Effects of combining static and dynamic fusimotor stimulation on the response of the muscle spindle primary ending to sinusoidal stretching.

1. A pair of fusimotor fibres, one static and the other dynamic, were stimulated simultaneously to test their combined action on the response of muscle spindle primary endings in the cat soleus to sinusoidal stretching. A frequency of 1 Hz was chiefly used, with a wide range of amplitudes (10 micronm-2 mm). The response of the ending was assessed from the parameters of the sine fitted to its firing averaged throughout the course of the cycle; this was felt useful even though the responses to the larger stretches showed certain non-linear features. 2. With small stretches (up to about 50 micronm amplitude) static action dominated, and the modulation of firing during conbined stimulation was little or no larger than that found during the static stimulation on its own, and much smaller than that found during the static stimulation on its own, and much smaller than that found during the dynamic stimulation. The phase of the response was, however, much the same for all three conditions. 3. With larger stretches the modulation with combined stimulation was intermediate between the values found on stimulating either fusimotor fibre on its own; the dynamic contribution increased progressively with the amplitude of stretching. 4. With larger stretches the phase of the response during combined stimulation was appreciably closer to that for static action than to that for dynamic action. But the differences between the various conditions were small (below 20 degrees) and seem attributable to various distortions of the response wave from away from a true sinusoid, rather than betokening a difference in the ratio of velocity to length sensitivity under the various conditions. This view was supported by the effects on phase of grading the rate of stimulation of one fusimotor fibre while holding that of the other constant. 5. Detailed comparison of the cycle histograms obtained under different conditions showed an interestingly asymmetrical pattern of summation and occlusion of the effects of the two kinds of fusimotor fibre. At the peak of the response to a large stretch static action summed with dynamic action, which was here the stronger, so that at this phase of the cycle the firing was greater with the combined stimulation than with either fibre on its own. But, in the trough of the response to the same stretch static action occluded any dynamic action, which was now the weaker, so that at this phase of the cycle the firing with combined stimulation was virtually the same as that with static stimulation on its own. With a small stretch, static action normally occluded dynamic action throughout the cycle; this is in line with the firing during static action now usually being greater than that during dynamic action for all phases of the cycle.


Release of adenosine triphosphate from isolated adult heart cells in response to hypoxia.

1. Adult rat heart cells were isolated enzymically and ATP was identified in the cell suspension using the firefly luminescence technique. Adenosine 5'-triphosphate (ATP) was not detected from cell suspensions obtained from hearts which had been left asystolic for 10 min.2. It was found that ATP 0.34 +/- 0.22 muM/mg protein was released by cells kept in an oxygenated condition, while ATP 1.28 +/- 0.41 muM/mg protein was initially released by cells made hypoxic.3. Addition of Ca(2+) in a concentration of 2 mM caused cells to initially extrude ATP 0.40 +/- 0.14 muM/mg protein. This was attributed to an inotropic effect.4. Extracellular ATPase activity in the fluid suspension was partially characterized, giving a K(m) of 13 muM and a V/2 of hydrolysed ATP 18.3 muM/min at 37 degrees C. Q(10) was found to be 4 between 25 and 37 degrees C. Enzyme activity remained unaffected by either hypoxic conditions or ouabain.5. If these amounts of ATP are released from myocardial cells rendered hypoxic in vivo, then it must be concluded that ATP plays a principal role in the local control of myocardial blood flow.6. It is proposed that release of ATP occurs through the sarcolemma from an intracellular pool, and that alteration of the configuration of structural membrane protein controls the amounts of ATP extruded.


Ia afferent activity during a variety of voluntary movements in the cat.

1. Implanted dorsal root electrodes were used to record discharge trains of single spindle primary afferents (Ia's) of the cat's hind limb during different types of movement.2. The length of the ipsilateral ankle extensors was continuously monitored by an implanted length gauge. Length changes occurring during active stepping were subsequently passively reproduced during brief anaesthesia.3. A comparison of the Ia responses in active and simulated step cycles revealed that moderate fusimotor drive to ankle extensor spindles probably occurred mainly, if not exclusively, during the E(1), E(2) and E(3) phases of active stepping.4. A temporal advance in the Ia response to passive stretching in the F-phase was attributed to the after-effects of fusimotor activity in the extension phases.5. Light thrust applied to the animal's back evoked a potent fusimotor response. This load compensation effect may provide an explanation for the apparently higher degree of alpha-gamma co-activation seen in the mesencephalic locomotor preparation.6. Ankle extensor Ia discharge decreased during falls, despite an increase in extensor e.m.g. This is seen as a clear example of independent alpha and gamma control.7. Placing reactions during walking were consistent with the notion that cutaneous inputs dominate over proprioceptive inputs in these movements.8. alpha and Ia discharge during paw-shaking showed many of the characteristics of that in decerebrate and spastic clonus. The present results suggest that movements resembling clonus may be part of the animal's normal repertoire.9. Isometric co-contraction of agonists and antagonists was found to involve alpha-gamma co-activation.10. Hamstring Ia discharge behaviour during stepping further highlighted the increases in firing rate which normally occur during passive muscle stretching in ;pre-programmed' movements.


The value of laparoscopy in general surgery.

Fifty-six general surgical patients were evaluated by laparoscopy, primarily for diagnostic problems, ascites or liver assessment for potential metastatic disease. There was minimal morbidity and no mortality from the procedure. Overall laparoscopic accuracy was 87%. In properly selected cases, laparoscopy can often resolve a diagnostic problem, determine the extent of disease and permit initiation of appropriate therapy.


Laparoscopic sterilization with spring-loaded clips: double-puncture technique.

The application of a spring-loaded clip to each fallopian tube using a second-incision clip applicator is a safe and effective method of laparoscopic sterilization. The operation is quick and easy to perform and is suitable for use with local anesthesia. The method avoids the dangers of hemorrhage, for the clip only alters 3 mm of the fallopian tube and does not transect the tube or mesosalpinx. No pregnancies have followed the sterilization procedure. An intrauterine pregnancy has occurred after a reversal procedure in one patient.


The snare method of laparoscopic sterilization: an analysis of 1,000 cases with 4 failures.

The snare method has proven to be an effective method of tubal resection for sterilization. In the most experienced hands, significant complications are indeed rare. However, the failure rate appears to be higher than that of the coagulation-alone method, at least in the postabortal patient. The necessity for pathologic confirmation, a tradition of surgery, is critically questioned. Additional coagulation of the tubal ends after resection is now recommended, especially in the patient seeking abortion as well as sterilization. The authors await the comparative long-term results of bipolar forceps and the newer mechanical methods of laparoscopic tubal sterilization. It is conceivable that the snare and other unipolar electrosurgical instruments designed for female sterilization will become obsolete.


The use of laparoscopy to determine the results of chemotherapy for ovarian cancer.

The chemotherapeutic management of patients with epithelial tumors of the ovary is hampered by a lack of diagnostic tests that are sufficiently sensitive for detecting residual or recurrent tumor. At the completion of a chemotherapy program, direct visualization of the peritoneal cavity is necessary to accurately assess the amount and location of residual tumor. Laparoscopy, with visually directed biopsies of residual tumor masses, can spare some patients a laparotomy and yet provide a safe and easy route for assessment of intraabdominal disease. If residual tumor is not seen at laparoscopy, than laparotomy with multiple peritoneal biopsies must be done so that residual tumor will not be missed and chemotherapy prematurely stopped. Laparoscopy is not an alternative to "second look" laparotomy but is a useful adjunct for determining the presence of resectable, unresectable or diffuse disease after chemotherapy.


Laparoscopic sterilization as an outpatient procedure.

Since June 1972, more than 2,000 laparoscopic sterilizations have been performed as outpatient procedures using neuroleptanalgesics. Electrocoagulation, spring-loaded clips or tubal rings were the methods used for tubal occlusion. All laparoscopies were performed in a family planning clinic. The surgical facilities were minimal and did not include general anesthesia equipment or a blood bank. The nearest hospital was about one-half mile from the clinic. The procedures were performed by a physician assisted by two paramedical personnel and a technician. Patients were scheduled to be at the clinic on the morning of the procedure and were discharged three to six hours after the procedure. Only one patient required hospitalization for treatment of a complication: her aorta was punctured during placement of the Tuohy needle. The patient was admitted to a local hospital and underwent laparotomy for repair; her subsequent recovery was uneventful. No bowel or bladder burns have occurred. Minor complications (emphysema of the abdominal wall, bleeding from the tubes, infections) have occurred in less than 4% of the patients. The results of this study indicate that laparoscopy in an outpatient clinic is safe and presents minimal additional risks to the patient if the surgeon is experienced.


Diagnostic laparoscopy from the pathologist's viewpoint.

In conclusion, laparoscopy provides an easy approach to the diagnosis of various intraabdominal diseases. Because biopsy specimens are often small, adequate sampling is essential for accurate diagnosis. It is important for the laparoscopist to understand the basic pathologic anatomy of the diseases under consideration in order to provide the pathologist with adequate diagnostic material. The use of special techniques, including electron microscopy, may be helpful in establishing specific diagnosis in selected difficult cases.


The scope and limitations of laparoscopic ovarian biopsy in the diagnosis of secondary amenorrhea.

Laparoscopically directed ovarian biopsy has been evaluated in 39 cases of secondary amenorrhea. The definite diagnosis was achieved in 29 cases. In 10 cases, ovarian histopathology alone was insufficient, and the estimations of gonadotropins were essential for the final diagnosis. The scope and limitations of this procedure for the differential diagnosis of premature ovarian failure and hypothalamic-pituitary lesions are discussed.


Cardenolide analogues. 2. 22-Methylenecard-14-enolides.

22-Methylene-3beta-hydroxy-5beta,20(S)-card-14-enolide (11) and 22-methylene-3beta-hydroxy-5beta,20(R)-card-14-enolide (12) were synthesized from digitoxin (1). Attempts to prepare the 14beta-hydroxy-22-methylene analogues were unsuccessful. The 20(R) isomer (12) was found in Na+, K+-ATPase inhibition studies to be twice as active as 14-dehydrogitoxigenin (17). The 20(S) isomer (11) was significantly less active than 17. The hydrolysis of steroid 3beta-tert-butyldimethysilyl ethers was also found to be much more difficult than with nonsteroids.


Microbial transformations of natural antitumor agents. 3. Conversion of thalicarpine to (+)-hernandalinol by Streptomyces punipalus.

Microbial transformation studies were conducted with the antitumor alkaloid thalicarpine. Streptomyces punipalus (NRRL 3529) converted thalicarpine to (+)-hernandalinol, the structure of which was determined spectroscopically and by synthesis from the known alkaloid hernandaline. This unusual biotransformation reaction most likely occurs by oxidative cleavage of the isoquinoline ring from thalicarpine through the intermediate hernandaline, which then undergoes further reduction to hernandalinol.


Response of hematopoietic cell lines derived from patients with Down's syndrome and from normal individuals to mitomycin C and caffeine.

Eight human hematopoietic cell lines, five derived from blood of patients with Down's syndrome (DS) and three from normal persons, were treated with mitomycin C (MC) and caffeine at various dose levels and for various durations. An increased rate of chromosome aberrations was found in all treated cultures. The extent of aberrations was correlated with the dose levels and duration; no difference occurred in sensitivity between the group of DS and normal lines at all dose levels and for all durations. Studies on the effect of MC severely reduced cell viability, but no difference was found in the rate of reduction of viable cell counts between DS and normal lines. Inhibition of mitoses by MC in DS lines, however, seemed stronger than that in normal lines.


Falsely negative Doppler examinations in testicular torsion.

Use of the Doppler ultrasonic flowmeter to assess testicular perfusion has potentially precise application in the evaluation of acute scrotal swelling. Recent reports suggest an almost infallible degree of accuracy in differentiating testicular torsion, with reduced or absent blood flow, from inflammatory processes, with accompanying increased vascular perfusion. This report of 4 falsely negative Doppler examinations confirmed by surgical exploration warns against relying on this as a single test in the diagnosis of testicular torsion. Only thorough clinical assessment of each patient and exploration in doubtful cases will assure maximum testicular salvage.


Sign of Leser-Trélat.

We report a case of squamous cell carcinoma of the lung associated with the sudden appearance of seborrheic keratosis and acquired ichthyosis. We conclude that the sign of Leser-Trélat is a rare cutaneous manifestation of internal malignant disease.


Thrombotic thrombocytopenic purpura-like syndrome associated with infective endocarditis. A possible immune complex disorder.

A thrombotic thrombocytopenic purpura (TTP)-like syndrome was the chief presenting feature in two patients with infective endocarditis. Clinical and laboratory aberrations of the syndrome were rapidly reversed by specific antimicrobial therapy. Hypocomplementemia and high levels of circulating immune complexes were detected initially in both patients. Because these returned to normal as the TTP syndrome abated, an immunopathologic mechanism may have been operative.


Echocardiographic left ventricular volume determination by direct measurements of the major and minor axes.

Major and minor axes of the left ventricle were measured by single beam echocardiography in ten cardiac patients and the measurements and calculated volumes by formula V=pi/6 D2 were compared with the angiocardiographic estimates. There was a favorable correlation between echocardiographic and angiocardiographic major axis dimention (r=0.79), left end-diastolic volume (r=0.96), and ejection fraction (r=0.81). On the contrary, left end-diastolic volume calculated by formula V=D3 was less correlated with angiocardiographic estimates (r=0.93) and the former had a tendency to overestimate the volumes where D exceeded 6.5 cm. These data indicate that in cases with markedly enlarged left ventricle, the use of formula V=pi/6 D2L is a more accurate predictor of volumes than formula V=D3.


Intracardiac flow dynamics with bi-directional ultrasonic pulsed Doppler technique.

1) Intracardiac flows were investigated by bi-directional pulsed Doppler technique with a combined use of the two-dimensional echocardiography. The flow at sampling sites in the heat and great vessels were correctly identified on the two-dimensional echocardiograms. 2) Soundspectrographic analysis of the flow Doppler signals was useful in obtaining information about flow modes and in differentiating flow signals from those of valves. 3) In healthy subjects, intracardiac flow revealed a laminar mode. As a matter of interest, a flow toward the aorta, which is a cranially turned flow, was found at the center and at the outflow tract of the left ventricle from mid to late diastole. 4) In mitral stenosis, the central stream at the stenotic portion exhibited an almost laminar and rapid flow. A good coincidence in flow mode was observed between clinical cases of mitral stenosis and experimental stenosis. 5) Disturbed flows were observed in the following diseased conditions. The diastolic regurgitant flow in the left ventricular outflow tract and mitral inflow in aortic regurgitation, the regurgitant flow into the left atrium and the diastolic mitral inflow in mitral regurgitation, the ejection flow in hypertrophic cardiomyopathy with outflow tract obstruction, and the tricuspid inflow in atrial septal defect. 6) Mechanisms of intracardiac flow dynamics were also discussed.


Intervertebral disc space infection: another low back syndrome of the young.

Pyogenic disc space infection is a rare and unappreciated cause of low back pain. Reported herein is a young man with chronic low back pain and the HLA-B27 antigen which initially led to the diagnosis of ankylosing spondylitis. However, serial lumbar radiographs and bone scan established an inflammatory lesion involving the L2-L3 intervertebral disc space, and persistently normal sacroiliac joints. A needle biopsy and culture of the disc space yielded Staphylococuss aureus. Treatment with antibiotics, bed rest and back bracing resulted in a complete resolution of symptoms and healing of the vertebral lesion. It is the purpose of this report to review the clinical, laboratory and radiographic features of intervertebral disc space infection as well as pitfalls in its diagnosis.


[Angiocardiographic and vectorcardiographic findings in Noonan's syndrome (author's transl)].

The angiocardiographic and vectorcardiographic findings in 18 patients with Noonan's syndrome are presented. The excentric hypertrophy of the left ventricle affecting the superior portion of the anterior wall, the posteroinferior portion and the septum was primarily investigated. The predominant lesion was left ventricular deformity. In one case only a hemodynamic burden was caused by the excentric hypertrophy. It could be demonstrated that angiocardiographically and vectorcardiographically differentiation between idiopathic hypertrophic subaortic stenosis and excentric hypertrophy in Noonan's syndrome is impossible. A good correlation however, existed between the morphological structures and the angiocardiographic aspect as well as the vectorcardiographic findings. If hemodynamic burden of the left ventricle is present, identical therapy is proposed for Noonan's syndrome as for idiopathic hypertrophic subaortic stenosis. Left heart catheterization is therefore indicated to prove excentric hypertrophy.


Lymphoblastogenesis inhibitory factor produced by human lung cancer cell lines.

A comparative study of the inhibitory effect of cell-free supernatants (CFS) from human lung cancer cell lines (ChaGo and PC-1) and from a human embryo fibroblast cell line on lymphocyte blastogenesis indicated that both lung cancer cell lines produce a large amount of the inhibitory factor while the production of such a factor from a control noncancer cell line is essentially very minimal or absent. The inhibitory effect of CFS of the lung cancer cell lines is not due to direct cytotoxicity. The inhibitory effect is found to be partially sensitive to heat treatment. A significant inhibition is still seen, even when the CFS of the lung cancer cell lines were present for 1 hour prior to the addition of phytohemagglutinin (PHA).


Reconstruction of sternal and abdominal wall defects in a case of desmoid tumor.

A case of desmoid tumor of the anterior chest and abdominal wall is presented. The entire body of the sternum along with the upper abdominal wall and inner parts of both breasts was resected. The resulting defect over the pericardium and abdomen was reconstructed by the omentum and Marlex mesh. The large skin defect was covered by bilateral thoracoabdominal tube pedicles. The patient had a stable chest wall with uncompromised respiratory function 1 week after the operation. Prevention of local recurrences of desmoid tumors requires wide excision of the involved soft tissues and bony structures. The principles of wide resection of soft tissue tumors, reconstruction of the anterior chest and abdominal wall defects, and planning the skin coverage over the resulting defect are discussed.


Long-term survival after tricuspid valve replacement. Results with seven different prostheses.

The experience with tricuspid valve replacement (TVR) with seven different prostheses, alone or combined with replacement of other valves, in 73 patients (64 rheumatic and nine nonrheumatic) between 1964 and March, 1975, at the University of Alberta Hospital has been reviewed. Early and late mortality rates in rheumatic patients were 41 and 23 percent, respectively (36 percent being alive after a mean of 5.6 years), compared to 33 and 11 percent, respectively, in the nonrheumatic patients (56 percent being alive after a mean of 2 years). Of all survivors, 88 percent were functionally improved. Among the rheumatic patients: (1) 88 percent had organic tricuspid disease; (2) of the 39 patients with tricuspid insufficiency who underwent corrective mitral surgery 7 years before TVR, the tricuspid insufficiency had progressed over the 7 years; (3) the number of patients with tricuspid insufficiency had increased (39 versus 59) over the same 7 year period; (4) a high early mortality rate was encountered in those who were preoperatively in New York Heart Association (N.Y.H.A.) Class IV, or who had cardiomegaly, or pulmonary hypertension, or poor ventricular function, or organic disease, or reoperation; (5) the percentages of survivors with different prostheses were: Starr-Edwards, 31 percent; Beall-Surgitool, 14 percent; Kay-Shiley, 46 percent, Björk-Shiley, 50 percent; Lillehei-Kaster, 100 percent; Cutter-Smeloff and Wada-Cutter, nil. Among the nonrheumatic patients, two with the Cutter-Smeloff, two with the Beall-Surgitool, and one with the Lillehei-Kaster were alive after 14, 37, and 15 months, respectively. Among all survivors of TVR, late thrombus and pannus developed on both ball and disc prostheses (Starr-Edwards, two; Cutter-Smeloff, one; Lillehei-Kaster, one). These findings suggest that TVR should be performed earlier in rheumatic patients to reduce the operative mortality rate and that the Lillehei-Kaster prosthesis is probably most suitable for TVR.


[Tissue mucopolysaccharides and collagen in hypokinesia in rats].

The study of 98 rats showed an increased amount of collagen in the skeletal muscle, heart and kidneys of rats exposed to prolonged hypokinesia. The content of hexosamines decreased in the skeletal muscle, liver and brain and increased in the heart. The content of hexuronic acids in th skeletal muscle and kidneys increased and in the heart decreased. By the 60th day of the recovery period the collagen content in the skeletal muscle did not return to normal. After the exposure changes in the content of mucopolysaccharides in the liver, heart, brain and skeletal muscle were in some cases more expressed than during hypokinesia. The changes are discussed in terms of their possible effect on tissue permeability and fluid-electrolyte metabolism of hypokinetic animals.


[Pathophysiological aspects of therapeutic procedures in Menière's disease (author's transl)].

Meniére's disease is a nosologic entity. Its underlying pathophysiological mechanism is based on a disturbance of the quantitative correlation between peri- and endolymph volume on the one side and on a qualitative disorder of sodium and potassium concentration in the inner ear fluids on the other, resulting in a disregulation of osmotic pressure within the labyrinth. However, a critical review of the current literature as well as personal observations confirm that at the present time the scientific basis of a causal therapy is still lacking. Hence, both conservative and surgical treatment of Menière's disease does not allow to cure the cause but only some of the symptoms.


[The pathogenesis of the acute symptoms of Menière's disease (author's transl)].

The pathogenesis of vertigo attacks and hearing fluctuations in Menière's disease is discussed on the basis of new electronmicroscopic observations on the perilymph endolymph barrier. The zonulae occludentes (z.o.) of the epithelial cells lining the endolymphatic space are the main sealing elements which control the passive ion transport. They consist of parallel running intramembranous fibrils (cell membrane fusion lines). Recent investigations demonstrated conditions which partially destruct some of such fibrils (e.g. increased osmotic pressure, endocrine disorders). This also may be true in Menière's attacks: tight z.o. are transformed to leaky z.o. such that a  high transepithelial ion exchange developes. This would result in reduced generation of the receptor potentials as well as in decreased activities of the first order afferent neurons as it was supposed earlier by other authors. This mechanism may be combined with a decompensation of active ion transport processes due to microcirculation disturbances. Finally it will be pointed out that true ruptures of the endolymphatic walls cannot be the usual mode of reversible lesions in Menières disease but a diffuse leakage of the perilymph-endolymph barrier.


[Medical treatment of Menière disease (author's transl)].

There is no causal medical treatment of Menière's disease, further it seems very doubtful if it is possible to achieve a complete loss of symptoms by drugs alone. In spite of the fact that there are a great number of drugs being applied, there are some general principles in the treatment of this disease which should be followed. These principles are: 1. Improvement of blood supply of the inner ear by various methods. 2. Sedation of the patients to avoid physical stress, as it has clearly been shown that in many patients there is a correlation between psychical stress and Menière attacks. 3. Dehydration of the inner ear hydrops by osmotic diuresis or diuretic drugs. 4. Partial destruction of inner ear structures by intratympanally administration of ototoxic drugs or anaesthetics.


[The intratympanic treatment of  Menière's disease with ototoxic antibiotics. A follow-up study of 55 cases (author's transl)].

Report about 55 patients suffering from severe unilateral Menières disease, seen over a period of 3-10 years. They were treated with intratympanic administration of Streptomycinesulfate or- better -Gentamycinesulfate. The medication was given using a plastic tube inserted behind the annulus by transmeatal approach. 0.1 ml Gentamycinesulfate (earlier Streptomycinesulfate were instillated every 5 hours until the first signs of inner-ear-reaction (nystagmus or vertigo) appeared. -In 90% of the cases vertiginous attacks ceased after therapy. Hearing was preserved in 76%, tinnitus and periaural pressure were influenced markedly.


[The results of saccotomy in morbus Menière  (review of 69 cases) (author's transl)].

The results of saccotomy in Morbus Menière are investigated using two statistics with different postoperative periods. After a short period of observation (10-26 months p.o.) the improvement of vertigo was found in 80%, while after an interval of 18-23 months the improvement was seen only in 50%. The results are better, if the disease is not older than one and a half year (70%). Therefore we recommend the saccotomy in Morbus Menière for cases of a short anamnesis.


[Neurectomy in Menière's Disease (author's transl)].

The transtemporal vestibular neurectomy permits an ablation of the peripheral end organ with only a low risk to the cochlea. In a totally deaf ear the internal auditory meatus is reached by a translabyrinthine approach. Besides the vestibular nerve the chochlear nerve is cut to reduce tinnitus. The neurectomy is a destructive procedure. It should be performed in otherwise resistent cases of Menière's disease.


[Endonasal antrostomy with endoscopical control for chronic maxillary sinusitis (author's transl)].

A transnasal approach to the maxillary sinus as a standard operation in chronic maxillary sinusitis is described. A mucosal flap in the lower nasal meatus is electrically circumcised, and a window of appropriate size is formed by osteotomy. The removal of pedicled polyps and cysts from the cavity is controlled by endoscopy, while most parts of the thickened mucosa remain in place and may recover and also line the uncovered areas. If necessary, an opening in the facial wall of 5 mm diameter is established for endoscopical control or manipulations. The preliminary results of 56 endonasal sinutomies are reported, which are satisfactory. The avoidance of postoperative dysesthesia or neuralgia is a marked advantage of the procedure.


[Aspects of surgical management of choanal atresia (author's transl)].

The indication for surgery of choanal atresia appears not uniform. In newborns the bilateral choanal atresia should be operated in the first days or weeks on account of threatening life complications. Unilateral atresia can be managed between the 3rd to 5th year; until this time the topographic conditions are enlarged nearly twice, which means much better conditions for operation. In the checked up cases (27 patients) the rate of relapse of the different surgical methods are explained. On account of a better view over the operating area and optimal plastic-surgical supply the transpalatinal approach is preferred especially in newborns and infants under microsurgical conditions and a description of the technique is given.


[Improved differentiation of suspected chronic laryngeal lesions by highly dosed antibiotic therapy for a short time and comparing cytology (author's transl)].

The valuation of chronic laryngeal lesions is eased by a combination of a highly dosed antibiotic therapy for a short time and observation of the therapy procedure by cytology. The cytological estimated dyscaryoseindex gives reference if suspicion on a malignant lesion can be kept in mind. Above this the proceeding enables us for exact and useful biopsies respectively for primary diagnostic and therapeutic operations.


[Microsurgical and phoniatric aspects in treatment of so-called benign vocal cord lesions (author's transl)].

Following a brief characterization of so-called benign vocal cord lesions (Kleinsasser) with corresponding illustrative  aids, the microsurgical as well as the speech therapy is dealt more intensively, as it has been found by the authors to be successful. A therapy schedule is set up consisting of pre- and postoperative teamwork between the surgeon and the phoniatrician whereby the results of the microsurgical treatment can be further improved.


[Granular neuroma of the larynx (author's transl)].

A case of a granular neuroma of the true vocal cord of a 47-year-old woman is presented. In world literature about 125 cases of this benign tumor in the larynx are published until now. The most common symptom of this tumor is hoarseness. The correct treatment is the total excision to avoid recurrence. The histology shows typical uniform cells, their cytoplasm filled with eosinophilic granules. The overlying epithelium may show pseudoepitheliomatous hyperplasia, which must not be misinterpreted as malignant squamous cell carcinoma. Finally the theory of Feyrter concerning the neurogenous origin of this tumor is discussed.


[Clinical and functional results in tracheotomized children (author's transl)].

Twenty-nine children between the ages of 2-months- and 7-years-old were tracheotomized at the Department of Otorhinolaryngology, Med. Centre, Ljubljana, from 1965 to 1974. Decannulation was performed 6 days postoperatively, on the average. Complications of tracheotomy were observed in 2 children only; one child died on the 7. postoperative day to basic disease. Twenty tracheotomized children were subject to follow-up examination consisting of history taking, clinical, otorhinolaryngologic, anthropometric and allergologic examinations. In eleven school children spirography and bodyplethysmographie for a possible tracheostenosis was performed. The calculated FEV1/FIV1 quotient, e.g. statistically significant values higher than 1.0 revealed tracheostenosis in two patients.


[Bacteriological findings in chronic infantile tonsillitis (author's transl)].

Under general anaesthesia cultures were taken from infantile tonsils prior to T & A. The bacteriological results and the serological classification of hemophilus are questionning literature reports. According to our findings one must consider haemophilus influencae as a resident of the common oral flora. There was no significant difference culturing tonsils with or without repeated antibiotic treatment. Hemophilus influencae combined with beta-hemolytic streptococci is common. Immunological considerations against infantile T & A, based on bacteriological observations are questioned.


[Skeletal scintigraphy in otolaryngology (author's transl)].

Close relation of non osseus facial skull portions to the skeleton cause rapidly the bone to become co-involved in presence of various diseases. Early diagnosis is of decisive importance for therapeutic measures. For localisation scintigraphy has proved particularly reliable in aids to early determination. This can be shown clearly in inflammatory diseases and tumour infiltrations with various tumour affections. Technical requirements and the use of skeletal scinitgraphy are demonstrated on hand of 6 cases.


[Pantopaque-cisternography- clinical examinations of possible late complications with special regards to neurological findings (author's transl)].

Extensive examinations after couple of months or years after pantopaque-cisternography were performed in 20 patients, in whom no central nervous system diseases were known and in whom no surgery of CNS was previously performed. With only one exception the contrast medium was found intracranially with preference to the sella and to the region of the frontobasis. No connection was found between the amount of pantopaque and the length of time since the performance of cisternography. No late neurological complications were observed.


[Ultrasound diagnosis in simulated middle-ear-effusions in isolated human temporal bones (author's transl)].

By means of simulated middle-ear effusions in isolated human temporal bones it could be demonstrated, that ultrasonic echos of the drum show typical patterns if the middle-ear is filled with fluid or not. In normal air-filled drums there is only the echo of the tympanic membrane, whereas in fluid-filled drums a second echo from the bony medial wall of the tympanon appears. --A method is described how to perform ultrasonograms under visual observation of the tympanic membrane.


[Peroxydase-marked antibodies of antibasement membrane of masugi-nephritis in the inner ear of guinea pigs (author's transl)].

Masugi-Nephritis was produced in guinea pigs. The antibasement-membrane-reaction was demonstrated by peroxydase-marked antibodies in renal glomerula and stria vascularis vessels. The histological and electronmicroscopical results confirm our morphological and immunofluorescence findings.


[Autoradiographic experiments on the cochlear capsule of the rabbit (author's transl)].

By means of autoradiography metabolic exchange on the molecular level is demonstrated. Mucopolysaccharides and proteins of the intercellular substance are incorporated in the same manner. The interglobular spaces however are excluded from metabolic turnover and do not show radioactivity. The adjacent cells resembling cartilage cells incorporate like osteocytes. Comparing the way of incorporation to cartilage cells of other areas of the otic capsule we find support of Manasse's theory that the cells of the globuli ossei of the adult orginate from cartilage cells.


[Physical and morphological investigations on cryosurgery of large vessels at different flow conditions (author's transl)].

Intravasal temperature measurements during cryosurgery on the A. carotis and V. jugularis of the rabbit are described. Different flow conditions and freezing systems are investigated. The measurements are compared with histological findings. Theoretical investigations about the freezing process give information about the physical condition of a total freezing of the vessels.


[A rare case of congenital rhabdomyosarcoma (author's transl)].

A case of a two-weeks-old female infant is reported who was born with an embryonal rhabdomyosarcoma in the size of more than a man's fist that was located in the area of the left half of the face. The tumor provoked an extreme disfiguration by its rapid postpartial growth when metastases had already developed. A palliative operation in order to maintain respiration and nutrition was performed when exitus letalis occured in hemorrhagical shock and consecutive circulatory break-down.


[Fibrosarcoma of the head and neck. Diagnosis and therapy (author's transl)].

We report about two patients with fibrosarcoma of the soft tissues of the face. We discuss the problems of biological viability of the tumor, of the diagnostics and of the etiological factors, and about the therapy. The prognosis depends on the  localisation, the degree of malignancy of the tumor and the therapy.


[Pain-sensation following classic neck-dissection (author's transl)].

Resulting neck-dissection surgery (including curative or conservative intervention) very complex pain-syndromes are next to losses of function at the top of complaints stated. The discussion of the case-reports of 242 patients with unilateral neck-dissection and the reexamination of 28 patients free of recurrence revealed several causes of head- and facial pain. The close relationship of functional disability and pain-sensation is discussed. The recommendation of elective neck-dissection - by critical indication - is supported. Resection of nervus accessorius may be necessary in some cases, immediate reconstruction by nerve sutures is recommended. By post-operative treatment the complaints often can be relieved.


[Late side-effects of antineoplastic treatment in childhood (author's transl)].

Every child has a 1:600 chance of developing cancer. Therapeutic progress was impressive throughout the past years. The number of late side-effects of therapy, however, is increasing, too. Among these, problems of fertility, therapy-induced genetic defects, impaired skeletal growth, endocrinologic defects (esp. hypopituitarism), anomalies of metabolism, chronic deficient bone marrow and reduced pulmonary function have to be discussed. One of the most severe consequences is the development of secondary tumors, which may occur in 4% of the long-term survivors. Tumor-treatment has to be performed at a center by a qualified team of oncologists; the same is valid for prevention and/or early detection and treatment of late side-effects of tumor therapy.


[The neck after radical neck-dissection. A follow-up study (author's transl)].

In 200 patients with uni- or bilateral neck dissections the long range cosmetic results, subjective complaints, and the neurologic status were studied at postoperative time intervals between 3 months and 10 years. The main disorders were related to both the absence of resected, tumor-involved structures and to hyperesthesia of the lateral neck skin. The function of the muscle portions of the shoulder was less disturbed than expected, and recovered with some time and training. Cases with bilateral neck dissections showed postoperative edema of the head, being resorbed, with a little persisting submental edema. Postoperative irradiation gave rise to an increasing number of neuralgiform symptoms.


[Reading machines for the blind].

Direct conversion reading machines for the blind with tactile and acoustic information output were analyzed. It is shown that direct conversion machines are simple enough, inexpensive and may be recommended for individual use. But an effective use of them requires a protracted period of learning. The present state and future prospects for constructing reading machines with vocal information output (machines with letter-wise recognition and the ones capable of synthetizing the speech) are enquired into. These machines are shown to help reach a greater reading speed, but are of a more complex nature.


An anatomical assessment of the "percutaneous rhizolysis" procedure.

The procedure known as rhizolysis has been claimed to denervate the lumbar zygapophyseal joints. Analysis of the surgical anatomy of the incisions used in the procedure reveals that theoretically they do not interrupt the nerve supply to the zygapophyseal joints. The procedure was performed at six levels in each of three cadavers. Subsequent dissection revealed that at no level was the nerve supply to the zygapophyseal joints interrupted. The writers conclude that denervation of the Zygapophyseal joints cannot be held to be the mechanism of any pain relief that rhizolysis may achieve.


Changing concepts in management of infective endocarditis.

Sixty-four patients were treated for 73 episodes of infective endocarditis over the five-year period 1970 to 1974 at St Vincent's Hospital, Sydney. There were 13 deaths with a mortality rate of 18-1% compared with 38% (1950 to 1959). Included were 13 cases of infection on prosthetic valves with three deaths. Fifty-one per cent of patients were studied by cardiac catheterization. Early or emergency surgery was performed in 28% of cases and late surgery in 16%. The improved results were due to multiple factors, including early diagnosis, prompt investigation in a specialized unit, rational use of appropriate antibiotics, careful management of complications and early surgery.


The electromagnetic flowmeter.

The electromagnetic flowmeter, which has developed since its inception into a reliable clinical instrument that has become the standard to which all other flowmeters are compared, is described. Perivascular and intravascular transducers now available, which can easily be used to give reliable, high fidelity recordings of blood flow and velocity, are also discussed.


The pulsed Doppler ultrasound flowmeter: experimental evaluation of velocity accuracy and range resolution.

Accurate quantitation of blood flow patterns, particularly in the physiological state, is important to the successful study of several problems in biomedical research. The pulsed Doppler ultrasonic flowmeter offers promise of overcoming some of the difficulties present in other methods. This flowmeter can be either implantable or noninvasive. Although a number of papers describe important design criteria, the design or selection of a Doppler system for a given task remains a complex matter involving many compromises based on theoretical considerations and very limited data. Experimental data from well-defined flows are needed to help identify those areas in which ultrasonic flowmeters can be most useful. This paper defines and evaluates two important parameters for the pulsed Doppler ultrasonic flowmeter by comparing experimental results with those predicted theorectically. The first parameter is velocity accuracy; the second parameter is range resolution. Findings show that centerline flow velocities in circular tubes can be estimated to within a few percent of the correct value, and that a 1.5-mm range resolution can be realized with the system tested.


History of early ultrasonic blood flowmeters.

Methods of measuring flow of fluids by acoustic techniques before 1960 are reported, and motivation for such documentation is presented. Serendipity played a role in introducing acoustic flowmeters to the Institute of Experimental Medicine of the Mayo Graudate School of Medicine. Ultrasonic flowmeters promise to be clinically useful in procuring dimensions of blood vessels, in measuring flow transcutaneously, and in studying the dynamics of flowing blood within the diseased cardiovascular system.


Genetics of retinoblastoma.

Retinoblastoma may be due to (1) a somatic mutation, which is not hereditary, (2) a germinal mutation, which is dominantly inherited, and (3) a deletion of the long arm of chromosome 13. In unilateral cases of retinoblastoma, the risk for the offspring is 5-6%, as 10-15% of these cases are due to a germinal mutation. In all the bilateral cases and in the unilateral hereditary cases, the risk for the offspring or the sibs is 40-50% depending on the penetrance of the gene.


[Electron microscopic of mucopolysaccharides in the goblet cells of the bronchial mucosa].

Author using various methods of fixation and electronmicroscopical histochemistry investigated the detectability of mucopolysaccharides in the goblet cells of the bronchial mucosa obtained by biopsy. Results show, that the method of choice of the detection of glycosaminoglycans in the goblet cells is the PA-Silver technique carried out after fixation with solution of glutaraldehyde only. This technique-- when appropriate control is used--seems to be specific.


[The importance of heterologous implants in cardiovascular surgery (author's transl)].

The importance of heterologous transplants in the substitution of heart valves in cardiac surgery and the substitution or bypassing of displaced arteries of the thigh in vascular surgery is discussed with reference to some results and developmental considerations. In addition to the alloplastic valve material, heterologous bioprosthesis from glutaraldehyde-fixed pig's valves has proved useful to an increasing extent for the substitution of diseased and functionally impaired heart valves. The results of followup examinations show equally favorable results in comparison with the alloplastic prosthesis. In vascular surgery, the calf collagen prosthesis has proved a real alternative to the alloplastic Dacron prosthesis at the level of the thigh.


[The pathogenesis of postoperative abdominal wound dehiscence. Part I: Clinical investigations to determine patient groups at risk (author's transl)].

Between 1955 and 1974 a total of 27 404 patients were laparotomied at the University Surgical Clinic in Munich. Abdominal wound dehiscence occurred during the postoperative phase in 324 patients. In comparison with the clinical findings of undisturbed healing in the total number of patients, some predisposing factors could be established which were statistically confirmed for the first time: age over 60, males, malignant primary disease, long operation time, low preoperative hemoglobin concentration, high blood loss and bigger blood transfusions. With the help of these risk criteria, endangered patients can be detected pre-or intra-operatively.


Effect of DNA Repair systems on antibacterial and mutagenic activity of an antitumor protein, neocarzinostatin.

Antibacterial and mutagenic effects of an antitumor protein, neocarzinostatin (NCS), on isogenic strains of Escherichia coli with normal or defective DNA repair systems were studied. Growth of the strains lacking recA gene was inhibited by NCS with much lower concentration than in the case of those possessing it, while the "differential inhibition for growth" (DIG) between the strains uvrA+ and uvrA- was not seen. NCS induces mutation in recA+ strains but not significantly in recA-, while no such difference of mutagenesis was noticed between the strains uvrA+ and uvrA-. These results suggest that NCS produces hardly excisable DNA damage which is repaired by an error-prone recombination process.


Computed tomography for Huntington's disease.

CT scans of twelve patients with Huntington's disease were compared with a large series of normal and abnormal scans. The frontal horn/bicaudate ratio in the Huntington's disease group was found to be much smaller than and statistically different from the normal or abnormal CT scan groups. The CT scan appears to be a useful adjunct in the evaluation of patients with suspected Huntington's disease.


Mechanism of noradrenalin liberation from the rat brain under the influence of nicotine.

Definite relationships were found between the noradrenaline concentration and Mg++-ATPase activity in the rat brain during the action of nicotine. It is suggested that Mg++-ATPase regulates the storage of noradrenalin in the tissue depots.


Patient acceptance of laparoscopic tubal fulguration versus falope-ring banding.

One hundred fifty patients were included in a double-blind study to evaluate whether they were more comfortable being sterilized by fulguration or by Falope-Ring banding. They were also studied to see if 4% Xylocaine applied to the tubes was helpful in decreasing the discomfort with banding as it has been shown to be with fulguration. The results confirmed the clinical impression that banding is very painful to the patient at the time of application and for the ensuing 24 hours. Although 4% Xylocaine is very helpful in reducing this discomfort at first, the effect is not lasting. Blood levels of Xylocaine were determined and shown to be well below the accepted toxic level. Fulguration remains the most comfortable form of laparoscopic tubal interruption.


Evaluation of danazol as an oral contraceptive.

The effect of Danazol as an oral contraceptive in doses of 50, 100, and 200 mg daily for 6 months was studied in 3 groups of 10 women. Both 50 and 100 mg Danazol daily were well tolerated, but one pregnancy occurred among the women receiving 50 mg daily, and 2 pregnancies occurred in women receiving 100 mg daily. There were no pregnancies in women taking 200 mg Danazol daily; however, the side effects were frequent and 5 of the 10 patients withdrew from the study prior to 6 months of therapy. Six patients in this study were followed intensively with blood hormone analysis, vaginal cytology, and pathologic evaluation, and these findings are detailed.


Intraocular lens fixation with Dacron mesh: Part I.

Rabbits were used to demonstrate the feasibility of using Dacron fibers to fix intraocular lenses. Adhesion occurred five days after insertion and was confirmed by histologic examination to consist of fibroblastic ingrowth into the Dacron fibers. This cellular response was consistent and remained localized. Anterior and posterior placement of the acrylic portion of the lens was compared. It is our clinical impression that the risk of pupillary block is increased with posterior placement of the lens.


Septum posticum cysts: an uncommon cause of chronic back pain.

The authors describe two patients with posterior thoracic pain associated with cysts of the septum posticum. One patient's pain was relieved by surgical removal of the cysts; the second patient's symptoms temporarily resolved after myelography. Posterior thoracic pain can be ascribed to myelographically proven arachnoid cysts when the pain is persistent, positionally exacerbated and associated with radicular sensory changes. Excision of the cysts may provide pain relief for some patients.


Prolonged relief of pain by brief, intense transcutaneous somatic stimulation.

The purpose of this study was to examine the effects of brief, intense transcutaneous electrical stimulations at trigger points or acupuncture points on severe clinical pain. The McGill Pain Questionnaire was used to measure the change in pain quality and intensity produced by stimulation. The data indicate that the procedure provides a powerful method for the control of some forms of severe pathological pain. The average pain decrease during stimulation sessions was 75% for pain due to peripheral nerve injury, 66% for phantom limb pain, 62% for shoulder-arm pain, and 60% for low-back pain. The duration of relief frequently outlasted the period of stimulation by several hours, occasionally for days or weeks. Different patterns of the amount and duration of pain relief were observed. Daily stimulation carried out at home by the patient sometimes provided gradually increasing relief over periods of weeks or months. Control experiments, which included two forms of placebo stimulation, showed that brief, intense electrical stimulation is significantly more effective than placebo contributions. Possible neural mechanisms that underlie these patterns of pain relief by brief, intense stimulation are discussed.


Some pharmacological observations on the analgesia induced by acupuncture in rabbits.

(1) The characteristics of an analgesia which can be elicited in rabbits by electrically activated acupuncture needles are described. (2) The analgesia can be reversed by systemic administration of the inhibitory amino acid antagonists bicuculline or strychnine. (3) Pharmacological procedures which interfere with tryptaminergic mechanisms, or destruction of the dorsal raphe nuclei, prevent the development of analgesia. (4) It is concluded that the production of analgesia probably depends upon postsynaptic inhibition of the transmission of afferent information from nociceptors, and at more than one site in the central nervous system.


Facet "denervation" in the treatment of low back syndrome.

Long-term pain relief occurred in 21% of patients with low back and leg pain who underwent injection or radiofrequency rhizotomy. When pain was accompanied by unequivocal limitation of straight leg raising, neither injection nor rhizotomy produced long-term relief. Leg pain improved more than low back pain. Improvement was limited to pain relief as reported to the physician and reduction of medication. There was no improvement in work or activity status. Despite the low success rate, facet "denervation" is uncommonly safe and seems to be of some usefulness in the treatment of patients with low back pain and sciatica.


Acute hemiplegia and cortical blindness due to moya moya disease: report of a case in a child with Down's syndrome.

We are reporting what we believe to be the first case of moya moya disease (hemiplegia associated with supraclinoid carotid stenosis and multiple cerebral telangiectasia) in a child with Down's syndrome. On cerebral angiography, multiple collateral vessels and rete mirabile (anastomosis of meningeal vessels with internal cerebral vessels) were noted, in addition to the supraclinoid carotid stenosis. Computerized tomography revealed nonobstructive hydrocephalus and findings consistent with multiple vascular insults or infarcts. It is not clear whether moya moya disease represents a true disease entity (congenital arterial dysplasia) or is a syndrome caused by nonspecific vascular reaction. Since abnormal vascular morphology has previously been described in children with  trisomy 21, we suggest that the presence of these two disease entities may not be coincidental. It may represent a genetic predisposition in Down's syndrome toward vascular abnormalities, with variable expressivity which manifested itself in this case by abnormalities in the cerebral circulation.


Differentiation of myosin in soleus and extensor digitorum longus muscle in differnt animal species during development.

CA2+-ATPase activity and light chains of myosin prepared from fast and slow muscles of rat guinea-pig and rabbit were studied during development from embryonic to old age to establish further correlation with the well-known developmental changes in contraction properties of these muscles. The changes involve the slow soleus muscle much more than the fast extensor digitorum longus muscle. Myosin-ATPase activity of the soleus muscle before or at birth is higher than in the muscle of adult animals. Myosin from the soleus muscle of embryos or newborn animals reveals light chains of myosin of both fast and slow type (with a preponderance of light chains of fast type in 26-days-old rabbit embryos). During postnatal development the amount of light chains of the fast type decreases, that of the slow type increases. Myosin from the soleus muscle of adult animals contains only light chains of the slow type. However, myosin from the soleus muscle of 30-months-old rats exhibits high myosin ATPase activity and contains light chains of myosin of both slow and fast type as in perinatal development. This is in agreement with the shortening of contraction time observed in this muscle in very old age. Thus developmental differentiation of myosine in the soleus muscle is followed by a trend of levelling out of the differences between fast and slow muscles of senescent animals. No such "biphasic" development is observed with respect to the fast extensor digitorum longus muscle.


Frequency of inferior vena caval abnormalcy due to a juxtaposed pathology.

Radionuclide inferior vena cavagrams were done in 135 patients who had hepatomegaly, splenomegaly or a mass in the vicinity of the inferior vena cava (I.V.C.). 2-5mCi 66mTc phytate, 99mTc S colloid, 99mTc O4-, 99mTc-LIDA, 99mTc pyridoxyledene glutamate or 113mIn colloid were injected directly and rapidly into  either a malleolar or a femoral vein while the patient lay supine under the 13.5'' detector head of a scinticamera. Rapid sequential scintiphotos were manually taken at approximately 1 sec. interval for 20-30 sec. Thus iliac vein, I.V.C., cardiopulmonary zone in infants, aorta and the arterial phase were visualized. 48% of these subjects had an abnormal I.V.C. and the depictions were interestingly varied, indicating that different patients responded in a different manner even to grossly similar pathologies. It became evident that this soft walled vessel could be compressed by both fluids and neoplastic tissue (Fig. 1, 2); the long I.V.C. channel could also be segmentally pushed away by a mass in its vicinity. (Fig. 2, 3, 4). An abnormal arterial flush usually differentiated between benign (Fig. 2) and malignant (Fig. 3) lesions, even when the mass was extra-hepatic (Fig. 4) and retiroperitoneal (Fig. 5). Such a systematic study of I.V.C. had not been possible earlier since the classical x-ray contrast inferior vena cavagram necessitates venous dissection, passage of a catheter, and the injection of large volume of fluid under an unphysiologically high pressure. The simplified radionuclide technique, however, permitted the study of neonates and critically ill subjects with massive ascites, while retaining a satisfactory reproducability.


Indications, technique and results of caudal epidural injection for lumbar disc retropulsion.

The indications, contra-indications and technique of caudal epidural injections in the treatment of low back pain and sciatica are described. Of 201 patients treated by epidural injection, about 56% had favourable results.


Practolol-induced autoantibodies and their relation to oculo-cutaneous complications.

Tissue auto-antibodies were investigated in fifty-one patients (twenty-five female, twenty-six male) receiving practolol for ischaemic heart disease or dysrhythmias and compared with those found in 204 patients (fifty-eight female, 146 male) with ischaemic heart disease who did not receive practolol. Antinuclear factor (ANF) was found in 24% female and 16% male patients receiving practolol, but only in 5% of female and 4% of male patients who were not taking practolol. Thyroid cytoplasmic antibody (TCA) was detected in 16% female and 20% of male patients receiving practolol, compared to 10% of females and 6% of males in the control group. The incidence of ANF and TCA was significantly higher (P less than 0-05) in patients receiving practolol compared to the control group. The occurrence of gastric parietal cell antibody (PCA) and smooth muscle antibody (SMA) was not associated with practolol therapy (odds ratio of 2-4 and 1-9 respectively). The incidence of skin and eye complications was found to be 10% and the female to male ratio of this complication was 4 : 1. The correlation between autoantibody production and oculo-cutaneous complications could not be established in such a small group but three of the patients with the complications were found to have PCA, although PCA was found not to be associated with practolol therapy. Four of the five patients with the complications did not have circulating ANF.


Oxyphenbutazone-induced goitre.

A woman who had taken oxyphenbutazone for 4 years because of back pain presented with goitre and hypothyroidism. This was shown to be due to an organification defect, caused or aggravated by oxyphenbutazone.


[Experimental studies of the state of the ground substance of the aorta in white rats exposed to the combined action of manganese and lead].

Biochemical and histochemical studies are undertaken with the purpose to establish the state of the aortic wall groung substance in white rats, poisoned over a 10-day period with lead acetate (1/100 LD50) and manganese bichloride (1/100 LD50), separately and in combination. It is demonstrated that either of the metals, both separately and in combination, lead to an increase of the quantity of acid, and to a decrease of the quantity of neutral mucopolysaccharides. It is worth noting that upon combined action, a relative augmentation takes place also of hyaluronic acid in all the layers of the aortic wall. The changes observed point to quantitative and qualitative alterations in the intercellular substances of the aortic wall leading, in turn, to disturbances in its permeability.


[Incidence and nature of diabetes mellitus (according to medical records and the data of preventive examinations of children and adolescents in Baku)].

The author studied the incidence of diabetes mellitus among the child population of Baku the last 10 years. Diabetes incidence proved to increase at the age of 11--14 and 15--19 years, and was more frequent in girls. Children with the aggravated heredity to diabetes should be placed under dispensary observation.


Renal arterial stenosis and circadian water and sodium excretion in subjects with a reduced fluid intake.

Circadian water and sodium excretion in patients with renal arterial stenosis is inverted, but if the fluid intake is reduced it can return to normal. The findings also furnish indirect evidence that changes in circadian water and sodium excretion in patients with renal arterial stenosis are related to the degree of hydration of the organism. When evaluating circadian water and sodium excretion in patients with renal arterial stenosis, the osmolarity (specific gravity) of the urine should thus be taken into account.


On the localization of the two glutamate pools in the brain. Comparison of their metabolic activities in human and rat brain tissue in vitro.

The conversion of U-14C-glucose and 1-14C-acetate was studied in rat brain tissue slices and human brain tissue. In both types of tissue, glucose was preferentially incorporated into the compartment with the large glutamate pool (probably localized in the neurones), while acetate was incorporated into the glutamate pool with rapid glutamine synthesis (probably in the glial cells). Glucose conversion to amino acids was 3.8 times greater in rat brain tissue than in human brain, but the utilization of acetate was only 1.34 times greater. These differences concur with the previously described lower neurone density and lower neuronal enzyme activities in man as compared with the rat and the almost equal glial cell density and glial enzyme activities in the two tissues.


Changes in integrated vagal afferent activity induced by model lung diseases in rats.

An attempt has been made in the present report to evaluate quantitatively the sensory activity in both vagal nerves of control rats and rats with experimental lung inflammation, by employing the integration technique. We evaluated background vagal nerve activity, resting respiration and activity during inflation at constant pressures of 5 to 20 cm of water. It was found that integrated vagal respiratory activity cannot  be assessed in absolute units under our experimental conditions, because of the large scatter of data. However, when the integrated values were related, for example, to resting respiration (in percentage), it was possible to compare some respiratory parameters in control, healthy rats of the Wistar strain and rats with lung inflammation. While background activity in control rats represents 75.9% of resting respiration, this parameter is significantly higher both in rats with 2-day carrageenin lung inflammation and those intoxicated with paraquat. Lung inflation at pressures 5, 10, 15, 20 cm H2O increased vagal activity linearly both in control and the two experimental groups with the degree of lung inflation. However, values in experimental animals corresponding to those of the control group were not reached until higher inflation pressures. From the functional aspect, experimental rats had characteristic tachypnoea which returns to control values after bilateral vagotomy. Since it was found that lung compliance was significantly decreased in both carrageenin and paraquat lung processes, it is being suggested that the diminished activity from lung receptors during inflation is due to mechanical properties of the lung tissue, namely lowered lung compliance.


Haemoglobin and the red cell membrane.

The results presented here indicate that haemoglobin is an integral part of the red cell membrane. The haemoglobin content of the membrane is highly dependent on the Ca++ content of the membrane in health and disease. Changes in the red cell interior alter the whole organization of the membrane and are even reflected in the binding of immunoglobulins to the red cell surface. The preferential binding of Hb-s A2 and S to the membrane has been confirmed. This phenomenon cannot be explained by differences in the charge between these haemoglobins and Hb A.


Diet-induced adaptation of intestinal fructose absorption in the rat.

The effect of dietary sucrose, fructose and glucose on the intestinal absorption of fructose and glucose was investigated in adult rats in vivo: Glucose absorption was not affected by the type of dietary carbohydrate, while the absorption of fructose was increased by the ingestion of the sucrose or fructose diet, as compared with the glucose diet. An almost maximal increase of fructose absorption was already observed when the quarter of the total dietary carbohydrates was replaced by fructose. Faecal fructose elimination declined during the feeding experiment. The enhanced intestinal absorption of the fructose load in rats fed the fructose diet was manifested by higher concentrations of fructose, but also of glucose and lactate in the hepatic portal blood.


Correlation of isonicotinic acid hydrazide infiltration across the blood-brain barrier to postnatal development in rats.

Changes in the isonicotinic acid hydrazide (INH) concentration in rat blood and brain were studied in correlation to postnatal development in groups of animals aged 21 and 42 days and 3 months. In the first part of the experiments, INH was administered intravenously to all the age groups in a dose of 100 mg/kg. In the second part, the dose was related to extracellular fluid volume, so that the 3-week-old rats were given 154 mg/kg, the 6-week-old animals 129 mg/kg and the 3-month-old animals 100 mg/kg. After a dose of 100 mg/kg, INH levels in the blood of 21-day-old rats were significantly lower than in 42-day-old and adult animals. The brain INH levels did not differ significantly. On relating the dose to the amount of extracellular fluid, there were no significant differences in the blood INH levels, but the levels in the brain of 21- and 42-day-old rats were significantly higher than in 3-month-old animals. Blood volume related to body weight and brain weight did not differ in the various age groups. The authors  conclude that the blood-brain barrier for isonicotinic acid hydrazide alters in rats during postnatal development. In young animals (21- and 42-day-old), more INH infiltrates into the CNS than in adult animals.


Lithium and erythrocyte membrane cation carrier studies in normal and manic depressive subjects.

Changes in the erythrocyte membrane cation carrier following lithium ingestion in normal human subjects were studied; ouabain sensitive potassium influx fell significantly during the lithium treated phase. Lithium was fed to rats and no change in erythrocyte Na-K ATPase was shown. These findings contrast with studies of lithium in manic depressive psychosis. The fluctuations in the erythrocyte membrane cation carrier were studied in 5 normal subjects over 12 weeks and the correlations between the parameters calculated. The erythrocyte sodium concentration correlated positively with the ouabain sensitive potassium influx. This too contrasts with findings in manic depressive psychosis.


Myocardial imaging with 123I-hexadecenoic acid.

123I-hexadecenoic acid is a terminally iodinated, 17-carbon fatty acid analog which is rapidly degraded in the myocardium. By determining regional myocardial distribution patterns and clearance rates, it may become useful as a single agent for estimating regional myocardial perfusion and for distinguished viable ischemic tissue from infarcted tissue. The high count rates obtainable with the iodine label permit acquisition of qualitative multiprojection images in only 3 min. per view, or quantifiable single projection high count images in 10 min. Ischemic defects may be observed in anginal patients without subjecting them to stress.


[Surgical treatment of congenital deformities of the thoracic wall].

The author describes an original procedure for the correction of deformities of the antero-lateral thoracic wall, stressing the tactical and technical principles. The mandatory operational steps are the following: wide chondrectomy, borad retrosternal separation of the periost, transversal osteotomy of the sternum and contention by metalic blades placed behind the sternum. The author stresses the surgical indications in all anterolateral deformities of the thorax and considers that the best age for performing the correction is after 10-12 years.


[Simon's posterior vertical lombotomy in the conservative treatment of upper lumbar renal and ureteral lithiasis].

The authors present their experience accumulated in the treatment of 107 cases in which they have applied posterior vertical lombotomies as a conservative method of renal lithiasis and of the upper lumbal urether, and they re-actualize ore of the less used approaches. From the very beginning it is evident that vertical posterior lombotomy can be used as a narrow approach and, at the same time it can be created or it may be widended, just as a classical lombotomy. A secure technique, that of intra-sinusal pyelotomy, will determine, together with the type of the lithiasis, a choice of posterior lombotomy, with a sufficiently wide access pathway, which only in exceptional conditions will necessitate a cranial or caudal extension. This type of lombotomy, without fatalities, intra-surgical hemorrhagic accidents, severe complications after surgery, and especially, lacking the risk of lithiasis relapse, allows for an in situ kidney surgery and will protect the tissues to the utmost.


[Changes in hemostasis in the postoperative period].

Hemostasis was investigated in the postoperative stage (at 24 hours and at 5 days) in 20 patients that had underwent major surgical interventions. The test applied for study of blood coagulation included : thrombocyte counting, the test of Howell, the activated recalcification time, the activated partial thromboplastin time, the prothrombin time (Quick), the thrombin time, estimation of fibrinogen concentration, the protamine sulphate test. The activity of the fibrinolytic system was investigated by the euglobulin clot lysis test and by the method of fibrin plates, while fibrinolysis inhibitors were assessed by determination of serum antiplasmines. Also the fibrinolytic degratation products were evaluated. The results indicate a biological condition that can be classified as "thrombophilia", characterized by hyperfibrinogenemia, the presence of fibrin monomers, a decrease of the fibrinolytic activators and an increase in the amount of antiplasmins, as well as a high percentage of fibrinolytic degradation products. Although the patients did not show manifest signs of thrombosis in the postoperative period, the results obtained indicate a tendency to intravascular formation and deposition of fibrin and suggest the necessity to apply prophylactic therapy with anticoagulants in the postoperative period.


[Personal experience with 2,500 closed heart mitral commissurotomies].

Between 1953 and 1976 a total of 2527 mitral commissurotomies have been performed in the Clinic for Cardio-Vascular Surgery of the "Fundeni" Hospital. This group included cases with pure mitral stenosis (predominantly following rheumatic disease), but also cases of mitral stenosis associated with other cardiac lesions in which the major hemodynamic element was the mitral obstruction. Criteria are discussed for surgery, the preoperative preparation of the patient, incidents, accidents and complications, as well as technical difficulties of the digital and/or instrumental mitral commissurotomies on closed heart, either carried out for the first time in the respective patient, or as iterative intervention. Comparing the results in relation with the functional stage of the disease (62.5% of the patients were classified in the III-IV evolutive degree, according to the NIHA classification), pulmonary hypertension (61.6% of the patients had medium or severe pulmonary hypertension), associated lesions (present in 17% of the cases--mitral failure predominated, together with tricuspid or aortic failures), it is appreciated that the technique of mitral commissurotomy on closed heart is an useful therapeutic method (88.6% very good and good results, a global death rate of 3.9%) that can be applied in a large category of patients, although there is a trend toward open-heart surgery, with all medico-economical major implications.


[Iatrogenic acute abdomen].

The autors present 41 cases of acute abdomen occuring after medico-surgical procedures, diagnostic explorations, or conservative treatments. The clinicat pictures of these patients were suggestive of acute abdomen of the peritonitis or hemorrhagic type. The severity of the cases was more frequently determined by the basic disease, for which the exploration was performed, by the retarded intervention and the septic fluid that flooded the peritoneal cavity. Without attempting to minimize the value of explorative or therapeutic procedures, that may sometimes determine acute abdominal syndromes, the authors stress the necessity to make a careful selection of the cases that will undergo these procedures, as well as the capability and the experience of those that will carry them out.


[Tarsometatarsal syphilitic osteoarthropathy].

Bone lesions that develop in the course of tertiary syphilis in the tarsus and the metatarsus are considered by most of the authors as being exceptionaly rare. In the author's statistics the tarso-metatarsal localizations are just as frequent as the tibial ones--generally recognized as elective localizations. A total of 10 cases are presented, of patients with tarso-metatarsal luetic osteoarthropathy, characterized by a mosaic of destructive lesions (osteoporosis, osteonecrosis, osteolysis, bone goma, spontaneous amputations of bone segments), coexisting with bone-constructive lesions (osteophitosis, compact layer condensation, osteosclerosis, peridiaphisal-epiphiseal muff), with periostal and articular reactions. The general clinical signs, the neurological symptoms, the local clinical signs and the specific serologic reactions fill in the nosological frame of the tarso-metatarsal luetic osteoarthropathy, a clinical entity clearly defined by the author. The fact is stressed that, as a rule, cutaneous lesions on the soles of the feet are wrongly taken for simple callosities, while, in fact, these are perforating lesions of the sole, a revealing peripheral sign, which, correctly interpreted, allows for making the diagnosis of tertiary syphilis with tarso-metatarsal osteoarthropathy.


[Fractures of the lower tibia. Results of 128 osteosynthesis].

The authors have treated 128 articular fractures of the lower tibial extremity. All were operated on, a cancellous graft being often added to the screw-plate fixation. 87 cases were re-examined after a 4-year average follow-up. It is concluded that surgical treatment is more valuable than conservative treatment. The results were satisfactory in 90 p. 100 of the cases, but it is emphasized that the patients were young and sportsmen, and that the fractures were closed most of the complications were related to a poor post-operative care.


[Role of neck-head arthroplasty in the treatment of per-trochanteric fractures after the age of 70. Apropos of 140 cases].

The authors compare the results obtained in two series of trochanteric fractures in patients aged more than 70 years. In the first series, the fractures in 64 patients were all treated by nail-plate fixation. In the second series, fractures in 76 patients were treated either by nail-plate fixation (39 cases) or insertion of a prosthesis (37 cases). Prostheses were inserted in unstable fractures. It is concluded that, in all main respects, the results in unstable fractures were better after prostheses than after fixation. This finding is thought to be due to the greater speed of the operation and the possibility of early weight bearing.


[Pseudospondylolisthesis and chondrocalcinosis].

Degenerative spondylolisthesis L4-L5 progressing rapidly toward a surgical intervention for a sciatica in a 52 years old female. The radiography, as well as an anatomo-pathological study, showed an erosive osteoarthrosis of the vertebral articular processes. The disc biopsy revealed a chondrocalcinosis which was also found in the knees on radiological examination. This observation provides, at the spine, a special example of "erosive osteoarthrosis with chondrocalcinosis".


[Physiopathology of osteochondritis of the hip].

The author has investigated to know whether Perthes disease is a localised epiphyseal distrophy or a symptom of a general perturbance of chondral tissue. The complexity of the structure of the femoral head is recalled as well as the development of its vascularisation. Pathogenic factors are discussed. It is concluded that Perthe's disease is probably a localisation of a general disease.


[Measurement of radiation to the hands during orthopedic surgery].

The irradiation dosis to which the surgeon's hands are submitted during operations carried out under control of the orthogonal fluoroscopic examination with image intensifier has been measured by lithium-fluoride ring-dosimeters. This measured dosis is low: 62,3 mrem on the average by operation and by person, e.a. a dosis 19 time less than the maximum weekly admissible dosis, which is 1.200 mrem. The risk run is thus very acceptable as far as the operations are not too numerous weekly for the same team, and also that utilizers are conscious of the necessity of respecting most elementary rules of prudence as much for themselves as well for their collaborators.


[Treatment, at birth, of luxating deformities of the hip. Difficulties, failures and complications. Discussion apropos of coxa vara deformities].

The author has studied 400 newborn babies thought to have unstable hip. The importance of careful clinical and radiological examination is emphasized. An abduction splint must be applied with caution and serial radiographs taken until the hip is normal. In spite of this, one instance of coxa magna, three of osteochondritis and five of coxa vara were found. A classification of coxa vara is suggested to distinguish concordant types compatible with normal hip function from other types.


[Fracture-dislocation of the calcaneus. Apropos of 4 cases].

The authors have observed four cases of a rare condition of fracture-dislocation of the calcaneus. The fracture line was in the sagittal plane and there were only two fragments. An anterior and medial fragment maintained its normal relationship with the talus whilst the posterior and lateral fragment became dislocated laterally underneath the fibular malleolus. Treatment should always be surgical by open reduction and screw fixation. Two cases out of four were not operated upon and these have poor results.


Microsomal ATPase of kidney papilla: sensitivity to diuretics and other inhibitors.

Microsomal ATPase isolated from rat kidney papilla was compared to that from kidney medulla. Microsomal Na, K-ATPase from papilla was more sensitive to inhibition by ouabain, Cad N-ethyl-maleimide, Hg++, Thiomerin, ethacrynic acid and Furosemide than the enzyme from the medulla. Mg-ATPase of the papilla was less sensitive than the medullary enzyme to inhibition by Ca++, Cd++, N-ethyl-maleimide, Hg++, ethacrynic acid and Furosemide. Papillary Mg-ATPase was less sensitive than papillary Na, K-ATPase to all the inhibitors mentioned. Medullary Mg-ATPase was more sensitive than medullary Na, K-ATPase to inhibition by ethacrynic acid and Furosemide but less sensitive than medullary Na, K-ATPase to all the other inhibitors. Papillary Na, K-ATPase is the most sensitive to inhibition and papillary Mg-ATPase is the most resistant to inhibition by various diuretic drugs. The possible significance of these characteristics is discussed.


Quantitative histological changes in isoproterenol induced cardiac growth.

In female rats daily injections of isoproterenol (0.3 mg/kg) produced a 40% myocardial growth within 10 days. Approximately 75% of the total growth was associated with increased muscle fiber size. The number of nuclei in muscle tissue was not affected while the nuclear population in the interstitial tissue was significantly increased.


Immunologic profile of patients with cured Hodgkin's disease.

Blood lymphocytes from 9 patients with Hodgkin's disease (HD) were studied. The results were compared with those of 6 seminoma testis patients and 9 healthy unrelated controls. All patients were in complete and unmaintained remission more than 10 years after termination of radiotherapy. The mean T-lymphocyte count of HD patients was lower than that of controls and seminoma testis patients. Lymphocyte DNA synthesis induced by pokeweed mitogen and phytohaemagglutinin was normal in both patient groups. Concanavalin A-induced DNA synthesis was low in 4 patients with HD although the mean stimulation of the group did not differ from controls or seminoma testis patients. Lymphocyte activation by PPD was slightly decreased in the 2 patient groups. No increase in spontaneous lymphocyte DNA synthesis was observed. The responding and stimulatory capacity in mixed lymphocyte culture was decreased in 3 and 2 HD patients respectively. 4 out of the 9 patients with HD but none with seminoma testis displayed severe impairment in T-lymphocyte functions. As 1 of the 4 had been treated solely by surgery, late effects of irradiation can only partly explain the results. The results may favour a hypothesis postulating a constitutional defect contributing to the immunoincompetence in HD.


Increased ATP-ase activity of lymphocytes after rosette formation with sheep red blood cells.

In a number of experiments it was demonstrated that in the E-rosette assay for human T-lymphocytes using sheep red blood cells, the ATP-ase activity of the lymphocytes increased in proportion to the number of rosettes being formed. Also, after increasing the number of rosettes by treatment of the sheep red blood cells (SRBC) with neuraminidase and after diminishing the number of rosettes by treatment of the lymphocytes with antilymphocyte globulin (ALG), change in the ATP-ase activity was proportional to alterations in the number of rosettes being formed. ALG itself stimulated the lymphocyte ATP-ase activity, possibly through activation of the same receptor sites as used by SRBC.


A case of T-cell lymphoma with Sézary cells in the blood and bone marrow accompanied by peripheral T and B lymphocytosis.

A case of T-cell lymphoma occurred in a man, aged 66, whose symptoms started as itching and the appearance of 1-2 cm indurated plaques with central pustules on the skin of the trunk and face. A few months later generalized lymphomas and splenomegaly were present. Investigations of the lymphocytic subpopulations in situ in fresh frozen sections of lymphomas and skin showed only T cells. Samples of blood and bone marrow disclosed lymphocytosis and Sézary cells. Both T and B lymphocytes were definitely increased in the blood. The value of tissue studies in analyzing lymphocytic subpopulations is emphasized as a differential diagnostic aid in classifying lymphomas. A relationship between the T-cell neoplasia and the T and B lymphocytosis to mycosis fungoides and the Sézary syndrome is discussed.


Unusual cutaneous manifestations of sarcoidosis.

The diagnosis of sarcoidosis is best established when there is evidence of granulomatous involvement in two or more organs. Three patients with unusual cutaneous manifestations of sarcoidosis, including palmar and follicular lesions, nonscarring alopecia, and widespread plaque or erythrodermic sarcoidosis, are reported. In all three patients the skin biopsy was important in establishing the diagnosis.


The use of ophthalmosonometry in the diagnosis of carotid artery stenosis.

One hundred and fifty-two patients underwent supraorbital Doppler studies of 304 carotid arteries to determine the presence or absence of hemodynamically significant lesions. Subsequent carotid arteriography was used to validate the accuracy of the test. Of 124 patients having abnormal Doppler examinations, 107 (86%) were angiographically proved to have lesions of the internal carotid artery that produced a stenosis of 50% or more. In the last 80 patients, the accuracy was increased to 94%. Of 115 proved stenoses or occlusions, the supraorbital Doppler examination correctly identified 99, for a diagnostic accuracy of 86%. In the last 50 patients, this accuracy was increased to 93%. Since only 58% of the patients with lesions had a bruit, the Doppler study was of particular value in identifying the patients with significant lesions in the absence of a bruit. Likewise, since only 61% of carotid arteries with bruits had lesions of hemodynamic significance, a normal Doppler examination could have been used to avoid angiographic screening of those arteries with bruits in the absence of major lesions, providing those hemodynamically insignificant lesions were not producing symptoms related to emboli. The technique of ophthalmosonometry and the significance of the test in clinical evaluation is discussed.


Prevention of endotoxin-induced changes in oxidative phosphorylation in hepatic mitochondria.

E. coli endotoxemia affects hepatic energy linked function by uncoupling oxidation from phosphorylation. This study was done to determine whether a steroid, methylprednisolone sodium succinate (MPS), as well as excess substrate sodium succinate (SS), alters directly the effects of endotoxin on hepatic mitochondria. An assay system using alpha-ketoglutarate (alpha-Kg) was developed to test this hypothesis. Isolated rat hepatic mitochondria were first incubated in concentrations of MPS, ranging from 2.0 to 6.0 mg/ml. At these concentrations uncoupling identical to that occurring with addition of endotoxin resulted. However, a more dilute solution of MPS, 0.12 mg/ml, permitted normal mitochondrial function. Preincubation of MT in 0.12 mg/ml of MPS, as well as with sodium succinate, prevented endotoxin-induced uncoupling. Both endotoxin and steroid resulted in increased ATPase activity in  the medium. While preincubation with MPS blocks the endotoxin effect, very high steroid concentrations alone are harmful. A direct action of steroids on mitochondria is evident, as well as a weaker protective effect due to excess substrate (alpha-Kg + SS). Since mitochondria are probably in direct communication with extracellular fluid, the assay system permits interaction of endotoxin, steroids, and substrates which mimic those which occur in vivo. The results of this study account for the previously reported variable effects obtained when steroids have been tested in vivo.


Pulmonary metastases, a potential biologic consequence of anesthetic-induced immunosuppression by thiopental.

This set of experiments was devised to determine the effects of the commonly employed anesthetic induction agent, thiopental, on the incidence of pulmonary metastases in a murine fibrosarcoma system. A correlation was made with cell-mediated immune responses in vivo and in vitro. In two separate experiments, thiopental-treated mice had a significantly increased incidence of pulmonary metastases. This was correlated with an impaired delayed hypersensitivity reaction to the de novo antigen. 2,4-dinitrochlorobenzene (DNCB) and a suppressed mixed leukocyte culture (MLC) reaction. However, if animals were sensitized with DNCB 5 days prior to receiving pentothal, no impairment of DNCB reactivity was noted. This suggests strongly that the observed defect is in the afferent arm of the immune response. Thiopental suppresses cell-mediated immune responses in this system, and the observed biologic consequence is an increase in pulmonary metastases.


In vitro and in vivo measurement of total antiplasmin activity.

Total antiplasmin was measured in vitro and in vivo. In the former case, rabbit plasma was mixed with various concentrations of Urokinase (UK) and the least concentration for appearance of fibrinolytic activity was estimated. This concentration was multiplied by the plasma volume of the rabbit to give the in vitro total antiplasmin. The mean value for 14 rabbits was 4,068.6 units. In order to estimate the total antiplasmin in vivo, UK solution was infused into rabbits. The infusion speed was multiplied by the time of the first appearance of fibrinolytic activity to give the total antiplasmin, although when the infusion speed was low, fibrinolytic activity did not appear during infusion. The mean in vivo total antiplasmin calculated for 6 cases where the infusion speed was high and fibrinolytic activity was observed, was 28,699.8 units, i.e. about 7 (range, 3-11) times the in vitro value.


Assay of the esterase activity of thrombin, plasmin and trypsin with a chromogenic substrate p-nitrobenzyl p-toluenesulfonyl-l-arginine.

p-Nitrobenzyl p-toluenesulfonyl-L-arginine has been synthesized. A number of trypsin-like enzymes can catalyze the hydrolysis of this ester leading to formation of p-nitrobenzyl alcohol. After separation from the ester and p-toluenesulfonylarginine by extraction into chloroform, the p-nitrobenzyl alcohol liberated can be measured spectrophotometrically at 271 nm. Under the conditions of the assay, the hydrolysis of 1 micronmol/ml of the ester is equivalent to an absorbance change of 4.45 cm-1 at 271 nm. With 0.10 mM p-nitrobenzyl p-toluenesulfonyl-L-arginine in 0.1 M Tris-HCl at pH 8.4 and 30 degrees, the enzymatic hydrolysis is linearly proportional to time up to consumption of 60% of the ester. Product formation is proportional to enzyme concentration with 0.05 to 0.2 NIH clotting units/ml for bovine or human thrombin, 0.005 to 0.02 CTA units/ml for human plasmin, and 0.01 to 0.04 microgram/ml protein for bovine pancreatic trypsin. In 0.1 M Tris-HCl at pH 8.4 and 30 degrees, Km is 14 micrometer and Vmax is 0.037 micronmol/min/NIH unit/ml for bovine thrombin, Km is 78 micrometer and Vmax is 0.31 micronmol/min/CTA unit/ml for human plasmin, and Km is 12 micrometer and Vmax is 138 micronmol/min/mg protein/ml for bovine trypsin. With bovine thrombin, activities at pH 7.3 and at pH 9.2 were 30% lower and 40-50% higher than the rate at pH 8.4. Samples of bovine and human thrombin ranging in specific clotting activity from 59 to 2133 NIH units/mg protein showed esterase activities varying from 0.15 to 0.4 micronmol p-nitrobenzyl alcohol formed/10 min/NIH unit.


[Ureteroureterostomies: indications and results (author's transl)].

Thirteen unilateral ureteroureterostomies and twenty-five transureteroureterostomies (TUU) were performed since 1968. In 22 of these, a transureteroureterocutaneostomy (TUUC) was done. Indications, operative procedures, results and complications are discussed. No complications due to the anastomosis were found. In six cases stenosis of the ureterocutaneostomy was demonstrated which, in four instances, made another form of urinary diversion necessary. Ureteroureterostomies should only be performed with well functioning kidneys and with one well preserved ureter. TUUC is recommended in cases with at least one dilated ureter.


Carcinoma of the breast with multinucleated reactive stromal giant cells. A light and electron microscopic study of two cases.

Two unusual carcinomas of the breast are described, containing nests of infiltrating neoplasm situated within stromal lacunar spaces, and surrounded by numerous benign appearing multinucleated giant cells. Within the stroma, there was extensive hemorrhage, hemosiderin pigment deposition, and large numbers of mononucleated inflammatory cells. The morphology of both tumors resembled the giant cell tumor of bone. Although a similar giant cell reaction has recently been described in association with a uterine leiomyosarcoma, we are aware of only two other examples of this entity in the breast, both reported over 40 years ago in the French literature. This is the first report in which electron microscopy confirmed the benign histiocytic nature of the giant cells. These cells had many of the ultrastructural features of multinucleated giant cells described in tissue culture, skeletal osteoclastomas, and foreign body granulomas. We propose that the giant cells arise from fusion of mononucleated stromal cells, and most likely are reactive histiocytic elements which are in some way related to the tumor cell nests. Further studies of these unusual neoplasms are needed to determine if the giant cell reaction in any way affects the prognosis of the patient.


Disseminated peritoneal leiomyomatosis.

Disseminated peritoneal leiomyomatosis is an unusual condition characterized by the development of numerous nodules in the peritoneal cavity which histologically have the appearance of smooth muscle tumors. The ninth proven case of this ill-understood disorder is presented here, with comments on some of the other published instances. Most reported cases were diagnosed in pregnant women, and there is good reason to believe that endocrine factors are of importance in the development of this condition. Attention is drawn to experimental studies in which an apparently similar condition has been produced in guinea pigs by endocrine manipulation. Clinically, the condition appears to be benign and the correct diagnosis is, therefore, of great importance. In the case presented here histological involution of the leiomyomatous peritoneal nodules could be demonstrated for the first time by two biopsies at an interval of 4 months--in the absence of any therapy apart from the termination of pregnancy.


[Microcalcifications in testicular germ cell tumors. Orientating study concerning its diagnostic utilization (author's transl)].

Connected to testicular germ cell tumors, microcalcifications have been identified by microscopic tissue evaluation, the significance of which has not yet been discussed. Microscopic and radiographic evaluation of histologic slides and paraffin embedded tissue specimens, respectively, of 129 germ cell tumors showed that 46.4% of testes with seminoma and 68.3% of testes with teratoma display microcalcifications as round or roundish psammomatous bodies or irregular-shaped dystrophic calcifications, in teratoma as particles of bone tissue or calcified cartilage. Whereas psammomatous bodies are located within tubules in compressed residual testicular tissue arranged in a shell-like zone around the tumor mass, dystrophic calcifications and bone and cartilage tissues are identified inside the tumor. Often more than 10 microcalcifications per cm2 are present. The diagnostic importance of these findings for clinical use is discussed. Above all, it must be made dependent on a radiographic method which will not be dangerous for testicular tissue.


Acinar cell hydropic degeneration induced by intraductal instillation of solutions into the parotid glands of the rats.

Saline or BSA were instilled 2, 5, 8 or 11 times at daily intervals into the parotid glands of rats, via Stensen's duct. Hydropic change of the acinar cells developed after 8 and 11 instillations. Histologically, the lesion was characterized by enlargement of the acinar cells, the cytoplasm of which contained vacuoles displacing the nuclei. In view of the negative results of various histochemical reactions the vacuolization was interpreted as hydropic in nature.


Morphologic differential diagnosis of idiopathic cardiomyopathies.

Scanning electron microscopic examination of the myocardium in cardiomyopathies is a valuable complementary method beside light and transmissionelectron microscopy for the differential diagnosis of this rare disease. In two cases of congestive cardiomyopathy no marked alterations of the myocardial architecture could be found whereas in one case of nonobstructive hypertrophic cardiomyopathy myocardial cell alterations and structure disorders could be demonstrated in an almost stereologic view. The pathogenesis of heart failure in this disease was clearly shown. Similar changes were not observed in hearts without cardiomyopathy or in other forms of cardiac hypertrophy.