[On the vocational prognoses of patients with peroneal muscular atrophy (author's transl)]. Examined were 43 patients and 27 relatives all suffering from a hypertrophic type of peroneal muscular atrophy. Owing to foot deformities and a slowing of the nerve conduction velocity a diagnosis was already possible in their childhoods in the majority of cases. Although, after the 20th year of age, the pareses of the legs progress only slowly, considerable pareses of the small hand muscles can still develop in adults. With adequate counselling, rehabilitation measures should become necessary only in rare cases, or, if a kypho-scoliosis has already developed in childhood (10% of our cases).


[Trampoline therapy with brain-injured children and adolescents (author's transl)]. Trampoline therapy is a useful part of the medical rehabilitation treatment of brain-injured children and adolescents, if the basic principles of accident prevention are observed. The therapy should only consist of systematically organised exercise series and be carried out by adequately trained sport teachers, medical paedagogues or physical therapists. In the "Jugendwerk Gailingen" an improvement of the standing balance and movement co-ordination was achieved in more than 20 patients with hemiparesis and tetraparesis. Only little progress was achieved in atactic and athetoid patients. It is important to stress the positive psychological effects of the trampoline therapy.


[Brachial plexus injuries caused by motor-cycle accidents- catamneses (author's transl)]. During the last eight years we examined 45 patients, mostly juvenile, with brachial plexus injuries arising from motor-cycle and moped accidents. The neurological findings, radiological picture on the myelogramme, sanguineous fluid, different electrodiagnostic examinations and sweat secretion tests provided information on the location of the lesion and the defects to be expected at a later date. However, no method permitted determination of the total extent of the damage. In some cases we observed partial, oftern considerable improvement even in the second and third post-accidential years. Follow-up studies showed the significance of the personality structure as well as social conditions with respect to vocational rehabilitation, and the danger of early resignation. Consequently, rehabilitation efforts should start immediately after the healing of the initially incurred injuries.


[Catamnestic studies of the value of vocational prognoses for persons with infantile brain-damage (author's transl)]. The basis of this study is the examination of 100 people who suffered from severe neurological and psychic defect syndromes. Of this group 49 were re-examined eight years later- age-range then 20 to 34. The vocational prognoses which were given at the first examination were determined according to the degree of severity of the disability and proved to be correct in 39 cases. In five cases each, the level of productivity was assessed either too high or too low. Only eleven of the sample group had an income exceeding DM 500,-45 were living either with their families or in institutions, and of the remaining four, who rented rooms, two were married. The course of life of this category of people, who suffers from such a wide range of disabilities, can be facilitated if attention is paid to the vocational prognosis before the individual starts vocational training.


Contrasting mechanisms of adrenal catecholamine release by acetylcholine and high potassium. Continuous twenty minute exposure of isolated perfused bovine adrenal glands to high potassium concentrations produced shorter durations of catecholamine release than twenty minute continuous stimulation with acetylcholine. Catecholamine release during continuous exposure to potassium decreased linearly on a semilog plot, whereas acetylcholine caused a biphasic release of catecholamine. Glands previously treated with high potassium responded poorly to acetylcholine; however, glands previously treated with acetylcholine showed a maximum response to high potassium concentrations. Full recovery of the response to acetylcholine after high potassium treatment occurred in twenty minutes. High potassium concentrations appear to evoke secretion of "readily releasable" material only, whereas acetylcholine has access to a larger catecholamine store in the adrenal.


In vivo dopamine release and prostaglandin E2. Cerebroventricular perfusion of cats pretreated with H3-dopamine was used to monitor the neuronal release of dopamine. Infusion of prostaglandin E2 (PGE2, 10-6M) has no effect upon this release. Electrical stimulation in the region of the ascending dopamine containing fibers in the lateral hypothalamus results in a marked increase in H3-dopamine release. Infusion of PGE2 during electrical stimulation does not alter this release either in the presence of normal (1.16 mM) or elevated (7.5 mM) Ca++. Under the conditions of these experiments, PGE2 does not modulate dopamine release to any measureable degree.


Comparison of the effects of R-(-)-2-amino-1-(2,5-dimethoxy-4-methylphenyl) propane (DOM), r-(-)-2-amino-1-(2,5-dimethoxy-4-methylphenyl) butane (BL-3912A) and 5-hydroxytryptamine on non-innervated vascular smooth muscle. Isolated strips of sheep umbilical arteries contracted in the presence of R-(-)-2-amino-1-(2,5-dimethoxy-4-methylphenyl) butane (BL3912A). These contractions faded over an hour period and at this time BL3912A antagonized contractions to R-(-)-DOM, 5-hydroxytryptamine (5-HT) but not to angiotensin. The initial contraction produced by BL3912A was antagonized by cinanserin, a 5-HT antagonist. These experiments indicate that BL3912A can be classified as a partial agonist of 5-HT receptors in sheep umbilical arteries.


Prostaglandin biosynthesis and metabolism in rat brain slices. Prostaglandin F2alpha and E were measured in the slices and in the media after incubation of rat brain slices. About 5 to 10 times more prostaglandin F2alpha than prostaglandin E was found, most of which was secreted into the media. In the absence of oxygen or in the presence of indomethacin, prostaglandin levels in both the slices and media were reduced. Serotonin, norepinephrine, epinephrine, and DOPA, at 10(-3) M concentrations, increased the prostaglandin F2alpha/E ratio in both the media and slices. The levels of prostaglandins F2alpha found in the slices and media when the slices were incubated with prostaglandin E2 increased significantly, this increase being independent of the presence of indomethacin. This suggests that prostaglandin E2 was being converted to F2alpha by a prostaglandin E2 9-ketoreductase in the rat brain slices.


Prevention by calcium administration of reserpine action on rat brain noradrenaline stores: a reappraisal. The conditions under which pretreatment with a calcium salt may prevent the action of reserpine on brain noradrenaline stores in the rat were investigated. The results show that only after subcutaneous administration of reserpine in the same site as a previous CaCl2 injection, was the action of reserpine prevented and reduced levels of this drug were found in the brain. Conversely, the depletion of encephalic noradrenaline following reserpine, as well as the reserpine brain concentration, were not affected by subcutaneously administered calcium chloride, when reserpine was administered either intravenously, or subcutaneously in a site different from that selected for pretreatment with the calcium salt. In essence calcium chloride, a well known irritant, acts accordingly at the site of subcutaneous administration, thus limiting by a non specific mechanism the absorption of reserpine. Under similar conditions, in fact, the absorption of a different drug, i.e. harmaline, was likewise altered. In view of these findings the significance of some studies on calcium-reserpine interaction appearing in the literature requires a reappraisal.


The effect of CC14 on uterine ornithine decarboxylase (ODC) in the rat. Inhibition by CC14 of the induction of ODC by E2 and o,p'DDT. The oral administration of carbon tetrachloride (CC14) to ovariectomized rats markedly inhibited the elevation of uterine decarboxylase (ODC) by estradiol-17beta (E2) and by 1-(o-chlorophenyl)-1-(p-chlorophenyl)-2,2,2-trichloroethane (o,p'DDT). The inhibition of ODC induction by CC14 does not appear to be mediated by the formation of an inhibitor of ODC activity. CC14 treatment caused no observable alteration in the uterine cytosolic E2 receptor. Namely, there was no alteration by CC14 in the number of E2 binding sites, in the affinity of the receptor for E2 or in the sedimentation constant of the 8S receptor. Furthermore, the possibility that CC14 inhibition of ODC induction is a resultant of an initial stimulation of this uterine enzyme by CC14 was excluded. The potential inhibitory effect of CC14 by direct of indirect route on uterine protein synthesis is discussed.


Preparation of guinea pig hepatic microsomes: a comparison of three techniques. Hepatic microsomal preparations by Ca2+-aggregation and gel filtration on Sepharose 2B were compared with the product obtained by differential centrifugation, using liver from adult male guinea pigs. The conventionally-prepared microsomes were translucent and rose-red in color. Those prepared by Ca2+-aggregation were a cream or light pink color whereas the gel-filtered microsomes were opalescent and white. The specific activities of microsomal p-nitroanisole O-demethylase, aniline hydroxylase and nonspecific carboxylase were highest in the Ca2+-aggregated microsomes, intermediate in the gel-filtered preparation and lowest in the conventional microsomes. Electron microscopy revealed vesicular preparations of similar appearance though the Ca2+-aggregated microsomes were larger and contained more aggregates of free ribosomes.


Effect of various estrogen treatment schedules on antithrombin III levels. Antithrombin III levels were determined in 18 normal indiviuals of both sexes, 24 pregnant women (at term), 20 patients treated with oral contraceptives and 21 postmenopausal patients treated with Premarin. There was no sex difference in antithrombin III levels in the untreated control group. Pregnant women at term had the lowest levels of antithrombin III. The second lowest values were exhibited by women on oral contraceptives. Both of these groups differed significantly (p less than 0.05) from the controls. Premarin treated postmenopausal women had somewhat lower levels of antithrombin III than controls but these were statistically not significant.


Effect of phospholipase C on lymphocyte responses to mitogen. Peripheral lymphocytes treated with phospholipase C (phosphatidylcholine cholin phosphohydrolase E [3.1.4.3]) were examined for their response to mitogen and rosette formations. High levels of phospholipase C (greater than 0.01 unit) showed significant toxic effects on the peripheral lymphocytes as examined by the trypan blue exclusion test. This was attributable to "impurities" in the Cl. perfringens phospholipase C preparation since recovery of the mitogen responses were incomplete after heat inactivation of the enzyme. Active phospholipase C at 0.005 unit significantly (50%) suppressed the PHA response with little or no effect on the PWM stimulation. Similarly, a significant suppression of E rosette formation occurred with phospholipase C (0.005 u) treated lymphocytes. Suppression of similarly treated lymphocytes to EAC rosette was slight. It is suggested that the removal of phosphorylated amines from membrane surfaces affects T-cells more than B-cells and that the use of phospholipase C is a useful means of examining membrane functions of the lymphoid system.


Adenine nucleotides in thiamine deficient rat brain. The net levels and turnover of ATP, ADP, and AMP were measured in the cortex and brainstem of thiamine deficient and control rats. In spite of a 63% decrease in pyruvate decarboxylase activity in the brainstem of severely deficient rats, metabolism of the adenine nucleotides was unaffected. These data indicate a major reserve capacity for pyruvate decarboxylase and show that the adenylate pool is not significantly altered in thiamine deficient rat brain.


The glycogen-depleting effect of non-epinephrine on the myocardium of the six and one-half day chick embryo. The myocardial glycogen of the six and one-half day chick embryo is lowered significantly by the in-ovo presentation of nor-epinephrine (1.0 to 20.0 micrograms/egg). This glycogen-depleting effect was neither dosage- nor time-dependent.


Effect of cycloserine stereoisomers and theophylline on the release of tritium from 2-tritio-L-alanine. The aearance of tritium in plasma water was measured after i.p. injection of 2-tritio-L-alanine as an index of alanine transamination in rats. L-Cycloserine (10 mg/kg) and D-cycloserine (150 mg/kg) inhibited tritium release, whereas theophylline (100 mg/kg) stimulated tritium release.


Structure-activity relationships of enkephalins in the stimulated guinea pig ileum. A number of analogs and homologs of methionine-enkephalin (H.Tyr. Gly.Gly.Phe.Met.OH) have been synthesized by the Merrifield method of solid phase peptide synthesis. Each peptide was assayed by inhibition of electrically evoked contraction of the guinea pig ileum. The minimum sequence required for biological activity in this preparation was found to be the pentapeptide unit. Methionine was readily replaced by norleucine to give an analog with approximately 50% of the potency of the parent compound. Leucineenkephalin has about 15-20% of the potency of the methionine dervative. Modification of the N-terminal tyrosine moiety (i.e. substitution by phenylalanine or removal of the amino group) practically abolished activity. Incorporation of O-methyl tyrosine into the peptide reduced potency to 1% of the parent compound. The significance of these and other findings in terms of the topography of the guinea pig ileum receptor site is discussed.


Simultaneous measurement of plasma levels of d-Propoxyphene and l-Propoxyphene using stable isotope labels and mass fragmentography. When racemic propoxyphene was administered orally to dogs, plasma levels of d-propoxyphene were higher than those of l-propoxyphene. The half-life of d-propoxyphene was also longer than that of the l-isomer. Measurements were performed by labeling one isomer of a racemic mixture with deuterium and then measuring d- vs. l- ratios by mass fragmentography. An intravenous experiment was also performed and confirmed the preferential uptake of the levo isomer. To do these experiments successfully propoxyphene isomers were labeled on the benzyl methylene with deuterium atoms. In vivo studies demonstrated that this labeling position was sufficiently far removed from the point of metabolic attack in the molecule so that no interfering isotope effect existed. The methodology outlined in this paper will be of great value in the study of the disposition of the individual isomers of racemic drugs.


Potentiation of isoproterenol effect by ascorbic acid. Intraduodenal administration of isoproterenol together with ascorbic acid caused a much greater increase in the heart rate and pulse pressure, and a greater decrease in the mean blood pressure of anesthetized dogs than was observed after intraduodenal administration of isoproterenol alone. No potentiating effect was observed when isoproterenol and the vitamin were injected intravenously.


Effects of cannabinoids on the perfused rat heart. In the isolated perfused rat heart cardiac rate and contractility are directly affected by four naturally occurring cannabis constituents, delta9-tetrahydrocannabinol, delta8-tetrahydrocannabinol, cannabinol and cannabidiol. All the drugs depressed myocardial contractility. Their effect on rate, however, was not uniform: delta8-Tetrahydrocannabinol produced cardiac arrhythmias but no other consistent change; both delta9-tetrahydrocannabinol and cannabinol caused tachycardia; but cannabidiol produced bradycardia, arrhythmias and asystole. In addition, as a consequent of the dispostion of the cannabinoids to accumulate in the isolated heart, high tissue concentrations appeared in conjunction with the direct cardiac effects.


Environmental interaction of lead and cadmium on reproduction and metabolism of male rats. To study the environmental interaction of lead and cadmium on reproduction and metabolism 70 male sprague Dawley rats were divided equally into 7 goups. Goups 1 and 2 served as controls, 3 and 4 were injected daily with 50 and 250 ug of lead respectively, 5 and 6 with 50 and 250 ug of cadmium respectively and group 7 with 25 ug of both lead and cadmium. After 70 days of injections rats were sacrificed. In group 6 cadmium injection caused enlargement of adrenal, liver, kidney and spleen but retarded growth, reduction in size of prostate, testes, epididymis and hepatic enzyme activity. Groups 4 and6 had the highest and most significant mineral concentration in blood and liver. Testes histology of group 7 showed an absence of spermatogenesis in some seminiferous tubules indicating that low levels of lead and cadmium together have a more synergetic damaging effect on rat testes than higher levels of lead or cadmium alone. This study suggests that blood mineral levels should be used with other more sensitive clinical tests to assess the toxicity picture in humans.


Bioenergetics in clinical medicine. IX. Gingival and leucocytic deficiencies of coenzyme Q10 in patients with periodontal disease. The specific activities of the succinate dehydrogenase-coenzyme Q10 reductase in mitochondria were determined for patients from a normal periodontal practice. The criteria for selection were patients having a bone score of 1.0-4.0 and a pocket depth of 2.5-5.2 mm. All 29 patients showed a deficiency of 20-63% of CoQ10-enzyme activity in gingival biopsies. The mean value was elevated (P less than 0.001) over that of controls. For corresponding blood samples, 24/28 (86%) showed deficiencies of 20-66% and a higher (P less than 0.001) mean value than that of controls. Periodontal patients frequently have significant gingival and leucocytic deficiencies of CoQ10. The leucocytic deficiency indicates a systemic nutritional imbalance and is not likely caused by neglected oral hygiene. A gingival deficiency could predispose this tissue to periodontitis and this disease could even augment the deficiency. These results support previously suggested adjunctive use of CoQ10 with oral hygiene for improved treatment presumably through bioenergetics.


Intersubject variation of warfarin binding to protein in serum of normal subjects. The protein binding of warfarin was determined in the serum of 18 normal adult subjects (8 males and 10 females). A statistically significant negative correlation between free fraction of warfarin and albumin concentration was found. The free fraction of warfarin in the serum of women was significantly larger than that in the serum of men, apparently due to the lower albumin concentration in the serum of women.


Effect of phenylbutazone on the metabolic disposition of warfarin in the dog. Phenylbutazone has been shown to modify the physiologic disposition of warfarin in the dog. Dogs pretreated with phenylbutazone for a week, and permitted to remain drug-free for an additional week, eliminated warfarin from plasma 2-3 times faster than non-pretreated controls with an average half-life of 7.8 hours. In-vitro hepatic microsomal metabolism of warfarin and cytochrome P-450 content were greater for hepatic microsomes derived from phenylbutazone pretreated animals.


Effect of growth hormone on weight and mitochondrial protein content of rat heart. In male rats hypophysectomy reduced the wet weight of hearts per 100 g body weight. The yield of mitochondrial protein per g heart was also decreased which is in contrast to that in liver. Adiminstration of bGH to hypophysectomized rats reversed these changes towards normal. It appears that some of the effects of growth hormone may vary in different tissues.


Influence of diaphragmatic contraction and expiratory flow on the pattern of lung emptying. Transdiaphragmatic pressure (Pdi) and expiratory flow (V) were monitored during vital capacity single breath N2 washouts in 7 seated subjects. Transient increases in V were produced (1) actively, by subjects increasing mouth pressure while expiring through a constant resistance of (2) passively, by the operator transiently decreasing the resistance. Voluntary contraction of the diaphragm (increased Pdi) was achieved when abdominal muscles were tensed while maintaining V constant. In 5 subjects a transient increase in Pdi of 25-150 cm H2O consistently produced a transient increase in expired N2 concentration of 1.80 +/- 0.06% (Mean +/- 1 SE); in 1 subject N2 concentration decreased by 0.8% to 2.7% N2, and in one subject the alveolar plateau was uninfluenced by changes in Pdi. Passive increases in V up to 21/sec had no effect on FEN2 in any of the subjects. Active increase in V changed FEN2 only when associated with increases in Pdi. Qualitatively similar results were obtained during helium (He) bolus washouts. However, whereas diaphragmatic contraction, maintained throughout expiration, had no measurable influence on the N2 washout, it changed the slope of the He alveolar plateau in 6 out of 7 subjects. We conclude that in normal subjects the alveolar N2 plateau is relatively insensitive to flow variations up to 21/sec. The fluctuations in FEN2 observed when the expiratory flow is varied are due to concomittant changes in Pdi. We propose that diaphragmatic contraction changes the pattern of lung emptying by altering the vertical gradient of pleural pressure.


Pulmonary arteriovenous anastomoses in the avian lung: do they exist? A search for pulmonary arteriovenous anastomoses was made in 15 adult domestic fowls using Lycopodium spores and microspheres. The diameter of the spores and microspheres ranged from about 10 to 33 mum. To dilate any pulmonary arteriovenous anastomoses, the birds were warmed to induce panting, killed with chloroform, or injected intravenously with papavarine. The spores or microspheres were injected either into the jugular vein under anaesthesia, or into the pulmonary artery after death. After the pulmonary arterial injections, the effluent from the pulmonary vein, and histological sections of the lungs, were examined for spores or microspheres. When injections were made into the jugular vein, blood smears from the pulmonary veins, left atrium, and the aorta, as well as histological sections of the lungs and other organs were inspected. The results of all these experiments showed that no spores or microspheres were ever found on the venous side of the pulmonary circulation, indicating absence of pulmonary arteriovenous anastomoses.


Pattern of breathing during hypoxia or hypercapnia of the awake or anesthetized cat. The breathing patterns during hypoxia and hypercapnia are similar in anesthetized cats but are qualitatively different in awake cats. The differences seen in the awake animals can be explained by either the central depressive effect of hypoxia or by a specific effect of hypercapnia on supra-pontine structures. The Breuer-Hering reflex sensitivity, i.e. the VT-TI relationship, appears, in the awake cat, quite similar to that recently described in man. The inspiratory activity is shown to be controlled by mechanisms dependent on the nature of the respiratory stimulation. The recent model proposed for the control of inspiration during anesthesia must be modified to account for the results observed in awake animal.


The interaction of the lung and chest wall in dogs. The deformation of the lung by the chest wall was observed on radiographs of the ribs and interspaces and on morphologic preparations of samples cut from the frozen thorax. The effect of these deformities on the distribution of ventilation and regional lung volume of the underlying lung was determined using Xenon 133. We found that ribs and interspaces deform the lung surface with different radii of curvature, suggesting local differences in pleural pressure and that traction on the thoracic limb caused deformities in the underlying interspaces which were similar to those produced by 20 cm H2O mouth pressure. Xenon 133 showed that these changes in pressure had no effect on the regional volume or on ventilation distribution in the underlying lung. We conclude that changes in pleural pressure produced by localized deformities exert their effect close to the deformity and that the underlying lung responds to the average pressure exerted over a much larger area of the pleural surface.


Lung tissue plasticity: morphometric analysis of anisotropic strain in liquid filled lungs. Lungs of rats were fixed at different inflation pressures (Ptp) during liquid filling with the pulmonary vessels tied to prevent vascular volume change after fixation had begun. Morphometric analysis showed that alveolar surface varied as a alveolar volume (Va) to the power 0.82, while the arithmetic mean tissue thickness varied as Va-0.2. This is interpreted as evidence for anisotropic expansion. Capillary volume (Vc) was found to increase from zero Ptp to a maximum at Ptp = 2 cm H2O then decrease as Va increased. Morphometric diffusion capacity of the membrane component increased as Va0.59 while that for whole lung (DL)paralleled the change in Vc. Alveolar capillary tissue unfolding is described as the main factor accounting for anistropic expansion of alveolar surface and for capillary configuration. The absolute values of Vc and DL were lower by 60% and 50%, respectively, compared with values obtained by standard instillation fixation methods and this is suggested could account for previous discrepancres between morphometric and physiologic estimates of DL.


Effect of antigen challenge on sensitized guinea pig trachea. Isolated tracheal preparations (ITP) were obtained from control guinea pigs and animals with acute and chronic experimental asthma (AA and CHA). It was observed that after in vitro antigen challenge, in addition to the classic Schultz-Dale response (the immediate increase in the tone of sensitized airway smooth muscle), a significant increase of the active state of airway smooth muscle was seen. This active state was observed as the potentiated, phasic, mechanical activities of ITP and was evaluated by both maximum active tension (AT max) and maximum rate of tension development (dT/dt). No apparent functional differences in the tonic response or the active state of airway smooth muscle between AA and CHA animals were found. Tracheas isolated from animals with CHA demonstrated smooth muscle hypertrophy as measured by wet, dry and relative weights of the tracheas. The repeated administration of antigen into the experimental bath was ineffective in inducing any physiological changes. The administration of histamine to ITP from control animals induced changes of mechanical activities of trachea comparable to those seen in both AA and CHA animals.


The effect of lung reflexes on the pattern of breathing in cats. Tidal volume (VT), and inspiratory (tI) AND EXPIRATORY (TE) durations have been measured in anaesthetized cats on stimulation of alveolar type J (nociceptive) and lung irritant receptors by intravenous injections of phenyl diguanide and of histamine acid phosphate respectively. The reflexes were studied during eupnoea, hypercapnic and hypoxic hyperpnoea, during rebreathing from hyperventilation apnoea and at different body temperatures. In all conditions the drugs caused rapid shallow breathing with reduction in VT, tI and tE. The VT/tI relationship for injection of the drugs was different from that caused by hypercapnic stimulation of breathing, but the tI/tE relationship was proportionally similar for all conditions. Recording single unit activity from phrenic motor fibres showed that the lung reflexes had little action on the initial frequency of discharge of the fibres, but cut short the discharge earlier than for the controls. The results are interpreted in terms of the ways in which lung reflexes can modify the pattern of breathing.


Functional significance of thoracic vagal branches in the chicken. One minute electrical stimulation was used to excite the right and left cervical vagi as well as specific points on, or branches of, the left thoracic vagus. Respiratory, heart rate and blood pressure responses were observed with the nerves intact and cut. Stimulation of either intact cervical vagus produced apnea, bradycardia and blood pressure depression. Stimulation of the cut ends after nerve section demonstrated that the heart rate and blood pressure effects were efferent and the respiratory change was afferent. No responses were observed due to stimulation of the vagus caudal to the lungs. Stimulation of cardiac branches reduced heart rate and blood pressure but did not produce significant respiratory effects. Middle and anterior pulmonary branches were found to contribute only to respiratory changes through afferent nerves. Sudden, sustained reduction of CO2 in the airways produced immediate, sustained apnea. The data suggest that CO2 sensitive thoracic receptors important in regulation of respiration are confined primarily to the lungs and that these receptors play no direct role in cardiovascular function.


[Arteries of the human thalamus. I. Artery and polar thalamic territory of the posterior communicating artery]. The posterior communicating artery participates to the thalamic vascularization in 60 to 70 p. 100 of the brains. It does by one unic, well characterized artery, the polar artery. Its territory comprises the rostral pole of the lateral region up to the mamillo thalamic fasciculus.


[Arteries of the human thalamus. II. Arteries and paramedian thalamic territory of the communicating basilar artery]. The basilar communicating artery (or mesencephalic artery) gives off more often one than two paramedian thalamic arteries. The paramedian territory, infero-medial, has a variable extent. It can include the polar territory when the polar artery does not exist. The paramedian artery arises as often from the controlateral basilar communicating artery than from the ipsilateral one. One basilar communicating artery may so have a very extensive bilateral territory.


[Study of 5 cases of ocular myopathy].

[Study of 5 cases of ocular myopathy]. The authors reported five cases of eyelid ptosis with progesssive external ophthalmoplegia. They emphasize infra-clinic diffusion, fatigability and variability impairment of extra-ocular muscles; coexistence of myogenic E.M.G. and single potential recurring at high frequency in the same patient; mitochondrial abnormalities in type I fibers, intense oxydative activity in superior oblique muscle and normal motor end-plates.


[Elementary logic and semantic fields in aphasia]. Modern linguistics, like genetic psychology, postulate a non-linguistic basis for the structurisation of the semantic fields. If such is the case, it should be possible to observe in aphasia, where semantic deficiency predominates, a related disturbance in the semantic fields and logic. Paraxodically, such disturbances have been observed both in Broca's aphasia and in the predominantly semantic aphasia of Wernicke. A qualitative analysis shows that quantitatively identical results in the semantic aphasias of Broca and Wernicke are the result of phenomenological convergence. The related disturbance in the semantic fields and logic appears characteristic of the semantic deficiency which, in aphasic semiology, is marked by the substitution of one word for another. These finding support the theory of the relative autonomy of phonemic and semantic disorders in Wernicke's aphasia. They confirm the linguistic and genetic theory that the structure of vocabulatory is based on extralinguistic factors. They do not however provide an explantation for semantic disorders in aphasia. Further research is required to discover on what functional system articulation of the symbolic function and general operative capacity is based.


Cancer of the large intestine in man: progress and problems. This article reviews the high incidence of colon cancer in Western countries; the contribution of cell biology and biochemistry to our knowledge of the behaviour of the disease is discussed. The use of a series of markers to obtain early evidence of metastasis and to make the prognosis is described. Some suggestions are made how to obtain improvements in the survival percentages.


[Allergic reaction to patent blue at lymphography (author's transl)]. The authors report three cases of severe and three cases of mild allergic reactions due to Patent Blue being used for the visualization of the lymphatic vessels at lymphography. The therapy and the possibilities of the prevention of this complication are discussed particularly.


Hodgkin's-like disease of the thymus. Clinical, surgical and morphological correlations. The histogenesis and relationship of so-called "granulomatous thymoma" to Hodgkin's disease is still a matter of controversy. Three of these lesions were selected from 43 thymomas and their clinico-pathological patterns are described. Two cases were diagnosed as Hodgkin's disease of the mediastinum because of the absence of epithelial structures of thymic origin. In one case, together with the morphological aspects of Hodgkin's disease, we noticed epithelial structures indicating a primary neoplastic lesion in the thymus. Accordingly we conclude that the term "Hodgkin's disease of the thymus" must be limited only to those lesions of the mediastinum in which structures of thymic origin are present. Other mediastinal Hodgkin's lesions, even in the presence of clinical, radiological and surgical evidence of thymic origin but in which it is not possible to observe such thymic structures, must be classified as Hodgkin's disease localized to the anterior mediastinum.


Viper venoms and coumarin-induced prothrombin. A comparison of several one-stage methods employing three different venoms as thromboplastins. Three venoms obtained from three vipers, namely Echis carinatus, Notechis scutatus scutatus and Oxyuranus scutellatus, have been used as thromboplastin in a one-stage assay of coumarin-induced prothrombin. Regardless of the venom used, prothrombin resulted to be low in coumarin-treated patients. The mean values obtained were 27.2, 33.6, and 24.2%, respectively. These values were comparable to those obtained by means of the classical one-stage method (24.8%). A good correlation was observed among the different methods. However, the levels observed using the Notechis scutatus scutatus venom method were slightly higher as compared to those obtained by means of the other viper venoms and by means of the classical one-stage method. The three viper venoms used seem unable to activate coumarin-induced prothrombin. The levels obtained were in fact, in each instance, definitely lower than those observed immunologically. Methods which employ these viper venoms may be used in the evaluation of prothrombin in coumarin-treated patients.


[Epidemiologic and etiologic factors in cancer of the breast. Catamnestic investigations on 749 patients of the Department of Radiology at Essen (author's transl)]. Morbidity- and morality statistics of cancer of the breast show a clear increase in almost all countries. The numbers of patients who died increased particularly in countries situated around the north-sea. It appears that unmarried women run a greater risk, as reported by many authors. On further risks we could not confirm that those women with few children predominated. Our results correspond to numbers calculated for abortions. More children increase the danger of breast cancer. These evaluations cannot be separated from the impact of shortened breast-feeding and sociologic factors which also influence the risk in an ill-defined manner. Breast-cancer is doubly to five times as common in female relatives of patients as shown in Anglo-american and our own materials. Age distribution among 742 patients shows, rather like that of some Scandinavian authors, peaks between 45 and 49 and between 56 and 63 years. This again raises the question of a post-menopausal stimulus. In our material there is an average delary of 4 1/2 months between first symptoms and start of treatment. The causes arise both from patients and doctors and, age apart, are responsible for the undue delay. Delay, invasion of lymph nodes and size of tumor establish a correlation between delay and stage of tumor. As to the site of the tomor the left breast was more often involved than the right in our patients. The upper lateral quadrant predominated. To extend the period of survival we shall have to reduce delay and develop further special techniques of treatment.


[The place of xerography combined with routine conventional mammography (author's transl)]. Xeroradiography is a valuable supplement to conventional mammography, especially in cases with dense glandular structure. In our patient material this new procedure was necessary for clarification of findings on conventional mammography in 16% of cases and improved diagnostic yield. Indirect and direct signs of carcinoma were more easely recognized with xeroradiography, since more detail is visualized because of greater latitude and edge contrast enhancement. Moreover the area visualized is considerably greater. The soft tissue structures can be seen to the level of the thoracic wall. Viewing the films is less tiring than reviewing conventional mammography films. A relatively greater exposure latitude and short exposure times are further advantages of this method.


[Mammographic observations on the growth of untreated cancer of the breast (author's transl)]. Report on 21 primary breast cancers in 19 untreated women. The longest follow-up was 1074 days, the shortest 24 days. Doubling time of the tumors was calculated with Collins formula. The necessary assessment of the volume of tumors was calculated with a simple method. Doubling time differs greatly and, in parts, greatly exceeds published data. The radiologic development is surveyed. Collins formula is discussed in its strict interpretation starting from the volume of one tumor cell. Our own results lead to conclusions on the radiologic diagnosis of breast cancer. Usually diagnosis is immediately followed by therapy. Observations on the spontaneous course of, expecially primary, cancer of the breast are therefore scanty. Larger numbers of repeated mammography of the same tumor do not exist. Clinical examinations of growth belong to earlier times, the patients even to past centuries (Bloom 1964). Systematic investigations of this type cannot be defended on ethical grounds. In order to acquire insight into spontaneous growth of this cancer one has to rely on the few cases in whom operation wa5 not done for various reasons Here repeat mammography was possible. Such cases are important in practice since repeat mammography may have to be recommended by the radiologist, our own material will be discussed.


[Cut-density in angiotomography (author's transl)]. Tests show that the usual definition of cut-density is not applicable to angiotomography. New appropriate data for definition should take account of the relation between vessel and direction of cut and between timing of cut and contrast. These data cannot be obtained by examination in vivo. The concept of cut-density should be abandoned for inear angiotomography and replaced by that of layer of definition.


[Posterior fossa angiomata with slow evolution: clinical aspects (author's transl)]. The AA. report 9 cases of arteriovenous angiomata in the posterior cranial fossa with chronic evolution: in 8 of these the diagnosis was made before a subarachnoid haemorrhagic episode precipitated the symptomatology. Angiomata in the posterior cranial fossa are detected less often than sopratentorial angiomata, and the possible reasons of this are considered. During the last 11 years in the Neurosurgical Institute of the University of Padua the incidence was 23%, one of the highest reported in literature. The clinical diagnostic criteria of angioma in the posterior cranial fossa with chronic evolution are also discussed. The importance of a fluctuating development of the symptomatology is emphasised with an almost constant association of signs of pyramidal and cerebellar involvement, as well as the differential diagnostic problems with multiple sclerosis. In six of the cases the malformation was so extensive to make it impossible to determine afferences and drainages, so that a surgical operation could not be carried out. This finding seemed rather peculiar, owing to the relatively poor simptomatology, mainly if compared with smaller supratentorial malformations. It appears from the literature that angiomata in the posterior cranial fossa including those found at autopsy are as common as the supratentorial ones; this would suggest that many of these lesions are not diagnosed in life.


[Simple tests to control a tomographic device (author's transl)]. Simple tests to prove the resolution sharpness and blurring of a tomographic system are described.


[A case of extreme gouty arthritis, shown xeroradiographically (author's transl)]. A case of extreme, obviously lead-induced gouty arthritis is described testing xerography for typical gouty changes. Xerography is less effective in showing differences of density than film-techniques. But highly structures shapes or their sudden abolition will be particularly clear owing to the effect of contour reinforcement. Defects of bone induced by tophi and new formations can be identified with certainly.


[Problems in the diagnosis of pheochromocytoma (author's transl)]. Reference is made to various possibilities of examination in diagnosis and localisation of pheochromocytoma demonstrated by several cases. The best radiological examination is angiography using Seldinger method, which by means of skilled technique, good contrast media and an optimal treatment with receptor-blocking medicaments will guarantee excellent x-rays for clear tumor localisation without real complications.


[Angiographic diagnosis of a carcinoma of the renal pelvis due to thorotrast (author's transl)]. Angiographic and histologic findings of a carcinoma of the renal pelvis of low vascularity. Angiography succeeds in demonstrating the tumor, the site of its origin and spatial relationship to the escape of contrast-medium.


[A new contrast-medium (author's transl)]. Infusion urograms were carried out on 2 groups of 100 in-patients each. The first group had injections of Conray FL 36, the second of Conray FL. Contrast in the early phase after 7 minutes was better with Conray FL 36 than with Conray FL. At later stages there was no clear difference.


[Lymphography in testicular tumors (author's transl)]. Results of lymphography in 101 cases of testicular tumor are described. Secondaries could be shown in 43% of seminomas and 46% of teratomas. Examples show the criteria of lymphographic diagnosis of secondaries. Lymphography permits a) more exact classification of stages b) better planning and control of treatment and c) prognosis.


[Protection of gonads in radiography of the pelvis (author's transl)]. The effectiveness of a new device for the protection of gonads has been tested by measuring doses on the water-phantom and on patients. The lead protector is applied below the light-soorce and protects the gonads in pelvic radiography. The reduction of dosage corresponds to the usual lead-protectors. It should be particularly useful in Orthopedics, since it is simple and hygienic.


[Xerographic diagnosis of lesions of the cruciate ligaments of the knee-joint (author's transl)]. First experience with xerography of the cruciate ligaments and their lesions in compared with the usual radiographic techniques. Both cruciate ligaments can be shown more often and with sharper contours by using double contrast-arthrography in xeroradiograms. The specific pictorial characteristics of xeroradiography are discussed.


[Pyloric stenosis - a complication of cholelithiasis. (Case of gallstone perforation into the duodenal bulb)]. Pressure-necrosis followed by stone perforation is ralatively rare among the complications of cholelithiasis. There is always a danger of a stenosis in the gastro-intestinal tract. Report of a case of perforation of a gallstone into the duodenal bulb producing few signs but the clinical picture of pyloric stenosis. Symptoms, signs and differential diagnosis are discussed on the basis of the literature.


[Concentration of contrast medium in xerophlebography (author's transl)]. We examine with phlebography usually a damaged vascular system. Radio-contrastmedia damage vascular endothelium. If we dilute them we may minimize the damaging effect. But when using the usual film-foliae combination, diagnostic results diminish the more we dilute. Results of 31 comparative investigations with film and xerphlebography show that dilution of contrast medium to 50 or even 25% will still produce phlebograms sufficient for evaluation with xerophlebography. It also has the advantage of a large picture: soft parts, veins and bony structures are visible of the same time. At present the method (chance of screening, gaps) renders routine use not advisable.


[Phlebography of the lower limb (author's transl)]. Description of the techniques of ascending phlebography and retrograde pressure phlebography of the leg and of means of showing insufficient perforating veins with selective percutaneous or intra-operative injection of contrast-media. Misinterpretation of the deep veins owing to muscular contraction for insufficiently continuous filling is explained. Phlebographic diagnosis of recent phlebothromboses, taking into accout isotope diagnosis, is particularly important for the recognition of post-traumatic so-called masked thromboses. The effectiveness of phlebography for the clarification of neurosegmental angiomatoses is discussed.


[Isotope phlebography (author's transl)]. Various techniques for showing venous function are recognized. The value of isotope phlebography is shown here on 39 unselected cases in whom contrast filling was also carried out. Rapid injection of 2 m Ci TC 99m into a dorsal vein of the foot produced isotope phlebograms with a Dyna camera 2 C.


[Radioiodine-fibrinogen test in the early diagnosis of venous thrombosis in the leg (author's transl)]. As long as there is no satisfactory prophylaxis for thrombosis, the radioiodine-fibrinogen test is a good supplement for the supervision of patients with a "high thrombosis risk" since the clinical symptomatology is not specific enough and phlebography cannot be used to extensively. The risk of hepatitis can be reduced when the selection of spenders is large enough. As a radionuclide, 125iodine does not appear to be any less effective than 131iodine. The postoperative injection is preferred to the preoperative injection.


[Technique and value of discography for the cervical syndrome (author's transl)]. Discography produces relatively many false pasitive findings. Their number, about 28% in our material, may be reduced decisively to below 10% when clinical, electro-physiologic and myelographic findings are considered together. It can be further reduced when results are judged in groups of varying value. Findings of high value are: 1) entry of the contrast fluid from the disc behind the posterior longitudinal ligament. 2) Exact reproduction of spontaneous pain during injection 3) The extension of a contrast band along the roots on the side and level of clinical findings. With such strict evaluation discographic findings are correct in 88%. In additon discography may be in certain cases the only method to elucidate a syndrome which clinically and in the myelogram permits various interpretations. Discography should always preceded operation. On the basis of 368 discographies with control of the diagnosis at operation its value is explained.


[Comparison between myelography and discography for lumbar prolapsed intervertebral discs (author's transl)]. For the diagnosis of lumbar P.I.D. discography is much superior to myelography. The risks of both techniques are the same, but the side-effects of discography are clearly less. Higher lesions remain a problem if they do not show up neurologically (s. the prolapsed disc at L 2/3). Here segmental blocking, posterior gaping of the intervertebral space and displacement of the dural sac show clearly the posterior prolapse. In the standard discogram of the lower 3 discs it would have been missed. In spite of this our present experience with lumbar discography is so positive, that we are about to test a long term series, whether and to which extend discography could replace myelography in cases where there is no hint at a space-occupying lesion, other than a disc or whether the order of these investigations should be reversed.


[Microlithiasis alveolaris pulmonum. (author's transl)]. A report was made of a long term observation of microlethiasis alveolaris pulmonum in a female patient who died at the age of 53. The rare, etiologically unclear disease is after a long course , always fatal due to right heart failure. This case was unique in that small spotty pulmonary lesions were found radiologically. They presented, a pathognomonic, unmistakable picture for a differential diagnosis of silicosis.


[Calcifications in mediastinal lymphoma after radiation therapy of Hodgkin's disease. (author's transl)]. One case of calcifications in mediastihal lymphoma after radiation therapy of Hodgkin's disease is reported. The incidence of these calcifications is remarkably low. They are mostly localized in the anterior mediastinum showing a characteristical pattern which is initially stippled, later confluent and coral-shaped. An open interval after radiation therapy is typical for this phenomenon. The cause of the calcifications is discussed.


[Diagnosis and differential diagnosis of the terminal esophagus. (author's transl)]. On hand of a few selected cases diagnostic and differential diagnostic problems of the cardia are discussed. Radiological and endoscopical values are presented.


[The cholecystogram as a prerequisite of the chemical litholysis from the view of the roentgenologist. (author's transl)]. The preoperative cholecystography and postoperative radiography of gallstones were compared in 68 patients. Calcified structures were detected in 32% of the stones which were free of calcium in the native roentgenograms. The possibility is stressed that the calciumocontent of cholecystographic transparent stones may be responsible for the failure of CDCA-therapy. 52 of the 68 patients additionally received a fat meal. A contraction of the gallbladder was not observed in 25% of these cases. From the missing contraction of the gallbladder should not be concluded that a CDCA-therapy is contraindicated. A functional analysis with a synthetic derivate of cholecystokinin is recommended.


[Suggestions for a routine methode. (author's transl)]. The advantages of the Shirakabe double-contrast method are well known. Nevertheless, the time involved to conduct the technique and the methods eliminate it from use as a standard examination technique. It is desirable to look for a practicable modification which can be used routinely in the medical practice. The above report deals with this problem.


[Patient identification (PnI) in oversized radiographs. (author's transl)]. In comparison with the "Skribor strips", the PnI system offers a high degree of certainty for the correct classification of patient data in regard to the X-ray and the documentation of the correct time. The existing difficiencies can be compensated for by further technical developments. The screen developed for this system requires a lower dose than the FZ secreen in order to obtain the same degree of detail.


A sensitive radioimmunoassay of parathyroid hormone in human serum using a specific extraction procedure. A radioimmunoassay of human parathroid hormone (PTH) is described. PTH was extracted from serum by adsorption to and elution from microfine silica, causing a 3.2-fold greater hormone concentration in extract than in serum. The extraction procedure eliminated from the assay unspecific interference caused by serum factors. The detection limit was 10 pg bovine PTH. The concentration of PTH was measurable in serum from 95% of normal subjects (mean, 68 pg/ml; SD., 18), was undetectable in sera from hypoparathyroid patients, and elevated in 96% of sera from patients with primary hyperparathyroidism. The presented data suggest that the assay mainly measures PTH(1-84).


Radioimmunoassay of human calcitonin in serum and tissue from healthy individuals and patients with medullary carcinoma of the thyroid gland. A specific radioimmunological method for measurement of immunoreactive calcitonin (iCT) in human serum and tissue is decribed. Of healthy individuals of both sexes, 85% had measurable iCT in serum (mean, 0.23 ng/ml). Of  29 patients who had received treatment for medullary carcinoma of the thyroid gland (MCT), 19 had increased serum iCT (0.60 ng/ml to 205 ng/ml). Elevated serum iCT was also found preoperatively in 2 MCT patients. Eleven of the patients with abnormal elevations of serum iCT were alive 4 to 13 years after the operation. Concentration of iCT in extracts from MCT varied from 0.5 to 540 ng/ml wet weight. The diagnostic value of this method and its importance for pre- and post-operative evaluation of these patients are improved by the use of selective venous catheterization in basal state and during stimulation of CT secretion.


Evaluation of radioimmunological methods for assay of plasma and urinary aldosterone. Two radioimmunological methods for assay of plasma and urinary aldosterone were carefully evaluated. In the plasma method a radioimmunoassay is preceded by chromatography on a Sephadex LH-20 column. The method for urine includes a preextraction, hydrolysis of the acid-labile conjugates of aldosterone, and a radioimmunoassay. Both methods fulfill the criteria of reliability and are suitable for both routine and demanding research assays. The plasma method, using columns of double length, is also applicable to analysis of aldosterone in plasma of newborn children, and pregnant females and in cord plasma. The concentration of plasma aldosterone in healthy subjects on an ad lib salt diet was 162 +/- 93 (S.D.) pmol/1 in the supine position and 312 +/- 217 (S.D.) pmol/1 upright. The urinary excretion of aldosterone in healthy subjects was 28.3 +/- 16.7 (S.D.) nmol/24 h.


Gluconeogenesis in human liver tissue. An in vitro method for evaluation of glyconeogenesis in man. Human liver tissue was obtained as surgical biopsies in 29 subjects operated on for uncomplicated gallstone disease. Liver slices were incubated in Krebs-Ringer bicarbonate buffer solution, pH 7.4, with 17 l-amino acids, lactate, glycerol, and glucose at various concentrations. The incorporation rate of alanine, lactate, and glycerol into glucose, glycogen, and CO2 was determined by use of 14C-labeled precursors. The gluconeogenetic rate of all substrates was increased 10-35 times by increasing precursor concentration in the medium. Insulin at a physiological concentration (300 mU/l) and dexamethasone  (0.001 mmol/l) had slight but significant effects on the incorporation rate of alanine into glucose and glycogen, respectively. Glucagon had no effect. Glucose in the incubation medium did not influence the incorporation rate of precursors into glucose, glycogen, or CO2, suggesting that glucose was not of importance for the regulation of the gluconeogenesis. The gluconeogenetic rate of a precursor was not dependent on or influenced by the presence of other precursors. The gluconeogenesis in human liver slices at physiological concentrations of precursors was 5-20% of the maximal rate reported for the rat liver. When the precursor concentration in the medium was increased, the gluconeogenetic rate increased to values close to those reported for the rat liver in vitro and for man in vivo. This in vitro preparation of human liver seems to be valid for evaluation of gluconeogenesis in man.


Gluconeogenesis in infancy and childhood. I. A method for the study of the in vivo gluconeogenesis from alanine and glycerol. The in vivo gluconeogenesis from alanine and glycerol in infants and children was studied by an isotope method, using 14C-labeled substates with subsequent separation of the radioactive compounds by thin-layer chromatography. Seven patients, aged 2 months to 2 years 11 months, with normal carbohydrate metabolism were studied. Trace amounts of [14C]alanine were injected intravenously in four fasting patients. The 14C moved quickly from alanine to lactate, with a peak activity in lactate obtained before 5 min. From 10 min on, the label disappeared rapidly from both. An equilibrium was established between alanine and lactate, displaced towards lactate. The peak activity in glucose was reached in 10-20 min, amounting to 10% of total injected activity. In one patient, who was also studied after a meal, the disappearance rate of alanine was reduced by 50%. Despite this reduction the appearance of label in lactate was increased, whereas the amount of label in glucose was much reduced. [14C]glycerol was injected intravenously in three fasting patients. In one patient, who received only a tracer dose of glycerol, 5 times more 14C appeared in glucose than in the patients studied with [14C]alanine. In two patients receiving a glycerol load together with the [14C]glycerol, the disappearance rate of glycerol was markedly reduced, as was the conversion of carbon to glucose and lactate.


Effect of increased venous pressure on the hydrostatic and colloid osmotic pressure in subcutaneous interstitial fluid in rats: edema-preventing mechanisms. The purpose of the present experiments was to study the effect of a rise in local venous pressure pressure (Pv) on interstitial fluid hydrostatic (Pi) and colloid osmotic pressure (COPi) in rats. The Pv of the hind limb was increased by ligating the iliac veins and the inferior caval vein. Interstitial fluid for protein and COP determination was sampled from subcutaneous tissue of the hind limbs by a wick technique, and the Pi was measured by a modified Scholander technique. When the Pv was increased from 3 to 12 mm Hg, the COPi fell from 9 to 4 mm Hg. The Pi averaged -1 mm Hg under control conditions and was unchanged when the Pv was elevated to 12 mm Hg. No edema was detected. Higher rises in venous pressures resulted in further but less pronounced falls in interstitial fluid COP. Edema developed and the Pi increased to +1 to 2mm Hg. The results show that the fall in COPi is an important edema-preventing factor during increased venous pressure, whereas a rise in Pi only seems to oppose further increase of an already existing edema.


Inhibition of meal-stimulated gastrin secretion after oral glucose. Serum gastrin concentration was measured in six male subjects before and after a beef meal, with and without 100 g of oral glucose being given 30 min previously. There was a pronounced inhibition of beef-stimulated gastrin secretion after the oral glucose load.


Progression of nephropathy in long-term diabetics with proteinuria and effect of initial anti-hypertensive treatment. The rate of progression of nephropathy was studied in 6 young male diabetics with intermittent proteinuria (Albustix) and in 10 young male diabetics with constant proteinuria by measuring glomerular filtration rate (GFR), renal plasma flow (RPF), and urinary albumin excretion by exact techniques. Albumin excretion was elevated in both the recumbent and the erect position in patients with intermittent proteinuria. GFR and RPF were at the same level as in diabetics without proteinuria, and no deterioration in renal function was noted during a mean control period of 32 months. In the patients with constant proteinuria the fall rate during a mean period of  33.6 months for GFR and RPF was 0.91 ml/min/month +/- 0.68 (S.D.) and 4.38 ml/min/month +/- 3.23 (S.D.) respectively. Initial fall rate in GFR correlated well with long-term fall rate, both of which were studied in 7 patients. In the same patients there was a positive correlation between the fall rate in GFR and diastolic blood pressure as well as albumin clearance. In 8 patients with constant proteinuria and mean blood pressure of 159/101 mmHg, antihypertensive treatment was started with propranolol alone or combined with hydralazine and furosemide. During a treatment period of 47 days blood pressure was reduced to 143/93 mmHg, and in the same period urinary albumin excretion was reduced significantly from a mean value of 3547 mug/min to 2414 mug/min (P less than 0.01). Further control studies will clarify whether end-stage of renal insufficiency will be postponed by antihypertensive treatment.


An individual nomogram for determination of glomerular filtration rate from plasma creatinine. From simultaneously determined values of the glomerular filtration rate and the concentration of creatinine in plasma an individual nomogram can be constructed from two scales. From this nomogram the actual glomerular filtration rate of the patient can later be read out solely from a new concentration of plasma creatine.


Micromodification of the Phadebas amylase test. A micromodification of the original Phadebas Amylase Test has been adapted for the LKB Calculating Absorptiometer. This test requires only 15 mul of serum and reduces the amount of reagent used by a factor of ten. The results of this semiautomatic micromethod have a coefficient of variation of about 4% and correlate well (r = 0.996) with the method as originally described.


Relationships between gastric acid secretion and recurrent duodenal ulcer after selective vagotomy and pyloroplasty in men. Relations between gastric acid secretion measurements and recurrence of duodenal ulcer within 1 to 4 years after selective vagotomy and pyloroplasty were evaluated in a series of 117 men. The discriminatory ability of spontaneous, histamine- and insulin-activated acid secretion measurements was significant and similar to that after truncal vagotomy and drainage. The measurements were of no practical value for the diagnosis of recurrent duodenal ulcer after vagotomy, but they provided a rationale for selective surgery in patients with duodenal ulcer and patients with recurrent duodenal ulcer after vagotomy.


The effect of antral distension on acid secretion and plasma gastrin in duodenal ulcer patients. The effect of antral balloon distension on acid secretion and the plasma gastrin concentration was studied in 8 duodenal ulcer patients. Antral distension significantly increased the acid secretion to about 30% of the peak acid response to pentagastrin without any change in the plasma gastrin concentration. Antral distension and concomitant intragastric neutralization, with the intention of facilitating release of antral gastrin, produced about the same acid response and did not evoke any plasma gastrin increment. The results suggest that the acid response to antral distension in duodenal ulcer patients is evoked without contribution of the gastrin mechanism, and that the acid response is probably mediated via a pyloro-oxyntic reflex. In this respect the duodenal ulcer patient seems to differ from the healthy subject, in whom antral distension produces no acid response, and from the dog, in which release of gastrin as well as pyloro-oxyntic reflex participate in the acid response to antral distension.


Regional ileitis (Crohn's disease). I. Kinetics of bile acid absorption in the perfused ileum. Bile acid absorption was studied by steady state perfusion technique in the ileum of 11 patients with regional ileitis (Crohn's disease). By computerizing absorption kinetics the presence of an active transport of glycochenodeoxycholic acid (GCDC) was rendered probable by finding a saturable transport system and a competitive absorption between conjugated bile acids. At the time of investigation 5 patients had no diarrhoea, whereas 6 patients had diarrhoea as defined from the amount of faecal output. In the former group the faecal bile acid excretion was low, the ileal absorption of GCDC high, and judged from the xylose absorption the ileal absorption surface large compared to the latter group, in which the faecal bile acid excretion was high, the ileal absorption of GCDC low, and the ileal absorptive surface small. It is concluded that malabsorption of bile acids in the ileum may be of significant physiological importance in the pathogenesis of diarrhoea in patients with regional ileitis.


Regional ileitis (Crohn's disease). II. Electrolyte and water movement in the ileum during perfusion with bile acids. Electrolyte and water movement was studied by steady state perfusion technique in the ileum of 11 patients with regional ileitis (Crohn's disease). Six patients who at the time of investigation had diarrhoea showed a constant secretion of salts and fluid during perfusion with control perfusate. Per 24 hours, the ileal effluents to colon would exceed the normal amount by 1-2 litres. In the 5 patients without diarrhoea the absorption patterns were normal. Electrolytes and water moved in parallel. Dihydroxy bile acids enhanced secretion or decreased absorption respectively, in the two groups of patients. It is concluded that functional disturbances of salt and water absorption in the inflamed ileum may be of significant physiological importance in the pathogenesis of diarrhoea observed in patients with regional ileitis.


Fat digestion after jejunoileal bypass operation for obesity. Fat digestion in the upper jejunum was studied in 12 obese patients treated by jejunoileal bypass including either 37.5 cm jejunum and 12.5 cm ileum or 12.5 cm jejunum and 37.5 cm ileum. Jejunum was intubated and a test meal ingested before and 1-2 months after operation. Jejunal aspirates were heated immediately to destroy lipase, pooled and assayed for dilution marker, bile acids and total fat. Lipolytic products were determined by thin-layer chromatography and densitometry. The micellar phase was achieved by ultracentrifugation and analysed for total fat. Results. Bile acid concentration and lipolysis decreased after both bypass operations. In accordance with this, micellar solubilization of fat was impaired after operation. Bile acid concentration and micellar solubilization were lower after bypass with a long, than after bypass with a short, ileal loop. Absorption of fat in the duodenum and upper jejunum did not change significantly after any of the operations. Conclusions. Jejunoileal bypass impairs fat digestion, but this does nto contribute significantly to the fat malabsorption after operation.


Semiquantitative measurement of lithocholic acid compounds in bile from patients with gallstones, before and during treatment with chenodeoxycholic acid. A method for two-dimensional thin-layer chromatography of unprocessed bile is described. The method gives distinct spots from lithocholic acid and its compounds with glycine, taurine, and sulfuric acid. The size of the spots is estimated by comparison with standard spots, and the concentrations of individual bile acids are expressed as a fraction of the total content of bile acids in the sample. The concentration of total lithocholic acid was found to be 1-3 (mean 1.5) per cent of the total concentration of bile acids in duodenal bile from 14 healthy persons. It was slightly higher in bile from 6 untreated patients with gallstones, and still higher, 3-7 (mean 4.0) per cent, in bile from the same patients during treatment with chenodeoxycholic acid. The difference between the concentrations of total lithocholic acid in the bile samples from healthy persons and from patients treated with chenodeoxycholic acid was statistically significant. Nearly all the lithocholic acid was conjugated with glycine or taurine, and approximately half of it was sulfated. The increase in total lithocholic acid concentration in the bile from patients consisted of glycine conjugates.


Response to jejunal acidification in man. II. Pancreatic, biliary and gastric responses. The effect of perfusion of the jejunum with acid on the secretion of bicarbonate, trypsin, and bile into the duodenum has been studied in 10 patients with duodenal ulcer and 8 control subjects and compared with the responses to intravenous infusion of secretin and cholecystokinin-pancreozymin (CCK). Both the secretion of bicarbonate and of trypsin into the duodenum were inversely related to the amount of acid dissipated during jejunal transit, so that if all the acid disappeared during transit of a 30-cm segment of jejunum, the pancreas did not secrete. In both groups of subjects, jejunal acidification elicited a relatively greater secretion of bicarbonate than secretion of trypsin or bile into the duodenum, compared with the response to the exogenous hormones. Jejunal acidification also inhibited the secretion of trypsin in response to concurrently administered exogenous hormones by the control subjects but not in patients with duodenal ulcer. We conclude taht the pancreatic response to acid in the human duodenum depends on exposure of the jejunal mucosa to the amounts of acid which are greater than (quite high, but variable) threshold in all subjects. Under the conditions of this study, patients with duodenal ulcer differed from control in lacking an acid-released jejunal inhibitor of the secretion of trypsin by the pancreas.


The possible precancerous significance of abnormal cells in gastric cytology specimens: a follow-up study of 545 patients. In a series of 545 patients without roentgenological and gastroscopical signs of gastric malignancy, the cytological finding was interpreted as normal (Papanicolaou I) in 351 patients and abnormal (Papanicolaou II-III) in 194 patients. In the abnormal group were included 48 patients with large nuclei and 11 patients with cytologically wrong positive smears (Papanicolaou IV-V), in whom x-ray examination, gastroscopy, and a follow-up study did not reveal any signs of gastric carcinoma. The two groups were collected under uniform principles and studied by the same methods. They were also comparable as to age and sex distribution. In a 15-year follow-up study it was found that 2 patients (0.6%) in the cytologically normal group and 5 (2.6%) in the abnormal group had died of gastric carcinoma. The difference was statistically significant. The 15-year death rate from gastric carcinoma in the cytologically abnormal group was statistically significantly higher than in the expected death rate in the general population of corresponding age and sex distribution.


Effect of barium meal on resting gastro-oesophageal sphincter pressure in normal human subjects. The effect of ingestion of 250 ml X-ray contrast medium on resting gastrooesophageal sphincter pressure was studied in 10 normal human subjects. Twenty minutes after initiated intake of the contrast medium, a significant fall in sphincter pressure was recorded. In the light of studies on the neurogenic and hormonal regulation of the sphincter pressure it is attempted to account for this effect, and it is concluded that it must be a manifestation of a reflectory relaxation of the sphincter region. From a clinical point of view the consequence must be a demand for standardized conditions with regard to composition and pH of the contrast medium, time schedule and degree of abdominal compression in those cases in which radiological evaluation of the resistance against reflux is called for.


Serum isoamylases in chronic pancreatitis. Serum isoamylases were quantitated separately in 15 patients with chronic pancreatitis. The mean activity of pancreatic isoamylase was 7 U/1 in the patients as compared to 88 U/1 in healtly controls, 8 of the patients completely lacked pancreatic isoamylase and the mean activity in the other was 15 U/1. Salivary isoamylase activities were moderately increased in the patients. Determination of the serum pancreatic isoamylase is a simple screening procedure that should be useful in the diagnosis of exocrine pancreatic insufficiency.


Serum bile acid concentrations in patients with liver disease. An enzymatic-fluorimetric method using a highly purified 3alpha-hydroxysteroid dehydrogenase (Sterognost-3alpha, Nyco) was used to determine fasting serum bile acid concentrations on 49 occasions in 43 patients with various liver diseases. A two-hour postprandial bile acid determination was carried out on 29 occasions in 27 of the patients. Fasting bile acid concentration correlated significantly both in cholestatic hepatobiliary and in parenchymatous liver disease to serum bilirubin and aspartate aminotransferase (ASAT) but not to alanine aminotransferase (ALAT), alkaline phosphatase, or albumin. The two-hour postprandial bile acid concentration was above normal in all patients with biochemical and/or histological signs of hepatobiliary disease, also when fasting concentration was within normal limits. In parenchymatous liver disease correlations existed between the two-hour postprandial bile acid concentration and bilirubin, ASAT, and ALAT. The sensitivity of serum bile acid estimation was compared to other liver function tests. Both the fasting and the postprandial serum bile acid concentrations tended to be more sensitive tests of hepatobiliary disease than bilirubin, ASAT and ALAT.


Familial polycythaemia vera: a study of 3 sisters. The familial occurrence of polycythaemia vera (PV) is rare, with only 3 authentic reports in the world literature. This paper describes a family of 8 females, 3 of whom have PV and another has pernicious anaemia. Clinical and haematological data is presented to support the diagnosis of PV and exclude other causes of familial erythrocytosis. Cytogenetic studies were performed in 2 of the patients.


Heparin elimination in uraemic patients on Haemodialysis. Heparin (100 U/kg bodyweight) was administered as single i.v. injections, and heparin concentration in plasma determined by polybrene titration. Mean concentration half-life was 74.7 min in the normal group (n = 6), 118.6 min in the nephrectomized patients (n = 5), and 97.8 min in the other uraemic patients (n = 6). The differences between the mean values for the normals and for the 2 patient groups were statistically significant (p is less than 0.001 and p approximately 0.2 respectively). Mean anticoagulant half-life (based on thrombin clotting time) was 64.3, 75.8 and 62.7 min in the 3 groups. The differences between heparin concentration half-life and anticoagulant half-life in the 3 groups were statistically significant. These differences may be partly explained by a significant fall in heparin cofactor activity after injection of heparin. There was a strong positive individual correlation between heparin concentration half-life and anticoagulant half-life in the patients (r = 0.94), but not in the normal group (r = 0.31). There was a strong negative individual correlation between heparin tolerance and heparin concentration half-life in the patients (r = -0.84), but no correlation in the normal group. It is concluded that severely impaired renal function has a significant, but moderate influence on heparin elimination.


Atypical intraerythrocytic pyruvate kinase in some haematological diseases. An atypical pyruvate kinase (PK) in erythrocytes was studied in a family with several different haematological diseases: non-spherocytic haemolysis, thrombocytopenia, myelofibrosis and polycythaemic traits. Atypical intraerythrocytic PK was also found in a group of non-related patients with myelofibrosis and polycythaemia vera. The atypical PK was characterised by abnormal urea inhibition and other relevant biochemical parameters.


Platelet consumption and plasma concentration of platelet factor 4 (PF-J). In 10 cancer patients platelet concentration, platelet consumption, platelet half-life time and plasms concentrations of platelet factor 4 were determined. A high freguency of thrombocytosis and increased platelet consumption were observed, and the plasms concentrations of platelet factor 4 was increased. However, no significant correlation was found between platelet consumption and the result of a single determination of platelet factor 4 concentrations in plasma.


Spontaneous and oxalate-induced radial segmentation of the nuclei of lymphocytes from peripheral blood from patients with chronic lymphocytic leukaemia. Radial segmentation of nuclei of lymphocytes from peripheral blood from 18 patients with chronic lymphocytic leukaemia was studied in heparinized blood samples incubated with and without oxalate, for 6 h, at 20 degrees C, and 37 degrees C. The yield of radially segmented nuclei was the same after incubation at 20 degrees C as at 37 degrees C. Treatment with sodium oxalate resulted in an increased formation of radial segmentation to the same extent at 20 degrees C as at 37 degrees C. No correlation was found between the size of the lymphocytes and the frequency of radially segmented cells. The number of radially segmented nuclei did not vary with the WBC or Hb value. Cytostatic treatment with chlorambucil and cyclophosphamide did not inhibit the formation of radially segmented nuclei.


The oxalate-induced radial segmentation of the nuclei in peripheral blood lymphocytes of different size. The incidence of oxalate-induced radial-segmented (RS) nuclei in lymphocytes from peripheral blood correlated closely with the diameter of the cell and with the diameter of the nucleus; the majority of RS nuclei were found in large lymphocytes. This observation supports the basic hypotheses, that large lymphocytes from peripheral blood represent a later stage in the cell cycle than small lymphocytes, that the tubulin content of lymphocytes increases during the interphase and that the incidence of RS nuclei reflects the tubulin content of the cells within the various size classes.


Neutrophil defect in multiple myeloma. Studies on intraneutrophilic lysozyme in multiple myeloma and malignant lymphoma. Intracellular lysozyme concentration was measured in neutrophilic granulocytes from 25 patients with multiple myeloma. At diagnosis intraneutrophil lysozyme activity was significantly reduced (mean reduction 50%). During clinical remission after 1-4 months of intensive chemotherapy values were normalized. In 18 cases studied at various stages of the disease from 6 to 70 months after diagnosis there was a significant negative correlation between the duration of the disease and neutrophil lysozyme concentration. The decrease in neutrophil lysozyme concentration was significantly correlated to clinical disease activity and the percentage of plasma cells in bone marrow aspirates, whereas there was no correlation between the concentration of M-protein in serum and the neutrophil lysozyme concentration. Plasma lysozyme concentration was normal. In contrast, neutrophil lysozyme concentration was normal in 18 patients with stage III-IV malignant lymphoma. Plasma lysozyme in this group was significantly higher than normal. The difference in neutrophil lysozyme patterns between multiple myeloma and malignant lymphoma supports the hypothesis that the defect in neutrophil maturation seen in malignant blood disorders is directly related to the infiltration of the bone marrow by pathologic cells.


Preparation of concentrated platelet suspensions by dehydration against polyethyleneglycol 20,000. Gel filtered platelet suspensions were concentrated by repeated dehydration against polyethyleneglycol 20,000 followed by dialysis against slightly hypotonic buffer. This method increased the platelet concentration 2-3 times with a recovery of 80-100%. The final cell suspension closely resembled the original platelet rich plasma as tested by a number of platelet tests.


Cell-mediated cytotoxicity for melanoma tumor cells: detection by a (3H) proline release assay. An in vitro lymphocyte-mediated cytotoxicity assay using [3H]proline-labeled target cells is described. The assay, modified from an original procedure of Bean et al., assesses the release of [3-H]proline by filtering the total culture fluid containing both trypsinized tumor cells and effector cells. Filtration is performed with a semiautomatic harvesting device using low suction pressure and large-diameter glass filters. Pretreatment of filters with whole serum diminishes adsorption of cell-free radioactive material considerably and thus increases the sensitivity of the assay. Nearly 100% of the radioactivity could be recovered with this harvesting device. The technique allowed the detection of cytolytic activities of lymphocytes after 6 h of incubation. Lymphocytes from patients with primary malignant melanoma showed a significantly higher cytolytic reactivity (P less than 0.001) than normal donors' lymphocytes against three different melanoma cell lines. In a series of parallel experiments on 36 patients and 18 normal donors, this modification of the [3H]proline test was compared with three different assays: the conventional microcytotoxicity test of Takasugi and Klein, the original [3H]proline microcytotoxicity test of Bean et al., and the viability count of tumor cells.


Measles virus-induced migration inhibition in vitro of leukocytes from patients with multiple sclerosis. The migration inhibition in vitro induced by measles virus material on leukocytes from 17 patients with multiple sclerosis (MS) was compared with that of 8 patients with various other central nervous system diseases and that of 12 healthy blood donors. Significant differences could not be demonstrated. The results do not indicate that MS patients' leukocytes show an altered behaviour to measles virus material in the migration inhibition test.


Sick-leave after road traffic accidents. 425 road traffic casualties, all covered by the National Insurance Scheme, were followed up regarding duration of inability to work. The average for the whole group was 35 days. There was a close relation between seriousness of injury and time off work. Motorcyclists had the longest time off work and cyclists injured in bicycle accidents the shortest. Casualties with orthopaedic injuries were off work for 120 days, on average, and accounted for 67% of the total paid sick-leave, although they constituted only 20% of those injured. The responsibility for the treatment of trauma is discussed.


The North Karelia Project: a programme for community control of cardiovascular diseases. In this article the background and principles of the intervention and evaluation of the North Karelia Project are presented. The project is a comprehensive community control programme concerning cardiovascular diseases in the province of North Karelia, Eastern Finland. In the baseline survey of the project (1972), 25-59-year-old males had a particularly high of CVD level risk factors; there were 54% current smokers, the mean cholesterol was 269 mg% and the mean casual blood pressure was 147/90 mmHg. According to the myocardial infarction register the incidence rate of acute myocardial infraction was, during the first year of the project (1972), 13.8 per thousand among 30-64-yearold males. During the first 2 1/2 of the intervention the percentage of current smokers decreased among males from 54 to 42. The percentage of males using low-fat milk increased from 17 to 48. The percentage of males who had had their blood pressure measured during the previous half year increased from 28 to 56 and those under antihypertensive drug treatment from 3.1 to 9.1. Local groups for secondary prevention of myocardial infarction were established all over the province. On the basis of the accumulated experience and theoretical considerations, the project plan has futher been elaborated.


Hypertension programme of the North Karelia Project. The present article describes the background and principles of a programme for community control of hypertension, which is part of the North Karelia project--a comprehensive community programme for the control of cardiovascular diseases. The hypertension programme also forms part of an international co-operative study by WHO. The programme consists of a community intervention integrated with the service structure. The methods used include health education of the public, education of health service personnel, organization of a service for the spreading of information and also for screening, treatment and follow-up. Every hypertensive person in the community is registered in the hypertension register and checked on annually. The evaluation is made mainly on baseline and terminal survey data from the intervention area and a reference area, the hypertension register, a myocardial infarction register and a stroke register in the intervention area.


Health situation and related social conditions among 66-year-old Finnish men. The aims of the study were to reveal the extent of physical activity, nutritional habits, smoking and alcohol consumption and the relation of these to previous occupation among recently retired men. The number of men belonging to various health risk groups was estimated on the basis of the results. About 10% had inadequate nutritional habits as judged from their food expenses and number of daily hot meals and about 20% practised physical exercise in the way which is considered necessary for the improvement of cardiovascular performance and maximal oxygen uptake. Only a small minority had been requested to undertake physical exercise. About 18% lived alone. The problems were more pronounced among the men retired from manual occupations compared with men whose main occupation had been of a sedentary nature. The results indicate that a considerable proportion of elderly men would need more advice and more adequate services in order to improve their daily living habits. Any such measures should preferably be started before retirement as the living habits adopted during the earlier periods of life seem to remain unchanged in old age. The results are based on an interview study carried out among 137 66-year-old men representing about 90% of the men of that age group living in Jyväskylä, a town of 60000 inhabitants in Central Finland.


On pensioners' circumstances in a large Swedish city. A report from Malmö. In 1972-1973 the authors carried out a field-work programme in a surburban area covered by the 4th Welfare District of Malmö with the objective of charting the general circumstances among the pensioners living there. Such surveys should be pursued in such a way that immediate needs would be disclosed and met. The findings were intended to form a basis for future improvement projects. As expected, the results show the necessity of tracking down hidden needs, often underestimated by the pensioners themselves, especially those in poor health and of limited means. Within the framework of a permanent field-work programme, those people must be made more aware of their own interests and rights.


Retirement and psychic investments.

Retirement and psychic investments. An attempt has been made to investigate the effect of retirement on the amount of psychic investment in the different sections of the social field. A further investigation was made on the application of the disengagement theory and the theory of role flexibility to the present material. The results do not support either of the theories. The material consisted of 28 pensioners, who were sent 3 questionnaires: on retirement, and 3 months and 1 year later. In processing the material, factor analysis and group analysis were primarily employed. In the group analysis, the observation units (84) (each answer from each subject) were divided into three groups. The present results showed a considerable degree of stability in the subjects, irrespective of their retirement; 82% had remained in the same group for all three questionnaires.


Transmission of vibration in the hand-arm system with special reference to changes in compression force and acceleration. The transmission of longitudinal vibration in the hand-arm system of five subjects was investigated. Altogether 405 individual tests were made. Vibration was measured with an accelerometer (weight 0.4 g) fixed in turn to the wrist, the elbow, and the upper arm by means of a supporting device (weight 34 g). A handle with strain gauges attached was used to study the effect of compression force (10, 20 and 40 N) and constant acceleration (1, 3 and 10 g) on the transmission of vibration at frequencies from 20 to 630 Hz. In the curves recorded, sharp dips appeared which were evidently caused by resonances from the soft tissues of the hand. However in the hand-arm system no common resonance frequency was observed that would harmfully affect the health of workers. Vibration in the hand-arm system was attenuated at an average of 3 dB per octave at the frequencies between 20 and 100 Hz. Between 100 and 630 Hz the attenuation was about 6 dB per octave in the wrist and 10 dB per octave in the elbow and upper arm. At the frequency of 630 Hz the attenuation was hence about 35 dB in the wrist and about 45 DB in the elbow. The attenuation of vibration in the elbow joint was 2 to 4 dB at all frequencies. The hand-arm system appears to be linear at the acceleration range considered; the increase in handle vibration by, e.g., 10 dB also increased vibration in the hand by 10 dB. When the grip strength was increased fourfold, i.e., 12 dB, vibration increased only 3 to 5 dB in the hand-arm system. Thus changing the weight of a vibrating tool does not reduce vibration enough. Therefore attempts to reduce vibration should concentrate on the mechanical parts of the engines.


Systolic time intervals as a measure of left ventricular function in viscose rayon workers exposed to carbon disulfide. In a group of viscose rayon workers exposed to carbon disulfide the systolic time intervals were calculated. They were determined from the simultaneous recording of an ECG, a phonocardiogram, and arterial pulse tracings. Results indicate a shortened left ventricular ejection time (lvet) and a prolonged isovolumetric contraction time (ICT), together with an increase in the ratio of ICT to LVET. These alterations, which occurred in the absence of any clinical signs or symptoms of heart disease, are interpreted as a consequence of an impaired left ventricular contractility, comparable to mild coronary dysfunction. Literature data support the hypothesis that the biochemical mechanisms involved in the effect of carbon disulfide on myocardial cells are (a) an interference with energy metabolism from the inadequate availability of thiamine and nicotinamide or a direct inhibition of cytochrome or (b) an interference with catecholamine metabolism and defective hormonal control of the energy utilization process. Impaired left ventricular function in rayon viscose workers exposed to carbon disulfide represents an early and highly sensitive sign of carbon disulfide intoxication, and the use of systolic time intervals as a noninvasive measure of myocardial performance may be a useful method for monitoring carbon disulfide exposed people.


Occupational lead exposure in Finland. VI. Final report. Between 1970 and 1973, 2,209 workers representing 30 different types of work were studied in Finland for lead exposure. The indicator of lead exposure was the blood lead concentrations (Pb-B) of the workers. The highest recommended value for Pb-B in Finland, 70 mug/100 ml of blood, was exceeded in the following types of work: PVC plastic manufacturing, storage tank manufacturing and repairing, machine shop work, treating metal surfaces, paint manufacturing, car radiator repairing, spray painting, machine shop work (railway), and storage battery repair. The types of work with the highest average exposure were lead scrap smelting (Pb-B median 79 mug/100 ml, range 35--118), storage battery manufacturing (Pb-B median 66 mug/100 ml, range 19--101), metal founding, (Pb-B median 53 mug/100 ml, range 6--108) shipbreaking (Pb-B median 49 mug/100 ml, range 26--106) crystal glass manufacturing (Pb-B median 41 mug/100 ml, range 12--82), car radiator repairing (Pb-B median 38 mug/100 ml, range 17--83), and PVC plastic manufacturing (Pb-B median 37 mug/100 ml, range 10--126). During the past 5 years cases of clincial lead poisoning have occurred in all of these types of work, and the patients received workmen's compensation. The usefulness of the national poisoning register in predicting the relative hazard of lead exposure in the types of work studied was evaluated with the aid of rank order correlation statistics. The analysis showed that the poisoning register is a useful indicator of lead exposure in the most exposed types of work. However, the present survey also revealed work in which the hazard had escaped recognition in this country: metal founding, car repairing, and car radiator repairing, for example. Although it seems possible to predict the most heavily exposed work types from national poisoning registers only, the detection of workers with less severe manifestations of toxic effects, or somtimes even poisoning, in other types of work first requires a systematic survey of all types of work with possible lead exposure, and then regular monitoring of all exposed workers.


Use of breath analysis to monitor methylene chloride exposure. Twenty male and female subjects were exposed repetitively to methylene chloride (CH2Cl2) vapor, 50, 100, 250, and 500 ppm, for 1,3, or 7.5 h in a controlled-environment chamber. Postexposure alveolar breath samples were collected in small glass breath tubes and analyzed for CH2Cl2 by gas chromatography. From these data is a series of breath CH2Cl2 excretion curves were constructed that can be used to estimate the magnitude of a recent exposure. The CH2CL2 breath concentration in the immediate postexposure period accurately reflected the vapor concentration to which the subjects had been exposed most recently. Breath samples collected 1--2 h following exposure were accurate indicators of the time-weighted average vapor exposure experienced by the subjects during the previous 8 h of occupational exposure. Breath analysis offers a practical, noninvasive method for monitoring occupational exposure to CH2Cl2.


Use of chlorophenols as fungicides in sawmills. Several commercial formulations of chlorophenols used as fungicides in sawmills were found to contain impurities, some of which are known to be much more toxic than the main products. The most frequent impurities were chlorinated phenoxyphenols, chlorinated diphenyl ethers, chlorinated dibenzofurans, and chlorinated dibenzodioxins. Samples of wood dust from several positions in two Swedish sawmills were analyzed. The results suggest that the impurities in the chlorophenol formulations are enriched in the work environment in relation to the chlorophenols themselves, probably because of the low volatility and high chemical stability of the impurities. The effect of various methods of fungicide application on the work environment is discussed.


X-ray fluorescence analysis of lead in human skeleton in vivo. The lead concentration in the skeleton of living man was measured by X-ray fluorescence analysis. Five former workers from a metal industry were studied. The mean lead concentration in their skeletons was estimated to be 62 mug/g with a standard error of +/- 5 mug/g. A comparison with the "normal" skeletal concentrations of lead in people from southern Sweden showed the skeletal concentrations of the men studied to be about three to nine times higher.


Exposure to anesthetic gases and ethanol during work in operating rooms. The concentration of halothane and ethanol in operating rooms was measured during 37 routine operations performed in nine different departments of surgery at six different hospitals. The time-weighted halothane concentrations in the respiratory zones of anesthetic and surgical nurses were 0.3--34.0 ppm (time-weighted average 7.2 ppm) and 0.1--9.2 ppm (time-weighted average 2.5 ppm), respectively, in the different operating departments. The corresponding ethanol concentrations were 0.3--36.5 ppm (time-weighted average 12.5 ppm) for anesthetic nurses and 1.5--46.6 ppm (time-weighted average 15.3 ppm) for surgical nurses. The anesthetic technique influences the exposure of the operating staff to anesthetic gases, but it does not affect exposure to ethanol. In controlled experiments volunteers were exposed to low concentrations of halothane or ethanol. About 60% of both substances was retained. The content of ethanol in the end-expired air approached zero within a few minutes after the end of exposure, while low residual concentrations of halothane were demonstrable for more than 1 h. Although exposure to ethanol is insignificant in relation to the metabolic capacity of the body, ethanol indicates the presence of volatile disinfectant components, and its spread through the room atmosphere should be kept in mind when the ventilation of operating rooms is designed. The effective elimination of airborne pollutants in operating rooms calls for good general ventilation in conjunction with local exhaust close to the sources of anesthetic gas leakage. General ventilation mainly affects the concentration of substances well-mixed with the room atmosphere, such as volatile disinfectant components and anesthetic vapor that has spread beyond the actual work zones of the medical staff. For a significant reduction in the concentration of anesthetic gases in the respiratory zones of the medical staff, the gases must be vented at the source of leakage. Since airborne anesthetics occur not only in operating rooms, general ventilation has to meet certain minimum requirements also in anesthetic induction rooms and recovery rooms. Operating rooms and anesthetic induction rooms must also be supplied with local exhaust systems.


Depressed cholinesterase activities among farm workers in New Jersey. The widespread use of organophosphate pesticides creates the possibility of excessive exposure of migrant farm workers to these compounds. Blood cholinesterase determinations were used to compare the organophosphate pesticide exposure of 57 migrant farm workers with that of 35 controls. Frequently reported symptoms of the farm workers which might be related to pesticide exposure were also studied, including headaches, dizziness, loss of weight, nausea, and a general feeling of weakness or loss of energy. Significantly depressed cholinesterase activities were found in the farm workers, with 10.5% of the farm workers having values below the lower limit of normal. There was no significant relationship between frequently reported symptoms of the farm workers and depressed cholinesterase levels.