Laryngofissure and cordectomy.

Laryngofissure and cordectomy. Laryngofissure and cordectomy is one of the first of the successful surgical procedures for the cure of cancer limited to the vocal cord. When the lesion is confined to the membranous cord and the motion of the cord is not impaired, cure rates ranging from 85 to 98 percent have been reported. Decline in the use of the procedure is due to the success of radiation therapy in achieving comparable cure rates while preserving normal voice quality. Hemilaryngectomy procedures are now done where laryngofissure and cordectomy had previously been indicated. The more extensive procedure gives greater security due to wider margins of resection and increase applicability, particularly when the lesion involves the anterior commissure. Although the indications for laryngofissure have diminished, the surgeon may use it when a simple, less extensive procedure is called for.


Supraglottic cancer.

Supraglottic cancer. Supraglottic cancer, because of the embryological development of the larynx, and of the arrangement of its lymphatic network, tends to remain limited within the vestibule of the larynx and the pre-epiglottic space also in its advanced stages of evolution. The cancer spread may superiorly involve the epilarynx, the vallecula, the base of the tongue, and the pyriform fossa; however, inferiorly, the invasion of the glottis is quite exceptional (1 percent of cases); therefore, supraglottic laryngectomy is the operation of choice. The lower the location of cancer in the vestibule, the safer the indication. The higher location generally requires an extension of surgical excision toward the tongue, arytenoids and hypopharnx. In view of the high percentage of lymph node metastases, supraglottic laryngectomy should be associated with neck dissection, mainly bilateral, also in cases with no evidence of enlarged lymph nodes. Supraglottic laryngectomy has been performed in 240 cases in the course of the last 14 years and the five-year cure rate has been 79 percent. Five postoperative deaths have been recorded. Rehabilitation time for the breathing and swallowing function has been three weeks as an average. Complications, such as fistula or infection have been exceedingly rare: uneventful recovery followed in all cases.


Radical neck dissection.

Radical neck dissection. Radical neck dissection has evolved into a standard surgical technique over the past century. It has been the most effective method of attempting to control suspected or gross metastasis to the cervical region. The technique embraces the en masse removal of all tissue elements in the space between the subdermis and the fascia colli. The perimeters of the dissection extend from the midline anteriorly to the anterior border of the trapezius muscle posteriorly, and from the clavicle to the mandible. The essential portion of this large mass of tissue is the cervical lymph system with its lymph nodes and afferent and efferent connecting vessels. Controllability of the cancer process is in direct proportion to the number of nodes involved, their size and their position in the neck. Complications in the routine radical neck dissection are minimal. Cure rates are influenced by the type, size and site of the primary cancer, the possibilities for the adjunctive treatment such as radiotherapy and chemotherapy, and the, as yet, little understood immunological factors. The radical neck dissection has proven itself to be an essential tool in the management of cancer in the head and neck.


Anastomosis between the two facial nerves. A case of traumatic facial palsy incurred during the removal of an acoustic neuroma via a sub-occipital craniectomy is presented. The palsy was rehabilitated to a satisfactory degree by anastomosing the normal to the paralyzed facial nerve using an autoplastic peripheral nerve graft of suitable length to join the two.


Effects of noise bands on contralateral pure tone adaptation. The purpose of this study was to investigate the changes in threshold tone decay which result from contralaterally presented stimuli at an intensity less than interaural crossover. Five tone decay tests were administered at both 1,000 Hz and 2,000 Hz to 25 normal hearing adults. At each test frequency five contralateral conditions (no competing noise, white noise, narrow band noise centered at the test frequency, narrow band noise centered below the test frequency, and narrow band noise centered above the test frequency), were presented at 40 db above detection threshold to the nontest ear. Results showed a significant shift in tone decay scores when the conditions of white noise and narrow band noise centered around the test frequency were compared to the condition of no competing noise. A shift was seen at both frequencies but that occuring at 2,000 Hz was significantly greater than the shift at 1,000 Hz. No significant increase in tone decay was found for contralateral noise bands above or below the test frequencies.


Blue light endoscopy.

Blue light endoscopy. The introduction of high intensity proximal light sources has greatly improved the already high standard in technique of endoscopy. The enable us to illuminate the periphery of the bronchi. The advantage of better illumination must, nevertheless, be paid for with a levelling of contrast, as the bright light outshines the fine differences (e.g., tubercles in yhr mucous membrane). In order to heighten the contrast, first theoretical, then practical tests were carried out with different colored lights. Filters (red, green, yellow and light blue) were placed in front of the light source and the subjective perceptible changes in contrast examined. These tests showed that the light blue filter gave a heightened contrast between light and dark red as well as between yellow and red. Intra- and submucosal nodules, scars, metaplasias, hyper- and parakeratoses as well as precancerous conditions are more clearly visible in the mucous membrane. Circumscribed lesions are better seen and specimens for histological vertification are more accurately located for biopsy. Foreign bodies are more easily grasped. The remaining filters heighten the contrast in special cases (such as mycosis and colored foreign bodies). Individual filters or multifilter disc placed between the light source and the glass fiber light carrier are easy to manipulate, so that colored light can be employed in routine bronchoscopy in order to improve diagnosis.


Delayed C.N.S. complications.

Delayed C.N.S. complications. Patients with esophageal stricture being treated with dilatation, who developed esophageal perforation or local peritonitis and subsequent central nervous system infection, are reviewed. It is suggested that the vertebral  venous system may be the route by which the metastatic infection is carried. Physicians caring for patients with esophageal stricture, who are receiving dilatation, should be aware of the possible intracranial complications and should be alert to the first sign of central nervous system abnormality.


Vestibular involvement in Bell's palsy.

Vestibular involvement in Bell's palsy. Vestibular involvement in the acute phase of idiopathic facial paralysis (Bell's palsy) was observed in 22 percent and 14 patients. These patients were evaluated by history, physical examination and caloric tests with electronystagmography (ENG) employing the Cawthorne-Hallpike technique. Bell's palsy has been considered a mononeuropathy limited to the facial nerve. Evidence of occasional involvement of other cranial nerves (Vth and/or VIIIth) suggests a polyneuropathy. Several theories have been advanced to explain the involvement of the vestibular nerve.


Fractionation and analysis of fluorescent products of lipid peroxidation. The fluorescence excitation spectrum of model conjugated Schiff base compounds that arise from the reaction of malonaldehyde with amino acids was shown to contain a maximum at 260-280 nm in addition to the previously observed maximum at 350-390 nm. Excitation at either maximum results in emission at a single maximum at 440-480 nm. The excitation and emission maxima of the model fluorescent compounds, together with the characteristic reductions in fluorescence intensity caused by alkaline pH or heavy metal coordination provide criteria with which to examine lipid peroxidation products for the presence of the conjugated Schiff base fluorophore. Silicic acid column chromatography and silica gel thin layer chromatography were employed to fractionate the fluorescent products of model lipid peroxidation systems and of rat testicular lipid soluble extracts. These products contained large families of compounds whose fluorescence characteristics were the same as those of the Schiff base fluorophores. The fractionation methods used enabled more thorough fluorescence characterization of many of the products of lipid peroxication, but the fluorescence criteria available do not provide definitive proof of structure.


Substitution reactions of linoleic acid hydroperoxide isomerase. Linoleic acid hydroperoxide isomerase was extracted from corn germ and partially purified by differential centrifugation. This enzyme catalyzed the isomerization of linoleic acid hydroperoxide.(see article) Isomerase also catalyzed the substitution of various reagents at the carbon bearing the hydroperoxide group. These fatty acid products had the following functional groupings: (see article) where X is either oleoyloxy, ethylthio, or methoxy resulting from the presence of oleic acid, ethanethiol, or methanol, respectively. A crude wheat germ extract containing both lipoxygenase and isomerase enzymes reacted with linoleic acid to yield alpha-ketols, gamma-ketols, and a substitution product, the linoleoyloxy ester of alpha-ketol. Characterization of these products from wheat germ enzymes showed that the substitution reaction was not unique to corn germ. Because anions of the reagents tested are typical nucleophiles, the substitution reactions may proceed by a nucleophilic mechanism as mediated by the isomerase enzyme.


24-Methylenelanost-9(11)-en-3beta-ol, new triterpene alcohol from shea butter. A new triterpene alcohol was isolated fron shea butter and its structure was shown to be 24-methylenelanost-9(11)-en-3beta-ol. Gas chromatographic correlations between this triterpene alcohol and other related compounds are discussed.


Dietary fats and properties of endoplasmic reticulum: I. Dietary lipid induced changes in composition of microsomal membranes in liver and gastroduodenal mucosa of rat. Rats were fed for four weeks with different lipid diets to determine the effects on the endoplasmic reticulum membranes of the liver and on the postmitochondrial supernatant fraction of the gastroduodenal mucosa. The diets contained cholesterol, cacao butter, olive oil, and these in combination. The results showed that dietary lipids were able to modify the composition of the hepatic endoplasmic reticulum and, to a lesser extent, that of postmitochondrial fraction of gastroduodenal mucosa. Cacao butter in the diet decreased the relative proportion of protein in hepatic microsomes. Cholesterol and olive oil were able to increase the cholesterol content of microsomes. The trypsin digestion of membranes revealed that cholesterol increased the solubility of microsomal protein and decreased the trypsin sensitive protein-lipid binding. The neutral fat diets increased the binding of proteins to the membrane, and cholesterol had no effect when it was given in combination. The low power photomicrographs revealed vacuolization of the cytoplasm of the hepatocytes when rats were fed on lipid rich diets. Also fatty degeneration was present. Cholesterol in combination with olive oil, however, did normalize the structure of the hepatocytes to a marked extent.


Effect of glucose administration on cholesterol and bile acid metabolism in rats. Glucose administered to fasted rats caused a marked stimulation in hepatic cholesterogenesis and cholesterol 7 alpha-hydroxylation, and an increase in biliary excretion of cholesterol and total bile acids. The excretion of cholic acid was not incluenced during the first few hr after glucose administration, but was significantly increased after 5 hr. Chenodeoxycholic acid showed a similar change, but the increase was only ca. one tenth of that of cholic acid. The excretion of deoxycholic acid was markedly increased by 1 hr, but gradually decreased thereafter. Pretreatment with neomycin abolished the increase in deoxycholic acid by fasting and glucose administration. Other bile acid components showed no significant change. It thus was presumed that cholesterol endogenously synthesized in the liver was metabolized mainly to cholic acid. In contrast, exogenous cholesterol was metabolized mainly to chenodeoxycholic acid. During the period of the acute enhancement of cholic acid formation from the endogenous cholesterol, biliary excretion of deoxycholic acid was increased. This probably occurred through the depression of 7 alpha-rehydroxylation of deoxycholic acid, or through the enhancement of microbial formation of deoxycholic acid in the lumen, and through the increase of intestinal absorption.


Occurrence of 7-methyl-7-hexadecenoic acid, the corresponding alcohol, 7-methyl-6-hexadecenoic acid, and 5-methyl-4hexadecenoic acid in sperm whale oils. Two sperm whale oils from the northern hemisphere and two from the southern hemisphere were fractionated. Triglyceride and wax esters were examined for fatty acids and alcohols with monoethylenic unsaturation bearing a methyl branch on an ethylenic carbon. The 7-methyl-7-hexadecenoic acid (0.37-1.37%) was accompanied by the corresponding alcohol (0.28-0.72%), but these materials were not accompanied by shorter chain homologues. The 7-methyl-6-hexadecenoic acid was relatively less important (0.23-0.68%), but was accompanied by 5-methyl-4-hexadecenoic acid (0.10-0.39%), and a partially identified C13 compound. Chromatographic properties on silver nitrate impregnated silicic acid TLC and on three GLC liquid phases are reported.


Response of lipogenesis and fatty acid synthetase to physical training and exhaustive exercise in rats. The effect of physical training and exhaustive exercise on fatty acid synthesis in rat liver and adipose tissue has been investigated. Exercise training (treadmill running) significantly (p less than 0.05) decreased body wt, eipdidymal fat pad wt, adipocyte size, and hepatic fatty acid synthetase activity. Training did not significantly affect adipose tissue cell number, lipogenesis from glucose-U-14C, or fatty acid synthetase. Exercise to exhaustion immediately prior to sacrifice significantly (p less than 0.05) decreased lipogenesis from glucose-U-14C and fatty acid synthetase in adipose tissue from trained but not untrained rats. Liver fatty acid synthetase was not significantly influenced by exhaustive exercise. The results of this study indicate that rats may adapt to physical training by decreasing adipose tissue lipogenesis during exhaustive exercise. This adaptation in energy metabolism may facilitate physically trained animals in conserving blood glucose during exhaustive exercise, thereby prolonging endurance.


Acetylenic acids from mosses.

Acetylenic acids from mosses. Two new acetylenic fatty acids, 9, 12-octadecadien-6-ynoic and 11, 14-eicosadien-8-ynoic, were identified from lipids of the moss, Fontinalis antipyretica. They resemble the previously identified 9,12,15-octadecatrien-6-ynoic acid by having a methylene interrupted unsaturated system. The C20 acetylenic acid shows that the capability of mosses to synthesize polyolefinic acids of this chain length applies, in certain species, also to olefinic-acetylenic acids.


Taxus baccata seed oil: a new source of cis-5,cis-9-octadecadienoic acid. Methyl esters prepared from the seed oil of the conifer Taxus baccata L. were found by gas liquid chromatography to contain 12% of a component which, when isolated by preparative thin layer chromatography and characterized by mass spectrometry, ozonolysis and nuclear magnetic resonance, was identified as cis-5,cis-9-octadecadienoic acid.


Biosynthesis of chitin by particulate fractions from Cunnighamella elegans. The enzyme chitin synthetase (UDP-acetylaminodeoxyglucosyl transferase, EC 2.4.1.16) in Cunninghamella elegans has been investigated. The enzyme was present in the microsomal, cell wall, mitochondrial and the soluble cytoplasmic fraction of the mycelium, with the former having the highest specific activity. The properties of the enzyme in this fraction were investigated; the Km for UDP GlcNAc was 1.23 mM and 2.08 mM GlcNAc in the presence of 1 mM UDP GlcNAc. The temperature optimum was between 26 degrees and 29 degrees C and maximal activity was at pH 6.25. Mg++ ions had no effect on chitin synthesis, but soluble chitodextrins inhibited the enzyme. The production of chitin synthetase was correlated with the growth of the fungus, maximum activity being found during the late exponential phase of growth. Chitin was confirmed as the sole product of enzyme action, by digestion with chitinase.


Influence of 3-chloropropane-1,2-diol on microbial lipid composition and its effect on the activity of some antibacterial agents. The organisms E. coli, S. aureus, K. aerogenes, Pr. vulgaris and S. abortusovis were inhibited by 3-chloropropane-1,2-diol at high concentrations (ca 10,000 mug/ml) and Ps. aeruginosa was unaffected. The phospholipid and lipoamino acid composition of E. coli, S. aureus and S. cerevisiae was altered by growth in the presence of 3-chloropropane-1,2-diol. The effect of growth under these conditions on the sensitivity of the bacteria to various antibacterial agents was determined and appears to depend on the hydrophobicity of the drug molecule. Cell division of E. coli and S. aureus was impaired by growth in the presence of 3-chloropropane-1,2-diol leading to filamentous forms. The change in phospholipid composition of both Gram-positive and Gram-negative organisms may influence cell division and antibiotic sensitivity.


Diverse responses of Staphylococcus aureus NCTC 10442 and some of its variants to methicillin. The methicillin resistant strain of Staphylococcus aureus NCTC 10442 when aged in a broth culture at 42 degrees C yielded variants showing responses of sensitivity, dependence and indifference to the antibiotic. These responses and that of resistance in the parent cells were displayed in agar dilution and agar diffusion experiments at 30 degrees C. At 42 degrees C, all four organisms were sensitive to methicillin.


Synergism of amphotericin B and 2-deoxyglucose against Histoplasma capsulatum yeasts in vitro. The glucose analogue, 2-deoxyglucose (2DG), enhances both the fungistatic and the fungicidal action of amphotericin B in Fungizone (Squibb) against Histoplasma capsulatum yeasts in vitro. This synergistic effect is more pronounced when the test substances are incorporated in double-diffusion agar plates than in liquid medium. Minimum inhibitory concentrations for 2DG and amphotericin B in Fungizone have been established. The effects of components of Fungizone other than amphotericin B as clinically administered were also studied. Neither sodium desoxycholate nor phosphate buffer had any effect on the test organisms when used in recommended clinical concentrations. The 5% glucose infusion solution greatly enhanced the growth of the pathogen and markedly decreased the effectiveness of amphotericin B. H. capsulatum yeasts quickly became resistant to stepwise increases of Fungizone but not of 2DG. Susceptibility to amphotericin B and to 2DG increased with time within certain limits of exposure. The A (albino) phenotype of H. capsulatum is considerably more resistant to amphotericin B than the B (brown) phenotype, but there are no differences in susceptibilities to 2DG. The potential clinical applications of these studies are discussed, since experimental animals and man are reported to tolerate large amounts of 2DG. The incorporation of 2DG in the polyene antibiotic preparation would render it more effective at lower doses and would decrease clinical toxicity.


Solubilization of coat protein from Bacillus thiaminolyticus spores. Solubilization of spore coat protein of Bacillus thiaminolyticus was investigated using various reagents, and partial characterization of solubilized protein was carried out. Five per cent of the sodium dodecyl sulphate (SDS) treatment was the most effective for solubilization of coat protein, and 5% SDS + 8 M urea and 0.06 N NaOH were also useful. Acrylamide gel disc electrophoresis indicated that the SDS-soluble fraction mainly consists of a single band of protein and its molecular weight was estimated at about 15,000. The SDS+ urea-soluble fraction comprised two proteins with a molecular weight of 14,500 and 32,000, and an alkali-soluble fraction of 12,000 and 25,000 respectively.


[A method of rational particle counting (author's transl)]. A method is described, which simplifies the counting of particles in a known volume. The counting of neurons of a brain region is used as an example for this procedure. The total volume is processed by histological serial sections. The total area of all sections of this volume is divided into counting squares by an ocular grid, from which we get a sample. This sample is described by the frequency distribution. The real number of particles in the volume is estimated by the values of the frequency distribution. The way of dividing, the size and the way of selection of these counting squares for a certain exactness of the estimation is determined. The method can be used for non-systematic distribution of particles in morphological structures.


[Comparative study of the ultrastructure of vibrioid green sulfur bacteria]. The fine structure of the cells was investigated on the ultrathin sections of green sulphur bacteria, two strains of Chlorobium vibrioforme, two strains of Pelodictyon luteolum, and one strain of Pelodictyon phaeum. All strains possess similar photosynthetic structures --"chlorobium-vesicules" underlying the cytoplasmic membrane. Irregularly localized, gaseous vesicules of the rhombic shape were discerned in the cytoplasm of P. luteolum and P. phaeum. The vesicules were surrounded by a unilayer membrane. The cytoplasmic membrane produced invaginations of the mesosomal type. Elementary sulphur as a product of oxidation of hydrogen sulphide, is presumed to be liberated from the cells by means of sacs, or invaginations, formed by the cytoplasmic membrane. The taxonomy of the vibrioid green sulphur bacteria is discussed.


[Oxidative phosphorylation in Propionibacterium]. Oxidative phosphorylation during electron transport in the respiratory chain was found in two propionic bacteria, P. shermanii and P. petersonii. Its effectiveness, with oxygen as the terminal acceptor of electrons, was higher in P. petersonii, a more aerobic culture, than in P. shermanii. Oxidative phosphorylation with the participation of the electron transport chain was not found in P. petersonii in the absence of oxygen. Oxidative phosphorylation can take place together with the reactions of propionic fermentation in P. shermanii upon a small rearrangement of the respiration chain (if fumarate reductase is substituted for cytochrome oxidase).


[Cellular protrusions of luminescent bacteria and relation of their appearance to cultivation conditions]. The luminescent cells of Photobacterium were studied by electron microscopy in order to establish what caused their sticking together and growth on the glass walls of the vessel during continuous cultivation. Electron microscopy revealed protrusions, of various shape and size, on the cells. The phenomenology of various protrusions, including fimbria, is described, and the effect of cultivation conditions (continuous culture, periodic culture) and growth phases on their emergence was elucidated. The sticking of the cells together and their growth on the glass walls were less expressed at pH between 7.5 and 7.9, when the amount of the cells with the fimbria was the least and they were formed during the later phase of growth.


[Production of Candida lipolytica protoplasts]. Optimal conditions were found for the production and isolation of the protoplasts of Candida lipolytica. The maximum amount of the protoplasts was produced after 90 minutes of the incubation with a crude preparation of the enzyme from Helix pomatia (100 mg/g wet biomass). Longer incubation results in lysis of the protoplasts and structural damages of the intracellular components. The yield of the protoplasts does not depend on the nature of stabilizing agent. A decrease in the stabilizer concentration increases the yield of the protoplasts four times. Preliminary treatment of the yeast cells with a 0.1 M solution of SH compounds (cysteine, beta-mercaptoethanol) does not increase the yield of the protoplasts; and 0.2 M solution of these compounds decreased the yield of the protoplasts.


[Characteristics of the intrinsic luminescence of Actinomyces olivocinereus--producer of heliomycin]. Some characteristics of UV-induced luminescence were studied with Actinomyces olivocinereus producing the antibiotic heliomycin. The luminescence of the growth medium was found to be caused not by heliomycin, but by some other factors. The luminescence of heliomycin in the colonies was quenched as a result of its screening with melanin pigments located in a layer between the aerial and substrate mycelium.


[Mechanism of retroinhibition in e regulation of flavinogenesis in yeasts of genus Pichia]. The kinetics of the synthesis of a riboflavin (RF) precursor, 2,6-dihydroxy-5-amino-4-ribitylaminopyrimidine (DHARAP), was studied using the washed cells of RF-deficient mutants of Pichia guilliermondii R7G and Pichia ohmeri R32 with blocked lumasine synthetase. RF inhibited the synthesis of DHARAP while cycloheximide in the absence of RF had no effect on this process. The data suggest that flavins regulate the biosynthesis of RF in P. guillier mondii and P. ohmeri b7 means of feed-back inhibition mechanism.


[Formation of acetoin by Actinomyces olivaceus cultures]. Actinomyces olivaceus and some other actinomycetes accumulate acetoin and 2,3-butanediol in the cultural broth. Addition of cobalt to the medium favours the accumulation of acetoin.


[Effect of high pressure on the carotenoid content of Blakeslea trispora Thaxter mycelium]. High hydrostatic pressure was shown to decrease the content of beta- and lambda-carotenes in the mycelium of Blakeslea trispora, but to increase the production of lycopene, neurosporene and phytoene.


[Growth and development of extreme-thermophilic bacteria at 70 degrees]. Nine cultures of non-sporeforming gram-negative extreme-thermophilic bacterium Thermus flavus have been isolated from hot springs of Kamchatka. Their optimal growth temperature on a solid potato medium was 70 to 76 degrees C, and on a liquid medium (20 per cent potato broth containing 0.5 per cent peptone and 0.1 per cent yeast extract) 70 degrees C. The minimum time of generation of the bacterium, strain 71, growing on the liquid medium at 70 degrees C, was 52 minutes. Other extreme-thermophilic cultures differ from the strain 71 by a lower growth rate. The maximum biomass yield was 1.96 g per litre of the medium after 6 to 9 hours of growth. The extreme-thermophilic bacteria of Kamchatka are similar to those from the hot springs of Japan.


[Activity of pentose phosphate pathway enzymes in alkane-oxidizing yeast cells]. The activity of the key enzymes of the pentose phosphate pathway (glucose 6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase, transketolase) was determined in cell-free homogenates of Candida lipolytica 695 and Candida tropicalis 303 growing on different carbon sources. The activity of these enzymes remained almost the same in the course of growth of both cultures. The activity of the enzymes differed only slightly in the cells metabolizing hexadecane and glucose. The activity of glucose 6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase in the cell-free homogenates of C. tropicalis 303 was twice as high as in the cells of C. lipolytica 695. The activity of transketolase was the same in both cultures. The main role of the pentose phosphate pathway is presumed to consist not in catabolism of the carbon source, but in biosynthesis of pentoses and other important intermediates.


[Reaction of soil microflora to propanide treatment]. Propanide, a herbicide, is hydrolyzed in the soil into 3,4-dichloroaniline and propionic acid. The amount of microorganisms resistant to propanide and 3,4-dichloroaniline increases when the herbicide is added to the soil, and then decreases when these compounds disappear from the soil.


[Selection of medium for esterase synthesis by Mycobacterium album by the method of mathematical planning of experiments]. The composition of a defined medium for the growth of Mycobacterium album Sohngen 726 was selected by the method of mathematic planning of the experiment. The specific activity of esterase during the growth of the culture on this medium is by 30 per cent higher than on the original medium.


[Nature of riboflavin precursors in Pichia guilliermondi yeasts]. Thirty-nine riboflavin-deficient mutants have been isolated from three yeast strains of Pichia guilliermondii (ATSS 9058, VKM Y-1256, VKM Y-1257) and F5-121 mutant which is capable of production of large amounts of riboflavin in the presence of iron in the medium. All mutants were divided into five groups according to the nature of precursors accumulated in the medium and growth reaction in media with 6,7-dimethyl-8-ribityllumasine and diacetyl. The mutants of the first group did not accumulate specific precursors of riboflavin either in the cells or in the medium. The mutants of the second, third and fourth groups accumulated, after the incubation with diacetyl, 2-amino-4-hydroxy-6,7-dimethylpteridine, 2-amino-4-hydroxy-6,7-dimethyl-8-ribitylpteridine and 6,7-dimethyl-8-ribityllumasine; therefore, they synthesized the following precursors of riboflavin: 2,4,5-triamino-6-hydroxy-pyrimidine, 2,5-diamino-6-hydroxy-4-ribitylaminopyrimidine and 2,6-dihydroxy-5-amino-4-ribitylaminopyrimidine. The mutants of the fifth group accumulated 6,7-dimethyl-8-ribityllumasine in the medium and lacked riboflavin synthetase activity, as was confirmed by enzymatic studies.


[Physiologo-biochemical characteristics of Candida tropicalis yeasts, cultivated on n-alkanes at supraoptimal temperature]. Cultivation of Candida tropicalis IBEM 303 without thermostatic regulation on n-alkanes results in an increase of the temperature in the fermenter to supraoptimal values and to the linear growth of the culture without distinct differentiation according to the growth phases. The cells grown at supraoptimal temperature differ from the cells cultivated at optimal temperature by the amount of some amino acids and oligopeptides liberated by the yeast into the cultural broth, by the chemical composition of the cells and their morphology.


[Formation and distribution of free amino acids in Cunninghamella elegans mycelium during growth on media with glucose and dodecane]. The growth, assimilation of organic nitrogen compounds, and production and distribution of free amino acids were studied during the growth of Cunninghamella elegans (--) 1204 on the defined medium 12 containing glucose and dodecane and without an additional carbon source (control). The culture utilized all leucine, glycine, and asparagine after three days of the growth, irrespective of the source of carbon in the medium. Glutamic acid was assimilated only in the presence of glucose. Some 15 free amino acids and 2 amides were detected in the cells, and also some correlations in the composition of the pool in the presence of different sources of carbon in the medium. The substitution of dodecane for glucose decelerates metabolism of free intracellular amino acids and stimulates their accumulation in the cells, especially if there is a deficiency of carbon sources: the overall content of amino acids and amides on the medium with glucose is from 2.2 to 4.1 mg/g; with dodecane, from 9.8 to 16.5 mg/g; in the control, from 16.4 to 25.8 mg/g.


[Characteristics of the cytodifferentiation of omega-particle symbiotic bacteria from the micronucleus of Paramecium caudata clone M1-48]. The structure of the omega-particle-bacteria, growing in the micronucleus of Paramecium caudatum (Ciliata, Protozoa), was studied by electrom microscopy in the course of their life cycle. The cytoplasm of the spindle-shaped vegetative cells contains a large number of dense particles and transparent regions comprising the fibrillar material. Such cells, via several intermediate stages, are transformed into elongated twisted cells that are regarded as spores. The spore consists of two parts: homogeneous, and that containing the membrane system and rounded light bodies. The membranes are often double and connected with the fibrils. The cell wall is constructed, during all stages, of the outer membrane layer and the inner electron-dense layer.


[Growth and oxidation of sulfur compounds by Thiocapsa roseopersicina in darkness]. The purple sulphur bacterium Thiocapsa roseopersicina, strain BBS, grown in the darkness in aerobic autotrophic conditions, oxidized sulphides to free sulphur and then to sulphates. This was accompanied with the fixation of carbon dioxide by the cells. Addition of glucose to the mineral medium increased the biomass yield; the cells oxidized thiosulphate still at a high rate. These results prove the possibility of switching T. roseopersicina from photosynthesis to a dark chemolithautotrophic way of life.


[Mechanism of action of beta-ionone on the carotene-synthesizing enzymes of Blakeslea trispora]. The addition of beta-ionone to the growing culture of Blakeslea trispora stimulates the synthesis of carotene, protein, and RNA. The experiments with the addition to the growth medium of an inhibitor of translation (cycloheximide) and an inhibitor of transcription (actinomycin D), in the presence of beta-ionone, suggest that beta-ionone stimulates the synthesis of carotene-forming enzymes de novo in B1. trispora, this effect being manifested at the level of translation of the templates in the ribosomes.


[Intrinsic waxes of saprophytic mycobacteria]. The ability of soil mycobacteria for the synthesis of true waxes may be revealed on media with hydrocarbons. Most strains produced only traces of wax, and some strains (2 out of 62) in considerable amounts (over 1% of dry biomass). The chemical composition of the wax depends on the structrue of oxidized substrate: a mixture of two to three homologues with the molecular weights of 452, 480 and 508, respectively, is formed on a medium with hexadecane, and a mixture of seven homologues with the homologous difference of 14 in the case of glucose.


[Growth of Azotobacter chroococcum strains on different substrates]. Azotobacter chroococcum 34, actively growing on alpha-ketoglutaric acid, and Azotobacter chroococcum B and KL, which almost do not assimilate this acid, can grow on the majority of substrates of the tricarboxylic acid cycle and on glucose, with and without nitrogen. The rate of assimilation of alpha-ketoglutaric acid is several times higher in the cells cultivated in the presence of this acid than in the cells grown on other substrates. This difference seems to involve the mechanism of transport of alpha-ketoglutaric acid into the cell.


[Decomposition of cholesterol by Achromobacter candicans]. The decomposition of cholesterol by the cell suspensions of Achromobacter candicans 42 and by the cell-free extracts of this bacterium was studied. The decomposition of cholesterol in the presence of the wet biomass during four hours of the incubation was 72.5 percent, and with the cells that were preliminarily lyophilized or treated by acetone 49.8 and 23.0 percent, respectively. The activity decreased from 70.0 to 50.0 percent if the biomass was kept at minus 3 degrees C during 70 days. The decomposition of cholesterol by the cell-free preparations (supernatant and protein after precipitation with ammonium sulphate to 0.7 saturation) constituted 40.0 percent of the cholesterol contained in a sample. One of the intermediate products of cholesterol decomposition was delta4-cholesten-3-one.


[Radiometric study of the decarboxylating activity of desert soil microflora]. Employment of growth media containing salts of organic acids, labelled with 14C, gave a rapid and intensive signal concerning the decarboxylating activity of microorganisms from desert soils. The value of the signal was higher than that during the decomposition of uniformly labelled glucose. The results of these studies would help to select the optimal growth medium for carrying out exobiological experiments.


[Effect of temperature on the phototransformation of purple sulfur bacteria bacteriochlorophylls and isolated chromatophores]. Photobleaching of P890 was shown to be independent of temperature within the range of +20 to -160 degrees C in purple sulphur bacteria and isolated chromatophores under oxidative conditions; therefore changes in the absorption at 890 nm are due to the primary photoact. No changes were detected in the absorption at 850 nm upon a slight decrease of temperature, which suggested the absorption at 850 nm upon a slight decrease of temperature, which suggested the conformation nature of these changes. The effect of temperature, which suggested the conformation nature of these changes. The effect of temperature on the photoinduced changes of absorption under reductive conditions seems to be due to the electron transport and the accompanying processes being blocked. The effect of temperature on the kinetics of P890+ reduction in the darkness under conditions when the cytochromes are preliminarily oxidized is determined by the participation of the secondary electron acceptors in this process. A decrease in temperature leads to blocking the transport of electrons from the primary acceptor to the secondary acceptors, which is expressed by a gradual disappearance of a slow component in the kinetics of p890+ reduction in the disappearance of a slow component in the kinetics of P890+ reduction in the darkness and by the intensification of a fast component resulting from the darkness and by the intensification of a fast component resulting from the interaction between the primary acceptor and P890+. Methodical aspects of absorption differential spectrophotometry of photosynthesizing organisms at low temperatures are discussed.


[Variability in the flavinogenic activity of Pichia guilliermondi yeasts]. The natural and induced variability of the flavinogenic activity was studied in the strain of Pichia guilliermondii ATCC 9058. The flavinogenic activity of the collection strain showed normal distribution; the amount of riboflavin(RF) accumulated in the medium differed several times in the extreme variants. In the clones with the maximum and minimum accumulation of RF, the distribution of the variants was asymmetric, due to the appearance of the cells with an average flavinogenic activity. The clones have acquired almost the same flavinogenic activity after being transferred eight times on a fresh medium. The asymmetric distribution of the variants according to their flavinogenic activity was found also in the case of the clones obtained from the UV-irradiated cells. The mutants have been isolated, which synthesized 3-30 times more RF than the parent strain in the presence of iron doses optimal for the growth. Five mutants that were most active in producing RF differed in the sensitivity of their flavinogenesis to high concentrations of iron, yeast autolysate, and carbon sources.


[Assimilation of 1-14-C-octadecane by the (-)4 strain of Blakeslea trispora]. The assimilation of 1-14C-octadecane by the (-) 4 strain of Blakeslea trispora was studied, i.e. the kinetics of 14CO2 evolution and the distribution of the label in the biomass, proteins, lipids, and water-soluble products of the fungus. B1. trispora oxidized octadecane even in the presence of glucose in the medium. The distribution of the label between the protein and lipid fractions was different when the fungus was grown on octadecane or on a mixture of octadecane with glucose. After 6 hours of the incubation the content of the label in proteins (the experiment with 1-14C-octadecane as a carbon source) was 33 percent, and 60 percent in lipids. In the experiment with a mixture of glucose and hydrocarbon, the content of the label was 8 percent in proteins and 95 percent in  lipids. These results show the participation of n-alkane and the products of its oxidation in the metabolism of Blakeslea trispora.


[Positive mutation as regards n-alkane oxidation in Pseudomonas denitrificans]. Differences in the overall protein composition were studied in the wild-type and mutant cells of Pseudomonas denitrificans. Pleiotropic mutation was established, which was characterized by quantitative and qualitative changes in at least 6 to 8 protein fractions and corresponded to the appearance of 2 to 3 steps of oxidation of higher n-alkanes, as had been found earlier in biochemical experiments. New enzymatic functions may appear on the basis of genetically determined proteins available, upon reorganization of the intracellular structure caused by propagating changes induced by mutation.


[Role of lipids in the acid resistance of saprophytic mycobacteria]. The resistance of saprophyte mycobacteria to acids increases on a medium containing paraffin. The content of free lipids and mycolic acids in the cells of Mycobacterium convolutum assimilating the hydrocarbon increases cf. that in the cells grown on meat-peptone broth. The structure of mycolic acids was established after studying their methyl esters by mass spectrometry. The cells grown on the medium with hexadecane contain mycolic acids C32--C36, with C34- and C36-compounds prevailing and the aliphatic chain in alpha-position containing 10, 11, 12, and 14 C-atoms. The cells cultivated on meat-peptone broth contain another type of acids of high molecular weight (greater than 700).


[Effect of histones on cell permeability, protein and RNA synthesis and RNA stability in Aerobacter cloaceae]. The histones of calf thymus were found to change the permeability of the cells of Aerobacter cloaceae, without producing any noticeable effect on their viability. Concomitant depolymerization of the cellular RNA indicates destruction of the ribosomes. The increased synthesis of RNA in interpreted as a manifestation of reparatory processes. Protein synthesis, virtually unaffected in the resting cells, was inhibited to some extent in the growing culture treated with histones. Some considerations concerning the mode of action of histones at the intracellular level are presented.


[Lipid composition of Cunninghamella elegans cultivated on n-alkanes]. The ability to oxidize n-alkanes was studied with various species of fungi belonging to the Cunninghamella genus. These fungi are able to assimilate hydrocarbons and to accumulate up to 1.5 g/litre of biomass. The most active strain was Cunninghamella elegans (-) 1204. The amount of lipids formed, and their composition, depended on the length of the carbon chain of oxidized alkane. The content of fat in the cells increased with the length of the hydrocarbon chain. The following lipid fractions have been detected: phospholipids, monoglycerides, diglycerides, triglycerides, sterols, free fatty acids, sterol esters, and hydrocarbons. The qualitative composition of the fractions depended, to a considerable extent, on the n-alkane utilized. Investigation of the fatty-acid composition of intracellular lipids has shown that fatty acids with an even number of carbon atoms are formed from hydrocarbons with an even number of these atoms, while fatty acids both with an even and odd number of carbon atoms are synthesized from hydrocarbons with an odd number of these atoms. The relative content of the acids with the same number of carbon atoms as that of the alkane being utilized increased with the length of the carbon chain.


[Intrinsic luminescence and differentiation in Actinomyces lucensis--producer of etruscomycin]. The luminescence of Actinomyces lucensis producing etruscomycin was found to be caused not by the antibiotic but by additional luminescent substances. No direct correlation has been established between the content of the luminescent substances and the intensity of the luminscence. The latter depends on the differentiation of the colonies, i.e. on the presence of a dark layer that screens the luminescence of the colonial mycelium and is localized under the aerial mycelium. The dark layer contains pigments of the melanin type.


[Oxidation of phenol by Bacillus stearothermophilus strains]. The assimilation of phenol as a sole source of carbon and energy was studied with the thermophilic bacillus isolated from the geothermal zones in the South Ural. This ability was displayed by 11 strains of Bacillus stearothermophilus among 26 studied strains. The most active strains oxidized all phenol, when its content in the medium was 0.1--0.2%, during two days, at 56--58 degrees C, with aeration; a considerable amount of biomass was accumulated and the medium was acidified. The maximum concentration of phenol, which did not suppress the bacterial growth, was 0.3%. The majority of the strains of Bac. stearothermophilus capable of phenol oxidation were isolated from the regions heated with parothermal gases which contained phenols.


[Mycoplasma-like sturctures in podzol soils of the southern taiga in the Irtysh region]. Mycoplasm-like organisms were found in taiga podzolic soils of the South Irtish region. They were detected in close contact with soil bacteria more ofter than in a free state. The mycoplasm-like organisms either were absorbed on the bacterial cell walls or grew inside the cytoplasm as filamentous forms; sometimes they filled the whole inner space of the cells, disrupted the cell wall, and were liberated into the surrounding medium.


[Vertical distribution of heterotrophic bacteria in the western half of the Indian ocean]. The peculatities of quantitative distribution of heterotrophic bacteria at various depths in the water colum of the western part of the Indian Ocean between 23 degrees N and 44 degrees S latitude were studied. A scheme of the hydrological sturcture of the Indian Ocean was constructed on the basis of microbiological data. In general features, this scheme has much in common with that which was depicted for the eastern part of this ocean in 1956--1957.


[Systematic position of Streptomyces luteofluorescens]. On the basis of the cell wall composition (the presence of meso-diaminopimelic acid and madurose sugar) and according to the morphological structure, Streptomyces luteofluorescens (type culture 719, ISP 5398) is transferred to Actinomadura genus. The organism is considered to be a new species of the Actinomadura genus -- Actinomadura luteofluorescens (Shinobu, 1962) Preobrazhenskaya et Lavrova, 1974, comb. nov.


[Review of the systematic position of Actinomyces orientalis (Pittenger et Brigham) Krass. 1970 and its reclassification as Proactinomyces orientalis (Pittenger et Brigham) comb. nov]. The micromorphology, growth cycle, chemical composition of the cell walls, and the susceptibility to lysozyme and specific phages were studied with the culture of Actinomyces orientalis RIA-1074. It is seggested on the basis of these studied to transfer the culture from the Actinomyces genus to the Proactinomyces genus and to rename it Proactinomyces orientalis (Pittinger et Brigham) comb. nov.


[Electron microscopic study of Candida tropicalis yeasts grown on a medium containing selenium]. The yeast Candida tropicalis 303 was cultivated on a medium containing selenium, and studied by electron microscopy. The vacuoles of these cells contained electron-dense granules. The correlation between the increase in the number of the electron-dense granules in the cells of C. tropicalis 303 and the biomass suggests the presence of Se0 in the Granules.


[Effect of lyophilization on the nitrogenase activity of Azotobacter vinelandii]. The activity of nitrogenase in the cells of Azobacter vinelandii grown from lyophilized and non-lyophilized cultures depends on the donor of hydrogen and the concentration of oxygen in the gaseous phase. The lyophilized cells are more sensitive to oxygen (O2 optimum for nitrogen fixation is ca. 1 percent) than the non-lyophilized cells (ca. 5 percent). The determination of acetylene reduction in the course of the culture growth has shown that nitrogen fixation in the lyophilized cells takes place after a lag-period (about six hours) at a rate lower than that of the non-lyophilized cells. The results obtained suggest that lyophilization increases the sensitivity of the cells to oxygen and decreases their nitrogenase activity which is however restored after a while.


[Morphological differentiation of cells in submerged cultures of Claviceps purpurea (Fr.) Tul., producing alkaloids]. Differentiation of the cells of the submerged culture of Claviceps purpurea (Fr.) Tul. was studied by electron microscopy. Two types of oviform cell were found: (1) the conidia which had one nucleus and vacuolized cytoplasm and were not involved in the production of alkaloids; (2) the chlamydospores with two nuclei, homogeneous cytoplasm, and high content in lipids. The chlamydospores, like the cells of sclerotia, were found to produce alkoloids.


The "coast" hydrostatic bed.

The "coast" hydrostatic bed. The water bed has ushered in a new era in prophylactic care for patients suffering from the sequetiae of spinal cord injury and other debilitating diseases which have rendered the skin susceptible to decubitus ulceration. A commercially available water bed is described which has resulted from improvements to a prototype bed first used in the spinal injuries unit of Prince Henry Hospital in 1969 (Jones and Burniston, 1971).


Increased resistance to helminth infestation in an atopic population. Faecal egg counts were compared in three groups in an area of universal hookworm infestation. Egg counts were lower in asthmatic and atopic non-asthmatic subjects than in a non-atopic population. The atopic population was defined by skin testing for immediate hypersensitivity responses. It is suggested that the atopic state may confer increased resistance to helminth infestation.


Hospital "de-ministration" experiences in six teaching hospitals. An experimental management programme at Sydney Hospital, first reported in this Journal in 1971, has now been repeated in five other teaching hospitals. These programmes confirm that when professional staff members are encouraged to participate in managing their hospital, they do so very effectively. Results include: better patient care, more patients treated, lower cost per patient, improved morale and flexibility in outlook. The benefits potentially available from the widespread introduction of this approach to managing hospitals are tremendous but to realize them requires radical changes in the way public hospitals are controlled by health authorities.


Large bowel cancer: a retrospective study of 635 cases. A retrospective survey of 635 cases of large bowel cancer treated at the Princess Alexandra Hospital, Brisbane, from 1956 to 1970 is presented. The age and sex incidence, presentation and pathology are discussed, and a detailed analysis is made of treatment and operative mortality rates. The resectability rate was 72-2%; the operative mortality rate for resectable colonic lesions was 6-6%, and for resectable rectal lesions, 7-3%. There was an operative mortality rate in the presence of acute obstruction of 17-5%. This study forms the basis of a prospective survey presently being undertaken at the Princess Alexandra Hospital.


Neonatal jaundice and glucose-6-phosphate dehydrogenase deficiency in Papua New Guinea. Of 50 jaundiced neonatal patients studied at the Port Moresby General Hospital, 11 (22%) were found to be glucose-6-phosphate dehydrogenase-deficient. No apparent exogenous precipitating causes for the jaundice were noted. Serum bilirubin levels exceeded 20 mg/100 ml in seven of these glucose-6-phosphate dehydrogenase-deficient infants, and exchange transfusions were required for three subjects. Glucose-6-phosphate dehydrogenase deficiency must be considered in the differential diagnosis of neonatal jaundice in Papua New Guinea.


Immunodiagnosis of a metastasis in a patient with a history of double malignant disease. This paper discusses the use made of the antigenic specificity of malignant tumours in the diagnosis and subsequent management of a patient with secondary malignant disease who had previously been treated for both carcinoma of the breast and malignant melanoma. A comparatively simple, rapid test (leucocyte adherence inhibition) was used to determine the patient's antitumour immunoreactivity. Cell-mediated immunity against both types of tumour was detected, but this was accompanied by serum-blocking factor corresponding to melanoma only, which indicated that the secondary malignant disease was melanoma.


Actinomycin D in the treatment of Paget's disease of bone. Fifteen patients with Paget's disease of bone were treated with actinomycin D for periods of up to 15 months. It was found that actinomycin D is effective in reducing the pain but not the neurological effects of Paget's disease. Careful adjustment of dose according to weight and initial response is necessary to prevent gastrointestinal side effects. If this is done, the risk of hepatic, renal, or haematological side effects is negligible.


Parietal cell vagotomy.

Parietal cell vagotomy. In a series of 100 consecutive patients who had parietal cell vagotomy performed, no drainage procedure was performed in 56 while 44 were drained. Dumping was significantly less in those who were not drained. All patients were tested for adequacy of vagotomy and for function of the nerve of Latarget at operation. Four patients have had further operations, two for proven recurrent ulcers. Parietal cell vagotomy has given excellent clinical results in this group of patients.


Sclerostripping--a "new" procedure for the treatment of varicose veins. A "new" procedure for dealing with varicose veins associated with severe-to-moderate long saphenous vein incompetence is described. It consists of a combination of high ligation of the saphenofemoral junction and stripping of the long saphenous vein, with compression sclerotherapy of its tributaries and veins which are varicose because of incompetent perforators at the time of the operation. A series of 150 patients treated over a period of four years by this method is described. The safety, effectiveness, and advantages of the method over those of more orthodox surgery are discussed. It is suggested that it is safe, and more effective than more orthodox operations.


Essential (hereditary or senile) tremor. Sixteen cases (eight in males and eight in females) of essential (hereditary or senile) tremor were collected over a two-year period. Ten patients had near relatives with a similar disorder. All but one patient had a tremor of the upper limbs which was absent when the arms were at rest, but which appeared on movement, and was made worse by emotion. The severity of the tremor varied considerably from patient to patient, and often was temporarily lessened by alcohol. The tremor involved the head and neck in six subjects and the legs in two. One subject has associated neurological abnormalities probably due to cerebral arteriosclerosis. Otherwise no neurological abnormality except tremor was present in any patient. No patient showed evidences of Parkinsonism. To the time of collection of the series the tremor had been present for periods of between one and 62 years. Many patients with essential tremor are not severely enough affected to warrant therapy. Propranolol, a beta-adrenergic blocking agent, appears to reduce the tremor in at least some patients who need treatment.


Gastric sarcoidosis presenting with haematemesis. Sarcoidosis is a very rare disease in Singapore. Sarcoid granuloma involving the stomach alone is even more rare, and only about 21 cases have been reported in the literature up to 1953 (Scott et alii, 1953). In a review of the literature, Wadina and Melamed (1966) found 34 cases of granulomatous involvement of the stomach, all purporting to be sarcoidosis. However, on closer examination of the evidence, many of these 34 cases of so-called sarcoidosis of the stomach were subject to doubt. Bleeding from gastric sarcoidosis is also rare, and only about eight cases have been reported in the literature up to 1970. The present report presents a further example of this rare cause of upper gastrointestinal bleeding and attempts to review the significance of sarcoid granulomas in the stomach.


How do you decide what it is and what to do? The setting out of management problems in the sequence of question--evidence--action follows practice realities in many situations more closely than the inductive sytle of evidence--diagnosis--action. Explicit setting out of the decision-making process provides a framework for clearer role-identification for different practice specialities, with the opportunity for closer cooperation and joint investigation. Sequential investigation and decision-making separate categories of patients. This streaming can maximize efficiency of investigation and minimize wasteful over-investigation. Teaching a sequential approach to diagnosis and management provides the student with a practical method for solving problems in the real world. If every investigation sought must be justified in terms of the specific question it is to answer, the student will be trained to avoid unnecessary investigation, and the young graduate will find it more difficult to "procrastinate by investigation" because of inability to face up to decision-making.


The management of popliteal aneurysms.

The management of popliteal aneurysms. Twenty-three patients with 34 popliteal aneurysms were treated between 1963 and 1974. Nearly half of the aneurysms were the site of thrombosis when they first presented, and of these nearly half required a major amputation. Surgical treatment of aneurysms in which the popliteal artery was patent was satisfactory; the only failure occurred when a Dacron graft became occluded after eight years. A small group of patients was observed for an average of one year, during which time the thrombus in one aneurysm embolized and one aneurysm became occluded, necessitating an amputation. The results of this series suggest that the prognosis for a limb with popliteal aneurysm depends on the patency of the popliteal artery at the time of the initial presentation, and lends support to the belief that popliteal arteries with aneurysms are best reconstructed before the onset of a serious complication.


Abdominal aortic aneurysm. Experience with the use of the straight tube method of treatment. Forty-three consecutive patients with an abdominal aortic aneurysm treated by means of a straight Dacron tube inserted inside the aneurysms are reviewed. There were no deaths among the 30 patients who had an elective operation, and three deaths in the group of 13 whose aneurysm had ruptured. The use of a straight tube to treat an abdominal aneurysm has many advantages, including lower mortality and morbidity rates. Experience suggests that this is the operation of choice for all aneurysms, whether for rupture or as an elective procedure, except for a minority of patients with aneurysms of the iliac arteries. A significant delay occurred in referral of 30% of patients, apparently owing to the belief that vascular surgery carried a grave risk. Of the patients with a ruptured aneurysm, 50% had their condition misdiagnosed; this led to delay in the patients receiving treatment. It is clear that clinicians are not sufficiently "aneurysm minded" when they examine the abdomen.


Anal dilatation and haemorrhoidectomy. A prospective study. The results of haemorrhoidectomy alone and anal dilatation alone for the treatment of 20 patients with second or third degree haemorrhoids were assessed prospectively over a 12-month period. After haemorrhoidectomy the symptoms of bleeding, lump, pruritus and discharge disappeared, and anal continence was maintained. Proctoscopy showed the occasional development of secondary piles high in the anal canal. Of those patients having an anal dilation alone, nearly half had symptoms and one had a mucus leak. Anal continence was unalttered in the remainder. Proctoscopy indicated the loss of anal venous engorgement.


The treatment of severe anxiety with chronically implanted intracerebral electrodes. A procedure is described which allowed discrete lesions to be placed in the frontal lobes and paracingulate white matter through chronically implanted intracerebral electrodes for the treatment of a severe and intractable anxiety state. This procedure enabled progressive treatment on an outpatient basis over a period of weeks so that the amount of treatment was geared carefully to the patient's response. This psychosurgical technique minimizes the risks of untoward side effects. The case history is presented of the first patient treated with chronically implanted intracerebral electrodes at the Neuropsychiatric Institute, Sydney.


Amputation stump management. A preliminary report on the use of shrink plastic film as a surgical dressing in amputation surgery. This report describes the use of clear plastic bags on vinyl chloride-vinylidine chloride copolymer (also known as S Film) for the postoperative management of amputation stumps. The bags are shrunk to the stump by the application of heat and act as a primary dressing. Their use has been effective in controlling postoperative oedema and infection as well as giving the surgeon direct visual access to the stump without disturbing the wound. A case of a below-knee amputation managed by this method is described.


A comparative study of nutrient intakes of migrant and Australian children in Western Australia. Little is known about the dietary patterns and nutrient intakes of preschool children in Australia. A study was undertaken in Perth on Australian and migrant children to obtain information on preschool diets. It was found that, although the mean nutrient intakes in both groups were adequate, some individual migrant national groups showed deficiencies of one or more nutrients. Many children were obtaining excessive calories and protein. The consumption of "empty calorie" foods was also high. In order to find different ways to teach good principles and practice of nutrition, the types of media which might influence parents were studied. It was considered that television and, to a lesser degree, radio were media which might exert a considerable effect if they were used to the best advantage. These forms of communication particularly were of potential value, as some migrant parents could not read English and some were illiterate. A positive nutrition education programme to combat commerical food advertising of "empty calorie" foods is recommended.


Ileocaecal tuberculosis.

Ileocaecal tuberculosis. This report is of a single case of ileocaecal tuberculosis presenting as subacute bowel obstruction, with clinical features suggesting an inflammatory cause. The diagnosis of tuberculosis was made at operation although tuberculosis was suspected beforehand. Treatment consisted of triple therapy only and appeared to be successful in so far as loss of symptoms resulted.


A general practitioner's study of his own workload and patient morbidity. In 1972 a study of workload and morbidity was undertaken by a New South Wales general practitioner. The writer analysed 5,618 of his own face-to-face patient contacts and have been set out below. A comparison was also made between the writer's morbidity statistics and those of the Australian Morbidity Survey. Both surveys were conducted at the same time and it was interesting to note a marked similarity in the percentages of disease episodes when classified into broad groups (such as respiratory disease, for example). The results have been useful as a basis for future research, as an educational tool for undergraduates and graduates learning about general practice and as an aid in practice management planning.


Random urine analyses from drug addicts in a methadone treatment programme. Random testing of urine from opiate addicts in the methadone treatment programme at the Drug Dependency Service, Brisbane Street, Sydney, was carried out for 18 months. Six samples from each of approximately 100 clients (that is, 580 specimens) have been analysed. It was found that clients receiving high methadone dosages (80 mg and over) used illegal opiates significantly less frequently than those on lower dosages. Furthermore, a decline in the use of illegal opiates and an increase in the proportion of "clear" urine specimens (that is, clear of all drugs except methadone) were indicators of the effectiveness of the methadone programme. It was concluded that urine testing was a useful and objective means of evaluating methadone or any other drug addiction treatment programme, and of monitoring what other drugs were being taken, both consciously or inadvertently in combinations. The results of urine testing can also be of value to counsellors in the therapeutic situation.


Vital capacity and one-second forced expiratory volume in Australian male factory workers. The vital capacity (VC) and one-second forced expiratory volume (FEV1) of 482 men were measured and corrected for temperature but not pressure. The relationship between both VC and FEV1 and height and age was examined and found to be linear. In using these relationships for significance testing the 95% confidence limit is 1.65 standard deviations below the predicted value. Our results are expressed in graphical form to facilitate interpolation and will thus be of use to the clinical practitioner in Australia. Neither weight nor smoking habit was found to influence the relationship of VC or FEV1 with age or height.


"What does 'hazard' mean?" A survey of Sydney schoolschildren. A survey of 1,348 Syndey school children, aged 10 to 13 years, carried out during October and November, 1973, and February, 1974, indicated that approximately 30% associated the word "hazard" with danger, risk or disaster; 11% associated it specifically with ill health; 16% defined it directly as "habit"; and a further 15% defined hazard as being "like a bad habit".


Metastatic basal cell carcinoma.

Metastatic basal cell carcinoma. A case of basal cell carcinoma which metastasized to an axillary lymph node is presented. There were no histological features that enabled either the presumed primary lesion or the metastasis to be distinguished from the usual non-metastasizing basal cell carcinoma. Evidence is presented that metastasis is considerably less freguent in Queensland that is reported in an overseas series.


The tourist as patient.

The tourist as patient. A review is presented of patients, mainly Australians and New Zealanders, who came to Fiji as tourists. One hundred and seven patients were seen in a six-month period in a general practice near Nadi International Airport, and 39 patients were admitted to the medical unit of the nearby Divisional Hospital over a two-year period. Attention is drawn to the need for informed advice to be given to patients about to embark on holidays abroad, and some of the common problems are discussed.


Reticulocytes in healthy pregnancy.

Reticulocytes in healthy pregnancy. High reticulocyte counts are commonly found during pregnancy in non-anaemic Greek and Italian women, whereas in Anglo-Saxon women counts rarely rise above 2-0%. In this study, the Greek and Italian groups had peak mean values of 2-9%, although it occurred some weeks earlier in the Italian group. The Anglo-Saxon group's peak mean value was only 1-5%. The differences between the Anglo-Saxon and other groups are statistically highly significant and should be recognized when assessing haematological profiles in apparently normal women.


Bronchial brush biopsy and primary lung carcinoma. Bronchial brush biopsy was performed on 100 patients with pulmonary lesions suspected of being malignant. Of 61 cases of proved carcinoma of the lung, in 44 or 72-1% brush biopsy yielded positive results. The technique used is described and an analysis of the results is presented.


Alcohol, tobacco and analgesics--Busselton, 1972. Mass health examinations carried out in Busselton in November and December, 1972, revealed that drinking and smoking were more prevalent amongst men, whereas more women took analgesic drugs. Compared with older age groups more young people consumed alcohol, tobacco and analgesics. Younger people are also taking up smoking and drinking at earlier ages than the older age groups. These findings stress the need for better health education to alter the attitudes of younger people. The people of Busselton would support legislation to allow spot breathalyser tests for drivers, women (70%) providing stronger support than men (57%). This suggests that public opinion could support continuing legislation to combat road accidents. Comparisons between the North Shore, Sydney, and Busselton populations indicated somewhat higher proportions of the urban people were consuming alcohol, tobacco and analgesics, particularly urban women. However, both Australian samples revealed disturbingly high proportions of subjects taking excessive monthly quantities of analgesics (3% to 5%) compared with the United Kingdom (2-8%). Previous reports of the high proportion of Traralgon people taking drugs or medication is supported by the Busselton data, which suggest the Australia requires stricter statutory control of analgesics, compulsory warnings on labels and restriction of sales to pharmacists.


A health and social survey of a group of children from rural New South Wales. Between the middle of May and middle of July, 1972, 177 children aged up to 15 years were admitted to a nursing home in Sydney on referral from their doctors in country areas of New South Wales for specialized investigation and treatment mainly of respiratory infections, congenital malformations and orthopaedic and ophthalmic conditions. Specimens of faeces from these children were examined for bacterial pathogens and parasites. These tests revealed the presence of intestinal parasites (mostly Giardia lamblia) in 91 of the children and of bacterial pathogens in 14 (a salmonella in one and shigellas in 13). The general health and development of the children and the socioeconomic status of their families were below the average for New South Wales.


Squamous cell carcinoma of both ears associated with hypercalcaemia. A case is presented showing rapid destruction of both ears by squamous cell carcinoma. The patient was transiently hypercalcaemic and hypophosphataemic; these biochemical abnormalities disappeared after radiotherapy.


Perception, memory and pathological identification as precipitating factors in parental attacks on children. This paper examines the origins and the importance of pathological identification by the parent of the child who was maltreated or is at risk of maltreatment. The understanding of these identifications suggests methods of effective preventive action without recourse to the undesirable practice of removing the child from the home, other than in exceptional circumstances. Brief case history vignettes illustrate the clinical application of this approach.


The maltreatment of children: some unresolved problems. Evidence suggests that physical results may be the least important criterion of successful management of maltreated children. Emotional, social, intellectual and personality development results should receive equal attention. The maltreated child may himself be a potential child-batterer and separation from his parents may not alter this prognosis. Professional ignorance, denial and collusion are all barriers to successful management, as are inadequate treatment facilities and a cumbersome legal system whose inappropriate priorities may readily produce tragedy.


Second trimester septic abortion and the Dalkon shield. The Dalkon shield was withdrawn from the market in the United States of America last year because of the reports of 11 maternal deaths and 209 cases of septic midtrimester abortions associated with the device in situ. Four cases of late midtrimester septic abortions resulting in neonatal deaths are presented. In one of these, the mother developed septicaemic shock and almost died. The true pregnancy rate with the Dalkon shield is much higher than was initially claimed, particularly if it is inserted in the puerperium. Surveys on the outcome of the pregnancy indicate that 50% end in spontaneous abortion and one in 20 pregnancies are ectopic. A high percentage of the abortions are septic. The Dalkon shield, therefore, has no advantages over other intrauterine contraceptive devices and it remains to be seen whether the recent modification of the device has overcome the disadvantages of the earlier version. If pregnancy is diagnosed with the device in situ, it should be removed if the string is visible. If pregnancy continues with the shield in place, the patient should be observed closely. Should septic abortion occur, active management is indicated and early evacuation of the uterus is recommended.


The tole of towing services at motor vehicle crashes. A survey of tow truck services operating in a defined area of the south-east suburbs of Melbourne was undertaken to determine their potential for delivering emergency medical care at the scene of crashes. Most towing firms have an association with a panel-beating shop, and operate within a limited area of one to three miles radius. The rapid response of tow trucks to crash scenes is due to their well-developed intelligence network of "spotters" and the short distances the trucks travel. Very little first aid is provided by the drivers, although one-fifth had some first aid training at some time. In about one-half of the calls to crashes a damaged vehicle is still at the scene, in about 20% an ambulance is called, and in about 5% a hospital admission occurs. Direct observation of 22 crashes suggests that on average, tow trucks arrive at a crash scene five minutes before the ambulance, and fifteen minutes before the police. There is a good case for making first aid training a preerequisite for issue of a tow truck operator's license.


The development of a genetic investigation centre at a maternity hospital. The development of a centre for the investigation of genetic aspects of still birth, neonatal deaths and mental deficiency is described. It is suitably located in a maternity hospital and provides counselling early enough to prevent the brith of a subsequent affected infant in high-risk groups. A variety of laboratory and other facilities are in close proximity. This has the advantage of allowing procedures, such as amniocentesis and ultrasound examination for prenatal diagnosis, to be arranged in consultation with hospital staff members. The aetiology of the first 120 cases seen, their reason for referral, recurrence risk, and "decision made", are reported in detail elsewhere. The mode of operation with regard to source of case, appointments, staff and records is outlined fully in this paper. The conclusion to be reached is that, within two years of its inception, the genetic investigation centre is already providing a useful community service.


Pindolol in hypertension: twice-daily versus thrice-daily dosage. Afternood lying and standing blood pressure, pulse rate and plasma pindolol levels were measured twice, a month apart, in 16 cases in which hypertension was well controlled either by pindolol alone or by pindolol plus a diuretic. During the month preceding each observation, the daily dose of pindolol was given in either two or three divided doses. Plasma pindolol levels could be measured in only seven cases. In these, 4 p.m. plasma pindolol levels were significantly lower on the twice-daily dosage regimen. Mean afternoon lying and standing blood pressure and lying pulse rate values were slightly but not significantly higher on the twice-daily regimen. Mean standing pulse rates were significantly higher on the twice-daily regimen. It appears that, for the control of hypertension, pindolol can be given in a twice daily regimen in most cases.


[The behaviour of creatine phosphokinase in serum after the intramuscular injection of a Tetracyclin preparation (author's transl)]. The single intramuscular injection of 275 mg Rolitetracyclin (Reverin) led to a rise in serum creatine phosphokinase in 11 out of 20 heart healthy patients, 7 cases with values over 100 mU/ml. In sane cases the initial values had still not been reached 72 hours after injection. With Rolitetracyclin given intravenously the creatine phosphokinase values do not alter, as with an isotonic Na-Cl solution given intramuscularly. A rise in the serum creatine phosphokinase was seen in 2 out of 6 cases after an intramuscular injection of Oxytetracyclin (Terramycin -Depot). One is not dealing with a reaction which is typical only to Rolitetracyclin. The cause is thought to be the setting free of enzymes through the musclelesions. The results underline the sensitivity of and problems involved with creatine phosphokinase in the diagnosis of heart-infarction.


[Postoperative prevention of thrombosis through the tonicizing of the caudal venous system. A new principle of drug therapy]. Haemostasis of the lower extremities is among the constituent factors of postoperative thrombosis risks ("Virchow's Trias"). Therapeutical efforts have, therefore, ever since focused on the idea of accelerating vein circulation. An equivalent effect is produced by Dihydergot which is thus qualified for postoperative thrombo-prophylaxis. This investigation proves the efficiency ofDihydergot. Results are based on 148 patients subject to longitudinal section tests along the 125-J-fibrinogen-test lines, from the 1st through to the 6th day after operation. In comparison with a control group, the results with the members of the therapy group gave evidence of a highly significant reduction of thrombosis frequency in the leg veins. Side-effects have not been noted. Tonus of the vessels and acceleration of the vein backflow by Dihydergot form a new therapeutical principle within the scope of postoperative thrombo-prophylaxis. The method is advantageous because it is highly efficient, practicable without complications, and is riskfree.


[Double gallbladders of the Y type. Case report and review of the literature]. The literature is reviewed about double gallbladder. The true double gallbladder is seperated in two gallbladders with two cystic ducts and two cystic arteries. One case is reported with double gallbladder and two cystic ducts coverage to form common channel before they join the common duct (Y shaped type). Both gallbladders and the very large dilated common bile duct contained gallstones. The radiological finding pre-operative was identical with the findings during the operation.


[The free gallbladder perforation].

[The free gallbladder perforation]. 15 cases of free gallbladder-perforation among 3,950 cholezystectomies during the last 15 years are discussed. There was no difference in the sex-distribution. The average age was 67 years. This factor together with delay of the operation because of atypical symptoms and perhaps a toxic agens in the gall are responsible for the high mortality of 26-70 p.c. Nearly always are gallstones and inflammation present. Therefore 2 consequences are made: 1) Acute cholecystitis with signs of diffuse peritonitis: Operation at once, otherwise during the first 3-5 days after preparation. 2) Widened indication for cholecystectomy by gallstone-illness is recommended.


Messenger RNA-containing ribonucleoprotein from mitochondrial polyribosomes of rat liver. A ribonucleoprotein was released from carefully purified rat liver mitochondrial polyribosomes after dissociation with 1 M potassium chloridepuromycin. This ribonucleoprotein was characterized by a sedimentation coefficient ranging from 10-14 S and buoyant density of 1.48 g cm(-3) in cesium chloride equilibrium centrifugation differing in these parameters from the subunits of mitochondrial ribosomes. Poly(A)-containing RNA constituted more than 30% of the total RNA content in this non-ribosomal ribonucleoprotein.


Poly(A)-containing RNA from Petroselinum hortense: isolation, properties and messenger function in vitro. Cell suspension cultures from parsley (Petroselinum hortense Hoffm.) were labelled in vivo with [2-3H] adenosine. The RNA isolated from the ribosomal pellet was fractionated on an oligo(dT)-cellulose column. Approximately 1.5% of the RNA, representing about 15% of the total radioactivity, was retained at high salt concentrations and eluted at low ionic strength. As determined by two independent methods, this fraction contained poly(A) segments with an average length of about 80 nucleotides. It was active as template in a cell-free system from wheat germ, directing the synthesis of peptides ranging in molecular weight from about 4000-40000 daltons.


[Genetics and idiopathic retinal detachment]. Study of all patients treated for retinal deteachment at the University Eye Clinic Lausanne from 1960-1971. All secondary detachments as well as 128 purely traumatic, 120 aphakic detachments and juvenile retinoschisis are not included in these statistics. Therefore there remain 802 patients with idiopathic detachments. A family occurrence is recorded in 7,6% of these cases. Bilateral detachment is observed in 25%. If one counts the controlateral degenerescence of the retina, bilaterality ascends to 42%. The disease occurs at an earlier age in cases with a family background. All these factors allow to appreciate the importance of heredity together with even more important peristatic factors. In 24% of cases, high myopia is associated with detachment. In this instance the heredity of detachment identifies itself with the heridity of myopia. This would be due to an autosomal monofactorial gene with variable penetration. Nevertheless in most cases, the detachment occurs independently of myopia. For the few hereditary cases (3,7%) the detachment or its predisposition would be due to a different gene, but also to a monofactorial autosomal dominant gene with variable and lower penetration, reaching even recessivity, acting together with peristatic often preponderant factors. Several pedigrees of high myopia as well as isolated retinal detachment are presented. Statistics beginning in 1960 do not allow any conclusion on Favre' or Wagner's diseases.


Drainage of subretinal fluid: why, when, where and how. The release of subretinal fluid is only required in certain complicated types of retinal detachment and should be avoided when possible. An important consideration in releasing subretinal fluid is the timing of this step in relation to the application of diathermy or cryotherapy as the primary treatment modality. Drainage should precede application of cryotherapy but follow the use of diathermy. The most satisfactory site for drainage is either immediately above or below the medial or lateral long ciliary nerve, just posterior to the equator of the globe. A technique for drainage of subretinal fluid has been developed and evaluated. An 'L'-shaped scleral flap is dissected to produce a relatively staphylomatous zone and the choroid is perforated near its center.


[Transport of 131I-hippuric acid and 22Na from the space between retina and pigment epithelium after experimental amotio]. A method was developed which allows up to puncture and fill the virtual space between retina and pigment epithelium with radioactive-labeled substances and to measure the transport of the injected substances out of this space. Experiments have been performed on 28 cats. 131I-iodo-omicron-hippurate and 22Na were used. The transport out of the space between retina and pigment epithelium of 22Na is much slower than that of 131I-iodo-omicron-hippurate. It is concluded that an active system in the pigment epithelium and/or retina is responsible for the transport of iodo-omicron-hippurate out of the eye


Release of subretinal fluid with the aid of the microscope. Report on 100 cases. When the incision of the choroid is performed with the aid of the microscope, release of subretinal fluid becomes an absolutely controlled microsurgical procedure. In a consecutive series of 100 eyes, operated with perforation and buckling, an anatomic reattachment rate of 83% was obtained. There have been 4 complications directly related to the release of subretinal fluid, 2 of which healed with good anatomical and functional result after additional treatment.


Controlled release of subretinal fluid.

Controlled release of subretinal fluid. Drainage os subretinal fluid is generally regarded as being unnecessary when local buckling procedures are carried out, particularly when the buckle is placed radially, unless the patient has chronic glaucoma or the choroidal vessels are markedly sclerosed.However, there are many cases of retinal detachment where the eye is otherwise normal and where radial procedure is the detachment operation of choice in which a limited and controlled release of subretinal fluid will help considerably in the localisation, treatment by cryotherapy and final positioning of the tear on the buckle. This paper describes the technique employed and the advantages which may be gained by using this method in cases of deep bullous detachment of the retina. The results which have been obtained in cases in which this method has been used during the last 3 years are described.


Intraocular injection of balanced salt solution and/or air as aids in the release of subretinal fluid. Intraocular BSS and air used in combination with buckling procedures and exoplants have been helpful as aids in the release of subretinal fluid. BSS can be injected into the anterior chamber or through the pars plana and the buckling area. Air should only be injected through the pars plana. The advantages are discussed. Careful technique is generally exempt of complications.


Traction release of subretinal fluid.

Traction release of subretinal fluid. The purpose of this investigation was to establish whether the hazards of drainage of subretinal fluid could be reduced. The technique employed utilizes a three-pronged circular grid with a central aperture, 1 mm in diameter. This rigid grid engages the sclera perpendicularly and can be satisfactorily controlled with one hand. Traction with this device elevates the scleral wall to a variable degree depending upon the rigidity of the sclera and the intraocular tension. This scleral elevation allows the point of penetration of the subretinal space to be further removed from the plane of the detached retina than normally would be achieved by conventional techniques. The data presented illustrates the advantages of this approach in terms of reducing the risk of retinal penetration, inadvertent vitreous release, and failure to penetrate the subretinal space in the drainage maneuver. It is suggested that this technique adds an additional safety feature to this problem area of retinal detachment surgery.


Drainage of the subretinal fluid and injection of saline solution into the vitreous body. In a group of 250 cases operated upon for retinal detachment, drainage of the subretinal fluid was carried out in 96%. Since in 54 cases, i.e. 22%, a large quantity of subretinal fluid was evacuated, saline solution was injected into the vitreous. The following complications due to drainage were noted: intraocular haemorrhages (16%), incarceration of the retina (1%) and temporary iridocyclitis (2%). None of these complications prevented reattachment. In 54 cases in which injection of saline solution into the vitreous was carried out, we have noted: temporary occlusion of the central retinal artery (5 cases), temporary cloudiness in the vitreous body (2 cases) and traumatic cataract (1 case). The injection of saline solution into the vitreous was well tolerated. Although the complications due to drainage are rather numerous (intraocular infection and haemorrhages, incarceration of retina, secondary retinal hole, glial proliferation in the vitreous, dehiscence at the place of drainage), these complications rarely occur if the drainage is carried out in a proper manner. Despite the fact that drainage and injection of saline solution into the vitreous do not cause more severe complications, however, we consider that the method of avoiding drainage and internal tamponage, whenever it is possible, represents a fully justified trend.


[Surgical treatment of retinal detachment without drainage: apropos of 100 consecutive cases]. Recent advances in retinal detachment surgery must end in a simplification of the techniques: cryo-applications associated with a scleral buckling by one or more Lincoff sponges parallel to the equator seems to be satisfactory in almost all cases. Subretinal drainage, whatever technique used, does not seem to ameliorate significantly the evolution which depends, essentially, on the indentation and localisation quality. Furthermore, scleral perforation seemed to caused supplementary complications in an important number of cases. Analytical review of 100 consecutive cases.


The role of non-drainage in reoperation. In a study of 194 reoperation in which one third of the cases were managed without drainage of SRF, it was found that a number of failures occurred after non-drainage. Analysis of these failures shows that more than half could have been avoided if the choice of operation had been correct. It is felt that with careful attention to the criteria which was used to decide on the choice of surgical technique, the results obtained by the non-drainage method should be as good in the more complicated case as they have already been shown to be in the primary case. Because the drainage of SRF carries with it a high risk of surgical complications and these complications frequently result in the development of MPR, management of the reoperation should be carried out without drainage of SRF whenever possible.


[Advantages and complications of non-drainage of subretinal fluid in detached retinal surgery]. Analysis of the results of 63 retinal detachments operated without drainage of the subretinal fluid. Three surgical techniques were used: scleral in folding, scleral pocket or extra scleral implants. Research of the factors which favoured the reabsorbtion of fluid. The cases who presented a particularly slow and late reabsorbtion of fluid were discussed and the different complications reviewed.


Encircling operations without drainage of subretinal fluid. An encircling constriction procedure has been added to the localized indentation operation. The inclusion of a cerclage does not in itself require drainage of subretinal fluid. Experiments were done in an animal model to determine the amount of constriction that would be tolerated by the eye without provoking a significant incidence of anterior segment ischemia or scleral erosion. From these experiments it was projected that the human eye might withstand a reduction in band length between 10 and 20% of its circumference without important morbidity. 119 patients were operated upon over six years with a cerclage constricted within these limits. Anterior segment ischemia occurred twice, scleral erosion not at all.


[Puncture in retinal detachment surgery]. This survey has been carried out over 186 operations for retinal detachment during which a voluntary or accidental drainage took place in 2/3 of the cases. Its frequency is studied according to the type of the detachment, its age, the duration of the preperatory rest, the number of operations and the surgical technique. The postsurgical evolution of detachments with drainage shows that the vitreous is more frequently clouded, later cleared up, and that there are more choroidal detachments and more retinal hemorrhages. The frequency of the early retinal flattening, the only one which has been studied, is not increased by drainage. It is no use debating the opportunity of drainage because indeed it is often imposed on the surgeon a as a last resort by the type of the detachment. The means for limiting its frequency are reviewed.


[Attitude toward subretinal fluid and consequent treatment of idiopathic retinal detachment]. 250 retinal detachments have had surgery for the first time: 70 with release of the subretinal fluid, 180 without release of the subretinal fluid. It appears that the postoperative intraocular conditions and functional results are better when drainage is not performed.


[Pars plana vitrectomy with the vitreous stripper]. We report on the construction and the function of a new microsurgical instrument for vitrectomy. The instrument is introduced into the vitreous cavity through a small scleral incision in the pars plana area. Microscope observation with slit-lamp illumination and a specially designed contact lens are used for this surgical procedure. Our clinical experiences and the indications are discussed.


Microsurgical roto-extractor instrument for vitrectomy. A double-edged cutting blade oscillates between a clockwise and a counter-clockwise high speed rotation without completing a full revolution. This imparts a great mechanicaldvantage and safety to the instrument's cutting efficiency. The cutter may also be used with a continuous high speed clockwise rotation. Multiple interchangeable probe tips are used that are of either double- or triple-walled construction. A fiber-optic light pipe surrounds the probe tip used for deep vitrectomy in conjunction with an irrigated fundus lens. A film will illustrate the use of the roto-extractor in two diabetic patients with old unabsorbed vitreous hemorrhage and membranes. In the first case, a pars plana incision was used for vitrectomy in conjunction with a cataract extraction. In the second case, the para plana vitrectomy was combined with an optical iridectomy necessitated by the presence of an updrawn pupil following previous cataract extraction complicated by vitreous loss. To date, 12 roto-extractors have been distributed to 12 various teaching institutions throughout the United States.


The current status of vitreous membrane surgery. The prognosis in complicated retinal detachments has improved with advances in vitreous surgery. Different types of vitreous membranes require different instrumentation and different surgical techniques. This presentation describes the indications, instrumentation and surgical techniques for the management of various types of vitreous membranes. An exhibit on vitreous surgery illustrates various instrumentation.


Late removal of dense posthemorrhagic vitreous membranes following cataract extraction. Severe, seemingly permanent intraocular hemorrhages caused by ocular trauma, Eales' disease and retinal vein thrombosis, lead to late formation of a dense retrolental membrane, vitreous liquefaction and intumescent cataract with faulty light perception. In the absence of ultrasound, the diagnosis was made possible only after removal of the cataract. Lens extraction and excision of the vitreal membrane led to surprisingly good recovery of vision. Three cases are presented and the pathological study of a posthemorrhagic membrane.


Further studies in the use of hyperbaric oxygen in retinal detachment with sickle cell anemia. Patients with sickle cell anemia in many cases develop proliferative retinopathy which frequently progresses to retinal hole formation and retinal detachment. These patients do very poorly with scleral buckling procedures. This is probably due to sickling of the red blood cells during surgery, which may interfere with the circulation to the structures of the anterior segment of the eye. We have previously reported avoiding this problem in three cases by performing a modified scleral buckling procedure in the hyperbaric oxygen chamber. This paper reports additional cases successfully treated with this technique. Blood studies performed during surgery in the hyperbaric chamber are reported and the technique is further described.


Miotic drugs, glaucoma, and retinal detachment. It has been reported in the literature, and is the clinical impression of many ophthalmologists, that the use of miotic drugs and especially Phospholine Iodide increases the incidence of retinal detachment. A review of 1,000 cases of retinal detachment is reported with a breakdown of the percentage of patients who previously had glaucoma and the various drugs with which they had been treated prior to the development of their retinal detachments. The incidence of bilateral cases is also studied and conclusions are drawn as to whether or not there is any increased incidence of retinal detachment or in the bilaterality in patients who are on miotic medications.


[Value of functional disorders in the diagnosis of idiopathic retinal detachment]. The most interesting aspect of functional retinal troubles as everyone knows lies in the fact that they (1) constitute an alerting symptom, especially in high-risk patients and (2) they are a localizing sign of retinal tears. The main problems though arise when the ocular fundus cannot be correctly seen because of altered transparent tissues. In all cases these functional troubles require a retinal examination without delay.


Genetical studies in nontraumatic retinal dialysis. 1. The retinal periphery was explored with binocular indirect ophthalmoscopy and scleral depression in members of the families of patients with detachment due to retinal disinsertions and 30 pedigrees have been thus obtained. 2. A genetic causation of this disease is postulated, based in the concentration of cases in some of the sibships studied (33% of the sibships with 2 or more siblings); furthermore, the disease was demonstrated in two identical twins and was absent in two fraternal twins. 3. The sex incidence was similar and the vast majority of affected individuals had normal parents, suggesting an autosomal recessive mode of inheritance for at least some of the cases.


Macular changes in congenital retinoschisis. Nine patients with congenital retinoschisis were examined. Two patients showed only the stellate c cystoid macular schisis without peripheral changes. Most of the affected eyes demonstrated a vision between 6/15 and 6/21. Fluorescein angiography did not reveal any macular abnormalities, even though changes were ophthalmoscopically visible. Patients in their twenties developed nonspecific macular degeneration, but did not have acceleration of visual deterioration.