Congenital absence of the vas deferens.

Congenital absence of the vas deferens. Fourteen personal cases of agenesia of the vas deferens, bilateral in 12 and unilateral in 2, are described. In 13 of the cases the diagnosis was confirmed by surgical exploration. In most of the cases cytologic examination of aspiration biopsy specimens and histologic examination of surgical specimens of the testes showed that spermatogenesis was normal. The appearance of biopsy specimens of the epididymides were normal except for a certain degree of interstitital fibrosis and dilation of the ductus epididymidis. Endeavours to produce an artificial spermatocele with the aid of an isolated flap of tunica vaginalis in several patients proved unsuccessful. In one patient with a naturally preformed spermatocele the latter was aspirated, and the patient's wife was inseminated with the cellular content from the aspirate. This procedure has been repeated on several occasions, but so far without any subsequent conception. The failure of treatment of these patients may perhaps be due to some change in the function of their epididymides. This possibility is discussed.


Sarcoid reactions in pulmonary neoplasms. In a consectuive series of 734 patients with malignant tumorous of the lung, sarcoid reactions were observed in the mediastinal lymph nodes in 20 cases, i.e. in 3.2% of the 630 patients in whom these nodes were studied. Among these 20 patients, sarcoidosis was suspected in three. In two of these, granulomata were revealed in the tumour. Another two had metastases in the affected lymph nodes. All the common histological types of lung tumour were represented in the patients, but squamous-cell carcinomata showed a statistically significant preponderance as compared with anaplastic carcinomata. Three causes of such sarcoid reactions have been suggested: 1. an immunological reaction to substances released by the tumour and transported along the lymphatics; 2. an unrecognized sarcoidosis predisposing to lung cancer; 3. the co-existence of sarcoidosis and malignant tumour, possibly due to a common aetiological factor. The significant preponderance of squamous-cell carcinomata observed in this study is in favour of the first theory, because the slower growth and higher tendency to necrosis of this tumour type may be assumed to give rise to a more vigorous and longer-lasting stimulation of the regional lymph nodes.


Reaginic bronchial allergy and the occurrence of reagins against mites in a representative sample of a local Swedish population. This study involves an investigation of 185 subjects, aged 35--54 years, a representative sample of persons with chronic obstructive lung disease in a local Swedish population. Bronchial asthma was diagnosed in 86 persons, chronic bronchitis in 69 and a combination of bronchial asthma and chronic bronchitis in 30. Reaginic bronchial allergy as a provoking factor was considered as definite when the case history, an intracutaneous test, a bronchial provocation test and a radioallergosorbent test were all positive with regard to one and the same allergen. This was found in 28% of the asthmatics. In 16% of the asthmatics, the diagnosis of reaginic bronchial allergy was not supported by all the four diagnostic criteria used but was considered as probable since the case history or the bronchial provocation test was positive in association with a positive RAST or intracutaneous test with the same allergen. Reaginic (IgE) antibodies in serum to mites (Dermatophagoides pteronyssinus) were found in 20 subjects, 18 of whom also had a positive intracutaneous test for house dust. Four of these 20 subjects had definite and 12 had probable reaginic bronchial allergy. One of the remaining four subjects had chronic bronchitis without asthma. The percentage of definite reaginic bronchial allergy may possibly be increased when reliable bronchial provocations with mite allergen can be performed. Increased IgE levels in serum were found in only eight of the 51 asthmatics with reaginic bronchial allergy and in two of the 65 other asthmatics.


Treatment of steroid-dependent asthma patients with beclomethasone dipropionate aerosol. Fifty-two steroid-dependent adults with chronic perennial asthma were transferred to beclomethasone dipropionate aerosol. The tests demonstrated a significant improvement with beclomethasone in terms of the diary score, bronchodilator use, and PEF and FEV1.0 measurements, as compared with the previous period of prednisolone treatment. Before the transfer, 26 of the patients displayed one or more diseases or symptoms which were probably due to systemic steroid medication. Morning cortisol levels, along with the response to tetracosactrin had in all cases returned to normal when tests were carried out 41 days after transfer to beclomethasone dipropionate. In a group of 12 patients with the lowest 11-OHCS basal values, the mean of their 11-OHCS values during prednisolone treatment was as low as 0.14 plus or minus 0.06 mumol/l, but tetracosactrin challenge induced an elevation to a normal level, 0.33 plus or minus 0.13 mumol/l. After 41 days of beclomethasone treatment, the corresponding values were 0.56 plus or minus 0.90 plus or minus 0.28 mumol/l. Thirty-seven patients experienced one or more disturbing symptoms after transfer to beclomethasone. In many cases, the symptoms of allergic rhinitis were troublesome and persistent leading to a sixfold increase in the use of antihistaminic tablets. When the patients had learned to exhale through the nose following beclomethasone inhalation, the use of antihistaminic tablets again diminished to some extent. Moreover, two cases of ulcerative colitis were encountered during the beclomethasone treatment. During a follow-up period of one year, 14 patients were again receiving prednisolone; most often, this was due to worsening of the asthma because of respiratory infections. During the beclomethasone treatment, a continuous significant improvement in PEF was noted after isoprenaline inhalation, suggesting that further benefit may be obtained by the employment of bronchodilator aerosols as an essential part of the treatment.


[Cancer of the esophagus and cardia: diagnostic problems]. For many decades, the problem of cancer of the esophagus has been dominated by constant failure in diagnosis and therapy. Today the widespread use of upper digestive endoscopy could seem to constitute, for the moment, the only hope of changing this situation. Leaving aside the clinical, radiological, and enoscopic symptomatology of invasive esophageal cancer, this study is limited to practical considerations on the technology of endoscopic diagnosis in esophageal cancerology; the endoscopic expression of carcinoma "in situ" and chronic irritative esophageal condition; the precancerous and early-stage symptomatology of cancer of the esophagus; and the problem of "pseudo-cancer" of the esophagus.


[Diagnosis of gastric cancer].

[Diagnosis of gastric cancer]. Gastric cancer is still a major cause of death in Europe. Radiologic examination continues to be the diagnostic method of choice, but its accuracy is no more than 50% at the first examination and 75% after repeated procedures. Fiberscopy with biopsy and/or cytology may provide a definitive preoperative diagnosis in as many as 90% of instances, including early cancer cases. With the widespread use of endoscopy it is possible to predict the discovery of one early cancer every 300-400 endoscopies in patients with gastric symptoms. In 5 years, 1,195 early gastric cancers have been found in Europe. These data afford grounds for greater optimism in gastric cancer management.


[Endobrachyesophagus and adenocarcinoma]. During 6168 esophagoscopies (ENT Clinic, Medical School of Lausanne and Hospital of Yverdon: 1963-1974), 164 cylindrical epithelial patches (26%) have been detected endoscopically with a regular progressive incidence from year to year (optical improvement, interest and progressive training of endoscopists). Endoscopically, a distinction can be drawn between: 1. the cylindrical epithelial islets of the upper (19%) or lower (4%) esophagus; 2. widespread cylindrical epithelial lining of the lower esophagus (77%). The first type cannot be associated in any significant manner with any organic pathology. It is of congenital origin and is, as a rule, without pathological significance. Statistically, however, the second type would seem to enter into the category of peptic esophagitis in its chronic form, and appears to constitute a form of cicatrization. The incidence of adenocarcinoma of the lower esophagus in association with this second form of cylindrical epithelial lining is significant. It would, therefore, be advisable for peptic esophagitis to be treated before it reaches its chronic stage and, in particular, before the appearance of cylindrical epithelial scars.


[Tumors of the small intestine, a radiological problem]. Radiology has a permanent role to play in the diagnosis of tumors of the small bowel. The barium meal remains the examination of choice, arteriography of the celiac and superior mesenteric arteries being an important complementary procedure. The experience and clinical sense of the examiner play a predominant part in the differential diagnosis of a tumoral lesion of the small bowel, but a precise radiological technique retains its value.


[Induction of colonic carcinoma in mice using 1,2-dimethylhydrazine hydrochloride]. Weekly injections of 1,2-dimethylhydrazine-HC1 were given to female NMRI mice (Versuchstierfarm Tuttlingen, Germany). The earliest histological changes are those of focal hyperplasia and focal atypias confined to single crypts. These changes are observed as early as 5 weeks after the first injection. Serial sections of the whole colon were analyzed for localization and incidence of these lesions. Whereas after 12 weeks the number of small lesions was greater than after 36 weeks of exposure, at 36 weeks there were in situ carcinomas and carcinomas with infiltration. It appears that the focal atypias confined to single crypts may heal. With H-3-TdR labelling, it could be demonstrated that before generalized changes are observed histologically, there is a widening of the proliferative compartment. After cessation of DMH exposure, these changes continue for many weeks.


[Pancreatic carcinoma in chronic pancreatitis]. Chronic pancreatitis and carcinoma of the pancreas are being diagnosed with increasing frequency throughout the world. When both occur together, the question of their causal relationship arises. Secondary chronic pancreatitis following carcinoma of the pancreas is relatively frequent and can be proven histologically in at least 10% of pancreatic cancers. How often primary chronic pancreatitis develops into carcinoma is controversial. So far, there are only a few prospective clinical studies of chronic pancreatitis which cover this problem. We have followed 146 cases of chronic pancreatitis for an average of 8.7 years. Two thirds of our patients show pancreatic calcifications. Our series includes a family with congenital pancreatic insufficiency. So far only one adenocarcinoma of the head of the pancreas has been diagnosed in a 58-year-old male. Another 57-year-old male patient died from a solid metastatic carcinoma, probably of pancreatic origin. Therefore, the incidence of pancreatic cancer in our series is 0.7 and 1.4% respectively. However, 8 more patients suffering from extrapancreatic malignancies have turned up during the follow-up period: 2 cancers of the tongue, 2 colonic carcinomas, 2 bladder papillomas, and 1 bronchial and 1 gastric carcinoma. Our studies indicate that carcinoma of the pancreas probably does not occur more frequently in chronic non-hereditary pancreatitis than in the average population. A review of the literature suggests that there may be a higher incidence of carcinoma in families with hereditary chronic pancreatitis. The frequency of extrapancreatic cancer in our patients is remarkable. As pancreatic carcinoma is rare in chronic pancreatitis there is no reason for early aggressive surgery, e.g. pancreatectomy, in these patients.


[Carcinoma of the papilla: bypass, Whipple, or papillectomy?]. The records of 41 patients who had carcinoma of the ampulla of Vater in the period 1952-1973, are reviewed. Palliative operations were disappointing in 16 patients since they resulted in an average survival of only a few months. The most impressive results were obtained with the one-stage Whipple procedure and, in selected cases, by simple papillectomy with survival of up to 6 years. However, not every surgeon is able to deal competently with the difficult problems of malignant jaundice. Special technical and tactical skill is a precondition and systematic diagnostic evaluation as well as modern intensive care are necessary for good results. The ampullomas have the best prognosis in the group of peripapillary tumors.


[Erythrocyte transfusion].

[Erythrocyte transfusion]. Red cells are the most important and usually the only necessary part of transfused whole blood. Transfusion of concentrated red cells involves several advantages for the recipient (decreased volume load, fewer transfusion reactions, better antianemic effect per unit). The plasma which is separated from whole blood during the preparation of packed red cells can be used for fractionation or for the preparation of platelet concentrates and other special products. The increasing need for blood components makes the substitution of whole blood by packed red cells for transfusion purposes mandatory. The only rare indication for whole blood is fresh blood (i.e. blood up to 48 hours after donation). Red cell concentrates with a hematocrit of 70% are particularly suitable for general use, since the viscosity still allows transfusion without difficulties. With regard to quality and storage time of red cells there is no difference between packed cells and whole blood.


[Indications for plasma substitutes].

[Indications for plasma substitutes]. During severe hemorrhage the O-2-transport capacity of blood is reduced due to the loss of hemoglobin. This reduction is, however, fully compensated down to 25% hematocrit by augmentation of the minute volume consequent on the decrease of blood viscosity due to hemodilution, though this holds only on condition that myocardial contractibility and total blood volume are not impaired. The compensation of lost intravasal fluid is therefore prevailing importance, but the substitute need not be blood and may consist of a suitable colloid solution. Physiogel, a modified fluid gelatin, has proved to be excellent for this primary substitution of blood losses. The plasma derivatives should be reserved for special indications, particularly for treatment of oncotic deficit, and here highly concentrated (10-20% albumin) preparations are needed. Blood transfusions are indicated when the hemoglobin content falls below the critical limit of 25% hematocrit.


[Unexpected hemorrhage in surgery].

[Unexpected hemorrhage in surgery]. Unexpected hemorrhage in surgery may be avoided whenever preoperative examinations have not detected a defect of hemostasis. A prospective study conducted before oral surgery demonstrated that a simple preoperative screening program was suitable for specific detection of patients with bleeding tendencies and to indicate the need for a more detailed evaluation of hemostasis. The screening program includes a detailed history with the aim of detecting congenital defects of hemostasis or bleeding tendencies due to prolonged, acquired disorders. The thromboplastin time (Quick test) should be performed to evaluate asymptomatic, acquired coagulation defects, especially liver disease, whereas the semiquantitative determination of platelets on blood smears is necessary to rule out thrombocytopenia. A dramatic complication of massive bleeding is the so-called "dilution syndrome" caused by simultaneous blood loss and transfusion of stored blood (or red cells alone), leading to a progressive reduction of clotting factors and platelets. Therapeutic and organizational measures which are necessary in this exceptional situation are briefly discussed.


[Substitution treatment of hemophilia a and b]. The availability of factor VIII and factor IX concentrates has considerably improved substitution therapy in hemophilia A and B respectively. The desired activity levels and the corresponding factor VIII or factor IX dosage are indicated. Antifibrinolyics have a favorable action when given simultaneously, though hematuria is an absolute contraindication for antifibrinolytic treatment. The administration of factor IX concentrate in case of hemorrhage due to oral anticoagulation or to liver disease, or in newborns, should be used in emergency situations only, since this material may provoke either thrombosis or disseminated intravascular coagulation. Transmission of hepatitis is also possible.


[Integrating the blood transfusion service into hospital activities]. The traditional and present activities of a regional transfusion center catering for the blood product requirements of a population of some 250 000 are reviewed. It is suggested that the work of a blood bank should be extended to the laboratory sector and cover immunohematology, hematology and coagulation. Through the laboratory the transfusion center would thus be in close liaison with hospital clinical departments. It is of advantage for the staff of the enlarged blood bank to perform some degree of clinical activity, to facilitate discussion of clinical and technical problems relating to hematological disorders in general.


Measurement and distribution of various heavy metals in the Danube River and Danube Canal aquatic communities in the vicinity of Vienna, Austria. Samples of mud, water, algae and fish were collected from the Danube River and Danube Canal and analysed by neutron activation techniques for various trace metals. The study was conducted over a ten-months time period. Results show no significant variation in levels of Cr, Co, Sb, Zn, Fe and Sc during the period of study. Comparison of the results obtained for the river with those obtained for the canal indicate that, with the exception of one sampling site, there are no statistically significant differences. Generally the values lie in the range accepted as normal for most fresh water systems. One site in the canal was found to have high Cr content in the mud samples at a point where the Vienna River joins the canal.


Disturbance of sleep by sonic booms.

Disturbance of sleep by sonic booms. After a pilot study (2 subjects, 19 nights) we tested two different subjects during 57 nights, administering sonic booms (1 mb, 300 ms; sound level of sonic boom in the bedroom 80-85 dB (A) and recording EEG and peripheral blood volume. After 7 nights without noise, 30 nights with either 2 or 4 sonic booms (alternately) were applied. After 10 more nights without noise, four nights with 8 and 16 bangs followed alternately. The last 6 nights were used as a comparison phase. Results showed that distrubance was obvious during all periods of noise. No adaptation could be observed during any of the experiments. On the contrary, during the night with 4 bangs there was a tendency for compensation, e.g., in the last two thirds of nights with 4 bangs, the total time of deep sleep was comparable with the nights without any noise.


Disc shedding in rodlike and conelike photoreceptors of tree squirrels. Electron microscopic observations suggest that the rodlike and conelike photoreceptors of diurnal tree squirrels shed outer segment discs. Twenty-four hours after injection of triated L-leucine, the rodlike photoreceptors show a band of radioactivity at the base of the outer segment. The conelike photoreceptor outer segments show only a pattern of diffuse labeling. These results strongly suggest that disc shedding can occur in photoreceptor outer segments in which proteins are diffusely renewed.


Blockade of acetylcholine receptors: a model of myasthenia gravis. In order to block acetylcholine receptors of muscle, the alpha toxin of the Formosan cobra (Naja naja atra) was given intravenously to rats. Electrophysiological and pharmacological changes typical of myasthenia gravis were recorded, including decremental responses to repetitive stimuli, curare sensitivity, neostigmine reversal, and posttetanic phenomena. This model supports the concept that a reduction of available acetylcholine receptors may play an important role in myasthenia gravis.


Vomeronasal organ: critical role in mediating sexual behavior of the male hamster. Sexual behavior in male hamsters is totally abolished by bilateral removal of the olfactory bulbs. This operation eliminates sensory input from both the olfactory and the vomeronasal systems. We previously demonstrated that peripheral destruction of the olfactory receptors caused anosmia but did not impair male hamster mating behavior. Here we demonstrate that peripheral deafferentation of the vomeronasal system produces severe sexual behavior deficits in approximately one-third of the treated animals. Combined deafferentation of both the vomeronasal and the olfactory systems eliminates copulation in 100 percent of the animals. This is the first experimental demonstration of a functional role for the vomeronasal organ in a mammalian species.


Meaning in visual search.

Meaning in visual search. Viewers briefly glimpsed pictures presented in a sequence at rates up to eight per second. They recognized a target picture as accurately and almost as rapidly when they knew only its meaning given by a name (for example, a boat) as when they had seen the picture itself in advance.


Vitamin D: 3-deoxy-lalpha-hydroxyvitamin D3, biologically active analog of lalpha-dihydroxyvitamin D3. The ability of chemically synthesized 3-deoxy-lalpha-hydroxyvitamin D3, an analog of the biologically active form of vitamin D3, (lalpha,25-dihydroxyvitamin D3), to stimulate intestinal calcium transport was assessed. The 3-deoxy analog acted significantly more rapidly than vitamin D3 and only slightly slower than lalpha,25-dihydroxyvitamin D3. Comparison of the dose-response curves of these three vitamin D derivatives emphasizes the importance of the 3beta-hydroxyl group to biological activity.


Genetic linkage between the HL-A system and a deficit of the second component (C2) of complement. From a family of 14 individuals, evidence was obtained suggesting linkage between the HL-A haplotypes and the transmission of a 50 percent deficit in the functional activity of the C2 component of complement.


Rates of protein evolution: a function of amino acid composition. Conservation of secondary and tertiary structure in proteins suggests that rates of sequence variation reflect differences in the total number of amino acid replacements that are compatible with preservation of structure. Consequently, rates of sequence variation depend on whether the constituent amino acids of individual proteins are, over-all, more subject or less subject to evolutionary substitution than normal. Such rates correlate well with a mutability term based on amino acid composition.


Neural plasticity in visual cortex of adult cats after exposure to visual patterns. Over a period of 2 weeks, adult cats were twice a day exposed for 1 hour to a visual environment consisting only of vertical stripes and for the rest of the time were kept in darkness. Subsequent investigation of the striate cortex showed a decrease in the number of neurons sensitive to orientations around the vertical relative to those sensitive to horizontal orientations. This indicates that plasticity of functional properties of the cortical neuronal network still exists in adult animals.


Adaptive significance of synchronized breeding in a colonial bird: a new hypothesis. Bank swallows nest gregariously in colonies usually ranging from 10 to 300 nests. Different pairs within the same colony are highly synchronized with each other, and 67 percent of the nests fledged their young over a period of only 6 days. This high degree of synchronization is demonstrated to be of adaptive significance. Reproductive fitness increases as a function of the precision of synchrony of the colony. It is proposed that social foraging plays an important role in maximizing the feeding efficiency in this species and that asynchronous breeding decreases the effectiveness of this social foraging, particularly in late nesters and among young, newly fledged birds. An individual that fledges either early or at the peak of synchrony will emerge to find a steady stream of other bird traveling to local, ephemeral, concentrations of food. The late emerger finds itself practically alone and thus is deprived of the potential benefits of the pooled information about locations of food resources available to the full colony.


Chronotypic action of theophylline and of pentobarbital as circadian zeitgebers in the rat. In the rat the deep body temperature rhythm, monitored by telemetry, can be reset in a predictable direction by a stimulant (theopylline) and by a depressant (pentobarbital). When the drugs are applied immediately before or during the early active phases of the circadian cycle, the rhythm is set back (phase delay). When applied later, past the thermal peak, theophylline, but not pentobarbital, shifts the rhythm ahead (phase advance). Theophylline and pentobarbital in addition to having a number of already established pharmacological properties are now further identified as chronobiotics: they are drugs that may be used to alter the biological time structure by rephasing a circadian rhythm.


Flavonoids as inhibitors of lens aldose reductase. Flavonoids are effective inhibitors of lens aldose reductase. Quercetin, quercitrin, and myricitrin are significantly more potent than the previously known aldose reductase inhibitors. The inhibitory activity is of the noncompetitive type. In addition, quercitrin effectively blocks polyol accumulation in intact rat lenses incubated in medium containing high concentration of sugars.


Antipsychotic drugs: direct correlation between clinical potency and presynaptic action on dopamine neurons. Neuroleptic (antipsychotic) drugs inhibited the electrically stimulated release of [3-H] dopamine from rat striatal slices. The concentrations for 50 percent inhibition (ranging from 11.5 nanomolar for spiroperidol to 800 nanomolar for thioridazine) correlated closely with the average daily dosages of 25 neuroleptic drugs used clinically for schizophrenia. The correlation includes butyrophenones, phenothiazines, reserpine, pimozide, clozapine, and (plus)- butaclamol. Clinically inactive isomers [trans-thiothixene, trans-flupenthixol, and (minus)-butaclamol] required 20 to 1000 times higher concentrations than the active isomers to inhibit release. Compared to the inhibition of [3-H] dopamine release, much higher neuroleptic concentrations were needed to inhibit the electrically stimulated release of other neurotransmitters--[3-H] acetylcholine, [3-H-a1 (gamma-aminobutyric acid). The neuroleptic drugs may block the presynaptic coupling between impulse and neurosecretion.


Lactosyl ceramidosis: normal activity for two lactosyl ceramide beta-galactosidases. Lactosyl ceramide beta-galactosidase activities in the fibroblasts from the previously described patient with so-called "lactosyl ceramidosis" were reexamined with the two recently developed assay methods which appear to measure two genetically distinct enzymes that can degrade this substrate. No deficiency of either of the lactosyl ceramide-cleaving enzymes was observed. In addition, sphingomyelinase activity was only one-sixth of normal, while all other enzymes examined were within the normal ranges.


Visual membranes: specificity of fatty acid precursors for the electrical response to illumination. Rat electroretinograms were measured as a function of dietary supplements of purified ethyl esters of linolenic acid, linoleic acid, and oleic acid. Polyunsaturated fatty acids derived from precursors of linolenic and linoleic acids appear to be important functional components of photoreceptor cell membranes, although in equal dietary concentrations, linolenic acid precursors affect electroretinogram amplitudes to a greater extent than linoleic acid precursors. The electrical response of photoreceptor cell membranes appears to be a function of the position of the double bonds as well as a function of the total number of double bonds in fatty acid supplements.


Parasite reproductive strategy and evolution of castration of hosts by parasites. A modification of the Euler equation is used to describe a simple parasite life history in which survival decreases with age at a rate determined by mortality of the parasitized host. The advantages of castration of hosts by parasites are discussed using the modified equation in which castration is equivalent to reducing parasite virulence in the host to near zero or zero. It is suggested that castrating parasites can infest a wider range of hosts with higher mortality rates and that within parasite groups having castrating and noncastrating species, the former should infest hosts with higher mortality rates and relatively larger gonads.


Reciprocation of renin dependency with sodium volume dependency in renal hypertension. An angiotensin II inhibitor was administered to rats with two-kidney Goldblatt hypertension. The inhibitor produced a marked drop in blood pressure after 5 weeks but no significant change after 15 weeks of hypertension. However, even after 15 weeks of hypertension, following sodium depletion by either diuretics or a low sodium diet, the animals again became renin dependent as readministration of the inhibitor induced a significant fall in blood pressure. The data indicate that two-kidney Goldblatt hypertension is initially renin dependent but subsequently becomes sodium volume dependent in a way similar, although more protracted, to that already described for one-kidney Goldblatt hypertension.


Intracellular distribution of free potassium in Chironomus salivary glands. Potassium activities have been measured in the nucleus and cytoplasm of Chironomus salivary gland cells, using potassium-selective electrodes. The data provide the first rigorous evidence that potassium is at electrochemical equilibrium across the nuclear membrane. In addition, no difference in potassium chemical activity was found between nucleus and cytoplasm.


Dichloroacetamide antidotes for thiocarbamate herbicides: mode of action. Thiocarbamate sulfoxides formed on metabolic sulfoxidation of thicoarbamate herbicides in plants and mammals are effective carbamoylating agents for glutathione and other tissue thiols. Dichloracetamides that protect corn from thiocarbamate herbicide injury more rapid detoxification of the thiocarbamate sulfoxides by increasing their rate of carbamoylation of glutathione through elevation of the root glutathione level and glutathione s-transferase activity.


Nuclear protein matrix: association with newly synthesized DNA. The residual structural framework of the cell nucleus termed the nuclear protein matrix, is associated with newly synthesized DNA in regenerating rat liver. One minute after rats are injected with [3-H] thymidine, more than 90 percent of the total tritium in nuclear DNA is associated with the matrix DNA although this DNA comprises only 25 percent of the total nuclear DNA. In contrast, the bulk DNA, 75 percent of total nuclear DNA, contains less than 8 percent of the total labeled DNA. The percentage of total labeled DNA associated with the bulk DNA increases for 30 minutes after injection and decreases correspondingly in the matrix DNA.


Oxidation of the carcinogens benzo [a] pyrene and benzo [a] anthracene to dihydrodiols by a bacterium. A mutant strain of Beijerinckia, after growth with succinate plus biphenyl, contains an enzyme system that oxidizes benzo [a] pyrene and benzo [a] anthracene to mixtures of vicinal dihydrodiols. The major dihydrodiol formed from benzo [a] pyrene was identified as cis-9, 10-dihydroxy-9, 10-dihydrobenzo [a] pyrene by comparison with a synthetic sample. Benzo [a] anthracene was metabolized to four dihydrodiols, the major isomer being cis-1, 2-dihydroxy-1, 2-dihydroxy-1, 2-dihydrobenzo [a] anthracene.


Supraependymal cells of hypothalamic third ventricle: identification as resident phagocytes of the brain. Cells lying on the ventricular surface of the hypothalamic ependyma of the tegu lizard exhibit the pseudopodial and flaplike processes characteristic of macrophages found elsewhere. Since they ingest latex beads, they may be considered a resident phagocytic system of the brain. The importance of ependyma and ventricular phagocytes as a first line of defense against viral invasion of the brain, as well as their role in the pathogenesis of certain virus-related diseases, is suggested by a number of experimental and clinical observations.


Strain differences during intraventricular infusion of norepinephrine: possible role of receptor sensitivity. Two rat strains previously shown to differ with respect to behavioral activity, regional brain tyrosine hydroxylase activity, and norepinephrine-elicited accumulation of adenosine 3', 5'-monophosphate exhibited differential behavioral responsiveness during the intraventricular infusion of norepinephrine. The results are interpreted in terms of differential catecholamine receptor sensitivity.


Far-field acoustic response: origins in the cat. Short-latency evoked potentials recorded from the vertex of adult cats in response to click stimulation (the far-field acoustic response) were analyzed in a series of lesion experiments to determine the origins of each component. The resultant data indicate that the primary generator of potential is the acoustic nerve; of potential 2, the cochlear nucleus; of potential 3, neurons of the superior olivary complex activated by projections crossing the midline; of potential 4, neurons of the ventral nucleus of the lateral lemniscus and preolivary region activated equally by crossed and uncrossed projections; and of potential 5, neurons of the inferior colliculus activated primarily by crossed projections.


Suppression of a field population of houseflies with Spalangia endius. Sustained releases of the microhymenopteran pupal parasite Spalangia endius, at a commercial poultry installation in north Florida, completely suppressed a population of houseflies with in 35 days.


Peptide inhibition of the Prausnitz-Küstner reaction. A pentapeptide was synthesized with the  same amino acid sequence that occurs in a unique region of the chaim of immunoglobulin E near the cysteine residue participating in the linkage between the two heavy chains. This pentapeptide has the capacity to block a standard Prausnitz-Küstner reaction as well as to inhibit a known positive skin test reaction. Other similar synthetic polypeptides had less or no inhibitory activity. The likelihood that this pentapeptide amino acid sequence does in fact represent the structure of the specific immunoglobulin E binding site for the mast cell and basophil is considered.


Glomerular epithelium: structural alterations induced by polycations. Perfusion of rat kidneys with the polycation protamine sulfate caused glomerular epithelial alterations resembling those observed in human and experimental nephrotic states. The changes included swelling, blunting, and flattening of epithelial foot processes, were accompanied by decreased stainability of glomerular anionic sites, and were largely reversed by subsequent perfusion with the polyanion heparin.


2,3-Diphosphoglycerate in erythrocytes of chick embryos. 2,3-Diphosphoglycerate, heretofore considered absent in avian erythrocytes, occurs in the erythrocytes of embryos to the extent of 4 to 5 micromoles per cubic centimeter of erythrocytes before hatching; it disappears from the cells within 8 days after the embryo hatches.


Exposure to asbestos in the use of consumer spackling, patching, and taping compounds. Analysis of representative samples of spackling, patching, and jointing compounds, purchased at retail stores in the New York City area, has shown that some contain asbestos minerals as well as other biologically active substances. Measurements suggest that home repair work involving the use of such materials may result in exposure to dust at concentrations sufficient to produce disease.


Hybridization analysis of histone messenger RNA: association with polyribosomes during the cell cycle. Hybridization of cell cycle stage-specific polyribosomal RNA's to histone complementary DNA indicates that histone messenger RNA sequences are present on polyribosomes of Hela S3 cells only during the period of DNA replication.


Erythrocyte receptors for (Plasmodium knowlesi) malaria: Duffy blood group determinants. Duffy blood group negative human erythrocytes (FyFy) are resistant to infection by Plasmodium knowlesi, a simian malaria that infects Duffy positive human erythrocytes. The P. knowlesi resistance factor, Duffy negative erythrocytes, occurs in high frequency in West Africa, where the people are resistant to vivax malaria. This suggests that Duffy blood group determinants (Fya or Fyb) may be erythrocyte receptors for P. vivax.


Neuronal locus specificity: trans-repolarization of Xenopus embryonic retina after the time of axial specification. Signaling within an embryonic Xenopus eye comprised of two fused eye fragments can reprogram, in turn, the anteroposterior and dorsoventral axes of one of the fragments. The responding fragment, subsequently isolated and allowed to round up and innervate the brain, shows corresponding inversions in its retinotectal map. This is the first evidence of trans-repolarization of presumptive retina and provides an assay system for analysis of positional signaling within the retinal field.


Rapid food-aversion learning by a terrestrial mollusk. The terrestrial slug Limax maximus can lean to avoid new palatable food if CO2 poisoning is paired with igestion of the new food. Some animals learn in one trail and remember without error for 3 weeks. Avoidance most commonly consists of complete rejection of the unsafe food, based on olfactory cues. This preparation offers the opportunity for detailed neurophysiological analysis of a rapid-onset learning mechanism of long duration.


Measurement of total iron binding capacity in Thai Blood donors by a micro-technique. A micro-method with a high percentage of reproducibility and recovery was used to determine TIBC in 207 Thai blood donors. The mean values of TIBC were found to be 312 mu-g per 100 ml (S.D. = 46) in 149 male and 339 mu-g per 100 ml (S.D. = 58) in 58 female subjects respectively. There was a good relationship between these values and those obtained from the macro-technique using bathophenathroline in 105 samples. The corresponding results determined by the macro-technique were 328 mu-g per 100 ml (S.D. = 59) and 328 mu-g per 100 ml (S.D. = 74) in 106 male and 40 female subjects respectively. These results were fond to be in accordance with the result reported previously by other authors using different methods. The micro-method used in the present studies needed only 0.2 ml of serum. Determination of TIBC by this method and serum iron by the ultra-micro technique would be very valuable in the investigation of anaemia in the field studies particularly in infants.


Experimental  infection of Rattus sabanus and Rattus muelleri with subperiodic Brugia malayi. R. sabanus and R. muelleri are very common in the lowland forests of Malaysia. In nature they are infected with Breinlia sp. and D. ramachandrani. In an attempt to determine whether they are also susceptible to subperiodic B. malayi and thereby being potential reservoirs of infection of the disease, 24 R. muelleri and 17 R. sabanus were experimentally infected with the parasite. Results show that although they can support the full development of the parasite, they are poor hosts. This confirms the observation that in Malaysia natural infection of Rattus spp. with the parasite has not been seen. These rats therefore are probably not important in the zoonotic transmission of subperiodic B. malayi in Malaysia.


Trichinosis: A recent outbreak in Northern Thailand. During April, 1973, and outbreak of trichinosis occurred in Mae Sruay District, Chiang Rai Province, about 900 kilometers north of Bangkok, Thailand. Thirty-one persons were involved, of whom 27 (20 males, and 7 females), ranging in age from 9 to 72 years, were questioned. One adult female died before being brought to hospital. All subjects gave a history of having consumed raw pork in the form of "lahb" and "nahm", favourite dishes of the northern Thai. Beginning the third week after exposure, all developed fever and myalgia. Other less common complaints were diarrhoea and oedema of extremities and palpebral skin. Leucocytosis was revealed in 37% and 55% had eosinophilia exceeding 20%. Nineteen patients had hookworm and Opisthorchis infections. About 63% were skin test positive with Trichinella antigen. Eight patients were admitted to hospital; muscle biopsy was done on one serious case and trichina larvae were detected.


Epidemiology of hookworm infection in Soong nern district, Korat province, Thailand. Stool surveys in Soong Nern district, Korat Province, were done by the MF concentration technique. The intensity of hookworm infection, egg counts, results of treatment by anthelminthic drugs, observations on new infections and reinfections following treatment throughout the year and the density of nematode larvae in soil in the study area were investigated. Hookworm infection rates were high in Na-Glang village, both in adult villagers and school-aged children. The intensity of hookworm infections was considered mild and after treatment the numbers of eggs in the stools diminished or disappeared. New cases and reinfection increased during the rainy month, due to socio-environmental factors in the village that favoured the development of hookworm larvai in the soil. Although in this study it was impossible to distinguish hookworm larvae among the nematode larvae collected form soil it was highly probable that hookworm larvae were present. Control of hookworm infection in the study area was proposed by improvement of environmental sanitation and health education.


Osteo-arthritis of the trapeziometacarpal joint. A review of a group of 87 patients with osteo-arthritis of the trapeziometacarpal joint is presented and the results of treatment by non-surgical means and by excision of the trapezium, by arthrodesis of the trapeziometacrapal joint and by prosthetic replacement are reviewed. Indications and contra-indications to surgery, as revealed by this series, and the type of operation best carried out in individual cases, are discussed. The common association of a median carpal tunnel syndrome, which should receive prior treatment, is emphasised.


Left bundle-branch block associated with acute inferior wall myocardial infarction. The electrocardiographic manifestations of left bundle-branch block associated with acute inferior wall myocardial infarction are presented. The classic features of uncomplicated left bundle-branch block are modified in the following manner. The QRS complex is diminished in amplitude, and the S-T segment and T wave reflect primary changes: a coved, elevated S-T segment and an inverted, symmetrical T wave. These changes occur in leads orientated to the infarcted surface.


The concept of 'masquerading' bundle-branch block. The electrocardiographic features and genesis of so-called masquerading' bundle-branch block are presented. The phenomenon is essentially a right bundle-branch block with left anterior hemiblock, with further modifications of the initial and terminal QRS vectors, so that the standard leads, and at times the left precordial leads, resemble left bundle-branch block.


A pitfall in electrocardiographic diagnosis. Acute pulmonary embolus versus actue high lateral infarction. A patient presented in the coronary care unit with acute chest pain and in shock. The electrocardiographic features suggested an acute high lateral myocardial infarction. Certain features were, however, paradoxical, and suggested reversed arm electrodes. A repeat electrocardiogram reflected the classic features of acute pulmonary embolism. It is evident that the "mirror image' of the classic S1Q3T3 presentation of acute pulmonary embolism mimics an acute high lateral infarction.


Atypical fibroxanthoma of the skin.

Atypical fibroxanthoma of the skin. Five cases of atypical fibroxanthoma of the skin are reported. This uncommon, benign skin lesion has a bizarre histological appearance, which may frequently be misdiagnosed as milignant by the unwary. It is, however, eminently recognisable and an awareness of the condition may prevent unnecessary radical surgery.


The problem of obesity.

The problem of obesity. In countries with unrestricted access to food, obesity is common and is associated with enhanced mortality. Morbidity is difficult to assess, but must be a cause for much concern. The mechanisms concerened in the development of obesity have been studied intensively, but any single factor which might distinguish the obese from the lean remains elusive. The management of obesity must be based on altering the eating habits of the patient, and this, in turn is still an exercise in persuasion rather than a pharmacological operation.


The role of posture in idiopathic oedema. Idiopathic oedema is a common disorder in women, and is diagnosed by exclusion of known causes of oedema. In 26 of 31 patients studied, the oedema was shown to be orthostatic, i.e. induced by the upright posture and relieved by recumbency. Approximately half of the patients with orthostatic oedema are orthostatic sodium retainers owing to excessive transudation from presumably defecive capillaries with a consequent fall in plasma volume, reduction in glomerular filtration rate and, frequently, excessive renal tubular reabsorption of filtered sodium because of orthostatic hyperaldosteronism. The other patients are orthostatic water retainers, perhaps because of abnormal ADH secretion in the upright posture. Measurement of changes in sodium and water excretion in the recumbent and upright postures are described for the differentiation of these conditions. When conventional diuretic therapy and sodium restriction lose their effectiveness - as often happens after several months - orthostatic sodium retainers may be treated with a combination of the following sympathomimetic amines (dextroamphetamine or ephedrine) to reduce fluid transudation, spironolactone (Aldactone) to promote excretion during recumbency of sodium retained in the upright posture, the use of elastic stockings during the day, and a conventional diuretic together with recumbency from 20h00 most evenings. The last three measures are also useful in orthostatic water retention. Considerable symptomatic improvement can usually be accomplished by these means.


Breast feeding and breast cancer.

Breast feeding and breast cancer. Clinicians who deal with numerous cases of breast cancer are aware of the fact that there is some relationship between childbearing and breast cancer, and also that nulliparous women are probably more prone to breast cancer than their parous sister.  however, a relationship between breast feeding and breast cancer is not certain. This is a preliminary report on a study of the breast feeding habits of breast cancer patients and non-cancerous patients, after an attempt was made to match controls for parity and age.


[Medical teaching facilities, Parowvallei]. The building complex which has been erected for training in the area of medicine is described in relation to the thinking which forms the background for these physical facilities. Provision is made for training of students in medicine, nursing and the paramedical services of physiotherapy and occupational therapy. The Faculty of Dentistry of the University of Stellenbosch is also on the site. Facilities exist for the training of a wide spectrum of medical technologists and technicians, and nursing colleges have been established for the training of both White and Coloured nurses. There are supporting services such as workshops, a laundry and animal facilities. A crèche for the children of working mothers, both White and Coloured, has been established, and a bank and a post office have also been built on the site. The Tygerberg Hospital provides a comprehensive service to patients and is planned to accommodate all ethnic groups under one roof with particular provision of facilities for the most specialised services. The emphasis is on the training of students in medicine, both undergraduate and postgraduate.


[Ventricular aneurysmectomy and infarctectomy]. During a 22-month period, April 1972 to February 1974, 4 patients underwent ventricular aneurysmectomy at the Karl Bremer and Tygerberg Hospitals for congestive cardiac failure. In addition, 1 patient with an aneurysm and 3 patients with acute myocardial infarcts, ranging from 16 to 28 days postinfarction, underwent emergency surgery for recurrent malignant arrhythmias. The preoperative treatment, cardiac catheterisation data and surgical findings are outlined. The over-all survival rate is 75% for a mean follow-up period of 12,5 months (range 8-22 months). It is concluded that aneurysmectomy, for congestive cardiac failure, and infarctectomy, for life-threatening ventricular arrhythmias, are gratifying and worthwhile procedures.


[Pathogenesis of mural thrombi in idiopathic cardiomyopathy]. Thirty-two hearts from patients with idiopathic cardiomyopathy were examined postmortem. A comparative morphological study of the human hearts and of hearts from cardiomyopathic hamsters, rabbits and baboons indicates that severe cardiac dilatation with intracavitary stasis and abnormal turbulent blood flow are the most important factors in the pathogenesis of mural thrombi in idiopathic cardiomyopathy.


[Lactate dehydrogenase isoenzymes in the growth of heart cells]. As part of a detailed biochemical study of developing and growing heart cells, the protein- or cell-specific activities of lactate dehydrogenase isozymes were determined in cultured neonatal hamster heart cells and in intact hearts of hamster embryos and neonates. Evidence for differentiative growth of heart cells in both systems was obtained, but the characteristic in vivo isozyme shift from species rich in M subunits to those containing mainly H subunits was reversed in the cultured cells, suggesting that controls normally determining this pattern change might be absent in the conditions of in vitro cultivation.


Catecholamine release as mediator of intracellular enzyme activation in ischaemic perfused rat hearts. Isolated rat hearts perfused at suboptimal pressures have been studied as a model for generalised myocardial ischaemia. Glycogen phosphorylase a and hormone-sensitive triglyceridase activities, measured as markers for endogenous catecholamine release, were significantly increased at low perfusion pressures. Pharmacological blockage of noradrenaline re-uptake accentuated these effects, and depletion of catecholamine reserves eliminated them. This phenomenon may be important in the pathophysiology of cardiac ischaemia and its serious complications.


[Chronic non-specific respiratory disease with reference to 926 cases]. This study has been compiled from the hospital records of 926 patients with chronic non-specific respiratory disease, i.e. asthma, chronic bronchitis and emphysema. The aims of the study were to ascertain the role of age, allergy, family history, cigarette smoking, social class and occupation in the genesis of these diseases, and to investigate aggravating factors and the morbidity associated with these diseases. Asthma was found to occur in the younger age groups, allergy and family history being the outstanding aetiological factors in this disease. In chronic bronchitis the age factor is not decisive, and the influence of allergy, family history and the smoking of cigarettes is evenly distributed. Emphysema occurs mainly in later life, although 2 cases of younger onset with alpha1-antitrypsin deficiency were noted. In this disease, allergy and family history appear to be of lesser aetiological importance than the smoking of cigarettes. The majority of patients in all diagnostic categories fell into social group III (skilled workers) and most did work not associated with dust. In each diagnostic category, a certain number of patients were found in whom the factors of allergy, family history, cigarette smoking and general atmospheric pollution did not play a part. In these patients the possible role of the microclimate at the place of work is emphasised and warrants further study. The high prevalence, especially of asthma and chronic bronchitis, among housewives is stressed. Aggravating factors, i.e. humidity, irritating substances, temperature variations, dust, and type and locality of work, are shown to influence the symptomatology of asthma, bronchitis and emphysema. These diseases have a high associated morbidity, resulting in the loss of working days and in early retirement for the sufferers.


[Comprehensive lung function test for outpatients: a present-day review and its application]. A method for the measurement of recognised lung function parameters is described. Bedsides being useful for the detection of early pathology, the information obtained by this method is generally sufficient for an early diagnosis. A large number of patients can be examined per day and the test is also informative in high-risk pre-operative patients. Furthermore, the method is suitable for epidemiological studies and has already been used by the Medical Research Council to determine the incidence of chronic obstructive lung disease in the Bellville area.


[Intra-uterine growth standards for Cape Colored babies]. Intra-uterine weight, length and head circumference values are reported for Cape Coloured babies. Separate values are given for girls and boys and for firstborns and laterborns. The weight percentile values are lower than those of Scottish babies, but higher than those reported previously for the Coloured population group.


[Problems with reference to genetic counseling in arthrogryposis multiplex congenits]. Arthrogryposis multiplex congenita (AMC) is a rare condition, which presents various problems to the genetic counsellor. Two cases are described and the possible modes of inheritance are discussed. A review of the literature in this respect favours an autosomal recessive inheritance which is, however, not applicable to all cases.


Neurochemical aspects of porphyria. Studies on the possible neurotoxicity of delta-aminolaevulinic acid. It has been proposed that delta-aminolaevulinic acid (ALA), which is overproduced in the inherited hepatic porphyrias, may be responsible for the neurological manifestations of the acute attacks seen in these disorders. Studies were conducted in rats to test the neurotoxicity of ALA. It was found that, after intraperitoneal or subcutaneous injections, ALA is rapidly eliminated via the kidneys. In nephrectomised animals sustained elevation of blood ALA concentration was demonstrated, but despite this, brain uptake was extremely low. Experiments on incorporation of [4-14-C]-ALA into brain haem yielded similar information. After intraventricular injection of [4-14-C]-ALA, significant uptake by brain tissue occurred. The subsequent disappearance of ALA was moderately rapid and was virtually complete within 24 hours. Uptake of [4-14-C]-ALA was apparently significantly greater in the hypothalamus than in other brain areas. The subcellular distribution of radioactivity did not reveal any preferential uptake by nerve endings. Intraventricular injection of unlabelled ALA revealed definite but transitory neurotoxic effects in doses of 3 micromoles and greater. These include involuntary movements and ataxia. No effect of ALA administration on brain protein synthesis could be demonstrated. It is concluded that ALA does have effects on the nervous system in vivo, but the significance of these effects in relation to the pathogenesis of the neurological manifestations of acute porphyria is questionable.


Urinary porphyrins and porphyrin precursors in normal pregnancy. Relationship to urinary total oestrogen excretion,. The relationship between urinary excretion of porphyrins, porphyrin precursors and total oestrogens in normal pregnancy was investigated. Significant increases in total oestrogen, delta-aminolaevulinic acid (ALA) and coproporphyrin (COPRO) excretion were noted. However, no close correlation was found between total oestrogen excretion and urinary output of ALA and COPRO. The results suggest that the observed increases in ALA and COPRO excretion during pregnancy may not simply be the result of steroid-mediated induction of hepatic haem biosynthesis, as has been proposed.


[Radiological service at Tygerberg Hospital]. The Tygerberg Hospital, of the Medical Faculty of the University of Stellenbosch, has a decentralised radiological service where 50% of the radiology forms part of specialised departments. This obviates patient traffic and ensures an efficient technical service and close collaboration between the radiologist and the specialist concerned. The main department, when finally completed in a few years' time, will have 24 diagnostic rooms for general and special purposes and about 30 decentralised rooms.


[Intravenous radioisotope angiography in carotid-cavernous fistula]. The use of intravenous radio-isotope angiography in 3 cases of unilateral carotid-cavernous sinus fistula is described. The lesion gives a characteristic image pattern distinguishable from that of arteriovenous malformation in this region. An abnormal registration of intense radioactivity is seen in the early phases, accurately localised to the cavernous sinus, with a distinctive sigmoid-shaped configuration. Rapid disappearance by a paradoxical apparent increase in blood flow to the ipsilateral hemicranium. This is attributed to the massively arterialised venous drainage. This technique of demonstrating the cerebral circulation dynamically is considered a valuable diagnostic supplement to the static scintiscan and to conventional roentgen arteriography in this lesion.


[Man is not just a number].

[Man is not just a number]. Man is not just a number, but a unique blend of body, personality and social being. Everyone will become ill at some stage of his or her life, because nobody enjoys perfect health. To understand fully the nature of this illness, the doctor should be aware of (1) stress, and the ways in which a human being can respond to it; (ii) the concepts of incompetence and psychosocial life crises; (iii) the postulates of Halliday; and (iv) the importance of good communication with the patient.


[Occupational therapy at the University of Stellenbosch 1961-1974]. Training in occupational therapy was started at the University of Stellenbosch with a 3-year diploma course offered as from 1961-1964. This developed into the presentation of a 4-year degree course, B. Occupational Therapy, in 1965. Clinical training took place at Karl Bremer Hospital until the move in 1974 to the new medical faculty facilities associated with Tygerberg Hospital. Facilities available in this complex have enhanced the possibilities of training in many ways, and have allowed an increased intake in student numbers.


The organisation of comprehensive audiological services in the Cape Province. There is an urgent need for comprehensive audiological services in South Africa to deal adequately with the problems of clinical, industrial and social medicine. The organisation built up in and around the Tygerberg Hospital is described, and may serve as a possible blueprint for what could be done in the rest of the country. In particular, the important role of the medical profession in the habilitation of hearing-impaired children is described, as well as the influence this has on the education of these children.


Circumstances associated with the contamination of food by aflatoxin in a high primary liver cancer area. The variable incidence of primary liver cancer has been shown to be related to the average daily intake of aflatoxin in various parts of the world. This study was made to detect and report strategic points of contamination of foodstuffs in the region with the highest known incidence of liver cancer. Methods of food production, harvesting, storage and preparation were examined, and defects which promote fungus growth on food were found at each stage. Most meals consisted of a single dish with three basic ingredients -- a protein, bulk carbohydrate and green vegetables. Groundnuts were the main source of protein, but were also the main cause of aflatoxin contamination, since casual traditional methods of agriculture are not suited to the production of this exotic crop. Aflatoxin production appears to occur in the main sources of carbohydrate, such as cassava and maize, during storage. Leaves of various kinds provide substitutes for green vegetables and common methods of handling the crop promote fungal growth. Western-type foods had a particularly low aflatoxin content, or were free of it. Education and economic opportunities external to the subsistence economy structure are contributing to the westerisation of some living habits, a process believed to be responsible for the observed decrease in the incidence of primary liver cancer. Current knowledge indicates that a pertinent but simple educational programme could further markedly reduce the incidence of the disease.


Effect of blood vitamin A levels on the dark adaptation of mineworkers. The average dark adaptation time for newly recruited Black mineworkers is longer than that reported for Whites. While this longer dark adaptation time may result from a number of pathological conditions, its most likely cause is a deficiency of vitamin A in the diet. A study was conducted in which the vitamin A level of the blood and the dark adaptation times were correlated in a group of Black mineworkers upon arrival and again after 4 - 6 months continuous work underground in a gold mine. The study indicated that a very marked decrease occurred in the miners' serum vitamin A level between the time of arrival at the mine and the second examination. This difference was found to be highly significant. This decrease was accompanied by an increase in mean dark adaptation time, which was significant at the 5% level. These observations accord with the findings of a previous study and are indicative of an inadequate dietary intake of vitamin A during the period when the miners were on the mine diet.


Effect of vitamin C supplementation on black mineworkers. Subclinical vitamin C deficiency frequently occurs in Black mineworkers, in spite of an apparently adequate daily intake. A study was undertaken to establish the minimum rate of supplementation that would effectively reduce the incidence of subclinical vitamin C deficiency. Two levels of supplementation were tested in relation to a control group. It was found that a supplementation rate of at least 235 mg/head/day is required to maintain reasonably adequate serum levels. It was also found that effective control measures are required to ensure that the supplement is added to the magou, the staple beverage of the miners. It is strongly recommended that the intake of every Black mineworker be supplemented at a rate of 200 - 250 mg/day.


Biochemical aspects of a study of 100 obese white subjects. The effect of a 7 100 kilojoule diet (50% of the energy derived from carbohydrate, mainly unrefined, 30% from fat, mainly unsaturated, and 20% from protein) on 100 overweight subjects was investigated. It was found that 45% of subjects did not complete the study, 9% continued with the study but did not lose weight, 25% lost weight moderately well and 21% responded very well and lost a mean of 15,9 kg over a 6-9 month period. Very little indication of water retention was found. The following biochemical changes occurred during the study period: 1. There was a marked improvement in the glucose tolerance of the groups that lost weight effectively. 2. This improvement in glucose tolerance was associated with a very marked decrease in the secretion of immuno-reactive insulin. 3. The tendency for serum cholesterol and triglyceride levels to decrease during the study was also evidenced in the changes which occurred in the lipoprotein electrophoresis patterns. Stepwise discriminant analysis performed on biochemical, clinical and psychological data failed to provide a practical means of discriminating in advance between the likely response of subjects to this dietary therapy with acceptable accuracy.


Effect of ascorbic acid on serum lipid levels and depot cholesterol of the baboon (Papio ursinus). Twelve young male baboons were kept on a diet low in ascorbic acid for 3 months before the experiment. Six animals then received intravenous injections of ascorbic acid 60 mg/kg body mass every third day, while an isotonic saline solution was administered to 6 control animals. The serum ascorbic acid concentration of the animals treated with ascorbic acid levelled off after 9 days, at about 1,1 mg/100 ml. Ascorbic acid treatment resulted in a significant increase (P smaller than 0,005) in serum cholesterol values during the initial stages of treatment, but these returned to normal when the body pool was replenished with ascorbic acid. Ascorbic acid also brought about a significant lowering in serum triglyceride values (P smaller than 0.05). In an acute experiment ascorbic acid caused a 12,7% increase in serum cholesterol level 2 hours after the intravenous injection of ascorbic acid 60 mg/kg body mass. The blood glucose value and serum triglyceride concentration were not affected. The results prove that ascorbic acid treatment causes mobilisation of cholesterol from body depots into the bloodstream.


Clinical determinants of survival from postoperative renal failure. In a series of 114 consecutive patients with acute renal failure, the over-all mortality rate was 60 per cent; 62 per cent of the patients had a documented episode of hypotension just prior to the development of acute renal failure. In 11 patients, a second episode of renal failure developed following recovery from the initial episode of acute renal failure; all of these patients died. The urine output rate during the course of acute renal failure was inversely related to the mortality rate in the series as a whole. The mean duration of acute renal failure in survivors of the present series was 11.0 plus or minus 1.4 days. Complications of renal failure in the order of their frequency included hemorrhagic hypotension, sepsis, sepsis with hypotension and consumption coagulopathies; only 12 per cent had no complications. Only six of 51 patients whose clinical course was complicated by sepsis with or without an episode of hypotension survived. By contrast, 30 of 53 patients who had hemorrhagic hypotension without sepsis survived. The date suggest that although acute renal failure has a high mortality rate, it is a benign disease that is potentially reversible. Regardless of age and sex, renal functional recovery will take place if the patient is maintained in good physiologic condition long enough without a continued stress, such as sepsis, hypotension or hypovolemia, all of which prolong renal ischemia. During the course of  renal failure, extreme care is essential to maintain adequate circulating volume without extracellular fluid overload; a second hemodynamic insult may result in serious damage to the regenerating renal tubules. We conclude that early recognition of acute renal failure, aggressive management of sepsis, careful titration of fluid and electrolyte therapy, meticulous monitoring, maintenance of the circulation and judicious utilization of dialysis will aid in reduction of mortality in these critically ill patients.


Bovine graft fistulas in patients with vascular access problems receiving hemodialysis. Thirty-three bovine grafts were placed in 28 patients for vascular access for hemodialysis. The indications were lack of shunt sites and anticoagulation with Coumadin in patients without vessels suitable for construction of a primary arteriovenous fistula. All but one of the grafts were loops placed in the forearm. There were 20 complications associated with the 33 procedures. Three patients required replacement of the initial graft in the early postoperative period due to thrombosis. One additional patient required two graft replacements  and eventual anticoagulation with Coumadin before a successful result was obtained. There have been no serious ischemic problems. Presently, there are 27 functional bovine grafts, and 68 per cent of these are currently used for vascular access for dialysis. Patient acceptance of the fistulas has been good. The loop bovine graft fistula in the arm is an excellent means for vascular access in the patient receiving hemodialysis.


Effect of suture materials on healing wounds of the stomach and colon. Wound healing in the stomach and colon of mongrel dogs was studied using physical, histologic and chemical techniques to evaluate effects of various suture materials on the healing pattern and to compare visceral wounds with skin wounds. The general pattern of healing for stomach and colon wounds is the same in rats, rabbits and dogs. However, the extent of healing, the percentage of strength of normal tissue attained by the wound, is less in the dog than in the rat or rabbit. Prolene and plain and chromic catgut produce the least and silk produces the greatest cellular reaction in the stomach and colon. We believe the effect of absorbable sutures on strength of stomach and colon wounds, while statistically significant, is not of any great clinical significance except perhaps in severely debilitated patients. A trial of Prolene sutures for anastomotic closure would seem indicated. The healing of stomach and colon wounds differs from the pattern observed for skin wounds. Breaking strength increases rapidly for 14 to 21 days postwounding and then does not change significantly. The wounds are metabolically more active than skin wounds since the rate of collagen synthesis is markedly elevated even after 120 days and the rate of noncollagenous protein synthesis is twice as great in the wound as it is in normal tissue. Colon and stomach wounds closed with absorbable sutures are weaker at 14 through 28 days than similar wounds closed with nonabsorbable sutures. Yet, when strength of wound is expressed as a percentage of strength of unwounded tissue, there is no difference between wounds blosed with absorbable or nonabsorbable sutures. Thus, it would appear that there is a general diminution of the strength of normal stomach and colon wall up to 6 centimeters from wounds which have been closed with absorbable sutures.


Total hip replacement as a salvage in traumatic lesions about the hip. One hundred and eight total hip replacements have been accomplished in an attempt to salvage a problem caused by trauma. Many times, patients with traumatic arthritic problems have a quick transition from a normal existence to a severe disability. They may not have had the ability physically or mentally to handle this disability seen in patients with rheumatoid disease or idiopathic osteoarthritis. It has been shown that these patients with total joint replacement can be rehabilitated to almost a normal degree of function. Complications occur, but with careful planning and execution, they can be held to a minimum. In the long run, a high incidence of degenerative disease is seen in these problems. The primary procedure should not be done so as to jeopardize a secondary reconstruction.


Experimental diminution fo splenci function by  selective embolization of the splenic artery. The splenic artery was occluded by the selective injection of Amicar-mixed clot or Gelfoam in 18 dogs. The dogs were sacrificed at 24 hours, two weeks and two months. Angiography was done before and after embolization, three hours after embolization and prior to sacrifice. White blood counts and hematocrit values were evaluated weekly in the dogs sacrificed at two months. The results of this study reveal differences in the effects of the two embolic materials. Because Amicar-mixed clot was partially lysed in the first several hours and also pushed peripherally, the depression of hematologic function seen with its use was transient and most spleens returned to a relatively normal gross and histologic appearance. With Gelfoam, although the embolic material was also pushed peripherally into the branches of the splenic artery in several of the dogs, the depression of hematologic function was prolonged, and moderate splenic parenchymal fibrosis was seen. The areas between the bands of fibrosis appeared normal. The results indicate that selective embolic occlusion of the splenic artery and its branches may offer a method of depressing splenic function in patients who are not candidates for splenectomy.


Natural history and experience with diagnosis and treatment of the Zollinger-Ellison syndrome. With better methods of diagnosis, patients will be identified earlier in the course of their disease and will often have atypical and borderline manifestations of the syndrome. Serum gastrin measurements with calcium and especially with secretin challenge will be the most important method of diagnosis. Any patient with acid hypersecretion who has a high serum gastrin level that does higher on secretin infusion should be considered to have the Zollinger-Ellison syndrome. A firm diagnosis of the Zollinger-Ellison syndrome should be made, if at all possible, prior to operation. At operation, a thorough search of the pancreas, duodenum, stomach, greater and lesser omentum and liver should be made for primary and secondary gastrinomas. If the preoperative data firmly establish the diagnosis of the Zollinger-Ellison syndrome, a total gastrectomy should be carried out even if no primary tumor is found. Similarly, a total gastrectomy should be done even if there are massive hepatic metastases. If total gastrectomy is not performed, the patient is apt to die of complications of acid hypersecretion. The only possible exceptions to the rule of always performing a total gastrectomy are in asymptomatic patients with easily excisable tumors or patients with tumors of the duodenum that are easily excisable, providing that in both instances after the excision of the tumor the output of gastric acid as measured at operation is immediately halted. All possible metastatic tumor tissue should be removed. The more tumor tissue removed, the longer the patient will survive. Metastases should be treated aggressively. They do not disappear after total gastrectomy in our experience, and they may kill patients. Patients should be followed after operation with serial measurements of serum gastrin concentrations and by hepatic scintillation scans and hepatic angiography. If hepatic metastases develop, intrahepatic artery infusions of 5-fluorouracil may slow tumor growth.


Diagnosis of deep venous thrombosis using a Doppler ultrasonic technique. A consecutive series of 118 patients was studied postoperatively by Doppler ultrasonic techniques and by either venography or radioiodinated fibrinogen. When using the latter diagnostic measures, 22 patients were shown to have deep venous thrombosis, an incidence of 18.6 per cent. The Doppler ultrasonic technique showed that 21 patients had deep venous thrombosis, an incidence of 17.7 per cent. When the patients diagnosed as having deep venous thrombosis by two separate methods were compared, it was shown that the Doppler technique gave two false-positive results and three false-negative results. It is concluded that this technique is accurate, and because of its convenience, lack of complications and ability to be repeated frequently, it should be the preferred screening technique for the diagnosis of postoperative deep venous thrombosis.


The surgical treatment of coarctation of the aorta. Patients with coarctation of the aorta have a significantly decreased life expectancy. Surgical correction is curative and involves a low mortality rate which increases with coexisting cardiovascular abnormalities. In our series, there were no operative deaths in patients with pure coarctation of the aorta. Age is an important factor and postoperative complications were more frequent in older patients. Re section of the narrowed area with end-to-end anastomosis is the technique of choice. If theis is not possible, a Dacron tube is a good alternative. Early diagnosis and early intervention are of utmost importance, even in asymptomatic patients.


Stercoraceous and idiopathic perforations of the colon. Fourteen patients have been encountered with stercoraceous or idiopathic perforations of the colon. Seven patients had a stercoraceous perforation; four had an idiopathic perforation; and three patients remained without exact classification. All the patients were admitted to hospital because of sudden abdominal pain. All except one patient, who was in an agonal condition, were operated on with a diagnosis of peritonitis. The preoperative clinical, radiologic and laboratory examinations were not specific, and in only one instance, the provisional diagnosis was correct. The main differnece between idiopathic and stercoraceous perforations was the macroscopic and histologic appearance of the perforation. In a perforated stercoraceous ulcer, the perforation was a round or an ovoid hole with necrotic and inflammatory edges, while in the idiopathic form, the perforation was a tear with a normal appearance of the colonic wall. The treatment consisted of a closure of the perforation and a proximally situated stoma, or exteriorization. Four patients of the seven with stercoraceous perforations survived. In idiopathic perforations, the prognosis was poor. All patients died during the first 24 hours after the operation. This possibly is an indication of some basic difference in the pathophysiology of these two diseases.


Injuries of the pelvic ureter.

Injuries of the pelvic ureter. Ureteral injuries may cause infection, fistula, and even death. By revealing abnormalities, preoperative pyelography warns the surgeon of hazards to be anticipated. Injury found during operation is managed by reimplantation, reanastomosis, or ureterostomy in situ, while deliberate ligature is avoided. Postoperative ureteral fistula is treated by reimplantation, although occasionally a tongue of reflected bladder wall converted into a  tube is required. In the absence of skilled urologic advice, ureteral injuries may be managed by the gynecologist.


Amputation through the knee for the nonambulatory patient. The first amputation through the knee to be done in the United States was performed 150 years ago. Since then, its advantages have been noted repeatedly, but widespread acceptance has never been attained. Amputation through the knee should be the procedure of choice for the poor risk, bedridden patient because it is simple, safe  and swift. There is minimal postoperative pain, and the stump is sufficiently long to be a useful appendage.


Experiences in intracranial surgery for aneurysms. This is a report of 54 cases of saccular aneurysms operated upon intracranially with a total operative mortality of 7.4%, poor results in four cases (7.4%) and excellent results in 46 cases (85.1%). For 53 supratentorial aneurysms, the operative mortality was 5.6%, with two operative deaths (4.8%) in the last 41 cases. Intermittent vascular occlusion with a newly developed special forceps and the use of moderate arterial hypotension were of value in dealing with these aneurysms.


Experimental cerebral vasospasm in cats: modification by a new synthetic vasodilator YC-93. Effects of a new synthetic vasodilator, YC-93, a derivative of 1. 4-dihydropyridine, on experimental cerebral vasospasm, were studies in cats. A topical administration of YC-93 solution was found to rapidly reverse the spasm of the basilar artery induced with a subarachnoi application of fresh blood, serotonin or porstaglandin F2 alpha. Pretreatment of the basilar artery with YC-93 prevented the development of experimental vasospasm with all these agents.


Indications for thoracic placement of the ventriculoperitoneal pumping chamber. The bulkiest portion of the shunts commonly used to divert the cerebrospinal fluid into the atrial or pleureal cavities is traditionally implanted under the skin behind, and above the ear. The scalp in this location is often thin and tightly attached to the underlying bone. Placement of these bulky devices beneath the skin may cause erosion of the scalp and exposure of the shunt. When erosion and infection occur, the shunt has to be removed. Reinsertion of the shunt is possible by placing the bulkiest portion, the pumping chamber, below the clavicle over the second rib.


Extradural toruloma in the lumbo-sacral region. An extradural toruloma developed in the lumbo-sacral region of a man. Symptoms had been present for two years, but he had been diagnosed as having tuberculosis of the lung seven years before. The mass was excised and the patient treated with Amphotericin B which had to be discontinued and Sulfa Soxizole substituted. He recovered and has remained symptom free for three years.


Establishing a private practice in neurological surgery; preparations, problems and pitfalls. In summary, the young neurosurgeon entering private practice will find he will have to make many non-medical decisions for which he has had little or no preparation during the course of his lengthy training. Just as one spends time planning a careful curriculum in leading to the specialty of neurological surgery, he must also dedicate many hours to establishing a private practice in that specialty. The time spent in investigating these problems in advance will minimize the frustrations in attaining the goal which we are all striving to achieve-personal satisfaction in the delivery of excellent health care.


The effect of surgical operation on growth hormone levels in plasma. This study was designed to clarify the details of any changes in serum growth hormone levels occurring in surgical patients. Intravenous glucose tolerance tests were performed upon three groups of six patients each, Group I, minor surgery (inguinal herniorrhaphy), Group II, moderate surgery (vagotomy and pyloroplasty), and Group III, major surgery (aortofemoral bypass). Plasma glucose and serum growth hormone levels were measured. Depression of glucose utilization occurred together with elevations of fasting growth hormone levels and increased growth hormone responses to intravenous glucose. It is suggested that the increased serum growth hormone levels are a response to the glucose intolerance caused by operation, modifying the pituitary growth hormone release.


The choleretic mechanisms of sodium taurocholate, secretin, and glucagon. Mongrel dogs were prepared by cholecystectomy, ligation of the lesser pancreatic duct, and insertion of modified Thomas cannulas into the duodenum and stomach. After recovery from surgery, experiments were performed by cannulation of the common bile duct for bile collection through the duodenal cannula. Bile flow and composition and the biliary clearance of erythritol were observed during secretin, glucagon, or sodium taurocholate choleresis and were compared with control studies. All test substances caused increased bile secretion. Sodium taurocholate caused a marked increase in bile salt output and in the biliary clearance of erythritol. Secretin caused a large increase in bile flow, no increase in bile salt output, and a very small increase in the biliary clearance of erythritol. The results indicate marked differences in the choleretic mechanism of sodium taurocholate and secretin and suggest that the principal action of taurocholate was on the canaliculi and the principal action of secretin was on the ducts.


Complete invagination of the vermiform appendix with villous adenoma, intussuscepting to the splenic flexure of the colon. The successful treatment of a patient with an invaginated appendix compounded by a bulbous, villoadenomatous polyp at the tip of the appendix, which became the leading part of a colic intussusception, is reported.


Effect of acute hemorrhagic shock on pulmonary microvascular fluid filtration and protein permeability in sheep. In an attempt to further delineate the pathophysiology of the shock-lung syndrome, we studied the effect of hemorrhagic shock on the pulmonary microcirculation in the adult sheep with lung lymph flow and lymph protein transport as indices of fluid filtration and vascular permeability to protein. We noted that lymph flow remained at baseline levels during shock, despite significant decreases in pulmonary artery and left atrial pressures. This suggests that microvascular pressure is maintained by an increase in pulmonary venous resistance. We demonstrated that lymph protein transport does not increase during shock, which indicates that a change in pulmonary vascular permeability to protein does not occur.


Assessment of arterial obstruction in vessels supplying the fingers by measurement of local blood pressures and the skin temperature response test--correlation with angiographic evidence. The systolic blood pressure measured in the fingers and wrists by the spectroscopic method and in the arm by auscultation were correlated with angiographic evidence of organic arterial obstruction in 29 patients. The pressures also were measured in 14 normal people. Results in the normal people suggest that a difference of more than 15 mm. Hg between the pressure measured simultaneously in corresponding fingers (or any two or more fingers), an absolute digital pressure less than 70 mm. Hg, or wrist-to-digit gradient of more than 30 mm. Hg, all in the warm subject and warmed hand, indicated the presence of organic obstruction. These criteria indicated the presence of organic arterial obstructive disease in 25 of 26 hands with definite angiographic evidence of it. The pressures were "normal" in five hands with no angiographic evidence of organic arterial obstruction. The digital skin temperature response to indirect heating was much less successful than were pressure measurements in identifying fingers with organic arterial obstructive disease.


Ruptured abdominal aortic aneurysm.

Ruptured abdominal aortic aneurysm. A total of 131 surgically treated ruptured abdominal aortic aneurysms have been reviewed. Factors affecting morbidity and mortality rates have been analyzed. In our experience very little improvement has occurred in the last 10 years and the question is raised whether a plateau has been reached in the management of this catastrophic disease. Patient selection is not considered to be the key to better results, since some operated patients inevitably die. Improved technique with better, more rapid control of blood loss, especially from venous tears, will continue to yield better results. Eighty-six nonoperative cases have been studied. Diagnostic accuracy is lower than it should be, often leading to delayed surgery or death.


The effect of electrical vagal stimulation on canine pancreatic exocrine function. The effect of electrical vagal stimulation on canine pancreatic exocrine function was studied in conscious dogs by stimulating intact thoracic vagus nerves, the distal ends of cut vagus nerves in animals with intact gastric denervation, and the distal ends of cut vagus nerves in dogs whose stomachs had been previously selectively denervated. The effectiveness of the stimulus was confirmed by monitoring gastric  hydrogen ion output. The results indicate that stimulation of intact nerves produced minimal alteration in pancreatic output and bicarbonate and protein secretion while significantly increasing gastric fistula hydrogen ion output. Stimulation of the distal ends (efferent fibers) of cut vagus nerves in dogs with intact gastric innervation significantly increased the volume and protein output of the pancreas and the acid output of the stomach. Stimulation of the distal ends of cut right and both vagus nerves in dogs whose stomach had been denervated previously, again, significantly increased the volume and protein output of the pancreas without stimulation of stomach hydrogen ion output. The data presented in this study suggest that the canine pancreas is innervated directly by vagal fibers, which when stimulated produce an increase in protein (enzyme) output and volume of secretion. Maintenance of the pancreatic response following denervation of the stomach suggests that the response is primarily the result of direct vagal innervation and is not produced by gastrin released from the antrum.


Treatment of experimental frostbite with intra-arterial sympathetic blocking drugs. A number of experimental and clinical studies have shown that early regional surgical sympathectomy decreases tissue loss following frostbite, presumably by relieving vasospasm and increasing blood flow. This study was performed to determine if a decrease in tissue loss following a standard cold injury could be obtained following a regional "medical sympathectomy" achieved by the intra-arterial administration of sympathetic blocking drugs. A standard cold injury was produced in rabbits and the animals were divided into nine treatment groups. Various treatment modalities were evaluated, including rapid rewarming, intra-arterial reserpine and tolazoline, and intravenous low molecular weight dextran. In the slowly rewarmed animals, the usual clinic situation, the regional intra-arterial administration of reserpine and tolazoline significantly reduced tissue loss, equalling the results obtained in the rapidly rewarmed group. These results indicate that the early achievement of a regional "medical sympathectomy" may be of benefit in reducing tissue loss following frostbite in patients, especially in those in whom rapid rewarming cannot be performed.


Erythrocyte filterability and lysosomal enzymes in patients requiring cardiopulmonary bypass. Erythrocyte filterability, an index of deformability, and lysosomal enzyme activity were studied in 34 patients requiring cardiopulmonary bypass. In addition fresh human erythrocytes were analyzed after incubation for filterability changes after exogenous lysosomal enzymes were added to the suspension medium. The results showed statistically significant elevations of the filterability index (decrease in  filterability of the red cells) after 10 minutes on cardiopulmonary bypass as well as postoperatively. Likewise cathepsin D concentration after 10 minutes of cardiopulmonary bypass of 8.4 plus or minus 0.8 U. was significantly elevated over the preoperative level of 5.3 plus or minus 0.7 U. Furthermore, the pump prime was found to have the highest filterability index as well as concentration of cathepsin D. Supporting our hypothesis that lysosomal enzymes may be a factor affecting erythrocyte integrity was the elevation of the filtration index to 10.5 plus or minus 0.3 U. during incubation with exogenous lysosomal enzymes compared with the control index of 9.0 plus or minus 0.2 U. This stduy implies that the pump prime should be an area of further investigation if alterations of erythrocyte filterability (deformability) and lysosomal enzymes during extracorporeal circulation are shown to have clinical importance.


Development of two indices of postoperative morbidity. Two indices of postoperative morbidity, Nursing Assessment Index and Observed Treatment Index, are described and evaluated in this study of 4,182 consecutive anesthetics. The use of these indices in studies of the quality and effectiveness of surgical and anesthetic care should increase the economy and precision with which the causes of unsatisfactory outcome are identified. Specific illustrations of the relationship of the preanesthetic status of patients to their postoperative morbidity as measured by these indices and mortality rates are given. In addition these two indices of morbidity measured on the seventh postoperative day are shown to be strongly co-related with subsequent in-hospital deaths. Thus, of the 100 patients with a Nursing Assessment Index worse than 3, 19 percent died; only 0.4 percent of the 550 patients who had no morbidity as measured by this index died. Although they ultimately survive, about an equal number of patients become seriously ill as die follow operations.


Mechanism of heparin protection in endotoxin shock. Blood clearance by phagocytosis, predominantly by the liver, presents an important mechanism for the elimination and detoxification of endotoxin. However, its effectiveness alone does not determine the outcome of an experimentally induced standardized endotoxin shock. Consequently other effects elicited by endotoxin--for instance, those on the coagulation mechanism or on an endotoxin-detoxifying enzyme system in plasma--must also play an important role in determining the ultimate fate of this condition, for it is now abundantly clear that interrupting such effects with heparin provides considerable protection.


A pathogenesis for alcoholic pancreatitis. Twelve patients with prior episodes of alcoholic pancreatitis and hyperlipemia were admitted to a metabolic ward during a quiescent period. By lipid feeding (316 to 894 Gm. per day), significant hypertriglyceridemia (greater than 600 mg. per 100 ml.) was induced in 11 of the 12 patients. Seven of the 11 patients with hypertriglyceridemia developed abdominal pain similar to but not as severe as that experienced during prior attacks of pancreatitis. Four of the seven patients with abdominal pain developed serum amylase elevations, and, of the remaining three, one had a serum lipase elevation and one a urinary amylase elevation. Alcohol ingestion is known to increase serum triglyceride levels in many individuals. A prior study demonstrated that 41 percent of the patients presenting to our hospital with alcoholic pancreatitis had serum triglyceride elevations. The data from the present study suggest that increased serum triglycerides act as an important intermediary in the pathogenesis of acute pancreatitis in some alcoholic patients.


Increased parathyroid hormone secretion and hypocalcemia in experimental pancreatitis: necessity for an intact thyroid gland. Elevated concentrations of serum parathyroid hormone and hypocalcemia occur following the induction of experimental pancreatitis in the pig, but only when the thyroid gland is present. Prior thyroidectomy completely eliminates these changes. Serum magnesium concentrations remained normal throughout the experiments despite the occurrence of hypocalcemia. These data support the hypothesis that calcitonin or another thyroid-related substance plays a role in the mechanism of the hypocalcemia which accompanies experimental pancreatitis in the pig.


Teaching law students in the medical schools. Traditional efforts in the law schools to improve interprofessional communication between the medical and legal professions have been confined to abstract case studies and other academic materials, sometimes augmented with visits and demonstrations by physicians in the classroom. This paper describes one approach to broaden the prespective of law students during their training by permitting them to experience directly the atmosphere of the teaching hospital and the sociology of surgery practice in that environment. The experiment has proved beneficial to the young members of both professions.


Bilateral adrenalectomy for advanced breast cancer: a 21 year experience. Of 680 patients who had bilateral adrenalectomies for metastatic breast cancer, 583 were evaluable. Two hundred and nine patients (36 percent) responded (180 objective, 29 subjective responders) for at least 6 months. Age, menstrual status, prior response to oophorectomy, disease-free interval, involved organ systems, and incidental splenectomy were correlated with adrenalectomy response. Patients aged 21 to 35 years did poorly (23 percent response rate), whereas 41 percent of patients aged 51 to 65 responded. Menstrual status appeared to have no effect upon whether or not a patient responded to adrenalectomy. Oophorectomy responders benefited from adrenalectomy 40 percent of the time and oophorectomy failures responded in 27 percent of the cases. Patients with a disease-free interval of zero to 2.5 years responded to adrenalectomy at a rate of 31 percent whereas patients with a free interval greater than 2.5 years responded at a rate of 50 percent. When a single visceral organ or any combination of bone and soft tissue was involved, the average response rate was 39 percent. However, when multiple visceral organs or a single visceral organ with any combination of bone or soft tissue was involved, the response rate dropped to 26 percent. Sixty-six patients had splenectomies at the time of adrenalectomy with a 44 percent response rate, whereas nonsplenectomized patients had a 35 percent response rate. The median survival rate of 209 adrenalectomy responders was 26 months; it was 10 months for 374 nonresponders. The 5 and 10 year survival rates for adrenalectomy responders were 18 and 7 percent, respectively, and zero percent for adrenalectomy nonresponders. The patients who received greatest benefit from adrenalectomy in this series were aged 51 to 65 years, had a disease-free interval greater than 2.5 years and had metastases limited to a single visceral organ or any combination of bone and soft tissues.


Evidence for enhanced uptake of adenosine triphosphate by muscle of animals in shock. Although it has been shown that infusion of adenosine triphosphate (ATP)-magnesium chloride (MgCl2) proved beneficial in the treatment of shock, it is not known whether this effect is due to improvement in the microcirculation or to direct provision of energy. In searching for the mechanism of this, we have now examined the in vitro uptake of ATP by soleus muscle of animals in shock. Rats were bled to a mean arterial pressure of 40 mm. Hg and so maintained for 2 hours. Following death the two soleus muscles from each animal were removed and incubated in Krebs-HCO3 buffer containing 10 mM. of glucose, 5 mM. (8--14C) of ATP, 5 mM. (8--14C) of ADP, or 0.5 mM. (8--14C) of adenosine, and 5 mM. of MgCl2 for 1 hour under an atmosphere of 95 percent O2 to 5 percent CO2. Following homogenization and centrifugation, samples of the muscle extract and the medium were subjected to electrophoresis to separate the various nucleotides. The concentrations of the several nucleotides in medium and muscle were calculated from the radioactivity observed in each fraction. The uptake of 14-C-ATP by muscles from animals in shock was three times greater than was the uptake by control muscles. This leads us to conclude that the beneficial effect of ATP-MgCl2 to animals in shock could be due to provision of energy directly to tissues in which ATP levels were lowered.