The Byars hypospadias repair. A review of 253 consecutive patients. Of 253 consecutive hypospadias repairs by various surgeons, using the Byars technique, 57 (22 percent) had postoperative fistulae; 41 required one operation, 9 required two operations, and 7 required more than two operations for closure of these fistulae. Other complications were infrequent. When performed either by attending or resident physicians, the Byars hypospadias repair produced complete correction of the chordee, a urethra of satisfactory length and caliber, normal penile appearance, and a fistula rate comparable to that reported after other procedures.


Long-term results of the island flap palatal pushback. We analyzed all 104 island flap pushback palatal repairs done through our Facial Rehabilitation Clinic in the period from 1965 to 1971. The results were compared to those in a group of 109 standard pushback repairs. The island flap group had a higher incidence of operative complications, of velopharyngeal insufficiency, and of secondary procedures to correct the latter. (The differences between the two groups were not statistically significant, however.) In this group of patients the island flap repair offered no particular advantage over the V-Y or the Dorrance pushback; in fact, it may have been deleterious. A hypothetical explanation for these results is offered, based on possible continuing osteogenesis by the transplanted mucoperiosteum, to produce an inflexible and poorly functioning velum.


A new method of treatment for mallet finger. A preliminary report. We describe a new technique to treat the mallet finger deformity. The method is both simple and efficient, and it does not require follow-up for splint or dressing adjustment. All of our 15 cases regained function without complications.


Dacryoscintigraph evaluation of the repaired lacrimal drainage system. We have used dacryoscintigraphy to study the efficiency of the lacrimal system following the repair of a divided lower canaliculus in 4 children. This test has been reliable in evaluating lacrimal function and suggests that a canaliculus can be repaired and splinted satisfactorily. Our experience with dacryoscintigraphy confirms that it is a safe comfortable, and reliable method for studying the patency of the lacrimal drainage system.


Use of a buried nasolabial flap to fill a depression over the lower jaw. Case report. A viable local flap is not plagued by the problems of resorption and dissolution. If it is to be denuded and buried, however, great care must be taken to select a donor area that is as hairless as possible. Otherwise, there may be cyst formation, drainage, and infection.


Use of nasopharyngeal tubes as aids to lateral port construction and maintenance of the airway in pharyngeal flap surgery. We suggest the bilateral placement of nasopharyngeal tubes of appropriate size as a simple aid in constructing lateral ports of the correct size when doing a superiorly-based, lined, pharyngeal flap for velopharyngeal incompetence. If one leaves the tubes in for 24 to 48 hours postoperatively, they are of great help in maintaining a clear airway during that period.


Free muscle transplantation by microsurgical technique to treat severe Volkmann's contracture. In a free muscle transfer, great care must be taken in selecting the muscle to be grafted. We have found the pectoralis major to be a good donor muscle. Although most muscles are not nourished by a single artery and a few veins, the vessels which enter the pectoralis major muscle with the nerves are the main nutrient vessels, and these vessels alone can adequately nourish this muscle. Neurorrhaphy should be performed at a site as close as possible to the muscle. Good indications for free muscle transfer are cases in which a flexor muscle has become necrotic, while the extensor muscle is viable--for example, if the flexor muscle has sustained traumatic crushing injury or if there is a Volkmann's contracture.


Augmentation mammaplasty by the transaxillary approach. Augmentation mammaplasty by the transaxillary approach seems to be a safe and anatomically sound procedure which produces consistent results with a low complication rate. Our experiences with this procedure and our modifications in the technique are described. Two instruments which were designed to facilitate the procedure are reported. An anatomical justification for the transaxillary method is made.


"Lethal midline granuloma".

"Lethal midline granuloma". We have recently had two cases of midfacial granulomas in which laboratory examinations and multiple biopsies did not reveal a more specific diagnosis. Both responded to treatment. We feel that in such cases therapy should be given and based on the extent of local destruction and the history of the disease in the patient.


Evaluation of digital escharotomy in burned hands. A controlled study of digital escharotomy showed a statistically significant increase in the number of salvaged phalanges. This procedure has minimal risk and should be considered in patients with vascular compromise of the upper extremity requiring escharotomy, who also have circumferentially burned fingers.


Excision of massive hemangioneurofibroma of the face. Nevus flammeus (cutaneous hemangioma, port-wine stain) may develop proliferative hamartomatous changes and go on to form monstrous deforming tumors. Excision is feasible, and it may be best to do it early. The mentally retarded, institutionalized patient can also benefit from the reconstruction. In 3 cases it was possible to preserve function of the muscles of facial expression, because of the superficial location of the tumor. Techniques to decrease blood loss are of variable value during the operative procedure.


The mucoperiosteal palate flap for closure of oral cavity defects. We have used a modification of a mucoperiosteal flap described by Lane for cleft palates in 3 patients with oral cavity defects from tumor ablations. The flap provides excellent lining for repairs when alternative flaps are unavailable. The vascularity of the flap and its texture allow a watertight closure which does not hinder the patient's ability to talk or eat.


Microvascular anastomosis: an experimental model utilizing the rabbit ear. Using the rabbit ear as an experimental model, a composite flap based on an anastomosed central artery and vein can be created and its viability determined. This inexpensive model can be used to train plastic surgical residents in microsurgery and in further investigations of the microcirculation of flaps and their survival.


Species differences in the trypsin separation of epidermis and dermis. Trypsin incubation was performed on split-skin grafts from rats, pigs, and humans. The separation of dermis and epidermis was best achieved when incubating in 0.5% crude trypsin in Hank's balanced salt solution. Separation occurred at 37 degrees C in 1 1/2 hours for all species. At 4 degrees C, the separation took 2 1/2 hours for pigskin, 3 1/2 to 4 1/2 hours for human skin, and 5 to 6 hours for rat skin. Histological examination showed a cleaner separation of both rat skin and pigskin was obtained at 4 degrees C than at 37 degrees C. Large areas of skin (1600 mm2) could be separated easily as long as adequate amounts of solution were used.


Prevention of thrombosis in arterial and venous microanastomoses by using topical agents. A replantation model, using the rat's foot severed at the ankle and replanted on an extended vascular pedicle, was used to study the effect of topical vasodilators in preventing microvascular thrombosis. Magnesium sulfate, Xylocaine, and papaverine gave arterial patency rates of 89% or more, compared to 65% for saline alone. There was no appreciable effect on the venous patency rates. The possible mechanisms of action for the various drugs are discussed.


A method for studying endothelial regeneration in small vessels. A simple, accurate method for demonstrating very small areas of endothelium is described. Some possible fields for further investigation are suggested. An outline of the possible normal mechanism of endothelial regeneration is described.


Benign atypical fibroxanthoma or a malignant tumor? A warning. Case reports. Atypical fibroxanthoma of the skin has been recognized recently as a pseudo-malignant tumor, probably reactive in nature. By all the classic morphological criteria, the lesion appears to be malignant--but in behavior it is benign. In older patients the head and neck are primarily involved, while in younger patients these tumors appear on the covered areas of the trunk and limbs. Complete local excision is considered to be adequate treatment.


[Pathological we-formation and dominance shifts in symbiotic psychoses]. The case history of symbiotic psychosis observed in a mother and her daughter is used to demonstrate the causes of origin of such forms of psychosis, the emphasis being on the description of a rare case of change of dominance. The paper also discusses the reactions shown by person coming in contact with such sychotics and, more particularly, by the partners of individuals with delusional symptomatologies.


[Experience with special classes for mildly brain-damaged children with behavior disorders]. Within the framework of a large-scale medical and pedagogical experiment conducted at Rostock, two special education classes for second graders were set up at the start of the 1965/66 school year in an attempt to prevent children with cerebral lesions from failing to pass courses already in the lower grades at elementary schools. As a result of this experiment, it was decided to start a school for special education children, and this school now has two parallel classes each for second, third, and fourth graders as well as one additional class in which pupils are prepared for the fifth normal education school grade. Psychological tests made as part of a longitudinal study in which 48 children who had been to this school from 1965, 1966, and 1967 were included and which spread over years including the 1971/72 school years, showed an improvement in motor development with slightly retarded intellectual development and unchanged lack of concentration power. Average attainments in the various subjects improved while pupils were attending special education classes and did not, after reintegration of such children into normal schools (fifth grade), drop below the general level of proficiency.


[Symptomatology and pathogenesis of Fisher's syndrome]. The symptomatology of Fisher's syndrome is described with reference to observations made on six own cases as well as to fifty cases described in the literature, and it is shown that, first, ataxia is not an obligatory symptom and that, second, symptoms are an expression, not of a lesion of the brain stem, but of an affection of the peripheral neuron.


[The problem of latent neuropathy in essential hypertension]. A neurographic examination of 54 patients with essential hypertonia did not reveal any significant differences, from a control group, in the maximum rate of motor conduction of the ulnar nerve. An assocation of subclinical neuropathy with essential hypertonia cannot, therefore, be confirmed, thus denying the statement made by Viskoper and his coworkers and saying that the motor nerve conduction speed was an objective index for determining the severity of diseases characterized by hypertension.


Some thoughts on the ego ideal. A contribution to the study of the "illness of ideality". Man searches continuously for the time when he was his own ideal--a time that is coincident with primary fusion with the mother. The fantasy of this fusion underlies the incest wish. Because of his helplessness, the child must postpone the realization of his incest wish and project it forward into the future. However, if the subject chooses the pathway of the oedipus complex and identification with the father to realize his incestuous fantasy, circumstance may lead him to circumvent the oedipal shpere and, through the mechanisms of regression, return to the mother of primary fusion. As in Aesop's adage, the ego ideal is at the source of the best and the worst of things.


A note on internalization as process.

A note on internalization as process. To the view of internalization as fantasy, there is counterposed the view of internalization as process. The philosophical roots and basic argument of the "fantasy" view are evaluated, particularly in reference to the position of metaphorical terms in psychoanalytic theory. Especially confusing is the literal interpretation of metaphors of spatialization distinguishing the inner dimensions of psychic experience from external referents. The persistent theoretical need is to translate metaphorical usage into meaningful and consistent theoretical terms. The organization of introjects cannot be reduced to memory elements, object representations, or fantasy products. Internalization as process refers to a series of real psychological events whose specific delineation and description has not been accomplished.


On parallel processes in therapy and teaching. Using the format of a continuous case conference, the authors demonstrate that the therapist-presenter develops unconscious identifications with the patient which are especially intense when difficulties (resistances) arise which he cannot resolve. The presenter then enacts these identifications in the seminar giving rise to responses from the seminar members which repeat the difficulties of the therapy. These parallel processes can be made explicit by eliciting the empathic responses of the seminar participants. By interpreting these parallelisms the authors have evolved a teaching methodology which, like therapy itself, provides an emotionally based learning experience for the participants.


Some problems in faculty selection of patients for supervised psychoanalysis. The selection of patients for supervised analysis by candidates involves special tasks in evaluation and prediction. A number of problems emerge when the entire faculty of an institute participates in evaluating such patients. These include the different ways in which the initial consultant and the Admitting Psychoanalyst view their roles; insufficient consideration given to the specific criteria of suitability for analysis by a candidate; and the tendency to emphasize oedipal pathology while overlooking relevant ego capacities.


A psychoanalytic model for human freedom and rationality. The nature and scope of freedom and rationality in man are explored in light of the problems posed by a deterministic framework for understanding and explaining human though, feeling, and behavior. It is argued that the sort of explanation afforded by a psychodynamic theory is fully compatible with attributing freedom and rationality to persons. In particular, psychoanalytic theory is able to account for the existence of causal laws governing all aspects of human behavior, while providing a schema by which we can distinguish rational from irrational behavior, and free acts from those that are unfree.


Sex differences in sympathetic-adrenal medullary reactions induced by different stressors. Male and female university students were exposed to two different stressors in each of two 110-min sessions, i.e., a cognitive task (color-word conflict) and repeated venipuncture. Catecholamine excretion, heart rate, and subjective reactions were  measured. Control values were obtained under conditions of relaxation in the laboratory. Subjects of both sexes responded to both stressors by increased heart rate and feelings of unpleasantness and distress. The pattern of adrenaline excretion, however, differed between sexes: in males both stressors induced a significant increase, whereas in females adrenaline excretion remained on the same level under the two stress conditions as during relaxation; Noradrenaline excretion was not systematically affected by either stressor in either sex group.


Hypothalamic chemostimulation and autonomic changes in curarized rats. Rats previously implanted with chronic double walled cannulae aimed at the lateral hypothalamic area (LHA) ate and drank reliably after minute injections of norepinephrine and carbachol respectively. Later on the rats were curarized and artificially respirated. After an habituation period during which rectal temperature, cardiac rate and peripheral vasomotor activity were continuously recorded, half of the subjects were injected with 1 mul of norepinephrine (40 x 10(-9) moles) and the other half with 1 mul of carbachol (2.4 x 10(-9)moles). Both drugs elicited hypothermia, bradycardia and vasodilatation. Bradycardia after carbachol was significantly greater than after norepinephrine and hypothermia and vasodilatation after norepinephrine were significantly greater than after carbachol. When the treatments were reversed essentially the same effects were observed.


Decreased intracranial self-stimulation after neuroleptics or 6-hydroxydopamine: evidence for mediation by motor deficits rather than by reduced reward. Rats were implanted with electrodes in the lateral hypothalamus, put on a 22-h food deprivation schedule and trained to bar-press for ICS and for food on a CRF schedule. Haloperidol (0.08 mg/kg) and pimozide (0.22 mg/kg) significantly decreased responding for both reinforces, although responding for ICS was decreased more than it was for food. The same doses of these drugs did not decrease food consumption of a 15-min ad libitum test after 22-h of food deprivation, suggesting that the decreased bar-pressing for food was not the result of anorexia or reduced motivation for food. When similar rates of responding for ICS and for food were obtained on a V1 60 schedule, haloperidol (0.1 mg/kg) reduced responding for food and ICS to a similar extent. Thus, when baseline rate is controlled for, neuroleptics do not selectively reduce responding for ICS. In addition, examination of cumulative response records revealed that rather than producing an extinction curve, as would be predicted if neuroleptics reduced the rewarding properties of ICS, haloperidol produced a uniform decrease in the rate of responding throughout the experimental  session. Similar results were obtained with intraventricular 6-hydroxydopamine (6-OHDA) injections. While these experiments do not exclude the possibility that dopaminergic (DA) systems participate in some central reinforcement mechanisms, they suggest that neuroleptics and 6-OHDA decrease responding for food or ICS primarily by impairing the function of DA systems critically involved in the initiation or maintenance of operant behaviour rather than by interfering with reward.


Effects of drug-state change on discrimination performance. A single dose of d-amphetamine (0.25, 0.50, or 1.00 mg/kg), administered in 5 successive sessions, did not seriously impede the discrimination performance of male Holtzman rats under cued reinforcement conditions. A 2.00 mg/kg dose, however, produced a total cessation of operant behavior. In 2 post-drug (saline) sessions, groups previously treated with 0.50 or 1.00 mg/kg demonstrated an initial decrement and subsequent recovery in performance. A second experiment demonstrated that rats administered either saline or 0.50 mg/kg d-amphetamine for 5 successive sessions showed a decrement and subsequent recovery in performance when switched to the opposite treatment condition for the next 2 sessions. These data may be explained in terms of a change in drug state.


Salsolinol differentially affects mice selected for sensitivity to alcohol. Salsolinol, a compound putatively formed following alcohol ingestion, differentially decreased the activity of lines of mice after 18 generations of genetic selection for alcohol sensitivity. Low doses of salsolinol produced significantly lower activity levels in the alcohol-sensitive long-sleep (LS) line than in the alcohol-insensitive short-sleep (SS) line. A hypnotic dose of salsolinol induced significantly longer sleeptimes in the LS line than in the SS line. Results are interpreted as supporting the hypothesis that salsolinol-like substances may mediate some of the effects of alcohol on the central nervous system.


Barbital alteration of central nervous system sensitivity to hexobarbital in the rat. Alteration in central nervous system (CNS) sensitivity to the hypnotic effect of the hexobarbital was assessed by analytical, electroencephalographic, and pharmacokinetic techniques in barbital-treated rats. Each of these conceptually diverse experimental methodologies yielded similar conclusions concerning the alteration of CNS sensitivity by barbital treatment.


Brain acetylcholine concentration and acetylcholinesterase activity in selectively-bred strains of rats. Significant differences in whole brain and in brain area acetylcholine concentration have been observed between the two strains of rats selectively bred for differences in speed of acquisition of conditioned avoidance. Brain acetylcholinesterase activity was similar in the strains. The strain showing poor conditioned avoidance behaviour possessed the highest brain concentration of acetylcholine. The finding supports a theory which describes a central cholinergic inhibitory system which may be active in the control of certain types of learning behaviour.


The influence of 241-Am and DTPA on morphometric parameters of the rat femur. Microradiographically detectable alterations of the bone structure in the femur of young rats induced by monomeric 241-Am(III) (i.v., 30 muCi/kg) were studied. The morphometric and dosimetric measurements were carried out by means of an electronic image analyzer. 8 weeks after injection of 241-Am a characteristic alteration of the frequency distribution of the chord lengths over the trabeculae in the epiphysis and over the metaphyseal marrow spaces was found. The structure of the spongiosa is irregular with both large, coarse and small fragmented trabeculae. The complexity of the bone architecture and the area of the endosteal surfaces is reduced. The surface/volume ratio in control animals varies between 36 mm-1 in the epiphysis and 64 mm-1 in the region of the epiphyseal cartilage plate. From the specific surface burden (pCi/mm2) the average dose rates were determined. There is no significant difference between the calcified tissue fraction in controls and animals with 241-Am, with the exception of the metaphyseal band where the locally high dose rates cause a devitalization of the tissue with inhibition of bone resorption as well as an abnormal trabeculation in the metaphysis. Treatment by Ca-DTPA reduces the 241-Am deposition nonuniformly and the pathological manifestations are markedly less pronounced. The mean trabecular width is about 100 mum in the epiphysis and has a minimum of 40 mum in the central part of the epiphyseal plate. The mean chord length over the marrow spaces varies between 90 and 210 mum.


Heritable chromosome aberrations in mammals after exposure to chemicals. The observation of dividing spermatocytes is routinely used to detect the induction of heritable chromosome aberrations such as reciprocal translocations in the treated animals or in their F1 offspring. 37 compounds have so far been tested for the induction of chromosome rearrangements in spermatogonia. Only 9 gave positive results. However, positive results were observed for all alkylating agents in the F1 test. From these observations it can be concluded that the spermatogonia which are the main germ cell type at risk represent a relatively safe germ cell stage.


Rate constants for nitrification and denitrification in soils. Rate constants for reactions in flowing solutions in soil can be calculated from extents of reactions as functions of depth, rates of flow, effective biomass of microbes and independent measurements of hydrodynamic dispersion. Constants have been calculated from data in the literature and are shown to be arbitrary unless all of these quantities have been evaluated. Good agreement of constants obtained in laboratory columns and in the field have been obtained for nitrification and denitrification in a few cases.


Selective radiolysis of enantiomers.

Selective radiolysis of enantiomers. The gamma-induced decarboxylation of beta-phenylalanine in the solid state is a chain reaction. Both enantiomers and the racemate of beta-phenylalanine-1-14C show different exponential dose-effect curves for the radiation-induced cleavage of 14CO2.


Effects of osmomolarity, calcium and magnesium ions on the structuredness of cytoplasmic matrix (SCM). The involvement of intracellular water content, calcium and magnesium ions in changes of the structuredness of cytoplasmic matrix (SCM) in human lymphocytes was investigated with the technique of fluorescence polarization.


Photochemically induced cross-links between DNA and alcohol dehydrogenase or salmine, respectively. Model experiments with two structurally different proteins (alcohol dehydrogenase and salmine) show that glycine, alanine, and tyrosine are by far more frequently involved in photochemically induced cross-link formations with DNA than is cysteine. The yields for cross-link formation of thymidine with salmine (cysteine-free) are about as high as those with alcohol dehydrogenase (athiol protein).


Radiation effects of poly(L-glutamic acid) and poly(L-lysine) in the helix-coil transitional state. The degradation of poly(L-glutamic acid) and poly(L-lysine) by X-rays and ultraviolet radiation has been studied at various pH values, including the helix-coil transition region. It was found that X-rays cause maximum degradation in the transition region for both polypeptides, indicating that the efficiency of degradation is affected not only by the secondary structure but also by some other factors related to the transition. On the contrary, the degradation by monochromatic ultraviolet 2537 A radiation showed a strong dependence on helix content of PLGA, suggesting that degradation occurs more effectively in the helical form than in the coil form. Theoretical calculations were made to approximate the pH dependence of degradation, assuming different cross sections for the peptide bonds in helix, coil, and junctions between helical and coil regions.


The influence of the counter wall and the counter shape on the spectral energy deposition in small volumes by 60Co gamma-rays and 200 kV x-rays. The spectral energy deposition in small volumes by 60Co gamma-rays and by 200 kV X-rays was measured with a walled spherical counter, a walled cylindrical counter and a wall-less cylindrical counter. The simulated volumes had dimensions of 0.1--3 mum. By comparing the spectra of the spherical and cylindrical walled counters the influence of the counter shape is derived. The wall effect is discussed by comparing the spectra and the mean lineal energy measured with the walled and the wall-less cylindrical counters. The influence of the counter size and of radiation quality on the energy deposition spectra is also analysed.


A nondestructive method for measuring electrical conductivity of intracellular matter of tissue in situ. A nondestructive method has been developed for measuring electrical conductivity of intracellular matter. The method is based on easily measurable electric parameters of cells in suspension. Experiments were made using suspensions of erythrocytes in a physiological salt solution. Results confirmed suitability of the method for determining conductance of the cytoplasm and were in close agreement with those reported by other authors. The method allows the determination of intracellular conductivity in tissue as well.


The in vivo effects of 2.45 GHz microwave radiation of rabbit serum components and sleeping times. An investigation was conducted to determine the effects of relatively low power density microwave exposures on various serum components of the Dutch rabbit. Both continous wave and pulsed mode exposures at 2.45 GHzwere used at power densities of 25,10 and 5 mW/cm2. Studies of 10 serum components were performed. Additional studies were conducted on changes in sleeping times of pentobarbital-sedated rabbits at various power densities. Gross and histopathological examinations were performed on representative samples of animals. Changes in the blood chemistry of irradiated animals were consistent with a dose-dependent response to a non-specific thermal stress at all power densities used. Observed physiological response, as well as rectal temperature measurements, indicated that the thermoregulatory capability of the rabbits was sufficient to compensate for the thermal burden at 5 and 10 mW/cm2, but could be overridden by a 2 h exposure at 25 mW/cm2. Pathology findings included a mild, repairable nephrosis in animals exposed at a power density of 25 mW/cm2. A further investigation of analeptic effects at power densities varying from 5 mW/cm2 to 50 mW/cm2 resulted in a statistically significant decrease in sleeping times, apparently proportional to power density below 15 mW/cm2.


[Pathology of renal tuberculosis (author's transl)]. Introduction of specific chemotherapy and vaccination leads to a remarkable recession of renal tuberculosis in the younger age group. Renal tuberculosis is the result of a haematogenous spread of tubercle bacillus. Haematogenous spreading occurs immediately after primary infection, or, in elderly patients, in combination with recurrency of tuberculous foci in lungs and hilar-lymphnodes. Simultaneous metastasis in the skeleton, especially in the vertebrae, are observed in 30%. The incubation period between tuberculous spread and clinical manifestation of renal tuberculosis lasts several years, in the average 5-8 years, for calcareous kidneys it may last as long as 20 years and more, for tuberculous pyelitis only a few months. Today it is possible to treat renal tuberculosis with drugs (Streptomycin, PAS and INH). In 13% the cicatrisation is combined with obstruction of calices and partial hydronephrosis, in 7% with obstruction of the ureter and total hydronephrosis. Early chemotherapy may prevent the development of tuberculous hydronephrosis.


Biological effects of diagnostic irradiation. Medical radiation continues to be an area of concern to the patient. However, the technologist can reassure him that trained operators apply the radiation and that there are many built-in and accessory safety factors. Beyond that, however, the technologist can reassure himself that he is not responsible for unnecessary radiation by making full use of all safety measures, whether they are part of or accessory to the equipment, or are part of his judgment as to technique. To do this, he needs a sound knowledge of how damage occurs and a continual updating on research and equipment that will make his reassuring words to the patient honest ones.


[Roentgen diagnosis of renal tuberculosis (author's transl)]. Roentgenologic procedures are of limited value, compared with other possible examinations. Early radiologic diagnosis is made rarely. Roentgenologic procedures are important for demonstration of successful treatment and for legal documentation. Excretory urography is effective only in combination with zonography and ureteral compression provided the amount of injected contrast medium is sufficient. Angiography is important in progressive or silent renal tuberculosis, especially in cases of a partial or complete non-functioning kidney. Difficulities in differential diagnosis are possible in unspecific pyelonephritis and malignant tumors.


Effect of operator training on patient exposure: an analysis of the NEXT data. The Nationwide Evaluation of X-ray Trends (NEXT) program has obtained data from various states on the physical factors related to patient radiation exposure from several common radiographs. Data from two years were examined for exposure, beam area/film area and exposure area product delivered to a "standard patient." The data were examined for differences as a function of operator training.


[Angiography of urotuberculosis (author's transl)]. 119 kidneys demonstrating changes consistent with renal tuberculosis were studied in a total of 94 patients by means of selective, transfemoral renal antiography. In the first stage of the disease, this method detected parenchymal involvement which could not be visualized by excretory urography. In stage II the arcuate arteries and occasionally the intralobular arteries, showed typical changes. Cavitation, pathognomonic for the presence of renal tuberculosis were found in 39.3% of these cases. In 40% of the cases the angiographic findingd were more extensive than the apparent findings of excretory urography. Angiography, thus, can render valuable information pertaining to the course of the disease and the necessity of operative intervention. Stage III was usually characterized by extensive changes specific for parenchymal destruction. Typical vascular lesions were readily recognized. Cavitation was found in 86.5% of these cases. Tortuosity and dilatation of the renal pelvis- and/or ureter-arteries revealed evidence of ureteral involvement (stage III2). In the presence of a non-functioning kidney angiography is mandatory to rule out renal aplasia and to differentiate between a kidney destroyed by other disease processes and the complete cavitary destruction of end-stage renal tuberculosis (stage III3).


[Clinic of Urotuberculosis (author's transl)]. Most of all cases of extrapulmonary tuberculosis i.e. 35% are urogenital tuberculosis UGT. A shifting of morbidity to older age Groups could be ascertained. 1164 cases were evaluated, 684 in a combined medicamentons - operative manner. Of the conservatively treated Group were 283 males and 197 females; the relation of the sexus in the other group is roughly the same. The frequency has a maximum in the forth decade. Whereas most of 90 patients, who have been in stationary treatment in April 1975, were between 40 and 60 years old. The pathogeny of the UGT is shown according to the scherne of Gloor. Most of the initial Symptoms (26.5%) are dysuria, the mext are hematuriae and ache of the flanks. On an average 1-2 years pass from the first appearance of symtonis to the time of diagnosis. The diagnosis can only be verified by evidence of Tbc-bacteria in cultures and biological experiments or through histological appearance. Essential informations on localisation and expansion are obtained by x-ray examination, that is urograms and urethrocystograms. Angiography and side-disconnectet isotope clearance are importantant additional examinations. According to the results of the x-ray examinations the stages can be ascertained: Stage I: parenchymal-ulcerated pattern - Stage II: ulcerated-cavernous pattern - Stage III: totally-destructing tuberculosis, tbc-pyonephrosis, Special terms characterize the obstructions of the urinary tract. For the therapy the following polity can be proposed: Stage I: chemotherapy - Stage II: chemotherapy, perhaps backed by conservative operative treatment - Stage III: chemotherapy and nephro-ureterektomy.


[Generalized skeletal dysplasias (author's transl)]. Skeletal Dysplasias are an important cause of short stature. Their overall frequency is unknown; their individual number exceeds 80. Prognostic and genetic counseling depend on a correct diagnosis of the specific bone dysplasia. Specific radiographic diagnoses are also needed for the meaningful interpretation of forthcoming histological, ultrastructural and biochemical studies which will help to elucidate the pathogenesis of skeletal dysplasias as prerequisite for a causal therapy.


[Which films should be taken? Suspicion for congenital skeletal dysplasia (author's transl)]. Clinical signs and roentgenologic alterations are important for classification of congenital skeletal dysplasis. It is summarized which skeletal parts are most important for the roentgenographic determination of bone dysplasia. A minimal survey includes films of the vertebral column (lateral projection of the pelvis, hand, knee and skull (lateral projection). A schematic presentation demonstrates the vertebral column lesions in the most important congenital skeletal dysplasias.


Advisory committees: free advice--for a price. Although it is understood that an advisory committee is "a group of persons outside the educational institution chosen from the community to advise those who are responsible for the planning, implementing, and maintaining of an educational program in radiologic technology that will meet the needs of a community, region, state, or nation," it is advice we buy at a price. No, the price is not in monetary values, but the price of forethought, planning, good organization and effective use of that committee.


[Importance of hand films in skeletal dysplasia (author's transl)]. The hand, as part of the skeleton, is generally involved in systemic skeletal dysplasia. However, the degree of abnormalities differs considerably in the various types of dysplasia. In some, abnormal appearance of the hand predominates, in other dysplasia films of the hand provide only little or no useful diagnostic information. At their first examination for growth disorders children often reveal bone dysplasia on roentgenograms of the hand. Therefore, evaluation of hand films should be done as thoroughly as possible. Morphologic and/or metric deviations of the hand may bring the first suspicion although they are not fully diagnostic. Systemic skeletal dysplasia should be diagnosed or excluded by additional adequate radiologic and other clinical examinations.


[The so-called chondrodystrophia of the newborn (author's transl)]. Chondrodystrophia (now: Achondroplasia) formerly believed to be a uniform disease rather is an entity comprising up till now at least ten radiologically differing types. Definite diagnosis of these types can only be made radiologically although certain clinical features are of additional help. For practical purpose a schematic representation of these types is given, based upon the classification of congenital osteochondrodysplasias by the ESPR (European Society of Pediatric Radiology, Rome, 1969). It emphasizes the characteristic radiological signs and describes the typical changes in body proportions. In a second part the single diseases are discussed according to the scheme with their radiological differential diagnosis and their prominent changes in the skeletal system. Some examples are given for possibly associated malformations and final prognosis.


[Radiological diagnosis (and differential diagnosis) of lethal type (congenital type) of hypophosphatasia (author's transl)]. Diagnosis of Hypophosphatasia can be proved by typical radiological findings. The paper presents a case report of a newborn living only a few hours. Diagnosis according to clinical aspect was "Osteogenesis imperfecta" although a postmortal x-ray-babygram was available but which had not been shown to a radiologist. Anatomical diagnosis with the histological findings was then altered to "Metaphyseal chondrodysplasia, Jansen-type". Finally the diagnosis could be corrected to congenital, lethal type of Hypophosphatasia after the babygram had been shown to a radiologist. The typical radiological features of congenital Hypophosphatasia are described subsequently and differential diagnosis of Congenital Osteochondrodysplasias is discussed. The importance of early or postmortal diagnosis for genetic counselling is stressed as well as a close cooperation between obstetricians and pediatric radiologists. Typical biochemical findings are mentioned.


[Measurement of the absorbed dose to the patient by computerized whole-body x-ray tomography with the aid of thermoluminescence dosimeters in an Alderson-phantom (author's transl)]. Radiation dosis for brain, lung, liver, and kidney examinations which were performed with computerized wholebody scanner (Ohio-Nuclear, 120 KV, 30 mA) was measured by LiF-TLD in the Alderson-Phantom. The absorbed skin dosis to the trunk by a single scan (filtration 6 mm A1) was found to be 1.2 rd at the entrance and 90 mrd at the exit. Patient investigations were simulated with a series of 5 scans. Under those conditions the maximum abdominal entrance dosis is 1.8 rd, at the body axis 700 mrd and near the exit 250 mrd. In this example the dosis to the gonads is less than 2 and 4 mrd, if the distance is more than 15 cm between the last scan and the gonads. Scattered radiation in the Delta-Scan room during an investigation is 1.5 mR/scan and 0.3 mR/scan for a distance of 1 m and 2 m from the irradiated volume.


[Ultrasonic diagnosis in diseases of kidneys (author's transl)]. The diagnostic value of echoscopy and echography in kidney disease is presented and illustrated. Ultrasound examination is primarily used for the differentiation of cystic and solid lesions of the kidney. Our personal experience and the recent literature on this problem is reviewed. Based on the overall diagnostic accuracy of more than 90%, a procedure to investigate space occupying lesions of the kidney is suggested. The indication for ultrasound scans in obstructive kidney disease and the unilateral nonexcreting kidney is briefly discussed.


[Gray-scale ultrasongraphy of the liver and gallbladder (author's transl)]. Better structural imaging of the liver with blood vessels can be achieved using the Gray-scale technique which delineates pathological processes better than the conventional B-scan-method. This technique enables a reliable diagnosic information. Due to its non-invasive character it can be utilized as a screening method or as an alternative or complementary examination to invasive methods.


Echography of suprarenal masses.

Echography of suprarenal masses. Ultrasound is used in evaluation of suprarenal rumors. Results are compared with angiographic and surgical findings. A practical approach is proposed.


[Importance of sonotomography in radiation therapy (author's transl)]. Ultrasound tomography provides true scale representation of body contours and organ structures. The image supplies substantial, individual geometrical data, essential for computerized radiation treatment planning. The mehtod is described. Typical planning examples for therapy are demonstrated. The value of follow up sonograms for radiation therapy is described. The limitations of the method are pointed out.


[Examination of the breast with ultrasound: limits and possibilities (authro's transl)]. Following a brief introduction to ultrasound the advantages and disadvantages of this examination are presented with regard to differentiation of benign and malignant tumors of the breast. This method is unsuitable for screening because of its present technical failures: its only importance lies in the differential diagnosis of benign lesions. These statements are based upon the case material of the Department of Gynecology and Radiology of the Postgraduate Medical School of Budapest.


The vagus reaction as a possible cause of severe complications of radiological procedures. Six severe reactions which appeared to be mediated via the vagus nerve were encountered in the course of various radiological procedures. Four patients were treated with intravenous atropine and responded successfully. The vagus reaction is proposed as a possible mechanism of death in the "allergic" reaction to contrast media seen during radiological procedures. This phenomenon and its treatment and prevention are discussed, as is its difference from the histamine effect.


Localized spinal cord atrophy: significance of its demonstration. Localized spinal cord atrophy was demonstrated in 6 cases by gas myelography. All of the patients had neck injuries with subsequent impairment of neurological function. Three representative cases are reported in full, and the remainder tabulated. The significance of the demonstration of this condition is discussed.


Brain scanning with the Anger multiplane tomographic scanner as a second examination evaluation by the ROC method. One hundred and one patients (43 abnormal, 58 normal) were re-examined with a commercial prototype of the Anger multiplane tomographic scanner after brain scintigraphy. The studies were interpreted independently by four observers of varying experience. Observer performance, in terms of ROC curves, was substantially better when interpreting the tomographic brain scans and camera scintigrams together or the tomographic scans alone than when interpreting the camera images alone. Re-examination with the scanner increases the accuracy of brain scintigraphy (observer performance) in cases in which there is difficulty distinguishing intracranial lesions from superficial foci of activity by camera scintigraphy alone.


Brain scanning with the Anger multiplane tomographic scanner as a primary examination. Evaluation by the ROC method. A commercial prototype of the Anger multiplane tomographic scanner was compared with a scintillation camera, in terms of observer performance, as a primary instrument for brain scintigraphy. Observer performance (diagnostic accuracy), expressed as ROC curves, was slightly better when reading the tomographic scans than when reading the camera images. In brain scintigraphy of a general population, the scanner has a small advantage over the scintillation camera. This advantage is directly proportional to the fraction of cases in which there is difficulty differentiating intracranial lesions from superficial foci of activity on the camera image.


Myocardial imaging with radionuclide-labeled particles. Analysis of the normal image, abnormal image, and technical consideration. Myocardial imaging following the direct injection of labeled particles is  an effective and safe method of studying regional perfusion. Perfusion defects can conveniently be classified as apical, anterior, inferior, or posterior and related to the distribution of specific coronary arteries. The hemodynamic effects of contrast material, inadequate mixing of particles, coronary anatomy, and associated cardiac pathology are important technical considerations affecting the performance and interpretation of studies using this technique.


Persisting perfusion defects after bronchoscopic removal or spontaneous expulsion of aspirated foreign objects. Follow-up lung scans were obtained in 9 children to determine whether perfusion lung scanning could be used to verify completeness of foreign-body removal. In 4 patients, extensive perfusion defects were present 4-19 days after removal of the object. In 1 patient, the area of hypoperfusion was larger than the territory served by a persistently obstructed lobar bronchus. Follow-up lung scans are of limited value for verifying completeness of foreign-body removal and localization of retained fragments.


Upper airway obstruction in infants and small children. Improved radiographic diagnosis by combining filtration, high kilovoltage, and magnification. Selective filtration, high kilovoltage, and fine focal spot magnification produce detailed radiographs of the airway of infants and small children. This technique has been applied to the study of upper airway obstruction in the glottic, subglottic, and supraglottic areas. Its great diagnostic yield is accompanied by a reduction in radiation dose compared to that of a nonfilter technique. The physical factors dictating choice of filter and film-screen combination are discussed.


Antegonial notching of the mandible: an often overlooked mandibular deformity in congenital and acquired disorders. Mandibular antegonial notching is a concavity of the undersurface of the body just anterior to the angular process (gonion) seen in congenital and acquired disorders. The notch tends to be longer in the congenital than in the acquired state, and the ascending ramus is at a more obtuse angle to the body.


Vertebral sarcoidosis in adolescents.

Vertebral sarcoidosis in adolescents. Two cases of vertebral sarcoidosis in pediatric patients are presented. All such patients reported have been black, 13-15 years old, and have a history of back pain. Radiographs of the involved vertebrae show primarily lytic destruction with sclerotic borders in some of the lesions. Fungal infections, tuberculosis, pyogenic osteomyelitis, Hodgkin's disease and metastatic disease must be considered in every patient with vertebral sarcoidosis.


Papillary necrosis in a child with homozygous sickle-cell anemia. A 4 1/2-year-old girl with S-S sickle-cell anemia was found to have papillary necrosis on excretory urography. This is believed to be the first reported case of papillary necrosis in a child with homozygous S-S sickle-cell anemia.


Gray scale shifts in ultrasound displays. Shifts in the displayed shades of gray were found in the initial evaluation of a gray scale ultrasound display. Quantitative measurements of these shifts were performed. These measurements, along with measurements of scan converter output and photographic exposure time, established television (TV) performance as the major cause of shifts. Random variations in photographic exposure time were shown to cause small random shifts. Recommendations are given to minimize the effects of these shifts in clinical sonograms. To minimize shifts, hardware modifications were made on a similar TV. These modifications substantially improved the TV performance.


A reappraisal of sonolucent renal masses. The authors present a differential diagnosis of echo-free renal masses and emphasize that such lesions are not always simple cysts. Of 312 renal sonograms, 15 showed sonolucent masses which proved to be something other than a simple cyst. Pathological diagnoses included abscess, hematoma, renal artery aneurysm, hydronephrosis, and homogeneous or cystic tumor. To achieve optimal diagnostic accuracy, it is insufficient to rely solely on sonolucency as demonstrated on the sonogram. Any disparities in the radiological, clinical, or ultrasonic findings demand further evaluation. Nephrotomography, angiography, aspiration biopsy, or exploration should be selected in a sequence which is appropriate to ensure correct diagnosis while minimizing the risk to the patient.


Inflammatory carcinoma of the breast.

Inflammatory carcinoma of the breast. Eighty-six patients with the clinical features of inflammatory carcinoma of the breast (erythema, peau d'orange, wheals or ridges) were treated with irradiation for potential cure between July 1948 and December 1970. Long protracted irradiation alone with a strong skin reaction offers 50% local control, which is the best rate yet reported. Any surgical procedure beyond biopsy is probably damaging: all patients subjected to mastectomy developed distant metastases and died. Ninety per cent of the patients were dead by five years and only 3 patients remain alive without evidence of disease 7, 10 and 14 years after radiotherapy. Analysis of survival rates, incidence, sites and times of appearance of local recurrences, and distant metastases is presented.


Endodermal sinus tumors of the ovary in children. The role of radiation therapy in relation to the clinical course. Endodermal sinus tumor of the ovary in children has been characterized by its general resistance to therapy and its almost uniform fatality. The multidisciplinary treatment of 5 such cases is described. The author's experience suggests that these tumors are responsive to irradiation. The rationale for a combined approach is discussed, and radiation treatment volumes and doses are suggested.


The effect of prednisone and irradiation on the rectum in dogs. In an attempt to diminish the severity of the acute and late effects of irradiation to the rectum of dogs, oral prednisone was administered to 10 dogs for 1 week prior to, during, and for 1 month following a 3-week fractionated course of 60Co exposures to the pelvis. A control group of 10 dogs received irradiation alone. The dogs were observed clinically, serial rectal biopsies were done during and following the acute reaction, and the rectum was studied following sacrifice. Observations suggest that prednisone has no beneficial effect on the acute inflammatory reaction, and increases the severity of the late tissue damage.


Visualization of differences in soft-tissue densities. The liver in ascites. The lateral liver border was demonstrated on the plain radiograph in 54 of 100 proved cases of ascites. The etiology of ascites, the density of the fluid, and the total protein content were similar whether the border was visualized or not. Tomography of the right upper quadrant indicated that the lateral liver margin is visualized in ascites as a result of contact between the liver and the surrounding fluid. Radiography of autopsied livers submerged in fluid demonstrated distinguishable differences in object density, and photodensitometry of the plain radiographs revealed a difference in blackness where the fluid and liver made contact. Comparison of mean liver density and mean ascitic fluid density showed a difference of 5%. These findings indicate that differences in soft-tissue densities (excluding fat) can be distinguished on the plain radiograph.


Electronic grids for electrostatic imaging systems. Electronic grids have been substituted for conventional grids in an electrostatic imaging system and have been useful in chest radiography. Electronic grids also appear to be useful for clean-up of small amounts of scattered radiation in radiographs of the extremities. More clinical work is needed before a statement about the use of electronic grids for other examinations can be made.


Direct chronotropic and dromotropic actions of contrast media: ineffectiveness of atropine in the prevention of bradyarrhythmias and conduction disturbances. Methyl glucamine sodium diatrizoate (Renografin 76) was directly infused into the isolated arteries to the sino-atrial and atrioventricular nodes of anesthetized dogs, causing a dose-related inhibition of sino-atrial nodal automaticity and atrioventricular nodal conductivity; these effects were not attenuated by autonomic blockade or cervical vagotomy. The important negative chronotropic and dramatropic effects of contrast media used for coronary angiography are direct actions and cannot be effectively blocked by premedication with atropine.


The diagnostic quality of optically processed radiographs. The diagnostic quality of optically processed radiographs was compared with that of unprocessed radiographs, using the number of lesions detected as a criterion. It was found that merely removing phase-shifted information with either a binary or focal spot filter alone did not improve image quality, however, use of the focal spot filter plus removal of all phase-shifted frequencies did lead to the detection of an increased number of lesions. The authors suggest that currently available optical filtration techniques should be evaluated with caution, as they may actually degrade diagnostic quality by increasing the visibility of phase-shifted information.


Film mammography: new low radiation technology. A new mammographic technique with Kodak MIN-R film and a Kodak MIN-R screen in a vacuum package has been evaluated in 607 cases. Direct mammographic comparison is made with the Du Pont Lo-dose system in the first 101 patients. The system provides excellent diagnostic quality images with at least a two-fold reduction in patient exposure compared to other current mammographic techniques.


Percutaneous transhepatic cholangiography utilizing the Chiba University needle. Percutaneous transhepatic cholangiography with the Chiba University needle has been performed in 42 patients with cholestasis. The examination was successful in 100% of patients with dilated intrahepatic bile ducts and in 89% of those with normal-size ducts. Complications were minimal. The results of this study suggest that PTC with the Chiba needle is superior to the current conventional methods. The patients with intrahepatic cholestasis, which often simulates extrahepatic biliary obstruction, were spared an unnecessary laparotomy.


Opinion: Caveat doctor: the x-ray collimator industry takes a giant step backward. Markedly improved imaging of the upper airway in infants and children with magnification high kVp technique is accomplished with added heavy filtration. Unfortunately, in the newer x-ray collimators, no slot is provided for this purpose. The authors can think of no reason, medical, physical or economic, as to why a simple slot cannot be provided. A few manufactures make machines with the added filter slot; all radiologists are urged not to neglect this information when selecting new equipment.


Subpulmonic pneumothorax in patients with chronic obstructive pulmonary disease. A spontaneous pneumothorax is occasionally seen under the lung on upright views, apparently due to subpulmonic trapping of pleural air by adhesions. This is most likely to occur in patients with chronic obstructive pulmonary disease (COPD), especially if they have extensive parenchymal scarring from previous tuberculosis. The authors describe 4 patients who had subpulmonic pneumothorax, severe COPD, and parenchymal scarring and presented in respiratory failure. None had other clinical symptoms suggesting pneumothorax. Radiologists should be aware of this condition, since it is potentially lethal.


Post-traumatic pneumatocele in the inferior pulmonary ligament. Pneumatocele localized to the inferior pulmonary ligament is an uncommon sequel of blunt chest trauma. Three such cases are reported and the characteristic location and appearance of the pneumatocele, as well as its benign course, are discussed. A similar radiographic appearance has been produced in cadavers by injecting air into the inferior pulmonary ligament.


Thoracic manifestations of renal cell carcinoma. Over 1/3 of patients with renal cell carcinoma will present with metastases with no symptoms referable to the kidney. Early metastatic disease is a result of the unique accessibility of the kidney to lymphohematogenous pathways. The thorax is particularly vulnerable. Several of the more unusual manifestations involving the thorax are illustrated, including 1 case with intra-alveolar metastases.


Bilateral pulmonary hilar lymphadenopathy. An unusual manifestation of metastatic renal cell carcinoma. Four patients with bilateral pulmonary hilar adenopathy secondary to lymphangitic spread from renal cell carcinoma were examined. Two additional cases had adenopathy secondary to nasopharyngeal carcinoma. Patients may initially present with bilateral pulmonary lymphadenopathy or as late as 3 1/2 years after the discovery of the primary renal tumor. The mechanism of lymphangitic spread probably is related to reflux of tumor emboli from the thoracic duct into the bronchomediastinal trunks because of incompetent lymphatic valves. In one case gallium imaging demonstrated bilateral hilar isotopic uptake as well as periaortic uptake.


Bradycardia and hypotension following use of intravenous contrast media. Eight patients had unusual reactions, including hypotension and bradycardia, to intravenous contrast media. These reactions appear to be vagal- or acetylcholine-mediated. Atropine treatment produced prompt reversal in several of the cases, and is felt to be the drug of choice for this particular type of idiosyncratic reaction.


Intravascular electrically induced thrombosis in the dog. Thrombus detection by ionic and nonionic contrast media. Reliable, large, nonobstructive thrombi were produced by electrical stimulation of the wall of the inferior caval veins in dogs, thus avoiding surgical trauma or introduction of chemical substances. Metrizamide was found to adhere longer to the thrombi than an ionic medium (iothalamate) at comparable iodine concentrations. This may be due to the much higher viscosity of metrizamide.


Diagnosis and pathophysiology of paradoxical embolism. Three cases of paradoxical embolism are presented. Although most systemic emboli originate in the heart, detection of other sources is aided by venography of the lower extremities, indocyanine green-dye curve studies of the inferior vena cava, obtaining right heart pressures, oximetry, and pulmonary angiography. Forty per cent of 55 patients reviewed had repeat episodes of systemic embolism and 2 of the 3 proved cases of paradoxical embolism had repeat episodes. Prolonged anticoagulant therapy may prevent recurrence.


Idiopathic nonfamilial acro-osteolysis with cortical defects and mandibular ramus osteolysis. A case is presented of progressive acro-osteolysis of the hands combined with progressive mandibular ramus osteolysis and multiple cortical defects. The features of acro-osteolysis are reviewed and classified.


Right axillary lymph node visualization by bipedal lymphography: a case report. In the course of bipedal lymphography, the right axillary nodes were filled with contrast medium from the right pelvic region via the subcutaneous lymphatics. This was verified in the absence of lymphatic obstruction or abnormal corollary lymphatic routes.


Radiopaque suppositories.

Radiopaque suppositories. The authors describe the radiographic appearance of several commonly used rectal suppositories. Such drugs are sufficiently opaque to be seen on abdominal radiographs and may simulate excreted urographic contrast medium or stones. Errors in interpretation can be avoided by asking the patient about rectal medication or by taking lateral or delayed films.


Regional enteritis complicated by nephrocalcinosis and nephrolithiasis. Case report. The authors report a case of regional enteritis complicated by nephrocalcinosis and nephrolithiasis. Enteric hyperoxaluria is documented and the pathophysiology is discussed.


Angiographic demonstration of a calcified splenic hamartoma. A case of hamartoma of the spleen is reported. Radiographic examination revealed a mass containing innumerable calcifications in the left upper quadrant. Angiography demonstrated an avascular mass. The authors believe that such calcification and avascularity are late manifestations of a slowly-growing splenic tumor which may well be hypervascular if examined earlier.


Contrast enhancement of cerebral infarcts in computed tomography. Approximately 60% of cerebral infarcts between 1 and 4 weeks old may be enhanced by contrast material. A recent infarct can be missed if contrast material is not used; however, recent infarcts can also be partially obscured by the contrast medium, so that a precontrast scan is necessary. Infarcts, arteriovenous malformations, and gliomas may appear similar on the CT scan. Recent infarcts can have a significant mass effect (seen in 22% of cases), and their anatomical location and morphology may or may not be helpful in the differential diagnosis. Ipsilateral ventricular dilatation, homogeneous low-density areas, and sharp margins are usually found in older infarcts.


Mach bands and density perception.

Mach bands and density perception. Perception of a roentgen image is greatly influenced by the production of Mach bands by the retinal neural networks. The mechanism of their production and contributing factors such as lateral inhibition, projection, contour, film density, object density, and background are discussed. Although Mach bands often facilitate perception of roentgen density, misinterpretation of their significance may lead to errors in diagnosis.


Quantification of bone mineralization using computed tomography. Computed tomography was used to find a sensitive parameter for bone mineralization. A precision scanning instrument was constructed for determination of the mineral distribution in sections of the forearm. The quality of the reconstructed images allows separate quantification of compact and spongy bone even when gamma rays are used. Computer simulation and measured of models and macerated human bones showed that under clinical conditions it is possible to quantify spongy bone density within an accuracy of +/-2%.


Radiographic anatomy of the accessory meningeal artery. The accessory meningeal artery (AMA) was studied in 6 cadavers and correlated with the angiographic findings in 50 normal patients. The AMA is easily identified angiographically, its origin varying with the course of the internal maxillary artery. The authors believe that all intracranial lesions which are not strictly intracerebral should be investigated by means of selective injection of the internal maxillary artery.


A connection between the production of prostaglandins during liver regeneration and the DNA synthetic response. The concentration of PGE equivalents in rat liver in vivo was increased during liver regeneration. The probability that this increase reflected a stimulation of prostaglandin synthesis was confirmed in vitro by the ability of homogenates of regenerating liver tissue to synthesize PGE2 and PGF2alpha from arachidonate. Indomethacin prevented these prostaglandin changes, and the subsequent increase in DNA synthesis. The administration of indomethacin to rats was found to induce a hypocalcemia, and to block the hypercalcemic action of parathyroid hormone. It is suggested that the influence of prostaglandins on DNA synthesis involves calcium metabolism.


Defective PGE reactivity in leucocytes of multiple sclerosis patients. Leucocyte migration inhibition in vitro, in response to antigen or mitogen, is suppressed by PGE2 (0.01-1.0 mug/ml). The susceptibility of leucocytes to such inhibition by PGE2 has been compared using cell preparations obtained from normal individuals, multiple sclerosis patients and from patients with other neurological diseases. The results indicate defective reactivity of leucocytes from multiple sclerosis patients.


Effect of topical indomethacin on UVR-induced redness and prostaglandin E levels in sunburned guinea pig skin. Prostaglandin E (PGE) levels in the skin have been shown to be elevated during the 24 hr. period following exposure of guinea pig skin to ultraviolet radiation from 280-320 nm in the so-called UVB or "sunburn spectrum". The development of increased PGE levels paralleled the development of the delayed phase of erythema. When applied immediately after UVB exposure, one topical application of 2.5% Indomethacin (IM) simultaneously decreased the redness and PGE levels in the skin to near normal within one hr. of treatment. The IM effect persisted for approximately 24 hrs. By 48 hrs. the PGE level in the sunburned skin was near normal whether or not the skin had been treated with IM. The redness which was evident at 48 hrs. did not respond to additional topical IM treatment. This suggests that a substance(s) other than PGE may be involved in this latter portion of UVB-induced erythema. A major role for PGE as an early mediator or potentiator of UVB-induced erythema has been deomonstrated. Any involvement of PGE with UVB-induced cell death or alterations in DNA synthesis seems unlikely.


Prostaglandin removal and metabolism by isolated perfused rat lung. We have investigated the mechanism(s) involved in the removal of prostaglandins (PG) from the pulmonary circulation by the lung. Unidirectional fluxes of PG from the circulation into the lung are measured in an isolated perfused rat lung preparation. Evidence is presented which suggests that a transport system for PG exists in lung tissue. This transport system is responsible for the removal of some PG from the circulation by the lung. PGE1 and PGF2alpha are substrates for this system, whereas PGB1, PGA1, and 15-keto-PGF2alpha are not. Since PGA1 is a substrate for the intracellular PG dehydrogenase, the selectivity of the lung's metabolism system for circulating PG is probably due to the selectivity of the transport system for PG. It is shown that the percentage of the pulmonary arterial concentration (CA) of PGE1 or PGF2alpha that is metabolized on passage through the pulmonary circulation decreases rapidly as CA increases. When the lungs were perfused with PGE1(PGF2alpha), the metabolites detected in the venous effluent were 15-keto-PGE1 (PGF2alpha) and 15-keto-13, 14-dihydro-PGE1 (PGF2alpha). The time course pattern of the appearance of metabolites in the venous effluent after the initiation of a constant CA, and the relative concentrations of the metabolites in the venous effluent, were examined as a function of CA.


Modification of alveolar hyperoxia induced pulmonary vasodilatation by indomethacin. Decrease in pulmonary vascular resistance was observed in neonatal minature pigs breathing 100% O2 or 95% O2:5% CO2. The pulmonary vasodilator response to hyperoxia ventilation was reduced by indomethacin in the intact animal and in the isolated perfused lung preparation. In the isolated perfused lung preparation, it was also shown that lung alveolar pO2 rather than pulmonary arterial pO2 was responsible for the pulmonary vasodilation. The study suggests that alveolar hyperoxia induced decrease in pulmonary vascular resistance may be mediated in part by release of prostaglandins. The relevance of this study with oxygen therapy in newborn infants is also discussed.


Inhibition of prostaglandin F2alpha-induced reflex bradycardia and hypotension by meclofenamic acid. Intravenous injection of prostaglandin F2alpha (4-15 mug/kg, i.v.) produces an increase in pulmonary arterial pressure in conjunction with reflex bradycardia and hypotension in the anesthetized cat. Meclofenamic acid (30 mg/kg, i.v.) inhibited the bradycardia and the reflex contribution to the systemic hypotension. Neither the PGF2alpha-induced pulmonary vasoconstriction nor the direct systemic vasodilator actions of PGF2alpha were blocked by meclofenamate. In addition, the reflex responses caused by i.v. veratrine and 5-HT were not inhibited by meclofenamate. These results suggest that meclofenamic acid selectively blocks the afferent mechanism by which PGF2alpha induces reflex bradycardia and hypotension in the cat.


Kinetic and metabolic studies of 15-methyl-prostaglandin F2alpha administered intra-amniotically for induction of abortion. The metabolism of tritium labeled 15-methyl-PGF2alpha, administered intra-amniotically, was studied in seven cases of mid-trimester abortion. The disappearance of the compound from the amniotic sac was a very slow process. A metabolite, dinor-15-methyl-PGF2alpha, was found in small amounts in the amniotic and kidney. Plasma levels of 15-methyl-PGF2alpha in the maternal circulation were determined.


Lack of evidence for inhibition of ovulation by aspirin in women. Prostaglandin synthetase inhibitors such as aspirin and indomethacin inhibit ovulation in experimental animals. The effect of therapeutic doses of aspirin on ovulation has been studied in 5 women. Ovulation, as assessed by measurements of urinary LH and plasma progesterone levels, basal body temperature and cervical mucus changes occured in all the control and treatment cycles. Serial sections of the corpora lutea failed to show any entrapped ova. The significance of finding a prostaglandin synthetase inhibitor which acts specifically at the ovarian level is discussed.


Effects of indomethacin and prostaglandins on the spawning behaviour of female goldfish. In goldfish, injection of ovulated eggs (from donor females) through the ovipore and into the ovarian lumen of females with vitellogenic oocytes induces spawning behaviour within several hours. Intraperitoneal (i.p.) injection of indomethacin (IM), 10 mug/g, either 10 h prior to, or coincident with, injection of ovulated eggs, completely inhibits the onset of spawning behaviour. IM injection similarly terminates ongoing spawning behaviour induced by egg injection. PGF2alpha (5 mug/g; i.p. injection) restores spawning behaviour of egg-injected, IM-blocked fish; at the same dosage, PGE2 is marginally  effective and PGE1 is without effect. As PGF2alpha and PGE2 also induce spawning behaviour in females which have not been injected with ovulated eggs, it is suggested that distension of the oviduct following ovulation or egg injection results in the release of PG which then acts in some way to induce spawning behaviour. The ability of PG to induce spawning behaviour is eliminated by hypophysectomy and restored by treatment with salmon gonadotropin: no steroid treatment was effective in restoring PG-induced spawning in fish which had been hypophysectomized for 3-4 months. The possible mode of action of PG in inducing spawning behaviour in female goldfish is discussed.


Prostaglandins and the initiation of labor. A total of 96, dated pregnant, New Zealand white rabbits were studied. In 58 animals the intrauterine pressure (IUP) of the unstimulated and PGF2alpha-stimulated myometrium was recorded, by the extraovular microballoon technique, before, during and after parturition. In the remaining 38 the concentrations of PGE and PGF and progesterone (P) were measured by radioimmunoassays (RIA). The samples were collected individually or sequentially during the perinatal period from uterine tissue and uterine or peripheral vein blood. At the critical time, at around parturition, when the myometrium is converted from a suppressed and refractory muscle into a spontaneously active and reactive organ (quantitated by recording the IUP), the uterine PGE and PGF levels decreased rather than increased (quantitated by RIA). Thus, this critical regulatory and functional change of the myometrium cannot be accounted for by an increase in the intrinsic uterine stimulant: PG, but only by a decrease in the suppressor: P. These findings, 46 years after the discovery of P, demand the further exploration of Corner's legacy.


Determination of 15-keto-13,14-dihydro-metabolites of PGE2 and PGF2alpha in plasma using high performance liquid chromatography and gas chromatography-mass spectrometry. A method is described for the measurement of 15-keto-13,14-dihydrometabolites of PGE2 and PGF2alpha in peripheral human plasma. This involves purification by high performance liquid chromatography followed by determination of levels by combined gas chromatography-mass spectrometry using tetradeuterated analogs of the metabolites as internal standards. The levels of these metabolites in plasma are considered to be a more reasonable index of the entry of PGE2 and PGF2alpha into peripheral blood than are the levels of the corresponding primary prostaglandins. The endogenous levels of 15-keto-13, 14-dihydro-PGE2 and 15-keto-13,14-dihydro-PGF2alpha found in peripheral plasma are 33 +/- 10 pg/ml (SD; n=6) and 40 +/- 16 pg/ml (SD; n=6), respectively.


Prostaglandins and renal function in acute extracellular volume expansion. Mechanisms determining the natriuresis in ECV-expansion are not yet completely understood. The present study was therefore undertaken to investigate if prostaglandins (PG) are involved in the natriuresis of acute ECV-expansion and by which mechanisms PG may affect renal Na-absorption. In non-expanded rats the PG synthetase inhibitor indomethacin (INDO) had no effect on renal function. In 37 Sprague-Dawley rats ECV-expansion with isotonic saline corresponding to an increase in b.wt. of 10% was induced. Twenty-one animals received an oral dose of 10 mg/kg b.wt. of INDO prior to ECV-expansion. Sixteen animals served as ECV-expanded controls (C). GFR (INDO: 12.5 +/- 1.0; C: 10.5 +/- 0.9 ml/min/kg b.wt.) did not significantly differ in both groups. However, total renal plasma flow (RPF) (INDO: 22.9 +/- 1.8; C: 30.1 +/- 2.7 ml/min/kg b.wt.), urinary flow rate (INDO: 1.11 +/- 0.20; C: 1.93 +/- 0.21 ml/min/kg b.wt.) and urinary excretion of sodium (INDO: 141 +/- 26; C: 267 +/- 46 muEq/min/kg b.wt.) and potassium (INDO: 13.0 +/- 0.9; C: 19.8 +/- 1.7 muEq/min/kg b.wt.) markedly decreased in animals pretreated with INDO. The results indicate that PG are involved in the natriuresis of acute ECV-expansion and suggest, that PG may inhibit the intrinsic capacity for Na-absorption in more proximal parts of the nephron possibly via intrarenal physical factors.


Characterization of prostaglandin production in tissue culture of rat renal medullary cells. Renal medullary cells from the rat were used to establish a cell culture line. The morphologic characteristics of these cells were similar to renal medullary interstitial cells. They produced substantial amounts of PGE when provided with arachidonic acid or fetal calf serum. PGE production was inhibited 80-90% by indomethacin or meclofenamate. PGE release by the cells was sensitive to and stimulated by changing the culture media. Stable levels of PGE in the media could be achieved if media changes were avoided during the experimental period.


Factors affecting prostaglandin synthesis by rat skin microsomes. Prostaglandin synthesis by rat skin was measured by a radiochemical method and the adrenochrome spectrophotometric method. About 70% of the total enzyme activity was located in the microsomal fraction. Incubation with (1-14C) arachidonic acid resulted in the formation of prostaglandins F2alpha, E2 and D2. The biosynthesis of these 3 prostaglandins was stimulated by reduced glutathione and hydroquinone, and was markedly dependent on pH. A number of non-steroid anti-inflammatory drugs produced a dose related inhibition of prostaglandin biosynthesis. Five potent corticosteroid anti-inflammatory agents previously found to be inhibitory when a skin homogenate was used did not inhibit prostaglandin synthesis by the microsomal fraction.


Effect of prostaglandins on vascular resistance and adrenergic vasoconstrictor responses in the canine uterus. Prostaglandins appear to play an important role in a number of reproductive processes. The effect of prostaglandins on numerous vascular beds has been extensively studied, but the effects on uterine hemodynamics have not. The present study was designed to determine the effects of prostaglandins of the A and E series on uterine vascular resistance and responses to adrenergic nerve stimulation in the canine uterus. PGE1, PGE2 and PGA1 were found to be potent uterine vasodilators. In addition, these agents were able to modify adrenergic vasoconstrictor responses. These effects on uterine vascular resistance and adrenergic vasoconstrictor responses were separable. The results of these studies suggest that prostaglandins of the A and E series may play an important role in regulating uterine blood flow in the nonpregnant animal.


Rapid block of gonadotropin uptake by corpora lutea in vivo induced by prostaglandin F2alpha. Intravenous administration of 125I-hCG to 7-8 day pseudopregnant rats resulted in maximum uptake of radioactivity to corpora lutea 2 hours after treatment. At this time tissue/plasma radioactivity ratios on an equal weight basis were: corpora lutea, 70.2 +/- 12.8; ovarian interstitium, 4.6 +/- 0.2; kidney, 2.2 +/- 0.1. No appreciable uptake was seen by adrenals or liver. Radioactivity in corpora lutea was associated primarily with membranes which sedimented at 2000g and when released by heat it was more than 63% bound to luteal LH receptor preparation in vitro. Radioactivity in renal tissue was associated primarily with the 100,000g supernatant fraction and was bound less than 1% to luteal LH receptors in vitro. PGF2alpha significantly reduced uptake (p less than .001) of 125I-hCG by corpora lutea within 30 minutes (-63%) as well as at 1 (-64%), 2 (-75%), 4 (-68%) and 24 hours (-85%). No clear effect of PGF2alpha on uptake of 125I-hCG by ovarian interstitial tissue was seen. Plasma progesterone was significantly decreased (p less than .001) within 30 minutes (-47%; p less than .01) after PGF2alpha treatment and also at 1 (-65%), 2 (-82%), 4 (-68%) and 24 hours (-92%). Two hours after PGF2alpha treatment the content of progesterone in corpora lutea was depressed (-46%; p less than .001). It is suggested that the rapid inhibition of luteal progesterone production induced by PGF2alpha in vivo occurs through a block in gonadotropin uptake by corpora lutea.


Effects of prostaglandins on leukocyte migration. Artificially synthesized prostaglandins (PGE1, PGE2, PGF1alpha, and PGF2alpha) were found, using Boyden's chamber, to induce significant migration of polymorphonuclear leukocytes (PMNs) of the rabbit; PGF2alpha had greater effects than PGE1 or E2. A typical dose dependent relationship was found between the PMNs migration and PGF2alpha concentrations. Indomethacin pretreatments of rabbits did not significantly alter the PMNs migration indicating that PGs synthetized in vivo was not involved in the migration. PGF2alpha was placed in the lower compartment opposite to PMNs and also in the upper compartment together with PMNs. No significant difference was found in the number of migrated PMNs between the two experimental conditions. PGs diffusion occurred across the millipore filter separating the two compartments where the concentrations were almost equal at the end of 3 hours incubation. It was thus concluded that PGs effects are to induce random PMNs movements rather than to initiate chemotactic directional migration.


Indomethacin potentiates the vasoconstrictor actions of angiotensin II in normal man. The blood pressure response to graded infusions of angiotensin II was assessed under control conditions and following short term (16 hour) indomethacin treatment utilizing normal men equilibrated on a constant diet of normal sodium and potassium content. Although basal mean blood pressure was unchanged, the increase in blood pressure with all rates of angiotensin II infusion ranging from 200 to 1000 ng/min was significantly greater with indomethacin treatment. Pre-infusion body weight and plasma renin activity were similar under the two conditions. These results suggest that prostaglandins modulate the systemic vasoconstrictor effects of angiotensin II.


The levels of main urinary metabolite of prostaglandin F1alpha and F2alpha in human subjects measured by radioimmunoassay. Radioimmunoassay technique for measuring 5alpha, 7alpha-dihydroxy-11-keto-tetranorprosta-1, 16-dioic acid, the main urinary metabolite of PGF1alpha and PGF2alpha (PGF2alpha-MUM), was further improved. It was postulated based on some experimental data that the PGF2alpha-MUM exists in the urine mostly as dioic acid form, not as delta-lactone form the daily excretion of PGF2alpha-MUM in men ranged from 14.43 mug to 36.14 mug and in women from 5.21 mug to 14.25 mug.


Inhibition of prostaglandin biosynthesis by triynoic acids. Prostaglandin biosynthesis from eicosa-8,11,14-trienoic acid in microsomes from bovine seminal vesicles is inhibited by acetylenic acids. Octadeca-6,9,12-triynoic acid and eicosa-8,11,14-triynoic acid are the most potent inhibitors. These acids both contain an omega-8 methylene group. Within the 20-carbon acetylenic acid series, inhibition decreases in the sequence eicosa-8,11,14-triynoic acid greater than eicosa-7,10,13-triynoic acid greater than eicosa-5,8,11-triynoic acid. Furthermore, eicosa-8,11,14-triynoic acid is a more potent inhibitor of arachidonic acid induced platelet aggregation than either eicosa-7,10,13-triynoic acid or eicosa-5,8,11-triynoic acid. The omega-8 methylene group is not the only determinent of inhibitory potency since docosa-10,13,16-triynoic acid is less potent than its 18 and 20 carbon analogs and all of these acids have an omega-8 methylene group.


Inhibition of renal PGE2-9-ketoreductase by diuretics. The metabolism of PGE2 by extracts of renal cortex is species dependent. In the rat PGE2-15-hydroxydehydrogenase initiates metabolism whereas in the rabbit PGE2-9-ketoreductase predominates. In man both mechanisms may operate. Each of the metabolic enzymes, which limits the vasodilator-diuretic actions of PGE2, was inhibited by ethacrynic acid, furosemide and indomethacin. Some inhibition of PGE2-9-ketoreductase was also observed with chlorthalidone, hydralazine and phentolamine but the thiazide diuretics and a number of other cardiovascular-active agents were without significant effect. We conclude that the inhibition of PGE2-9-ketoreductase and PGE2-15-hydroxydehydrogeanse could contribute to the mechanism of action of the non-thiaxide diuretics in man.


The role of protein synthesis in the stimulation by LH of prostaglandin accumulation in rat preovulatory follicles in vitro. Preovulatory follicles isolated from immature rats, treated in vivo with pregnant mare's serum gonadotropin, were incubated in vitro and the accumulation of prostaglandin E measured. The addition of luteinizing hormone (5 mug/ml) increased this accumulation, after a lag period of 3 hours. This delay suggested the involvement of macromolecular synthesis in the mechanism of prostaglandin stimulation by luteinizing hormone. When the synthesis of protein was inhibited by the addition of puromycin (100 muM), the luteinizing hormone stimulation of prostaglandin E in these follicles was completely abolished. This inhibition was not seen with an analogue of puromycin, which does not inhibit protein synthesis, puromycin amino-nucleoside. These data suggest that concomitant protein synthesis is required for the luteinzing hormone stimulation of prostaglandin accumulation in rat follicles.


Avian oviduct motility induced by prostaglandin E1. Oviduct segments from infundibulum, magnum, uterus, utero-vaginal junction and vagina of actively laying hens at preoviposition time were tested for their contractile reaction to prostaglandin E1 by in vitro or in vivo methods. Maximum stimulatory response was observed from the muscular strips of the proximal oviduct segment (infundibulum) and a complete relaxation was recorded from the distal part (vagina) at molar concentrations of 1.4 X 10(-7), 3.4 X 10(-7) and 7.0 X 10(-7). The uterine strips reacted with a stimulatory response at higher concentrations (1.4 X 10(-6) and 2.8 X 10(-6) moles), but lacked any significant change at lower concentrations. The uterovaginal muscular strips showed a mild but prolonged inhibitory response, while the magnum responded with a significant increase in the luminal pressure when tested in vivo. It is concluded that PGE1 exerts a stimulatory effect on the uterus to initiate transport of the egg to subsequent segments (utero-vaginal junction and vagina), which relax under PGE1 influence and allow passage of the egg by pressure differences.


Considerations into the mechanism of estrogen-stimulated uterine prostaglandin synthesis. Progesterone priming of the ovariectomized rat, followed by a single injection of estradiol-17beta (10 mug) is followed by an increased uterine synthesis of both PGF and PGE. The administration of an estrogen antagonist (MER-25; 10 mg) concomitantly with estradiol had no effect on uterine prostaglandin synthesis. Similarly, the administration of either Actinomycin D or cycloheximide, antibiotics demonstrated to inhibit mRNA and protein synthesis, respectively, is without effect on estrogen-stimulated uterine prostaglandin synthesis. These results are considered with regard to the classic receptor theory of estrogen action and are a preliminary indication that estrogen-stimulated uterine prostaglandin synthesis may not require those receptor mediated events.


The effects of progesterone, prostaglandin F2alpha and oxytocin on the calcium-activation of the uterus. The relationship between "activator-calcium" (A-Ca), progesterone (P), prostaglandin F2alpha (PGF2alpha) and oxytocin (Oxy) has been examined in 100 uterine strips of 34 pregnant and 100 strips of 34 post partum rabbits. At the 25th day of gestation, uterine P was 13.9+/-1.3 ng/g, while within 3-12 hours post partum 3.3+/-0.3 ng/g tissue (P less than 0.001). Uterine strips, mounted isometrically in Krebs' solution, sustained maximum excitability in a steady state when exposed every 30 seconds for 4 seconds to an electric field of 12 V/5 cm (a.c.). The maximally contracting muscles were then rinsed at intervals of 6 minutes with Ca-free Krebs. In Ca-free Krebs, the post partum uterus lost 31% of its Ca and 96% of its excitability in a short 25 minutes, while the pregnant uterus lost 30% of its Ca and 93% of its excitability in 50 minutes (P less than 0.001). Since the extracellular space is approximately 30% in the uterus, this approximately 30% Ca, lost by both muscles, most probably was extracellular Ca and the small A-Ca fraction which is presumably "bound" more strongly at the membrane systems of the P-dominated pregnant, than the non-dominated post partum uterus. The significantly faster and more complete recovery from Ca-deficiency and inexcitability of the pregnant than the post partum uterus (P less than 0.001), at different levels of external Ca, further substantiates this premise. So does the demonstration that exposure to Ca-free Krebs increases 45Ca-efflux 400% in the post partum and only 110% in the pregnant uterus (P less than 0.001). Exposure to 100 ng/ml PGF2alpha in normal Krebs has a similar effect on the 45Ca-efflux of the post partum uterus, while the response of the pregnant uterus is indistinct (P less than 0.001). These highly significant differences between the post partum and the pregnant uteri in their Ca-efflux explain the higher threshold (P less than 0.001) and lower "sensitivity" to PGF2alpha and Oxy (P less than 0.001) of the pregnant than the post partum uterus. The already very highly significant differences between the two muscles, in threshold and sensitivity to these two most potent oxytocics, were increased still further by rendering the uterine strips Ca-deficient. All together, these findings substantiate the early contention (1-7, 18, 19) that uterine function at the cellular level is regulated by opposing actions of the suppressor P and the intrinsic stimulant PG or other oxytocic agents on threshold, excitability and the Ca-activation of the contractile process.


Further studies on prostaglandin E2 (PGE2)-induced gonadotropin release: comparison with the effect of 15-methyl PGE2, PGAs, PGBs and prostaglandin endoperoxide analogs. It is known that PGE2 is a potent stimulus of LH release. To determine if the effect of PGE2 could be enhanced and/or prolonged by retarding its metabolic degradation, a derivative, 15-methyl PGE2 (15-E2) which is more slowly degraded than the natural compound was injected intravenously (i.v.) at various dose levels or into the third ventricle (3rd V) of ether-anesthetized, ovariectomized, estrogen (OVX, Eb)-treated rats and its effect on gonadotropin release was compared with that of PGE2. Both PGs injected i.v. were equally effective in increasing plamsa LH and maintaining the elevated levels, although 15-E2 induced a larger and more sustained increase in plasma FSH than PGE2. By contrast, 3rd V PGE2 was clearly more effective than 3rd V 15-E2 in releasing LH and to a lesser extent, FSH. The effect of 15-E2 on LH was similar to that produced by 3rd V PGE1, injected at a similar dose. However, its effect on FSH was greater than that of PGE1. To evaluate the effect(s) of prostaglandins of the A and B series on gonadotropin release, PGA1, PGA2, PGB1 or PGB2 were injected intraventricularly in OVX, Eb-treated rats. PGBs were injected into conscious, free-moving rats. PGA2 or PGB2 increased plasma LH concentrations although much less effectively than PGE2. Third V PGA1 or PGB1 were ineffective. The 3rd V injection of two cyclic esters (U-44069 and U-46619), stable analogs of the PG endoperoxide PGG2 and PGH2, induced a small, transient increase in LH levels and did not alter plasma FSH in conscious, free-moving animals. PGE2 injected intraventricularly at a similar dose was demonstrated to be mcuh more potent than the analogs in stimulating LH and FSH release. The results indicate that: 1) 15-E2, in spite of its described long-lasting activity, does not appear to be more potent than the natural compound in releasing LH, although when injected i.v., it appeared to induce a more sustained increase in plasma FSH; 2) although PGA2 and PGB2 can also act centrally to stimulate LH release, their low potency suggests that this is a pharmacological effect; and 3) the two analogs of PG endoperoxides tested proved to be poor stimuli for gonadotropin release. The significance of these findings is discussed.


Electroconvulsive shock and norepinephrine uptake kinetics in the rat brain. The kinetic constants, apparent Km and Vmax, for the uptake of 3H-1-norepinephrine in cerebral cortical homogenates of the rat brain were not altered 5 min after a single electroconvulsive shock (ECS). However, one day after the last of a series of 14 ECS the apparent Km and Vmax were significantly increased above sham-shock controls, and ECS rats lost weight. Three days after the last ECS apparent Km and Vmax were significantly decreased, while the rate of weight gain tripled in the ECS rats. One week after the last ECS the kinetic constants and rate of weight gain were no different from sham-shock controls. These data are indicative of the strong compensatory mechanisms in the normal rat to the alterations induced by ECS.


The contribution of epidemiology to knowledge of cancer. Epidemiology has contributed to knowledge of cancer in five ways. First, it has demonstrated that all cancers that are at all common anywhere vary in incidence from place to place and from time to time. The amount of variation is large, sometimes several hundred fold, and no cancers are so uniformly common that they would affect as many as 1 per cent of people by 75 years of age, in the absence of other causes of death, in all countries. Studies of migrant groups and the changes that have occurred with time show that this variation is, in large part, due to environmental factors and that most cancers are, in principle, preventible. Secondly it has shown that the incidence of specific cancers can be correlated with the prevalence of factors in the environment that might be suspected of causing the disease. Recent correlations include those between oesophageal cancer in Iran and the consumption of certain locally produced foods, between colon cancer and the presence of certain groups of anaerobic bacteria in the faeces, and between liver cancer and the amount of aflatoxin in the diet. These correlations do not provide direct evidence of causation, but they do suggest ideas for investigation by other methods. Thirdly, epidemiology has provided means for testing hypotheses by relating the occurrence of particular types of cancer to the personal characteristics of individuals, either by studying the past experience of people with and without cancer, or by following up people whose exposure to suspected agents has been previously defined. In this way it has been possible to detect dozens of occupational hazards in industry, which is many more than have been detected by laboratory experiment. Fourthly, epidemiology has confirmed that an agent is a cause of cancer by monitoring the effects of intervention to reduce or prevent exposure. An example is provided by observation in British doctors, who have reduced their consumption of cigarettes to half the national average and have experienced a corresponding reduction in the risk of death from cancers of the lung.


[Estimation of risk as a function of risk factors. II.--Application to the multivariate analysis of coronary heart disease in a middle aged male population (author's transl)]. The annual incidence of coronary heart disease (CHD) in a 8000 male professionnal group, aged 42-53, is computed from the model of LELLOUCH and al. described in the first part of this work. It is shown that each of five risk factors (cholesterol, blood pressure, cigarettes consumption, diabetes history and abnormal electrocardiogram) brings its own contribution to the CHD risk, which may be estimated by an exponential function of a linear combination of the levels of the five factors. "Risk tables" useful in current practice are described.


[Epidemiology of S. aureus cross-infections in dermatological wards]. Over a three-year period, 196 of 3115 patients admitted in a dermatological department became infected with S. aureus (6,2 %). 205 strains of S. aureus were isolated. Serologic typing, phage-typing and antibiotic sensitivity tests revealed 3 epidemic and 2 endemic strains. The 3 epidemic strains infected 24 patients: 12 from july to november 1972 were infected with a serotype 66438 S. aureus resistant to fusidic acid. 6 patients (male) were infected with a serotype III in february and march 1972; 8 patients were contaminated with a serotype 18 S. aureus from december 1973 to february 1974, after staying in a surgical department. Of the 2 endemic strains 1, phage-pattern 53/79, is non-typable by serologic-typing; this strain has been observed only in the dermatological department and 20 patients were infected with, from january to october 1974. The second endemic strain, phage-pattern 81/+ serotype I, cross-infected 16 patients during this three-year survey; 12 of them were admitted repeatedly. During this three-year survey, it could be proved that, at least, 1 out of 3 patients is infected with an epidemic or an endemic strain. We can suggest that the factors enhancing cross-infection in dermatological department are: the sex of patients (80 % were male); presence of a tween splitting enzyme by S. aureus promotes growth of Staphylococci on the skin; patients transfered from a department to another or repeatedly admitted are more often infected. But, as they are source of some outbreaks, they need special measures (asepsis and hygiene); corticoïds or immunodepressors enhance cross-infection; antibiotics must not be only limited but varied too.


[Estimation of risk as a function of risk factors: 1. Description of the method (author's transl)]. This paper describes a model which makes allowance for unequal follow up times in estimating the risk as a function of risk factors. It is the exponential model with a hazard which is also an exponential function of risk factors. Computing methods and an extension of the model are given.


[Chronic bronchitis and risk factors in employees of the sanitation départment, city of Geneva]. The MRC questionnaire on respiratory symptoms was applied to 429 employees of the sanitation department of the city of Geneva. At the same time, the PFR was determined. The prevalence of the chronic bronchitis was shown to be three times as high in this sample as in the active population of Geneva from the same age group. According to our results, the severity of the respiratory symptoms as well as the level of the respiratory function depended, besides age, on the three risk factors which had been taken into account: cigarette smoking, a history of broncho-pulmonary disease and occupational exposure to weather conditions and air pollution. In the absence of these factors, the severity of symptoms was the lowest and the respiratory function the highest. With all these factors combined, the severity of symptoms was the most pronounced and the function the worst, particularly in bronchitics. It seems that prevention of chronic bronchitis should not rely only upon antismoking propaganda but that the combination of several risks factors should be avoided.