Easy orientation of the cut ends for nerve suture.

A technique for orienting cut nerve ends for suturing is presented. A mirror is used to reflect one end, making its image identical to that of the other end--so that proper orientation is greatly facilitated.


Indentation tonometry of breasts.

We present an indentation tonometer for use in measuring the softness or firmness of human, female breasts. It provides objective measurements which are consistently reproducible.


Review of 1,000 major facial fractures and associated injuries.

The records of 1,020 major facial fractures were reviewed, and it was found that the occurrence of life-threatening associated injuries was highly predictable on the basis of the pattern of facial fractures and the circumstances of the injury. Certain groups of patients have a high probability of associated serious injuries of the central nervous system, the trunk, or the extremities. Probably these patients should be primarily under the care of a surgeon who is capable of the diagnosis and emergency therapy of these associated injuries, as well as the facial injuries, so that appropriate priorities can be established and put in effect.


Major electrocardiographic changes during chemical face peeling.

In phenol face peels, when 50 percent or more of the face was treated in less than 30 minutes, there was a high incidence of cardiac arrhythmias. When the same was done during a period of 60 minutes or more, arrhythmia did not occur. Other factors studied in this group of 43 patients, including the preoperative electrocardiograms, did not correlate with the development of arrhythmias. We believe that patients undergoing phenol face peels should have cardiac monitoring, and appropriate cardiopulmonary resuscitative capabilities should be available.


The crocodile tear syndrome.

Gusto-lacrimation, or "crocodile tear syndrome," is a rare complication, with 95 cases reported in the literature. Two patients are presented here, one after a facial fracture which apparently extended into the temporal bone proximal to the optic ganglion, and one after a Bell's palsy. The mechanism appears to be a misdirection of regenerating gustatory fibers destined for the salivary glands, so that they become secretory fibers to the lacrimal gland and cause homolateral tearing while the patient is eating. A simple procedure, involving subtotal resection of the palpebral lobe of the involved lacrimal gland, proved to be an effective corrective measure in these cases. Although it was not done in these cases, it would perhaps be advisable to do a Schirmer's test to assist in determining the amount of gland to be removed.


Hypoglossal-facial nerve anastomosis for reinnervation of the paralyzed face.

The hypoglossal-facial nerve crossover is a valuable surgical procedure for the treatment of certain types of facial paralysis. It is most effective when used as an integral part of a primary ablative operation for the treatment of cancer in this region. In the treatment of long-standing facial paralysis, its application requires an intact peripheral facial nerve system and some functioning mimetic muscles with an obliterated proximal facial nerve segment. It is recognized that other procedures are available for repair in patients who meet essentially these same criteria. The disadvantages are minimal intraoral crippling, mass movements of the face and, in some instances, hypertonia of the face. The advantages are improved facial tone, protection of the eye, intentional facial movements controlled by the tongue, and movements associated with physiological functions of the tongue.


Factors influencing final range of motion in the fingers after fractures of the hand.

We evaluated 123 patients in which we treated 150 fractured fingers primarily. Sixty-seven percent of these fractured fingers required open reduction with internal fixation; the remainder had closed reduction with internal or external fixation, or immediate arthrodeses. Active and passive range-of-motion (ROM) exercises were usually begun within 3 days after injury. The active and passive ROM of all joints of each finger in the involved hand were measured at regular intervals until no further change in ROM occurred. An associated crush injury, a flexor or extensor tendon injury, or a skin loss (each) caused a significantly more frequent decrease in the final ROM of the unfractured fingers of the same hand. An associated joint injury, more than one fracture per finger, a crush injury, a flexor or extensor tendon injury, or a skin loss (each) caused a significant decrease in the ROM of the fractured fingers. After treatment of a simple fracture, the ROM in both the fractured and the unfractured fingers was essentially normal.


The carpal boss: surgical treatment and etiological considerations.

We report on 30 symptomatic cases of carpal boss which were treated surgically. The condition represents a highly localized degenerative arthritis at the base of the middle metacarpal, and is seen primarily in relatively young patients. Symptomatic relief was obtained by excision of degenerated tissue in all these patients.


Applanation tonometry of breasts.

We present a simple method for measuring intramammary pressure. We believe this technique could be helpful in evaluating the firmness of breasts following the implantation of prostheses, and capsulotomies done for this reason.


Successful replantation of an amputated leg in a child.

We report the successful replantation of an amputated leg in a 4-year-old boy. Four years after the replantation, skeletal growth and nerve regeneration were good and he had an excellent recovery of function and appearance. This result was undoubtedly enhanced by his youth, the ideal conditions for nerve repair, and the good preservation of the amputated leg in ice water. Replantation of an amputated lower extermity should be tried if the conditions mentioned above are fulfilled.


Bone regeneration within a coralline hydroxyapatite implant.

The hypothesis that incomplete resorption of osteons in an autogenous cortical bone graft may limit its replacement by new bone regeneration was explored by implanting a hydroxyapatite replica of a coral skeletal structure into bone gaps. This implant contained channels and interconnections similar to those in osteon-evacuated bone grafts. In 6 implanted mandibular defects in dogs, two of which were examined at two, 4, and 6 months, 11 percent, 46 percent, and 88 percent of the implant areas were filled with regenerated bone. The regenerated bone was a woven type at two months, but changed to a lamellar type by 6 months. In two implanted defects examined at 12 months, biodegradation of 29 percent of the implant had occurred. The bone regeneration was physiological, the implant was biocompatible, and the biodegradation began after the bone had regenerated.


Experimental evaluation of ceramic calcium phosphate as a substitute for bone grafts.

Tricalcium phosphate (Synthos) is a bioceramic material which can be carved with a scalpel and wired into place as a bone graft would be. The process of bone replacement of the prosthesis begins with an ingrowth of cellular loose connective tissue, which is replaced later by dense connective tissue. Around the periphery of this dense fibrous connective tissue, osteoid tissue becomes evident and on later specimens this mixture seems to be converted to bone--which at first is in the form of spicules but later takes on the characteristics of lamellar bone (with tricalcium phosphate particles seen within its lacunae). The progressive replacement occurs in a circumferential pattern, but most heavily at the bone-prosthesis interface. Although the periosteum is beneficial, we do not feel that the major source of bone formation is as the soft tissue or subperiosteal area. The replacement of the tricalcium phosphate prosthesis is slower than we originally thought, or than reported by others. We have noted pockets of tricalcium phosphate, incompletely replaced, in dogs up to 18 months after implantation. We believe this may be related to the larger sized prostheses we used (2 x 2 cm blocks) with, therefore, longer distances that the ingrowth and calcification had to traverse.


Hemangiomas of the eyelid: visual complications and prophylactic concepts.

We describe a late survey of 51 patients who had hemangiomas of the eyelid in infancy, together with the visual complications found and a program designed for prevention of the latter.


The distally-based gluteus maximus muscle flap.

We describe a distally-based gluteus maximus muscle flap to cover trochanteric pressure sores. The results in 4 patients have been gratifying.


Maxillonasal dysplasia (Binder's syndrome).

Eleven patients with Binder's syndrome (nasomaxillary hypoplasia) have been treated by the Toronto Craniofacial Team from 1972 to 1977. The treatment has consisted of onlay bone and cartilage grafts to the nose and perialar region for young children, or when the occlusion is normal. However, cases with severe malocclusion were treated by a Le Fort I and/or Le Fort II osteotomy when the children were older. When the malocclusion was less severe, interceptive orthodontics have been useful. The nose can be significantly lengthened and enlarged through a frontal craniotomy incision connected with an upper buccal sulcus incision, without any incision on the face.


Classification of oblique facial clefts with microphthalmia.

We believe the Tessier classification system facilitates the description of complicated facial clefts, and we describe its use in 4 cases--all of whom had variations of a Tessier-3 cleft. Microphthalmia is associated with the Tessier-3 cleft. Computerized axial tomography may be helpful in differentiating an extreme microphthalmia from a true anophthalmia, and in detecting bony clefts not seen on roentgenographic studies. Facial tomograms show that abnormalities of the medial wall of the orbit in the Tessier-3 cleft vary from actual clefts to widening of the ethmoid. In our experience (with 4 patients) mental retardation does not necessarily occur in patients with the Tessier-3 cleft and extreme microphthalmia. Abnormalities of the nasolacrimal apparatus may be the most constant finding in patients with the Tessier-3 cleft. Children with the Tessier-3 cleft should be identified early for purposes of determining the proper treatment and valid genetic counseling.


Immunoglobulin, complement, and histocompatibility antigen studies in keloid patients.

The increased collagen synthesis and deposition, which is characteristic of keloids, may be related to an immune response initiated by wounding. Therefore, we examined various systemic and localized immune parameters in keloid patients to establish if such factors are related to keloid pathogenesis. To determine if there is a systemic immune response, we compared the serum levels of IgG and IgM in keloid patients to those in a closely matched population. In addition, we measured complement levels (Clq, C3, and C4) and receptors for sheep (E), mouse erythrocytes (MRBC), and complement (EAC) on blood lymphocytes. All of these were in the normal range in the keloid patients. However, the extractable IgG from keloid tissue was significantly increased (compared to normal skin and normal scar controls), suggesting a localized immune response. To determine whether keloid formation is associated with a specific histocompatibility locus, human lymphocyte antigen (HLA) profiles of 45 keloid patients were analyzed; no significant differences in the incidence of HLA-A and B antigens were found (compared to 200 controls). These studies suggest that there is a localized immune response involved in keloid pathogenesis, one which is not related to either the HLA-A or B histocompatibility loci.


Effects of diffused soluble steroid on capsules around experimental breast prostheses in rats.

Saline-filled miniprostheses were implanted beneath the dorsal panniculus carnosus of rats. The control prostheses contained only saline, while the experimental prostheses contained soluble methylprednisolone sodium succinate. At 10-day intervals the in situ compressibility of the tissue mound around the implants was measured mechanically. At 60 and 120 days, the control mounds were harder than those around the steroid prostheses, and the control prostheses were surrounded by a thicker capsular membrane. The control capsules contained more non-collagenous protein than the steroid modified capsules. We suggest that this non-collagenous protein may be related to the proteopolysaccharide cement which binds the fibers of immature scar together--and that the effect of our steroid treatment was to reduce this proteopolysaccharide component of the capsule membrane and thereby cause its dissolution.


Stages of forced termination: uses of the death metaphor.

Several patients undergoing forced termination appeared to experience a series of staged reactions similar to those described in dying patients. On the basis of this parallel we explored the effects of using the specific clarification that the ending of therapy was similar to a death. This technique appeared to effectively free up those patients who were stuck in a particular stage of the process so that they could complete the termination. Supporting case material is presented and the clinical implications of this innovation are discussed.


Migrant farm workers: social conditions, adaptive belief systems, and psychiatric care.

Two migrant farm labor camps were observed during two summer harvesting seasons. A part of the observations consisted of interviews with 104 farm laborers, with 16 of them being interviewed intensively. Migrant farm workers were exploited by the crew boss and the farm owner, and they in turn exploited each other. Consequently, many workers left farm work. Those who remained in the camps adapted their attitudes and their views to the conditions. Though they had a begrudging respect for the crew boss, they showed an overriding concern with exploitation. They conveyed a numbness about life, themselves, and their place in society; this numbness was combined with self criticism and an attempt to maintain some self-respect. They expressed distrust for and suspicion of others, and though they could not articulate it very well, they felt great fear and anxiety. In order to diagnose and treat disorder in migrant farm workers, psychiatrists must understand the exploitive social setting of migrant farm work and the adaptations of workers to that setting.


Doomed status: observations on the segregation of impaired old people.

The antecedents and consequences of the segregation of severely impaired old people within institutions is a problem that deserves more research attention than it has so far received. Given that such segregation exists and that it has some positive benefits for both staff and residents in homes for the aged, it is proposed that there exist among administration and ward staff impulses to avoid the mentally impaired aged, and that these impulses are part of a more general phylogenetic residue. Many animals show avoidance reactions in the presence of strange objects or strange conspecific individuals, and the more advanced the animal, the more disturbed he seems to be. It is suggested that the segregation of impaired old people consigns them to a doomed role, rather than a sick role, and that the process operates largely through the impact of the activation of the emergency team and the withdrawal of community support and can result in the death of the individual, partly by means of suggestion. Examples of sudden unexplained deaths are drawn from material on simpler societies.


Patients' comments on psychiatric inpatient treatment experiences: patient-therapist relationships and their implications for treatment outcome.

Only few researchers pay systematic attention to what patients may have to say about their treatment experience during psychiatric hospitalization. This study not only delineates the various therapeutic aspects of an open psychiatric inpatient unit based on the patients' comments, but also attempts to correlate the data with the objective outcome of treatment rated clinically by the therapists and independently by the author. Positive patient-therapist relationship has been found to be the most significant factor correlated closely with the treatment outcome. The correlation may support the relevance of the patients' comments regarding subjectively perceived therapeutic benefits vs. objective actual benefits.


Adverse reactions to hypnotherapy in obese adolescents: a developmental viewpoint.

Hypnotherapy is a method of treatment for resistant obesity. This study was undertaken to ascertain the efficacy and/or risks it holds for adolescents. All tended to see hypnosis as a quick solution to longstanding problems. Other forms of weight control therapy had been unsuccessful. Untoward reactions occurred in many teenagers. These included: dissociated state, depersonalization, anxiety and fears. Patients who were not in a deep state of hypnosis were disappointed and viewed this as another failure experience. The severe side effects were observed in those patients in the earlier developmental phases of adolescence.


The suicidal character.

Suicidal behavior is generally taken to be symptomatic in nature rather than egosyntonic. However, any behavior which comes to be used as a means of adaptation to the world long enough tends to become ego-syntonic. There are some suicidal people for whom suicidality has become a means of securing nurturance from the interpersonal world. The usual "crisis response" to suicidality reinforces such patients in their suicidal styles. Increased long-term risk becomes the price of short-term nurturance. Specific alterations of treatment and management are indicated if such patients are to be helped to long-term survival.


[Ten years Heidelberg Day Hospital (author's transl)].

The article reports on the patient pattern at the Heidelberg day hospital according to the following criteria: Age, sex, social status, diagnoses, etc. The number of cases treated, as well as the development of the number of patients per year, and their period of hospitalization are reviewed over a period of ten years. Basing on a small sample of patients subjected to follow-ups, possible success criteria, such as employment and social relations, are discussed.


[Therapeutic atmosphere in psychiatric wards--an attitudinal study (author's transl)].

Psychiatric care in the Federal Republic of Germany has been consistently improving in recent years. In many psychiatric institutions therapeutic development has moved away from the "custodian" pattern toward a sociopsychiatric and patientoriented therapy. Those who are mainly concerned with this change, namely, the patients themselves, have so far been approached only rarely to give their opinion about conditions in their ward or to say how they experience and assess the situation in their ward. The present study attempts to explore, with the help of a questionnaire, the attitude of inpatients toward the psychiatric institution or ward. The following results are considered to be important: There is hardly any difference in the attitude of the patients toward the four hospitals investigated in Baden-Württemberg; Patients treated in open wards were significantly more satisfied than patients in closed wards; with increasing age, the patients expressed greater satisfaction with regard to the hopes for the future imparted by aimed therapeutic measures, and also with regard to material aspects of their environment; female patients are on the whole more content than male ones; the socioeconomical level and diagnosis of the patients influence their attitude toward the psychiatric institution.


[The compulsory confinement of mental patients (author's transl)].

Compulsory transfer of mental patients to closed hospital wards will continue to be a special burden on psychiatrists, social workers, relatives and legal courts. Attempts to establish close mutual therapeutic contacts must set in as early as ever possible. Medical and legal aspects regarding the implementation of the "confinement laws" are described, while taking into consideration recent developments in medical treatment and legislature.


[The limits of social reintegration after longterm psychiatric hospitalisation (author's transl)].

In cooperation with the University Clinic for Psychiatry, Innsbruck, the social psychiatric service of the regional government of South Tyrol set up a rehabilitation programm, under which 35 longterm hospitalized schizophrenic patients with an average stay in hospital of 12,9 years have been taken over by district institutions as outpatients. The object of our investigation was to study critically the working capability and the social relations of the 35 patients, the duration of postclinical catamneses is at least 3, at maximal 25 years. The degree of obtained reintegration is documented by the working situation and the number of social contacts. The obtained extent of resocialization and the proved positive social adaptation make it sensible to start a rehabilitation even with cronical patients with hospitalisation over decades: precondition is however a continual psychiatric care and control.


[Further developments in legislation governing guardianship and nursing care laws (author's transl)].

The legal measures covering protection and care in connection with legislation governing guardianship and fosterage involving medical nursing, which have remained unchanged in principle since 1896, increasingly create the risk of obstructing and hampering the treatment and rehabilitation of mental patients. In order to counteract this development, which is hostile to therapy, as can be demonstrated by means of concrete examples, a number of differentiated deliberations to improve the situation have been included in the expertise preparatory to the inquiry on the situation of psychiatry in the Federal Republic of Germany, dated 1975. These suggestions, which are well differentiated and aim at a minimum restriction of the rights of the individual in respect of protection of his personality, seem to be hardly sufficiently known, so that no use is made of them in public, political and expert discussions. Hence it appeared necessary to point once again to these suggestions as impressively as possible.


[A sociotherapeutic living-centre for psychiatric patients (author's transl)].

One of the functions of a psychiatric hospital is the so-called private or guest-house function. Each methodical-therapeutic approach, eventually constitutes to the existence of a normal human residence. The anthropological structure of this residence, is characterised by a polar buffer between openess and privacy. In the "Sociotherapeutic Centre" at the psychiatric hospital "Wolfheze", stature is given to this private or guest-house function. The importance of the sociotherapeutic centre, lies in the living together of patients, with and for each other. The numerous hospitalizing neurotic effects, of long term nursing in big-pavilions, are minimised by the living together of patients in small groups. Hospitalization is primarily considered as a positive matter. The negative effects of the treatment fall under term "hospitalizationsyndrome". Living, hospitalization on one side and rehabilitation on the other are no contrast. The differences of these living-groups offer the best chances for socio-therapy and rehabilitation.


A naturalistic study of social influences on meal size among moderately obese and nonobese subjects.

The present study examined the amount of food chosen by moderately obese and nonobese customers in a university cafeteria as a function of whether they were about to eat alone or were explicitly accompanied by others during lunch. It was hypothesized that many overweight individuals are self-conscious about eating due to perceived social pressures, and that obese people would therefore choose less food (i.e., suppress intake) when eating with others than when alone. Food selections of a matched sample of overweight and nonobese individuals were recorded, and subjects were observed as they took a seat to determine if they ate alone or with others. Caloric values of foods chosen for each meal were computed. Results for the number of calories indicated that, as predicted, overweight subjects purchased less food when accompanied than when alone. Nonobese individuals, by contrast, chose more food when with others than when alone. In addition, males chose more food than females and obese subjects chose more than normals. Results were discussed in terms of the impact of social variables on eating behavior, and the theoretical importance of weight consciousness and pereceived social pressures in understanding correlates of obesity. Several alternative explanations were addressed.


Social interactions, communications, and the coronary-prone behavior pattern: a psychophysiological study.

Sixty subjects classified as either Type A or Type B interacted in pairs by pressing buttons which transmitted messages through a television screen while the heart rate and digital blood volume pulse were computer-monitored. Partners could cooperate, compete, punish, reward, or withdraw on each interaction and could send 1 of 55 messages communicating feelings, requests, and behavioral intentions between interactions. Interactions and communications between Type A subjects were strikingly different from Type B subjects. Type A's were noticeably more aggressive competitive. Type A dyads also exhibited larger digital vasomotor responses than  Type B dyads. When Type A subjects and Type B subjects interacted with each other, rather than with a same-type partner, the differences between them in behavior and vasomotor response largely disappeared.


Effects of thematically relevant and general stressors on specificity of responding in asthmatic and nonasthmatic subjects.

Twenty-nine mild asthmatics and 12 nonasthmatics were exposed to three films of varying emotional content to assess differential patterns of physiological response in the cardiac, ventilatory, and bronchial systems. Results indicated that only cardiac interbeat interval (IBI) and total respiratory resistance (RT) were reliable indices of reactivity. In a film of thematic relevance to asthmatics which depicted asthmatic children in a hospital setting, asthmatics evidenced sustained elevation of RT throughout the entire film with no reactivity in IBI. Nonasthmatics did not evidence any significant reactivity to the film. In a film of a generally stressful nature which depicted industrial accidents, asthmatics evidenced elevated RT in response to the accident scenes. Both asthmatic and nonasthmatic subjects responded to the post-accident periods with increases in IBI. In a film depicting a mother giving up her child for adoption, asthmatics responded to the relinquishing of the child with elevated RT. These results are discussed in terms of the necessity of evolving a comprehensive theory of specificity patterns in psychosomatic disorders which goes beyond models of symptom specificity and stimulus-response specificity, neither of which can adequately account for these results. The results are further seen as supporting the utility of selecting stressors of thematic relevance to asthmatics and measuring symptom-relevant indices of physiological reactivity to isolate these specificity patterns in response to stress.


Psychological stress, ego defenses, and cortisol production in children hospitalized for elective surgery.

This study was designed to investigate the relationship between the effectiveness of coping mechanisms and physiological indicators of distress in children faced with the experience of hospitalization and surgery. Twenty-five children between the ages of 7 and 11 were studied in the out-patient department, 2 weeks before surgery, and again during their hospital stay. Effectiveness of defenses and defense style was measured by a clinical interview and by the Rorschach test. Cortisol production rates were measured by the analysis of 24-hour urine collections at home and again in the hospital. Ward adjustment was also rated by a ward questionnaire. The results indicated no relationship between defense effectiveness and cortisol production rates in the out-patient department and an inverse relationship between cortisol production and defense effectiveness under the stress of hospitalization. Defense style was found to correlate with coping under stress. Four different groups of children emerged, suggesting four different types of reaction to the hospital experience.


The gross national health product: a proposed population health index.

A population health status index designated as the gross national health product (GNHP) is proposed as a general measure of the health of nations or population groups. The GNHP integrates mortality and disability data into a single number in units of disability-free life years lived per 100,000 population. It is based primarily on mortality ratios and life expectancies of component age groups of the population, modified by their respective disability experiences. A computational example with data currently available on U.S. geographic regions from publications of the National Center for Health Statistics shows that the GNHP was highest in the West, indicating the highest number of disability-free years lived. Because of simplicity in its computation and interpretation, the GNHP can be used by health systems agencies (HSAs) in monitoring their performance or in conducting comparative studies.


Hypertension followup in an urban black population.

In a 5-year period, 215 black hypertensives were identified at a neighborhood primary care center that offered free services to residents of a low-income housing project. The mean length of followup for the group was about 34 months, and 183 persons were followed for more than 1 year. Their mean age was 56 years; there were 34 men and 181 women in the group. Fifty-six percent of the 215 persons had a history of hypertension when they came to the center. Three types of outcome measures were examined in this study: (a) compliance, in terms of continued activity in the clinic; (b) lower blood pressure, preferably in the normal range; and (c) development of complications of hypertension. Sixty-seven percent of those alive and still residing in the area were continuing in the program; 37% achieved normotension and an added 21% had improved blood pressure readings. There was no statistical difference in the occurrence of hypertensive complications by initial severity of the hypertension or by how well the blood pressure was controlled. The 75 obese women in the group had more severe hypertension, more new complications, and were less likely to achieve normotension than the 106 nonobese women. These relationships were statistically significant.


Human antirabies treatment in the United States, 1972.

Data were examined on 965 persons treated in six States (Delaware, Florida, Georgia, Illinois, North Dakota, and South Carolina) and New York City in 1972 for possible rabies exposure. Males 10-19 years were found to be the group at greatest risk, and exposures occurred most frequently during the warm months. Dogs, other domestic animals, and wildlife were about equally responsible for human exposures in the six States, but 99% of the exposures in New York City involved dogs.  Antirabies postexposure prophylaxis varied markedly among reporting areas and frequently did not follow current recommendations. The mean delay in initiation of treatment after exposure was 4 1/2 days. The mean number of doses of vaccine for treatment was 12; only 10% of the persons treated received antirabies serum.


Home-made radiographic phantoms.

The article describes a method of manufacture for homemade radiographic phantoms. The stages of manufacture and material requirements are described. The phantoms described are used as teaching aids in the Royal Naval School of Radiography.


Effect of narcotics on monoamine oxidase activity of mouse brain.

The effect of morphine, levorphanol and methadone on the monoamine oxidase (MAO) activity of mouse brain was studied. Both methadone and levorphanol produced a concentration-dependent inhibition of whole brain mitochondrial MAO in vitro with an IC50 of approximately 7.4 x 10(-4) for levorphanol and 2.5 x 10(-6)M for methadone. Methadone also produced a 60% inhibition of the MAO activity of the hippocampus, a 32% inhibition of the striatal and hypothalamic enzyme, a 30% inhibition of liver, and a 20 and 23% inhibition of the cerebral cortex and cerebellum, respectively. Naloxone did not antagonize this effect of methadone. In contrast, morphine had little effect in vitro except at very high concentrations where it was inhibitory. This was not linear with concentration and no IC50 could be estimated. This would imply that the inhibition by morphine is non-specific. When acutely administered to mice, morphine and methadone, again differed. Methadone produced a slight but significant inhibition of whole brain MAO and a 34% inhibition of the striatal enzyme. Morphine, on the other hand, produced a marked enhancement in the activity of the striatal enzyme. Since this action could not be demonstrated in vitro, it would suggest that the in vivo effect of morphine is indirect resulting from an alteration of some other modulating system.


The influence of chlordimeform on calcium and glucose homeostasis.

The effects of single and repeated administration of chlordimeform on calcium and glucose homeostasis were examined in the rat. A single injection of chlordimeform (100 mg/kg, i.p.) produced a rapid 15 percent decrease in plasma calcium and a 64 percent rise in plasma glucose. The administration of chlordimeform (75 mg/kg, i.p., twice daily) over a period of 7 days caused an 8 percent reduction in plasma calcium, a 50 percent decrease in duodenal calcium transport and a 20 percent decrease in body weight.


Light-evoked changes in chick optic lobe adenylate-cyclase.

The effects of exposure to 48 h darkness and to stroboscope stimulation on chick optic lobe adenylate-cyclase activity were studied. A significant decrease in adenylate-cyclase after 48 h exposure to darkness occurred with return to normal values after re-exposure to light. Stroboscope stimulation for 3 min produced instead a marked increase in optic lobe adenylate-cyclase. Present experiments suggest that cAMP may serve as inhibitory messenger in synaptic transmission along central visual pathways.


Brain sulfatide and non-lipid sulfate metabolism in hypothyroid rats.

Neonatal hypothyroidism reduced the concentration of sulfatide in myelin and synaptosomes isolated from brains of 20-21 day old rats. The in vivo incorporation of 35SO4 into sulfatide of myelin, microsomal, animals, as was the incorporation of the isotope into non-lipid sulfate (sulfated glycoproteins and mucopolysaccarides) of microsomal and synaptosomal fractions. In contrast, when animals were made hypothyroid at one month of age, no depletion of brain sulfatide or alteration of incorporation of 35SO4 into sulfatide was found, although incorporation of the isotope into non-lipid sulfate of myelin, mitochondria and synaptosomes was increased by this treatment. These results indicate that the metabolism of sulfatide and non-lipid sulfate of brain membranes is much more susceptible to alteration by hypothyroidism in neonatal than may alter the metabolims of sulfatide and non-lipid sulfate in neuronal as well as myelin membranes.


Sugar derivatives and liver mitochondria. I. - Effect of methyl-3,5-di-O-benzyl-2-chloro-2-deoxy-D-arabinofuranoside.

Effect of fifteen sugar derivatives on oxygen uptake and oxidative phosphorylation by liver mitochondria were tested. Full details of the possible mechanism of action of methyl-3,5-di-O-benzyl-2-chloro-2-deoxy-D-arabinofuranoside (VI) was presented. This sugar derivative seems to act as inhibitor of the electron transport in the respiratory chain and as an uncoupler.


Effective plasma concentration of N-acetylprocainamide in rats.

Six groups of rats received saline or N-Acetylprocainamide (NAPA) 2--50 mg/kg, intraperitoneally. Thirty minutes later heart rates were measured and simultaneously a blood sample was withdrawn from each rat. There was a linear relationship between plasma concentrations and the administered doses, suggesting linear pharmacokinetics for NAPA. The heart rate was decreased significantly when the average NAPA plasma concentration was 16.8 microgram/ml, which is similar to that found in man.


Side-chain monofluorinated analogs of amphetamine and p-chloroamphetamine. Effects on release of dopamine and 5-hydroxytryptamine from rat striatum.

Monofluorinated analogs of (+/-)-amphetamine and (+/-)-p-chloroamphetamine, in which the methyl group was replaced with a monofluoromethyl group, have pKa values approximately 1.65 units lower than those of their amphetamine counter-parts but retain some ability to stimulate release of dopamine and 5-hydroxytryptamine, respectively, from rat corpus striatum.


Measurement of propranolol, 4-hydroxypropranolol and propranolol glycol in human plasma.

An HPLC method for the quantitative determination of propranolol, 4-hydroxypropranolol, and propranolol glycol in human plasma is described. The limits of sensitivity for the method were: 1 ng/ml propranolol; 5 ng/ml 4-hydroxypropranolol; and 1 ng/ml propranolol glycol. Data obtained from 6 healthy volunteers given a single 160 mg oral dose of propranolol revealed mean (+/- SEM) peak plasma levels of 31 +/- 10 ng/ml for 4-hydroxypropranolol and 9 +/- 2 ng/ml for propranolol glycol. These plasma levels were less than the peak concentrations recorded for propranolol (123 +/- 34 ng/ml. The rates of plasma decay of these two metabolites were greater than that observed for propranolol.


Pharmacokinetics of verapamil in man.

Verapamil was given intravenously (10 mg) and orally (120 mg) in six healthy subjects. After intravenous administration, the serum levels in all subjects declined bi-exponentially. Thereupon, pharmacokinetic parameters were calculated using a two-compartment open model. The half-lives of distribution (T 1/2 alpha) and elimination (T 1/2 beta) phases showed 0.23 hour and 4.21 hour on an average respectively. The apparent volume of distribution [Vd (area)] showed 2.51 1/kg and body clearance (C1b) showed 500.64 ml/min on an average. Renal clearance was smaller than normal human creatinine clearance. After oral administration, the time to reach peak blood level (Tmax) was reached within 1.84 hour and the peak serum concentration showed 219.09 ng/ml on an average. The bioavailability was only 22.47% on an average. Verapamil produced a marked prolongation of PQ interval on electrocardiogram and the degree of PQ interval prolongation was closely related to the increase in serum concentration of this compound. QRS, QTc and RR interval were not changed by this compound.


Ether-induced vasodilation in the rat.

The hypotensive effect of ether in rats was investigated by the direct Fick technique to determine whether hypotension was produced by reduced cardiac output or decreased total peripheral resistance. Relative to the conscious state, ether anesthesia decreased mean arterial pressure 9%, total peripheral resistance 47%, oxygen extraction 37%, and heart rate 7%; changes were qualitatively similar to those produced by hydralazine (0.5 mg/kg, i.v.) except that hydralazine did not decrease heart rate. These effects were no longer present two hours after withdrawal of ether. This study demonstrated that ether anesthesia in rats has a potent systemic arterial vasodilating action which is offset by increased cardiac output, resulting in mild hypotension.


Solvent system effects on drug absorption.

The in situ rat gut technique was used to determine 14-C salicylic acid absorption from aqueous solutions containing 20% glycerol, 20% propylene glycol, 10% ethanol, and 20% polyethylylene glycols (PEG) 4000 and 6000. A phosphate buffer solution of salicylic acid served as a control. Observed rate constants for disappearance of activity from the gut are 0.031 min-1 for glycerol, 0.0327 min-1 for PEG 6000, 0.0395 min-1 for propylene glycol, 0.475 min-1 for polyethylene glycol 4000, 0.0558 min-1 for ethanol, and 0.0752 min-1 for the control. The rate of disappearance from the gut is significantly slower than control for 20% glycerol, PEG 4000 and PEG 6000 solutions (p less than or equal to 0.01). Activity disappears more rapidly from 10% ethanol solutions than from PEG 6000 and glycerol (p = 0.01). Water flux into and out of the intestinal lumen was estimated from tritiated inulin concentrations in the perfusate. A trend for increased loss of activity from ethanol and control solutions associated with net water efflux from the intestine was observed. These results suggest that the composition of drug delivery systems may significantly affect the absorption of drugs from solution.


[Segmental venous replacemnet with heterologous graft (author's transl)].

Results of animal experiments are presented on the applicability in the low pressure system of a collagen prosthesis, which has been used successfully, for considerable time, in the arterial replacement in patients and dogs. Grafts of up to 7 cm in length were implanted into the suprarenal segment of the inferior vena cava (v. cava caudalis) in dogs and observed clinically over a period of more than 500 days. Histological investigations were made. With some limitations the results obtained are considered as good and point towards the applicability of the examined graft material in the low pressure system.


Morphological and biochemical changes in striated muscle after experimental tourniquet ischaemia.

Histological and biochemical changes were studied in the striated muscle following total tourniquet ischaemia between one and four h, the reflow time being 30 min and 24 h. Electronmicroscopy was applied to study the fine structure of the muscle after 24 h reflow. In light microscopy ischaemic changes were not seen even when the tourniquet time was extended to four h. When a four-h ischaemia was followed by a 24-h recovery period, the electron microscopy showed a variety of minor mitochondrial changes such as condensed and slightly dilatated mitochondria. The SDH activities did not vary significantly between the experimental and control samples even after a four-h ischaemia followed by 30 min or 24h reflow. The differences between the experimental and control samples were, however, highly significant in the LDH values in the groups where ischaemia had lasted for three and four h. The results indicate that tourniquet ischaemia for two to three h does not significantly affect the striated muscle of a rabbit and the alterations even after a four-h ischaemia seem to be partly reversible.


The role of upper airways and of sensoric receptors on reflex bronchoconstriction.

The influence of bilateral transection of the nervi laryngici cranialis, laryngici caudalis and glossopharyngici on ACH and allergen-induced bronchoconstriction was tested in 15 dogs. In three dogs the free preparation of bilateral nervi laryngici cranialis was performed for control measurements. Partial transection of pulmonary left nervus vagus was performed in three dogs and compared to radical transection of the same nerve in three animals. Transection of the nervi laryngici cranialis as well as of the nervi glossopharyngici was followed by the inhibition of the allergen-induced bronchoconstriction. The bronchoconstriction following ACH challenge was not influenced by transection. Bronchoconstriction induced by allergen returned to the same values within three weeks after surgical intervention. Partial unilateral dissection of the vagus nerve on lung hilus shows a small decrease in bronchial constriction induced by allergen and by ACH. Complete unilateral dissection of the vagus nerve on the lung hilus reduced the bronchial constrictoric response to both substances significantly.


The use of a programmable pocket calculator in clinical dietetics.

The application of programmable pocket calculators to clinical dietetics is described. The development of programs for the HP-67 and 97 for the evaluation of nutritional intakes of patients with obesity, renal disease, etc. and for the calculation and interpretation of food intakes in nutritional surveys is given in detail. The calculators simplify the practical work, shorten the calculation time substantially and allow direct incorporation of newly published data into analysis.


[Effect of urethane and penthobarbital on the behaviour of the renin-angiotensin-system in rat (author's transl)].

The behaviour of the renin-angiotensin-system was investigated after urethane and penthobarbital anaesthesia in rats. The recent results support the early observation that urethane increases the plasma-renin-activity and the haematocrit. It was further shown that urethane in the customary anaesthetic dose causes hypoproteinaemia and a decrease in the pressor response to angiotensin and in renin substrate concentration. Based on these results, its use as an anaesthetic in experiments connected with the renin-angiotensin-system does not appear to be appropriate.


Measurement of velocity of air flow in the sinus maxillaris.

Anemometry with the hot wire and hot film technique previously described, enables the rhinologist to record slow and rapidly changing air flow in the maxillary sinus. The advantages and disadvantages of this method are considered. Anemometry together with manometry may be designated sinumetry and used as a diagnostic procedure following sinuscopy in chronic maxillary sinus disease. The value of the function from velocity of time allows the estimation of flow-volume in the sinus. Furthermore, the method is useful to evaluate the optimal therapy to restore ventilation in the case of an obstructed ostium demonstrated before and after surgical opening in the inferior meatus.


Relationship between nasal obstruction and pulmonary ventilation in laryngectomized patients.

Respiratory gases (Po2 and Pco2) in arterial blood were determined in 19 laryngectomized patients (47 to 77 years of age) following nasal obstruction. Po2 values were somewhat elevated, but the difference was statistically insignificant, while Pco2 value remained the same. These results to a certain extent correlate with the findings of Cave et al. on dogs, but with a minor correction which we explain by the effect of the second reflex arch of the trigeminal--phrenic and intercostal nerves. Respiration (rate, tidal volume and minute volume) was also tested and the results agreed with the findings of respiratory gases.


133Xenon washout in the paranasal sinuses--a diagnostic tool for assessing ostial function.

A 133Xenon washout test is presented and interpreted. It was developed on the basis of studies into the accumulation of aerosols of different makes (lithium chloride in the form of ultrasonic, vibratory and pressurized aerosols) in the paranasal sinuses and sequential scintigraphy with radioactively labeled aerosols (99m Technetium colloidal sulfur) and is designed to shed light on the gas exchange in the paranasal sinuses and the patency of their orifices. The test constitutes a valuable addition to the battery of diagnostic tools for assessing paranasal sinus function and, at the same time, documents the true value of aerosol therapy.


Ostium resistance in acute maxillary and frontal sinusitis.

Ostium function tests were performed in 18 normal maxillary and 6 normal frontal sinuses. Further 57 patients with acute maxillary and 16 patients with acute frontal sinusitis were followed using sinumanometry until resolution of infection occured. After initial obstruction of the ostium, resistance decreased exponentially until complete decongestion. Respiratory pressure changes in the sinus during forced nasal breathing are a positive sign for healing of sinusitis. The amplitude of these fluctuations should be documented during each lavage and facilitates indication for drainage procedures.


[Phantom substances for the simulation of tissue of the soft parts in ultrasonic diagnostics (author's transl)].

The image-transmitting methods using ultrasound are gaining ground in medicine and are being increasingly used alongside the methods of diagnosis based on x-ray film. Whereas the use of phantoms for purposes of measurement and instruction has been common for a long time, there have so far been hardly any suitable phantoms for ultrasound. One of the reasons for this state of affairs is that only very little is known about the materials which are suitable for the simulation of body tissue. Among the physical factors which are important in ultrasonic examination are; the speed of sound, sound impedance, and the sound attenuation coefficient. The article reports on methods for selecting suitable phantom materials, and on measurements at an ultrasonic frequency of 4 MHz.


[Examinations of rare-earth film-screen-systems for image detectors in mammography (author's transl)].

Intensifying screens based on Gd2 O2 S : Tb were analysed for x-ray exposure reduction and resolution using in mammorgraphy. The contrast of these screens coupled with a single emulsion film was tested and the density dominante was determined. A resolution grid on this density exposured shows the detail resolution and judge the quality profile of these new film-screen-combinations. To all factors was compared a non-screen industrial film for long time processing. The application of Gadolinium intensifying screens in mammography allowed an exposure reduction of 75% at the same image quality like a nonscreen industrial film.


[Roentgen findings in the full-size abdominal radiograph in occlusion syndromes at the visceral aortic branches (author's transl)].

The acute visceral ischaemia syndrome (which, in typical cases, is caused by embolism or thrombosis of the arteria mesenterica cranialis or, in some cases, by a functional reduction of flow in that vascular area), is usually assigned to the roentgenologist under the heading "acute abdomen" for effecting an abdominal fullsize radiograph. Although this does not allow safe diagnosis and differential diagnosis, it does provide valuable pointers in quite a number of cases. One of the most specific symptoms is the so-called flexure cut-off symptom consisting of a pronounced accumulation of gas (wind) from the caecum to the left flexure. a typical case and one each similar case in a chronic visceral triple occlusion and a polycythaemia, are demonstrated. The mandatory diagnostic consequence of this symptom is immediate aorto-arteriography unless a functional cause is evident and can be successfully treated by conservative measures.


[Explatory roentgen examination of the anal canal (author's transl)].

Endoscopy is supplemented by a roentgenographic exploration of the anal canal via single and double-contrast methods, as part of routine irrigoscopy. A brief description is given of the technique employed in the examination of 256 patients. Normal roentgen anatomy is described in detail, followed by a definition of the different stages according to the degree of blood filling.


[Exceptional diabetic arthropathy of the foot (author's transl)].

The osteopathy of the foot is a rare complication of diabetes mellitus. It is seen in the distal parts mostly. The arthropathy ("Charcot-joint") is even more rare, and is regularly combined with a neuropathy. The roentgen signs of the "diabetic foot" are demonstrated, as there are osteoporosis, iuxta-articular cortical defects, osteolysis of the bone ends, bone destruction and reconstruction, periost reaction and sklerosis of the bone shafts.


[Angiography of the femoral artery with metrizamide without narcosis (author's transl)].

Metrizamide (Amipaque) is a new, non-dissociating contrast medium enabling completely painless angiographic examination of the arteries of the lower extremities. The contrast and visualisation--even of small vessels--are of the same standard as that of the angiographies effected with Amidotrizoat (Angiografin). Since general anaesthesia has been eliminated, the indication for angiography of the femoral artery can be broadened in the case of risk and emergency patients.


Transient right bundle branch block during His bundle electrogram in a case with ventricular parasystole.

A case with ventricular parasystole and transient right bundle branch block during His bundle electrogram is reported. Although on surface electrocardiogram no preexisting atrioventricular (A--V) conduction disturbances could be noted, His bundle electrogram showed latent infrahisian conduction changes. This suggests a susceptibility for induced right bundle branch block during right heart catheterization and may take part in the mechanism of the ventricular ectopic activity of the patient.


The logical structure of electrocardiographic diagnosis.

The description of a mathematical model of structure of electrocardiographic (ECG) diagnosis is given, starting from the automatically measurable characteristics of bioelectrical currents generated in the course of cardiac activity. The "dynamic diagnosis", established for rhythm and for atrioventricular conduction disturbances--by analysis in real time of the periodicity of electrical phenomena--is differentiated from the "static diagnosis", established for the other situations--by the logical intersection of amplitude conditions with duration of the waves belonging to a given ECG lead. Likewise, mathematical rationale separates atrial from infraatrial electrical activity.


Echocardiography in ischemic heart disease.

The kinetics and dimensions of the septum and left posterior ventricular wall as well as left ventricular performance were investigated by echocardiography in 50 patients with painful ischemic heart disease. In 10 cases hypokinesia and low left ventricular performance were found, more marked in those with a history of angina pectoris and myocardial infarction. The utility of this technique for exploring myocardial contractility and its limits is discussed.


Concentration of serum immunoglobulins in acute and chronic hepatic diseases. I. Serum-levels of IgG, IgA, IgM and IgD in young patients with viral hepatitis.

Concentrations of IgG, IgA, IgM and IgD were measured against WHO Reference Preparation 67/97 and British Standard 67/37 in sera from 105 patients with viral hepatitis and 110 "current" controls. To allow comparison at different ages and between sexes, constants previously determined on sera from a large "laboratory" group of controls were used to calculate "scores" for all Ig values. The patients' IgM scores were remarkably higher than those of controls and were bimodally distributed. About 68% of the patients had IgM scores more than 2 SD above the expected mean for laboratory controls. The distribution of IgG and IgA scores appeared unimodal, but schifted to the right of controls. The mean values of IgG and IgA scores were significantly greater in patients than in controls, and in female patients compared with males. Moreover, 16% (12 of 73) of the male and 47% (15 of 32) of the female patients had Ig G scores more than 2 SD above the expected mean. With regard to IgD, no significant difference between patients and controls was observed.


[Bone necrosis during osteomalacias].

On the basis of 3 personal cases, the authors study the characteristics of osteonecroses during osteomalacias. They compare their findings to those in the literature. Clinically, the location at the femoral head is predominant, with absence of pain and functional tolerance often noted. On the radiological level, the demineralization of the skeleton is not constant, and there are few Looser-Milkman striae. In the lower limbs the necrosis is always located in the supporting areas, showing a restricted surface with little or no perinecrotic condensation and an absence of bone sequestrum. The cartilage remains intact for long periods. A pathogenic interpretation is proposed: the increasingly fragile state of the bones causes a subchondral fatigue fracture. The malacia bone thus adapts itself to the mechanical constraints thus imposed on it.


Concentration of serum immunoglobulins in acute and chronic hepatic diseases. II. Viral hepatitis; time-dependent changes in immunoglobulin concentration.

Immunoglobulin (Ig) concentrations were determined on blood samples drawn of 6 occasions over a 2-month period from 38 young patients with viral hepatitis. The main and joint effects of sex and day factors on mean Ig levels were studied by using a 2-way ANOVA model. No distinct pattern of variation was observed for IgA, IgG and IgD, whereas the mean values of IgM showed a statistically significant variation throughout the study period. Female patients had significantly higher mean Ig values than males; for each Ig-class, however, the day-to-day variation was very similar in the two sexes, as reflected by an unsignificant sex-day interaction. The results suggest that serial measurements of IgM levels can be useful for identifying those patients at risk of developing chronic hepatitis and for an early detection of viral hepatitis in persons at very high risk of contracting this disease.


[Partial decalcifying algodystrophy].

Partial decalcifying algodystrophy (PDA) appears in two forms: one, a radial form, affects, following a certain metameric topography, one or two radiuses of the hand or of the foot (two cases reported); the other, a zonal form, is more peculiar: only part of a condyle or of the femoral head, are demineralized for two to three months. The authors report 7 cases of this misleading zonal form, 2 of them after histological verification. The image leads to various diagnostic errors: osteitis or infectious osteo-arthritis, acute inflammation close to the bone, and especially malignant processes. However, zonal PDA has its own characteristics: demineralization, that becomes clear only during the second month, and quickly extends over a rather long sub chondral bone surface. Tomography is very useful: it demonstrates better the severe sub chondral osteoporosis and the retention of the bone sole, which becomes detached from the bone. Scintigraphy shows the massive localized or panregional hyperfixation and sometimes other infraradiological sites (hips, knee or ankle). Zonal osteoporosis remains partial and misleading for only 2 or 3 months, after which it becomes a classical panregional form. The rate of development is that of DA. Painful impotence quickly increases, with cure in 6 months.


Long-term effect of radiotherapy on the lymphocyte lysosomal enzymes and serum immunoglobulins in patients with cancer of the larynx.

Thirty male patients ranging in age from 40 to 70 years, investigated 6--9 years after radiotherapy for cancer of the larynx, showed various alterations of the lysosomal apparatus of peripheral blood lymphocytes. These changes, consisting of diffusion of the lysosomal enzymes within the cytoplasm and disappearance of normal lysosomal granules, were related to a greater extent to the beta-glucuronidase and N-acetyl-beta-glucosaminidase positive-lysosomes than to the acid phosphatase-positive ones. Determination of the enzymatic activities was achieved by cytochemical techniques. The increased immunological reactivity of the patients was reflected in the frequently elevated immunoglobulin levels, particularly that of IgA, in the serum and an increase of the enzyme-positive lymphocyte count in the blood.


Beneficial and adverse effects of atropine in patients with acute myocardial infarction.

The action of atropine on heart rate, prevention of arrhythmias, electrical activity and heart contractility was studied in 35 patients with acute myocardial infarction. Atropine had a favourable effect in 24 out of 27 patients with sinus bradycardia, and hypotension present in some cases was improved. Ventricular extrasystoles observed in 12 patients were suppressed within one hour after atropine administration. A--V block was well influenced in 9 of 16 cases. Nine patients with A--V block, of whom 8 with pump failure, presented arrhythmias after atropine. In 12 patients atropine determined a transient enhancing of the ST segment elevation, caused a persistent increase of the Q wave and altered the systolic time intervals by reducing contractility, with subsequent partial return to initial values. The data obtained justify the use of atropine for the improvement of sinus bradycardia, of arterial hypotension and of A--V block. During the effect of the drug there occurred electrical and contractility changes and, in some patients with pump failure, arrhythmias appeared. These observations demonstrate the necessity of monitoring the patients under atropine treatment and of using small doses, repeated if necessary.


[Multiple myeloma of bones. Retrospective study of prognostic factors based on a series of 243 patients].

The authors have made a retrospective study of 243 cases of multiple myelomas, most of them treated with alkylating agents. The average age at the time of diagnosis was 65 years (+ 10). The ratio of the sexes was 1 : 1. Seventy two per cent of the patients had a bone rating of 2 or 3 according to the criteria of Durie and Salmon. Fifty-eight per cent of the patients were anemic (Hg 12 g per cent), with less than 15 per cent being leucopenic or thrombopenic. Hypercalcemia (105 mg 0/00) was noted in 27 per cent of cases. The distribution of immunochemical types is as follows : IgG, 51.5 per cent; IgA, 28 per cent; pure Bence Jones, 20.5 per cent. The respective percentages of kappa and lambda light chains were 64.2 per cent and 35.8 per cent. In this series, nearly 80 per cent of the patients were at phase III according to the classification of Durie and Salmon, and 30.8 per cent at phase B. The median survival, including all phases, increased from 8 months without alkylating agent, to 20 months with melphalan and/or cyclophosphamide. The factors influencing the survival of the patients treated were age, the hemoglobin level, calcemia, renal deficiencies, the immunochemical type, the stage of the disease, and the response to alkylating treatment. The value of these different prognostic factors is discussed.


[Results and long-term risks of immuno-suppressive treatment in chronic juvenile arthritis. Apropos of 40 cases].

In 40 children suffering from a form of chronic juvenile arthritis (CJA), the authors found encouraging results after immuno-suppressive treatment. Indeed, major corticotherapy, often necessary in these forms, could be stopped in nearly half the cases. The immediate improvement in the clinical signs of the disease was very clear and the signs of corticoid intoxication regressed, and in particular growth was normally resumed in many of the children. While the immediate infectious and hematologic consequences are generally benign, the occurrence of malignant hemopathies at a distance, seen in 3 cases, mean that use of this type of therapy should be totally reconsidered during CJA. The authors feel that because of this grave oncogenic risk, the immunosuppressive treatments should not be reserved merely for forms that involves the vital prognosis in the more or less short run.


[Bone histomorphometry and osteo-articular manifestations of idiopathic hemochromatosis].

An histomorphometric study of the bones was done on 28 patients suffering from an idiopathic hemochromatosis. There was a normocalcinemic hyperparathyroidism in half the cases. It appeared to be closely linked to hypersideremia and to be responsible for the sub-chondral arthropathy. The other lesions demonstrated were an osteoporous one, whose relations with hypogonadism was shown, and osteoidosis variations, which most often decreased rather than increased, and whose causes still seem uncertain.


Gastric morphology, function, and immunology in first-degree relatives of probands with pernicious anemia and controls.

Gastric morphology, function, and immunology was studied in 68 patients with pernicious anemia (PA), 183 of their first-degree relatives, and 354 control subjects. The PA relatives and controls were comparable in age and sex distribution. In both groups, mean gastric acid output decreased and mean fasting serum gastrin levels and the prevalence of atrophic gastritis increased with age. The total prevalence of chronic gastritis was similar in the two groups, but severe atrophic gastritis of the body of the stomach (AGB), achlorhydria, parietal cell antibodies, and a raised fasting serum gastrin level were significantly more common in PA relatives than in controls. Of the PA relatives 23 had severe AGB which was indistinguishable from the gastric mucosal lesion found in PA probands and was, as a rule, accompanied by several other characteristics of type A gastritis. These included a normal antrum (78%), slight or absent inflammatory cell infiltration in the gastric mucosa (70%), achlorhydria (91%), high fasting serum gastrin level (83%), parietal cell antibodies (65%), and intrinsic factor antibodies (22%). The mean age and the proportion of subjects with slight and moderate AGB of all AGB subjects was significantly lower in PA relatives than in controls. This suggests an early onset and a rapid progression from mild to severe AGB in PA relatives. Thus, the PA relatives appear to consist of two populations, one with a high and one with little or no proneness to severe AGB. This bimodal distribution suggests the participation of a single major factor, probably genetic, in the pathogenesis of severe AGB in PA relatives.


Depression of exocrine pancreatic secretion by collection through duodenoscopic catheters.

Two dogs were equipped with gastric and duodenal cannulas permitting quantitative collection of pure pancreatic juice. Two series of experiments were performed: 1) collection through a short catheter, length 35 cm, volume 0.3 ml, and internal diameter 1.0 mm, and 2) collection through a long catheter used for duodenoscopic cannulation in man, length 110 cm, volume 1.7 ml, and internal diameter 1.0 mm at the tip and 1.4 mm in the other part of the catheter. After a basal period of 30 min the secretion was stimulated with secretin in the doses 0.1, 0.5, and 2.0 clinical units/kg/h, each dose being infused over a period of 30 min. With the long catheter the dose-response curve for fluid and bicarbonate was shifted to the right. The basal secretion of fluid was depressed 40%; with increasing secretory rates the depression was less pronounced. No significant depression of the bicarbonate concentration was seen. The protein secretion was insignificantly reduced.


Assessment of cerulein effects on serum bile acids concentration in liver disease. Comparison with the test meal.

Twenty-four liver patients and seven healthy subjects underwent the enzymatic-fluorimetric assay of total serum bile acids during fasting and after a hyperlipidic meal, both alone and with the intramuscular administration of 0.3 microgram/kg of cerulein. A third test with cerulein alone was carried out on the control group and on 12 liver patients. The liver patients were divided into two groups; those with moderate and severe liver disease, according to the degree of liver function impairment and the clinical data. The best discriminant efficiency was observed in the test with the meal alone, even if, in the liver patients, the meal with cerulein caused a greater percentual increase of serum bile acids. After taking into account the most significant correlations between serum bile acids and liver function tests, the addition of cerulein to the meal may be recommended for liver patients with previous cholecystectomy or gallbladder pathology.


Agarose gel electrophoresis of duodenal juice in normal condition and in children with malabsorption.

Agarose gel electrophoresis (at pH 8.6) was used for qualitative determination of pancreatic enzymes in duodenal juice. The various enzymes were identified by staining techniques with specific chromogenic substrates, by quantitative determination of enzymes in eluates of gel slices, and by immunoelectrophoresis. The various protein bands corresponded to the following enzymes (from the anode to the cathode): chymotrypsin, trypsin, carboxypeptidase A, chymotrypsin, amylase (around the slit), lipase, elastase, and trypsin. The method was applied to a study of exocrine pancreatic function in 10 adults and 83 children suspected of having malabsorption. The duodenal juice, also analyzed for trypsin and amylase content, was collected in fasting condition and after a test meal of water. In patients with normal pancreatic function, all the enzyme bands were present and easy to recognize. In 87 patients carboxypeptidase A was present as two bands in 68 (80%), anodal trypsin as two bands in 39 (45%), and cathodal trypsin as two bands in 85 (97%). Electrophoresis of duodenal juice gave as much information from the fasting sample as after the test meal. Six children with pancreatic insufficiency (cystic fibrosis and Shwachmar's syndrome) had no or only faintly stained enzyme bands and a strongly stained albumin-containing band most anodally. The method is simple, rapid, and useful in routine work. The combination of this qualitative test with a quantitative one (e.g. trypsin determination) provides good information about exocrine pancreatic function.


Partial reconstruction of intestinal continuity in the treatment of severe side effects following intestinal shunt operation for obesity.

Severe side effects of intestinal shunt operation were the indication for reoperation of eight patients. To maintain the acquired weight loss, complete revision of the bypass and return to normal gastrointestinal continuity was omitted. The shunt was taken down and moved 20 cm in proximal direction on the terminal ileum. After this procedure weight loss was converted to a small gain in weight, diarrhoea decreased, and electrolyte disturbances turned out to be a minor problem. At the same time quality of life improved. We suggest that this type of reoperation is adequate in most patients suffering from severe side effects after intestinal bypass operation.


Pneumatosis cystoides coli associated with high H2 excretion. Treatment with an elemental diet.

A patient with severe diarrhoea and gas-filled cysts in the wall of the colon is reported. The patient had normal lung function but an extremely high end-expiratory H2 fasting value. Treatment with an elemental diet for 2 weeks resulted in a decreased H2 value and in regression of the cysts. After 4 months on a normal diet extensive recurrence was observed. We conclude that excessive intestinal gas production may play a role in the pathogenesis of the cysts.


The effect of parietal cell vagotomy and selective vagotomy with pyloroplasty on iron absorption. A prospective randomized study.

Iron absorption from a composite meal was studied in 37 male patients before and 1 year after parietal cell vagotomy (PCV) and selective vagotomy with pyloroplasty (SV + P) in a prospective randomized series. The ability to absorb dietary non-haem iron was studied by relating in each subjects the food iron absorption to the absorption from a small dose of ferrous iron, which has been shown to be unaffected by gastric surgery. After both PCV and SV + P there was a malabsorption of food iron which was statistically significant in patients with increased iron requirements caused by phlebotomy. Malabsorption of food iron was less marked after PCV and SV + P than in patients after gastric resection, and it is concluded that there may be no need for a general prophylactic iron supplementation in patients operated on with PCV and SV + P.


Biopsy and brush cytology in the diagnosis of gastric cancer.

In a prospective study the diagnostic value of biopsy and that of brush cytology in the diagnosis of gastric cancer were compared. The patients included in the study were endoscopied because of upper abdominal dyspepsia. When the endoscopic appearance of the mucosa suggested malignancy, and in all cases in which ulcerations were seen, brush cytological smear and at least five biopsies were obtained. The cytology and the biopsy specimens were assessed by two different pathologists in a mutual blind fashion. If the result of the examination suggested or showed the presence of cancer, it was considered positive. The results were evaluated by means of sequential analysis. When 195 examinations had been included in the study, disagreement had occurred in 8 cases, in all of which the biopsy was verified as correct. This difference is significant. In 187 cases the result of the 2 tests were in agreement, but in 3 cases the result of both tests were falsely negative. It was concluded that no diagnostic advantage was gained by the addition of brush cytology to endoscopic biopsy.


Ulcer risk in a duodeno-gastric antireflux operation in dogs.

Duodenogastric reflux is a possible pathogenetic mechanism in some type I gastric ulcers. An antireflux operation is therefore a logical procedure but involves the risk of marginal ulceration. To examine this risk, the following study was performed: 18 dogs were divided into 3 groups of 6. One group had an antireflux operation performed (AR), one had AR plus parietal cell vagotomy (AR + PCV), and the third was a control group that was given daily injections of 40 mg repository histamine. All control dogs developed ulcers after 7-84 days, mean 37 days, of histamine. Three dogs in the AR group developed ulcers spontaneously 55-92 days postoperatively, whereas none of the AR + PCV group developed ulcers spontaneously 72-108 days postoperatively. After histamine injection two of the remaining three AR dogs developed ulcers after 3-4 days of stimulation, and three of the six AR + PCV dogs developed ulcers after 4-5 days of stimulation. It is concluded that the AR operation is heavily ulcer-prone and that PCV does not protect sufficiently against ulceration.


Intestino-gastric reflux in dogs: spontaneous, after gastrojejunostomy, and after Roux-en-Y gastrojejunostomy with various lengths of the defunctioning loop.

Intestino-gastric reflux was measured in dogs with duodenostomy and gastrostomy by using chromium-51 injected through the duodenostomy. No transpyloric reflux was demonstrated. When gastrojejunostomy was performed, a large reflux was demonstrated. After conversion of the gastrojejunostomy into a Roux-en-Y gastrojejunostomy with various lengths of the defunctioning loop, a decrease in reflux was demonstrated, significantly correlated to the length of the loop. The calculated length corresponding to no reflux was found to be 49 cm.


Plasma enteroglucagon after jejunoileal bypass with 3:1 or 1:3 jejunoileal ratio.

Enteroglucagon concentration in peripheral blood was determined before and after a test meal in 24 morbidly obese patients. Eighteen had jejunoileal bypass, 6 with a 3:1 and 12 with a 1:3 jejunoileal ratio of the functioning segment, and 6 were unoperated. All three groups exhibited an increment of enteroglucagon concentration after the meal. Both the fasting values and the postprandial integrated increments were higher in operated patients than in unoperated patients and higher after 1:3 bypass than after 3:1 bypass. The findings agree with the hypothesis that enteroglucagon secretion is stimulated by exposure of the lower bowel to upper-bowel content, and that the effect of enteroglucagon is, as seen after bypass operation, stimulation of growth and reduction of motility of the intestine.


Survival rate in Crohn's disease and ulcerative colitis.

The survival rate in 709 patients with chronic inflammatory bowel disease (CIBD) was calculated by the log rank test. There were 297 patients with Crohn's disease (CD) and 412 patients with ulcerative colitis (UC). In both diseases there was a survival rate of about 94% in the first year of observation against an expected rate of 99.5% in a general population matched for sex and age. This was because a large number of patients were severely ill at their first admission and required immediate or early surgery. During the subsequent 11 years the death rate in CIBD was higher (two to three times) than in the general population. After 12 years the survival rate was about 77% in both CD and UC. The difference was statistically insignificant. There was no significant difference in the sex ratio. The cancer rate was low. No gastrointestinal cancer occurred among patients with CD. Colorectal cancer was found in four patients with UC, three of whom presented with cancer on their first admission. It is concluded that recurrence and reoperation for recurrence in Crohn's disease have not impaired the prognosis compared to ulcerative colitis in this series.


Radioimmunoassay of group I pepsinogens (PGI) and the effect of food on serum PGI.

A sensitive and precise radioimmunoassay of group I pepsinogens (PGI) in serum is described. The method is a modification of the one described by Samloff and Liebman. The most important improvement is that 125I-labeled PGI can be stored diluted for at least 7 weeks without loss of immunoreactivity. The present method has a detection limit of 2.6 ng/ml, a within-assay precision of 6%, and a between-assay precision of 17% in the normal range. A light test meal had no significant effect on serum PGI. Serum PGI in 388 non-fasting subjects 20-49 years old was 164 +/- 5 ng/ml (mean +/- S.E.M.). In these subjects serum PGI was significantly higher in men than in women. In both sexes the frequency distribution showed two peaks, indicating the presence of two different populations.


Abnormal duodenal loop: influence on basal and food-stimulated motility pattern.

Basal and food-stimulated motility patterns were studied in seven patients with distal duodenal anomalies (DDA) and in seven controls. A discordant pressure pattern and a significantly higher frequency of pressure waves was observed in DDA both in the basal state and after food intake in comparison to controls. It is concluded that the shape of the duodenal loop can influence basal and food-stimulated motility patterns in the duodenum, and thereby probably also the transport mechanism through the duodenal loop.


Autonomous erythropoietin induced erythrocytosis.

Erythrocytosis in a young Sinhalese man is described. The patient was known to have had a raised Hb and PCV for at least 10 years. Subsequent investigations failed to support the diagnosis of polycythaemia vera or to reveal a cause for secondary polycythaemia. Blood erythropoietin values were raised, but no cause for inappropriate secretion could be identified. Although there was no evidence of erythrocytosis in the family, the findings in this patient appear to be those of a condition which has been called familial polycythaemia. The spleen was unusually large and was associated with hypersplenism and thrombocytopenia. Problems of diagnosis and management are described. Phlebotomy appears to be the treatment of choice, with a regimen of regular venesection for the control of symptoms due to hyperviscosity and vascular occlusion.


The relationship between marrow iron stores, plasma ferritin concentrations and iron absorption.

The percentage absorption from a 3 mg dose of ferrous iron was measured in 50 subjects with iron stores that varied over a wide range. Iron status was assessed by a number of measurements, including the haemoglobin concentration, the plasma iron concentration, the total iron-binding capacity, the plasma ferritin concentration and the concentration of non-haem iron in the bone marrow. There were good inverse correlations between the log percentage iron absorption and both the log marrow non-haem iron concentration (r -0.94; P less than 0.001) and the log plasma ferritin concentration (r -0.78; P less than 0.001). In addition, there was a positive ferritin concentration (r +0.84; P less than 0.001). These results suggest that reticuloendothelial iron stores represent an important determinant of iron absorption and that their size can be guaged from the plasma ferritin concentration.


Heat production by lymphocytes in chronic lymphocytic leukaemia.

Using microcalorimeters of the thermopile conduction type heat production was measured in lymphocytes from peripheral blood in 8 normals and 10 patients with chronic lymphocytic leukaemia (CLL). The heat production per CLL lymphocyte was lower (1.8 pW/cell) than that found in normal lymphocytes (2.6 pW/cell). Due to the high numbers of lymphocytes in the peripheral blood the estimated heat production of the intravascular lymphocyte pool in CLL was considerably higher than in normals. Since the circulating lymphocytes constitute a minute fraction of the total lymphoid mass in CLL it is suggested that the accumulation of metabolically active lymphocytes in blood and tissues may explain the common clinical signs of hypermetabolism in this disease. The results also indicate that calorimetry may be a useful technique for metabolic studies in suspensions of malignant cells.


Concomitance of an active and an inactive mutant of red cell pyruvate kinase (PK).

A new mutant red cell PK associated with mild chronic haemolytic anaemia is described. The propositus, double heterozygous for a maternal gene coding for a structural abnormal enzyme and a paternal gene coding for a catalitically inactive enzyme, was suitable for an accurate functional characterization of the PK variant since his erythrocytes contained only one active mutant form of this enzyme. The active isoenzyme was characterized by low activity, decreased affinity for phosphoenolpyruvate, incomplete fructose-1,6-diphosphate activation, increased 'zero-time transition temperature', increased stability to guanidine-HCl and storage at +4 degrees C, increased guanosine-5'-diphosphate and cytidine-5'-diphosphate utilization, altered electrophoretic pattern with a single slow-moving component and abnormal isoelectric point. Affinity for ADP, ATP inhibition, optimum pH, molecular weight of the subunits, antigen concentration and immunological properties were in the normal range.


Elevated plasma lysozyme in Hodgkin's disease. An indicator of increased macrophage activity?

Plasma lysozyme levels were studied in 42 patients with Hodgkin's disease and were found significantly increased. Plasma lysozyme varied with the stage of the disease and with symptoms, but did not correlate with the histological subtype or with blood neutrophil and monocyte counts. Serial measurements in four patients on MOPP treatment showed a rapid decrease following treatment. The increased plasma lysozyme in Hodgkin's disease stems most likely from the macrophage system, either because the macrophages are hyperactive and/or because the malignant cell in Hodgkin's disease is of macrophage origin.


Haemolytic anaemia of pregnancy.

Haemolytic anaemia apparently induced by pregnancy is reported in an otherwise healthy woman, with a negative family history. Folate deficiency, haemoglobinopathies, enzymopathies, hereditary spherocytosis, paroxysmal nocturnal haemoglobinuria, interstitial haematomata, hypertensive toxaemia, auto-immunity and infections were excluded. The autohaemolysis test showed increased lysis in the presence of added glucose. This abnormality was corrected by insulin when excess glucose was present, but not by insulin alone. It is suggested that this patient's erythrocytes may have been altered by placental lactogen and/or prolactin in such a way as to make them abnormally dependent on insulin for the uptake of glucose.


Analysis of the serum IgE levels in nonimmunized rats of various strains by a radioimmunoassay.

An assay, the paper radioimmunosorbent test (PRIST) for the measurement of total serum IgE in the rat, that allows the measurement of IgE down to a level of 0.25 ng/ml, is described. With this assay it has been demonstrated that significant differences exist in normal serum IgE levels in non-immunized rats. These differences are strain-dependent, and strains may be classified as to low (less than 50 ng/ml), medium (50--300 ng/ml) or high (greater than 300 ng/ml) serum levels. The serum IgE level is not sex-dependent. Environmental factors have a pronounced influence, optimal housing conditions resulting in low and stable levels while suboptimal conditions result in high levels with great fluctuations. Hybridization experiments suggest a multigenic control, with low IgE strains having a dominating suppressor effect.


A radioimmunoassay for evaluation of the IgE and IgG antibody responses in the rat.

An assay, the paper radioallergosorbent test (PRAST), for the measurement of specific serum IgE antibody in the rat is described in detail. This assay has been used, in conjunction with a modified PRAST for the determination of relative specific serum IgG antibody and the PRIST assay for total serum IgE [13], to measure specific IgE and IgG and total IgE immune responses in normal parasite infected rats immunized using various protocols. The results indicate that there is a relationship between the basic IgE level and the immune response, i.e. a rat strain with a low constitutive IgE level demonstrates a weak response whereas a high level strain reacts strongly. When PRAST and passive cutaneous anaphylaxis (PCA) were compared, using standardized IgE antibody containing sera, the results were in good agreement. However, PRAST is the preferable assay as it shows less intrinsic variation, is more sensitive than PCA, and is not influenced by high serum IgE levels in the recipient animal.


Human natural cell-mediated cytotoxicity against fetal fibroblasts. IV. Comparison of cytotoxic activity with antibody-dependent cell-mediated cytotoxicity.

The dependence of human natural killer (NK) cell activity on antibodies was investigated. Absorption of the culture medium with target cells, trypsinization of the effector cells followed by a brief recovery, and incubation of the effector cells in serum-free nutrient medium did not affect natural killer cell activity against fetal fibroblasts. No soluble mediator in the nutrient media of effector cell--fibroblast co-cultures could be demonstrated. It was therefore concluded that antibodies are not involved in the cytolytic activity of natural killer cells. However, competition data and the activity of isolated NK cells against antibody-coated target cells suggested overlapping between the effector cells mediating natural and antibody-dependent cell-mediated cytotoxicity.


Lymphocyte studies in rheumatoid arthritis. III. A comparative study of the responses of peripheral blood and synovial fluid lymphocytes to phytomitogens.

The response of peripheral blood and synovial fluid lymphocytes to three non-specific mitogens has been studied. The paired samples were taken from patients with a range of inflammatory arthritides. Unstimulated synovial fluid lymphocytes (SFL) tended to have a greater uptake of tritiated thymidine than had unstimulated peripheral blood lymphocytes (PBL). This background uptake of tritiated thymidine by SFL showed a positive correlation with the response these SFL then showed to the mitogens. A significant depression was observed in the SFL response to phytohaemagglutinin when compared with the paired PBL response; this was seen in both the rheumatoid arthritis and other inflammatory joint diseases groups. SFL responses to concanavalin A and pokeweed mitogen, although depressed in individual cases, failed to show a significant depression overall. Attempts to restore the SFL response to that of the paired PBL by removal of any possible blocking substance from the cell surface either by pre-incubation of SFL in tissue culture medium or by enzyme treatment were unsuccessful. This suggested that cell surface blockers were possibly not the reason for deficient SFL reponses and that other factors were involved.


Arthroplasty of the knee joint. With special reference to complications.

Ninety-one arthroplasties of the knee joint--all performed by the same orthopaedic surgeon, were followed for from 6 months to 6 years (mean 3.5 years). At the time of the primary operation the mean age of the patients, most of whom had rheumatoid arthritis, was 60 years. The prostheses most often used were the Geomedic, the modular and the polycentric. The most consistently good results were achieved with the Geomedic prosthesis. The primary arthroplasty failed in 16 knees (17.6%); deep infections developed in four knees (4.4%). In three knees the prosthesis fractured and in two knees the supporting bone fractured. All these fractures occurred in the medial compartment of the knee joint. Loosening of the prosthesis--with or without concomitant infection or fracture of the prosthesis--was the most common local complication (nine knees). Reoperations were performed, during the follow-up period reported on here, on all knees in which complications developed, except one. Eight knees, about 9%, required arthrodesis. In six knees the prosthesis was replaced, and one knee was treated by arthrotomy and closed irrigation. The four deep infections resolved during the follow-up period--one after arthrodesis of the joint and one after arthrotomy and closed irrigation. In the other two knees with deep infection the prosthesis was replaced.


Arthritis associated with Mycoplasma pneumoniae infection.

Eleven arthritic patients with serological evidence of Mycoplasma pneumoniae aetiology are presented. They were found among 1259 patients with serologically confirmed M. pneumoniae infection; 6 patients had monoarthritis, which has not been described in association with M. pneumoniae infection before and 5 had polyarthritis.


Differentiation between psoriatic arthritis and rheumatoid arthritis: a biochemical and statistical analysis of fingernail amino acids.

The differentiation between psoriatic arthritis and rheumatoid arthritis can be clinically difficult if there is no manifest psoriasis of skin or nail. In order to clarify this diagnostic problem, the amino acid patterns in seventy-five psoriatic and non-psoriatic nails have been studied. Using gas--liquid chromatographic techniques and discriminant analysis, a high degree of differentiation (96%) has been established between the normal looking nails of patients with psoriatic arthritis and those with rheumatoid arthritis. This biochemical/statistical approach to the fingernail enhances diagnosis in difficult clinical problems, particularly where there are no overt manifestations of psoriasis.


A histochemical study of alkaline and acid phosphatase activity in osteoarthritic synovial membrane.

In order to determine the localization and activity of alkaline and acid phosphatase in the synovial membrane of osteoarthritic hip joints, enzymo-histochemical analyses were performed using Burstone's and Barka & Anderson's methods. Frozen sections of synovial biopsy material from 12 osteoarthritic and 6 control hip joints were studied. Alkaline phosphatase was found located in fibroblasts below the lining cells and in capillaries and precapillary arterioles. Acid phosphatase was seen in the lysosomes in the lining cells. Semiquantitative evaluation by means of initial time determination showed significantly greater activity in osteoarthritic synovia than in the control group. Whilst the increased activity of lysosomal enzymes is presumably implicated in the joint cartilage damage seen in osteoarthritis, the significance of elevated alkaline phosphatase levels is not yet clear.


Shoulder problems in juvenile chronic polyarthritis.

A high incidence of shoulder involvement was seen in severely disabled young people suffering from juvenile chronic polyarthritis who were undergoing surgical procedures on the lower limbs. The progressive nature of the radiological changes is described. Possible lines of surgical management are considered.


Clinical and radiological features of ankylosing spondylitis in the 1950's and in 1976 at the same hospital.

The clinical and radiological pictures of AS in two patient series were compared to ascertain whether or not the course of AS has changed since the 1950's. Clinical and radiological features were analysed from X-ray pictures and records of patients with a diagnosis of AS treated at the Rheumatism Foundation Hospital in 1952--59 (168 patients) and 1976 (160 patients). No significant difference in the clinical findings could be demonstrated between the two patient series. The radiological progression in the sacroiliacal joints and the lumbar spine was more rapid in the 1950's than in 1976. In the 1950's 82.1% of all patients had grade III or IV sacro-iliitis, whereas the figure for 1976 was 67.5%. The difference is statistically significant (p less than 0.01). Two-thirds of patients with a duration of the disease of less than 4 years had grade III or IV sacro-iliitis in the 1950's compared with only one-third in 1976. 14.6% of the patients in the 1950's and 4.8% in 1976 had more than 10 lumbar syndesmophytes. The difference is statistically significant (p less than 0.01). Possible reasons for the difference observed are discussed.


Researching occupational mortality. The problem of comparison.

In a number of countries, studies on occupational mortality have proved to be a useful epidemiological tool for the surveillance of on-the-job health risks. In Scandinavia, studies of this type are facilitated by record linkages made possible by the personal identity number. Health selection of occupational groups makes the problem of comparison one of critical interest in analytical epidemiology of occupational mortality and morbidity. Three generally applied principles in choosing control groups are discussed. Uses of random samples of the whole population will most likely yield under- or overestimates of the true risk of the occupation. It is recommended that comparison groups be introduced from other occupations or from the same occupation if possible making the groups similar with respect to socio-economic factors and especially health selection.


Trends in blunt abdominal trauma among hospital in-patients. Developments in a Swedish rural district over 30 years.

To analyse changes in background factors, injury pattern, and prognosis regarding blunt abdominal trauma in Sweden, the 30-year postwar (1946--75) development was investigated in a rural district. 396 patients were treated, showing a great increase during the last 5 years. The highest frequency was seen in patients aged 11--30 years. Abdominal trauma occurred most commonly during July and August. The growing aetiological importance of road accidents is shown. Equestrian accidents were common early in the period and again towards the end. The incidence of cerebrally confused patients increased. The organs most commonly traumatized were kidney, liver, and spleen. The frequency of multiple intra-abdominal injuries and also associated extra-abdominal injuries increased with time. There was a tendency towards shorter hospital stays. Mortality rates did not change during the period, even though injuries have become increasingly severe (judged by the Injury Severity Score). It is concluded that the improved care of patients compensated precisely for the increased severity of injuries, as reflected in mortality.


Risk factors for premature death in men 56--60 years old. A prospective study of men born 1914, living in Malmö, Sweden.

In a five-year follow-up of a random sample of men aged 55 the association between risk factors and premature death was analysed. The overall mortality in five years was 5.8%. The mortality among the smokers was 8%; among non-smokers 2%. Of 16 cancer deaths all were smokers except one who was an ex-smoker. In spite of treatment of hypertension (greater than 165/110 mmHg) there was an association between high blood pressure and premature death, particularly when cause of death was cardiovascular disease. There was no association between premature death and serum cholesterol, serum triglycerides or physical activity. The study is based on 703 men, of whom 41 died. The autopsy frequency was 93%. Only 3 men (0.4%) were lost to follow-up.


What part does the occupational environment play in the occurrence of accidents? Views of accident victims, their fellow-workers, safety delegates, and enterprise managements.

In a survey of occupational accident cases admitted to Malmö General Hospital during a period in 1974, interviews were carried out with the accident victims, and, at their work places, with their fellow-workers, safety delegates, and management representatives as well. The interviewees were asked to express their views on aspects of the occupation environment, which might have had a bearing on the causes of the accident in question, for instance noise, harmful substances, physical and mental stress and accident risks. The results showed wide variations between the views of the four groups regarding the same environment situation and the actual accident. Often the explanations were rather descriptions of "supernatural" concepts in other words. This means that in this field there is a great need for an objective instrument for the analysis of accidents and their circumstances. There is no such instrument available today and there is a growing need to develop accident research and its methods, as well as of a practical instrument for the safety work. There is also a need for a more qualitative analysis of accidents. To this end we used a model developed by J. Surry (4) and later modified by the Swedish Work Environment Fund (5). A further development of this model is proposed.