Hemorrhage with pelvic fractures: efficacy of transcatheter embolization.

To determine the effectiveness of angiography in identifying bleeding sites and controlling the massive and often fatal hemorrhage accompanying pelvic fractures, the hospital course and outcome of 28 patients who underwent angiography after pelvic trauma were reviewed. In 20 patients, active bleeding was demonstrated. Transcatheter occlusions of bleeding arteries were performed in 18 of these, with angiographic ontrol of hemorrhage in 18 and clinical control in 17. Two patients with active bleeding were not embolized because of subsequent surgical intervention in one and technical angiographic difficulties in the other. Blood transfusion requirements averaged 32.1 units in the 48 hr or less before occlusion and 5.2 units during 48 hr after occlusion. Of the 18 patients who underwent arterial embolization, nine died, seven of associated injuries, one of extrapelvic hemorrhage, and one of hypotension. Nine patients survived to be discharged. These results confirm that transcatheter occlusion of bleeding vessels in the pelvis reduces hemorrhage and facilitates the management of patients with pelvic trauma.


Percutaneous ureteral stent placement for stricture management and internal urinary drainage.

Percutaneous ureteral stent placement was attempted in nine patients with 14 ureteral lesions. Eight strictures in six patients were successfully stented. Three were subsequently converted to indwelling ureteral stents. The technique is described. No significant complications occurred. The procedure should be attempted as part of percutaneous nephrostomy for benign ureteral strictures, ureteral fistulae, or when ever long term nonoperative diversion can be useful.


Abruptio placenta: sonographic and pathologic correlation.

In cases of abruptio placenta, the ultrasound examination may be negative if external bleeding occurs without a large enouth accumulation of blood to be sonographically visible. A positive sonogram may demonstrate either a retroplacental hematoma or a hematoma that has dissected beneath the chorionic membranes. Six cases of abruptio placenta are presented with sonographic and pathologic findings.


Evaluation of glenoid labrum by double-contrast shoulder arthrography.

Double-contrast shoulder arthrography was used to define the normal and abnormal arthrographic anatomy of the glenoid labrum. A retrospective study of 12 patients suspected of having labral abnormalities or who had unexplained shoulder disability consistent with capsular laxity was undertaken. In four of the nine patients with abnormal arthrograms, the study revealed critical anatomic alterations not detectable on physical examination or pain radiographs.


Intertrochanteric fractures: current concepts of an old subject.

The pre- or intraoperative classification of intertrochanteric fractures into stable and unstable is based on the status of the bone in the critical calcar femorale area and the obliquity of the fracture line. Modern management of unstable intertrochanteric fractures may include displacement at the fracture site, osteotomy, and fixation with a sliding screw system. These procedures produce postoperative films of an "unusual" appearance. The radiologist must understand the principles of classification and management to properly interpret the pre- and postoperative films.


Symptomatic bursa formation with osteochondromas.

Two cases of bursa formation in association with osteochondromas are presented. This condition may be confused radiographically and clinically with malignant transformation of the cartilage cap. Ultrasound examination on one of the patients proved helpful in arriving at the correct preoperative diagnosis. Ultrasonography was also helpful to the surgeon with regard to size and extent of the bursa.


Fracture of the hook of the hamate.

Three patients with hamate hook fractures were evaluated. These fractures were difficult to diagnose clinically and radiographically. Mechanisms of injury reported in the literature include blunt trauma to the hamulus or pisiform, forceful swinging of a grasped object, or a forceful muscular contraction. Delayed diagnosis may result in late complications including carpal tunnel syndrome, flexor tendon rupture, ulnar nerve palsy, or ulnar artery compromise. Pain when grasping or swinging an object is often a clue to the correct diagnosis. Normal standard and carpal tunnel views do not exclude this injury. Tomography may be necessary for radiographic detection and permits detailed evaluation of fracture margins. Pertinent carpal anatomy is reviewed.


The opisthion on the lateral radiograph of the cervical spine.

Ten adult dry skulls were radiographed in the lateral projection to evaluate the appearance of the opisthion, the posterior margin of the foramen magnum. The opisthion was seen on all 10 skulls and its position was confirmed by outlining it with barium paste. In cross section, it is a teardrop-shaped structure continuous with the internal occipital crest. A beak-shaped shadow anterior to the opisthion was also examined with the barium technique. It is an overlap shdow formed by the interior margin of the foramen magnum and the inferior border of the occipital bone on the same side. In a review of 50 random radiographs of the cervical spine, the opisthion was identified on 42 (84%) and the beak-shaped overlap shadow was seen on 28 (56%). The spinolaminal line, which delineates the posterior margin of the cervical spinal canal, was an unreliable indicator of the position of the opisthion in 17 (40%) of the 42 cases in which the opisthion could be identified.


Increasing patient complicance in preparing for barium enema examination.

Since feces may mimic important lesions of the colon, adequate cleansing is required for a good diagnostic study. An experiment was designed to assess the effect of advance oral and written communication on patient compliance with instruction for preparing the colon for the barium enema. These communication methods were compared against a control group in the extent to which they would encourage patients to more adequately follow cleansing instructions. It was found that each of these increased the quality of the preparation to a similar degree and when combined resulted in the most optimal level of cleansing.


Carnitine content of liquid formulas and special diets.

Radioisotopic analyses for carnitine content were done on infant formula, formulas for tube feeding, food supplements, and chemically defined diets. The carnitine content of the diets depend on the protein source. Products whose main protein source is soy protein isolate, casein, or egg white solids contain 4 nmole carnitine per milliliter or less, with most of them containing undetectable amounts of carnitine. Products based on milk or beef contain 50 to 656 nmole carnitine per milliliter. The daily requirement of the body for carnitine is unknown. Evidence is discussed that indicates that the possible use of carnitine as a supplement to formula diets intended for long-term care needs to be considered.


Nutritional manipulations and tumor growth. II. The effects of intravenous feeding.

The effects of acute parenteral nutritional manipulations on tumor and carcass growth were examined in the rat. Carcass mass was maintained in animals fed diets either orally or intravenously. Reduction in liver incorporation of tritiated methyl thymidine and increases in liver fat content in the total parenteral nutrition groups indicated that the high carbohydrate, high nitrogen, intravenous diet was less than optimal. Tumor growth as measured by changes in volume, weight, DNA content, or nitrogen content was unaffected by the various nutritional regimens. Tumor dpm/microgram DNA was reduced by those intravenous regimens that were associated with hyperglycemia. Host carcass weight, can be maintained with intravenous nutrition, but normal growth is not restored by the current intravenous regimens.


Proficiency testing in immunohematology in Ontario, Canada, 1975-1977.

Since April 1975 the proficiency of laboratories in Ontario that perform immunohematology tests has been assessed. While the majority of test samples have required only ABO and Rh(D) typing, others have posed problems. The error rate in uncomplicated ABO typing was 1.3/1,000 in 17,479 tests and that in straightforward Rh(D) grouping, 6.6/1,000 in 17,757 tests. False-negative (36/1,000) and false-positive (1.4/1,000) direct antiglobulin tests occurred. Errors in detection of strong alloantibodies (e.g., anti-D) were 19.7, 10.2 and 5.1/1,000 in three test samples. A2B or A2 cells with anti-A1 in serum were sent out in two surveys; error rates in ABO interpretation were 189 and 52/1,000, respectively. Laboratories also experienced difficulty in interpreting the Rh(D) type of cells with positive antiglobulin tests. These surveys have had several effects: (1) laboratories with poor performance have been identified, (2) patterns of practice have been influenced, (3) areas of ignorance have been identified, and (4) a stimulus has been provided for continuing education in immunohematology.


Urinary myelin figures in gentamicin nephrotoxicity.

The nephrotoxicity of gentamicin is associated with formation of myelin figures within the proximal convoluted tubules of experimental animals and man. By electron microscopy, the authors studied urinary sediments of patients who were treated with gentamicin to detect the occurrence of myelin figures. All three patients who had renal impairment and were treated with gentamicin had numerous urinary myelin figures. By contrast, myelin figures were not observed in urinary sediments of four patients who had no renal impairment despite gentamicin therapy, or nine patients who had no renal impairment and did not receive gentamicin therapy. Occasional myelin figures were detected in a urinary sediment of one of eight patients who had renal impairment and no gentamicin therapy. When the urinary sediments of patients who had gentamicin nephrotoxicity were compared with those of patients with Fabry disease, morphologic differences between the myelin figures of the two groups were detected. The study demonstrates the presence of myelin figures in urines of patients with acute renal failure receiving gentamicin, and suggests that the finding of these myelin figures within urine samples may contribute to the diagnosis of gentamicin-induced nephrotoxicity.


Serologic diagnosis of access device-related staphylococcal bacteremia.

Staphylococcal bacteremia occurs frequently in patients undergoing long-term hemodialysis (dialysis patients). Although such bacteremia is frequently uncomplicated, it may be associated with endocarditis, metastatic infection or suppuration at the access site requiring excision of the access device for control of the infection (complicated bacteremia). To distinguish patients with uncomplicated bacteremia from those with complications, we measured staphylococcal teichoic acid antibodies by agar-gel diffusion and immunoglobulin G (IgG) antibodies by radioimmunoassay in 18 patients with staphylococcal bacteremia undergoing long-term hemodialysis. Although teichoic acid antibodies were not detected in five patients with uncomplicated bacteremia, they were observed in only three of 13 patients with complicated bacteremia. IgG staphylococcal antibodies were present in 10 of 13 patients with complicated bacteremia compared to none of five patients with uncomplicated bacteremia compared to none of five patients with uncomplicated bacteremia (p less than 0.05). Thus, radioimmunoassay was spuerior to agar-gel diffusion in identifying dialysis patients with complicated bacteremia. In patients with increased concentrations of IgG staphylococcal antibodies by radioimmunoassay, the diagnosis of endocarditis, metastatic infection and suppuration at the access site should be considered. Prolonged antibiotic therapy and/or operative removal of the access device may be necessary.


The mucopolysaccaridoses: clinical and biochemical correlations.

The mucopolysaccharidoses (MPS) are hereditary diseases that result in deformities related to connective tissues. Some types of MPS lead to progressive mental retardation. Biochemically, these syndromes are characterized by excessive accumulation and excretion of various types of glycosaminoglycans (mucopolysaccharides). These diseases result from absence of various lysosomal enzymes involved in glycosaminoglycan degradation. The definition of the defects in the MPS has led to advancing diagnosis, counseling, and the possibilities of prenatal diagnosis of this group of dieseases.


Plasma thyrotropin-releasing hormone, prolactin, thyrotropin, and thyroxine concentrations following the intravenous or oral administration of thyrotropin-releasing hormone.

In a further evaluation of the use of oral thyrotropin-releasing hormone (TRH) in puerperally lactating women, a radioimmunoassay for its measurement has been developed. Its concentration in plasma as well as that of prolactin (PRL), thyrotropin (TSH) and thyroxine (T4) were measured following either intravenous or oral administration of TRH. Basal concentrations of TRH in 14 normally cycling women ranged from less than 5 to 17 pg/ml. Two luteal phase studies produced peaks in plasma TRH 5 to 10 minutes after 100 micrograms of TRH administered intravenously with a return to basal concentrations within 2 to 3 hours. In 10 normally menstruating women, ingestion of 10 mg of TRH orally resulted in plasma TRH which peaked at 423 +/- 123 pg/ml (standard error of the mean) at 30-minutes. Plasma PRL, TSH, and T4 also increased and remained slightly elevated at 4 hours. These 8-hour studies were performed in a puerperal lactating woman who had ingested 10 mg of TRH orally twice a day for 7 days prior to blood sampling. TRH concentrations declined throughout each day while TSH rose slightly in the first 1 to 2 hours but remained within normal limits. The prolonged administration of 10 mg of TRH orally twice daily to three puerperally lactating women resulted in elevations in plasma TRH 2 to 3 hours following hormone administration, yet no significant increases in plasma TSH were observed. Both endogenous TRH and TSH were measured before and after 22 nursing events in nine puerperally lactating women. There was no change in the concentration of either substance and all values were similar to those obtained in normally menstruating women.


Incestuous rape: a cause for hysterical seizures in four adolescent girls.

Four cases are presented of hysterical seizures in adolescent girls as a consequence of forced incestuous relationships with their fathers. It is suggested that, for all girls presented to the clinician with symptoms of hysterical seizures, a detailed history should be taken to explore for the possibility of incest.


Comparison of proximal and distal colonic muscle of the rabbit.

Mechanical length-tension properties and response to neurohumoral agents were compared for proximal and distal colonic muscle. Resting tension during stretch, acetylcholine-stimulated tension, and the total tension were determined. Proximal circular muscle developed a maximum total tension of 0.96 +/- 0.18 kg/cm2 (mean +/- SE) compared to 0.86 +/- 0.06 kg/cm2 for the distal colon (P greater than 0.05). Resting tension was 0.33 +/- 0.03 kg/cm2 for the proximal colon and 0.05 +/- 0.01 kg/cm2 for the distal colon at the length of optimal acetylcholine-stimulated tension (Lo) (P less than 0.01). Longitudinal muscle showed a similar difference for the proximal and distal colon. The high resting tension in the proximal colonic muscle was reduced by nitroprusside or calcium-free Krebs with EGTA. Dose-response curves to acetylcholine, histamine, phenylephrine, and isoproterenol were similar for the muscle of either part of the colon. Gastrin or cholecystokinin had no effect on the muscle. In summary, the circular or longitudinal muscles of the proximal and distal colon have different length-tension properties but only minimal differences in response to neurohumoral agents.


Slowed rate of gastric emptying of solid food in man by high caloric parenteral nutrition.

We studied the effect of high caloric parenteral nutrition on the rate of gastric emptying of solid food. The linear pattern of gastric emptying was not altered by parenteral nutrition, but the gastric emptying rate was consistently slowed. The degree of slowing of gastric emptying while on parenteral nutrition correlated with the increase in blood glucose induced by the intravenous nutrient load. These findings may explain the oral food intolerance displayed by some persons receiving both oral and high caloric intravenous nutrition.


Immediate changes in protein-concentration in aqueous humor induced by intracapsular lens extraction in human eyes.

In 71 patients that underwent intracapsular extraction of the cataract it was possible to collect aqueous humor (a.h.) in sufficient quantities at the beginning and at the end of the operation. Using radial immunodiffusion albumin, IgG and alpha-1-antitrypsin were measured in the samples. In secondary a.h. huge variations in the concentrations were apparent. The primary permeability of the blood-aqueous barrier and the time between sampling had no influence on the relative increase of the proteins. No statistically significant difference was found between normotensives and hypertensives and patients with or without myopia of higher degree (over 6 diopters). The relative increase of proteins according to their difference in molecular weight followed the same pattern as described for anterior uveitis. In patients for whom an enzymatic zonulolysis with trypsin was used for the extraction, the relative increase of IgG was significantly smaller than in those that did not receive this treatment (P less than 0.005). The possible sources contributing to the formation of secondary a.h. are discussed.


[Anesthsiological experiences in experimental surgery].

The paper reports experience with methods of anaesthesia in rabbits, rats, mice, guinea-pigs, pigs, sheep, baboons, dogs and cats. Special problems of handling, mode of injection and intubation are discussed. A comprehensive survey of literature provides further information about the proposed patterns of anaesthesia and informs about other anaesthetic methods, not practised by the authors.


Silicone elastomer for nasojejunal intubation and central venous cannulation in neonates.

Modifications are described to two techniques using silicone elastomer tubing in neonatal nutrition. The first enables nasojejunal intubation to be performed easily for feeding by this route. The second provides a central venous line for parenteral alimentation. These modifications are suggested as improvements to the original techniques described.


Intercellular junctions in the rhesus monkey pars distalis.

Four rhesus monkey pituitary glands were examined by transmission electron microscopy. Three types of intercellular junctions, desmosomes, hemidesmosomes and zonula adherens-type junctions, were observed between adjacent granular cells, folliculo-stellate cells, and joining a folliculo-stellate cell with a granular cell. Demosomes were most commonly observed between granular cells while the zonula adherens-type junctions were generally found between the folliculo-stellate cells.


Relationship between serum and seminal plasma prolactin in bonnet monkeys.

The relationship between serum and seminal plasma concentration of prolactin were investigated in four adult bonnet monkeys. Hyperprolactenemia induced by acute and chronic treatment with chlorpromazine showed significantly higher prolactin levels in seminal plasma on 8th and 16th day respectively, by which time the serum prolactin levels have already reached pretreatment levels. The study suggests that it may be possible to affect the sperm fertilizing capacity by pharmacologically affecting serum prolactin concentrations.


[Diagnosis of post-operative jaundice (author's transl)].

The typical factors responsible for post operative jaundice are: 1) increased pigment load; 2) hypoperfusion; 3) sepsis and 4) drugs. In the patient evaluation, one should carefully review the patients chart for hypotensive episode during surgery, the drugs being administerd and the evolution of the illness which will facilitate the identification of the causal factors. Aside the aminotransferase, alkaline phosphatase and bilirubin levels, the risk of hemolysis, of sepsis, the synthetic function of the liver and the integrity of the biliary tree must be established. Post-operative jaundices appear quite often in a context of multiple etiology. However, it is very important to know when surgery is hazardous and when it is mandatory and lifesaving.


[The management of mediastinal infection following cardiac surgery. Role of the reanimation and of hyperalimentation (author's transl)].

Apprehended complication of the cardiac surgery by median sternotomy, the mediastinitis leads very often to a high death rate, a long hospital-treatment, frequent and sometimes serious sequelae. Considering eleven cases, we are trying to show the interest brought by the choice of the immediate thorax-closing method, in so far as this technic is associated with a correct disinfection of the mediastin a good irrigation-drainage properly well-maintained and overseen, a reanimation technic the main purpose of which is to assure a sufficient caloric and nitrogenous supply.


[Pharmacology of nitroglycerin (author's transl)].

Nitroglycerin is a vasodilating agent by virtue of its actions on vascular smooth muscle fibers. It may be administered intravenously (using either 5 p. cent dextrose, or propylene-glycol solvant), sublingually, orally or by topical administration. It is rapidly metabolized, principally by liver. Its is not toxic. The vasodilatation that is produced is both arterial and venous and is dose-related in dog (1 microgram to 100 micrograms/kg/min). However, resistance and tachphylaxis may occur. Its principal use is for angor treatment, but it has been used for the treatment of arteriopathy of the lower limbs, biliar hypertony and arterial hypertension. It has been recently administered for the treatment of acute phase of myocardial infarction and during pre, per- and post-operative periods in cardiac surgery, neurosurgery and hip surgery, as myocardial protector or anti-hypertensive agent or hypotensive agent. The absence of toxicity and the rapid reversibility of its cardio-vascular effects which are similar to the effects of sodium nitroprusside are important reasons for its use in anesthesia and cardiac intensive care.


[Monoclonal immunoglobulins and serum viscosity: contribution of the idea of activation energy to the paraprotein concept (author's transl)].

The simultaneous study of dynamic and cinematic viscosity in 34 control sera and 49 paraprotein sera showed that there was a simple relationship between the viscosity and the total serum protein content both in normal sera and in paraprotein sera. When the ratio of monoclonal immunoglobulins/total proteins is less than 55%, the viscosity is little or not modified in the case of the IgGk paraproteins studied, whereas it was increased in the case of IgA, IgM and IgG LAMBDA SERA. Beyond 2 cSt, it is not however possible to incriminate a particular type of heavy chain nor even a light chain. The measurement of the viscosity in relation to the temperature permitted us to show that the IgA, IgG, and IgM sera studied all presented an activation energy of outflow (E in Kcal) higher than that of normal sera and the highest rise is due to IgA paraproteins. The concept of energy activation permits us to say that paraproteins have a different behaviour from normal proteins, probably due to disorders in their structural arrangement.


[Enteral feeding with reinjection in the terminal gut (author's transl)].

About one case, we describe our technology. The main avantage of the method is to reduce strongly septic complications resulting from intravenous feeding. It can be used as soon as the gastrointestinal tract is functional without any risk and it is the most effective means of providing nutrition for an extended period.


[Cryoglobulin analysis by ultracentrifugation in density stabilized gradient followed by immunodiffusion (author's transl)].

A technique is described which combines ultracentrifugation in a density gradient stabilized by gelification, with agar gel immunodiffusion. The use of this procedure to determine sedimentation parameters and antigenic determinations is presented and illustrated with the diagramms obtained in the identification of various cryoglobulins.


Some hygienic problems in the production of meat and bone meal from slaughterhouse offal and animal carcasses.

A study of uncut anthrax-infected slaughterhouse waste in the sterilizer of an animal destructor after the prescribed heating at 130 degrees C for 30 min showed that in 17 cases Bacillus anthracis was able to survive. The determination of z-values for B. anthracis and B. stearothermophilus showed that when slaughterhouse waste is cut up into pieces of no more that 50 g weight the temperature at the centre may lie between 120 degrees C for 20 min and 130 degrees C for 10 min for destruction of spore formers. The resulting animal meal is of improved protein quality by this treatment. These results and conclusions cannot be directly transferred to fat bath treatment of meat, because of the significant difference caused by the use of vapour pressure methods.


Fish farming in ponds and lakes to provide an important protein supplement to the food basket, and connected public health problems.

Fish farming in ponds can be of great value in various ways: 1) By adding fat-free and relatively inexpensive animal protein to the food basket; 2) By removing waste water in a most hygienic as well as economic way; 3) By saving the cost of transport and storage of meat from warm-blooded animals by breeding fish near the consumer. Our task is to prevent the spread of disease in fish, to prevent transmission of health hazards to man, and to inspect the quality of fish all along the line from the ponds through marketing to the consumer.


[Primary gastric plasmacytoma with IgG dysgammaglobulinemia and macrocytic anemia (author's transl)].

The authors report a case of a woman aged 76 years with a single plasmocytoma of the stomach secreting large quantities of a paraprotein of the IgG type with Kappa light chains. A macrocytic anemia due to deficiency of gastric intrinsic factor was also present. This pathological association is extremely rare. About sixty cases of gastric plasmocytoma are been reported in the published literature and their principal characteristics are briefly outlined.


[Diabetic ketoacidosis: results with two different patterns of insulin administration (author's transl)].

The response to insulin treatment in 15 children with diabetic ketoacidosis is studied. Insulin continous infusion was administered to nine patients. The other six patients received insulin subcutaneously except one half of the first dose injected by vein as a bolus. Both patterns of insulin administration proved to be equally effective. Anyway the insulin continuous infusion appears as a simple and easier method for a good general control and to prevent hypoglycemic episodes. To prevent a hyperglycemic rebound it is suggested that a dose of subcutaneous insulin must be injected immediately after the insulin infusion is discontinued. A discordance between hyperglycemia correction and the degree of acidosis has been noticed in some patients; this can be corrected decreasing insulin infusion rate.


[Mucolipidosis. biologic characteristics (author's transl)].

Mucolipidosis II is a severe inherited lysosomal storage disease characterized by profound psychomotor retardation, severe Hurler-like skeletal changes and normal urinary mucopolysaccharide excretion. Mucolipidosis II is a related disorder distinguished by its milder course, milder to absent mental retardation and survival to adult life. Cultivated fibroblasts from patients with both of these disorders display large inclusions on phase microscopy and reduced levels of many acid hydrolases. However, culture medium fibroblasts out the body fluids of affected patients show enormously elevated levels of these hydrolases. The lysosomal enzyme activities in serum, leukocytes, fibroblasts extracts and culture medium from seven patients with mucolipidosis II are similar to those found in four cases of mucolipidosis III. The findings of excessive excretion of sialyl-oligosaccharide in urine and of increased level of sialic acid compounds in cultured fibroblasts associated with a sialidase deficiency in leukocytes, fibroblasts and serum are discussed.


[Mitral echocardiography in hunter syndrome (author's transl)].

An echocardiographic study was realized in four patients with the Hunter syndrome (mucopolysaccharidoses II), evidenced by the clinical, radiologic and laboratory data. Mitral incompetence was present in two of the cases. In cases without mitral incompetence the echocardiographic tracing showed multiple mitral systolic echoes with a normal left atrium. On the other hand in cases with mitral incompetence the echocardiograms showed multiple systolic and diastolic echoes of the mitral valve with left atrial enlargement.


Psychophysical evaluation of cochlear prostheses in a monkey model.

Functional aspects of cochlear prostheses implanted in the scala tympani were tested in monkeys trained to perform a simple reaction-time task. Thresholds for detection of electrical stimulation and dynamic ranges were tested for a wide range of frequencies of sinusoidal stimulation and for biphasic rectangular pulses of various durations and repetition rates. The results are comparable with available data from implanted human patients and extend these findings, exploring various aspects of electrical stimulation in greater detail.


Design factors in the characterization and identification of otitis media and certain related conditions.

Because the state of our knowledge of many aspects of the etiology and pathogenesis of otitis media and related conditions is deficient, precise characterizations of certain aspects of the disease may not be possible. In fact although most studies in the past have failed to define the specific disease state to be investigated, the specific type of otitis media or related condition to be studied must be as clearly defined as is clinically possible in order for any prospective study of otitis media to be valid. The state of the art of the presently available methods to identify these conditions also poses certain limitations; at present, there are five methods to identify otitis media and related conditions: history, audiometry, tympanocentesis/myringotomy, otoscopy (including otomicroscopy), and impedance measurements (tympanometry and assessment of the middle earl muscle reflex), and they all have inherent elements of unreliability. Historical information obtained from parents or the child is usually unreliable; a positive history may aid in defining the problem, but a negative otologic history does not rule out the presence of otitis media since it is frequently asymptomatic. Audiometry has been shown to be a poor method of identifying otitis media. Although tympanocentesis or myringotomy is the most reliable way to identify otitis media with effusion (OME), it is invasive, frequently requires an anesthetic, and is usually a confounding variable. In an effort to establish the diagnostic value of otoscopy, tympanometry, and the presence or absence of the middle ear muscle reflex in identifying OME, the diagnostic findings by these three methods, were compared with the findings at myringotomy in 239 children (425 ears). The study showed that even experienced clinicians had some difficulty in identifying those ears with effusion (sensitivity) and had even greater difficulty in making a diagnosis of those ears without an effusion (specificity). Tympanometry employing patterns that have been validated with myringotomy findings was found to be as accurate as expert otoscopy. On the other hand, the presence or absence of the middle ear muscle reflex was found not to be a useful method of diagnosing the presence of OME due to its extremely low specificity. An algorithm derived from the combination of the three methods had highest sensitivity and specificity. From this study, the following recommendations regarding the identification of OME are suggested. All investigators who employ otoscopy should be validated by comparing their assessments either with the findings at myringotomy or with a previously validated otoscopist. Interobserver realiability of all otoscopists should be established prior to and maintained during clinical studies of OME. Only electroacoustic impedance instruments in which the tympanometric patterns have been validated should be used. Tympanometry employing validated tympanometric patterns has a high degree of sensitivity and specificity, and as such can provide an objective method to identify OME...


Conductive hearing loss effects on children's language and scholastic skills. A review of the literature.

A review of available studies investigating the consequences of conductive hearing loss for language acquisition and scholastic performance was carried out. It uncovered no study that met the standards of rigor needed to provide a definitive answer to this question, although the burden of the evidence is that a persistent mild hearing loss, especially if present since infancy, probably has a measurably deleterious effect on the language of most but not all children. Diagnostic criteria documenting the severity, age of occurrence and duration of middle ear effusions were lacking. Measures of the detrimental effects of conductive losses on linguistic skills frequently were limited to the number of grades children were retained in school, their reading or vocabulary level on achievement tests, or a comparison of their scores on the verbal and performance scales of intelligence tests. Very few studies followed the acquisition of language in affected children or examined its structure. Very few considered the interaction between the socioeconomic and cultural environment of the child and the consequences of his hearing loss. The review underscored the need for prospective multidisciplinary studies in order to evaluate the actual impact of this common pediatric problem.


Otitis media and child development. Design factors in the identification and assessment of hearing loss.

Otitis media with effusion (OME) is the major cause of auditory dysfunction in preschool and early-grade schoolchildren. At especially high risk are children with cleft palate/lip; some groups of mentally retarded children; children from underprivileged communities and children with severe or profound sensorineural hearing loss. In neonates the major concern is to identify those with severe sensorineural hearing loss but awareness of the likelihood of OME is also vital. The hearing loss associated with OME in its early stages may be as small as 10--15 dB and in consequence conventional hearing tests employing pure tones are inadequate is screening procedures. Acoustic impedance testing has proved to be a practicable, acceptable, sensitive and efficient method of identification of OME in infants and children. Impedance measurement cannot, as yet, provide accurate assessment of hearing loss, but this is probably not a serious drawback. The primary requirement is to detect OME in order that swift and effective treatment can be instituted.


Influence of otitis media on hearing and development.

Otitis media affects nearly every child at some time; many children have mild-to-moderate hearing losses for prolonged periods. The effects of these losses on language and educational development may be significant; possible mechanisms are discussed. Especially in suboptimal listening situations, speech perception may be impaired by even a mild hearing loss. Patterns of imperception are predicted by comparison of composite audiometric data from children with middle ear effusions with speech power data, and by analysis of sound pressure waveforms of speech filtered to simulate the typical hearing loss of these patients. A new method of analysis of brain stem evoked responses, yielding response components attributable to binaural interaction, is reported. This and other evoked response techniques may be able to identify objective changes in auditory nervous system function attributable to relative sensory deprivation during development. Finally, directions for further research in this area are discussed.


Design factors in the assessment of intelligence.

The use of intelligence tests to assess the effects of otitis media on the development of children is discussed in this article. An overview of the development of intelligence tests is provided and some of the limitations and central issues of controversy concerning intelligence testing and the IQ are reviewed. Basic intelligence tests are described in terms of their characteristics and uses; the questions which an investigator must ask about any given intelligence test measure are posed and answered. Finally, cautions concerning the applicability of intelligence tests for evaluating the effects of otitis media are offered.


Bile studies after liver transplantation.

An analysis of bile composition following orthotopic liver transplantation in the rhesus monkey showed that during rejection only small quantities of viscid bile were produced and that this was associated with increased cholesterol saturation. Bile composition in patients after liver transplantation also showed that bile was supersaturated with cholesterol in the early postoperative period while the enterohepatic circulation of bile acids was interrupted by a draining T tube. However, further study of patients showed a poor correlation between bile composition and the development of biliary complications. An analysis of bile 'sludge' showed that after transplantation two types were encountered. The first, containing large quantities of unconjugated bilirubin, was present when intrabiliary obstruction was associated with long-standing mechanical obstruction. The second type, present in patients developing masses of intrabiliary 'sludging' shortly after transplantation, consisted mainly of necrotic donor biliary tract due to damage during preservation. An intrabiliary perfusion technique was developed which in animal models reduced the extent of donor biliary damage.


Evaluation of a culture procedure for identification of Neisseria gonorrhoeae.

A new rapid culture technique (Microcult GC) for identification of Neisseria gonorrhoeae was compared with a standard culture procedure in 151 patients (59 males, 92 females) suffering from urethritis and/or cervicitis. In 86.8% of the patients identical results were achieved when the new and the standard culture techniques were compared. In 4% the new culture technique revealed N. gonorrhoeae, confirmed by Bram-stain microscopy, when the standard culture was negative. However in 9.1% the reverse was true. In conclusion the new technique showed a decrease of 5% compared with the standard culture method. None of the methods gave rise to detectable false reactions. The new culture procedure might be a complement in the diagnosis of gonorrhoea because of its ease and rapidity (results are available after 24 h) but the method should not be used as a single diagnostic as it suffers from an unacceptable non-specifity especially in women.


Influences of hearing impairment on early language development.

It is difficult to determine exactly the effects of chronic otitis media on early language development, in part because we do not know whether hearing loss resulting from otitis media is intermittent or constant, and in part because it is difficult to assess the precise language ability of very young children. This paper focuses on those aspects of language development which one might expect hearing impairment to affect, and presents several hypotheses about the possible effects of mild-to-moderate hearing loss on the earliest stages of language development.


Design factors in the assessment of language development in children with otitis media.

In this paper the findings of studies which have examined the effects of chronic otitis media, suffered during the early years of life, on the cognitive, linguistic and academic development of the child are reviewed and critqued. A summary of findings on factors which play a role in normal language development are then presented to point to possible reasons for chronic otitis media having detrimental effects on development. Finally, possible ways of testing the hypothesis that the disease has such effects are discussed.


[Presence of abundant heterochromatin in the karyotype of Cebus: C. cappucinus and C. nigrivittatus].

The karyotypes of Cebus capucinus and C. nigrivittatus (Primates, Platyrrhini) are compared after applying several banding techniques. The chromosomes have abundant intercallary heterochromatin which can be stained by R-, T- and C-band techniques and which are late replicating. The X chromosome resembles that of man and of numerous primates. However, the late replicating pattern of the X in female lymphocytes resembles that of the late replicating X of human fibroblasts rather than of human lymphocytes. Banding patterns of certain chromosomes appear analogous in Cebus and Cattarhini, including Man.


Otitis media and developmental disability. Epidemiologic considerations.

Review of the literature indicates that: a) otitis media is a common disorder with risk being highest in the pre- and early school years, b) no marked differences in sex distribution of incidence exist, c) frequent recurrences are the hallmark of this disease, and d) mild hearing deficit lasting for months is not uncommon. A retrospective study in a defined population is suggested as an initial effort to investigate the proposed associations between developmental disability and hearing loss, developmental disability and history of otitis media, and finally, hearing loss and history of otitis media. Such an approach, however, a) could not determine the absolute risk of developmental disability in children with otitis media, and b) would underestimate the frequency of otitis media, since occult otitis media would not be thus identified. The determination of an accurate incidence of otitis media and of the absolute risk of developmental disability in children with otitis media calls for a prospective study. Such an investigation is likely to be justified only as a part of a collaborative study designed to measure multiple outcomes from a limited number of antecedents.


[Partial trisomy 2p due to a familial translocation 2/6. Cytogenetic and clinical case with special reference to ophthalmologic changes].

A translocation 2/6 inherited for 3 generations is described. The propositus, carrier of a partial trisomy 2p, showed multiple morphological anomalies of which microphtalmus and persistance of primary vitreous body were of particular interest. Based on a comparison of this with seven other patients in the literature, the most characteristic clinical symptoms of partial trisomy 2p are concluded to be the following: abundant lanugo at birth, glabella prominence, anteverted nares, dermatoglyphic anomalies, and malformations of the eyes.


[Electrophoretic distances between the different species of mangabeys monkeys (author's transpl)].

The separation of the group of Mangabeys into two genera, Cerecocebus and Lophocebus, is justified by electrophoretic criteria. The same criteria permit assignment of the species aterrimus to an intermediary position within the second genus as well as the demonstration of the absence of differences between two species of Cercocebus.


Medical ethics and controlled clinical trials.

The controlled clinical trial is a relatively new phenomenon; the first large clinical trial on evaluation of streptomycin in therapy of pulmonary tuberculosis occurred in 1946. In such a study, two or more groups of patients with similar characteristics are chosen by random allocation to receive one or more therapies. The essential ethical dilemma is based on the risk-benefit ratio of the new therapy. Ethical factors that must be considered in the design of controlled clinical trials include provision for informed consent, nature of alternate therapy, confidentiality of data, source of funding and potential conflict of interest, remuneration of subjects, criteria for ending participation of the subject, criteria for concluding the trial, compensation of injured subjects, compliance with institutional, municipal, state and federal regulations and provisions for special groups such as the fetus and pregnant woman, infants and young children, institutional patients and prisoners. Federal guidelines for research in specific areas are now available through the reports of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. To date, commission reports include recommendations for research in fetuses and pregnant women and in children. Protection of the subject is best provided by the the quality of the protocol, integrity of the investigator, valid informed consent, and review of the research program by an independent committee composed of scientists and consumers.


[Cytogenetic study of six species or sub-species of mangabeys monkeys (Papiinae, Cercopithecidae) (author's transl)].

Chromosome banding patterns of six Mangabey species or sub-species are studied and compared. By comparison with the other Papiinae previously studied (Papio and Macaca) Lophocebus albigena and L. aterrimus possess very similar karyotypes, differing a most by a pericentric inversion of the Y chromosome. The other four, Cercocebus torquatus torquatus, C. t. fuliginosus, C. galeritus galeritus and C. g. chrysogaster differ by a complex rearrangement of chromosome no. 10 and by acquisition of heterochromatin on chromosome no 12. No difference was detected nor between the two Lophocebus nor between the four Cercocebus. Cytogenetic criteria age thus in agreement with the morphological, immunological and hematological data, separating the two genuses, and placing Lophocebus closer to the Papio and Macaca than to Cercocebus.


[Cytogenetics of two Lorisidae (Nycticebus coucang and Perodicticus potto). Comparison with the lemurs and the simians (author's transl)].

The karyotypes of two Lorisidae (Prosimians) Nycticebus coucang and Perodicticus potto have been studied, using many banding techniques. These karyotypes are compared with each other and also with those of Microcebus murinus (Lemur) and of Cebus capucinus (Simian, platyrrhine). The karyotype of M. murinus appears ancestral to the other. That of the Lorisidae cannot be an intermediatry stage between the karyotypes of the lemurs and of the simians. An important part (12 p. cent) of the genome of N. coucang is comprised of heterochromatin ; it and the juxta centromeric heterochromatin stain negatively with C-banding techniques. C-banding therefore is insufficient to delineate constitutive heterochromatin, late replication being the only universal criterion.


Immunoglobulin class and light chain type of oligoclonal bands in CSF in multiple sclerosis determined by agarose gel electrophoresis and immunofixation.

Agarose gel electrophoresis and immunofixation of CSF and serum from 39 patients with multiple sclerosis (MS) revealed oligoclonal IgG in the CSF in all cases and oligoclonal IgA and IgM in 1 patient each. IgG kappa bands only were found in 10 patients, while no patient had IgG lambda bands alone. IgG kappa bands predominated in 20 patients and IgG lambda bands in 5, while 4 patients had the same number of IgG kappa and IgG lambda bands. Twenty-seven patients also displayed IgG bands with kappa and lambda present simultaneously. Bands of free lambda chains were found in 7 patients, while free kappa chain bands were not seen. One or 2 faint IgG bands in 4 patients constituted the only serum abnormality. In 4 additional MS patients selected on the basis of normal findings on agarose gel electrophoresis of the CSF, immunofixation did not reveal oligoclonal Ig, while isoelectric focusing showed bands in 1. Immunofixation is recommended for proving the presence of oligoclonal Ig in CSF and for characterizing oligoclonal Ig into classes and types of light chains.


Bilateral rhinocerebral phycomycosis.

A 51-year-old diabetic woman developed bilateral rhinoorbitocerebral phycomycosis. Successful treatment was accomplished by correction of the ketoacidosis, surgical debridement, and amphotericin B therapy. Rhinoorbitocerebral phycomycosis is a fulminant and frequently fatal disease most often seen in debilitated hosts. This survival suggests that aggressive therapy is indicated in patients with extensive fungal involvement.


Immunochemical characterization of sex steroid-binding protein (SBP) of human sera.

An immunodiffusion autoradiographic technique for the characterization in antigen-antibody immunoprecipitates of sex steroid-binding protein (SBP) is presented as well as procedure for the preparation of monospecific antiserum anti-human SBP. The latter consists of rabbit immunization with SBP-antibody precipitates obtained after preparative electroimmunodiffusion of human pregnancy plasma.


Stimulation of cell-mediated resistance in mice to infection with Listeria monocytogenes by vitamin A.

Vitamin A given as retinol-acetate, retinol-palmitate as well as the derivates retinoic acid and a retinoid, strongly fortified the resistance of mice to infection with virulent cells of Listeria monocytogenes. However, strong enhancement of resistance was only achieved when high toxic doses of vitamin A were given. Apparently, this effect was due to a stimulation of the function of the mononuclear phagocytic system rather than of the T lymphocyte.


[Plastic reconstruction of the anchyotic region from a cephalothoracopagus rabbit with prosophthalmy and cebocephaly (author's transl)].

1. By means of radiographies, of microscopic serial sections and of a cardboard geometric reconstruction (magnification 80), an investigation has been made of the more complete "anterior" face of cephalothoracopagus rabbit with anchyoty, synoty, otocephaly, prosophthalmy and cebocephaly. 2. All details are organized according to a well precise plan: a. all structures touching the principle plane of symmetry are fused; b. everything which would exist beyond that plane did not develop. 3. The heads of mallei are fused. The nearly normal auditory ossicles build a transversal chain. The bases of stapes are thickened. The centres of ossification of the heads are fused but normal. Each Corpus incudis shows a normal centre of ossification. 4. The outer epithelial rudiments of the tympanic membranes remain separated by a cleft. 5. The derivatives from the first branchial arch are defective, the anterior processes of malleus being fused. The lack of Meckel's cartilages induces cebocephaly, which provokes itself prosophthalmy and otocephaly. 6. There is a clear tendency-even in the deeply altered regions-towards a harmonious symmetry.


[Study of the formation and the normal and pathological evolution of the eye neural primordium (author's transl)].

The analysis of duplicate embryos, cyclops and colobomic fissure defects show that: 1. - optic vesicle and colobomic fissure are inducted by the prechordal plate. The combined inductive influence of prechordal plate and notochord carry eye absence out; 2. - initial failure of the colobomic fissure is always associated with retina folds and produce lens, vitreous and optic nerve anomalies; 3. - colobomic fissure is one indispensable anatomic structure to the optic fiber migration from the retina to the optic pedicle. Retina cutting in 4 days old chick embryos determine the disappearing of the pedicle cells. Contact between the optic fiber and the pedicle cells determine the glial cells differentiation. The colobomic fissure is a very important period of the eye evolution and the eye organisation.


Distribution of gold among plasma fractions in rheumatoid patients undergoing chrysotherapy compared with its distribution in plasma incubated with aurothiomalate in vitro.

The distribution of gold among the globulin, albumin, and unbound fractions of plasma, obtained either from rheumatoid patients receiving long-term aurothiomalate therapy or from samples incubated with aurothiomalate in vitro, has been investigated. In the rheumatoid patients it has been found that, although the majority of the plasma gold is always bound to albumin, the distribution varies cyclically in phase with the dose schedule. An explanation of these phenomena is provided, based on data obtained from the reaction between aurothiomalate and plasma constituents in vitro.


[Correlation between the presence of a bacterial symbiont in oocytes of Parcellio dilatatus petiti, and the sterility of the cross: P.d. petiti male x P.d. dilatatus female].

A symbiotic bacteroid matroclinously transmitted is present in the ovocytes and the follicular cells of the sub-species Porcellio dilatatus petiti of the Saint-Honorat island, as well as in all hybrid females born from a petiti mother. It is absent in the Porfellio dilatatus dilatatus females (population of Poitiers) and this seems to cause the lithality in the periblastula stage -- as a result of abnormal anaphases--of practically all the embryos of the crossing : male petiti x female dilatatus.


[Mitral valve prolapse and spasmophilia in children and adolescents].

71 cases of mitral valve prolapse (MVP) in the child and adolescent with an age range of 3 to 20 years were reviewed. The clinical symptoms, electrocardiography and catheter and angiographic data of this mitral abnormality were analysed. A systematic study of the electrocardiogram showed a tendency to spasmophilia in 68% of cases. The serum calcium, phosphate and magnesium levels were normal in 90 to 95% of patients. A reduced erythrocytic magnesium level seems to have been found in some patients. It is interesting to observe the similarity between the clinical signs in MVP and in spasmophilia. These clinical, biochemical and electrocardiographical results justify the systematic investigation of children and adolescents with MVP, with a view to the diagnosis of spasmophilia.


[Pulmonary stenosis with intact ventricular septum. Surgical experience in 200 cases, excluding the neonatal period].

Experience over 10 years, studying two groups of patients (group I: 79 cases aged between 2 months and 2 years, group II: 151 cases aged over 2 years) has shown that the operative prognosis of severe forms is now the same as in simple forms. Interest is now focused on the long term function of the right ventricle with regard to the surgical procedure. The main discussion in management is between isolated pulmonary commissurotomy, whatever the anatomical form, and operations such as we perform which associate ventricular resection with or without an infundibular patch in severe cases. The possible causes of late ventricular dysfunction are discussed, especially the muscular resection, the operative myocardial protection and the preoperative myocardial sclerosis. The good results observed in this series as opposed to the doubt as to the cause and variability of late ventricular dysfunction do not justify a change in our management at present.


[Complete correction of Fallot's tetralogy in infants. Preliminary results].

Complete repair was undertaken in 28 infants with severe forms of tetralogy of Fallot because severe cyanosis or anoxic spells. Age at operation ranged from 8 days to 11 months (mean: 4,4 months). Among the 24 cases without any other intracardiac defect, there were 6 early deaths related in 4 cases to a wrong indication or a technical error. Re-investigation was performed in 14 out of the 18 survivors from 3 weeks to 6 months post-operatively: the result is good in 10 cases, fair in 1 case, and poor in 3 cases requiring twice a reoperation with 1 further death and 1 good final result. More accuracy in selecting the surgical patients and improvement in operative techniques should result in a further decrease of our early mortality rate. Primary complete repair should therefore become a substantial alternative to the palliative shunts which results seem to be hazardous in the more severe types of the defect.


[Valve-fitted prosthetic tubes in the pulmonary outflow tract. Results of a series of 45 operations].

The malformations requiring valve fitted prosthetic tubes in the pulmonary outflow tract were mainly persistent truncus arteriosus and pulmonary atresia with ventricular septal defect in this series. The surgical mortality before 18 months was 75% and 19% after this age. The long-term clinical result (average follow up period: 2,5 years) was good or acceptable in 20 of the 32 survivors. There were 5 late deaths and 6 reoperations. The main causes of long-term failures were progressive pulmonary hypertension without shunt, acquired stenoses on the prosthesis and late infection. It is important to assess poor results by catheterisation as reoperation is frequently possible with a relatively low mortality rate (1/6) and encouraging results.


[Complete correction of Fallot's tetralogy with a Waterston shunt].

The influence of a Waterston shunt on the mortality in complete correction of Fallot's tetralogy varies from series to series. Some authors believe that it has no influence and others, on the contrary, believe it plays an important role to the point of recognising a particular premonitory syndrome of pulmonary hypertension and a low output state. This divergence of opinion in patients with comparable lesions is surprising, and cannot always be explained by poor surgical indications (irreversible pulmonary hypertension) or by problems of surgical technique. In our experience the conditions of cardiopulmonary bypass are of prime importance and we believe that the common factor in surgical failure is poor myocardial protection. This point of view is suggested by our present results in the correction of moderate and severe forms of Fallot's tetralogy under cardioplegia and seems to be reinforced by the results of extensive repair in forms with a Waterston shunt, said to be high risk procedures, that is to say with considerable asymmetry of the pulmonary vascularisation by stenosis of the right main pulmonary artery.


[Acquired pulmonary atresia complicating tetralogy of Fallot].

Pf 51 cases of Fallot's tetralogy who underwent preoperative angiography before a palliative anastomosis and then a second angiography before complete correction, 10 had developed pulmonary atresia (infundibular in 8 cases, valvular in 2 cases). The type of anastomosis (Blalock-Taussig of Waterston), and the interval between the two operations do not seem to be determinant factors. The initial severity of the stenosis seems to favour the development of atresia but this is not invariable. The authors discuss the aggravating role of the anastomosis and the consequences of this type of complication.


[Results of surgical correction of ventricular septal defects in infants].

Of a consecutive series of 91 babies aged less than 2 years, operated on for closure of a ventricular septal defect during the last four years, the 61 cases with a minimum post operative follow up period of 18 months were retained for review. Closure of the ventricular septal defect was carried out directly 41 times, and after pulmonary artery banding in the other 20 cases, using deep hypothermia with a short period of circulatory arrest and cardiopulmonary bypass.


[Intermdeiate forms of atrioventricular defects. Reflections apropos of 50 consecutively operated cases].

Fifty cases of intermediate forms of atrioventricular defect were treated surgically. The operation was performed in the traditional manner in all cases. One post-operative death and three cases of severe mitral incompetence leading to reoperation were observed. The authors emphasise that it is essential to look for and excise the chordae and abnormal fibrous bands, that it is generally unnecessary to touch the tricuspid valve and that there is a danger of obstructing the aortic canal if the correction of the asymmetry of some mitral clefts is attempted. Analysis of the results leads them to tend to respect the cleft mitral valve when the regurgitation is minimal and to suture it all along its length when the regurgitation is severe. Mitral annuloplasty may be a useful complementary procedure and a left atrial approach may be proposed with this in mind in certain cases. Conduction defects remain a serious problem in this type of surgery; not so much complete heart block, which is exceptional, but trifascicular block, often present preoperatively, whose prognostic is, to say the least, uncertain.


[Surgical treatment of double outlet left ventricle].

Three young patients with double outlet left ventricle were operated on at the Centre chirurgica Marie-Lannelongue. There was one secondary death. The follow up period of the two survivors is 24 months and 8 months respectively. The diagnosis of this rare congenital abnormality is difficult because of the multiplicity of the anatomical changes and the diversity of the final clinical entity. This is reflected in the attempts at classification. These difficulties are increased by the high incidence of incomplete forms of the condition which gives rise, especially in vivo, to problems of terminology. Echocardiography provides valuable information in the diagnosis of these forms by showing the abnormal relationship between the interventricular septum and the origin of the great vessels. A complete work up is essential before any decision can be made on management. Particular importance is placed on the topographical and morphological features of the atria and ventricles, the connections of the aorta and pulmonary arteries, and the state of the pulmonary tract. Modern surgical techniques have made correction possible in most forms of the disease, but involves complex procedures which leaves doubts on their long term outcome.


[Computerized axial tomography in diagnosis of congenital heart diseases. Preliminary report].

Transverse sections of the heart and great vessels may be obtained by tomodensitometry using an exposure time short enough to carry out the investigation during apnoea, and an infusion of contrast medium. The definition is good enough for the investigation to be considered as a useful adjunct to the normal investigations in complex congenital cardiac abnormalities. All measurements are instantaneous, including the study of pulmonary density which allows assessment of the pulmonary vascularisation.


[Cardiological aspect of Kearns' syndrome. Apropos of 3 cases, with histopathological study of the conduction tissue in one of them].

Three cases of Kearns syndrome are reported. The neuro-ophthalmological signs were comparable with ophthalmoplegia, pigmentary retinal degeneration and polymorphic neuro-muscular and sensory deficits. The electrocardiological signs were observed 2-4 years after the onset of the condition; the cause of death in each case was related to complete heart block. The post-mortem findings in one of the cases were spongial degeneration of the central nervous system and a seemingly primitive degeneration of the Bundle of His and its branches.


[Primary cardiomyopathy in children with lipid infiltration of the myocardium and skeletal muscles and demonstration of a palmityl-carnitine transferase deficiency. Apropos of 4 cases].

The authors report four cases of metabolic cardiomyopathy with lipid infiltration diagnosed by skeletal muscle and myocardial biopsy in children with no clinical signs of muscular dystrophy. Normal or increased serum and urinary carnitine levels excluded a primary carnitine deficiency. A deficiency in muscular-palmityl-carnitine-transferase was demonstrated. This pathogenic mechanism may be an indication for treatment with carnitine, but the results are less spectacular than in primary carnitine deficiency states.


[Lipidic myopathy with severe cardiomyopathy caused by a generalized carnitine deficiency. Favourable course during carnitine hydrochloride treatment].

The case of a girl who presented with gastrointestinal upsets with nausea, vomiting and occasional hypoglycaemic attacks during childhood is reported. At about 5 years of age generalised muscular weakness with severe amyotrophy, cardiomegaly with a cardiothoracic ratio of 0,63, left ventricular hypertrophy on electrocardiography and left ventricular dilatation with hypokinesis on echocardiography were observed. A few weeks later she developed severe cardiac failure. Muscle biopsy showed muscular dystrophy with lipid infiltration due to carnitine deficiency )serum carnitine 9 nmoles/ml, normal values: 46 +/- 6,9 nmoles/ml; muscle carnitine 0,27 nmoles/mg, normal values: 3,0 +/- 0,79 nmoles/mg fresh frozen weight). She improved rapidly with carnitine chlorhydrate and a diet low in lipids and high in medium chain triglycerides. Regression of muscular symptoms and cardiac failure was observed. After 13 months follow-up with no tonicardiac therapy she is much improved; the signs of heart failure have disappeared, the cardiothoracic ratio is now 0,55 and the electrocardiogramme and echocardiogramme are normal.


[Right pulmonary artery-left atrial fistula. Review of the literature apropos of a case].

This is a rare congenital abnormality with only 17 other reported cases in the world literature. The most frequent sign is cyanosis with peripheral arterial desaturation. Angiography with selective injection in the main pulmonary shows early opacification of the left atrium, so confirming the diagnosis. Occasionally, a catheter can be passed through the fistula. Without surgical treatment there is a danger of systemic arterial embolism and two fatal cases were found in our review of the literature. The fistulous connection is often aneurysmal. It arises either from the right main pulmonary artery or from its branch to the inferior lobe. Associated vascular and pulmonary malformations are not rate. Surgical closure of the fistual is curative with immediate regression of the cyanosis and suppression of possible embolic complications.


[Right aortic arch with retro-esophageal component. 2 cases].

Right-sided aortic arch with a retro-oesophageal segment is much rarer than right-sided aortic arch without a retro-oesophageal segment. As opposed to the latter situation which is always associated with congenital heart disease, it is usually an isolated finding. The left subclavian artery arises from a posterior diverticulum and may be stenosed at its origin, giving rise to a systolic murmur as in one of the reported cases, or to a subclavian steal syndrome. The ligamentum arteriosum completes the aortic ring and may give rise to respiratory problems at varying ages and of variable severity, sometimes attributed to asthma. In one of the cases followed up over 15 years chronic respiratory problems and late tracheal lesions were observed. Although the possibility of a double aortic arch may be raised, early surgical treatment is desirable.


[Presentation of continuous electrocardiograms in compressed form. Preliminary note].

The conventional electrocardiogramme is poorly suited to the study of continuous electrocardiographical recordings. The rapid interpretation of recordings obtained by the Holter method is not compatible with the preservation of an analogous record of the whole period under study. The study of continuous electrocardiogrammes by computer uses only part of the data recorded. The technique of compression based on the principle of Contourography is a method of preserving continuous electrocardiographical records in their analogical form. This recording is a useful addition to the Holter method.


[Hemodynamic changes during increasingly rapid atrial pacing].

The cardiac output (Qc), indices of left ventricular function in the isovolumic period (dp/dt/Pt), max, and during the ejection period (EF, VCF), the end diastolic and end systolic ventricular volumes, the speed of ventricular filing, the module of elasticity of the ventricular chamber (kp) and the end systolic pressure-volume relationships were measured in 20 patients (11 normal in group I and 9 with and apparently primary cardiomyopathy in group II) at rest and during progressively rapid atrial pacing. The Qc was lower and the indices of left ventricular function in the isovolumic and ejectional phases, the end systolic pressure-volume relationship and speeds of ventricular filling were decreased in group II: kp was the same in both groups of patients. At progressively higher heart rates the cardiac output slightly in both groups, the systolic volume decreased, (dp/dt/Pt) max increased, the ejection fraction and VCF were unaltered. The speeds of filling and kp were unchanged. The end systolic pressure-volume relationship increased. In group I the reduction in systolic volume seemed to be related to a greater reduction in the end diastolic volume than in the end systolic volume. In group II, the reduction of the systolic volume was related only to a reduction of the end diastolic volume.


[Results of open heart mitral commissurotomy in 85 patients].

Open heart mitral commissurotomy was performed in 85 patients between January 1973 and January 1976. This series comprised 38 patients with pure mitral stenosis and 47 patients with associated mitral and aortic or tricuspid lesions. Mitral commissurotomy, always complete, was associated with correction of mitral incompetence, either preexisting or peroperative, in 19 cases; in 44 cases with correction of an aortic lesion and in 10 cases with correction of a tricuspid lesion. The surgical mortality was 2.3 p. 100 (2 deaths); one post-operative myocardial infarction and one spontaneously regressive post-operative jaudice was observed. No cases of post-operative systemic embolism was observed. A short apical systolic murmur was detected in 12 cases. The results of this series together with those already published suggest that the indications of this operation should be widened and that it should be employed whenever the best immediate anatomical result and long-term prognosis are desired.


[Paroxysmal supraventricular tachycardia with complete atrio-ventricular block or dissociation].

Recent studies have shown the high incidence of concealed Bundles of Kent in the reentry circuits of paroxysmal supraventricular tachycardia. Arguments in favour of the nodal or junctional level of reentry were observed in supraventricular tachycardia with complete atrioventricular dissociation. Two such cases under went electrophysiological investigation. In the first case, tachycardia was terminated by a complete infrahisian block. However, during atrioventricular dissociation, tachycardia  could be initiated by a single atrial stimulus after an increased nodal conduction time and terminated by a single atrial stimulus or cardiac message. In the second case the supraventricular tachycardia presented with complete atrioventricular dissociation due to a retrograde ventriculo-atrial block. Atrial stimulation at progressively higher rates and premature atrial extra stimuli initiated the tachycardia but could not terminate it, so confirming the non-participation of the atrium in the reentry circuit. These two cases suggest that the ventricle (case I) and the atrium (case II) are not indispensable links in junctional or nodal reentry circuits. Case II was suggestive of a common initial pathway developing retrograde unidirectional block during tachycardia.


[Wolff-Parkinson-White syndrome. Correlation between the results of electrophysiological investigation and exercise tolerance testing on the electrical aspect of preexcitation].

Fourteen patients with permanent electrocardiographical features of the Wolff-Parkison-White syndrome in sinus rhythm referred for electrophysiological investigation also underwent maximal exercise tolerance tests. The working hypothesis was that in patients with the Wolff-Parkinson-White syndrome with accessory pathways of longer effective refractory periods than the normal pathway (group I) the delta wave should disappear on exercise, whilst in patients with accessory pathways with shorter refractory periods than the normal pathway (group II) the delta wave should persist. Of the 9 patients in group I,the delta wave regressed in 8 and persisted in 1 patient; of the 5 patients in group II, the delta wave persisted in 4 of them. Three patients had attacks of tachycardia during or just after the exercise tolerance test. These results suggest that the exercise tolerance test may help in the identification of patients with accessory pathways with long refractory periods, less susceptible to rapid ventricular rhythms should atrial fibrillation occur, and therefore with better prognoses.


[Echocardiographic diagnosis of 4 cases of tricuspid valve endocarditis].

Four tricuspid endocarditis cases are reported. Echocardiography found, four times, large vegetations on the tricuspid leaflets leading to the diagnosis. The degree of tricuspid insuffisancy was appreciated by the RV/LV ratio. Successive echos have permitted to survey the evolution and specially to establish a clear decrease of abnormal tricuspid echoes succeeding to pulmonary embolisms. In the four cases, surgery confirmed the diagnosis.


[Echocardiographic study of 4 cases of dilatation of the sinus of Valsalva].

Four cases of dilatation of the sinus of Valsalva with or without rupture were studied by echocardiography before surgical correction. In three cases the dilatation affected the right anterior sinus with rupture into the right atrium or ventricle. In the other case dilatation of the right anterior sinus dissecting the interventricular septum was associated with an aneurysm of the left anterior sinus dissecting the free wall of the left ventricle.


[Coronary endarterectomy associated with coronary artery bypass in severe coronary artery disease. 50 cases].

The surgical indications of coronary endarterectomy were defined from a study of 50 cases in which endarterectomy was associated with aorto-coronary bypass surgery. This total represented 6 p. 100 of all the aorto-coronary bypass operations performed in the same period. Coronary endarterectomy was performed "on principal" for the right coronary artery, and "of necessity" for the left anterior descending artery. The special techniques of endarterectomy on the left anterior descending artery are described. Endarterectomy does not increase the operative risk and enables revascularisation of vessels unsuitable for bypass surgery. 85 p. 100 patients are asymptomatic with an average follow up period of 2 years after endarterectomy and aorto-coronary bypass graft of the right coronary artery.


[Improvement and normalisation of the QRS complex by stimulation of the bundle of His in complete left branch block].

The asynchronism of ventricular activation resulting from a major degree of left bundle branch block (QRS greater than or equal to 0.12 s) may be suppressed by stimulation of the distal portion of the His Bundle, whether the block be intermittent (3 cases) or permanent (17 cases). The selective stimulation of the His Bundle normalises ventricular depolarisation whilst non-selective stimulation narrows the QRS complex by the fusion of the activation wave fronts from the His Bundle and the interventricular septum. The reestablishment of synchronous ventricular conduction by His Bundle stimulation is generally interpreted as a sign of longitudinal dissociation in the proximal portion of the His Bundle. This results does not, however, exclude the possibility of a very localised lesion at the origin of the left bundle, responsible for a conduction delay, and suppressed by stimulation carried out close to the zone of block (summation effect, electrotonic influence).


[Aortocoronary bypass for the threatened spread of acute myocardial infarction].

21 patients with unstable angina in the acute myocardial infarction period were treated by early surgery, on average on the 3th day after infarction. Resistance to medical therapy given in the coronary care unit, associating modern pharmacological agents and circulatory assistance, on the one hand, and the presence of lesions on the coronary arteries accessible to surgery on the other, were the surgical indications. The absence of operative mortality and of electrical changes after operation seem to be related to the many advances made in the various stages of the medico-surgical management. These results suggest that revascularisation surgery with an acceptable risk may be proposed to patients with unstable angina after a recent myocardial infarction.


[Risks and median-term results of aortic valve replacement for calcifying aortic stenosis in 100 patients more than 70 years old].

100 patients with poorly tolerated calcific aortic stenosis underwent aortic valve replacement by the same surgical team (Starr-Edwards prosthesis: 52 cases, Bjäork prosthesis: 43 cases, Lillehei-Kaster prosthesis: 2 cases, and Hancock bioprosthesis: 3 cases) between July 1971 and April 1978. The hospital mortality was 17% and acute pulmonary oedema and cardiomegaly were poor preoperative prognostic factors. The late mortality was 14.5% with an average follow-up period of 25 months (range: 2 to 74 months). The survival rate expressed as an actuarial graph was 63.1 +/- 4% at 4 years. 90% of the patients operated move up at least one class in the New York Heart Association classification and 2/3 return to Stage I. The cardiothoracic ratio improved from 0.58 +/- 0.06 to 0.51 +/- 0.03 (p less than 0.02) and the Soko low-Lyon index from 40 +/- 13 to 25 +/- 6 (p less than 0.001). The main complication encountered at middle term was haemorrhage, observed in 17.5% patients. Comparison of the spontaneous outcome of the disease with the results of surgery favour surgical treatment of patients over 70 years old with poorly tolerated calcific aortic stenosis. The valve of choice should be the bioprosthesis when dependance on anticoagulant therapy and the associated risks of haemorrhage are taken into consideration.


[Partial blockage of the inferior vena cava. Results apropos of 110 cases].

Rheoplethysmography with occlusion (RPO) is useful in the diagnosis of deep venous thrombosis. Bilateral phlebography with cavography performed afterwards as an emergency gives information as to the embolic potential of the thrombosis and orientates treatment towards surgical interruption of the inferior vena cava. In the C.H.U. at Grenoble 83 clips, 25 umbrella filters and 2 ligatures were placed on the inferior vena cava from 1974 to 1977. Prevention of pulmonary emboli was achieved in 99% cases with lower limb embolic foci. Follow-up by RPO and isotopic phlebography showed that the course of venous thrombosis of the lower limbs seemed to be unchanged by partial interruption of the inferior vena cava, provided that elastic stockings and adequate anticoagulant therapy adapted to venous haemodynamics are used.


[Recurrent acute pericarditis. 20 cases].

62 of 100 cases of acute pericarditis observed over 15 years were so-called acute benign pericarditis. 20 of these patients (30%) had multiple relapses. Relapse could not be predicted. The interval between the initial affection and first relapse was usually more than one month (18/20). Each relapse was accompanied by pain, fever, ST-T changes, slight cardiomegaly and acceleration of the ESR. Corticotherapy appeared to be responsible for relapse in 13 cases. In 6 cases the eradication of a deep septic focus prevented further relapses. In two cases the duration of anti-inflammatory therapy was thought to have been insufficient. Antibiotic therapy did not seem to be a provocative factor. Relapses may be numerous (10 to 12) and prolonged (24-36 months) especially in the corticodependant forms in which steroids should be tailed off gradually according to a strict protocol.


[Myocardial infarction and late pericarditis].

The post-infarction syndrome was observed in 8 out of 138 consecutive patients with acute myocardial infarction; 24 other cases of the post-infarction syndrome diagnosed over the preceeding 3 years were also reviewed. In order to determine the clinical significance and the prognosis, this group of 32 was compared to another of 105 patients with myocardial infarction without pericarditis, with respect to age, sex, medical history and characteristics of the underlying necrosis (location and size). Several clinical signs are discussed. This study showed the post-infarction syndrome was associated with large infarcts, the course of which was marked by arrhythmias, conduction defects and haemodynamic problems. A considerable inflammatory syndrome was often observed. The relation between the post-infarction syndrome and early pericarditis is not proved; on the other hand, a close correlation between late pericarditis, atrial fibrillation and left pleural effusion was demonstrated. The long term prognosis of infarcts complicated by the post-infarction syndrome is without doubt determined by the size of the necrosis and by the presence of ventricular aneurysms which are frequently associated.


[Arterial pressure during exertion in patients operated on for aortic coarctation].

19 patients were studied after operation for coarctation of the aorta. The average age at operation was 13.7 years. Crafoord's operation was performed in 16 cases and in the other three an aortic patch was necessary. The average post-operative period was 4.7 years. 14 cases were classified as good results: normal femoral pulses and arterial blood pressure. The other 5 cases were considered as unsatisfactory: 2 mediocre results with normal arterial blood pressure but diminished femoral pulses and oscillometric indices; 3 poor results with hypertension at rest. On exercise with bicycle ergometry the following results were obtained: the systolic blood pressure rose in a comparable manner to that observed in normotensive individuals of the same age on exercise except in 2 cases. These two patients had an aortic patch and one had a residual intraaortic pressure gradient. The pronostic significance of these findings is not known. However the use of an aortic patch is often associated with abnormal blood pressures at rest or on exercise. The fact that the majority of patients operated for coarctation of the aorta have normal blood pressure profiles on exercise should be emphasised.


[Effects of intravenous trinitrin infusion on systemic and coronary circulations during atrial electric stimulation].

Intravenous infusion of trinitrin (0.38 +/- 0.25 mg/hour) during rapid atrial pacing reduced pulmonary capillary pressures, cardiac output, coronary blood flow and myocardial oxygen consumption. At these dosages trinitrin allows patients with ischaemic heart disease to undergo atrial pacing in the best conditions by maintaining the pulmonary capillary and systemic arterial pressures and myocardial lactate production within limits close to the basal values. The beneficial effects last during the recovery period after the termination of pacing and of the intravenous infusion.


[Spontaneous blocks by intra-atrial conduction disorders of reciprocating atrioventricular rates using a Kent's bundle].

Paroxysmal tachycardia in Type A Wolff-Parkinson-White syndrome was due to a reciprocating rhythm involving a left lateral Kent Bundle in the retrograde direction. Spontaneous interruption of the reentry resulted not from block in the normal or accessory atrioventricular pathways but from an intraatrial conduction defect: delay in conduction between the left and right atria on intraatrial reentry terminated the tachycardia.


[Anomaly of the origin of the circumflex artery. Effects on the risk of mitral and mitro-aortic valve replacement].

An anomalous circumflex coronary artery arising from the main right coronary artery is an added risk in mitro-aortic valve replacement. The infortunate history of a patient with an anomalous circumflex artery visualised on pre-operative cineangiography who underwent a double valve replacement is reported. The first 10 post-operative days were uncomplicated with no haemodynamic disturbances. Thereafter, major ventricular arrhythmiad 54th post-operative days) without signs of myocardial infarction, which were responsible for her death. On autopsy a large anomalous circumflex artery arising from the main right coronary artery was shown. In its course, posterior to the aorta, it was literally wedged between the rigid sewing rings of the two prosthetic valves. No thrombus was found within, and there were no myocardial lesions. The only apparent cause of the arrhythmias and death of the patient was the compression of this large circumflex artery.


[Right ventricle with double outlet and intact interventricular septum. Report of 1 case and review of the literature].

Double outlet right ventricle with an intact interventricular septum is an exceedingly rare malformation. Only six other cases have been found in the world literature. The clinical, electrocardiographic, radiological and anatomical features of this condition were reviewed on the occasion of the diagnosis of a new case. Cardiac catheterisation and angiography performed in only one other case is not definitive in the presence of mitral atresia.


[Lymphangioendothelioma. A rare cause of atrioventricular block].

A new case of lymphangio-endothelioma of the nodal tissue is reported. Complete atrioventricular block had been followed up for 20 years. The histological features are described in detail and the embryological origins of the tumour are discussed. This report underlines the exceptional character of this "smallest benign tumour which can be mortal".


[Total anomalous pulmonary venous return into the coronary sinus. Apropos of 1 case with a difficult diagnosis and surgical success].

The case of an 8 year-old boy with total anomalous pulmonary venous return into the coronary sinus is reported. The coronary malformation comprised a considerable dilatation of the coronary sinus which made diagnosis very difficult even at open heart. The surgical success was obtained by resecting the interatrial septum and partitioning the atrium. The anatomical diagnosis of this condition and the malformations with which it could be confused are discussed: TAPVR into the right atrium, cor triatriatum. The two parts of the coronary sinus, confluence of the cardiac veins and the left horn of the sinus venosus, are described.


[Echocardiographic aspects of left atrial thrombosis in 1 case of severe mitral stenosis].

The principal echocardiographic features of the main cardiovascular emergencies are discussed. After setting out a method of detailed analysis for echocardiography, the changes found in the main causes of severe chest pain, systemic embolisation and sudden heart failure are described. Special emphasis is laid on the signs of aortic root dissection, pericarditis and tamponade, ruptured valve, the mechanical complications of acute myocardial infarction and, in particular, on the assessment of residual myocardial function. Finally, the authors maintain that echocardiography should be a systematic complementary investigation for patients in the coronary care unit.


[Severe pulmonary embolism and recurrent thrombophlebitis caused by hereditary antithrombin III deficiency].

Severe pulmonary embolism with thrombosis of the inferior vena cava was observed in a 16 year old girl with no risk factors and treated successfully by fibrinolytic therapy. Secondarily, despite heparino-therapy, upper limb venous thrombosis occurred. Investigation of the clotting factors in the patient and her family revealed a hereditary deficit of antithrombin III. The features of the haemotological diagnosis of this rare condition and the therapeutic implications are discussed.


[Value of echocardiography in cardiovascular emergencies (not including congenital cardiopathies)].


[Vitamin B2 deficiency and total parenteral nutrition].

A 15 year old adolescent with Crohn's disease who received total parenteral nutrition for three months developed riboflavin deficiency. The aetiology, the clinical picture and the method of diagnosis of this unusual deficiency are reviewed. The importance of an adequate intake of vitamin B2 and the other B group vitamins, particularly in the malnourished, is emphasied.


A diffuse mixed histiocytic-lymphocytic lymphoma associated with immunological abnormalities.

A diffuse generalized lymphoma histologically classified as mixed histiocytic-lymphocytic type and associated with profound immunologie abnormalities is reported. The patient had an autoimmune hemolytic anemia, an autoimmune thrombocytopenia, polyclonally increased IgG and IgM, polyclonal secretion of kappa and lamda chains into urine, very low serum complement C3 and antibodies against glomerulus and smooth muscle. When studied with the modern surface-marker techniques, the lesion was found to be composed of entirely lymphoid cells of the B-lymphocyte series. The proper classification of this tumor could be a primitive immunoblastic sarcoma. The relationship of the present tumor to the non-neoplastic angioimmunoblastic lymphadenopathia is discussed. The necessity of applying the surface-marker techniques in the classification of malignant lymphomas is emphasized.


Grooming and consort partner selection in a troop of Japanese monkeys (Macaca fuscata).

The Arashiyama West troop of  Macaca fuscata consists of 150 monkeys transported from Kyoto, Japan, in February 1972 to their present location near Laredo, Texas. At this site the animals range over 108 acres and during the study period were only minimally provisioned and disturbed. In the report of a 3-year study of consort partner selection it was suggested that yearlong social bonds within the troop appeared to be distinct from consort bonds formed during mating season. Like Sade, we consider grooming to be a good measure of yearround affinitive bonding in macaques. This study compares the pairs formed for consorting with those formed for yearlong grooming activities, by the 94 individuals who formed consort relationships during the mating season of 1973--1974. It was found that yearlong grooming involved pairs of monkeys which were significantly different from those for consorting. Grooming was relatively frequent between related monkeys, while consort partners were seldom related. In addition, yearlong grooming patterns were not disrupted during mating season. These results suggest that consort and grooming activities are behavioral expressions of two important social networks, involving mutually exclusive social bonds.


[Neuroblastoma].

The review deals with neuroblastoma, its frequency, localization, features of its clinical course and microscopic patterns. The ability of neuroblastoma for maturation and sometimes for spontaneous regression as well as the relationship between tumors of the autonomous nervous system and the so-called neuroblastoma in situ and von Recklinghausen's disease are discussed. Some light and electron microscope differential diagnostic criteria are given. An attempt is made to explain certain clinico-biological features of neuroblastoma from the point of view of current embryological data.


[Chagas polyneuropathies].

The results of a research realized in a small community in the countryside of the state of Bahia, Brazil, where there is high frequency of infection by Trypanosoma cruzi. are reported. By evaluation the neurological clinical examination of 99 individuals it was observed that the most frequent finding on those 50 patients with positive sorology there was a diminution of deep reflexes. Additionally, it was found that among the 20 patients in whom more than one altered deep reflex was present, in 18 cases there were concomitant sorological evidence of Chagas disease.


Kanamycin in the treatment of penicillinase-producing gonococcai infections.

A retrospective study of 356 cases of bacteriologically proven penicillinase-producing gonococcal infections treated with a single dose of 2 g of kanamycin intramuscularly was carried out. It was found that 14 patients failed to complete followup examinations. Of the remaining 342 who were examined bacteriologically following treatment, 335 were found to be cured of the infection. The cure rate was 96%. No adverse reactions were noted after administration of the drug. Compared to the other drugs used, kanamycin was relatively cheaper. The authors conclude that kanamycin is safe, economical and very effective in the treatment of gonorrhoea caused by the strains of penicillinase-producing Neisseria gonorrhoeae in South East Asia.


Recognition of an asymptomatic male carrier of Neisseria gonorrhoeae in Singapore - a case report.

Neisseria gonorrhoeae was isolated from centrifuged urine deposit of an asymptomatic male. The case history and significance of this asymptomatic infection are described.


Congenital abnormalities: "is it wise to have another child?".

Congenital abnormalities affect some five per cent of all live births, and are a major factor in childhood morbidity and mortality. Most physicians, therefore, encounter a variety of developmental disorders, and must frequently deal with problems faced by a handicapped patient and his family. This task is becoming increasingly difficult with the growth and sophistication of genetic knowledge and changes in society's attitude toward medical practice. Although congenital abnormalities are classified according to a variety of presumed genetic or environmental 'causes', it is important to remember that most developmental disorders result from complex interactions of genes and environment, and that time is an important factor. Optimal understanding of a congenital defect may, therefore, be best achieved by study of a patient within the wider context of his family. The family history is one of the most powerful tools available in establishing a diagnosis and in answering parents' questions concerning prognosis and recurrence risk. Ultimately, however, decisions based on genetic counselling must be made by the parents themselves, within the context of their own fears, beliefs and aspirations.


Effect of heat stress on plasma concentrations of prolactin and luteinizing hormone in ewes.

Basal concentrations of prolactin but not luteinizing hormone were elevated in ewes by 8--10 h of heat stress given daily during the first 11 days of their oestrous cycle. However, the prolactin and luteinizing hormone responses to thyrotrophin releasing hormone and gonadotrophin releasing hormone were unaffected.


Inflammatory diseases of the bowel: a Malaysian experience.

A 10-year experience in the diagnosis and treatment of 92 patients with inflammatory bowel diseases in Kuala Lumpur is described. Tuberculosis (34 cases) was the most common inflammatory bowel disease of surgical importance. The clinical presentation of tuberculous enteritis and Crohn's disease is similar, though tuberculosis is strongly suggested by associated pulmonary disease and radiological evidence of caecal involvement. The finding of 10 cases each of Crohn's disease and ulcerative colitis is in keeping with an increased awareness of these conditions in a developing urban society where facilities exist for thorough investigation of diarrhoeal diseases. Amoebiasis sometimes causes a granulomatous lesion simulating carcinoma. Diverticular disease of the colon as known in the West is of very rare occurrence.


The use of 22Na as a tracer for long-term bone mineral turnover studies.

Sodium-22 has been studied as a tracer for bone mineral metabolism in rats and dogs. When incorporated into bone during growth from birth to adulthood, the bone becomes uniformly tagged with 22Na, which is released through the metabolic turnover of the bone. The 22Na not incorporated in the bone matrix is rapidly excreted within a few days when animals are fed high, but nontoxic levels of NaCl. The 22Na tracer can be used to measure bone mineral loss in animals during space flight and in research on bone disease.


Suprathreshold retinal damage due to single 6 picosecond 1060 nm laser light pulses.

The retinas of rhesus monkeys were exposed to 6 ps laser light pulses at 1060 nm at 62 and 95 muJ. Lesions were examined by light and transmission and scanning electron microscopy. Evidence of damage was seen in all retinal layers, being most severe in the photoreceptor inner and outer segments. In addition to damage mechanisms previously proposed, it is suggested that the peak power flux density achieved with extremely short pulses may lead to some absorbance by inner retinal layers.


A survey of intra- and interspecific variation for pupation height in Drosophila.

Pupation heights of various natural and laboratory populations of Drosophila melanogaster, D. simulans, and D. pseudoobscura were observed in the laboratory under conditions of continuous darkness or continuous light. Generally higher mean pupation heights were observed under conditions of darkness. D. melanogaster tended to pupate higher than the D. pseudoobscura populations, and D. pseudoobscura tended to pupate higher than D. simulans. The order of these species differences was similar whether pupation was measured in light or in darkness. Results of selection for pupation height in D. melanogaster suggest the presence of genetic variation for this character. The possibility that a relationship exists between adult and larval behaviors was explored by measuring the pupation heights of larvae from strains selected for geotactic behavior as adults, and also by measuring geotaxis of adults from strains selected for pupation height.


Oviposition site preference in Drosophila.

Comparative studies of oviposition site preference (OSP) in Drosophila suggest that choice of oviposition site is an important adaptive behavior which influences individual fitness and the potential of populations for speciation. OSP has been investigated under conditions which provided females with a choice of standard medium or medium containing ethanol for oviposition. OSP is an extremely labile behavior in the laboratory, but a technique has been developed which minimizes variation between replicates and allows the detection of OPS differences between semispecies of a single species. An analysis of the OSP of 14 Drosophila species shows that this behavior is not correlated with phylogenetic relationships. OSP with respect to ethanol may be correlated with the presence of ethanol in the environment and the activity of alcohol dehydrogenase in the species tested.