Surgical treatment of Ebstein's anomaly. Early and late results in seven consecutive cases.

The surgical treatment of Ebstein's anomaly is discussed on the basis of our experience with 7 patients who underwent operation at this clinic during the last ten years. The age of the patients (2 males, 5 females) ranged from 17 to 47 years (mean 27 years) at the time of operation. Two patients were in functional class II and five in classes III or IV (N.Y.H.A.). The Wolff-Parkinson-White syndrome was concomitant in 2/7 cases and patent foramen ovale or atrial septal defect (ASD) with right-to-left shunt was present in 6/7 cases. The valvular anomaly was typical in 5 patients and stenosis of displaced tricuspid leaflets into right ventricular outflow region was detected in two patients. Tricuspid valve replacement (TVR) with disc valve prosthesis was performed in 5 patients (Björk-Shiley model in 4 cases, Kay-Shiley model in one) and tricuspid valve commissurotomy in two patients. All six patients with interatrial communication underwent closure of this communication simultaneously. One patient had concomitant epicardial mapping and attempted division of the anomalous conduction pathways was unsuccessful. This patient died on the 14th postoperative day from ventricular fibrillation. No other early or late mortality was recorded. Life-long anticoagulation therapy was introduced in all 5 patients with TVR. Thrombotic malfunction of the prosthetic valves necessitated re-operation and new prosthetic valve replacement in two patients 15 and 16 months after the first TVR. One of these patients had recurrent prosthetic thrombosis twice which was successfully treated with streptokinase. The other patient's prosthesis is functioning well 18 months after re-operation. All 6 long-term survivors were improved and remained in good condition, in functional class I, 1, 3, 3, 8, 9, and 10 years, respectively, after operation.


Total anomalous pulmonary venous drainage.

Twelve patients with total anomalous pulmonary venous drainage (TAPVD) underwent complete surgical correction. Six were of the supracardiac type, 2 were cardiac and 4 of the infracardiac type. Pulmonary hypertension due to pulmonary vein obstruction was present in 6 patients. There were 6 early deaths, which occurred on the table or soon after surgery. One patient died 8 months after the operation because of a marked obstruction of the pulmonary venous inflow. Early diagnosis and operative correction in these severely ill patients should not be delayed. Postoperative intensive care and long-term follow-up are of the greatest importance.


Anomalous pulmonary venous drainage from the left lung to the right atrium. Successful surgical treatment in an 11-year-old girl.

An 11-year-old girl with anomalous pulmonary venous drainage from the left lung to the right atrium was corrected by anastomosing the anomalous trunk to the left auricular appendage. Postoperatively she developed a left-sided chylothorax which resolved on medical treatment. A postoperative angiocardiography one year after surgery showed a well-functioning anastomosis.


Our experience with the Carpentier-Edwards bioprosthesis.

Sixty Carpentier-Edwards porcine valve bioprostheses stabilized with glutaraldehyde were implanted in 55 patients with acquired and congenital heart disease. The follow-up period ranged between 1 and 12 months. There were 3 hospital deaths (5%) and 2 late deaths (4%) in 24 mitral, 24 aortic, 5 mitral-aortic, 1 tricuspid and 1 pulmonary valve replacements. All patients were anticoagulated from the second postoperative day onwards for a period of 3 months after which those with sinus rhythm had their anticoagulants withdrawn. Paravalvular leakage led to re-operation in 3 cases (4%). No valve failure due to cusp rupture was encountered and no thromboembolic complications have occurred. Thirty-three patients were studied postoperatively by non-invasive methods and the results are presented.


Fresh autologous blood in open-heart surgery. Influence on blood requirements, bleeding and platelet counts.

The role of fresh autologous blood on haemostasis was studied in 30 patients undergoing aortic valve replacement. All the patients were extremely haemodiluted during the perfusion by using a non-haemic priming solution and withdrawal of 15% of the blood volume at the start of operation. In half of the patients, the autologous blood was retransfused immediately after the termination of perfusion. In the other half, donor blood was given in this period, while the retransfusion of autologous blood was delayed until three hours postoperatively. An increase of circulating platelets was found after the withdrawal of blood and replacement with double the amount of Ringer's acetate. Significantly less donor blood and plasma was transfused in the patients receiving early transfusion of autologous blood. An average reduction of 36% donor blood and 45% plasma was obtained. The blood losses were also less in these patients, but the differences were not significant.


Myocardial protection during heart surgery. An experimental evaluation of normothermic and hypothermic cardioplegia.

Heart surgery with hypothermic cardioplegia during normothermic bypass is sometimes complicated by rewarming of the myocardium caused by collateral flow of arterial blood. This problem is particularly evident in surgery of congenital malformations. The present work is a comparative study in dogs on 3 methods of avoiding the rewarming problem. In the first group, the heart was kept cold and the warm blood was drained off from the left atrium. In the second group, total body hypothermia to the level desired was used and in the third group, normothermic cardioplegia was induced (Cardioplegin) in normothermic animals. In the two latter groups, the undesired temperature gradient between heart and body was eliminated. Evaluation of the differences was made by means of ventricular function determinations. Local, hypothermic cardioplegia showed the best postoperative function (69%) followed by the total body cooling which was fully acceptable (41%). Normothermic cardioplegia after the same duration of arrest showed a too low myocardial performance (20%).


Spontaneously thrombosing congenital crural arteriovenous fistulas. Report of a case.

A report of spontaneously thrombosing arteriovenous fistulas in the popliteal and crural region jeopardizing the peripheral circulation is presented. A favourable effect was achieved with a femoral-posterior tibial bypass utilising a great saphenous graft.


Results of surgical treatment of arterial embolism.

A report is given of the results obtained by surgical intervention in 260 patients with arterial embolism involving the extremities, in whom a total of 299 emboli devloped. Excellent results were obtained in 63.5% of the cases. It is emphasized that embolectomy is indicated in all cases, irrespective of the interval between onset of symptoms and surgery, unless gangrene of the limb is manifest. Furthermore, re-operation is is recommended on patients in whom fresh clots develop in the artery after an otherwise successful embolectomy. The mortality rate proved to be relatively high (28%) and the causes thereof are discussed.


Tissue gas tensions in the calf muscles of patients with lower limb arterial ischaemia.

O2 and CO2 tensions were measured in the gastrocnemius muscles of patients submitted for reconstructive arterial surgery due to obstructive arteriosclerosis (37) or abdominal aortic aneurysm (5). Four patients without signs of arterial ischaemia served as controls. Measurements were carried out by means of implanted silastic tonometers during breathing of air and 100% O2 and immediately after walking on a treadmill. Peripheral blood pressures in the ankles were recorded with a Doppler apparatus. Baseline tissue gas tensions showed no essential differences between the various groups of patients: intermittent claudication, pain at rest, praegangrene, abdominal aortic aneurysm and controls. In contrast, baseline ankle pressures correlated well with the severity of the disease. During breathing of oxygen, the smallest increases of muscle PO2 were observed in extremities with pain at rest or praegangrene and the highest responses were recorded in controls and aneurysm patients. Muscle PCO2 values showed no alterations during oxygen breathing. In physical exercise, muscle PO2 and PCO2 levels as well as ankle blood pressures remained unchanged in controls and patients with aneurysm but no claudication. However, in all groups with arterial ischaemia, the exercise test resulted in a profound fall of muscle PO2 and ankle blood pressure and an increase of muscle PCO2.


Current status of parietal pleurectomy in recurrent pneumothorax.

Parietal pleurectomy was devised as definitive treatment in a series of 50 patients with persistent or recurrent pneumothorax. There have been no significant complications; 3-5 year follow-up has shown no recurrence, indicating that pleurectomy is a safe and reliable procedure and preferred to chemically or mechanically induced pleuritis because it entails fewer complications and shortens hospitalization.


[Sociopharmacology--psychoactive drugs as an example].

Psychoactive drugs influence the social behavior of men and primates deeply. Many neuroleptics block the activity of social learning and therefore have an antitherapeutic effect. Sociopharmacology deals with drug effects which have no pharmacological basis: placebo effects, and physician and patient expectations from the drug which may lead to self-fulfillling prophecies. When the physician is prescribing psychoactive drugs he is under numerous influences: the expectations of the patient; the pressure of his therapeutic helplessness in view of many odd illnesses which cannot be explained somatically; his professional obligation to treat the patient; and marketing. The importance of a trusting doctor-patient relationship as a pre-requisite for successful treatment with psychoactive drugs is discussed.


[Recurring loss of conciousness with middle brain symptoms in migraine].

A 49-year-old woman subject to frequent migraine attacks since childhood was seen for repeated episodes of confusion followed by loss of consciousness lasting for several hours. EEG during the acute stages showed marked slowing with bifrontal monorhythmic delta waves. After each episode, both the clinical and EEG findings subsided within hours. A similar course is described in a man who died at the age of 69 after preterminal mental deterioration. Autopsy showed evidence of bilateral damage to the hippocampal regions, apparently due to frequent impairment of perfusion in the last years of life. Atherosclerotic changes were within the normal range for his age. In both cases, the ischemic episodes are interpreted as consequences of constriction of the basilar artery, and it is assumed that the underlying mechanism is at least akin to that of migraine.


[Thorascopy as a diagnostic and therapeutic precaution in lung and pleural diseases].

Thoracoscopy is a method involving little discomfort for the patient but of high diagnostic effectiveness for pleural alterations. A histological diagnosis was established in 56 cases out of a total of 60 pleural effusions of unknown origin. In 10 pleural or pleuropulmonary diseases, anatomical classification was possible in all cases. In cases of pneumothorax (21 patients) the bronchopleural fistula could very often be seen and closure by detaching of pleural adhesions or cauterization was possible. These manipulations are usually followed by insufflation of sterile talcum powder through the thoracoscope. Suspicion of ruptured diaphragm due to accident was easily and quickly verified. No complications occurred in our 100 thoracoscopic examinations.


[Physicians: how might patients see you and how do we see ourselves? A questionnaire concerning the physician-patient relationship].

Patients and doctors in specialized surgical, medical and gynecological clinics in the Zurich area replied to the Giessen test and a questionnaire on their attitude towards work. The results suggest that the traditional idea of the doctor-patient relationship as propagated by medical sociology (e.g. PARSONS) seems rather to correspond to patients' stereotyped (projective) ideals, but positively not to the realistic self-assessment of doctors. Doctors do not depict themselves as being as socially esteemed, self-satisfied and self-assured about their skills as patients would like them to do.


[Cimetidine versus antacids].

The rationale of ulcer therapy with cimetidine or antacids is to block or neutralize gastric acid secretion intragastrically. 5 tablets of cimetidine can inhibit gastric acid secretion in duodenal ulcer patients by more than 50% over a 24-hour period. Approximately 250 ml per day of a highly active antacid is necessary to achieve a similar effect. The effect of cimetidine on night secretion is superior. In acute ulcer attack cimetidine brings about healing of the ulcer in duodenal ulcer disease in about 80% of all patients in about 4-6 weeks, and a maintenance dose of 200 mg in the evening may prevent a recurrence within a year in about 50% of all patients. According to American studies, antacid therapy in the above-mentioned dosage may achieve a similar healing rate in duodenal ulcer patients in acute attack. However, it is unknown whether high antacid therapy prevents ulcer recurrences. If acceptability of the treatment by the patient, side effects and costs are taken into account, cimetidine appears to be superior to high doses of antacid. However, it must be considered that in many European countries, including Switzerland, the spontaneous healing rate is up to 60% in placebo studies. It is thus legitimate to continue treating uncomplicated ulcers with the small antacid doses customary in Europe.


[Generalized periarticular calcinosis. Generalized hydroxylapatite disease].

The complex of symptoms know as generalized periarticular calcinosis is a disease observed clinically as occurring in periods lasting only a few days, and with a mainly monoarticular arthritic or tenosynovitis character which may be localized in various joints. A primary chronic course of the disease is rare. Crucial for the diagnosis is the demonstration of multiple periarticular calcifications, which can be identified biochemically as hydroxyapatite. The calcification probably initiates the burst of inflammation, and for this reason the symptoms can be certainly classified pathogenically as a crystalline synovitis. Etiologically, the disease is probably due to both genetic and acquired metabolic anomalies. Modification of calcification cannot be undertaken in our present ignorance of the exact pathogenesis, and for this reason the therapy of generalized periarthritis must remain symptomatic. The effect of non-steroid antiphlogistics, corticosteroids and colchicin is, however, unsatisfactory.


[Isoelectric electroencephalography approximately 6 hours after ventricular fibrillation due to myocardial infarct. Apropos of a case with favorable development].

A 59-year-old patient was resuscitated after ventricular fibrillation due to anterior myocardial infarction. Ventilatory and cardiac arrest lasted for more than 20 minutes. 5 h 50 min later the EEG was isoelectric. The evolution was nevertheless favourable and the patient was able to leave hospital one month later and to resume work half-time 5 months later. The problems of anoxic ischemic encephalopathies, isoelectric EEG and their treatment are discussed.


The surgical treatment of duodenal ulcer.

Based on experience of a pilot series of 100 patients treated by parietal cell vagotomy (PCV) and a prospective clinical comparison between PCV (in some cases with drainage added) and selective gastric vagotomy (SGV) with drainage (D) or antrectomy (A) in some 900 patients, the following conclusions can be drawn: PCV is followed by virtually no sequelae. When drainage is added this is no longer the case and the results are the same as those following SGV + D. PCV and SGV + D show the same recurrence rate at 3 years (approx. 7%). Men do better than women after PCV but not after SGV + D. Preoperative gastric acid secretion had no predictive value in these studies. In non-obstructing duodenal ulcer the surgical choice appears to be between PCV (no sequelae) and SGV + A (no recurrence). The optimal operation for prepyloric ulcer cannot as yet be determined.


[Dosage dependence of the effect of somatostatin on human splanchnic blood flow].

The effect of three different doses of somatostatin on splanchnic blood flow (SBF) and on arterial plasma insulin, glucagon and glucose was determined. 125, 250 and 500 microgram/h of somatostatin was infused during 60 minutes in 3 groups of 6 patients undergoing arterial-hepatic-venous catheterization; no patient had clinical evidence of metabolitic or hepatic disease. Continuous infusion of 125 microgram/h somatostatin was without significant effect on SBF, whereas 250 microgram/h resulted in a mean 28% reduction of SBF (p less than 0.05). Doubling the dose to 500 microgram/h affected SBF similarly (21% reduction of SBF). In contrast, administration of all three doses of somatostatin suppressed the circulating insulin and glucagon levels significantly. In a recent report somatostatin had been administered in a dose of 250 microgram/h to control gastric ulcer hemorrhage. The present studies demonstrate that this dose results in a significant reduction of SBF which cannot be further depressed by increasing the dose.


[Caerulein and the test meal: a comparison of their effects on pancreatic exocrine secretion in the dog].

Relatively small doses of caerulein (10, 20, 40, 100 ng/kg/h) were given to conscious dogs with chronic duodenal and gastric fistulas and the exocrine pancreatic response was compared with that obtained by a test meal. Test meal stimulated pancreatic secretion was nearly equivalent to that achieved with 10 ng caerulein/kg/h. Plasma secretin levels did not significantly change during test meal stimulation.


[Fractional distribution of anti-glucagon immunoreactivity (GIR) and amino acid concentration in the plasma in duodenopancreatectomized patients; preliminary report].

Glucagon immunoreactivity (IRG) was measured in plasma of 8 duodenopancreatectomized patients with antiserum 30-K. Arginine infusions failed to raise plasma IRG, whereas in control subjects IRG rose 3-fold. Column chromatography revealed that the basal IRG measured in these plasmas was not due to glucagon (molecular weight 3485) but to other plasma factors, mainly of high molecular weight. This suggests that diabetes mellitus does not require the presence of glucagon to produce the clinical picture, as suggested by other authors. Plasma levels of the amino acids alanine, serine, ornithine, and arginine were significantly (p less than 0.05) elevated, the former two being gluconeogenic substrates and the latter two constituents of the urea cycle. This amino acid abnormality may be a consequence of glucagon deficiency.


[Angiodysplasia of the colon: diagnosis and therapy].

Angiodysplasias of the colon are rare causes of intestinal bleeding. Diagnosis is by angiography or colonoscopy. In 6 patients with severe anemia in whom conventional methods had failed to reveal the source of bleeding, colonoscopy demonstrated angiodysplasias in the cecum or ascending colon. They were treated endoscopically. In a follow-up period of 3 months to 4 years only 1 patient has sometimes suffered occult fecal blood loss, but is adequately treated by oral iron therapy. No patient has had a severe recurrence of bleeding, nor was colonic resection necessary. It is concluded that endoscopic therapy of angiodysplasias is a valuable alternative to surgery with low risk and high efficiency.


[Nonspecific ulcer of the colon: a report on 12 endoscopically diagnosed cases].

Report on 12 patients with nonspecific ulcers of the colon diagnosed by colonscopy and biopsy. In 10 patients the course was favorable with conservative management. In 2 patients the symptoms were aggravated; in both patients this was due to a penetrating malignant tumour diagnosed at laparotomy a few weeks later. It is proposed that nonspecific ulcers of the colon should be managed conservatively. Further investigations and laparotomy are indicated only when symptoms progress.


[Prospective study of digestive tumor detection by endoscopy: a comparison of brush cytology and histology].

The diagnostic accuracy of endoscopic appearance, histology and brush cytology has been compared in a prospective study of 192 cases involving esogastric lesions. Macroscopic diagnosis of malignancy was more frequent in benign lesions (23/145) than in true malignancies (21/42). Histology was positive in 29/36 tumors and cytology in 23/36. In cytology there were no false negatives in esophageal tumors, but there were 52% false negatives in gastric tumors and 66% in carcinoma in situ. The combination of the 2 methods resulted in a correct diagnosis in 86% of the tumors in this study.


[Modification of gastric emptying after a selective proximal vagotomy. Barium and isotope studies].

The study of gastric emptying by isotopic and barium feeding, in 43 patients, before and 6 months after highly selective vagotomy, showed no retention after this type of operation. Whereas during the first 45 minutes following ingestion of the test meal, there was no modification of emptying, a significant acceleration thereafter was demonstrated by both methods. The isotopic meal allows continuous study of gastric emptying which appears to be more regular after the operation. There was no difference in gastric emptying between patients suffering from post-prandial gastric fullness, mild diarrhea or dumping syndrome.


[Echographic diagnosis of cholelithiasis].

Ultrasonography of the gallbladder is a simple diagnostic tool in a clinical situation suggesting the presence of gallstones. The radiologic-surgical survey of our one hundred most recent cases reveals no false-positives and only very few false-negatives. These results are discussed.


[Sonography and retrograde endoscopic cholangiopancreatography in unclear upper abdominal complaints].

Real-time scanning is of great importance as a screening method for the examination of parenchymal organs in the pigastrium and allows rapid evaluation and exact diagnosis of lesions in the biliary duct system and the pancreas. Sonographic findings are expanded by endoscopic cholangiopancreatography (ERCP). The two methods are complementary tools.


[Primary malignant lymphoma of the stomach. Analysis of 38 cases].

A retrospective analysis is presented of 38 cases of malignant lymphomas of the stomach, 20 of the reticulum cell type, 6 lymphoblastic, 6 lymphocytic and 4 mixed forms. Two patients had a primary Hodgkin's malignant lymphogranuloma. A follow-up was obtained for 35 patients. There proved to be no significant difference between the symptomatology of carcinoma and lymphoma of the stomach. In patients with lymphomas only signs of stenosis were missing, although the majority of the tumors were located in the antrum. As a consequence of the extreme tendency of the lymphomas to exulcerate (89%), the mean duration of symptoms of 21/2 months (patient's delay) is shorter than that for carcinomas. Malignant lymphomas of the stomach are very difficult to identify as such by radiology and endoscopy, because of their uncharacteristic macroscopic appearance. The best diagnostic method has proved to be endoscopic wire-loop biopsy, which serves to obtain adequate material for histology. An unexpected finding was that at the time of operation half of the patients had clinical stage I E. This indicates that lymphomas remain limited to the stomach longer than carcinomas do. The prognosis depends on both histological type and clinical stage. It is somewhat better than that of nodal malignant lymphomas. The 5-year survival rate of all cases with malignant lymphoma of the stomach is 31%.


[Effect of the sun on circulating 25-hydroxycalciferol levels in normal subjects in Switzerland].

The principal source of human natural vitamin D is cholecalciferol produced in skin by the action of ultraviolet light. Plasma levels of 25-hydroxyvitamin D (25-OH-D), the hepatic metabolite of cholecalciferol, increased by 39.3% in 20 healthy young Swiss subjects after a 3-week holiday in the sun. Significant increases of circulating 25-OH-D (p smaller than 0.001) were found as much as 2 months later when compared with a group not deliberately exposed to sunshine. A short vacation in the sun therefore appears to be beneficial in replenishing vitamin D body stores.


[Normal values for vital capacity and forced expiratory capacity of the lungs in old age].

In 545 healthy men aged 71-90 years and 160 women aged 71-85 years, vital capacity and FEV1.0 in the standing position were measured using a closed spirometer system. Analysis of the results from different groups based on age and body size makes it possible to extend an already existing nomogram for prediction of normal values for vital capacity up to 90 years in men and up to 80 years in women. There is no linear relationship between age and vital capacity in men and women aged 20-90 years. The average FEV1.0 is more than 70% of the effective vital capacity in men and women aged 71-90 and 71-85 years respectively. A reduction of more than 20% in vital capacity, and a FEV1.0 below 65% of the actual vital capacity, is to be considered pathological in men and women of any age.


[Prognostic factors of survival and tumor recurrence following surgery and radiotherapy for breast cancer with positive axillary nodes. La Chaux-de-Fonds, 1968-1975].

Survival and treatment failure are analyzed in a homogeneous group of 70 pre- or post-menopausal patients with operable breast cancer and histologically involved axillary nodes. From March 1968 to December 1975, all patients underwent simple or radical mastectomy, followed by radiotherapy in 67. The period of observation varied from 11 months to 10 years. Treatment failures were observed on 34 patients: 10 loco-regional relapses, 21 distant metastatizations, and 3 tumors in the other breast. Analysis of actuarial survival curves shows a statistically significant difference between patients with 1 to 3 positive axillary nodes and patients with 4 or more, but no difference with regard to the volume of the tumor and the patient's age. Comparison of disease-free period curves shows statistically significant differences between patients aged below and over 55 years, tumor of less or more than 2 cm, and 4 or fewer axillary nodes. These results are comparable to those in the literature and form a contribution to a Swiss study of post-operative adjuvant chemotherapy in breast cancer with positive axillary nodes.


[South American blastomycosis (paracoccidioidomycosis) in Switzerland. Clinical course and morphological findings in a case following long-term therapy].

The clinical course and morphological findings are reported of visceral paracoccidioidomycosis or South American blastomycosis with lung involvement in a 47-year-old male after specific antimycotic treatment for 11 years. The patient had been infected during a stay in São Paulo, Brazil, from 1950 to 1954. The diagnosis was established in 1959 after his return to St. Gall, Switzerland, in tissue from buccal mucosa and cervical lymph node biopsy and in fungus cultures. The patient was treated with Fungizone (amphotericin B) and with the sulfonamide Fanasil. He died in 1970 from acute right heart failure. Autopsy revealed multiple encapsulated mycotic foci in both lungs, together with healed foci and pulmonary fibrosis. Histological examination showed a large amount of Paracoccidioides brasiliensis in the mycotic foci, but cultural proof was no longer possible. In the buccal mucosa and lymph nodes, only fungus-free scars were observed. There are only a few effective antimycotic agents. With a thorough knowledge of their side effects and dosage modalities, it is possible to achieve highly satisfactory results.


[Essential bone cyst and its therapy].

Twenty-nine cases of unicameral bone cyst treated surgically are reported. The literature is reviewed and different methods of treatment are discussed. Important factors contributory to the risk of recurrence are identified and stressed.


[Pulmonary Actinomyces-viscosus infection].

The isolation of Actinomyces viscosus from the pleural fluid of a patient with pleuro-pneumonia and empyema is described. This is believed to be the first human Actinomyces viscosus infection in Switzerland.


[The primary ovarian carcinoid. Case report].

A rare primary carcinoid tumor of the ovary, found incidentally in a 68-year-old woman, is reported. There had been no symptoms of carcinoid syndrome. Grossly, the unilateral tumor was cystic, measuring 13 cm in greatest diameter. Microscopically it consisted mainly of solid epithelial cords. The demonstration of argentaffin cells and the absence of a concomitant teratoma, dermoid or pseudomucinous cyst led to the diagnosis of a pure primary ovarian carcinoid tumor. On average the prognosis of such lesions is good and recurrence or fatal metastases are rare. Treatment consists of salpingo-oophorectomy. To rule out a metastasizing carcinoid with similar histologic features, the contralateral ovary should be biopsied since metastases almost invariably occur bilaterally.


[The hand in diabetes. Study of 97 diabetics compared to a control group].

To determine whether there is hand involvement specific to diabetes, 97 diabetics were compared with the same number of matched controls. Hands were examined with particular emphasis on skin, intrinsic muscles, articular mobility, sense of touch and vibration, digital systolic pressure, and radiological analysis of bones and joints. The most significant involvement, clearly present in 7 cases and less specifically in 12 other diabetics, included all of the following: atrophy and weakness of intrinsic muscles, painful interphalangeal rigidity limiting extension or flexion of the fingers, periarticular swelling of the phalanges, and trophic changes of the skin. Separately, these changes are not specific to diabetes: in the control group, although less frequent, they were found in patients aged 60 and over and are considered to be signs of senescence. Diabetes apparently accelerates the process of aging. Diabetic changes in the hand appear to be facilitated by neuropathy but not by arterial involvement. X-ray revealed a higher incidence of osteopenia and above all of vascular calcifications in the diabetic.


[Risk factors for heavy cigarette smoking in young men: a longitudinal study].

In a three-year follow-up on 841 males questioned at the age of 19 and 22 years, an attempt has been made to determine the characteristics of social situation and personality which are correlated with constant heavy cigarette consumption, and what other risk factors are also involved. Bivariate analyses, multiple regression, and path analysis revealed the following influencing factors: personality traits such as nervousness and extraversion, low social integration, low assessment of the subject's own health situation, loose ties with parents, lower school level, increased alcohol and cannabis consumption. No correlation was found with religion, social status of parents, masculinity, blood group or rhesus factor.


[The physiology of sleep and the physiopathology of insomnia].

After a review of the semiology and organization of normal sleep, the neuronal structures presently accepted as participating in sleep mechanisms are discussed. During a series of experiments designed to define the physiopathological role of slow wave sleep in chronic insomnia, we recorded in our laboratory normal subjects of both sexes and insomniacs whose predominant disorders was sleep maintenance. Sleep modifications as a function of aging chiefly involve stage 4, which is reduced by about one half between the ages of 19 and 30. Analyzing a large group of normal and insomniac subjects, it is possible to show a statistical association between very low values of slow wave sleep and short and fragile total sleep. This association cannot be explained simply by an increase in waking pressure. Comparison of a group of 16 insomniacs with 16 age and sex matched normal subjects shows in the insominacs a deficiency of production of slow wave sleep (stages 3 and 4), most probably linked to a disturbed waking/sleep balance, whereas the other parameters of sleep, especially paradoxical stage, remain unmodified. These results are consistent with the hypothesis of a physiopathological role of slow wave sleep deficiency in chronic primary insomnia; on the other hand, slow wave sleep may possibly be responsible for sleep induction and maintenance, playing the role of a physiological hypnogenic mechanism.


[Prognosis of intensively treated newborns: psychomotor development during the first years of life].

330 out of 616 surviving newborns treated in the neonatal ICU of Berne University Children's Hospital from 1.1 1974 to 31.12. 1976 were considered, on the basis of strict criteria, to be especially at risk for the development of abnormal cerebromotor symptoms, 287 were followed up. At age 3--42 (mean 15) months, 10% of these especially endangered children showed clear-cut, and 24% slightly abnormal, symptoms. If related to the total number of surviving patients, all of whom were either ill or at risk for disturbed neonatal adaptation, this corresponds to 5 and 11% respectively. Based on this population, an approximate incidence of cerebral palsy of 5% at age 15 months can be calculated for the whole pediatric population. This value is comparable to the 2% actually found in the total pediatric population. Furthermore, a statistically significant decrease in abnormal symptoms with increasing postnatal age was found. Newborns with convulsions, however, do not have this favourable prognosis.


[Evaluation of a new commercial latex test for the study of rheumatoid factors].

A new commercial test of IgG-sensitized latex particle agglutination is compared with a long-established latex test for detection and titration of rheumatoid factors. The comparison was conducted on samples from three groups of patients: 125 with seropositive rheumatoid arthritis (RA), 115 seropositive samples from patients with various diseases except RA, and 100 seronegative samples with varying diagnosis including RA. The new test is very simple to perform. Its sensitivity, however, was lower than that of the Rheins test by about 2.5 dilutions. Its specificity as to the diagnosis of RA was significantly better than that of the Rheins test.


[Inquiry of the Swiss Cardiology Society on long-term pacemakers in Switzerland in 1976 and 1977].

The Swiss Society of Cardiology has conducted a national inquiry into the state of pacing in Switzerland for the years 1976 and 1977. With a total of 1250 pacemakers implanted each year and a rate of first implantation of 146 per year and per million inhabitants, this study illustrates the methods of Swiss cardiologists and the problems which they meet in the field. It is generally agreed, as in other countries, that stimulation of the right ventricle by endocavitary approach with demand pacemakers generated by lithium batteries appears to be excellent for the moment. Pacemakers which can be programmed were not in widespread use during the period of this study. The incidence of various complications is considered.


[Correlations between hemodynamic measures and respiratory functions in patients with chronic obstructive lung syndromes].

Fourteen patients with chronic obstructive pulmonary disease underwent right catheterization with a Swan-Ganz catheter to correlate lung function with hemodynamic features at rest and on exercise. There appears to be a good correlation between some pulmonary function tests (FEV1, RV/TLC, PaO2 at rest and on exercise) and mean pulmonary artery pressure at rest and on exercise in these patients.


[The combination mass radiography--blood pressure measurement. Experiences and results in the Canton Bern].

The combination of mass radiophotography and blood pressure measurement was started in the Canton Berne (population approx. 1 million) in 1974. Experience with this method has been highly satisfactory: An average of 80% of personnel attented mass radiophotography on a voluntary basis and 97--i00% participated in the blood pressure measurement. The costs were low because a well-established service could be utilized. In this way, it has been possible to examine 90,000 persons within three years, or 45% of the population (age 30 to 65 years). The results for 1977 were analyzed using a general computer program. A total of 17,112 persons aged 30 years and more and belonging to the working population were examined: 14.6% of the screened population had hypertension of greater than or equal to 160 and/or greater than or equal to 95 mm Hg. Diastolic pressure was found to be greater than or equal to 100 mm Hg in 5.9% and greater than or equal to 110 mm Hg in 1.8%. 54.8% of the detected hypertensions were unknown to the examined persons and 17.8% were under treatment. Correlations with other findings, such as pathologic images of the heart in the X-ray and smoking, have been investigated. An interesting fact was the remarkable difference in the percentage of hypertension between population groups (10.7--20.7%) and occupations such as industry, trades and public utilities (3.0--29.8%). It has been shown that screening for hypertension is not only a propaganda move. A large number of undetected hypertensive subjects can be passed on for treatment.


[Hormone-producing thyroid carcinoma with hyperthyroidism. Analysis of 6 cases and review of the literature].

Report on 6 female patients with follicular thyroid carcinoma producing hyperthyroidism. Two of them had large metastases with hormone production, while 4 mimicked an autonomously functioning thyroid adenoma. Hormone synthesis was investigated in the tumor tissue of one patient and was found to be similar to that of normal thyroid tissue.


[Determination of the IgE serum level: RIST or PRIST? Results of a ring test in Switzerland].

Serum IgE concentrations, determined by two commercial kits (Phadebas RIST and PRIST) in 93 adult controls resulted in a geometrical mean value of 47 (RIST) and 35 U/ml (PRIST) respectively within a + 2 SD value of 195 and 331 U/ml respectively. The difference between the separated random samples is statistically significant (t = 3.79; p less than 1%), but the correlation is still fairly satisfactory (r = 0.79). In the lower regions the IgE values with RIST are as a rule a little higher than with the PRIST method. Surprisingly, one patient showed an extremely low IgE value (7 U/ml) with PRIST, but a considerably higher one (530 U/ml) with RIST. Such marked differences are found occasionally in the literature: heterophile antibodies against bovine gammaglobulin are regarded as responsible for the interference in the Sephadex system of RIST. As the reproducibility of the IgE determinations with the PRIST method is excellent (the correlation coefficient for two PRIST determinations was r = 0.93), and as PRIST allows much lower IgE estimates, this procedure should be given preference, particularly in pediatric patients. On the other hand, RIST must be used for the determination of extremely high values, as for instance in patients with severe atopic dermatitis or with parasitic infestations. In fact they can no longer be exactly evaluated by PRIST. Quality control of IgE serum determinations among twelve randomly chosen laboratories in Switzerland in 5 patients was satisfactory, with one exception. In the case of extremely high values, however, only a few laboratories try to determine the exact value. Indications of more than 500 U/ml were considered sufficient, with actual values amounting to 12,500 U/ml. It is also advisable to standardize the serum dilutions, the use of reference serum and the price. Finally, the indications for IgE determination are discussed. It is considered to have an important bearing on the differential diagnosis and prognosis of atopic diseases in infants and children.


Studies on purification of oestrogen-induced protein from rat uterus and its physiological role in cultured cells.

This paper presents evidence to show the presence of an oestrogen-induced protein (IP) from rat uterus which is able to stimulate the incorporation of 3H-thymidine into DNA of 3T6 fibroblasts in vitro. The purified uterine protein fraction has been shown th contain less than 10 detectable proteins. The molecular weight of IP band is about 50,000 Daltons with an iso-electric point of 4.5. Comparison of oestrogen-treated and -untreated uterine cytosols on SDS-acrylamide gel electrophoresis indicates that the IP band is also present in the untreated controls. It is therefore suggested that the oestrogen-induced protein may be analogous or identical to the growth-promoting protein synthesized by LX cells.


Chemical evidence for production of hydroxyl radicals during microsomal electron transfer.

Rat liver microsomes generate methane from dimethyl sulfoxide and ethylene from either methional or 2-keto-4-thiomethylbutyric acid during electron transfer initiated by reduced nicotinamide-adenine dinucleotide phosphate (NADPH). Hydrocarbon gas production is suppressed by hydroxyl radical scavenging agents. Azide, an inhibitor of catalase, augments the production of hydrocarbon gases. These observations constitute chemical evidence for the generation of hydroxyl radicals by microsomes.


Vitamin D deficiency and reproduction in rats.

Female weanling rats from a colony maintained on a diet low in vitamin D were raised on a diet that was deficient in vitamin D but was otherwise adequate. Vitamin D deficiency was confirmed in the rats by hypocalcemia and the absence of vitamin D metabolites in blood. These females gave birth to litters that were slightly smaller than control litters from females maintained on a vitamin D-containing diet. The pups from the vitamin D-deficient mothers appeared normal throughout lactation, and at weaning had normal concentrations of calcium and phosphate in the plasma. These results indicate that vitamin D and its metabolites are not necessary for reproduction and fetal development in the rat.


Discrimination learning without short-term memory: dissociation of memory processes in pigeons.

Pigeons were trained to perform delayed matching to samples of food and no food when each sample concurrently served as the outcome of a discrimination learning trial which immediately preceded each matching trial. Ambient light presented during the delays after the samples of food or no food severely disrupted matching but had no effect on the rate of discrimination learning.


The psychophysical function: harmonizing Fechner and Stevens.

The methods of Fechner and Stevens for assessing sensation quantity usually yield different psychophysical functions even when all other factors are controlled. In this experiment, corresponding differences occurred when different features of the same sensory receptor signals were analyzed. In the visual system, the receptor potential saturated if the peak but not the area was measured; these results match visual psychophysical functions obtained with the methods of Fechner and Stevens, respectively. This result suggests that both methods are equally valid but that each method yields the particular psychophysical function appropriate for a particular kind of information processing. A novel factor in determining sensation quantity, namely the time used by the observer to make a judgment, is implicated by the data.


Tight junctions in a fluid-transporting epithelium of an insect.

Occluding junctions have been found between the lateral cell borders at the base of the rectum of Periplaneta americana. They appear as punctate membrane appositions in thin sections, and after incubation in physiological solutions containing lanthanum before fixation the inward penetration of tracer is impeded in this same basal area. Moreover, freeze-fracture studies of this region reveal simple linear ridges on fracture face P and grooves on fracture face E, which are similar to the less complex vertebrate tight junctions. The luminal clefts, which permit free inward diffusion of tracers, present no tight junctions, but do have septate junctions. These results support the contention that, contrary to earlier speculation, arthropods do possess tight junctions; these, rather than septate junctions, appear to form the morphological basis of at least some of the permeability barriers observed in invertebrates.


Watching fat digestion.

During fat digestion a number of physicochemical events can be seen directly by light microscopy. Under simulated physiological conditions, hydrolysis of emulsified fat droplets by human pancreatic lipase in the presence of colipase and bile salt micelles proceeds with the sequential formation of two visible product phases. A lamellar liquid crystalline or crystalline phase containing calcium and ionized fatty acid forms first; this is followed by the production of a "viscous isotropic" phase composed predominantly of monoglycerides and protonated fatty acids.


Dexamethasone stimulation of metallothionein synthesis in HeLa cell cultures.

HeLa cells in culture synthesize metallothionein. To investigate the effects of glucocorticoids on metallothionein synthesis we adapted HeLa cells to growth in a defined medium lacking hydrocortisone. In this defined medium, containing 1.5 x 10(-6)M Zn2+, dexamethasone (10(-6)M) caused a five- to sixfold increase in the synthesis of metallothionein. Progesterone (10(-5)M), a known antagonist of glucocorticoids, inhibited this response by 50 percent.


Melatonin synthesis by the retina.

Melatonin fulfills many of the criteria for classification as a hormone. Until recently it was considered to be elaborated exclusively by pineal organs. Melatonin synthesis by other tissues has been indicated but not demonstrated unequivocally. Trout retinas in a whole-organ culture system in vitro synthesized tritiated melatonin from a substrate containing tritiated serotonin. This raises the possibility that the trout retina is an endocrine organ.


Liposomes and local hyperthermia: selective delivery of methotrexate to heated tumors.

Liposomes with phase transitions a few degrees above physiological temperature delivered more than four times as much methotrexate to murine tumors heated to 42 degrees C as to unheated control tumors. Most of the accumulated drug appeared to be intracellular and bound to dihydrofolate reductase, the enzyme blocked by methotrexate in its role as an antineoplastic agent.


Induction of copulatory behavior in sexually inactive rats by naloxine.

The intraventricular injection of D-alanine-methionine-enkephalinamide (D-Ala2-Met-enkephalinamide), a synthetic analog of Met-enkephalin that is resistant to enzymatic degradation, inhibits copulatory behavior in sexually vigorous male rats in doses which do not influence motor activity or feeding behavior. This effect is prevented by naloxone, a specific inhibitor of opioid receptors. In addition, injections of naloxone induce copulatory behavior in sexually inactive male rats. These results suggest that endorphins play an important role in the regulation of sexual behavior.


Rank order of sarcoma susceptibility among mouse strains reverses with low concentrations of carcinogen.

Ten mouse strains in which aryl hydrocarbon hydroxylase can be induced, or F1 hybrids of these strains, were ranked according to their sarcoma susceptibility when exposed to a high concentration (5 percent) of the chemical carcinogen 3-methylcholanthrene. This rank order was reversed when the concentration of 3-methylcholanthrene was reduced to 0.05 percent.


Anomalous amide I infrared absorption of purple membrane.

Infrared absorption of purple membrane reveals an amide I frequency that falls outside the range normally found for alpha helices. This may indicate along with x-ray diffraction the existence of bacteriorhodopsin alpha helices with unusual structure.


Distribution of RNA transcripts from structural and intervening sequences of the ovalbumin gene.

A study was made of the function of the intervening sequences in the ovalbumin gene, Radioactively labeled DNA probes for the intervening sequences were prepared and RNA's were isolated from whole cells, nuclei, and polysomes of estrogen-stimulated chick oviducts. The concentrations of messenger RNA (mRNA) transcripts from ovalbumin structural sequences (mRNAov) and transcripts corresponding to intervening sequences were then estimated by hybridization to cloned DNA probes. Oviduct tissue contains approximately 58,000 molecules of mRNAov sequences per tubular gland cell and most of these sequences are present in the cytoplasm. In contrast, there are 200 to 300 molecules of RNA per cell which are transcribed from the intervening sequences of the natural ovalbumin gene and almost all of these are found in the nucleus. The difference in distribution of structural and intervening sequence transcripts suggests that, unlike mature mRNA, the intervening sequences are not preferentially transported to cytoplasmic polysomes.


Siamese cat: altered connections of visual cortex.

In siamese cats, each side of the brain receives a retinal input serving part of the ipsilateral visual field as well as the normal contralateral field representation. Both corticothalamic and cortico-cortical projections are systematically rearranged, but while one is retinotopically appropriate, the other fails to make a distinction between ipsilateral and contralateral fields. Different rules appear to govern the development of these two sets of connections.


Iron deficiency prevents liver toxicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin.

The compound 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) causes hepatocellular damage and porphyria in C57B1/6J mice, among a wide range of toxic effects. We compared the effect of TCDD toxicity in iron-deficient mice with that in mice receiving a normal diet. Porphyria did not develop in the iron-deficient animals, and these animals were also protected from hepatocellular damage and certain other toxic effects of TCDD.


Cement line motion in bone.

Compact bovine bone subjected to constant torsional load for long periods of time exhibits large anelastic effects. Displacements occur at the cement lines and are responsible for part or all of the long-term deformation. The absence of an asymptotic creep strain is consistent with an interpretation of the cement line as a viscous interface.


Chicken gizzard: relation between calcium-activated phosphorylation and contraction.

Of the proteins in mechanically disrupted chicken gizzard fibers (no functional sarcolemma) only the 20,000-dalton light chains of myosin underwent large Ca2+-and Sr2+-dependent changes in phosphorylation. Phosphorylation closely corresponded with the Ca2+- and Sr2+-activated tensions. Adenosine 5'-O (3'-thiotriphosphate) only in the presence of Ca2+ induced irreversible Ca2+-insensitive activation of tension and thiophosphorylation of the 20,000-dalton light chains, and blocked incorporation of 32P from [gamma-32P]adenosine triphosphate into the myosin light chains.


Smoking impairs long-term dust clearance from the lung.

The time for the long-term clearance of dust from human lungs was measured. Three heavy cigarette smokers and nine nonsmokers inhaled a harmless trace amount of magnetic dust, Fe3O4. From periodic measurements with a sensitive magnetic detector of the amount of this dust remaining in the lungs, a clearance curve was determined for each subject. This magnetic tracer method allows clearance to be safely followed for a much longer time than with radioactive tracer methods. The dust clearance in the smokers is considerably slower than in the nonsmokers. After about a year, 50 percent of the dust originally deposited remained in the lungs of the smokers whereas only 10 percent remained in the lungs of the nonsmokers. The smokers therefore retained five times more dust than the nonsmokers. This impaired clearance of Fe3O4 suggests impaired clearance in smokers of other dusts, such as toxic occupational and urban dusts. The higher retention of these dusts may contribute to the higher incidence of lung diseases in smokers.


Embryonic rodent brain contains estrogen receptors.

Estradiol-binding proteins with the properties of putative estrogen receptors are present in cytosol extracts of embryonic mouse hypothalamus and other brain regions. These embryonic estrogen receptors are adultlike in their high affinity and limited capacity for estradiol, sensitivity to diethylstilbestrol, ability to adhere to DNA, and behavior during DNA-cellulose affinity chromatography. As early as 4 days before birth, mouse hypothalamus has approximately 40 percent of the adult concentration of hypothalamic estrogen receptors with these properties. These observations raise the possibility that embryonic rodent brain has the biochemical potential to respond to sex hormones and that the critical period of brain sexual differentiation could be initiated prenatally.


Teleostean urophysis: urotensin II and ion transport across the isolated skin of a marine teleost.

The caudal neurosecretory peptide urotensin II rapidly inhibits by 30 percent the short-circuit current across the isolated skin of a marine teleost. The effect appears to be specific and cannot be attributed to actions of epinephrine, urotensin I, or arginine vasotocin. The results strongly suggest that urotensin II may act directly on ion-transporting cells involved in teleostean hypoosmoregulation.


Intraretinal distribution of cone pigments in certain teleost fishes.

Microspectrophotometric investigations of visual pigments in the teleost family Cichlidae determined that morphological "twin cones" need not be "pigment twins" as well. In each species there were two pigments that could be found in these cells; a "longwave" and a "shortwave" type whose precise spectral location varies for each species, making the terms red and green inadequate to describe them. Studies of the receptor mosaic with the nitro-blue tetrazolium chloride reduction technique permitted the sampling of larger receptor populations and confirmed that twin cones in several cichlid species could be either longwave-longwave, longwave-shortwave, or shortwave-shortwave pairs, and that the relative proportions of these twin cone types vary in different parts of the retinas. Nonuniform distribution of pigment types was also evident in the eyes of several other species from a variety of piscine taxa.


Human skin fibroblasts derived from papillary and reticular dermis: differences in growth potential in vitro.

Papillary fibroblasts, when compared to reticular fibroblasts from the same skin specimen, exhibit greater proliferative capacities in vitro. These results demonstrate a difference in function between morphologically similar cells obtained from the same tissue. Such findings represent an important consideration in the study of cell aging in vitro.


Conditioned inhibition: selective response of single units.

Single cell activity and local field potentials in parastriate cortex of cats and rabbits were studied during a Pavlovian discrimination procedure. Cell activity was selectively modified; conditioned changes occurred in response either to the reinforced stimulus or to the unreinforced one, but not to both. Cells exhibiting conditioned alteration in response to the unreinforced stimulus are thought to participate in specialized circuits mediating conditioned inhibition.


Nanosecond X-ray diffraction from biological samples with a laser-produced plasma source.

By using 4.45-angstrom radiation generated by Cl+15 ions in a laser plasma and nanosecond exposures, low-angle x-ray diffraction patterns were obtained from dried rat spinal nerves and a powder of cholesterol. Three to four 400-picosecond, 45-joule pulses were required for the exposure. This new technique should have wide application in structural kinetic studies.


Hydroxylase cofactor activity in cerebrospinal fluid of normal subjects and patients with Parkinson's disease.

A method for measuring hydroxylase cofactor activity in human cerebrospinal fluid is described. The hydroxylase cofactor content of cerebrsopinal fluid from Parkinsonian patients is approximately 50 percent that of normal subjects. A significant correlation between hydroxylase cofactor and the concentration of homovanillic acid in the cerebrospinal fluid was observed.


Local cerebral glucose metabolism during controlled hypoxemia in rats.

2-Deoxy-[14C]glucose metabolism was examined in brains of hypoxic, normotensive rats by autoradiography, which revealed alternating cortical columns of high and low metabolism. Activity in white matter was increased severalfold over that in adjacent gray matter. The columns were anatomically related to penetrating cortical arteries with areas between arteries demonstrating higher rates of metabolism. The results suggest the presence of interarterial tissue oxygen gradients that influence regional glucose metabolism. The relatively greater sensitivity of white matter metabolism to hypoxia may lead to an understanding of white matter damage in postanoxic leukoencephalopathy.


Clomid administration to pregnant rats causes abnormalities of the reproductive tract in offspring and mothers.

In rats, a single injection of clomiphene citrate (Clomid) during pregnancy causes multiple abnormalities of the reproductive tract in the offspring and mothers. These abnormalities probably result from the ability of Clomid to cause long-term estrogenic stimulation.


Neurotoxic fragrance produces ceroid and myelin disease.

Acetyl ethyl tetramethyl tetralin (AETT), a component of soaps, deodorants, and cosmetics, produces hyperirritability and limb weakness in rats repeatedly exposed to the compound. Brain, spinal cord, and peripheral nerves are discolored blue, show progressive neuronal ceroid degeneration, and develop spectacular myelin bubbling. These neurotoxic properties of AETT provide the basis for industry's decision to withdraw the compound from consumer products. In addition, AETT offers the experimentalist a new probe to explore the etiology and pathogeneses of human ceroid and myelin diseases.


Sites of transition between functional systemic and cerebral arteries of rabbits occur at embryological junctional sites.

The vascular smooth muscle of cerebral blood vessels is relatively insensitive to sympathomimetic stimulation compared with muscle from systemic vessels. The transition in the vertebral artery occurs just rostral to the emergence of that artery from the foramen of the lateral process of the atlas and in the internal carotid artery just before it enters the carotid canal. These sites in the adult correspond to embryological junctions between segments of the vertebral and internal carotid arteries derived from the primitive dorsal aortas and their branches with vessels originating locally from the bilateral longitudinal neural arteries. Topographic patterns of vascular properties may in some cases be explained by the different sites of origin of their primordial mesodermal cells.


Tectorial membrane: a possible effect on frequency analysis in the cochlea.

Mathematical analysis and computer and network simulations of the cochlea show that, given appropriate values of specific physical constants, radial shear motion between the tectorial membrane and the reticular lamina may provide the sharpening of frequency analysis observed in cochlear nerve fibers in comparison with the mechanical amplitude distribution on the basilar membrane. According to the analysis, the sharpening occurs through an interaction of the longitudinal mechanical propagation  constant of the tectorial membrane with the wavelength on the basilar membrane.


Hippocampal afterdischarges: differential spread of activity shown by the [14C]deoxyglucose technique.

Differential spread of afterdischarge activity initiated electrically in ventral and dorsal parts of the hippocampal formation was studied by the [14C]deoxyglucose technique in rats. Afterdischarges initiated in either the ventral or dorsal hippocampal formation, without activation of the ventral subicular cortex, increased glucose utilization in the lateral septum. In contrast, afterdischarges initiated by direct activation of the ventral subicular cortex increased glucose utilization in extensive areas of the ipsilateral amygdala, claustrum, hypothalamus, preoptic region, and basal forebrain.


Clinical study of 81 gastrointestinal carcinoid tumors.

The behavior and treatment of gastrointestinal carcinoid tumors have been the subject of much discussion. Size, location, and histologic invasiveness have been shown to correlate with regional and remote metastasis in previous series. We reviewed 81 patients with gastrointestinal carcinoids seen at the Medical University of South Carolina Teaching Hospitals since 1950. An unusual case of a 0.5 cm primary ileal carcinoid with widespread intra-abdominal and hepatic metastases is documented. In this series carcinoids were found (in order of decreasing frequency) in the ileum, appendix, rectum, right colon, duodenum, jejunum, stomach, ampulla of Vater, sigmoid colon, and pancreas. Metastases were found in 17% of the overall group. Two carcinoids presented with intussusception, while one was found within a Meckel's diverticulum. In addition to the small metastatic ileal carcinoid, one patient with a rectal carcinoid measuring 0.4 cm was found to have metastases after low anterior resection. Because all extra-appendiceal gastrointestinal carcinoids are potentially metastatic, it is stressed that regional lymphadenectomy en bloc with primary excision is the treatment of choice wherever feasible. If the lesion is small or has not invaded deeply, local excision with close follow-up may be an acceptable alternative.


Treatment of cholelithiasis in patients with sickle cell anemia.

The incidence of cholelithiasis and surgical risk of cholecystectomy in patients with sickle cell anemia is reviewed. Records of all patients with sickle cell disease currently attending the Medical University of South Carolina Hematology Clinic were reviewed. An oral cholecystogram has been part of the initial evaluation for the past year. The records of 16 patients having cholecystectomy from 1968 to 1977 were reviewed with regard to diagnostic studies, preoperative preparation, morbidity, and mortality. When the status of the gallbladder is known, the incidence of cholelithiasis is 67%. The morbidity of elective cholecystectomy was high (37%); there was one death. Cholecystectomy is not recommended for the discovery of asymptomatic gallstones because of the relatively poor surgical risk and short life expectancy of these patients.


Surgical treatment of hyperparathyroidism.

Hyperparathyroidism, as seen by a single group of surgeons in a community of 320,000 is reviewed in a retrospective fashion. It was shown that symptomatic hypocalcemia could occur up to 110 hours postoperatively and was most likely to occur in individuals showing skeletal demineralization preoperatively. Though large doses of calcium were required postoperatively in three patients, permanent supplementation was not necessary in two of them. Five of seven patients operated upon for secondary hyperparathyroidism received little or no benefit, stimulating critical review of the appropriate indications in this patient population. Mechanical suction proved to be clearly superior to passive drainage.


Serum concentrations of 25-hydroxyvitamin D in Florida children: effect of anticonvulsant drugs.

The mean serum concentration of 25-hydroxyvitamin D (25OHD), determined by nonchromatographic radioassay, was significantly lower (P less than .02) in Florida children with epilepsy treated with anticonvulsant drugs (34.4 +/- 11.3 [SD] ng/ml) than in normal subjects (40.9 +/- 14.3), despite exposure of both groups to sunlight throughout the year. In 12% of children treated with anticonvulsant drugs, the 25OHD level was below the lowest value recorded in the control group. The mean serum concentration of 25OHD in normal Philadelphia children (27.5 +/- 9.1 ng/ml) was significantly less than in either group of Florida subjects. Annual monitoring of calcium homeostasis and vitamin D status is indicated in Southern children receiving anticonvulsant drugs, but routine vitamin D supplementation of such patients is unnecessary.


Gastric, intestinal, and gallbladder varices: hemodynamic and therapeutic considerations.

Atypically located varices are frequently overlooked in the differential diagnosis of gastrointestinal bleeding in patients with portal hypertension. The circulatory changes associated with these lesions are described and their relation to diagnosis and treatment emphasized.


Medical education and the dying patient.

Several recent cases illustrate the medical-ethical-legal consequences associated with lack of awareness in caring for and treating the dying patient. We question whether solutions advanced by others are feasible or desirable for use in medical education, and suggest looking to the familiar principles of clinical medicine. These principles can be used to acquaint students and residents with the clinical model of medicine so they can learn the differences between the rights and duties of those occupying the "sick" and "dying" roles. Once these differences have been understood, then the rules for moving patients from one role to another can be gradually acquired in the course of medical practice. The task now is to resuscitate these traditional abilities in the context of our times.


Simple screening technic to estimate postoperative narcotic use.

The General Health Questionnaire, a 30-item, self-response inventory, identified individuals who required significantly more pain medication after elective cholecystectomy. The questionnaire is well tolerated by surgical patients and is easy to score. It can identify those individuals prone to request excessive narcotic medication postoperatively.


Death caused by brain herniation during hemodialysis.

Brain edema with brain herniation during or after dialysis has been reported previously. However, coexisting lesions of the central nervous system (CNS) which might play a facilitating role were present in these case reports. Described here is an 18-year-old white man with renal failure who developed clinical signs consistent with brain herniation while receiving his first hemodialysis treatment. He died two days later, after discontinuation of the supportive therapy and after the confirmation of brain death. Autopsy results documented brain edema with uncal and cerebellar tonsillar herniation without other coexisting pathologic lesions. The etiology of brain edema during the initial phase of dialysis is discussed.


Myopathy limited to the quadriceps and gastrocnemius muscles occurring in three brothers.

This is a report of three cases of myopathy limited to the quadriceps and gastrocnemius muscles, occurring in the male offspring of the same mother but two different fathers. They have many similarities to a previously described clinical syndrome called quadriceps-confined myopathy. The pedigree demonstrates an apparent sex-linked recessive condition which has not been demonstrated previously. Information gained from a review of the literature is related to these three cases. It is suggested that these cases are part of a poorly defined clinical entity and that a new classification of quadriceps-gastrocnemius muscular dystrophy be introduced.


Respiratory failure secondary to Mycoplasma pneumoniae infection.

Three previously healthy patients presented with bilateral pulmonary infiltrates, hypoxemia, and respiratory failure associated with Mycoplasma pneumoniae infection. None had underlying pulmonary or immune deficiency diseases. One died with dense fibrotic reorganization of the lungs, and another survived after prolonged mechanical ventilatory assistance. Two developed pulmonary superinfections with Pseudomonas aeruginosa. All had extrapulmonary complications: one had Coombs'-positive hemolytic anemia, another myocarditis, and all three had abnormal results of liver function tests, consistent with hepatocellular dysfunction.


Surgical management of nasal valvular obstruction of dorsal origin.

Nasal obstruction from valvular dysfunction may take many forms besides alar collapse. Some valvular stenoses result from scarring and tissue loss from the dorsum of the nose. Any surgical correction should take into consideration replacement of lost tissue. Several surgical means of handling this type of obstruction are described.


Simplified endometrial testing by the Milan-Markley technic.

Recent articles have urged physicians to give increased attention to the use of cytologic and histopathologic technics in the detection of precancerous and cancerous endometrial lesions, since there is an increasing incidence of malignant disease at that site. A routine cervicovaginal smear is inadequate to diagnose cancer of the endometrium. This paper describes a technic for rapid smearing and fixation of endometrical cells. The method of obtaining endometrial cytologic and histologic material is by the use of a helix. A report on 1,748 endometrial cytologic smears is given.


"Diphtheroid" pneumonia.

We have described a case of pneumonia caused by Corynebacterium CDC Group D2 which was diagnosed by Gram stain of a specimen obtained by transtracheal aspiration and recovery of the organisms from the aspirate specimen in pure culture. Treatment with penicillin was successful.


Pulmonary infection with Petriellidium boydii.

A 52-year-old woman with pulmonary involvement with Petriellidium boydii in a bronchiectatic lung segment is described. Pulmonary involvement with this organism has been most frequently described in patients with underlying systemic diseases or compromised immune systems. This patient apparently had neither problem and was normal in all other aspects. Surgical resection was done to avoid local pulmonary parenchymal invasion or dissemination of this fungus. The patient is now in good health two years after operation.


Electrocardiographic changes associated with multiple yellow jacket stings.

A previously healthy 38-year-old man was stung multiple times by yellow jackets without any signs of anaphylaxis being observed. An electrocardiogram taken 16 hours later revealed episodes of wandering atrial pacemaker, junctional rhythm, and intermittent premature ventricular contractions. These arrhythmias disappeared spontaneously.


Myospherulosis.

A young Thai immigrant presented with a mass in the left hip, pain, and difficulty in ambulation. At operation, the mass was found to be a group of cysts containing bizarre, fungus-like structures like those first described in Africa and recently in St. Louis. The cause of this condition may be iatrogenic, resulting from a peculiar reaction to intramuscular injection.


Persistent tracheal dilatation: onset after brief mechanical ventilation with a "soft-cuff" endotracheal tube.

Persistent tracheal dilatation, a sign of severe tracheal damage, has been reported in the past primarily as a complication of prolonged mechanical ventilation through high-pressure, low-compliance cuffs of tracheostomy and endotracheal tubes. A case is presented in which a 26-year-old man developed severe tracheal dilatation with a soft-cuff endotracheal tube beginning four days after intubation, which persisted despite only eight total days of intubation and mechanical ventilation. The pathogenesis and possible prevention of this complication are reviewed.


Ureteral obstruction caused by malacoplakia of the bladder over the ureteral orifice.

We have described a case of malacoplakia presenting with uremia in a young, previously healthy black man. Malacoplakia was found in the bladder over both ureteral orifices, causing obstruction. The patient was treated with antibiotics, a percutaneous nephrostomy tube, and finally with transurethral resection of the malacoplakia over the ureteral orifices. The patient's renal function improved dramatically and he is presently asymptomatic.


Sickle cell anemia in the neonatal period.

Although sickle cell anemia rarely presents with clinical manifestations in the newborn period, it should be considered a possible cause of unexplained early jaundice in black newborn infants. If sickle cell disease is suspected, sickle cell preparation and hemoglobin electrophoresis of the infant and of both parents should be carried out.


Hemangioma of the ovary in an 81-year-old woman.

We have reported a case of cavernous hemangioma of the ovary in an 81-year-old woman with uterine prolapse and without ascites. Review of the literature reveals that this is the oldest patient reported. The size of the lesion is considered large at 5 cm in diameter. No associated disease or other lesions were present. The lesion was an incidental finding with no complications.


Septic arthritis after ureteroneocystostomy.

Acute infectious arthritis is an uncommon disease that is most commonly caused by Neisseria gonorrhoeae or gram-positive cocci. Gram-negative bacteria are an infrequent and highly virulent cause of septic arthritis and most commonly enter the circulation through the urinary tract, as in this case after ureteroneocystostomy. The resulting arthritis carries a mortality of 25% and a morbidity of 80%. Early recognition and treatment with appropriate antibiotics and mechanical drainage is imperative. Needle drainage of the affected joint has been shown superior to open surgical drainage.


Disseminated intravascular coagulation in sickle cell crisis.

We conclude that DIC can occur as a result of sickle cell crisis in the absence of sepsis and we recommend that patients with sickle cell disease, particularly those with hemoglobin SC disease, presenting in crisis should be considered at risk for the development of disseminated intravascular coagulation. With symptomatic treatment and improvement of the crisis, our patient's coagulopathy resolved.


Studies on spinal and peripheral muscles from patients with scoliosis.

This report describes part of a wider study on muscles from patients with adolescent idiopathic scoliosis. The aim of the study was to clarify if there exists a side-related pathology in the spinal musculature and if extraspinal muscles are abnormal in scoliosis patients. In scoliotic patients, both spinal and peripheral muscles showed frequent abnormalities when examined morphologically and histometrically by light and electron microscopy. Idiopathic scoliosis patients differed from the others. Morphologic pathology seemed worse on the concave side. A mild Type I fiber atrophy occurred in spinal muscles on the concave side and in the deltoids. A generalized tendency towards small myofibers was also noted. The findings suggest that there is a generalized specific neuromuscular disorder causing idiopathic scoliosis.


Lung function in young persons after spinal fusion for scoliosis.

The long-term changes in vital capacity and in total lung capacity after spinal fusion for 43 scoliotic patients are described. The values recorded were seldom lower after surgery but did not show any marked subsequent increases with patient growth. Subsequent increases in volumes are less marked in the group of patients with paralytic scoliosis. These findings suggest that the psychological advantages of improving the patient's appearance by surgery and of preventing any respiratory condition from worsening may be achieved, although the total capacity and vital capacity are not much improved by spinal fusion.


Mechanical properties of human lumbar spine motion segments. Influence of age, sex, disc level, and degeneration.

The influences of age, sex, disc level, and degree of degenration on the mechanical behavior of 42 fresh cadaver lumbar motion segments are reported. The motions and intradiscal pressure changes that result from the application of flexion, extension, lateral bending, and torsional moments; compression; and anterior, posterior, and lateral shears are described. The authors find that the mean behaviors of the different segment classes sometimes differ, but these differences are seldom pronounced. Scatter in the behavior of individual motion segments is pronounced, and very often overshadows any class differences.


Simultaneous anterior and posterior surgical approach to the thoracic and lumbar spine.

A technique for the simultaneous anterior and posterior surgical approach to the thoracic and lumbar spine is presented. No intraoperative repositioning of the patient is required. The procedure requires a surgical team of two spinal surgeons and two assistant surgeons, as well as an anesthesiologist familiar with hypotensive techniques. The procedure as utilized in 14 cases has proven to be safe and expeditious. The simultaneous anteroposterior approach has proven to be especially useful in cases with combined anterior and posterior instability. The technique described provides the experienced spinal surgeon with the best solution to certain complex spinal problems.


Neurologic recovery of paraplegia following use of salmon calcitonin in a patient with Paget's disease of spine.

A case report of spastic paraparesis due to Paget's disease of the dorsal spine is presented. The patient became almost completely paralyzed in the lower limbs in spite of a decompressive laminectomy. He was treated with salmon calcitonin with very rapid neurologic recovery. The limits of the regimen and possible complications are discussed.


The influence of backrest inclination and lumbar support on lumbar lordosis.

The influence of backrest inclination and lumbar support on the shape of the lumbar spine in sitting positions has been studied radiographically on 38 healthy subjects. Four angles of backrest inclination and four different sizes of lumbar support were studied. In addition, the lumbar support was placed at three different lumbar levels. When sitting down from a standing position, the pelvis rotates and the lumbar lordosis decreases. Increases in the backrest-seat angle had only minor effect on the lumbar lordosis. A lumbar support, on the other hand, had a significant influence: the lordosis increased with increasing support. The location of the lumbar support with respect to the level of the spine did not significantly influence the measured angles.


Thoracic disc herniation. Treatment and prognosis.

Thoracic disc herniation is difficult to recognize. Diagnosis is easily made when the patient has a paraparesis, but at this point the disc herniation is usually large, and the result of the disc removal is less certain. Most of the 7 patients discussed had an early diagnosis made. Six patients were treated by the transthoracic anterolateral approach, and improvement occurred in all.


The stoop-test in lumbar entrapment radiculopathy.

Disabling neurologic symptoms with a paucity of focal signs are frequently encountered in patients who suffer from intermittent cauda equina compression syndromes. The stoop-test has diagnostic merit in these instances. The author's clinical experiences, the test, and its anatomic basis are described.


The treatment of lumbar spondyloptosis or impending lumbar spondyloptosis accompanied by neurologic deficit and/or neurogenic intermittent claudication.

Three patients with complete lumbar spondyloptosis and 8 patients with fourth-degree spondylolisthesis suffering from radicular signs and symptoms are reported. There were 8 female and 3 male patients in the study. A high incidence of neurogenic intermittent claudication was noted in this condition. Decompressive laminectomy and foraminectomy were performed on all patients followed by transabdominal console fusion. Length of follow-up varied from 3 to 17 years, with a mean value of 13.5 years, and results are reported. Radicular signs and symptoms had completely subsided in all cases. Nine of 11 patients are free from signs and symptoms and 2 suffer from residual pain, although less severe than before surgery. All 3 males fathered children after surgery, which is in contrast to the opinion that anterior lumbosacrial fusion is followed by infertility in males. Special attention was given to individuality of remodeling of the lumbosacral junction over the course of time. Solid fusion was obtained in 10 of the 11 patients, while the console fusion collapsed because of failure to follow instructions after surgery in 1 patient.


Congenital atlantoaxial fusion. A case report.

An adult patient, after a minor fall, had a painful neck, and roentgenograms of the affected area showed a separate odontoid with the remnant fused to the anterior ring of the atlas. The multiple nature of the anomalies, coupled with the lack of significant trauma, indicated that the finding was that of congenital atlantoaxial fusion.


Factors influencing drug compliance in ambulatory Black urban patients.

The present study was designed to ascertain the causes of patient non-compliance among 150 urban Black patients. Three groups of patients were studied: those with acute illnesses, a chronic asymptomatic group and a chronic symptomatic group. The incidence of causes of non-compliance was found to be similar to that described in other population groups. A variety of faults in the health care delivery system has been pin-pointed and is discussed.


Clinical experience with methylphenidate.

The indications for the use of methylphenidate in 250 children are reviewed, and the effect of the drug is examined. Concentration was improved or hyperactive behaviour diminished in 89% of the children with normal intelligence and with no gross physical defect, in 72% of the children with cerebral palsy, and 68% of the children with subnormal intelligence. In children with emotional disturbance, response to methylphenidate was seldom satisfactory. Significant side-effects occurred infrequently and only 2 children lost weight during the period of medication.


The problem of child safety in South Africa.

In Europe and the USA accidents are regarded as a public health problem. South Africa has not kept pace with this trend, particularly in the field of child safety. The Child Safety Centre, which aims at the investigation and prevention of childhood accidents, was established in Cape Town in 1978.


Immunization in childhood.

A symposium on immunization provided an opportunity for resolving many of the uncertainties and inconsistencies which prevail, among general practitioners in particular, with regard to immunization programmes in childhood.


Future health workers for Southern Africa.

Long-term planning for health in southern Africa must be holistic; such planning must include sociological, economic, political, manpower and epidemiological considerations. This paper proposes a health system model and examines the educational implications of the model for future health workers.


Metastatic breast carcinoma presenting as obstructive jaundice. A report of 3 cases.

Three patients who developed obstructive jaundice after mastectomy for carcinoma of the breast are presented. Prognosis is invariably poor as widespread metastases are usually present at the time of presentation. The pathogenesis, investigations and clinical significance are discussed.


The postoperative myelogram.

Myelographic changes after spinal operation are often difficult to interpret especially with regard to the differentiation between arachnoiditis and recurrent disc prolapse. The radiological appearances using iophendylate (Myodil) and the distinguishing features are discussed and illustrated.


A comparison of the plasma viscosity and the erythrocyte sedimentation rate as screening tests.

Plasma viscosity (PV) and the erythrocyte sedimentation rate (ESR) were determined in 343 patients. The results were correlated with the presence or absence of a clinical diagnosis usually associated with a raised ESR. The percentages of false-positive results were 4,9% and 3,8% and those of false-negative results were 12,8% and 13,1% for the PV and ESR respectively. PV measurements led to the detection of 8 cases of hypoproteinaemia in patients with normal ESR values, and could also detect and quantify hyperproteinaemias. In coeliac disease the PV correlated closely with the total plasma protein measurement. In a case of subacute bacterial endocarditis (SBE) the two tests varied with the disease process in approximately parallel fashions. PV measurements have several important technical advantages over the ESR, and could replace the ESR as a primary screening test for organic disease. They can also be used to detect hypoproteinaemia in a malnourished population.


[Psychiatric aspects of therapeutic abortion].

The indications for termination of pregnancy in terms of the Abortion and Sterilization Act of 1975, and the evaluation of 100 pregnant White women are discussed.


[The influence of sports injuries on sport participation and work].

The incidence and complications of sport injuries in athletics, basketball, gymnastics, hockey, netball, cricket, tennis and soccer were analysed from questionnaire responses of 239 sport participants in Pretoria. Lower limb injuries were most common (73%). Torn tendomuscular organs represented 29,3% of the total number of injuries; sprains, strains and dislocations 35,9%; and fractures 20,5%. Medical treatment was sought by 62,8% of the patients. A total of 60,7% of the subjects was advised to suspend further participation in sport, but 30,6% failed to do so and more than half of these again sustained injuries. Those who were booked off from work totalled 18,0%, but a further 4,5% stayed away from work voluntarily.


Choledochocele. A case report.

A case of a young man with a choledochocele is presented. The entity is rare and symptoms are usually nonspecific. Pre-operative diagnosis is often not made but is usually possible provided both barium study and cholangiography are performed. The clinical presentation and diagnosis are discussed.


Isolation of UV-sensitive clones from a haploid frog cell line.

An isolation procedure has been developed which yielded five clones of haploid frog cells which are sensitive to ultraviolet light. This procedure employed a conventional mutagenesis, followed by time for phenotypic expression and then an enrichment for UV-sensitive mutants. The enrichment relies upon the uptake of bromodeoxyuridine (BrdU) by repairing cells following UV-induced damage, rendering repair-proficient cells differentially sensitive to photolysis by black light. The photolysis is potentiated by use of the bisbenzimidazole dye Hoechst 33258. The enriched population was screened for radiation-sensitive isolates resulting in 5 sensitives from 96 tested. No mutants were obtained from 300 isolates tested from a population which had not undergone enrichment.


Cloning of Drosophila cells: effect of vitamins and yeast extract components.

Yeast extract, a component of Drosophila cell culture media, is shown to contain substances of high, intermediate, and low molecular weight, that are, respectively, essential, inhibitory, and stimulatory for colony formation in semisolid agar medium. Furthermore, it is shown that high concentrations of pyridoxal greatly increase the cloning efficiency of Drosophilia cells. A cloning method with line Kc is described which routinely gives cloning efficiencies in excess of 20%.


TAM selection of Drosophila somatic cell hybrids.

The selection of MDR3, an adenine-salvage-deficient variant of the Kc line, is described. It is resistant to methylpurine and to diaminopurine and is TAM (thymidine, adenine, methotrexate) sensitive. Two wild-type (TAM-resistant) cell lines, Schneider's line 3 (S3) and Dübendorfer's line 1 (D1), due to their different nutritional requirements, are unable to proliferate in medium ZH1% used for line MDR3. This allowed the selection of hybrids between MDR3 and either D1 or S3 in TAM cloning medium after treatment with polyethyleneglycol. Hybrids were identified by the isoenzyme pattern of NADP-dependent isocitrate dehydrogenase.


Identification of a mouse gene required for binding of Rauscher MuLV envelope gp70.

Mouse chromosome segregating somatic cell hybrids were established between a mouse thymic leukemai cell line (GRSL) and Chinese hamster E36 cells. The GRSL cells specifically bound purified Rauscher leukemia virus gp70 while the E36 cells exhibited no binding. The hybrids selectively bound Ruascher gp70 depending on the presence of a mouse cellular gene for the ecotropic murine luekemia gp70 receptor. A syntenic relationship was observed between the DIP-3 chromosome marker (on chromosome 5) and the gp70 receptor in primary clones and subclones of these hybrids; this was confirmed by chromosome analysis. The involvement of H-2 in the binding of Rauscher MuLV gp70 could be ruled out, because discordancies of the receptor presence and H-2 absence as well as of the receptor absence and H-2 presence type could be observed. Our results indicate that the Rec-1 (replication ecotropic MuLV) gene of Gazdar et al. (4) may well be the receptor gene for the ecotropic murine leukemia virus.


Studies on 1-beta-D-arabinofuranosyl cytosine-resistant mutants of Chinese hamster fibroblasts: III. Joint resistance to arabinofuranosyl cytosine and to excess thymidine--a semidominant manifestation of deoxycytidine triphosphate pool expansion.

Variants isolated from mutagenized Chinese hamster fibroblasts by a single cycle of exposure to ara-C distributed into two classes: (1) deoxycytidine (dC) kinase deficient clones with a high level of resistance, this phenotype was recessive in hybrids; and (2) clones exhibiting joint resistance to thymidine (dT) and to "low" ara-C concentration, this phenotype was accounted for by an increased dCTP pool. The incorporation of exogenous dC into macromolecules was markedly altered in these variants. In hybrids, the phenotype of joint resistance to dT and ara-C was semidominant. Through a second selection step, variants cumulating recessive high resistance to ara-C and semidominant dT resistance were recovered. The identification of these two classes of ara-C-resistant variants suggests an interpretation of the known phenotypes of ara-C resistance as manifestations of chromosomal gene mutations. Dominant resistance mutations might contribute to the survival of cancer cells during prolonged ara-C chemotherapy.


Isolation of hydroxyurea-resistant CHO cells with altered levels of ribonucleotide reductase.

A Chinese hamster ovary cell line selected for resistance to hydroxyurea was serially cultivated in the absence of a selective agent, and cells with decreased resistance to the cytotoxic effects of hydroxyurea gradually accumulated in the population. Three stable subclones with differing drug sensitivities were isolated from this mixed population and were found to contain intracellular levels of drug-sensitive ribonucleotide reductase which correlated with the degree of cellular resistance to hydroxyurea. This new class of hydroxyurea resistance was expressed in a codominant fashion in cell-cell hybridization studies. Also, the enhanced enzyme activity in the drug-resistant cells was observed only during the cell cycle S phase of synchronized cells. The properties of these drug-resistant lines indicate that they will be useful for genetic and biochemical studies.


A ts mutant isolated from CHL cells: inhibition of DNA replication at nonpermissive temperature.

A mutant Chinese hamster cell clone has been isolated from an S phase culture. This clone, ts154, could not replicate DNA at nonpermissive temperature (39 degrees C), although it synthesized DNA normally at permissive temperature (33 degrees C). After transfer to 39 degrees, ts154 cells replicated DNA semiconservatively through precisely two complete rounds and divided twice before they ceased DNA synthesis and further growth. The mutation in ts154 affects DNA replication specifically, as its rates of cellular transcription, its ability to support growth of vesicular stomatitis virus, and its ribo- and deoxyribonucleoside triphosphate pools were normal at 39 degrees. Cultures of ts154 resumed DNA replication within 6h when shifted from 39 degrees to 33 degrees, even after 78 h at the nonpermissive temperature. Upon return to 33 degrees, mutant cells achieved a normal steady-state rate of DNA synthesis by 10 h, suggesting that they had come to rest within G1 phase at 39 degrees. Resumption of DNA synthesis and growth after a shift-down to 33 degrees were sensitive to cycloheximide in ts154, and thus likely required synthesis of new protein.


Repair of postirradiation rectovaginal fistula and stricture.

Postirradiation rectovaginal fistulas are notoriously difficult to repair, as are the strictures that are usually associated with them. Previous attempts have involved resection and low anastomosis by various techniques. Patients considered not suitable for resection have been treated by permanent fecal diversion. A technique of repair not previously reported has been described. It relies on the proximal part of the colon as a vascular pedicle graft, used as a patch to close the rectal defect and to provide circumference to relieve any associated stricture. Five patients are reported in whom complicated fistulas and strictures have been corrected with restoration of normal rectal function.


Nonoperative management of intrahepatic hemorrhage and hematoma following blunt trauma.

Four patients with blunt abdominal trauma did not have surgical treatment for intrahepatic hemorrhage and hematoma. Two patients were diagnosed 24 hours after injury as having significant active hemorrhage, although their clinical status was stable. They were successfully treated by superselective transcatheter occlusion of the hepatic artery and they recovered without incident. Two patients were diagnosed one week after injury as having quiescent intrahepatic hematoma and they too recovered without complication. Although more patients will have to be evaluated, it is our belief that nonoperative management of selected patients with an intrahepatic hematoma is reasonable and safe. Patients should be observed periodically with radioisotope scans, ultrasound or computerized tomography until the hematoma resolves.


Preoperative chemotherapy in soft tissue sarcoma.

The preoperative use of chemotherapy in the management of soft tissue sarcoma is a recent concept in the multidisciplinary management of neoplasia related to the development of more effective drug combinations. The reason for chemotherapy preoperatively is to define the effectiveness of drug treatment, permitting a rational basis for long term adjuvant treatment. In addition, major surgical morbidity may be precluded if chemotherapy is effective, allowing lesser surgical procedures, such as limb-sparing local resection. Patient selection for this approach must be individualized and is based upon the major determinants of prognosis, including the stage of the tumor according to the TNM and G--grade--classification. Radiation therapy is an essential component of the multimodality approach to soft tissue sarcomas, and the interaction of all three therapeutic modalities must provide optimal tumor control and minimal morbidity.


The problem of the cystic duct remnant.

Symptoms persisting after cholecystectomy for gallbladder disease are often attributed to a long residual cystic duct. Of 30 patients who underwent excision of their cystic duct remnant, 15 were found to have common duct stones which accounted for their symptoms, while an additional four patients had had previous episodes of jaundice which suggested passage of a common duct stone. Those patients with common duct disease in addition to the cystic duct remnant were completely relieved of their symptoms by operation while only eight of the patients without common duct stones obtained relief. A cystic duct remnant infrequently causes symptoms in the absence of pathologic conditions in the common duct.


Undesirable effects of hemometakinesia induced by vascular reconstruction.

Hemometakinesia, the borrowing of blood by one part of the body for use by other parts or tissues, is a well regulated physiologic mechanism involving selective vasodilation and vasoconstriction. It has been shown, however, that diversion of blood flow following vascular reconstruction may impoverish tissues from which the blood flow is borrowed, causing ischemia in these vascular beds. Observations on 12 patients out of a group of 100 who had undergone vascular reconstruction of a limb deterioration. It is suggested that the type and site of the vascular disorder and the expected diminution of blood flow in other involved arterial circuits should be considered in selecting the most appropriate vascular surgical procedure. Searching for and recognizing the hemodynamic significance of a silent lesion in the carotid or gastrointestinal circuit or in a contralateral limb may avert a vascular crisis after the primary lesion has been successfully treated.


Secretion of insulin by the canine pancreas perfused ex vivo with fluorocarbon emulsion.

Canine gastroduodenopancreatic blocks were isolated and perfused ex vivo with oxygenated bloodless fluorocarbon emulsion. Pancreatic and gastric secretions were collected. Exocrine pancreatic secretion was stimulated with secretin infused intra-arterially. This study was undertaken to find out whether or not the pancreas, perfused with fluorocarbon emulsion, preserves its endocrine function. Immunoreactive insulin was determined in the perfusate samples obtained from a venous site in the perfusion circuit. Glucose concentration was also measured in the same samples. Insulin appeared in all experiments within the first ten minutes of persuion of the preparation with fluorocarbon. Insulin was present in all samples collected during 5.5 hours of perfusion. Results of this study suggest that endocrine function of the pancreas was preserved under the conditions of extracorporeal perfusion used.