Heavy metal levels and delta-amino-levulinic acid dehydrase levels in peripheral polyneuropathy.

On the basis of assay of heavy metals in whole blood (lead, cadimum, chromium, copper, nickel and manganese) and delta-amino-levulinic-acid dehydrase (ALA-D) and ALA in urine in a normal Danish population, the levels of these clinco-chemical factors were assayed in 23 patients with peripheral neuropathy of unknown etiology. All patients studied showed electro-physiological sign of denervation and/or reduced motor or sensoric nerve conduction velocity. Cadmium and manganese were never found to be increased. In all but four patients, an increase of one or more heavy metals was found. Ten patients showed raised levels of two or more metals, the dominant metal being lead (10 cases), nine patients showed increased in chromium. A significant corrleation was found between increasing lead levels and decreasing ALA-D activity. Although normal concentrations of manganese were found, correlation analysis revealed a significant correlation between increased manganese and decreased ALA-D. The raised values of heavy metals could not be traced to occupational or other exposure to heavy metals and the increased values were not related to tobacco consumption. The findings are discussed in relation to known data on neuropathy and the results seem to indicate a multifactorial patholgenesis of the disease. Among factors contributing to the precipitation of the syndrome may be raised levels of heavy metals.


Ultrastructure of Lewy bodies in the stellate ganglion.

The Lewy body, a characteristic nerve cell inclusion in idiopathic parkinsonism, was examined by electron microscopy in the stellate ganglion, obtained from 9 patients at autopsy. Three main forms of Lewy bodies or Lewy body-related structures were demonstrated: A.Rare filamentous Lewy bodies, similar to Lewy bodies in the central nervous system. B. Granular Lewy bodies in nerve cell processes. C. Abnormal nerve cell processes, filled with heterogenous material. Large dense core vesicles were prominent in the last 2 forms. None of these abnormalities were found in 2 control groups consisting of 9 parkinsonism cases without central nervous system Lewy bodies, and 17 cases without parkinsonism. The filamentous Lewy body (type A) was found in the perikaryon and was surrounded by neuromelanin, whereas the other forms (type B and C) were seen in nerve cell processes. Mitochondrial inclusions, present mainly, but not exclusively, in neuromelanin-containing cells, were not related to Lewy body formation or to parkinsonism.


Extraocular muscles: light microscopy and ultrastructural features.

Thirty extraocular muscles (EOM) from 20 patients were evaluated by light microscopy (LM), electron microscopy (EM), and enzyme histochemistry (EZH). Twenty-one EOM were obtained from 13 patients with strabismus, 9 EOM from 4 patients undergoing eye surgery for other reasons and from 3 autopsy cases. One mum thick sections revealed marked variation in muscle fibre shape and size and in myofibrillar structure; also noted were small, hypertrophied, whorled, and ringbinden fibres. Dense and granular material in the central portion of some fibres and sarcomere disruption in 2--3 mum sections was observed. EZH revealed the absence of the classical mosaic pattern usually found in skeletal muscles. ATPase studies were inconsistent and did not correlate with the expected reciprocal activity of NAD-H diaphorase, particularly on the large fibres. Ultrastructural features consisted of vacuoles within myofilament bundles, "smearing" of Z bands, and "nemaline rods". Occasional myelin figures and lipid-like droplets were observed in subsarcolemmal spaces, associated with scattered clusters of glycogen granules. Abnormal mitochondria and subsarcolemmal inclusions of dense and granular material were conspicuous. "Leptomeric" profiles, "Zebra bodies", or "striated bodies" were noted in 8 EOM's, and an Hirano body was found in 1. The intramuscular nerves contained structures resembling "Luse bodies" in 7 cases. These observations suggest that EOM from individuals with and without strabismus possess unique structural characteristics suggestive of developmental and morphological disarrangement of contractile elements. Some of these changes might play a role in the pathogenesis of strabismus and in the development of clinical symptoms. These features are significantly different from striated skeletal muscle. Therefore the criteria used in the pathological evaluation and diagnosis of skeletal muscle disorders cannot be unequivocally applied to EOM investigations. These data establish the necessity to determine histological norms, ultrastructural patterns, and develop new enzyme histochemistry criteria for the evaluation of EOM. Only then can an acceptable comparison of EOM and skeletal muscle be made.


Smooth-muscle antibodies and antibodies to cytomegalovirus and Epstein-Barr virus in leukaemias and lymphomata.

By means of the indirect immunofluorescent method, smooth-muscle antibodies (SMA) were detected significantly more often in patients with malignant diseases (11.7%) than in normal controls (3.3%) (0.02 greater than pgreater than 0.01). SMA occurred in 23.8% of patients with Hodgkin's disease, in 13.3% of patients with myeloproliferative diseases and in 4.7% of patients with lymphoproliferative diseases. Other tissue antibodies were rare and they were found to occur at the same frequency in patients and controls. The occurrence of cytomegalovirus (CMV) antibodies did not differ significantly in patients and controls and, in both groups, the frequency of these antibodies increased with increasing age. The frequency of Epstein-Barr-virus (EBV) antibodies increased also with increasing age both in patients and controls, but these antibodies were found more frequently in patients than in controls (p=0.03). No relationship between the occurrence of SMA and viral antibodies was demonstrated. Thus, the development of SMA in patients with malignancies could not be shown to be due to CMV or EBV infection.


Hepatography with intravenously injected emulsified iodolipids. Preliminary results.

Hepatography by slow intravenous infusion of AG 60 99 Guerbet (iodized lipids in a stable emulsion) was performed in 31 patients, aged 17 to 77 years, to detect circumscribed hepatic lesions: metastases, cysts, and hepatic abscesses. The tolerance was good with minor side effects unrelated to the patient's age. The uptake of the medium involves the entire liver and lasts for several hours, allowing tomography to be carried out. Intrahepatic lesions with a diameter of less than one centimeter may be demonstrated. Hepatography proves to be the most accurate method available at present for exploration of the liver.


Hepatosplenography by intravenous injection of a new iodized oily emulsion.

Hepatosplenography with intravenously injected iodized lipid emulsion has been performed in 30 cases and the results reported. The side effects were minor and transient, as the elimination is rapid. The uptake in the liver was satisfactory and permitted tomography both of the liver and the spleen. Small neoplasms and splenic nodules in Hodgkin's disease could be detected and located accurately.


[Changes in area of mucous membrane in otosclerosis].

In 98 samples of middle-ear mucosa, taken from patients during otosclerotic stapes surgery, considerable pathological changes in the organization of the capillaries were found (endothelial hydrops, proliferation of the intima and adventitia, total obliteration of small vessels). They caused pathological reactions of the mesenchymal elements of the submucosa: fibrocytes undergo lysis, collagen fibres show fibolysis and hyalinosis. Free and cellular bound calcium deposits are located in these lytic areas. Even the epithelial stratum reveals uncommon inclusions such as glycogen and acid mucopolysaccharides. The basement membranes of the capillaries as well as of the epithelium show enlargements and solution of their ultrastructure. The changes of the connective tissue and of the epithelium are secondary to the capillary obstructions.


Treatment of glioblastoma multiforme. A review.

Experience in irradiating 114 patients with glioblastoma multiforme is reviewed. The split-course therapy utilized in this series, even to high doses (approximately 5 600 rad in 20 fractions over 45 to 50 days), was not associated with an improved survival and does not seem of benefit over conventional fractionation. Adding BCNU (or perhaps tri-iodothyronine) to medium field (less than 135 mc) and moderate dose irradiation (5 000 rad in 25 treatments in 33 days) may improve the outlook for patients with glioblastoma multiforme. An expanded controlled clinical trial to assess this promise of improved treatment results seems indicated.


The pathophysiology of sleep disorders in pediatrics. Part I. Sleep in infancy.

In this part of the chapter we have described the characteristics of two alternating sleep states - REM and NREM sleep in preterm and full-term infants. We have indicated how individual physiologic measures, recorded during sleep, mature and become synchromized into patterns that define the sleep states. We have described abnormalities in this process and have related them to clinical populations of deviant infants. Throughout, we have emphasized the complexity of the process and the methodologic sophistication required to investigate adequately the multiple dimensions of sleep. Despite somewhat discrepant and confusing reports in the literature, we continue to believe that sleep studies will provide rewarding insights into the central nervous system functioning of the developing young infant.


Lactic acidosis in childhood.

Children with chronic metabolic acidosis should be investigated to determine the presence of an organic acid, especially when the plasma electrolyte profile shows a deficiency of anion. One of the organic acids that should be looked for in such a patient is lactic acid. Lactic acidosis due to tissue hypoxia is a well-known phenomenon (e.g., in shock and cardiopulmonary disease) and has not been discussed in this essay; nor has lactic acidosis due to exogenous causes like infusion of fructose or sorbitol, or admiministration of phenformin. Chronic lactic acidosis in infancy is a rare condition. It may be associated with glycogen storage disease Type 1, fructose diphosphatase deficiency, methylmalonic acidemia, propionic acidemia, pyruvate carboxylase or dehydrogenase deficiency and Leigh's subacute necrotizing encephalomyelopathy (SNE). Some patients with chronic lactic acidosis do not have nay of these diseases and comprise an "idiopathic" group. This is a heterogeneous group, probably having several different causes for the metabolic error. In Leigh's SNE, a metabolic block in the formation of thiamine triphosphate in brain has been demonstrated and has been attributed to the presence of an inhibitor of thiamine pyrophosphate-adenosine triphosphate (TPP-ATP) phosphoryl transferase in body fluids. The inhibitor has also been encountered in cases of intermittent cerebellar ataxia and of primary hypoventilation (Ondine's curse), which may represent variants of Leigh's disease. Increased blood levels of lactate, pyruvate and alanine frequently are encountered in SNE, but it still is not clear whether they are due to a primary or secondary disturbance in the catabolism of pyruvate. Disturbed lactate and pyruvate metabolism has also been encountered in isolated cases of mental retardation and growth failure, in mitochondrial myopathies and in polyneuropathies, and may be expected to occur in Wernicke's encephalopathy. Finally, it has been noted in malignancy and in association with other rare metabolic disorders.


Improved detection of myocardial infarction with technetium-99m stannous pyrophosphate and serum MB creatine phosphokinase.

The relative sensitivity and combined value of myocardial technetium-99m stannous pyrophosphate imaging and determinations of serum MB creatine phosphokinase (the "myocardial" CPK isoenzyme) in detecting acute myocardial infarction were evaluated in 41 patients with suspected infarction and 23 patients recovering from cardiac surgery. In the patients with suspected infarction, myocardial infarction was confirmed in 25 and was consistently associated with increased serum MB CPK. Abnormal radionuclide images were obtained in 23 of 25 patients (92 percent) with definite myocardial infarction and in 2 of 16 patients without confirmed infarction. Although the localization of infarction by imaging correlated well with the localization by electrocardiogram, infarct size estimated by imaging did not correlate well with estimates based on peak total serum CPK activity or serial changes in CPK activity. Serum MB CPK activity increased after cardiac surgery in 6 patients undergoing valve replacement and in 17 patients undergoing coronary arterial bypass surgery. However, no patient with valve replacement and only 1 of the 17 with bypass surgery had an abnormal radionuclide image. These results suggest that (1) abnormal radionuclide images in patients without infarction can be distinguished from abnormal images indicative of ischemic necrosis by consideration of MB CPK activity and (2) interpretation of elevated MB CPK activity, particularly in particularly in patients undergoing cardiac surgery, is facilitated by evaluation with imaging.


A comparative morphometric analysis of the effects of thyroxine and ACTH on the zona fasciculata of rat adrenal cortex.

The effects of thyroxine and ACTH on the ultrastructure of cells of the adrenal zona fasciculata were studied by morphometric analysis and compared by two-way analysis of variance. The results indicate that the effects of thyroxine and ACTH are different and independent. The statistically significant differences in effect of thyroxine and ACTH are: thyroxine causes an increase in the volume fraction of mitochondria and a decrease in the volume fraction of endoplasmic reticulum independent of ACTH; thyroxine causes a decrease in surface density of mitochondria and endoplasmic reticulum in the absence of ACTH, but in the presence of ACTH this effect is moderated by an interaction of throxine and ACTH. There were no statistically significant effects of either thyroxine or ACTH on volume fraction or surface density of liposomes.


Postprandial plasma triglyceride and cholesterol responses to a low-fat meal.

Postprandial plasma cholesterol and triglyceride (TG) levels were measured after the consumption of a relatively low-fat (35% of calories) diet in 41 subjects. Plasma cholesterol levels did not change appreciably during the postprandial state. In 34 subjects a biphasic plasma TG response curve was noted, with an initial peak occurring 1 to 3 hr after feeding and a secondary TG peak 4 to 7 hr after the meal. The primary peak was greater than 90%, accounted for by chylomicrons, whereas the secondary peak represented very low-density lipoproteins (greater than 82%). Furthermore, the heights of the primary and secondary peaks were closely correlated to the fasting TG level (r = 0.61 and 0.72, respectively) indicating that the fasting TG concentration is an important determinant of the postprandial TG response. Because low-fat (high-carbohydrate) diets are known to raise fasting TG levels in patients who do not have fasting hyperchylomicronemia, and because relatively few patients have chylomicrons in the fasting state, these data suggest that such diets may lead to day long increases in plasma TG levels in the majority of subjects.


Anorexia-producing intermediary metabolites.

Major phases of the physiology of food intake regulation remain hypothetical. There is a central regulatory mechanism for hunger and satiety, but the signals and messages that activate the brain centers remain conjectural. The alimentary tract regulation, the regulation by osmoreceptors, the thermostatic, the glucostatic, the lipostatic, the amino acid, and the hormonal food intake regulation theories leave many questions unanswered. Low molecular weight peptides appear to have an important effect on brain functions. Hypothalamic peptides such as thyrotropin-releasing hormone, gonadotropin-releasing hormone, and somatostatin have been assigned new roles in various brain functions. The hypothalamus and probably other parts of the brain produce also anorexigenic peptides. Anorexia is a common manifestation of cancer. It is proposed that peptides, oligonucleotides, and other small metabolites produced by the cancer and by the tumor-bearing host are responsible for the genesis of the anorexia. They produce the anorexia through a peripheral effect on neuroendocrine cells and neuroreceptors and through a direct effect on hypothalamic and other central nervous system sensor and responder cells.


Additive risk factors in atherosclerosis.

The tissues of human subjects assayed for a higher level of vitamin D than the tissues of 6-month-old swine which had been fed a commercial ration containing 14 times more vitamin D3 than the National Research Council recommended requirement for growing swine. Bioassays of commercial livestock feeds indicate much higher vitamin D contents than the National Research Council recommendation. High levels of vitamin D activity are demonstrable in tissues from the animals on such livestock feeds. The grossly normal areas of the aorta of weanling swine fed 100,000 IU of vitamin D3/pound of basal ration during the initial 6 weeks had a higher frequency of degenerated smooth muscle cells than the grossly normal areas of the aorta of swine fed the commercial ration, or 7.43+/-0.45 and 5.60+/-0.27/100 cells, respectively, at the age of 3 months. Tbe addition of 13 pounds of hydrogenated fat and 200 g of cholesterol/100 pounds of the commercial ration further increased the frequency of degenerated smooth muscle cells by 0.53 (P less than 0.05) or to 7.96 +/- 0.39/100 cells in the grossly normal areas of the aorta of weanling swine fed this fat-supplemented ration to 3 months of age.


Decreased T-lymphocytes in patients with mammary cancer.

The levels of thymus-derived lymphocytes (T-cells) in samples of peripheral blood from 47 patients with carcinoma of the breast, 36 patients with benign mammary lesions, and 33 matched normal controls were determined. Results were analyzed with three statistical tests. It was found that the mean percentages of T-lymphocytes differed significantly among the three groups of patients (p less than 0.001). The mean percentages of rosette-forming lymphocytes were 72.8 for the normal group, 60.6 for patients with benign mammary lesions, and 45.1 for the patients with carcinoma. The finding of lower levels of T-lymphocytes in the peripheral blood of individuals with mammary cancer is of particular significance since all the patients in this study were otherwise in apparently good general health and undergoing no treatment.


Germ-cell tumors of the mediastinum, postmortem findings.

Autopsy findings in 20 cases of clinical extragonadal germ-cell tumors arising in the anterior mediastinum are presented. The histologic types were: 2 choriocarcinomas, 3 seminomas, 3 malignant teratomas, 3 embryonal carcinomas, and 9 mixed germ-cell tumors. All of the patients were men, and the ages ranged from 14 to 45 years, with a mean of 32.5 years. The mean survival for these patients after diagnosis was 10.9 months. Local recurrence was characteristic of non-seminomatous tumors. In patients with seminoma, local control of the disease was good, but distant metastases were the cause of death. The most frequent sites of metastases were lungs, bones and liver. In all 20 cases, the testes were carefully step-sectioned. Occult tumor was found in only one case of embryonal carcinoma and a well-defined testicular scar with calcification in a patient with choriocarcinoma. Both patients had lower retroperitoneal metastases. These findings support the premise that, in the majority of cases, these tumors had a primary extragonadal origin.


The occurrence in a neonate of a pancreatic adenoma with nesidioblastosis in the tumor.

A newborn with persistent hypoglycemia and fixed insulin secretion unresponsive to medical management underwent 80% pancreatectomy. A 1-cm. nonencapsulated islet-cell adenoma near the tail of the pancreas was identified histologically. Islet-cell granules stained with indirect aldehyde fuchsin. Throughout the tumor, areas of nesidioblastosis were identified. The persistence of this embryologic process suggests a basic mechanism for the adenoma formation.


Red cell uridine monophosphate kinase: effects of red cell aging on the activity of two UMPK gene products.

We have previously reported that uridine monophosphate kinase (UMPK) is genetically polymorphic in man, and that the UMPK2 gene product has less activity than that of UMPK1 when measured in normal red cells. In this paper we present evidence that the activity of UMPK, like that of many other enzymes, declines during red cell aging, and that the lower activity of UMPK 2, as compared with UMPK 1, is best explained by its more rapid catabolism.


Variance of plasma free and esterified cholesterol in adult twins.

Total, free and esterified cholesterol were measured in the plasma, high density lipoproteins, low density lipoproteins, and total cholesterol in the very low density lipoproteins of 141 pairs of adult white male twins. Free cholesterol in plasma, high density lipoproteins and low density lipoproteins had significant genetic variance. Esterified cholesterol had greater total variance in dizygotic than monozygotic twins, interpreted as evidence for greater environmental influences on the two types of twins. After bias due to unequal environmental effects on the two types of twins was removed, there was no significant genetic variance for any esterified fraction of cholesterol.


The HCG-beta-subunit radioimmunoassay: potential error in HCG measurement related to choice of labeled antigen.

Antiserum generated against the hormone-specific beta-subunit of hCG uas used with different labeled antigens to measure circulating hCG in patients having trophoblastic disease. When 125 I-hCGbeta served as the labeled antigen, a small number of patient sera failed to show parallelism with the second IS-hCG reference and erroneous estimates of hormone concentrations were obtained. Replacement of the 125I-hCGbeta with labeled hCG corrected the nonparallelism exhibited by these samples. Inhibition curves obtained with purified hCG and hCGbeta suggested that both the nonparallelism and its correction with the change in labeled antigen would be consistent with the possibility that this assay aberration may result from the presence of free hCGbeta in these sera.


Virilizing adrenocortical adenoma studied by selective adrenal venography.

A 15-year-old girl with primary amenorrhea, hirsutism, and enlargement of the clitoris was found to have an increased titer of the urinary neutral 17-ketosteroids which failed to decrease after the administration of dexamethasone and an adrenal tumor was demonstrable on venography. Analysis of the adrenal venous effluent revealed gradients on the side of the tumor for testosterone, androstenedione, estradiol, and dehydroepiandrosterone sulfate. Following removal of the tumor, the hirsutism improved markedly, the menses returned, and sexual maturation progressed.


Failure of systemically administered adenine arabinoside to affect humoral and cell-mediated immunity.

The effect of a high dosage (250 mg/kg of body weight) of adenine arabinoside or ara-A (9-beta-D-arabinofuranosyladenine) on humoral immunity was studied in New Zealand white rabbits infected with the McKrae strain of herpes simplex virus. The rabbits were treated daily for 14 days with subcutaneous injections of ara-A. The primary and secondary humoral responses, as measured by neutralizing antibody titers, developed similarly in control and treated groups. Similar drug treatment was used on guinea pigs before or after sensitization with BCG vaccine. Subsequent challenge of the sensitized animals with Old tuberculin solution indicated that ara-A treatment had no effect on the induction or previously established cell-mediated immunity. The lack of immunosuppressive activity of ara-A at dosage levels higher than those used in primates makes this drug a potentially effective agent in the systemic treatment of herpetic infections.


Ultrastructure and formation of lamellated inclusion bodies in induced lung tumors of the European hamster.

Utlrastructure and formation of lamellated inclusion bodies (LB) in N-dibutyl-nitrosamine-induced lung tumors in European hamsters are described. Two types of LBs are observed: one with cross-barred lamellae and one with concentric lamellae. Both types develop from lysosome-like dense bodies which are formed by the Golgi apparatus. More mature forms fuse with rough endoplasmic reticulum (RER). Mature LBs migrate to the cell surface, where their contents are extruded into the alveolar lumen by means of a merocrine secretion. The extruded lamellae give rise to the myelin figures and lattices that are reported to possess surfactant properties.


Effects of glucocorticoids on carbohydrate metabolism.

A patient with pre-existing diabetes mellitus who was receiving corticosteroids in an effort to prevent transplant rejection was presented. The patient's hyperglycemia was exacerbated by the corticosteroids, and the discussion centered around this aspect of the case. The clinical effects of glucocorticoids on carbohydrate metabolism were reviewed, and four general points were made: (1) the chronic effects of corticoids on glucose tolerance are much less pronounced than the acute effects; (2) the degree of impariment is proportional to the pre-existing status of glucose tolerance; (3) development of frank diabetes mellitus in a previously normal patient is unusual; and (4) the abnormalities of carbohydrate metabolism induced by glucocorticoids fit the pattern of an insulin resistant state. The subject was reviewed and relevant in vivo and in vitro observations were presented in support of the above concepts, and to help identify the pathophysiologic mechanisms involved. It was postulated that glucocorticoids affect glucose metabolism by decreasing glucose utilization and by increasing hepatic glucose production. The possible mechanisms underlying these effects were discussed.


The occurrence and frequency of type C virus-like particles in placentas from patients with systemic lupus erythematosus and from normal subjects.

Type C RNA virus-like particles were found by electron microscopy in term placentas from 3 patients with systemic lupus erythematosus (SLE), 1 with probable SLE, and 2 normal patients. The virus-like particles were mainly of a budding or immature type located at or near the cell membrane of syncytiotrophoblasts in chorionic villi. Type C virus-like particles were not observed in the term placenta from a patient with chronic discoid LE, nor in early gestation specimens from 1 normal patient and 4 patients with SLE. The frequency of the Type C particles varied greatly: They were readily found in the patient with probable SLE, and only here were groups of budding particles observed. Type C particles were less numerous in one normal placenta and rare in the other positive placentas, both SLE and normal. Heretofore undescribed crystalline inclusions were found in the cytoplasm of chorionic villous endothelial cells from 3 patients with SLE and 1 with discoid LE. Tubuloreticular structures were observed in the maternal endometrium of 1 patient with SLE.


Primate kidney function in hemorrhagic shock as influenced by dibutyryl cyclic AMP.

Standardized hemorrhagic shock was employed to study alterations in electrolyte and water handling in the owl monkey, either normally hydrated or moderately dehydrated. Increase in fractional clearance of osmolarity,sodium, and calcium occurred with retransfusion after the hypotensive phase. In the hydrated animals, free-water clearance became positive, and the urine-to-plasma osmolarity ratio [(U/P)osM] decreased below 1.0. In the dehydrated animals, free-water reabsorption (TCH2O) decreased but remained negative,while (U/P)osM remained above 1.0. Dibutyryl cyclic AMP (DBcAMP) was infused into the renal arterial supply in an attempt to correct a possible deficiency of cyclic AMP production. In the hydrated group, free-water clearance (CH2O) became more positive with infusion, and (U/P)osM decreased even further, with no effect on fractional sodium clearance. Effects were less or absent in the dehydrated group. Possible explanations for the observed effects of DBcAMP are considered. It was concluded that the loss of concentrating power seen in hemorrhagic shock occurs at a step beyond the production of cyclic AMP by adenylate cyclase.


Muscle fiber involvement during training of different intensities and durations.

The extent of skeletal muscle fiber type involvement during exercise training was evaluated by assessing the increase in oxidative markers in the muscles of rats trained by various exercise programs. Rats were trained by running 6 days/wk at 1 mph for 12 wk by one of four protocols: group I-10% grade, 2 h/day; group II-10% grade, 4 h/day; group III-30% grade, 40 min/day; and group IV-30% grade, 2 h/day. No distinction was found between the different programs for the increase in cytochrome c content or citrate synthase (CS) activity of mixed muscle. The more intense programs utilizing a 30% grade induced an increase in CS activity in the fast-twitch white (FTW) fiber that was twice that found in the 10% grade groups. The fast-twitch red (FTR) fibers of the 2 h/day or more groups showed a similar increase (90-95%) in CS activity except for the group that ran for only 40 min/day. These data suggest that: 1) running durations of moderately intense exercise longer than 2 h/day do not further increase the oxidative capacity of the working muscles; and 2) more intense exercise builds on the performance of previously used FTR fibers and additionally involves the low oxidative FTW fibers.


Short versus long hospitalization:  a propspective controlled study. IV. One-year follow-up results for schizophrenie patients.

The authors compared treatment results for 141 schizophrenic patients randomly assigned to short-term or long-term hospitalization. Test results indicated that the long-term group was functioning significantly better one year after admission according to global measures only. The authors caution that the differences between the two groups, although statistically reliable, were modest and may have been confounded by the amount of psychotherapy the patients received after hospitalization. Although there appears to be a general advantage to the long-term approach, further work will be needed to identify patient subgroups for whom this more expensive treatment is cost effective.


Limitations of Brief Hospital Treatment.

A total of 175 newly admitted inpatients who lived with their families were randomly assigned to three treatment groups: standard inpatient care and brief hospitalization with and without transitional day care. Case reports of 6 of the 9 patients considered "study failures" illustrate that effective postdischarge adaptation is limited by the patients' degree of impairment as well as the family and community capacity to accept them. Although rapid return to the community is beneficial to many patients, rigid adherence to this policy is neither wise nor clinically effective.


Radiation therapy for testicular tumors metastasizing to the lungs.

Records of 63 cases of testicular tumors treated at the Hunter Radiation Therapy Center, Yale-New Haven Hospital from 1962 through 1971 were reviewed. One hundred percent cure rate was obtained in the 36 Stage I and II pure seminoma (Group I) patients. For Stage I, the para-aortic and homolateral iliac lymph nodes were irradiated to a dose of 3,000 to 3,500 rads in three to four weeks. Elective irradiation of the mediastinum and supraclavicular areas was omitted. For Stage II, such extended field irradiation was employed to a dose of 2,000 to 3,000 rads in two to three weeks. Six (or 43 percent) of the 14 embryonal carcinoma (Group II) patients are alive for a minimum of three to a maximum of eleven years. Both teratoma (Group III) patients are alive at five and seven years as well. All eight Stage I teratocarconoma (Group IV) patients are alive with no evident disease at three to ten years. Our data indicate the difference in prognosis between patients who subsequently developed localized lung metastases and those who initially presented with pulmonary disease. We conclude that intensive combined efforts of both radiation and medical oncologists can salvage a considerable number of patients with metachronous onset of pulmonary metastases.


Radiation therapy in the treatment of glioblastoma.

A retrospective study of 127 cases irradiated for glioblastoma was made to assess the role of radiation therapy and to determine the optimal technique of radiation therapy. The over-all survival rates of our series were 52 percent at one year, 19 percent at three years, and twelve percent at five years after radiation therapy. Survival time of the patients is influenced by various factors other than treatment: age, sex, histologic grading, duration of symptoms, and location of tumor. Among these factors, the location of the tumor was the most important in our present series. Surgical treatment can extend the survival time. More extensive resection results in longer survival, provided that the location of the tumor allows such a surgical procedure. Radiation therapy can prolong the survival time of those with glioblastoma, but a high tumor dose of more than 6,000 rads or 1,700 rets is necessary to improve the prognosis significantly. Therefore, irradiation should be administered through generous fields according to the extent of the tumor under precise planning to determine the accurate localization and extent of the tumor.


Growth analysis of pulmonary metastases from salivary gland tumors.

Three cases of primary salivary gland tumors with lung metastasis are presented with extremely long survival (six, ten, and twelve years). The tumor doubling time was calculated and the growth rate of the pulmonary metastasis was found to be slow and erratic. A simplified table was devised, which permits rapid calculation of the tumor doubling time without the use of graphs. The presence of lung metastasis from some primary malignant salivary tumor is not necessarily an ominous sign: a long survival without symtoms is possible.


Concepts for treatment of micrometastases developed in murine systems.

Small tumor cell foci, whether left in situ during primary surgical excision or escaping lethal radiation damage, as well as distant metastases, are the primary reason for treatment failure in man and are the proper targets for the chemotherapist and immunotherapist. Since cure probably requires reduction of the total body burden of tumor cells to very small numbers (possibly to less than one cell), and since first-order kinetics of tumor cell kill by drugs appears to be a natural law in cancer chemotherapy, drug treatment should be started as soon as possible after likely noncurative primary treatment with surgery or radiation. Current knowledge of tumor cell population growth kinetics indicates that the growth fraction (viable tumor cells undergoing active cell replication) is inversely related to population size. Tumor cells in micrometastases should, therefore, be more sensitive to anticancer drugs active against anabolizing cells than are tumor cells in the larger, grossly apparent primary tumor from which they were derived. This indicates the probability that micrometastases will be effectively responsive to more drugs than is the primary and clinically apparent tumor from which they came. Studies with at least four metastatic and uniformly fatal murine solid tumors (lung, breast, colon, and melanoma) have demonstrated significantly improved cure rates with drug treatment following surgical removal of the grossly apparent primary tumor than can be obtained with either surgery or drug treatment when used alone. Further, both disease staging and drug dosage have been shown to influence cure rates of combined-modality treatment. With several mouse tumors, a significantly smaller number of viable tumor cells can establish lethal tumors in the presence of radiation-inactivated tumor cells than in their absence. This suggests that small numbers of residual viable tumor cells in radiation-treated tumor sites may be a greater threat to clinical cure than smaller tumor cell populations remaining in situ after surgery.


Optimal visualization of esophageal varices.

Twelve patients with known esophageal varices and willingness to cooperate were included in the study. Medications administered were placebo, 2 mg of glucagon, and 30 mg of propantheline bromide. All medications were given double-blind and crossover. On the basis of this study the authors believe that for optimal visualization of esophageal varices the following is the procedure of choice: (1) the patient should remain horizontal (this is best done in the left lateral position for comfort and ease of expectoration) for ten minutes after swallowing high density barium; (2) the patient should "clear his throat" frequently and expectorate all saliva (barium sticks to the pharynx and makes the patient want to swallow and "clearing his throat" by forced expiration helps the patient to expectorate this coating and prevents swallowing); (3) filming should be done in expiration in the supine (left posterior oblique to table top) position; and (4) in equivocal cases the examination can be repeated with an anticholinergic drug if the patient has no contraindications to its use. The patient should empty his bladder just before administration of the drug. The intelligent use of these factors should result in a saving of both fluoroscopic time and film, and give the radiologist a safe optimal diagnostic yield.


Involvement of the gastric antrum in Ménétrier's disease.

Thirteen cases of Ménétrier's disease from the files of the Armed Forces Institute of Pathology that could be documented pathologically and correlated with appropriate roentgenograms were analyzed for the distribution of folds. Enlarged folds occurred in a localized area or in several areas simultaniously. The greater curvature of the body was most often involved (77 percent), but the antrum was affected in almost one-half (46 percent) of the cases; thus, the concept of relative antral sparing is not valid, and the diagnosis should be considered when there is gastric rugal enlargement in any distribution. The condition seems to be classified best as a hyperplastic gastropathy rather than a hypertrophic gastritis.


Normal pancreas and splenic variants simulating suprarenal and renal tumors.

Two cases of a normal pancreas simulating a renal or suprarenal mass on excretory urography are described. Three cases of unusually shaped spleens and one case of an accessory spleen mimicking renal and suprarenal masses on excretory urography are also presented. The rare entity of splenosis presenting as a renal "mass" on arteriography is also illustrated. The importance of selective arteriography in confirming or establishing the true nature of these pseudotumors which were initially seen on excretory urography is emphasized.


Rhabdomyosarcoma in the pediatric age group.

Forty-five consecutive cases of pediatric rhabdomyosarcoma were studied as to age at onset, histological type, primary site, stage of disease when first seen, method of treatment, and survival. It appears that rhabdomyosarcoma is a relatively radiosensitive tumor which can be controlled locally with radiation alone or in combination with surgery to excise the bulk of the tumor mass. On the other hand, chemotherapy must necessarily play a major role in treatment since most cases are first seen in the late stages of the disease. Close cooperation among a wide range of specialists, such as the pediatrician, radiation therapist, pediatric oncologist, pathologist, and surgeon is essential to accomplish a maximum therapeutic effect in the unfortunate children who develop this relatively rare but aggressive tumor.


Postadrenalectomy pituitary adenoma (Nelson's syndrome) in childhood: clinical and roentgenologic detection.

Following total adrenalectomy in Cushing's syndrome associated with adrenal hyperplasia, but not with adrenal adenoma or malignancy, elements of the pituitary may be stimulated to grow rapidly and even aggressively. There is strong evidence to support the idea that there is a pre-existing tumor in many, if not all, of these cases. In some, the tumor may be too small to deform the sella turcica. After adrenalectomy, these patients should be observed carefully and frequently for hyperpigmentation, visual field defects, and sella turcica enlargement.


Changing clinical and roentgenographic patterns of necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) occasionally deviates from the classical presentation of the disease. Small bowel dilatation and pneumatosis are frequently present prior to the actual onset of the clinical presentation. Pneumatosis intestinalis, an important diagnostic sign of NEC, is quite variable; it may be present, persist, worsen, or disappear; or at times it may not be present at all. A severe complication of necrotizing enterocolitis is perforation which in 50 percent of the cases presented without obvious free intra-abdominal air. Accumulation of fluid in the abdomen is stressed as strong evidence for perforation and a strong indication for surgery. The varying features indicate that NEC has a clinical spectrum that extends from benign to severe, and recognition of all these variations will lead to better diagnosis and to a better understanding of the disease. The clinical and roentgenologic variations make classification difficult but the variety most likely represents the combination of a great number of susceptible children and a greater recognition of the disease.


Arteriographic manifestations of pheochromocytoma.

Fourteen patients with 16 pheochromocytomas were studied arteriographically over a seven year period. Abnormalities identified the tumor site in 15 instances, but only a single subtle change was present in six of these. Renal artery stenosis was present in eight instances and was significant initially in at least one patient and may become significant in others. A hypertensive response to the study occurred in one-half the patients even though most had received adrenergic blocking drugs. Phentolamine remains the drug of choice in treatment.


Embolic occlusion of the superior and inferior divisions of the middle cerebral artery with angiographic-clinical correlation.

Clinicians, in defining cerebral vascular syndromes, recognize embolism to the superior and inferior divisions of the middle cerebral artery in addition to embolism of the individual branches. In the present study 14 examples of arteriographically visualized divisional occlusion are analyzed, and a good correlation is demonstrated between the roentgenologic and clinical findings.


Cerebral blood volume alterations during fractional pneumoencephalography.

Simultaneous and continuous measurements of the cerebral blood volume (CBV), cerebrospinal fluid (CSF) and blood pressure were carried out in six patients during fractional pneumoencephalography in order to examine intracranial volumetric interactions. Three patients (Group A) showed normal encephalographic findings, and in three patients (Group B) communicating hydrocephalus with convexity block was found encephalographically. In all patients the injection of air was followed by an immediate increase of CSF pressure and blood pressure and a concomitant decrease of CBV. The initial CSF pressure was invariably re-established within 3 to 3.5 min. During this time interval the CBV of the patients of Group B decreased significantly and 30 percent more than that of Group A. Furthermore, after restoration of the original CSF pressure, CBV returned to its initial level in all patients of Group A, whereas it remained unchanged or showed a further decrease in the patients of Group B. Removal of an amount of CSF corresponding to half of the amount of injected air was followed by a significant reactive hyperemic response in two normal patients. The intracranial volumetric alterations during fractional pneumoencephalography are discussed in detail with respect to the underlying physiologic mechanisms and are suggested as a model for acute and low pressure hydrocephalus.


Frontal ventricular dimensions on normal computed tomography.

The computerized axial tomographic examinations of 200 normal patients and volunteers between the ages of ten to 81 years were evaluated. Determination of the ratio between the width of the brain and a dimension representing the distance between the outer borders of the lateral ventricles was made at two levels. This ratio, the cerebroventricular index, seems to be a reliable indicator of ventricular size. The standards vary with the age of the patient.


Bronchography in patients with hemoptysis.

Retrospective analysis of 196 cases suggests that bronchography has limited value in the evaluation of hemoptysis. Most patients with a single episode of hemoptysis and normal plain chest roentgenographic and bronchoscopic findings do not require bronchographic examination. Advances in cytologic and biopsy procedures (fiberoptic bronchoscopy, bronchial brushing, needle aspiration) have largely replaced the usefulness of bronchography even when the plain chest roentgenogram is abnormal.


Isolated rotatory subluxation of the carpal navicular.

Rotatory subluxation of the carpal navicular can cause wrist pain and may lead to severe and disabling degenerative changes. Correct diagnosis depends on recognition of the typical roentgenographic signs. Sixteen patients with neither rheumatoid arthritis nor a lunate or a perilunate dislocation had rotatory subluxation in nineteen wrists. Many had only vague or remote histories of trauma. There were a navicular-lunate gap in all nineteen wrists, and foreshortening of the navicular in sixteen wrists, usually with a ring sign. The abnormalities were best demonstrated on well-centered posteroanterior roentgenograms of the wrist with the hand in slight radial deviation. In two patients, wrist arthrography demonstrated abnormal communication between radiocarpal and intercarpal joints.


The notched articular process of C7 (dorsalization of C7).

The frequency of variation from the standard in the articular processes of C7 is very high (43.9 percent). These variations are: (1) A notch on the back of the superior articular facet. (2) Elongation the the "articular pillary" so that the posterior edge of the inferior articular process of C7 lies backward in relation to the posterior edges of the other cervical articular process. (3) A combination of both. Item 1 should not be mistaken for a fracture and item 2 should not be mistaken for a dislocation. These variants represent a partial dorsalization of C7.


Spinal neurofibromatosis.

Neurofibromatosis is a congenital abnormality due to maldevelopment of the neurectoderm and mesoderm. Spinal abnormalities are a frequent occurrence and the roentgenological changes observed in 21 patients are presented. These include scoliosis, posterior scalloping of vertebral bodies, and the roentgenological features associated with intraspinal tumors and thoracic meningoceles.


Demonstration and dimensional analysis of the normal pancreas with gray-scale echography.

For consistent identification of the normal pancreas, preliminary longitudinal scanning at, or near, the mid-line and subsequent oblique scanning in the long axis are necessary prerequisites in delineating the anatomic outline of the pancreas. The range of normal measurements for different anatomical regions of the pancreas was determined, based on the dimensional examinations of this organ in 328 patients free of pancreatic disease. These provide objective guidelines for analysis of the pancreas in abdominal echography. Echography provides a rapid, non-invasive method of imaging the pancreas. This study demonstrated that visualization of the pancreas as a separate structure does not imply that it is consequently abnormal.


Intra- and extracerebral arachnoid cyst. An atypical roentgenographic presentation.

Arachnoid cysts present in a variety of ways, and the preoperative diagnosis usually requires a high degree of suspicion. Bony changes consistent with a chronic focal mass effect, a relative paucity of clinical findings compared to the size of the lesion, and an extracerebral mass with an intracerebral component suggest the possibility. We present a case in which there appears to be a large, deep intracerebral mass associated with an extracerebral expansion.


Radiation-induced renovascular hypertension.

Radiation is known to produce changes in the small vessels and interstitium of the kidneys resulting in hypertension. Two cases of renal artery stenosis and resultant hypertension secondary to abdominal irradiation are reported and the literature is reviewed.


Postesophageal narrowing associated with Barrett esophagus.

Two children have been found to have partially obstructing lesions beyond the esophagus in association with mid-esophageal stricture. Both were found to have columnar epithelium-lined (Barrett) esophagus, and gastro-esophageal reflux. The more distal obstruction, in the pylorus and descending duodenum respectively, may have contributed to the development of the Barrett esophagus. It is recommended that any barium study of the esophagus which reveals an unexplained stricture should include visualization through the duodenojejunal junction as an aid to diagnosis, management, and understanding.


Multichambered bladder anomalies.

This report reviews multichambered bladder conditions, offers a workable classification of them, presents a detailed case report, and discusses the possible causes of these anomalies. We wish to stress the importance of careful examination of the genital area in the newborn and early roentgenologic evaluation of the genito-urinary system when an anomaly is found.


Localized nodular synovitis of the knee: a report of two cases with abnormal arthrograms.

The arthrographic appearance in two cases of localized PVS of the knee involving the region of the infrapatellar fat pad is reported. Lesions in this area may present with confusing symptomatology, and the true abnormality may be overlooked in a search for meniscal lesion. The arthrographic picture is non-specific and a number of entities must be considered.


Transfemoral lumbar epidural venography.

Lumbar epidural venography performed in 107 patients with normal or nondiagnostic myelograms resulted in correct preoperative diagnosis in 25 of 27 patients (92%) with herniated disc disease and three of six patients (50%) with nerve root compression without associated disc herniation. Compression or occlusion of an epidural and/or radicular vein at the disc level is the most significant venographic abnormality. Potentially confusing venographic findings such as flow defects, extravertebral veins mimicking epidural veins, and occlusion of radicular veins by the catheter must be recognized to prevent false diagnoses. Lumbar epidural venography is valuable for the diagnoses of herniated lumbar discs not demonstrated by myelography.


Epidural venography: diagnosis of herniated lumbar intervertebral disc and other disease of the epidural space.

Epidural venography is a simple and safe procedure for the diagnosis of herniated intervertebral disc and other disease of the epidural space. It is especially useful in symptomatic patients with normal or equivocal myelographic findings. The accuracy rate of positive venograms is 88.2% in this series of 58 patients. Five illustrative cases are presented.


The cardiac pacemaker: a different twist.

A new complication of transvenous pacing is described. Twists developing in an endocardial lead indicate that the pulse generator pocket is too large. Pacemaker failure because of electrode dislodgement or lead fracture will ensue.


Iliocaval thrombi in pulmonary thromboembolic disease.

Rational management of patients with pulmonary thromboembolic disease should include assessment of the risk of additional emboli. Other authors have shown that the possibility of fatal pulmonary embolism is higher when the iliofemoral system contains thrombus, and it is recommended that vena caval interruption rather than simple anticoagulation is indicated. Additional factors governing the therapeutic choice should include the magnitude of the original embolic occlusion as well as the presence of antecedent cardiopulmonary disease. In these instances large thrombi in the iliocaval system should be regarded as potentially life threatening. A sequence of angiography beginning with right iliac and vena caval opacification, proceeding to pulmonary arteriography, and terminating with retrograde left iliac vein study provided information needed to individualize the therapeutic approach. Several case reports illustrate the spectrum of abnormalities and their therapeutic implications.


Venography in penetrating injuries of the extremities.

Of 30 consecutive cases of penetrating injuries to the extremities studied both by arteriography and venography, five were found to have significant venous injuries. Three of these cases are presented to show the value of venography in detecting inadequate venous collateral circulation, intraluminal thrombus, and venous obstruction. It is suggested that preoperative venography will compliment arteriography, aid in the diagnosis of venous injuries, demonstrate variable venous anatomy, and outline other venous pathology outside of the area of trauma.


Selective arterial embolization for control of hemorrhage in pelvic malignancy: femoral and brachial catheter approaches.

Selective transcatheter embolization with Gelfoam pledgets was used to control intractable pelvic hemorrhage in two patients with gynecologic malignancy. There were no complications or sequelae associated with the procedure, and no further bleeding occurred. This method requires only Seldinger catheterization techniques under local anesthesia and should be considered in patients whose medical condition precludes major surgery or in whom operative ligation cannot be performed.


Peripheral embolization complicating bilateral renal infarction with gelfoam.

Selective arterial embolization is a technique with wide therapeutic applicability. However, regardless of the nature of the embolic particles, reflux into the aorta with peripheral embolization is a serious potential complication. A case is described in which this complication occurred. We recommend that all such embolizations be performed with a balloon catheter occluding the target artery.


Crossed renal ectopia: angiographic findings in six cases.

Angiographic findings in six patients with crossed renal ectopia are reported. Crossed fused ectopia was present in four cases, and the remaining two had single crossed ectopic kidneys. All kidneys, including the nonectopic ones, had an anomalous blood supply. No constant arterial pattern was discernible, and renal arteries were found to arise from the aorta both above and below the normal level as well as from the iliac arteries. It is suggested that angiography be undertaken in all cases when surgery is contemplated.


Angiographically induced renal failure and its radiographic detection.

Decreased renal function following arteriography is much more common than is currently realized. Steps to detect this failure are necessary, especially in high risk patients, so that stressful situations such as surgery can be avoided. A recently performed prospective random study of 100 patients undergoing angiography demonstrated a 10% incidence of renal failure. Those patients most at risk had preexisting renal disease as indicated by an elevated serum creatinine and/or cardiovascular disease severe enough to require digoxin, diuretics, or nitroglycerin. No cases of renal failure occurred in the absence of one or both of these processes. The likelihood of postangiographic renal failure was unrelated to the quantity of contrast as measured either by total volume or per kilogram body weight.


Arthrographic evaluation of injuries of the first metacarpophalangeal joint: gamekeeper's thumb.

The radiographic evaluation of gamekeeper's thumb is described in an experimental study in nine cadaveric hands. After the application of radial stress at the metacarpophalangeal joint in the extended and abducted thumbs in an attempt to create defects in the ulnar collateral ligament, initial and stress radiography and arthrography were employed. In four cadavers a fracture of the proximal phalanx was noted; stress radiography revealed variability in joint stability. Arthrography outlined ulnar extravasation in six of the nine cadavers; surgical confirmation of a capsular tear was obtained following careful dissection in each of these six cadavers. It would appear that plain films, stress radiography, and arthrography complement each other in the diagnosis of gamekeeper's thumb.


Isolated fracture of the medial portion of the lateral mass of the atlas: a previously undescribed entity.

Four cases of fracture of the medial aspect of the lateral mass of the atlas are presented. Unlike most cases of atlantal fracture, definite history of a blow to the vertex could not be established. While the exact mechanism of injury is unknown, it is postulated that the bone fragment is produced by a combination of stretching the ligamentum transversarium and pressure on the lateral mass due to contraction of the neck muscles. All four patients were neurologically intact and complained of pain in the distribution of the greater  occipital nerve. It is suggested that this fracture might be identified more often in patients with similar histories and complaints by use of laminagraphy, since part or all of the atlas is frequently obscured on routine open mouth roentgenograms of the upper cervical spine.


Concomitant dislocation and intraarticular foreign body: a rare complication of the Charnley total hip arthroplasty.

In the Charnley total hip arthroplasty, periarticular foreign bodies represent potential foci for intraarticular migration at the time of hip dislocation. This complication, although very rare, should be verified radiographically to prevent unsucessful attempts at closed reduction. Although intraarticular radiopaque foreign bodies should be identified on plain radiographs of the hip, intraarticular radiolucent foreign bodies require positive-contrast arthrography for identification. Two illustrative cases are presented.


Embryogenesis of the human occipital bone.

From an original study of fetal specimens, the embryogenesis of the human occipital bone is described. The occipital bone in man is derived from cartilage, except for the interparietal segment which has a membranous origin. Normally there is no midline cerebellar fissure or synchondrosis.


99MTc-diphosphonate uptake in neuroblastoma.

Marked uptake of 99mTc-diphosphonate was noted in an extraadrenal neuroblastoma. Calcification was not demonstrable on radiographic or light microscopic examination, nor was crystalline material identified on electron microscopic examination; capillaries in the lesion appeared to be intact. Similar uptake of phosphate radiopharmaceuticals by a variety of lesions has been reported, and possible mechanisms for this phenomenon are discussed.


Adjuvant chemoimmunotherapy in advanced lesions of the head and neck.

Growth of malignant tumors of the head and neck has been associated with progressive impairment of immunologic activity. Successful control of disease has been shown to reverse this defect. Preliminary results of a nonrandomized trial reduced recurrence of head and neck cancer for a median time of 11.5 months in eight of 10 patients who received chemoimmunotherapy adjuvant to surgical resection or radiation treatment. The number of patients in the series was small and the followup time too short to determine the length of effectiveness for this treatment. Based on these results, a new protocol has been initiated to randomize patients with advanced T3 and T4 lesions into groups for comparison of adjuvant chemotherapy alone with adjuvant chemoimmunotherapy.


Immunotherapy of malignancies: current status.

The results of various in vitro analyses indicate there is an active immune response against antigens associated with human malignancies. This immune response apparently can be augmented by nonspecific immunologic stimulates such as BCG. These agents are effective for destroying tumor when injected locally into intracutaneous disease but are not as effective for subcutaneous disease. Preliminary clinical trials indicated that immune stimulants are effective when administered systemically. The effect is only minimal for diseminated disease, but the therapeutic benefit is clearly augmented for patients with a minimal residual tumor burden, such as those patients with metastases to regional lymph nodes. Thus immunotherapy is a systemically active mode of therapy. Its toxicity is minimal, and it appears to be effective in a wide spectrum of the disease. However, immunotherapy is not effective for a large residual tumor burden; consequently it must be used in combination with other modes of treatment such as irradiation therapy or chemotherapy. Early experiences with BCG immunotherapy for malignant melanoma and C. parvum for oat cell carcinoma are encouraging. It is remarkable that a nonspecific immunologic stimulant does, in fact, have this effect. Immunotherapy experiments in animals suggest that in order to achieve maximal benefit. BCG must have close contact with tumor cells or must be combined with a tumor-associated antigen. If these principles are true for man, it would seem that improvements for nonspecific immunotherapy in human neoplasms would be further augmented if a tumor-related antigen could be extracted from human tumours and combined with a nonspecific immunologic stimulant.


Angiography in Crohn's disease revisited.

The diagnostic value of angiography was studied in 116 patients with Crohn's disease. Angiograms showed abnormalities in over 90% of the cases. Many angiographic features were nonspecific; only the "zoning sign" and the presence of paraintestinal mesenteric neovasculature were considered diagnostic. Crohn's colitis could be distinguished from ulcerative colitis in only 30% of the cases. Angiography, as a diagnostic adjunct to barium studies, will reveal the presence of lesions and their extent. This is particularly important in suspected postoperative recurrence of Crohn's disease. Angiography is a potential differential diagnostic aid in doubtful cases of inflammatory and malignant bowel disease.


Hepatic angiography in ulcerative colitis and Crohn's disease.

Liver angiography was performed in 13 patients with Crohn's disease and three with ulcerative colitis. Of these patients, 13 underwent liver biopsy, and findings were correlated with results of angiography and biochemical tests. Twelve liver biopsies were abnormal, primarily showing fatty infiltration and reactive hepatitis. Thirteen angiographies were abnormal, with widened and tortuous liver arteries being the most common finding. Liver function tests were within normal limits for all but three of the 16 patients, thus correlating poorly with findings of the other tests. These data show that angiography is useful in detecting hepatic abnormality, but evaluation with liver biopsy is necessary to determine the nature of the lesion.


Megacystis-microcolon-intestinal hypoperistalsis syndrome: a new cause of intestinal obstruction in the newborn. Report of radiologic findings in five newborn girls.

Five newborn girls presented with small intestinal obstruction and microcolon and a giant bladder (megacystis). Organic causes of obstruction were not found, and the gastrointestinal tract failed to function after appropriate diversion. Two died in the postoperative period, two lived several months on central venous hyperalimentation, and one died at 34 months of age following chronic though intermittent hyperalimentation. Pathologic studies showed an abundance of ganglion cells in both dilated and narrowed areas of intestine; the combined small bowel-colon  length was one-third of normal in the absence of an evident obstructive or vascular insult. The five patients represent the most severe manifestation of defective intestinal peristalsis in a larger group of distended newborns in whom organic gastrointestinal obstruction is not found. Treatment with central venous hyperalimentation may sustain life, and some patients eventually recover gastrointestinal function. The hypoperistalsis is largely refractory to pharmacologic treatment; its cause is unknown.


Multiple "bull's-eye" lesions in gastric lymphoma.

Three adolescent patients with multiple gastric target lesions and gastric lymphoma are reported. Each had either histiocytic or poorly differentiated lymphoma. The literature was reviewed to ascertain whether multiple gastric lymphomatous target lesions were confined to adolescent patients or to patients with a particular histologic subtype. Review of 119 cases in the literature did not support either hypothesis.


Vascular impressions of the gut secondary to chronic vascular occlusive disease.

Clinical diagnosis of chronic vascular occlusive disease is difficult since symptoms are often vague. The presence of discrete extrinsic contoural defects along the medial aspect of the descending duodenum or proximal small bowel is a useful diagnostic feature in such patients. Five of eight patients with chronic vascular occlusion who had examination of the upper gastrointestinal tract demonstrated this finding. If presented with this radiographic observation on barium study, visceral arteriography should then be considered.


A new concept of ascitic fluid distribution.

Of 26 patients with ascites examined by B-mode ultrasonography, 14 had scans appropriate for evaluating the presence of fluid within the abdominal cavity. These studies demonstrate localization of fluid  anteriorly around the tip of the liver and emphasize the importance of such factors as density relationships and the "pliability" of the anterior abdominal wall in the distribution of ascitic fluid. A reveiw of the literature is presented.


Glucagon and barium enema examinations: a controlled clinical trial.

In a double-blind crossover clinical trial, 10 healthy volunteers received placebo and 2 mg glucagon intramuscularly preceding barium enema examination on separate days. In addition, 50 patients were given either placebo or 2 mg glucagon prior to barium enema examination in a double-blind study. The results of 38 variables determined on each study population were similar. When glucagon was given, both the patients and examiners noted significantly less discomfort and more bowel relaxation. There were no significant changes in pulse, blood pressure, or electrocardiogram. Adverse reactions did not occur frequently enough to allow confident comparison of placebo and glucagon. It is concluded that the use of glucagon can provide a more comfortable barium examination with acceptable safety.


Spontaneous internal drainage of pancreatic pseudocysts.

Six cases are reported in which spontaneous internal drainage between a pancreatic pseudocyst and the alimentary tract became established. In each instance the communication was demonstrated radiologically. The clinical circumstances and radiographic features of these cases are described, and the existing literature pertaining to this phenomenon is reviewed.


Lumbar epidural venography in the diagnosis of disc herniations.

Epidural venography is a relatively simple and highly accurate method of diagnosing disc herniations in the lumbar region. Good opacification of the epidural venous plexus can be obtained by selective catheterization of ascending lumbar and/or internal iliac veins. Experience with 227 cases is described. The examination appears to be at least as accurate as myelography at the L4-L5 level and more reliable than myelography in cases of lateral disc herniations at L5-SI. Epidural venography is recommended as the examination of choice in patients with suspected lumbar disc herniation.


Experimental induction of hypoparathyroidism with parathyroid hormone antibodies.

This study describes the effect of a single injection of parathyroid hormone antiserum on the serum calcium, serum phosphate, urinary cyclic AMP, and urinary phosphate levels in the intact perfused rat. A significant decline in serum calcium level with concomitant elevation in serum phosphate level and decreased urinary excretion of phosphate and cyclic AMP was noted. These findings strongly suggest that a transient hypoparathyroid state was induced by the parathyroid hormone antiserum.


[Inhibition by diethyldithiocarbamate (DEDTC) of acute hepatotoxic effects induced by polyhalogenated hydrocarbons (PHHC)].

Hemoglobin-free perfused rat livers were treated with carbon tetrachloride, chloroform, trichloroethylene and halothane by equilibrium of the perfusion medium with the varorous PHHCs. The resulting swelling of liver tissue, the potassium loss and the decrease of the perfusion rates were reduced by DEDTC to a different degree: The decrease of swelling, potassium loss and of the microcirculatory alteration by DEDTC was dose dependent in the case of carbon tetrachloride and halothane, whereas the effects of chloroform and trichloroethylene were not markedly influenced. Glutathione was mostly ineffective when given in similar doses. Pretreatment of rats with phenobarbital for 3 days increased itself swelling, K+-loss and reduction of perfusion rates, when the livers were perfused in absence of PHHCs. The effects of PHHCs in livers from pretreated rats were seldom greater but often lower than additive ones. Chiefly the effects of halothane were not markedly influenced by treatment of rats with phenobarbital. Isolated parenchymal liver cells were exposed to gas mixtures of O2, CO2 and PHHCs under controled conditions. Changes of the shape and staining of the cells were used for additional information. In view of these latter effects chloroform appeared as the most toxic and halothane as a nontoxic agent. DEDTC inhibits all effects of PHHCs demonstrated in isolated hepatocytes.


Studies of the hemopoietic microenvironment. VIII. Andrenergic and cholinergic innervation of the murine spleen.

Neurohistochemical techniques were used to confirm morphologically the distribution of adrenergic and cholinergic nerves to the splenic microvasculature. The results form the basis of this report. Using these methods, adrenergic innervation was observed only in the adventitia of arteries and arterioles. No cholinergic innervation was found in this site. No adrenergic or cholinergic innervation could be demonstrated to the channels of the red pulp, venules or veins. These data provided morphological evidence that in the murine spleen only splenic arteries and arterioles are innervated; and these have only an adrenergic innervation.


Steroid concentrations in cows with corticotropin-induced cystic ovarian follicles and the effect of prostaglandin F2alpha and indomethacin given by intrauterine injection.

In 7 instances, cystic ovarian follicles resulted when adrenocorticotropin (ACTH) was administered daily during the follicular phase of the estrous cycle in cows. Two cows given daily injections of hydrocortisone (cortisol) during the follicular phase of the estrous cycle did not develop cystic ovaries. Plasma concentrations of estradiol in cows with induced cystic ovarian follicles were similar to the peak values observed at estrus and were between 6 and 12 pg/ml. Progesterone concentrations in plasma of cows with cystic ovaries were low, between 1 and 2 ng/ml. Ovulation occurred when 2 cows were given human chorionic gonadotropin (HCG) during the period of ovarian cyst development with ACTH administration. Several days of administration of ACTH was required to cause cyst development. Ovulation occurred at the expected time in 1 cow when injections began on day 19, that is, late in the follicular period. In another cow, when treatment was stopped on day 3, after the expected time of estrus a delayed ovulation occurred. In 2 cows with induced cystic ovarian follicles, cyst atresia occurred spontaneously about day 13 to 17 of the cycle. In these cows, new follicular growth and ovulation followed (although delayed in 1 cow). The time of atresia of cystic follicles was not influenced by the intrauterine injection of 10 ml of sterile saline solution on days 8, 9, and 10 in 1 cow. When 5 mg of prostaglandin F2alpha in 10 ml of sterile saline solution was given (uterine injection) in 2 cows on days 8, 9, and 10, cyst atresia occurred earlier than the time of spontaneous atresia. Intrauterine administration of 100 mg of indomethacin in 10 ml of sterile saline solution daily for 13 or 14 days to 2 cows, starting on day 12 or 13 of the cycle, resulted in persistence of the induced cystic ovarian follicles. After cessation of indomethacin treatment, atresia of cysts followed and new follicular growth and ovulation occurred.


Pathogenesis of duck plague in the bursa of Fabricius, thymus, and spleen.

White Pekin ducks were inoculated orally with duck plague virus and killed at 24-hour intervals after inoculation. Spleen, thymus, and bursa of Fabricius were collected and examined by light, fluorescent, and electron microscopy. Necrosis of lymphocytes occurred in the bursa of Fabricius, thymus, splenic periarteriolar lymphoid sheath (T lymphocytes), and splenic germinal centers (B lymphocytes). Viral nucleocapsids were present in the karyoplasm of lymphocytes, but these cells necrotized before virions were formed. Periarteriolar reticular sheath cells and sinusoidal lining cells in the spleen, epithelial cells in Hassall's corpuscle of the thymus, epithelial cells between the cortex and medulla of the follicles in the bursa of Fabricius, and macrophages in all 3 tissues contained nucleocapsids in the nuclei and virions in cytoplasmic vacuoles before necrosis occurred.


Precipitin response of cattle to commercial wart vaccine.

Fifty young bulls were given commercial wart vaccine upon their arrival at a bull stud establishment. The bulls were given 2 additional vaccinations 2 and 24 weeks later. The precipitin antibody response of these bulls to bovine papilloma virus was monitored. Antibody levels increased significantly, particularly after the 3rd vaccination was given at 24 weeks, but decreased markedly within 20 weeks after the last vaccination was given. These results demonstrated that formalin-inactivated bovine papilloma virus was capable of inducing precipitin antibody similar to infective bovine papilloma virus. Multiple, repeated vaccination provided the best serologic response.


Speculations on neurogenic pulmonary edema (NPE).

Evidence suggests the following pathogenesis for neurogenic pulmonary edema. The initial phase results from a centrally mediated, massive, sympathetic discharge. This produces intense, generalized, but transient, vasoconstriction with a resultant shift of blood from the high-resistance systemic circulation to the lowresistance pulmonary circulation. Marked increases in pulmonary vascular pressures and marked increases in pulmonary blood volume then produce pulmonary edema because of the hydrostatic effect of increased pulmonary capillary pressure. In addition, pulmonary hypertension and hypervolemia injure pulmonary blood vessels, altering pulmonary capillary permeability and producing lung hemorrhage. After the transient systemic and pulmonary vascular hypertension subside, the patient is left with abnormal pulmonary capillary permeability, so that pulmonary edema persists in the face of normal hemodynamics and normal cardia function.


Immune status in lung cancer: effects of BCG immunotherapy.

Immunotherapy with bacille Calmette-Guérin (BCG) was administered according to a standard regimen to 23 patients with primary lung cancer who had completed conventional treatment, including surgery and/or radiation therapy. Five additional patients did not receive BCG. Skin tests and in vitro lymphocyte studies were performed serially at intervals for 12 months or until death. The aggregate of skin responses to nonmycobacterial antigens and lymphocyte responses to phytohemagglutinin and recall antigens increased only in the group of 7 patients with no clinically evident disease 12 months after the start of BCG administration. The group of 5 patients who did not receive BCG, but who remained clinically disease free, did not experience immunoenhancement, nor did BCG-treated patients with residual or recurrent malignancy. Patients who had received radiation therapy before BCG also did not experience immunoenhancement, but these patients also had recurrent or persistent disease. Enhancement of certain aspects of the immune response to within 1 SD of the response of a group of subjects with nonmalignant pulmonary disease was prognostic of a favorable clinical outcome at 12 months.


Fatal case of influenza pneumonia with suprainfection by multiple bacteria and Herpes simplex virus.

A case of influenza pneumonia is described in which death occurred from persistence of the influenza infection and suprainfection with two bacteria, Staphylococcus aureus and Escherichia coli, and another virus, Herpes simplex. Of additional interest were the observations that this overwhelming illness developed in a previously healthy person, that typical influenza virus particles were present in antemortem lung tissue, and that the patient died despite 6 days of extracorporeal membrane oxygenation and corticosteroids.


Paget's disease of the male breast: a collective review and case report.

A brief review of the world literature is presented, of which 19 cases are accepted as genuine Paget's disease of the male breast, and one new case is reported. Emphasis is put on early diagnosis by biopsy, and definite treatment by radical mastectomy.


Gastric and extragastric leiomyoblastoma: report of six new cases with a review of the literature.

Six case reports of leiomyoblastoma are presented, five involving stomach, and one involving jejunum. The malignant potential of these tumors is questionable. The literature is summarized and the symptomatology, age and sex predominance commented upon. A brief pathological description is noted. The survival statistics, although unmeaningful at this time, are presented.


Granular cell myoblastoma of the lid: case report.

Granular cell myoblastoma, a tumor found commonly in the tongue and subcutaneous tissue, has rarely been reported in the orbital region. The second case of primary granular cell myoblastoma in the eyelid is reported.


Abnormal guanosine 3', 5'-monophosphate during photoreceptor degeneration in the inherited retinal disorder of C3H/HeJ mice.

Elevated levels of guanosine 3'-5'-monophosphate (cyclic GMP) are associated with photoreceptor degeneration in the retina of C3H/HeJ mice. This abonormality has been shown to result from a deficiency in the activity of a receptor-specific cyclic GMP phosphodiesterase. The apparent susceptibility of photoreceptor cells to an abnormality in cyclic GMP metabolism suggests that cyclic GMP may play a role in photoreceptor function which is essential to the viability of these specialized cells.


[Inflammatory pseudotumor of the lung in infancy (histiocytoma) (author's transl)].

A four year old boy with a clinical picture of acute pneumonia is presented. Antibiotic therapeutic improved the clinical and analytic symptomatology but a round, radiologic shadow persisted after three months of evolution. Thoracotomy was performed and by histopathologic examination histiocytoma of lung diagnosed. Literature is reviewed and the clinical, radiologic, pathologic and etiopathogenetic features are commented. These lesions should be considered as benign to avoid extensive resection.


Head and neck tumours in Rhodesia.

A retrospective 5-year study of head and neck tumours treated at a general hospital in Rhodesia and an attempted follow-up of the patients were undertaken in connection with the setting up of a joint head and neck clinic. The relevant data are outlined in this report.


[C14-variamycin content in normal and tumorous brain tissues of white rats].

Penetration of variamycin, a new antitumor antibiotic into the normal and tumor tissues of the brain of rats with multiform glioblastoma was investigated. The content of the C14-labeled antibiotic was determined radiometrically. The radioactive label penetrated into the normal and tumor tissues of the brain during the first hours after the drug administration. The level of the radioactivity in the tumor tissue was higher than that in the normal brain tissue during the whole period of the study. The greatest deviation in the contents of the radioactive label in the tumor and normal tissues was observed 2 and 3 hours after administration of the labeled antibiotic, i. e. 4.3 and 3.6 times respectively.


Fluorocitrate ototoxicity. A morphologic and cytochemical model for primary neural degeneration in the guinea pig cochlea.

Fluorocitrate, an inhibitor of the tricarboxylic acid cycle at the aconitase reaction, produces a time and dose related neural dystrophy in the guinea pig cochlea. There is direct inhibition of succinic dehydrogenase activity but not nicotinamide adenine dinucleotide dehydrogenase and cytochrome oxidase via cytochrome c activities. The dystrophic neural changes morphologically are similar to those noted in primary neural degeneration and neural presbycusis in man. Neural degeneration in aging appears to be the result of a  dissociation of biochemical reactions preventing the proper utilization of organic fuel molecules for generation of energy and direct or indirect inhibition of respiration.


[Screening of antitumor antibiotics, formed by molds].

A system for screening fungal metabolites with cytotoxic activity against tumor cells is described and the results obtained using this system are discussed. It was found that 35.2 per cent of the strains isolated from uranium mines had a cytotoxic effect on the EAC cells in vitro. As for the strains isolated from other sources only 6.85 and 9.87 per cent of them inhibited the EAC cells in vitro. Five substances, i. e. vermiculline, PSX-I, Frequentine, bikaverin and duclauxin isolated from 227 evaluated cultures showed a strong inhibitory effect on the EAC cells and other tumors in vitro.


Isolation of viruses and mycoplasmas from middle ear effusions: a review.

Reports of studies of middle ear effusions (MEE) obtained by needle aspiration are reviewed in this paper; viruses were isolated from 29 of 663 patients (4.4%) and respiratory syncytial virus was isolated most frequently (22 patients); only one mycoplasma, M. pneumoniae, was recovered from the MEE of 771 patients. Viruses were also sought from the throat or nasopharynx of 249 patients with MEE; 59 patients (23.7%) had a respiratory virus present. M. pneumoniae was isolated from the throat or nasopharynx in three of 116 patients. Although these results indicate that viruses and mycoplasmas are uncommonly found in effusions associated with acute or chronic otitis media, few studies have been attempted in recent years. The discovery of additional respiratory viruses and development of new techniques for isolation and identification of viruses indicate that the present results may be incomplete.


[Sensitivity of pathogenic clostridia to antibiotics].

By the sensitivity levels of the gas infection causative agents, i. e. pathogenic Clostridia to antibiotics, the latter were conditionally divided into 4 groups. The 1st group included the most active antibiotics, such as tetracyclines,, penicillins, cephalosporins, rifampicin, 7-chlor-7-desoxylincomycin. Their minimum inhibitory and bactericidal concentrations did not usually exceed 2 gamma/ml. For most of the strains the inhibitory and bactericidal concentrations amounted to the tenth and hundredth fractions of gamma/ml. The antibiotics of the 2nd group, i. e. erythromycin, lincomycin,ristomycin and levomycetin inhibited multiplication and viability of pathogenic Clostridia in concentrations of 20 gamma/ml. Erythromycin was most active among them The 3rd group consisted of oleandomycin, novobiocin, geliomycin and azalomycin, the minimum inhibitory concentrations of them being 20 to 50 gamma/ml. The antibiotics of the 4th group, i. e. neomycin, monomycin, kanamycin, streptomycin, polymyxin and others affected pathogenic Clostridia at very high concentrations, amounting to the hundrenth and thousandth of gamma/ml.


Sulfamethoxazole-trimethoprim-polymyxin therapy of serious multiply drug-resistant Serratia infections.

Nonpigmented multiply drug-resistant Serratia marcescens caused an extensive outbreak of infection at the Nashville Veterans Administration Hospital. Isolates were of one serotype resistant to all currently available antimicrobial agents for therapy of systemic infections except for occasional susceptibility to chloramphenicol and kanamycin. Frequently strains were susceptible to nalidixic acid, and all were susceptible to amikacin (BB-K8). Drug-resistant strains caused 130 infections, 12 bacteremias, and 7 infection-associated deaths. Combinations of antimicrobial agents were evaluated for synergism against Serratia strains from infected patients. "Checkerboard" isobolograms indicated in vitro static synergism between sulfamethoxazole, trimethoprim, and polymyxin (STP). Killing curves using clinically achievable concentrations of STP verified the bactericidal effect of STP against these strains. In a daily dosage of 1,600 mg of sulfamethoxazole and 320 mg of trimethoprim orally in combination with 100 to 300 mg of colistimethate parenterally, serum cidal levels at 1:8 or greater were achieved in five of six patients. Clinical improvement or microbiological cure was effected in four of six patients. STP may be potentially useful for selected Serratia infections for which single agents are unavailable or ineffective.


Metronidazole bioassay.

Urine from patients receiving metronidazole [1-(2-hydroxyethyl)-2-methyl-5-nitromidazole] orally or per vagina were subjected to paper chromatographic fractionation and examined for anticlostridial activity. Unmodified metronidazole and several metabolites were detected. These findings indicate that the clostridial bioassay may be limited in its applicability to the study of the pharmacodynamics of metronidazole as it does not differentiate between the parent substance and some of its metabolites. Moreover, some of the latter, although they possess antibacterial activity, may not have antiprotozoan activity.


In vivo synergy between 6 beta-amidinopenicillanic acid derivatives and other antibiotics.

Both an oral and a parenteral form of a 6beta-amidinopenicillanic acid derivative were found to have appreciable activity against gram-negative bacteria and poor activity against gram-positive bacteria in vivo. When administered orally or parenterally, definite synergy was demonstrated between the amidinopenicillins and ampicillin, amoxicillin, benzylpenicillin, cefazolin, or carbenicillin in infections with a number of gram-negative bacteria, including Klebsiella, Enterobacter, Escherichia, Proteus, Salmonella, and Haemophilus species in mice. Synergy was also observed between the parenteral amidinopenicillin and benzylpenicillin in the Staphylococcus aureus infection but not in infections with other gram-positive organisms. No synergy was demonstrated between the parenteral amidinopenicillin and erythromycin or oxytetracycline in infections with gram-positive or gram-negative organisms. Synergy between the parenteral amidinopenicillin and gentamicin was observed only in the case of Escherichia coli.


Effect of delayed evisceration on the microbial quality of meat.

The postomortem invasion of muscle and other tissues by bacteria from the intestinal tract was studied with the use of radioactive tracers. The injection of 14C-labeled bacteria or spores into the intestines of guinea pig carcasses within 24 h of death resulted in the rapid spread of 14C throughout carcasses. When live bacteria were injected along with the labeled cells, it was not possible to isolate viable organisms from the body tissues if the living animal had been exposed to the bacteria. It appears that animals are immune to their normal intestinal flora and that this immunity persists after death; thus passage of these bacteria into the lymphatic system does not necessarily result in the presence of live bacteria in carcass tissues. It therefore seems that a delay of up to 24 h before evisceration would not lead to deep tissue contamination of the carcass by organisms usually present in the intestines. Further evidence for this hypothesis was obtained by showing that muscle and lymph nodes from uneviscerated lamb carcasses hung for 24 h at 20 C remained sterile.


LevoDopa test and estrogen receptor assay in prognosticating responses of patients with advanced cancer of the breast to endocrine therapy.

The ability of L-dopa to arrest pain can be used to predict objective response of skeletal disease to endocrine ablation or additive therapy. In the present study, 43 patients with painful skeletal metastases were evaluated for the relief of pain by L-dopa, given 250 mg to 500 mg orally every 4 hours for 4 days. Sixteen of the 25 responders to L-dopa had objective response to either previous or later hormonal therapy while all the 18 non-responders did not benefit from endocrine ablation. The results of L-dopa responses also correlated well to the presence of absence of cytoplasmic ER in tumor. These results demonstrate that both tests (L-dopa and ER) are reliable indicators, one complimenting the other, in prognosticating response to endocrine therapy and should be used prior to hormone treatment. Alternative therapy should be considered for patients who are non-responders to the L-dopa test and/or whose tumors contain negligible ER. The long term therapeutic value of L-Dopa, however, is limited.


Hematuria and rectal bleeding in the child with Klippel and Trenaunay syndrome.

We have operated upon 588 patients with Klippel and Trenaunay syndrome. The underlying factor is a congenital malformation of the deep veins: agenesis, atresia or compression by fibrovascular bands of the popliteal, femoral or iliac veins. Of these 588 patients, 6 children between 15 months and 4 years of age had severe rectal bleeding and hematuria. One of these children died from massive bleeding of the rectum with septicemia. Another boy was saved by rectal resection and the last one by subtotal cystectomy. The important venogram shows an absence of the anterior venous pathway (superficial femoral vein) compensated by the abnormal development of 2 venous groups, the vein of the sciatic nerve and large veins along the external aspect of the inferior limb. These 2 venous groups penetrate into the pelvis by the sciatic and gluteal notches and terminate in the internal iliac vein which becomes enormous and has a very high flow. This overflow hinders drainage of the venous collateral from the rectum, the bladder and the vagina. The retro adductor vein, prolongated by the deep femoral vein, represents an anastomosis between the sciatic nerve vein and the common femoral vein. The surgeon must try to widen this pathway.


The rhabdoviruses of Entamoeba histolytica and Entamoeba invadens.

Rhabdoviruses have been described in plants, arthropods and vertebrates including man. Members of the group are of agricultural, veterinary and medical importance. The presence of a rhabdovirus in Entamoeba histolytica and Entamoeba invadens is the first record of their existence within protozoa. The morphology of this virus is described and its significance discussed, in relation to a possible lysogenic state and pathogenecity of Entamoeba species.


The susceptibility of isolated guts from various species of mosquito to some arboviruses.

Isolated guts cultured in vitro from Aedes Aeaegypti and Ae. togoi were more susceptible to infection by SIN, SF, CHIK and WN viruses than tissue similarly cultured from Anopheles gambiae and An. stephensi. Langat TP 64, a tick-borne virus, failed to infect any of the cultured mosquito tissues.


Technetium stannous pyrophosphate myocardial scintigrams in the recognition of myocardial infarction in patients undergoing coronary artery revascularization.

Myocardial imaging using technetium 99m stannous pyrophosphate (99mTc-PYP) has been utilized preoperatively and three to five days postoperatively to detect myocardial infarction in 48 patients undergoing aortocoronary bypass grafting, including 7 having valve replacement (5 aortic, 2 mitral) in addition to revascularization. In the total group of patients operated on there were 3 deaths (6%). Preoperatively, 26 patients had unstable angina and 10 had severe left main coronary artery disease. Eleven of the 48 (23%) were women. ECG and enzyme-proved infarctions occurred in 6 of the 48 patients (12%), but the addition of 99mTc-PYP myocardial imaging demonstrated scintigraphic evidence of infarction in 15 patients (31%), including 2 who died in the operating room. The 99mTc-PYP myocardial imaging technique, which has proved safe, simple, and relatively inexpensive in these patients, suggests that the incidence of infarction after coronary bypass operations is somewhat higher than has been previously recognized from just ECG and enzyme changes. This technique also has been of value in helping to exclude myocardial infarction in difficult clinical situations such as postoperative arrhythmias and the postpericardiotomy syndrome.


Carcinoma of the lung: results of treatment over ten years.

Mediastinal lymph node dissection in conjunction with pulmonary resection was performed on 437 patients with bronchogenic carcinoma at the University of Michigan Medical Center from 1959 to 1969. The absolute five- and ten-year survival rates for patients undergoing curative resection were 36.2 and 14.4%, respectively. The five-year survival of those without nodal metastases was 49.3%, and it was 31.1% in patients with hilar metastases only. The five-year survival of patients with mediastinal metastases who received radiation therapy was 23.1%. Of the 193 patients with squamous cell carcinoma, 43% lived five years free from disease. The five-year survival of patients undergoing resection who had no hilar lymph node metastases was 53%, and it was 47.5% in those with hilar metastases only. The five-year survival in patients with mediastinal metastases who received postoperative irradiation was 34.4%.


[Inhibition of 3', 5'-cyclic AMP phosphodiesterase in the guinea pig lung by a new anti-allergic: 10-(3-quinuclidinylmethyl) phenothiazine (LM 209)].

The action of a new antiallergic agent, 10-(3-quinuclidinylmethyl) phenothiazine or LM 209, on cAMP phosphodiesterase (PDE) was studied on a guinea-pig lung preparation and compared with that of other compounds such as cromoglycate (I), dexamethasone (II), dexchlorpheniramine (III), promethazine (IV) and theophylline (V). Compounds I, IV and V are competitive inhibitors whereas LM 209 and compound III are non competitive inhibitors of PDE. Compound II is practically inactive on the enzyme. Compounds III and V produce an inhibition of equal intensity, independently of the substrate concentration. Compounds I and IV are more active on PDE with low affinity than on PDE with strong affinity, whereas it is the contrary with LM 209. The mechanism of action of LM 209 at the pulmonary level is discussed in the light of these findings.


An investigation of the effects of a pyridyl and a piperidyl 1, 3-dioxolane derivative on neuromuscular transmission.

2-(4'-pyridyl)-1,3-dioxolane methiodide (KCL-301-14) and 2-(1'-methyl-4' piperidyl)-1,3-dioxolane hydroiodide (KCL-301-39) facilitated the force of contraction in low doses and blocked it in higher doses in the in vivo cat soleus muscle preparation. Both drugs in the cat also reversed d-tubocurarine and succinylcholine blockade, produced post-drug repetitive activity, blocked post-tetanic potentiation (PTP), had no direct muscle affect and reversed the PTP suppression caused by d-tubocurarine and succinylcholine. In the rat phrenic nerve-diaphragm and the chick biventer cervicis preparations in vitro, facilitation, then blockade of the contraction were seen as concentrations increased. However, KCL-301-14 reversed d-tubocurarine and increased succinylcholine blockades in the rat and chick. KCl-301-39 increased both d-tubocurarine and succinylcholine blockades in the rat and chick. The different effects seen in the cat vs. the rat and chick with these drugs are probably due to species variation.


Dialysis in renal failure casued by amyloidosis of familial Mediterranean fever. A report of ten cases.

Ten unselected patients with renal failure casued by amyloidosis associated with FMF were treated by regular hemodialysis therapy from 1969 to 1974. They were compared to age-matched control patients treated by hemodialysis in the same unit during the same period, who were suffering from renal failure caused by other disease. Mortality in FMF and control patients was 30% with no significant difference in mean survival, shunt life, serum albumin or hemoglobin levels between the two groups. There was no significant difference in blood pressure measured predialysis or postdialysis in patients with FMF or in controls. The synthetic ACTH stimulation test showed adequate or elevated adrenocortical function. It is concluded that life can be prolonged up to 3 1/2 years by hemodialysis in renal failure caused by amyloidosis complicating FMF, and that renal failure casued by FMF is not a contraindication to regular hemodialysis therapy.


[Pseudohypohyperparathyroidism or Frame's pseudohypoparathyroidism type I].

Case report of a girl with fibrous osteitis lesions associated with clinical and biological symptoms of pseudo-hypoparathyroidism: hypocalcemia, hyperphosphoremia, absence of increase of phosphaturia (urine phosphate level) and especially of cyclic AMP after parathormone injection, high serum parathormone level. Similar cases described in literature are shortly analyzed. The genetic, pathogenic and nosologic problems of such an association are reviewed.