control group: a greater glucose utilization in the nabame and thirame rats, a smaller glycogen and glucose utilization, associated with an increase of alpha-glycerophosphate, in the zineb animals. These results were considered altogether with those obtained in a previous paper by the same authors, which concerned liver ketone bodies and adenine nucleotides changes after the same experimental conditions, and it was concluded that the 3 dithiocarbamates actually had a common effect on rat metabolism: they all impaired glucose utilization by the liver. Also, fat mobilization from peripheral depots was shown to occur in the 3 experimental groups, resulting in liver fatty acid oxidation in the nabame and zineb rats, and in liver steatosis for the thirame ones...


[Responses and physiological modifications of intestinal sucrase in rats fed diets containing various carbohydrates]. Weaning rats were submitted during 3 months to complet and balanced diets where only glucidic constituent varied. They were sacrified when fed or after 16 h fasting. 1. The value of intestinal sucrose K(M) is higher in rats fed on glucose dietary than in rats fed on sucrose, fructose or glucose + fructose dietary. These modifications are independant of the states of digestion. 2. The V(MAX) is diversely influenced by the states of digestion: hydric diet increases the V(MAX) in animals fed on sucrose diet when intestinal repletion has the same effect in animals receiving glucose diet. Fructose diet decreases it irreversibility in both cases. 3. Growth of animals is sagging respectively in order from sucrose and glucose diets to glucose + fructose and fructose diets, then weight of organes is unaffected. It was noted that perirenal and epididymal fats are more abundant in rats nourished with glucose diet than with fructose diet. 4. The glucoregulation is correctly effectued in either starved or fed animals and shows an available adaptation of organism in energetic utilisation of various studied sugars. Plasmatic, hepatis and intestinal free fatty acids levels are constant and equal in all series of expements in spite of important variations of reverse fat.


[Biochemical control of thiamine status in neurotic patients]. It is well established that the glucose represents the main energy source of the brain and that its metabolism supposes the presence of the vitamin B1. On the other hand, it is known that in industrialized countries, the consume (absolute or relative) of products without vitamin B1 (sugar, strong drinks) or containing it insufficiently (preparations derived from flours of low extraction, canned foods) registered a noticeable growth. On account of these premises, we made the hypothesis that the thiamino-glucidic unbalance to which the modern consumer is exposed, could be a factor contributing to the appearance of neurosis, which present now an increased incidence. In order to verify this hypothesis, we studied the vitamin B1 nutritional status in 65 patients recently taken to hospital with "nerosis sick", as well as with 49 healty subjects, who served as controls. We determined the spontaneous thiaminury (concentration, morning hourly debit and per gramme of creatinine), the provoked thiaminury (by means of an loading test, unpublished yet), as well as the erythrocyte transketolase activity and the pyruvic acid in the blood and in the urines (concentration and debit per gramme of creatinine) Compared with the control group, the patients of neurosis the average thiamin excretion was twice reduced, the transketolase activity diminished by 22 per cent, while the pyruvic acid level in blood and its renal elimination were increased by 31-38 per cent (p less than 0,001). After the vitamin B1 treatment, the values changed significatively (p less than 0,05), approaching those found in the healty subjects.


Polynucleotide sequence divergence among strains of Salmonella sub-genus IV and closely related organisms. Polynucleotide sequence relatedness studies were carried out to determine the extent of divergence present in Salmonella sub-genus IV strains, related strains of Salmonella of other sub-genera and the Citrobacter genus. Salmonella sub-genus IV were 91-97% related. The Salmonella of sub-genus I, II and III showed lower binding (79-87%) to Salmonella sub-genus IV. The change in thermal elution midpoint closely followed the reassociation data. Relatedness of Salmonella sub-genus IV and C. freundii ranged between 44 and 57%, which confirms that these organisms belong to different genera. The taxonomic position of Salmonella sub-genus IV is discussed according to the actual classification of the family Enterobacteriaceae.


[Experimental infection of axenic mice by "Yersinia enterocolitica" (author's transl)]. Although most of Yersinia enterocolitica strains isolated from man have no pathogenicity for laboratory animals, it has been demonstrated that some strains are pathogenic for conventional mice and that most of the strains are probably pathogenic for Nude mice. The authors report the results of the infection of germ-free mice with a strain of Y. enterocolitica which is non pathogenic for holoxenic mice. It appears that C3H/He mice are sensitive to the infection by gavage or aerogenic and peritoneal routes. They all die within 8 to 12 days after injection of an inoculum of 5.10(5) viable cells. Germ-free NCS mice were also sensitive to the oral and aerogenic infection but not to the peritoneal infection; the difference between C3H/He and NCS sensitivity to this way of infection could be explained by a higher bactericidal activity of the peritoneal phagocytes of the latter. The C3H/He and NCS holoxenic control mice infected with the same inoculum of the same strain, did not show any symptoms and all attempts to isolate Y. enterocolitica failed three months after the challenge. Germ-free mice killed by the infection showed histopathological findings, i.e. abscesses involving intestinal wall. liver and spleen; they were similar to those described in experiments with pathogenic strains for conventional mice (holoxenic) and to those observed in infection of athymic Nude mice with strains non pathogenic for conventional mice. This infectious disease model is discussed in regards to the natural human infection.


[Calcium absorption by the rat from various milks in relation to their total phosphorus and lactose contents]. The absorption of calcium corresponds to a strictly determined mechanism inhibited by phosphates and activited by carbohydrates. We investigate in what extent the absorption of milk calcium from various species has the same proceeding. 4 months old rats are given orally solutions of CaCl2 alone or in combination with sodium dihydrogen phosphate or lactose or these both compounds. We compare calcium absorption of these solutions to that of milk from woman, cow or sow, or to dilutions of these two latter milks. All these fluids are dosed so that they correspond each other by their respective content in total calcium, total phosphorus and lactose. Each solution contains 45Ca. Blood samples 1,30, 4, 6 and 24 hours after ingestion allow establishing the variations of plasma radioactivity. Rats are sacrified after 24 hours. In certain cases, samples from digestive tube contents and feces provide a coefficient of calcium absorption. The osseous retention is obtained from femur radioactivity. In breif, we may consider that milks from cow and sow provide calcium the absorption of which is settled after their respective content of total phosphorus and lactose. Opposed effects of these inhibitors and activators of calcium absorption compensate so that calcium from these milks is just a little better utilized by adult rat than calcium from an isocalcic solution of CaCl2. Calcium from woman milk, rich in carbohydrates, poor in total phosphorus is better absorbed than that from the two latters, however less than we might expect from its high lactose content. We may wonder that calcium utilization from cow milk is as moderate as that of a solution of CaCl2. But skeleton mineralization which may be fulfilled by milk is made better because of that: it is not chloride but calcium phosphate which ensures this mineralization, a phosphate which alone would impair this mineralization without the compensative role of lactose.


[Changes in weight of fresh and dried vegetables on cooking]. The present study represents part of a more important work relative to normal food refuse and change of weight of varied food according to different ways of cooking. The study has been realized on vegetables and some fruits of frequent utilization in the population. It was accomplished by 25 voluntary housekeepers from Paris and Marseille during a whole year according to precise instructions about the method of weighings, every vegetable having to be weighed, three times at different intervals, during the year; 3203 weighings were mode corresponding to 2 399 kg of divers types of vegetables. The results have pointed out important variations according to the kinds of vegetables and methods of cooking. At boiling, the most utilized method, the variations of weight according to the weight before cooking are very important extending from + 10 p. 100, for Brussel sprouts and fresh flageolets at--25 p. 100 and--36 p. 100 for lettuce and endive, the last of weight being the highest for fine leaves vegetables, lesser for roots and tubers, and around zero for artichokes, french beans, cauliflower, aubergines. Other methods of cooking, through concerning a more limited number of kinds of vegetables have pointed out that "sauté" brings a higher loss for the vegetables studied; Similar observations can be made for braising and stewing, frying leads to the highest loss reaching--48 p. 100 for chips. However the weight of fresh pulses varies slightly at boiling and stewing, it is the same for potatoes. As for dry beans, the increase of weight is less important than the percentage curently utilized for the calculation of surveys, the loss of weight according to cooked fruits pears and apples is not high (about 10 p. 100). These results should be taken into consideration for the exploitation of food surveys, especially norvadays when surveys are made more often at home and at the hospital and concern the individual consumption either by weighing the food consumed at table in dining-room or on the tray of the patient, and also when surveys are realized by interrogatory, the food being then, cooked, without refuse. From this point of view the last two tables present the results for a practical utilization. The first one gives the different kinds of vegetables studied with every way of cooking observed, the numbers of weighings effected the weight corresponding to 100 g raw and the weight corresponding to 100 g cooked, the other one presents the kinds of vegetables classified according to importance of the variations of weight for different ways of cooking in connection with the weight before cooking.


[Dwarf colony mutants of "staphylococcus": study of three strains isolated from patients with osteosynthesis (author's transl)]. Dwarf colony mutants of staphylococci were isolated from per operative samplings obtained from three patients with a bacterial contamination of their osteosynthesis material. The dwarf mutants grown in trypticase soja agar (TSA) after 72 h at 37 degrees C (two cases) and in nutrient broth (one case). They displayed poor growth (very small, transparent colonies on TSA), reduced biochemical activity, deficient pigment formation and intermediary resistance to aminoglucoside antibiotics (kanamycin, streptomycin, gentamicin). Biochemically, two types of metabolic defects have been demonstrated among these dwarf strains. Two of them are vitamin K2-less (strains 30 and 73) and are supplemented by menadion natrium bisulfit at concentrations ranging from 0.2 to 10 mug per ml. In these cases the dwarf colony mutants coexisted with normal colony of S. epidermidis (case 30) and S. aureus (case 73) belonging to serotypes 52260 and I respectively. The third strain (case 163) supplemented by horse blood is hemin-requiring. This strain could be characterized in media supplemented with blood, because it was isolated only as dwarf colony mutant from the patient; it belongs to serotype 52260 (S. epidermidis). This hemin-less dwarf mutant is the single responsible of the pathological manifestations of the patient 163. In the cases of vitamin K12-less mutants (strains 30 and 73) the coexistence of dwarf mutants and normal colonies of the same serotype may make possible the elucidation of relapse in infectious complications of the patients with osteosynthesis.


[Study of Enterobacter strains belonging to a particular group related to Enterobacter aerogenes (author's transl)]. Thirty strains of Enterobacteriaceae constitute a new group related to E. aerogenes with the following differential biochemical characters: urease+, KCN-, sorbitol-, mucate- and gelatinase-. Ten of these strains with antigenic similarities and polyresistance to antibiotics were isolated from urine in the same hospital.


[Influence of some nutritional factors on the canthaxanthine pigmentation of the rainbow trout]. The present investigation was made to approve nutritionnal factors which affect the utilisation of food canthaxanthin by hatchery trout. Rainbow trout were obtained from a commercial trout farm, kept in running water and feeding in experimental pellets for 4 to 8 weeks. Five diets were tested (1-standard [7.5 u.i/g], 2-low protein content, 3-High lipid content, 4-non supplemented with vitamin A, 5-High vitamin A content [23 U.I./g]). All diets containing 250 mg of canthaxanthin per kilo of food, the fish were fed at the rate of approximately 2.5 p. 100 of their body weight per day. The estimation of canthaxanthin from fish tissues was accomplished as follows: the tissues were gomogeneized and extracted with several volumes of solvents. The solution containing all the pigment was evaporated. The purification of the canthaxanthin was obtained by column silica gel chromatography. The pigment was eluated with ethyl-ether as solvent. Quantitative assay of total carotenoïd was effected by spectre photometric estimation of optical density at 480 nm of this fraction dissolved in benzene. The carotenoïd composition of this fraction was studied by silica-gel thin layer chromatography. In these conditions:--it was shown by spectral studies that the canthaxanthins present in the diet are essentially those deposed in the flesh of the trout fed;--a series of experiment were made to examine the effect of composition of artificially composed feeds for pigmentation of the rainbow trout. The pigment deposition was found to correlate with the amount of lipids present in these diet. In this condition, the pigment is more dispersed with lipids present and the pigment absorption may be facilitated and later be deposed. 8 weeks alimentation are needed to observe the effect of these nutritionnal factor;--when the diet is non supplemented with vitamin A, the same quantity of canthaxanthin mixed with this food gives trout redder flesh than the standard diet. On an other hand, an antagonist effect of diet with high vitamin A content is demonstrated on the amount of the pigment deposed in the flesh of trout;--no effect of protein content of the diet was found in these experiments;--no effect of ratio calorie/protein of the diets with the intensity of deposed pigment in the flesh rainbow trout;--a correlation between neutral lipids of the tissue and the pigment deposed in the flesh of the trout fed with canthaxanthin was confirmed.


Effect of pilocarpine ocular therapeutic systems on diurnal control of intraocular pressure. The pilocarpine ocular therapeutic system is an innovative ocular drug delivery system which releases pilocarpine into the tear film at a constant rate of 20mug/hr or 40mug/hr. The system was evaluated in 22 hospitalized patients with bilateral open angle glaucoma to determine its ability to control ocular pressure throughout the diurnal interval. Only the right eye of each patient was treated with the pilocarpine ocular therapeutic system; the other eye served as a control. Twelve pressure measurements were made with a noncontacttorometer over a 34-hour test period. In general, the pilocarpine ocular therapeutic system provided satisfactory around-the-clock control of intraocular pressure and was well tolerated by the patients.


Chromophobe adenoma and chiasmal syndrome without enlargement of the bony sella. Four cases of chiasmal syndrome resulting from chromophobe adenoma with normal-sized sella turcica are reported. The predominantly suprasellar growth of these tumors was probably the result of a well-pneumatized sphenoid sinus and/or a congenitally deficient diaphragma sellae. In patients with chiasmal syndrome, a high suspicion of a surgically treatable lesion must be maintained in spite of radiographs showing a normal-sized sella. In spite of the difficulties presented by normal variations, subtle findings should be searched for on the plain films and given additional weight in the patient with a chiasmal syndrome. An aggressive diagnostic work-up, including pneumoencephalography with thin-section tomography, should be pursued in all such patients before accepting some alternate explanation, such as demyelinating disease, for visual impairment.


Oribital floor fractures: a retrospective study. A retrospective series of 365 orbital floor fractures was studied and many variables were analyzed. Some type of ocular or orbital adnexal damage was present in 32% of the patients. After a repair procedure there was a low incidence of decreased visual acuity, and there were no implant extrusions. Late enophthalmost and diplopia were found to be related to the type of orbital floor damage. The comminuted floor fractures and fractures associated with prolapse of orbital tissue into the maxillary antrum were more prone to demonstrate these late sequelae. Despite various surgical procedures there was a 19% incidence of late diplopia and an 11% incidence of late enophthalmos.


Specific retinal breaks in aphakic retinal separation. The frequency and location of specific retinal breaks in a consecutive series of 169 phakic and 121 aphakic primary nontraumatic rhegmatogenous retinal separations categorized into lattice and nonlattice groups was determined. Small horseshoe tears in the oral region of the retina at the posterior vitreous base were responsible for 44.1% of aphakic nonlattice detechments. Aphakic detachments associated with lattice degeneration had a greater relative frequency of associated nonlattice tractional breaks in addition to lattice breaks.


The effect of light deprivation on the flickering B-wave. The effect of light deprivation on the flickering beta-wave was investagated. Results indicate that the flickering beta-wave is extremely reduced in the eye light-deprived for 14 to 20 days relative to the normal eye. The ratio of the second beta-wave (in a series of flickering beta-waves) to the ratio of the first beta-wave appears relatively unaffected by light deprivation, but the ratio of the fourth beta-wave to the first is significantly affected by light deprivation. The effect of light deprivation on the beta-waves evoked by a 13.4 milliambert flickering light is greater for beta-waves evoked later in the series than for beta-waves evoked earlier in the series.


Serum factors precipitating with bovine lens extract in cataract patients and noncataract patients. The present study tested the assertion that there exists exclusively in persons with senile cataracts a serum factor capable of precipitating with gamma crystallin extract from bovine lens. The results of this work do not support this assertion without the imposition of rigid specifications regarding test solution concentrations and observation time. Among the 84 subjects tested, 2 individuals had posterior subcapsular cataracts. The precipitates resulting from incubation with serum from these individuals were similar to those resulting from incubations with serum from senile cataract patients. The present study did not confirm the existence of exclusive serum factors capable of precipitating with gamma crystallin extract in patients with senile cataracts.


Studies in diagnosis of choroidal melanoma: use of 67Gallium. A series of clinically suspected malignant melanomas was used to test the usefulness of 67Gallium citrate using external counting techniques. The comparison was made with angiograms, 32P uptake, and clinical examinations. 67Gallium citrate uptkae proved to be an unreliable diagnostic tool with the described techniques. However, sufficient tissue concentration was obtained tin the tumor to suggest that improved probe counting systems with better resolution of ocular from extraocular tissue may allow this to become a useful technique in differentiating tumor from nontumor ocular pathology. A good indirect and direct ophthalmoscopic examination, along with periodic observation, were the most useful techniques for diagnosis in these cases. 32P uptake was extremely reliable (100%) and quite helpful in assuring the proper diagnosis.


[Rendu-Osler disease: apropos of 50 cases followed at the Gustave-Roussy Institute]. Rendu-Osler disease is an hereditary disease due to a predominantly antosomic heredity. The statistics given for 50 cases include 27 males 7 p. 100 of which had no familial antecedents. Clinically, Rendu-Osler disease begins in adulthood (44 p. 100) and often in late adulthood. In fact, it does not become really severe until about the age of 50 or 60. Epistaxis is the most frequent accident and proves fatal in more than 10 p. 100 of cases. Treatment of the nasal symptoms, whether this involves surgical excision followed by grafting or plesiocurietherapy using irridium wires, is very disappointing. The future alone will prove whether embolization gives more permanent results.


[Super-selective arteriography and embolization in severe epistaxis]. Super-selective arteriography technique is described. This examination enables the finest collaterals of the branches of the external carotid to be shown. Numerous anastomoses which explain the ineffectiveness of certain arterial ligatures used in epistaxis can be seen. Embolization has become an extremely common method for all facial malformations responsible for epistaxis and for O.-R.-L. tumours fed by the external carotid. Several cases are described which demonstrate that embolization in severe epistaxis is a speedy, elegant and permanent method.


[Trichocephaloidis beauporti n. sp., new cestode of Charadriiformes and some Passeriformes in Guadelupa (author's transl)]. Description of a new species of Dilepididae, Trichocephaloidis beauporti n. sp., parasite of Charadriiform Birds (Tringa flaviceps; Micropalama himantopus; Gallinago gallinago delicata; Squatarola squatarola) of Guadelupa and also of a Passeriforme, Quiscalus lugubris. This species can easily be separated from other Trichocephaloidis by the structure of bifid rostellum and the length of Hooks (70-77 mu). Trichocephaloidis charadrii is synonym of Trichocephaloidis megalocephala.


[Our attitude toward so-called essential severe epistaxis. The problem of vascular ligatures]. The authors describe their therapeutic attitude over the past few years towards severe epistaxis. In an emergency, anterior and posterior tamponage using thick tents is the main treatment used. Double balloon probes have been discontinued, in spite of the fact that they were well-tolerated, on account of the disappointing results they gave. In cases of relapse, when the posterior tampon is removed after 48 hours, systematic ligature of the sphenopalatine artery is carried out on arteriosclerosis patients aged about fifty who have high blood pressure. In other cases, the authors wait to see the effect of leaving a second tampon in place for a further 48 hours. In patients suffering from renal inadequacy, reabsorbable tents are preferable, prevention being the main aim, avoiding all treatment liable to counteract haemostasis. Generally speaking, ligature of the external carotid is often ineffective. It is the sphenopalatine artery which should be tied off (100 cases in the O.-R.L. Dept. of the Hôpital Foch). Ligature of the ethmoid is rarely indicated.


[Rendu-Osler disease treated by endonasal radiotherapy (evaluation of 62 cases)]. Two groups of patients were treated by plesiocurietherapy. The first group of 17 patients received only one exposure to radium (between 1949 and 1960). The second group received one or more doses of irridium 192 (between 1960 and 1973). The average period for stabilization of the disease was 13,2 months with radium and 20,4 months with irridium. Unfortunately, this does not give a permanent cure and, for irridium 192, the percentage of successes is only 30 p. 100 after 5 years. Logically, radiotherapy with irridium 192 should only be used when other methods have failed. The progressive accumulation of radio-lesions may, in fact, make the use of other techniques impossible.


[Enumeration of the cestodes of plankton and marine invertebrates. 9th contribution]. This 9th Contribution concerns Cestodes obtained from: A Lamellibranchiata, B Gastropoda, C Pteropoda, D Cephalopoda, E Crustacea.


[Neopolystoma euzeti n. sp. (Monogenea, Polystomatidae) first member of the genus Neopolystoma Price, 1939 in Africa (author's transl)]. Neopolystoma euzeti n. sp., a parasite of the urinary bladder and the rectum of the freshwater tortoise Clemys caspica var. leprosa in Tunisia, is mainly characterized by its genital spines in high number (33 to 36) and the very important extension of the vitellaria. It is the first species of the genus Neopolystoma Price, 1939, to be described in Africa, the others being known from North America, Japan and Eastern Siberia.


[Hymenolepis guadeloupensis n. sp., new cestode of domestic duck Anas boschas, Linné (author's transl)]. Description of a new species of Hymenolepididae, Hymenolepis guadeloupensis n. sp., parasite of domestic duck, Anas boschas Linné, in Guadalupa. This species, actually, cannot be completely identified to Hymenolepis fista Meggitt, 1933, Cestode of asiatic Cotton ygmy goose, because the latter is insufficiently described.


[Experimental schistosomiasis. II. Infection of Biophalaria glabrata by 2 miracidia of Schistosoma mansoni]. The authors have infected 127 B. glabrata by 2 miracidia of S. mansoni, either on the Same day, or introducing a second miracidium after 3, 7 and 16 days. 1 All the groups of planorbid snails had a low percentage of positivity (31 to 41 %). 2 The first cercarial emissions, in the 4 groups were scattered in the time, the delay being in correlation with the second infection. 3 In the snails reinfected after 3 and 7 days occured the highest emissions, those with the simultaneous double infection or second infection delayed to 16 days, had the lesser emissions. 4 An interval cycle of about 3 weeks was discovered for the highest emissions. All those phenomena are probably due to competition between the sporocysts born from both miracidia. Moreover, evident reduction of the fecundity in the positive snails were shown only after the beginning of the cercarial emissions, while a normal, or even increased fecundity was established in the prepatent period of the infected snails.


The different components of gastric emptying after gastric surgery. Gastric emptying of liquid and solid meals was studied before and after operation in 22 male patients who were admitted to a prospective randomized trial of truncal vagotomy and antrectomy and proximal gastric vagotomy in the treatment of duodenal ulceration. After operation the emptying of both solid and liquid meals was biphasic, with a passive early phase and a later controlled active phase. A significant increase in early liquid emptying was produced by both operations, and after truncal vagotomy and antrectomy also with the solid meal. Active emptying of the liquid meals was unaffected by either operation, but both operations significantly prolonged the active emptying of the solid meals. The clinical symptoms of dumping were related to rapid early liquid emptying (cascading) and those of gastric retention were related to delayed active emptying of the solid meal. These findings explain how the same operation can produce the opposing symptom complexes of dumping and gastric retention and how both sets of symptoms can occur in the same individual.


The diagnosis and assessment of abdominal aortic aneurysms by ultrasonography. A study of 150 patients examined by ultrasonography is described. It was designed specifically to diagnose and investigate abdominal aortic aneurysms. Sixty-four aneurysms were found. Ultrasonography was useful in distinguishing aneurysms from other conditions and there was a high degree of correlation between size measured by scanning and operative size. In addition to the demonstration of rupture it was possible to perform serial measurements. The technique is simple and quick and causes minimal disturbance to the patient.


Hazards in the management of large intra-abdominal tumours. Whatever their nature, large intra-abdominal tumours interfere with respiratory and circulatory function by producing elevation and splinting of the diaphragm and partial occlusion of the inferior vena cava. The main hazards involved in removing such tumours are consequences of abdominal decompression, which may produce a labile cardiovascular state, respiratory difficulties, and rapid intestinal distension. A knowledge of the deranged physiology and its management may avert these complications. Careful preparation, modification of anaesthetic technique, postoperative ventilation, and external abdominal compression are important. To illustrate the discussion two cases of large ovarian cysts are described.


Subtotal amputation for carcinoma of the penis with reconstruction of penile stump. Partial and total amputation are well-accepted procedures for the surgical treatment of carcinoma of the penis. In certain cases after adequate amputation the residual penile stump is too small from the penoscrotal junction to offer useful function, and a total amputation is therefore usually performed. In such cases a subtotal amputation with reconstruction of the penile stump avoids a perineal urethrostomy and permits micturition in the erect posture.


Bioplast fibrin buttons for liver biopsy and partial hepatic resection. Absorbable buttons made from fibrin (Bioplast buttons) have been used to facilitate liver biopsy or to control haemorrhage from the liver in 3 dogs and 14 patients. The buttons are easy to use, effective, and readily absorbed.


Effect of 2 br-alpha-ergocryptin (CB 154) on serum prolactin and the clinical picture in a case of progressive gigantomastia in pregnancy. A 24 year old woman who had epilepsy since the age of 7 years and who was still using antiepileptics, developed an excessive mamary growth (gigantomastia) during pregnancy. Treatment with CB 154 (Sandoz), 2 Br-alpha-ergocryptin in a dose of 2.5 mg three times a day from the 27th week of pregnancy, resulted in prompt improvement with a corresponding decrease in the plasma prolactin, return of the breast temperature to normal, and disappearance of the EEG-abnormalities. After parturition and subsequent mammoplasty the woman soon became pregant again. During this pregnancy, which terminated in the birth of a normal child, treatment with CB 154 was started early and continued throughout pregnancy with success and without side effects.


Multiple mesenteric cysts diagnosed by ultrasound. A case report. The diagnostic value of ultrasound in mesenteric cysts in infancy and childhood is demonstrated by a case report of a 4 year old girl with multiple cysts in the transverse mesocolon and with no other symptoms or signs than an enlargement of the abdomen. Neither clinical nor radiological examination could give the diagnosis, whereas ultrasound examination promptly revealed large, thin-walled, partly locular, cystic masses.


A study of cumulative effects and recovery from anaesthesia with intermittent doses of althesin. A comparison with methohexitone. The cumulative effects and post-anaesthetic recovery of Althesin were studied by comparing the drug with methohexitone in a series of 60 patients undergoing surgery for varicose veins. Anaesthesia was maintained with each anaesthetic agent in 30 patients by administration of intermittent doses of the respective drugs in accordance with the surgical stimulus. When repeat doses were required at intervals of 2 to 5 minutes, the fall off in requirements was observed with both anaesthetics, more distinctly with Althesin than with methohexitone. No significant difference could be observed in the time required for immediate awakening after the two drugs. However, the majority of the patients anaesthetized with Althesin displayed a peculiar lack of mental clarity for a short period after recovering consciousness. The recovery from anaesthesia was studied by various tests and observations. Recovery after Althesin appeared to proceed slightly faster than after methohexitone. When Althesin was required in high total dosage (exceeding 150 mu1/kg), the immediate awakening was associated with emotional upset and confusion. Frequency of nausea and vomiting after anaesthesia was considerably higher in the Althesin group than in the methohexitone group. These symptoms might be toxic due to the excessive dosage given. Using the induction time as a basis for calculation of the potency ratio, Althesin and methohexiton were found to have the ratio of 1:33 (expressed in mu1/kg : mg/kg).


Use of 131I-toluidine blue in radionuclide imaging of enlarged parathyroid glands. Parathyroid scintigraphy with 131I-labelled toluidine blue was performed in 40 patients, 30 of whom were operated for suspected hyperparathyroidism. Hyperplastic glands or adenomas could be localized by scintigraphy in 18 of 27 patients who proved to have hyperparathyroidism. The correlation between scintigraphy and operative finding was always correct when the parathyroids weighed more than 2 g. Scintigraphy was correctly negative in one, falsely negative in 6, and falsely positive in 5 of the operated patients. In a group of 10 unoperated patients, scintigraphy was positive in one of the 3 patients with suspected hyperparathyroidism, but negative in the others. Although 131I-toluidine blue is not ideal as a scintigraphic agent for the parathyroids, we are of the opinion that it represents an improvement compared with 75Se-selenomethionine.


Spigelian hernia.

Spigelian hernia. Six consecutive patients with Spigelian hernia treated operatively over a period of ten years are reported. There were no complications, no deaths, and no recurrence in this series. Recognition of this rather rare lesion may be difficult, but it is important because of its quite high predisposition to incarceration and strangulation. The main pathological and clinical features are discussed, and the literature briefly reviewed.