Anomalous muscle bundle of the right ventricle. A report of seven cases.

It was within the last decade that right ventricular outflow obstruction due to anomalous muscle bundle was clearly described as a separate cardiac malformation seven cases of anomalous muscle bundle of the right ventricle were presented, and the diagnosis and surgical indications of this anomaly were discussed. The clinical differentiation of these patients from those with isolated VSD, pulmonic stenosis, and tetralogy of Fallot was not easy. Right ventriculograms that demonstrated the anomalous muscle bundle as a wedge-shaped filling defect are most useful for differentiation. All patients' anomalies were corrected with intracardiac surgery. The postoperative course was very satisfactory and all patients showed complete relief of the obstruction.


The role of extracellular materials in cell movement. I. Inhibition of mucopolysaccharide synthesis does not stop ruffling membrane activity or cell movement.

The involvement of mucopolysaccharide synthesis in cell locomotion was investigated by determining the effects of inhibition of synthesis on ruffling membrane activity and cell movement by embryonic heart fibroblasts. Mucopolysaccharide synthesis was inhibited directly by treatment with a glutamine analog, 6-diazo-5-OXO-L-norleucine (DON), and indirectly with cycloheximide. DON treatment reduced synthesis to 20% of control values, and cycloheximide reduced synthesis to less than 10% of control values, as measured by incorporation of [35S]sulfate into mucopolysaccharides. Nevertheless, ruffling membrane activity and cell locomotion continued under both conditions. Cytochalasin B did not inhibit mucopolysaccharide synthesis, although it did stop ruffling and locomotion. These results suggest that if mucopolysaccharides are required for cell movement, they must have long half-lives or represent only a minute fraction of the normal synthetic load.


Aortic dissection immediately following division of a patient ductus arteriosus.

A case of aortic dissection following division of a patent ductus arteriosus in a 20-years-old female is presented. The possibility of an idiopathic dilatation of the aorta or of preexisting medial abnormalities as predisposing factors besides the cross clamping of the aorta or of the ductus is outlined. The dissection was successfully treated transecting the abdominal aorta, contrary to the classical thoracic approach, and repairing the dissection of the distal end of the abdominal aorta interposing a graft between the divided ends.


24-Hour secretory pattern of dehydroisoandrosterone and dehydroisoandrosterone sulfate.

Dehydroisoandrosterone (DHA) and cortisol were measured by radioimmunoassay and protein binding techniques respectively in plasma from blood taken at 20-min intervals over 24-h periods in 3 normal men, 2 women with Stein-Leventhal syndrome and a man with a benign adrenocortical adenoma. In all subjects but the latter, DHA and cortisol were episodic and synchronous throughout the entire day; in this patient, continuous secretion of cortisol by the tumor apparently abolished stimulation of the contralateral adrenal, and DHA production was negligible. Dehydroisoandrosterone sulfate analysis in plasma displayed a pattern which, probably because of its origin both by secretion and sulfation and its long half-life showed less synchronicity with DHA and cortisol and less fluctuation than did the free hormones.


Insulin and glucose as modulators of the amino acid-induced glucagon release in the isolated pancreas of alloxan and streptozotocin diabetic rats.

The hyperglucagonemia that occurs in vivo in animals made diabetic with alloxan or streptozotocin is not suppressed by high glucose but is suppressed by exogenous insulin. These observations together with other studies suggested that insulin-dependent glucose transport and metabolism by the alpha-cells serves as the primary mechanism controlling glucagon secretion. This hypothesis was tested in the present investigation. The possible interactions between glucose, insulin, and a mixture of 20 amino acids at physiological proportions were examined in the isolated-perfusin diabetic rats. Release of insulin and glucagon were used as indicators of theta-cell and alpha-cell function. According to rigid criteria the diabetic animals entering the study were severely diabetic. It was found that in vitro: (a) basal glucagon release (measured in the absence of an alpha-cell stimulus or inhibitor) was extremely low, even lower (i.e. 10%) than the basal rates seen in controls; (b) the alpha-cells of alloxanized- and streptozotocin-treated rats responded with a biphasic glucagon release to stimulation by an amino acid mixture; (c) this alpha-cell response was reduced after both streptozotocin and alloxan; (d) glucose at 5 mM was a potent inhibitor of amino acid-induced glucagon secretion in both types of experimental diabetes; (e) in alloxan diabetes alpha-cell stimulation by amino acids can be curbed by exogenous insulin, whereas glucagon secretion by the perfused pancreas of streptoxotocin diabetic rats appeared to be resistant to insulin action. The data indicate that the modulation of glucagon secretion by glucose in vitro is indipendent of insulin and that other unknown factors extrinsic to the pancreatic islets are responsible for the hyperglucagonemia observed in vivo.


The fungicidal mechanisms of human monocytes. I. Evidence for myeloperoxidase-linked and myeloperoxidase-independent candidacidal mechanisms.

We tested the ability of human peripheral blood monocytes to kill Candida albicans and Candida parapsilosis. Evidence that multiple fungicidal mechanisms operate in normla monocytes was found. Normal monocytes ingested and killed viable C. albicans, and could iodinate heat-killed C. albicans. Both functions were defective in monocytes from subjects with myeloperoxidase deficiency or chronic granulomatous disease. Methimazole, isoniazid, and aminotriazole inhibited iodination by normal monocytes without impairing their ability to kill C. albicans, indicating that iodination was not essential to the myeloperoxidase-hydrogen peroxide-mediated fungicidal system of the monocyte. C. parapsilosis, an organism killed with supranormal efficacy by monocytes from a patient with hereditary myeloperoxidase deficiency, was selected to examine the myeloperoxidase-independent fungicidal mechanisms of monocytes. Monocytes were obtained from the blood of normal or leukemic subjects and homogenized in 0.34 M sucrose to yield fractions rich in cytoplasmic granules. These fractions were extracted with 0.01 M citric acid and the soluble components were separated by micropreparative polyacrylamide electrophoresis. Monocytes were found to contain cationic proteins, other than myeloperoxidase, that kill C. parapsilosis in vitro.


Space maintenance in a child dental care program.

Five types of space maintainers were placed in 196 children participating in an extensive dental care program during a four-year study. Children with space maintainers were examined at six-month intervals. During the study, some sort of difficulty was encountered with 43% of the appliances inserted. The most common problem encountered was lost or missing appliances. Sixteen appliances had broken arch wires or loop wires; only ten broken bands were noted. Anther problem was distortion of arch wires. Suggestions are made for possible modifications in the space maintainers to reduce the incidence of problems.


Reduction of fear-related dental management problems with use of filmed modeling.

In this study of the modification of anxiety-related disruptive behavior in dental treatment, matched groups of inner-city children attending a pedodontic clinic were shown a videotaped demonstration of a 4-year-old black child undergoing a dental restorative procedure or were given an unrelated drawing task before dental treatment. Children who viewed the videotape demonstration of a peer model coping with dental procedures showed significantly fewer fear-related disruptive behaviors during restoration of lesions. Observations of children's anxiety levels made by dentists and independent observers validated the effectiveness of viewing the videotaped demonstration. No significant correlation was found between the children's reports of their anxiety and their behavior during dental treatment.


Viral hepatitis as an occupational hazard of dentists.

To estimate the risk of viral hepatitis for practicing dentists, a questionnaire survey was conducted in the greater Los Angeles area among the part-time faculty of the University of Southern California School of Dentistry. An icteric episode diagnosed as hepatitis had been experienced by 11, representing 3.9% of the 285 dentists to whom questionnaires were mailed or 4.5% of the 242 respondents. All illnesses occurred after graduation from dental school, and five were after 1967. For general dentists, the minimal frequency was 2.7 (5 of 187 in the sample). Specialists with emphasis in surgical forms of dentistry had hepatitis with a significantly higher frequency: 3 of 19 oral surgeons; 1 of 13 periodontists; and 1 of 9 endodontists. The risk did not vary in this sample with the proportion of young adult patients (15 to 29 years of age) in the practice or recognizable illicit self-injection among patients. Auxiliary dental personnel seem to have a lower risk than dentists themselves. Measures to reduce the hazard are indicated, but at present these are confined to greater care in avoiding percutaneous introduction.


The surgical treatment of acne conglobata of the face.

Successful treatment of Acne conglobata is only possible by surgical excision. Two procedures are most favoured. Gross excision and fine trimming by dermabrasion with subsequent secondary reepithelization gives excellent results without scars: If a radical excision is preferred or if cartilage is exposed, a full thickness skin graft has to be applied. The results are good although slight difference in colour between facial skin and skin graft must be noted. For each of these two procedures a case is presented and treatment and results are discussed.


Mixed lymphocyte reactivity and cell-mediated lympholysis to trinitrophenyl-modified autologous lymphocytes in C57BL/10 congenic and B10-A recombinant mouse strains.

Cell-mediated lympholysis (CML) to trinitrophenyl (TNP)-modified autologous splenic lymphocytes has been recently reported in the mouse (1). Both the sensitization and effector phases of this phenomenon were shown to be T-cell mediated. Effector cell specificity studies indicated that modification of the target cells is a necessary but insufficient requirement for cytolysis, and suggested that altered cell surface components controlled by genes mapping in the mouse major histocompatibility H-2 complex (MHC) are important in the specificity of the cytotoxic reaction (1). In allogeneic models the generation of cytotoxic effector cells has been shown to be preceded or accompanied by immunogen- induced proliferation of responding lymphocytes, i.e. a mixed lymphocyte reaction (MLR) (2-5), although the generation of effectors may not necessarily always be the consequence of extensive cell proliferation (5). If the induction of cytotoxic effector lymphocytes by modified syngeneic spleen cells is characteristic of sensitization with cellular alloantigens, one would expect to find that sensitization with TNP-modified autologous cells would also induce thymidine incorporation by the responding cells in the culture. The present report demonstrates that both stimulation of thymidine incorporation and generation of cytotoxic effector cells are part of the in vitro response to TNP-modified autologous lymphocytes. However, the MLR to TNP- modified autologous cells consistently appeared to be less pronounced when compared with an allogeneic MLR, whereas the cytotoxic activity of the effector cells generated by sensitization against TNP-modified autologous cells was frequently as high as that detected against H-2 alloantigens. These two components of reactivity to "modified self" are verified in several C57BL/10 congenic and B10.A recombinant mouse strains.


Discharge of spindle afferents from jaw-closing muscles during chewing in alert monkeys.

The discharge of muscle spindle afferents from monkey spindle afferents from monkey jaw-closing muscles was studied during mastication of natural foods by extracellular recording from the fibers or cell bodies of the tract and mesencephalic nucleus of the fifth nerve. In all, 39 muscle afferents were studied. The spindle associated with 18 of the afferents was positively identified by the afferent's response to gentle, localized palpation of either the temporalis or masseter muscle. Discharge patterns were observed during mastication, and in the majority of cases the qualitative passive response characteristics of the spindle afferent were determined. During steady chewing spindle afferent discharge typically paused briefly during the initial rapid upward part of the chewing cycle. Firing generally began as the jaw slowed its upward movement, and firing rates during the slow grinding portion of the upward movement were within the range of 50-80 spikes/s. All spindles exhibited a brisk discharge during the opening movement, typically within the range of 100-150 spikes/s. One-third of the spindle afferents exhibited a brief, high-frequency burst of firing at the very beginning of the opening movement, presumably as a result of stretch applied to a spindle just previously subjects to fusimotor excitation. Although the results of the study make it clear that spindles in jaw-closing muscles are coactived along with the extrafusal muscle fibers, the fusimotor bias does not seem capable of sustaining discharge in the face of rapid shortening of the muscle. Furthermore, the fact that discharge rate during opening, when the jaw-closing motoneurons are quiescent, is much higher than at any part of the closing cycle, when the motoneurons are active, suggests that the muscle spindles cannot provide the primary excitatory drive to the motoneurons.


Analysis of response properties of deefferented mammalian spindle receptors based on frequency response.

Sinusoidal responses of primary and secondary endings in deefferented spindles of anesthetized cats were studied over the low-frequency range 0.001-0.1 Hz. Stretch amplitudes were chosen conservatively small (25-100 mum peak-to-peak) so as to lie within the linear region. 1. At 0.1 Hz average sensitivity was 350 pps/mm for primary endings and 80 pps/mm for secondary endings. Sensitivity fell to lower values at lower frequencies, but even at 0.001 Hz, corresponding to 17 min/cycle, sensitivity remained elevated above static values determined with large stretches. Phase lead varied from 5 to 50 degrees and, in the case of primary endings, tended to be greater at lower frequencies. 2. Except for the different scaling factors, the only apparent difference between the frequency responses of primary and secondary endings was a tendency for primary endings to show a greater phase lead over the range 0.001-0.01 Hz. 3. Dynamic responsiveness was assessed theoretically from frequency-response data by calculating responses to ramps at various velocities. Over most of the velocity range dynamic responses were not proportional to velocity. The greater dynamic responsiveness of primary endings during large (6 mm) ramp stretches might be related to frequency response below 0.01 Hz. 4. Certain aspects of dynamic responsiveness to large ramps (6 mm) were accounted for by assuming all phases of responses were attenuated by 25 dB in the case of primary endings and 20 dB in the case of secondary endings. The nonlinearity responsible for attenuation appears to occur at an early stage in the sensory process. 5. Comparison of individual responses to slow ramps with predictions based on linear theory indicated the presence of abrupt departures from linearity for both primary and secondary endings.


Transition in sensitivity of spindle receptors that occurs when muscle is stretched more than a fraction of a millimeter.

We studied the responses of 34 deefferented spindle receptors to slowly applied ramp stretches (0.01-1 mm/s) of small (0.02-0.2 mm) and intermediate (0.2-1 mm) amplitudes. The afferent discharge from primary and secondary endings was recorded from filaments of dorsal root in anesthetized cats. 1. Responses of most endings to ramps of intermediate amplitude showed abrupt changes in slope (discontinuities) which were highly repeatable. Discontinuities occurred more nearly at constant stretch (in the range 50-400 mum for different receptors) than at constant discharge rate. They were less pronounced in the case of secondary endings. 2. Changes in sensitivity occurred when the degree of stretch exceeded a transitional amplitude which ranged from 50 to 200 mum. These changes were studied by constructing plots based on a family of responses to a family of ramps which were scaled versions of each other. The plots indicated that reductions in sensitivity occurred both during stretch and during adaptation; the reductions were more marked for primary than for secondary endings. 3. Responses were modified considerably by preceding changes in muscle length. When the last change was an increase of a few millimeters, discontinuities became more pronounced and other changes in the appearance of the dynamic response occurred, particularly in the case of primary endings. These changes could last for several minutes, but were abolished by a single test stretch of intermediate amplitude. 4. The resetting of high sensitivity that occurs when muscle length is changed, the discontinuities, the transitions in sensitivity, nonlinear adaptation, and the effects of previous length change appeared to be related phenomena. They can all be accounted for by the hypothesis that polar zones of intrafusal muscle fibers possess a frictionlike property, one analogous to that which has been described for whole muscle. A simple nonlinear model which shows these features is presented. 5. The adequate stimulus for a change in primary ending discharge is a small change in muscle length, relatively independently of its velocity. The dynamic response arises mainly from a changing sensitivity to length itself, which is a nonlinear property.


The pulmonary vascular bed in children with Down syndrome.

Sixty-nine children with Down syndrome (mongolism, trisomy 21), with atrial septal defect, patent ductus arteriosus, ventricular septal defect, or endocardial cushion defects, and 315 children with similar cardiac anomalies without this syndrome underwent cardiac catheterization during an 8-year period from 1964 to 1973. Only patients under 17 years of age were included in the study. Nine tenths of the children with Down syndrome but only one fourth of the control group had abnormally high pulmonary arterial pressures. For example, 9 of 11 children with defects of the atrial septum and Down syndrome had pulmonary hypertension; in contrast, only 5 of 55 control subjects with similar defects had pulmonary hypertension. The data suggest that children with congenital heart disease and Down syndrome have an unusually high pulmonary vascular resistance and a propensity for early development of severe damage to the pulmonary vascular bed.


GLC determination of nicotinamide in multivitamin formulations after conversion to nicotinonitrile.

A method was developed for the quantitative GLC determination of nicotinamide. It is based on the conversion of nicotinamide to nicotinonitrile. This dehydration reaction is mediated with trifluoroacetic anhydride and catalyzed by base. The GLC properties of this nitrile are excellent. The reaction conditions, extraction, and stability properties of the derivative as well as the choice of internal standard are discussed.


Evidence that the deferential vein acts as a local transport system for androgen in the rat and the dog.

Ligation of the deferential vein of the rat has been shown to bring about a reduction in the androgen-dependent activity of the prostatic RNA polymerase enzyme. In the dog, the content of androgens in this vein is of the order of that found in the testicular vein and many times higher than that of peripheral plasma. It seems that the cauda epididymidis alone is sufficient to maintain the ipsilateral lobes of the prostate and seminal vesicles providing an intact ductus deferens and contralateral testis are retained. The results are discussed in relation to the hypothesis that the deferential vein of the dog and rat may serve as a direct transporting system for androgens from the epididymis to the prostatic complex.


Kinetics of cell proliferation in benigh and premalignant tumors of the human epidermis.

A double labeling method with two levels of tritiated thymidine was used to study 6 patients  with seborrheic keratosis, 1 with a fibroepithelial tumor of Pinkus, and 1 with basal cell nevus syndrome manifesting three pits on the palm of the hand. The two latter types of lesions, known to be able to evolve into basal cell carcinoma, had an increased S-phase duration (18 hr for the germ cells of the palmar pits) as compared with normal epidermis (10 hr). This situation was similar to that observed in basal cell carcinoma, However, the S phase was not lengthened in seborrheic keratosis (9.2 plus or minus 1.6), a benign tumor in which malignant transformation is extremely rare. S phase was also of normal duration in the benign eosinophilic septa of the tumor of Pinkus.


Proteases during the growth of Ehrlich ascites tumor. I. The fibrinolysin system.

Component levels of the fibrinolysin system in the plasma and ascitic fluid of Swiss mice bearing Ehrlich ascites tumor cells were determined during a 15-day tumor growth time phase. During tumor growth, the concentration of plasminogen in the ascitic fluid decreased inversely to the total packed cell volume. Free plasmin was not present in the ascitic fluid nor was there any measurable plasminogen activator activity. Both antiplasmin activity and fibrinogen levels present in the fluid decreased during tumor growth. The nuclear and mitochondrial-microsomal subcellular fractions of the tumor cell exhibited plasminogen activator activity. No significant changes in the above parameters occurred in the plasma during the tumor growth period we studied.


[Studies on the spatial velocity electrocardiogram in left ventricular overloadings].

Conventional ECG, Frank system VCG and the spatial velocity ECG were recorded in 42 cases of healthy adult men, 76 cases of hypertension and 26 cases of aortic insufficiency, and were studied qualitatively as well as quantitatively in order to clarify the characteristic changes in the spatial velocity ECG in the systolic and the diastolic overloadings of the left ventricle. Spatial velocity ECG were recorded by means of the spatial velocity electrocardiograph, leading three scalar ECG of Frank system (X, Y, and Z leads) into the differentiating, the squaring, the adding and the square root circuits in orders. Computations were performed automatically according to the following formula: see journal for formula. Spatial velocity ECG and three scalar ECG of Frank system were simultaneously recorded by the four channel heatwriting oscillograph with paper speed of 100 mm per second. The forty Hz and 4 Hz of the sinusoidal waves were introduced into the circuits for the calibrations of QRS and P and T waves respectively. P waves of the spatial velocity ECG in normal subjects showed 2-peaked (5%), 3-peaked (6%), and 4-peaked (26%) patterns exhibiting 3-peaked P waves as the basic pattern in normal. The three peaked and 4-peaked patterns were observed in 33% and 67% in hypertension, and in 35% and 65% in aortic insufficiency respectively. Two-peaked P wave was not observed and the incidence of the 4-peaked P waves of the spatial velocity ECG increased in the left ventricular overloadings..


Fatal immune complex glomerulonephritis without deposits.

Repeated intravenous injections of egg albumin in rabbits produced small antigen-excess complexes and severe glomerulonephritis. Immunoglobulins and complement in the glomeruli were not clearly demonstrated by immunofluorescence; deposits were found to be sparse by electron microscopy. This study demonstrates that soluble immune complexes are responsible for the glomerular reaction. The apparent absence of deposits is thus not sufficient to exclude an immune complex pathogenesis.


Cardiomegaly in chronic anemia in ratsman experimental study including ultrastructural, histometric, and stereologic observations.

Postweanling rats maintained on a milk-sugar diet develop a sideropenic anemia, the hemoglobin values falling to less than 30 per cent within 8 to 10 weeks. In that period the heart weight increases by more than 3 times, both ventricles enlarging proportionately. As in other forms of cardiac hypertrophy, a progressive increase in the numbers of connective tissue cells occurs. Ultrastructural and stereologic studies show an appreciable proliferation of the mitochondrial mass in myocardial cells, the mitochondrial fractional volume increasing from a normal of 0.38 to 0.48 per unit cell volume. This quantitative increase is accompanied by a progressive deterioration of the internal cristal structure and the appearance of abnormal, degenerating, and necrotic forms of mitochondria as congestive cardiac failure develops. Myofibrils remain normal. The heart of an anemic rat subjected to an additional workload produced by subdiaphragmatic aortic constriction shows an earlier deterioration of the mitochondrial ultrastructure and stereologic profiles. However, it does not become as large as the heart of the purely anemic animal. In anemic animals with an increased workload, the myofibrillar fractional volume increases from a normal of 0.52 to 0.57 per unit cell volume initially. The active sarcomerogenesis is achieved by Z-band proliferation, which was not observed in the heart of the purely anemic animal. These findings provide a structural basis for the functional and biochemical cardiac deterioration observed in the cardiomegaly induced by chronic anemia.


Glomerular fibrinolytic activity after thrombin perfusion in the rat.

The effects of thrombin perfusion on glomerular fibrinolytic activity (GFA) have been assessed quantitatively in isolated rat glomeruli. Gfa was augmented by increasing total thrombin perfused to a maximal dose of 120 units per 100 gm. Fifty per cent maximal GFA occurred at a dose of 38 to 42 units of thrombin per 100 gm. independent of duration or rate of perfusion. After termination of infusion, GFA diminished and thrombi were no longer observed. Simultaneous administration of thrombin and epsilon-aminocaproic acid was associated with sustained high GFA and persistence of thrombi, presumably due to inhibition of the action of plasmin on fibrin, but it had no effect on tissue activators of plasminogen.


Homologous dura mater cardiac valves. Study of 533 surgical cases.

A group of 533 patients had cardiac valves replaced with homologous dura mater valves. The dura mater was preserved in a solution of 98 per cent glycerol and antibiotics for a period of 12 days before used. The leaflets were mounted in a stainless steel ring covered by Dacron velour. Two hundred forty-five patients had mitral valve replacement; 205 patients, aortic valve replacement; 17 patients, tricuspid valve replacement; and 2 patients, pulmonary valve replacement. Sixty-four patients were subjected to multivalvular replacements. The patients were followed for a period of 1 to 40 months after surgery with satisfactory clinical and hemodynamic results. Because 2 patients developed endocarditis produced by fungii, fungicidal drugs were added to the preservative solution. No bacterial endocarditis has been observed. No pressure gradient through the valve has been noted at rest. Anticoagulant drugs have not been used in the postoperative period.


Metabolic adjustments of the kidney involved in the adaptation to potassium loading.

Potassium adaptation involves the development of the ability of the kidneys to secrete large amounts of potassium into the urine. This is accompanied by an adaptive increase in the specific activity of sodium-potassium-ATPase in the kidney, predominantly in the medulla and the papilla, but also involving the cortex. It is likely that these changes are localized to the distal tubule and are especially marked in the collecting ducts although there is no direct evidence bearing on this. Net secretion of potassium in isolated kidneys taken from chronically potassium loaded animals is completely eliminated when ouabain, a specific inhibitor of sodium-potassium-ATPase, is added to the perfusion medium. The secretion of potassium appears also to depend critically on the availability of glucose as substrate.


[10 years of tympanoplasty in the hands of an ear, nose and throat surgeon. An analysis of successes and failures (author's transl)].

The successful performance of a tympanoplasty by an otologist working for the health service is guaranteed when the operative results are systematically checked and critically evaluated against clinical-scientific advances. Certain criteria are discussed, based on an experience of 827 tympanoplastics, such as preoperative treatment, assessment of the pathological-anatomical conditions, restoration of sound conduction, tubal function, the problem of the drum transplant, reconstruction of the meatal wall and especially attocotomy which proved very satisfactory in 72 cases.


[Enzymatic and immunological inflammatory reactions in the middle ear (author's transl)].

During chronic otitis media intact immunoglobulins are split by extracellular bacterial proteinases into fragments of different molecular weight, The most malignant extracellular proteinases with the greatest proteolytic activity against intact immunoglobulins are the bacterial proteinases of Pseudomonas aeruginosa. These proteinases cannot be inhibited by the other serum proteinase-inhibitor except for Alpha-2-Macroglobulin of the human blood serum. This inhibitor has a very high molecular weight, so that we cannot find it in a higher concentration in the middle-ear-secretory. We can liberate this inhibitor by injuring the blood vessels during a tympanoplasty. In this way we get an inhibitory effect against these proteinases and combined with an appropriate antibiotic therapy we can cure a chronic otitis MEDIA. In order to demonstrate that there are immunological reactions in the middle ear against homografted ossicles, various transplantation with homologous ossicles have been performed between two inbreeding rat strains. After sensitisation of the host animals against antigens of the donor animals with skin grafts a reliable histologic infiltration with plasma cells and lymphocytes and the rejection of the graft could be insured. After a simple homologous transplantation without sensitisation, these rejection reactions occurr only rarely and in a diminished form. Cialit storage of middle ear ossicles decreases the solubility of the contained proteins and this in turn diminishes the antigenicity, the amount the antigens, or it retards their liberation. It is for these reasons that Cialit-stored ossicles are more slowly transformed, and there are less inflammatory reactions and adhesions than with untreated ones. The osteogenetic capability of the ossicles is not affected by the Cialit storage.


[Medial or lateral placement of the graft in myringoplasty comparative studies of both operation techniques using electronic data processing (author's transl)].

After medial placement of the graft in myringoplasty the remaining air-bone gap within the speech range is on an average approximately 10,- dB. This remaining air-bone gap is, according to secured statistics, on an average approximately 10 dB lower than in a lateral placement of the graft. The bone conduction does usually not change in either operation method. The additional support of meatal skin graft on the underlayed fascia does not have any influence on the audiologic finding. The percentage of the reperforations is in type I with a rate of 18% rather high; both operation methods do not significantly differ.


[Homologous transplants in the middle ear (author's transl)].

The original concept of tympanoplasty included besides the closure of the middle ear, the removal of pathological middle ear components leaving intact the functional and healthy components. The special conditions that prevail in the middle ear (aeration, absence of intrinsic trauma) allow the reconstruction of the middle ear mechanics to a great extent. Animal experiments and clinical experience reveal good transplantation properties of denatured and preserved ear ossicles. They are partly replaced by the body's own true tissue, and preserve the original form over a period of years. Denatured dear drums with malleus, incus, and parts of the stapes give astounding acoustic results. The posterior bony canal wall in old radical cavities can be replaced by the posterior wall of the human temporal bone which has been preserved in Cialit.


[Experience with the quilt-plasty in tympanoplastic operations (author's transl)].

I presume the technique of quilt-plasty is already well known, Experience has shown that preserving the anterior tympanomeatal angle with the quilt-plasty leads to a better fixation and thus a better vascular supply. The success rate could be improved spontaneously both anatomically and audiologically. We use this method especially for subtotal and total defects in spite of the risk of a secondary perforation developing during the healing process. These tend to be much smaller than the primary perforations and may be dealt with in outpatients by a revision operation. 2195 ear operations were performed in three years, 1204 were tympanoplasties. 18 secondary perforations were seen with the quilt-plasties. They either healed spontaneously or were finally closed with a small operative revision in ambulant patients, The quilt-plasty is thus our method of choice.


[Tuberculosis of the middle ear and tympanoplasty (author's transl)].

The clinical picture of tuberculous otitis media is described. Nowadays the desease usually appears as a infection of the mucous membrane. The problems concerning the diagnosis of this specific infection by histological or bacteriological methods are discussed. Special questions about the performance of a tympanoplasty in a tuberculous otitis media are considered.


[Tympanoplasty of today (author's transl)].

The author explains why he developed the access to the meso-hypotympanum via the angle between the facial nerve and the chorda tympani in 1953 which he then demonstrated at many occasions. The value of this access--later used by other ear surgeons and named mastoidectomy with intact canal wall technique or posterior tympanotomy--for chronic otitis media was always denied by the author. These methods do not give sufficient way to the main focus of pathology in the epitympanum mainly to the pretympanic recess in front of the head of the malleus; The danger of deep penetrating cholesteatoma in the petrous bone is too great. Only complete opening combined with complete reconstruction serves really eradicating the pathology completely as well as full reconstruction of the middle ear and the external canal; this means osteoplastic epitympanotomy. With the help of this operation it is possible to continue in the same stage with complete mastoidectomy and complete sinus operation.


[The endoscopy of paranasal sinuses. Diagnostic and therapeutic possibilities (author's transl)].

This paper deals with further experiences in endoscopy of the maxillary sinus and in possibilities of endoscopy of frontal and sphenoidal sinuses. Some coloured photographs taken during endoscopy are shown. As the result of 301 sinuscopies of maxillary sinus performed, it could be shown that in 36% of the cases x-ray findings didn't exactly correspond with the endoscopy findings. In further 22% there was no correlation at all between the x-rays and findings at operation. This shows the great importance of sinuscopy and reveals its diagnostic values. The author used the endoscopy of the maxillary sinus not only for diagnostic purposes but for the treatment of chronic purulent sinusitis as well as complete removal of the socalled solitary cysts of the mucous membrane. A therapeutic gap between the two extreme (conservative treatment on one side and radical surgery Caldwell-Luc on the other side) ist bridged using this method. Finally the indications for endoscopy of maxillary and frontal sinuses are shown clearly in a table.


[Complications in the paranasal sinuses due to surgery via the ethmoidal labyrinth (author's transl)].

An analysis of 174 relevant cases of operations via ethmoidal labyrinth shows that there are no more frequent complications of the paranasal sinuses postoperatively. We found only 5 immediate and 4 indirect postoperative complications; the aims of operation were the orbit and the sella turcica.


[Air pressure and flow in the nose6 represented in a double-logarithmic system (author's transl)].

The x-y-recording system is developed from rhinorheomanometry in written polygraph tracings sharing a common time base. Furthermore, using tracing in a double-logarithmic diagram, the pressure-versus-flow diagram can easily be expressed with a straight line. Using fractional numbers as exponents, a precision is achieved that has previously not been posisible. The pressure-versus-flow diagram of the whole nose can easily be described, by calculation and by tracing, as the diagram of the right and left nasal cavities. The physiological-medical use of the system is shown. In order for the system to be routinely employed, a direct writing apparatus would be necessary.


[Nasal patency in the population of tropical coasts (author's transl)].

264 normal subjects living in tropical coastal climate (Cuba) were studied by means of contralateral rhinomanometry. The decreased nasal patency in white subjects when compared with European criteria is apparently caused by vasodilation due to the climate. There was a statistically significant difference in nasal patency between the white and the black race. Mulattos show intermediate characteristics both from the anatomical and functional point of view.


[Hyposmia in bilateral recurrent laryngeal nerve paralysis (author's transl)].

The hypothesis that denervation of the motor nerves of the larynx regularly results in hyposmia, has been examined by measuring the olfactory acuity in patients with bilateral recurrent laryngeal nerve paralysis. Hyposmia occurred in 28% of the patients who were decannulated following successful endolaryngeal artytenoidectomy (Thornell procedure).


[Vestibular adaptation-, habituation- and fatigue-test (author's transl)].

Basing on personal experiences as well as clinical manifestations the three phenomenon of habituation, adaptation and fatigue, have been analyzed. The vestibular tests have proved to be more physiological than the audiological ones. Diagnostic vestibular tests are therefore more informative.


[Investigations on the vestibular recruitment (author's transl)].

Searching for some kind of vestibular recruitment that might be similar to the audiological recruitment as defined by Fowler, a caloric test was done at 44 degrees, 33 degrees, 30 degrees, 26 degrees, 17 degrees. The parameter of vestibular response was the maximum slow component speed, In total 36 Menière-patients were electronystagmographically examined. Out of the 36 only 16 were analyzed further for the question of vestibular recruitmen, who showed strictly unilateral lesions, who were attack-free since some months and who showed clear audiological recruitment at four different recruitment tests. The following results were obtained: 1. The values obtained for the sound side of Menière-patients correspond to values described as normal in literature. 2. The affected side showed less reaction at all temperatures, in no case there was a tendency to recruitment. 3. With considerable loss of excitability, a "flat curve" was resulting, indicating decruitment.


[Is there a correlation between vestibular and cochlear hypofunction in Menière's disease? (author's transl)].

The vestibular findings in Meniere's disease show large variations. In the attack-free interval, with strict unilateral disease, very often there seems to be a vestibular hypoexcitability. This canal paresis is mostly manifesting itself by a reduction of the velocity of the slow phase, and not so much by the shortening of the duration of a calorically induced nystagmus. With vestibular end-organ-diseases the relative hypoexcitability is most pronounced with strong cold stimuli. The correlation between hearing loss and vestibular function loss of 16 Meniere patients was examined at different caloric stimuli from 44 degrees to 17 degrees C. The generally accepted mode for determining vestibular hypoexcitability (mean value of the 44 degrees and 30 degrees -stimulus) only showed a very slight correlation to hearing loss. The determination of vestibular hypofunction at different caloric stimuli--or, at least, the additional application of a strong cold stimulus--seems to give new and valuable vestibular diagnostic possibilities.


[The acute cervical vertigo under otologic and osteopathic view (author's transl)].

The acute cervical vertigo with the single symptome of rotary vertigo is most probably caused by a functional disturbance in the upper third of the cervical spine. Distinct patho-anatomical changes could not be observed. The findings on the cervical spine are based on an osteopathic examination. The therapy of choice is a manipulation. Three cases are reported.


[Comparison of two different recording sites in electrocochleography: promontory and external mastoid position (author's transl)].

One possible evaluation of the functional unit: hair-cell/afferent neurit is the recording of an action-potential (AP) from the acoustic nerve. The authors report their experience in recording the AP from an external position on the mastoid planum and from a transtympanic position on the promontory. The promontory site is prefered because of the higher electrical response amplitude and because of its relatively reduced sensitivity against myogenic potentials. Characteristic findings in normal ears and in some pathological conditions are to be demonstrated.


Human carotid artery diameter and flow by a noninvasive technique.

This paper presents a technique tested in vitro and in dogs and used in humans to measure carotid artery blood flow continuously by placing a transducer on the skin over the artery. The tranducer consists of a pulse echo crystal used to locate the carotid artery and measure its diameter and wall velocity. It also has a pair of Doppler shift crystals used to measure the velocity of the artery wall and blood flow in the vessel. It was found that the pulsatile artery wall distension was between 8 and 13 percent of the diastolic diameter. The peak blood flow varied inversely with pulse rate. Occlusion of one carotid resulted in an increase in diastolic but not systolic flow in the other.


Kinetic behavior of associating enzyme systems ofthe type M in equilibrium M2 in equilibrium M3 in equilibrium ... and of the type 2M in equilibrium D in equilibrium D2 in equilibrium D3 in equilibrium ...

A theoretical analysis has been made of dependencies of specific enzymatic activity (a) on the concentration of the enzyme for associating enzyme systems, in which the association of protein molecules leads to the formation of linear associates of an unlimited length (M in equilibrium M2 in equilibrium M3 in equilibrium ...) and is accompanied by steric shielding of active centers, and also for systems of the type 2 M in equilibrium D in equilibrium D2 in equilibrium D3 in equilibrium ... (M is an inactive monomer and D is an active dimer), in which the specific enzymatic activity of the dimer does not depend on the degree of association. For both models an analysis has been made of the S-shape of the curves of the dependence of a on the concentration of the substrate. Experimental data for glutamate dehydrogenase from ox liver and phosphofructokinase from rabbit skeletal muscles have been used as illustrations.


Effects of renal nerves on renal hemodynamics. I. Direct stimulation and carotid occlusion.

Renal nerves were stimulated either directly (loop electrodes) or indirectly (bilateral carotid occlusion with maintenance of control blood pressure) in anesthetized dogs to determine the effects on renal blood flow (RBF), glomerular filtration rate (GFR), sodium excretion (UNaV), and intrarenal distribution of blood flow (microsphere method). Direct nerve stimulation decreased RBF 20% in 9 of 10 dogs; but GFR, UNaV, and intrarenal distribution of blood flow did not change significantly. Carotid occlusion decreased RBF in 9 of 10 dogs. There was a 22% fall in RBF for the whole group, GFR decreased 33%, and UNaV decreased from 0.39 to 0.17 muEq/min/g (p smaller than 0.05). A small (8%) decrease in midcortical fractional flow (p smaller than 0.05 after carotid occlusion was the only distributional flow change observed. The results disclosed no relationship between changes in sodium excretion and changes in total RBF, GFR, or intrarenal distribution of blood flow following nerve stimulation. These studies also indicate that the renal effects of carotid occlusion are probably not mediated by renal nerve stimulation alone.


A possible case of beriberi heart failure in a chronic hemodialyzed patient.

A case of beriberi heart failure in a chronic hemodialyzed patient is described. The etiology and the diagnostical criteria are discussed. The possibility of this complication in chronic hemodialyzed patients is considered.


Glomerular ultrastructural abnormalities in a patient with mixed IgG-IgM essential cryoglobulinemic glomerulonephritis.

Distinct glomerular ultrastructural lesions in the form of nodular subepithelial and intramembranous, as well as discrete and band-like subendothelial deposits are described in a patient suffering from mixed IgG-IgM essential cyoglobulinemic glomerulonephritis. It is suggested that the deposits may represent immune complexes which are belived to play a central role in the pathogenesis of the glomerulonephritis.


[Frequent dermatologic diseases in the newborn and children].

Sebaceous gland activity in the newborn and children is extensive at first in the epidermis, and later decreases owing to defective operation of the sweat glands, circulation changes, growth of the hair, and a predisposition to infection, for which significant treatment is required. In addition to the genetic "typus neurodermiticus", pharmaceutical, alimentary and respiratory allergens and psychological factors may play a part in the appearance of atopical dermatitis. Onset is usually in the 2nd to 6th month and the side of the face and the scalp are affected. The clinical picture varies considerably with age and includes sanious foci covered with scabs on the head and eczema flexurarum. Differences in family history, age and the location of sites will distinguish this form from seborrhoeic dermatitis. Gluteal dermitis is secondary to congestion caused by dampness, rugging and soaking, and the action of stools and urine (bacterial amniogenesis). The main complications of neonatal and infantile impetigo are: glomerulonephritis, exfoliative dermatitis, pulmonary abscess, pulmonitis and osteomyelitis; phlyctenular, serpiginous impetigo with large and small bullae is particularly important. Treatment of neonatal and infantile dermatosis must take account of the fact that increased reabsorption and congestion are contraindications for the local application of corticoids and preparations containing salicylic and boric acid.


[Mitochondrial abnormalities and ocular myopathies with downward-spreading evolution. Apropos of 2 new cases].

Two cases, one being probably familial, of ocular myopathy are reported. In both the onset was in childhood by ptosis of the eyelids and the course lasted more than 20 years. The patients (32 and 49 years) presented involvement of the ocular muscles as well as of the facial, pharyngolaryngeal, neck and limb muscles. There was, in both cases, marked body weight loss which could not be explained by the muscular atrophy alone, and a thyroid nodule which was not accompanied by evident change in thyroid function. Muscle biopsy studies were carried out : electron microscopy showed in both cases aggregates of mitochondria exhibiting various changes ; in one case histochemistry demonstrated that these changes were confined to type 1 muscle fibres. These cases of descending ocular myopathy can be included therefore in the group of the smaller than myopathies with abnormal mitochondria greater than.


Extracardiac abnormalities in infants with congenital heart disease.

Extracardiac anomalies (ECA) occur in 25% of infants seen during the first year of life for significant cardiac disease. Often the ECA are multiple and one third of the affected infants have some established syndrome. In infants with endocardial cushion defect, patent ductus arteriosus, atrial septal defect, ventricular septal defect, malpositions, tetralogy of Fallot, and complex coarctation ECA occur in 25% or more of the cases. The most frequent ECA are in the musculoskeletal system or associated with a specific syndrome. The presence of an ECA significantly increases the mortality in infants with CHD.


[Enzyme activity of yeasts as an indicator of their physiological state].

During yeast cultivation the activity of hexokinase and phosphofructokinase, the triggering enzymes of glycolysis, was measured and the total amount of nucleic acids was determined.  The impoverished medium--postdistillation molasses residue--was used for yeast generation in the studies.  A decline in the enzyme activity was observed, wheras the total amount of nucleic acids remained unaltered.  The activity of hexokinase and phosphofructokinase increased significantly when the yeast cultivated on the molasses residue were stimulated by an addition of a small amount of molasses upon low aeration.  The measurement of the activity of the above enzymes is a sensitive test and can be recommended for studying the technology of alcohol fermentation.


Control of the synthesis of a single enzyme by multiple regulatory circuits in Neurospora crassa.

Neurospora crassa synthesizes and secretes an extracellular protease into its growth medium when an exogenous protein serves as its principal source of sulfur, nitrogen, or carbon. The enzymes produced under these three growth conditions have been compared by a number of criteria. The results indicate that the same extracellular protease with a molecular weight of 31,000 is synthesized during the three different metabolic conditions. A regulatory mutant, which lacks a positive signal required for the synthesis of a family of related enzymes for sulfur metabolism, cannot synthesize the protease in response to a limitation for sulfur; yet, this same mutant is capable of producing the enzyme when it is limited for either nitrogen or carbon. A second regulatory mutant, defective in the control of nitrogen metabolism, fails to synthesize the protease only when it is limited for nitrogen. The evidence suggests that a single structural gene for this extracellular protease exists and that it is regulated in a complex fashion such that control signals arising from any one of the three distinct regulatory circuits can activate it for expression. A model is proposed for complex regulation of the synthesis of this enzyme.


Does phospholipase C stimulate thymide kinase activity of rat liver extracts prepared after partial hepatectomy.

Our purpose was to determine whether phospholipase C stimulated thymidine kinase activity of regenerating rat liver. We determined effects of phospholipase C upon TMP formation by rat liver extracts prepared at 0, 12, 24, 36 and 48 hr following partial hepatectomy. Data were obtained which supported these conclusions: (a) Commercial preparations of phospholipase C contained nucleoside phosphotransferase activity; (b) phospholipase C exerted no appreciable stimulatory influence upon thymidine kinase activity of regenerating rat liver; and (c), apparent stimulation of thymidine kinase was associated with linked activities of two enzymes, viz., liver extract-ATPase activity and nucleoside phosphotransferase activity.


[The effect of antidiuretic hormone and catecholamines on transepithelial sodium transport].

Experiments were conducted on the isolated frog skin; it was shown that the activating action of pituitrin on the transepithelial transport of sodium decreased, and that of adrenaline increased with reduction of the concentration of this ion in the incubation medium.  Strophanthine K, an inhibitor of (Na-+--K-+) -activated ATP-ase, prevented the activating effect of adrenaline on sodium transport, and in the medium with a low concentration of this ion--it only partially inhibited its actibating effect.  A conclusion was drawn that the mechanisms of ADH and catecholamine activation of sodium transport by frog skin were not identical, although they had some common links.  It is supposed that (Na-+--K-+)-activated ATP-ase was directly involved in the action mechanism of catecholamines on the system of active sodium transport in frog skin.


The effects of 3-methylindole on hemolysis, transport of Na+, and ATPase activities of bovine erythrocytes.

Biochemical effects of 3MI on cellular membranes were investigated. This study was conducted to examine the effects of 3MI on the hemolysis of erythrocytes, the transport of 22Na+ in resealed erythrocyte ghosts, and on the ATPase activities of erythrocyte membranes. The percent of hemolysis as a function of 3MI incubation time was sigmoidal. Seventy-five percent of the hemoglobin was released with the second 2 hr of incubation during which the concentration of 3MI in the cells reached a plateau of 2500 mug/ml of packed RBC. The effect of 3MI at a subhemolytic concentration on passive and active 22Na+ transport were not significant. The total and Mg2+-dependent ATPase activities in the membranes were significantly increased after 1 hr of incubation with 3MI at concentrations of 100, 200, 300, 400 and 500 mug/ml (P less than or equal to 0/ml (P smaller than or equal to 0.02).


A study of connective tissue macromolecules in skin of mice with goldthioglucose-induced obesity.

The effect of obesity on the connective tissue composition of skin was investigated in mice with goldthioglucose (GTG)-induced obesity.  Four months after GTG treatment, the obese animals were sacrificed.  Acid mucopolysaccharides, glycoproteins, collagen, and elastin were analyzed in the skin and compared to the controls.  Total MPS in the skin from obese animals decreased, reflected mostly in hyaluronic acid.  Chondroitin showed an increase over controls.  The content of soluble glycoproteins varied; total carbohydrate and sialic acid of the glycoprotein tended to increase with obesity.  Collagen and elastin both tended to decrease with obesity.


[The influence of different sugar reducing preparations on several pathogenetic components of diabetic angiopathy].

On the basis of clinico-laboratory examination of 500 patients suffering from diabetes mellitus a comparison was made of the influence of treatment with insulin and sulfanilamides on disturbed metabolic processes promoting development of vascular affections.  There were found no differences in the action of insulin and oral agents on the indices of lipid, protein and mucopolysaccharide metabolism and on activity of the enzymes of the pentose-phosphate cycle.  Corticosteroid excretion normalized with the compensation of diabetes, irrespective of the type of the sugar-reducing preparations.  A more pronounced increase in catecholamine excretion was seen in insulin therapy apparently in connection with greater variations in glycemia level.  A conclusion was drawn on analogous effect of insulin and sulphanilamides on the metabolic changes under study in diabetes.  In difference from the action of insulin, a marked allergization of the of the organism accompanying the action of sulphanilamides, and their normalizing effect on the vascular permeability should be referred to the positive aspects of sulphanilamide action.


Neuraminidase treated homologous IgG and immune deposit rental disease in inbred rats.

Immune deposit renal disease followed intravenous or intraperitoneal injections of neuraminidase treated homologous IgG or neuraminidase alone. No alterations were associated with several groups of controls. This preliminary study suggests that one mechanism by which microogranisms may be involved in the development of immune renal disease is by chemical alteration of immunoglobulin.


Abnormalities in grooming behavior and tryptophan hydroxylase activity in the superior colliculi in cats with pontile and frontal neocortical lesions.

Cats with pontile or frontal neocortical lesions display a dissociation of the appetitive and consummatory components of grooming behavior when their body surface is tactually stimulated, an abnormal behavior that waxes and wanes with the seasons of the year. Tryptophan hydroxylase activity is significantly decreased in the superior colliculi of cats with pontile lesions and of cats with frontal neocortical lesions. The results suggest that the change in tryptophan hydroxylase activity is mediated neuronally and is a transneuronal effect on the serotonergic input to the superior colliculi. Pharmacological manipulations of the serotonergic system in normal cats failed to induce the abnormal behavior, indicating that other factors are involved in the genesis of the abnormal behavior.


Response to electric shock in rats: effects of selective midbrain raphe lesions.

The forebrain serotonin (5-HT) concentrations of rats with lesions in the median (M; n equal to 5), dorsal (D; n equal to 5), and both (DM; n equal to 6) midbrain raphe nuclei were, respectively, 22, 48, and 70% lower than in control animals (n equal to 10). The lesion and control groups, however, did not evidence differences in pain sensitivity as measured by the flinch-jump technique. On the other hand, of the animals tested, those with M (n equal to 3) and DM (n equal to 4) lesions required more trials than controls (n equal to 6) to acquire a one-way avoidance response. D lesion rats (n equal to 2) did not differ from controls in one-way avoidance learning, except in terms of prolonged escape latencies during the first three trials. The previously reported increased sensitivity to painful stimuli subsequent to medial forebrain bundle lesions or para-chlorophenylalanine administration, therefore, does not appear to be due exclusively to disruption of ascending 5-HT fibers originating in the dorsal and median raphe nuclei. The effects of midbrain raphe lesions of avoidance learning, furthermore, depend on lesion locus, and are not due to either hypo- or hyperalgesia.


[Critical evaluation of the surgical treatment of vertebral lesions due to neurofibromatosis.  31 cases (1954-1973)].

Scoliosis is a complication of spinal lesions in neurofibromatosis, and leads frequently to major deformities with dislocations.  The authors conducted a critical study of 31 cases surgically treated during the 1954-73 period of time.  The techniques of spine straightening and of arthrodesis were recalled.  The authors conclude that in case of moderate deformity (less than 100 degrees) Harrington's operation was satisfactory enough when correctly conducted.  In case of severe dislocation and kyphosis, straightening was obtained after long lasting casts and halo tractions.  Then posterior fusion using Harrington's rods had usually to be completed by anterior, transthoracic fusion for better solidity.


[External hypertension syndrome of the patella.  Its significance in the recognition of arthrosis].

Some chondromalacia are caused by an hyperpressure on the lateral articular facet of the patella.  The authors describe the clinical signs and the radiological findings in this condition.  It is due to a retraction of the lateral patellar ligament.  They have operated on 133 cases and reviewed 115 knees.  After a simple section of the lateral patellar ligament, results were satisfactory in 80 percent of the cases.  Biopsies of the malacic cartilage were performed and pathological changes were described.


[Partial traumatic epiphysiodesis of the lower end of the tibia in children.  Treatment with disepiphysiodesis].

The author has treated 20 cases of secondary varus deformity of the tibia after ankle traumas in children.  These deformities were related to a partial premature epiphyseal closure, the plate being mashed at the time of the trauma.  These cases were usually treated by corrective osteotomy.  In two cases an attempt was made at resecting the bone briding the plate and filling the defect by methyl-metacrylate.  The results appeared to be encouraging.


[The stage of articular destruction in the rheumatoid hand].

Function incapacitation of the hand in rheumatoid arthritis was studied on 33 patients (54 hands).  35 were operated on.  All cases had reached the stage of articular destructions.  The authors emphasize the importance of preserved proximal inter-phalangeal joint for digito-palmar pinch.  Thumb unstability was not severely disabling as long as the other digits were normal.  However, when it was associated with hyperextension deformities of the other fingers, the hand became useless.  Surgical indications in rheumatoid hand were detailed.  The importance of restoring thumb function was pointed out.


[Juxtacortical osteogenic sarcoma localized in the hand.  Presentation of 2 cases].

Until the present time, only four cases of parosteal osteogenic sarcoma arising from the bones of the hand have been reported in the literature.  The purpose of this paper is to document two new cases of parosteal osteogenic sarcoma of the hand.  These tumours were localized in the proximal phalanx of the ring finger in one case and in the third metacarpal bone, in the other case.  Both patients were treated by amputation of the involved metacarpo-digital ray and radiation therapy.  They were free of the disease six years and eighteen months, respectively, after treatment.


[Treatment of hypercalcemia with mithramycin].

The authors treated 17 patients with hypercalcaemia (which in 16 cases resulted from a malignant disease) by means of 1 to 3 daily perfusions of 25 g of mithramycin per kg body weight. In all patients the treatment resulted in reduction in the level of calcaemia. In 12 patients the level of calcaemia was reduced to less than 105 mg/litre; in 16 patients to less than 110 mg/litre. In no patient was the calcaemia reduced to less than 70 mg/litre. The only notable inconvenience of the treatment was vomiting during the perfusion. Mithramycin seems to be the treatment of choice for hypercalcaemia of cancerous origin.


Cellular potassium transport and ATPase activity in Bartter's syndrome.

The cellular membrane function expressed as ATPase activity and active cellular K+ changes during in vitro incubation has been studied in two siblings with Bartter's syndrome. The K+ content of skeletal muscle was 20% lower than for controls, and the active potassium transport ability of single skeletal muscle cells was also lower than that of controls. The total ATPase activity of red cell membranes was higher, but the ratio of Na+-K+-activated to Mg2+-activated ATPases was lower than for control patients. The results favour the hypothesis that a primary defect causing the Bartter's syndrome could be an inherited generalized membrane dysfunction in the handling of cations.


Heterotopic bone formation in abdominal scars.

Twelve patients with heterotopic ossification in abdominal scars have been studied. Two patients were elderly females. Operative excision was required in seven: two for local symptoms, two for suspected local malignant recurrences and three for further intra-abdominal procedures. The other five instances were diagnosed roentgenologically. The mechanisms of formation of such lesions are not clear, but both the implantation and metaplasia theories may be correct.


The filtration limitations of ultrapore filters.

The filtration effectiveness of four commercially available microaggregate filters was determined using 14-day-old stored human blood in a constant infusion system. All filters significantly reduced the volumes of microaggregates contained in 500 ml. of blood. Three of the filters tested either occluded or failed to effectively remove microdebris from larger volumes of blood. These filters should be employed only for single blood transfusions. A fourth filter--of grid design--was effective in removing microdebris from 2,000 ml. of blood, the limits of the study. When employing microaggregate filters in massive transfusion situations for the prevention of pulmonary dysfunction, filtration characteristics and efficiencies of the filters employed must be known so that inadvertent administration of microdebris to the patient might be prevented.


Echinococcal cyst beyond the pulmonary sieve.

This is a presentation of 10 unusual cases of hydatid cyst beyond the pulmonary sieve. One of these cases has not been described previously. Some comments and a discussion are included.


Evaluation of blood filters: dynamics of platelets and platelet aggregates.

Microaggregates of platelets have been found in stored blood and in extracorporeal circulation systems and the potential microembolism of these particles intensely studied. Four currently available filters were studied for their filtration effectiveness of induced platelet microaggregates and for the removal of normal platelets from blood collected in acid citrate dextrose or heparin. Dacron wool filtration significantly (P less than 0.001) reduced aggregates in 13 to 80 mu sizes to a level similar to that in normal blood. In general, as filtration effectiveness increased so did the elimination of normal platelets.


Single donor, HL-A matched platelet transfusions for thrombocytopenic patients undergoing surgery.

Thrombocytopenic patients, who displayed hemostatic disorders and had been previously sensitized by repeated blood transfusions and/or pregnancies, were supported for surgical procedures by platelet transfusions obtained from a single ABO and HL-A matched donor by the use of continuous collection centrifugation. Because of the low incidence of HL-A identical donors, compatibility was assessed by known serological cross-reactivity of the HL-A determinants. In three cases repeated platelet transfusions had excellent in vivo survival, and sensitization could not be detected by a battery of immunological assays. In one case there was immune sensitization and refractoriness to repeated platelet transfusion, as documented by accelerated in vivo destruction of donor and third-party platelets bearing the disparate factor HL-A8. Although serologic tests for lymphocytotoxic and leukoagglutinating antibodies were negative, the patient displayed cellular immunity in leukocyte aggregation and cell-mediated plateletolysis tests. The single donor, continuous collection technique appears to have the technical advantage of rapid, efficient collection and the immunological benefit of a restricted spectrum of allosensitization.


Histometrical estimation of scar tissue in hypertrophied human heart muscle.

Histometrical estimation of scar tissue was made on 28 hypertrophied human hearts obtained at autopsy in order to know the significance of scar tissue in the process of cardiac hypertrophy and in the development of cardiac failure. Estimation was made on histological specimens of the anterior wall of the left ventricle and the posteromedial papillary muscle, according to Chalkley's point counting method, and the amount of scar tissue was expressed by percentages. The mean percentages were 4.6, 8.5 and 18.3 in the epicardial, endocardial part of the left ventricle, and the papillary muscle. There were very significant differences between these 3 mean percentages. There was a very significant correlation between the percentages of scar tissue in the endocardial part of the left ventricle and heart weight. There were no definite correlations between the percentages of scar tissue in the epicardial part or in the papillary muscle and heart weight. From these results, possible causes of scar formation and significance of scar tissue to the development of cardiac failure were discussed.


[On glycosaminoglycans (mucopolysaccharide) in a case of pulmonary fibrosis (author's transl)].

Glycosaminoglycans from a case of pulmonary fibrosis (desquamative interstitial pneumonia of usual type) was analyzed by means of proteolytic digestion, solvent fractionation, column chromatography on anion exchanger, electrophoresis and enzymatic digestion. The result suggested an increase in dermatan sulfate and possibly of heparan sulfate in the fibrotic lung as compared with the normal. It is preferable to take the samples for analysis from a freshly excised specimen of the lung, because there was a sign of degradation of glycosaminoglycan due to storage of the specimen in a solution of formalin.


External velour dacron grafts in renal artery reconstruction.

Aortorenal interposition grafts were performed in dogs using a new external velour knitted Dacron graft. Encapsulation and endothelialization of these grafts occurs as early as two weeks postoperatively. Complete healing is seen by six weeks, and the cellular lining of these grafts appears to be continuous with, and histologically similar to, the endothelium of contiguous arteries. The healed nonthrombogenic characteristics of this graft material represents a considerable improvement over graft materials of conventional design.


Morphological studies in tissues surrounding alloarthroplastic joints.

Histological, histochemical and ultrastructural studies were done on soft tissue surrounding alloarthroplastic joints. In 38 cases a prosthesis of the hip joint and in 2 cases of the knee had to be exchanged and replaced. In most of the cases the reoperation became necessary because the anchoring of the prosthetic parts in the bone loosened. Up to 18 months after the first operation infection was responsible for the malfunctioning in some cases. Other complications were luxation and material faults. The morphological changes are determined by the tissue reaction to the different alloplastic materials used and by the time interval they remained in the organism. The large polymerized acrylic cement particles are phagozytosed by multinucleated foreign body giant cells. About 12 months following the implantation of the artificial joints small double refractile particles appear and evoke characteristic morphological changes. The particles are abraded by the continuous friction of the moving alloplastic or metallic surfaces of the prostheses. Usually they are phagozytosed by histiocytes, which form large granulomas and undergo degenerative changes as is indicated by the ultrastructural and histochemical findings. These alterations are more pronounced and occur sooner in prosthesis with parts (rotation ball or cup.) fabricated by polyester than in those made by polyethylene. The abraded particles not only are transported to the inguinal lymphnodes, but also to the tissue between prostheses and bone, where they induce the same morphological changes as in the capsule. Hence the fibrous membrane separating bone and prostheses increases in width, and the spongy bone is partially destroyed by the proliferating histiocytes. It is assumed that by impairing the anchoring this foreign body reaction to the abraded alloplastic particles is the leading cause of the loosening of this kind of artificial joints.


[The left ventricle in chronic cor plumonale (author's transl)].

The volume of both ventricles was estimated in 25 hearts with chronic cor pulmonale. Also, the weight of the left ventricle, including the whole septum and the free part of the right ventricle, was determined to be 100 g. Distinct hypertrophy of the right ventricular part of the septum could be demonstrated in all cases. A weight increase of the left ventricle, including the whole septum, is frequently caused by the hypertrophic ventricular part of the septum. Th relative weight of the right ventricular portion )calculated according to Muller's method) was subtracted from the weight of the left ventricle plus the whole septum. After this weight correction, a hypertropyh of the left ventricle could only be demonstrated in cases with hypertension or renal arterio= and arteriolosclerosis. In one case of left ventricular hypertrophy, hypertension could not be ruled out. In most of the cases a distinct dilation of the left ventricle could be found. The highest degrees of dilation were found in patients with brohchiectases of the lungs. Our results indicate that the structural dialation of the left ventricle may be due to an increased shunt-volume by bronchopulmonary anastomoses.


[Combined chemotherapy in generalized lymphogranulomatosis].

The author presents an analysis of the results of the combination chemotherapy with natulan, vincristin, novembichine and prednisolone in 43 patients showing generalized lymphogranulomatosis, mainly with recurrences following radiation and chemotherapy with different antitumor substances. The results of the combination chemotherapy were compared with the data obtained in management of 94 patients having lymphogranulomatosis, stage III-IV, with natulan solely. It is shown that the combination therapy is effective, in principle, and provides an opportunity to gain objective remission in 65% of cases. A therapeutic effect of polychemotherapy depends on the administered total doses of the substances. A regimen consisting of no less than 5-6 cycles seems to be an optimum one, since it yields the greatest incidence and duration of remissions. As compared with the results of polychemotherapy in the fiven contigency of patients, natulan, used as a single tool of the specific therapy, shows a somewhat better effect.


[Dyanamics of ovarian tumor incidence].

The materials pertaining the morbidity in 1659 primary registered patients with malignant ovarian tumors in Kazakhstan during the period since 1967 to 1971 have been analyzed. It has been found that in the Republic, as a whole, an average number of over 330 patients with malignancies of different age, nationality and sites of residence are recorded annually. There was noted a quantitative difference in the morbidity among felamles of various national groups and between separate regions of the Republic, as well as in Alma-Ata City (19.6 per 100.000 females in 1970).


[Comparative study of the female genital cancer morbidity in the Georgian SSR, Latvian SSR and Kazakh SSR].

Within a period of 1966-1970 in the three republics according to standardized indices for 100.000 females cancer of the female genitalia was found in 42.32 (in Georgia--29.1; in Kazakhstan--43.02; in Latvia--54.85). Dynamically, there was noted a stabilization of indices on cervial cancer and growth in ovarian and, especially, endometrial cancer incidence. In dynamics there is an "ageing" of cancer of the female gentalia.


[Experience with prophylactic examinations of rural women for the detection of malignant neoplasms (based on data from the northern group of districts of the Udmurt ASSR)].

Difficulties in the organization of adequate prophylactic examinations have necessitated an application of the expedition method of examining the population by a team of specialists. This method has been used in North Regions of Udmurt ASSR, and since 1962 a total of 13425 females were examined, who shoed pathological changes in the genitalia in 41.3 of cases, cervical precancerous conditions--in 115.4, cervical cancer--in 0.71 and other affections--in 223.2 per 1000 females under investigation.


Studies on human adipose cells in culture: relation of cell size and multiplication to donor age.

In an effort to test the adipose hyperplasia theory of obesity in humans, adipose cells, derived from anterior abdominal walls of human infants and children, were grown in synthetic medium (McCoy's 5A Medium) supplemented with 20% fetal calf serum. Adipose cells which became delipidinized in culture were found to be capable of division and the rate and number of cell divisions was age dependent. Cells of infants under 1 yr of age and cells derived from early adolescent children divided to varying degrees in culture. Adipose cells from children aged 1-10 yr showed no cell division. Cell division was never observed in a lipid-laden adipocyte. Measurements of cell diameter showed that after the first year of life, cell size increased progressively with age. During the first year adipose cell size appeared to reflect the rapid hyperplasia of the first 3 mo, reaching smallest size at 3-12 mo but increasing thereafter.


[Observations on the Prune-Belly syndrome].

5 Male children exhibiting the typical features of the Prune-Belly syndrome (malformations of the urogenital tract, aplasia of abdominal muscles) are described. Two of these are deaf. This syndrome has also been observed in a few females. Final interpretation of the cause and pathogenesis cannot yet be given. In two siblings with defects of the abdominal muscles an contractures of the joints, but without renal anomalies, a new and hitherto undescribed hereditary syndrome seems to be present.


[Dental findings in children with hearing disorders].

Tooth findings are reported of 972 children aged between 3 to 18 years who suffer from impaired hearing. Logopedic pupils had significantly more tooth anomalies than those with impaired and normal hearing. The deaf pupils had significantly less dysgnathias than others with impaired hearing. As compared to those with normal hearing there was no significant difference.


Mortality and life-table in Down's syndrome.

The causes of death in 130 patients with Down's Syndrome and mortality rates from a material of 524 patients were tabulated; a life-table for the ages over 5 years was constructed. An overall death rate of 5-7 times the general population rate was found. No sex difference was observed. The excess mortality was expecially high for heart disease and respiratory disease. Also infectious diseases, others than pneumonia and tuberculosis, showed high mortality rates.


Ball valve prostheses: current appraisal of late results.

Advanced actuarial techniques are used to analyze late results in 912 patients who had isolated mitral or aortic valve replacement with ball valve prostheses from 1965 to 1974. Experience with noncloth-covered and cloth-covered valves is compared in terms of late survival, rate of thromboembolic complications and reoperation and the influence of anticoagulation. The cloth-covered prostheses have substantially reduced the incidence of emboli after mitral valve replacement (1.9 vs. 6 emboli per 100 patient years) and have thus far eliminated emboli after aortic valve replacement in patients receiving warfarin. Patients with a cloth-covered aortic valve who did not receive warfarin had nine emboli per 100 patient years. The safety of cloth-covered valves is clearly enhanced by warfarin therapy; the efficacy of anti-platelet drugs is still uncertain. Strut cloth wear was found at reoperation in 10 patients. This should be prevented in the new model 2400 composite strut ("track") valve by a narrow metal track on the inner surface of each strut. The substantial recent reductions in operative mortality and in prosthesis-related complications pose important questions regarding timing of operations and selection of prostheses. These decisions must be individualized for each patient on the basis of a thorough analysis of late results using modern statistical methods.


Current status of the Beall, Bjork-Shiley, Braunwald-Cutter, Lillehei-Kaster and Smeloff-Cutter cardiac valve prostheses.

The Starr-Edwards ball valve prosthesis is generally the standard by which other cardiac valve substitutes are compared. This report reviews information pertaining to several prostheses--the Beall mitral valve and the Bjork-Shiley, Braunwald-Cutter, Lillehei-Kaster and Smeloff-Cutter aortic and mitral valves--considered by some to have specific advantages over the Starr-Edwards valves. Hospital and late mortality rates after valve replacement are comparable for the four aortic valve prostheses reviewed and depend more on patient selection than on the specific prosthesis utilized. Extensive clinical experience with the Bjork-Shiley aortic valve indicates that this prosthesis offers hemodynamic advantages over ball valve prostheses, especially in patients with a small aortic root. Clinical experience with the Lillehei-Kaster pivoting disc prosthesis has been less extensive, but this model provides theoretical hemodynamic advantages similar to those of the Bjork-Shiley aortic valve prosthesis. Problems associated with cloth wear and the unexpectedly slow rate, in man, of tissue ingrowth into the fabric of the Braunwald-Cutter aortic valve prosthesis have been discouraging, although this prosthesis has been associated with a very low thromboembolic rate in patients receiving anticoagulant therapy. The Smeloff-Cutter aortic prosthesis is hemodynamically similar to the Starr-Edwards prosthesis and has been proved to be a reliable and durable aortic valve substitute over the past several years. Mortality after mitral valve replacement is also largely influenced by factors other than prosthetic valve design. On the basis of postoperative data, the five mitral valve prostheses reviewed do not appear to have substantial hemodynamic differences. For patients with a small left ventricular cavity the low profile prostheses, such as the Beall, Bjork-Shiley and Lillehei-Kaster, may be advantageous. Most available evidence indicates that patients receiving aortic or mitral valve prostheses should be given anticoagulant therapy postoperatively.


The effect of adrenaline on acetylcholine synthesis, choline acetylase and cholinesterase activity. Acta Physiol. Pol. 1975, 26 (1): 45-54. The purpose of the study was to assess the participation of adrenaline in the processes of acetylcholine synthesis and breakdown in white rats. After intraperitoneal administration of adrenaline the content of acetylcholine in the tissues (brain, stomach, sciatic nerve, lumbar spinal cord) initially, slightly decreased, increased in the 30th, 60th, and 120th min, and then fell again below the initial value after 240 min. The rise in acetylcholine tissue content after administration of adrenaline seems to be due to its increased synthesis. This was also confirmed by in vitro investigations. The fall in the tissue acetylcholine content was associated with reduced synthesis of acetylcholine in the cerebral cortex. The increase in acetylcholine synthesis in the brain tissue after adrenaline given in vitro and in vivo does not seem to be caused by activation of choline acetylase. The activity of cholinesterase in the brain was not changed after adrenaline administered in vivo and in vitro.


Intramyocardial pressure: effect of preload on transmural distribution of systolic coronary blood flow.

Impairment of systolic coronary blood flow (CBF) may be mediated by intramyocardial pressure (PIM). However, the effect of systole on the magnitude and transmural distribution of coronary blood flow has not been investigated. The purpose of this study was to measure this effect, and, indirectly, intramyocardial pressure. It is assumed that intramyocardial pressure acts on the coronary vessels as a Starling resistor, such that local coronary blood flow is determined by the equation: Coronary perfusion pressure minus intramyocardial pressure equals resistance times coronary blood flow. This equation was integrated with respect to time and solved simultaneously for intramyocardial pressure and resistance by measuring regional coronary blood flow (radioactive microsphere technique) during maximal coronary vasodilatation in two states: beating and hypocalcemic diastolic arrest. Measurements were made in 7 to 16 concentric layers of the left ventricle of 16 dogs. Intramyocardial pressure ranged from near zero to twice peak left ventricular pressure. The transmural distribution of intramyocardial pressure and systolic coronary blood flow depended on preload. The transmural distribution of the ratio of intramyocardial pressure to coronary perfusion pressure was not significantly different from unity across the left ventricular wall at low levels of preload (0 to 4 mm Hg). At moderate to high levels of preload (7 to 35 mm Hg) this ratio was not different from unity (mean 1.03 and 0.96) in the two inner fifths of the left ventricular wall, but was significantly lower (mean 0.79, 0.64 and 0.41, respectively) in the middle and two outer fifths. These data show that intramyocardial pressure shuts off systolic coronary blood flow across the entire left ventricular wall at low levels of preload, and at high levels of preload determines a gradient of decreasing systolic coronary blood flow from the subepicardium to zero in the subendocardial layers. This finding suggests that a dilated or failing left ventricle receives systolic flow to the outer myocardial layers, whereas at low preload levels myocardial perfusion occurs entirely during diastole.


Follow-up studies of World War II and Korean war prisoners. II. Morbidity, disability, and maladjustments.

US Army veterans taken prisoner (POW's) in World War II and in the Korean War are compared with controls as to hospital admissions from 1946 to 1965 (1954-1965 for Korean War POW's), and as to symptoms, disability, and maladjustments in 1966-1967. Sequelae of the POW experience are both somatic and psychiatric, and are of greatest extent and severity among Pacific World War II POW's. Among European World War II POW's only psychiatric sequelae are apparent. Somatic sequelae were most prevalent in the early years after liberation, but for Pacific World War II POW's they persist in the form of higher hospital admission rates for many specific causes in the most recent period. Nevertheless, persistent psychiatric sequelae (especially psychoneurosis but also schizophrenia) are the more notable and pervasive for both Pacific World War II POW's and Korean War POW's as seen not only in elevated hospital admission rates but also in VA disability awards and in symptoms reported on the cornell Medical Index Health Questionnaire. The excess morbidity appears to correlate well with retrospective accounts of weight-loss and nutritional deficiency diseases and symptoms during the POW period.


Sudies in simpler tubocclusion methods.

This report reviews animal and human studies undertaken to develop simpler, safer, and more acceptable methods of female sterilization. Animal studies revealed inadequate prevention of pregnancy by tubocclusive methods from within the uterus, and the laparoscopic route was chosen. A series of clips were evaluated, and a clip was designed which would have a spring load, be wide enough to cause true tissue necrosis, have a firm grip on the tube to prevent dislodgement, and have a smooth external surface. Extensive human trials of the clip and applicator have resulted in over 1,000 patients with clips applied by 27 physicians in 10 centers throughout the world. Six pregnancies appear to have been due so far to application onto structures other than the isthmic portion of the tube. Complications due to the clip itself appear to be minimal, and the feasibility of performing this operation under local anesthesia in a hospital facility other than the operating room is currently under evaluation.


Play as occupation: implications for the handicapped.

That play is a need-fulfilling and appropriate occupation in the life of every person, and particularly in the life of the handicapped, is the basic assumption of this paper. Play is defined, characterized, and discussed in relationship to its role in the treatment process. Various classical and modern theories of play are presented, with the optimum arousal theory of play presented as most significant in the rehabilitation process of the handicapped individual. The approach to this assumption is basically theoretical, and concludes with pragmatic suggestions for optimizing the meaningful involvement of patients in play.


Cardiac tamponade in myxedema.

Pericardial effusions are frequently found in myxedema and , when present, are asymptomatic and usually of no hemodynamic consequence. We report a patient with ascites and pericardial effusion due to myxedema who developed cardiac tamponade following abdominal paracentesis. This case emphasizes that treatment of patients with myxedematous chronic pericardial effusions should include avoidance of those measurements which may reduce venous filling pressure or effective cardiac output regardless of the thyroid status.


Mithramycin effects on calcium, phosphorus and parathyroid hormone in osseous Paget's disease.

Six patients with symptomatic osseous Paget's disease were treated with a four-day course of mithramycin (25 mug/kg/day). The effects of treatment on the plasma calcium, phosphorus, parathyroid hormone, and the urinary fractional clearance of calcium and phosphorus were studied. Mithramycin produced significant hypocalcemia and hypophosphatemia, and also significantly and simultaneously increased the plasma parathyroid hormone concentration. Despite the increase in parathyroid hormone, the hypocalemia persisted because of the probable blocking effect which mithramycin exerted on the osteoclasts. The physiological response of the kidney to the elevated plasma parathyroid hormone appeared to be well preserved, as evidenced by the decreased fractional excretion of calcium and the increased fractional excretion of phosphorus in the urine; however, the fall in the clearance of calcium could be the result of the decreased filtered load.


Melanotropic activity in extrahypophyseal regions of rodent brain: effect of age, hormones, and drugs.

Two or more melanotropic peptides are present in extrahypophyseal regions of mammalian brain. Previous studies showed that extrahypophyseal melanotropic activity is not influenced by hypophysectomy, adrenalectomy, or exogenous glucocorticoid. The present study investigated the possible influence of the following factors on the level of melanotropic activity in whole brain, cerebral cortex, cerebellum, midbrain, and brainstem of mouse and rat: age, sex, starvation; and of the following hormones or drugs administered by the intraperitoneal or intracerebral route: norepinephrine, dihydroxyphenylalanine, pargyline, 6-hydroxy-dopamine, alpha-methyltyrosine methyl ester, reserpine, acetylcholine, pilocarpine, atropine, serotonin, p-chlorophenylalanine, pentobarbital, pentylenetetrazol, insulin, melatonin, and cycloheximide. Only age influenced extrahypophyseal melanotropic activity. The activity per unit of tissue wet weight or of tissue protein increased in all regions progressively from birth to 1 yr of age. Extrahypophyseal melanotropic activities perunit wet weight of tissue at 50 wk averaged 4.3 times those at birth. When brain of adult rodents was fractionated by differential centrifugation, the major proportion of melanotropic activity was recovered in myelin (27-35 percent), nerve endings (20-22 percent), and mitochondria (25-30 percent). The lower activity in newborn brain resulted not onlyfrom absence of a myelin fraction, but also from lower activity at birth in nerve endings and mitochondria.


Proteolytic enzymes as adjuncts to antimicrobial prophylaxis of contaminated wounds.

When a tissue is injured, its vessels exhibit a marked increase in vascular permeability. Blood proteins, including fibrinogen, traverse the vessel walls and lead to the development of a surface coagulum. This inflammatory response continues until primary closure of the wound edges is accomplished. The thickness of the surface coagulum is roughly proportional to the time interval between wounding and closure. This coagulum encompasses the surface contaminants, preventing contact with either topical or systemic antibiotics. The presence of this surface coagulum limits the time in which antibiotic prophylaxis is effective. At three hours after injury, antimicrobial prophylaxis of contaminated wounds has no therapeutic value. Hydrolysis of the protein coagulum by proteolytic enzymes enhances the activity of the antibiotic in experimental wounds. The success of proteolytic enzymes as adjuncts to delayed antibiotic treatment can be correlated with the clot lysis activity of the enzymes in vitro. Travase, the most potent fibrinolytic enzyme, is the most effective adjunct to delayed antibiotic therapy of contaminated wounds. In contrast, the active enzymes found in Elase, which exhibit no significant clot lysis activity in vitro, do not potentiate the activity of antibiotics in wounds subjected to a delay in treatment. Travase prolongs the period of effective topical antibiotic action for at least eight hours in experimental contaminated wounds. The therapeutic merit of Travase is also apparent when the antibiotic is administered systemically. Travase shows promise as an adjunct to a variety of antibiotics that are effective against both gram-positive and gram-negative organisms. The results of these experimental studies support our belief that clinical studies support our belief that clinical studies should now be initiated to test the therapeutic value of Travase as an adjunct to antibiotics in heavily contaminated wounds subjected to an unavoidable delay in treatment.


Evaluation of prosthetic grafts of different porosity for arterial reconstruction.

Autogenous jugular veins and Dacron grafts of different porosities were implanted as short bypass grafts around ligated femoral arteries in the dog. Patency rates for periods up to eight months were: vein, 79 per cent; DeBakey Dacron (lowest porosity), 39 per cent; Wesolowski Weavenit (imtermediate porosity), 56 per cent; high porosity Dacron, 8 per cent. The failure of sixteen of the twenty-four high porosity grafts was related to perigraft hematomas that occurred two to seven days after operation and later thrombosis. The higher the porosity of the graft, the better the healing pattern as evidenced by fibrous bonding of the inner and outer linings of the grafts through the interstices. In the spectrum of grafts with increasing porosity there is apparently an optimal porosity beyond which late bleeding counterbalances the better healing properties of the higher porosity graft.


Hemangioma of the liver. Diagnosis with combined use of laparoscopy and hepatic arteriography.

A case of hepatic hemangioma is reported in which preoperative diagnosis, with the combined aid of serial selective hepatic arteriography and laparoscopy, was necessary. The patient underwent right hepatic lobectomy after extensive extrahepatic individual ligations with no severe postoperative complications. The combined use of selective hepatic arteriography and laparoscopy is emphasized as essential for the correct diagnosis of hepatic hemangioma.


[Clinical, electron-microscopic, and histochemical investigations of conjunctivitis lignosa (author's transl)].

A case is briefly described in which a typical conjunctivitis lignosa appeared after the eye had suffered lime burns. In order to help clarify the morphological connection between mucopolysaccharide production and fiber development in the tumor tissue which occurred after the burn, samples were examined histologically, histochemically and with the use of the electron microscope. The tumor had a cartilage like consistency. Its structure could be devided into three regions. Region A is the pseudo-membrane. It has root like extensions which anchor it to the underlying tissue, and which morphologically appear partially homogeneous and partially fibrous. Blood cells and cell remnants are included in the tissue of the pseudomembrane. The histochemical examination of the pseudomembrane did not present a uniform picture. Along with small amounts of dermatan-sulfate and chondroitin-sulfate B the membrane probably contained a rather large amount of hyaluronic acid. The pseudomembrane borders on a granular tissue (Region B) which is distinguished by the wide metachromatic sheathes of the blood vessels found in it and the particularly large number of active fibroblasts along its edges. The silver impregnation method and the electron-microscopic examination showed that the vascular sheathes consist of bundles of reticular fibers which constitute a three-dimensional network. A similar sort of sheath was observed around the fibroblasts. Chondroitin-sulfate makes up the largest fraction of the mucopoly-saccharides near the fibers and appears particularly concentrated at the intersections of the fibers, although it is also diffusely distributed as well. Dermatan-sulfate (or heparan-sulfate) is found only in the mucopolysaccharide sheath of the fibers themselves. The deep region of the tumor (Region C) consists almost exclusively of blood vessels, their sprouts and the fibroblasts which, with their wide fibrous sheathes, almost fill the spaces between the blood vessels. The reticular fibers and their mucopolysaccharide sheathes have the same structure as that observed in Region B, The fact that the mucopolysaccharides did not appear in plaques but rather as bound primarily to the fibers is grounds for suggesting that a fiber development disorder, probably stemming from the pericytes and fibroblasts rich in ergastoplasm and fibrilles, could play the principle role in conjunctivitis lignosa. The cartilagen like consistency of the tumor could be a result of the arrangement of the fibers and their mucopolysaccharide sheathes. Brief remarks are included concerning the therapeutic consequences of the study.


Elective postoperative I.P.P.V. for extensive head and neck skin grafting.

Patients with extensive skin-grafting of the head and neck are managed for the first 24-48 hours postoperatively in the Intensive Care Unit with muscle paralysis, controlled ventilation, timed parenteral analgesia and sedation. The aims are to provide full immobilization of the graft and to allow pressure dressings without embarrassment to the airway. The regime is suggested as an added indication for intensive care therapy.