Bilateral abductor vocal cord paralysis in Charcot-Marie-Tooth disease.

This report descirbes the unusual association of bilateral abductor vocal cord paralysis (BAbVCP) and Charcot-Marie-Tooth disease in a boy and his natural mother who have been followed for eight years. The boy initially presented with life-threatening respiratory distress at age ten years; BAbVCP was documented by direct laryngoscopy. Mirror laryngoscopy confirmed BAbVCP in the mother. Neurological diagnosis was made by history, physical examination, electromyography, and nerve conduction velocity studies. The BAbVCP may represent an additional genetic marker within the spectrum of heredodegenerative disorders. Of clinical importance is examination of voice and respiratory symptomatology of patients with heredodegenerative diseases and neurological work-up of patients with familial vocal cord paralysis. Further genetic and clinical studies of X cranial nerve involvement in heredodegenerative disorders are warranted.


Aneurysmal bone cyst of maxilla.

A case of aneurysmal bone cyst of the maxilla is reported. The clinical and radiological feautres, histopathology and treatment, are described in detail. Although the pathogenesis is still obscure, surgical excision is considered to be the treatment of choice.


Variation of endocochlear PO2 and cochlear potentials by breathing carbon dioxide.

The effect of carbon dioxide on oxygen dioxide tension in the endolymph was determined by the micropolarographic technique. Different concentrations (5% and 10% CO2) and different exposure times (3, 5, and 20 minutes) were investigated. The highest levels of PO2 in the endolymph (101.7, 93.9 and 69.5 mm Hg) were accomplished by respiration of 10% CO2, 90% O2, for 20, 5 and 3 minutes consecutively. The lowest PO2 increase, 50.7 mm Hg was observed after breathing 5% CO2, 90% O2 for 20 minutes. Extreme hypercapnia caused an increase of endocochlear potentials (EP) in all groups. In the second group EP increased from +79.3 to +84.9 and in all groups they had returned to the pretreatment level after CO2 discontinuation. These results support the theory that carbonic anhydrase participates in the generation of EP. At the same time that EP increased, cochlear microphonics declined and opposite after the breathing mixture was discontinued. The results permit the conclusion that high levels of PO2 in endolymph is achievable even with short periods of respiration with high CO2 mixture, and suggest the role of carbonic anhydrase during EP generation.


Effect of ammonia on nasal resistance in atopic and nonatopic subjects.

Nasal airway resistance (NAR) was assessed from the slope of pressure-glow curves obtained during normal nasal breathing. Volunteers were classified as atopic or nonatopic according to strict critera. 100 ppm NH3 was introduced into each nostril for periods ranging from 5 to 30 seconds with frequent NAR monitoring. A progressive increase in NAR responses was obtained with incremental NH3 exposure, but no significant difference was noted between the mean response of atopic and nonatopic subjects. Control exposures to compressed air under the same pressure generally produced only a small change in NAR, while aerosolized buffered saline increased NAR more than compressed air. The nasal response to NH3 was effectively inhibited by intranasal atropine administration but not by chlorpheniramine. The nasal response to NH3 was effectively inhibited by intranasal atropine administration but not by chlorpheniramine. The described procedure provides a safe and simple method for studying semiquantitatively the short-term effects of inhaled irritants on the nose.


Hypernephroma metastatic to the palatine tonsils.

Review of the literature discloses 76 cases of carcinoma metastatic to the palatine tonsil. Of these cases reported or mentioned, 51 were detailed sufficiently or occurred frequently enough to allow analysis. We add two new cases of hypernephroma, and also study the courses of patients with primaries of the stomach, breast, lung and melanoma and seminoma. Bilateral tonsilar involvement is found to be very common in melanoma and not uncommon in seminoma and adenocarcinomas of the stomach and breast. It is uncommon for bronchogenic carcinoma and hypernephroma to metastasize to both palatine tonsils. When laterality is present the left tonsil is more commonly involved than the right, except by melanoma. Regarding neoplastic involvement of the primary organ, the left side gives rise to malignancies more often than the right side. Only seminoma has a high incidence of other metastases. The mean time interval between development of the primary and the tonsillar secondary is one year or less in seminomas, bronchogenic carcinomas and adenocarcinomas of the stomach, but 2 1/2 years or more for adenocarcinomas of the breast and kidney and melanomas. The mean time of survival after appearance of the tonsillar metastasis is nine months or less, regardless of the cell type of the primary malignancy.


Response of nasal airway resistance to hypercapnia and hypoxia in man.

The response of nasal airway resistance (Rn) to various degrees of hypoxia and hypercapnia was measured in six subjects using active posterior mask rhinomanometry. All resistances were computed during expiration at the flow rate of 0.5 liter/sec. Hypercapnia, induced by breathing gas mixtures of various contents of carbon dioxide, significantly decreased Rn (P less than 0.05, Wilcoxon signed rank test). The reduction in Rn was proportional to the inspired partial pressure of carbon dioxide over a range of 0 to 50 torr. Breathing gas mixtures of high and low contents of oxygen produced no significant change in Rn (P less than 0.05, Wilcoxon signed rank test). These results indicate that the nasal airway is actively involved in the respiratory response to hypercapnia but not to moderate hypoxia.


Role of the vidian nerve in nasal allergy.

Clinical studies were performed to evaluate the role of the vidian nerve at onset of symptoms in nasal allergy. A localized area of one side of the nasal cavity was stimulated with known allergen and 0.1% histamine chloride in patients with perennial nasal allergy. The effect of unilateral vidian neurectomy and sensory anesthesia on glandular and vascular response was evaluated. With localized nasal stimulation, hyperrhinorrhea was seen in both sides of the nasal cavity before vidian neurectomy. Unilateral vidian neurectomy blocked hyperrhinorrhea only in that nasal cavity in which the nerve was sectioned. However, hyperrhinorrhea from the contralateral side, with an intact vidian nerve, was blocked with sensory anesthesia of the opposite side of the nasal cavity where the stimulation was applied. Nasal hypersecretion in allergic rhinitis was assumed to be mostly due to stimulation of sensory receptors by a chemical mediator and reflexive stimulation of the nasal glands. Vidian neurectomy, however, did not have any apparent influence on the swelling of the nasal mucosa caused by localized stimulation of allergen and histamine.


Acute laryngeal abscesses.

The clinical features of laryngeal abscess have changed markedly since the introduction of antibiotics and are rarely seen by clinicians today. Three cases of acute laryngeal abscess associated with malignancy, airway instrumentation and a preexisting laryngocele respectively are presented. Management of these cases included immediate tracheostomy, intravenous antibiotics and surgical drainage. Current etiological factors and modes of presentation are discussed. Laryngeal abscess remains a serious and potentially lethal problem requiring emergent treatment. Serious sequelae may result from this disease.


Congenital anosmia: detection thresholds for seven odorant classes in hypogonadal and eugonadal patients.

Detection thresholds for a representative from each of seven odorant classes (putrid, pepperminty, ethereal, camphoraceous, pungent, musky, floral) were determined by double-blind smell testing of seven normal males, six normal females, 6 patients with uncomplicated congenital anosmia and 13 patients with the syndrome of congenital anosmia and hypogonadotropic hypogonadism (the Kallmann syndrome, olfactogenital dysplasia). The median detection thresholds did not differ significantly between hypogonadal and eugonadal anosmics for any of the odorants, suggesting that the endocrine deficit does not result from inadequate rhinencephalic input to brain centers controlling gonadotropin release. Phenylethylmethylethylcarbinol (PEMEC), a stable chemical of the floral class, was detecred at very low concentrations (10(-6) to 10(-8) M in water) by all normals tested. Since no patient with congenital anosmia was able to distinguish even undiluted PEMEC from water, we suggest that this compound is the material of choice for convenient, rapid and objective testing of the sense of smell (cranial nerve I).


Tinnitus as a presenting symptom in pernicious anemia.

An unusual case presenting to the otolaryngologist as pulsatile tinnitus is discussed. Fowler points out that the circulatory response to anemia is increased cardiac output. There is associated tachycardia and increased arterial pulse pressure. Because of this increased flow state and turbulence, systolic bruits, venous hums, and "capillary" pulsations are found. This increased flow state is perceived in the ear as a transmitted pulsatile tinnitus. The successful treatment of this patient's pernicious anemia corrected the hyperdynamic circulatory state, and resulted in disappearance of her tinnitus.


[Increase in ovarian K+ levels in impuberal rats treated with gonadotropins: characteristics of the phenomenon].

In Pregnant Mare Serum Gonadotrophin (PMSG) primed rat ovaries, the K+ level and 42K uptake were increased (+14% and +47% respectively). This phenomena was observed only for target organs (ovaries and testis) and was detectable 30 minutes after PMSG injection. The K+ level augmentation was still demonstrated when the macromolecules biosynthesis were blocked by actinomycin. In hypophysectomised rat, LH or FSH had the same effect as PMSG on K+ level.


[Activity of the octanol dehydrogenase, of the alcool dehydrogenase and aldehyde dehydrogenase on the farnesol metabolism. Photoperiodic and neurhormonale regulation, controlling the metabolism of the juvenile hormone, in Pieris brassicae (author's transl)].

The antagonistic photoperiodic behaviour of the farnesol dehydrogenases indicates that the photonic control mechanism of the brain acts on the farnesol derivates. This cerebral control is double. The first system, linked at the allatotrope function is proportionnal at the photoperiod and acts on the octanol dehydrogenase 0,32. The second system controle the deshydrogenases ADH bands 0,50--0,58, is linked at the darkness. It is linked also at the neurocerebral activity then it stops its activity at the 4th day of the 5th stage. This last seems to be the determinating control for the establishment of the diapause since in short photoperiod, when the inhibition by this system ends, the alcool dehydrogenases 0,50-0,58 series is suractivated in rate with the lasting of the scotophase. In darkness, the 1st system functionnes cyclically and has a maximum synchron with the single maximum of the 2nd system. Inversally, in continuous light, the 2nd system is synchronisated with the 1st which has a prolongated action, maybe linked with a prolongated activity of the neurosecretory cells of the pars intercerebralis and corpora allata.


[Gonadotropic function in female Cushing's syndrome (author's transl)].

Gonadotropic function has been studied without selection in 38 female patients with Cushing's syndrome followed during four years. The level of gonadotropins FSH and LH was low in all etiologies of the syndrome. LH-RH stimulation is normal in adrenal hyperplasia and adenoma, and very low in carcinoma. These abnormalities are cured after reduction of hypercorticism. The share of either cortisol or androgens is discussed. A predominant hypercortisolism blunting action on gonadotropic function is possible, cortisol being the common factor of Cushing's syndrome.


[Role of progesterone in the insulin-resistance during pregnancy in the rat (author's transl)].

Progesterone inhibits insulin action in vivo and in vitro. In vivo the hypoglycemic action of an intravenous injection of insulin is counteracted by a simultaneous injection of progesterone. In vitro, insulin effect on glucose uptake and on 14CO2 production from 14C-glucose is inhibited by progesterone in female rat diaphragme muscle, adipose tissue and isolated adipocytes. Thus, progesterone plays an important role in carbohydrate metabolism during pregnancy in the rat.


[Estrogen dependance of the progesterone "receptor" in human tissues (author's transl)].

The concentration of specific progesterone receptor (RP) has been measured in the endometrium of 31 normal menstruating women during the two phases of their menstrual cycle, and compared with the plasma oestradiol-17 beta (E2) concentrations. There was no relationship between RP and plasma E2 when the two phases of the cycle were considered, however a correlation was observed when the follicular phase was only considered. The relationship between oestrogen and RP was then more directly studied in a breast cancer cell line in tissue culture (MCF-7). RP induction by E2 as well as oestriol was demonstrated, but oestrone was ineffective.


[Study of plasma androstenedione and testosterone levels in hypercorticism syndromes].

Plasma T and A were studied in 10 patients with hypercorticism. In the female patients, plasma A and T were elevated in 4 cases of Cushing's disease, slightly decreased in 2 cases of adrenal adenoma and greatly increased in I case of adrenal carcinoma. In 3 male patients, A plasma levels followed ACTH levels, but T was subnormal, irrespective of the cause of hypercorticism. Furthermore, in 8 normal men, the decrease of plasma T, observed after ACTH administration, was not directly related to ACTH, but rather to cortisol, as it was not observed after metyrapone induced ACTH increase. As no change in LH secretion was shown and as dexamethasone reduced the testosterone response to HCG, it seems likely that glucocorticoids act directly on testosterone biosynthesis.


[Comparative effects of tamoxifen and estorgens on the induction of progesterone receptors and uterine growth in rats].

Effects of prolonged administration (7 days) of Tamoxifen (Tx: 100 micrograms/day), oestradiol-17 beta (E2; 1 microgram/day) and oestriol (E3; silastic capsules) on the uterine weight, protein, DNA and progesterone receptor (RP) content of prepubertal rats have been studied. It has been observed when compared with E2 that Tx induces a dissociated action after two days of administration; the RP content is still increasing when the other parameters are at a constant level. E3 has a similar action to E2.


[Calcitonin-cells in the thyroid of the human fetus. Immunocytochemical study (author's transl)].

Calcitonin (CT)-cells were detected, by using an anti-human calcitonin serum (hCT), in the thyroid of the normal and anencephalic human fetuses. The first CT-cells were observed at 14 weeks of gestation. The CT-cells were at first isolated afterwards were appeared in parafollicular localization. The CT-cells were only observed in the middle of the upper or medium third or the lateral lobes, along the central axis of the lobes. No CT-cells were detected in the isthmic region or in the inferior third of the lobes. CT-cells were also seen in the thyroid of the anencephalic fetuses. The specificity of the immunocytological reaction was ascertained after incubation of anti-hCT serum with homologous or heterologous antigens: after incubation  of the anti-hCT serum with hCT, the immunocytological reaction was disappeared, but no modification of the reaction was noted after incubation with somatostatin, T4 or parathormone. The CT appeared precociously in the thyroid of the human fetus and their localization was the same that in the older subjects.


[Determination of plasma and urinary estrogens by use of a new enzyme method].

The transhydrogenase function of the oestradiol dehydrogenase of human placenta is used in such a condition as the transhydrogenase activity is directly related to oestrone and oestradiol concentration. The method is highly specific. Reacting oestrone with hydrazin before the assay allows specific determination of oestradiol. The limit of sensitivity is 10 picograms (precision 10%) in plasma and 1 microgram in urine (precision 10%). The determination is done directly on hydrolyzed urine without extraction and is rapid and highly specific. The method seems to be competitive for oestrogen radioimmuno assay in plasma and offers great advantages towards conventional chemical methods in urine. Repetitive profiles of urinary oestrogen excretion can be obtained easely.


[Quantitative aspects of iodine metabolism in one case of congenital iodotyrosine deiodinase defect (author's transl)].

In a 27 years old patient an iodotyrosine deiodinase defect was responsible for a profound hypothyroidism (T4-RIA: indetectable -- TSH: 190 microU/ml) associated with a large goiter (about 300 g). MIT and DIT secretions were measured from the urinary cumulative specific activities, and the molar MIT/DIT ratio was 2.2. The thyroidal iodine exchangeable pool was as low as 177 micrograms. In two comparable patients rendered euthyroid by Lipodol injection, total thyroidal 127I pool was around 40 mg and the MIT/DIT ratio was degraded to 7 suggesting a mild biosynthetic defect by iodine excess.


[Thyroid cancer with amyloid stroma. Results of a familial study].

We have recently studied a kindred in which there have been 2 proven and 2 probable cases of medullary thyroid carcinoma without pheochromocytoma, hyperparathyroidism or Cushing's disease. Four other members suffered from intestinal occlusion and death occurred in three of them. The family has been traced through 4 generations (80 members) and 47 members could be examined; circulating calcitonin and carcinoembryonic antigen levels were measured. This study leads to two conclusions: 1) Medullary thyroid carcinoma is transmitted as an autosomal dominant trait with a high degree of penetrance. 2) Carcinoembryonic antigen is a valuable tumour marker particularly if no calcitonin radioimmunoassay is avialable for the diagnosis of M.C.T.


[A case of regressive Riedel's thyroiditis (author's transl)].

Riedel's struma is one among the locations of an invasive fibroinflammatory and sometimes multifocal process, of unknown etiology. This disease is extremely rare. The authors report a further case in a 41 year old man who had been developing a woody goiter for 3 months. Laboratory investigations showed normal inflammation tests, high rates of antithyroid antibodies and mild hypothyroidism. A surgical operation only consisted in a biopsy, which revealed typical histological features. The only treatment used was a suppletive therapy. During the evolution, antithyroid antibodies progressively decreased, hypothyroidism moderately increased and, chiefly, the goiter completely disappeared after 18 months. To our knowledge, regressive evolution was reported in very few cases after corticoid therapy, but never spontaneously.


[Simultaneous radiocompetitive assay for 25 hydroxyvitamin D and 24, 25 dihydroxyvitamin D in human serum (author's transl)].

A specific competitive protein binding assay for 25 hydroxy-vitamin D and 24, 25 dihydroxyvitamin D in human serum has been developed. It includes a chromatographic step on a Sephadex LH 20 column to specifically separate the metabolites. The average value was for 25 hydroxyvitamin D 11.9 +/- 6.6 Ng/ml (mean +/- SD) and for 24, 25 dihydroxyvitamin D 6.85 +/- 3.29 ng/ml in ten normal subjects sampled in autumn. In hepatic insufficiencies the mean level of 25 hydroxyvitamin D was lower and the mean level of 24, 25 dihydroxyvitamin D was higher than in normal subjects. In patients with renal insufficiency the 25 hydroxyvitamin D levels were normal and the 24, 25 dihydroxyvitamin D levels were low but not suppressed. The two sterols were also determined in some patients with idiopathic hypercalciuria.


[Multiple effects of resorcinol on thyroid function (author's transl)].

In rats, I.V. injected resorcinol led to a decrease in thyroid radioiodine uptake and labelled iodothyronine/iodotyrosine ratio with no changes in the percent of thyroidal labelled iodide or radioiodine release. When thyroid lobes were incubated in vitro with radioiodine, resorcinol concentrations from 10(-3)M to 10(-6)M gave an increase in the percent of thyroidal labelled iodide and iodotyrosine/iodothyronine ratio. In animals fed 5% resorcinol for 2 weeks we observed an increase in thyroid weight, a decrease in plasma T4, no change in the percent of free T4, a decrease in T4 half life and no significant changes in T3 half life. Thyroidal labelled MIT/DIT and T3/T4  atios increased. Resorcinol, given in diet during 5 days to rats which had a low thyroidal thyroglobulin content after PTU administration for 2 weeks, gave, in comparison with rats fed PTU only, an increase in thyroidal thyroglobulin/DNA ratio and a decrease in thyroidal radioiodine release contrasting with an increase in plasma TSH. These differences did not exist when resorcinol was given for one month.


[Prolactin-secreting adenomas in males. Study of the hypophyseal-gonadal axis].

The pituitary gonadal-axis has been studied in 25 cases of PRL-secreting adenomas in men. Besides impotence, infertility, arrest or lack of puberty may be observed, basal levels of LH and FSH are in the low normal range but a weak increase of LH is observed after LH-RH. Testosterone (T) levels are low in most of the patients and only normal in 5. In two cases with actively secreting-PRL adenomas, normal circadian rhythms of T and PRL are abolished. After CB 154 treatment, an improvement of the clinical and biological symptoms is observed in 8 out of 10 men. An increase of LH response to LH-RH under CB 154 is obtained in 5 cases. This is in favour of a functional effect of the hyperprolactinemia on the pituitary.


Osmotic opening of the blood-brain barrier and local cerebral glucose utilization.

The effects of osmotic opening of the blood-brain barrier (BBB) on local cerebral glucose utilization (LCGU) were studied in rats with the carbon 14-deoxyglucose method. The BBB was opened to Evans blue dye by unilateral carotid artery perfusion with hypertonic mannitol solution. (14C)-Deoxyglucose was injected 15 minutes or two to three hours later. Osmotic opening of the BBB resulted in focal areas of intense LCGU in affected areas of the perfused hemisphere. In the contralateral hemisphere, glucose utilization was diminished, especially in cerebral cortical areas. The effects were reversible. LCGU was normal in both hemispheres when permeability to Evans blue returned to normal two to three hours after carotid artery perfusion. In 3 of 5 experiments the administration of high doses of intravenous diazepam immediately following carotid artery perfusion with mannitol prevented an increase in LCGU in the perfused hemisphere but did not prevent lowering of LCGU in the contralateral hemisphere. Increased LCGU following osmotic opening of the BBB was not accompanied by a rise in local cerebral blood flow as measured by the iodoantipyrine method. Blood flow was, in fact, significantly decreased.


[The effect of eyestalk extirpation on the development of Pisidia longicornis (Crustacea, Decapoda, Anomura) (author's transl)].

Eyestalk removal has been performed on the larvae of Pisidia longicornis the first day after moulting to the second zoea stage. In the eyestalkless animals: -- The duration of the second zoea stage is not significantly affected. -- The megalopa stage is always abbreviated. -- The megalopae exhibits a reduced color-pattern.-- Difficulties occur often during moulting to the adult stage. -- The pleopods of some first and even second or third stage adults retain some setae.


[Adrenoleukodystrophy (Schilder-Addison's disease): a probable case in an adult (author's transl)].

Adrenoleukodystrophy (Schilder-Addison's disease) is a sex-linked recessive syndrome usually observed in children, associating neurological disorders and Addison's disease. Its outcome is death after a few years. The authors report the case of a man in whom a spastic paraparesis and a mental deterioration appeared at the age of 30 years. A biological adrenal deficiency was found: plasma cortisol and urinary 17-hydroxy-steroids and 17-ketosteroids failed to increase after synacthen stimulation; plasma ACTH level was above normal. Since two nephews of the patient suffered from adrenoleukodystrophy, the same disease is likely in the reported patient.


[Appearance and localization of pancreatic polypeptide (PP) containing cells in the pancreas of human fetuses (author's transl)].

PP-cells were detected by using an anti-bovine PP (BPP) serum (a gift ot Dr. R. E. Chance, Eli Lilly Laboratories, Indianapolis) in the pancreas of the normal and anencephalic human fetuses, and decreased premature infants. The first PP-cells were observed as early as 10 weeks of gestation. The PP-cells were located in the periphery of the islets. The islets containing PP-cells were essentially located in the lower part of the head of the pancreas, whereas glucagon-cells are located in the other regions of the pancreas. Somatostatin- and insulin-cells were uniformly distributed in the pancreas. The PP-cells seemed to be related to the ventral bud of the pancreas.


Sporadic distal myopathy with early adult onset.

With the exception of the large series of adult-onset hereditary distal myopathy from Sweden, few cases of primary muscle disease with a definite distal predilection have been published. We report 3 sporadic cases of distal myopathy with the following features: (1) early adult onset (26 to 33 years); (2) slowly progressive weakness affecting first the distal leg muscles and later the arms; (3) marked elevation of creatine phosphokinase (more than 10 times the normal value); and (4) electromyographic and histological evidence of myopathy in distal muscles. The differential diagnosis is discussed and other reported cases are reviewed. The differences between hereditary cases reported by others and the sporadic cases reported here form the basis for a tentative subclassification of this syndrome.


[Hypophysial stimulation of oestradiol-17 beta secretion in Carp, Cyprinus Carpio L (author's transl)].

Using radioimmunoassays, plasma levels of carp gonadotropin (c-GTH) and oestradiol-17 beta (E2) are measured every day in Carp, during induced spawning (water temperature = 15 degrees C). Ten Carps injected twice intraperitonealy with a total extract of Carp hypophysis (0,6 mg/kg BW at Jo and 5,4 mg/kg BW at J1) are compared to a lot receiving only  saline solution. No evolution is detected in that last group when in the experimental one E2 level increases with exogenous c-GTH (see table). Even if E2 levels are low at the end of vitellogenesis, steroidogenic structures remain sensitive to an exogenous hypophysial stimulation. Secretion ability differs within individuals (correlation coefficient between total estimated c-GTH and E2 = 0,15).


Bolous versus steady-state infusion for determination of CSF outflow resistance.

For rapid changes in cerebrospinal fluid volume an exponential relationship was demonstrated between CSF pressure and CSF volume in 15 cats. This relationship was valid over a CSF pressure range from 7 to 50 mm Hg and for acute increases of up to 9% to total CSF volume (approximately 13 ml for humans). Our data agree well with previous reports for the cat. A similar relationship has been shown in the dog and in humans. It has been claimed that, given the equations for CSF bulk flow and the exponential relationship between CSF pressure and CSF volume, one can calculate CSF outflow resistance by observing the decay of CSF pressure after a bolus injection into the CSF space. This claim was evaluated in an additional 18 cats. In these animals CSF outflow resistance calculated by the bolus method was compared with resistance calculated by a steady-state infusion method over the CSF outflow resistance range of 74 to 293 mm Hg/ml min-1. Resistance calculated by the bolus method underestimated resistance calculated by the steady-state method, and this underestimate grew larger with increasing resistance. The bolus technique is therefore not a valid method for determining CSF outflow resistance. The explanation offered for these results is that the decay of CSF pressure after a bolus injection into the CSF space occurs not only because of runoff of the injected volume of CSF but also because of "pressure relaxation" of the brain parenchyma around the CSF space. The phenomenon of pressure relaxation was not considered in developing the equation for calculation of CSF outflow resistance by the bolus technique. The time dependency of pressure relaxation allows for a fundamental element of hysteresis within the CSF space. A method of quantifying this element of hysteresis is suggested.


[Effects of gonad-inhibiting factor from the brain upon morphology and metabolism in germ cells and sexula somatic cells of nemertines (author's transl)].

After the deprivation of gonad-inhibiting factor (GIF) from the brain in adult Nemertines of both sexes, the sexual characters appear and/or grow rapidly. Very early, RNA synthesis is promoted in young oocytes, DNA synthesis is increased in spermatogonia and primary spermatocytes and protein synthesis is significantly increased in germ cells and sexual somatic cells. The brain origin of GIF suggests a polypeptide nature whereas its effects are those of sex steroid hormones in Vertebrates. GIF could be a regulating hormone which would inhibit the secretion of tropic hormone(s) produced by unknown cells in proximity to the sexual targets.


[Is sexual differentiation in cephalopods embryos (Sepia officinalis L) under endocrine control (author's transl)].

The sex differenciation in the gonad of the cuttlefish is only evident after the hatching, -- the "A" cells become spermatogonia or ovogonia. In the embryonic gonads, bigger cells called "B" seem participate in this differenciation (ultrastructural active aspects in concordance with sexual differentiation).


[Seasonal variations in epinephrine (E) and norepinephrine (NE) levels determined in organs of eel (author's transl)].

E and NE concentrations were measured by using a spectrofluorimetric method in various organs of eels, for a one year period. NE was found at higher levels than E in the whole brain, the heart, and the spleen. Maximal E levels occurred in kidney. Moreover (E + NE) sum is 40 to 190% higher than during spring and summer when compared to autumn and winter levels. According to the fact that seasonal variations of catecholamines were not found in the eel plasma, these results suggest that the observed seasonal variations can be related to fluctuation in CA amounts localized in synaptic structures.


Endoneurial lipid composition of normal human sural nerve.

The endoneurial lipid composition was determined in 7 human sural nerves from subjects without known neurological disease. The nerves were morphologically normal, with myelinated fiber density of 7,710 +/- 1,210/mm2 (mean +/- SD). Endoneurium contained 30.7 +/- 1.5 mg total lipid per 100 mg of dry weight. Cholesterol was the predominant lipid (9.1 +/- 1.0 mg). Cholesterol ester was present only in very small quantities (0.2 +/- 0.1 mg). Cerebroside concentration was 4.5 +/- 0.3 mg, and sulfatide was 1.5 +/- 0.3 mg. The most abundant phospholipid was sphingomyelin (4.3 +/- 0.3 mg), followed by phosphatidylethanolamine (4.1 +/- 0.2 mg), phosphatidylcholine (3.8 +/- 0.2 mg), and phosphatidylinositol-phosphatidylserine (1.7 +/- 0.2 mg). Eighty-one percent of cerebroside nonhydroxy fatty acids were long chain (C20 to C26), and 67% were saturated. Technological advances now permit microchemical lipid analysis of human sural nerve biopsies in cases of neuropathy. When compared with our normative data, such studies may further the understanding of peripheral nerve disorders.


[Ultrastructure of prolactin cells of three Mugilidae during adaptation to fresh-water (author's transl)].

The behaviour of three species of Mugilidae (Mugil ramada, Crenimugil labrosus and Mugil auratus) during adaptation to fresh water is very different. Those differences may be explain by variants of their prolactin cells activity. The adaptation of Mugil ramada and Crenimugil labrosus to fresh water is easy and last over a long time; the prolactin cells, with a slow activity in sea water, become during adaptation more active. In Mugil auratus in sea water, prolactin cells present already a sign of strong activity. After transfert in fresh water, they appear to be unable to increase their activity. The adaptation of this species is difficult and short-lasting.


Nerve lipid abnormalities in human diabetic neuropathy: a correlative study.

To study endoneurial lipid composition in human diabetic neuropathy, we biopsied sural nerves from 3 middleaged men with adult-onset diabetes mellitus. Magnitude of electrophysiological abnormalities and myelinated fiber loss paralleled the clinical severity of neuropathy in all cases. Cholesterol ester concentration was elevated to about 800% of normal in diabetic nerves. Reduction in total endoneurial lipid concentration correlated best with decrease in myelin volume as calculated from measured fiber diameters. Cholesterol, cerebroside, and most phospholipids were reduced in keeping with the severity of fiber loss in each nerve. The phosphatidylinositol-phosphatidylserine fraction was most reduced in the least affected nerves. Cerebroside nonhydroxy fatty acids in diabetic nerves were of shorter chain length and more saturated than normal. It is not yet clear whether the abnormalities of phosphatidylinositol-phosphatidylserine and cerebroside fatty acids are of pathogenetic importance or whether these changes may be the nonspecific consequence of axonal degeneration.


Mucocutaneous eruptions due to antiepileptic drug therapy in children.

Three children with bullous erythema multiforme and 1 with toxic epidermal necrolysis associated with antiepileptic drug therapy are described. One patient is unique because of seven mucocutaneous eruptions caused by three classes of antiepileptic drugs. Lymphocyte stimulation by antiepileptic drugs could not be demonstrated in the 2 patients in whom appropriate studies were performed, and no precipitating antibodies to antiepileptic drugs were found. Observation of four diagnostic and therapeutic principles, which are illustrated by the course of our patients, may reduce the incidence of life-threatening mucocutaneous eruptions and simplify the long-term management of individuals in whom such reactions occur.


[Circadian and circannuel fluctuations of pineal metatonin content in Testudo hermanni G. (Reptilia-Chelonia) under natural conditions of photoperiod and temperature (author's transl)].

Pineal content of melatonin is measured by RIA. The tortoise, Testudo hermanni, in natural lighting, shows peak night-time melatonin levels during summer (may to september) at the period of greatest activity. During hibernation, melatonin levels are very low and no circadian variation can be detected.


Oral phenytoin loading in adults: rapid achievement of therapeutic plasma levels.

Oral loading doses of phenytoin were estimated from a simplified pharmacokinetic model. Twenty patients were administered a calculated average dose of 19.1 mg per kilogram of phenytoin divided into two to four increments given over 3 to 21 hours (10.55 +/- 4.74, mean +/- SD). Plasma samples drawn 2 to 22 hours (10.75 +/- 4.32, mean +/- SD) after completion of the loading dose resulted in therapeutic levels ranging from 8.1 to 18.0 microgram per milliliter (11.42-11.37 +/- 2.41, mean +/- SD). Thus, this regimen in which no increment of the loading dose exceeds 600 mg is sufficient to achieve and maintain therapeutic plasma concentrations 18 to 24 hours after initiation of the loading dose.


Subacute motor neuronopathy: a remote effect of lymphoma.

Ten patients developed a subacute lower motor neuron syndrome as a remote effect of Hodgkin's disease or other lymphoma. The illness usually followed a benign course independent of the activity of the underlying neoplasm. Seven of the patients improved spontaneously, and 3 became neurologically normal. Two patients died of intercurrent infections related to immunosuppression. Neuropathological examination of these 2 patients and 3 previously reported cases showed prominent neuronal degeneration restricted to the anterior horns of the spinal cord and mild posterior column demyelination. Demyelination was also present in the anterior roots of our autopsied patients and was accompanied by large, hyperchromatic Schwann cells. The cause of the illness is obscure, but both radiation therapy and opportunistic infection may be contributing factors. Attempts at virus isolation have been unsuccessful. The syndrome should be distinguished from the more common direct effects of lymphoma on the nervous system, since its identification spares the patient additional, potentially harmful therapy.


The origin of fasciculations in motoneuron disease.

The collision technique was used to determine the origin of distal fasciculations in 25 motor units from 9 patients with amyotrophic lateral sclerosis and 6 with other diseases involving motoneurons. Fasciculations originated in the nerve proximal to the knee or elbow in 15 and distally in 2; multiple sites of origin were found in 8 motor units. The origin was not related to the presence or absence of electromyographic evidence for collateral sprouting or lesions in descending suprasegmental pathways.


Musical hallucinations in a deaf elderly patient.

A remarkably observant 89-year-old woman experienced the abrupt onset of musical hallucinations on the background of longstanding progressive hearing loss and in the absence of psychosis or major dementia. These hallucinations were nearly constant, wellformed perceptions of religious hymns, and their content could be altered by several mechanisms. The patient also occasionally heard voices recapitulating childhood experiences. One can speculate that the syndrome relates to sensory deprivation.


Choroid plexus papilloma and infantile spasms.

A 7-month-old infant had the infantile spasm syndrome, consisting of flexor and extensor spasms, developmental delay, and hypsarrhythmia. Corticotropin produced delay, and hypsarrhythmia. Corticotropin produced improvement in the clinical symptoms and reverted the generalized electroencephalographic abnormalities to more focal ones. Removal of a choroid plexus papilloma of the left lateral ventricle was followed by clinical recovery. One year later the child was normal developmentally and neurologically and was seizure free on anticonvulsant therapy.


Brain electrical activity mapping (BEAM): a method for extending the clinical utility of EEG and evoked potential data.

The difficulties inherent in extracting clinically useful information by visual inspection alone from the massive amounts of data contained in multichannel polygraphic recordings have placed limits on the accuracy and range of utility of electroencephalography and evoked potentials. A method for condensing and summarizing the spatiotemporal information contained in recordings from multiple scalp electrodes is described. Data dimensionality is reduced and visibility increased by computer-controlled topographic mapping and display of data as color television images. Examples are given in which such brain electrical activity mapping (BEAM) (1) localizes tumors in patients with normal or nondiagnostic EEGs, (2) adds additional information to that visible on computerized axial tomography, and (3) demonstrates electrophysiological abnormalities in patients with functional lesions but normal CT scans. A sensitivity to the functional component of a neurological lesion suggests that BEAM may provide complementary information to the anatomical definition provided by the CT scan.


Substances which modulate leukocyte migration are present in CSF during meningitis.

We studied the effects on in vitro leukocyte migration of cerebrospinal fluid from 14 patients with and 7 patients without meningitis. Meningitic CSF, but not control CSF, contained activity that was chemotactic for peripheral blood leukocytes. In an unusual case of staphylococcal meningitis associated with a blunted CSF pleocytosis and a poor clinical response to antibiotics, an inhibitor of leukocyte chemotaxis was identified in the CSF. This inhibitor may have diminished local leukocyte accumulation in vivo and thereby adversely affected host defense mechanisms and clinical outcome. No inhibitors were found in other CSF samples tested. Soluble mediators present in CSF may modulate the local accumulation of leukocytes and therefore affect host defenses in meningitis.


Tarsal tunnel syndrome: electrophysiological study.

Tarsal tunnel syndrome (TTS) is a rare compression neuropathy of the posterior tibial nerve. Typical symptoms are burning pain and paresthesia in the toes and along the sole of the foot. The presence of Tinel's sign and objective sensory loss in the territory of any of the terminal branches of the posterior tibial nerve are diagnostically helpful. The terminal latency and sensory nerve conduction velocity in medial and lateral plantar nerves were studied in 20 normal controls and 21 cases of TTS in 17 patients. Prolonged terminal latency was observed in 11 cases, with TTS, while sensory nerve conduction abnormality (either absent nerve potential or slow sensory nerve conduction velocity) was found in 19. The sensory nerve conduction velocity in the lateral and medial plantar nerves is a superior objective diagnostic index of TTS.


Cerebral and retinal vascular complications of inflammatory bowel disease.

Recurrent retinal branch artery occlusions, carotid thromboembolism, cerebral venous thrombosis, transient brainstem ischemia, and massive brainstem and cerebral infarction complicated the course of inflammatory bowel disease in 5 patients. Three patients had ulcerative colitis and 2 had regional enteritis. The usual risk factors for stroke were absent. Neuropathological examination in 1 patient showed in situ thrombosis of small cerebral and brainstem arteries and veins. Coagulation studies showed thrombocytosis, short partial thromboplastin times, and elevation of fibrinogen and Factor VIII levels. Platelet counts and coagulation factors returned toward normal after control of intestinal inflammation in each of the 4 surviving patients. Inflammatory bowel disease can be accompanied by a hypercoagulable state that predisposes to stroke.


Diffuse cerebral ischemia in the cat: III. Neuropathological sequelae of severe ischemia.

The neuropathological consequences of sever diffuse cerebral ischemia were investigated in an animal model in which postischemic alterations of regional brain blood flow and energy metabolism had been previously characterized. Pentobarbital-anesthetized cats received either 15 or 30 minutes of ischemia produced by basilar artery and bilateral carotid artery occlusions plus mild hypotension; this was followed by 60 to 90 minutes of normotensive recirculation. The brains were perfusion-fixed for light microscopy. Both insult durations resulted in unequivocal ischemic cell change affecting neurons of the cerebral neocortex, striatum, thalamus, and hippocampus and portions of the rostral brainstem. Animals with 30 minutes of prior ischemia differed from those with 15 minutes of ischemia in showing a more apparent regional accentuation of ischemic change in the parasagittal cortical gyri--the sites of previously documented focal postischemic heterogeneities of blood flow and metabolism. In other respects, however, the overall distribution and spectrum of severity of the ischemic alterations were similar for the two insult durations. These data support the view that significant permanent neuronal injury may result from a period of cerebral ischemia as brief as 15 minutes.


Thalamic degeneration in X-chromosome--linked copper malabsorption.

Thalamic degeneration was present in 5 autopsied cases of X-chromosome-linked copper malabsorption (X-cLCM), Menkes' kinky hair disease. Among the thalamic nuclei, those in the formatio paraventricularis, intralamellaris, and extralamellaris were spared. The nuclei projecting to the granular cortices had severe neuronal depopulation. The thalamic nuclei that send axons to the agranular cortices were less often and less severely involved. The thalamic afferent system was intact except for degeneration of the red nucleus. Cerebral cortical lesions varied from case to case and usually were less marked than thalamic neuronal changes.


Central somatosensory conduction time in comatose patients.

Somatosensory conduction time between the dorsal column nuclei and the cerebral cortex may be measured following median nerve stimulation by recording evoked potentials from both scalp and neck. Central conduction times were significantly increased relative to normal (5.6 +/ 0.5 msec) in 11 of 24 comatose patients. Results within 10 and 35 days of onset of coma were correlated with the final clinical outcome. Conduction times were independent of serum phenobarbital (0 to 630 mumol per liter) and of central body temperature (35.0 to 38.5 degrees C). Serial studies in coma demonstrated (1) short-term increases during temporary metabolic disorders, and (2) sustained increases with gradual recovery over many months, particularly after head injury.


Transfer factor is ineffective in amyotrophic lateral sclerosis.

Sixty-six patients with amyotrophic lateral sclerosis (ALS) participated in a double-blind, placebo-controlled study of transfer factor. A structured rating score of neurological function was recorded after each monthly administration of transfer factor or placebo. Statistical analysis of mean scores for all patients and for those with specific clinical abnormalities showed no significant difference between the two groups. There was no evidence of therapeutic value for transfer factor. During the observation period of nearly one year, more than two-thirds of the deterioration occurred in the first six months. Meaningful clinical trials of other potential therapeutic agents could probably be conducted within six months in double-blind crossover trials.


Dermatomyositis and toxoplasmosis.

In a patient with childhood dermatomyositis, high toxoplasma antibodies were found at the time of diagnosis. A direct immunofluorescence technique demonstrated active toxoplasmosis in the muscle biopsy. The response to treatment and follow-up in this patient suggest that toxoplasmosis could have caused the dermatomyositis.


Atrial myxoma with intellectual decline and cerebral growths on CT scan.

A woman with left atrial myxoma had progressive disturbance of intellectual function, headache, and prominent constitutional symptoms. The absence of stroke is noteworthy. Multiple high-density lesions with contrast enhancement were seen by CT scan, suggesting metastatic neoplasms, hematomas, or hemorrhagic infarcts. Serial study showed progressive enlargement of the lesions. The only cerebral lesion examined histologically proved to be an organizing hematoma, originating most likely from adjacent small arteries found to be plugged by embolic myxoma.


Genetic distances among the five tribal populations of Andhra, Pradesh, South India.

In this paper, data on genetic distances among five tribal populations ae given. Among the five tribes, Koya Dora, Raj Gond and Naikpod are autochthonous populations of the Deccan plateau whereas the other two groups, Pardhan and Lambadi are migrants. Kova Doras were sampled from five distant localities. Genetic markers typed are: A1A2B0, Rho(D) blood group systems glucose-6-phosphate dehydrogenase deficiency, transferrin, haptoglobin, groupspecific component, haemoglobin, colour-vision deficiency and tastability to P. T. C. Using frequency data for the above nine genetic loci, genetic distances between the five endogamous tribes, and between the five groups of Koya Dora are calculated by adopting the statistical method of Edwards (1971). While genetic distances between Koya Dora, Raj Gond and Lambadi are minimal, the genetic distance between Pardhans and other tribal groups is maximum. Naikpods occupy an intermediate position. The closeness of Lambadi with Koya Dora and RAJ Gond can be regarded as coincidental. Interestingly, the differences in the genetic distance values between five Koya Dora groups are as great as the differences between the five endogamous tribal populations tested for the same loci. Genetic affinities of these tribal populations are discussed in relation to their ethnic origin migration and geographical isolation.


As to the influence of climate on head form.

In two quite different geographical regions--Moçambique and Hierro (an island of the Canaries)--observations have been made which point to an influence of climatic conditions on head dimensions: In localities of higher altitude or/and with colder climate maximum head breadth, minimum frontal breadth and auricular height proved to show higher dimensions compared with localities of milder (more hot) climate.


["Basic brown", a too little considered iris color].

The eye colour is mainly effected by the two components melanin and structural blue of the iris stroma which generally are present in various mixtures respectively combinations. Are these components lacking the dark pigment epithelium can produce a so-called "basic brown". The exact distinction between "brown" and "basic brown" is without doubt of considerable value for anthropological as well as for genetical examinations of eye colours.


[Lethal and mutagenic action of N-nitroso-N-methylbiuret on the producers of levorin, amphotericin and mycoheptin].

The lethal and mutagenic effect of N-nitrozo-N-methylbiuret (NMB) on the organisms producing levorin, amphotericin B and mycoheptin was studied. The mutagen effect depended on the dose, culture and physiological state of the spores. NMB had a low mutagenic effect on the levorin-producing organism characterized by high activity and genetic homogenicity with respect to the colony morphology and antibiotic production. As for the organisms producing amphotericin B and mycoheptin characterized by high genetic heterogenicity, significant variation of all the features studied was observed on their exposure to the mutagen. Inspite of diverse reaction of the organisms producing levorin, amphotericin B and mycoheptin to the effect of NMB mutants with increased antibiotic production were obtained from the three cultures. The lethal and mutagenic effect of NMB on the mycoheptin-producing organism depended on the process of the spore DNA replication. The spores during the DNA replication period were least sensitive to the lethal effect of the mutagen and most mutable with the respect to the colony morphology. For selection of highly active and stable strains exposure to NMB of the spores of the mycoheptin-producing organism during replication of DNA proved to be more effective than that of the spores during the lag-phase.


[Antibiotic sensitivity of the microflora isolated in ENT diseases].

Sensitivity of beta-hemolytic streptococci of group A, Streptococcus viridans, Staphylococcus aureus, epidermal staphylococci, pneumococci, Proteus and Ps. aeruginosa isolated in 1975-1978 from patients with tonsillitis, otitis, sinusitis and other otorhinolaryngological diseases was studied with respect to 19 antibiotics. Data on comparison of the antibiotic sensitivity of the microflora isolated from the patients with otorhinolaryngological diseases in 1964-1974 and 1975-1978 are presented. It was shown that beta-hemolytic streptococci were highly sensitive to all the antibiotics tested except tetracycline. Among Streptococcus viridans the strains resistant to many antibiotics were more frequent than among beta-hemolytic streptococci. Most of the Staphylococcus aureus strains were sensitive to gentamycin, cephaloridin, oxacillin and resistant to the other antibiotics. The epidermal staphylococci were characterized by approximately the same antibiotic sensitivity as Staphylococcus aureus. Resistance of the predominating majority of the Pneumococcus strains to tetracycline was noted. Proteus and Ps. aeruginosa were resistant to all the antibiotics except aminoglycosides. The microflora isolated from the cases with otorhinolaryngological diseases in 1975-1978 were mainly characterized by lower antibiotic sensitivity than that isolated from the cases with the same diseases in 1964-1974. It is possible to suppose that the microorganisms isolated from the patients with otorhinolaringological diseases had no significant differences with respect to their antibiotic sensitivity from those isolated from the patients with other pathological processes.


[Effect of carminomycin on the energy metabolism of the liver in rats].

The effect of carminomycin on the liver energetic metabolism was studied experimentally on rats in dynamics after its intraperitoneal administration in a single LD50 and the therapeutic doses for a treatment course. It was found that changes in the rat liver tissues on the part of the energetic metabolism occurred irrespective of the antibiotic dose and the administration multiplicity. Mainly they were of reversible nature: the balance of consumption and resynthesis of the phosphate macroergs was impaired, the glycolytic processes increased, shifts in the activity of the enzymes of the pentose phosphate pathway of oxydation were observed. The level of the above changes was more pronounced when carminomycin was administered in LD50. The adrenal system played an important role in the mechanism of the shifts noted.


[Formation of broad-spectrum antibiotics by cultures of the genus Micromonospora].

Data on the study of antibiotic production by the representatives of Micromonospora and the use of ion exchange resins for intensification of screening antibiotic-producing organisms among Micromonospora are presented. It was found that out of 172 strains of Micromonospora tested 92 (53.5 per cent) cultures produced antibiotics, 18 of which were active against gramnegative bacteria. The use of carboxylic ion exchange resins at early microbiological stages of the screening provided an increase in the frequency of finding broad spectrum antibiotics from 10.4 to 19.7 per cent.


[Postradiation effect of caffeine on the producer of mycoheptin, Streptoverticillium mycoheptinicum].

The modifying effect of caffeine on irradiated spores of Streptoverticillium mycoheptinicum, producing mycoheptin was found. Postradiation treatment of the strain O883: spores with caffeine resulted in decreased survival of the spores proportionally to the radiation dose increase and postradiation caffeine treatment. An increase in the frequency of the morphologically changed colonies, as well as the low and highly active variants with respect to mycoheptin production was observed. The effect may be explained by the fact that caffeine possibly inhibited the reparation process in the irradiated spores of the strain tested. The method of postradiation treatment of the spores of the mycoheptin-producing organism with caffeine which provided selection of highly active variants by the antibiotic production with the use of definite doses may be considered promising in selection of actinomycetes.


[Characteristics of hospital strains of Staphylococcus].

Some properties of hospital staphylococcal strains isolated from the patients with purulent postnatal mastitis were studied. It was found that all the strains of the phage type 80.81 widely distributed in the obstetric hospitals were polylysogenic and polyresistant to antibiotics. The resistance markers in most of the isolates were located on the plasmids. Elimination of the plasmids carrying the antibiotics resistance markers resulted in a simultaneous change in the strain lysogenic spectrum while the phage type and fermentative properties, such as production of plasmocoagulase, DNAase and lecithinase did not change. The capacity for hemotoxin production was lost simultaneously with antibiotic resistance in 1 out of 17 cultures tested.


[Sensitivity to antibiotics and antibacterial preparations of conditionally pathogenic bacteria isolated from patients with gastrointestinal tract dysfunctions].

Sensitivity of 690 cultures of the conditionally pathogenic microbes of Enterobacteriaceae and Pseudomonadaceae to 17 drugs was studied with the agar diffusion method. It was found that 98.6 per cent of the cultures had multiple resistance to 2--10 drugs. Most of the cultures were resistant to erythromycin, carbenicillin and ampicillin. Different species of the conditionally pathogenic microorganisms were resistant to different numbers of the drugs. Thus, Ps. aeruginosa cultures were resistant to 6--10 drugs, the cultures of Citrobacter were resistant to 3--8 drugs and the cultures of Kl. pneumonia were resistant to 2--5 drugs. Levomycetin, tetracycline, streptomycin and biseptol proved to be the most active antibacterial drugs.


[Antimicrobial action spectrum of triterpene and steroid glycosides].

Antimicrobial activity of 9 triterpene glycosides of the plant and animal origin was studied. It was found that saponins inhibited the fungal growth to different extents and had no activity against grampositive and gramnegative bacteria. Triterpene glycosides of the animal origin, i.e. holoturins A and B, stichoposids A and C had the most pronounced antifungal activity as compared to the saponins isolated from plants. Changes in the length of the carbon chain from 2 to 6 monosugars had no significant effect on the activity of the triterpeneglycosides studied.


[Effect of various kanamycin dosage forms in experimental nonpenetrating infected injuries to the cornea].

Animals with experimental non-penetrating local wound of the cornea of the type of erosion infected with highly virulent strains of Staph. aureus were treated at various periods, i.e. in 15 minutes, 2, 6 and 9 hours with kanamycin solution (10000 gamma/ml) and kanamycin imbibized films. The therapeutic effect of the kanamycin solution on the non-penetrating infected wound of the cornea was higher when the treatment was started at earlier periods after infection with Staph. aureus. At later periods when the inflammatory process was highly developed the effect of the kanamycin solution on the wound was lower. As for the use of the kanamycin films the regularity was the reverse: they had a higher therapeutic effect in pronounced inflammation and highly developed infection of the eye.


[Effect of tetracycline group antibiotics on the barrier properties of the small intestine epithelium].

The effect of 5 tetracyclines on the barrier and transport properties of the small intestine epithelium was studied. The barrier properties were estimated by a change in the ionic selectivity and conductivity of the epithelium, as well as by enterocyte linkage. The current of the short circuit served the characteristics of the Na transport system state. Dimethylchlortetracycline, methacycline and oxytetracycline in concentrations of 10(-7) g/ml decreased the epithelium conductivity and increased the cell linkage. Tetracycline and methacycline in concentrations of 10(-9) g/ml had an analogous effect. The effect was observed 10--20 minutes after the start of incubation with the substance. No effect on the current of the short circuit was observed within the concentrations of 10(-4) to 10(-9) g/ml. It is suggested that the decreased conductivity and increased linkage are due to adsorption of the tetracycline molecules in the region of close cell contacts.


[Biological properties of clinical staphylococcal strains with a varying number of antibiotic resistance markers].

The study of a number of biological properties of 1881 clinical strains of Staphylococcus showed that in the group of the antibiotic resistant staphylococci there was a tendency for different manifestation of some biological properties depending on the number of the resistance determinants. The staphylococcal strains resistant to 5--7 antibiotics differed from those resistant to a less number of the drugs by greater manifestation of the pathogenicity properties: lecithinase, hyaluronidase and hemolytic activity.


[Use of paper indicator discs for determining the minimal inhibitory concentration of antibiotics].

Sensitivity of clinical strains of Staphylococcus and some Enterobacteriaceae to a number of widely used antibiotics was compared simultaneously with the use of two methods, i. e. the agar diffusion method and the method of serial dilutions. Regularities in distribution of the staphylococcal strains according to their sensitivity to antibiotics, such as erythromycin, benzylpenicillin, levomycetin and others were also studied with respect to every year using indicator paper discs. Interrelation observed during the comparison of the microbial sensitivity with the use of the two assay methods provided elaboration of the criteria for classification of the strains as "resistant" or "sensitive". The differentiation boarder for these two groups was determined according to the principle of the assay error minimization. A necessity of using standard dry media for specification of individual characteristics of various drugs in estimation of the microbial sensitivity to them by the agar diffusion method is emphasized.


[Effect of a DNA-rubomycin complex on the molecular mass, radiosensitivity and reparation of gamma-induced single-stranded breaks in the DNA of sarcoma 180 cells].

The use of the DNA-rubomycin complex resulted in appearance of one-thread breaks (OB) in DNA and markedly increased the number of the DNA OB determined immediately after irradiation. The DNA-rubomycin complex decreased the volume of the repaired OB and induced postreparation degradation of the one-bond DNA (oDNA) in the sarcoma 180 cells. The effect of the decrease in the molecular mass of the oDNA 6 hours after the irradiation to the level of the initial damage is probably in favour of the fact that degradation takes place in the areas of the repaired breaks. The data indicated that the viscosimetric method for the analysis of the OB in DNA may be promising in estimation of the efficacy of radiation and chemotherapy of solid tumors.


Pulmonary circulation pressures in surgical patients. The use of the Swan-Ganz catheter.

Experiences with the Swan-Ganz catheter in 'high risk' surgical intensive care patients are described. After description of the catheter and catheterization technique, normal values from the literature are presented. Attention is drawn to the occurrence of artefacts in the pressure curve, which can lead to the inference of faulty results from the measurements. Attention is also drawn to the effect of intrathoracic pressure on pulmonary vascular pressures. A review of possible complications is given, with recommendations how these may be avoided or at least reduced to a minimum. The authors' material is used to demonstrate the value of the catheter, showing that the CVP is not always a trustworthy parameter for hemodynamic monitoring. The conclusion is drawn that the 'high risk' patient on the surgical intensive care unit gains from the use of the Swan-Ganz catheter.


The curative treatment of rectal cancer at the Cleveland Clinic.

This article reviews the policy of the Cleveland Clinic regarding the curative treatment of rectal cancer. The use of Turnbull's no-touch technic permits avoidance of peroperative tumor seeding via the lumen of the bowel or the lymphovascular pedicle. The postoperative accumulation of blood in the presacral space is precluded by leaving the peritoneum of the pelvis open and by irrigation and suction via sump drains. The authors review the different factors influencing the choice of treatment.


Venous hypertension of the hand caused by subcutaneous arteriovenous fistulae established for hemodialysis.

Side-to-side arteriovenous fistulae established in patients on chronic intermittent hemodialysis can cause venous hypertension. This gives rise to pain, pigmentation and trophic ulcers. Four patients with these complications are described. In three patients, with a fistula between the radial artery and the cephalic vein, the thumb and the second and third fingers were affected. In the fourth patient, with a fistula between the ulnar artery and the basilic vein, the fourth  and fifth fingers were involved. This finding suggests segmental venous drainage of the hand. All patients were cured by ligation of the distal vein. An end-of-vein-to-side-of-artery fistula does not cause the complication described, and for this reason is to be preferred.


Two extensive giant-cell tumours of the proximal humerus treated by resection-reconstruction or excochleation-cryosurgery.

Giant-cell tumours of bone occur infrequently. Recurrence is often observed following excochleation. Due to the fact that most of these tumours are located in the epiphysis of long bones, treatment of extensive tumours with preservation of joint function usually is troublesome. Two patients are presented: one underwent resection and implantation of an endoprosthesis, the other one excochleation in combination with cryosurgery.


Critical evaluation of low-dose heparin in laryngectomy.

In a clinical trial thromboembolic prophylaxis with subcutaneous low-dose heparin was given to 20 patients admitted for surgery on the larynx. All patients (40 totally) had a malignancy. The study was not primarily directed on the antithrombotic effect, but on complication factors. In the control group pulmonary embolism was found four times, but not in the group of patients receiving heparin. No increase of blood loss in the heparin group appeared, although this group included very difficult operations. No complications were seen to arise from the injections of the heparin.


Epidermal dystrophy. Occurrence after psoriasis therapy with psoralen and long-wave ultraviolet light.

Focal dystrophy of epidermal cells has been recognized in about half of 37 patients treated with psoralen and long-wave ultraviolet radiation (PUVA) for psoriasis. This lesion appeared in many patients by the end of the clearing phase of therapy and was present to a similar degree one year after the beginning of the treatment. It is probable that most such changes are transient, but the appearance suggests the possibility that cells have undergone somatic mutation that potentially could be dangerous.


Cryosurgery of porokeratosis plantaris discreta.

Porokeratosis plantaris discreta is a distinct clinical and pathological entity often resistant to conservative management. Twenty-one lesions of porokeratosis plantaris discreta were treated cyrosurgically in 11 patients. Removal of the blister roof two weeks after cryosurgery with retreatment of any residual lesion proved an effective method for removal of such lesions without scarring. A cure rate of 90.5% was achieved using this technique.


Steroid-induced acanthosis nigricans in dermatomyositis.

Acanthosis nigricans of the groin, axillae, and neck developed in a patient on long-term steroid therapy for dermatomyositis after eight years. The dermatosis resolved spontaneously ten years after the steroid use had been discontinued. Review of three personal cases and the literature suggests that acanthosis nigricans may have a hormonal basis.


Staphylococcal scalded skin syndrome in an adult with Hodgkin's disease.

An elderly man with Hodgkin's disease who was receiving multiple drug chemotherapy became septic and a wide spread bullous eruption developed. Intraepidermal cleavage on skin biopsy supported a diagnosis of the staphylococcal scalded skin syndrome (SSSS) type of toxic epidermal necrolysis. Blood cultures confirmed a staphylococcal septicemia. Occurrence of this syndrome in an adult is unusual. A review of the literature on SSSS indicates an increased mortality when adults are compared with children with this syndrome.


Insulin allergy. Report of a case with delayed local reaction.

A diabetic patient had delayed local cutaneous allergic reactions to insulin. We describe his lesion, biopsy findings, and treatment. Allergic reactions to insulin may be immediate local or systemic, which are lgE-mediated. Recommended management of local reactions is to use a single-peak pork insulin of the insulin zinc suspension series. Progressive immediate local reactions may herald the onset of systemic reactions. Hospitalization and desensitization to insulin may be required for systemic allergic reactions to insulin.


Hydrofluoric acid burns. A report of a case and review of the literature.

Burns caused by exposure to hydrofluoric acid are occurring with ever-increasing frequency due to the wide use of this acid in industry and research. Such burns are characterized by severe progressive tissue destruction and excruciating pain resulting from the unique properties of the freely dissociable fluoride ion. The subungual tissues are especially susceptible to the destructive effects of hydrofluoric acid. The proper treatment of hydrofluoric acid burns requires prompt recognition and the institution of specific therapeutic measures by the attending physician.


Mal de Meleda treated with 13-cis retinoic acid.

Identical twins with mal de Meleda, a rare genodermatosis, displayed the characteristic "glove and sock" hyperkeratosis, hyperhidrosis, and malodor. Their parents, who are first cousins, are unaffected and originated from Calabria, Italy, which is not far from Meleda (Mljet). The disorder is probably transmitted as an autosomal recessive trait. Previous therapy with grenz rays, topical preparations of adrenocorticosteroids, lactic acid, retinoic acid, and bland emollients had been unsuccessful. One of the twins was treated with 13-cis retinoic acid taken by mouth for 16 weeks with dramatic improvement. The major adverse effect was cheilitis, which did not force discontinuation of the treatment.


Botryomycosis. A bacterial cause of mycetoma.

Botryomycosis is a chronic, granulomatous, bacterial infection in which grains are produced. Clinically, it may not be distinguished from a mycetoma of fungal origin. A case is reported in which the causative organisms were Staphylococcus aureus and Pseudomonas aeruginosa.


Wells' syndrome. Recurrent granulomatous dermatitis with eosinophilia.

Two cases of granulomatous dermatitis with eosinophilla (Wells' syndrome) are reported. With Wells' original four cases, these two cases define a distinctive dermatosis with onset as cellulitis and formation of solid edema and either final spontaneous resolution or resolution with steroid therapy. Microscopic study showed diffuse tissue eosinophilia and fibrinoid flame figures, evolution of associated focal necrobiosis, and formation of focal microgranulomas associated with eosinophils. Biopsy of muscle and fascia showed comparable fasciitis and eosinophilic myositis. Immunofluorescence in one case disclosed fibrin in the dermis and lgM, lgA, and C3 in the blood vessels of the muscle. Recurrences of the lesions often appeared to be related to drug administration or surgery.


Erythema multiforme as a complication of BCG scarification technique.

Erythema multiforme occurred in a 31-year-old woman as a complication of BCG immunotherapy administered by scarification for a Clark's level IV malignant melanoma. This is an unusual complication of the scarification technique.


Quantitative analysis of lymphoid cells in myocosis fungoides, Sézary's syndrome and parapsoriasis en plaques.

Semi-thin sections are superior to paraffin sections for differentiating lymphoid cells. To test their possible significance in the diagnosis of cutaneous T-cell lymphomas, the following investigation was made: A quantitative analysis of lymphoid cells in the cellular infiltrate of cutaneous lesions of mycosis fungoides (11 cases), Sézary's syndrome (9 cases), and parapsoriasis en plaques (14 cases) was made using semi-thin sections of epon-embedded biopsies. As controls biopsies of patch test reactions, contact dermatitis, initial psoriasis, and erythema chronicum migrans were studied. A high percentage of Lutzner (Sézary) cells was consistently found in Sézary's syndrome and occasionally in parapsoriasis en plaques only. In mycosis fungoides lymphocytoid cells with the nuclei less dense than in normal lymphocytes were predominant. In most tumorous lesions of mycosis fungoides and of Sézary's syndrome an increased percentage of immunoblasts was noted. Normal lymphocytes were the most frequent cell type in parapsoriasis en plaques as well as in the controls. These findings may prove helpful in the diagnosis of problem cases, for which the use of semi-thin sections is recommended.


Melanin granula distribution and phagocytosis in psoriasis vulgaris after PUVA therapy.

Melanin-containing basal cells of the epidermis, melanin-containing macrophages, mast cells, eosinophilic granulocytes and plasma cells were quantitatively investigated with the purpose of gaining an understanding of the quantitative changes in these cell systems under PUVA therapy. This patients have been exposed to solar radiation some weeks or months before the begin of the PUVA-treatment. Different dying-processes were used to investigate biopsy samples of psoriatically healthy and psoriatically affected skin, from 28 patients before, and 39 patients after PUVA therapy, using a 2 d micrometer with a field of view of 0.1 mm2. Altogether more than 9,000 fields of view have been analysed. The average radiation amount was 12 irradiations with an average total energy of 21.5 J/cm2. It was found that the count of granula-containing basal layer cells decreases in the psoriatic "healthy" region due to pigment incontinence and increase in the psoriatically affected region. The subepidermal melanin-containing phagocytes increase in both regions to a similar extent. In the case of the mast cells there was no trend to degranulation. The count of eosinophilic granulocytes and plasma cells was unchanged.


Human malignant melanoma antigenic properties of phenol water extracts.

Tumor-associated antigens were demonstrated in phenol water extracts of human malignant melanoma by migration tests with leukocytes from melanoma patients and controls: in 25 out of 60 melanoma patients weak reactivity was observed, usually stimulation of leukocyte migration, while leukocytes from 37 controls were negative in 100 tests. The frequency of positive reactions did not differ significantly in patients with and without metastases. Humoral antibodies against antigens of phenol water extracts were not detectable in melanoma patients. Rabbits did not produce antibodies against tumor typical substances after immunization with phenol water extracts. Tumor associated antigens of phenol water extracts are presumably not targets of antitumor immune reactions that can influence the clinical course.


Effect of antiandrogens on the binding of androgen to cytosol and nuclei of hamster sebaceous glands.

Cyproterone acetate, R 2956, Ro 7-2340 and Sch 13521 in the daily dose of 8 mg injected intramuscularly to castrated adult hamsters for 3 weeks were all found to significantly antagonize the stimulatory effect of exogenous testosterone propionate (80 microgram im, every other day) on the sebaceous gland as well as the prostate and the seminal vesicle. With a view to clarifying the mechanisms of action of these antiandrogenic drugs on the sebaceous gland, the present author carried out both in vivo and in vitro experiments and examined how they would interfere with the binding of 3H-dihydrotestosterone (DHT) to cytosol and nuclei. When 200-1000 excess quantities of the antiandrogens were administered to the experimental animals 10 min before injection of 3H-testosterone, all of them except R 2956 reduced the bound radioactivity in the nuclei of the sebaceous gland by more than 40%. Incubation of the cytosol fraction with 1 x 10(-7) M of cyproterone acetate caused a 70% decrease in radioactivity of the specific binding. In contrast, such inhibitory activities of the three other antiandrogens were less conspicuous even at 1 x 10(-6) M. In the homogenate of the sebaceous gland incubated with 1 x 10(-8) M of DHT, the other drugs than Sch 13521 curbed the characteristic binding of DHT to macromolecules of the nuclei by nearly 70% at 1 x 10(-6) M.


[Investigations of the effect and mechanism of action of the beta-sympathomimetic ritodrine on the synthesis and release of dipalmitoyl-lecithin in the fetal rabbit lung (author's transl)].

For a period of 8 days, pregnant white New Zealand rabbits were treated either with the beta-sympathomimetic Ritodrine (1 mg/kg) body weight daily) or with 0.9% saline solution. The fetuses were delivered by caesarian section on the 25th and 30th day of gestation (term being 31 days). No significant difference was found between the Ritodrine and saline treated groups with respect to the levels of dipalmitoyl-lecithin (DPL) obtained from the homogenates as well as the alveolar lavages of the fetal lungs. These results indicate that with this experimental model, prepartum treatment with Ritodrine has no effect either on DPL synthesis or its release into the alveolar spaces. Furthermore, treatment with the beta-sympathomimetic produced no significant change in the concentrations of the specific glucocorticoid receptors in the cytosol and nuclei of the fetal lungs, and in addition, the lung cytosol glucose concentrations as well as the plasma corticosteroid levels were unaffected. These findings support the conclusion that the synthesis of DPL in the fetal lung is not stimulated by Ritodrine.


[The structure of decidual mucosa in the accessory horn of an uterus bicornis (author's transl)].

The loosely attached decidual mucosa in the accessory horn of an uterus bicornis does not principally differ from the mucosa in the horn containing the fetus. Structural studies show that the regression of decidual endometrium to a endothelium-like lining is a hormone-dependent process such as stromagland dissociation. Mechanical factors due to expansion of the fetus certainly play no major role. Degenerative phenomena, such as focal necrosis, sclerosing edema, thrombosis, and inflammatory infiltrates probably appear more frequently in the accessory horn. They may be explained by more pronounced regional disturbances concerning perfusion and the inferior sealing of the uterine cavity.


[Patterns of fetal heart frequency during the second stage of labour and expulsion period--typical patterns, frequency, risk of acidosis and evaluation (author's transl)].

Four patterns of fetal heart frequency with normocardia, two with tachycardia and three with bradycardia are described during the expulsion period. The most frequent patterns are normocardia with decelerations (48%), normocardia with decelerations and final bradycardia (21.1%) and basal bradycardia with decelerations (13.5%). The frequency of acidosis (pH of the umbilical artery less than or equal to 7,200) of these three patterns amounts to 8.3, 24.1 respectively 26.7%. The mean values of pHUA of normocardia with decelerations and final bradycardia, bradycardia, bradycardia with decelerations, tachycardia with decelerations and final bradycardia with prepathologic respectively pathologic Scores (Hammacher's Score, greater than or equal to five points) range from preacidosis to acidosis. Scoring of cardiotocograms seems to be of greater clinical significance than the measurement of deceleration areas.


[Prenatal sex determination by radioimmunoassay of testosterone with and without chromatography of the amniotic fluid (author's transl)].

Amniotic fluid testosterone measured by radioimmunoassay (RIA) without chromatography (immunoreactive testosterone) seems not to be a definitive test for prenatal sex determination in all cases. In this study testosterone (T) levels measured by RIA with chromatography of the amniotic fluid samples were compared with immunoreactive testosterone (iT) values, to determine the predictive accuracy of the two methods. In 111 amniotic fluid samples between 15 and 19 weeks of gestation iT and T were measured parallelly. There are significant differences between iT- and T-means of both sexes (p less than 0.001). 95%-condifence limits of iT-values of the male and female fetuses are largely overlapping. In contrast, the overlap of 95%-confidence limits of the T-values is only minor. The measurement of testosterone with chromatography of the amniotic fluid samples shows for prenatal sex determination in over 90% accuracy. This result is due to the elimination of sex-specific differences in crossreacting steroids within the amniotic fluid of both sexes.


[Problems of dextran-charcoal-separation of free from antibody-bound steroid in a direct radioimmunoassay of progesterone without chromatography and extraction (author's transl)].

A method for radioimmunoassay of serum progesterone is described which does not require extraction. A chromatographic step is not necessary because of the high specifity of the antibody. The intrassay coefficient of variation was 6.1% and the interassay coefficient of variation was 8.4%. The detection limit was 10 pg/tube that means 1 ng/ml serum. The test on parallelity was correct up to 10 microliter serum. The results compared with results of a radioimmunoassay with extraction were identical. High concentrations of hormone in serum and an antibody of high specifity are required for the direct radioimmunoassay of steroids. Using the dextran-charcoal system for separation of free from antibody-bound steroid the relationship of the quantity of serum to the quantity of charcoal is of great importance. These problems are discussed.


[On the effect of PGE2 and PGF2 alpha on circular and longitudinal myometrium strips of different corpus uteri tissues of the guinea pig in vitro (author's transl)].

The effects of PGE2 and PGF2 alpha on corpus uteri and cervix strips of guinea pigs were studied in vitro. Myometrium strips developed maximal contraction activity at concentrations of 10(-7) M PGE2 and 5 x 10(-7) M PGF2 alpha in the organ bath, respectively. As for corpus uteri myometrium strips, longitudinal (extern) and circular (intern) layers of the organ wall showed comparable Prostaglandin-induced contractions. On the other hand, longitudinal and circular strips from cervix uteri tissue showed adverse Prostaglandin effects: PGE2 relaxed the cervix strips by lowering the muscle tone, the contraction frequency and a complete stop of contractions within most experiments lasting for an average time of 15 min. PGF2 alpha induced strong contractions of the same kind like corpus uteri strips did. The results indicate a role of PGE2 in the opening of the cervix, whereas PGF2 alpha possibly plays a role in the involution of the uterus post partum.


[Iatrogenic urethral pathology in paraplegic patients].

A review is made of the urethral pathology of iatrogenic origin in 127 paraplegic patients in which the etiopathogenic mechanisms and the treatment applied are annalysed as well as the results obtained and the most suitable prophylaxis of the said pathology.


[Various aspects of the vessels of the renal glomerulus seen through the scanning electron microscope].

The kidney glomeruli of the rabbit have been examined by means of repletion with celloidin and subsequent corrosion. The observation has been done with a scanning electronic microscope. In their most general and common aspect, the glomeruli have variations in their arteries; in some cases these are homogenous whilst in others they may be different within a single glomerulus and different among each other. When the glomeruli are dissected, these differences are seen much better as there can be seen to be several collaterals, those emerging from the afferrent trunk which may have different devices and several shapes as some are more or less elongated whilst in other circumstances these arteries are spiral with numerous curls. We cannot specify whether these differences are purely morphological or different functional states. When glomeruli are observed in a single area, they present different shapes and sizes which suggests that these differences are typical of each glomerulus and never dependent upon the topography where they are located. The arteries of the glomeruli are generally arranged in lobules. These may be different in the size, length and arrangement of the vessels since, as we clearly state in this paper, the vascular lobules are different from each other within a single glomerulus.


[Comparative ultrastructural study of the epithelial stromal junction in the prostatic gland].

In this paper, the authors carry out a comparative study of the structures adjacent to the alveolar periphery of the prostate-glands of men, dogs and bulls. In the three cases an E.S.J. (Epithelial-Stromal-Junction) similar to that described in the mammary gland and characterized in the first two cases by the existence of four, ultrastruct strata, consisting of the basal lamina, the somas of the adjacent fibroblasts and their cytoplasmic expansions as well as the arrangement of the intercellular, collagen microfibrils, was found to exist in this gland. In the case of the bovine prostate gland, the structural organization of the E.S.J. was basically characterized by the structural arrangement of the collagen microfibrils. The structures described constitute models on which to base future research on the hyperplastic and neoplastic processes of the prostate gland.


Primary osteoathrosis of the hip and Heberden's nodes.

One hundred patients with primary osteoarthrosis of the hip were examined for evidence of generalised arthrosis associated with Heberden's nodes, and in addition their hips were graded by the radiographic pattern of loss of joint space. Twenty-nine patients had bilateral concentric loss of joint space, and 18 in this group had Heberden's nodes. None of the 17 patients with bilateral upper pole changes had Heberden's nodes, and only 7 of the 31 patients with unilateral upper pole changes had Heberden's nodes. None of the 6 patients with medial loss of joint space had Heberden's nodes. This study has shown an association between Heberden's nodes had primary osteoarthrosis of the hip where this is characterised by concentric loss of joint space. The association is most marked where hip changes are bilateral, suggesting that hip involvement in generalised osteoarthrosis is part of a generalised disorder with possible genetic or biochemical abnormalities.


Sacroiliitis detected by bone scintiscanning: a clinical, radiological, and scintigraphic follow-up study.

Twenty-four patients had abnormal sacroiliac joints detected by quantitative sacroiliac scintigraphy but no radiological evidence of sacroiliitis on original investigation. We studied them again after intervals of 12 to 36 months. Four patients developed radiological change. Two young, HLA B27-positive men had undoubted ankylosing spondylitis, and a young woman had possible ankylosing spondylitis. A middle-aged man had changes that could be attributed to post-traumatic osteoarthrosis. Of the remaining 20 cases 15 had symptoms and signs suggestive of inflammatory disease of the axial skeleton (and peripheral arthropathy in 5 cases). The sexes were affected equally (8 females, 7 males), and only 2 of the 15 were B27-positive. The response to anti-inflammatory medication was generally good to excellent, and scintiscans tended to improve. Of the remaining 5 patients, 3 had mechanical or traumatic problems, and in 2 there was no explanation for the abnormal sacroiliac scintiscan. We conclude that quantitative sacroiliac scintigraphy may detect ankylosing spondylitis prior to the develpment of radiological change and that it can identify an organic basis for backache in patients with a spondylitis-like syndrome. The clinical circumstances must be taken into account, as scintigraphic abnormalities are not diagnostic of any specific disease entity.


Behçet's syndrome: a family study and the elucidation of a genetic role.

A family with features of the mucocutaneous ocular syndrome is described. A 4-generation study reveals that the condition has been inherited as an autosomal dominant trait with variable expressivity. Psychiatric symptoms and myalgia have been prominent features peculiar to our patients.


[Testicular teratoma in infancy].

The authors describe a case of testicle-based teratoma, in a 20-month old boy. Due to the characteristics of the palpation and its eventual transillumination, it may be confused with a hydrocele. They stress its rarity and on the basis of a review of the literature, they explain its histological peculiarities and refer to its prognosis, usually benign, when it is diagnosed at about 2 years of age, providing that a very careful examination of the histological sections rules out the presence of anaplastic cells. Finally there is a short discussion on the possibilities of complementary therapy when there are metastases.


An evaluation of repeat intra-articular injections of yttrium-90 colloids in persistent synovitis of the knee.

The effectiveness of a second intra-articular injection of yttrium-90 colloid was studied in 30 patients with persistent synovitis of the knee. All had responded poorly to a first injection of yttrium-90 yet seemed likely to benefit from this therapy. With a minimum review period of 6 months complete remission of synovitis was obtained in 20%, while 63% gained symptomatic relief, with some reduction of synovitis. No improvement occurred in 17%, and in this group generalised disease activity was more apparent.


[Ureteral triplication with one blind branch].

We present a case of a double left ureter, one of which branched with one blind branch, which has not been described in the literature.


IgA rheumatoid factor in the sera and saliva of patients with rheumatoid arthritis and Sjögren's syndrome.

With a sensitive radioimmunoassay we have found elevated IgA rheumatoid factor (IgA-RF) levels in the sera of patients with rheumatoid arthritis, Sjögren's syndrome, and systemic lupus erythematosus. The IgA--RF showed a pattern of reaction with human IgG subclasses and animal gammaglobulins similar to that of IgM-RF from the same patients. Rheumatoid factors of both classes were shown to be present in saliva of patients with rheumatoid arthritis and Sjögren's syndrome.


[Rupture of a single renal cyst in the excretory ducts].

After observing one case, the authors review the contemporary literature on ruptures of single kidney cysts in the pyelo-calicial cavity. They comment upon the pathogenesis of this entity which is produced by an increase in the intracystic pressure, an increase in the pressure inside the pyelo-calicial cavity or a decrease in the resistence of the wall separating the cyst from the intrarenal cavities. They review all the possible etiological causes (intracystic haemorrhaging, infection, traumatism, idiopathic disorder in the dynamics of the cystic fluid, obstructions in the excretory ducts, previously pathological stones, etc.). They enumerate the principles for the radiological diagnosis issued by McLaughlin and Pfister, to which the authors of this paper add, as a matter of interest, the retraction of the cortical at the level of the renal cavity.


Synthesis of sulphated proteoglycans by rheumatoid and normal synovial tissue in culture.

Synthesis of sulphated proteoglycans by cell lines derived from explants of 7 rheumatoid and 9 normal specimens of synovial tissue, as well as by 7 lines of skin fibroblasts from non-rheumatoid patients, was examined. Cells of all 3 types were cultured as monolayers. They were then disaggregated and their capacity to synthesise proteoglycan estimated in cell suspensions by the incorporation of [35S]-sulphate into CPC-precipitable material during 2 hours of incubation. Cell suspensions incorporated somewhat more [35S]-sulphate than corresponding duplicate monolayers. Synovial cells from rheumatoid patients incorporated 2 to 3 times as much [35S]-sulphate as synovial cells from normals. Skin fibroblasts, however, incorporated less [35S]-sulphate than rheumatoid or normal synovial cells up to the fifth passage. Thereafter their incorporation gradually increased to overtake that of synovial cells. About one-half to one-third of the total [35S]-sulphate labelled material was closely associated with cells from synovial tissues and fibroblasts respectively.


[The role of C reactive protein in urological neoplasms].

The authors make a study of 46 urological patients (16 control and 30 neoplasia persons) determining the R.C.P. before and after the operations. The positive results obtained (77%) should lead to the said test becoming routine in uro-genital neoplasias.


Acetylator phenotype in spontaneous SLE and rheumatoid arthritis.

Acetylator phenotype was determined in 22 patients with spontaneous systemic lupus erythematosus and the proportion of 'slow' acetylators compared with that obtained in a group of patients with rheumatoid arthritis and a group of healthy controls. 73% of the SLE group were designated 'slow' compared with 72% of the rheumatoid group and 64% of the control group. These differences were not significant.


[A case of urethrocele (radiographic image)].

The authors present a case of male urethrocele situated at the base of the free portion of the penis, on the inferior side and containing 240 g. of dirty and fetid urine. The urethra is free from any stenosis, obstacle or stone. They mention the case of Gausa Raspall in Barcelona, presented in 1949 along with the clinical picture of the male urethrocele. They also include a retrograde urethrocystograph with antero-posterior and oblique anterior left projections.


Serum copper and its relationship to clinical symptoms in rheumatoid arthritis.

Total serum copper and ultrafilterable copper levels in patients with rheumatoid arthritis were determined and related to articular index, erythrocyte sedimentation rate (ESR), and serum iron concentration. Relationships were found between serum copper and ESR, and between ultrafilterable copper and articular index. The relationship between serum copper and serum iron was found to be a drug-dependent.


Rapidly progressive scleroderma associated with carcinoma of the oesophagus.

A patient with scleroderma of recent onset was found to have a carcinoma of the oesophagus. The rapid progression of the scleroderma suggested the possibility that it represented a systemic manifestation of malignancy.


Hypercholesterolaemic arthropathy in primary biliary cirrhosis.

A new cause of severe transient fitting polyarthritis is described in a patient with primary biliary cirrhosis. Hypercholesterolaemia is thought to provoke acute inflammatory periarthritis and peritendinitis. The clinical features are sudden onset of peripheral joint pain and effusion, with redness of the overlying skin, often precipitated by unusual exercise. Cholestyramine may help to prevent this form of arthritis.


Attitudes of the public to arthritis.

A survey of the public's attitude to arthritis was commissioned by the Arthritis and Rheumatism Council (ARC) in 1974. The survey was carried out by National Opinion Polls (NOP) Market Research Ltd. The ARC were interested to find out whether people underestimated arthritis and what they thought about the consequences. Respondents were asked to rank a number of illnesses in terms of their seriousness and the loss of work to which they give rise. They were also shown a series of statements about arthritis and rheumatism in order to elicit the extent of their agreement with the views these represented. The public appear to have fairly realistic ideas about the magnitude of the problem and of its nature and associations. However, although the pain of arthritis and rheumatism was appreciated, their possible impact in terms of disturbance of the normal pattern of daily life tended to be underestimated. The findings reflect the climate of opinion from which present and potential arthritis sufferers come and may therefore reveal part of their attitudes to their disease.


Traumatic injuries of the portal vein. The role of acute ligation.

Injuries to the portal vein are rare but have a high risk with a mortality of 50--70% secondary to exsanguinating hemorrhage. When managing injuries to the portal vein, lateral venorrhaphy, end to end anastomosis, or an interposition graft should be attempted whenever possible. However, in a hemodynamically unstable patient or when confronted with a nonreconstructable injury, acute portal vein ligation may be the procedure of choice as it is safely tolerated in some 80% of patients. Of eleven reported patients in whom the portal vein was ligated acutely for traumatic injury, six survived. Four of the nonsurvivors died of massive associated injuries. Of the six surviving patients, five tolerated acute ligation of the portal vein without complication. Should portal vein ligation be performed a "second look" operation is essential in 24 hours to examine the bowel for viability. A portosystemic shunt with its inherent complications should not be done as a primary procedure when attempts at reconstruction of the portal vein have failed. Shunting should be reserved for those few patients who develop stigmata of portal hypertension or impending infarction of the bowel.