[Clinical and radiological appearance of early gastric cancer in comparision with endoscopical and surgery findings (an analysis of 40 cases) (author's transl)].

Forty cases of so-called early gastric cancer were investigated for their clinical symptomatology and radiological appearance. The essential symptoms are noncharacteristic abdominal pain and weight loss. Polypoid early cancer and depressed types which appear to be benign are problematical for x-ray diagnosis. In occult symptoms like depressed position or breaking off of mucosal folds in the surrounding of an ulcus, malignant growth is thought to occur. The x-ray diagnosis was compared with the gastroscopic diagnosis. The percentage of mucosal carcinomas which were secured preoperatively by biopsy could be increased considerably. In cases of polypoid early cancer the biopsy shows the most negative results. Often the basis of these polyps is cancerously degenerated only partially. Therefore we demand to take more tissue on different places. Especial problematically in x-ray diagnosis is the flat growing form of early gastric cancer if it is situated subcardially. Three of these cases could be neither diagnosed as benign nor as malign. Here the gastroscopy is superior to the x-ray diagnosis. A comparison with the results of surgery shows that half of the cases can be identified as malignant by the microscopical diagnosis only. The laparotomy without opening of the stomach can also lead to misinterpretations. The most important task of the x-ray diagnosis is the early detection of occult changes of gastric mucosa.


[The possibilities of occupational rehabilitation of radically treated patients with rectal cancer (author's transl)].

The analysis of social and occupational rehabilitation of 372 patients with recta cancer in working age radically treated at N. N. Petrov Research Institute of Oncology of the USSR Ministry of Health in 1950--1970 revealed, that not less than 50% of patients returned to work and were readapted in their family and social environment. About 70% of patients are working, having an invalidity group. The interrelationship and the direct influence of different factors (characterizing the state of the patient's organism, the type of tumor, the stage of the disease, the character of treatment, the presence of complications and functional disturbances, as well as age, sex, profession, length of service) on the process of occupational readaptation, and also on the conclusions of expert comissions for evaluation of working ability were determined with the method of correlation analysis. These findings permit to evaluate the role of each factor, the degree of its stability and the character of its influence. The decisive factors, which determine occupational readaptation of patients with rectal cancer after radical treatment, are: sex, age, profession educational level, severity of functional disturbances. The influence of stage of disease (if radical operation is possible) on the success of occupational rehabilitation of patients with rectal cancer is not considered significant.


[Epidemiology of malignant neoplasms of the breast, uterine cervix, endometrium, and rectum of females in the G.D.R., 1962--1972 (author's transl)].

Based on a model described earlier, the time trend of incidence, mortality, prevalence, duration of medical care and 5-years survival rate is calculated for the following malignant neoplasms of female population in the G.D.R.: breast, uterine cervix , corpus uteri and chorionephithelioma (combined), and rectum (ICD 8th, revision Nos. 174, 180, 181/182, 154). Calculated rates agree quite well with published observations. The results support the assumption that care of cancer patients could be improved between 1962 and 1972. Some suggestions for further development of cancer control are discussed.


Further investigations on possible correlation between agglutinability and osteoinductive properties of established cell lines.

Various cell lines, including SV40 virus-transformed human and mouse fibroblasts, established fibroblastic and epithelial cell lines, as well as their hybrids were tested for osteoinductive properties versus presence of Concanavalin A receptors. No correlation was found between the presence of these receptors and osteoinductive properties of cells. So far, however, no osteoinductive cell line was found without Concanavalin A receptors. Thus, the significance of surface properties of cells in transmission of osteoinductive signal(s) remains an open question. None of the fibroblastic lines exhibits osteoinductive potential, in contrast to the HT-40 and WISH epithelial lines.


Enzymatic labeling of gamma-globulin and insulin with iodine-125.

The parameters of enzymatic labeling of proteins with iodine 125 were examined. The manner and sequence of reagent addition, the effects of reagent concentration, reaction time and total Na125I activity on the labeling yield were determined.


Correlation between immunohistochemical localization of carcinoembryonic antigen (CEA) and histological estimation of carcinomas, normal mucosae and lymph nodes of the digestive tract in humans.

The localization of the carcinoembryonic antigen (CEA) in carcinomas and mucosae of the digestive tract in humans and in mesenteric lymph nodes was studied by indirect immunofluorescence. In colonic and gastric adenocarcinomas, CEA had typical centroglandular localization. Cytoplasmic localization of the CEA was seen in invasive cancer cells having lost their glandular organization. CEA was also present in colonic and gastric mucosae surrounding the tumor. In gastric mucosa obtained at autopsy from subjects with nonneoplastic diseases, CEA was found only in glands having undergone intestinal metaplasia. In lymph nodes of cancer patients CEA was always present in metastatic cells and in germinal centers. Characteristic localization of CEA in germinal centers of metastatic and nonmetastatic lymph nodes could suggest the presence of CEA-anti-CEA immune complexes.


IME -- an inhibitor of interferon activity isolated from mouse embryonic tissues. II. Biological characteristics.

The biological properties and mode of action of IME were studied. Extracts of homogenized and lyophilized mouse embryos served as source of IME, which was found to be localized mainly in cells of mouse amnionic membranes and embryonic tissues. Growth of embryos was accompanied by falling activity of the inhibitor. IME activity was manifested only if it acted on cells in established antiviral state, and only in systems with efficient protein synthesis in all stages. IME stimultes cell metabolism. The findings from this study constitute material for further research on factors antagonistic to interferon.


Modifying action of levamisole on the course of adjuvant-induced polyarthritis in rats.

Treatment of August rats with levamisole (L-tetramisole) distinctly depressed the development and the course of adjuvant-induced polarthritis (A-pa). The depressing activity of the drug was dose-dependent. However, spontaneous stimulation of lymphocytes from A-pa rats treated with levamisole was decreased only after the first 7 days of treatment. Moreover, these lymphocytes showed no changes in PHA-reactivity in comparison with untreated animals. It was concluded that levamisole in some circumstances may show immunosuppressive activity; however, it did not seem to act directly on lymphocytes.


Heterogeneity of aggregates of the human erythrocyte membrane glycoproteins.

The crude red cell glycoproteins obtained by four different methods are compared. The most selective isolation of the major membrane glycoprotein (MN blood group glycoprotein) is achieved by the phenol-water extraction procedure. A different degree of aggregation of this glycoprotein in water and in various buffers is demonstrated. The gel filtration of the crude glycoprotein on a Sepharose 4B column in 0.05 M pyridine--acetate buffer of pH 5.3 gives four fractions with different chemical compostition and serologic properties. The fractions obtained are heterogenous in SDS-PAGE and represent different kinds of glycoprotein aggregates. The distribution of serologic activities in the fractions obtained indicates that A, B and I activities found in the crude prepration of red cell glycoprotein are not connected with MN glycoprotein.


Heterogeneity of glycoproteins of the human erythrocyte membrane. Fractionation in sodium dodecyl sulfate containing solutions.

Human erythrocyte membranes and the glycoprotein isolated by phenol-water extraction of membranes were fractionated by gel filtration on Bio-Gel P-300 in 1% SDS. It was shown by this procedure that lipids (and possibly other membrane components) promote the dissociation of glycoprotein aggregates in SDS-containing solutions. The isolated glycoprotein gives several fractions on gel filtration in 1% SDS. The main fraction contains the major sialogylcoprotein (MN), which can be obtained in an electrophoretically homogeneous form (PAS-1) when only a part of the major peak is pooled and re-chromatographed. The purified glycoprotein has elevated MN blood group activity, does not show I activity, and contains components of alkalibabile oligosaccharide chains in slightly higher proportion than crude glycoprotein. The other fractions have distinctly different carbohydrate composition and contain glycoproteins of different electorphoretic mobility in SDS-PAGE.


Polymorphism of esterase D in the Polish population.

Distribution of esterase D types was studied in a sample of the Polish population numbering 885 subjects. Frequency of EsDl-1 type was 0.810, EsD2-1 -- 0.174, and EsD2-2 -- 0.16. Frequency of the genes EsD1 and EsD2, which determine this system, were 0.897 and 0.103 respectively. A study of 613 mother-child pairs revealed agreement with the hypothesis of two alleles in the EsD locus. The prevalence of EsD genes in the Polish population was similar to those reported in other European populations.


Prevalence and inheritance of C3 types in the Polish population.

In a sample of the Polish population numbering 1,458 subjects, the three common types, C3S, C3F and C3FS, were found with frequencies of 0.6790, 0.0295 and 0.2901 respectively, besides two rare variants, C3FO, 7S and C3SO, 25S. Frequencies of C3S and C3F genes were 0.8248 and 0.1746 respectively, and of the CSFO,7 and C3SO,25 genes, 0.0003 each. Distribution of types in 695 mother-child pairs was consistent with the hypothesis that the C3 system depends on a single genetic locus in which codominat alleles are situated. No children of C3S and C3F mothers with opposite homozygous types were encountered. Hereditary character of the C3FO, 7S variant was confirmed by family studies in which the rare C3FO,7 gene, in combination with C3S or C3F genes, occured in three generations.


Histologic changes in the spleen of rabbits following long-term and multiple immunization with sheep red blood cells.

Results of immunologic and histologic studies on rabbits immunized with sheep red blood cells (SRBC) showed dependence of the immunologic response (PFC, RFC) on the histologic structure of the spleen, particularly width of the sinusoidal vessels. Histologic changes in the spleen are a result of immunization and their intensity is related to the dose of antigen. The influence of dosage of antigen and histologic structure of the spleen on regulation of the immunologic response are discussed.


Biological activity of sera obtained by hyperimmunizing rabbits with interferon from mouse L cells.

Rabbits immunized with interferon from mouse L cells for long periods of time produced interferon-neutralizing antibodies with titers from 1:80 to 1,2000. The anti-interferon sera also contained antibodies against antigens contaminating the interferon preparations such as albumin, bovine gamma-globulin, chicken albumin, extract from L cells, and Sindbis virus antigens. Some sera also displayed cytotoxic activity against cells of transplantable murine leukemia. These antibodies could be removed by specific absorption. Titers of antibodies neutralizing interferon were not correlated with the titers of antibodies against concomitant antigens. In hyperimmunized rabbits interferon-neutralizing antibodies persisted for long periods of time in spite of interrupting immunization.


Morphology of lysosomes in different phases of growth of lymphoblasts of L5178Y murine leukemia.

Parallel studies were carried out on the morphology of lysosomes, activity of DNA synthesis measured by the rate of 3 H-thymidine incorporation, and proliferative activity on the basis of values of the mitotic index of leukemia L5178Y lymphoblasts under varying growth conditions. Morphology of lysosomes was studied by the method of intravital staining with euchrysine. Observations were made on cells growing from the logarithmic phase to saturation density and synchronized by double blocking of DNA synthesis by hydroxyurea. The results showed some variation of the morphology of lysosomes related to growth phase of the cells.


Immunoglobulin content of experimentally induced amyloid in hamsters.

Experimental amyloidosis in hamsters induced by Di-Te-Per vaccine was studied for periods of 14 to 126 days. Immunohistochemical analysis showed that after the 4th week of immunization amyloid deposits containing immunoglobulins accumulated in the liver, spleen and renal glomeruli. The amount of immunoglobulin in the amyloid deposits increased in the final stage in the kidneys, spleen and portal spaces of liver. In the spaces of Disse the amount of immunoglobulin after 4 and 18 weeks of immunization was similar.


Clinical value of carcinoembryonic antigen: diagnosis, prognosis, and follow-up of patients with cancer.

Plasma carcinoembryonic antigen (CEA) in nanograms per milliliter was assayed in 149 patients with benign and 567 patients with malignant disease. Elevated CEA level (greater than 5.0) was a good indicator of malignant disease but a poor screening test for cancer because of the high false-negative rate. Degree of elevation of plasma CEA level correlated with incidence of metastatic disease in patients with colorectal, gastric, and breast carcinomas, but no correlation was seen between CEA levels and status of lymph nodes in patients with localized disease. Patients with localized colorectal cancer, but elevated CEA levels before resection, had a 2.1-fold increase in the incidence of recurrence; however, this added to the prognostic value of Dukes' staging only when the CEA level remained elevated postoperatively. In 87% of patients with colorectal cancer, the CEA level was elevated at the time of recurrence, but a therapeutic value of reexploration for unexplained CEA level elevation was not confirmed.


Ecthyma gangrenosum: survival with individualized antibiotic therapy.

Five burn patients with ecthyma gangrenosum were treated with gentamicin sulfate in an individualized aminoglycoside regimen. Dosages greater than the currently recommended 3 to 5 mg/kg/day were necessary and ranged from 15 to 30 mg/kg/day. These increased dosages cannot be used routinely but only as serum level data indicate the need. Four of the five patients survived their course of ecthyma gangrenosum. The single fatality received a much smaller dosage of gentamicin as compared with the other four patients. No ototoxic or nephrotoxic reactions were noted in any of the patients.


Gas in the appendix: a sometimes significant but nonspecific diagnostic sign.

The gas-filled appendix is an uncommon roentgenographic sign that has been considered to be virtually diagnostic of acute appendicitis when the appendix is positioned caudad to the cecum in the right lower quadrant of the abdomen. Three patients had gas in the appendix in the absence of acute appendicitis. This diagnostic sign is therefore not specific for appendicitis. Regardless of its location, the appendix may contain gas despite the absence of intrinsic disease.


Fine-needle aspiration biopsy in ampullary and pancreatic carcinoma.

Cytological verification of the angiographic, sonographic, and/or intraoperative diagnosis of pancreatic or ampullary carcinoma may be achieved by fine-needle aspiration biopsy (FNAB). Fifteen biopsies were done in 13 patients, 12 of whom were thought to have pancreatic carcinoma clinically. The FNAB specimen confirmed this in 11 of them. Also, one equivocal (suspicious), two false-negative, and no false-positive results were recorded. Complications were not seen. In addition, four patients with ampullary carcinoma had pancreatoduodenectomy on the basis of FNAB specimens. Since this method is more accurate and is safer and simpler than the traditional wedge or core biopsy of suspected pancreatic or ampullary tumors, and since it may eliminate the need for laparotomy in selected cases, we consider it the preferred method for immediate diagnosis of these neoplasms.


Remote bypass grafts for managing infected popliteal artery lesions.

Infected false aneurysms of the popliteal artery may complicate vascular repairs for trauma or primary arterial disease. Adequate debridement and drainage are necessary if the limb is to be salvaged, but direct arterial grafting through the infected area cannot be performed safely. Vascular reconstruction can be accomplished by performing a femoropopliteal or iliopopliteal bypass through a lateral approach, then the infected artery can be removed safely through separate incisions. This technique was used successfully in managing four patients with infected popliteal artery pseudoaneurysms.


Restenosis or occlusion after carotid endarterectomy: a survey with ocular pneumoplethysmography.

One hundred seventy-three carotid endarterectomies in 141 patients operated on during a 12-year period were surveyed both clinically and by ocular pneumoplethysmography (OPG)-Gee. Seventeen (12%) patients had positive OPG examinations. Three arteries (1.7%) demonstrated symptomatic recurrent stenosis in accord with earlier reports. An additional 8.1% of the operated arteries had asymptomatic recurrent stenosis. A total recurrence rate of 9.8% was found. Because of the considerable silent recurrence rate we have found, we recommend annual screening by OPG. Angiography and repeated endarterectomy are then used when appropriate.


Mechanism of obstruction of closed-wound suction tubing.

The mechanism of obstruction of closed-wound drainage tubing was investigated by means of coagulation tests performed on wound drainage fluid and by examination of the contents of the tubes after their removal. Although clotting is commonly thought to be responsible for the obstruction, the wound drainage fluid was found to be essentially incoagulable and little fibrin was evident within the tubes. By contrast, bits of tissue were frequently found within the tubes, and these frequently virtually occluded the lumen. This observation, that tissue fragments are responsible for tube obstruction, permits a rational approach to the solution of this problem. For example, meticulous wound flushing and irrigation, or perhaps tubing of different design, might lead to a reduced incidence of tube failure.


Proximal gastric vagotomy and suprapyloric antrectomy. Experimental evaluation in dogs.

In five dogs with Heidenhain pouches, proximal gastric vagotomy and suprapyloric antrectomy did not alter the rate of gastric emptying of 300 mL of 1% dextrose or of 40 plastic spheres, or disrupt the barricade preventing duodenogastric reflux. However, the operation did slow gastric emptying of 50 g of cubed liver and increase the postprandial secretion of hydrochloric acid from the pouch. We concluded that suprapyloric antrectomy can be combined with proximal gastric vagotomy without disturbing the gastric emptying of liquids and indigestible solids or resulting in increased duodenogastric reflux. However, the operation does slow gastric emptying of digestible solids.


The cavaportal shunt in interruptions of the suprarenal inferior vena cava.

Abrupt interruption of the suprarenal inferior vena cava can have dramatic consequences and can be difficult to repair successfully. In the case reported, an excellent result was obtained by a cavaportal anastomosis, with minimal consequences on renal and hepatic functions.


Appendicitis in acute leukemia.

The cases of five children with acute leukemia complicated by appendicitis were reviewed. All but one child had typical signs and symptoms of acute appendicitis, though four children were receiving prednisone. All five children underwent appendectomy, and all survived the immediate postoperative period. One child had a spontaneous remission following appendectomy. Two of three children in relapse suffered serious postoperative complications. Our experience supports the surgical management of appendicitis in acute leukemia.


[Radioautographic study of acid glycoprotein synthesis by tracheal and bronchial glands during ontogeny].

The synthesis of acid glycoproteins in the glands of the respiratory pathway has been studied radioautographically by means of sodium sulfate in the cat ontogenesis. 35S-sulfate incorporation into the fetal gland has been stated to increase by the time of delivery. After birth and in young kittens, 35S-sulfate incorporation into the gland decreases. Acid glycoproteins are intensively synthesized by the tracheal and bronchial gland in young and adult animals. In old animals this process is lowered. The synthesis of acid glycoproteins by the tracheal and bronchial glands in ontogenesis changes both quantitatively and qualitatively.


[Correlation between the processes of proliferation and differentiation in the histogenesis of somatic muscle tissue in birds].

The development of muscular tissue fibers has been studied in 8--19-day-old chick embryos by methods of electron microscopy, autoradiography and cytophotometry. Differentiated myogenic elements are derived from promyoblasts which devide during myogenesis at slightly changing parameters of the mytotic cycle. Promyoblasts fuse with each other or with symplasts or else can develop into myoblasts containing myofilaments in their cytoplasm. At later stages of myogenesis, some promyoblasts pass into "rest" condition with characteristic changes in the structure of nucleus, cytoplasm and muscular cells. These cells are situated between the basal and cytoplasmic membranes and identified as cell-satellites (myosatellites). They represent an important subpopulation of the muscular system, which preserve a certain ability to perceive stimuli to proliferation and differentiation, forming the cambial system of the skeletal-muscular tissue.


[Histone alteration in the nuclei of different types of neurons in a "mirror" epileptiform focus in rat brain].

Total histones estimated after M. Alfred and I. Geschwind were studied cytophotometrically in nuclei of neurons of different types (layers III and V in the frontal-parietal cortex and in the thalamic lateral nucleus) of the "mirror" epileptiform focus in the rat brain on the 11th and 63d day after cobalt implantation. On the 11th day of the experiment, integral optic density of the histones decreased by 33%, 25% and 37%, and the area of the nuclei -- by 27%, 24% and 35% in the neurons of layers II and V in the frontal-parietal cortex and in the thalamic lateral neucleus, respectively. On the 63d, integral optic density of the histones in the neurons mentioned increased respectively by 42%, 52% and 42%, and the area of the nuclei -- by 21%, 43% and 27%. Concentration of the histones in the nuclei decreased by 3--9% on the 11th day and increased, except layer V, by 9--18% on the 63d of the experiment. Interconnection between changes in histone content and total proteins in cytoplasm of functionally different neurons in the "mirror" epileptiform focus is disscussed, with special reference to histones as a regular of genetic activity for protein synthesis.


[Neurohistologic and histochemical findings concerning the accessory fiber of several incapsulated receptors].

In order to clarify the role of catecholamines in encapsulated receptors, Pacinian corpuscles and the bulbs of Krause have been studied by the fluorescent method of Falck. Fluorescence, specific for catecholamines, has not been revealed in the receptors. Catecholamines do not seem to be neuromediators in stimulating sensitive nerve terminals. The regulatory role of catecholamines in the activity of the encapsulated receptors is discussed. The neurohistological method of tissue fixation in the mixture of zink-iodine -- osmic acid has revealed some additional nerve fibers (Timofeev's apparatus) in the bulbs of Krause of the cat lip and nose. In order to understand the nature of the additional fibres in the bulbs of Krause, a branch of the trigeminal nerve has been sectioned in the suborbital area. After sectioning the staining of both the main and additional fibres in the bulbs of Krause in the lip and nose has disappeared. The data obtained support the view on sensitive nature of the additional fibres (Timofeev's apparatus) in the sensitive bulbs of Krause.


[Development of accessory structures of the mechano- and chemoreceptor apparatus of the tongue during rat ontogeny (scanning electron microscopy)].

The dynamics on the formation of different types of mechno- and chemosensitive papillae in the rat tongue has been studied during different periods of postnatal ontogenesis by means of scanning electron microsopy. Asynchronous maturation of these papillae has been demonstrated, they perform certain functions during the early postnatal ontogenesis and reach their functional maturity by the age of 3 weeks when animals go over from suckling to solid food.


[Structure and biometric indices of the lumbar ganglia of the sympathetic trunk of normal cats and cats subjected to hormonal stimulation].

The structure of different components from lumbar ganglia of the cat sympathetic trunk were studied in norm and 6h after intramuscular administration of prednisolone (5 mg/kg). Paraffin sections were stained with azocramine after Heidenhain, Wallart and Houette, azure II -- eosin. Biometry of different ganglial structures was performed by G.G. Avtandilov's dotted method. It was demonstrated that as a response to prednisolone administration, certain morphological changes appeared in all ganglial components. The walls of capillaries grew thicker, endothelial nuclei protruded into their lumen. Collagenous fibres of the connective tissue capsule and ganglial stroma grew thicker and acquired twisted appearance, the amount of the basilar substance increased. Simultaneously, there was a sharp increase of the nuclear section area in perineuronal ganglia. The total area of neuronal sections in the ganglia also increased at the expense of both increasing area of neuronal cytoplasm and hypertrophy of their nuclei.


[Comparative study of dehydrogenase and diaphorase activity in spinal ganglion neurons in vivo and during their cultivation in vitro].

Enzymatic activity was investigated in spinal ganglia of 10-day-old chick embryo and in 10-day-old cultures of these ganglia (the method of "flying glasses"). Histochemical preparations were photometrically treated with the one-wave plug-method in the device MCFB-1 (LOMO) with the diameter of the probe 8 mkm. As the result of the investigations on optic density, a definite conclusion was made about relative activity of 15 enzymes and a general scheme of neuronal metabolism was graphically presented under the conditions of cultivation, enzymatic activity of krebs cycle was demonstrated to decrease, while that of diaphorase and lactate dehydrogenase to increase. The data on topography of enzymatic distribution in neurons, satellites, lemmoncytes and fibroblasts were also presented.


[Morphometric analysis of the state of the intramural nervous apparatus of rat duodenum].

Structural organization of the intramural apparatus of the duodenum has been studied in normal white rats. By means of a planimeter, the area of the nerve cells and their nuclei has been estimated in serial sections of the cranial and caudal parts of the duodenum; a definite regularity on the nerve cell types distribution has been stated in different parts of the duodenum. Concentration of afferent nerve elements has been noted in the cranial part of the duodenum.


[Effect of pesticides on cholinesterase activity in the nervous elements of the heart in pregnant animals and fetuses].

Cholinestarase activity in the cardiac neural elements of pregnant animals and in their offspring was studied under the effect of chlororganic pesticide -- polychlorcamphen and phosphororganic pesticide -- valexone. The substances in question were demonstrated to produce variously pronounced unidirected changes in cholinesterase activity in neural structures that testifies to interconnection and dependence of the changes in the system mother -- fetus. The alterations observed in nonsynaptic (trophic) cholinesterase make it possible to speak about the disorder of cholinergic innervation and about the importance of acetilcholinesterase trophic function as a regulator of cellular processes, an inhibitory index of differentiation during embryogenesis.


[Hepatitis B surface antigen in the liver and pericholedochal lymph nodes in chronic hepatitis and cirrhosis of the liver].

Morphological characteristics of the liver and the presence of HBsAg in the blood serum, liver tissue, and pericholedocheal lymph nodes were examined in 25 patients with chronic liver diseases and 2 asymptomatic carriers of HBsAg. The antigen in tissues was demonstrated by indirect immunofluorescence and histochemically by staining with alcohol-arsein and aldehyde-fuxin. The antigen was found in the blood, liver tissue, and hepatocyte cytoplasm in both carriers and 10 patients. In 5 patients with liver cirrhosis and HBsAg antigenemia the antigen was also found in the liver tissue, in 1 patient it was absent in the blood but found in the liver, and in 2 patients it was absent in the blood and in the liver. In 5 patients with chronic hepatitis the antigen was demonstrated in the blood serum and the liver, in 12 patients it was not detected either in the blood or in the liver. In 8 patients enlarged pericholedocheal lymph nodes were examined, and in 6 of them HBsAg was detected in macrophages of the lymph nodes.


[Liver tissue lactate dehydrogenase isoenzymes in cirrhosis].

Isoenzymes of the liver tissue lactate dehydrogenase (LDG) were examined in 37 patients with micro- and macronodular cirrhosis. LDG isoenzymes were studied by histochemical and cytophotometrical methods, electrophoresis in polyacrylamide gel, densitometry. The results were treated statistically. Uneven (mosaic) distribution of LDG activity in hepatocytes was observed in hepatocirrhosis. Different hepatocytes and fibroblasts had dissimilar sets of LDG isoenzymes. Anodal isoenzymes showed a higher activity in the bile duct epithelium. Cathodal isoenzymes in hepatocytes were localized mostly near the external cell membrane and the nuclear membrane. Micronodular cirrhoses are characterized by an increased activity of LDG2 and LDG3 and a decreased activity of LDG5 in the liver tissue. Macronodular cirrhoses are characterized by a decreased activity of LDG1 and LDG3 and an increased activity of LDG5. In the presence of hepatocyte insufficiency the activity of LDG1 decreased. Changes in the liver tissue LDG isoenzymes profile is due to a number of degenerative and regeneratory lesions typical of the cirrhotic process. The determination of the profile of the liver tissue LDG isoenzymes is important for the establishment of the type of cirrhosis, the degree of hypoxia, the intensity of regeneration processes, and the effectiveness of the therapy given to the patient.


[Hepatitis and cirrhosis of the liver (classification, morphology and morphological differential diagnosis].

The current classification of hepatitis and hepatocirrhosis is evaluated on the basis of the literature analysis and the study of the author's own material. Morphological criteria for differential diagnosis of liver diseases of viral and alcohol etiology are proposed. A clinical pathologist examining a liver biopsy may confirm or establish the etiology of the disease, determine the degree of activity and compensation of the process. An analysis of these criteria helps a clinician to choose the method of treatment and to determine the prognosis of the disease.


[Papillomatosis of the opening of the major duodenal papilla in chronic, recurrent pancreatitis (based on surgical biopsy data)].

Examinations of 55 major duodenal papillas (MDP) amputated in patients with chronic relapsing pancreatitis revealed papillomatosis of the opening zone in 20 (36%). Papillomatosis developed when the pancreating and bile ducts discharged into the duodenum separately at the top of MDP without forming an ampoule. Papillomatosis was manifested by fibrous-epithelial papillar hyperplastic outgrowths representing pathologically altered folds of the MDP mucous membrane. The features of changes in papillary outgrowths were shown to include circulatory disorders, lympho-plasmocytic infiltration of the stroma, adenomatosis, etc. The causes of papillomatosis development and its association with chronic relapsing pancreatitis are discussed.


[Gastric mucosa in esophageal cancer].

The fundal mucous membrane was examined histologically and morphometrically in 92 patients with oesophageal cancer and 5 patients with cancer of the cardial part of the stomach greatly extended into the oesophagus; the mucosa was obtained by operational biopsy. In 4.1% of the observations the mucosa was unchanged, in 30.9 per cent superficial gastritis, in 26.8% moderately marked atrophic and in 38.2% marked atrophic gastritis were found. In most patients gastritis appeared to preceed the main disease. A certain correlation was observed between the degree of atrophy of the gastric mucosa and the reduction of the secretory function, but this was observed in some of the patients only. In half of the patients with superficial gastritis achlorhydria was demonstrated.


[Cytology of large cysts of the breast].

Cytological examinations of punctates of 200 large mammary gland cysts distinguished three variants thereof: cysts without signs of epithelium proliferation; cysts with signs of epithelium proliferation; and cysts with signs of epithelium proliferation and atypia. In 12 operated patients with the cyst of the second variant no cancer was detected. Among 9 operated patients with cysts of the third variant 3 were found to have intraductal cancer with initial invasion (including one case of malignized cystadenopapilloma). Detection in cytological examinations of cysts with signs of epithelium proliferation and atypia is sufficient for excision biopsy. Such patients should be considered as a higher risk group.


[Ultrastructure of the microcirculatory bed of the myocardium in coronary insufficiency].

The features of microcirculation in the myocardium were studied experimentally in 20 dogs when the blood flow in the skirting branch of the left coronary artery was limited by 30 and 50%. The disorders developing in the zone of ischemia were found to consist of a number of adaptative and pathological changes: changes in the tension of microvessels with predominant dilatation of the venous genu; occlusion of the capillary lumens with extremely swollen endothelial cells and sometimes their compression by edematous cardiomyocytes; aggregations of red blood cells; dilatation of interendothelial junctions: activation of micropinocytosis; intestitial edema. The experimental results indicate that disorders in microhemocirculation, transport and intermediary metabolism are one of the causes of contractile myocardium damage when a focus of ischemia develops in it, alongside with the limitation of the flow capacity of the main artery.


[Unusual forms of collagen fibrils in dermatoses].

Electron microscopic examinations of the skin from foci of lesions in scleroderma, psoriasis, parapsoriasis, and lupus erythematosus revealed two types of unusual collagen structures consisting of loosely packed fibrils 5--8 nm in diameter with a cross-striation period of 150--170 and 80--90 nm. The former were localized in the epi- or perineurium of pulpless nervous fibers of the derma, the latter among collagen fibers. These structures appear to occur rather widely in collagen metabolism disorders (tumours of neurogenic origin, some skin tumours, collagen diseases).


[Hemochromatosis with a predominant lesion of the heart].

A fatal case of generalzyed hemochromatosis in a man of 30 was studied.The disease ran a course with the predominant involvement of the myocardium accompanied by circulatory insufficiency. At the end of the disease a large thrombus formed in the left ventrical cavity. No correlation between the biological tests pathognomonic for the disease (the normal iron and sugar content in the blood) and significant morphological changes in the visceral organs was observed. The familial predisposition to hemochromatosis was revealed.


[Pathological anatomy of rubeolar embryo-fetopathy].

The paper describes two cases of congenital rubeolar embryo- and fetopathy which show that in infection with rubella virus in the 1st trimester of pregnancy the virus effect may be limited to the period of embryogenesis or extend to the fetal period as well. In the first instance, multiple developmental defects occur at the organ level; in prolonged virus effect organogenesis disorders are combined with tissue displasias and inflammatory processes, that is, the pathology typical of the fetal period. Congenital rubella is characterized by a subacute course and wide generalization of the alterative-productive inflammation: productive dermatitis, subacute productive-necrotic encephalitis and endophthalmitis, as well as giant-cell metamorphosis of alveolocytes.


[Microbes and cancer].

Recently, due to the use of germ-free animals in cancer research, many facts have been accumulated indicating that bacteria may produce different effects (enhancing or inhibiting) on carcinogenesis, depending on the features of the carcinogenic substance metabolism. At the same time, epidemiological investigations have shown that in human populations with a high or a low risk of cancer development (mostly cancer of the colon and mammary gland) the composition of the intestinal bacterial flora and its metabolic properties have peculiar features. In both instances, certain bacterial species are presumed to take part in the formation of final carcinogenic metabolites or in the synthesis of endogenic carcinogens (and/or cocarcinogens).


Measles and rubella virus antibodies in patients with multiple sclerosis. A longitudinal study of serum and CSF specimens by radioimmunoassay.

A longitudinal study on rubella, measles, and respiratory syncytial virus antibodies in serial serum and CSF specimens from 20 multiple sclerosis (MS) patients was performed, using solid-phase radioimmunoassay. Albumin and immunoglobulin G (IgG) levels were also measured to check the integrity of the blood-brain barrier and the intrathecal IgG production. All the patients had local IgG production in their CNA. A local antibody production against one or more of the viruses studied was evident in 15 patients. Fluctuations in the intrathecal viral antibody synthesis were evident in eight patients. No correlation was found between these changes and the clinical course of the disease. The results suggest that the intrathecal antibody synthesis in MS is only partially against any given virus, and in most patients the bulk of the oligoclonal CSF antibodies is against antigens other than those studied here.


Generalized cortical electrodecremental event. Clinical and neurophysiological observations in patients with dystonic seizures.

Patients with seizures accompanied by generalized cortical electrodecremental event (CEE) have clusters of clinical spells with tonic, dystonic, or atonic components and involvement of autonomic functions. When electroencephalographically detectable foci are present, they behave in a peculiar way; throughout the entire cluster of seizures focal spiking is reduced in the short interictal periods as well as during each individual seizure with CEE, at which time it is suppressed. Focal firing reappears reinforced at the end of each spell and also at the end of the cluster. These facts suggest that the foci responsible for CEE are deeply located. A complex excitatory-inhibitory feedback probably exists between cortical and subcortical foci. These seizures should be differentiated from similar attacks of nonepileptic or epileptic nature. A correct diagnosis is essential given the different therapeutic implications.


Flicker fusion thresholds in multiple sclerosis. A functional measure of neurological damage.

Patients with multiple sclerosis (MS) have been shown to have a measurable deterioration in the ability to perceive temporal variations of light. Compared to the traditional critical flicker fusion (CFF) measure, a modified flicker fusion test showed an improved sensitivity for denoting neurological deficit in temporal vision. One hundred twenty-two patients with MS were examined. The traditional CFF test exhibited abnormalities in 48%; the modified test exhibited abnormalities in 78% of the same patients. These results appear to be independent of whether or not the demyelinating disease clinically involved the visual system. Also, the percentage of abnormalities demonstrated by combining both techniques was unexpectedly high (60% to 80%) in patients with minimal evidence of neurological involvement.


The pattern of memory loss resulting from intravenously administered diazepam.

A word recognition task was designed to determine the stage in memory affected by a single 10-mg intravenous injection of diazepam and the duration of the effect. Injection in three experimental subjects produced an anterograde amnesia for the 14 to 24-minute period immediately after injection. Memory loss resulted from impaired storage, the stage during which information is entered into memory. Retention and retrieval stages of memory were unaffected. This temporary amnesia may result from increased inhibition in the hippocampal system produced by diazepam, which shares many properties with the inhibitory neurotransmitter gamma-aminobutyric acid.


The bilateral isodense subdural hematoma on computerized tomographic scan.

Blood causes striking changes on computerized tomography. However, chronic subdural hematomas may become isodense with brain and therefore not visible directly. Midline and ventricular displacement, effacement of cortical sulci, narrowing of white matter on one side, and ventricular distortion should suggest a unilateral isodense process. Bilateral isodense subdural hematomas pose a major problem on computerized tomography since there are no indications of a mass lesion. A negative report could lull the clinician into a false sense of security. In these cases, general disappearance of sulci and considerable narrowing of ventricles are helpful findings. A particularly important and overlooked sign is an abnormally decreased bicaudate cerebroventricular index. Above all, a high degree of suspicion is vital.


Early-morning dystonia. A late side effect of long-term levodopa therapy in Parkinson's disease.

Four women with Parkinson's disease undergoing prolonged levodopa therapy had daily episodes of dystonic posturing, affecting one lower extremity, several years after initiation of treatment. The dystonia occurred only in the early morning, on awakening and before the first dose of levodopa, when the patients were in the akinetic-rigid state with no dyskinesias. It further interfered with gait, slowly subsided within one to two hours, and did not recur until next morning. This abnormal involuntary posture was unaffected by manipulations of daily levodopa dosage and schedule, completely disappeared after withdrawal of drug therapy, and recurred following its readministration. Additional adverse reactions including dyskinesias, "on-off" phenomena, and declining efficacy of levodopa were present in all patients. Early-morning dystonia may represent another late side effect secondary to long-term levodopa administration in parkinsonism.


Subacute sclerosing panencephalitis during pregnancy. A surviving normal infant.

A normal infant was born to a 15-year-old girl who developed subacute sclerosing panencephalitis in the fifth month of pregnancy. The serum measles antibody titers of the infant gradually declined during the first year of life. The child, now age 3, has no neurological abnormalities.


Use of the ECG in the diagnosis of childhood spinal muscular atrophy.

The appearance of tremors in patients with childhood, chronic spinal muscular atrophy has been known for years. We were struck by the presence of a "muscle tremor" artifact in the ECGs of all our patients with this diagnosis. This observation has not been noted previously. The consistency of this finding in patients with this disease is the basis for this report.


Craniopharyngioma with midbrain involvement.

An adult patient had a cranlopharyngloma that involved and displaced the midportion of the midbrain, producing Weber's syndrome. Oculomotor paresis in cranlopharyngloma is not always due to parasellar involvement but may be due to midbrain involvement.


[Comparative results of trepanotrabeculectomy and iridencleisis in primary glaucoma].

For the last 10 years 500 iridencleisis and 250 trepanotrabeculectomies were performed. For this study are subjected only 205 cases of basal and total iridencleisis and 100 cases of trepanotrabeculectomy, performed in chronic open and chronic closed angle glaucoma. The authors point out that some common factors play the role on the final results, independently of the type of the operation. It was observed that the results were worse in patients having the diabetes and/or arterial hypertension, when the operation is performed in the advanced age or in the late stage of glaucoma, and also if the eye was already operated. To evaluate the result of the operations (basal and total iridencleisis, trepanotrabeculectomy) the authors estimate that is not enough to take the intraocular tension as the unic parameter, one should take in consideration also the visual field, visual acuity and also the state of the optic disc in the follow-up period (see Tbl. 4). This period should not be shorter than one year. With the trepanotrabeculectomy (85%) and with total iridencleisis (86,5%) the intraocular tensions could be normalised in the higher percentage than with the basal iridencleisis (75,5%). On the other hand, if one take also the other parameters for the evaluation (visual field, visual acuity, status of the optic disc) one could conclude that the best result was achieved with trepanotrabeculectomy (80% the complete consolidation), and than with total iridencleisis (69,4%) or basal iridencleisis (67%). In trepanotrabeculectomy the peroperative and postoperative complications are rare.


[Surgical treatment of retinoschisis (author's transl)].

We have made a review of 20 retinoschisis without retinal detachment operated on 12 patients. There is no case of hereditary retinoschisis, the affection may occur at any age, and there is no preferential refractive error. Main surgical indications were macular involvement or impending involvement, and associated retinal tears. A good anatomical result has been obtained in 90% of our cases (18 out of 20) with 2/3 complete reattachments and 1/3 almost complete reattachments (with minimal and well sealed residual schisis). Association of cryocoagulation and indentation is more effective than cryocoagulation alone. On the functional point of view we have had 15% of improved visual acuities and 30% of worsened ones, thus surgical intervention implies macular risks that one must try to prevent by using procedures as atraumatic as possible.


[Uveitis and multiple sclerosis: myth or reality?].

The authors have examined three hundred cases of sclerosis (prospective study of an hundred patients, retrospective study of two hundred observations) in order to assess the frequency of uveitis during the disease and to make out a possible relation between the two diseases. The percentage of uveitis is small: 2% and the frequency of uveitis in multiple sclerosis appears not different of that of a normal population. In spite of the simularity of the pathogenic hypothesis, it does not look that a correlation may be made between the two diseases.


[34 epibulbar malignant tumours (author's transl)].

Based on a study of 34 cases, the authors make therapeutical and diagnostical references concerning the epibulbar malignant tumours. These were met with a frequency of 10% of the total amount of the malignant tumours of the visual apparatus. The most frequent setting were at the level of the bulbar conjunctiva and of the sclero-corneal limb, especially in front of the opening of the palpebral slit and in the temporal area. The histological examination of the tumours pointed out the following morphological types; epitheliomas (61%), especially spino-cellular, malignant melanomas (32%) and sarcomas (6%). The therapeutical attitude was the surgical one -- the accurate extirpation -- in the limited tumours, followed by radiotherapy when neoplasic lesions were found at the limit of section. In the invaded tumours, the exenteration of the orbit was performed followed by radiotherapy. On the terms of such a therapeutical conduct, the distant prognosis proved to be dependent on two factors: a. The early diagnosis, that is the stage of the therapeutical action. It is insisted upon the importance of the signs of malignization of some benign tumors: papillomas or naevi. b. The nature and origin of the tumour: the secondary tumours are more severe from the beginning.


[Remarks concerning a case of oculogyric crisis (author's transl)].

A case of intermittent spasm of the oculo-palpebral motility present features which permit its inclusion among oculogyric crisis. The therapy with clonazepam gave good results supporting the etiological hypothesis of an alteration of the neurons at level of the mesencephalic reticular system.


Small choroidal melanomas. A long-term follow-up study.

Complete follow-up information was obtained on 65 patients whose eyes had been enucleated for small choroidal melanomas three months to 34 years previously. All tumors were 300 cu mm (10 x 10 x 3 mm) or less in volume. The average and median lengths of follow-up were nine years and 7.2 years, respectively. The 5-, 10-, and 15-year tumor-related death rates were found to be lower than those previously reported for small melanomas after enucleation, and the same as the estimated tumor-related  mortality in patients who had not undergone enucleation. The average volume of tumors that caused metastatic death was more than twice that of tumors that did not. There were no metastatic deaths in 42 patients with tumors less than 98 cu mm (7 x 7 x 2 mm) in volume. Waiting to observe growth in tumors less than 98 cu mm in size did not appear to increase the risk of death from metastatic melanoma.


Hysterical hemianopia. The 'missing half' field defect.

Hysterical hemianopias are uncommon and usually occur in association with other lateralized complaints. The most frequent pattern consists of decreased vision in one eye, an ipsilateral hemianopia on testing the "affected" eye, full fields in the other eye, and a complete hemianopia toward the affected side on testng with both eyes open. The incompatibility of the monocular and binocular fields quickly demonstrates the functional nature of this alleged visual loss.


Photoreceptor misalignment accompanying a fibrous scar.

A 9-year-old boy with dense fibrous scars at the macula had visual acuities of 6/12 and 6/9 and an abnormal color match (pseudoprotanomaly). The Stiles-Crawford effect functions were abnormal in both eyes, showing maximal sensitivity at the nasal edge of each pupil. The data suggest that the foveal photoreceptors, although spared destruction by an adjacent focus of healed chorioretinitis, have been distorted by fibrous traction arising from that defect.


Lactate dehydrogenase levels and isozyme patterns. Measurements in the aqueous humor and serum of retinoblastoma patients.

Lactate dehydrogenase (LDH) activity was determined in 24 cases of histologically proved retinoblastoma. The mean level was 1,825 IU/L, with a range of 10 to 15,920 IU/L. Twenty-two patients had elevated aqueous humor LDH levels. In two, the aqueous humor level was within the normal range. Student's t testing showed a highly significant difference between cataract and retinoblastoma aqueous humor. The retinoblastoma aqueous humor to blood ratio ranged from 0.045 to 58,529--not a good index of retinoblastoma. Isozyme patterns of retinoblastoma aqueous humor were statistically similar to those of normal cataract aqueous humor. The serum LDH level of cataract patients was not statistically different from that of retinoblastoma patients. The LDH 5/LDH 1 ratio of retinoblastoma aqueous humor ranged from 0.042 to 27.05--not a good index of retinoblastoma, as 28 of 34 aqueous samples of cataract patients had LDH 5 greater than LDH 1. Ten of 13 retinoblastoma patients had aqueous humor LDH 5 greater than LDH 1. The best index of the presence or absence of retinoblastoma is the total aqueous humor LDH level.


Familial corneal hypesthesia.

A 4-year-old boy with severe, diffuse, asymptomatic, punctate, epithelial corneal erosions had bilateral sharply decreased corneal sensation with normal skin sensation in the distribution of the trigeminal nerves. Subsequent family studies disclosed five family members with similar corneal changes and decreased corneal sensation and no punctate erosions. None had decreased skin sensation in the distribution of the fifth cranial nerve. No environmental factors or evidence of local or systemic disease accounted for these findings.


Ophthalmomyiasis interna posterior. Subretinal tracks and intraocular larvae.

Only seven cases of identifiable intraocular botfly larva infestation have been reported in North America--five since 1969. Two additional cases, both from the same institution, are documented here. The offending maggot or larva was visible in both instances. The findings in each case were diagnostically and morphologically striking. The characteristic funduscopic finding of subretinal tracks, along with the appearance of the larva--encysted in one patient and free-floating in the other-deserves emphasis, since this condition is not always benign and may not be as rare as previously assumed.


Giant papillary conjunctivitis with ocular prostheses.

In seven patients who each had either a methyl methacrylate corneal shell, a postenucleation ocular prosthesis, or a keratoprosthesis, giant papillary conjunctivitis of the tarsus of the upper lids developed after prolonged wear. These cases expand the spectrum of disease that was initally described in wearers of hard and soft contact lenses. The papillary changes in prostheses wearers did not always produce symptoms and were not readily reversible. Basophils and mast cells characterized the inflammatory infiltrate, suggestng an antigen-antibody mechanism underlying the response. Increased production of epithelial mucin, in contrast to goblet cell mucin, may play a role in producing symptoms in this syndrome.


Ocular findings in Kenny's syndrome.

In 1966, Kenny described two patients with an unusual congenital syndrome including dwarfism, thickened long bone cortex, transient hypocalcemia, and normal intelligence. These and other patients previously were incorrectly described as "myopic". Ocular findings in four subjects ranged from uncomplicated nanophthalmos with hyperopia to extreme pseudopapilledema, vascular tortuosity, and mucular crowding. Postmortem findings from one patient showed calcium deposits demonstrable only by special histochemical stains that were distributed uniquely in the cornea. This distribution differed greatly from the pattern seen in band keratopathy. Retinal calcification was also an unusual feature. Because one patient exhibited a pseudodoubling of the optic papilla, the literature was reviewed. We conclude that no convincing case of true doubling of the optic nerve has been described. Ophthalmologists should be alert for undiagnosed electrolyte abnormalities, especially hypocalcemia, in patients with Kenney's syndrome.


Double elevator palsy.

Of 15 patients with monocular limitation of elevation, six had no deviation in primary gaze while the remaining nine had hypotropia of the involved eye. Twelve of 15 patients had restriction to upgaze on forced duction testing. Eleven of these 12 had normal upward saccadic velocity, which suggested normal elevator function. Four patients had reduced saccadic velocity, which indicated true elevator weakness. Superior rectus muscle paresis alone could account for limited elevation and would reduce upward saccadic speed. Patients with a diagnosis of "double elevator palsy" only infrequently (about one quarter of cases) have palsy of an elevator muscle and may have only a single elevator palsy. The identification of a true elevator weakness is most important in planning management.


Normal and staphylomatous sclera of high myopia. An electron microscopic study.

The posterior sclera of three normal eyes and five staphylomatous, myopic eyes was examined by electron microscopy. The following notable differences were found in myopic sclera: a predominantly lamellar, collagen fiber bundle arrangement; a reduction in the diameter of the fibrils; a greater dispersion for the range of fibril diameters; an increase in unusual star-shaped fibrils on cross section; and a greater prevalence of fibril groups with uniform but extremely fine diameters. These findings essentially agree with those in other studies of the myopic sclera. The ultramicroscopic changes encountered inpathologic myopia are judged to be compatible with an abnormal proteoglycan composition of the interfibrillary substance in the ectatic sclera.


Benign epithelioid cell nevi of the iris.

Two benign acquired melanocytic lesions of the iris stroma had distinctive clinical and pathologic features. One tumor was loculated and polypoid, suggesting ectopic glandular tissue, while the other was a flat tumor with a rich surface capillarity. Both lesions histologically were composed of mononucleated, binucleated, and multinucleated hypopigmented epithelioid and elongated "myoid" cells, widely separated in a finely fibrillar eosinophilic stroma. The ultrastructural features of one case included hyperconvoluted nuclei, conspicuous cytoplasmic filaments are rare, filamentary-striated (leptomeric) structures, scant organelles and inclusions except for numerous mitochondria and glycogen granules, small and infrequent melanosomes, and a fibrillary extracellular matrix focally organized into banded basement membrane material.


Repair of an inadvertent buttonhole or leaking filtering bleb.

Buttonholing of conjunctival flaps at the time of filtering glaucoma surgery or a leak in the flap postoperatively can cause serious problems and may be most difficult to repair. A new delicate atraumatic needle has been used successfully in five cases to close conjunctiva to conjunctiva or conjunctiva to cornea defects.


Senile entropion.

A new surgical procedure has been developed for the correction of senile entropion of the lower lid. The procedure consists of horizontal shortening of the lower lid by a pentagonal wedge resection combined with an infratarsal eyelid suture technique. Twenty eyelids of 13 patients with entropion have been operated on over the last 4 1/2 years with use of various modificatons of this procedure. The average follow-up period is two years three months, with the longest being 4 1/2 years and the shortest being three months. There has only been one temporary recurrence and no overcorrections. The technique is simple and effective when applied to chronic senile entropion unassociated with severe enophthalmos or any cicatricial component.


Intraocular penetration of topically applied lincomycin hydrochloride in rabbits.

Ocular penetration of lincomycin hydrochloride in albino rabbits was determined by bioassay. On topical application, the frequency of multiple instillation of drops played an important role in producing therapeutic levels in the anterior chambers. Therapeutic levels were attained in the cornea, aqueous humor, and iris-ciliary body, with peak values occurring at 30 to 45 minutes. Varying the pH of the dosing solution did not change ocular absorption and distribution substantially. Removal of corneal epithelium, however, greatly enhanced absorption. Relative to clindamycin, lincomycin hydrochloride had longer onset of peak values and lower overall concentration in ocular tissues. Intravitreous injection of lincomycin hydrochloride produced therapeutic and steady levels of antibiotic in anterior chambers. Injection produced a concentration in aqueous humor twice that achievable topically. The major route of elimination from the posterior chamber was through retina-choroid.


The effect of phenylephrine on the cornea.

Rabbit corneas were treated with three drops of phenylephrine hydrochloride with the epithelium intact or denuded. Corneal thickness was measured before and after drug treatment, and at various times after treatment the corneas were fixed for scanning and transmission electron microscopic observation. The results of this study show that phenylephrine caused a dramatic increase in corneal thickness (drug-induced edema) and cellular vacuolation within the keratocytes and endothelial cells in the corneas without the epithelium. Corneal thickness did not change and the ultrastructural changes were minimal following drug application in those corneas with the epithelium intact. Results of this study also suggest that phenylephrine has a cytotoxic effect on the corneal endothelium and keratocytes when used in corneas where the epithelium has been removed. In coreas with intact epithelium, the damage was less severe and limited to the epithelium.


Factors related to corneal epithelial complications after closed vitrectomy in diabetics.

In a series of 30 vitrectomy patients, postoperative corneal complications developed in 14 (47%). Thirteen (92%) of the 14 patients with complications were diabetic. Other factors that were positively correlated with the development of corneal complications included decreased corneal sensitivity, intraoperative lensectomy, and intraoperative epithelial debridement. The corneal complications involved the epithelium in 11 (78%) of the 14 complicated cases, with involvement of the endothelium (as manifested by stromal edema) in five (35%) cases. The diabetic human corneal epithelium contains considerable levels of sorbitol and fructose, which indicates the probable presence of the sorbitol pathway. As in the lens, this pathway may lead to osmotic changes that make the diabetic corneal epithelium more vulnerable to damage intraoperatively. Postoperatively, reepithelialization is delayed because of a probable failure of adhesion of cells to the underlying basement membrane.


Schirmer test after topical anesthesia and the tear meniscus height in normal eyes.

The height of the inferior tear meniscus was measured in 86 normal eyes. A value greater than 0.1 mm was obtained in 93% of the eyes that were studied. However, attempts to correlate meniscus height with subsequent Schirmer test results showed that these measurements varied randomly. Schirmer tests that were conducted on 265 eyes without instillation of 0.5% proparacaine hydrochloride and on 466 eyes with proparacaine showed that topical anesthesia reduced mean test values by 40%. When proparacaine was used prior to testing, no decrease in tear production with advancing age was demonstrated, nor were results significantly different in males and females. Schirmer test values, ranging from 0 to 3 mm, were obtained in 15% of the normal volunteers when the test was performed after instillation of topical anesthesia and after blotting of the tear lake from the inferior cul-de-sac.


Fluorescein angiography in pigmented iris tumors.

Three pigmented iris tumors were studied with fluorescein angiography. Two malignant melanomas leaked dye very early in the arterial phase, while blockage of fluorescence was noted in one melanocytoma. The angiographic appearance of these three lesions was consistent with that, which would be anticipated, based on knowledge of similar lesions in the fundus of the eye. We recommend that fluorescein angiography be performed for all pigmented iris tumors as part of the diagnostic evaluation.


Talc emboli and macular ischemia in intravenous drug abuse.

A patient with decreased visual acuity had small, glistening white particles that were scattered over both posterior poles. Monochromatic fundus photography revealed ghost vessels and intraluminal particulate matter in small retinal vessels. Fluorescein angiography demonstrated nonperfusion of small arterioles and macular capillaries. The patient admitted to multiple intravenous injections of crushed methylphenidate (Ritalin) hydrochloride tablets, which contain talc 18 months prior to examination. To our knowledge, visual loss and irreversible macular ischemia from talc emboli have not been previously documented.


Blue field entoptic phenomenon in cataract patients.

The blue field entoptic phenomenon (BFE), which allows the observation of one's own leukocytes flowing in macular retinal capillaries, was used to predict postoperative macular function in 136 consecutive patients undergoing uncomplicated cataract operation. The results were compared to those obtained with three commonly used tests: two-light discrimination, color perception, and the Purkinje vascular entoptic phenomenon. All four tests identified a nearly equal number of the good maculae (visual acuity 20/40 of better) ranging from 87% for the two-light discrimination test to 94% for the BFE test. However, the tests varied greatly in predicting poor macular function (visual acuity 20/50 or worse). The BFE test identified more than 75% of the poor maculae; the Purkinje vascular entoptic test and the two-light discrimination test, only 22%; and the color perception test, 11%. A positive response to the BFE test indicated a .98 probability of good macular function; a negative response indicated a .82 probability of poor macular function, predictions that were better than the other three tests or their combination.


Pupillary and visual field evaluation in patients with melanocytoma of the optic disc.

Twenty patients with melanocytoma of the optic disc underwent Goldmann perimetry and pupillary evaluation. Two patients (10%) had normal visual fields. Three (15%) had minimal blind spot enlargement. Fifteen patients (75%) had a greatly enlarged blind spot, of which ten had concomitant nerve fiber bundle field defects. These consisted of a nasal step in two cases (10%), relative nerve fiber bundle defects in four cases (20%), and an absolute arcuate defect in four cases (20%). The blind spot enlargement relates to the pigmented tumor extended beyond the disc boundary, thereby shading the peripapillary retina. The nerve fiber bundle defects result from injury to the visual axons passing through the nerve head, although the mechanism is uncertain. A Marcus Gunn pupillary sign produced by the melanocytoma was found in six patients (30%), all of whom had a substantial relative or absolute nerve fiber bundle defect.


Retinal rivalry in functional amblyopia.

Thirteen patients with varying degrees of amblyopia were examined for perception of retinal rivalry with the use of the phase difference haploscope. Visual acuity was varied in the fixing eye by the addition of plus lenses, equalizing ocular dominance. Retinal rivalry could be detected over wide ranges of visual acuity disparity by amblyopic patients with visual acuity better than 20/50. Rivalry could not be detected, however, by patients with less than 20/50 visual acuity in their amblyopic eye.


Intraocular cysticercosis.

Two intravitreal Taenia cysts were removed intact by pars plana vitrectomy from a 59-year-old woman who had never left the continental United States. The intraocular course of the cysts progressed from an initial chorioretinal location, accompanied by an intense focal inflammatory reaction, to free floating in the vitreous cavity within two months; thereafter, there was only a low-grade vitritis for an additional five months until removal. Light and electron microscopic studies suggested Cysticercus cellulosae as the infecting agent, although mature hooklets were absent. Local pork products were considered to be the source of the infection. Preretinal fibrosis and posterior subcapsular vacuoles were the final residua and did not progress after removal of the cysts. Although uncommon in the United States, cysticercosis should be considered in cases of focal necrotizing chorioretinitis.


Benign hemangioendothelioma of the lacrimal gland fossa.

A mass was surgically removed from a patient who complained of a swelling in the lacrimal gland fossa. Histopathologic evaluation of the mass showed an unusual variant of the benign capillary hemangioma that exhibited abundant endothelial cell proliferation, and that could alternatively be classified as a benign hemangioendothelioma.


Corneal trauma from projection of metallic mercury into the eyes.

A 24-year-old woman sustained bilateral ocular lesions due to projection of mercury into the eyes during an explosion in a chemical laboratory. A lamellar keratectomy was performed on the right eye four hours after the accident, and 12 days later, the same procedure was performed of the left eye. Studies by light and electron microscopy were done on both specimens. The essential findings were total loss of epithelium, necrosis of keratocytes, absence of inflammatory reaction, and absence of superficial stromal repair in the specimen that was obtained 12 days after the accident. These findings indirectly confirm the importance of epithelium and normally vascularized conjunctiva in healing wounds of the cornea.


Neuromyopathic ptosis: a new surgical approach.

Neuromyopathic ptosis is a progressive disorder frequently associated with other ocular abnormalities. These include dry eyes, absent Bell's phenomenon, protractor weakness, and heterotropia. Thus, correction of this ptosis has not been well described and is avoided by many surgeons. Since ptosis usually occurs early in life, correction is of functional, economic, and cosmetic importance. Clinical and histologic findings suggest that degeneration and defects of the levator aponeurosis contribute to the ptosis. During the past two years, we have used the aponeurotic approach to correct neuromyopathic ptosis. We describe 19 eyelids with a minimum one-year follow-up. Most eyelids were purposely undercorrected. A mean lid elevation of 3.3 mm with good symmetric results was obtained. Procedures were performed under local anesthesia. Advantages of this technique are (1) patient cooperation for adjustment of lid height and contour at surgery; (2) preservation of other suspensory structures (Müller's muscle and Whitnall's ligament); (3) easy adjustment of lid height postoperatively; (4) preservation of all tear-producing structures; (5) avoidance of corneal irritation from posterior sutures; and (6) maintenance of anatomic planes, which simplifies reoperation, if necessary. We believe this conservative approach corrects most eyelids with neuromyopathic ptosis.


Ultrastructural comparison of capillary and cavernous hemangiomas of the orbit.

Capillary and cavernous hemangiomas are often grouped together as if they were modulations of the same entity. To clarify this nosologic question, three capillary hemangiomas in children and four cavernous hemangiomas in adults were studied by transmission electron microscopy. The capillary hemangiomas consisted of two variably admixed zones, solid cellular zones and zones with open vascular lumens. However, both zones had similar organization. Each vascular unit was composed of endothelial cells and pericytes, which persisted in a tumor three years after its clinical appearance. Macrophages and degenerating cells were found in the interstitium and may be related to the clinical feature of partial spontaneous regression. The cavernous hemangiomas had much larger lumens, and wider and more heavily collagenized trabeculae. The vascular walls were created by multilaminar smooth muscle cells. Therefore, capillary hemangioma is completely different from cavernous hemangioma, which resembles a venous tumor.


The human limbus. A scanning electron microscopic study.

Fourteen human limbal biopsy specimens were obtained from seven normal subjects. The epithelial surface was examined by scanning electron microscopy. Epithelial cell surfaces varied greatly in shape and size, and mosaics of three- to six-sided irregular polygons were formed. Microvillar borders of cells were distinct. Cell sizes ranged from 3 to 20 micron across. Light and dark cells were present and randomly distributed. A few cells were covered with microplicae; the remainder of the cells were covered with microvilli. Intercellular crypt openings measuring 1 to 10 micron in diameter were distributed randomly over all specimens. These openings were believed to be related to goblet cells. Many openings were plugged with what appeared to be mucus. Many surface-level intercellular structures were present; they corresponded in diameter to the surface openings. The human limbal epithelium varies from both the upper tarsal conjunctiva and the cornea.


Fine structure of the tissue lining the cochlear perilymphatic space against the bony labyrinthine capsule.

The perilymphatic tissue covering the bony labyrinthine capsule was studied in chinchillas by help of the thin-section and the freeze-fracture methods. Among the extremely flat and extended cells there were demonstrated fasciae occludentes and maculae communicantes. It is supposed that the perilymphatic tissue is arachnoidal tissue, too.


Noise-noise effect upon the spreading of the posttraumatic progressive necrosis in the organ of Corti.

Progressive necrosis of the organ of Corti caused by a disturbance of the ionic composition of the Cortilymph resulting from the infiltration of endolymph into the organi of Corti after traumatization of its barrier against the scala media, is greatly intensified by posttraumatic stimulation with noise of physiological intensities. This effect is attributed to oscillation of the cochlear partition, with resultant greater blending of the Cortilymph and the endolymph. Stimulation augments necrosis fourfold towards the base of the cochlea and twofold towards the helicotrema. Posttraumatic stimulation is one of the factors which markedly potentiate the regressive effect of acoustic trauma.


[Comparative studies of the endolymphatic sac and duct in embryonic skull (author's transl)].

The endolymphatic sac and duct were studied in 25 embryonic ears of humans between the 10th and 25th week of development. In the early stage the anlage develops as a protrusion medio-caudally from the utricle. During further development vacuoles appear within the connective tissue surrounding the duct and sac which eventually unite with the endolymphatic system enlarging the endolymphatic space as an answer of the connective tissue to the expansion and proliferation of the endothelium. In older specimens (fronto-occipital diameter: 40 mm) we find a tongue-like projection of the wall of the duct into the utricle known as the endolymphatic valve. This structure is covered with a thickened folded epithelium. It is stabilized by fibrous, cartilaginous, and bony tissue. Under normal conditions it therefore seems improbable that it can serve as a valve as supposed by other authors. The proliferation of endothelium and a concentration of blood vessels in this might indicate a higher metabolic activity with a biochemical filtering mechanism.


Loss of stereocilia in the human organ of Corti.

The process of disappearance of the stereocilia at the top of the outer hair cell was described by observing aged human cochlea under scanning electron microscope. After loss of hair, remnants of hair could be recognized at the top of outer hair cells. As the process continued, the remnants of the stereocilia increase in percentage, while the remaining abnormal hair decrease. As remnants gradually disappear, the W-configuration faded away. At the same time, the diameter of the hair cell top decreased by shrinking. Before the supporting cells made a complete cover, there may be a depression in the reticular lamina due to shrinking of the top of the hair cell. However, if the depression persists, there is the potential danger of reticular lamina rupture. Existence of a breaking point in the stereocilia of the outer hair cell was proposed.


The fate of hemidesmosomes in laryngeal carcinoma.

The ultrastructural morphology of the hemidesmosomes in malignant epithelial cells of invasive squamous cell carcinoma of the human larynx was studied by electron microscopy. In the more advanced carcinomas the hemidesmosomes are reduced in number or absent over extensive areas of the epithelial stromal junction. In some places the hemidesmosomes are observed to be in the process of being dislodged from their normal sites at the plasma membrane of the basal carcinoma cell. After dislodgment from the basal plasmalemma into the subepithelial connective tissue the hemidesmosomes are seen to round off with the cytoplasmic attachment plaques lying on their inner circumference. A constant feature of the detached hemidesmosomes is the absence of inserting tonofilaments. Frequently, the detached hemidesmosomes are found to be in close association with detached multilayered basement membrane material in the stroma. The detached hemidesmosome-structures appear to migrate down into the deeper layers of the connective tissue space apparently loosing their distinct ultrastructure. These observations indicate that the detachment of hemidesmosomes and their subsequent downward dermal migration may result in a loss of epithelial-stromal adherence in invasive epithelial cancer of the larynx.


The origin of the waveform of cochlear whole action potential.

An explanation is given why the recorded action potentials of the cochlea manifest themselves in the complex N1N2-form. The separate AP of the nerve fibers are not diphasic but triphasic in form. With algebraic addition of the, in different phase, AP present in the auditory nerve the N1N2 complex originates. This is illustrated by the observed form changes in the recorded signals during the cutting experiments of the auditory nerve.


Intramodal and interaural interactions of the human slow auditory evoked potential.

It is proved that the human slow auditory evoked potential (SAEP) possess intramodal (frequency) and interaural specific properties. It is shown that tonotopic and bilateral organization of the SAEP generating system is better expressed at lower stimulus intensities. It is concluded that neuron populations of the SAEP generating system which perceive less different tone stimuli overlap each other greater than those which perceive more different stimuli. The data on intramodal and interaural specificity of SAEP are discussed from the point of view of its extralemniscal origin.


Immunoglobulin levels of tonsillar cells.

Immunoglobulin G, A and M contents of homogenized tonsillar lymphocytes were measured. Higher Ig values were found in adults than in children. Inflammatory processes increased the immunoglobulin levels of tonsillar lymphocytes. The changes in tonsillar IgG and IgA levels suggest the importance of local immunoglobulin production in the defence mechanism of tonsils. Two isolated IgA deficiencies were detected among the 85 patients.


Tinnitus caused by bilateral shunts from the occipital arteries to the intracranial veins. A case report.

A patient with objective tinnitus and a pulse synchronous murmur over both left and right sides of the mastoid regions is described. Microphones placed over the mastoid regions recording "phonomastoidograms" clearly demonstrated the pulse synchronous tinnitus. Arteriovenous shunts from the occipital arteries to the sigmoid sinus were later demonstrated with angiograms. After bilateral surgical removal of the arteriovenous shunts the incapacitating tinnitus disappeared. The importance of thorough examination of pulse synchronous tinnitus is discussed.


An investigation of the auditory frequency-following responses as compared to cochlear potentials.

Comparisons were made of cochlear microphonics (CM) and scalp recorded frequency-following responses (FFR) from chinchilla and human. The latency of the scalp/ear-lobe recorded FFR was found to be nearly zero with respect to CM. Further, auditory nerve action potential were noted to diminish rapidly after death whereas the CM component in FFR reduced gradually. The decay of the CM component of FFR measured at the scalp after death followed an identical time course to that of the CM at round window. These observation lead to the conclusion that FFR does not originate in the brain stem but is essentially cochlear potentials picked up by electrodes located at the scalp.


Changes of blood metabolites in horses after racing, with particular reference to uric acid.

Changes in concentration of a number of blood metabolites in 30 thoroughbred horses were recorded after an 1110 metre race. No significant changes occurred in blood urea or aspartate aminotransferase during the three hours after racing. Plasma sodium, potassium and calcium levels were increased immediately after racing but had returned to normal one hour after racing. Plasma phosphate showed a significant fall in concentration one hour after racing. Creatinine and lactic acid concentrations were elevated ten minutes after racing and although they subsequently decreased, the level of lactic acid was still significant one hour later. Uric acid levels were well above resting levels at ten minutes after racing but rose even more in the subsequent hour. Urinary uric acid levels were also elevated during this time. Three hours after racing some horses still had elevated plasma uric acid levels and all of them showed a significant rise in creatine phosphokinase. The possible physiological basis of these findings is discussed.


The longevity of Fasciola hepatica metacercariae encysted on herbage.

An experiment was described in which guinea pigs were used as tracer animals in an attempt to assess the longevity of Fasciola hepatic metacercariae on pasture at Werribee, Victoria. The metacercariae had been encysted on both an irrigated and non-irrigated area at various times during 1976. It was determined that, under the conditions of the experiment, metacercariae can survive and remain viable for up to 10 weeks during the winter. It was also determined that longevity during the summer was greatly reduced, and was of the order of only 1 week. The significance of these findings, with respect to the epidemiology of the disease, was discussed.


The effect of prior infection with Fasciola hepatica on the resistance of sheep to the same parasite.

The development of flukes that resulted from a challenge dose of 175 F. hepatica metacercariae was compared in 4 groups of sheep that were maintained under grazing conditions on fluke-free pasture. One group had been previously uninfected and all subgroups of each of the other 3 groups had been exposed to one of a range of previous doses of metacercariae. The preliminary infections of 2 of the 3 groups had been terminated respectively after 7 and 14 weeks. The third previously infected group had received its preliminary infection as 2 doses of metacercariae, 7 weeks apart. The latter infection had been terminated after 14 weeks. No appreciable differences in the mean numbers, length, prepatent period or fecundity of flukes, established as a result of the challenge dose of metacercariae, were detected between the control group and the 3 previously infected groups. It was concluded that under the conditions of the present experiment no evidence was detected that would suggest that previous infection with F. hepatica conferred any significant resistance to a future challenge.


Effectiveness of anthelmintic treatments against levamisole-resistant Ostertagia.

Adult worms from a population of Ostertagia consisting of 88% O. circumcincta and 12% O. trifurcata were found to survive a double drench (14 mg/kg) of levamisole. An anthelmintic assay on this population found that against levamisole the LD50 was 11.95 mg/kg and the LD99 was 67.75 mg/kg. Three benzimidazoles were also tested against this population and the LD50 and LD99 were respectively thiabendazole 11.8 and 144.9 mg/kg, oxfendazole 0.17 and 6.10 mg/kg and albendazole 0.08 and 2.55 mg/kg. The percentage of worms killed by the recommended dose rate was levamisole 24%; thiabendazole 91%; oxfendazole 99% and albendazole 99%.


Chemotherapy of acute bovine anaplasmosis.

The efficacy of a standard tetracycline, imidocarb and a new experimental long-acting tetracycline (T-200) in the treatment of anaplasmosis was examined in 5 groups of 9 nonsplenectomised, adult, 4-year-old, speyed cattle. The efficacy of T-200 was further examined using 9 splenectomised calves. One treatment of imidocarb (3.5 mg/kg) or T-200 (20 mg/kg) or 2 treatments (10 mg/kg) of a standard tetracycline were very effective in controlling the infection in the intact cattle. On inoculation of T-200 (20 mg/kg) controlled infection in 5 splenectomized calves, whereas all 4 untreated control calves died. T-200 did not sterilise either intact or splenectomised cattle.


Serological classification of Australian strains of Erysipelothrix rhusiopathiae isolated from pigs, sheep, turkeys and man.

154 strains of Erysipelothrix rhusiopathiae from pigs, sheep, turkeys and man were serotyped by using the double diffusion gel precipitation test. Ten of the 18 serotypes were detected in 151 of the strains. Three strains failed to react with any of the type specific antisera. It was found that serotype 1a shared an antigen(s) with serotype 1b, and that serotype 6 shared an antigen(s) with serotype 14. Serotype 2a and 2b were difficult to distinguish. Since serotypes 1 and 2 were isolated from cases of septicaemia in pigs, and since serotypes 1, 2, 4 and 7 were isolated from cases of arthritis, it was suggested that factors other than serotype were important in causing the various forms of swine erysipelas. The fact that the distribution of serotypes 1a, 1b and 2b between septicaemic and arthritic pigs was similar supported the conclusion that arthritis was consequent to bacteraemia. Serotypes 1a, 1b, 2b, 5, 12 and 15 were isolated from cases of arthritis in sheep, and serotypes 1a and 5 from cases of erysipelas in turkeys. Serotype 2b was isolated from a human specimen.


Snake bite in dogs.

In 7 years snake bite was diagnosed in 80 dogs. Sporting breeds figured prominently. The average was 3.6 years. The commonest presenting signs were salivation, vomiting, dilated pupils, absence of the pupillary light reflex, depression and generalised muscle weakness, hindlimb ataxia and respiratory distress. Sixty-seven cases (84%) occurred in 6 warmer months on the year. Fifty-one dogs (64%) were seen either to be bitten or in contact with a snake. Tiger and Brown snakes were implicated on 32 and 3 occasions respectively. An overall recovery rate of 87% was obtained for patients receiving antivenene, fluid and support therapy. The period from treatment-to-full recovery was shorter for cases in which the bite-to-treatment period was one hour or less (24 hours) when compared with the recovery time for all cases (36 hours). The prognosis was poor for dogs presenting with the triad of complete flaccid paralysis, dyspnoea and a sub-normal temperature.


Helicopter passenger survival suit standards in the UK offshore oil industry.

Special protective clothing for helicopter passengers in transit to and from installations in the U.K. offshore oil industry is considered essential. Such clothing is required to increase the survival chances in the unlikely event of a helicopter ditching. This paper discusses the nature of the threat to life in such an event and proposes standards for the specific protective clothing required to meet it. Test criteria are also outlined, to ensure that standards set are maintained.


Effect of water and electrolyte replacement during exercise in the heat on biochemical indices of stress and performance.

Eight healthy young men exercised on alternate days in a warm, humid environment (32 degrees C, 65% RH) at 50% VO2 max for 2 h while receiving a water supplement (WS), glucose-electrolyte solution (ES), or no fluid supplement (NS). The average weight loss after 2 h of exercise and NS was 2.44 kg with a resultant plasma volume decrease of 17%. This acute period of exercise with no fluid replacement elicited significant increments in serum levels of cortisol, dopamine-B-hydroxylase and uric acid. Alternatively, exercise in the heat for the same duration with water or electrolyte supplement failed to effect significant alterations in any of these physical or biochemical factors compared to preexercise levels. Heart rates under the influence of heat stress and exercise with NS averaged 18% higher at each time period studied compared with WS or ES.


Tolerance of domestic fowl to high sustained +Gz.

A system is described for the acceleration treatment of domestic fowl. A reasonable endpoint for acceleration tolerance is provided by a bradycardia which occurs fairly close to the lethal limit. In a group of 61 male Rhode Island Red chickens exposed to 6 Gz, the mean tolerance (+/- S.D.) was 11.1 +/- 10.6 min. Among individuals, the acceleration tolerance is inversely related to both body size and age, and positively to pre-treatment heart rate.


SPH-4 helmet damage and head injury correlation.

Human tolerance to head impact was assessed by correlating the force levels required to duplicate damage seen in 14 SPH-4 aviator helmets retrieved from U.S. Army helicopter crashes with resulting head injury. Head injury occurred at peak acceleration levels far below 400 G, which is the value currently used by the U.S. Army as the pass-fail criterion in evaluating the impact attenuation performance of prospective aircrew helmets. Concussive head injuries occurred below Severity Index values of 1500 and below Head Injury Criterion values of 1000. These are considered concussive threshold values by the National Operating Committee on Standards for Athletic Equipment and by the Department of Transportation, respectively. Because peak transmitted force was the best estimator of the Abbreviated Injury Scale values assigned to the 14 cases, it may be a more effective criterion to use in the evaluation of helmet impact attenuation performance than is peak G, Severity Index, or Head Injury Criterion.


Central and cerebral hemodynamics and metabolism of the healthy man during head-down tilting.

Experiments on six healthy test volunteers, who underwent simultaneous catheterization of different cardiovascular compartments, were carried out to study the effect of head-down tilting at an angle of -20 degrees on the central and cerebral hemodynamics and metabolism. By the third hour of exposure, the test subjects showed a decrease in the systolic arterial pressure and increases in the systolic pressure of the right ventricle, heart rate, cardiac output, and oxygen intake. They also displayed a trend for an increase in the content of adenosine triphosphate, a decrease in the content of pyruvic acid, and essentially no changes in the concentration of lactic acid and activity of lactate dehydrogenase in the arterial blood and in the blood flowing out from the brain. The oxygen arteriovenous difference for the systemic and cerebral circulation decreased by 24% and 13%, respectively. The above circulatory and metabolic changes seem to reflect processes of adaptation of the human body to functioning under conditions of cephalad fluid shifts.


Time for loss of increased cardiac responsiveness to isoproterenol in cold-acclimated rats after removal from cold.

Female rats exposed to air at 5 +/- 1 degree C for 12 weeks had a greater increase in heart rate in response to s.c. administration of d,l-isoproterenol (8 microgram/kg body weight) than warm-acclimated controls when both were tested in air at 25 +/- 1 degree C. After removal from cold for 24, 48, or 72 h, cold-acclimated rats still showed a greater responsiveness of heart rate to s.c. administration of isoproterenol (8 microgram/kg body weight) when compared with warm-acclimated controls. However, by 96 h after removal from cold, the responsiveness of heart rate to isoproterenol in the cold-treated group no longer differed from that of the warm-acclimated group. Hence, the increased beta-adrenergic responsiveness of heart rate in cold-acclimated rats was lost at some time between 72 and 96 h after removal from cold.


Caloric and exercise requirements of space flight: biostereometric results from skylab.

The biostereometric study of the Skylab astronauts used stereophotogrammetry to make accurate three-dimensional measurement of body form, from which regional and total body volumes were derived. Volume changes in the thighs and calves, over the course of the flight, showed a high correlation with inflight exercise on the bicycle ergometer, and suggested that an exercise level of 80-100 W-min/d/kg lean body mass would be necessary to prevent inflight muscle atrophy. The bicycle ergometer is thus a relatively inefficient means of preventing leg muscle atrophy. Inflight caloric intake showed a high correlation with the change in volume of the buttocks, the abdomen, and the body as a whole, and suggested that a caloric intake of 47-51 kcal/d/kg lean body mass would be necessary to prevent a change in body fat. Only one of the astronauts exceeded this range and gained body fat; the group as a whole showed a mean fat loss of 1.2 kg.


Evaluation of the helicopter in aeromedical transfers.

Since the end of the Vietnam conflict, the technology of moving patients by helicopter has been applied to peacetime uses. There is doubt, however, that the helicopter has much to offer the patient when used as a routine and semi-emergency ambulance. This study reviewed 52 consecutive aeromedical evacuation requests which included both civilian and military patients. By comparing the patient's condition at both pickup, delivery and his subsequent course, it was determined that most patients would not have been unduly harmed by the slower methods of ground transfer. Only 33% of the patients were benefitted by rapid aeromedical transfer. Those patients benefitted can roughly be grouped as true surgical and medical emergencies. The use of the helicopter for routine transfers is to be discouraged.


Ruptured arteriovenous anomaly in a former woman astronaut candidate.

A case is reported of a former woman astronaut candidate who withstood the rigors of the preliminary physical examinations for this position. Some years later, she sustained a subarachnoid hemorrhage from an arteriovenous malformation in the right parieto-occipital area, which was successfully excised. Postoperatively, she had a marked visual deficit, from which she completely recovered within 3 months. The development of psychomotor seizures 5 months later was due to probable scarring in the right parieto-occipital region of the cerebral cortex, the interpretive area for orientation of body image in space, which had been supplied by the clipped right anterior and posterior cerebral arteries feeding the arteriovenous anomaly. These seizures have been well controlled on anticonvulsants. A lesion in the temporoparieto-occipital region due to a hemorrhage from a ruptured arteriovenous anomaly, resulting in the disabling symptoms of disorientation or loss of body image due to impairment of the interpretive cortex, could be devastating to the pilot and a mission. This case raises the question of an automatic use of the CT brain scan in screening potential space candidates, and even the consideration of a percutaneous femoral four-vessel arteriogram in all, or possibly selected, candidates. Most neurosurgeons and neuroradiologists probably would consider the risks of the latter procedure too great to justify its use for fear of permanent complications to the space candidate.


Formation of an unstable covalent intermediate during the inhibition of electric-eel acetylcholinesterase with 1,3,2-dioxaphosphorinane 2-oxides.

The kinetics of interaction of eel acetylcholinesterase (EC 3.1.1.7) with 1,3,2-dioxaphosphorinane 2-oxides were investigated. It was demonstrated that the rate of spontaneous re-activation as well as the re-activation profile in the presence of 2-pyridine aldoxime methiodide of the inhibited enzyme are irrespective of the leaving group of three inhibitors and exhibit the same values. The dissociation constant of the corresponding Michaelis complex was evaluated by two independent methods and the results were found to be in close agreement. It was shown that the active site is essential for interaction between the enzyme and the various dioxaphosphorinanes. The mixed anhydride of diethyl phosphoric acid and 2-hydroxy-1,3,2-dioxaphosphorinane 2-oxide behaves exactly as would be predicted from a typical diethyl phosphate inhibitor. Enxyme that was incubated with the cyclic acid or the corresponding methyl ester recovered immediately upon extensive dilution. Inhibition of enzyme in the presence of  high concentratasions of the corresponding 2-chloro and 2-fluoro derivatives decreased the regeneration rates as well as the maximal amount of the re-activated enzyme. This observation could not be explained in terms of a classical aging process. On the basis of the kinetics observations it is suggested that an unstable covalent phospho-enzyme intermediate is formed during the reaction between acetylcholinesterase and 1,3,2-dioxaphosphorinane 2-oxides.


Structure and synthesis of naturally occurring anhydrovitamin A2.

The structure of naturally occurring anhydrovitamin A2 was elucidated as 3-hydroxyanhydroretinol from study of its u.v.--visible, i.r., n.m.r. and mass spectra. The structure has been confirmed by a chemical synthesis. Saccobranchus fossils, a freshwater fish, can convert 3-hydroxyretinol into 3-hydroxyanhydroretinol, which in turn is converted into-3-dehydroretinol. Chemical conversion of 3-hydroxyretinol into 3-dehydroretinol was also carried out.