Necrotizing fasciitis of genitalia.

A review of 12 patients with necrotizing fasciitis of the genitalia is presented. All patients had rapidly progressing cellulitis and necrosis of the fascia caused by a combination of various organisms, most frequently by Escherichia coli. Beta streptococcus, which is generally thought to be the causative organism in these cases, was present in only 4 patients. Management consisted of extensive surgical debridement, urinary and/or fecal diversion, antibiotics, and necessary reconstructive procedures.


Changing concepts in management of pelvic rhabdomyosarcoma in children.

Survival with embryonal rhabdomyosarcoma of all sites has improved dramatically in recent years with the increased use of long-term, cyclic, multidrug chemotherapy. Protocols have been established and are currently being evaluated by the Intergroup Rhabdomyosarcoma Study. The management of embryonal rhabdomyosarcoma of the pelvic viscera, though, remains troublesome. Limited surgical excision is rarely possible and high-dose radiotherapy to the bony pelvis may cause severe and disabling growth disorders. Yet, survival with these lesions is increasing as with rhabdomyosarcoma from all sites and is directly related to a well-planned and aggressive multidisciplinary program. We have seen 12 cases of pelvic rhabdomyosarcoma within the last seventeen years at this institution. These cases will be reviewed in regard to varying modes of therapy and survival. Our current therapeutic approach, based on national and local experience, will be presented.


Reversible upper tract dilatation with ileal conduit stomal ulceration or encrustation.

Six pediatric patients with progressive upper tract dilatation were noted to have stomal encrustation and ulceration. In all cases, the upper tract dilatation subsided with effective conservative treatment of the stomal lesion thus obviating surgical revision of the stoma.


Leaking left hypogastric artery aneurysm causing bilateral ureteric obstruction.

A pelvic hematoma arising from a leaking left hypogastric aneurysm resulted in the acute onset of bilateral flank pain and bilateral ureteral obstruction in a sixty-four-year-old black man. Intravenous pyelogram revealed a pelvic hematoma with narrowing of both lower ureters, hydroureteronephrosis, and anterior bladder displacement. Cystoscopy revealed anterior displacement of the bladder base which appeared pulsatile. Arteriography confirmed the leaking hypogastric aneurysm, and successful surgical ligation was performed.


Ureteral colic secondary to blood clot in hemophiliac.

Cryoprecipitate therapy replaces necessary clotting factors in a patient with factor VIII deficient hemophilia. In such a patient with hematuria, cryoprecipitate therapy can initiate the formation of a massive blood clot in the urinary collecting system. A case is reported of a factor VIII-deficient hemophiliac in whom ureteral colic and poor function of the right kidney developed because of a blood clot formed shortly after cryoprecipitate therapy.


Adjuvant chemotherapy in renal leiomyosarcoma.

Our encounter with a patient with renal leiomyosarcoma prompted a survey of the world literature in which 84 cases were found. The use of chemotherapy after nephrectomy is advocated since our patient survived more than four years without metastases. The rationale for our chemotherapeutic protocol is discussed.


Multiple primary prostate cancer.

Although increasing reports are noted of apparent endometrial carcinoma of prostatic origin, the controversy is present of the actual existence of such an entity. The association of papillary prostatic cancer (endometrial or ductal) with the typical microacinar variety has also been previously presented. This report is an account of 2 cases of multiple prostatic primary tumors. The first case is the twelfth reported case of endometrial (utricular) carcinoma not only simultaneously associated with microacinar type carcinoma, but also with a previous transitional carcinoma of the urinary bladder. The second case is a papillary carcinoma and associated microacinar type with the papillary component responding dramatically to chemotherapy. Significant aspects of interest in this case include the site of papillary metastasis to the lungs, elevated estrogen levels with normalization after treatment, and finally response to chemotherapy.


Angiomatous lymphoid hamartoma or pseudolymphoma of pelvic retroperitoneum: clinical significance and evaluation of pelvic ureter.

Angiomatous lymphoid hamartomas or pseudolymphomas have been reported most commonly within the chest and usually are mistaken for thymic tumors of lymphomatous tissue. Pelvic retroperitoneal location, to our knowledge, has been described only on three occasions. Only a high index of suspicion can make one recognize this rare lesion and save unnecessary radical surgery and/or radiation therapy. Removal of the mass led to dissappearance of associated systemic manifestations in many of the patients.


Urodynamic evaluation as neurologic test of sacral cord function.

The use of urodynamic evaluation as a diagnostic tool for evaluating subtle neurologic lesions involving the second, third, and fourth segments of the sacral spinal cord is redefined. Six illustrative cases are presented.


Preoperative renal embolization as adjunct to radical nephrectomy.

Radical nephrectomy preceded by preoperative renal artery embolization using Gianturco-Anderson-Wallace steel coils has objective value as determined by comparing records of 15 patients who had adjunctive embolization with 15 patients who did not. Embolization of the major renal artery facilitated surgery allowing initial renal vein ligation resulting in reduction of blood loss and operative time. The described experience and current literature review support adjunctive embolization and document minimal risk to the patient.


Cystometry in upright position: accurate identification of decompensated bladder.

Cystometrograms obtained in the physiologic erect position have been found to picture accurately the classic decompensated bladder in women with recurrent urinary tract infections. The standard supine cystometrogram, however, may be inaccurate or normal in females with a history of infrequent voiding and prolonged vesical overdistention.


Some characteristics of recurrent calcium stone formers in Puerto Rico.

We have studied 83 patients with recurrent calcium stone formation in an attempt to determine an approximate incidence of metabolic disturbances associated with stone disease. Male veterans (n = 42), male non-veterans (n = 13), and women (n = 28) composed the group. We divided the groups in such fashion because they represented generally two distinct socioeconomic groups. Primary hyperparathyroidism was present in 19 per cent of the subjects; a marked predominance of women (15/16) was noted. Hypercalciuria of renal or intestinal origin was present in 23 per cent of the group. Of interest was a group of male veterans (17/83) in whom normocalciuria, normocalcemia, and normal serum phosphate were associated with high values of immunoreactive parathyroid hormone. These subjects had low urine phosphate. This set of findings indicates that these patients may be a new subgroup of stone-forming patients. Metabolic abnormalities could not be detected in 38 per cent of the patients. Classification of stone subjects is essential for rational management.


Primary carcinoma of ureter. Report of 27 new cases.

A retrospective analysis of 27 cases of primary carcinoma of the ureter is presented. The ages of the patients ranged from forty-two to eighty-three years, with the highest incidence between the fifth and seventh decades. Males were more frequently affected than females, and the tumors were usually found in the lower third of the ureter. Hematuria and flank pain were the presenting symptoms in the majority of cases. Poorly differentiated invasive tumors had poor prognosis when compared to well-differentiated noninvasive lesions. Total nephroureterectomy with excision of bladder cuff is the preferred treatment for ureteral carcinoma in view of the high rate of ipsilateral tumor recurrence.


Double pigtail ureteral stent.

Problems encountered in patients with ureteral obstruction treated with single pigtail polyethylene ureteral catheters (stents) were largely due to positioning difficulties, proximal migration, and irritation of the bladder mucosa by the distal flange. A new, double pigtail modification of this self-retained internal stent limits migration, minimizes irritant side effects, and facilitates endoscopic, percutaneous, and open surgical positioning over a springwire guide. These stents provide useful alternative to surgical correction or external tube diversion in many patients with complicated ureteral obstruction.


Pleural effusion secondary to ureteral obstruction.

Urinary tract obstruction may produce a pleural effusion detectable by chest x-ray film. This uncommon finding must be differentiated from intrathoracic and intraperitoneal causes of pleural effusion, including intrathoracic metastases when a malignant tumor is the cause of the urinary tract obstruction.


Spontaneous extravasation of urine in chronic ureteric obstruction.

Two cases of spontaneous extravasation of urine in chronic ureteric obstruction are presented. In 1 case the long-standing partial ureteric obstruction was caused by enlarged lymphomatous glands, and extravasation was followed by a perinephric abscess. In the second case, believed to be unique, there was a moderate chronic ureteric obstruction post irradiation, and extravasation was induced by a sudden rise in intra-abdominal pressure due to vomiting.


Review of neurogenic bladder in multiple sclerosis.

Neurologic involvement of the urinary bladder and urethral sphincter in multiple sclerosis has been known for some time. Thirty-one patients with a proved diagnosis of multiple sclerosis were evaluated urologically for symptoms of urinary incontinence, retention, or urinary tract infection. On initial presentation, 27 (74 per cent) were found to have neurogenic bladders of which 23 (85 per cent) were of the uninhibited type. Electromyography of the periurethral striated muscle revealed vesicosphincter incoordination in 9 of the 19 patients studied. Approximately one-half of the patients with uninhibited bladders had uncoordinated sphincters. Modalities of treatment are discussed.


Another look at torsion of testis.

A retrospective review was done of all patients who had been discharged with a diagnosis of testicular torsion from 1967 to 1977. Multiple staff physicians were involved at the Milwaukee Children's Hospital. Incidence, age, presenting symptoms, and testicular survival were compared with previous reports in the literature. A 69 per cent testicular survival from torsion of the testis is a marked improvement over other series. Some suggestions for other diagnostic and therapeutic acids are mentioned.


Leydig cell tumor of testis.

In adult patients with Leydig cell tumor of the testis, endocrinologic signs occur in 30 per cent of the cases and often precede the onset of a palpable testicular mass. Gynecomastia is the most common endocrinologic manifestation and probably is due to increased estrogen secretion by the Leydig cells. In the patient with adrenogenital syndrome and testicular enlargement it is difficult to distinguish Leydig cell tumor from adrenal rest hypertrophy. Four patients with Leydig cell tumor and endocrinologic manifestations are discussed; three are adults who presented with gynecomastia and the fourth is a patient with congenital adrenogenital syndrome. In the adult patient inguinal orchiectomy is the treatment of choice, while in the patient with adrenogenital syndrome initial management by high-dose steroid suppression should be attempted prior to testicular exploration.


Surgical approach to large müllerian duct cysts.

Failure of the müllerian duct system to undergo complete involution in the male embryo may result in cystic dilation of these remnants. When these cysts attain great size, they may become paopable abdominally and cause voiding symptoms. A case is presented and the operative approach described. A suprapubic approach affords the best exposure for the complete removal of large müllerian duct cysts.


Combination radiotherapy and chemotherapy in murine bladder cancer.

A murine transitional cell carcinoma tumor model has been used to evaluate the combined use of radiotherapy and three chemotherapeutic agents, doxorubicin hydrochloride (Adriamycin), cyclophosphamide, and cis-diamminedichloroplatinum. The preliminary radiation therapy evaluation demonstrated that the tumor is radiosensitive. The combined use of cyclophosphamide and radiation therapy was the most effective regimen, especially when the drug was started prior to radiotherapy. Cis-diamminedichloroplatinum and radiation were a lethal combination, but a synergistic effect was produced when the drug was given after completion of radiotherapy. Doxorubicin hydrochloride and radiotherapy may be synergistic, but more evaluation is necessary.


Spontaneous regression of renal cell carcinoma metastases after preoperative embolization of primary tumor and subsequent nephrectomy.

Preoperative arterial embolization and infarction of a large renal cell carcinoma followed by radical nephrectomy seven days later led to spontaneous regression of pulmonary metastases. However, a cerebral metastatic deposit manifested itself fourteen months after surgery, requiring craniotomy. Presently, the patient is alive and well with no evidence of disease twenty-one months after his original surgery. The immunologic implications of this favorable response to treatment are discussed, and immunologic testing of similar cases is encouraged.


Frozen semen -- a poor form of fertility insurance.

Two previously fertile males have requested surgical vasectomy reversal after divorce and failure of their new younger wives to conceive by repeated inseminations with their stored frozen semen. The sperm had been preserved for six and five years, respectively, as "fertility insurance" prior to sterilization by bilateral vasectomy. It is clear that the storage of fertile semen does not guarantee future fertility.


Psychologic effects of vasectomy in voluntarily childless men.

Forty-four childless men and 51 vasectomized parents were compared as to their childhood backgrounds, marital satisfaction, social/emotional adjustment, physical and emotional problems attributed to the vasectomy, and attitudes toward vasectomy as a means of birth control. The findings suggested that for young married men, firmly committed to childlessness and in agreement with their wives regarding the necessity of the operation, vasectomy appears to be as physically and psychologically safe as in married parents for at least a two-year period. There were differences in the childfree men and fathers in styles of adjustment, with the childfree reporting themselves to be more independent, mobile, and less tied to tradition; these differences were seen as being more related to choosing a childfree life style than to the choice of vasectomy as a contraceptive method.


Hemangioma of scrotum, perineum, and buttocks.

A case of cavernous hemangioma of the scrotum with involvement of the perineum and buttock is presented and discussed.


Lymphangioma of scrotum.

A case of lymphangioma of the scrotum is reported. The presenting symptoms of this unusual tumor are an increase in size of the lesion with tenderness or persistent lymphorrhea. Total surgical excision is the definitive treatment.


Wegener granulomatosis. Unusual cause of necrotizing urethritis.

We report a case of Wegener granulomatosis presenting as a destructive urethral mass. The initial clinical impression was carcinoma, and a urinary diverting procedure was considered before the correct diagnosis was established. The importance of recognizing this unusual disease and its dramatic response to appropriate therapy are emphasized.


Virilizing adrenal cortical carcinoma with hypertrophy of spermatic tubules in childhood.

A review of adrenal cortical carcinoma in childhood is presented, including endocrinologic aspects. Electron microscopic features are presented, as well as the finding of hypertrophied spermatic tubules. The importance of serial steroidal determinations is stressed as a "tumor marker" that may help in early detection of recurrent disease and possibly increased long-term survival.


Interstitial cell tumor of testis: a delicate problem.

Interstitial cell tumor of the testis is a rare tumor in humans. There have been 39 cases reported in children and 13 malignant tumors in adults. Two cases of interstitial cell tumor in childhood, 5 benign types in adults, and 2 malignant tumors are presented herein. In regard to the therapeutic consequences, a plea is made to define the malignant potential of the tumor on histologic criteria alone.


Leukemic infiltration of penis.

Leukemic infiltration of the urinary tract is most common in the kidneys. Other areas are involved much less frequently. We report a case of leukemic infiltration of the penis.


South American blastomycosis of epididymis.

Reported herein is the first Brazilian case of epididymal involvement by South American blastomycosis, and apparently the second case to be reported in the world literature.


Clinical dilemma in management of yolk sac tumor of childhood testis.

An "expectant" approach to management of yolk sac type testis tumors in two boys led to therapeutic failure. The rationale for such "nontherapy" in light of current knowledge is discussed. The need for more sophisticated tumor staging as well as improved chemotherapeutic approaches in treatment planning is suggested.


Ammonium acid urate stones in Navajo Indian children.

Three Navajo children presented with a total of five upper tract acid urate stones. Although this stone is thought to be rare in the United States, it may be more common than is generally believed. Age, diet, environment, and in some instances urinary tract infection may be predisposing factors in the development of acid urate stones. Possible prophylactic measures are briefly discussed.


Idiopathic calcinosis of scrotum.

A forty-three-year-old man complained of painless, firm scrotal nodules which had first appeared at age sixteen. These were diagnosed clinically as multiple epidermoid inclusion cysts and were excised. Histologically they were composed of calcified, amorphous, granular material, characteristic of idiopathic calcinosis of the scrotum. This is a rare, benign condition without any recognized underlying metabolic abnormalities. The cause of idiopathic calcinosis of the scrotum is unknown, but we believe it is due to dystrophic calcification of dartoic muscles.


How accurate is angiographic staging of renal carcinoma?

Angiographic interpretations were compared with the pathologic findings of 75 patients undergoing nephrectomy for renal carcinoma. Angiography correctly predicted the clinical stage in only 36 per cent of the cases. This failure rate was attributed to the lack of consistent radiologic criteria for determining invasion of the perinephric fat, renal vein, and extension to regional lymph nodes.


[Transcutaneous catheterization of the vena cava superior through the internal jugular vein in children].

The use of the internal jugular vein together with other branches of the superior vena cava for the percutaneous catheterization of the latter is a method broadening the possibilities for organization of longlasting infusions in children; besides, the anatomical peculiarities of the internal jugular vein provide for a high precision of the localization of the catheter in the superior vena cava.


[Effect of the type of anesthesia and the parameters of single-lung ventilation on the extent of venous shunt in lung surgery].

As a result of the studies, carried out upon 30 patients following lung operations, it has been found that an optimal hyperventilation of a single lung with an increased oxygen level in the respiratory mixture prevents the occurrence of hypoxemia and hypercapnia.


[Effect of artificial hyperventilation of the lungs on acid-base equilibrium and blood and cerebrospinal fluid gases in patients with postoperative psychosis].

The alkaline shift of blood Ph together with marked metabolic acidosis in the liquor were found postoperativery in 42 patients operated upon the colon and small intestine at the height of postoperative psychosis. The patients developed tachipnoe up to 32-36 per minute, followed with a great energy expenditure. As a consequence, artificial pulmonary ventilation (APV) at the  hyperventilation regime was administered to a part of the patients to correct acidosis of the liquor. Postoperative psychotic patients need an early administration of the APV at the hyperventilation regime, which is one of effective methods of correcting liquor acidosis in the complex therapy of psychoses.


[Selection of a method and surgical tactics in late repeated operations on the lungs and pleura].

The experience with the surgical treatment of 97 patients subjected to late repeated operations on the lungs and pleura is generalized in this work. 68% of these patients had pleural empyema and bronchial fistulae. The authors prefer the radical surgery to pulmonectomy, pleuropulmonectomy, decortication, lung resection and repeated amputation of the main bronchus. Fatality in the late repeated operations was noted in 3.09% of cases and complications--in 10.3%.


[Hemodynamic changes and nephropathy associated with surgery in obstructive jaundice].

Some marked changes of central hemodynamics resulting in functional renal disorders have been found in patients with mechanical jaundice. The hemodynamics may help in normalization of renal hemodynamics indices.


[State of the glucocorticoid function of the adrenal glands in gynecological patients operated on under epidural anesthesia balanced with sodium oxybutyrate].

The alterations of hydrocortisone concentration in the blood serum have been studied in 29 gynecological patients. Epidural anesthesia combined with sodium hydroxybutyrate surface anesthesia prevents an unnecessary activation of the hypothalamo-pituitary-adrenal system. A sedative effect of sodium hydroxybutyrate favours the elimination of emotional stress in patients. The preservation of an adequate and not excessive adrenocortical response to the surgical trauma has been noted as well.


[New method of endoprosthesis of the femur head].

The author has developed an original method of endoprothetics of joints (application N 2651054/13). Endoprothesis is fabricated from plastics to a cast taken from the removed articular end of the bone. This allows to manifacture an exact replica. An individual endoprothetics has been used successfuly in the treatment of 12 patients with fractures and pseudoarthroses of the femoral neck.


[Ways of reducing the extent of amputation of the limbs in endarteritis obliterans].

As a result of the development of vascular surgery, the interest in so called "minor surgery" (exarticulation of the toes, transmetatarsal amputation of the foot) has been resuscitated of late years. A comparative analysis of various methods of the treatment of 145 patients with obliterating endarteritis of Stages IV and V is performed. An intense pre- and postoperative therapy, hyperoxybarotherapy included, was carried out. The patients were subjected to sympatectomy, intraarterial infusion and skin plasty.


[Changes in microcirculation and respiration in acute intra-abdominal pathology according to electrokymographic data].

Electrokymography was applied for studies of pulmonary circulation and ventilation in 31 patients. A decrease of pulmonary circulation by 23.3% and lung ventilation reduction by 15.6% were found. The disturbance of circulation and ventilation ensues from the changes of microcirculation in acute intraabdominal pathology.


[Gastrostomy and esophagoplasty with a pedicle graft from the greater curvature of the stomach as stages in surgical and combined treatment of cancer of the thoracic esophagus].

Not infrequently cancer of the middle and lower thirds of the esophagus metastasizes into the subfrenic lymph nodes, which justifies a revisional laparotomy for completing the diagnosis of the tumor process spreading. A peduncular gastrostomy is carried out at the revisional laparotomy. A one-stage  operation of extirpation and plasty of the esophagus with a stomach tube, housed in the bed of ablated esophagus, involves a great risk and is followed by a high fatality rate.


[Surgical treatment of non-neoplastic lesions of the terminal portions of the biliary and pancreatic ducts and major duodenal papilla].

The author presents his classification of the operations on major duodenal papilla and terminal portions of the common bile and pancreatic ducts. Indications for various types of operations are set forth.


[Abacterial principle in surgery].

The authors dispose an experience with 250 surgical interventions with employment of abacterial insulators. The operations were carried out upon the abdominal organs, thorax, bones, vessels, urogenital organs etc. in neonates and elder children. A number of advantages of the surgical method with employment of abacterial insulators are ascertained.


[Endorectal "Shchetkin symptom" in acute surgical diseases and injuries of the abdominal organs].

The results of the digital rectal examination of 218 patients with "acute abdomen" syndrome are generalized here. 145 patients (66.5%) showed a greater pain-fullness at the detachment of the finger from the anterior wall of the rectum than at the pressing on the latter. 183 patients were operated upon; in 126 of them free liquid was found in the abdominal cavity. The endorectal "Shchetkin symptom" was positive in 79% of operated patients (in 93.7% of patients with abdominal free liquid found at the operation).


[Effect of perfusion of the abdominal cavity on the course of the postoperative period].

The perfusion (washing) of the abdominal cavity with isoosmomolar solution by I. I. Deryabin and M. N. Lizanets method following operations carried out upon 104 gynecological patients and 26 cases of Caesarean section was carried out. The perfusion did not bring about any unfavourable effect upon the postoperative clinical course or noxious effect upon the mesothelium of the abdominal cavity. No reliable changes in the biochemical and electrolytic blood composition were shown. The method aided in the prevention of enteroparesis, peritonitis and adhesive disease.


[Comparative evaluation of remote results of radical and conservative operations in initial forms of rectal cancer].

According to the authors' data, the 5 years' survival following economic resections of the rectum for cancer is not worse than that after radical operations, done on properly determined indications.


[New features in the course and outcome of treatment of lactation mastitis].

An analysis of the outcomes of the treatment of 150 patients with lactational mastitis has warranted the conclusion on a secondary origin of the disease in many cases. Not infrequently lactational mastitis occurred as a result of a pathological delivery and hospitalism, in 8% of patients lactational mastitis being nothing but a local manifestation of a general purulent infection--sepsis. In the most of patients a radical dissection of the abscess has proved to be an effective and sufficient therapeutic method. The greatest difficulties were encountered in the treatment of sepsis with necrosis, sequestration or fusion of vast portions of the mammary gland.


[Tuberculosis of the breast].

The author observed 6 cases of mammary gland tuberculosis. 3 patients showed disseminated nodular form of mammary gland tuberculosis, 2--sclerotic form and 1--ulcerative form. Contrast-free mammography is an essential aid in diagnosis. Surgical intervention with postoperative specific antibacterial therapy is a radical method of treatment. Sectoral resection of the mammary gland should be carried out in young patients and amputation--in elderly ones.


[Surgical treatment of acute occlusion of the main arteries of the arm].

An experience with the treatment of acute occlusions of the upper limbs vessels in 41 patients is presented. The conservative treatment of 10 patients has brought about poor results (2--gangrene, 5--considerable functional disorders of the limb). 31 patients were subjected to surgical treatment. Complete restoration of the circulation in the limbs occurred in 19 patients, a satisfactory compensation of the circulation occurred in 8 patients. The amputation of fingers was carried out upon 4 patients.


[Transbronchial transthoracic sanation of chronic suppurative foci in the lungs].

A new method of bronchial sanitation consisting in conducting a polyurethane tube through the pulmonary tissue and thoracic wall outward under the bronchoscopy control is suggested. The method has been used successfully in 22 patients.


[Pathogenesis of pulmonary complications in severe mechanical non-thoracic trauma].

On the grounds of morphologic studies the authors suppose that pulmonary complications of a severe mechanical trauma without injuries to thoracic organs are due to microcirculatory disorders and to microatelectases resulting from the trauma.


[Open diaphyseal fractures of long tubular bones in traffic accidents].

An analysis of the treatment of 203 patients with open diaphysial fractures of the long tubular bones, resulting from motor-road accidents has been carried out. Late results have been studied in 134 cases (66%) with follow-up ranging from 1 to 10 years. 69% of them have completely restored their working capacity with the possibility to return to their previous work. The results of the treatment were estimated in three-mark grading system terms: 55.7% of all the examined patients showed good results, 30.9% showed fair results and 13.4% showed poor results (pseudoarthrosis, malunion, osteomyelitis).


[Diagnosis and treatment of nerve injuries in fractures and bone diseases in children].

The author observed 78 children with injuries to the nerves. In 49 patients the injury was due to fractures or bone diseases. In 29 patients the nerve injuries were associated with the bone surgery (osteosynthesis, open reposition of fragments etc.) Peculiarities of the diagnosis and treatment of nerve injuries in children are described.


["Isolated" volvulus of the small intestine in newborn infants and its surgical treatment].

Malformations of the structure and fixation of the small intestine mesentery in nenates constitute essential morphologic predisposing factors for the occurrence of an "isolated" volvulus and are responsible for clinico-radiological peculiarities of the pathology. The children, operated upon for "isolated" small intestine volvulus, who had shown this pathology, should be under a prolonged medical supervision.


[Functional evaluation of reduction of venous outflow from the testis in left-side varicocele in children].

A functional state of venous return from the testicles was estimated on the grounds of a direct measurement of pressure gradients among main points of venous return on 61 unoperated adolescents, aged from 13 to 15, and with marked varicocele; and in 10 children of the same age without varicocele (a control group). The results of the estimation have proved that the hydrostatic pressure in the veins of the pampiniform plexus is directly responsible for their hyperdistension in the vertical position. An exceptional role of renal venous hypertension in the genesis of varicocele in children is doubtful.


[Technic for restorative operations in injury to the proximal portion of the femoral vein].

Some problems of surgical treatment of wounds of the proximal portions of the femoral vein are discussed. Considering the development of chronic venous insufficiency, resulting from the ligation of the vein at this level, the necessity of a timely restoration of the main blood flow in such vascular injuries is noted.


[Disputable and indisputable questions in the problem of traumatic shock].

When characterising the so called disputable and indisputable points in the traumatic shock problem, the authors acquaint the reader with phases of the development of shock and with its symptoms, which facilitates significantly diagnostic possibilities and allows to follow the dynamics of the disease. The physicians will benefit from the scheme of antishock therapy suggested by the authors.


[Clinical characteristics of the early postshock period in traumatic disease].

The clinical course of an early (up to 14 days) postshock period of traumatic disease in 112 patients, treated for a combined trauma complicated with shock, has been studied. It has been established that within first 2 days after shock more than half of the patients develop increased coagulative activity of the blood, which rises still more in the following period. Progressive anemia, connected apparently with hemopoietic depression, is characteristic of the postshock period. In the second period (3--14 days after trauma) 60% of examined patients showed hypokalemia. A great percentage of inflammatory complications is likely to be due to the decrease of the defense--adaptative mechanisms, resulting from changes of the reactivity in the injured after shock.


[Determination of the free oxygen tension in the tissues of the lower extermities in varicose disease and the postthrombophlebitic syndrome].

The determination of the free oxygen tension in the calf muscles was carried out in 118 patients with varicosis and postthrombophlebitic syndrome. It was found that with the progress of hemodynamic disturbances the severity degree of chronic tissue hypoxia rises. In early postoperative period in patients operated upon during the compensatory and subcompensatory stages of venous reflux the polarography indices proved a considerable improvement of the tissue oxygen balance.


[Diagnosis of incompetent communicating veins in contrast medium-sensitive patients].

A new functional method of phlebotonometry was used by the authors in 36 contrast--sensitive patient with postthrombophlebitic syndrome and varicosis for the purpose of diagnosing incompetent calf communicants. The determination of venous pressure in the superficial veins in these patients should be carried out between tourniquets three times at rest and against the backgrounds of the Valdman's test with the patient in a horizontal position by means of Valdman apparatus with elongated capillary tubes.


[Gangliectomy in the treatment of obliterating arterial diseases of the lower extremities].

The work is based upon the experience with the treatment of 400 cases of obliterating diseases of the lower limbs arteries by means of gangliectomy. The evaluation of the operation is grounded on 2- and 10-years observations over the patients. When the blood flow insufficiency is not too severe, it, most commonly, results in a considerable decrease of the intensity of intermittent limping and favours the removal of destructive lesions. Beneficial results of the surgery most often persist for many years. In a higher obstruction of the arteries the results are somewhat poorer, the same as in case of obliterating atherosclerosis when compared to obliterating endoarteritis.


[Use of a membrane oxygenator for correcting acute, experimental respiratory insufficiency].

A model of acute respiratory insufficiency ARI was created in the experiments on 16 dogs by means of a valvular device furnishing a free inhalation and a limited expiration. The diaphragmatic oxigenator devised in VNIIP with an armoured diaphragm of "Sigma"--type was switched on at the height of ARI. 3 hours' perfusion corrected successfully the manifestation of hypercapnic hypoxia. The pulmonary function restored after the experiment.


[Polycystosis of the liver].

The authors operated 15 cases with polycystotic liver. The diagnostic value of ultrasound echolocation and hepatoscanning in polycystosis was noted. In authors' opinion the surgical treatment of polycystotic liver should be carried out in due time during the clinical manifestations phase and ought to be radical enough to yield satisfactory results.


[Anthropometric and topographic characteristics of the gallbladder in cholecystitis].

Anthropometric studies were carried out upon 228 patients with cholecystitis, and the findings were compared to those obtained in the control group. The location of the liver anterior margin, projection of the gall-bladder fundus, the upper point of the gall-bladder, the site of the fusion of the cystic duct and the hepaticocholedochus versus the spine and the costal arch margin were studied in 174 patients. On the grounds of these studies a classification embracing 9 variants of the gall-bladder position has been suggested together with some variants of oblique incision in the right subcostal region with regard to the individual topography of the gall-bladder.


[Characteristics of the pathogenesis and treatment of acute cholecystitis in the middle-aged and elderly].

On the grounds of 98 own clinico-pathomorphologic studies and analysis of 112 records the authors have come to the conclusion that at the root of the pathogenesis of acute cholecystitis in elderly and senile patients is the disorder of the gall-bladder wall blood supply, resulting from thrombosis of atherosclerotic vessels against the back-ground of increased coagulation. The authors believe, that the treatment of cholecystitis in these patients with drugs, decreasing the coagulation of the blood and improving hemocirculation, has pathogenetic grounds.


[Resection of the pancreas in necrotic pancreatitis].

The grounds for expediency of pancreatic resection in various periods of the necrotic pancreatitis clinical course are presented together with the description of a simplier technique of a left-side resection of the gland combined with spleenectomy. The left-side resection of the pancreas was carried out in 74 cases, pancreatoduodenal resection--in 1 patient. 4 patients died.


[Creation of a model of chronic pancreatitis].

A model of chronic pancreatitis has been created in 13 mongrel dogs. The animals were withdrawn from the experiment 2 months after the beginning of it. According to the author's data, artifically created insufficiency of the constrictors of the common bile and pancreatic ducts in dogs is analogous to unfitness of the sphincter in man and results in the development of the changes in the abdominal cavity, specific for chronic pancreatitis.


[Surgical complications of ascariasis and their treatment].

548 cases of abdominal complications of ascariasis such as intestinal ileus--208 (37.9%), perforation of the intestinal wall and postoperative complications--35 (6.4%), appendicitis--26 (4.8%), gastrointestinal bleedings--11 (2%), lesions of the bile passages, liver and pancreas--25 (4.6%) and pseudoabdominal syndrome--243 (44.3%), have been analysed. Consideration has been given to the peculiarities of the diagnosis and treatment. The total lethality constituted 4.4%. The highest fatality occurs in case of the lesions of the hepatobiliary system and destructive injuries to hollow organs.


[Primary multiple malignant tumors of different localizations].

The authors observed 57 patients with primary multiple tumors of various localization. The intervital diagnosis of polyneoplasms was established in 37 patients, the second tumor was found in 20 of 57 cases at the autopsy. 2 neoplastic nodes were found in 52 cases, 3-- in 4 cases, in one case 6 primary multiple neoplasms were found in the sigmoid colon (5 malignant polyps and 1 ulceroinfiltrative carcinoma).


[External intestinal fistulae].

The authors describe external intestinal fistulae found within 11 years at 5000 urgent operations on abdominal organs in 56 patients. 20 of them showed fistulae of appendicular origin, 15 developed fistulae following various traumas of abdominal organs, 1--after intestinal ileus, in 3 cases fistulae were due to incarceration of hernia, in 17 cases external fistulae were applied in intestinal neoplasms. Small gut fistulae were noted in 15, colon fistulae--in 41 patients. The total of 19 patients died, most of them had malignant intestinal neoplasms.


[Pathomorphological changes and the level of intestinal resection in acute occlusion of the mesenteric vessels].

The analysis of 239 case histories and of 229 autopsy recores of patients died from this disease in set forth in the article. The ratio of mesenteric thrombosis and embolism constituted 2.78% of all the autopsies. The occlusion of the superior mesenteric artery was found in 76.0% of all the autopsies, of the mesenteric veins--in 14.7%, of the inferior mesenteric artery--in 4.2%, of both superior and inferior mesenteric arteries--in 4.2% and of the celiac and superior mesenteric arteries--in 0.83%.


[Method of computing the electrolytes in correcting water-salt metabolic disorders].

The derivation of a unified equation for carrying out the correction of any anion and cation deficiency of the blood plasma is set forth. A scheme of the correction of the most important plasma electrolytes deficiency is suggested. The main principle of the scheme is to begin the correction from a smaller deficiency.


[Treatment of peritonitis in abdominal injuries].

According to the author's data, peritonitis occurred in 250 (20.8%) out of 1200 cases of abdominal injuries, 69 of these 250 patients died (27.6%). The main means combating this complication was an early surgical intervention. A complex of postoperative therapeutic procedures, aimed at the prophylaxis and treatment of peritonitis in these patients, is described.


[Creatine kinase test in frostbite].

The activity of blood serum creatine kinase was studied in 37 cases with various degree of frostbites and in healthy individuals. The dynamic study of blood serum creatine kinase in frostbites cases during the first week allows for the differentiation between deep and superficial frostbites.


A light and electron microscopic study of a normal adrenal medulla and a pheochromocytoma from a horse.

The outer medullary (juxtacortical) zone of a normal equine adrenal gland had columnar chromaffin-positive cells arranged with their long axes perpendicular to fine vascular channels. The deeper medullary regions were composed of smaller irregularly round to polygonal chromaffin positive cells in small packets. Both cell types contained two types of membrane-bound cytoplasmic secretory granules. Osmiophilic granules with a homogeneous core, crenated membrane and narrow submembranous halo predominated in the columnar juxtacortical cells. The rounder, central medullary cells contained predominantly electron dense granules with a wide irregular electron lucent space between an eccentric core and the granule membrane. In contrast, irrespective of cell type or zone, cells from a pheochromocytoma contained only one type of granule similar to that described for the juxtacortical region of the normal equine adrenal medulla. The tumor cells could be classified into three subtypes based on density of granule packing but the granules were morphologically similar in all tumor cells.


A lymphomatoid granulomatosis of the lungs in young dogs.

Clinical signs in three young dogs with primary lung neoplasms included cough, weight loss and anorexia. Chest radiographs taken in the terminal stages of the disease showed nodular and diffuse consolidation of the lungs typical of primary neoplasms. Macroscopically the lungs were infiltrated by firm, pale tissue; similar tissue replaced the enlarged bronchial lymph nodes. In two dogs similar deposits were found also in the liver and spleen. The infiltrates were composed of atypical, polymorphous lymphoreticular cells. Invasion of pulmonary blood vessels and of bronchi and bronchioles was striking. The lesions closely resembled those of lymphomatoid granulomatosis, a rare human disease of unknown cause.


Polioencephalomyelitis in cats.

Six cats with chronic progressive neurologic signs of ataxia, paresis, tremors, pupillary abnormalities and seizures had polioencephalomyelitis of probable viral origin. Lesions were most severe in the spinal cord. The uniformity in distribution and nature of the lesions in all six cats strongly suggested a common cause. The condition was compared with other viral infections of known and unknown cause.


Fatal mycotic pulmonary disease of captive American alligators.

Fatal pulmonary disease occurred in two captive American alligators. The entomopathogenic fungus, Beauveria bassiana, was isolated from pulmonary lesions in both alligators. An extended hibernation period because of a severe winter and a failure of the zoo heating system may have predisposed the alligators to infection.


Ulcerative glossitis and stomatitis associated with exudative epidermitis in suckling swine.

Thirty piglets 1 to 4 weeks old from five herds had epidermal, foot, conjunctival and renal lesions typical of exudative epidermitis. Ten piglets had a large central ulceration of the dorsum of the tongue. Three piglets had multiple erosions of the hard palate and one had mucoid degeneration of the urinary bladder epithelium and a thick viscous material in the renal pelvis, ureters and urinary bladder.


Histology of salivary gland infarction in the dog.

Salivary gland infarction was found in two adult dogs. The main changes were ischaemic necrosis, capsular fibrosis and regenerative hyperplasia of surviving ductal epithelium. Necrosis of arterial tunica media and thrombosis were found only in the infarcted parts of the salivary glands. The lesions appeared to be confined to the salivary glands; no cause of the infarction was found.


Megaloesophagus and associated gastric heterotopia in the cat.

Two young adult male Siamese cats had heterotopic gastric mucosa in the dilated and inflamed oesophagi. Normally differentiated gastric mucosal glands were present and there was severe ulceration in one cat. It is uncertain whether the gastric heterotopia was a reparative change after oesophagitis or whether it represented a coincidental anatomical anomaly.


Studies on the pathogenesis of swine dysentery. I. Characterization of the lesions in colons and colonic segments inoculated with pure cultures or colonic content containing Treponema hyodysenteriae.

Swine dysentery was induced in pigs and in ligated colonic segments by inoculation of pure cultures of, or colonic contents containing, Treponema hyodysenteriae. The mildest changes, best seen in ligated segments 48 or 72 hours after inoculation, were congestion and leucocytic margination in mucosal capillaries and depletion of mucigen from goblet cells lining the base of the crypts of Lieberkühn. Superficial mucosal necrosis and crypt cell hyperplasia were later changes. Perfusion studies with India ink did not demonstrate occlusive mucosal ischemia in acute swine dysentery. Mucosa with lesions of swine dysentery contained at least 10(5) colony forming units of T. hyodysenteriae per gram. Mucosa without lesions had 10(5) or fewer T. hyodysenteriae per gram. Segments with acute swine dysentery were distended with clear mucoid fluid with electrolyte composition indicative of net colonic secretion. No increase in the concentration of volatile fatty acids was detected in content from intact colons or colonic segments with lesions of acute swine dysentery.


Porcine nephropathy induced by long-term ingestion of ochratoxin A.

Nine pigs were fed crystalline ochratoxin A in their feed at a concentration of about 1 mg/kg. Three pigs and their controls were killed after 3 months and 6 pigs and controls were killed after 2 years. A decrease of the ratio TmPAH/CIn, increased urinary glucose excretion and decreased ability to concentrate urine, occurred within a few weeks and aggravated slightly during the 2-year period. Changes in renal structure, characterized by degeneration and atrophy of proximal tubules, interstitial fibrosis and hyalinization of glomeruli, were progressive during time of exposure, but terminal renal failure was not reached. The kidney, liver, muscular and adipose tissue contained 3 to 27 microgram ochratoxin A/kg after 3 months of exposure. No further accumulation of ochratoxin A residue was found after 2 years of exposure.


Effects of Jatropha curcas on calves.

Jatropha curcas seed was fed to six calves at doses of 2.5, 1 and 0.25 g/kg once and to two other calves at 0.025 g/kg up to 14 days. The onset of toxic manifestations in the six calves was rapid and death occurred within 19 hours of administration. The two calves that received daily the lowest dose of J. curcas showed signs of poisoning and died within 10 to 14 days. The clinical signs of diarrhoea, dyspnoea, dehydration and loss of condition were well correlated with the pathological findings. There was an increase in aspartate aminotransferase, ammonia and potassium and a decrease in total protein and calcium in the serum of jatropha-poisoned calves.


Colonic obstructions due to enteroliths in four horses.

Four cases of enterolith obstruction in horses aged from six to 14 years are reported. All four cases had symptoms of persistent low grade abdominal pain and anorexia with an absence of defaecation. Examination revealed reduced gut motility and accumulation of gas, but heart and respiratory rates, rectal temperatures and complete blood counts were all within normal limits. Enteroliths of varying sizes were removed from the region of the transverse colon in all four horses.


Spongy transformation of the brain in sheep with lupinosis.

Spongy transformation in the brain of sheep affected with chronic lupinosis in the field is described. Identical lesions were reproduced in sheep with experimental acute and chronic lupinosis. The primary brain lesion was vacuolation of the white matter of the brain stem with no malacia, neuronal damage or gliosis being present. The extent and severity of the vacuolation was related to the severity of the liver lesion.


Experimental sarcoptes scabiei infestation in pigs: (2) Effects on production.

A study on the development and effect of experimental Sarcoptes scabiei var suis infestations in growing pigs is described. Pigs were infested at either weekly or fortnightly intervals throughout each experimental and individual growth rates and feed conversion ratios were determined. The animals were fed diets which contained either optimal or sub-optimal levels of protein. They were housed either intensively or extensively. In all experiments the majority of infested animals developed a generalised hypersensitivity to sarcoptes mites and performed significantly less efficiently than non-infested littermates. Mean growth rates were depressed from 9.2 to 12.5 per cent and feed conversion efficiencies by a similar margin. Well fed, intensively housed pigs developed a more severe hypersensitivity reaction than poorly fed, extensively housed pigs.


Mackellar Memorial Lecture. The veterinary profession in the EEC.

The European Economic Community was one of the major concerns of the later years of the late Campbell MacKellar. Besides being deeply involved in the affairs of the UEVP--the body representing the practising arm of the veterinary profession in Europe--he was one of the United Kingdom's representatives on the Federation of Veterinarians of the EEC over a period which saw that body emerge into an active pressure group with a real contribution to make to veterinary affairs within the Community. So said Alastair Porter in his introduction to the first MacKellar Memorial Lecture, which he gave last autumn. The following article is abridged from Mr Porter's address.


The use of alpha blockade in the treatment of congestive heart failure associated with dirofilariasis and mitral valvular incompetence.

Four dogs with congestive heart failure associated with dirofilariasis and mitral valvular incompetence initially responded to treatment with digoxin or etamiphylline camsylate, and frusemide but became refractory to this therapy and were in cardiac decompensation. Frusemide dosage was increased and the alpha adrenoreceptor blocking drug prazosin hydrochloride was added to the therapeutic regime. Six weeks later all dogs were stabilized and their clinical condition was markedly improved.


Ischaemic necrosis of the navicular bone and its treatment.

In a survey of 95 control horses and 16 horses with navicular disease, the incidence of erosions and discoloration of the flexor cartilage of the navicular bone was no different between the control horses and those with navicular disease. All cases of navicular disease showed thrombosis of the distal navicular nutrient arteries and this could be related to a change to a rounded or flask shape of the distal nutrient foramen of the navicular bone. Erosions and discoloration of the navicular bone are therefore of no significance in navicular disease. Previously described lines of treatment are of little value in the treatment of navicular disease. Preliminary experience with the use of anticoagulant therapy may indicate another alternative form of treatment, but the long term results have yet to be assessed.


Cervical vertebral instability (wobbler syndrome) in the dog.

Observations on a series of 38 cases (35 Doberman Pinschers and three Great Danes) of the canine wobbler syndrome are described. Radiographic examinations suggested that the primary lesion is an intervertebral instability at C6/7, but with time, secondary changes of the disc degeneration and prolapse and vertebral body malformation causing stenosis of the vertebral canal occur. Cases detected at a young age and showing only the primary lesion were treated successfully, by disc fenestration alone or by disc fenestration and intervertebral screwing. The success rate in older cases with secondary lesions was poor and in this type of case, cord decompression by dorsal laminectomy appears necessary.


A survey of gastro intestinal helminth parasites of stray dogs in Zaria, Nigeria.

A survey of helminth parasites in stray dogs was carried out in the Zaria area. Out of 180 dogs examined 65.6 per cent (118/180) were found positive for Ancylostoma caninum, while Toxocara canis and Trichuris vulpis were detected in 41.1 per cent (74/180) and 13.9 per cent (25/180) respectively. Other helminth parasites found Taenia ovis 35 per cent (63/180) Taenia hydatigena 67.8 per cent (122/180), Echinococcus granulosus 0.006 per cent (1/180) and Dipylidium caninum 97.8 per cent (176/180).


[Effect of precipitating antibodies to pancreatic kallikrein on arginine esterase contact activation in human and rabbit blood].

Effect of precipitating antibodies against pig pancreatic kallikrein on the BAEE-esterase activity was studied in human blood plasma and in rabbit blood serum, activated by kaolin. An inhibitory effect of the antibodies on the increased BAEE-esterase activity was observed within the first minute of incubation after treatment with kaolin. The inhibition of the BAEE-esterase activity constituted 65.1% in human blood plasma and 40.9% in rabbit serum. Possible mechanism is discussed on the inhibition of contact activation of arginine esterase in human and rabbit blood by antibodies against pancreatic kallikrein.


[Participation of protein-lipid complexes in the mineralization of dental enamel].

Insoluble complex protein-lipid-calcium phosphate was formed on neutralization of dental enamel solution. Nonpolar lipids were extracted by chloroform-methanol mixture; the phospholipids maintained their connection with the solid phase. After incubation of the enamel precipitate with an anionic detergent the enamel protein became solubilized and was studied by means of electrophoresis. The role of proteins and lipids in calcification of the dental enamel is discussed. Biological calcification appears to operate via a universal mechanism, as evidenced by similarity in molecular structures of organic mixtures of various mineralized tissues.


[Use of alpha-ketobutyrate for the differential determination of the activities of lactate dehydrogenase isoenzyme subunits].

Estimation of alpha-ketobutyrate dehydrogenase activity might be used for quantitative evaluation of LDH isozyme subunits H and M. Empiric constants, which are included in equations for calculation of the activity of subunits and applied for purified human LDH isoenzymes, were not altered in presence of blood serum and were quite reproducible from day to day. Reliability of quantitative differentiation of the activities of H and M subunits by means of alpha-ketobutyrate was demonstrated by analyses of standard LDH isoenzyme mixtures as well as normal and pathological blood sera with typical patterns of LDH isoenzymes. Estimation of activity of the LDH isoenzyme subunits using alpha-ketobutyrat e proved to be rapid, simple and unexpensive method for determination of LDH isoenzyme spectra in physiological fluids.


[Changes in the noradrenaline content in the rabbit myocardium in electrostimulation of the aortic arch].

Excessive stimulation of reflexogenic zone of rabbit aortic arch resulted in impairments of noradrenaline tissue reserves in heart muscle. Administration of one of the precursors of noradrenaline l-DOPA not only prevented the decrease in tissue noradrenaline content in myocardium, but restored completely its reserves, exhausted by electrostimulation of the aortic arch.


[Zinc- and copper-containing superoxide dismutase activity in rat tissues normally and in hypoxia].

Acute hypoxic hypoxia caused a distinct decrease in activity of Zn2+, Cu2+-containing superoxide dismutase in cytosols of rat liver and brain tissues and less distinct--in liver mitochondria and microsomes, brain mitochondria and blood plasma. On the basis of the data published in the literature, hypoxic inhibition of the enzyme appears to be the significant reason for the posthypoxic activation of synglete-oxygen pathway of lipid peroxidation in tissues, enriched with catalase [liver, kidney, blood ] as well as of hydroxyl-radical pathway of peroxidation in tissues with the low catalase activity [brain, heart, lungs].


[Effect of anabolic steroid hormones on protein and lipid metabolic indices in thermal injury].

Burns of 20% of rat skin caused a decrease in content of albumins and gamma-globulins in blood and simultaneous increase in content of alpha 1- and alpha 2-globulins. Content C17 : 1 and C19 : 1 monoenoic fatty acids was decreased in blood and liver tissue of the rats with burns. These patterns were normalized after administration into the animals of synthetic anabolic steroid nerobolyl at a dose 5 mg/kg. Burning castrated male rats led to a decrease in concentration of albumins, alpha 1- and alpha 2-globulins in blood with simultaneous increase of monoenoic fatty acids in blood and liver tissue. Nerobolyl normalized these patterns at a dose 20 mg/kg, while a dose 5 mg/kg was distinctly less effective.


[Selection of preparations with anticipated antiestrogen activity].

Specificity of interaction between estrogen-receptor systems of guinea pig uterus and oviducts and six estrogens was studied. The obtained datas suggest existence of tissue specificity in estrogen-receptor interaction in uterus and oviducts. Modifications of the steroid molecule led to decrease in extent of estrogen affinity. Introduction of an ethyl group into 17 alpha-position resulted in the effect, by the rate of estrogen-receptor binding equal to reduction of 17 beta-hydroxyl. Low but distinct affinity of 17 alpha-estradiol, its structure and stability, enabled to select this substance as a preparation with anticipated anti-estrogenic activity.


[Factors affecting the DNA-binding activity of the blood serum in in patients and healthy persons at low ionic strength].

Interaction of blood serum proteins with native DNA at low ionic strength [0.05 M NaCl and 0.015 M sodium citrate], estimated by adsorption of DNA-protein complex on nitrocellulose filtrs, depended on specific activity, molecular weight of DNA as well as on the amount of DNA and blood serum in the samples. DNA-binding activity of blood serum from the patients should be estimated at such ratio of components, when the blood serum from healthy persons adsorbed minimal quantities of DNA, since the molecular weight and specific activity of the DNA preparations might vary in various samples. As a factor, regulating the rate of DNA binding on filtrs, such amount of blood serum from patients should be added to the samples, which corresponded to the maximal amount of normal blood serum causing no binding with the DNA preparations.


[Preparation of monospecific antibodies to A-protein and an immunochemical study of its distribution in normal and tumorous tissues].

Monospecific antibodies against A-protein from rat liver cytosol were prepared. Complete nonidentity was established in comparison of the A-protein and ligandin, which was similar to A-protein in binding properties. Besides, A-protein found in cytosol of liver tissue was present in cytosol of small intestine. It was not found in the cytosol of other 17 tissues. A-protein appeared in ontogenesis earlier than ligandin: its concentration sharply increased in rat embryonal liver within 16--18 day of gestation. Level of A-protein was decreased 2--4-fold in primary rat hepatomas. A-protein and ligandin are the isoforms of binding proteins, which characterize different steps of the differentiation of the hepatocytes.


[Activity of Krebs cycle oxidative enzymes in the brain in hypothermia].

Cooling of rats down to the rectal temperature of 33--35 degrees without the use of narcotic and neuroplegic drugs did not cause distinct alterations in activity of the oxidative enzymes of tricarboxylic acid cycle--isocitrate dehydrogenase, alpha-ketoglutarate dehydrogenase, malate-, succinate- and pyruvate dehydrogenases in brain tissue. At the same time, inhibition of the activity of these dehydrogenases occurred in profound hypothermia (cooling to 19--20 degrees). In this case the activity of succinate dehydrogenase was decreased less distinctly as compared with the activity of NAD-dependent dehydrogenases. Succinic acid appears to be an especially important substrate for oxidation in brain of the chilled rats.


[Physicochemical aspects of the mechanism of the mineralization of epiphyseal cartilage in enchondral osteogenesis].

Mechanism of epiphysial cartliage mineralization is considered in terms of ion exchange concepts. Chondroitin-sulfate of matrix, which is a polyelectrolyte, served as a donor od calcium ions. Pericellular zone of matrix is considered as a semipermeable membrane. The energetic basis of the process is provided by interacellular glycogenolysis in chondrocytes, entering the zone of mineralization. High concentration of glucose in lacunas of chondrocytes led to osmotic transport of water from matrix to lacunas, causing an increase in concentration of ions in free volume of the matrix. Due to ion exchange release of calcium ions occurred from the phase of polyelectrolyte into the free volume, where the state of saturation was achieved and dicalcium phosphate CaHPO4 was precipitated. Stereologic studies of epiphysial cartilage, simulation experiments and calculations corroborate the mechanism of mineralization advanced.


[Importance of the initial monoamine oxidase activity for the development of the activating or inhibiting action of indolylhydrazides].

Effects of beta-(2-methyl indolyl-3) propionic acid hydrazide and alpha-butyl-beta-(2-methyl-5-carboxy indolyl-3) propionic acid hydrazide on the activity of monoamine oxidase were studied in rat brain in vitro. The compounds activated distinctly serotonin deamination under conditions of the enzyme inhibition, caused by pretreatment with iproniazide. The activation occurred only in the samples, which were not inhibited with iproniazide. The treatment with iproniazide prevented any alterations in content of amines, caused by the compounds in the rat brain in vivo.


[Physiological activity of kappa-casein glycomacropeptide].

Low molecular peptide fragment [molecular weight 700-2,000] was isolated from the preparation of k-caseine glycomacropeptide using gel chromotography on Sephadex G-25 superfine. After intravenous administration the peptide inhibited gastric secretion more distinctly as compared with the initial preparation. The data obtained suggest that the inhibitory effect of glycomacropeptide was caused by fragment but not by the whole molecule.


[Type A and B monoamine oxidase activity in hyperbaric oxygenation].

Substrate specificity of monoamine oxidase (MAO) of the A type from rat brain and liver tissues was altered after exposure of rats to an increased oxygen pressure [4 ati O2, 1 hr]. Simultaneously with a decrease in monoamine deaminating activity the enzyme acquired an ability to deaminate several substances, which are not MAO substrates in normal state, in particular, aminosugars. Activity of MAO of the B type was not altered in brain under hyperoxia. Alterations in catalytic properties of MAO of the A type were apparently important in development of the oxygen intoxication.


[Hepatotoxicity of the lipid components of the lipopolyysaccharides from typhoid bacteria].

Distinct increase in amount of total lipids occurred in mice liver tissue after intraperitoneal administration of typhoid lipids A and B (the latter was nonhydrolytically isolated from typhoid lipopolysaccharides). The alteration referred primarily to neutral lipids, especially to triacyl glycerides, content of which exceeded 3- and more-fold the initial one to the end of a day. The similarity was observed in alteration of triacyl glycerides, phospho- and glycolipids in presence of both lipid preparations. These lipid components resembled intact lipopolysaccharide from typhoid bacteria in their effect on content of lipids in liver tissue. In treatment with these lipid preparations concentration of NEFA was either unaltered or distinctly decreased.


[Arachidonic acid biosynthesis in the rat small intestine].

Ability of epithelium of rat small intestine mucose to synthetize arachidonic acid was studied in vivo and in vitro. Linoleic acid and 2-14C-acetate were used as precursors. The fatty acids were fractionated using thin-layer chromatography on silica gel impregnated with AgNO3. The label was incorporated into all the fractions but the highest radioactivity was found in the fraction of arachidonic acid; this suggests that the enzyme systems, carrying out the synthesis of polyenic fatty acids, occur in the mucosa of small intestine.


[Methodological variants of neuroleptanalgesia (author's transl)].

A survey is presented of the variations of neuroleptanalgesia. Modification of the injection technique, the hypnotic, the analgesic or the neuroleptic partial effect of the drug combinations produces four variations. The principles of the classical type of neuroleptanalgesia, namely the ability to selectively influence the single components of anaesthesia and the predominant use of a strong analgesic must remain unaltered in the definition of a variant. The use of clear nomenclature is used in an attempt to overcome the confusion which still exists in this field.


[The combined treatment of Parkinson's disease with L-dopa plus decarboxylase inhibitors (carbidopa, benserazide) (author's transl)].

An open cross-over study of 20 patients with Parkinson's disease performed with two drugs containing L-dopa and a peripheral aromatic amino acid decarboxylase inhibitor (benserazide, carbidopa) confirmed the conclusions reached in other clinical trials that this combined treatment of Parkinson's disease is the most effective form of drug therapy available at present. With both drugs, Madopar or Sinemet, an optimum therapeutic result was obtained with relatively small doses of L-dopa (the reduction in L-dopa dosage amounting to about 80%). A loss of efficacy with both drugs, which has observed during long-term treatment of patients with Parkinson's disease, could be avoided by switching the patients from Sinemet to Madopar and vice versa. Determination of L-dopa in the plasma demonstrated that with either drug similar plasma levels of L-dopa were achieved during clinically effective treatment.


[Cerebral manifestation in a case of Sjögren's syndrome (author's transl)].

A case of Sjögren's disease is described in which isolated cerebellar symptoms were prominent. Serological investigations gave no evidence of disseminated immune vasculitis, systemic lupus erythematosus or any other autoimmune disease. The cerebrospinal fluid protein changes, which were diagnostic of an autoimmune process in the CNS and suggestive of Sjögren's syndrome are discussed.


[Relationship between loss of sight and mortality in diabetics with retinopathy (a retrospective study over the terminal 5 years) (author's transl)].

1642 diabetics with retinopathy were controlled at half-yearly intervals over 4 to 10 years (6 years on average) using fundus photography, fluoresceinangiography and measurement of visual acuity. 83 of these patients died and the data documented in 43 patients over a mean period of 5.2 years prior to death allowed a retrospective evaluation of the clinical findings and therapeutic results. 27 patients had undergone bilateral and 16 unilateral photocoagulation at the beginning of the observation period. 9 patients were blind already at the outset. Of 13 patients who became blind during the observation period 10 had not undergone photocoagulation of the affected eye. The time span between blindness and death was shorter (1.5 years) in the 3 patients (5 eyes) who had undergone photocoagulation than in the untreated diabetics (4.3 years). All 23 patients in whom the initial visual acuity was maintained had undergone photocoagulation. Presence of florid diabetic retinopathy or nephropathy adversely influenced the results of photocoagulation.


[Renal carcinoma (author's transl)].

A brief discussion of the epidemiology and aetiology of renal carcinoma is followed by a description of the clinical features. Attention is drawn to the significance of haematuria, especially microhaematuria and the para-neoplastic syndrome (toxic and endocrine tumour effect) in establishing an early diagnosis. Intravenous urography still remains the most important diagnostic procedure, whilst renal angiography is indispensable for the precise definition of tumour localization and extension. It is possible to solve most of the problems of differential diagnosis (primarily distinguishing between cyst and tumour) by means of renal angiography and sonography. Therapy is still based on surgical treatment, transperitoneal, "radical" tumour extirpation leading to an improvement in the results in about 15% of the cases, especially in stages III and IV. A 5-year survival rate may be expected in 60 to 70% of stage I and stage II cases, in about 40% of stage III and only a few percent of stage IV cases. Cytostatic therapy offers no improvement in results at the moment. Irradiation before and after surgical treatment, as well as hormonal medication produces a modest rise in the 5-year survival rate. The decisive factor is early diagnosis of renal carcinoma, because about half of all patients show evidence of metastasis already at the first examination.


[Two cases of primary sclerosing cholangitis (author's transl)].

Two patients with symptoms of progressive obstructive jaundice, a history of vague pains in the right upper quadrant and laboratory evidence of biliary obstruction underwent laparotomy. A stone-free, but extremely thick-walled gallbladder was found in both patients. Intraoperative cholangiography showed diffusely-stenosed extrahepatic bile ducts suggestive of chronic inflammatory changes in the biliary system. The correct diagnosis was made only on histological examination, which revealed primary sclerosing cholangitis with secondary cholestatic changes of the liver. Postoperative treatment included long-time corticosteroid therapy. Both patients have remained jaundice-free for periods of one and two years, respectively, to date, but the eventual prognosis is poor. The diagnosis, which can be made only surgically, therapy and prognosis are discussed.


[Factor XIII and the risk of postoperative impaired wound healing and bleeding (author's transl)].

Factor XIII concentration was investigated pre- and postoperatively in the plasma of 139 patients undergoing major abdominal surgery. Postoperative complications (impairment of wound healing and haemorrhage) were significantly more frequently seen in patients with a low concentration of factor XIII. A low preoperative concentration of factor XIII can be interpreted as a high risk factor.


[Reoperation on the biliary tract (author's transl)].

A report is given on 154 patients subjected to reoperation of the biliary tract, including 19 cases of stricture to complete destruction of the common bile duct. The preoperative findings, indications, methods of operation and late results are described and discussed.


[Periathritis of the sesamoid bone of the metatarso-phalangeal joint of the large toe (author's transl)].

Several cases serve to illustrate the clinical features of calcifying periarthrosis of small sesamoid bones described in this report. Osteomalacia of sesamoid bones must be considered in the differential diagnosis.


[Advances in the field of surgical therapy of strabismus (author's transl)].

During the past 10 years the surgical treatment of strabismus has received different new impulses. Two fundamental novelties in this field have been reported and three not unimportant contributions towards the facilitation of, or improvement in therapy: Cüppers described a method to improve and/or eliminate the dynamic squinting angle in cases of ocular nystagmus by the so-called "Fadenoperation" and Aichmair demonstrated the possibility of re-establishing the function of a traumatically paralyzed abducens muscle by means of muscular neurotisation. Aichmair and Abel discovered in a comparative study that there is no necessity to bandage patients after a squint operation; this is of especial importance in small children as there need no longer be any fear of the postoperative binocular bandage. Aichmair and Fries demonstrated a simple method for the precise measurement of the volume of implantates to eliminate enophthalmus after blow-out fractures; this helps the surgeon to avoid over- or undercorrection. They stressed, furthermore, the importance of the right shape of the implantate. de Decker published a new method of tucking of the superior oblique and of recession of the inferior oblique that facilitates the operation and at the same time enables more accurate dosation.


[Biomechanical gait analysis in infantile cerebral palsy (author's transl)].

The gait pattern is recorded by use of a high-speed camera, whilst x/y coordinates of the joints are registered by a Vanguard Motion Analyzer and stored on punched tape for processing, using specially-developed computer programmes. The results are mainly plotted as stick diagrams, chronograms, angle-time diagrams and angle-angle diagrams, allowing an immediate assessment of the gait pattern. Furthermore, the data are stored for statistical analysis in regard to evaluation of the efficacy of physiotherapeutic and orthopaedic measures.


[Mechanisms common to the development of malformation in congenital and sporadic forms of atrial septal defect (type II) (author's transl)].

Familial prevalence of some congenital cardiopathies leads to the conclusion that genetic factors might be involved. The case histories are presented of three families with atrial septal defect, Type II (ASD II) in which autosomal dominant inheritance was assumed on account of the pedigree analysis. Each family member was examined serologically, morphologically and morphometrically. One family was also tested for cytogenetic abnormalities. It is highly probable that the gene responsible for the defect is linked to the HLA system (Lod score = + 3.612) and is, therefore, located on the short arm of chromosome 6. The morphological examinations demonstrated uniformity of individual ear traits in related patients; moreover, the palmar dermatoglyphics showed a tendency to shortening of main line C, to ulnar and distal shifting of the carpal triradius and to an increase in hypothenar patterns. In addition a study was carried out of patients with apparently sporadic cardiopathy. A similar trend as to palmar configuration was observed. An attempt was made to connect known factors causing malformations with the results of this investigations.


[Osteopoikilosis (author's transl)].

Report on radiological and clinical findings in a female patient with osteopoikilosis. A successful specific treatment of this hereditary and constitutional systemic disease of cancellous bones is not available.


[Comparison of the analgesic effect of nicomorphine in two different solutions (author's transl)].

The analgesic effect of nicomorphine in two different solutions was tested in 120 patients after cholecystectomy. The patients were divided into three groups: group I was given nicomorphine diluted with water, group II nicomorphine diluted with propylenglykol, group III propylenglykol alone. The degree of pain sensation was determined by interrogation. Pulse, respiratory rate, blood pressure as well as capillary pO2 and pCO2 were measured 10 and 30 minutes after medication. No difference in pain relief could be established in the two groups receiving nicomorphine. Respiratory depression with a significant decrease of respiratory rate together with an increase of pCO2 was observed in the two nicomorphine groups. In the placebo group there was no significant change in the tested parameters. A small decrease of pO2 was observed in all patients after laparotomy.


Chronic hepatitis associated with drug abuse: significance of hepatitis B virus.

One hundred and seventy-seven former heroin addicts, consisting of 85 who were newly admitted to a methadone maintenance program and 92 who had received methadone for a mean period of 30 months, were prospectively studied for up to 2 years in order to determine: (1) the effect of heroin withdrawal on the hepatic abnormalities, and (2) the incidence of HBsAg, anti-HBs, and anti-HCc as indices of the frequency of hepatitis B virus infection. Our study indicates that (1) hepatic abnormalities persist when heroin is discontinued and are not temporally related to drug and/or needle usage, and (2) that 71% of subjects had either HBsAg or anti-HBs; anti-HBc was tested for in 16 patients and was present in 100%, although 9 of the 16 were both HBsAg- and anti-HBs-negative. This study suggests that hepatitis B is largely responsible for the liver dysfunction. It is proposed that an abnormality in immune function, induced by heroin, is responsible for the high incidence of chronic hepatitis. Attention is drawn to the similarity between former drug addicts and hemophiliacs, since both develop chronic hepatitis in spite of anti-HBs in the serum.


Pathogenesis and therapy of liver disease in protoporphyria.

Protoporphyria is an inherited disorder in man characterized by the overproduction of protoporphyrin, a compound that is excreted by the liver. Hepatobiliary disease may occur in protoporphyria, and several cases have been reported in which death was due to liver disease. Based on the histological evaluation of liver biopsy specimens from 18 patients, 6 of whom died with cirrhosis and liver failure, we speculate that liver disease in this condition is caused by protoporphyrin deposits in hepatobiliary structures. These deposits are composed of crystals and have a characteristic birefringence when examined by polarization microscopy.One patient with early liver damage was given cholestyramine and vitamin E in an attempt to reduce the amount of protoporphyrin which the liver excreted daily. Liver function tests returned to normal, and red cell and plasma protoporphyrin levels decreased. A repeat liver biopsy after one year of therapy showed healing, with decrease of the protoporphyrin deposits.Liver disease in protoporphyria may be treated by directing therapy toward the metabolic abnormality.


The role of hepatotrophic factors in liver regeneration--a brief review including a preliminary report of the in vitro effects of hepatic regenerative stimulator substance (SS).

Details are presented of a technique for maintaining adult liver parenchymal cells in culture in a nonproliferating state. Hepatic regenerative stimulator substance (SS), prepared from weanling rat liver, will stimulate tritiated thymidine incorporation into liver DNA when injected into another rat or mouse. Preliminary experiments are presented which show that SS stimulates non-proliferating adult hepatocytes to incorporate increased amounts of (3)HT dr into DNA when SS is added to the culture medium. The response is dose dependent and a lag period of about 12 hours exists between addition of SS to the cultures and the stimulation of DNA synthesis. Preliminary screening of several cell lines in culture reveals that only liver related cell lines (hepatomas) respond to SS. A brief review of other hepatotrophic factors is also included.


The paracellular pathway and bile formation.

Choleretic infusions of taurocholate (40 μ moles for one hour) result in a significant increase in the number of lateral cell surface invaginations observed by scanning electron microscopy adjacent to the junctional complex of bile canaliculi in rat liver. Transmission electron microscopy indicates that these invaginations resemble "blisters" induced by osmotic gradients across epithelial tissues, a morphologic change which correlates with increases in ionic and hydraulic conductivity of the paracellular "shunt" pathway in such tissue. Since taurocholate infusions result in localization of ionic lanthanum chloride within hepatocyte junctional complexes, bile acids may also stimulate the movement of fluid and electrolytes across paracellular pathways during the process of bile formation.


Induction of rat liver alkaline phosphatase by bile duct ligation.

Bile duct ligation causes a five- to sevenfold increase in the activity of rat liver alkaline phosphatase within 12 hours after ligation and a similar rise in the activity of alkaline phosphatase in serum. The increased serum activity is due entirely to the appearance of a new isoenzyme that has the properties of rat liver alkaline phosphatase. The increase in both serum and liver alkaline phosphatase is prevented by the prior administration of cycloheximide in a dose that inhibits protein synthesis by 70%. Rat liver alkaline phosphatase was then purified to homogeneity. Antibody was raised to purified rat liver alkaline phosphatase in rabbits. The antibody was coupled to sepharose 4B and affinity columns made. (3)-H-leucine was then injected into the portal veins of sham operated rats and rats with bile duct ligation four hours after ligation. One hour after injection and five hours after ligation, animals were sacrificed. Liver alkaline phosphatase was purified by means of affinity chromatography and double immunoprecipitation with rabbit antibody to rat liver alkaline phosphatase and goat anti-rabbit gamma globulin. Bile duct ligation increased the incorporation of (3)-H-leucine into liver alkaline phosphatase more than threefold compared with sham operated rats, 164 CPM/mg protein vs. 49 CPM/mg protein (p < .001). The data indicate that the increased activity of rat liver alkaline phosphatase after bile duct ligation is due to enzyme induction rather than to activation of a pre-existing, relatively inactive enzyme.


Itch in liver disease: facts and speculations.

Pruritus in hepatobiliary disease is commonly believed to be caused by retention of bile acids with their sequestration in the skin. HOwever, we have recently demonstrated that skin levels of bile acids in patients with cholestasis correlate poorly with pruritus. In this report, we present additional data concerning the relationship of pruritus to bile acid retention: (1) the urinary excretion of sulfated and nonsulfated bile acids was not significantly different in patients with cholestasis who itched compared to those who did not; (2) one patient with itch associated with a liver abscess had normal levels of bile acids in serum, skin, and urine; (3) patients with primary biliary cirrhosis who itched had lower serum bile acid levels than patients with mechanical biliary obstruction who did not itch.These studies support our premise that pruritus in hepatobiliary diseases is not directly related to bile acid retention. They suggest that the type of cholestatic disorder, and not simply the magnitude of the cholestasis, as estimated by the elevation of serum bile acids, is important. We propose that the agent responsible for pruritus is produced in response to cholestasis, possibly through activation of the alternate pathway of bile acid synthesis. Properties of the hypothetical pruritogen are discussed.


Hepatic copper accumulation in primary biliary cirrhosis.

Hepatic copper accumulation is a regular feature of primary biliary cirrhosis (PBC). The levels are directly related to the clinical stage of the disease. Since the copper values in PBC are comparable to Wilson's disease, there is the potential for copper toxicity, although this is speculative since the two diseases differ in the binding, distribution, and intracellular localization of the copper. The involvement of copper toxicity in the progression of PBC is supported by the observation that the highest values occur in association with the hepatic failure that occurs in the advanced stage.Corticosteroid therapy appears to decrease hepatic copper levels in PBC. Although this therapy does not invariably lower the hepatic Cu content in patients with PBC, it does so in many individuals. Therapeutic trials with d-penicillamine are in progress. When results are available they will guide us in the management of individual patients with PBC. In the meantime, dietary copper should be restricted as is done in management of Wilson's disease.


Familial intrahepatic cholestasis: an update.

Familial intrahepatic cholestasis is a confusing group of syndromes. Four forms are defined and discussed in detail ("arteriohepatic dysplasia," the Byler syndrome, the THCA syndrome, and Norwegian cholestasis). A comparison of the distinguishing characteristics of these syndromes demonstrates that they share many features, including areflexia, retinal degeneration, and paucity of the intrahepatic bile ducts on biopsy. Alternatively, some traits appear to be specific for a single syndrome: posterior embryotoxon and bony anomalies for arteriohepatic dysplasia, the presence of an abnormal bile acid for the THCA syndrome, and giant cell transformation for Norwegian cholestasis. These syndromes, although rare, merit complete evaluation because, as nature's experiments in bile formation, they represent models of cholestasis and may provide clues to the understanding both of other forms of cholestasis of unknown etiology and of the normal mechanisms of bile formation.


The three syndromes of fat embolism: pulmonary manifestations.

The clinical course and radiographs of 30 patients with fat embolism syndrome were reviewed. In all cases the classic triad of neurologic dysfunction, respiratory insufficiency, and petechiae were present. Three responses to embolized fat were noted. The hyperacute response was seen in two patients with paradoxical embolization of fat to the systemic circulation. A "classic response" was noted in 18 patients with transient respiratory compromise and variable radiographic findings. The two deaths in the group responding in the classical manner were attributed to massive pulmonary emboli. The third response, noted in ten patients, consisted of a chest radiograph compatible with pulmonary edema in the clinical setting of the adult respiratory distress syndrome. In this group the degree of respiratory dysfunction and pulmonary damage correlated with the development of disseminated intravascular coagulation. Pathologic correlations are presented and the mechanisms by which embolic fat produces tissue damage are discussed.


Feminization of chronic alcoholic men: a formulation.

A review of the factors historically thought to contribute to the feminization of men with Laennec's cirrhosis is presented. Objective scientific data is presented both in support of and in rejection of such factors when available. Recent hypotheses about the significance of an altered estrogen to androgen (E/T) ratio as being important in the pathogenesis of feminization also are discussed. Finally, a hypothesis which incorporates the findings of hypogonadism and cirrhosis with portal-systemic shunting is presented as a pathogenic mechanism for the feminization of men with alcohol-induced Laennec's cirrhosis.


[Studies on sleep quality in old age].

A survey of 480 randomly chosen men and women over 65 years of age observed complaints concerning the quality of sleep in 26%, the use of sleeping drugs in 33%; complaints and/or drugs were found in 45% of cases. On the average complaints were more often made by women. The percentage of men complaining increased from 65 to 90+ years. In the group over 90 years of age both sexes showed the same frequency. The quality of sleep was correlated with self-rated health-status, mobility and impairment especially of the cardiovascular system. No correlations were found with contentment, place of residence, noise, outdoor exercise and socioeconome status. Sleeping drugs were most effective in subjects with cerebral impairment and of least effect when subjects suffered from cardiovascular trouble.


[Differential diagnosis of sleep disorders in old age].

Somnipathy represents neither an independent disease nor a nosological entity. The simple formulated complaint: "I can't sleep" requires a very detailed investigation of the surrounding conditions, habits and the physiological situation of the patient. Further one has to consider, resp. to rule out a great number of causes of diseases, i.e. those of the internal organs, the central nerve system and the psyche. The majority of cases of somnipathy in elderly patients reveals a treatable cause, of the prescription of hypnotics becomes unnecessary.


[Fine-structure changes in Toxoplasma gondii trophozoites after deep-freezing with dimethyl sulphoxide (author's transl)].

The changes observed in trophozoites of Toxoplasma gondii after deep-freeze preservation were examined by electron microscopy. Toxoplasmas (strain BK) from peritoneal exudate of infected NMRI mice were supended in Ringer's solution, deep-frozen in liquid nitrogen with 5% dimethylsulphoxide (DMSO), and compared after thawing with control samples with and without the addition of DMSO. Slight structural changes such as widening of endoplasmic reticulum, formation of fissures in the cytoplasm, and loosening of chromatin were only observed in some of the free toxoplasmas of the DMSO control. Among the deep-frozen parasites, about 1/5 of the free stages showed no or only slight morphological changes. In contrast to this, almost all intracellular forms found in macrophages showed lesions. The most remarkable change was a partial destruction of the inner cell membrane complex. The outflow of ribosome-containing protoplasm with ballon-like swelling of the outer elementary membrane was observed as a consequence of this frequent lesion. The outflow of protoplasm induced a drastic decrease in the electronic density of the whole cytoplasm. Other characteristic degenerative signs were vacuolation of cytoplasm up to formation of great optically empty spaces, widening of the perinuclear space, swelling of mitochondria, disintegration of rhoptria, micronemata, and Golgi zone, coarse-plaque loosening, and displacement of electron-dense areas of the nucleus up to disintegration with maintenance of the karyoplasm. In some almost completely disintegrated trophozoites, enlarged mitochondria with remarkable electronic density were observed. Apart from the cell membrane, the conoid was the longest-persisting organelle. The alterations observed after deep-freezing permit the conclusion that the free cells, which were only slightly impaired or not at all, remained infective.


[Sleep disorders in a isolation situation. Hyposomnia in older convicts].

Modern world is hostile to sleep and by its achievements it disturbs our hereditary biological rhythm. About 80% of all the cases of hyposomny are caused by emotional disturbances in the broadest sense. Somnipathy in a prison shows of course considerable characteristics, although here, too, we can find the same problems a normal doctor working outside a prison has to cope with. 54% of all the inmates of the prison in Straubing (= JVA Straubling) complain about somnipathy; from the prisoners more than 50 years old only 43%. Physical diseases cause somnipathy within 19% of the older prisoners where we find predominantly heart-diseases and circulatory diseases. 5% of somnipathy are due to an abuse of coffee or nicotine and the rest is due to emotional disturbances in the broadest sense. The normal medical treatment for simple somnipathy is of no success in a prison and the prisoners abuse the normally used medicaments to get into a state of ectasy. Therefore medicaments on a vegetable basis are used, also neuroleptica and medicaments against depression, where there is practically no danger for addiction.


[Management of sleep disorders from the geriatric psychiatry aspect].

Sleep disorders are a common phenomenon in patients of all age groups and often are not easy to influence. In geriatric patients sleep disorders are even more common and often are the main complaint. In addition to pharmacotherapeutic approach with a number of different psychotropic drugs non-drug procedures should also be used in the treatment of geriatric and psychogeriatric patients and combinations of different therapeutic approaches can be indicated. With every patient complaining of disturbed sleep a careful exploration of the origin of the sleep disorder is imperative prior to treatment.


Changes in worm burden, haematological and serological response in rats after single and multiple Angiostrongylus cantonensis infections.

Thirteen groups of rats were first sensitized with single or double doses of 5--30 third-stage larvae of Angiostrongylus cantonensis, followed by a challenge infection with 100 larvae at various periods after the primary infection. Seven other groups of rats receiving only the sensitizing infection served as the controls. In all the sensitized rats, a significantly (p less than 0.05) smaller mean number of adult worms was found established in the challenge infection as compared to the control. The frequency of the sensitizing dose and timing of the challenge infection appeared to influence the intensity of the host's response. There was no conclusive evidence to indicate that the immune response could retard the growth, development, or sex ratios of the worms established in subsequent infections. A positive haemagglutinating antibody response was first observed in some rats as early as four weeks post-infection with 100 larvae when the worms began migrating from the brain to the lungs. The antibody response and eosinophilia were most pronounced during the oviposition of the female worms and hatching of first-stage-larvae. Changes in white blood cell, lymphocyte, and neutrophil counts were also followed in some groups.


Discussion of the relationships between Schistosoma and their intermediate hosts, assessment of the degree of host-parasite compatibility and evaluation of schistosome taxonomy.

Studies of the spectrum of the intermediate hosts of schistosomes and the relationships between parasites and intermediate host snails have been carried out with each researcher using different methods. A comparison between compatibility studies has therefore been impossible. The following three basic problems in these kind of studies are discussed in this paper: (1) the standardization of experimental materials such as schistosomes, intermediate and final hosts, (2) the methods involved in the experiments, and (3) the sort of data which must be collected. Standardized methods and materials are described in this paper. The relationships between the genus Schistosoma and the intermediate host snails belonging to the two genera Biomphalaria and Bulinus, and the mechanisms behind the process resulting in various degrees of compatibility between the two involved organisms are reviewed and discussed. Why certain combinations of schistosomes and snails result in the production of cercariae and others do not is still unknown, but there is now some indication of a camouflage behaviour during the intramolluscan stages, e.g., the larvae in the snails cover themselves with snail material and are not recognized as foreign objects. The same mechanism has already been found in the schistosomules in the final host. Much of the confusion in the discussion of the relationships between schistosomes and intermediate hosts is the result of a lack of an objective way to describe and assess the compatibility between the two. Based on a series of experiments with S. haematobium, S. intercalatum, S. bovis, S. mansoni, and several species of possible intermediate hosts, the following index for estimating the degree of compatibility is proposed: the total cercarial production from 100 exposed snails (TCP/100 exposed snails). Seven classes have been suggested: the first one (Class 0) with a TCP/100 exposed snails of zero, is called 'refractory'; the next one (Class I) called 'not very compatible' has a TCP /100 exposed snails between 1 and 10,000; the last group (Class IV) called 'extremely compatible' produced more than 500,001 per 100 exposed snails during the entire lifespan. The ability to use a spectrum of intermediate hosts and the compatibility in the taxonomy of schistosomes is discussed. The results for the different species of schistosomes indicated that each species consists of strains with 'hybrid populations' in between.