Evidence for an increase in presumed somatic mutation during the ageing of human cells in culture.

A method has been developed for the direct measurement of genetic variants in mammalian cells in culture which does not require cell division and is therefore suitable for ageing studies. Previous evidence suggests that these variants are mutations. The variant frequency was measured during the lifespan of populations of MRC-5 human embryo lung fibroblasts. The frequency increased substantially during the lifespan of the culture and regression analysis shows that the increase is exponential. No increase invariant frequency was found in a immortal transformed line cultured for over 100 passages. Evidence is presented that the variants are regulatory mutations. This is the first direct evidence for the involvement of presumed somatic mutations in the ageing of mammalian cells. 5-Fluorouracil but not p-fluorophenylalanine shortened the life of the cells and increase the variant frequency. The data lend support to a model in which mutations are an expected consequence of errors in protein synthesis.


Changes in extrathyroidal conversion of thyroxine (T4) to 3,3',5-triiodothyronine (T3) in vitro during development and aging of the rat.

Changes with age in the rate of in vitro conversion of thyroxine (T4) to triiodothyronine (T3) by organ homogenates were determined in female Wistar rats from 6 days to 18 months old. The conversion rates in liver and kidney homogenates of pups before day 13 are very low, and then rise to reach the maximum value at around day 23. During the period of sexual maturation the conversion activity suddenly decreases, and shows afterwards a gradual decline with age. The activity in both liver and kidney of male rats is higher than that of females except in the immature liver. A sudden rise was observed in the conversion activity of organ homogenates when the rats were released from a period of restricted food intake which started at an early age before maturity was achieved.


On the ultrastructural diversity and essence of residual bodies in neuronal ceroid-lipofuscinosis.

In 4 patients with neuronal ceroid-lipofuscinoses (NCL) (3 patients with the junvenile type, 1 patient with the late infantile type), the ultrastructural spectrum of residual bodies in the central and peripheral nervous system presented curvilinear profiles in all cases and regions investigated and many more ultrastructural patterns within and beyond regions commonly accessible to biopsy, probably due to age dependence, local tissue and cellular biochemical factors. Sampling from basal ganglia especially yielded combined curvilinear-fingerpint bodies, from peripheral ganglia additional membranous bodies. Residual bodies in NCL were present in almost every cell type, similar to the distribution of regular lipofuscin. Although the classical subgroups of NCL contain electronmicroscopically well defined residual bodies, permitting distinction of the late infantile type from the juvenile type, the ultrastructural differences are more of a quantitative than of a qualitative nature. However, they are not pathognomonic. N.m.r. spectra of ceroid and lipofuscin support the concept of their biochemical similarity, and argue against the proposition that they contain a single major component.


Changes with age in copper and superoxide dismutase levels in brains of C57BL/6J mice.

Superoxide dismutase activity in brains of male C57BL/6J mice decreased with age by 36% on a protein base and by 32% on a DNA base between 50 and 900 days of age. Brain copper increased by 45% up to 600 days of age and appeared to increase slightly from 600 to 900 days of age. Feeding of copper gluconate (5 x 10(-3)M) failed to change the level of copper in either young or old brain, and superoxide dismutase activity was not significantly increased or inhibited by copper feeding. Cupric chloride (2.35 x 10(-6)M) was found to inhibit purified superoxide dismutase (2 x 10(-8)M) by 50%. These observations indicate that brain copper concentrations do not directly determine the activity levels of the copper containing enzyme, superoxide dismutase, under normal ageing conditions.


Viscosity of lymphocyte plasma membrane in aging mice and its possible relation to serum cholesterol.

Lymphocyte membrane fluidity was examined in aged mice and characterized as a qualitative and effective change which takes place in the aging process. Fluorescence polarization of diphenylhexatriene-labelled mouse spleen cells is substantially higher in cells from old mice (20--36 months) than young mice (2--7 months). A similar difference was also observed with isolated plasma membranes from spleen cells of old and young mice. The overall estimate is that the lipid microviscosity in the lymphocyte plasma membrane from old mice is about 20% higher than that of young mice. The cholesterol/phospholipid ratio determined for the isolated plasma membrane preparations was 0.68 and 0.9, respectively, which is probably the main cause for the difference in membrane viscosity. An elevated cholesterol/phospholipid ratio was also observed in the blood serum of old mice. It is plausible that the source of excess membrane cholesterol in the old mouse lymphocytes originates in the high serum cholesterol.


Lithium effects on social aggregation in the goldfish (Carassius auratus).

In the first experiment, using 240 goldfish in pairs, the effects of lithium chloride on social aggregation were observed. It was found that aggregation was reduced between two fish when both had received lithium treatment. When, in the second experiment, 24 fish were investigated in groups of three, it was found that maximal disruption of aggregation occurred when all three fish were lithium treated, but that partial social disruption occurred following lithium treatment of two out of three fish. The results are interpreted in terms of a possible lithium induced impairment of central processing of the sensory stimuli responsible for eliciting social following responses.


Isotopically labelled compounds in the study of extracellular fluid space in dog bone.

The extracellular fluid space in dog bone has been examined using a series of isotopically labelled compounds. Sodium-77 bromide and indium-113m ethylenediaminetetracetic acid were used as extracellular fluid space markers, radioactive water as a total fluid space marker, and potassium-43 chloride to examine the existence of a bone membrane. The clearance of each tracer from bone was monitored for a period of 2h post-injection. Graphical analysis of the clearance curves shows that the number of exponential functions vary depending on the type of tracer used. The fact that a sum of three exponential terms can completely describe each curve indicates that a simple model consisting of three compartments is sufficient to approximate the clearance of these tracers from bone and its associated fluid space. It is concluded that bone consists of an extracellular fluid space, and that this space may well play an important part in the transference of solutes and the mechanisms involved in their localization on the hydroxyapatite crystals of bone.


Variation of glutathione levels in Finnsheep.

Blood glutathione was measured in Finnsheep. Inheritance data show that the two types of GSH concentrations were under independent genetic control. GSH levels were found to be associated with potassium levels and reproduction in Finnsheep.


Monoamine oxidase in platelets and brains of non-psychiatric and non-neurological geriatric patients.

Monoamine oxidase (MAO) activity has previously been found to be high both in brain and in platelets in patients with Alzheimer's disease and low in patients with cycloid psychosis and suicidal behaviour and/or ethanol abuse. To establish if there is a correlation between brain and platelet MAO activities in patients without psychic disease, blood samples from patients in a geriatric ward were collected before death and from 4 different parts of the brain at autopsy. The MAO activities in platelets and brain were then estimated with different substrates. No correlation between the MAO activities in the two tissues was, however, found, regardless of the substrate used.


Measuring provider continuity in ambulatory care: an assessment of alternative approaches.

A comparison is made of existing measures of provider continuity in ambulatory care to assess differences and limitations. New measures are proposed that complement and improve upon certain limitations of existing measures. These measures are applied to a pilot study of hypertensive patients being seen in a medical outpatient clinic of a teaching hospital. The need for further development and refinement of continuity measures is indicated, and a unifying framework for measuring provider continuity is suggested.


Evaluation of a drug therapy protocol in an HMO.

Effective means of affecting physician prescribing behavior must be developed if the quality of health care is to be improved. A drug therapy protocol for otitis media, containing a rationale for drugs, doses and days of therapy by patient age, was developed by a physician panel at one site (EI) of an HMO, and implemented at both EI and a second site (EII); a third site was a control. A comparison of prescribing during two phases, before and after implementation of the protocol, suggested that the protocol had a greater influence at site EI than site EII, and that it had a greater influence on the panel physicians than on other prescribers at site EI. Questionnaire responses indicated that clinical experience and personal involvement were the most important protocol use influences. If participation is critical to protocol compliance, the protocol method to improve the quality of health care is severely limited.


The impact of a computerized medical record summary system on incidence and length of hospitalization.

The present study examined the influence of a computerized medical record summary system on incidence and length of hospitalization. Additional indicators of process of care were also considered. A prospective, randomized design was used where 241 experimental patients had a computerized medical record summary and 238 control patients had the traditional medical record. All patients were followed and compared over a two-year period. Although no difference in incidence of hospitalization was found between patients with and without the summary, during the second year, patients with summaries spent fewer days in the hospital. Patients with summaries also had more completed referrals for consultation, assigned diets, detected new problems and diagnostic tests on record than patients without the summary.


Examining the annual drug utilization of a cohort of low income health plan members.

Changes in the annual drug utilization of a cohort of 828 low income Kaiser Foundation Health Plan members in the Oregon region over a four-year period are examined. The study also attempts to identify relationships between consistency in the levels of annual drug utilization and characteristics of the cohort, prescriptions received and doctor office visits (DOVs). The results show no change in the: 1) annual prescription rate; 2) types of drugs received each year; 3) annual DOV rates; and 4) annual prescribing rate by physician specialties. There was consistency in the annual drug and DOV utilization rate among the cohort through time. Consistency in the level of drug utilization was not always directly related to consistency in the level of DOV utilization. Consistent high users of drugs, while few in number (4.6 per cent), received a large proportion (37.3 per cent) of all prescriptions. A substantial proportion (15.8 per cent) of the cohort were consistent nonusers of drugs. Consistency in the level of drug use was related to: sex and age, purpose (disease classification) of the DOVs, the types (new or refill) of prescriptions received, the therapeutic classes of drug received, the number of prescribing physicians and the number of pharmacies patronized.


Primary care and social control.

Role performance in primary care becomes problematic when a disproportionate emphasis is placed on the physician's legitimizing function which is geared to endorse entry into the sick role so that he is less able to devote himself to curative or preventive tasks. Israel is used as an example of a society in which the delivery system of medical care has moved far in this direction as a result of pressures both from consumers and from the wider social system. The former utilize the medical care system for its latent as well as for its manifest functions, while the latter makes use of it for legitimation of role avoidance and for allocation of scare resources on the assumption that universalistic criteria of medical need are used in these processes. Excessive utilization rates of clinical facilities and dissatisfaction among primary care physicians are apparently among the dysfunctional results of these patterns. Some questions are raised as to the implications of placing major social control mechanisms in the hands of the medical care system which in effect is not really geared to handle these tasks.


Differences in attitudes toward terminal patients among selected medical specialities of physicians.

Medical specialty of physicians was related to attitudes toward dying patients to determine if differences occur as suggested by the literature. Data from a questionnaire completed by 1,012 physicians from the classes of 1972--1975 in five selected medical schools were analyzed using the chi-square distribution to test the relationship between the response to each of the 11 Likert-type statements and the medical specialty of the physicians. Mean responses by medical specialty to the statements were ranked and correlated to Rea's ranking with respect to the probability of dealing with terminal patients by specialty using a Spearman Rank Correlation Coefficient. Support was found for Rea's conclusion that physicians such as oncologists with a high probability of relating to dying patients tended to be more open with the patient whereas a specialty like obstetrics-gynecology with a low probability tended to operate in more of a closed awareness context.


Interaction exchange structure and patient satisfaction with medical interviews.

The verbal interaction between patients and physicians in 52 initial interviews in a university hospital screening clinic was studied using a new discourse coding system. Factor analysis of category frequencies showed that each interview segment, medical history, physical examination, and conclusion, consisted mainly of two or three types of verbal exchange. Patient satisfaction with the interviews, assessed with a questionnaire that yields separate scores for satisfaction with cognitive and affective aspects, was found to be associated with exchanges involving the transmission of information in particular interview segments. Affective satisfaction was associated with transmission of information from patient to physician in "exposition" exchanges during the medical history, in which patients told their story in their own words. Cognitive satisfaction was associated with transmission of information from physician to patient in "feedback" exchanges during the conclusion segment, in which physicians gave patients information about illness and treatment.


Treatment of intractable ascites in patients with alcoholic cirrhosis by peritoneovenous shunting (LeVeen).

Several hemodynamic abnormalities in the patient with cirrhosis comprise a unique distributive circulatory disturbance that causes intractable ascites and that is, in turn, worsened by the resulting ascites. Ascites is promptly alleviated by drainage of the ascitic fluid into the intravascular compartment. The circulatory abnormalities improve in part because of elimination of the ascites, and also because of a compensatory hypervolemia. The consequences of the latter, especially in the immediate postoperative period, are increased likelihood of pulmonary edema and of gastrointestinal bleeding from heightened portal vein pressure. Postoperative coagulopathy is also a significant problem. Careful selection of patients for the procedure, close postoperative observation and vigorous use of diuretics and other agents will usually enable these complications to be obviated or successfully treated. Increases in body muscle and fat masses and serum albumin concentrations indicate nutritional improvement. Despite evidence of benefits from the procedure, these patients continue to die from the complications that threaten other cirrhotics: effects of return to alcoholism, gastrointestinal hemorrhage, recurrent infections and intestinal obstruction. Thus, it is not yet clear that the benefits include prolongation of life.


Chemical hepatitis: pathogenesis, detection and management.

The toxic effects of many nonmedicinal chemicals include serious hepatic injury, often accompanied by various degrees of damage to other organs. Some chemicals produce only mild damage. Others are capable of producing injury only after ingestion of large amounts, after severe exposure, or in combination with another agent such as alcohol.


Vitamin and mineral supplements in the management of liver disease.

While pharmacologic doses of specific vitamins or minerals are probably not warranted as a therapy for acute or chronic liver disease, deficiencies of micronutrients among patients with liver disease are extremely common, act to the detriment of the patient, and should be corrected so that normal metabolic processes can allow both regeneration of tissue and resistance to infection.


[Use of a fibrin glue for reconstructing the posterior meatal wall (author's transl)].

In 15 cases of tympanomeatoplastics of the last year a special "glue", consisting of human fibrinogen and thrombin, was used to glue grafts of homologues cartilage into the defect of the posterior wall. In 14 of 15 cases the result was satisfactory.


[Cerebrospinal fistula tight closure of dural defects using surgical adhesives. A comparative experimental study (author's transl)].

In 3 cats artificial bony and dural defects of the posterior frontal sinus walls facing the frontal brain were closed with the help of a physiologic fibrin-based adhesive system (FAS) and a synthetic tissue adhesive (N-butylcyanoacrylate) in an attempt at comparing the relative merits and demerits of the 2 techniques. The bony and dural defects were partially covered with fascial tissue. Subsequently, the defects were sealed with adhesive using cyanoacrylate for the left frontal sinus and FAS for the right one. Unless healing was complicated by wound infection, fibrous tissue was found to have bridged the defects on either side 14 days after surgery, ensuring cerebrospinal fistula tight closure. Wound infection occurred in 2 cases involving the frontal sinuses closed with FAS. Micro-organisms had apparently been introduced from the respiratory tract and, in one case, spread to the contralateral frontal sinus treated with cyanoacrylate. Thus, the risk of infection associated with FAS appears to be higher than that of conventional techniques. Germ growth was found to be inhibited in vitro by adding an antibiotic to the FAS. For this reason, we would recommend the admixture of an antibiotic to the FAS whenever the adhesive is used in surgical fields which are exposed to infection. Further sutdies are needed to find the best suited antibiotic, its optimum dosage and mode of applications.


[The application of cortical bone avoiding retraction pockets in case of cholesteatoma operations (author's transl)].

All those different operation methods thought for the preservation and reconstruction of the posterior canal wall in the last decennium show us in a high degree the extension of the problems. We ourselves have--after first enthusiasm for the "temporary meatotomy"--later preferred the "combined-approach-technic". Hereby the care to avoid retraction pockets in the lateral attic wall stood ahead. After the first use of muscle, connective tissue and fascia, later on the lyophilised dura and the cartilage, we today prefer cortical bone of the planum mastoideum. This is thought to be the original material for this purpose not having been in touch with the cholesteatoma or the matrix and guarantees by the accompanied periosterm a seamless pass over to the remaining canal wall. Also an additional usage of lyophilised dura--situated bricklike along the separating line--avoids a new retraction. In case of the slightest suspection for the possibility of a residual cholesteatoma a "Second look" operation should be carried out one year after the first operation. A further control should follow after 5 years.


[Tympanosclerosis (author's transl)].

With a new method--that is embedding non-decalcified tissue in Methylmethacrylat and then slicing it--the patho-histological phenomenon of the tympanosclerosis can be demonstrated with 4 patients on account of the material acquired with the tympanoplasties showing rare localisations (such as stapedial tendon, mastoidale). According to our experiences (42 cases) tympanosclerosis is mainly to be found in female patients not older than 40 years. The genesis of the tympanosclerosis and its reparation through surgical techniques are discussed.


[Direct continuous measurement of middle ear pressure: method and clinical results (author's transl)].

Method (part 1): A method for the direct measurement of the middle ear pressure for clinical use is introduced. This method allows continuous pressure registration in the normal and pathological middle ear. The determination of the parameters influencing middle ear pressure like volume of the middle ear cavity, gas resorption, tube function is possible. The influence of body movement, changes of temperature etc. on the middle ear pressure can be registrated. The precondition for this method is a tube in the tympanic membrane. Clinical results (part 2): In 42 patients pressure development in physiological tube function and dysfunction, in patulous Eustachian tubes and tube obstructions can be registrated. The volume of the middle ear cavities and the increasing negative pressure because of gas resorption can be analysed with this method. In obstructed tubes different development of negative pressure may indicate differences in the elasticity of tympanic membranes. This method gives valuable criterion on middle ear pressure changes considering parameters like gas diffusion, tube function, cavity volume and membrane elasticity in normal and pathological middle ears.


["Sudden binaural deafness" after acute heroin intoxication (author's transl)].

After intoxication by an overdose of intravenously applied heroin, a 20 year old man developed a nearly symmetrical, tub-shaped sensorineural deafness of max. 50-60 dB at the frequencies 1000-4000 Hz, which receded completely within 3 days. In addition, a short survey is given of hitherto known neurological complications after heroin intoxication.


[On the audiology of multiple sclerosis (author's transl)].

The paper reports about a female patient who developed an uncommon, unilateral, reversible hearing defect while suffering from multiple sclerosis. The tone audiogram showed a break in the hearing threshold curve down to values no longer measurable, progressing from the high to the low frequencies. There were all symptoms of a retrocochlear hearing defect. After about a month a restitutio ad integrum was achieved. The paper continues with discussions on the seat of the focus of demyelinisation with particular reference to the central part of the N. acusticus, whose myelin sheaths are formed by glia cells.


[N. glossopharyngeus and tonsillectomy (author's transl)].

Due to its course in the pharyngeal space, the trunk of the glossopharyngeal nerve can be damaged during tonsillectomy which results in paralysis of the soft palate and impairment of the sense of taste. These symptoms may recede within two years but permanent damages can be seen as well. They can be treated by logopedia and relaxation therapy.


[Vestibular results before and after neurectomy of the vestibular nerve in cases of vertigo resistant to medical treatment (author's transl)].

25 patients suffering from vertigo due to peripheral-vestibular disorders resistant to medical treatment underwent neurectomy of the vestibular nerve. Präoperatively 24 showed a pathological result in the neurotological examination. In 83% of the cases an abnormal caloric reaction could be seen in the frequency-calorigram, which graphically represents the caloric test. The postoperative objective vestibular results always correlated with the subjective feeling of vertigo. We could see a decrease and finally a disappearance of the horizontal unidirectional spontaneous nystagmus. It is of value to examine the gaze nystagmus in none directions of gaze. In the positiogram, a quantitative scheme of the positional test, one could recongize a decrease of the nystagmus intensity in the follow-up examination. The same was found by testing the vestibulo-spinal reactions. Although the neurectomy of the vestibular nerve involves a serious operation it is nevertheless the first choice of treatment. 96% of the cases are free from vertigo. Postoperative there is a very low complication quota.


[Contribution on household dust allergy (author's transl)].

In 1970 the allergy out-patient department of the First Otolaryngological University Hospital of Vienna reported for the first time about the increasing significance of mould fungus allergies in the respiratory tract. RAST now makes in possible to analyze the indivudual fractions of a household dust sensitization by way of experiments. We have seen that in the case of positive RAST reactions to household dust, which is a mixed antigen unspecific as such, evidence can be found for at least one of the antigens "mould fungus", "household dust mite", or "animal hair" in positive RAST categories. Among the 107 cases of the RAST categories 2 und 3 with respect to household dust (h3) a household-dust mite sensitization was evidenced in 88 percent, the respective figures for animal hair sensitization being 49 percent and for mould fungus sensitization 43 percent.


Improved case finding for pediatric hearing loss: cost analysis of school screening programs.

The majority of school hearing conservation programs employ pure tone identification audiometry as a basis of referral for further evaluation. An analysis of the cost impact of school screening programs is presented and a method of relating costs to screening program accuracy is described. This type of analysis may be used as a model for estimating cost impact and cost-benefit for pure tone audiometry and other techniques of screening for hearing loss.


Otosclerosis surgery: reassessment of its value in 1978.

Today, surgical correction is the treatment of choice for the hearing loss associated with footplate otosclerosis. Experience with stapes surgery reveals this to be functionally and economically superior to the long-term use of hearing aids. There is, however, a predictable rate of surgical complications. Sensorineural hearing loss, dizziness and/or facial nerve palsy have an immense social and economic impact upon the patient, the family and the surgeon. Otosclerosis surgery will be presented in the perspective of benefits, untoward results, and alternate forms of treatment. A cost analysis of the foregoing will shed light on the future of otosclerosis surgery.


Management of the totally disabled middle ear.

A short review of past techniques and materials used in treating the totally disabled middle ear is presented. Basic principles to be observed in management of this problem are discussed and the method of middle ear rehabilitation using the double layer Silastic technique is introduced. Cases (231) are reviewed with comments on the functional results achieved. It is concluded that a reliable total ossicular replacement prosthesis has yet to be produced.


Protocol for determining the auditory percepts of electrical stimulation of the cochlea.

The percepts of electrical stimulation of the auditory nerve can best be determined in man. An eight channel bipolar electrode array has been developed which allows discreet stimulation of segments of auditory nerve via the scala tympani. In addition, a programmable stimulator has been developed which allows the delivery of different waveforms and stimulus patterns. Hopefully this will begin to allow the generation of the elements of speech.


Bilateral cochlear implants: histological findings in a pair of temporal bones.

The specimens were obtained from a 63-year-old white male with acquired lues. The patient experienced sudden profound deafness on the left side 15 years prior to death, and a similar loss on the right side 3 years later. By the time of death he had carried a single induction coil in the right ear for 3 years and multiple (5) hardwire electrodes in the left ear for 8 years. A complete micro-dissection or "mini-autopsy" of the specimens was performed, and the modiolus was sectioned. Photomicrographs of the dissections will be shown. In the right ear supporting elements and numerous nerve fibers were present in the apical turn. The electrode on this side was apparently tolerated well; scala tympani was normal in shape and appearance. On the left side no nerve fibers were found in the osseous spiral lamina and there was extensive new bone formation in scala tympani. It is difficult to determine if or to what extent the implants were responsible for the severe sensorineural degeneration observed in both specimens. There was severe scarring and ossification of the posterior ampulla in both ears, in all likelihood resulting from the surgery. Some aspects of surgical techniques will be discussed in view of the histopathological findings.


A method for refixation of the multifractured respiratory cranium.

So-called Tantalum-Visors are used to refixate the multifractured facial skeleton, torn off the base of the skull by trauma, in a three dimensional way to avoid dishface and pseudotelorismus. These visors are kept in storage: a small model--glabella visor, and a large one--zygomatic visor. Of both types, a bigger one is for the head of a male, a smaller for a female and still smaller for youth, because it is impossible to make an individual mold immediately following an accident.


Optokinetic nystagmus: a comparative study of two stimulators.

The neural mechanisms for optokinetic nystagmus (OKN) may be clinically relevant to the two methods used to detect these abnormalities. If one subscribes to the cortical (macular) theory, visual fixation is always involved and results by conventional drum rotation or by pursuit of a moving light source ought to be the same. Conversely, if OKN can be the result of peripheral vision and subcortical pathways, results with the drum (which does not require macular vision) and moving light (which does) ought to be different. Both the drum and moving light methods were compared on a sample of 514 patients. Both methods compared equally in eliciting abnormal responses in patients with an established diagnosis and in correlation with calibration, gaze, and false positive responses. The drum was superior in the remainder of comparisons.


Surgical correction of complete tracheoesophageal cleft.

Laryngotracheal esophageal cleft is a rare congenital anomaly that should be considered in the differential diagnosis of any neonatal respiratory distress aggravated by feeding. Diagnosis is difficult and repeat endoscopic examinations may be necessary. In complete clefts, immediate surgical repair is indicated with combined approach through the chest and neck and incorporation of part of the esophageal wall into the repair. Because the cleft may be associated with esophageal atresia and/or tracheal esophageal fistula, it should be suspected in patients who have persistent symptoms after successful repair.


Computed tomography of the larynx.

The normal computed tomographic anatomy of the larynx and surrounding structures is illustrated and discussed. An attempt is made to distinguish various types of tissues in cross-sectional display. The advantages of computed tomography over other modalities used for imaging the laryngeal region include the capacity to depict structural relationships in cross-section, to better define cartilaginous involvement by adjacent neoplasms, and to identify vascular components with contrast enhancement. The clinical application of computed tomography with respect to radiation therapy treatment planning of laryngeal tumors in an important feature of this imaging technique.


Technique of preserving the spinal accessory nerve during radical neck dissection.

Preserving the spinal accessory nerve during radical neck dissection eliminates shoulder disability and does not compromise the incidence of neck recurrence in properly selected cases. The literature and standard textbooks only superficially refer to the method dissecting this nerve. We describe our technique of preserving the spinal accessory nerve during radical neck dissection.


Histamine, norepinephrine and serotonin content of nasal polyps.

Histamine, norepinephrine and serotonin were assayed and localized by fluorescence histochemistry in normal mucosa and nasal polyps because of their possible role in the development of inflammation and edema. Histamine was present in greater concentration in nasal polyps than in normal mucosa. Norepinephrine was present primarily in the base of nasal polyps and in greater concentration than in normal mucosa. Patients with aspirin sensitivity and asthma had much lower histamine concentrations in their nasal polyps than all other patients with nasal polyps. A proposal for a possible mechanism of formation of nasal polyps based on vascular and inflammatory mechanisms and incorporative roles for histamine and norepinephrine is presented.


Tracheostomy-related subglottic stenosis: bacteriologic pathogenesis.

Subglottic stenosis carries devastating consequences. Its pathogenesis, and therefore prevention, have thus far eluded precise definition. The following data suggest that tracheostomy results in a contaminated wound, secondarily infecting a larynx which may have been injured by prior intubation, fracture, or surgery. The interpretation of these data is based upon the tested assumption that infection prolongs healing of injured tissue and predisposes to scar and stricture formation. Therefore, the ability of control stomal contamination by the judicious use of topical or systemic antibiotics may play an important role in the prevention of complications in an organ functionally by-passed by the tracheostomy cannula.


Histopathology of congenital subglottic stenosis.

Three patients with congenital subglottic stenosis are presented and whole organ serial-section studies of their larynges are discussed. A superiorly displaced first tracheal ring is observed to form a cartilaginous subglottic stenosis in one. This "trapped first ring" is demonstrated in horizontal, sagittal and coronal planes. Subglottic stenosis is a clinical diagnosis which describes multifarious histopathological forms of narrowing within the subglottic larynx.


Sleep apnea syndrome associated with upper airway obstruction.

A working protocol is presented which has developed to help the clinician in the diagnosis and management of patients suffering from the sleep apnea syndrome associated with various types of upper airway obstruction.


Acoustic neuroma surgery with emphasis on preservation of hearing.

A review is presented of 34 cerebellopontine angle tumors surgically removed between 1973 and 1978 by the author at the New York University Medical Center. A diagnostic protocol is outlined: An acoustic PEG (small volume pneumoencephalogram with polytomography) is utilized where a medium to large tumor is suspected, and a Pantopaque fossagram for the smaller tumors. Indications are given for the middle fossa, translabyrinthine and suboccipital approaches, depending on tumor size and level of hearing. Hearing was successfully preserved at or near the preoperative level in 3 of 6 extracanalicular tumors operated upon using the suboccipital microsurgical approach. Audiometric data are given, demonstrating the preservation of hearing. The surgical technique is described. There were no fatalities in the entire series. The incidence of permanent facial nerve palsy was 8%. Nerve palsy occurred in large tumors only.


Transoral management of localized carcinoma of the oral cavity using the CO2 laser.

Since 1972 we have been cautiously exploring the use of CO2 laser in the management of carefully selected cases of localized carcinoma of the oral cavity. At the present time our experience is based on the treatment of 57 patients with cancer of the oral cavity. The CO2 laser has been found to be an indispensable tool in the transoral management of T1 carcinomas, multiple superficial carcinoma, extensive leukoplakia and verrucous carcinoma. The laser allows precise excision of the lesion and involved mucosa and provides and excellent specimen for histologic verification of the margins. The morbidity of laser excision is minimal, so that a tracheotomy is not needed and patients can almost always be discharged on the following day. (Follow-up data on those patients at risk for 30 months indicate excellent control rates).


Combined otoneurosurgical approach to patients with chronic ear disease and cerebrospinal otorrhea.

We report a combined otoneurosurgical approach in the treatment of a patient with meningitis due to an arachnoid cyst, extending through the dura and petrous bone into the middle ear. The combination of mastoid surgery and temporal craniotomy including opening the dura was necessary to determine the nature of the problem, excise the disease and repair the defects. Two recent cases at our Institution of cerebrospinal otorhinorrhea and chronic ear disease illustrate the difficulty in carrying out definitive repair of dural defects from within the mastoid cavity. Case 2 had three bouts of meningitis and two brain abscesses separated by 25 years. Case 3 had eight bouts of meningitis in 19 years. The authors recommend at otoneurosurgical team approach in patients with cerebrospinal otorhinorrhea permitting treatment of the temporal bone, dura and brain.


The otolaryngologic presentation of myasthenia gravis.

Myasthenia gravis is a neuromuscular disease of insidious onset, characterized by weakness and fatigability of voluntary muscles. Most patients present with symptoms relating to the head and neck and thus may be seen first by the otolaryngologist. Predominant symptoms may be ocular (ptosis or diplopia) or related to fatigue of the oropharyngeal or laryngeal musculature (dysarthria, dysphonia, or dysphagia). Alleviation of muscular weakness and fatigability after administration of anticholinesterase drugs is pathognomonic of myasthenia gravis.


Relapsing polychondritis--report of ten cases.

Relapsing polychondritis is a rare disease of unknown etiology. There are approximately 211 reported cases in the world literature. This is a report of ten cases from the Cleveland Clinic Foundation. McAdam's diagnostic criteria for R.P. were reviewed and modified. For diagnosis, all patients had to have 1. at least three or more diagnostic criteria, histologic confirmation not necessary; 2. one or more of McAdam's signs with positive histologic confirmation; or 3. chondritis in two or more separate anatomic locations with response to steroids and/or Dapsone. Chondritis of the auricles (9/10 patients) and arthropathy (8/10 patients) are the most common presenting signs. Chondritis was also seen in the nose (6/10) and the upper respiratory tract involving the larynx and trachea (4/10). Cochlear and vestibular damage and ocular inflammation were each seen in 5/10 patients. Patients were treated with steroids and/or Dapsone. Both drugs were reliable in abating episodes of activity and in decreasing recurrences. These results further support Dapsone as an alternate form of treatment for RP.


Orbital-facial complications of sinusitis in children.

Although complications of sinusitis in children have lessened remarkably since and advent of antibiotics, nevertheless they still occur. In a 25-year period at the Hospital for Sick Children, 6,770 patients with the diagnosis of sinusitis were reviewed and 159 of these had orbital-facial complications. Surgical intervention was necessary in 17 to prevent more serious complications. Although there were no deaths in non-malignant disease, two patients developed permanent optic atrophy, presumably because of delayed surgical drainage. On occasion, malignant disease may simulate inflammatory processes.


Negative pressure in the middle ear by ciliary propulsion of mucus through the eustachian tube.

Mucus was placed in the middle ears of 11 cats. A needle and stop-clock placed in the bulla communicated with the tympanic cavity. The pressure changes in the needle were transcribed on a flowing graph via a transducer in communication with the stop-clock. Negative pressure developed in each test ear. The average maximum negative pressure was 12 mm Hg  with a minimum of 2 mm Hg and maximum of 24 mm Hg. The peak negative pressure, reached in 30 to 60 min. in most ears, occurred in 10 min. in one and in 3 hrs. in another. The qualitative results show all ears developed a negative pressure when mucus was in the tympanic cavity. The quantitative data suggest an average maximum negative pressure of 12 mm Hg reached at about 1 hr.


A new permanent tracheostomy tube--speech valve system.

A permanent tracheostoma is often necessary in patients with respiratory diseases such as severe bronchial asthma or chronic bronchitis in order to reduce dead space. Another group of patients who require a permanent tracheostoma are those with laryngeal stenosis or bilateral vocal cord pareses whose general condition makes them unsuitable candidates for more advanced surgical procedures. This has usually been achieved by a conventional tracheostomy tube which, however, carries many problems; the ability to cough is greatly reduced when a sufficient intra-abdominal pressure cannot be acquired, speech is impaired, the tube has to be changed regularly, it must be fixed by bands around the neck, etc. These problems can be significantly reduced by using a short, straight tube placed in the stoma and kept securely in position by an outer flange and four flaps on the tracheal side. To this tube is attached a special two-way valve adjustable for either inspiration and expiration or for inspiration only in which case it also serves as a speech valve. Up to now this construction has been used in 16 patients with excellent results, one patient has had this device continuously since 1970 without any complications.


Pseudoepitheliomatous hyperplasia of the external ear, middle ear, and mastoid.

A case of pseudoepitheliomatous hyperplasia involving the external, middle ear, and mastoid air cells and labyrinth resulting from long standing irrigations with alcohol is described for the first time.


Multiple malignancies in patients with primary carcinomas of the head and neck.

Eight hundred and twenty-five patients with primary carcinomas of the head and neck area were studied. Of these, there were 54 individuals with multiple primary neoplasms. Synchronous lesions occurred in 19 patients while nonsynchronous lesions occurred in 35. The frequency of occurrence of second neoplasms was 6.5%, which nearly doubles that of previously recorded series. A conclusion which can be made from this study is that, as long as the carcinogenic agent (alcohol and/or tobacco) continues to be present, the patient will continue to be affected.


Brain stem evoked response audiometry in a clinical practice.

Brain stem evoked response audiometry (BERA) is an effective method of evaluating the auditory pathway from the peripheral endorgan through the brain stem. The authors have found this test to be a valuable adjunct to the neurotologic evaluation and have applied the study to over 500 patients (639 ears) in a 22 month time span. BERA has an excellent success rate (98%) in determining the presence of cerebellopontine angle lesions and is helpful in establishing whether a hearing loss is of cochlear or retrocochlear type. The authors have found BERA of use in the diagnosis of multiple sclerosis as well as other neurologic diseases affecting the brain stem. It is a valid method of dealing with suspected malingerers and those who cannot respond to standard audiometric techniques. BERA has been helpful in determining the threshold of hearing in these patients. The authors conclude that BERA is a clinical study of practical significance and that more otolaryngologists should consider adding it to their diagnostic protocol.


The normal nystagmic response of infants to caloric and perrotatory stimulation.

Infants (276) were tested with perrotatory and caloric vestibular stimulation at 3-month intervals, from birth till 12 months of age and at 6-month intervals from 12 to 24 months. They were grouped by gestational age and weight at birth. Statistical analyses of the various features of the nystagmus obtained at different ages were performed. Premature and low weight infants were found to have the longest latency and smallest frequency, amplitude and speed of slow component during the first 6 months. As they matured, the latency of response became shorter while the other parameters increased. Complete maturation of responses was attained in all infants within 6 to 12 months of age. Standards for normal vestibular responses in infants up to 24 months of age are set in this study.


The accuracy of the simultaneous binaural bithermal test in the diagnosis of acoustic neuroma.

Forty-three patients with a surgically confirmed unilateral acoustic neuroma were studied preoperatively with both alternate and simultaneous binaural bithermal caloric tests using horizontal lead electronystagmography. Twenty-four patients had a significant reduced vestibular response on the side of the tumor utilizing the alternate binaural bithermal calorization of Fitzgerald-Hallpike. The addition of the simultaneous binaural bithermal stimulus improved the diagnostic accuracy of caloric testing from 56% to 86%. The simultaneous test was of particular accuracy in diagnosing the inferior vestibular nerve neuroma. The simultaneous stimulus, which adds only six and one-half minutes to overall testing time, is felt to be a valuable adjunct to the alternate test of Fitzgerald-Hallpike.


Long-term effect of otosclerosis on bone conduction.

There have not been many studies of long-term sensorineural function in otosclerosis. The reports of long-term follow-up of lateral canal fenestration cases show a surprising stability of bone conduction. Because the experience of the senior author in stapes surgery suggests that some patients with clinically proven otosclerosis have a tendency for progression of sensorineural hearing loss, a review of over 500 ears in patients with proven otosclerosis was undertaken. Data from the study indicate that patients with otosclerosis have more sensorineural hearing loss than the general population. Also some otosclerotic ears have a tendency for progression of sensorineural hearing loss.


Current attitudes of laryngectomy patients.

Improved surgical techniques and adjunctive therapeutic measures are producing more long-term survivors of laryngeal carcinoma and facilitating voice preservation through the methods of conservation surgery; however, when surgery includes total laryngectomy, prolonged rehabilitation involving many disciplines may help patients to adjust to many new aspects of their daily lives and to avoid the severe depression which may attend this procedure. In order to evaluate the program currently in use at our institution and to provide suggestions for developing and improving rehabilitative programs, we have used interviews and questionnaires to study 60 laryngectomy patients. The study focused on the patients' attitudes and their impressions of the adequacy of the preoperative and postoperative visits by physicians, speech pathologists, nurses, social workers, and other members of the therapy team.


A clinical-radiographic classification of skull base lesions.

Lesions involving the base of the skull can be divided into primary and secondary disease processes. The primary group consists of bone lesions more often seen elsewhere in the skeletal system while the secondary group consist of those lesions extending to the base of the skull by direct extension from adjacent intracranial or extracranial sites. The purpose of this paper will be to arrive at a classification of skull base lesions based on the roentgen localization of the disease process. The base of the skull because of its anatomically variable curvature can be difficult to evaluate on good quality conventional radiographs. In addition to the changing angles of the bone itself, the overlying soft tissues of the pharynx and neck only serve to further conceal areas of bone pathology. The advent of polytomography and CAT scanning has greatly aided the evaluation of this region which clinically is extremely difficult to assess. In some instances invasive modalities such as angiography and posterior fossa myelography are necessary to define the lesion. With these diagnostic methods available, rather than discovering classical patterns of disease, a variety of disease processes have been found that radiographically mimic each other. Similarly, on a purely clinical basis, many of the disease entities present in a similar fashion. It is only by a combined approach that an intelligent differential diagnosis can be offered.


Anterior skull base surgery for benign and malignant disease.

Teamwork between the head and neck surgeon and the neurosurgeon utilizing the craniofacial resection technique greatly extends the frontiers of surgery for tumors of the anterior half of the skull base. Tumors for which this technique may be used include benign and malignant tumors arising in the frontal bone or frontal sinus, nasal vault, ethmoid, maxilla, sphenoid or orbit. Selected nasopharyngeal lesions such as angiofibromas with anterior or middle fossa extensions and sphenoid or clival chordomas may also be approached in this manner. This report evaluates the surgical techniques currently in use for managing these tumors, by discussing the benefits of combined resection, technical modifications of the techniques, and the results of using these techniques in 12 patients. The initial results are encouraging.


Malignant potential of keratoacanthoma.

Keratoacanthoma is generally considered to be a benign cutaneous lesion with initial rapid growth and spontaneous involution over several months. It is not generally appreciated that the keratoacanthoma may have a malignant potential or be associated with carcinoma. When a lesion diagnosed as keratoacanthoma recurs after excision, underlying malignancy must be considered. Four examples of keratoacanthoma associated with underlying malignancy are presented from the Ochsner Medical Institutions to emphasize the above points.


Solitary frontal sinus fracture.

Both the anterior and/or posterior wall of the frontal sinus as well as the nasofrontal duct may be injured by blunt force, commonly secondary to automobile accidents. In this group of 13 solitary frontal sinus fractures, the anterior wall was involved in all cases, and the posterior wall in 2. Antibiotic therapy was given to prevent anticipated infection. Comminuted or depressed fractures of the anterior wall were treated by elevation and/or wiring. Surgical treatment was not employed when there was a linear fracture of the anterior wall in good alignment. Posterior wall fragments were removed and periosteal flaps used to close the defect when the dura was intact. One case required neurosurgical treatment for a dural tear and necrotic frontal lobe cortex.


Stomal recurrences: a clinicopathological analysis and protocol for future management.

From 1965 to 1975, 452 total laryngectomies were performed at the Washington University Medical Center, St. Louis, Mo. During this period, 33 stomal recurrences were diagnosed. These are clinicopathologically analyzed with regard to tumor size, site, histopathology and original surgical procedure. An association with transglottic tumors, emergency tracheotomy and, surprisingly, hemilaryngectomy is noted. Three theories of etiology are discussed. Since treatment to date is disappointing, several proposed methods of prophylaxis are presented. These include emergency laryngectomy, recurrent laryngeal lymphatic dissection and postoperative radiotherapy. The role  of wide local excision and mediastinal dissection is also examined. Based upon the analysis and the proposed methods of prophylaxis, a protocol is suggested for the future management of this dreaded complication.


Bacteriology and treatment of chronic otitis media.

Tympanocentesis was performed in 50 patients with chronic otitis media. Pus was cultured aerobically and anaerobically. Aerobes only were isolated from 21 patients, 3 had only anaerobes (peptococcus sp.) and 26 had both aerobes and anaerobes. There were 68 aerobic isolates. Pseudomonas aeruginosa was recovered in 36 (72%). Other aerobes commonly recovered included proteus sp. and Staphylococcus aureus. There were 48 anaerobes isolated. Anaerobic gram positive cocci were isolated in 24 instances. Sixteen Bacteriodes sp. were recovered, including 7 B. fragilis and 6 B. melaninogenicus. The patients were divided into two groups according to their antimicrobial therapy: 28 received carbenicillin and 22 clindamycin. An aminoglycoside was added when aerobic enteric gram negative rods were present in significantly high numbers in the culture. There was good to excellent response to therapy in more than half of the patients and in 12% there was a remission from symptoms for up to one year. Thirty-six percent of the patients had no response to therapy. There were no statistical differences in response to therapy in the two groups treated. Antimicrobial therapy directed against aerobic and anaerobic isolates from chronic otitis media had a high success rate in complete eradication of the infection.


Luetic hydrops--diagnosis and therapy.

Nine patients presenting at the Shea Clinic over the past eight years with a history of fluctuant hearing loss were subsequently found to have neurosyphilis. Treatment has consisted of penicillin, given by various routes, oral steroids and vasodilator therapy. We have, based on recent investigations, begun using high dose intravenous penicillin in this regimen. Results have been encouraging in two patients, with rapid improvement in hearing. A protocol outline for diagnosis and therapy of syphilis is included in the discussion.


Lymphocytes, neutrophils and serum immunoglobulins in patients with precancerous states of the larynx.

In 24 men aged 32 to 58 years with precancerous states of the larynx, i.e., leukoplakia, papillomas and pachydermia the peripheral blood lymphocytes were cytochemically stained for N-acetyl-beta-glucosaminidase, beta-glucuronidase, acid phosphatase and glycogen; and the neutrophils were stained for alkaline phosphatase, myeloperoxidase and lipids. The results were expressed in terms of the absolute counts of reaction-positive cells and of the activity index score. The serum immunoglobulins IgG, IgA and IgM were also determined by Mancini's method. The results obtained were compared with those in 20 healthy men aged 20 to 30 years. The patients exhibited elevated numbers of N-acetyl-beta-glucosaminidase and beta-glucuronidase-positive lymphocytes. A characteristic feature was an increase in the absolute counts of lymphocytes with diffuse and granular-diffuse types of cytochemical reaction for all enzymes studied. The number of cells with the granular type of enzymatic reaction (intact enzyme-positive lysosomes) was significantly diminished. These cytochemical alterations were accompanied by a significant increase in the serum IgA level. These results are discussed with reference to the lymphoid system response to tissues of precancerous lesions of the larynx. So far as the neutrophils are concerned the patients exhibited significant intracellular deficiency of beta-glucuronidase and decrease in the lipid content as well as an elevated alkaline phosphatase activity. The possible significance of the beta-glucuronidase deficiency in neutrophils for the diminished cytotoxic response of these cells against the tumor and precancerous lesion cells is discussed.


Brain stem auditory evoked potentials in patients with congenital atresia.

The purpose of this paper is to illustrate the value of the brain stem auditory evoked response in the definitive assessment of newborn and older infants with congenital malformations of the auditory system. Clinical cases selected illustrate the methodology required in the evaluation and demonstrate how the technique can facilitate immediate and appropriate medical and habilitative services.


Congenital middle ear cholesteatoma: two unusual cases and a review of the literature.

Forty-three patients with congenital middle ear cholesteatoma have been described since the first case in 1953. In these patients ten cholesteatomas were confined to the anterior mesotympanum in young children who had no ossicular damage. Involvement of the posterior mesotympanum (8 ears), meso and epitympanum (21 ears), and antrum and middle ear (7 ears) was associated with an 81% incidence of ossicular erosion in addition to other abnormalities. Anterior mesotympanic cholesteatomas were readily identified by the appearance of a white mass behind a translucent drum. The other congenital cholesteatomas had a more varied appearance with a mass and a whitish appearance each noted in about half. In almost half there was a bulging of the TM. Two new cases are reported: a 4-year-old with an extensive epi and mesotympanic cholesteatoma initially misdiagnosed as non-suppurative otitis media and a 23-year-old with the third reported case of bilateral congenital cholesteatoma.


The coexistence of parathyroid adenoma and thyroid carcinoma.

Not well-known and inadequately understood is the high incidence of conexistent parathyroid adenoma and nonmedullary thyroid carcinoma. In a series of 144 patients with parathyroid adenoma, 11 (8%) were found to have concurrent thyroid carcinoma. Although similar to other multiple endocrine tumor syndromes, these two tumors have no common embryologic cell origin. The most likely explanation for this apparent relationship is the specific oncogenic effect of hypercalcemia on the thyroid gland.


Endolymphatic sac valve implant surgery. I: The technique.

A resurgence of interest in surgery on the endolymphatic sac (ELS), not only for relief of vertigo but also for stabilization or improvement of hearing, has emerged. With the concept of operating early in the course of the disease after the diagnosis is well established, various modifications of existing procedures on the ELS have been utilized in an attempt to improve the overall results. One such major modification is the unidirectional inner ear valve implant modified from the eye valve for glaucoma. This valve implant has produced impressive one-year results for both hearing improvements and relief of vertigo in patients who were scheduled for labyrinthectomy. Subsequent preliminary reports by several investigators show good to excellent results for the hearing (AAOO--Class B or A) as well as the vertigo without consideration for the stage of the disease. This study presents primarily the step by step technique with drawings and a color atlas to facilitate the correct performance of this surgery.


Endolymphatic sac valve implant surgery. II: The unidirectional inner ear valve implant.

A unidirectional inner ear valve implant was developed to direct excess endolymph out of the inner ear in the hydropic state (Ménière's disease) into the mastoid cavity. A detailed technical description of the valve implant is presented as well as some technical aspects of the valve implant based on the surgical anatomy of the endolymphatic sac.


[Pathogenesis of the neonatal cholestasis syndrome (author's transl)].

Cholestasis means reduced flow of bile between hepatocytes and duodenum. Functional as well as mechanical factors may be important in the pathogenesis of cholestatic syndromes. Extra- and intrahepatic cholestasis can be distinguished. Intrahepatic bile ducts use to be dilated in extrahepatic cholestasis after early infancy; they are however not dilated in obstructive jaundice of the newborn. Neonatal cholestatic syndromes caused by liver cell diseases may in addition cause an obstruction of extrahepatic bile ducts. At the present time most workers in the field do believe that extrahepatic cholestasis in the newborn is rather due to inflammation than to congenital malformation.


[Cholestasis in early infancy - histological findings (author's transl)].

Cholestasis in early infancy produces reactive alterations of liver parenchyma within the first weeks of life; histological examination of liver biopsy specimens may give hints as to the underlying disease. Differentiation of bile duct atresia and giant cell hepatitis at an early stage is especially important. Hyperplasia of the intrahepatic bile duct system can be due to rather different diseases. Congenital abnormalities of the duct system can be distinguished from reactive alterations only by early liver biopsy. Certain histological changes may give evidence of congenital or other metabolic disorders. Hemochromatosis of the neonatal period has been characterized morphologically but not as yet biochemically.


[Endoscopic retrograde cholangiopancreaticography (ERCP) and percutaneous transhepatic cholangiography (PTC) in cholestatic syndromes of children and adolescents (author's transl)].

Conventional cholangiography had failed to establish a diagnosis in 5 children aged 6 weeks to 14 years and in 6 adolescents aged 14 to 18 years suffering from cholestasis; therefore endoscopic retrograde cholangiopancreaticography (ERCP) was performed, allowing to establish congenital biliary tract anomalies, cholelithiasis and benign obstruction of the extrahepatic biliary tract as causes of the cholestatic syndromes. Thus ERCP again turned out to be a valuable diagnostic procedure. Percutaneous transhepatic cholangiography (PTC) using the Chiba technique has not yet been applied in infancy to a great extent. Application of PTC however should be considered as well in cholestasis. It cannot yet be decided, if ERCP or PTC is to be prefered in neonatal cholestasis; further investigations are needed to clear up this point.


[Autonomous nervous system and bile ducts (author's transl)].

Storage, concentration and excretion of bile in the extrahepatic bile duct system are rather complicated processes being regulated by the autonomous nervous system. Groups of ganglionic cells and nerve fibers are located in the papilla, the neck of the gall bladder, and to a lesser degree in the wall of the gall bladder, that is to say in parts of the system which are important in regard to coordination of the excretory function. The number of ganglionic cells decreases in diseases which go along with functional disorders of the bile duct system. If the papilla Vateri and the duodenal musculature are disconnected anatomically, the papilla will retain autonomous muscular activity which however will not be coordinated any more with duodenal function, as the chymus passes by. Parasympathetic activity plays a major role in regulating the complicated mechanism of bile excretion. The autonomous nervous system is important for normal functioning not only of bile excretion but also of other organs; this explains the coincidence of dyskinesia of the bile ducts with other functional disorders being observed rather often. Autonomous regulation of bile excretion has to be taken into consideration as well, when it comes to outlining a therapeutic regimen.


[Diagnosis and treatment of choledochus cysts (author's transl)].

Two cases we observed initiated a survey of the literature concerning the surgical management of choledochus cysts. We compared long-term results with regard to postoperative complications, rates of necessity of reoperation and operative mortality in 316 reported cases. Resection of the choledochus cyst and a subsequent biliodigestive anastomosis performed as choledocho-jejunostomy (as outlined by Roux) is the therapy of choice in this rare disease, since it gives the best long-term results.


[The uni-quatro camera - a new camera for documentation of monitor pictures (author's transl)].

A new camera system is described, which was devised to take pictures of monitor screens on special X-ray film, and it is compared with conventional methods of documentation. Quality of pictures obtained with this method is optimal, handling is quick and simple, and, in spite of that, the camera is smaller and less expensive than other multiformate cameras. Polaroid, special X-ray films and other films may be used interchangeable for all sorts of monitor screens. A report is given about the routine use of this system in ultrasonography.


Fatty acids in female Macracanthorhynchus hirudinaceus (Acanthocephala).

Neutral lipids and phospholipids in the body wall, lemnisci and pseudocoel and neutral lipids of fluid found in the "tube" system of the lemnisci and the lacunar system of the body wall of Macracanthorhynchus hirudinaceus (Acanthocephala) were determined by the technique of thin layer chromatography and gas chromatography (GC). Sixteen different fatty acids from nonpolar lipids were identified as follows: 8:0, 10:0, 11:0, 12:0, 13:0, 14:0, 14:1, 16:0, 18:0, 18:1, 18:2 and/or 20:0, 18:3 and/or 20:1, 20:3, 22:1, 24:1 and 22:6. In addition, there were three unidentified GC peaks corresponding to chain lengths greater than 20 carbons. Sixteen different fatty acids from phospholipids were identified in each of the three fractions analyzed. They were as follows: 10:0, 11:0, 12:0, 13:0, 14:0, 14:1, 16:0, 16:1, 18:0, 18:1, 18:2 and/or 20:0, 20:2, 20:3, 22:1, 24:1 and 22:6. Four unidentified peaks were also observed. There was a significant difference in the percentage of lipid as well as the concentration of particular fatty acids when each fraction was compared. There was also an abundant supply of sterols and glycerides in each fraction.


Trans fatty acids: positional specificity in brain lecithin.

Fifteen-day-old rats were divided into three groups: one group received an intracerebral injection of 5 microCi of 9-trans,12-trans [1-(14)C] octadecadienoic acid; the second group was given 5 microCi of the same compound plus an equal wt of nonradioactive all cis arachidonic acid; the third group was given 5 microCi of 9-trans [1-(14)C] octadecenoic acid. All animals were sacrificed 8 hr after injection. Glycerophosphocholine (GPC) was isolated and partically deacylated with phospholipase A2 from Crotalus Adamanteus venom. The results of this study were as follows: 1) after t[1-(14)C]18:1 injection, there was twice as much radioactivity in the 1-position as in the 2-position; 2) when tt[1-(14)C] 18:2 was injected, more than 90% of the total radioactivity was found in the 2-position; 3) following tt[1-(14)C]-18:2 + nonradioactive arachidonate injection, ca. 75% of the total radioactivity still remained in the 2-position; and 4) all of the injected [1-(14)C]-tracers showed evidence of undergoing beta-oxidation to form acetyl-CoA, which was converted to radioactive palmitate. The possibility is discussed that the observed distribution pattern of the injected radioactive tracers may be attributed to tissue metabolic specificity. Ramifications of the deposition of dietary trans fatty acids in the brain during the developmental stage of the central nervous system are also discussed.


(+)Nortrachelogenin, a new pharmacologically active lignan from Wikstroemia indica.

A new lignan, (+)-nortrachelogenin (I), and a known compound, daphnoretin were isolated from Wikstroemia indica C.A. Meyer (Thymelaeaceae). The structure of (+)-nortrachelogenin was established as 8(R)8'-4,4',8'-trihydroxy-3,3'-dimethoxylignan-olid, (9,9') on the basis of spectroscopic evidence and comparison with its enantiomer, (-)-nortrachelogenin. +-nortrachelogenin(I) showed effects on the central nervous system producing depression in rabbits.


A comparative study of the lipid composition of isolated rat Sertoli and germinal cells.

The lipid composition of enriched preparations of Sertoli cells and of germinal cells, isolated from the testes of mature rats, has been investigated. Sertoli cells contained a much lower content of phospholipids (in particular, much less phosphatidylcholine and phosphatidylethanolamine) and a higher content of triacylglycerols than did germinal cells. In addition, the Sertoli cells had a higher ratio of esterified to unesterified cholesterol than did germinal cells. Total lipids of Sertoli cells contained considerably lower levels of palmitic and docosa-4,7,10,13,16-pentaenoic acids and higher levels of stearic and oleic acid than did the total lipids of germinal cells. The major phospholipid classes and the triacylglycerols of Sertoli cells similarly contained less palmitic and docosa-4,7,10,13,16-pentaenoic acids, more stearic and oleic acids and also more arachidonic acid than did the corresponding lipid classes of the germinal cells. Minor differences between cell types were also noted for the content of palmitoleic, linoleic, docosa-7,10,13,16-tetraenoic, docosa-4,7,10,13,16,19-hexaenoic and tetracosa-9,12,15,18-tetraenoic acids.


In vitro conversion of erucic acid by microsomes and mitochondria from liver, kidneys and heart of rats.

Microsomes and mitochondria of liver, kidneys, and heart were incubated with [14-(14)C] erucic acid in three assay media: one favorable for chain elongation (NADPH + KCN), another favorable for beta-oxidation and the last one for shortening (NADP + KCN). Elongating reactions occurred mainly in microsomes, those of kidneys being very active; the mitochondria also showed some activity, heart mitochondria being, however, more active than the microsomes, when considering the amount of erucic acid activated. In the medium for beta-oxidation, practically no shortened fatty acids were found. On the contrary, when beta-oxidation was inhibited, and in the presence of NADP, the formation of shorter monoenes, probably in the outer membrane of the mitochondria, was observed, namely eicosenoic acid in high amount, oleic acid and hexadecenoic acid. Mitochondria from liver were very active as were those of heart, when compared with the quantity of activated erucic acid. In heart, the mitochondria shortened erucic acid into oleic acid and hexadecenoic acid, which were then probably used as energy substrates. With carnitine and without NADP, shortened fatty acids were formed in the mitochondria of liver, probably by the first reactions of beta-oxidation. In this case, the proportions of oleic acid and hexadecenoic acid were higher than with NADP alone. In the presence of carnitine and NADP, the level of the chain-shortening reaction did not differ from that observed with NADP alone. It appears, therefore, that the activated erucic acid is mainly directed towards shortening reactions and not towards transfer reactions across the mitochondrial membranes.


The effects of phenobarbital on biliary lipid metabolism in cholesterol gallstone subjects.

The effect of 1.7-2.2 mg/day oral phenobarbital over short (1 MO) and long term (6-24 MO) treatment on primary bile acid (BA) secretion, composition, synthesis, pool size, and enterohepatic cycling rates as well as phospholipid (PL) and cholesterol (C) secretion rates and biliary composition was determined in 12 asymptomatic cholesterol gallstone subjects while 5 normals had only short term studies. Phenobarbital enhanced BA and C secretion (BA-636 +/- 166 to 2110 +/- 382 mg/hr, p less than 0.001 and C-42 +/- 5 to 224 +/- 48 mg/hr, p less than 0.001) and BA cycling rate in all subjects studied during stimulated enterohepatic circulation but, during fasting, it only enhanced BA secretion (451 +/- 129 vs. 759 +/- 159 mg/hr, p less than 0.05) in gallstone subjects. Cholic acid (CA) production rate (171 +/- 28 to 395 +/- 9 mg/hr, p less than 0.05) and pool size (727 +/- 80 to 1209 +/- 132 mg/hr, p less than 0.05) were increased during long term treatment of gallstone subjects, while the proportion of CA in bile and deoxycholic aicd (DCA) in feces increased. Treatment decreased biliary cholesterol from supersaturated to saturated levels (9.5 +/- 0.6 vs. 6.1 +/- 0.9 moles %, p less than 0.02) in all fasting gallstone subjects and decreased cholesterol crystal loads during long term treatment; but, while prohibiting gallstone growth, it did not affect stone dissolution over 24 months' treatment. Phenobarbital also failed to affect biliary lipid composition or bile acid pool size in short term treatment of normals. Thus, phenobarbital affected hepatic metabolism of CA by enhancing production rate, secretion, and pool size; and intestinal metabolism of both CA and chenodeoxycholic (CDC) acids by increasing their cycling rates. Phenobarbital may have failed to produce stone dissolution by enhancing CA production and pool size more than that of CDC.


The content and composition of sterols and sterol esters in sunflower and poppy seed oils.

The composition and proportion of free sterols and sterol esters in crude sunflower and poppy seed oils were determined, using preparative thin layer chromatography followed by gas chromatography with cholesterol as an internal standard. Free sterols and sterols esters were also isolated in a liquid fraction obtained by low temperature crystallization (-80 C) of the oils and enriched with minor lipid classes. This enrichment procedure provided a liquid fraction suitable for studies of minor components in the oils. However, selectivity towards sterol esters was observed since sterols esterified to very long chain fatty acids (C20-C24) were preferentially retained in the precipitate. The proportion of free and esterified sterols were found to be 0.34% and 0.28%, respectively, in the sunflower oil, whereas the corresponding figures for poppy seed oil were 0.33% and 0.05%. Sunflower oil was characterized by a relatively high percentage of delta 7-sterols, preferentially obtained in the esterified fraction, and by very long chain saturated fatty acids of sterol esters. The sterols in poppy seed oil were composed almost entirely of campesterol, stigmasterol, sitosterol and delta 5-avenasterol, although their percentage distributions were remarkably different in the free and esterified fraction.


Metabolism of naphthenic hydrocarbons. Utilization of a monocyclic paraffin, dodecylcyclohexane, by rat.

3H-Dodecylcyclohexane was incorporated in rat diet in order to study the metabolic utilization by mammals of a monocycloparaffin chosen as a typical naphthenic constituent of mineral oils. Dodecylcyclohexane was largely absorbed. No elimination of the hydrocarbon was observed in urine while an extended excretion of 3H occurred via this route. About 7% of absorbed dodecylcyclohexane was stored in the carcass, while the rest was omega-oxidized to cyclohexyldodecanoic acid, which incorporated into neutral lipids and phospholipids. The aliphatic chain of this unusual fatty acid underwent the normal fatty acid degradation pathways, leading to even fatty acids, squalene, cholesterol and nonlipid resynthesis, while the cyclohexyl ring was eliminated as urinary metabolites. Incorporation of omega-cyclohexyl fatty acids in phospholipids may raise a point of toxicological significance which is to be investigated.


Distribution of hydrocarbons in bovine tissues.

Liver, heart, kidneys, muscle and adipose (perirenal and subcutaneous) tissues were collected from six animals for analysis of their hydrocarbon composition. Qualitative and quantitative determinations were carried out by gas chromatography and combined gas chromatography-mass spectrometry. Although differing in the proportions, a homologous series of n-alkanes ranging from n-C12 to n-C31 was found in all the samples examined. The isoprenoid hydrocarbons phytane and phytene (phy-1-ene and phyt-2-ene) were also identified.


Determination of free choline and phosphorylcholine in rat liver.

A simple procedure for determination of levels of free choline and phosphorylcholine in hepatic tissue is outlined. The method makes use of the enzyme acid phosphatase to liberate choline from phosphorylcholine and incorporates the ability of choline to react with potassium triiodide to yield choline periodide for the measurement of choline and phosphorylcholine in liver. The method is accurate for both entities (recovery of 97-100% for choline and 92-98% for phosphorylcholine). For phosphorylcholine, the method is markedly simpler than other methods previously described and the results for normally fed rats are of the same order of magnitude. The applicability of the method was shown when it was demonstrated that diets containing different amounts of choline influenced the level of choline and phosphorylcholine in liver.


Familial pheochromocytoma, hypercalcemia, and von Hippel-Lindau disease. A ten year study of a large family.

Long-term epidemiological and laboratory studies were carried out in a kindred with familial pheochromocytoma associated with von Hippel-Lindau disease. Thirteen members were affected by the syndrome and the trait appears to be transmitted in an autosomal dominant fashion. Of 13 patients, 7 had pheochromocytoma alone. Of the remaining six patients, one had pheochromocytoma combined with von Hippel-Lindau disease, four had pheochromocytoma with retinal disease only, and a single patient had a retinal lesion without pheochromocytoma. In four patients, pheochromocytoma antedated the development of retinal lesions. Ten members also had mild hypercalcemia without accompanying elevations of PTH in the 4 patients in whom this was determined. In all, hypercalcemia was corrected with removal of tumors, and no patient had a return of hypercalcemia in the absence of recurrent increases in urinary catecholamines. The clinical presentations in 12 patients varied markedly, as did their urinary excretion rates of norepinephrine, epinephrine and their metabolites. However, an analysis of the data revealed significant correlations not previously described between the urinary excretion of free catecholamines (norepinephrine plus epinephrine), blood pressure, the free catecholamine content of the tumor and the age of the patient. Urinary excretion of free norepinephrine plus epinephrine appear to be decreased with advancing age (p less than 0.001). Both systolic and diastolic blood pressures and the age of the patient were inversely correlated (p less than 0.01). A significant inverse relationship between the tumor content of free catecholamines and the age of the patients was, although to a lesser degree, also present (p less than 0.05). As a whole, the size of the tumors and their norepinephrine content were not correlated. We present a concept that, in familial pheochromocytoma, the metabolism of catecholamines is altered by the process of aging, and that this change modifies the clinical presentations of the disease.


Membranous glomerulonephritis with extra-renal disorders in children.

Thirty of 85 children with membranous glomerulonephritis (MGN) had associated extraglomerular disorders. The relation of these associations to membranous glomerulonephritis (MGN) is discussed. The causal relationship of acute hepatitis (5 cases), persistent hepatitis B antigenemia (6 cases), systemic lupus erythematosus (2 cases) and syphilis (1 case) may be ascertained; in similar conditions a definite antigen (Ag) has been found in MGN deposits. The association with SS or SA hemoglobinopathy (3 cases) ans with a preceding streptococcal infection (4 cases) raises the possible responsibility of renal tubular epithelium (RTE) Ag and of a streptococcal Ag. D-penicillamine therapy (1 case) is a well-known cause of MGN although the acting Ag remains unknown. Four children had serum sickness-like symptoms, two had hematologic disorders and two had proximal tubular dysfunction, one of them with proven anti-tubular and anti-alveolar basement membrane antibodies. A decrease in plasma C4, Clq, and factor B with normal C3 was frequently observed. The multiple Ag previously described as causative of MGN are recalled. The prevalent incidence of HBsAg is stressed, and the necessity for further investigations in patients with MGN in order to find an underlying disease is emphasized.


Pulmonary 'mainline' granulomatosis: talcosis of intravenous methadone abuse.

Seventeen intravenous abusers of methadone underwent clinical, roentgenologic and physiologic assessment. Two complained of dyspnea on exertion and two had cor pulmonale. Of 15 patients whose fundi were examined, nine had talc particles in their retinal vessels. The chest roentgenograms of seven showed a diffuse pin-point micronodular pattern and two of the seven also manifested volume loss, one with coalescence of opacities simulating progressive massive fibrosis. Twelve patients had some degree of pulmonary dysfunction, 10 with lowered steady state diffusing capacity and 11 with decreased flow rates (FEV1 and MMF). There was no hyperinflation, but two showed an increase in residual volume. Corticosteroid therapy was attempted on two and was ineffective. Necropsy on the one patient who died revealed severe pulmonary fibrosis and talc granulomas in lungs, liver, kidneys and lymph nodes.


The syndrome of inappropriate antidiuretic hormone secretion (SIADH): pathophysiologic mechanisms in solute and volume regulation.

1. Studies on eight patients were performed to clarify the mechanism(s) of altered sodium metabolism and volume regulation in SIADH. The mechanism controlling water excretion was also studied to determine whether there is evidence that altered osmoregulation may be the basis for inappropriate ADH secretion in some patients. 2. These studies show that cumulative sodium balance and aldosterone secretion rates in patients with SIADH are negatively correlated with water intake. There is also a negative correlation between aldosterone secretion and urinary sodium excretion. In the absence of normal urine diluting ability, this increased excretion of sodium becomes a mechanism that allows an increased quantity of water to be excreted despite the persistence of an ADH effect on the renal tubules. 3. Within the range of hyponatremia observed in our studies, changes in serum sodium concentration were accounted for by changes in solute and water balance. One patient, who was potassium deficient during the studies, retained large quantities of sodium and potassium that could not be accounted for by an increase in either serum osmolality or body weight. These observations suggest that intracellular osmotically active solute is either lost or "inactivated" in some manner as intracellular potassium is replenished. 4. Marked impairment of urine diluting ability was demonstrated in all patients. However, two patients with SIADH associated with pulmonary tuberculosis exhibited graded responses to water loading, which suggests that ADH secretion may have been suppressed as serum osmolality was progressively reduced. Whether this can be attributed to a basic alteration or "re-setting" or osmoreceptor function, or is merely an indication that greater than normal reductions of serum osmolality are required to inhibit potent nonosmotic stimuli, remains to be determined.


Hematin therapy for acute porphyria.

1. A therapeutic trial of intravenous hematin is presented. Eleven cases of AIP and one of VP who did not improve with conventional treatment (high carbohydrate intake) received this new agent. 2. Urinary ALA, PBG and, when possible, uroporphyrin and coproporphyrin were used to monitor the chemical response to the treatment. Objective clinical parameters of hypertension and tachycardia were followed when present in addition to subjective estimates of acute porphyric symptomatology (abdominal pain, backache, extremity pain and paresthesias, weakness, depression, etc.). 3. At a dosage of approximately 3 mg/kg, diminution of urinary ALA and PBG excretion was achieved in every patients. Hypertension and tachycardia improved in those instances where they were observed in association with the attack. Also, subjective improvements in the clinical status of the patients were observed frequently. 4. Hematin appears to be a promising therapeutic agent for the treatment of acute attack forms of porphyria.


The clinical course of mesangial proliferative glomerulonephritis.

Patients with a pure mesangial proliferative glomerulonephritis may present with either hematuria, asymptomatic proteinuria, or nephrotic syndrome. For patients with hematuria, the clinical course is self-limited, and spontaneous resolution of recurrent episodes of macroscopic hematuria occurred in many of these patients. For patients with asymptomatic proteinuria, a spontaneous decrease in proteinuria occurred and none of these patients developed a progressive course. The clinical course of patients with nephrotic syndrome was similar to that usually observed in children and adults with pure minimal change lesions. A complete remission of the nephrotic syndrome occurred in most of these patients during treatment with prednisone and cyclophosphamide. Overall, the prognosis for the patients reported in this series was quite good.


Acquired C1 esterase inhibitor deficiency and angioedema: a review.

A case of acquired C1INH deficiency with angioedema is described. Fifteen cases are thus far recorded. The clinical syndrome of angioedema in these patients closely resembles hereditary angioedema (HAE). Most cases are associated with a paraprotein, cryoglobulin, or autoantibody, which presumably initiates C1 activation and C1 Inhibitor consumption. C1INH, C4 and C2 levels are low in acquired C1INH deficiency, as in HAE. A distinguishing feature is that C1 titers are very low in the acquired disease and only minimally depressed, if at all, in HAE. Most cases have appeared in patients with an underlying lymphoproliferative or autoimmune disease. Therapy is directed at the underlying disorder, but androgen therapy may be helpful in preventing attacks. Future potential therapeutic approaches are discussed.


[Effect of metal dust on the respiratory system. I. Experimental studies].

The Wistar rats were intratracheally administered 50 mg of PbO dust, the same amounts of metalliferous dust from one of lead--and zinc works and of ferrotungsten dust, and 10--15 mg of cadmium dust (greater doses of cadmium dust resulted in animals' death). After 6 months, and in the case of cadmium dust after 9--12 months, the animals were dissected and their lungs were morphologically examined and hydroxyproline level was determined. In all groups hydroxyproline was found to be increased but fibrosis was different, especially in the group exposed to cadmium dust.


[Effect of metal dust on the respiratory system. II. Clinical examinations].

Studies were carried out in 4 groups of workers occupationally exposed to cadmium, tungsten, manganese and lead. All those groups were homogeneous, composed exclusively of men aged 35--45, of similar height, body weight, and duration of employment above 10 years. Following the same criteria, a group of forestry workers, unexposed to dust, was randomly selected. The smoking habit was similar in all groups. Several--days--clinical observation included a detailed interview (MRC questionnaire), physical and radiological examination and a wide range of functional tests of lungs. The results reveal clinical and physiopathological symptoms which might be indicative of emphysema. The results of some studies also indicate the possibility of intraparenchymatous fibrosis of lungs in the tungsten--exposed--workers. No clear effects upon the respiratory system were found.


[Blood coagulation system in workers exposed to noise and vibration].

The authors examined the blood coagulation system in the following 3 groups of workers occupationally exposed to noise and vibration: A--those in whom the examination was conducted 7--16 hrs after finishing the work, B--those in whom the examination was conducted at the 3rd or 4th hour of work, and C--those suffering from angioneurosis of the vibration syndrome of II or III period who have not been exposed to vibration for some recent years. These investigations indicated the lack of blood equilibrium tending to hypercoagulability, shortened duration of plasma recalcination, increased elasticity coefficient of mE thromboelastogram coagulation, increased fibrinogen concentration; these changes were most evident in the group with advanced vibration disease and in those in whom the examination was conducted at their working time. Fibrinolysis duration was significantly prolonged during work, and shortened in those with advanced angioneurosis. In the opinion of the authors, those disturbances in the blood equilibrium system may be accounted for by the conformation changes of proteins.


[Effect of vibration and noise on the fat balance in exposed workers].

In 265 workers exposed to local vibration of low and medium frequencies and to industrial noise, the level of total lipids, phospholipids, beta lipoproteins and total cholesterol in the blood serum was examined. The level of all those substances, except cholesterol, was found to be increased. Based on the discussion, the possibility is assumed of the influence of the neurohormonal system upon the disturbances in lipometabolism.


[Effect of vibration and noise on glycosaminoglycan (mucopolysaccharide) and hydroxyproline excretion].

In 126 humans occupationally exposed to local vibration and in 50 humans exposed to general vibration, glycosaminoglycanuria (GAG) and hydroxyprolinuria (HP) were examined. In addition, all subjects were exposed to industrial noise. An increased GAG excretion in those exposed to the vibration of low and medium frequencies was found, which is indicative of a damage to the basic substance of the connective tissue. The exposure to the lowest frequencies increases the HP excretion, thus indicating a damage to the collagen fibers.


[5-Hydroxyindoleacetic acid and creatinine excretion in thermal stress].

The determination of 5-HIIA and creatinine excretion in thermal stress was performed in two series, in the first (I) on 102 healthy men aged 20--45 yrs (58 smokers and 55 non-smokers) and in the second one (II) on 20 men after drinking of 1 1 water immediately before thermal stress. The subjects remained at rest in the climatic chamber for 90 min in the temperature of 45 +/- 1 degrees C and relative humidity of 70 +/- 5 per cent. Thermal stress resulted in a significant increment of body temperature after 45 min and after consecutive 45 min of exposure, and lack of steady state. Creatinine and 5-HIIA were determined in two urine portions after 45 and after consecutive 45 min of exposure. Total amounts of excreted 5-HIIA and creatinine in the first urine portion in (I) and (II) were significantly higher in comparison with normal values; they did not depend on the amount of urine voided. The 5-HIIA excretion was significantly higher in smokers after the first 45 min of exposure only. Total amounts of excreted 5-HIIA and creatinine after another 45 min of exposure in (I) and (II) were significantly lower. The high correlation has been found between excretion of 5-HIIA and creatinine, indicating a similar process of excretion of both substances. Hydratation before the thermal stress exerted advantageous effect on the thermoregulation in men. The results of this study have been discussed in conjunction with the data in literature.


[Criteria used in the evaluation of the usefulness of surface-active agents in the fight against dustiness in coal mines].

The paper specifies the technical and biological criteria for evaluating the surface-active compounds used in preventing the dustiness, mainly in mines. In addition, effects of these compounds on the organism were discussed.


[Radiological picture of pneumoconiosis in welders].

In the group of 35 welders with pneumoconiosis, the evolution of radiological changes was observed, after cessation of work in exposure. In 9 cases radiological changes retreated completely; in 16 cases they were clearly reduced, whereas in the remaining 10 persons no changes in radiological picture were found. The findings indicate that the radiological changes in welders' lungs may be reversible and as such they are most probably induced by dust retention.


[Effects of detergents on lead absorption].

The effects of orally administeredated detergents (rokafenol and siarczanol) on the absorption of lead from rabbits alimentary duct were reviewed. The absorption of lead was evaluated by the activity of delta--aminolevulinic acid dehydratase of erythrocytes, delta--aminolevulinic acid level in urine and the level of lead in the blood and liver. The detergents were found to increase the absorption of lead.


Hyperglucagonemia in liver cirrhosis with portal-systemic venous anastomoses: responses of plasma glucagon and gastric inhibitory polypeptide to oral or intravenous glucose in cirrhotics with normal or elevated fasting plasma glucose levels.

Plasma immunoreactive glucagon (IRG) was examined in volunteers with biopsy-proven cirrhosis of the liver after recovery from surgical portal--caval anastomosis. A wide range of increased total plasma IRG concentrations was found after overnight fast in groups of cirrhotic subjects with and without fasting hyperglycemia. Gel filtration chromatography of plasma showed a major component in the 3500-mol wt fraction in all cases so studied. Administration  of glucose i.v. caused rapid suppression of total plasma IRG in normoglycemic and non-insulin-dependent hyperglycemic cirrhotic subjects. After administration of oral glucose, total plasma IRG was suppressed rapidly in normoglycemic cirrhotic subjects, while non-insulin-dependent hyperglycemic cirrhotic subjects exhibited delayed but prolonged suppression. Chromatography of selected plasma with glucose-suppressed total IRG showed a major decrease in the 3500-mol wt component in every case. Exaggerated increments of plasma gastric inhibitory polypeptide were demonstrable in both groups of cirrhotic individuals after administration of oral glucose, and it is speculated that this peptide may contribute to stimulation of glucagon secretion in liver disease associated with insulin deficiency.


A continuous analyzer for monitoring respiratory gases and expired radioactivity in clinical studies.

A system for the continuous monitoring of gas exchange as well as 14CO2 from metabolic studies is described. The analyzer incorporates modifications over previously published systems. These modifications include accurate control of analyzer pressure for stable baselines during the long periods of measurement, accurate control of temperature, the measurement of oxygen consumption during high oxygen patient therapy, the measurement of oxygen consumption of patients on a mechanical respirator, and describes a unique flux system to calibrate the analyzer detectors. The closed system provides expired breath data for O2, CO2, and 14CO2 on critically ill patients for long periods of time without stressing the patient and without using a face mask or mouthpiece. These data allow for the calculation of daily energy expenditures of hypermetabolic patients and for the assessment of various metabolic responses with 14C substrates.


Release of human pancreatic polypeptide and gastrin in response to intraduodenal stimuli: a case report.

A recent clinical case afforded an opportunity to study the effects of duodenal stimulation on plasma human pancreatic polypeptide and gastrin concentrations, independent of gastric stimulation. A distension stimulus was provided by rapid injection of 100 ml of water and saline via a T-tube into an isolated duodenal afferent limb. In a third experiment, the saline contained 200 pg/ml of heptadecapeptide human gastrin. Within 2 min after each injection, a rapid rise in circulating human pancreatic polypeptide levels appeared that fell promptly towards basal thereafter. Injections of 100 ml of Flexical, a supplemental tube feeding, resulted in a biphasic human pancreatic polypeptide response, the initial peak comparable to that seen following distension with water, saline, or saline containing gastrin, and a second peak of much greater magnitude and duration followed the initial peak. Plasma gastrin concentrations were not influenced following any of the stimuli. Duodenal distension alone may induce an early transient increase in plasma human pancreatic polypeptide concentrations, while intraduodenal nutrients per se may induce a later increment of greater magnitude and duration.


Human adipose tissue in culture. VIII. Studies on the insulin-antagonistic effect of glucocorticoids.

Biopsies of human adipose tissue were maintained for 1 wk in vitro with physiologic (1.5-30 X 10(-8) M) or pharmacologic (300 X 10(-8) M) concentrations of hydrocortisone or 1000 muU/ml insulin, or both. After this period, the explants were washed and incubated for 2 hr according to techniques generally used to study fat cell metabolism. Physiologic concentrations of hydrocortisone mainly exert an insulin antagonistic effect. Thus, the long-term effects of insulin in increasing lipolysis, as well as glucose metabolism to triglycerides, were reduced, as were the acute effects of insulin on these parameters. At these concentrations, the glucocorticoid itself did not influence the basal metabolic rates when due consideration was given to simultaneous changes in mean fat cell size. At higher concentrations, which may easily be reached during nonspecific glucocorticoid therapy, the glucose metabolism was reduced. Hydrocortisone decreased the number of insulin receptors. However, this cannot solely explain the insulin-antagonistic effect, since it was not overcome by a supramaximal concentration of insulin. Insulin and hydrocortisone together increased the lipoprotein lipase (lpl) activity several times. The resultant changes in LPL appear to depend upon the insulincorticosteroid ratio.