Idiopathic membranoproliferative (mesangiocapillary) glomerulonephritis: a clinicopathologic study.

In 51 patients with type 1 and 9 patients with type 2 membranoproliferative glomerulonephritis, we found a male predominance in both types, a wide age range but with younger patients having predominantly type 2 disease, and clinical presentations that varied and included the nephrotic syndrome, an abnormal urinalysis only, acute nephritis, and recurrent hematuria. Hypertension and impaired renal function at the time of first evaluation, which were present in more than one-third of the patients, presaged a poor prognosis; in most of these patients end-stage renal failure or worsening of renal function occurred. Acute nephritis at onset was also related to a deteriorating course and was especially frequent in patients with type 2 membranoproliferative glomerulonephritis. Retrospective analysis of treatment regimens, in which patients were given an average of 1 year of therapy with prednisone alone or combined with cytotoxic agents, showed no effect in patients who had progressive forms of the glomerulopathy.


The relationships between pancreatic ductal obstruction and pancreatic secretion in man.

Precise relationships between pancreatic ductal obstruction and pancreatic secretory capacity have not been established. In this study, we describe the quantitative relationships between the lengths of opacified ducts obtained at retrograde pancreatography and the secretory capcity of the gland for volume, bicarbonate, lipase, and trypsin. Forty-five patients (17 with pancreatic cancer, 6 pancreatitis, 5 other malignancies, and 17 nonmalignant, nonpancreatic disease found at laparotomy) were studied with a method of duodenal intubation and perfusion with basal saline perfusion alone or with continuous intravenous infusion of secretin or of cholecystokinin-pancreozymin. Secretory outputs of volume, bicarbonate, and enzymes compared with the length of opacified ducts showed a significant (P less than 0.05) linear relationship for patients with pancreatic cancer, pancreatitis, and other cancers. The resulting data imply that obstruction of the pancreatic duct is important in decreasing secretion of the pancreas in pancreatic disease. The relationship between obstruction and pancreatic secretion demonstrates that a decrease in exocrine pancreatic secretion cannot be detected until more than 60% of the total length of the main pancreatic duct has been obstructed.


Ebstein's anomaly: the clinical features and natural history of Ebstein's anomaly of the tricuspid valve.

The clinical features and natural history of Ebstein's anomaly are analyzed on the basis of experience with 67 consecutive patients who have had a mean follow-up of 12 years. Of the total group, 26 (39%) of the patients remained in functional Class I or II and 41 (61%) progressed at some time into Class III or IV. Death occurred in 14 (21%) of the patients, and these were characterized by one or more of the following features: (1) they were in functional Class III or IV, (2) they had moderate to severe cardiomegaly with a cardiothoracic ratio greater than 0.65, (3) they had cyanosis or an arterial oxygen saturation of less than 90%, and (4) they were infants when the diagnosis was made (10 patients, of whom 5 died). In patients in Class III or IV, a comparison was made between patients treated medically (10) and those treated surgically--either with tricuspid valve replacement (15) or with a modified tricuspid annuloplasty (16). It appears that modified tricuspid annuloplasty is the procedure of choice, because despite an operative mortality of 25% (4 patients), 12 of the 16 patients so treated improved clinically or had a reduction in heart size.


Morphologic spectrum of Ebstein's anomaly of the heart: a review.

The rare and curious congenital malformation of the tricuspid valve known as Ebstein's disease or Ebstein's anomaly has been a subject of considerable interest to the cardiologist and the morphologist since its first description by Wilhelm Ebstein in 1866. With the evolution of various surgical techniques for the correction of this anomaly, a thorough understanding of the pathologic anatomy of the malformation assumes greater practical importance. It is now clear that although all hearts with Ebstein's anomaly have in common displaced basal insertions of the septal and posterior leaflets of the tricuspid valve, each case may be pathologically and hemodynamically unique. The malformed tricuspid valve may be incompetent, stenotic, or rarely, imperforate. It may be found in a left-sided tricuspid valve with inversion of ventricles. It is important that these individual variations be recognized so that the operative approach can be tailored to the particular variant of the malformation at hand.


The right ventricular myocardium in Ebstein's anomaly: a morphometric histopathologic study.

Ebstein's anomaly of the tricuspid valve is associated with right ventricular dilatation in approximately two-thirds of cases. Dilatation may be massive. It involves not only the right ventricular wall proximal to the tricuspid valve (atrialized ventricle) but also the right ventricle distal to the valve (funtional right ventricle), including the right ventricular infundibulum. For further definition of the pathogenesis of dilatation of the functional right ventricle (distal chamber), a morphometric histopathologic study was performed on 10 hearts with Ebstein's anomaly and 10 normal age-matched control hearts. In the group with Ebstein's anomaly, five hearts exhibited dilated ventricles and five did not. The study demonstrated that dilatation of the right ventricle in Ebstein's anomaly was associated not only with thinning of the wall but also with an absolute decrease in the number of myocardial fibers counted through the thickness of the wall from endocardium to epidcardium.


Surgical repair of Ebstein's anomaly.

Ebstein's anomaly is a complex malformation that has been treated by various surgical techniques, with variable results. We have developed a repair-by plication of the free wall of the atrialized portion of the right ventricle, posterior tricuspid annuloplasty, and right atrial reduction--that has been used since 1972 in 16 patients. The repair is based on the construction of a monocusp valve by the use of the anterior leaflet of the tricuspid valve, which is usually enlarged in this anomaly. There were 14 operative survivors and no instances of complete heart block. Two patients with refractory dysrhythmias due to the Wolff-Parkinson-White syndrome underwent successful intraoperative epicardial and endocardial mapping and surgical division of accessory pathways. This repair has resulted in improvement in the operative mortality and in gratifying early and late results in most patients.


Ebstein's anomaly in an 85-year-old man.

This is a report of the longest survival of a patient with Ebstein's anomaly. The patient had no cardiac symptoms until the age of 79 years, when he presented with severe tricuspid incompetence and congestive heart failure, from which he ultimately died. The diagnosis was established by utilizing two-dimensional sector echocardiography.


The Mayo Three-Community Hypertension Control Program. I. Design and initial screening results.

The Mayo Three-Community Hypertension Control Program implemented graduated programs for the control of high blood pressure in three rural southeastern Minnesota communities, beginning in 1974. Prevalence of hypertension (when defined as diastolic blood pressure, at initial screening, of 95 mm Hg or more) was similar to that found for comparable groups by age and sex in the United States generally, but an atypically high frequency of known but untreated hypertension was found. Programs of public and professional information, systematic household screening, continuing professional education (two communities), and a new community hypertension clinic (one community) were initiated, and plans were made to evaluate the programs simultaneously by means of total rescreening of persons found to be hypertensive initially. The present report describes in detail the design of the program and the results of initial screening in relation to findings in other populations at the time. Subsequent reports assess the impact of each program on its target community and of a community hypertension clinic within the one setting where this component of a model program was established.


The Mayo Three-Community Hypertension Control Program. II. Outcome of intervention in entire communities.

A pronounced decline in blood pressure levels of hypertensive patients occurred in each of three rural Minnesota communities 1 to 2 years after the inception of community programs to control high blood pressure in these populations. An experimental hypertension clinic was established in one community to integrate a nurse practitioner into a physician-supervised program of long-term patient management. In the community with this innovative, partially subsidized practice arrangement, we observed declines in diastolic pressures of hypertensives. However, comparable degrees of blood pressure reduction occurred in the two other communities, with traditional solo or small group practice arrangements, where intervention was limited to detection and referral alone or was supplemented with continuing education of physicians in the management of hypertension. The evaluation of these three community programs suggests, among other conclusions, that this innovative community model for hypertension control, based on the recommendations of the Inter-Society Commission for Heart Disease Resources, contributed to favorable short-term blood pressure outcomes for the community. The observation of similar overall outcomes as measured by blood pressure reduction in all three communities was unexpected; the clinic's impact appears to have been matched by the effectiveness of screening and referral, alone or with continuing education, in the two other communities.


The Mayo Three-Community Hypertension Control Program. III. Outcome in a community-based hypertension clinic.

As part of a broader community program to evaluate approaches to hypertension control, a Community Hypertension Clinic, staffed by two nurse practitioners, was set up in a rural community. Hypertensive persons were identified either by an initial central blood pressure screening or by a subsequent home screening. Slightly more than half of the hypertensive patients at initial screening, or 256 persons, elected to go to the Community Hypertension Clinic for second-stage screening, whereas the remainder elected to see their physicians or to do neither. After secondary screening at the Clinic, 120 patients eventually came under care and were managed by the nurse practitioners. After 2 years of follow-up, 57% of the Clinic patients had office-recorded diastolic blood pressures of less than 90 mm Hg. The Community Hypertension Clinic dropout rate was only 5% after 30 months of operation, for participants whose duration of follow-up ranged from 12 to 27 months (median 16 months), when a repeat home blood pressure screening examination was performed. Comparison of outcomes was thus possible between persons who attended the Community Hypertension Clinic and those who were referred to their physicians' offices. Persons with more severe hypertension most often elected to go to the Clinic, whereas patients with milder degrees of hypertension tended to go to their private physicians for follow-up or failed to make the recommended second-stage screening contact altogether. Greater declines in blood pressure were observed in the Clinic group.


Albright's syndrome with rickets.

Four patients are reported who had Albright's syndrome, hypophosphatemia, and inappropriately low renal tubular reabsorption of phosphate. Three of the patients had radiologic evidence of rickets or osteomalacia, and the fourth had a bone biospy, which showed microradiographic evidence of a previous mineralization defect. Serum parathormone values were elevated before treatment in two patients. Intravenous infusions of calcium in one patient, and of calcium and parathormone in a second patient, showed appropriate target-organ responsiveness. Patients generally showed radiologic improvement of rickets after treatment with large doses of vitamin D, but such treatment failed to restore normal serum values of phosphorus and alkaline phosphatase. It is postulated that a substance elaborated from the dysplastic bone may be interfering with phosphate reabsorption in the renal tubule.


Adrenal scintiscanning with NP-59, a new radioiodinated cholesterol agent.

Adrenal imaging in the past has been limited in its clinical application by the long interval between administration of dose and visualization of adrenal glands. We review our experience with the use of a newer labeling agent, NP-59, in 29 patients with various adrenal disorders and in 4 normal subjects. With this agent, identification of adrenal lesions is possible with a high degree of accuracy, and diagnostic information is usually available within 48 hours. NP-59 is particularly useful in evaluating primary aldosteronism and selected cases of Cushing's syndrome.


Severe pancreatic involvement in three generations in von Hippel-Lindau disease.

Von Hippel-Lindau disease is a hereditary neoplastic disorder that is most commonly manifested as vascular tumors of the retina and cerebellum. Although visceral involvement is uncommon and is almost always clinically silent, we have encountered three closely related patients with extensive symptomatic pancreatic involvement. One patient had pronounced exocrine pancreatic insufficiency.


Demonstration of steroid-producing gonadal tumors by external scanning with the use of NP-59.

Bilateral testicular Leydig cell tumors in a patient with Nelson's syndrome and a Leydig cell tumor of the ovary in a woman with a virilizing syndrome were successfully imaged with [6beta-131I]iodomethyl-19-norcholest-5(10)-en-3beta-ol (NP-59). Uptake by these tumors was comparable to uptake by adrenal glands in patients with funtioning adrenal tumors or bilateral hyperplasia. Scanning the gonads with NP-59 may be a helpful imaging procedure in localizing possible sites for exploratory surgery in certain cases of gonadal neoplasia.


Utilization review and containment for hospital utilization: some implications of providing care in the "most appropriate setting".

The study examines the potential for savings in the use of hospital resources if utilization review policies succeed in curtailing excessive use of hospital facilities. Excessive use is defined as the utilization of hospital care when ambulatory care is medically feasible and acceptable. A utilization review policy would be expected to counteract the tendency to substitute inpatient for outpatient treatment by assuring that all patients with identical medical problems and demographic traits would be treated in an identical least cost setting regardless of their social and economic circumstances. It might, thus, ascertain that the use of hospital facilities would not be systematically affected by patients' non-medical or socioeconomic characteristics. Specifically, the study distinguishes between two types of utilization control policies, pre-admission certification and concurrent or continuing-stay review of hospital episodes, and asks how each can contain excessive utilization. It concludes that continuing-stay review is not likely to have any appreciable effect on shortening hospital episodes because the effects of nonmedical factors on extended stay are small and concentrated among patients whose diagnoses might not qualify them for hospitalization under a pre-admission screen. However, pre-admission certification has a considerable potential for containment of hospital utilization through the reduction in the number of admissions. Also, as a corollary, the study shows that utilization review policies should not be evaluated, as they often are, in terms of their effect on length-of-stay, but rather in terms of their effects on hospital admissions and case mix.


Validity of medical staff judgments in establishing quality assurance priorities.

The validation of a structured group judgment procedure to establish priorities for quality assurance activities was undertaken in six medical institutions in the United States. Validation focused on the extent to which health improvement could be documented by outcome-based projects focusing on priority topics. Predictive (criterion-related) validity was sought by analyzing five successively more stringent levels of evidence: 1) feasibility of implementing a quality assessment project within the topic areas selected by the prioity procedure; 2) accuracy of identifying health deficiencies or strengths; 3) verification of establishing correctable causes of health deficiencies; 4) capability of effecting significant improvement of health deficiencies; and 5) credibility of evidence that improvement achieved is directly attributable to corrective actions taken. Within the limits of generalizability, predictive validity was documented at every level of analysis. It is recommended that the structured group judgment process used in this study be more thoroughly evaluated and considered for quality assurance planning purposes.


Hospital screening for tuberculosis: a quality assurance trial.

A quality  assurance trial which dealth with tuberculin testing and isoniazid prophylaxis for tuberculosis infection among hospitalized patients was undertaken at a short-term, general hospital of the Indian Health Service. Standards for care were developed by the hospital staff using questionnaire and Delphi process techniques. Following the demonstration of baseline deficiencies in clinical performance, tuberculin testing became a standing admission order. Subsequent changes in the completeness of tuberculosis screening and in physician response to a positive tuberculin skin test were demonstrated. Among hospitalized patients of unknown tuberculin reactivity, PPD screening coverage increased from 45 per cent to 87 per cent (p less that 0.005). Improvement in the appropriate initiation of isoniazid prophylaxis was demonstrated. The absence of simultaneous changes in other health surveillance activities suggests that the improvement in tuberculosis screening was attributable to the quality assurance intervention and not to the other intervening variables. An approach to selecting alternatives for remedial action when quality assessment has documented a deficiency is presented and disucssed.


The use of length of stay distributions to predict hospital discharges.

Many hospital admissions scheduling or admissions control systems reported in the literature rely on estimates of future discharges to help control the variance in daily patient census. One of the two most frequently reported methods of estimating discharges attempts to explain the variance in historical length of stay (LPS) data. This paper explores the relationship between LOS variance explanation and the ability to predict discharges and concludes that even a large improvement in the ability to explain LOS variance will only marginally reduce the errors in the associated discharge predictions. In drawing this conclusion, a general discharge prediction model is developed and a more relevant statistic than per cent variance explained is introduced.


An analysis of case mix complexity using information theory and diagnostic related grouping.

Case mix complexity measurements are essential to determine health care efficiency and effectiveness. Measures of patient care processes and outcomes must be adjusted for case mix before valid comparisons can be made. Hospital reimbursement, particularly prospective reimbursement, must take into account differences in case mix. In addition, a key variable for hospital classification is case mix. There are, however, no widely accepted easily computed case mix measures. Information theory measures of case mix have been developed but their acceptance has been limited by a lack of verification of their basic assumption that concentration of disease is related to clinical complexity. We discuss the rationale underlying the mathematical computaton of information theory measures and demonstrate a statistically significant relationship between clinical measures of case mix complexity and information theory measures of case mix complexity.


Variations in surgery in Ontario.

In 1974 there was five-to eight-fold variation in the frequency with which tonsillectomy, colectomy, hysterectomy, cholecystectomy and appendectomy were performed in Ontario's 49 counties. All five procedures were resource sensitive; over 50 per cent of the variation in rates was explained by numbers of acute care treatment beds and physicians. Generally, counties with high or low rates for any one procedure had corresponding rates for the other four. The highest rates were found in less populous rural eastern Ontario counties, while university teaching centers ranked among the lowest for all five operations although they had the highest ratios of beds, general practitioners and surgeons. Linkages between university medical centers and community hospitals, widespread dissemination of surgical rate data, surgical audit and review of surgical indications and practices in university centers and community hospitals are proposed to aid in rationalizing surgical practices in Ontario.


Innovations: components of bundles.

Acceptance by target populations of new programs funded by government is a phenomenon which one should be able to explain with existing innovation theory. In a study of a newly formed group health practice, funded in part by OEO, it is found that a commonly used set of predictors has little utility in explaining  individuals' adoption decisions or their levels of knowledge and attitudes regarding the program. Additional analysis suggests that the ways in which potential and actual clients reacted to certain components of the program "bundle" determined their decisions.


Evaluation of economic effects of drug product selection legislation.

Drug product selection legislation is intended to achieve savings in the cost of prescription drugs without adversely affecting the quality of care by allowing pharmacists the opportunity to dispense less costly generically equivalent drug products in place of the product which had been prescribed by the physician. Various conditions under which the pharmacists are authorized by state laws to exercise theoption to substitute are discussed. The study then identifies and examines the conditions under which savings may and do occur, using the legislation in Michigan as the model. Over 60,000 acutal prescriptions were examined for the three-year period, April 1, 1974 through March 31, 1977--which covers the period of the year immediately before the legislation became effective and the two subsequent years-to determine: 1) the extent to which substitution is possible; 2) potential savings from generic substitution; and 3) very substantial potential cost savings from drug product selection, the actual savings represent only an extremely small proportion of the potential. This principally is due to the fact of the low rate of substitution among eligible prescriptions. Thus, if the gap between actual and potential savings is to be reduced, more attention must be given to affecting the pattern of drug selection among pharmacists.


Utilization of hospital services in the Individual Practice Association on Guam: a comparative analysis.

The HMO Act of 1973 gives impetus on a nationwide scale to the development of health care delivery systems capable of providing or arranging for comprehensive health services for our nation's consumers. However, while the organizational mode of the group-practice model HMO is well defined and tested, there has not been a similar "track record" established for the individual practice HMO. In this study, the author compares the utilization of hospital beds in two operating programs: an individual practice and a group-practice HMO, serving employees of the Government of Guam, U.S.A. Substantial differences in utilization between the two systems are observed over a 12-month period. With the focus on developing the IPA to meet the objectives for which it is intended, it is suggested that organizational structure, provider incentives, and how utilization controls were employed account for the discrepancy.


Use of physician services under two prepaid plans.

Use of physician services under two prepaid plans offered to Stanford University staff is analyzed and compared. One is a Kaiser plan; under the other (Clinic plan), physician and outpatient ancillary services are provided by a predominantly fee-for-service group practice and hospital services are covered by a Blue Cross policy. The two plans provide much the same benefits but, in addition to the difference in their organization, they differ in their financial provisions. While the Kaiser plan has only a token copayment for office and home visits, the Clinic plan has a 25 per cent coinsurance provision applying to all physician and outpatient ancillary services. Despite these differences, the mean number of physician visits per year is the same for the two groups after account is taken of differences in age composition, socioeconomic status, health status, attitudes toward seeking care, length of plan membership, family size and satisfaction with the plan. However, when adjustment is also made for differences in physician affiliation, the Kaiser rate becomes half a visit higher than the Clinic rate. This is because under both plans, members who have a specific plan physician as regular source of care use more services than those without one, and because only 42 per cent of Kaiser members compared with 87 per cent of Clinic members stated that they had a specific plan physician.


Satisfaction with medical care: its measurement and relation to utilization.

Both the conceptualization and the measurement of satisfaction have been of major concern in medical care research. Some scholars used satisfaction as a determinant of utilization, others as a consequence of utilization. Measures of satisfaction are largely content oriented. Reliabilities are reported, but validity is usually assumed (face validity) or assessed through correlations with a criterion variable like "wish to change providers." Using multidimensional scaling techniques, this study identifies several components in the construct "satisfaction" and relates them to the utilization of services. A general satisfaction measure provides us with an assessment of physicians and the medical care delivered, a specific satisfaction measure assesses past experience with the regular source of the care. Both of these can be divided into a positive and negative subcluster. Regressions were computed predicting satisfaction from utilization, and utilization from satisfaction, each time controlling in a preceding step for sociodemographic factors. The relationships varied strongly by provider; as a rule, a larger proportion of the variance could be explained analyzing for one provider at a time than for all providers combined. Analyzing one provider at a time showed that satisfaction substantially increased the proportion of explained variance in utilization in hierarchical regression, but utilization did not increase the explained variance in satisfaction.


Quality assessment and the art of medicine: the anatomy of laceration care.

Assuring high quality medical care has remained an elusive goal because of several problems which have hampered development of effective medical audit programs: inadequate patient data, unreasonable evaluative criteria and insensitive audit procedures. The present study demonstrates the use of a clinical algorithm to help overcome these problems. An examination of medical record data from a series of 703 laceration patients treated in an emergency service yielded only 27 cases (4 per cent) with medical records sufficiently complete to use for auditing physician compliance with algorithmic criteria. Substituting a structured checklist for the handwritten note increased this rate to 86 per cent. A computer-assisted branching audit of 1,400 laceration cases demonstrated that 1) physician compliance with an algorithmic instruction varied significantly (p less than .001) according to the specific instruction, and 2) compliance with a given instruction varied significantly (p less than .001) across different providers. These results underscore the need for medical audit with educational feedback which is provider specific.


[Postoperative care in portal hypertension surgery (author's transl)].

The postoperative courses of 26 patients admitted to an Intensive Care Unit after different types of surgery on their portal tree are studied. All were diagnosed as having portal hypertension secondary to chronic liver disease and had presented one or more episodes of bleeding. Those complications of greater risk with an important early mortality rate are: 1) recurrence of the gastrointestinal hemorrhage, independently of the type of lesion which originates it; 2) recurrence of ascites because these patients more often develop dehiscence of the abdominal wall, serious dilutional hyponatremia and severe functional renal insufficiency; 3) acute renal failure, both functional or caused by an organic tubulo-interstitial nephropathy; 4) peritonitis; 5) persistent hepatolytic episode; 6) hyperdynamic heart failure; and 7) re-operations in general, independently of the causes. The frequency of these complications and the greater or lesser seriousness of their development in the postoperative period are dependent on: 1) the age of the patient with a better prognosis for those under 50; 2) the histopathologic type of the hepatic lesion, with hepatic fibrosis having a more favourable evolution in comparison with cirrhosis; 3) the degree of decompensation of the hepatopathy immediately before the operation, evaluating signs of functional hepatic deficit, cytolysis and degree of portal hypertension. The greater the preoperative activity, the worse the postsurgical prognosis. 4) The elective or urgent character of the surgery. During the postoperative course of emergency surgery all types of complications may appear. The emergency operation which has effectively achieved the stopping of the esophageal bleeding has been the porto-azygos disconnection, which allows later a portosystemic shunt with a greater probability of success. 5) The type of anastomosis carried out. Radicular shunts were those which had a lower postoperative mortality rate and those which progressed better because of the small number of problems occurring in the early postoperative period.


[Treatment of acute respiratory insufficiency in an intensive care unit (author's transl)].

The clinical records of 304 patients with acute respiratory insufficiency were studied in retrospect. All of them had been treated in an Intensive Care Unit during its first year and a half of operation. One hundred and thirty-one patients suffered from chronic obstructive lung disease and acute episodes of chronic respiratory insufficiency. The remaining 173 had acute respiratory insufficiency due to various etiologies. The overall survival for patients with acute episodes of chronic respiratory insufficiency was 66 percent, significantly higher than the 53 percent survival of patients with acute conditions (p less than 0.02). Sixty percent of the chronic cases had to be treated with mechanical ventilation; the mortality rate was 45 percent. Mortality was 70 percent among individuals with acute conditions who received mechanical ventilation. Almost two thirds of deaths occurring in acute cases resulted from non-respiratory complications. Mortality due to respiratory causes was significantly higher in patients with chronic conditions (p less than 0.01). Twenty-three of the 171 patients given artificial ventilation (13 percent) presented secondary respiratory complications as a result. The incidence of pneumothorax was 5 percent and a statistically significant association between barotrauma and PEEP was found (p less than 0.05).


[Diabetes and pregnancy. A prospective study of 14 cases (author's transl)].

Fourteen pregnant women with diabetes mellitus according to White's classification were studied. The presence or absence of bad signs of prognosis in pregnancy were noted throughout gestation. The development of microangiopathic lesions was evaluated at the beginning and end of gestation by direct ophthalmoscopy with two observers. Microangiopathic lesions were found at the end of gestation in some patients who had not had them at the beginning. This would suggest that pregnancy is a risk factor in the development of diabetic retinopathy. The lecithin-sphingomyelin ratio in the amniotic fluid was determined by thin-layer chromatography as an index of fetal respiratory maturity. This determination served as a reliable index of maturity in all cases except one. Lastly, fetal morbidity and mortality were established according to previous determined classifications.


[Clinical study of gastric lymphomas and pseudolymphomas (author's transl)].

The differentiation between gastric lymphomas and pseudolymphomas represents a clinical, surgical, and pathologic problem affecting both prognosis and therapy. Twenty patients were diagnosed for gastric lymphomas or gastric pseudolymphomas. Only those in stages IE or IIE were included in the first group (13 patients). Pseudolymphomas were diagnosed in seven patients on the basis of histopathologic criteria; all seven had peptic ulcers. Survival among the 13 patients diagnosed for lymphomas was low; six of them died within the first year. The seven cases diagnosed as pseudolymphoma progressed favorably over periods between 2 months and 5 years. The histologic parameters on which the differentiation of the two conditions was based included: a) cell type; b) distribution and limits of infiltration; c) presence of peptic ulcers in pseudolymphomas; and c) characteristics of the regional lymph nodes. The various possible mechanisms of pseudolymphomatous reaction are discussed. It is suggested that the relatively good prognosis reported in some series of gastric lymphomas may be due to the inclusion of pseudolymphomas. There is obvious justification for distinguishing between this two conditions.


[Eosinophilic pleural effusion during the course of a giardiasis. Report of a case (author's transl)].

A case of eosinophilic pleural effusion with coincidental intestinal infestation by Giardia lamblia is reported. After reviewing the possible causes of this type of pleuritis no clinical or laboratory data were obtained which could explain this condition, excepting the giardiasis, in the course of which there is no bibliographic reference in this sense. After the parasitosis had been treated with metronidazole the parasitologic negativization coincided with the disappearance of the pleural effusion. A review of the etiologies described in relation to eosinophilic pleural effusion and of the factors involved in the movilization of eosinophils, especially those which have a relationship with parasitosis, was carried out. Parasitosis may be capable of determining immune reactions with release of eosinophilotactic substances. The fact that the lung of experimental animals has been shown to be a suitable tissue for the release of factors with eosinophilotactic activity, could indicate that this organ has a special reactive capacity and probably, together with it, a closely related structure such as the pleura could have it too.


[Dementia and hemodialysis (author's transl)].

The authors present a 60-year-old patient undergoing periodic hemodialysis who, 3 years after beginning the treatment, developed a clinical picture consisting of disturbances of language, motor dispraxia, loss of memory and concentration, irritability, great change of personality, myoclonias and asterixis. This led progressively to a total loss of motor coordination, including speech. He died 5 months later in a state of dementia, psychosis and incontinence of sphincters. The symptomatology increased after hemodialysis sessions. The normal analytical studies carried out in these cases (electrocardiogram, electromyography, complete roentgenologic study) and also Zn, Cu, and ceruloplasmin measurements were normal. The electroencephalogram showed only a slow tracing with delta waves. Various etiopathogenic possibilities are commented on, as for example alterations in the dialysis water, the use of detergents in cleaning the artificial kidney, a syndrome of imbalance, a decrease in the body potassium and poisoning caused by certain metals such as tin, zinc and aluminium or by drugs which contain benzodiazepine derivatives. The authors conclude that the picture corresponds to a metabolic encephalopathy.


[Urolithiasis among flight personnel (author's transl)].

Urinary calculosis is, according to the different medical statistics, one of the most common diseases among flight personnel. The causes which favour urolithiasis are reviewed in relation with the flight factors themselves and the type of life which these professionals lead. Diet, low intake of fluids, and the loss of water through the skin and lungs, are together with the sedentary nature of the work the most obvious causes as etiological factors. The risks which this pathology supposes for flight personnel and their suitability for flight under these conditions are studied. Likewise, the measures which should be established to prevent this anomaly as far as possible are reviewed.


[Result of the administration of high doses of bumetanide to patients with chronic renal failure who are on a program of hemodialysis (author's transl)].

High doses of furosemide were given to patients with chronic renal failure who were on a program of dialysis with the aim of achieving less frequent dialysis or a more liberal diet for these patients. The result of the oral administration of 12 mg of bumetanide per day in 12 patients with renal insufficiency submitted to periodic hemodialysis were evaluated. The residual renal function of these patients varied between 1.5 and 6 ml/min of creatinine clearance. A significant variation could not be established in the predialysis values of urea, creatinine or potassium, nor of the interdialysis weight increase, nor of the urinary excretion of Na and K. On the contrary, the predialysis natremia levels varied from 133 to 138 mEq/l (p less than 0.01) under the effect of the medication and this coincided with a significant increase of the diuresis. As secondary effect the authors frequently recorded myalgia of variable intensity without significant changes in the serum enzymes of muscular origin.


[Vascular approach for periodic hemodialysis. Clinical course of 100 internal arteriovenous fistulas (author's transl)].

The clinical course of 100 internal arteriovenous fistulas in patients observed over a period of more than 6 months was analyzed. Ninety-six were practiced in the upper extremities as side-to-side anastomoses in the forearm between the radial artery and the nearest vein; three were constructed in the lower limbs as anastomoses between the femoral artery and the internal saphenous vein; and one was an autograft of the saphenous vein in the forearm. The most important complications observed were thrombosis (arising chiefly from scant venous development, surgical procedures, and episodes of arterial hypotension), distal ischemia, distal venous flow, infection of the fistula, and insufficient flow. A blood flow over 350 ml/min was achieved in all except two patients. The actuarial survival of individuals with arteriovenous fistulas is high at the present time, with 86 percent of the fistulas functioning after 3 years. The longest period of satisfactory arteriovenous fistula function is 8 years and 3 months.


[Jadassohn's nevus sebaceus and nevus unius lateris. Report of an observation with multiple dysplasia (author's transl)].

The case of a female patient with multiple ectodermal and mesodermal malformations present since birth is reported. The cutaneous lesions were of two types: Jadassohn's nevus sebaceus and nevus unius lateris. These entities have been described in the literature as congenital dermatologic alterations of nevoid character and organoid structure. They can be considered as congenital epidermal nevi. In many cases, including this one, there are various associated disorders especially of the nervous system, eyes, and skeleton. Both syndromes are cutaneous hamartomas which can be differentiated histologically but not by the anomalies accompanying them. Their dermatologic aspects are very similar. The histopathologic characteristics of the skin lesions of nevus unius lateris consist of hyperkeratosis, acanthosis, and epidermal papillomatosis. In Jadassohn's nevus sebaceus there are also alterations of the skin adnexa, namely the absence of hair follicles and the presence of numerous mature sebaceus and hyperplastic glands. In general, the presence of organoid nevus may be a sign of multiple ectodermal and mesodermal malformations. Both syndromes are often present in the same patient, as in the case described here, and their etiology is the same. It is based on an alteration in embryogenic development affecting primarily, though not exclusively, the formations of ectodermal origin. Thus Jadassohn's nevus sebaceus and nevus unius lateris are both forms of phacomatosis. Clinical cases have in common the cutaneous cited above, either in combination or singly. The other possible signs and symptoms are variable, depending on which stage of embryogenic development is affected. There may be defects in the structures of both ectodermal and mesodermal origin.


[Myocardial infarction due to buckshot lodged in the right coronary artery (author's transl)].

A rare case of myocardial infarction produced by a buckshot lodged in the right coronary artery is presented. It resulted from a shotgun blast aimed at the right side of the chest. The patient was admitted to an Intensive Care Unit in a state of shock 1 hour after the accident. The diagnosis was suspected from the first moment because of ECG disturbances and it was later confirmed by coronary angiography. Hemodynamic studies were carried out simultaneously. The patient also presented hemothorax requiring pleural drainage. X-rays revealed a lung contusion with an intraparenchymatous hematoma the whole length of the projectile pathway. During the clinical course a slight hemopericardium was demonstrated by echocardiography; it was originally suspected on the basis of the X-rays. Drainage was not necessary. The patient left the Intensive Care Unit 7 days after entry and was discharged from the Hospital 5 days later. His clinical and hemodynamic condition was good and ECG indicate cicatrization of the myocardial infarction of the diaphragmatic face. The diagnosis and treatment of open or closed traumas of the thorax with similar cardiac involvement in emergency conditions are discussed. The authors prefer not to operate immediately in these cases.


[Medullary aplasia, sarcoidosis, and malacoplakia. A case report (author's transl)].

A 49-year-old man presented medullary aplasia, sarcoidosis, and malacoplakia as evidenced by biopsy. This is apparently the first case of this association to be described in the literature. Medullary aplasia is basically an aplasia of the erythroid series, though it may be a pure aplasia of the red cells alone. A histologic study of the left testicle removed because of an infectious orchiepidydimitis led to the discovery of malacoplakia. Skin nodules appeared later; two of them were extirpated and revealed the existence of sarcoidosis. There was no evidence of sarcoidosis at any other level. The immune mechanism involved in pure red cell aplasia with or without thymoma are well known. The association of malacoplakia and sarcoidosis, two similar conditions, is closely related to alterations in cell immunity. The possibility that common immune factors were present in this patient. After eliminating different therapeutic approaches used in other cases, an immunosuppresive therapy was applied.


[Uremic pericarditis. Preliminary evaluation of treatment with indomethacin (author's transl)].

Numerous therapeutic schemes have been proposed for pericarditis, whether or not accompanied by pericardial effusion in patients with terminal chronic renal insufficiency of subjects on periodic hemodialysis. All of the authors agree that dialysis must be initiated, or at least must not be interrupted once it is begun. There is some disagreement over the system that should be used (peritoneal dialysis or hemodialysis). Anti-inflammatory drugs have been used in association, since the condition is an inflammatory disease. Five episodes of pericarditis with daily hemodialysis and local heparine were treated, plus five other cases with the addition of 3 mg indomethacin/kg/day for 8 days. No secondary effects of indomethacin were reported. A definite reduction in the duration of pain, fever, pericardial rub, and increase in the size of the cardiac shadow was seen in the episodes treated with the association of indomethacin. This furthermore involved the number of days the patient was subjected to hemodialysis. Partial pericardiectomy was practiced on two patients not treated with indomethacin. The later course of the patients treated with indomethacin was more favorable since pericardial effusion did not lead to significant hemodynamic symptoms. There were no recurrences or other complications.


[Neuropsychic manifestations in systemic lupus erythematosus (author's transl)].

Thirty-three cases of systemic lupus erythematosus in women are studied in retrospect. Eight patients (24 percent) presented a total of ten neuropsychiatric episodes that could be attributed to the underlying disease. The neuropsychiatric manifestation that was most often observed was cerebrovascular stroke (40 percent) followed by psychic disturbances and convulsions. A facial paralysis coinciding with an hypertensive crisis was noticed in one case. Another patient presented a peripheral sensitive neuropathy. Five episodes occurred prior to diagnosis or during the first year of the disease. In two patients the neuropsychiatric manifestations constituted the initial symptom of systemic lupus erythematosus. ECG proved to be one of the most valuable diagnostic tools among the complementary studies. It was altered in cases of organic pathology and normal when disturbances were of psychic origin. The C3 fraction of the serum complement revealed a definite difference between patients with and without neuropsychiatric manifestations. Concentrations were lower in persons which psychic disturbances than in patients without them. The pathogenesis of neuropsychiatric manifestations of systemic lupus erythematosus is discussed. They cannot be attributed exclusively to coagulation disturbances nor to treatment with corticosteroids. The immediate prognosis of neuropsychiatric episodes was good: there was partial or total recuperation in eight of the ten episodes. However, the long-term course of systemic lupus erythematosus shows that these manifestations represent an unfavourable prognostic factor in this disease.


[Sensivity of Mycobacterium kansaii and Mycobacterium marinum to different antituberculous drugs (author's transl)].

Mycobacteriosis includes clinical manifestations caused by especies of the genus Mycobacterium other than M. tuberculosis and M. bovis. Therapy for these conditions has not been clearly sistematized as it has for tuberculosis, particularly because of the natural resistance that the etiologic agents present to a large number of antituberculous drugs. The sensitivity of M. kansasii and M. marinum to eleven tuberculostatic agents was studied in order to determine which one were best suited for treatment of cases caused by these species. The drugs showing the strongest action against M. kansasii were rifampin, cycloserine, streptomycin, and prothionamide. M. marinum was even more sensitive except to isoniazid, which is ineffective. As a general rule, especially if the sensitivity of the isolated strain is unknown drugs with little or no action on M. kansasii and M. marinum should not be used. Particularly the use of isoniazid and PAS should be avoided.


[Isolated rheumatic tricuspid insufficiency (author's transl)].

Insufficiency on the tricuspid valve alone due to cardioarticular rheumatism is a rare condition. A 12-year-old boy had had six episodes of rheumatic fever over the previous 5 years. The only damage done to the heart was insufficiency of the tricuspid valve; none of the other valves were affected. The phonocardiographic response to the amyl nitrate and methoxamine tests as well as the correct evaluation of the jugular phlebogram confirmed the diagnosis of this valve pathology. The study of this heart condition was completed with the diagnosis of rheumatic fever (Jones' criteria, modified) and an angiohemodynamic evaluation of the patient (which must include left and right ventriculography using a Bourassa catheter on the right). This pathology is extremely rare and we have found no reference to it in the literature in this country.


[Hematologic aspects of alcoholism (author's transl)].

Alcohol causes different hematologic alterations on each of the three bone marrow cellular series. Its effect on the red series leads to the appearance of megaloblastic disturbances, erythroblastic vacuolization, iron metabolism abnormalities, and hemolytic syndromes. Megaloblastic disturbances may arise as a consequence of folic acid or vitamin B12 deficiency or of a direct toxic effect of ethanol on the erythroblasts. Iron metabolism alterations include reversible sideroblastic anemia, and hemosiderosis. The three hemolytic syndromes related to the consumption of ethanol are: acanthocytosis, stomatocytosis, and Zieve's syndrome. Alcohol induces leukopenia and functional deffects of the leukocytes; these facts explain the frequent susceptibility of chronic alcoholics to infection. Ethanol may act upon the megakaryocytic series to produce reversible thrombopenia and various alterations in platelet function. Thus alcohol exerts toxic effects on bone marrow, which interfere with the proliferation, maturation, release and survival of the three cellular series, either directly or by means of complex mechanisms related to the metabolism of folic acid, vitamin B12, pyridoxine, or iron. Alcoholism should therefore be considered as a possible cause whenever an obscure hematological condition comes under scrutiny.


[Hepatic involvement in boutonneuse fever (author's transl)].

Boutonneuse fever is a rickettsioses which is endemic in the Mediterranean countries. Since 1972 we have had the chance to study eight observations os this disease (6 in the last year) and our attention has been drawn by the constant hepatic involvement. This was biological in all cases and histopathologic in the five patients submitted to a liver biopsy. Functional liver tests showed an elevation of SGOT and SGPT in six patients, as well as of the alkaline phosphatase and/or gamma-GT in five. No signs of hepatocellular insufficiency were detected and posterior controls demonstrated a complete normalization of the analytical parameters. As regards the histopathologic findings the most important was the fibrous enlargement of the porta spaces with slight infiltration by round cells, hyperplasia of the Kupffer's cells, and accumulations of histiocytes and lymphocytes. In no patient did we observed epithelioid granulomas. The authors conclude that the hepatic involvement in boutonneuse fever is benign but very constant, which means that it ought to be known about and that it has no defined histopathologic patterns.


[Malignant hypereosinophilic syndrome. Report of an exceptional case (author's transl)].

The case of a 43-year-old man with a highly malignant hypereosinophilic syndrome is reported. The condition is classified as such according to Hardy and Anderson's criteria, accepted by many other authors. Other diseases of known etiology which may present high levels of eosinophils in the peripheral blood, such as parasitosis, allergies, neoplasias, collagenosis, etc., were discounted beforehand. The difficulties in distinguishing between these diseases are discussed; they are often accompanied by clinical manifestations which also arise in very different conditions including eosinophilic leukemia, Engfeldt and Zetterström's eosinophilic collagenosis, Löffler's fibroplastic endocarditis, etc. A particularly striking feature of this condition is the formation of large tumor masses of mature eosinophils. They begin in various bones, which they destroy almost completely, and invade the surrounding tissues, destroying them as well. These tumors act similarly to malignant eosinophilic myelocytomas, a fact which has not been reported previously in the literature as far as we know. Although the eosinophils act as though they were neoplastic, they maintain the characteristics of mature cells, both cytomorphologically and ultrastructurally as well as cytochemically (consistently chloroacetate esterase negative). The tendency to diagnose eosinophilic leukemia solely on the basis of the malignancy of the condition and a tissue infiltration of eosinophils without determining the existence of cytologic and/or cytochemical anomalies of the cells showing them to be leukemic is discussed. The authors were unable to find any reports in the literature in which the eosinophils were presented with unmistakeably blastic cellular characteristics. Various nosologic considerations are offered.


[Heart function and phonomechanocardiography (author's transl)].

The phonomechanocardiographic parameters most closely associated with heart failure are reviewed and a critical judgement is made of the method. The conclusion is drawn that phonomechanocardiographic measurements help to establish approximate limits of functional normality in cases of moderate abnormality. When acute phonomechanocardiographic alterations appear following infection or toxic heart disease or the use of potentially cardiotoxic drugs, the diagnosis of miocarditis can be made on an objective basis. To control the clinical course of heart failure the following parameters are useful: variations in the period of expulsion, "a" and "telediastolic" indices of the apexcardiogram, and the expulsion period/pre-expulsion period and expulsion period/systolic isovolumetric phase coefficients. Although phonomechancardiography lacks exact biological precision, it represents a rational and no invasive method for estimating heart function. It provides a means for recognizing diverse functional anomalies at their onset and for controlling their development. It thus helps in choosing adequate preventive and therapeutic measures to keep an early functional miocardial disease from becoming a serious case of heart failure.


[Kinetics of beta-methyl-digoxin in different degrees of renal function (author's transl)].

Creatinine clearance was evaluated in individuals with varying degrees of renal function following the administration of beta-methyl-digoxin. From the results of the experiment it can be deduced that significantly increased hematic values and renal clearance values definitely lower than normal appear only in patients of a creatinine clearance of less than 50 ml/min. Furthermore, a positive correlation between creatinine clearance values and beta-methyl-digoxin levels was noticed. This correlation was in proportion to the amount of serum albumin. The degree of distribution of free digitalis and digitalis bound to proteins within the vascular system played an important role in the complex kinetics of digoxin. This relationship is suggested as an indirect index of the proportions of free beta-methyl-digoxin and of beta-methyl-digoxin bound to plasma proteins.


Hypertensive emergencies.

The clinical syndrome of accelerated hypertension is a relatively rare complication of hypertensive disease. The syndrome is recognized by high blood pressures, progressive neurologic and visual symptoms, acute renal damage, cardiac failure, and microangiopathic hemolytic anemia. When diagnosed, it must be recognized as an acute medical emergency. The patient should be admitted to an intensive care unit, arterial lines should be placed, and the blood pressure lowered as soon as possible. Once blood pressure has been controlled, oral medications should be begun. Long-term results in the treatment of hypertensive emergencies are gratifying. It is anticipated that with more experience gained in the use of medications in this situation, an even better prognosis will be achieved.


Dissection of the aorta.

Our approach to management, both initial and definitive, is summarized in Table 2. Patients with proximal dissection require surgical intervention after medical stabilization, unless prior debilitating illness precludes general anesthesia or prolonged vascular surgery. If myocardial infarction or cerebrovascular accidents has complicated the dissection, results are extremely poor, regardless of therapy. Patients with distal dissection have a good prognosis with medical therapy alone, unless aortic rupture or impending rupture, hematoma progression despite a maximal drug program, vital organ compromise, or inability to control pain or blood pressure medically supervene. Dissecting aneurysm of the aorta, while potentially a promptly fatal event, is amenable to aggressive therapy provided that one is alert to the possibility of this disease. Despite all  technical advances, the single most important factor in making the diagnosis of dissecting aortic aneurysm is a strong index of suspicion on the part of the physician.


[Gas gangrene (author's transl)].

Gas gangrene which is due to clostridial contamination of a wound is a rare disease. The clinical picture is quite characteristic. Untreated the disease has a near 100% mortality for which reason treatment should be started as early as possible. Surgical debridement remains the therapeutic cornerstone. Administration of antibiotics is recommended and the efficacy of treatment with hyperbaric oxygen is beyond doubt. The only proven prophylactic means consists in the proper surgical management of wounds.


[An expanded basic documentation of treatment and follow-up for operated cancer patients (author's transl)].

Presented is a program of recording all facts in the fate of a cancer patient relevant for therapy and prognosis in a manner suitable for EDP. Beside optimal medical treatment it is the substance of the documentation system to produce the complete pathogram of all registered cancer patients. From the day of establishment of the diagnosis and the begin of clinical treatment in the Evgl. Krankenhaus up to the following 5 years the cancer patient runs through a strongly termed and tumor specific follow-up. All informations and facts are registered in a codable medical record, a basic documentation for tumor patients, a follow-up and a final questionaire. In the so coded pathogram of the cancer patient we only use international binding classifications and coding systems. The pathogram is the result of a longer development and testing time in the surgical department of a smaller hospital. The presented principles of documentation include all basis necessary for the establishment of a clinical cancer registry and documentation follow-up.


[Biopsy of para-aortic lymphnodes in patients with malignant lymphomas (author's transl)].

In treatment of malignant lymphomas exploratory laparotomy with splenectomy, liver and lymphnodes biopsy is necessary in order to individualize appropriate management. The surgeon must make maximal effort to obtain lymphnodes for histological examination. The surgical anatomy of the retroperitoneum in space of abdominal aorta and the biopsy procedure of paraaortic lymphnodes were described. The literature was reviewed.


[Pressure-diameter-relationship of the papilla duodeni. An experimental study (author's transl)].

While extending the papilla duodeni of dogs by probes of increasing diameter, mural pressure was measured as an equilibration of the hydrostatic pressure within the probes along a distance of 12 mm. Pressure-diameter-curves at the duodenal end of the papilla show the mural pressure promptly increasing to a maximum when partially extended, then declining and rising again when extended extremely. Proximal to the papillary end the mural pressure first declines and then continuously increases with larger probe diameters. The pressure-diameter-curve of the papillary end resembles the length-tension-diagram of isolated smooth muscle in vitro, and represents the normal physiological action of the sphincter zone.


[Intense segmentary subserosis lipomatosis of the small bowel (author's transl)].

Report of an operated case with an intense segmentary subserosis lipomatosis of the ileum, the clinical and anatomical symptoms of this very seldom disease described.


[On the role of myotomy in the treatment of diverticular disease (author's transl)].

Spontaneous motor action of fresly prepared circular and longitudinal muscle strips were examined in two separated trials. Bowel musculature of diverticular patients were compared with those of normal subjects. Finally all explantations were examined histologically. 1. There was no difference in electrical activity and tension development regarding circular muscle strips of patients suffering from D.D. and those of normal subjects. 2. The longitudinal muscles show however significant differences in contrast to normal subjects; to sum up D.D. presents us a spastic and contracted taenia. 3. The histological investigations did not explain the different electromechanical results. There were however remarcable ribbons only in the longitudinal muscle of D.D.--known from myoma uteri. The results of the electrophysiological analysis have importance for our surgical concept in the treatment of peridiverticulitis. They justify the horizontal myotomy in the left, functionally disturbed colon descendens additional to the resection as an preventive procedure.


[Reflux and reflux disease following gastric resection (author's transl)].

Intragastric concentrations of lysolecithin and bile acids were determined in 112 patients with different types of gastrectomy for peptic ulcer (Billroth I and Billroth II). These values were correlated with intragastric pH, bacterial contamination, gastric mucosal changes and Visick grading. A maximal amount of duodenogastric reflux was found in retrocolic gastrojejunostomy (Billroth II). Smaller, but still highly pathological values were observed in the antecolic gastrojejunostomy with Braun enteroanastomosis as well as in different types of gastroduodenostomy (Billroth I). 70% of the operated stomachs were bacterially contaminated. There was a good correlation between amount of reflux, bacterial contamination and pH-value. Above pH 6 no stomach was sterile, the lysolecithin-concentration increased more than proportional. Gastric mucosal changes correlated closely with the intragastric lysolecithin concentration and the bacterial contamination. There was no correlation between amount of reflux and Visick-grading, no complaints were found in some cases with extreme reflux values as vice versa. The postoperative alkaline reflux gastritis is described, the consequences including the carcinoma of the gastric stump are mentioned. The principles of ulcer surgery are analysed under these aspects.


[Actual diagnostic problems in facial nerve palsy (author's transl)].

From the great number of diagnostic attempts in facial nerve palsy the main procedures are summerized in this article with an evaluation of their significance. The demonstrated limitations of their clinical relevance should lead to a careful assessment of their results. However, a clinically worthwhile concept for functional and topographical diagnoses can be proposed. In each case of facial nerve palsy it is necessary to exclude all other etiological factors before the diagnose of Bell's palsy is made. The importance of early diagnose is stressed.


[Trauma of the facial nerve at the geniculate ganglion (author's transl)].

Fractures of the pyramid, longitudinal fractures in the majority of cases, lead to a damage of the facial nerve in the surrounding of the geniculate ganglion. This area has to be controlled surgically when a facial nerve paralysis occurs after a head injury.


[Surgical treatment of early facial palsies in cases of longitudinal fractures of the temporal bone (author's transl)].

Longitudinal fractures of the temporal bone are complicated by facial palsies in 10--25% According to the results of Fisch the lesions of the facial nerve are ever situated at the labyrinthine segment of the nerve. The most frequent lesion is the impression of bone fragments in the Fallopian canal. Clinical controls of the progredience of the palsy and tomographies are necessary. The only successful therapy in cases of early facial palsies due to longitudinal temporal bone fractures is the total decompression of the facial nerve with the combinated transmastoid approach and middle fossa approach.


[A method of suture-free anastomosis of nerve transplantation is being reported, using facial nerve as the example (author's transl)].

After microsurgery preparation, the endings of the nerve trunk, which have been freed from epineurium, are approxiamated on top of a gelatin platelet (gel foam) which has been soaked in a nutrient solution. The gelatin platet is then formed like a tube and wrapped around the ends of the anastomosis. Using this procedure, suture-induced reactions in the vicinity of the anastomosis are prevented. The connection is sufficiently firm so as to withstand tension incurred in chewing and in movement of the head. Additionally, the gelatin coating prevents early onset of fibrosis, which as a process is normally induced by the surrounding tissues onto transplants. Simultaneously, nutrition of the transplant is guaranteed during the first post-operative days. In all cases operated hitherto, good to satisfactory return of function has been observed. The earliest onset of function-return was observed at four (4) months after the operation and the latest completion occurred at eighteen (18) months. Thus far, no negative results have been observed using this method.


[Anaesthesiological and ENT surgical aspects in long operations (author's transl)].

In ENT surgery due to the differential anatomy of the operation area, radical tumour surgery, necessary plastic surgery and covering of resulting defects, plus efforts in maintenance and reconstruction of important functions the resulting operations are frequently lengthy. In 27 patients whose operations required longer as 10 hours the problems of anaesthesia and operation were analysed and discussion from various angles. With close teamwork between surgeon and anaestheist in the planning and carrying out of such procedures and in the postoperative care it is possible to eliminate higher risks due to the prolonged operation time. The perioperative mortality rate within a time period of 4 weeks was in our case 0%.


[The use of a computer in the ENT-office (author's transl)].

A computer was installed into several offices in order to find an adaptable system for doctors of all specialties and perhaps also clinics and hospitals. The electronic assistant is very useful in the administration especially by filling out formes and for printing diagnoses and code numbers. The advantages of the electronic device, which is expandable, are compaired with the manual system that has been used so far.


[Early diagnosis of chordoma by fine-needle aspiration biopsy (author's transl)].

Successful surgical therapy or radiation of chordoma depends on an early morphologic diagnosis. Two cases of chordoma in the sphenooccipital region are reported, in which fine-needle aspiration biopsy was performed. This method is controlled by X-ray. For gaining sufficient material it is superior to surgical biopsy. The cytomorphology of chordoma and its differential diagnosis are discussed.


[Neurosurgical aspects of the treatment of acoustic neurinoma with special consideration of the facial nerve (author's transl)].

The decisive progress in the field of surgical treatment of acoustic neurinomas has occured after the introduction of the operating microscope. This is a survey of the microsurgical treatment of cerebellopontine angle tumors with special emphasis of the facial nerve and demonstration of individual cases. Moreover, the technique of the dissection and preservation of the continuity of the facial nerve during removal of a tumor is analysed. The possibilities of reconstructive surgery of an end-to-end suture or nerve graft in case of facial nerve lesions after removal of a tumor are discussed.


Radioactive suture in the treatment of head an neck cancer.

I-125 seeds in Vicryl suture have been used as a radioactive suture in 24 cases of advanced malignancy of the head and neck. Twelve cases had metastatic carcinoma attached to the internal or common carotid artery. The goal was to excise surgically as much tumor as possible, then implant any residual tumor with this radioactive suture which remains as a permanent implant (half-life of 60 days). This preliminary study shows that use of I-125 impregnated Vicryl suture in this manner appears to produce improved long-term palliation and may increase local cure rates.


Upper airway obstruction due to coccidioidomycosis.

The inpatient experience regarding coccidioidomycosis of head and neck was reviewed at the University of California Medical Center, San Francisco and affiliated hospitals. Four cases in which upper airway obstruction required otolaryngological consultation and intervention are reviewed in detail. History, epidemiology and pathophysiology of coccidioidomycosis involving upper airway are discussed. Suggestions for diagnosis and management are outlined.


The opercular syndrome--diagnostic trap in facial paralysis.

We describe a patient with a left facial paralysis and hemotympanum following left parieto-occipital skull trauma. The initial admission diagnosis of intratemporal facial nerve injury secondary to temporal bone fracture was incorrect. Normal facial movements during involuntary activity (yawning, laughing at a joke) and focal seizure activity on the paralyzed side of the face, seen subsequently, indicated the site of lesion as supranuclear. The diagnosis of opercular syndrome was made. This syndrome can result when the contralateral frontal lobe is injured. Supranuclear weakness of muscles supplied by the hypoglossal or spinal accessory nerves is also present. Unlike other central paralyses, the facial paralysis in operculum syndrome may not demonstrate "forehead sparing" and consequently it may be mistaken for a peripheral paralysis. The neuroanatomic basis for the syndrome is discussed. Signs and symptoms are outlined to help the otolaryngologist avoid this diagnostic pitfall.


A technique for pharyngeal reconstruction in heavily irradiated patients.

A technique for esophageal reconstruction using a staged deltopectoral tubed, pedicled flap has been highly successful in irradiated patients. The basic principle involves use of the neck skin as the posterior wall and the dorsal and lateral aspects of the tubed flap to form the anterior and lateral walls of the newly constructed pharynx. The ventral surface forms the cutaneous covering. The submental area and base of tongue are used for implantation of the distal end of the flap, taking advantage of the abundant blood supply of this area. It is a fail-safe method of reconstruction, particularly applicable in cases in which the local skin is of poor quality.


Oncocytoma of the maxillary sinus.

A case of oncocytoma of minor salivary gland origin of the left maxillary sinus is presented. No previous reports of oncocytoma confined entirely to the maxillary sinus were found in an extensive computerized search (Medline and Cancerline) of the world literature. The diagnosis and management of these histologically benign but locally aggressive tumors occurring in the head and neck are discussed.


Tracheoesophageal space abscess.

Two cases of a newly described complication of endotracheal intubation are presented with a discussion of the pathophysiology, clinical symptoms, and treatment evaluation. Treated late, bilateral arytenoid fixation associated with subglottic stenosis is the eventual outcome. Reconstructive efforts in one patient have allowed decannulation two years after onset of his disease following bilateral arytenoidectomy. No reconstructive efforts were attempted in the second patient because of her basic underlying disease process. Early recognition is important and exploratory laryngotracheal-fissure advocated for suspected cases in order to perhaps decrease the devastating consequences of late treatment.


Survival after unplanned carotid rupture.

A series of 13 cases with unplanned carotid rupture is summarized. Time from surgery and radiation to rupture, survival time after rupture, and whether tumor is present or not at death is given. The longest survivor lived one year and eight months after rupture and was one of three patients without known tumor at death. Long-term planning for care in the head and neck tumor patient should include the patient and family. Decisions should be made objectively by all rather than during acute care crises. Occasionally a decision not to treat a pending or actual carotid rupture may be the patient's choice.


Complications of intranasal ethmoidectomy: a review of 1,000 consecutive operations.

A series of 1,000 consecutive intranasal ethmoidectomies performed on 565 patients was reviewed. There were 28 complications (2.8%) in 26 patients. No patient died, and none became blind. This experience suggests that, in experienced hands, intranasal ethmoidectomy for polypoid disease and chronic ethmoid sinusitis can be a safe operation.


Eye protection in the paralyzed face.

All patients with a VIIth nerve paralysis with any limitation of closure of the eye should have in the office or out-patient clinic setting: 1. paper tarsorrhaphy of the upper or possibly lower lid; 2. artificial tears and/or ointment; and 3. glasses to protect the cornea from air currents. Kinetic and static surgical procedures are discussed. The kinetic procedures include facial nerve repair and grafting, VIIth-XIIth nerve anastamosis, muscle nerve block transplantation, transposition of nonparalyzed muscle and cross over. The principals of VIIth nerve repair and grafting and presented in the intracranial, internal auditory canal, labyrinthine, tympanomastoid and extratemporal sites. The static procedures include resection of redundant skin, fascia lata strip suspension, weakening of contralateral non-paralyzed musculature, and adjunctive procedures such as resection of ptotic melolabial fold, plication of parotid-masseteric fascia, dermal graft suspension, blepharoplasty, brow lift, canthoplasty, horizontal shortening of lower lid, fascial suspension of lower lip, McLaughlin tarsorrhaphy, and palpebral spring. Patient counseling is emphasized.


Eustachian tube function related to the results of tympanoplasty in children.

The results of tympanoplastic surgery to repair a perforation of the tympanic membrane are less satisfactory in children than in adults. This paper reports the results of a propspective study of 45 children (51 ears) which was undertaken to determine which, if any, detectable and controllable pre or intraoperative parameters might predict the outcome of tympanoplasty surgery. A "successful" tympanoplasty was defined as that in which the initial graft took, in which the tympanic membrane remained intact, and which was not associated with high negative middle ear pressure, otitis media with effusion, or cholesteatoma during a follow-up period of one to two years. Assessment of hearing related to the tympanoplastic surgery was not included as an outcome measure. With this criteria, the overall success rate of tympanoplasty in children was 35%. The success of tympanoplasty was not related to graft placement, although the laterally placed grafts had a higher take rate (67%) than grafts placed medially (49%). Preoperative measures, such as the assessment of Eustachian tube function using the modified inflation-deflation test and tympanometric evaluation of the contralateral ear, failed to predict the success of tympanoplasty. Tympanoplasty universally failed in the ears in which an acquired cholesteatoma was present. Children remain uncertain candidates for tympanoplasty surgery since, as a group, their Eustachian tube function is not as good as that of adults.


Tuning fork decay.

Tuning fork tests are used routinely by many otologists. A different group of otologists find the tests inconsistent and unreliable. This controversy has probably developed because the audiometer has replaced the tuning fork in hearing measurement. As a result, the art of use of the tuning fork is poorly learned. This study examines decay, one of the physical parameters of tuning forks. Measurements of acoustic (sound wave) and vibration (stem movement) decay were made. Alteration in decay due to pressure changes on the fork stem were studied. Acoustic signals were generated in an anechoic chamber. Vibration measurements were obtained using an artificial mastoid. Analysis of the signals was accomplished by a system of amplifiers, filters, tape recorders, and a graphic recorder. Tuning fork sound decay is a property of the instrument which occurs every time the fork is struck. The decay is a constant in decibels per second. The acoustic mode and the vibration mode decay at similar rates for the same fork. The strike frequency (a higher frequency than the fundamental produced when the fork is struck) also has a constant decay rate in decibels per second, and it is reported here for the first time. Force of 800 gm. and less applied to the bottom of the stem in vibration measurement caused minimal decay constant changes. When the physical parameters of the tuning fork (including this information on damping) are fully studied, tuning fork testing should become more of a science and less of an art.


Frequency and significance of epithelial atypia in laryngeal papillomatosis.

The clinical records and microscopic sections from 32 patients were reviewed in an attempt to correlate histopathologic features with clinical behavior. Three general clinical groups were identified on the basis of recurrence rates and extent of papillomatosis. In those lesions with the highest frequency of recurrences, epithelial atypia tended to be most pronounced. Although some of the lesions were quite disturbing, there was no evidence of invasive carcinoma. It remains unknown to date whether these cytologic abnormalities represent a neoplastic alteration or possibly atypia on the basis of rapid, but benign, cellular turnover. Further studies at our center and other institutions are necessary to test the proposed classification which, if validated, would provide a means of predicting the course of the disease and efficacy of the chosen management in these difficult cases.


The use of postoperative irradiation--its goals and 1978 attainments.

The use of postoperative irradiation as an adjunctive measure for better control of local and regional disease after a surgical procedure has been used at the Anderson Hospital since approximately 1965. The common clinical setting occurs in those patients in whom, after surgical ablation of the tumor, there are microscopic foci of residual disease at the margins, perineural invasion, histologically a very poorly differentiated carcinoma, dermal lymphatic involvement, multiple nodes in the neck or very large nodes in which the tumor has broken through the nodal capsule and entered the connective tissue. We have been applying this criterion for the treatment of salivary gland malignancies, squamous carcinomas of the hypopharynx and supraglottic larynx, and all sites in the head and neck in which there was extensive cercical nodal metastasis. The results of this therapeutic approach will be reported and discussed.


Increased survival with surgery alone vs. combined therapy.

Recent investigations have questioned the efficacy of a combined therapy regimen with irradiation. The purpose of this study was to compare the survivals with surgery alone versus combined therapy (pre-op irradiation) and to analyze any apparent differences to identify the source(s) of failure. Two and five-year determinate survivals for this group identify the source(s) of failure. Two and five-year determinate survivals for this group were found to be significantly better for surgery alone. There is no instance where combination therapy is found to be statistically superior. An analysis of treatment failures showed that distant metastases occurred at a greater rate in the combined therapy patients than they did with those treated by surgery alone. The advisability of combined therapy using preoperative irradiation with its increased cost and morbidity to the patient is questioned if it does not improve survival over surgery used as a single modality.


Health care costs of laryngeal surgery.

The total costs of various laryngeal surgeries were considered from initial visit through one year postoperatively. For the four most widely used procedures, average costs were: laryngoscopy with biopsy, $1,000.00; hemilaryngectomy, $5,035.00; total laryngectomy $6,010.00; and supraglottic laryngectomy and neck dissection, $12,096.00. Most ancillary service charges decrease as length of hospitalization increases except for pharmacy and respiratory therapy. Physicians whose decisions affect health care should also take cognizance of health care costs.


Effect of prophylactic antibiotics in radical head and neck surgery.

One hundred major head and neck operations performed on 77 patients were evaluated regarding the effectiveness of an aminoglycoside and cephalosporin antibiotic combination given prophylactically to prevent postoperative infection. The postoperative infection incidence was 6%, significantly lower than that reported in similar series where no antibiotics were used. The addition of the aminoglycoside did not appear to provide any additional protection compared with the use of cephalosporin alone.


Glottic reconstruction after near total laryngectomy.

It is generally accepted that vertical partial laryngectomy can yield satisfactory cure rates in properly selected glottic carcinomas. Several authors have discussed different reconstructive techniques following extended vertical partial laryngectomy. These have included the use of stents, keels, various soft tissue "free" grafts, or muscle transplants. All of the above require prolonged tracheostomy and staged surgical procedures with the resultant upper airway sometimes being less than satisfactory.


Chronic vasomotor rhinitis: cryogenic and other surgical modes of treatment.

Cryosurgical treatment of chronic vasomotor rhinitis provides a safe, effective and uncomplicated mode of management for this very common otolaryngologic disorder. Data relating to three hundred fifty patients is presented with particular reference to patient selection criteria, cryosurgical techniques and results.


The cochlear aqueduct: structural considerations.

Perusing 170 series of temporal bone sections, the course of the aqueduct was found to be a spindle shape, based on numerous dilatations in the middle section. Ample space was offered for development of bony excrescences such as exostotic depositions and osteoma-like protrusions of all sizes. These added considerably to the difficulties of a free passage through the aqueduct.


Impulsive and sinusoidal rotatory testing: a comparison with results of caloric testing.

The usefulness of rotatory testing (impulsive and sinusoidal) as an indicator of impaired horizontal semicircular canal function was evaluated in 63 patients with unilateral and bilateral decreased caloric responses. The rotatory stimuli were precisely controlled over a large magnitude range and EOG recorded nystagmus responses were quantified using digital analysis techniques. Rotatory testing was consistently abnormal in patients with complete unilateral caloric paralyses but was normal in over one-half of the patients with significant but less than complete unilateral caloric paralyses. The difference in maximum slow component velocity (SVMX) of induced nystagmus after the largest rotatory stimuli was the best indicator of unilateral impaired function. The patients with bilateral decreased caloric responses demonstrated three categories of rotatory response: 1. normal at all magnitudes of stimulation, 2. decreased but present after large magnitude stimuli, and 3. absent responses. It is concluded that although rotatory testing cannot replace caloric testing it can provide useful clinical information particularly in patients suspected of having bilateral vestibular disease.


Directional handle for Zeiss operating microscope.

A new directional handle for the Zeiss operating microscope is presented. This handle offers the advantage of single-handed (right or left) control by natural movement of the wrist. The handle may be used by grasping it through the see-through sterile drape or sterilized separately and placed outside the sterile microscope drape.


Calibrated otoplasty.

The number of patients seeking correction of abnormally protruding ears has decreased in the past ten years because of changing hairstyles and concepts of body image. During the same time there has been an increase in the number of surgeon and surgical disciplines seeking to perform cosmetic otoplasty. To compensate for this deficit in total volume experience of the individual operator and to insure patients of a consistently acceptable cosmetic result, the concept of calibrated otoplasty is presented. A study was made of a large number of ears which appeared to be esthetically in harmony with each other and with the side of the head. The distance relationships obtained from this study were applied not only to the creation of a new antihelix in the first ear but the degree to which the ear projects from the side of the head. At the conclusion of the first ear operation, careful measurements were taken for use in the second ear operation to insure its being as near normal as the first in form and degree of projection of the ear from the head. This concept of calibrated otoplasty is explained in detail with illustrations of all required measurements plus a series of surgical illustrations showing application of the technique.


Linear nevus sebaceous of Jadassohn.

Though the described lesion is uncommon, it is nevertheless important to recognize for several reasons. Its rapid growth during certain phases makes early recognition and surgical excision mandatory to preclude cosmetic deformity. In addition, its significant tendency for malignant degeneration makes early excision the preferred treatment.


Office photography for facial cosmetic surgery.

A photographic record of the appearance of the patient's face and neck preoperatively, and of the changes resulting from surgery is a most important aspect of facial cosmetic surgery. This report describes a practical, efficient system of photography performed in the surgeon's own office. The photographic equipment can be placed in a relatively small area at a total cost of well under $1000. The procedure described, when smoothly running can provide almost 99% efficacy in obtaining consistently good photographs with a minimum of effort and time spent by the surgeon and his office staff. The photographs are a precise, valuable record (medically and legally) of the patient's preoperative and postoperative appearances, and are important for the patient to see and for the surgeon to study. The patient is provided with a striking reminder of preoperative reality; the surgeon with insight into the progress of his surgical expertness.


[Simulator of cardiac activity signals].

Imitators of physiological signals are in need for production of electronic medical equipment and modeling the biological systems. The known imitators are rather intricate and incapable to control the output signal within a wide range. The imitator now offered allows to reproduce any signal that reflects the activity of a cardiovascular system under normal and pathologic conditions.


[Equipment realization of the Bouilland selective transformation for the routine analysis of the slow waves of cardiac rhythm].

An increased amplitude of the cardiac rhythm slow waves is a significant indication for the initial stage of occupational fatigue. To control the dynamics of these waves, a multichannel device is offered which measures continuously the cardiac cycle duration (R--R intervals) and transforms the measured values in the real-time mode.


[Electroureterograph and dynamoureterograph].

The results of investigations made by the authors showed that the signal spectra of the bioelectrical and mechanical activity of the ureteral smooth muscles lie within the range of 0.05--1 Hz. The developed devices for registration of electro-and dynamograms of ureters may be utilized in investigating the functional state of the urinary system of the organism.


[Automatic instrument for measuring blood pressure indirectly].

The PPB-01 automatic blood pressure meter is recommended to ease the medical staff efforts, provide higher accuracy, and ability to further data input in the devices for automatic processing of biomedical information. Its functioning is based on variation of the slope of positive pulse-wave part. The meter features a high noise immunity and permits measurement at a moderate motor activity.


[Possibility of increasing the efficiency of the apparatus for analysing the R-R intervals of electrocardiograms].

To increase the operation speed of devices recording the R--R intervals on electrocardiograms, the authors performed a theoretical analysis of the differential-statistical method used for signal transformation, and elaborated a special block for p4-ch-0l electronic polygraph. Clinical trials confirmed the theoretical and experimental results and indicated that the new block based on the differential-statistical signal transformation allows, by means of recorders, to register the rhythmograms at a high resolution and without distortions.


[Flexible ultrasonic echo-probes and the prospects for their use in oncological practice].

Medico-technical requirements for a flexible echo-probe that can be connected to the Soviet-made ultrasonic diagnostic devices of the uda-724, uda-871, ékho-aa, ékho-12 types etc, were laid down. A mock-up of a flexible echo-probe, based on the electrical scanning by an ultrasonic beam was constructed. The use of flexible echo-probes broadens the possibilities for the ultrasonic investigations of tumours in the esophagus, stomach and rectum in the oncological practice.


[Digital readout of the results in using the IPR-01 sequential reaction measuring instrument].

A scheme of the device for connecting to the IPR-01 digital readout appliance was adjusted. This consists in that the signal from a time-metering unit (TMU) goes to the control unit outlet, which secures the read-out of the signals from the TMU, continuing in the information storage conditions.


[Medical equipment at the Leipzig Fall Fair, 1978].

This is an attempt to reveal the main directions and trends in the medical technique progress, as evidenced by the most interesting exhibits at the 1978 Autumn Leipzig Fair. Advantages of the functional-block designing method were noted, seen in the instruments made for clinical diagnostic laboratories. Promising features are emphasized, intrinsic for units intended for reconstructive X-ray tomography, autoanalysers for studying blood, enzymes and substrates, as well as for ultrasonic diagnostic devices. The latter provide a combination of A and B-mode echography, or the M-type scanning with Doppler ultrasonic pulse investigation. Such a combination allows to fix on the echogram the precise position of the structure being investigated by the Doppler approach.


[Experience of the Medequipment Scientific and Industrial Combine in organizing and performing controlled operation of medical equipment].

Most effective form of organizing operation under control of medical purpose products in their exploitation conducted by the manufacturing plant and medical establishments with direct participation and under methodological guidance of the designing body. The processing and analysis of the gathered information help detect main causes of design and technological nature leading to lowering the quality of the product.


Infective endocarditis caused by slow-growing, fastidious, Gram-negative bacteria.

In a review of endocarditis caused by fastidious, slow-growing gram-negative rods, similarities in the spectrum of disease overshadow differences among cases grouped by specific organisms. Cardiobacterium hominis, Actinobacillus actinomycetemcomitans and Haemophilus species usually seed previously damaged cardiac valves presumably during bacteremia from an upper respiratory site. The clinical presentation resembles that of Streptococcus viridans endocarditis and is usually subacute or chronic. Despite bacteriologic cure, severe CHF and/or systemic embolization frequently develops during or following the course of antibiotics, resulting in significant morbidity and a high mortality rate. This report of nine cases diagnosed at five hospitals in a 7-year period suggests that endocarditis due to these organisms is more common than previously appreciated and frequently goes unrecognized. This is probably due to a lack of attention to the requirements for culture of this group of bacteria with propensity for granular growth in broth. We have proposed specific cultural techniques appropriate to the search for these organisms in patients with apparent culture-negative endocarditis.


A randomized comparative trial of three aminoglycosides--comparison of continuous infusions of gentamicin, amikacin and sisomicin combined with carbenicillin in the treatment of infections in neutropenic patients with malignancies.

Continuous infusions of gentamicin, amikacin or sisomicin combined with carbenicillin were compared in a randomized study in the treatment of 572 febrile episodes in 281 patients with cancer. The three treatments (C+A, C+A and C+S) were equally effective with no significant differences in response rate overall (67%, 68%, 67%) or in any infection, except septicemia where C+G had a significantly lower response rate than the other two groups. Pneumonia, the most common infection, had the lowest response rate for all three groups (45-50%). Klebsiella spp. were the most common pathogens and showed a lower response rate than other gram-negative bacilli (P = 0.003). Patients with persistent severe neutropenia had a response rate of 56%. Azotemia was significantly less common in patients with documented infection treated with C+A than in the C+S group. Combinations of carbenicillin plus an aminoglycoside antibiotic are effective for the treatment of infections in neutropenic patients.


Xanthogranulomatous pyelonephritis (XGP): a local disease with systemic manifestations. Report of 23 patients and review of the literature.

The clinical, pathological and radiographic findings of 135 cases of xanthogranulomatous pyelonephritis have been reviewed. It is a form of renal suppuration and obstruction most commonly seen in middle aged women although all ages and both sexes may be affected. There is no race predilection. Gram-negative organisms are usually present and bilateral involvement has not been reported. The most common offending organism is Proteus mirabilis. Hepatic dysfunction is seen and appears to normalize with removal of the XGP process. Preoperative angiography may increase the accuracy of differentiating this disorder from hypernephroma and may aid the surgeon in planning his approach to kidney resection depending upon the staging of XGP. Chronic renal failure is not usually a feature of XGP and nephrectomy is curative without any incidence of recurrence.


[Device for time lapse studies on living cells in vitro (author's transl)].

Optical components of an inverted microscope have been utilized to set up a device for the observation of living cells under phase contrast conditions. Time lapse recording is performed either by use of a super-8 movie-camera or by a 1/2 inch video device. A special design provides a high focal stability. Standard plastic culture flasks can be used for high optical quality recordings. Both types of recording require low light intensities which results in a minimal light induced cell damaging.


An investigation of change in medical students' conceptualizations of psychiatric patients due to a short training course in psychiatry.

The paper describes an investigation of medical students' conceptualizations of different psychiatric patients categories, using the Katz-Braly stereotype measuring technique and the semantic differential technique. The conceptual content of sixteen fourth year medical students' stereotypes of psychiatric patient categories was elicited and their evaluations of the categories were measured. These measures were taken before and after a two-month training course in psychiatry and special attention was paid to changes that appeared to result from the educational process. The Katz-Braly stereotype measure produces a work picture of each patients category involving four traits; for instance for the category neurotic the following traits were derived: 'temperamental', 'hypochondriacal', 'worried' and 'tense'. The important triats for each category were analysed separately to determine if any statistically significant changes in the stereotype had occurred over the two-month training course. Several significant additions and omissions of traits were found. These changes may be explained as the result of teaching, the students' direct experience of psychiatric patients and their acquisition of a new technical vocabulary. Despite the changes in the students' stereotypes of patients, their evaluations of the patients, as measured by the semantic differential, remained substantially unaltered by the training course.