Quantitative characterization of THC and ethanol interaction. The anticonvulsant activity of ethanol, delta9-tetrahydrocannabinol and their combinations was measured in the maximal electroshock seizure test. The determined median anticonvulsant doses (ED50) of drug combinations were compared with those calculated on the assumption of additivity of doses. No significant difference was found between the determined and expected values. It is concluded that in this test ethanol and THC may interact additively.


Synthesis and characterization of alpha-phenyl-gamma-butyrolactone, a metabolite of glutethimide, phenobarbital and primidone, in human urine. A novel metabolite, alpha-phenyl-gamma-butyfolactone has been isolated in urine samples of patients severely intoxicated by either glutethimide, phenobarbital, or primidone. This lactone was prepared synthetically and its spectral data and chromatographic properties were compared to those data obtained from the urine samples of drug overdosed victims. The results of these comparisons confirm the presence of this lactone in human urine following the ingestion of large amounts of the parent drug.


Quantitation in plasma and urine of acebutolol and a major metabolite with preliminary observations on their disposition kinetics in man. An acetyl-homologue-metabolite, present in concentrations of up to ten times those of the unchanged drug, in the plasma of patients receiving oral doses of acebutolol, is reported. Combined gas chromatography--mass spectrometry has been utilized to determine the structure of the acetyl-metabolite. This acetyl-metabolite has been measured as acebutolol by previously published non-specific methods for the determination of acebutolol in biological fluids. A specific and sensitive gas chromatographic method is described for the separate quantitation of acebutolol and its acetyl-metabolite in plasma and urine. Using our method, preliminary data on the disposition kinetics of acebutolol are presented. The difficulties in interpreting previously published pharmacokinetic data for acebutolol, based on a non-specific method of analysis, are emphasized.


Dopaminergic activity of some apomorphine analogs. The dopaminergic activity of ten apomorphine analogs was studied in rats lesioned unilaterally with 6-hydroxydopamine in the nigro-striatal system. Of these ten compounds, N,N-dimethyl-5,6-dihydroxy-2-amino-tetralin (M-7), N-methyl-5,6-dihydroxy-2-aminotetralin (M-8) and N,N-dimethyl-4,5-dihydroxy-2-aminoindan (DDAI) exhibited potent dopaminergic stimulant activity by causing the rat to turn to the unoperated side. The turning behavior of apomorphine, M-7, DDAI and d-amphetamine were antagonized by haloperidol. M-7 and DDAI also induced pecking in pigeons and their effects were also blocked by haloperidol. It is concluded that M-7, M-8 and DDAI are direct acting central dopaminergic agents.


How phlebotomy affects the erythrocyte metabolism of high- and low-glutathione sheep. Erythrocyte glutathione concentration increases dramatically in low-glutathione sheep of the Finnish-Landrace breed. To determine if this phenomenon occurs in low-glutathione sheep of the Corriedale or Merino type, the packed cell volume was decreased to less than 16 by phlebotomy. Glutathione concentrations increased in high- and low-glutathione sheep. Low-glutathione sheep returned to pre-phlebotomy levels by the 18th day; high-glutathione sheep increased, then decreased below pre-phlebotomy levels for the duration of the experiment. Packed cell volumes increased linearly (1-07 per cent per day) for 19 days. The maximum reticulocyte percentage (11-4) occurred on the eight day. Some erythrocyte enzymes increased as the mean cell age decreased, but some did not change. Erythrocyte adenosine-5'-triphosphate and creatine appear to be related to the reticulocyte count.


Immunisation against bovine tropical theileriasis (Theileria annulata infection). Fully susceptible cross-bred calves, six to nine months of age, were immunised by tick-induced Theileria annulata infection treated with chlortetracycline at 16 mg/kg body weight for four, eight or 16 days. The infections were induced with 10 ticks (Hyalomma anatolicum anatolicum) or 30 ticks (H dromedarii). The recovered calves were tested for immunity to homologous severe challenge, 50 or 73 days after the first infection. The reaction of the calves to infections was evaluated by noting the prepatent period, symptoms, degree of anaemia, rate of parasitisation of lymphocytes and erythrocytes. It was observed that untreated calves developed acute theileriasis characterised by typical symptoms and lesions and 56 to 66 per cent mortality. The medicated calves, however, developed a mild form of the disease. Calves which recovered from treated or untreated infections were solidly resistant to subsequent severe homologous infection. Judged from the severity of anaemia in the infected calves, eight day and 16 day medication provided slightly better protection than four day medication. It was concluded that eight day medication afforded adequate protection against the severe immunising infection, and allowed the development of solid resistance to severe homologous challenge.


Preferential transport into colostrum of Fc fragment derived from serum IgG1 immunoglobulin in the goat. The selective transport of blood IgG1 into colostrum in ruminant species is not well understood. Therefore, the transport of Fc fragments isolated from serum IgG1 (Fc gamma 1) and IgG2 (Fc gamma 2) in normal and pregnant goats was studied. The animals were injected intravenously with radio-labelled 125I-Fcgamma1 and 131I-Fcgamma2 fragments. The plasma disappearance rate of both fragments showed that at parturition the Fcgamma1 fragment had a higher disappearance rate than Fcgamma2. Over 70 per cent of the inoculated dose of 125I-Fcgamma1 and only 11-12 per cent of 131I-Fcgamma2 could be recovered in the 24 h colostrum. The results indicated that structural differences between the H chains of IgG1 and IgG2 were implicated in the selective transport of IgG1 into colostrum in ruminants.


Morphology and classification of subdivisions of the intrahepatic vascular and biliary systems in sheep. Tensol casts and histology were used to demonstrate sub-divisions of the portal and hepatic veins, and arterial and biliary systems. Portal and hepatic venous subdivisions were most readily identified. Based upon size, location, sequence of branching and histological characteristics a nomenclature for the sub-divisions of the portal vascular system was proposed. The names of distributing, primary, terminal, secondary (long and short) and tertiary veins were adopted to identify portal veins branches. The same criteria allowed the identification of three hepatic vein branches, central, sublobular and hepatic; the central hepatic veins and to a much lesser extent the sublobular hepatic veins drained the sinusoids. Casts of the arterial system demonstrated the arterial blood supply to the biliary system, to the sinusoids and portal vein vasa vasorum but they were of little use in identifying subdivisions. Arterial subdivision identification is possible by using accompanying portal veins as morphological markers and designating the subdivision after the vein. This approach is also applicable to the biliary system and provides a more accurate means of subdivision identification than does the broader division into ductules, intermediate and large ducts.


Passive immunity in the lamb. Effects of a second feed of colostrum on antibody absorption from the first feed. Lambs were taken from their mothers before sucking and fed pooled colostrum (30 g/kg body weight), containing added antibody to egg albumin, 1 h after birth. At 4 h after feeding there was a two-fold range in immunoglobulin (IgG) concentration and a sixteen-fold range in anti-egg albumin activity in their sera. The coefficient of correlation between the IgG and antibody concentrations was significant but low (r = 0.445, P less than 0.02). When a second feed of colostrum without added antibody was given 6 h after the first, both the IgG and the antibody concentrations increased significantly, indicating that there had been increased absorption from the first feed, rather than absorption from the second. The increases in IgG had a significant negative correlation with the IgG concentrations before the second feed (r = 0.760, P less than 0.001). Sera from control lambs fed only untreated colostrum gave only trace, probably non-specific, antibody reactions. The results suggest that single feeds of colostrum are generally inefficient, and that the passive immune status of young lambs may be improved and made more uniform by subsequent feeds, even though these may be themselves deficient in IgG.


The rate of rise of intraventricular pressure as an index of myocardial contractility in conscious and anaesthetised ponies. Measurements of the rate of rise of left ventricular blood pressure (dP/dt) have been made in conscious and anaesthetised ponies. Concurrent measurements of heart rate, mean arterial pressure and left ventricular pressure were also made in order to assess their relationship to values of dP/dt. Thiopentone-halothane and thiopentone-ether anaesthesia reduced the maximal rate of rise of intraventricular pressure (dP/dt max) from conscious control levels. After correcting for variations in the loading conditions of the ventricle, the depressant effect of halothane was still apparent, but the action of ether was not. It was concluded that the negative inotropic effect of halothane in the pony was greater than that of ether, possibly because a compensatory sympathoadrenal stimulation occurred during ether but not during halothane anaesthesia.


A study of the complement fixation test in Salmonella dublin infection. The complement fixation test was evaluated in a study of Salmonella dublin infection in cattle. In calves vaccinated with a live S dublin vaccine at three days of age, complement fixing (CF) antibodies were not detected in colostrum-fed calves although CF antibodies were detected at low titre in colostrum-deprived calves. In calves vaccinated at three months of age and in experimentally infected cows, CF antibodies persisted for three to six months but serum agglutinin (SA) antibodies persisted at diagnostic titres for longer periods. When serum samples from outbreaks of S dublin infection were examined, the CF results were in agreement with the SAT in the majority of samples obtained from adults and calves suffering from enteric disease. In samples from cases of S dublin abortion, a number of samples had negative CF titres although the SA titres were indicative of infection. Non-specific CF reactions occurred in serum samples from cattle infected with salmonella serotypes other than S dublin.


Characterisation of an epizootic haemorrhagic disease virus. A high titre of epizootic haemorrhagic disease (EHD) virus was obtained from roller bottles of African green monkey kidney (Vero) cells. Cell associated EHD virus was purified by use of Genetron-113 and sonication. Purified viral particles were probably icosahedral with a diameter of 58 nm and contained capsomeres which appeared to be composed of five and six subunit structures. Phenol extracted nucleic acid from purified EHD virus when treated with orcinol or diphenylamine gave colour reactions and ultraviolet absorption spectrums characteristic for ribonucleic acid (RNA). EHD viral RNA had a melting temperature of 86 degrees C in 0.015 M NaCl-0.0015 M sodium citrate. RNA from EHD virus did not react with formaldehyde, but after it was heated at 102 degrees C for 10 min hyperchromicity was observed. Electrophoresis of EHD-RNA in 5 per cent polyacrylamide gels showed the genome to be composed of at least five different segments.


Factors regulating tapeworm populations: estimations of the infection pressure and index of clustering from Taenia hydatigena before and after the removal of infected dogs. A pasture was prepared so that an equilibrium of fresh and ageing eggs of Taenia hydatigena was present. This was done by placing dogs with patent infections on it for six months. Five months after their introduction, groups of lambs were grazed there for two, four, eight, 16 or 32 days. The dogs were then removed. Three and six months later, further groups of sheep were grazed there for a similar period. The infection pressures and the indices of clustering of the eggs were calculated by an examination of the lambs for cysts at autopsy. When the dogs were present, the daily rate of infection was about 60 per cent of the flock. This was reduced to 6.5 per cent then to 3.5 per cent within three and six months respectively after their removal. Very high cyst counts were obtained in some animals and the indices of dispersion diverged from a Poisson model during the period when the lambs were maintained on the pasture in the presence of the dogs. There was a trend for a reduction in the mean cyst counts and the index of dispersion tended to conform more closely to a Poisson model the longer the dogs were excluded. There was also a corresponding reduction in the survival rate of the cysts. It was suggested that an asymptote of less than 100 per cent in the prevalence rate may be accounted for by the acquisition of resistance without the persistence of infection and this was induced in some animals by the initial ingestion of ageing organisms which gradually formed the predominant type after the removal of the dogs from the pasture.


Factors regulating tapeworm populations: estimations of the build-up and dispersion patterns of eggs after the introduction of dogs infected with Taenia hydatigena. The build-up of the eggs of Taenia hydatigena was measured on a pasture following the introduction of infected dogs. Susceptible lambs grazed on the pasture beforehand showed that only small numbers of randomly dispersed infective eggs were present. Two dogs each with four patent T hydatigena were chained to kennels placed in the middle of the pasture. The build-up of eggs was determined by grazing further tapeworm-free lambs there for 10-day periods. High cyst counts were obtained in some of these lambs grazed within 10 days of the introduction of the infected dogs. The mean cyst counts remained at a similar level during the 85-day investigation. This indicated that at least part of the pasture became virtually saturated with eggs shortly after the dogs were introduced and remained so while the dogs were there. Some animal management practices that favour this 'epidemic' pattern and lead to a 'cysticercosis storm' are discussed.


Factors regulating tapeworm populations: the changing opportunities of lambs for ingesting the eggs of Taenia hydatigena. Some intrinsic factors that may modify the transmission of cysticercosis caused by Taenia hydatigena in lambs have been assessed and the age at which the infective pattern should no longer be modified by the grazing-learning process and by colostrum-derived antibody, estimated. Lambs of 0-1, 2-3, 5-6, 8-9, 11-12 weeks of age, were placed for one week on a pasture experimentally contaminated with eggs of T hydatigena. The lambs were allowed to suck their mothers from birth. About half the lambs up to three weeks of age were free from larval tapeworms at autopsy; the rest had only a small number of cysts. Some of the lambs grazed on the pasture at or after five weeks of age, became heavily infected. The light infections in the very young lambs could have resulted from either a limited contact with eggs or from passively transferred antibody or, more likely, from a combination of these factors. The high cyst counts observed in some of the older lambs were consistent with the ingestion of eggs in clusters. The rise in the total cyst counts was concomitant with increasing pasture intake. The higher survival rates for the cysts found in the older rather than the younger animals were compatible with the waning before five weeks of age of colostrum-derived antibody.


Induction of pneumonia in gnotobiotic calves following inoculation of Mycoplasma dispar and ureaplasmas (T-mycoplasmas). Cloned cultures of Mycoplasma dispar and of Ureaplasma sp were inoculated endobronchially into gnotobiotic calves. The resulting pneumonia was estimated to involve 2 to 10 per cent of the lung although no clinical signs were observed. The histopathological lesions consisted of infiltration with mononuclear cells, cuffing (peribronchiolar lympho-reticular hyperplasia), catarrhal bronchiolitis and atelectasis. The results indicate that both M dispar and Ureaplasma sp are capable of causing sub-clinical cuffing pneumonia in calves.


The anthelmintic efficacy of fenbendazole against thiabendazole-resistant strains of Haemonchus contortus and Trichostrongylus colubriformis in sheep. The anthelmintic efficacy of fenbendazole (methyl 5-(phenylthio)-2-benzimidazole carbamate) was tested in sheep against standardised strains of Hcaemonchus contortus and Trichostrongylus colubriformis, known to be resistant to thiabendazole (LD90 for thiabendazole against H ontortus was 200 mg/kg bodyweight and against T colubriformis was 150 mg/kg). Fenbendazole at dose rates of 5, 10 and 20 mg/kg per os reduced total worm counts in H contortus infected sheep by 66, 90 and 100 per cent respectively, with similar reductions recorded for worm egg outputs. For the thiabendazole resistant strain of T colubriformis, fenbendazole reduced total worm counts in infected sheep by 4, 44 (40-48), 79 (75-83), 96 and 100 per cent at dose rates of 5, 10, 20, 40 and 80 mg/kg per os. Significant suppression of worm-egg production by thiabendazole resistant T colubriformis was obtained with fenbendazole at dose levels of 5 mg/kg and above. The implications of these results are discussed in the light of the increasing occurrence of strains of trichostrongylid nematodes resistant to currently available benzimidazole anthelmintics.


Studies on the epidemiology of Uncinaria stenocephala infections in British greyhounds: seasonal availability of larvae on grass runs. The numbers of Uncinaria stenocephala larvae on the grass in a small paddock used continually for exercising greyhounds followed the seasonal pattern associated with gastro-intestinal nematodes of ruminants, pigs and horses in Britain. Contamination persisted throughout the winter months but near-zero values were recorded in the early summer, followed by a rapid rise in mid-July to a peak level in September.


Detection of antibiotic residues in calf tissues. Groups of calves were injected with penicillin, ampicillin or oxytetracycline and a variety of samples were taken from the calves when slaughtered and tested for the presence of antibiotic residues by microbiological assay. Diaphragm and urine samples were found to be suitable for measuring detectable levels of antibiotics in calves given therapeutic injections.


Auto-antibodies in ovine fascioliasis.

Auto-antibodies in ovine fascioliasis. In sheep, low complement fixation (CP) and passive haemagglutinating (PH) auto-antibody titres increased after primary and challenge infections with F hepatica, possibly to aid removal of tissue debris. Although the CF auto-antibodies were neither organ nor species specific and cross precipitating activity could be detected between sheep liver, kidney, lung and cattle and human livers with heterologous hyperimmune whole sheep liver anti-serum, sheep mitochondria do appear to contain an organ and species specific pH antigen.


In vitro maintenance of juvenile Fasciola gigantica and their use to establish infections in mice. Studies on the growth of juvenile Fasciola gigantica in vitro on tissue culture feeder layers and their subsequent infectivity for mice have indicated that although no significant growth occurs in vitro the juveniles are not damaged physiologically for at least six weeks. Thus the in vitro system may be used with confidence in studies of the physiology of newly excysted flukes. Significantly more flukes became established in mice from an intraperitoneal injection of juveniles than from an oral infection of metacercariae. This may be due to inappropriate physicochemical conditions for excystment in the gut of the mouse. Early growth of flukes in mice occurred at a similar rate to that in cattle, so the mouse is probably a satisfactory model for studies on migration and establishment of F gigantica.


Functional recovery from spinal cord trauma following dexamethazone and chlorpromazine therapy in dogs. The spinal cords of 20 normal dogs were exposed via dorsal laminectomies and damaged with a known impact force. Ten dogs were treated with dexamethazone and 10 dogs with chlorpromazine for five days after surgery. The results showed that neither drug had a significantly beneficial effect on the functional recovery of the spinal cords, when compared to a control group of similarly traumatised dogs.


The lipid composition of cattle sebaceous glands: a comparison with skin surface lipid. The lipid composition of isolated sebaceous glands from Ayrshire calves was compared with that of freshly secreted skin surface lipid. The sebaceous gland contained a higher proportion of phospholipid and unesterified fatty acid and a lower proportion of triglyceride; otherwise there was little difference in lipid composition between samples from the gland and the skin surface.


Effect of papain-induced emphysema on the distrubtion of pleural surface pressure. Distribution of transpulmonary pressure (Ptp) at FRC, during spontaneous breathing, and during inflation of the relaxed respiratory system was studied in the supine, lateral and head-up postures after papain had been injected intratracheally into dogs. Functional and morphological changes of the lung resembling those of panlobular emphysema occurred in papain-treated dogs. In all postures the relationship between lung height and Ptp at FRC was steeper and shifted to the left of that obtaining for normal dogs. During artifical inflation changes of Ptp were larger in the dependent than in the upper lung and the vertical gradient of Ptp eventually disappeared, as observed in normal dogs. During spontaneous breathing changes of Ptp were uniform in the horizontal postures, but larger over the upper regions in the head-up posture; whereas they are uniform in all postures in normal dogs. From local Ptp values and lung P-V curve, distribution of specific lung volumes at FRC and ventilation during spontaneous breathing were assessed for both normal and papain-treated head-up dogs: the results agreed with those obtained using radioactive gases in normal and in elderly man or emphysematous subjects with no apparently localized lesions.


Fluid flow in the human foetal lung: a theoretical model. A theoretical model is developed to predict pressure changes and velocity profiles within the foetal lung during its sporadic bursts of activity. Because of the small volume flow rates and relatively high frequencies, the linearised, unidirectional Navier-Stokes equations are used to calculate these values. About 70% of the pressure drop occurs in the first four generations and is an order of magnitude higher than the equivalent Poiseuille pressure drop. Velocity profiles, pressure falls within each generation together with the total pressure drop at different times during the cycle are illustrated.


The effect of limb movements on the regulation of depth and rate of breathing. In anesthetized dogs and rabbits passive or active limb movements (1) shifted to the left the relationship between tidal volume (Vt) and inspiratory time (Ti), (2) lowered the relationship between expiratory time (Te) and Ti and decreased its slope, and (3) increased the output to the inspiratory muscles (Vt/Ti). These effects increased with increasing the frequency of movements. Similar effects were obtained after vagotomy. When the stimulus was started during expiration. Te was shorted in spite of the previous unaffected Ti, Arterial PCO2 during exercise was similar (active movements) or below (passive movements) control value. Since other chemical and physical humoral factors do not seem involved, the whole increase of ventilation should be produced by neurogenic stimuli. The time course of Te, Ti and VT/Ti at the onset and at the offset of limb movements indicates an abrupt and a slow component in the neurogenic drive. A single contraction of the limb during expiration of inspiration affected the timing and the VT/Ti of 3-8 breaths.


Effects of ambient pressures, He and Sf6 on O2 and CO2 transport in the avian egg. The CO2 and O2 tnesions were determined in the air cells of 14-16 day old chicken eggs before and after transfer to a 21% O2 in He or SF6 atmosphere. In the former gas mixture the air-cell PCO2 (which reflects the arterialized blood PCO2) fell rapidly from 32 torr in air to 17 torr in He-O2 attaining a new steady state in 2-4 h. In the SF6-O2 mixture PCO2 rose from 36 torr in a similar period. A similar PCO2 increase was also observed when eggs were compressed to 2 atm of air while exposure to 0.5 atm with a 40% O2-N2 mixture decreased PCO2. Since gas transport across the eggshell is by gas phase diffusion, these findings can be explained by the changes in the diffusion coefficient of CO2 which increase in the presence of He and decrease in SF6. Furthermore, the diffusion coefficient is also inversely related to the absolute pressure. Quantitative prediction of the changes of PCO2 in the He and SF6 mixture cannot be made, since the binary diffusion coefficients are not necessarily applicable in a ternary gas mixture. However, effective diffusion coefficients in these multicomponent mixtures can be derived on the basis of the observed PCO2 changes.


Ternary gas diffusion - in vitro studies. The purpose of these experiments was to compare diffusive gas movement in a two-gas system with that in a three-gas system. Gas mixtures of different compositions were placed initially on either side of a removable partition dividing a cylindrical lucite diffusion chamber, filled with 3 mm glass beads. This served to slow diffusion, minimize convective currents generated by removing the partition, and stabilize temperature within the chamber. In two-gas systems, after the partition was removed, oxygen equilibrated between the two parts of the chamber more rapidly in a helium environment than in a nitrogen environment, conforming with predictions based on binary gas laws. Results obtained with a three-gas system differed significantly from those obtained with the binary system. With 21% oxygen in belium initially in one half of the chamber and 21% oxygen in nitrogen in the other, PO2 rose transiently in the He-O2 side of the chamber. Qualitatively, similar results were obtained when the O2-N2 mixture was replaced by 100% nitrogen. Pressure in the system remained essentially constant. The possible mechanisms responsible for the PO2 rise were studied using a computer model of the system. This showed that movement of a given gas may be affected significantly by movement of other gases in the system. Hence, application of binary gas diffusion laws to systems containing more than two gases may lead to significant errors.


Airway occlusion pressures in awake and anesthetized goats. The pressures generated by the inspiratory muscles as they contract isometrically during airway occlusion seem to be a measure of respiratory neuron efferent activity. The ventilatory and occlusion pressure responses to increasing levels of CO2 were studied in goats, awake and anesthetized, with and without inspiratory flow resistance. Hypercapnia was produced by rebreathing. Randomly, during rebreathing, inspiratory airflow was prevented on single breaths. Ventilation and pressures developed during the first 100, 200, 300 and 400 milliseconds of an inspiratory effort against a complete occlusion increased linearly with CO2 in both awake and anesthetized animals. Anesthesia reduced both the ventilatory and occlusion pressure responses to CO2. Inspiratory resistance increased occlusion pressure responses in awake goats but not in the same animals when anesthetized. Inspiratory airflow resistance seems to augment respiratory efferent activity as reflected in the pressure responses only in conscious goats. Thus the response to an inspiratory resistance seems to depend on the state of consciousness.


[Technic for an inflatable and releasable balloon in neurology. Experimental study. Application in man]. We consider our method with an inflatable and releasable balloon to be trustworthy and now applicable to the treatment of carotido-cavernous fistulas; it may not be possible in all cases to pass the ballon on through the fistula and inflate it in the cavernous sinus, but it seems to us so very important to preserve the carotid flow that we think that this should be achieved whenever possible. Certain arterial aneurysms could profit from this technique. We have purposely omitted all diagnostic application of the method which serbinenko has described in his article: selective opacifcation of certain branches of the internal carotid, deliberate temporary occlusion of certain branches to enable the amount of tolerance to be assessed. All these exploratory methods which we are beginning to carry out will form the subject of a later paper.


[Striato-nigral degeneration. A propos of 2 anatomo-clinical cases]. Two sporadic cases of striato-nigral degeneration were characterized by the onset at the age of 61 of an akinetic-hypertonic syndrome and of a minimal or absent rest tremor, with a pyramidal syndrome, sphincter disorders, dysphonia, difficulty in swallowing and an unfavorable development in the space of two or three years not affected by L-Dopa. In one case, total insomnia was demonstrated by means of 3 polygraphic recordings during the night, two of them consecutive, and aprobenecide test showed a definite fall in H.V.A. and 5 H.I.A.A. in the lumbar cerebrospinal fluid. Anatomical verification showed, in one case, isolated putamino-nigral degeneration, and in the other associated with lesions of the olivo-cerebellopontine system. Much of the excess pigmentation found only in the putamen was melanotic in character and resulted perhaps from the striato-nigral degeneration, making it possible to classify this more accurately among the other multisystem degenerations, especially olivo-ponto-cerebellar atrophy and Shy-Drager syndrome


[Morphological aspects (optical and ultrastructural) of hypertrophy of the olivary bulb]. The present paper is an anatomical study of 3 cases which evolved with hypertrophy of the inferior olives: a case of zoster encephalitis, a multifocal leucoencephalopathy and a post-traumatic encephalopathy. In all three cases a relationship was demonstrated between the dentate nucleus and dento-olivary pathway - a relation of topical order in some instances - and the hypertrophic lesion of the inferior olive. Examination in the electron microscope revealed in the hypertrophic olivary cell not only dystrophic lesions but also progressive intracellular phenomena, such as maintenance of the Nissl bodies, multiplication of the mitochondria and especially marked proliferation of the neuro-filaments. This shows that, at least in some of the evolutive phases, hypertrophy of the inferior olives is based upon a real hypertrophy of the olivary cell. In addition, lesions of the glial system of the hypertrophic inferior olives were noted with the presence of osmiophil degeneration whose morphology clearly differed from that of Rosenthal's fibres.


[Meningeal arterio-venous fistulas with cortical venous drainage]. Pure dural arteriovenous fistulas are still not properly understood, and pose problems wich are far from being resolved. Among these, dural fistulas with cortical venous drainage represent a very special entity since they alone are expressed clinically by a neurological brain syndrome. Diagnosis is difficult and mistakes can be made as it is only by means of hyperselective arteriography of the branches of the external carotid that an accurate diagnosis can be made. However, their diagnosis assumes considerable importance since surgical or radiological treatment of hese fistulas brings about complete disappearance of clinical symptoms.


[Catecholaminergic axons in the human cerebral cortex. Observation by histofluorescence of cerebral biopsies in 2 cases of Alzheimer's disease]. Catecholamine axons have been visualized in human cerebral cortex obtained during routine neurosurgical operations. The fluorescence histochemical method of Lindvall et al. was used, slightly modified (calcium-deprived buffer, glyoxylic acid fixation followed by formaldehyde vapours exposition). The frontal cortex was more richely provided with catecholamine terminals than the parietal cortex. Two general types of axon morphology are evident. The most frequent is thin and sinous, sometimes forming clews, or loose basket-like arrangement around presumed nerve cells. The other one is moniliform and demonstrates spherical evenly-spaced varicosities. They look like, respectively, the well characterized dopaminergic and noradrenergic axons of the rat cerebral cortex. In two cases of Alzheimer's disease, noradrenergic-like fibers were missing and voluminous green-fluorescent varicosities, sometimes in obvious connection with typical axons, were observed in the proximity of senile plaques.


[Variations in local cerebral blood volume depending on the mean arterial blood pressure in man]. A radio isotopic technique is described to measure and monitor the cerebral blood volume during a controlled arterial hypotension induced by sodium nitroprusside in anesthetised patients (neurolepanalgesia) submited to surgery for a ruptured saccular aneurysm. The study was made in 10 cases from 90 mm Hg to 30 mm Hg mean blood pressure monitored from a transducer connected to an intra humeral microcatheter. The figures obtained show an increase of the cerebral blood volume from 90 mm Hg to 50 mm Hg in every patient and a linear correlation when the pressure is lowered under 50 mm Hg level; therefore under a mean arterial pressure of 50 mm Hg the autoregulation arterial mechanism is out of work.


[Study on the intraspinal cord regeneration of sensory fibers sectioned in the posterior root of the cat]. In order to assess the potential ability for posterior column fibers to repair, cat sensory root fibers where their repair is known to be possible. Progress of the outgrowth of fibers into the spinal cord (posterior columns) was tested by observation of the animals, histological investigation of the roots, examination of the posterior columns on cross-section at various levels, and by electrological investigation of conduction from root to spinal cord. The results obtained indicate that repair of root fibers may continue into the spinal cord, both segmentally and all along the posterior columns. These results are discussed and compared with failure of repair of posterior column fibers after spinal cord section.


[Nosographic approach of heriditary myopathies. Attempt at classification and diagnosis by means of erythrocyte cholinesterase and serum pseudocholinesterase analysis]. An original biological study involving assessment of red cell cholinesterase and serum pseudo-cholinesterase activity has given the authors a new approach to the classification of progressive muscular dystrophy: as a result, it has become possible to isolate Duchenne dystrophy and the carries of this disease and to distinguish them from cases of Becker's disease. Also, Leyden-Möbius dystrophy appears to deserve the name as it differs from limb-girdle dystrophy. Finally, there is a case to be made for classifying separately, because of its special biological characteristics, Steinert's myotonic dystrophy.


[Childhood aphasia with epilepsy. Remission with antiepileptic treatment]. The authors describe an example of an aphasic syndrome peculiar to children. This syndrome, which has previously been described by several authors, is characterized by an unusual form of aphasia, by its association with epileptic attacks, and by its onset in the absence of any apparent aetiology. In such cases, the effectiveness of anti-epileptic treatment on the aphasia is variable, often quite poor; on the other hand, in the case described in this report, administration of anti-epileptic treatment was followed by spectacular regression of the aphasia.


[Hodgkin's granuloma of the cerebral hemisphere. Apropos of one case]. With reference to a case of Hodgkin's granuloma of the frontal lobe, a review of the literature has enabled 8 similar cases of intra-cerebral localisation of this disease to be reclassified. Their mechanism is discussed on the basis of neuropathological data and in particular their development in situ. Excision of the lesion appears to be the treatment of choice.


Synovial fluid in the calf.

Synovial fluid in the calf. While awareness of synovial rupture of the knee joint confirmed by early arthrography increases, concomitant deep-vein occlusion may be being overlooked. Two cases of this are described, illustrating different mechanisms of venous occlusion by synovial rupture. Early thrombosis occurred in one patient from direct pressure as a result of haematoma following anticoagulant therapy and in another due to presumed external irritation of the vein. Although isolated bursae do not apparently rupture, tendon sheaths occasionally do. An example of lateral popliteal mononeuritis as a result of rupture of a tense peroneal tendon sheath is also given. Synovial rupture is primarily a clinical diagnosis but in selected cases, deep calf venography may be useful rather than arthrography. Almost a century ago, William Morrant Baker published his work on synovial protrusions showing his awareness of the consequences of free fluid in the calf. Some comments are made on his life and work.


Spinal changes in idiopathic chondrocalcinosis articularis. The lumbar-spine radiographs of 67 patients with idiopathic chondrocalcinosis articularis were reviewed for disc calcification and other changes. Calcification was present in 21 (31%) of the patients, seen most frequently at the L 2-3 disc space. The 21 patients as a group were significantly older than the 46 patients without disc calcification, and also had a much higher incidence of chondrocalcinosis in peripheral joints. There was no association with back pain or spinal stiffness. The 21 patients with disc calcification included six patients with a destructive peripheral arthropathy, and three of them had destructive changes affecting the lumbar spine. Three patients with a destructive peripheral arthropathy were also included in the group without disc calcification, and one of these had a destructive arthritis of the lumbar spine. For comparison, there was a 55% incidence of spinal chondrocalcinosis in nine patients with primary hyperparathyroidism and peripheral joint chondrocalcinosis, and a 6% incidence in 100 anteroposterior lumbar spine radiograph 'controls', taken before intravenous urography, although in this latter group the changes were minimal and confined to the margin of a single disc in each case.


The great toe as a clinical problem in rheumatoid arthritis. Two hundred consecutive in-patients with rheumatoid arthritis were examined for pain or deformity of the feet, and of the great toe in particular. Some abnormality occured in 196 feet and the deformities observed are presented. The symptoms that arise from these deformities are mainly derived from ill-fitting shoes, and the need for suitable foot-wear is emphasized. Two hitherto un-named entities are described namely Hallux tortus and chisel toe, since they give rise to their own shoe-fitting problems.


The effects of antacids on enteric-coated salicylate preparations. A volunteer study was undertaken in which the effect of the co-administration of therapeutic doses of aluminium hydroxide and magnesium trisilicate on the excretion of aspirin derived from enteric-coated preparations was studied. A significant alteration in the pattern of salicylate excretion was seen, but the mechanism of the interaction cannot be deduced from the present study. It was concluded that the interaction was of potential therapeutic importance, and further studies based on this pilot investigation have been initiated.


Muscle strength before and after menisectomy: a comparison of methods of post-operative management. In patients who have undergone menisectomy, isometric strength of the extensor and flexor muscles of the knee improves more rapidly when flexion exercises are encouraged. Immobilizing the knee joint in a back-slab and restricting the patient to static bracing of the quadriceps delays the recovery of strength, particularly in the more flexed positions of the knee joint.


The effect of rheumatoid arthritis on the social situation of housewives. Thirty-seven housewives treated in hospital for rheumatoid arthritis were investigated with particular reference to their husbands' reactions. Although most patients had 'accepted' the disease, many were distressed by both the physical aspects of it (tiredness, pain and limitation of activities) and by the psychological aspects (guilt, fear of being a burden, and not understanding the disease). In 70% it was felt that their husbands understood the disease, but half the patients had difficulties in coping with the anxiety of their husbands. Those whose arthritis had developed before marriage fared better in terms of fear of losing their independence, understanding the disease, guilt feelings, adjustment to the disease, their husbands' understanding and friction in the home. Patients with milder disease were more anxious, but experienced the greater understanding of their husbands. Help was required in enabling the patients to cope with their fears, to manage practically, and to deal with the anxiety of their husbands. Help in coping with the fears and in allaying the anxiety of their husbands was most required in those with mild disease and those in whom it had progressed to become socially disabling, but without confining the patients to their homes.


Application of visual-analogue scales to the measurement of functional capacity. Visual-analogue scales can be used to measure the subjective aspect of functional ability but, in a group of patients with severe rheumatoid arthritis, the severity of impairment of two predetermined functional tests was low in comparison with the severity of pain. Measurements of the ability to carry out these two functions, using visual-analogue and descriptive scales, and also using the time taken to perform the tasks, were not useful measures of the effectiveness of treatment of rheumatoid arthritis. Poor correlations were obtained between different measures of the same function and between different functions measured in the same way.


Cyclophosphamide, gold and penicillamine--disease-modifying drugs in rheumatoid arthritis--tailored dosage and ultimate success. Gold appears to be the disease-modifying drug of first choice for two reasons: response and absence of long-term toxicity. Although cyclophosphamide produces results as good or better than gold, the possible long-term toxicity outweighs the clinical benefit except in the unusual case. Penicillamine appears to be an acceptable drug of second choice.


[Axial computer tomography of the brain]. Computertized tomography of the brain, developed by Hounsfield - has decisively altered neuroradiologic procedures. Without the need of contrast media, cerebral structures (ventricles cisternes, sulci and physiological calcifications) and pathologic lesions (infarctions, hemorrhage, edema, tumors and malformations) may be visualized. Tumors can be diagnosed in 95 to 99% by this method. Tumors of the midline structures and of the posterior fossa are more easily detected than by conventional methods. In head injuries epidural and subdural hematoma, contusional edema and hemorrhage may be differentiated. Hydrocephalus externus and internus can be shown by computertized tomography. Probably computertized tomography will become the most frequently applied neuroradiological method in the future.


[Surgery of gastric and duodenal ulcer]. The variety of surgical techniques to deal with gastric and duodenal ulcers has been increased by non-resecting methods (truncular, selective, selective proximal vagotomy with or without pyloroplasty). Selective proximal vagotomy has proved its worth in uncomplicated chronic duodenal ulcer. Additional drainage is needed when there is pyloric stenosis. In 309 patients of the surgical department of Cologne-Lindenthal in the years 1970 to June 1975 selective proximal vagotomy for chronic duodenal ulcer had an operative mortality of 0.7%. 1-5 years later 88% of patients had no recurrence. The main cause of recurrence is incomplete vagotomy which could be avoided by the routine intra-operative use of the electrostimulator of Burge. In chronic gastric ulcer removal of the ulcer is needed because of the danger of malignant degreneration. Two third resection is the standard technique. In patients at risk vagotomy, pyloroplasty and excision of the ulcer are indicated.


[Radiologic diagnosis of retrograde jejunogastric invagination following gastrectomy]. Retrograde jejunogastric invagination is a rare late complication of operations on the stomach. Clinically signs and symptoms (colic-like upper abdominal pain, cyclindrical resistance and hematemesis) resemble that of high ileus. This complication, when wrongly interpreted or unknown, has a high mortality. One case following delivery shows the radiologic signs.


[Localisation of mammographic findings, suspect of malignancy but not palpable, and their histologic patterns]. A technique of marking non-palpable changes in mammograms for the surgeon is described. The suspected area is injected with contrast medium and patent blue. The radiologist can assess the exact site and the surgeon can recognize it at operation. Radiographs of the specimen removed can make sure whether the suspect area was removed. There were 13 preclinical cancers, 2 cancers in site, 1 sclerosing adenosis, 1 proliferating mastopathy, and 66 fibrous or fibrocytic mastopathies. Among contrast media Urografin 76% appears the best because of its sufficient contrast density and complete reabsorbtion. So far there have been no serious complications


[Orbital phlebography].

[Orbital phlebography]. For the diagnosis of intra- and retro-orbital processes, orbital phlebography occupies a key position whereas carotid arteriography visualizing the ophthalmic artery has only a limited diagnostic value for the assessment of absolute intra-orbital processes. Use of subtraction method and magnification technique brought essential improvement to the vessel representation of the orbit. Combination of these techniques in connection with computerized axial tomography (EMI-Scanner), as a rule, allows localization and identification of intraorbital space-occupying processes without difficulty.


[Important radiologic findings following blunt thoracic trauma (author's transl)]. In patients suffering from traffic accidents traumatic lesions of the chest are of special importance since in  50% of deaths the thoracic trauma is responsible for the final outcome. The fatal course is, however, not always due to severe and irreparable dammage to thoracic organs, but very often due to under-estimation of initial symptoms and thus inadequate treatment. For the proper diagnosis of traumatic lesions of the thorax the plain film of the chest is, therefore, fundamentally important. In this paper, which is mainly dealing with lesions of the airways and lungs, the significance of radiological symptoms is stressed and a correlation with pathophysiologic as well as histologic data is attempted.


[Diagnostic radiology in the field of traumatology (author's transl)]. Diagnostic radiology is important for casualty surgery. Evaluation of the valuable radiological indications presupposes knowledge of and experience in tactical and technical procedures. Knowledge of the biochemical processes, in the area of a fracture is also essential. The most important criteria were briefly presented.


[The value of ossovenography in advanced female genital carcinoma. A contribution to diagnosis of combined obstructive edema (author's transl)]. The pertrochanteric ossovenography brought important results on the etiology of combined obstructive edema of the lower limb after genital carcinoma. Its advantage in comparison with other methods of phlebography is the lack of embolic danger for the patient, its suitability even in thrombosis of the V. femoralis and the optimal contrast staining of venous system and anastomoses. The combined obstructive edema is characterized by a block of pelvic veins and a complete or incomplete block of lymph vessels. The combined obstructive edema depends only on the venous block as is demonstrated. A report on therapy and prognosis of 30 cases is given.


[Bilateral breast cancer (author's transl)]. The frequency of bilateral primary (simultaneous and nonsimultaneous) breast cancer in 1420 patients was reported. The number of cases of bilateral breast cancer not caused by metastases amounted to 1,75%. The problems and significance of follow-up checks was discussed.


Autophagia in myeloid precursors: an explanation for neutropenia in Chediak-Higashi syndrome? Neutropenia is an almost constant feature of Chediak-Higashi syndrome (CHS). There is evidence for a central mechanism of neutropenia. Ultrastructural studies of the bone marrow from a child with CHS showed marked autophagic phenomena within myeloid precursor cells and mature neutrophils. Autophagic vacuoles were randomly distributed in the cytoplasm of the cells from the granulocytic series and some of them contained giant granules which thus appeared particularly resistant to the autophagic process. The vital cellular damage through endophagocytosis suggests the possibility of intramedullary destruction as an explanation for neutropenia.


Plasma iron and erythrocytic glutathione peroxidase activity. A possible mechanism for oxidative haemolysis in iron deficiency anemia. The red cell glutathione-peroxidase (GSH-Px) activity of 9 normal subjects is compared with that of 15 cases of iron deficiency anaemia and with 13 cases of heterozygous beta-thalassemia with the same degree of anaemia and hypochromia. 2 cases of sideroblastic anaemia with high serum iron levels were also examined. Enzymatic activity was found to be significantly decreased in iron deficiency anaemia (about 55% of normal range), while it was not affected in heterozygous beta thalassaemia and it was increased in the 2 cases of sideroblastic anaemia. Moreover, GSH-Px activity exhibited a significant correlation with serum iron levels in all the patients studied. The observed modifications in GSH-Px activity are not correlated with erythrocyte ageing because reticulocyte-poor fractions exhibited GSH-Px activity which was not significantly reduced in respect of the reticulocyte-rich ones. These data seem to suggest that iron has a crucial connection with erythrocyte GSH-Px and that the enzyme deficiency may be of some importance in explaining the decreased red cell survival observed in severe iron-deficiency anaemias.


Effect of hyperlipidaemic diet and clofibrate treatment on rat erythrocyte lipids. Lipids of rat plasma and erythrocytes were analysed during hyperlipidaemic diet and clofibrate treatment. The diet increased the plasma cholesterol and phospholipid concentrations after 3 weeks' lipid feeding. Clofibrate in a dose of 200 mg/kg body weight did not inhibit the increase in plasma cholesterol and phospholipid contents, but significantly decreased the concentration of plasma triglycerides. The lipid diet slightly increased the erythrocyte cholesterol and phospholipid concentrations without affecting the red cell morphology or reticulocytosis. After 1 week's treatment, clofibrate in a dose of 200 mg/kg body weight caused a 2-fold increase in the cholesterol content and a rise in the cholesterol-phospholipid ratio of red blood cells of rats fed the hyperlipidaemic diet. These results suggest that the erythrocyte cell membrane can increase its cholesterol content and possibly play a role in cholesterol transport.


Autoradiographic evidence for reutilization of DNA catabolites by granulocytopoiesis in the rat. The proliferating granulocyte precursor pool of rat bone marrow was labelled during DNA synthesis by continuous infusion and by single injection of 3H-thymidine (3H-TdR), as well as by single injection of 125I-iododeoxyuridine (125I-UdR). The appearance of neutrophilic granulocytes in the blood stream after these various labelling procedures was studied by autoradiography. Labelling patterns of blood neutrophils were identical during continuous infusion and after single injection of 3H-TdR, and 100% labelling of the blood compartment was achieved. This result indicated reutilization of DNA catabolites to occur in granulocytopoiesis leading to continuous availability of 3H-labelled DNA precursors even after a single injection of 3H-TdR. Attempts to suppress reutilization of label by infusion of cold thymidine 1 h after injection of 3H-TdR were unsuccessful. However, a change in the labelling pattern of blood neutrophils was seen after single injection of 125I-UdR, a DNA precursor poorly reutilized in comparison to 3H-TdR. This result provided further evidence for reutilization of DNA catabolites by the cell system investigated. A comprehensive discussion of the results indicates that thymidinemonophosphate is the biochemical level of reutilization in granulocytopoiesis.


Testicular function after radiotherapy to inverted 'Y' field for malignant lymphoma. Testicular function was estimated by sperm counts, hormone assays and recording of reported conceptions in 9 patients irradiated for malignant lymphoma. The treatment had been an inverted 'Y' field including the inguinal regions with, in addition, a mantle field in 8 patients. Azoospermia or severe oligozoospermia was found in all but 1 patient, and the FSH levels were uniformly elevated. Testosterone and LH were within normal limits except in 2 patients with slightly subnormal testosterone levels. 7 of the patients were married to women of fertile age, and in 3 cases the wife became pregnant and give birth to a healthy child. The time lapses from irradiation to conception were 18, 40 and 57 months. 2 of these patients had severe oligozoospermia on examination 2 and 4 months respectively from conception. Thus fertility may possibly be underestimated by sperm counting and hormone assays after this type of radiotherapy.


Chromosome studies in untreated polycythaemia vera. Bone marrow chromosomes were studied in a series of 50 consecutive, unselected cases of untreated polycythaemia vera (PV). A pathological cell line was present in 7 patients (= 14%). 3 patients each had 1 extra chromosome no. 8 and 1 extra no. 9. 2 patients had a similar but not identical marker chromosome including material from the long arms of chromosome no. 1. 1 of these patients also had a 20q- deletion. 1 patient had an extra unidentified isochromosome. 1 patient had a monosomy 16. In 5 cases the abnormal clone dominated over cells with normal karyotype. In each of 6 patients a singular hyperdiploid cell was observed. 1 or several polyploid or randomly hypodiploid cells were found in most patients. The findings in our material are compared to other reports of chromosome studies in PV and allied disorders. Except for the 20q- deletion no abnormality typical for PV has so far been detected, but some chromosomes seem to be involved more often than others (1, 8, 9, 20). Patients with chromosome aberrations did not show any clinical, laboratory or morphologic features which could separate them from cases with normal karyotypes. The prognostic significance of the chromosome abnormalities encountered in early PV cannot be defined at present.


Chromosome abnormalities after chlorambucil therapy of polycythaemia vera. Bone marrow chromosomes were studied in 2 patients with polycythaemia vera (PV) at the time of diagnosis and several times subsequently during therapy with chlorambucil. Both patients were normal in the initial study, but later developed pathological diploid cell lines with structural chromosome abnormalities. Case 1 presented after 25 months of myelosuppressive therapy a deletion of chromosome no. 12, del (12) (p11), in 60% of the diploid cells. 10 months later all studied cells in the marrow contained this deletion. In addition, the deletion of chromosome no. 20, described as characteristic for PV, was found in 3 cells. Case 2 demonstrated after 40 months on chlorambucil the presence of a balanced translocation, t (1;5) (p36;q31) in 90% of the cells. In none of the patients were any definite clinical, laboratory or morphological signs of an approaching leukaemic transformation of the polycythaemic disorder present.


Platelet function and plasma free fatty acids during acute myocardial infarction and severe angina pectoris. The relationship between platelet function and plasma free fatty acid concentration has been studied serially during the initial 24 h in 11 patients suffering from acute myocardial infarction and in 5 patients with severe angina pectoris, Similar results were obtained in the 2 groups. Plasma free fatty acid concentration was initially high, and decreased significantly. The distribution of plasma free fatty acids remained unchanged. Platelet concentration was constant, whereas the percentage of reversible venous platelet aggregates initially was higher than in 11 healthy persons matched for age and sex. Platelet aggregates decreased transiently at 16 h. Venous reversible platelet aggregates correlated significantly with concentration of plasma free fatty acid, thus establishing a possible link between a change in lipid metabolism and platelet function. Plasma concentration of platelet factor 4 increased slightly but significantly during the initial hours. This may indicate an increased platelet release reaction.


The peripheral platelet count in response to intravenous infusion of isoprenaline. 5 healthy male volunteers received i.v. infusions of isoprenaline in doses of 0.03, 0.06 and 0.09 mug X kg-1 X min-1 over a period of 6 min. A statistically significant decrease in the peripheral platelet count was obtained, but no dose-response-curve for isoprenaline was observed. It is suggested that while an i.v. infusion of epinephrine causes a release of platelets from the exchangeable splenic platelet pool, isoprenaline might have the opposite effect on the spleen, thereby causing a decrease of platelets in the peripheral blood.


Fasting (acute energy deprivation) in man: effect on polymorphonuclear granulocyte functions, plasma iron and serum transferrin. The effect of 10 days of total fasting (energy deprivation) on blood polymorphonuclear granulocyte functions, leukocyte numbers, iron and transferrin levels was evaluated in 14 healthy, normal-weight males. Granulocytes from 7 of the subjects were tested in vitro. A statistically significant depression was noted in their bactericidal capacity against Staph. aureus. The 14 subjects showed a marked decrease in the stainable activity of granulocyte alkaline phosphatase and decreases were noted in plasma iron and serum transferrin levels. The iron saturation of serum transferrin was unchanged. Thus, impairment of granulocyte bactericidal functions may occur secondarily to short-term total energy deprivation, in the absence of iron deficiency.


Bone marrow metastases from prostatic cancer-marked cytolytic effect after only a few days of treatment with diethylstilbestrol. A 42-year-old male patient became hospitalized with severe back pain and marked bleeding tendency from disseminated intravascular coagulation. The bone marrow aspirate showed numerous nests of cancer cells presumably from a prostatic carcinoma. After only 4 days of treatment with diethylstilbestrol his condition was markedly improved, and a new bone marrow aspirate showed extensive necrosis of the cancer cells.


Unclassified haemolytic anaemia with splenomegaly and erythrocyte cation abnormalities--a disease of the spleen? An unclassified case of haemolytic anaemia with voluminous splenomegaly is reported. This anaemia was normocytic without any specific morphologic aspect of red blood cells (RBC); Coombs test was negative; the osmotic fragility was normal; the increased autohaemolysis was not affected by the presence of glucose; Hb studies were normal; no RBC enzyme deficiency was found; RBC lipids and membrane proteins were normal; there was a marked reduction in RBC survival with exclusive splenic uptake of erythrocytes. Before splenectomy, RBC cations and water content were abnormal: 1) the RBC water was decreased moderately; 2) the RBC sodium was about twice the normal mean with an increased 22Na turn-over; 3) the RBC potassium was markedly reduced and 42K influx was twice the normal mean; 4) the RBC calcium content was increased. Splenectomy was followed by rapid disappearance of haemolysis and RBC water and cation disturbances. Because of this extremely rapid disappearance after splenectomy the authors suggest this case of haemolytic anaemia could be a primary disease of the spleen.


Serial serum enzyme studies in infectious mononucleosis. Serial examinations of the white cells in the blood and serial determinations of serum glutamic oxaloacetic transaminase (GOT) and serum lactic dehydrogenase (LDH) isoenzymes have been performed in 36 patients with seropositive infectious mononucleosis. The first blood sample taken after the onset of the disease showed an increased number of mononuclear cells in the blood in 90% of the cases, elevated GOT level in 70% and elevated LDH level in 100%. Mainly isoenzymes I, II and III accounted for the elevated LDH values, while only 35% of the patients had increased LDH V (liver fraction). The number of mononuclear cells in the blood was normalized in all patients after 5 weeks and GOT normalized after 10 weeks. On the other hand, half of the patients had increased LDH, particularly isoenzymes I, II, and III, 4 months after the onset of the disease. The results indicate that the liver involvement probably is slight and of short duration, while the proliferation of lymphoid cells in the tissues, probably responsible for the main part of the LDH increase, continues for a considerably longer period.


The dilemma of partially treated bacterial meningitis. An analysis of 62 patients with pyogenic meningitis is presented, 23 (37%) of whom had received pre-diagnosis antibiotic therapy. Positive bacteriological identification could be achieved in 73% of the partially treated group as opposed to 97% in the previously untreated group but otherwise such pre-treatment made little impact on the diagnosis, characteristic cerebrospinal fluid changes sufficient for diagnostic purpose being present in all but one case. The study also fails to demonstrate any advantage of immunoelectroosmophoresis over conventional bacteriology in the problem cases of partially treated bacterial meningitis.


The occurrence of human intestinal parasites in Finland. A survey of the occurrence of intestinal parasites covered 243 inmates of institution for the mentally retarded, 537 hospital patients from 4 areas, 100 military servicemen, and 65 prisoners. Two faecal samples from each patient were examined by the formalin-ether concentration technique. Among the mentally retarded the prevalence of intestinal parasites was high, 41.3% among children and 51.5% among adults. The commonest parasite was Entamoeba coli. In Helsinki, the prevalence among children in hospital was only 7%, but among adult out patients, 18.9%. Among hospital patients in other areas, military servicemen, and prisoners in Helsinki the prevalence of intestinal parasites was low. The high prevalence of this protozoon, 14.8% among adult out-patients in Helsinki, probably reflects the increase in tourism. Four cases of Trichuris infection were detected among the mentally retarded.


Gentamicin-induced nephropathy.

Gentamicin-induced nephropathy. 162 consecutive gentamicin courses have been evaluated retrospectively with respect to nephrotoxicity of gentamicin (GM). Of these, 120 courses were administered in 106 patients for more than 2 days and under adequate control of plasma creatinine (PCr). In 62 of these 120 courses, PCr concentrations increased. In 17 courses (14%), GM therapy was found to be the only demonstrable etiology to the rise in PCr. The 17 courses with GM-induced reduction in kidney function were characterized by a prolonged duration of treatment, a high total dose of GM and a somewhat higher level of serum GM than the 58 courses of GM treatment in which PCr remained unchanged. No significant differences were found with regard to age, average daily dose of GM, average daily dose per kg and average daily dose in proportion to average diuresis. Additional administration of other nephrotoxic drugs did not increase the incidence of GM-induced nephropathy. When GM was the only demonstrable cause of nephropathy, the elevation in PCr concentrations were generally mild and transient, while the nephropathy when other factors were involved more often became severe and occasionally irreversible.


Interaction between cephaloridine and furosemide in man. The effect of a moderate oral dose of furosemide (80 mg daily) on the serum half-life of cephaloridine was studied. In 14 patients not previously treated with diuretics this dose was found to prolong the half-life significantly. A corresponding decrease of the half-life of cephaloridine was observed when furosemide was withdrawn from 2 patients who were treated with diuretics at admission to hospital. The concurrent treatment with furosemide and cephaloridine did not affect the renal function of the patients studied. From the results obtained it seems possible that even moderate doses of a potent diuretic increase the nephrotoxicity of a cephalosporin.


Effect of foundry size on the dust concentration of different work phases. The dust concentrations of different work phases in iron foundries of different sizes were studied. The results of the total dust measurements made during the Finnish Foundry Project were considered according to the eight main work phases, and the 51 iron foundries were divided into four groups according to the number of foundry workers. The division between the groups at 25, 50, and 100 workers is related to the degree of mechanization in Finnish foundries. The total dust concentration clearly increased in sand making and melting as the size of the foundry increased. The concentration decreased in molding, coremaking, knock-out, and cleaning as the number of workers increased. No significant differences between the foundry groups could be found during casting. The factors affecting the differences in dust concentrations are discussed.


Carbon monoxide in foundry air.

Carbon monoxide in foundry air. The concentration of carbon monoxide in the air of 67 iron, steel, or copper alloy foundries using sand molding was measured. About 1,100 carbon monoxide determinations were made. High concentrations of carbon monoxide were found in the area around the cupolas and the casting sites in iron foundries. The blood carboxyhemoglobin levels of 145 workers from iron foundries were measured. The carboxyhemoglobin level of 6% was exceeded in 26% of the nonsmokers and in 71% of the smokers.


Metal fumes in foundries.

Metal fumes in foundries. The metal content of melting and casting fumes was analyzed with X-ray fluorescence, atomic absorption, and mass spectrometric methods. The composition of fumes varied with the kind of alloy, the quality of scrap, and the type of melting process. In addition foundry workers' exposure to metal fumes was evaluated. The measurements of airborne metal concentrations in 10 steel foundries, 15 iron foundries, and 11 copper alloy foundries showed that exposure to lead, copper, and zinc may present a health hazard.


Gases formed from furan binding agents.

Gases formed from furan binding agents. Furfuryl alcohol and formaldehyde concentrations in the air of coremaking areas of 10 iron and steel foundries were measured. The mean concentration of furfuryl alcohol and formaldehyde was 4.3 cm3/m3 and 2.7 cm3/m3, respectively. Furfuryl alcohol exceeded its threshold limit value (TLV) of 5 cm3/m3 in 22% of the determinations; and formaldehyde (TLV=2 cm3/m3) in 38%. In addition phenol concentration was determined in one foundry; and phosphoric acid concentration, in two foundries. The concentrations of phenol and phosphoric acid were far lower than their TLVs. The question is raised as to whether exposure to furfuryl alcohol and formaldehyde in foundries in combination with exposure to dust and smoking can increase the risk of chronic bronchitis.


Angina pectoris, ECG findings and blood pressure of foundry workers in relation to carbon monoxide exposure. A prevalence study on angina pectoris, ECG changes, and blood pressure was carried out with those 1,000 workers (response rate 93.1%) with the longest exposure time (minimum 4.2 years) from a statistical sample of 20 foundries. The history of angina was obtained from a questionnaire recommended by the World Health Organization, and the ECGs were coded according to the Minnesota code. On the basis of measurements of the concentration of carbon monoxide (CO) in the air, the workers were divided into three occupational exposure groups, one with definite CO exposure, one with slight or occasional CO exposure, and one without CO exposure. Allowance was also made for present and past smoking habits. All comparisons were made on an intrastudy basis between the different subcategories. The prevalence of angina showed a clear dose-response relationship with regard to CO exposure from either occupation, smoking, or both, but no such trend was found for ECG findings suggestive of CHD. These results may suggest a greater sensitivity in detecting CHD on the part of the angina questionnaire. The systolic and diastolic blood pressures of CO exposed workers were slightly higher than those of other workers when age and smoking habits were taken into consideration. However, exposure to heat was intermixed with exposure to CO. It could be shown that selection based on health had operated in the foundries. Hence, the prevalence found can be considered to be underestimates of the "true" occurrence of cardiac disorders. Nevertheless both angina and "coronary" ECG findings were more prevalent than in other methodologically comparable studies on the general population or industrial workers without toxic exposure.


Prevalence of pneumoconiosis and chronic bronchitis in foundry workers. The prevalence of pneumoconiosis, chronic bronchitis, and impaired lung function was studied among those 1,000 foundry workers (response rate 93.1%) with the longest exposure time (minimum 4.2, mean 17, SD 9 years) from a representative sample of 20 foundries. Pneumoconiosis was diagnosed from 100 x 100 mm radiographs, and the false positives and false negatives were evaluated from normal-size radiographs from all those with a positive finding and a sample of those with a negative finding. Chronic bronchitis was studied by means of a translation of the MRC Short Questionnarie on Respiratory Symptoms. Forced vital capacity and forced expiratory volume in 1 s were measured with a Vitalograph Single Breath Wedge Spirometer, and the FEV % was calculated from these variables. The subjects were grouped according to smoking habits and dust exposure, which could be fairly well evaluated from measurements performed in connection with the health survey. All comparisons were made between different subcategories. The overall prevalence of pneumoconiosis was 3.8%, when allowance had been made for false positive and false negative findings. Most cases were mild. Chronic bronchitis occurred more frequently among those occupied in jobs classified as dusty. Smoking also strongly increased its prevalence; a combination of both exposures produced the strongest effect. The effect of smoking was also evident as an impairment of lung function; however, no such effect of dust exposure could be shown in this material. Since this was a prevalence study, the selective removal of workers from dusty jobs probably led to underestimates of all the health effects studied. In spite of the effect of selection excess bronchitis could be demonstrated in workers from dusty environments. Therefore effective dust control must be initiated not only with regard to silica dust but also with respect to total dust.


A mortality study of foundry workers.

A mortality study of foundry workers. The mortality of foundry workers was studied from a sample of all those men employed in 20 representative iron, steel, and nonferrous foundries for any period of time during 1950 through 1972. A statistical sample of 3,876 men from all those 15,401 workers with at least 3 months' exposure formed the cohort under study. The actual number of person-years of follow-up became 47,160. Total and cause-specific mortality was studied in the entire cohort and in different categories based on exposure time and occupation. The foundry workers' experience was compared to that expected on the basis of the general male population's death rates in Finland, and different categories of the cohort were compared to each other through direct standardization. During the period from 1950 through 1973, there had occurred 224 deaths. The mortality approached the expected value computed from the age-adjusted general male population, the standardized mortality ratio (SMR) being 90 for all foundry workers and 95 for workers in "typical" foundry occupations. The corresponding standard mortality ratios based on the estimated total number of person-years, after the application of corrections for sampling fractions, were 86 and 95, respectively. There was a slight shift of the age of death towards younger age groups among the casters, fettlers, and furnace tenders. Mortality from coronary heart disease showed a standardized mortality ratio of 80 for the whole cohort; no significant differences were found for any occupational category. Lung cancer mortality was higher than expected (SMR 150) in the entire cohort; closer analysis revealed that the excess was confined to iron foundries, and especially to molders with more than 5 years of exposure. There were no more violent deaths than expected, not even from work accidents. Because most occupational cohorts have standardized mortality ratios that are well below 90, the present results were interpreted as probably indicating slightly elevated mortality. The most important finding was the concentration of lung cancer among molders in iron foundries.


Turnover and health selection among foundry workers. The quantity, reasons, and health selection involved in labor turnover were studied with the use of questionnaires and employers' records. The basic material was the personnel of 20 representative foundries. The turnover in 1950--1972 was estimated from a sample of 588 workers. The causes and health selection were studied with questionnaires put to the 1,789 current employees (91% response), the 493 foundrymen who had left after at least 5 years of exposure (the 5-year-plus men, 71% response) and 424 of those who had left after less than 1 year of exposure (the 1-year-minus men, 55% response). The men were asked to describe their present and earlier work at the foundry, the nature and duration of their exposure, diagnosed lung and heart diseases, and chronic bronchitis and angina pectoris and to assess their present and former state of health and work capacity. The disability analysis was based on a sample of 2,834 men whose data were taken from the Social Insurance Register. The disability findings were compared to expected values based on the Finnish male population. Turnover proved to be rapid; short periods of employment predominated. The major reasons for leaving were poor work conditions, physically demanding work, low pay, and poor health. The turnover was fastest in dusty occupations. Relatively more exfoundrymen, both 5-year-plus and 1-year-minus, than current employees felt their health and/or work capacity to be poor. More of the older men in the 5-year-plus group than men of the same age in the current group had chronic bronchitis and diagnosed lung disorders. Both the 5-year-plus and the 1-year-minus exfoundrymen had relatively more diagnosed heart disorders than did the current employees. The disability prevalences of the foundrymen in any category of diseases did not exceed the expected values based on the male population. The overall findings indicate early health selection prior to pensionable disability and/or death.


Image modulation in corona discharge photography. Photographic images obtained by the Kirlian technique are principally a record of corona activity during an exposure interval. Most of the variations in the images of the corona of a living subject who is in contact with the photographic film can be accounted for by the presence of moisture on or within the subject's surface. During exposure, moisture is transferred from the subject to the emulsion surface of the photographic film and causes an alteration of the electric charge pattern on the film, hence the electric field at the surface of the subject. As a result, large variations in the density of corona images, corona streamer trajectories, and image coloration can be brought about. The radial extent of corona images--that is, the range of corona streamers--is an inverse function of the resistance in the circuit formed by the high-voltage supply, the subject, and the film-electrode configuration. This is because the voltage at which corona is initiated is dependent on the rate of rise of the voltage impressed between the subject and the electrode, and the rate of rise is governed by the applied voltage waveform and the voltage drop across the resistance. The range of streamers is proportional to the corona onset voltage. However, we have not seen any influence of large changes in skin resistance on streamer range. Presumably, this is due to the shunting effect of skin capacitance. In general, the photographic response to moisture suggests that corona discharge photography may be useful in the detection and quantification of moisture in animate and inanimate specimens through the orderly modulation of the image due to various levels of moisture.


Picosecond chemistry.

Picosecond chemistry. The ability to directly measure and evaluate ultrafast processes with unprecedented time resolution and reliability has greatly extended our knowledge about the kinetics of primary processes in chemistry and allied physical and biological sciences. Improvements in the reliability and versatility of picosecond techniques should lead to an increase in the experimental information about basic interactions in atomic and molecular systems.


Cooperative computation of stereo disparity. The extraction of stereo-disparity information from two images depends upon establishing a correspondence between them. In this article we analyze the nature of the correspondence computation and derive a cooperative algorithm that implements it. We show that this algorithm successfully extracts information from random-dot stereograms, and its implications for the psychophysics and neurophysiology of the visual system are briefly discussed.


Bounds on "bound water": transverse nuclear magnetic resonance relaxation in barnacle muscle. Relatively mobile protons that do not exchange with D2O exist in barnacle muscle cells. These are not part of the nonfreezing "bound water" that does exchange. Ninety-seven percent of the muscle water exhibits a single transverse relaxation time of 35 milliseconds: one water molecule per thousand, which is briefly and irrotationally bound, will produce the observed relaxation properties.


(D-Ala2)-Met-enkephalinamide: a potent, long-lasting synthetic pentapeptide analgesic. [D-Ala2]-Met-enkephalinamide (DALA), a synthetic enkephalin analog designed by in vitro analysis, binds to opiate receptors almost as tightly as methionine-enkephalin. Since it is not susceptible to degradation by brain enzymes, low doses (5 to 10 micrograms) cause profound, long-lasting, morphine-like analgesia when microinjected into rat brain.


Genetic composition of a high-yielding influenza A virus recombinant: a vaccine strain against "Swine" influenza. Analysis of the RNA migration pattern of a high-yielding influenza virus recombinant, X-53, used in vaccine production, reveals that only the two genes coding for hemagglutinin and neuraminidase antigens were derived from the "swine" influenza virus parent. A/New Jersey/11/76, while six were acquired from the A/PR/8/34 (HON1) parent, donor of the high yield characteristic.


Variations in writing posture and cerebral organization. Two tachistoscopic tests of cerebral lateralization were administered to 73 subjects classified by handedness, sex, and hand orientation in writing. The results indicated that the direction of cerebral lateralization could be indexed from a subject's handedness and hand posture during writing. In subjects with a normal writing posture, the linguistically specialized hemisphere was contralateral to the dominant hand, and the visuospatially specialized hemisphere was ipsilateral; the reverse was true in subjects with an "inverted" hand position during writing. Females and subjects having an inverted hand posture manifested smaller degrees of lateral differentiation than males and subjects with a typical hand posture.


The biochemical high-risk paradigm: behavioral and familial correlates of low platelet monoamine oxidase activity. A population of individuals potentially at risk for psychiatric disorders was identified by screening 375 college student volunteers for low platelet monoamine oxidase (MAO) activity levels. The lower and upper 10 per cent in MAO activity were interviewed and family history data were obtained. Low-MAO probands reported more frequent psychiatric or psychological counseling and problems with the law. Families of low MAO probands had an eightfold increase in the incidence of suicide or suicide attempts over those of high-MAO probands. This suggests that reduced MAO levels, reported previously in patients with affective disorders and chronic schizophrenia, may predict a vulnerability to psychiatric disorder.


St. Louis encephalitis: clinical and epidemiologic aspects, Mississippi, 1974. During July, August, and September 1974, 23 confirmed or presumptive cases of St. Louis encephalitis occurred in Mississippi. Attack rates were highest in the northwest corner of the state and among persons over 70 years of age. Rural and urban residents had similar attack rates. Nine persons have not resumed their pre-illness level of activity because of residual neurologic impairment six months after their illness. Additional cases of St. Louis encephalitis are expected in the next few years.


Mohs' chemosurgery and skin cancer.

Mohs' chemosurgery and skin cancer. Experience in treating 1, 275 skin cancers with Mohs' chemosurgery is presented. The Mohs technic uses microscopic examination to avoid excision of normal tissue and assure complete removal of the tumor. Chemosurgery is indicated for tumors which are poorly demarcated or which arise in areas known to have a high recurrence rate. It is the procedure of choice for almost all recurrent lesions.


Clinical comparison of isoflurance and halothane anesthetics. Isoflurane and halothane were compared in two similar groups of 100 patients each. Isoflurane compared favorably with halothane in producing adequate anesthesia in all our patients. Induction period was a little stormy when there was direct induction with isoflurane. Maintenance was excellent and recovery was good. Mean concentration necessary to induce anesthesia was 3.07% with isoflurane and 2.56% with halothane. Mean maintenance with isoflurane was 1.39%, compared to 1.40% with halothane. Less curare was required for relaxation when used with isoflurane than with halothane. This difference was not seen with pancuronium (Pavulon). Patient recovery was faster with isoflurane than with halothane. Incidence of delirium and shivering in the recovery period was similar for both agents. Incidence of nausea and vomiting was greater with isoflurane. Other clinical and biochemical postoperative comparisons did not show any significant differences between the two agents.


Pancreatic ascites.

Pancreatic ascites. Two patients with pancreatic ascites secondary to acute pancreatitis are presented. Successful drainage was carried out in one patient with distal pancreatectomy and Roux-en-Y pancreaticojejunostomy and in the other by cystoduodenostomy. Most cases of pancreatic ascites are due to a mild peritoneal reaction casued by inactivated pancreatic enzymes liberated after ductal or pseudocyst disruption. A majority of cases are successfully treated by surgical correction of the underlying pathology.


Clinically significant hypercorticism secondary to local steroid therapy. Multiple gastric ulcers developed secondary to systemic absorption of the topical synthetic steroid in this case. Rapid healing occurred as well as the resolution of the moon facies and hypertension on cessation of topical steroid administration and routine treatment for ulcers.


Adolescent genital dermatoses.

Adolescent genital dermatoses. The female adolescent period rivals the menopausal years as a most tumultuous interval. Hormonal changes account for many dermatoses not seen in older women. Vulvar problems that commonly affect the adolescent are discussed in reference to the pathophysiology which may induce these changes. The hormonal milium at this time period is emphasized. A concise grouping of disease processes, as well as a description, clue to diagnosis, and treatment of each entity is presented.


Which colonic polyps should be excised endoscopically? A review of 464 consecutive polypoid lesions of the colon reveals that virtually all pedunculated polyps and over 80% of 218 sessile polyps were removed colonoscopically. Although size or location of the lesions occasionally precludes colonoscopic excision, the endoscopic appearance of a sessile polyp is the most important factor in deciding upon the method of excision. In gneeral, smooth, soft, nonulcerated sessile lesions of all sizes were excised endoscopically, while approximately half of the larger (2-6 cm) firm, irregular-surfaced, benign sessile lesions, and all ulcerated or malignant sessile lesions required laparotomy for proper management. All polypoid lesions should be viewed endoscopically before deciding the method of excision, regardless of their size, location, or general appearnce by barium enema. Experience with endoscopic morphology and snare electrocautery technics was most important, since more than 85% of all polypoid lesions in this consecutive series were removed endoscopically.


Pyogenic granuloma of the hand.

Pyogenic granuloma of the hand. Pyogenic granuloma is a benign, vascular lesion occasionally seen on the hand. It many be quite alarming to the patient. Adequate surgical excision is advocated as the treatment of choice.


Infective endocarditis as a complication of heroin use. Infective endocarditis in heroin addicts has been reported to have a mortality as high as 85% and reports have varied widely regarding predominant valvular involvement and infecting microorganisms. A retrspective study was done and 61 cases of heroin-associated infective endocarditis were identified at Freedmen's Hospital and the District of Columbia General Hospital, Washington, DC between January 1969 and January 1973. Our results indicate that staphylococcal infection of the tricuspid valve has a much higher incidence in this population than has generally been believed and that it is the predominant presentation of infective endocarditis in these patients. The outcome of patients in our series compares favorably with previous reports and suggests that early diagnosis and prompt institution of appropriate antimicrobial therapy are important and may lead to improved survival in addicts with tricuspid endocarditis.


Culture, adaptation, and patterns of disease. The sick patient, rather than the disease process itself, should occupy the central focus of the physician's attention. Such an approach recognizes the interaction of physiologic and emotional forces in the occurrence of disease. It allows for a consideration of the contributory role of emotions in the precipition of physical illness and a recognition that physical illness may produce emotional sequelae of relevance to the total clinical problem. It is an approach which views man as an adapting animal, whose environment may play a crucial role in his adaptation and his disease. Only with such a perspective of man and disease can the principles of medical treatment be realistic.


Appendictiis in pregnancy.

Appendictiis in pregnancy. Twenty-nine cases of acute appendicitis during pregnancy are presented, and the recent literature is reviewed. Occurring once in 1,600 gestations, appendicitis carries a pregnancy loss of 10.8%. Difficulties in diagnosis and delays in treatment increase with advancing gestational age. Aggressive management may minimize the resultant maternal morbidity and fetal mortality.


Reconstruction of the oral cavity after obliterative surgery for cancer. Simple and reliable methods for reconstruction of the oral cavity after obliterative surgery for carcinoma include (1) nasolabial cheek flaps, (2) hemiforehead and total forehead flaps, and (3) temporal island flaps. In general, the nasolabial flap is sufficient for resurfacing areas of the oral cavity anterior to the second molar tooth, while the temporal island flap provides satisfactory coverage posterior to this area. The forehead flap, which is very durable and reliable, is reserved for reconstruction of the more massive defects. Technics and use of each reconstructive procedure are described.


Brief treatment of sexual problems.

Brief treatment of sexual problems. Brief, behaviorally oriented treatment of sexual dysfunction is gaining increasing acceptance in medicine and psychiatry. However, relatively few clinics have published their treatment results. During a 2 1/2-year period, 36 couples with diagnoses of sexual dysfunction were treated with a modified Masters and Johnson protocol. The initial success rate was 83%, but the degree of improvement reported by the couples varied from marked to equivocal. Eighty-nine percent of the male partners and 83% of the female partners manifested psychologic signs or symptoms that either warranted a psychiatric diagnosis or were noted as significant traits or symptoms. With an average of 7.9 months of follow-up, the failure rate increased from 17% to 38%. This increase was attributed in part to the degree of combined psychosexual disorder identified in the patients. The etiologic relationships between psychiatric conditions and sexual dysfunctions are not fully understood and will require further study.


Cardiac valve replacement in the first 21 years of life. From 1969 through 1974, 25 patients under age 21 years had prosthetic cardiac vlave replacement at the Emory University Hospital. Twenty-nine valves were replaced in this group. Patients ranged in age from 2 to 21 years, with a mean of 14 years. Concomitant correction of associated cardiac lesions was required in 14 (56%). Five (21%) had had prior open valvuoplastic procedures. Operative mortality for the entire group was 12%, with an additional late mortality of 8%. There have been no early or late deaths in the last three years' experience. Best results are obtained when early correction of isolated valvular lesions is done as soon as clinical deterioration on vigorous medical management is recognized. The presence of multiple intrcardiac lesions or prior valve surgery does not preclude excellent results. Current indications for surgical correction and follow-up management are presented.


Histologic factors affecting prognosis of pure seminoma of the testis. The histologic features of 92 cases of pure seminoma of the testis were reviewed in relation to the presence and degree of fibrosis, necrosis, granulomatous and lymphocytic reactions, interstitial cell hyperplasia, and lymphatic and/or vascular invasion associated with the primary tumor. No relationship between any of the histologic factors studied and survival was established.


Early surgical managment of penetrating ocular injuries involving the posterior segment. Pars plana vitrectomy technic can be used in the early management of certain penetrating ocular injuries involving the posterior segment, including selected intraocular foreign bodies. This study reports the results of ten consecutive cases of intraocular foreign bodies in the posterior segment treated by a combination of vitrectomy (including lensectomy when necessary) and foreign-body extraction with forceps. The foreign body was successfully removed in nine of ten eyes, and nine of ten eyes were salvaged. This favorable experience using early vitreous surgery suggests that the vitrectomy technic can be used in other penetrating injuries involving the posterior segment that are not associated with intraocular foreign bodies. Possible indications for early vitrectomy are presented, including cases with a poor prognosis when managed by conventional methods.


Immunology of the lung.

Immunology of the lung. Recent conceptual advances in immunology are reviewed. Although immune reactions take place in all organs, those occurring in the lung were chosen for illustrative purposes. The lung's enormous surface area has direct contact with the external environment through the airways and receives all of the cardiac output, a situation which exposes it to numerous, potentially harmful agents. The four basic types of immune responses are depicted as ending with tissue injury, but in most instances these reactions protect the host from disease. Manipulation of the immune system with transfer factor, new routes of immunization with existing vaccines, and other forms of immunotherapy are potential avenues for future management of disease.


Pregnancy complicated by Cushing's syndrome. A case of Cushing's syndrome occurring during the eighth month of pregnancy was presented. Steroid values and the results of dexamethasone suppression tests were markedly abnormal. Urinary steroid excretion reverted toward normal following delivery and prior to the removal of a large adrenal cortical adenoma.


Intramedullary lipoma of the distal femur. A rare case of intramedullary lipoma involving the distal femur is presented and discussed in relation to previously reported cases. The 26 previously reported extracranial cases of this bone lesion are briefly reviewed. Emphasis is placed upon establishing a definitive pathologic diagnosis by open biopsy when one is dealing with a large bony lesion that has indefinite radiologic features.


Respiratory insufficiency after intraperitoneal administration of Kanamycin: failure of calcium gluconate to reverse toxic effects. A 47-year-old woman developed postanesthesia respiratory insufficiency five hours after an intramuscular injection of 0.5 gm of kanamycin and one hour and 40 minutes after peritoneal lavage with 1.0 gm of kanamycin. The respiratory insufficiency was not reversed by an intravenous infusion of 400 mg of calcium gluconate. This is the third reported instance of respiratory insufficiency after kanamycin lavage. Only one of the previously reported patients responded to intravenous infusion of calcium gluconate, despite the experimental evidence supporting its efficacy.


Massive intraperitoneal hemorrhage from ruptured corpus luteum during anticoagulant therapy. The unpredictability of hemorrhagic complications during anticoagulant therapy is well known. An unusual case of massive intraperitoneal hemorrhage from a ruptured corpus luteum during such therapy is presented. That this complication is uncommon may be  because relatively few premenopausal women are placed on anticoagulant therapy. In addition, the most likely condition for which premenopausal women are given anticoagulants is thrombophlebitis associated with pregnancy and childbirth when ovulation is inhibited.


Congenital absence of the left pericardium: an unusual palpation finding and echocardiographic demonstration of the defect. A patient with classical clinical and roentgenographic features of congenital absence of the left pericardium is described. On physical examination in the supine position, the precordial apical impluse was markedly displaced laterally. In the left lateral decubitus position, however, the apical impulse was felt in a mor medial location. This apparently paradoxical movement of the apical impulse was not found in persons with normal hearts or with left ventricular enlargement of hypertrophy, and may be characteristic of the pericardial defect. Further, with echocardiography we were able to demonstrate the absence of a pericardial echo on the lateral surface of the heart. Thus, echocardiography may be a useful noninvasive tool in the diagnosis of this defect.


Traumatic rupture of right diaphragm presenting as pleuropneumonia. We present a case of rupture of the right diaphragm, due to an automobile accident, discovered after a period of eight years and presenting a clinical picture of pleuropneumonia. The radiologic appearances of traumatic hernia of the diaphragm are more difficult to appreciate on the right side because of the presence of the liver and delayed symptoms. This may be dangerous or sometimes fatal.


Tracheobronchiomegaly (Mounier-Kuhn syndrome). Tracheobronchiomegaly is a rare congenital disorder due to defective development of elastic and muscle tissues in the upper airways. The characteristic radiologic features shown by bronchography include marked dilatation of the tracheobronchial system and diffuse saccular bronchiectasis. These findings and recurrent episodes of pneumonia lead to a progressive loss of pulmonary function. Even with vigorous medical therapy the prognosis is poor and severe respiratory failure eventually develops.


Recovery from malignant hypertension with anuria after prolonged hemodialysis. A 29-year-old black woman with malignant hypertension and anuria was treated with hemodialysis and antihypertensive drugs. Her renal function improved and her creatinine clearance was 28 ml/min after 4 1/2 months of treatment. Similar cases in the literature are reviewed.