Panoramic orthopantomography for patients with multiple injuries. A preliminary report.

The text introduces an apparatus for panoramic tomographies enabling examination of supine patients. The apparatus is suitable for examination of patients with multiple injuries and suspected jaw fractures.


[Formation of a large blister with subsequent necrosis of the skin following paravenous contrast medium injection at the dorsum of the foot in a patient with oedema and deep phlebothrombosis (author's transl)].

In a female patient with an oedema of the leg as a result of deep phlebothrombosis, a great blister developed at the dorsum of the foot proximal to the site of injection following phlebography effected by paravasal contrast medium injection. The blister was transparent and contained clear, serous liquid. Skin necrosis developed at this site which took months to heal. The reason is sought in a stasis of contrast medium caused by the oedema. It is suggested that in future cases of this kind, cortisone treatment should be attempted.


[Mastocyte osteoporosis].

We present five cases of severe osteoporosis accompanied by a skin and/or bone mastocytosis. The rarity of mastocytosis demonstrates that these cases are not the result of simple coincidence, especially since none of them involves other general of phospho-calcium anomalies that could explain the demineralization. The latter is accompanied by a high level of histaminemia or histaminuria, a non-specific anomaly. Mastocyte osteoporosis involves a great many unknown factors on the physiopathological level, but in practice it is necessary to look for a mastocytosis when confronted with a severe osteoporosis that appears to be primary. Cytostatic treatment (chlorambucil, cyclophosphamide) seems capable of improving the evolution of the bone disease.


[Partial algodystrophy].

The authors describe, on the basis of 7 cases, a special form of decalcifying algodystrophy not described in the literature, characterized by a very localized pain beginning gradually, or more often suddenly. It is of mechanical or mixed type, accompanied by local, pseudo-inflammatory signs being either apparent or discrete, very elective and very sharp pain upon palpation of a very limited area of a condyle or a tibial plate, with hyperfixation located through scintigraphy with technetium 99m polyphosphates, and regressing either spontaneously, or more quickly under treatment, of which thyrocalcitone is the essential part, without undergoing a phase of intense loco-regional demineralization. This form of algodystrophy, that they propose to call partial algodystrophy, can, like the other forms of algodystrophy, appear in monofocal or plurifocal form, either straight off or at a distance from the first incidence, which leads this new radioclinical type to be considered a simple form of algodystrophy of the limbs, midway between the types without radiological anomaly during development and the complete and extensive ones with major radiological signs. Finally, they underline the great value or scintigraphy in diagnosing this form of algodystrophy and algodystrophy without radiologic anomaly.


[Idiopathic hypercalciuria. Correlative study of bone tissue and phosphocalcium investigations].

The authors report on the clinical, biological and radiological anomalies observed in a series of 42 cases of idiopathic hypercalciuria. An histological bone study showed "osteomalacia" type changes (an increase in the osteoid volume and a decrease in the mineralization speed). The Ca45 isotope studies showed that there was an exchangable pool of calcium and a turnover, which was generally low. A study of the kidney functions revealed a decrease in the tubular reabsorption of calcium, while that of phosphorous remained within normal limits. There was no case of hyperparathyroidism in this series. The authors pose the question of whether the failure of calcium to settle on the tissues and the lack of tubular reabsorption of calcium, does not result from the relatively ineffective action of the endogenous circulating parathyroid hormone.


Carcinoembryonic antigen (CEA) in patients with alcoholic liver diseases.

The mean plasma carcinoembryonic antigen (CEA) level was found to be significantly increased in 66 patients with alcoholic liver disease (4.4 micrograms/1) compared with the mean CEA level in 164 healthy blood donors (1.6 micrograms/1, p less than 0.001). Eighteen of the patients (27%) had values above our upper normal values of 5 micrograms/1, compared with 3 of 41 (7%) in a group of patients with non-alcoholic liver diseases. On the other hand, the mean CEA values in the two groups did not differ significantly. The CEA level remained unchanged in patients who continued drinking. However, in 20 patients who stopped drinking, the mean CEA levels dropped significantly from 6.6 micrograms/1 to 3.7 micrograms/1. Concomitant fluctuations were seen in CEA, gamma-glutamyltranspeptidase (gamma-GT), asparate aminotransferase (ASAT), and alkaline phosphatase, although a significant correlation was found only between CEA level and the level of gamma-GT (r = 0.32, p less than 0.02). The correlation between CEA and gamma-GT was best in 41 patients without complicating disorders (r = 0.55, p less than 0.001). CEA was significantly increased in patients with complicating disorders. Much of the increase of CEA in many patients with alcoholic liver disease might be secondary to complicating disorders in the respiratory and/or gastrointestinal tracts. This could possible explain why patients with alcoholic liver disease more often than other patients with benign diseases have elevated CEA.


Determination of HBeAg by radioimmunoassay: prognostic implications in hepatitis B.

A radioimmunoassay was used to determine the presence of the hepatitis B e antigen (HBeAg) and anti-HBe in the serum of 12 hepatitis B patients, who were follofed from an early phase of the illness into convalescence. The duration of detectable HBeAg in serum from these patients, in all ow whom the disease ran a normal course, was compared with the persistence of HBeAg in serum of nine patients with a protracted course and persistence of HBsAg in serum for more than 1 year. None of the hepatitis B patients with a normal course of the disease had HBeAg demonstrable for more than 9 weeks after the onset of illness (mean 5.4 weeks), whereas all patients developing chronic hepatitis had HBeAg in serum for more than 1 year after the onset of illness. These findings indicate that the detection of HBeAg in serum by radioimmunoassay for 10 weeks or more after the onset of illness implies a great risk of progression of the hepatitis B infection to chronic liver disease.


Time course and sensitivity of secretin-stimulated pancreatic secretion and blood flow in the anesthetized dog.

Time-effect relationship and sensitivity of pancreatic exocrine secretion and pancreatic blood flow were established, to test the supposition that blood flow to the pancreas is controlled by the secretory process. Pancreatic exocrine secretion rate was stimulated by incremental iv doses of secretin (Karolinska, 0.001--4 U/kg) in pentobarbital anesthetized dogs. Arterial pancreatic blood flow was measured by electromagnetic flowmeters; secretion rate was determined by measurement of frequency of consecutive secretory drops. Exocrine secretion rate and blood flow increased markedly. Secretion responded at a dose level 3-7 times lower than blood flow did. So at low secretory performance, the pancreas seemed to be well provided with basal blood supply. At moderate and high secretory levels blood flow did increase, but the flow increase was seen 16-22 sec before the secretion increase. So the additional support of blood flow in the secretory process occurred during the cellular preparation and during the start of the secretion increase. This suggests that secretion increase and blood flow increase are mediated by independent processes or receptors, but these processes seem to cooperate in processing the pancreatic juice.


Plasma gastrin concentrations following sham feeding in duodenal ulcer patients.

Sham feeding experiments were performed in 20 duodenal ulcer (DU) patients by using adequate sham feeding and modified sham feeding (the 'chew-and-spit' technique). A 15-min sham feeding induced a marked secretion of gastric acid but only an insignificant increase in total gastrin or in gastrin17 concentrations in plasma. Nor did prolonged sham feeding (30 min) with intragastric neutralization significantly increase the gastrin concentrations. We conclude that sham feeding in DU patients induces a release of recognized gastrin components in amounts that are barely detectable radioimmunologically. Therefore, the acid secretory effects of vagally released gastrins in DU patients remains to be established.


Cephalic phase of pancreatic-polypeptide secretion studied by sham feeding in man.

The effect of sham feeding on pancreatic-polypeptide (PP) secretion was studied in 26 duodenal ulcer (DU) patients and in 8 healthy subjects. Modified sham feeding (MSF) by the 'chew and spit' technique induced a rapid increase in plasma concentrations of PP both in DU patients, 56 (2-138) pmol/l, and in the healthy subjects, 24 (2-45) pmol/l, median peak-increment and range. Four out of 26 DU patients and 2 out of 8 healthy subjects did not show any PP response to MSF. The PP response to MSF was abolished by pretreatment with atropine, or benzilonium, a quarternary anti-muscarinic agent with minimal cerebral actions. The PP response to MSF was not dependent on the gastric acid response, since a PP response to sham feeding was found in 13 out of 17 patients with selectively denervated parietal cell area, and thus, without acid response. During adequate sham feeding, in which the food is also swallowed but does not reach the stomach, the PP increment, 100 (81-129) pmol/l, was larger than during MSF in the same patients, 51 (8-78) pmol/l, median and total range, P less than 0.05, N = 7. No correlation was found between the PP and acid responses to sham feeding. It is concluded that cephalic stimulation provoked by tasting, chewing and swallowing is a major stimulus in the initial, rapid PP response during a meal; and that the PP cells are probably stimulated directly by a cholinergic mechanism.


The lactulose hydrogen breath test as a diagnostic test for small-bowel bacterial overgrowth.

The lactulose hydrogen breath test has been evaluated as a diagnostic test for small-bowel bacterial overgrowth using the 14C-glycocholate breath test for comparison. Twenty-seven patients with suspected bacterial overgrowth and 37 control patients were studied. The lactulose test was positive in 8 out of 9 patients with Subsequently proven bacterial overgrowth, all of whom had positive 14C-glycocholate tests. However, 6 patients with ileal disease or resection had positive 14C-glycocholate tests but negative lactulose tests. subsequent bacteriological study of duodenal juice from these patients was negative. Negative results were obtained by both tests in the remaining 12 patients, none of whom were subsequently shown to have bacterial overgrowth. All 37 control subjects had negative lactulose tests. The lactulose breath test is a simple and promising diagnostic test for the detection of small-bowel bacterial overgrowth and, unlike the 14C-glycocholate test, has the advantage of being able to distinguish bacterial overgrowth from ileal disease.


Lymph and blood enzymes and pathologic alterations in canine experimental pancreatitis after administration of benzo-pyrones.

The effect of Venalot, a combination of two benzo-pyrones, on canine experimental acute pancreatitis was examined. Activities of lymph and blood plasma enzymes, thoracic duct lymph flow, and morphological changes of the pancreas were compared with those of a control group of dogs. The drug was found to enhance the removal of amylase and trypsin via lymph from the gland and to decrease the elevation of plasma amylase and lactate dehydrogenase. When administered simultaneously with the induction of pancreatitis, benzo-pyrones were effective in the reduction of pancreatic edema and necroses.


Kinetics of the agglutination of IgG-coated latex particles by C1q: the influence of heat-labile serum components.

Interaction between human C1q and IgG coated latex particles has been studied by means of a standard aggregometer equipment. A dose-dependent agglutination was observed and 100 ng of C1q were readily detected. The kinetics of the agglutination was also monitored. Serum, partially purified C1, and high molecular weight fractions from Sephadex G-200 fractionated serum produced agglutination only in the presence of EDTA. In the absence of this chelator these products disintegrated preformed C1q-IgG-latex particle agglutinates. This disagglutinating principle is heat-sensitive and tentatively macromolecular C1 dependent. The most probable basis of the activity is the competition between C1, with a high affinity for IgG particles, and C1q. The inability of C1 to induce particle agglutination might be caused by the C1 subunits C1r and C1s sterically inhibiting the subunit C1q to bridge between the particles.


Assessing vulnerability to schizophrenia or manic-depression in borderline states.

In a discussion of the article on genetic determinants of borderline conditions by Siever and Gunderson, a phenotypic continuum between pure schizotypal and pure affective conditions is postulated. Many "borderline" cases are seen as attenuated forms of schizophrenia, schizoaffective psychosis, or manic-depression. A Venn diagram illustrates differences among syndromes described by Gunderson, Kernberg, Spitzer, and Klein ("hysteroid dysphoria"). Evidence is presented suggesting that Gunderson's borderline syndrome contains more schizotypal individuals than Kernberg's, whereas hysteroid dysphoria is nearer the affective pole of the continuum. A second diagram illustrates how the strength and nature of the genetic factors vary according to the syndrome.


The treatment of female borderlines.

Failure to complete needed operations in the separation-individuation process during early childhood development is increasingly suspected of being a major source of borderline pathology. Building on Mahler's descriptions of this process as an interpersonal operation between child and mother, we have directly intervened in the patient-mother relationship in a small group of adult female borderlines. All patients displayed rapid and apparently complete clearing of borderline symptoms following limited conjoint therapy. Although neuroses remained, the criteria for a borderline diagnosis were no longer met. Treatment results with six women who had pretreatment and posttreatment psychological testing are reported. Testing confirmed clinical impressions of significant shifts in psychological defenses as well as perceptions of self and others. Fundamentals of this approach are discussed briefly, and observations regarding possible borderline pathology, mother-daughter interactions, family dynamics, and therapeutic philosophy are made. This approach appears not only to be effective but offers promise of simplifying both the role of the therapist and the therapy itself.


Therapist ratings of achievement of objectives in psychotherapy with acute schizophrenics.

Therapist ratings of patients' achievement of objectives in psychotherapy were used to examine the impact of drugs on psychotherapy, to identify attributes of patients who achieve therapy objectives, and to assess the importance of the implementation of a crisis-oriented model of therapy. Patients were part of a project investigating the long-acting phenothiazine fluphenazine enanthate and crisis-oriented family therapy in a 6-week program of aftercare treatment for briefly hospitalized first admission acute schizophrenics. The 44 patients in this study were randomly assigned to the psychotherapy condition and to either a high or low dosage of phenothiazines. Therapist ratings of the achievement of therapy objectives were significantly related to independent ratings on two outcome measures, the Global Assessment Scale and the Brief Psychiatric Rating Scale (BPRS) factor Thought Disorder, at 6-month followup. Analyses of predictors of the achievement of therapy objectives revealed significant interactions between drug level and Venables and O'Connor ratings of paranoid symptomatology among good permorbid patients and between drug level and BPRS ratings of Hostility for the entire sample.


The psychotherapy of schizophrenia: Semrad's contributions to current psychoanalytic concepts.

Elvin Semrad's contributions to the understanding and psychotherapy of schizophrenia are described. The author defines the principles that guided Semrad in his theoretical understanding of schizophrenic patients, and elaborates the practical application of these principles. Semrad's contributions are related to recent work by Winnicott and Kohut on the holding environment and on the self-object and narcissistic transferences. The author's formulations about the relationship of schizophrenic regressions to borderline and narcissistic personalities, and the relevance of Semrad's work to these concepts, are reviewed.


The relatedness of borderline and schizophrenic disorders.

This article is an editor's introduction to the theme of a special issue of the Schizophrenia Bulletin devoted to borderline conditions. The editor reviews various approaches to defining borderline patients and concludes that these descriptive efforts are now showing considerable consensus. Questions remain, however, about whether borderline patients constitute a diagnostic category that is unrelated to schizophrenia or some other established diagnostic group. The historical origins of these questions are briefly reviewed, and then the multiple interpretations given to the current research efforts to answer them are described.


Sex differences in schizophrenia: a commentary.

A critique is offered of Samuels' article suggesting that reported sex differences in concordance rates for schizophrenia are either methodological artifacts or a function of sociological processes. Evidence of sex differences in age of onset, clinical expression, concordance rates among primary relatives, and premorbid competence is cited. Finally, it is concluded that sex differences in schizophrenia offer important clues to the development of the disorder and should be considered in future theories of schizophrenia.


Diagnosis of borderlines: a discussion.

In a discussion of two reviews of the literature on borderline conditions by Liebowitz (1979) and Rieder (1979), the author briefly describes his own research on clinical aspects of the borderline syndrome. Each of the investigators involved in the study of borderline conditions seems to have his own theoretical position and diagnostic evaluation procedures. There seems to be a consensus, however, that the syndrome represents a basic developmental defect with relatively "stable instability" within four subcategories.


Two reviews of the literature on borderlines: an assessment.

The author discusses Liebowitz's (1979) and Rieder's (1979) reviews of current issues regarding the diagnosis of borderline patients. He cites the need for further research examining the basic characteristics of the borderline syndrome. He also recommends that greater attention be directed toward defining subtypes of the syndrome. The author believes that a combination of the descriptive approach of Gunderson and Kolb (1978) and his own psychostructural approach (Kernberg 1977) would prove fruitful.


Justification for separating schizotypal and borderline personality disorders.

Siever and Gunderson (1979) have questioned the decision to separate Schizotypal Personality Disorder from Borderline Personality Disorder in DSM-III. The justification for this separation rests not on genetic evidence, but rather on the relative independence of the behavioral characteristics of two dimensions that up to now have both been referred to with the appellation "borderline." We believe that this separation provides the tools with which investigators may usefully study the interaction of genetic and environmental factors as they relate to personality and the major psychiatric disorders. The benefits of this separation are already apparent in that research investigators are now using two terms to describe different phenomena, when previously they were using the single term borderline. Proposed diagnostic criteria for Schizotypal Personality Disorder and Borderline Personality Disorder are appended.


Relapsing spontaneous pneumopericardium and pneumothorax with proven pleuropericardial defect. A case report.

A pneumopericardium was seen in a 25-year-old man each time he developed a right-sided pneumothorax. The chest roentgenograms were suggestive of a pleuropericardial defect. This was confirmed by subsequent thoracotomy.


Treatment of severe haemoptysis by embolisation of the bronchial artery. A case report.

A case report is presented of a 50-year-old man with severe haemoptysis. The exact source of the bleeding was not known and medical treatment had no effect. Selective angiography of the bronchial arteries showed extravasation of the contrast medium into a bronchus. Embolisation of the bleeding bronchial artery caused the haemoptysis to stop immediately.


Sarcoidosis of the stomach. A case report.

A case of sarcoidosis of the stomach in a 76-year-old woman is described. Fiberoptic gastroscopy and roengenograms presented the appearance of an infiltrating carcinoma. It was possible to follow the spontaneous behaviour or roentgenograms during a period of 4 years. A preceding, spontaneously remitted lesion of the lungs is described, and the lack of parallelism between the two lesions is discussed. The case is seen in the light of other cases described in the literature, and the difficulties concerning the differential diagnosis are discussed.


Cardiac output and blood pressure at rest and during exercise in boys with bronchial asthma.

Cardiac output, using dye-dilution technique, and intra-arterial blood pressure at rest and during exercise on a bicycle ergometer were determined in six boys with bronchial asthma, mean age 11.9 years. Intra-arterial blood pressure was also measured in another group of eight boys with bronchial asthma. Cardiac output, stroke volume, arteriovenous oxygen difference, blood pressure and total peripheral vascular resistance at rest and during exercise up to maximal level were within the normal limits of healthy boys of the same age. At maximal exercise, cardiac output averaged 12.4 l/min, stroke volume 66 ml, systolic, diastolic and mean blood pressures 128, 81 and 107 mmHg, respectively, and total peripheral vascular resistance 10.9 mmHg/l/min. The maximal arteriovenous oxygen difference amounted to 14.1 ml/100 ml blood which is similar to that in healthy adults.


Blood volume and arterial blood gases in patients with chronic obstructive lung disease during and after acute respiratory failure.

The blood volume and arterial blood gases of 18 patients with chronic obstructive lung disease were studied over a period of 1/2 to 5 years, including 35 acute exacerbations of the lung disease. Treatment during exacerbation was directed at infection, bronchial obstruction and hypervolemia. Long-term diuretic therapy was instituted during the follow-up period. On admission all patients suffered from severe dyspnoea, all but two had signs of peripheral oedema and/or liver congestion and one-third had increased jugular venous pressure. Blood volume was increased in all patients and eight of them had a hematocrit above 50%. PaCO2 was severely reduced and PaCO2  increased on admission. At discharge, these symptoms and signs had all diminished or disappeared. Blood volume had fallen an average of 11 and a further reduction of 0.41 was noticed during the follow-up period. Blood gases had improved by discharge and a further improvement accompanied the reduction of blood volume during the follow-up period. It is suggested that 1) hypervolemia is common in patients with advanced chronic obstructive lung disease; 2) hypervolemia may impair arterial oxygenation; 3) long-term diuretic therapy seems to be necessary for maintaining a normal blood volume.


Elimination of test particles from the human tracheobronchial tract by voluntary coughing.

The effect of coughing on the elimination of inhaled 6 micrometer radioactively tagged teflon particles in humans was studied by external measurements of the radioactivity retained in the lungs before and after 1--2 min of voluntary coughing. In six healthy subjects coughing produced no substantial elimination of the particles. Six out of eight patients with lung disease produced expectorate and also eliminated particles from the lungs by coughing. The other two patients had no phlegm, did not produce any expectorate and did not eliminate particles by coughing. An increased amount of tracheobronchial secretion thus seems to be necessary for coughing to be effective. In the patients, the elimination of particles by coughing was fairly reproducible, suggesting that the test model may be useful for investigation of the influence of physiological and pharmacological factors on the elimination process.


Proteins in bronchial secretion of children with chronic pulmonary diseases. I. Relation to clinical diagnosis.

Bronchial secretions from 207 children suffering from various pulmonary diseases and from 15 healthy controls were tested concentration of IgA, IgG, lactoferrin and lysozyme. The results obtained suggest that in many cases of chronic lung diseases in children the levels of lactoferrin and immunoglobulins, especially secretory IgA, are very low. In severe infections (cystic fibrosis, bronchiectases) significant increase of IgG concentration was observed.


Proteins in bronchial secretion of children with chronic pulmonary diseases. II. Relation to bronchoscopic and bronchographic examination.

The concentration of immunoglobulins, lactoferrin and lysozyme we compared in bronchial secretions obtained from children with various chronic lung diseases. The IgG, lactoferrin and lysozyme, but not secretory IgA, concentrations were shown to be increased during chronic inflammatory response.


Occupation and bronchial carcinoma.

All patients newly diagnosed as bronchial carcinoma were studied during a 5-year period. There were 212 male and 61 female patients. A careful occupational history was taken and the occupations of the patients in 1950 were compared with the County's official occupational statistics of that year, and their chest X-rays were scrutinized for pleural plaques. A significantly higher proportion of metal workers and workers from the building industry was found among the patients, while agricultural workers were under-represented. Smoking habits did not explain the difference. The number of patients with pleural plaques was four times higher than expected. It is concluded that dust in certain occupations has an additive effect on the carcinogenic effect of smoking.


Lung cancer and residency--a case-referent study on the possible impact of of exposure to radon and its daughters in dwellings.

In view of the well-known urban-rural difference in lung cancer rates, remaining also after standardization for smoking, it is suggested that low levels of radon and its daughters in dwellings might be of etiologic importance to this disease. To test this hypothesis, a case-referent (case-control) study was undertaken in a rural area; it considered residency in wooden houses (assumed to be associated with low-level exposure to radon and its daughters), "mixed type" houses (medium exposure) and stone houses (high-level exposure) among cases of lung cancer and referents (controls). The results indicate an increased risk of lung cancer among residents in "mixed type" and stone houses. Additional studies are highly desirable to confirm or refute these findings, which, if valid, mean increasing lung cancer hazards caused by a decrease in ventilation in future energy saving unless special measures are undertaken to reduce radon daughters in dwellings.


Hazards in the work environment--hydrogen sulfide. Spectrophotometric determination of hydrogen sulfide.

A convenient method for determing hydrogen sulfide in air has been developed in which the gas is first absorbed in silica gel and thereafter analyzed spectrophotometically. The limit of detection is one part per billion when measured at a wavelength of 670 nm.


An exchange of membrane filter samples of airborne asbestos between one United Kingdom and three Scandinavian laboratories.

An asbestos fiber counting trial based on the postal exchange of mounted and unmounted membrane filter samples was conducted between laboratories in Denmark, Norway, Sweden and the United Kingdom. The exchange was organized on the same basis as a previous international exchange involving nine countries (5); the United Kingdom laboratory had also participated in the previous exchange. Differences in counting techniques were distinguished from those due to the method used to make the filter transparent. Counting techniques gave rise to the biggest differences, giving a ratio of highest to lowest count of 2.75 for amphibole and 3.2 for chrysotile asbestos slides. A comparison was also made with the results of the previous international trial; it was made possible by the recounting of some of the slides from this exchange. Serious deterioration over two years was found in all slides except those mounted with the acetone/triacetin method.


Effects of vanadium on the upper respiratory tract of workers in a vanadium factory. A macroscopic and microscopic study.

An epidemiologic cross-sectional case-history study on the injurious effects of vanadium was carried out among the workers of a vanadium factory. The upper respiratory tract of 63 male workers exposed to vanadium dust was examined macroscopically and microscopically, and the findings were compared with those of a reference group of workers who were exposed to inert dust only. The groups compared were of similar ages and had similar smoking habits. Nasal smears and sputum cells were studied microscopically, and biopsies for histological study were taken from the nasal mucosa. The biopsies from the vanadium workers showed a significant increase in the number of plasma and round cells, and the histological picture was almost characteristic. There were no increased numbers of secretion eosinophils or other signs indicative of allergic inflammation.


Individual mercury exposure of chloralkali workers and its relation to blood and urinary mercury levels.

On two occasions, chloralkali workers were investigated with regard to personal air mercury exposure, blood mercury and urinary mercury. The first investigation (13 workers, 2 weeks) was made at an exposure above the threshold limit value (64 microgram/m3, range 36--112), the second (16 workers, 8 weeks) at a lower exposure (23 microgram/m3, range 15--43). At the higher level of exposure, good correlations were found between air exposure and blood or urinary mercury for the group, but not for individuals. At the lower level, the correlations were less pronounced for the group. For individuals, the best correlation was found between mean air exposure during one week and blood mercury about half a week later. Other individuals, mainly the least exposed, showed no such correlation. Corresponding correlations were not found for urinary mercury. The urinary excretion rate was determined only for the last few hours of the workday, but the results agree with earlier investigations of 24-h excretion on a group basis. The threshold limit value for mercury in air (50 microgram/m3) corresponds to 150--175 nmol Hg/1 blood (= 30--35 microgram/1) for the group, with large individual variation.


[Overview of the epidemiology of stonefish poisonings, their treatment and preventive measures].

A review is presented of work on envenomation by stonefish (Synanceja spp.), which represent not only a danger for the inhabitants of tropical coasts but also for tourists. Stonefish are common in shallow water of reef areas by the shores of the Indian and Indopacific Ocean. The bizarrely shaped fish is often taken for a weed-covered stone and accidents occur when swimmers, divers or fishermen step on the stings of the dorsal fin. These stings are provided with poison glands. The venom has neurotoxic, myotoxic and hemorrhagic effects. The case of a 39-year-old diver is cited who suffered a stonefish stab which lasted for several weeks. Generally envenomations by Synanceja cause severe local pain and enormous swelling of the limb; systemic symptoms as usually found with neurotoxins are  common; death may occur by shock, by paralysis of the diaphragm or cardiac arrest. For first aid bathing of the limb in hot water is recommended. Clinical measures are local analgesia, local neutralization of the venom, if possible antiserum therapy and intensive care with symptomatic treatment of systemic complications. The most effective prevention is adequate foot protection when wading in the sea.


[Exhaled hydrogen test in the detection of lactase deficiency].

To determine the validity of breath H2 measurements in detecting lactase deficiency, capillary blood glucose and breath H2 were measured after ingestion of 50 g lactose in 34 patients with abdominal symptoms or diarrhea. 18 patients had biopsy-proven lactase deficiency and 16 normal lactase activity. Blood glucose determination produced 2 false-positive results while breath H2 measurements provided 2 false-negative and 4 false-positive results.


[Hemolytic crisis and acute kidney failure from rifampicin].

Two cases are reported of hemolytic crisis and acute anuria after intermittent rifampicin medication. Immunologic tests demonstrate that the hemolysis was of the drug-induced heteroimmune type whereas the pathogenesis of the anuria was uncertain. For both complications the prognosis is good.


[Isolated hepatosplenic tuberculosis: 1 case].

A 27-year-old woman presented with high spiking fevers, progressive malaise, weight loss, and marked hepatosplenomegaly. The clinical picture and laboratory findings (including hepatic scintiscan, coeliac arteriography and abdominal lymphangiography) prompted surgical exploration of hypochondriac organs. On laparotomy, both liver and spleen surface exhibited extensive inflammatory lesions. Histopathologic investigations on hepatic tissue showed microscopic caseating granulomata. Specific stains and cultures for mycobacterium, fungi etc. were negative in tissue preparations. Antituberculous and steroid therapy elicited a rapid response. Follow-up observations indicated the resolution of specific hepatic lesions.


[Idiopathic hemochromatosis: current problems in diagnosis and therapy].

The main interest in idiopathic hemochromatosis (IH) currently centers more and more on early detection of the basic pathogenetic mechanisms of the disease, and on the prevention of organ lesions rather than therapy of the late syndrome. An understanding of the pathophysiology of this inborn error of iron metabolism, which is briefly outlined, enables the physician to motivate a still healthy potential IH patient for the simple but life-long therapeutic regimen (phlebotomy). The possible organ lesions of IH are briefly mentioned, and early recognition of arthropathy as a far from exceptional first symptom of the disease is emphasized. With regard to the detection of the latent disease, the practical value of liver biopsy, serum iron, the still debated serum ferritin, and the desferrioxamine test are discussed. Personal experience with a new and sensitive test for the screening of relatives, the cobalt absorption/excretion test, is also presented. After the recent clarification of the mode of inheritance of IH (autosomal recessive), the question arises whether heterozygote individuals, who obviously exhibit increased iron absorption, augmented transferrin saturation and an increased hepatic iron content, should also be treated prophylactically.


[Fenestration of the peritoneal cavity with a mersilen net. A contribution to the treatment of peritonitis].

A new method for the treatment of peritonitis, fenestration of the peritoneal cavity with a mersilen net, has been used in two patients. Drainage by mersilen net window proved adequate for weeks. No complications occurred and the disadvantages of the conventional method were not encountered.


[Carcinoma of the anal canal. Anatomical study of 21 cases].

21 cases of carcinoma of the anal canal in 20 patients are reported. There is a marked predominance in females (17 cases). The preferential location is the posterior wall of the anal canal. Basaloid type carcinoma is most frequent. At the time of diagnosis most patients exhibited marked extension of the tumour, either in the form of infiltration of adjacent organs (10/18 cases), especially to the rectovaginal space, or of metastases to regional lymph nodes or elswhere. The prognosis is as a rule poor. Apart from 3 patients still living, there were no survivors at 3 years.


[Normogram study of the health of male industrial workers in northern Switzerland. Part 3: present medical care - frequency].

A study has been conducted to obtain representative data on the health of industrial workers in northern Switzerland. 1260 men from 44 plants were covered. At the time of the study 21.3% were under treatment by a doctor. From all these patients 14.4% were suffering from heart diseases, 12.6% from articular rheumatism and muscle diseases, 10.3% from neurological and 9% from dermatological diseases. Of subjects aged 43--65, 1.7 times more were under treatment by a doctor than subjects aged 20--42.


[Spontaneous pneumathorax and pregnancy].

A case is reported of rare spontaneous pneumothorax during a first pregnancy and recurring during a second pregnancy. No explanation or pathological reasons have been found which could cause this condition. The literature confirms the rarity of this pathology in connection with pregnancy. The pregnancy hormonal levels do not seem to play a role in the pathogenesis. No alpha 1-antitrypsin deficiency was observed.


[Bartter's syndrome: Recurrence in the course of a treatment inhibiting prostaglandin synthesis].

Two adults with Bartter's syndrome were treated first with propranolol and a potassium-sparing diuretic and then with indomethacin for 22 months. Inhibition of prostaglandin synthesis by indomethacin, confirmed by a fall in urinary excretion rate of prostaglandins E2 and F2 alpha, induced a marked decrease in plasma renin activity and aldosterone excretion rate and an increase in plasma potassium. While the first patient was well controlled by this therapy, the second had elevation of prostaglandin excretion after 8 months associated with a relapse of symptomatic hypokalemia. Reintroduction of propranolol in addition to indomethacin led to renormalization of plasma potassium. A therapeutic trial with another prostaglandin synthesis inhibitor, meclofenamate, also produced partial correction of hyperreninemia and hypokalemia but only for a short time. From these observations it is concluded that (1) inhibition of renal prostaglandins by indomethacin or meclofenamate represents an effective but transient therapy for Bartter's syndrome, and (2) while prostaglandin secretion may elude pharmacological inhibition, the addition of propranolol restores complete inhibition and the therapeutic benefits of the previous treatment.


[Chemotherapy of human echinococcosis with mebendazole (Vermox): preliminary clinical results].

Two patients with inoperable multiple Echinococcus granulosus infections involving the lungs and the liver (one patient) were treated with the following daily doses of mebendazole (Vermox): 3 days 1000 mg, 3 days 1500 mg, the following 3 months 30-40 mg/kg body weight. One of the patients had been treated before with mebendazole in similar doses for 3 periods of 5-6 weeks each. The patients received the drug as 500 mg tablets divided into 3 daily doses after meals. After termination of treatment a distinct regression of lung cysts was demonstrable in both patients, with the exception of one cyst. The liver cyst in one of the patients had also decreased in size. About 8 months after therapy signs of reactivation of lung cysts were observed in one patient, and a new course of mebendazole treatment was therefore started.


[Histopathologic classification of malignant melanoma of the skin. Retrospective study of 149 cases].

In a retrospective study, the histological slides of 149 cutaneous melanomas are classified according to CLARK et al. (1969) into four levels of dermal invasion and three types of melanoma. Simultaneously, the depth measured in millimeters is added in a slightly modified version of BESLOW's method. This demonstrates the practicability of CLARK'S classification with only a few routine sections. The presumptions are (1) The tumor must be cut through its largest extension. (2) The bordering parts of the lesion in the epidermis must be examinable. (3) The specimen must be excised down to the subcutaneous fat. (4) Beside the Hämalaun-Eosin stains, a Van Gieson Elastica stain should be available to determine the level of invasion. Although it is easy to recognize level V, it is difficult to distinguish level II from III or III from IV in some cases. Our material, as compared to the literature, contained more nodular melanomas and lesions of levels IV and V. The reasons for this are discussed. The prognosis of nodular melanomas is worse than that of superficial spreading melanomas even when they are classified into the same level of invasion. A good correlation between the survival rate and the level of invasion is shown. In addition, the prognostic value of the histological staging can probably be optimized by measuring the  vertical extent of the lesions in millimeters.


[Pathogenesis of bone marrow necrosis in a patient with cancer].

Bone marrow necrosis was observed in a 23-year-old pregnant woman with severe anemia and thrombocytopenia due to bilateral ovarian carcinoma. After removal of the primary tumors, the hematological findings returned to normal, but the progression of the metastasis lead to respiratory insufficiency and death. The possible mechanisms leading to bone marrow necrosis are discussed. In our case, it could be shown that emboli of tumor cells into the vessels of the bone marrow lead to the necrosis of the marrow. The embolization was temporarily stopped after removal of the ovaries.


The theoretical basis of column chromatography in multicomponent separation.

Microparticulate packings (silica and chemically bonded silica) developed in our institute and produced in China have been evaluated by the method published previously with a column efficiency of 1,400 to 10,000 theoretical plates per 10 cm length for HPLC and 1,700 to 4,400 plates per 10 cm length for GC. By varying the surface area of silica and composition of the eluent, the linear relationship of capacity factor of various compounds and the high speed chromatograms of HPLC and HPGC have been given.


Role of sustained neurones of cat lateral geniculate nucleus in processing luminance information.

The properties of the sustained cells in the lateral geniculate nucleus of cat have been studied quantitatively. These cells may be subdivided into two groups, the brightness and the darkness detectors. The former is photoexcitatory neurone and the latter, photoinhibitory. In both types, the rates of sustained discharges are closely related to the levels of retinal illumination over a range about 4 log units. The receptive fields of sustained cells again can be roughly divided into two subtypes according to their size. The large receptive field cells all belong to darkness detectors and are distributed mostly at retinal periphery, which may play some role in signalling the background luminance. The small receptive field cells comprise all brightness detectors and a part of darkness detectors, which are located predominantly around area centralis and may transmit the message of brightness or darkness about picture details and enhance the boundaries of a two-dimensional figure.


Mercury vapor as a contaminant of hospital environment.

Surveys for airborne mercury in two Ottawa hospitals have been conducted. Two different analytical methods were used. Although the concentrations of mercury vapor were below the TLV, all samples analyzed showed measureable amounts of mercury to be present. Predominant sources of mercury contamination are broken thermometers and sphygmomanometers.


Flow cytometry: a high-resolution instrument for everyone.

A new flow configuration for flow cytometry has been devised in which a flat, laminar stream of water, containing the stained cells in a narrow sector, is formed on a microscope cover slip by a pressurized jet of water directed onto the glass at low angle. The stream of cells is viewed by means of a fluorescence microscope with incident illumination and a pulse photometer. Coupled to a multichannel pulse height analyzer, the instrument constitutes a stable and easy-to-operate flow cytometer with a resolution equal to or better than a coefficient of variance of 1.4 percent in measurements of cellular DNA.


Distribution of nitrogen-13 from labeled nitrate (13No3-) in humans and rats.

The body distribution of gavaged or intravenously administered nitrate labeled with nitrogen-13 was studied in humans and rats with the following results: (i) the labeled compound is not quickly absorbed from the stomach; (ii) the concentration of the label increases inside the lower intestinal tract (cercum and large intestine) when ingested or intravenously injected; and (iii) humans and rats have the capacity to store a portion of the label in their bodies. These observation indicate that depletion of body stores, the passage of nitrate down the gut, or the secretion of nitrate into the intestinal lumen may be a better explanation of the urinary, ileal, and fecal concentrations of nitrate and nitrite recently measured in humans that a bacterial nitrification reaction in the intestines, as suggested by Tannenbbaum et al.


Influence of cartilage geometry on the pressure distribution in the human hip joint.

To elucidate the role of mechanical factors in the etiology of osteoarthritis, the detailed geometry of the weight-bearing cartilage layer over the human hip socket is compared with the corresponding pressure distribution. The shape of the pressure distribution is strongly correlated with the shape of the cartilage compression distribution.


Immunocompetence in the lowest metazoan phylum: transplantation immunity in sponges.

Isografts of Callyspongia diffusa fuse compatibly, but allografts are invariably incompatible. Extensive polymorphism of cell-surface histocompatibility markers is evident. The histocompatibility barriers range from strong to weak depending on the interclonal combination, but early rejection with conspicous cytotoxic sequelae is typical. Reaction times of first-set, second-set, and third-party grafts indicate highly discriminating transplantation immunity with a specific memory component.


The oilbird: hearing and echolocation.

Oilbirds can navigate in total darkness by echolocation. The sound energy in their sonar cries is unevenly distributed over the range from about 1 to 15 kilohertz, with a dominant frequency range of 1.5 to 2.5 kilohertz. This corresponds to the most sensitive range of their hearing as determined by neurophysiological methods. Behavioral tests in their home cave indicate that the smallest object avoided by this is a disk 20 centimeters in diameter.


Thyroxine increases nerve growth factor concentration in adult mouse brain.

The effects of thyroxine and propylthiouracil on nerve growth factor concentrations in cerebral cortex, cerebellum, and brainstem of adult male mice were assessed by using a sensitive radioimmunoassay for the beta-subunit of mouse nerve growth factor. Thyroxine administration significantly increased the concentration of nerve growth factor in all three brain areas compared to control values, whereas propylthiouracil was without effect. These results suggest that thyroid hormones stimulate nerve growth factor synthesis in the mature central nervous system, and raise the possibility that the influence of thyroid hormones on central nervous system development might be mediated or influenced by nerve growth factor.


Periodicity of deoxyribonuclease I digestion of chromatin.

Two methods have been used to measure the single-strand lengths of the DNA fragments produced by deoxyribonuclease I digestion of chromatin. The average lengths obtained are muliples of about 10.4 bases, significantly different from the value of 10 previously reported. This periodicity in fragment lengths is closely related to the periodicity of the DNA double helix in chromatin, but the two values need not be exactly the same.


Normal anterior endoderm corrects the heart defect in cardiac mutant salamanders (Ambystoma mexicanum).

Recessive mutant gene c in axolotl embryos results in an absence of heart function. Normal (+/+) anterior endoderm cultured with mutant (c/c) hearts totally corrects the defect.


Immunoassay by differential pulse polarography.

An immunological method based on labeling an antigen with an electroactive group detectable by differential pulse polarography has been demonstrated. Estriol labeled with mercuric acetate is electroactive, giving a reduction wave at -300 millivolts versus a standard calomel electrode. Addition of estriol antibody to 4-mercuric acetate estriol diminishes the peak current as a result of the antigen-antibody binding reaction. Separation of free-labeled estriol from antibody-bound-labeled antigen is unnecessary. The method is potentially useful as an analytical immunological technique.


Fluorescent retrograde double labeling: axonal branching in the ascending raphe and nigral projections.

Red fluorescent Evans blue and blue fluorescent DAPI-primuline were injected into the anterior-medial and lateral-caudal forebrains, respectively, of the same rats. Separate clusters of cells labeled by retrograde transport were observed in the substantia nigra, while in the dorsal raphe many cells were double-labeled. Thus, single raphe cells send divergent axon collaterals to widespread forebrain areas.


Binocularity in kittens reared with optically induced squint.

The effects of conflicting visual images were studied without the confounding influences of oculomotor abnormalities: strabismus was simulated by rearing kittens with ophthalmic prisms before the eyes. After the animals had matured, the response properties of neurons in the visual cortex were studied. The proportion of binocularly excited neurons decreased; however, the extent of the ocular dominance alterations was related to the amount and direction of the prism-induced deviation.


[Decrease in the alcohol level in blood and urine stains].

Changes in the known alcohol levels in blood and urine stains on different underlays were studied. Alcohol levels were determined using the Widmark method at 60 min. intervals. Moisture and temperature of the surroundings were measured simultaneously. The alcohol levels decrease to zero or 0,3% values 3 to 4 hrs. after the application of stains.


[Medico-legal investigations of 66 homicides].

The experiences gained from the medicolegal investigation of murdered 34 women an 32 men are being dealt with. In the causes of death prevailed the combined injuries, followed by the blunt force injuries, asphyxia, injuries by gunfire and sharp force injuries. In the majority of cases the offenders are men up to the age of 30. The investigation covered the laboratory examination of the clothes of the victims and offenders, biological stains, histology and hairs. 22% of the victims and 60% of the offenders were under the influence of alcohol at the time of homicide. Drugs were found in 19% of the victims and 20% of the offenders. The medicolegal investigation of homicide requires further and improved methods especially in the examination of biological stains.


Hemophilus parainfluenzae endocarditis.

We describe a case of Hemophilus parainfluenzae endocarditis in a previously healthy 26-year-old man, and review 21 cases from the literature. Although H parainfluenzae is considered to be part of the normal flora of the upper respiratory tract in man, it can cause serious disease. H parainfluenzae endocarditis is often difficult to diagnose. The patients generally had a history of recent infection of the upper respiratory tract, but a majority denied previous heart disease. Upon entry to the hospital, after an average of seven weeks of febrile illness, nearly one third of patients were found not to have a heart murmur. Furthermore, the organism was often difficult to grow from blood cultures, a problem possibly related to the need for accessory growth factors. The mortality with modern therapy was 12%, and the major complication was cerebral embolus. Antibiotic therapy of choice is ampicillin, generally used together with an aminoglycoside, though ampicillin alone may be sufficient.


Infectious mononucleosis with severe neutropenia and opsonic antineutrophil activity.

Severe granulocytopenia is an uncommon complication of infectious mononucleosis, only 18 cases having been reported previously. Our review and experience with this case would indicate that (1) severe granulocytopenia is usually diagnosed at about the third or fourth week of illness, (2) bone marrow examination most commonly reveals lack of mature neutrophil precursors in the myelocytic series, (3) the duration of usually short, lasting about a week, and (4) most patients recover without treatment. The laboratory findings in our case suggests that the neutropenia may be antibody mediated.


Posterior pseudoaneurysm of the left ventricle: a prospective echocardiographic diagnosis.

A 69-year-old man had a posterior pseudoaneurysm of the left ventricle shown by echocardiography and cardiac catheterization. The patient had resection of the pseudoaneurysm and did well. The case illustrates the usefulness of echocardiography for detecting and evaluating left ventricular pseudoaneurysm and the effectiveness of surgery for that entity.


In utero distal pulmonary meconium aspiration.

We have recently had eight cases of severe meconium aspiration syndrome which occurred despite clearing of the posterior pharynx of meconium after delivery of the head but before delivery of the body. Seven of the eight cases had documented fetal distress before delivery. Two stillborns with meconium aspiration are presented and illustrate that electronic fetal monitoring and aggressive obstetric intervention should be coupled with the suctioning technic to prevent significant mortality and morbidity associated with meconium-stained deliveries.


Gastroduodenal Crohn's disease.

Three new cases of gastroduodenal Crohn's disease are presented, two with obstruction and one with massive gastrointestinal bleeding. Of the 124 cases reported in the literature up to 1972, only four had massive gastrointestinal bleeding. An accurate preoperative diagnosis is difficult. When peptic epigastric distress and retention type of vomiting are associated with diarrhea, the diagnosis of gastroduodenal Crohn's disease should be strongly considered. A surgical bypass procedure or resection is indicated when symptoms of duodenal obstruction do not respond to medical treatment.


Myopathy of chronic organophosphate poisoning: a clinical entity?

The acute aspects of organophosphate poisoning are well understood. Persistent weakness and muscular wasting in some cases have been attributed to neuropathic effects resulting in muscular atrophy from denervation. Recently, necrosis of skeletal muscle has been induced by chronic inhibition of cholinesterase with organic phosphates in a reproducible experimental model. The literature on organophosphate poisoning in man alludes to cases in which it appears plausible to postulate this mechanism as a cause of a residual myopathy. A new case in which chronic organophosphate intoxication may be implicated in the etiology of a proximal myopathy is presented. Reports of additional cases, followed up from the onset of symptoms, are needed to determine whether primary myopathic effects are a clinically significant complication of chronic organophosphate poisoning.


Arthrography in acute shoulder dislocations.

Arthrography of the shoulder was performed on 50 patients with acute traumatic shoulder dislocations. The mean interval between injury and arthrogram was 2.3 days, with a median interval of one day. Anterior dislocations occurred in 96% of patients, and posterior dislocations in 4%. Initial dislocations were present in 74%, and recurrent dislocations in 26%. The most frequent abnormality identified or arthrograms was an enlarged but intact shoulder capsule (58%), most commonly seen in shoulders subject to recurrent dislocations (77%). Shoulder joint capsular tears or disruptions were seen in 48% of the patients. The next most common lesion was fracture (52%), identified on standard roentgenograms. These included Hill-Sachs lesions (28%), greater tuberosity fractures (22%), and coracoid fractures (2%). Ruptures of the rotator cuff, present in 28% of the cases (14 patients), occurred more frequently in initial dislocations (62%) than in recurrent ones (36%). The high frequency of enlarged intact shoulder capsules, even after an acute initial joint dislocation (58%), suggests that the humeral head does not routinely rupture the capsule during dislocation, but rather tears the glenoid labrum at its bony attachment and dislocates subperiosteally, dissecting a false pouch below the periosteum and under the subscapularis.


Pulmonary function studies in acute pulmonary histoplasmosis.

We performed follow-up pulmonary function studies on three patients with acute pulmonary histoplasmosis over a period of several months, and found that the disease is benign and usually responds well to treatment or is self-limiting. There are four major changes in lung function, namely a restrictive defect, an impairment of diffusing capacity, stiff lung, and obstruction in small airways. These changes usually lead to disturbance of ventilation-perfusion ratios and impaired gas transport across alveolar capillary membranes, resulting in arterial hypoxemia. There is also hypocapnia from alveolar hyperventilation commonly found in restrictive and stiff lung syndrome.


Preoperative diagnosis of splenic abscess by ultrasonography and radionuclide scanning.

Abscess of the spleen is uncommon and potentially lethal, but until recently it was rarely diagnosed except by exploratory celiotomy or at autopsy. Now, with the advent of radionuclide scanning, ultrasonography, and selective angiography, earlier diagnosis is possible in most cases. We report a case of traumatic abscess of the spleen, which was diagnosed preoperatively and ultrasonography and scanning with gallium citrate Ga 67 and technetium Tc 99m without the need for the more invasive technic of angiography.


Value of nephrotomography in evaluating nonvisualized kidney in renal absence: the colon sign.

Nephrotomography is a simple, highly accurate, noninvasive procedure and is extremely helpful in differentiating a nonvisualized kidney due to renal agenesis, ectopia, or nephrectomy from other acquired renal diseases. Early recognition of the characteristic malpositioning of the colon, "the colon sign," eliminates the need for more invasive investigations.


Microsurgical technics in reconstructive surgery of the fallopian tube.

Only in the last few years have gynecologists begun to investigate the use of microsurgical technics. Investigators in Europe, Canada, and the United States have recently reported improvements in patency and intrauterine pregnancy rates using these meticulous technics. At Vanderbilt University Medical Center, gynecologic microsurgery has been applied for the last two years, and this report reviews our experience in 24 patients undergoing reversal of a previous sterilization. Preoperative counseling and evaluation of patients considering surgery are discussed. Technical points regarding choice of instruments, intraoperative technics, and ancillary therapy, such as steroids, postoperative hydrotubation, and the use of intraperitoneal dextran, are reviewed. The results are presented and compared with reports using conventional surgical technics for reversal of female sterilization.


Serum ferritin as an early determinant of decreased iron stores in pregnant women.

Serum ferritin has been shown to be an excellent determinant of iron stores. In a consecutive group of women registering at the regular prenatal clinic, we measured serum ferritin, iron, iron-binding capacity, and hemoglobin to determine their hematologic status as to anemia. It was found that serum ferritin is the most sensitive determinant of depleted iron stores, with serum iron being next in sensitivity. This assay is a rapid, economic, sensitive measure of iron stores, and results are not altered significantly by other types of anemia or oral iron therapy.


Rat bite fever misdiagnosed as Rocky Mountain spotted fever.

A patient who had been exposed to ticks and who had also been bitten by a laboratory rat developed fever, headache, and a rash. He was treated with chloramphenicol for Rocky Mountain spotted fever, and recovered. Blood cultures, however, grew Streptobacillus moniliformis, a causative agent of rat bite fever. The case report illustrates the clinical similarities between rat bite fever and Rocky Mountain spotted fever.


Treatment of localized pulmonary phycomycosis.

A patient cured of localized pulmonary phycomycosis occurring at the site of a previous lung abscess is described and the other survivors of this unusual entity are discussed. Whole-lung computerized tomographic (CT) scanning was useful in confirming the presence of a single localized lesion and led to the choice of surgical excision. A diagnostic and therapeutic approach including whole-lung CT scanning and preoperative and postoperative systemic amphotericin B therapy is suggested pending pathologic review of the tissues for possible fungal invasion beyond the resected area. The value of surgical excision when the disease appears localized is emphasized.


Percutaneous catheterization of the gallbladder with ultrasonic guidance.

We have described a case in which the gallbladder was catheterized by the Seldinger technic, using ultrasonic guidance. The biliary tree was flushed until clear and free passage of bile into the duodenum occurred. Thick inspissated bile can cause intrinsic echoes in the gallbladder that can be mistaken for gallstones.


Hypoplasia of the abdominal aorta associated with rubella syndrome.

Our patient, a 23-year-old white woman with congenital rubella syndrome, presented with claudication and upper extremity hypertension. To our knowledge this is the first patient with congenital rubella syndrome to present with an abdominal coarctation. Since 75% of the patients with abdominal coarctation are young women, this may be only a chance association.


Gonadoblastoma associated with malignant teratoma.

A case of gonadoblastoma associated with malignant teratoma in the contralateral ovary is described. Considerations are offered concerning the malignant potential of dysgenetic gonads as well as the diagnostic and therapeutic approaches in such situations.


Penile tourniquet syndrome caused by hair.

We have described two circumcised children who developed a urethral fistula caused by long hairs constricting and ulcerating the penis. These cases are presented to remind physicians to examine the infant's penis when he presents with a swollen glans, abnormal urinary stream, and a parent with long hair.


Intussusception after jejunoileal bypass.

We have described a case of intussusception of the defunctionalized loop of small bowel after jejunoileal bypass. This complication may be avoidable by suturing the free end of the proximal jejunum to the root of the transverse mesocolon. Diagnosis is aided by closely placing silver clips on these same structures and observing for their separation on radiographs of the abdomen.


Fibrous dysplasia and precocious puberty (McCune-Albright syndrome).

A patient with fibrous dysplasia and precocious puberty, with pneumogynographic demonstration of an enlarged uterus and ovaries at age 16 months has been followed up to age 14 years. The pneumogynographic findings and the chemistries implicate central nervous system stimulation as the cause of the precocious puberty.


Lightning: a rare cause of intrauterine death with maternal survival.

Being struck by lightning is frequently a fatal event. Prompt attention to cardiopulmonary resuscitation, even in the patient who appears dead, will often bring dramatic results. In the pregnant patient, one can only hope that rapid restoration of cardiac and pulmonary activity will decrease perinatal mortality.


Gaucher disease in the Afrikaner population of South Africa.

The chronic non-neuropathic form of Gaucher disease has been encountered in 10 individuals in the Afrikaner population of South Africa. The minimum prevalence in this community is 1 in 200 000 with a gene frequency of 0,0022, a heterozygote rate of 0,0044 and at least 9 000 clinically asymptomatic carriers of the abnormal gene. This gene must be present in about 1 in every 220 Afrikaners. The majority of previously reported patients have been Ashkenazi Jews, in whom the condition is relatively benign. By contrast, the disorder in the Afrikaners is precocious in onset, with serious complications and rapid progression. The occurrence of Gaucher disease in a relatively high frequency in the Afrikaner population is important in terms of differential diagnosis, genetic counselling and prevention.


Blood viscosity during fluid infusion in the preterm infant.

Whole blood viscosity, haematocrit and plasma osmolality were measured in a group of preterm infants receiving a standard infusion (60 ml/kg/d) of 10,7% dextrose water with 4% sodium bicarbonate. There were no significant changes in the three parameters during the infusion period. It was concluded that although the infused solution was hypertonic, it did not result in a hyperviscous or hyperosmolar state.


Decompression sickness in South African sport divers.

During the period 1 January 1969 to 31 December 1977 56 underwater diving accidents were reported among amateur sport divers in South Africa. Of these, 4 were diagnosed and treated as decompression sickness (DS), an incidence of 7%. Analysis of the 4 cases of DS indicates that they were all in the serious type II neurological category. This is in keeping with results found in Hawaii and Australia, and the reasons for this finding are discussed. An emergency medical system (EMS) for on-site, pre-chamber and decompression chamber treatment is discussed.


The value of the anteroposterior radiograph in 'hidden' fractures and dislocations of the lower cervical spine. A case report.

Fractures and dislocations of the cervical spine may be overlooked if the lower cervical vertebrae are not adequately demonstrated on the supine lateral radiograph. Failure to diagnose cervical spinal injury radiologically may have tragic consequences should delayed spinal cord damage ensue. A case report illustrating this is presented. Since no difficulty is encountered in demonstrating the lower cervical vertebrae on the anteroposterior view with the patient supine, careful attention to the position and appearances of the spinous processes on this radiograph may enable diagnosis of fractures and/or dislocations to be made. Three radiological signs of value are discussed.


Treatment of familial hypercholesterolaemia by partial ileal bypass.

Ten patients with heterozygous familial hypercholesterolaemia (Fredrickson type II) were treated by the operation of partial ileal bypass. Postoperatively, serum cholesterol levels fell by an average of 34% (P less than 0.005), and the decrease was satisfactorily sustained over a period of 12-30 months. Angina and xanthomas also improved in some patients. Postoperatively all patients experienced considerable diarrhoea, which lessened with time. Other complications of surgery included abdominal distension and cramps, colonic dilatation, sepsis and intestinal obstruction. It is concluded that partial ileal bypass significantly lowers serum cholesterol levels, but that in view of the complications the operation should be offered only to carefully selected patients who are intolerant of or unresponsive to conservative measures.


Hypertension in urban Black outpatients. Who gets treated and for how long?

Two-thirds of all Black patients who attended the Medical Outpatient Department of the Johannesburg General Hospital for the first time during May 1975 had recorded diastolic blood pressures of 90 mmHg or above. Almost one-third of all patients were treated for hypertension. About half of the patients with diastolic blood pressures between 90 and 119 mmHg were started on treatment, a decision which was predicted by diastolic blood pressure, recorded symptoms and systolic blood pressure, but not by age. Four of the 50 patients with diastolic blood pressures of 120 mmHg or above were not treated. Less than one-third of all patients started on anti-hypertensive treatment were still returning for treatment at the end of 1 year. There was no difference in initial diastolic blood pressure between those patients who did and those who did not return for treatment. Hospital policies are required for standardizing initial decision-making and long-term treatment of hypertension. Strategies to improve compliance by altering health care delivery and changing patient behaviour must be developed and evaluated.


Rubella infection and other factors associated with congenital cataracts in Cape Town.

An analysis of 56 patients with congenital cataracts was made to determine which factors played a role in the causation of these lenticular defects in Cape Town. There is good evidence that 16% of the defects were caused by intra-uterine rubella virus infection and that a further 30% were hereditary in origin.


[Community psychiatry and general practice].

As part of the development of a comprehensive community-orientated psychiatric service, a questionnaire with multiple-choice answers was sent to 244 general practitioners in the catchment area of Stikland Hospital. The attitudes and opinions expressed regarding certain principles of community psychiatry are analysed and discussed.


[Occupational health as a priority].

The development of occupational health services in the Republic of South Africa has been limited by three factors. Firstly, occupational safety completely overshadowed occupational health. Secondly, about 8 state departments were active in its administration. Thirdly, occupational health was not interpreted as a preventable disease under the old Public Health Act No. 36 of 1919, and was hence excluded from the usual community health activities. The recommendations of the 1975 Commission of Inquiry that occupational health should fall under the scope of the Department of Health, and that the National Research Institute for Occupational Diseases should be transferred from the South African Medical Research Council to the Department of Health, have not yet been implemented. The advantages of such implementation and the estimated costs involved are discussed. A primary prerequisite is that all occupational diseases should be made notifiable diseases.


Agnogenic myeloid metaplasia and spinal cord compression.

A 55-year-old White male with agnogenic myeloid metaplasia, proved on bone marrow trephine biopsy, underwent splenectomy for abdominal discomfort. Six months later he developed paraparesis and on myelography multiple extradural obstructions were seen. In the absence of other obvious diagnostic possibilities, these were attributed to areas of extramedullary haematopoiesis, and he was treated with local radiotherapy. However, the neurological deficit progressed and emergency laminectomy and decompression were undertaken. Tissue obtained at this time confirmed the diagnosis of agnogenic myeloid metaplasia. A repeat myelogram showed complete relief of the obstruction, but the patient developed fulminating septicaemia and died. These findings are reported in view of the great rarity of spinal cord compression due to multiple areas of extramedullary haematopoiesis.


[A new method of measuring serotonin in plasma and cerebrospinal fluid].

A new rapid method for the microdetermination of serotonin (5-hydroxytryptamine) in plasma and cerebrospinal fluid is described. A recovery coefficient of 98% was obtained in the present method, with the use of [3H]-hydroxytryptamine creatinine sulphate as an internal standard, compared with recovery coefficients of 31% and 66% for the two existing methods generally used for serotonin determination. This method involves a one-step sample deproteinization by perchloric acid, resulting in a high stability of serotonin.


Eosinophilic fasciitis. A case report.

We describe a patient with a scleroderma-like illness which involved the arms and legs but not the face and hands. Clinical, laboratory and histological features were those of the recently described syndrome, eosinophilic fasciitis. This rare condition is worthy of note because it appears to have a much better prognosis than conventional scleroderma, and because it responds very well to corticosteroid therapy.


Serum ferritin estimation in the assessment of iron stores in severe iron deficiency anaemia in pregnancy and the response to treatment.

Serum ferritin estimation was used to determine the iron stores in 55 patients with severe iron deficiency anaemia in pregnancy. The response to oral or intravenous iron therapy was monitored in 18 of these patients. The results in all cases indicated deficient iron stores. Replenishment of iron stores was significantly greater in those patients treated with parenteral iron. This may be the treatment of choice for severe iron deficiency anaemia during pregnancy.


The clinical syndrome of Impila (Callilepis laureola) poisoning in children.

The administration of herbal medicines made from Callilepis laureola is common among the Black population in Natal. This practice can and does cause poisoning, which has only been diagnosed with any confidence at postmortem examination, where the characteristic hepatic and renal tubular necrosis is obvious. Necropsy records of 50 children in whom these typical histological changes were noted were analysed retrospectively in order to determine the clinical picture. Results show that the disease can be recognized in young Black children when there is hypoglycaemia and an alteration in the level of consciousness, together with evidence of hepatic and renal dysfunction. This syndrome can easily be distinguished from viral hepatitis and fulminant hepatic failure, but less readily from Reye's syndrome.


[Carcinoid tumour of the stomach].

Carcinoid tumours are not common, but have been found along the digestive tract and at other sites in the body. The carcinoid syndrome is associated with some of these tumours. A case of gastric carcinoid, without the syndrome, is discussed, and a review of the biochemistry involved and the treatment is given.


Galactosaemia in three Rhodesian infants.

The clinically relevant types of genetic galactosaemia involve deficiency of galactose-1-phosphate uridyltransferase (EC 2.7.7.12) or galactokinase (EC 2.7.1.6). Specific diagnosis is made by quantitative assay of these two enzymes. Seven Black patients were referred from Harare Hospital, Rhodesia, with features suggestive of galactosaemia. Enzyme assay identified classic homozygous transferase deficiency in 3 of these patients. The incidence in this population was calculated to be 1:52 000.


Haemostatic factors in Black and White diabetics.

Haemostatic factors in 33 Black and 32 White maturity-onset diabetics were analysed and compared with those in 19 normal Black and 19 White subjects. The Black-White diabetic group comparisons revealed depressed antithrombin (AT) III functional activity, a raised factor VII level and a raised factor V level in females in the White diabetic group. On comparing the White diabetics with their respective controls a rise in factor VIII and fibrinogen activity was demonstrated. These changes are suggestive of a hypercoagulable state in the White maturity-onset diabetic. In contrast, Black diabetics have higher functional AT III levels than their respective controls. This may indicate a protective reaction which would explain in part the reported lower incidence of occlusive vascular disease in this group. Platelet hyperactivity was not demonstrated in the majority of White and Black diabetics. Black diabetics and controls demonstrated higher factor VIII levels than the corresponding White groups, confirming previous observations of raised factor VIII levels among Blacks and suggesting that this feature is a racial characteristic.


Treatment with diazepam of children with drug-induced extrapyramidal symptoms.

Thirteen patients with acute dystonia and extrapyramidal symptoms as a result of drug intoxication are reported. In a number of instances, the symptoms were due to more than one drug being given to the patient, among which were phenothiazine derivatives, non-phenothiazine tranquilizers and metoclopramide. Diazepam (Valium) given intravenously caused the patients to fall asleep immediately and to wake within an hour, free from all symptoms. It is felt that in patients with drug-induced extrapyramidal symptoms, diazepam should be considered as the possible drug of choice.


The use of glycosylated haemoglobin measurements in the control of the diabetic patient.

Glycosylated haemoglobin (HbA1c) has recently been used as an indicator of long-term diabetic control. This study compares the efficacy of HbA1c measurements and postprandial blood glucose estimations in assessing diabetic control in 51 diabetic patients. It was found that the HbA1c levels reflected overall diabetic control significantly better than did a single postprandial blood glucose estimation. HbA1c measurements give considerable aid in the assessment of the longitudinal blood sugar control in the diabetic, and may be a useful indicator of the efficacy of diabetic treatment.


Protean appearance of craniopharyngioma on computed tomography.

Craniopharyngiomas present a diverse appearance on computed tomography. Histological diagnosis is not always possible, but computed tomography is of great assistance in the delineation of the tumour as well as of the degree of associated hydrocephalus. Computed tomography also enables rapid non-invasive follow-up after surgery or radiotherapy, or both.


A new method for producing virus plaques in cell cultures.

Human oesophageal carcinoma cells can be grown on one side of a microporous gelatin membrane and fed from the other side. When they are infected with human herpesvirus type I at high dilutions, they produce plaques of virus-infected cells which can be detected by ordinary staining methods. This procedure may be suitable for the determination of the numbers of infectious particles in preparations of other viruses which are difficult to assay by conventional plaque assay techniques.


Maternal and child care services in rural Kwazulu.

Two hundred rural Zulu mothers were interviewed individually in order to obtain general information relevant to maternal and child care services, identify specific needs and problems related to the health of mother and child, and determine where the services failed or succeeded in answering these needs and problems. The main findings were the following: very low income per head per household (less than R2 per week), acceptance of both traditional and modern health practices during pregnancy, widespread demand for well-baby services in contrast to the underuse of available child health facilities, and negativism about general health matters.


Angiography in the diagnosis and management of duodenal arteriovenous malformation. A case report.

A case of duodenojejunal arteriovenous malformation with repeated melaena without apparent cause on endoscopy and barium studies is presented. The importance of arteriography in the diagnosis and management is emphasized.


Cysteine biosynthesis in a fungus, Histoplasma capsulatum.

We have analyzed a step in cysteine biosynthesis in several strains of the pathogenic dimorphic fungus, Histoplasma capsulatum. Mycelial cells of all strains tested are prototrophic. However, the yeast phase cells of most stains do not grow in the absence of -SH-containing compounds due to the apparent lack of an active form of sulfite reductase, a crucial enzyme in the cysteine biosynthetic pathway. In contrast, the yeast phase cells of one strain (Downs) have been found to have an active sulfite reductase and can grow in the absence of cysteine if serine is added. A different metabolic block must thus exist in this strain. Sulfite reductase in the yeast form of Downs strain is completely repressed by growth on cysteine while the mycelial form seems to be constitutive. The yeast and mycelial phase extracts were analyzed on polyacrylamide gels. A distinct protein band appeared in extracts prepared from the yeast cells incubated in minimal or serine-containing media, but not in extracts from mycelia or from cysteine-grown yeast cells.


[Microsporum gypseum: endothrix parasitism with medium or large spores in hair of children].

Five cases of tinea corporis in children by Microsporum gypseum are presented. In four of them an endothrix type of parasitism with arthrospores 4 to 8 microns in diameter was observed. In the other case ectothrix and endothrix types of parasitism were seen in different hairs. Endothrix infection of hairs by species of the genus Microsporum has not been clearly demonstrated until the present. Three isolates were identified as Nannazzia gypsea of the "+" mating type.


Evaluation of industrial yeasts for pathogenicity.

Eleven yeasts representative of species of industrial interest were compared with Candida albicans for their potential pathogenicity for untreated and cortisone-treated mice. Only C. tropicalis produced a progressive infection similar to that produced by C. albicans. Candida lipolytica, Torulopsis spp., and Hansenula polymorpha were not recovered from mice 6 days after inoculation. Kluyveromyces fragilis, C. pseudotropicalis, C. utilis, C. guilliermondii and C. maltosa were recovered from mice but did not produce evidence of infection.


Black-white differences in private pensions: findings from the retirement history study.

This article compares older black workers and older white workers on coverage under private pension plans, the receipt of pension benefits upon retirement, and the job characteristics associated with both coverage and receipt. Data are from the 1969 and 1975 interviews of the Retirement History Study and describe pre-ERISA conditions among persons in their late fifties to mid-sixties. Black workers were much less likely than white workers to have been covered by a private pension on their longest job. Moreover, among those who were covered, they were less likely to have received benefits. The racial differences appear to result in part from subtantial differences on job characteristics, particularly industry.


The ultrasound of thyroid masses.

Ultrasonography of the thyroid gland permits differentiation between cystic, solid, and mixed lesions, allowing conservative management of cystic lesions, which constitute 20% of hypofunctioning nodules. The combination of ultrasonography and fine needle aspiration cytology appears to be a great advance in the preoperative diagnosis of nontoxic goiter and permits individualized treatment in as precise a manner as is possible at present.


Angiographic study of cerebral vasospasm following rupture of intracranial aneurysms: Part I. Time of the appearance.

An investigation of the time of appearance of vasospasm as seen angiographically after the onset of subarachnoid hemorrhage was carried out on 797 cases of intracranial saccular aneurysm in which operations were performed. It has been reported that vasospasm often occurs early after the onset of subarachnoid hemorrhage. With only one subarachnoid hemorrhage, vasospasm occurred within three days after the hemorrhage in only 4.2% of the 120 cases in this study. The appearance of vasospasm was most frequently seen angiographically between ten and 17 days. During this period vasospasm was seen in 49.1% of 116 cases. In those cases with a subarachnoid hemorrhage one to 17 days before the last one, vasospasm within three days after the last hemorrhage was seen in 38.7% of 62 cases. During the period between ten and 17 days after the last hemorrhage, vasospasm was seen in only 20% of 25 cases. The preceding subarachnoid hemorrhage, which had occurred between one and 17 days before the last hemorrhage, seemed to be responsible for the high rate of vasospasm within three days after the last hemorrhage, and the low rate of vasospasm in the period between ten and 17 days after the last hemorrhage.


Angiography study of cerebral vasospasm following the rupture of intracranial aneurysms: Part II. Relation between the site of aneurysm and the occurrence of the vasospasm.

The relation between the occurrence of vasospasm and the site of ruptured aneurysm was investigated. Vasospasm tended to occur initially on arteries close to the aneurysm, later extending to other locations. Contralateral spasm was more frequent the closer the site of the aneurysm to the mid-sagittal line. The spasm observed angiographically varies in relation to the site of the aneurysm; the site of the hematoma in the subarachnoid space was supposed to be the cause of such variation.


Vertex epidural hematomas.

Fourteen cases of vertex epidural hematomas encountered in patients admitted over a 12-year period (1964-1976) at the University of Genoa Neurosurgical Clinic are presented. Special emphasis is put on the large number of cases (nine) without a free interval. Clinical and neuroradiological findings, treatment and results are reported. A clinical classification of this traumatic pathology according to the epidural hematoma classification of Pecker et al is proposed.


Trigeminal neuralgia caused by compression of trigeminal nerve by pontine vein.

A case of trigeminal neuralgia which was apparently caused by compression of the trigeminal nerve by a pontine vein is presented. Complete relief followed the coagulation and dissection of the vein.


A telemetric pressure sensor for ventricular shunt systems.

A fully implantable telemetric differential pressure sensor has been developed which is incorporated with a shunt valve system. It is a unique single diaphragm device that allows in vivo confirmation of zero-point and pressure calibrations. The telemetry is implemented by a resonant circuit in the sensor and a radio frequency detector outside the body, and the in vivo pressure calibration is derived from a pressure-balancing method. The pressure sensor has been implanted with shunts in several patients, and is shown to be valuable both for measurements of intraventricular pressure and for determining proper function of hydrocephalus shunt valves and catheters.


Contamination of Pantopaque by glass.

Investigation has shown that when ampules containing Pantopaque are opened, a variable amount of fragments of glass may fall into the Pantopaque. When the Pantopaque is injected into the spinal canal these fragments may also be injected. As yet the results of injecting fragments of glass into the spinal subarachnoid space are unknown. The glass can be removed by passing the Pantopaque through a 0.22 micron Millex Filter.


Experimentally induced cerebral aneurysms in rats: Part III. Pathology.

Experimentally induced cerebral aneurysms in rats treated with unilateral ligation of the common carotid artery, deoxycorticosterone and salt hypertension, and beta-aminopropionitrile, were studied macroscopically and with light-microscopy. The material consisted of 13 aneurysms located on the anterior cerebral-anterior communicating arterial complex and one on the posterior cerebral artery. The findings were generally in accordance with that of spontaneous lesions in man. The results show the validity of these experimental aneurysms as a model for saccular cerebral aneurysms in man.


Trigeminal neurilemmoma presenting as a sphenoid sinus mass.

Trigeminal neurilemmomas have been known to invade the posterior fossa. Infratemporal fossa, encroach upon the lateral wall of the sphenoid sinus and extend along the three divisions of the trigeminal nerve. Herein described, is a patient with a trigeminal neurilemmoma that extended into the sphenoid sinus, necessitating transphenoidal excision.


Intramastoid packing for CSF rhinorrhea following acoustic neurinoma removal.

A case is presented of cerebrospinal fluid rhinorrhea following operation on an acoustic neurinoma by suboccipital transmeatal approach. The rhinorrhea was cured by sealing the mastoid air cells with muscle pieces. Possible route of CSF rhinorrhea and significance of its treatment are discussed.


Prolonged cerebral "luxury perfusion" after removal of a convexity meningioma.

Following total removal of a convexity meningioma, serial computerized tomographic scans disclosed massive hemispheric contrast enhancement compatible with "luxury perfusion". Maximum enhancement occurred one month following the operation and resolved two months postoperatively. Luxury perfusion appeared to be associated with slowly resolving cerebral edema.


Precocious puberty of cerebral origin.

Eighty-two cases of precocious puberty of cerebral origin were reviewed. All shared as a common factor the distortion, compression, or destruction of diencephalic structures. Attempts were made to parallel basic research findings with those derived from human pathology, hoping to gain further insight into the physiopathology of precocious puberty of cerebral origin.


Effect of a calcium antagonist on experimental constriction of human brain vessels.

In search for a potent dilatator or deactivator of constriction of cerebrovascular smooth muscle, the effects of a specific antagonist of the calcium influx necessary for the excitation-contraction coupling process was studied on isolated human pial arteries. The arteries were constricted by addition of noradrenaline, 5-hydroxytryptamine, human plasma or blood. All these agents induced a strong contraction which could effectively be reduced by addition of the Ca++-antagonist, nifedipine, to the organ bath. It is suggested that calcium antagonists might be of value in the treatment of cerebrovascular spasm following a subarachnoid hemorrhage.


Supracerebellar-infratentorial approach to pineal tumors.

Utilizing the Krause exposure, we have operated on 21 cases of tumors of the pineal region encountering a wide variety of histology with an overall 30% incidence of benign lesions. There has been no significant morbidity in the post-operative management of these patients and one surgical death in a patient with a highly malignant glioma who developed a delayed hemorrhage into the tumor following the operation. In those tumors of recognized malignancy, post-operative radiotherapy has been utilized. In tumors of the germinoma, variety radiation of the entire neural axis is advocated. Since many of the patients have undergone radiotherapy prior to our exposure of the pineal tumor, we have had an opportunity to witness the effects of radiation on this region. In those cases of benign tumors we have found dense adhesions between the tumor and the brain, making definitive surgical treatment of the tumor more difficult.


The Doppler ultrasonic flowmeter as an adjunct to operative management of cerebral arteriovenous malformations.

The Doppler ultrasonic flowmeter has been used to assist in the removal of five intracranial arteriovenous malformations. The instrument is generally available in most institutions, and is simple and easy to use. It provides a means for locating and confirming the boundaries of a malformation, distinguishing feeding arteries from arterialized draining veins, determining whether the artery is going to the malformation or normal brain, and evaluating the completeness of obliteration.


Fluid and electrolyte disturbances in patients with intracranial aneurysms.

Eighty-eight cases with water and electrolyte disturbances, including polyuria, hyper- or hyponatremia, were found in 1,000 cases of surgically treated cerebral aneurysms and 80 nonoperated cases. In this paper, the clinical courses of the 88 cases were studied and an investigation was made of the hypothalamic lesions seen in ten autopsy cases. Water and electrolyte disturbances were most numerous in cases of anterior communicating aneurysms, and the prognosis was poor. Those with hypernatremia had a poor prognosis, with a 42% mortality rate during hospitalization. In contrast, the mortality rate for those with hyponatremia was 15%. Post-mortem studies showed various hemorrhagic and/or ischemic changes in the hypothalamus, with a high incidence of cerebral vasospasm. Massive hemorrhages in the hypothalamus tended to be associated with hypernatremia.


Hypertension following carotid endarterectomy.

Seventy-nine patients undergoing staged bilateral carotid endarterectomy were studied to determine the relationship of perioperative hypertension to postoperative neurologic deficits. Six of the eight neurologic deficits following 158 endarterectomies (5%) occurred after the first operation, all being temporary. Comparison of the mean blood pressures in patients with and without postoperative strokes revealed no statistically significant differences. Patients on antihypertensive medications were at a significantly higher risk of developing postoperative strokes. A trend towards higher blood pressure was noted following the second endarterectomy, particularly when they were staged more than 60 days apart. Based on our findings, a cautious approach is warranted in the treatment of postendarterectomy hypertension.


Cerebrospinal fluid rhinorrhea: localization of dural fistulae using metrizamide, hypocycloidal tomography and computed tomography.

Demonstration of the exact site of the dural fistulae in cerebrospinal fluid rhinorrhea is difficult. This paper presents a technique for accurate localization of these fistulae, using metrizamide cisternography combined with both hypocycloidal tomography and computed tomography.


"True" posterior communicating artery aneurysm.

A "true" posterior communicating artery aneurysm was noted in our series of 490 intracranial aneurysms among 419 patients. The possible surgical significance of this type of aneurysm is discussed.


Intra-operative computerized axial tomography.

A case is presented in which the entire surgical procedure for a recurrent brain glioma was carried out on the computerized axial tomography (CAT) table. Repeated intra-operative CAT scans provided vital information as to the extent of the tumor. Using this method there was no remnant of tumor tissue detectable on the CAT scan at the end of the operation.


Cerebral venous angiomas.

The literature on venous angiomas is generally confusing, although recent reports confirm the existence of this entity. A survey of the published cases, with addition of two of our own, is presented in the current study. Characteristic histological and angiographic features are described. The value of radioisotope techniques is emphasized with regard to the modifications which these angiomas cause in cerebral circulation.


Epicranial plexiform neurofibroma.

Epicranial plexiform neurofibroma is a rare presentation of neurofibromatosis. Two such cases are presented in which epicranial tumors constituted isolated manifestations of the disease except for skin pigmentation. Tumor development began at two and three months of age respectively; one case showed a calvarian bony defect associated with the tumor.


Cerebral arteriovenous malformation with intracranial hypertension.

A parasagittal arterio-venous malformation with symptoms and signs of intracranial hypertension, is reported. The CT scan was considered normal, but following contrast enhancement the responsible lesion was demonstrated. The pertinent literature is briefly reviewed and possible pathogenetic mechanisms for the intracranial hypertension are discussed.


75Se-sodium selenite as a diagnostic aid in the assessment of peripheral pulmonary opacities.

To establish or exclude the diagnosis of bronchial carcinoma a series of 43 patients with peripheral pulmonary opacities was studied by lung scanning after intravenous injection of 75Se-sodium selenite. A diagnosis was ultimately obtained in all patients. The incidence of both false-positive and false-negative results was high. Selenite was taken up by a range of non-neoplastic processes including inflammatory lesions. The value of the procedure in distinguishing bronchial carcinoma from non-neoplastic conditions of the lung that radiographically mimic carcinoma was not confirmed.


Pleural effusion: laboratory tests in 300 cases.

The cause of pleural effusion was studied in 300 consecutive patients by clinical examination and laboratory tests. The three most common causes were found to be cancer 117 cases (metastatic 65, bronchogenic 34, mesothelioma 10, lymphoma 7, other 1); tuberculous infection 53; and bacterial infection 38. The cause was not found in 62 patients. Cancer diagnosis was established by cytological examination of pleural fluid (63), closed pleural biopsy (37), and open pleural biopsy (11). Tuberculosis was diagnosed by culture of pleural fluid (12), closed pleural biopsy (38), and open pleural biopsy (3). In cases of empyema 12 Gram-positive and two Gram-negative cocci and two anaerobes were identified. The various causes and the usefulness of the different investigative procedures are discussed, and the data evaluated in the light of current knowledge about mechanisms of transfer through the pleural space.


Dilatation of the azygos vein simulating a mediastinal tumour.

A mediastinal tumour was simulated by gross dilatation of the azygos vein resulting from compression by enlarged hilar lymph nodes at the point where it crossed the right main bronchus to enter the superior vena cava. This cause of dilatation of the azygos vein has not previously been reported. Published reports are reviewed and attention drawn to the large proportion of patients (11/19) with this condition who had needless thoracotomies. The possibility of making a diagnosis by means of clinical observation and simple radiological techniques and thus avoiding surgical intervention is discussed.