[Clinical, endocrinological, histological and chromosomal investigations on Klinefelter's syndrome].

In a clinical study 101 patients with Klinefelter's syndrome (Kl. sy.) are evaluated. Clinical, endocrinological and histometrical aspects were of main interest. The results were compared with a group of patients with azoospermia by obstruction. The statistical evaluation showed significant differences concerning body-height, volume of ejaculate, size of testis, and the concentration of FSH and LH in serum. Histometrical investigations showed significant differences for the diameter of seminiferous tubules and their wall-thickness. The various degrees of Leydig-cell-increase at Kl. Sy. are described as--increased--excessively increased--and adenomalike. Sex-Chromatin was found positive in 62 of 64 cases of Klinefelter's syndrome, verified by chromosome analysis. The number of Barr-bodies ranged from 1-45 (200 cells evaluated) x mean was 9,6. The analysis of chromosomes in 64 cases showed a karyotype of 47,XXY in 59 cases, a 46, XY/47,XXY mosaic in 4 cases and 46,XX/46,XY/47,XXY mosaic in 1 case. The discussion pointed out, that Kl. sy. has no typical, but a variety of symptoms. The position of the evaluation of sex-chromatin for diagnosis and the possibilities of errors are discussed. The problem of fertility in Kl. sy. is mentioned, as we found two cases with complete spermatogenesis, yet with azoospermia, among our patients. The pathogenesis of the characteristical histological changes in testis with Kl. sy. remains open. The mechanism which may lead to the striking increase of Leydig-cells is discussed.


Leydig cell differentiation induced by stimulation with HCG and HMG in two patients affected with hypogonadotropic hypogonadism.

In order to elucidate the ultrastructural characteristics of the precursor cell of Leydig cells and its subsequent differentiation, testicular biopsies from two patients with hypogonadotropic hypogonadism, obtained prior to and after treatment with HCG and HMG, were studied in comparison with those of prepubertal, pubertal and postpubertal testes. Prior to HCG and HMG stimulation, the testicular interstitium of both patients showed the following spindle-cell-types: Fibroblasts, myofibroblasts and a cell-type similar to the myofibroblast but differing from it by the arrangement of microfilaments and the development of the smooth endoplasmic reticulum as well as lipid droplets. It may be considered the precursor of Leydig cells. In the following stages of differentiation observed in the biopsies after treatment, there is a progressive involution of microfilaments and rough endoplasmic reticulum, a transient period of hyperplasia of the Golgi complex, and the definitive development of cell components involved in steroid biosynthesis, such as the smooth endoplasmic reticulum, polymorphic mitochondria with tubular cristae, lipid droplets and diverse lysosomal bodies. From early stages of differentiation, gap junctions occurred between the cells. Numerous axon profiles were also present among the cells. Only in a small percentage of cells did vesicle-bearing axons closely appose the Leydig cell membrane.


Silent infection in male accessory genital organs and male infertility.

A silent infection of the male accessory genital organs was found in the semen of 78 patients (22,3%) of 350 infertile men. All the sperm characteristics (except agglutination) were significantly deteriorated in the infection group as compared to the sperm of 36 normal men. The volume was significantly larger than normal. In this group there was significant leukocytosis and, as a sign of prostatic hypofunction, reduced seminal acid phosphatase and citric acid activity. Chemotherapy for a period of two to four weeks improved leukocytosis and sperm transiently. Only acid phosphatase was normal three months after the treatment. Suggested reasons for the infertility of the silent infection group are: 1. hypofunction of the male genital organs, caused by a primary, strong infection suffered earlier. 2. The chronic, nonclinical infection of the male accessory genital organs, mainly as a complication of the primary infection. Chemotherapy for a period of four weeks seems to be too short to correct the silent infection as well as the infertility.


Hemodynamic effects of phentolamine in mitral stenosis and congestive cardiomyopahty.

Nine patients with alcoholic cardiomyopathy and 8 patients with mitral stenosis were studied by right and left heart catheterization. Hemodynamic observations were made during control period and during the infusion of phentolamine at a rate of 0.3 mg per minute. The patients with the cardiomyopathy responded to phentolamine with a significant decline in the left ventricular filling pressure, pulmonary artery mean pressure, peripheral resistance, and arteriovenous oxygen difference. There was a significant increase in the cardiac index. The patients with mitral stenosis did not show any hemodynamic improvement after phentolamine infusion.


Effect of digitalis on diminished baroreceptor sensitivity in diabetics.

The baroreceptor sensitivity was estimated in 50 normal controls (Group A) and in 50 diabetics of comparable age (Group B). The technique used was infusion of angiotensin (0.5 microgram/min) and measurement of the bradycardic response resulting from the increase of blood pressure. The slope was used as an index of baroreceptor sensitivity. Diabetics had significantly lower baroreceptor sensitivity and a higher resting heart rate. Sensitivity decreased with age in both groups. The reproducibility of the method was excellent. Deslanoside-C (0.8 mg) significantly increased the baroreceptor sensitivity in 11 normal controls and 9 diabetics. Very low sensitivity was found in 26 diabetics who had no evidence of orthostatic hypotension, neuropathy, or retinopathy. However all 17 patients with the above findings had very low sensitivity.


Medical management of hypertension.

In a paper like this, with such diverse information, it is impossible to summarize the content completely. Suffice it to say that a stepwise approach to the management of essential hypertension has been presented, beginning with a diuretic agent as the cornerstone of management for most patients. Recommendations for the addition of a second, third, or even a fourth agent have been offered based on a discussion of the site of action of various therapeutic agents. The common side effects and toxicity of various drugs have also been discussed. It cannot be overemphasized that the physician's knowledge of his patient and a thorough understanding of drug actions, interactions, and reactions are mandatory if highly effective, individualized therapeutic programs are to be implemented. Likewise, educating the patient about his disease and eliciting his maximal cooperation are keys to therapeutic success.


Hypertension detection and compliance: permanent site hypertensive evaluation--a new method of increasing patient compliance.

A new method--permanent site hypertensive evaluation with patient revisits--is suggested as a unique way to increase patient compliance. This method reduced mild hypertension for 50% and increased normotension. The easy availability of permanent sites may induce the patient to return regularly, or the patient may be testing the medication or his physician. But whatever the means, normotension is the aim of compliance. Thanks to Mark Cohen and his pharmacy staff, Dot, Ruth, Jim, and George for their many long hours of detection work; to my nurse monitor, Pauline Platt; and to my secretary, Gene Koswoski. This study was done in cooperation with the Montgomery County Branch of the Southeastern Pennsylvania Chapter of the American Heart Association, Philadelphia, Pennsylvania.


Reproducibility of the response to diluent challenge in adult asthma.

The authors have demonstrated that patients with bronchial asthma may react to diluent provocative challenge. The pattern of airway response to diluent was found to be reproducible. The data herewith presented suggest that the baseline airway obstruction in adult asthma is highly variable but the degree of baseline obstruction is not related to the response to diluent challenge.


Factors of importance in determining the prevalence of indoor molds.

The concentration of molds isolated in 68 homes of allergic patients in southern California using the Andersen volumetric sampler varied from a minimum of 36 to a maximum of 5,984 isolate/M3 air sampled. The most frequently isolated included Cladosporium, Penicillium species. Alternaria, Sterile (Non-sporulating) Mycelium, Epicoccum, Aspergillus species, Aureobasidium and Dreschlera. Statistically significant higher mold isolates were associated with high shade and high levels of organic debris near the home and poor landscaping and landscape maintenance. Low concentrations of mold isolates were associated with the presence of a central electrostatic filtration system and good compliance with dust controls. The viable mold spore levels were lower in homes where the electrostatic filtration unit was operated continuously rather than intermittently. No statistically significant correlations could be made between indoor mold isolates and any of the following: number and age of the occupants, age and size of home, month of survey or the presence of indoor plants.


Non-compliance in asthmatic children: a study of theophylline levels in a pediatric emergency room population.

Sub-therapeutic theophylline levels due to patient (parent) non-compliance is a significant cause of outpatient treatment failure in childhood asthma. In a study of 50 known asthmatic children with acute asthmatic episodes, 98% had sub-therapeutic theophylline levels less than 10 mcg/ml with 75.5% due to inadequate patient (parent) compliance.


Immunization of chickens and turkeys against avian influenza with monovalent and polyvalent oil emulsion vaccines.

Chickens and turkeys vaccinated with inactivated virus oil-emulsion vaccines containing different concentrations of either 1 (monovalent) or 4 (polyvalent) strains of avian influenza virus (AIV) were challenged-exposed with virulent AIV A/chicken/Scotland/59 or A/turkey/Ontario/7732/66. Four of 6 vaccines protected completely against postexposure mortality. Vaccine valency did not alter the serologic and challenge-exposure responses of chickens vaccinated with AIV A/turkey/Wisconsin/68, which was the virus component common to both monovalent and polyvalent vaccines. The magnitude of the serologic responses and protection against challenge-exposure were dependent on the concentration of virus in the vaccines. These data indicate that control of virulent AIV in chickens and turkeys by vaccination with inactivated vaccines may be feasible.


A proposed mechanism(s) of transitory ischemic injury to myocardium.

The main objective of this study was to produce primary acute ischemic injury to myocardium in a live animal. In vitro, guinea pig platelets were sensitive to perturbation and aggregation by a suspension of ultrafine fibrillary collagen material isolated from the aorta of an aged burro (Equus asinus). The platelets responded to the stimulatory action of this material down to 100 to 200 ng (dry weight) added to 0.45 ml of platelet-rich plasma, as determined by aggregometric technique. Aortic fibrillary collagen material injected IV into guinea pigs (350 to 1900 microgram protein/kg of weight) produced a transitory disappearance of virtually all circulating platelets within 5 minutes. In animals in which blood samples were taken 2.5 hours after injection, 50 to 75% of the average base-line platelets in the circulation of controls returned to the circulation. In other experiments, 3 anesthetized animals were injected by jugular vein with an amount of active fibrillary collagen material (300 microgram as protein/kg of animal weight) estimated to produce reversible platelet aggregation in vivo. Two control animals were injected with the same dose of the material that had been inactivated (15 minutes at 100 C) to abolish platelet aggregation. Treated and control animals were maintained under general anesthesia for 2.5 hours. Intraventricular pressures and electrocardiographs (ECG) were monitored continuously for the first 30 minutes. The injection of the active fibrillary collagen material caused a large ventricular pressure elevation (170/10, 180/10, and 150/10 mm of Hg) in approximately 40 s. Preinfusion ventricular pressures in the 3 animals were 65/0, 85/5, and 88/0 mm of Hg, respectively. Within 60 s, there was a reduction in the absolute platelet number in the peripheral circulation. The elevation of ventricular pressure persisted for approximately 5 minutes and was followed within 30 minutes by a set of ECG events suggestive of acute myocardial ischemic injury, which included premature ventricular contractions, transient S-T segment depression concurrent with ventricular hypertension, and S-T segment elevation with reversed tall upright T-waves in association with a decrease to the preinfusion ventricular base line. Other ECG changes included prolongation of the P-R segment, missed ventricular contractions, and arrhythmia. The ECG changes seemed to be subsequent to platelet microthrombus formation in the pulmonary arterial microcirculation. By 2.5 hours after the treatment, platelets "rebounded" into the circulation in 2 surviving guinea pigs, and left ventricular pressures and ECG profiles returned to the preinfusion base lines. Guinea pigs IV infused with similar amounts of inactivated (15 minutes at 100 C) fibrillary collagen material did not show changes.


Body water content and turnover in cats fed dry and canned rations.

Body water content and total body water turnover in cats fed commercially available dry food and then given canned rations were determined with tritiated water. Cats during the feeding of either ration did not differ in body water content or turnover. Cats during the feeding of the dry ration derived a greater fraction of their total water turnover from drinking water, and these cats drank more water per gram of dry matter intake than when fed the canned ration. On the basis of total water intake, however, those given the canned ration had significantly greater water intake per gram of dry matter; also, their total water turnover per gram of dry matter was greater. Compared with other animals, cats have a similar ratio of body water to body solids, but the rate of water turnover per unit of body weight is slower.


Elaboration of chemotactic substances by alveolar cells: possible mechanisms for the initial neutrophilic response in feline caliciviral pneumonia.

In vitro experiments established that the interaction of feline calicivirus (FCV) with alveolar macrophages and pneumocytes results in the generation of chemotactic factors that produce directed migration of neutrophils in Boyden chambers. Factors were produced independent of immune mechanisms and of discernible serum factors. Lysates of noninfected alveolar macrophages and pneumocytes did not possess chemotactic activity, indicating that chemotactic factors were not preformed in these cells. Noninfected alveolar macrophages also elaborated neutrophil chemotactic factors in culture; however, activity was greater when macrophages were infected with FCV. The results of this study suggested that the neutrophilic response in the peripheral portion of the lung of cats exposed to aerosols of FCV was the result of the elaboration of complete chemotactic factors from FCV-infected alveolar cells.


Comparison of the cardiopulmonary effects of etomidate and thiamylal in dogs.

The cardiopulmonary effects of etomidate, a nonbarbiturate, short-acting, IV anesthetic, were compared and contrasted with those of thiamylal sodium in chronically instrumented conscious dogs. Etomidate, when administered IV at dosages of 1.5 and 3.0 mg/kg of body weight, produced anesthesia lasting from 8 +/- 5 and 21 +/- 9 minutes, respectively. Heart rate, aortic blood pressure, left ventricular peak pressure, left ventricular end diastolic pressure, left ventricular contractile force, and myocardial oxygen consumption were unchanged after administration of either dose of etomidate; however, the dosage of 1.5 mg/kg produced significant (P less than 0.05) increases in respiratory rate and decreases in tidal volume. The minute volume remained unchanged from base-line values. Significant (P less than 0.05) decreases in tidal volume, arterial pH, and partial pressure of oxygen were produced, and minute volume remained unchanged when 3.0 mg of etomidate/kg of body weight was administered. Thiamylal sodium (8.0 mg/kg of body weight; given IV) produced anesthesia lasting for 14 +/- 5 minutes. Significant increases (P less than 0.05) in heart rate, arterial blood pressure, left ventricular peak pressure, and myocardial oxygen consumption were observed after IV administration. Left ventricular contractility was significantly (P less than 0.05) decreased. Respiratory rate was not significantly (P less than 0.05) affected by thiamylal although tidal volume and minute volume were decreased. These respiratory alterations resulted in significant (P less than 0.05) increases in the arterial partial pressure of carbon dioxide and decreases in pH and the partial pressure of oxygen. On the basis of cardiopulmonary function, etomidate offered rapid, safe, short duration anesthesia superior to that of thiamylal sodium.


Serum and urine inorganic fluoride concentrations and urine oxalate concentrations following methoxyflurane anesthesia in the dog.

Plasma fluoride, urine fluoride and urine oxalate concentrations were measured before administering an anesthetic to 8 dogs, and at 0, 3, 9, 24, 48, and 72 hours following 1.5 hours of anesthesia with 1% methoxyflurane. Plasma and urine osmolalities were measured and compared with fluoride and oxalate values. Fluoride concentration increased in both plasma and urine following anesthesia when compared with the preanesthetic concentrations. Maximum mean plasma inorganic fluoride was 106.71 mumoles per liter (+/- 25.44 SE) at 9 hours after exposure to methoxyflurane was completed. By 72 hours after exposure to methoxyflurane the plasma fluoride concentration was 23.47 microM/L (+/- 5.74 SE). Mean urine inorganic fluoride concentration was highest at 9 hours after exposure to methoxyflurane and reached 6047.03 microM/L (+/- 1378.46 SE) as compared to the mean preanesthetic base-line concentration of 542.68 microM/L (+/- 132.93 SE), and the 72 hour mean urine fluoride concentration which was 1593.78 microM/L (+/- 579.46 SE). Urine oxalate concentrations, when compared with urine osmolality (mg/mOsm), increased throughout the study. The 72-hour concentration after exposure to methoxyflurane was 2.5 times the preanesthetic (mg/mOsm) oxalate concentration. Plasma osmolality did not change markedly during the study. Urine osmolalities varied between animals and collection times, but a consistent pattern did not occur. Clinical and laboratory signs of renal dysfunction were not observed in any animal during the study.


Efficacy of an inactivated virus vaccine for prevention of porcine parvovirus-induced reproductive failure.

Gilts vaccinated IM either once (4 gilts) or twice (2 gilts) with an acetylethyleneimine-inactivated porcine parvovirus (PPV) vaccine before they were bred were subsequently exposed intranasally and orally to virulent PPV at about the 40th day of gestation (from 37 to 43 days). At 2 weeks after vaccination, all had hemagglutination-inhibiting (HI) titers for PPV (from 20 to 80) which decreased by the time the immunity was challenged with virulent virus (from 10 to 40), but increased thereafter (from 160 to 1,280). Titers of singly and doubly vaccinated gilts were similar throughout the experiment. The gilts were killed at about the 84th day of gestation (from 80 to 87 days), and their litters were examined. Litters were comprised of 68 live fetuses and 1 dead fetus (7 to 14 fetuses/litter). Neither viral antigen, PPV, nor homologous HI antibody was found in any of the fetuses. In addition, 4 gilts were kept in contact with the vaccinated gilts and were treated similarly except for vaccination. These 4 gilts remained free of HI antibody until after they were exposed to virulent PPV during gestation. At the time the gilts were killed the titers were 1,280 to 2,560. Their litters were comprised of 11 live fetuses and 26 dead fetuses (8 to 11 fetuses/litter). Virus was isolated from fetuses of all litters. Viral antigen was found in 24 of the dead fetuses and 10 of the live fetuses. All infected live fetuses also had HI antibody for PPV. The 2 boars used to breed vaccinated and nonvaccinated gilts (usually each gilt was bred to each of the 2 boars), but not exposed to virulent PPV, remained free of HI antibody for PPV.


Relative importance of winter survival of larval nematodes in pasture and infected carrier calves in a study of parasitic gastroenteritis in calves.

A study was done in Maine to determine the relative importance of winter survival of nematode larvae in pasture and infected carrier animals as sources of infection for susceptible calves. Under the conditions of the experiment, it appeared that winter survivals in pasture of the infective stages of the genera Ostertagia, Cooperia, Nematodirus, and Trichostrongylus were of greater importance than carrier animals as sources of infection for susceptible calves. While animals in plots infected the previous summer and simultaneously allowed to graze alongside infected carrier animals did show more worms than those grazed only in infected plots, these differences were not statistically significant. Both groups had significantly (P greater than 0.01) more worms than did calves grazed only with carrier animals for the period of the experiment (8 weeks). It was also observed that carrier calves with low fecal egg counts (less than 200 eggs/g of feces) introduced in early spring to uncontaminated pasture could produce enough parasitic contamination by early fall to cause fulminating infections in susceptible calves grazing the pasture at the same time. Infected animals that survived clinical disease during their 1st summer developed a strong immunity which limited their acquisition of further infections when they were exposed to severe pasture contamination the following year.


Comparison of vaccination and treatment in controlling naturally occurring infectious bovine keratoconjunctivitis.

A vaccination study for infectious bovine keratoconjunctivitis was conducted on 108 newborn Hereford calves in the US Department of Agriculture Meat Animal Research Center cattle herd at Clay Center, Nebraska. Groups were allocated so that age of calf, sex of calf, and age of dam were equally distributed between the 54 vaccinated (group I) and the 54 nonvaccinated (group 2) control calves. The dams of both groups of calves were monitored as group 3 controls. An autogenous Moraxella bovis bacterin (formalin-killed, whole cells) was given IM at birth and at approximate intervals of 2 weeks for a total of 3 doses. Bacterial isolation rates for the cattle in groups 1, 2, and 3 during the summer were 92.6%, 92.6%, and 54.1%, respectively, and disease rates were 100%, 96.3%, and 70.6%. The rates were significantly (P less than 0.05) different between calves and cows. Vaccination of calves at birth permitted serum antibodies to develop before the calves were extensively exposed to infection; however, immunity to the disease did not develop. In a treatment study of other animals in the same herd, but in another pasture, the same criteria were used for allocation of 107 cow-calf pairs. Eye spray was applied to treated principals (group 4, 52 calves; and group 6, 53 cows) each week after examination and sample collection. Controls consisted of 54 calves (group 5) and 54 cows (group 7) that were examined and cultured bacteriologically in the same manner. The bacterial isolation and disease rates were less (P less than 0.05) in the treated calves (group 4) than in the nontreated controls (group 5). The differences in bacterial isolation rates between groups 6 and 7 were not significant, but group 6 had less (P less than 0.05) grade III lesions than did group 7. Weekly treatment appeared to be more effective in reducing the incidence of disease than did vaccination.


Distribution of glutathione peroxidase activity and selenium in the blood of dairy cows.

The distribution of glutathione peroxidase (GSH-Px) activity and selenium concentrations among several components in the blood of dairy cows was examined. Approximately 98% of the GSH-Px activity in peripheral blood was associated with the erythrocytes when enzyme activity was expressed as units per milliliter of blood. The GSH-Px activity expressed per cell was approximately fourfold greater for peripheral leukocytes than for erythrocytes. The cellular component contained a greater proportion (approx 73%) of whole blood selenium than did the plasma. A positive linear relationship (r = 0.958) between blood GSH-Px activity and blood selenium concentrations was found in dairy cattle under practical field conditions.


Immunologic properties of soluble materials from Brucella species.

The purpose in this study was to examine the immunogenic properties of various preparations of aqueous ether extracts of Brucella suis and Brucella canis. The B suis strain 3b and B canis strain RM-6-66 were grown on tryptose agar, and aqueous ether extracts were prepared from the cells. The ether was removed, and the extracts were clarified by centrifugation for 10 hours at 144,000 X g and fractionated by gel chromatography. The B suis endotoxin-containing precipitate, obtained from aqueous ether extracted material by ethanol precipitation, and fraction 1, prepared from ultracentrifugal supernate by column chromatography, protected mice against homologous infection. The B canis aqueous ether-extracted material also protected mice against B suis infections.


Characterization of the equine platelet aggregation response.

Equine platelet aggregation responses to bovine collagen, adenosine diphosphate (ADP), serotonin, epinephrine, and arachidonate in a platelet aggregometer were recorded. Equine platelets exhibited irreversible aggregation when incubated with ADP at a final concentration of 10 microM and bovine collagen. A secondary aggregation wave was recorded from platelets from certain horses at final ADP concentrations of 1 to 5 microM. Serotonin and arachidonate induced a weak reversible aggregation response, but a response was not observed following epinephrine addition. Equine platelet aggregation was influenced by concentration of anticoagulant (sodium citrate). Platelet aggregation responses at 37 C were indistinguishable from those recorded at 39 C. Platelet aggregation responses also were altered if the aggregation tests were not performed within 4 hours of blood sample acquisition. An assessment of platelet aggregation from multiple blood samples from the same horse indicated that the procedures described provide a reliable method to assess equine platelet aggregation in vitro.


Phenylbutazone inhibition of equine platelet function.

Nonsteroidal anti-inflammatory drugs impair platelet aggregation and secretion in man, pigs, and rabbits and inhibit platelet thromboxane/prostaglandin synthesis. The present investigation studied the effects of phenylbutazone on platelet aggregation and bleeding times in the horse. Aggregation responses to adenosine diphosphate and collagen were markedly impaired 15 minutes and 2 hours after treatment, but 4 hours after treatment, platelet responses approximated those prior to treatment. The in vivo effect of phenylbutazone correlated with its plasma concentrations. Phenylbutazone, like aspirin, appeared to exert its effect by inhibiting thromboxane/prostaglandin synthesis, because thrombin-induced malondialdehyde formation was inhibited. However, unlike aspirin, free arachidonate-induced malondialdehyde synthesis was reduced but not eliminated, which suggested that phenylbutazone may have more than one site of action. Although collagen-induced platelet aggregation was impaired, a response was still present, and bleeding times were not altered by phenylbutazone treatment. To account for these findings, it is proposed that equine platelets can respond to collagen by thromboxane/prostaglandin independent pathways. The physiologic and pathophysiologic importance of these findings is discussed.


Correlations between leukocidin production and virulence of two isolates of Fusobacterium necrophorum.

Leukocidin production by Fusobacterium necrophorum was suggested to be an important element in the development of intraabdominal and liver abscesses in mice. Leukocidin production by cultures of F necrophorum was demonstrated by an in vitro assay. One of two isolates of F necrophorum was demonstrated to produce leukocidin. The leukocidin-producing strain was observed to be more infective than the nonleukocidin-producing strain (as demonstrated by abscess formation following intraperitoneal injection of immune-suppressed and normal mice). The infectivity of the leukocidin-producing strain was increased by successive passage in immune-suppressed mice. A simultaneous increase in leukocidin production was also demonstrated. The nonleukocidin-producing strain could not be passed effectively and was relatively noninfective for mice.


Experimentally induced synovitis of chickens with Mycoplasma synoviae: effects of dexamethasone treatment.

Specific - pathogen - free chickens were inoculated in the right tibiometatarsal joint with a synovitis-derived Mycoplasma synoviae strain before or during dexamethasone treatment. Development of synovitis in chickens inoculated during the drug treatment was apparently delayed in comparison with development of synovitis in non-treated chickens. Severity of clinical synovitis in chickens inoculated before the drug was given was apparently less than that in chickens not treated or in chickens treated with dexamethasone. Histopathologic changes in the early stage of the infection (1 to 2 weeks) were not modified by dexamethasone treatment, although those changes in the succeeding stage (6 to 7 weeks) were greatly lessened. A relationship was observed between the dosage of dexamethasone and the severity of synovitis, as well as the kinds of cells that infiltrated into the joint lesions. Although serum antibody titers in chickens treated with an excessive dose of dexamethasone were markedly lower, clinical, bacteriologic, and histopathologic observations in chickens treated with dexamethasone were similar to those previously found in surgically thymectomized chickens. These results may support the theory that multiple synovitis of chickens caused by M synoviae infection develops mainly because of an immune response, especially by thymus-dependent functions.


Evaluation of a cuprimyxin-hydrocortisone acetate suspension in the treatment of otitis externa in dogs and cats.

The therapeutic efficacy of a 0.5% cuprimyxin plus 1% hydrocortisone acetate-water-base suspension was evaluated in 130 clinical cases of otitis externa in dogs and cats in various geographic areas of the United States. The otic microbial flora was studied before treatment in 125 (96%) of the dogs and cats, with multiple isolates recovered from mated from 70%, yeasts from 65%, and fungi from 5% of the animals. Evens though multiple drug reistance was frequently observed in the bacterial flora, all bacteria and yeast isolates were sensitive to cuprimyxin. Of the 130 treated animals, a statistically significant (P less than 0.01) favorable response was obtained in 84,6% and no response in 13;1%; in2.3%, the condition became worse. An adverse reaction (pain at the time of first application) was observed in 1 (0.8%) animal.


Effects of hyperparathyroidism and dietary calcium supplementation on bone healing.

Effects of nutritional secondary hyperparathyroidism and dietary calcium supplementation on bone healing were determined. Groups (n = 4) of 5 mature male dogs each were fed the following diets: group 1, control diet (0.48% Ca, 0.43% P); group 2, test diet (0.12% Ca, 1.14% P): group 3, control diet plus calcium; group 4, test diet plus calcium. The dietary calcium supplementation was calcium gluconate. Lesions were induced in the right tibial cortex by trephinization. Within the time limitations of this study, it was determined that nutritional secondary hyperparathyroidism does not inhibit bone healing and that dietary calcium supplementation does not aid bone healing.


Studies on bone-remodeling rates on the Beagle: A comparison between similar biopsy sites on different ribs.

Two male littermate standardized colony-raised Beagles were studied to find out whether there was any statistically significant difference in the measurements of bone-remodeling determinations at similar sites on different ribs of the animal. Tetracycline fluorescent-labeling studies were performed on these animals, the midportion of the proximal, midshaft, and distal thirds being sampled from the 5th, 7th, 9th, and 11th ribs. Statistical analysis of the findings indicates that there is no significant difference in bone-remodeling activity between similar sites on alternate ribs. This fact permits studies on bone-remodeling activity in an animal to be done in which the same animal is used as its own control and in which more than two experimental biopsy samples are required.


Dose titration of oxfendazole against common nematodes of swine.

Oxfendazole, a benzimidazole carbamate, was administered as a 0.5% feed additive to 88 pigs naturally infected with two to four nematode species. Dose rates of 1.5 mg/kg of body weight, 3.0 mg/kg, 3.75 mg/kg, 4.5 mg/kg, 6.75 mg/kg, or 9.0 mg/kg were 100% efficacious against Oesophagostomum dentatum and 99.2% to 100% effective against Ascaris suum. Dose rates of 4.5 mg/kg, 6.75 mg/kg, and 9.0 mg/kg were 92.7%, 98.9%, and 99.5% effective, respectively, against mixed populations of Metastrongylus apri and M pudendotectus. Results were variable with Trichuris suis infections. Efficacy was based on the number of nematodes recovered at necropsy. Palatability and acceptability of the feed additive were good, and adverse reactions following administration were not observed.


Detection of arbovirus antibodies in avian sera by the complement fixation-inhibition test.

The complement fixation-inhibition (CFI) test was described for the detection of antibodies to arboviruses in bird sera. The CFI antibody present in bird sera inhibited the standard complement-fixation reaction of a reference complement-fixing antigen-antibody pair. Using reference antigens (St. Louis encephalitis, eastern equine encephalomyelitis, western equine encephalomyelitis, and yellow fever) prepared from infected mouse brains and reference antisera prepared in rabbits or horses, reproducible CFI antibody titers were obtained in artificially immunized chickens. Time-course studies on the CFI immune response in birds inoculated with live St. Louis encephalitis virus indicated that the CFI antibody was distinct from the antibody detected by the hemagglutination-inhibition test.


Activation of lung connective tissue cells in vitro.

Guinea pig lung fibroblasts "activated" in vitro by exposure to connective tissue-activating peptides I and III, and guinea pig tissue extracts showed enhanced glycolysis and accelerated glycosaminoglycan synthesis. Formation of hyaluronic acid, and to a lesser extent, chondroitin 4/6-sulfate was stimulated by these agents.


Connective tissue formation by lung fibroblasts in vitro.

Guinea pig lung fibroblasts were grown in monolayer culture after enzymatic disaggregation of lung parenchyma. Light and electron microscopy indicated that the cultures were relatively homogeneous with respect to cell type. Synthesis of matrix glycosaminoglycans and collagen was demonstrated throughout the life of the culture. The properties of the guinea pig cell strains make these a suitable in vitro model system for studying the regulation of connective tissue metabolism of pulmonary tissue.


A chronic isolated tracheal segment to study airway reflexes in conscious dogs.

Airway reflexes are difficult to study in conscious animals because associated changes in ventilation alter intrathoracic airway dimensions. By studying an isolated segment of extrathoracic trachea, we have overcome this problem. In each of 2 dogs, we created surgically an isolated tracheal segment just below the larynx, sealed at one end and tapered at the other to a 3-mm opening via a skin fistula. A chronic tracheostomy was also created near the thoracic outlet. We monitored intraluminal pressure (Pseg) of the isolated segment to reflect changes in smooth muscle tone. During anesthesia, with pentobarbital, gentle mechanical stimulation of the carina, deflation of the lungs, and asphyxia for one min increased Pseg (+9 to +/- 16 cm H2O). Lung inflation and alveolar hyperventilation decreased Pseg (-9 to -16 cm H2O). Five breaths of 2 per cent histamine aerosol increased Pseg (+5 cm H2O) when resting tone was normal. We also coated lumen of the isolated segment with tantalum powder and documented roentgenologically changes in the size of the segment that reflected changes in smooth muscle tone; constriction and dilation in response to asphyxia and lung inflation, respectively, were demonstrated directly by this technique. In conscious dogs, lung inflation decreased Pseg, and carinal stimulation increased Pseg. Instillation of lidocaine hydrochloride (Xylocaine) into the isolated tracheal segment blocked cough caused by mechanical stimulation of the segment, but carinal stimulation still caused constriction of the segment under these conditions which indicated that afferent, but not effrent parasympathetic innervation of the segment had been blocked selectively. Conversely, instillation of atropine sulfate into the isolated tracheal segment blocked constriction of the segment caused by carinal stimulation, but mechanical stimulation of the segment still caused cough under these conditions, which indicated that efferent, but not afferent parasympathetic innervation of the segment had been blocked selectively. We conclude that an innervated extrathoracic tracheal segment constricts and dilates via cholinergic pathways and is suitable for the study of airway reflexes in conscious dogs.


Comparison of two methods of measuring tracheal mucous velocity in anesthetized beagle dogs.

Tracheal mucous velocity measurements were made in 6 beagle dogs using both Sackner's method of radiographing teflon discs and Chopra's method using a gamma camera to detect the movement of instilled labeled material. Dogs were anesthetized by intravenous injection of 30 mg of sodium pentobarbital/kg of body weight in case 1 after pretreatment with atropine and Innovar-Vet; in case 2, without the pretreatment. The mean velocities measured using the 2 techniques were significantly different in both cases: case 1, 3.7 +/- 3.3 mm/min for Sackner's methods and 7.5 +/- 3.7 mm/min for Chopra's method (p less than 0.001); case 2. 3.7 +/- 3.1 mm/min for Sackner's method, and 5.5 +/- 2.1 mm/min for Chopra's method (p less than 0.05). Systematic differences in velocities should be considered when comparing data from investigators using different techniques.


Reverse nitrogen gradients in the study of phase III and cardiogenic oscillations of the single-breath nitrogen test.

The slope of phase III, phase IV, the slope of phase IV, and cardiac oscillations were measured on tracings obtained by both the regular single-breath N2 test (Tech I) and by a reverse technique (Tech II) in 9 healthy volunteers. Tech II consisted of 3 consecutive vital capacities (VC) of 100% O2 followed by one VC of room air. Theoretically, this should create a reversed apicobasal N2 gradient quantitatively similar to that of Tech I. From the total lung capacity following the VC2 of air, we monitored N2 concentration continuously at the mouth during a slow expiration in a manner similar to that of the single-breath N2 test. With Tech II, it is possible to preserve phase IV and its reversed slope in the presence of an almost flat slope of phase III and markedly blunted cardiac oscillations. When compared to Tech I, the slope of phase III with Tech II decreased from 0.66+/-0.20% N2/L (mean +/-SD) to 0.19+/-0.12 (p is less than 0.001), and cardiac oscillations decreased from a mean % N2 change with each heart beat of 0.87+/-0.37 to 0.24+/-0.21 (p is less than 0.005), whereas phase IV, although reversed in direction, remained quantitatively unchanged (0.35+/-0.15 L with Tech I and 0.37+/-0.14 L with Tech II), and the slope of phase IV tended to increase (2.7+/-1.9% N2 with Tech I and 3.4+/-2.1% N2 with Tech II, p=NS). We conclude that the N2 gradients within the lungs responsible for the slope of phase III and cardiac oscillations are largely independent of the gradients that give rise to phase IV and the slope of phase IV.


Disseminated Mycobacterium chelonei infection: response to sulfonamides.

A disseminated infection due to Mycobacterium chelonei occurred in a hemodialysis patient after rejection of his second renal transplant. Painful subcutaneous nodules and abscesses were found on both legs. Therapy with sulfisoxaxole and kanamycin produced a prompt response twice, as did sulfisoxazole alone on 2 additional occasions, despite resistance in vitro to both drugs. Clinical relapses occurred 3 times when administration of sulfisoxazole was discontinued.


The elastic properties of lobes of excised human lungs.

Static pressure-volume curves were obtained from the upper and lower lobes of 5 excised human lungs. Comparison of the upper and lower lobe pressure-volume curves showed a small but significant difference. The upper lobes contained a greater percentage of total lobar capacity above approximately 80 per cent of the lung volume. It would thus appear that the difference in lobar elastic properties could influence ventilation distribution in normal humans.


Lung function in children with sickle cell anemia.

Lung volumes and expiratory flows were measured in 12 children with sickle cell anemia and 12 height-matched black control subjects. Diffusing capacity of the lung for CO, pulmonary capillary blood volume, the membrane component of diffusing capacity, arterial blood gases on breathing room air and 100 per cent O2 were measured in the subjects with sickle cell anemia. The lung volumes and expiratory flows of subjects with sickle cell anemia were no different from those of the control subjects. Diffusing capacity for CO was maintined in the noraml range despite the severe anemia by increases in pulmonary capillary blood volume and the membrane component of diffusing capacity. All subjects with sickle cell anemia had mild hypoxemia and abnormal increases in calculated shunt. Pulmonary function in children with sickle cell anemia appears to be determined by their race and anemia.


A cluster of Mycobacterium gordonae isolates from bronchoscopy specimens.

During a 2.5-year period, 52 patients at Yale-New Haven Hospital had Mycobacterium gordonae recovered from specimens obtained by suction at bronchoscopy; 2 of them also had smears positive for acid-fast bacilli. Almost all of the isolates came from patients bronchoscoped by the same physician, one of 4 who performed the procedure during that period. Only this physician added one drop of green dye, stored in a 100-ml bottle, to the cocaine used for topical anesthesia during the procedure; cultures of the dye yielded Mycobacterium gordonae. Contamination with this organism, a cause of positive acid-fast smears, may result in an initial inappropriate diagnosis of Mycobacterium tuberculosis.


The influence of lower respiratory illness in infancy and childhood and subsequent cigarette smoking on lung function in Sydney schoolchildren.

A prospective study of respiratory illness history and lung function of 10,898 school children in Sydney was begun in 1971. At the first visit, a history of previous asthma and of bronchitis before and after the first 2 years of life was obtained from a parental questionnaire, and maximal expiratory flow-volume curves were recorded. These lung function studies were repeated yearly between 1972 and 1974, at which time a history of respiratory illness during the previous 12 months and a personal smoking history were recorded, Two groups of children from a random selection of primary and secondary schools in Sydney were studied. Their respective mean ages were 8.9 yr (primary group) and 12.6 yr (high school group) in 1971. Mean values for the maximal flow at 50 percent of the forced vital capacity were lower in children with a history of bronchitis and/or asthma than those in the control group. This was true in both age groups in both sexes. No differences were found in the 0.5-s forced expiratory volume or forced vital capacity. The differences in maximal flow at 50 per cent of the forced vital capacity were present again in 1974. In 1974, the data from smokers were compared with those from nonsmokers; small differences were found. The results suggest that bronchitis in infancy and childhood as well as asthma may affect lung function as children grow, that the abnormality may not be detected by the forced expiratory volume, that the abnormality persists, and that it is possible that the abnormality is further affected by smoking.


Tuberculin test conversion during repeated skin testing, associated with sensitivity to nontuberculous mycobacteria.

To determine whether repeating the tuberculin test after a brief interval might result in tuberculin conversion, we tested 213 healthy volunteers twice, 1 month apart, with 5 TU of tuberculin purified protein derivative (PPD). Three nontuberculous mycobacterial antigens (PPD-G, PPD-Y, and PPD-B) were also applied with the first tuberculin test. By widely used criteria, 14 volunteers (6.6 per cent) converted their tuberculin tests from negative to positive on the second testing. Whereas 13 of 103 subjects (12.6 per cent) with nontuberculous antigen sensitivity converted their tuberculin test to positive, only one of 110 subjects (0.9 per cent) with no known prior mycobacterial sensitivity converted to positive (P less than 0.005; x2 = 10.05). When retested with 5 TU of tuberculin PPD 6.5 months after the second test, nine of 13 converters reverted to negative. We conclude that tuberculin conversion may occur when the skin test is repeated at 1 month, and that boosting of cross-reacting mycobacterial sensitivity might have caused a portion of the conversions in this population of young, healthy midwestern volunteers. Sensitivity to Mycobacterium tuberculosis might also be boosted by tuberculin testing. Because the prevalence of sensitization by tuberculous and nontuberculous mycobacteria can be expected to vary in different populations, the significance of tuberculin conversion will also vary with the population being tested.


Absence of synergism between exposure to asbestos and cigarette smoking in asbestosis.

To assess both independent and synergistic effects of exposure to asbestos and cigarette smoking on the development of asbestosis, survey data from 4 groups of workers exposed to asbestos were analyzed with multivariate statistical models. Survey methods were standardized and included for the 383 subjects a respiratory symptoms questionnaire, occupational history, physical examination, pulmonary function testing, and a chest radiograph. Exposure to asbestos and cigarette smoking were assessed by questionnaire. Synergism between the 2 exposures was not present for previously identified manifestations of asbestosis including bilateral fine crackles, clubbing, dyspnea, radiographic abnormality, decreased forced vital capacity, and decreased single-breath diffusing capacity of the lung for CO. However, additive, independent effects of these 2 exposures were present for each of these parameters.


The management of allergic bronchopulmonary aspergillosis.

Twenty-five patients with allergic bronchopulmonary aspergillosis (ABPA) were observed for periods of 12 months to 10 years (average duration, 2.6 years) after initial therapy with prednisone, which was then tapered and discontinued unless maintained at minimal doses as required for control of asthma. Thirteen patients have had no recurrence, 4 patients did not comply with the initial regimen and could not be considered to be controlled, and 8 patients had 12 recurrent episodes of ABPA characterized by pulmonary infiltrates with no explanation other than ABPA. The exacerbations were closely correlated with sharp increases in total serum IgE, which subsequently decreased after resumption of prednisone therapy. The increase of IgE preceded the pulmonary infiltrates in 7 or 12 exacerbations. The exacerbations, characterized by increased serum IgE and pulmonary infiltrates, may be associated with minimal symptoms. Acute asthma without pulmonary infiltrates was not associated with increased IgE. Four exacerbations occurred during administration of beclomethasone diproprionate used for control of asthma, and therefore, this agent does not appear to prevent or reverse exacerbations of ABPA. Twelve exacerbations occurred in 8 persons, with 2 patients having 4 and 2 recurrences, respectively. This suggests that exacerbations are more likely to occur in certain patients. Serial measurements of total serum IgE appears to be a useful index of disease activity in ABPA. In the 4 patients who did not comply with the prednisone therapy regimen or regular physician visits, patterns of IgE changes, clinical evaluations, and chest roentgenograms were not of use in evaluation of the clinical state or progress of the patient. A treatment regimen is suggested for initial therapy and recurrences of ABPA on the basis of these observations.


Acute pulmonary injury in rats by nitrofurantoin and modification by vitamin E, dietary fat, and oxygen.

The subcutaneous administration of nitrofurantoin to rats caused severe pulmonary damage, characterized by edema, congestion, and hemorrhage. The acute lethality of the drug was greater in rats fed vitamin E-deficient diets high in polyunsaturated fats as compared to rats fed the NIH open-formula diet. The survival times of vitamin E-deficient rats were increased if such animals were fed diets supplemented with vitamin E and/or diets containing saturated fat (lard) for 3 weeks before administration of nitrofurantoin. The toxicity of nitrofurantoin was enhanced in both the rats deficient in vitamin E and in those given vitamin E supplements and exposed to O2-enriched atmospheres. These results, in conjunction with previous metabolic studies in vitro showing redox cycling and O2 activation in rat lung microsomes in the presence of nitrofurantoin, illustrate certain similarities with the lung-toxic herbicide, paraquat, and raise the question of whether the 2 agents may be capable of damaging lungs by a common mechanism.


Percutaneous transhepatic cholangiography with a small-gauge needle: results of a two-year study in a community hospital.

Fifty patients in a community hospital underwent evaluation of the biliary system by the new small-gauge needle technique of percutaneous transhepatic cholangiography. The high success rate, ease of performance, and low complication rate attest to the worth of this procedure in the diagnosis of hepatobiliary disease.


Percutaneous transhepatic cholangiography: an experience with the Chiba needle.

Percutaneous transhepatic cholangiography (PTC) with a "skinny" Chiba needle identified the biliary tree in 30 of 31 patients (97%) with extrahepatic obstructive cholestasis (EHC). The method was successful in only eight of 18 patients who had cirrhosis with unexplained jaundice. The biliary tree was visualized after one or two attempts in 23 of 31 patients with EHC (74%). The success rate was significantly greater (p greater than 0.001) in those patients with EHC than in those with EHC, in whom the biliary tree was visualized in 9 of 27 (33%). Difficulties in correctly interpreting the PTC findings in four patients are described.


The use of ultrasonography in the diagnosis of calculous gallbladder disease.

During a 12-month period from September 1976 to September 1977, 114 patients in a community hospital had ultrasonography as part of their diagnostic work-up for suspected gallbladder disease. While 65 per cent had an additional study, such as an oral cholecystogram or intravenous cholangiogram, 35 per cent had ultrasonography as the only study to make the diagnosis. All patients in this group had laparotomy and cholecystectomy to confirm or disprove the diagnosis of calculous gallbladder disease. The overall accuracy rate of ultrasonography for calculous gallbladder disease was 90 per cent, which compares favorably with the standard oral cholecystogram. Ultrasonography has some distinct advantages in certain clinical situations such as acute cholecystitis, jaundice, pancreatitis and pregnancy. A review of our clinical experience in the everyday use of ultrasonography for calculous biliary disease has been discussed, and guidelines for the use of ultrasonography as part of the diagnostic armamentarium for gallbladder disease are presented.


Effect of portasystemic shunt on hypersplenism: clinical study in 129 patients with cirrhosis.

The effect of portasystemic shunts on hypersplenism has been evaluated in 129 patients who were operated upon. Correction of hypersplenism was obtained in 79 per cent of patients with shunting procedures without splenectomy and 90 per cent of those with splenectomy. The improvement was significant and lasting. These results confirm the beneficial effect of splenic decompression on hypersplenism after simple portasystemic shunt. On the basis of these data, we feel that a difficult splenectomy can also be avoided in patients who have cirrhosis with striking hypersplenism.


Acute rupture of the lateral ligaments of the ankle joint, diagnosis and surgical treatment.

A useful method for the diagnosis of acute rupture of the lateral ligament of the ankle joint is presented. Twenty-three patients with ruptures of the lateral ligament of the ankle joint were treated surgically with suture of the lateral ligaments of the ankle. Accurate preoperative diagnosis with stress films and arthrography under local anesthesia of the ankle joint is imperative. No instances of infection or other complications were observed. All patients achieved a normal range of ankle function within three to six months. Radiograhs of the injured ankle in the forced inversion position following operation showed full stability of the ankle joint. In our opinion, all ankle injuries should be examined roentgenographically with forced inversion of the foot. Tilting of the talus of at least 10 degrees must be followed by arthrography of the ankle joint under local anesthesia. If there is leakage of contrast material along the peroneal tendon sheaths and around the joint cavity, the lateral ligament of the ankle must be sutured immediately in order to regain stability of the ankle joint.


Adult hypertrophic pyloric stenosis.

Adult hypertrophic pyloric stenosis is an unusual disease of obscure etiology which causes varying degrees of gastric outlet obstruction. Diagnosis by history, physical examination, and roentgenography is difficult but can be readily made with fiberoptic gastroscopy where a characteristic pyloric "cervix sign" is seen. All of the many operations for relief of gastric outlet obstruction have been tried with this lesion, with resection and Billroth I reanastomosis the accepted treatment. Two patients are reported with adult hypertrophic pyloric stenosis who had typical endoscopic findings. One was treated with distal gastrectomy, and the other was adequately treated by endoscopic dilatation alone. It is suggested that endoscopic dilatation is acceptable as primary therapy in suitable cases.


Two forms of trehalase activity in mice.

Trehalase activities from mouse serum and kidney have been compared on ion exchange chromatography (DEAE-cellulose and SP-Sephadex). The two activities showed a distinct behaviour. This was confirmed by polyacrylamide gel electrophoresis and thermal lability, suggesting the presence of at least two forms of the hydrolytic enzyme trehalase in mice.


Differential scanning calorimetry of the thermal denaturation of human serotransferrin.

The thermal denaturation of iron-free and iron human serotransferrin has been studied by differential scanning calorimetry. At pH 7.9 in 0.05M Tris, 0.1M NaHCO3 buffer, two transitions (Td = 60.1 degrees, 70.7 degrees C), at a 5 degrees C/min heating rate, were observed for iron-free serotransferrin. The respective enthalpies of denaturation were found to be 143 and 229 kcal/mol. Iron serotransferrin exhibits a single thermogram peak with Td = 83.4 degrees C and delta H = 616 +/- 15 kcal/mol (linearly extrapolated to 0 degrees C/min heating rate), at pH 7.8. An activation energy of 104 kcal/mol was computed by the procedure of Beech. A value of 112 kcal/mol was calculated from a first-order kinetics Arrhenius plot. Rate constants were determined at several temperatures from the onset temperature to Td. Denaturation temperatures and enthalpies were linearly dependent on heating rates. The thermal denaturations of iron-free and iron serotransferrins are irreversible, under the experimental conditions used. In contrast to conalbumin, thermograms of serotransferrin solutions partially saturated with ferric ions exhibit only the peaks corresponding to those obtained on separate DSC scans of iron-free and iron serotransferrin, respectively.


[Congenital cystic adenomatoid malformation of the lung (author's transl)].

Four cases of congenital cystic adenomatoid malformation of the lung are described. One was a stillborn, and the other three newborns, all of them surviving after lobectomy. Pathological, clinical and radiological features are discussed and compared with previously reported cases.


[Morbidity and mortality of acute renal failure in neonatal period (author's transl)].

A retrospective study of 35 newborn with acute renal failure is presented. The main causes of renal failure were neonatal hypoxia by asfixia or hemorrhagic shock (eight), congenital malformations (two) and hypertonic dehydration (25). Mortality rate was 22% including two neonates with severe congenital malformations. Sepsis was considered as the main complicating factor and often as inducer of renal failure. It was present on 55% of cases and on 75% of the deceased newborn. Cerebral injury was frequent but a follow-up study is necessary to establish the rate of neurologic sequelae. Early diagnosis and treatment of renal failure will decrease complications with improvement in prognosis. Etiological analysis of neonatal renal failure shows the need of a better health education of people and also medical control of pregnancy and perinatal period.


[Growing cranial fractures in infancy (author's transl)].

Seventeen cases of growing cranial fractures in infancy are presented, eleven males and six females. Seventy per cent of the cases suffered a traumatic episode before one year of life. Thirteen of the total group experienced surgical intervention in which a completely defective duramater and alterations of the leptomeninges and the subsequent cerebral cortex were encountered. Leptomeningeal cysts were found in nine patients or 70 per cent of the cases. Ventricular system revealed alterations in all cases that were studied by means of neumoencephalography or computerized axial tomography. Evolution of 15 of the cases was follow up for a period of time which varied between five months to eleven years of age. An analysis of electroencephalographical alterations and neurological sequelae is made. An uncommon form of clinical-electroencephalographic evolution is described in one of the cases.


[Radiological manifestations of Meckel's diverticulum (author's transl)].

Multiple clinical and radiological manifestations of Meckel's diverticulum are commented, presenting four cases with acute abdominal manifestations and one with chronic symptomatology, which were selected from a series of nineteen cases that were surgically verified. The authors realize a critique of the radiological techniques in the literature of the suspected cases of said entity.


[Neuronal ceroid-lipofuscinosis. Diagnosis by skin biopsy. Physiopathology (author's transl)].

Authors report a case of Batten's disease (neuronal ceroid-lipofuscinosis), in its late infantile form (Jansky-Bielschowsky), so as the ability to identify the process by ultrastructural study of the skin.


[Male pseudohermaphroditism due to deficit in the conversion of cholesterol to delta5 pregnenolone (author's transl)].

One patient, aged 13 months, considered phenotipically a female, was admitted with a picture of acute dehydration. Familial history (one sister dead from the same picture at the age of 18 months), clinical data (several episodes of dehydration, dark skin and mucosae, and slight abnormalities in the external genitalia), hormonal examinations (low plasmatic levels of cortisol, aldosterone, androgens and low urinary excretion of 17 hydroxycorticoids, dehydroepiandrosterone and ethiocholanolone), chromosomal examination (karyotype XY) and histological data (normal testis) suggested a diagnosis of male pseudohermaphroditism with complete feminization due to an abnormal conversion of cholesterol in delta5 pregnenolone. Late appearance of the first episode of dehydration, particularly intense cutaneous pigmentation and statural growth and bone maturation both unaffected, are some particular traits of this patient.


[Schwartz-Jampel syndrome. A case report and review of literature (author's transl)].

A new case with distinctive features of Schwartz-Jampel syndrome is reported, which makes the patient number 28 after reviewing world literature on the subject. Clinical, genetic, neurophysiological and pathological point of view is studied. The myotonic discharges which the patient presented while resting, did not diminish either with general anesthesia or with curarization, being this the pattern of a true myotonia.


[Total colonic aganglionism (author's transl)].

Total colonic is the most frequent form of extensive aganglionism. Diagnosis is difficult, but it must be taken in mind whenever either muscoviscidosis or ileal atresia are considered. Nine cases out of a series of 319 aganglionisms seen between 1957 and 1977 are reported. Ileostomy can be lifesaving but Duhamel-Lester Martin technique must be elected as a definitive treatment. The modification proposed by the authors, carried out in three cases, can be performed as a first-choice operation in the newborn. The long term results in these three cases are compared to those of other techniques. A general review of the problem is made.


[Peptic ulcer in children (7 cases). Importance of fiberendoscopy (author's transl)].

The authors studied 7 cases of peptic ulcers (2 gastric and 5 duodenals) in patients whose ages ranged between 3 and 13 4/12 years. They represented 0.5% of hospital inpatients. A history of acetyl salicilic acid ingestion was present in 3 of the cases. In 2 of the cases emotional factors were associated. Initial symptoms were distributed as follows: abdominal (4), hematemesis (2) and melena (1). The clinical course was favorable for 5 of the patients; in one of them signs of bulboduodenitis became evident in the fourth month; in another one the clinical signs persisted and a new ulcer appeared 4 months after the initial diagnosis. High levels of gastrin were found in this case. The importance of gastroduodenal fiberendoscopy in infancy for the diagnosis, histological confirmation and follow-up of peptic ulcer is emphasized.


[Meckel syndrome (author's transl)].

Authors study four cases, two siblings in two different families, with several anomalies allowing to consider them as examples of the Meckel-Grüber syndrome. A review of the recent literature about this entity is made, as well as a comparative study of the anomalie present in the published cases.


[Stimulation of growth hormone (HGH) secretion by physical exercise (author's transl)].

Authors study forty eight children with severe lineal growth retardation. The more frequent causes of a stunted growth were ruled out previously (systemic and chronic diseases, metabolic disorders, genetic alterations, etc.). As a screening test, physical exercise was used to detect growth hormone (HGH) deficiency. A normal response was considered when HGH levels rose more than 7,0 ng./ml. after 20 minutes of continuous exercise. In those cases in which this level was not attained. insulin-hypoglycemia alone and followed by insulin plus an arginine infusion were used as stimuli, to confirm the lack of HGH response. A correct response to the exercise was found in 81% of the cases. It is concluded that the physical exercise as HGH stimulus is a good screening test. It presents a high degree of confidence with some other qualities, mainly: little disturbances to the patients, a rapid performance, lack of unpleasant colateral effects, and the possibility that it can be carried out by sanitary non-medical personnel.


[Neonatal small left colon syndrome (author's transl)].

Two cases of neonatal intestinal obstruction, with clinical, radiological and evolutive characteristics typical of the "neonatal small left colon syndrome", are described. Some etiological aspects are commented upon as well as differential diagnosis, which must be done with a certain number of diseases that produce intestinal obstruction in the newborn. Authors consider of great interest the high incidence of this syndrome in children born to diabetic mothers, diagnostic value of barium enema and the usually benign clinical course with very simple therapeutic procedures.


[Congenital cystic adenomatoid malformation of the lung with systemic circulation (author's transl)].

A new observation of CCAML which systemic circulation is presented. At this occasion authors update literature review published in 1973. The total number of cases reported is 78 which our case has to be added. The existence of a systemic artery has only been demonstrated previously in three patients.


[Benign familial neonatal convulsions (author's transl)].

Newborn male with convulsive crisis from the third day of life. Analysis and complementary examination, EEG excepted, were normal. After the 40th day of life, no further crisis were observed. Clinical evolution and psychomotor development were normal. Anamnesic findings: 13 members in five generations presented new born conculsions. No psychomotor alterations in the development were observed in all of them, excepted one. An early knowledge of this clinical picture, already described in six families, may avoid dangerous clinical examinations as well as a prolonged anticonvulsive treatment. The mode of inheritance is dominant autosomial.


["Free" 9p trisomy in a male child with severe mental retardation (author's transl)].

A new case of free 9p trisomy is described. The GTG banding technique and the Giemsa-11 method showed that the extra chromosome comprised precisely the 9pter leads to q12 segment. The carrier is an eleven-year-old male child with typical facial features: globulous nose, antimongoloid slant of palpebral fissures, downward turning of mouth angels and winged ears, severe mental retardation particularly regarding language and characteristic dermatoglyphics.


The chronic sequelae of non-A, non-B hepatitis.

Twenty-six of 388 patients (6.7%) followed prospectively after open-heart surgery developed non-A, non-B hepatitis. Of these 26, 12 had an elevated (often fluctuating) serum alanine aminotransferase (SGPT) for greater than 1 year. Liver biopsy, done in eight of 12, showed chronic active hepatitis in six and chronic persistent hepatitis in two; one patient with chronic active hepatitis had early cirrhosis. Anicteric patients with peak SGPT greater then 300 IU/L were at greatest risk of developing chronic hepatitis. Chronic non-A, non-B hepatitis was symptomatically mild and unaccompanied by physical signs or laboratory evidence of autoimmune disease or severe chronic liver disease. In all 12 patients there was spontaneous improvement in serum transaminase over a period of 1 to 3 years, and four patients had sustained normalization of SGPT. Thus chronic active hepatitis is a common sequela of acute non-A, non-B hepatitis but may have a better prognosis than chronic active hepatitis of other causes.


Knowledge and use of placebos by house officers and nurses.

Sixty house officers and 39 registered nurses in a university teaching hospital were surveyed to ascertain their knowledge of placebo action and their patterns of placebo use. The majority of physicians and nurses greatly underestimated the percentage of patients who experience pain relief when given placebo. Placebos typically were given to disliked patients who were suspected of exaggerating their pain or had failed to respond to usual medical regimens, or both. Positive responses to placebo medication were then interpreted by the physicians as evidence that the pain had no physiologic basis. Many studies have shown that overdemanding and complaining patients are, if anything, less likely to respond to placebo than patients well liked by the hospital staff. Nevertheless the results of our survey suggest that this is precisely the type of patient "at risk" for placebo treatment.


Serum triiodothyronine and other clinical and laboratory indices of alcoholic liver disease.

Admission serum triiodothyronine (T3) values in 124 patients hospitalized for alcoholic liver disease were correlated with clinical and laboratory indices of liver function and commonly used determinants of thyroid function. Patients with low admission serum T3 levels had significant alterations in serum albumin, bilirubin, prothrombin time, and alkaline phosphatase associated with clinical signs of portal hypertension and collateral circulation, with little difference in serum glutamic-oxaloacetic transaminase, serum gamma glutamyl transpeptidase, or serum ornithine carbamyl transferase. This group also had a significant decrease in free T3 index despite an increase in T3 uptake; the slight reduction in total thyroxine (T4) was associated with an increase in free T4 index and no change in serum thyrotropin (TSH). For patients with alcoholic liver disease, low admission serum T3 and free T3 index values when accompanied by normal serum T4, free T4 index, and TSH levels appear to be indicative of severe liver dysfunction and increased mortality risk.


Ultraviolet phototherapy of uremic pruritus. Long-term results and possible mechanism of action.

The beneficial effect of sunburn-spectrum ultraviolet (UVB) phototherapy on uremic pruritus was studied. Seven patients were treated twice weekly for 4 weeks with UVB to one half of the body and placebo phototherapy to the other half. All patients noted generalized improvement without localization of benefit to the UVB side, suggesting a systemic effect of UVB. A comparison of three schedules varying from one to three treatments weekly showed that the percentage of patients responding was not influenced by frequency of UVB exposure, although patients treated more intensively improved faster. In three patients, improvement was delayed until 2 weeks after completion of a course of six treatments over 2 weeks, indicating a delayed onset of benefit in at least some patients. Overall 32 of 38 patients improved after a course of six or eight UVB exposures. Pruritus has recurred in 15 patients after a mean remission of 3 months. Sixteen patients are known to remain in remission for a mean of at least 10.6 months after the first or second course of treatment. The present evidence indicates a systemic mechanism of action for the long-lasting relief of uremic pruritus afforded by UVB phototherapy.


Amyloidosis in chronic heroin addicts with the nephrotic syndrome.

Four chronic heroin addicts had renal amyloidosis and the nephrotic syndrome. Amyloidosis had the secondary type of tissue distribution and developed after many years of addiction. That chronic immunologic stimulation by one or more exogenous antigens or multiple acute inflammatory episodes were important factors in the pathogenesis of amyloidosis in these patients is postulated. Amyloidosis, although uncommon, must be considered among the different types of renal involvement that are known to occur in drug addicts, especially those with the nephrotic syndrome, and amyloid should be specifically searched for in their renal biopsies.


Immunopathologic studies of pneumonitis in systemic lupus erythematosus.

We performed immunohistopathologic studies on biopsied lung tissue obtained from two patients with lupus pneumonitis using immunofluorescence, immunoperoxidase, electron microscopy, and acid-microelution. In both patients, immunofluorescence showed granular deposits of IgG, the third component of complement (C3), and DNA in the alveolar walls. The immunoperoxidase technique in both and electron microscopy in one showed that these deposits were in the interstitium of the alveolar walls and in the alveolar capillary walls. The eluates obtained from cryostat sections of the biopsied lungs contained antinuclear factor of IgG class in one patient and showed anti-DNA antibody activity in both. We suggest that the deposits are immune complexes composed of DNA, anti-DNA antibody, and complement and that deposits of DNA-anti-DNA immune complex may play a role in lupus pneumonitis.


Racemic warfarin and trimethoprim-sulfamethoxazole interaction in humans.

Eleven normal humans were studied to evaluate the reported interaction of racemic sodium warfarin and trimethoprim-sulfamethoxazole prospectively. Single oral doses of racemic warfarin, 1.5 mg/kg of body weight, were administered with and without 320 mg of trimethoprim and 1600 mg of sulfamethoxazole orally, beginning 7 d before the warfarin and continuing daily throughout the hypoprothrombinemia. Daily plasma samples were analyzed for one-stage prothrombin activity (Quick) and for warfarin content by high-pressure liquid chromatography. Transient cutaneous reactions developed in four of 11 subjects: a morbilliform rash in three (studies discontinued) and generalized pruritus in one. A highly significant augmentation of the warfarin effect on the mean one-stage prothrombin activity (P less than 0.03) occurred with trimethoprim-sulfamethoxazole, but no significant effect was found on the warfarin half-life (P greater than 0.5). It is concluded that trimethoprim-sulfamethoxazole interacts with racemic warfarin, possibly at a receptor-site locus.


Primary familial bilateral carpal tunnel syndrome.

We identified bilateral carpal tunnel syndrome in 19 of 43 living persons of a nonconsanguineous family. No single common etiologic feature was seen. Sixty-three percent of the afflicted kindred had symptomatic digital flexor tenosynovitis. Noninflammatory thickening of the flexor retinaculum or tendon sheaths, or both, was the commonest surgical finding. The 44% prevalence, early age of onset, and equal sex ratio differ from idiopathic carpal tunnel syndrome. Family pedigree suggests an inheritable disorder transmitted by an autosomal dominant gene with a high degree of penetrance.


Uric acid excretion: quantitative assessment from spot, midmorning serum and urine samples.

Uric acid excretion can be measured in milligrams of urinary uric acid per decilitre of glomerular filtrate by obtaining the product of urinary uric acid and serum creatinine concentrations and dividing by the urine creatinine (all concentrations in mg/dL). In 29 normal adult men, the excretion rate in spot, midmorning samples was 0.4 +/- 0.1 (SD) mg of uric acid per decilitre of glomerular filtrate. Eight of 36 untreated gouty men excreted acid at a rate more than three standard deviations above normal. Excretion of uric acid is conveniently and physiologically assessed by this simple method.


Acute oliguric renal failure induced by indomethacin: possible mechanism.

A patient with compensated congestive heart failure suffered acute deterioration of her renal function and cardiac status, requiring peritoneal dialysis, in association with indomethacin therapy. Discontinuation of this inhibitor of prostaglandin synthesis led to a prompt improvement in both her renal function and cardiac status. The patient was rechallenged with indomethacin and again developed acute reduction of her glomerular filtration rate and severe volume retention, which were again totally reversed when the drug was stopped. Urinary prostaglandin E was measured by radioimmunoassay in this patient and five additional patients with congestive heart failure and prerenal azotemia. All patients were found to have elevated levels of urinary prostaglandin E. The possible role for renal prostaglandin E as a compensatory mechanism to the vasoconstrictive stimuli present in congestive heart failure is discussed. The potential danger of inhibitors of prostaglandin synthesis in patients with congestive heart failure and prerenal azotemia is emphasized.


Possible nosocomial transmission of group Y Neisseria meningitidis among oncology patients.

Within 4 days, two oncology patients in the Clinical Research Unit had bacteremia causes by group Y Neisseria meningitidis. Three additional patients, identified by prevalence survey, were found to have nasopharyngeal colonization with that serogroup, compared with only one employee (not associated with patients) and no family contacts. Infected and colonized (case) patients were located in the same or adjacent rooms but did not have close contact. A comparison of host and risk factors showed no significant differences between case patients and the other (control) patients located in the same rooms. In retrospect, the index patient, who had marked sputum production but was not isolated, had unrecognized meningococcal pneumonia and probably was the hospital source of a heavy, airborne dispersal of organisms to other patients. Respiratory isolation is warranted for patients with suspected N. meningitidis infection.


Reactive hyperreninemia in renovascular hypertension after angiotensin blockage with saralasin or converting enzyme inhibitor.

Baseline plasma renin activity and responses to saralasin and converting enzyme inhibitor SQ 20881 (teprotide) in 47 untreated patients with surgically correctable renovascular hypertension were compared to those in 100 patients with high- and normal-renin essential hypertension. All 32 renovascular patients on normal sodium intake had high renin-sodium profiles and renin values greater than or equal to 5 ng angiotensin I/mL.h, as compared to 20 of 64 with essential hypertension. Diagnostic discrimination was greatly enhanced by infusion of saralasin or SQ 20881, which elicited marked reactive hyperreninemia in 31 of 32 renovascular patients but in only two of 64 with essential hypertension. Reactive hyperreninemia appeared to be more a specific test for renovascular hypertension than depressor responses. Prior dietary sodium depletion abolished this specificity. The results suggest that after initial screening with renin measurements, testing with angiotensin blocking agents may be a useful secondary screening procedure for more invasive and definitive procedures.


Ventriculoatrial intervals: diagnostic use in paroxysmal supraventricular tachycardia.

Reciprocating tachycardias due to reentry either within the atrioventricular (AV) node or using an accessory AV pathway are a common cause of paroxysmal supraventricular tachycardia in humans. Unfortunately, although of potential therapeutic value, differentiation of these forms of reciprocating tachycardia may be difficult and require detailed electrophysiologic study. To develop diagnostic criteria that permit exclusion of participation of an accessory AV pathway in reciprocating tachycardia without extensive laboratory testing, results of electrophysiologic studies were examined in 50 patients with Wolff-Parkinson-White syndrome, 15 patients with accessory AV pathways that conducted only in the ventriculoatrial direction, and 15 patients with reentry within the AV node. The interval between onset of ventricular activation and both earliest recorded atrial activity (V-Amin) and high lateral right atrial electrogram (V-HRA) was measured during tachycardia. A V-Amin of 61 ms or less or V-HRA of 95 ms or less did not occur in patients with accessory AV pathways, but occurred frequently (12 of 15 and seven or eight, respectively) in patients with reentry within the AV node. Therefore, in patients with paroxysmal reciprocating tachycardias, V-A interval measurements provide a screening test capable of excluding participation of an accessory AV pathway.


Obstruction of the proximal right coronary artery with acute inferior infarction due to blunt chest trauma.

Two patients developed an acute transmural myocardial infarction due to severe obstruction of the proximal right coronary artery after blunt chest trauma. Neither had a history of ischemic heart disease, and both had an arteriographically normal left coronary artery. In one patient significant resolution of the subtotal obstruction occurred within 3 months. An intimal tear or subintimal hemorrhage with luminal thrombosis, or both, are the suggested mechanism of coronary arterial occlusion. Spasm and platelet aggregates may contribute. Despite a large number of automobile accidents, obstruction of the right coronary artery due to blunt chest trauma has not been previously described. This suggests it has been overlooked and should be especially suspected in persons with injury to the sternum and an acute inferior myocardial infarction.


Pheochromocytoma associated with hypercalcemia and ectopic secretion of calcitonin.

A 17-year-old woman manifested fever, abdominal pain, headache, and hypertension caused by a solitary, benign pheochromocytoma. She also had hypercalcemia and elevated plasma immunoreactive calcitonin levels. After removal of the pheochromocytoma, calcium and calcitonin levels returned to normal. Studies of peripheral and tumor venous blood showed no excess or ectopic parathyroid hormone secretion, but the tumor contained and secreted calcitonin. Sporadic pheochromocytoma may secrete calcitonin and cause hypercalcemia by non-parathyroid hormone-mediated mechanisms. The potential is clearly present for confusion with multiple endocrine neoplasia, type 2 (medullary thyroid carcinoma, pheochromocytoma, and primary hyperparathyroidism).


Bladder complications in patients receiving cyclophosphamide for systemic lupus erythematosus or rheumatoid arthritis.

The bladder complications of 54 patients treated with oral cyclophosphamide for systemic lupus erythematosus (43) or rheumatoid arthritis (11) were reviewed. During an observation period of 241 patient years, we saw seven cases of acute hemorrhagic cystitis and two cases of transitional cell carcinoma of the bladder. Bladder carcinoma was identified 28 and 60 months after withdrawal of the drug and resulted in the death of one patient. The late-occurring serious toxicities of cyclophosphamide should limit the use of the drug in the treatment of nonmalignant inflammatory rheumatic conditions.


The effect of a primary-care pathway on internal medicine residents' career plans.

There has been no evidence that primary-care pathways, a recent innovation in internal medicine residency programs, have affected the career choices of their trainees. We report the experience of the first four cohorts of primary-care trainees in internal medicine compared with traditional-pathway trainees at Boston City Hospital. Primary-care residents remained committed to their plans for a career in general internal medicine throughout training. In contrast, two thirds of the traditionally trained residents who were planning a career in general internal medicine at the beginning of their training changed their plans to subspecialty medicine. Thus, the primary-care pathway reinforced the career plans of trainees in general internal medicine, whereas traditional training influenced potential generalists toward subspecialty medicine.


A national study of internal medicine and its specialties: II. Primary care in internal medicine.

A nationwide study of practitioners in 24 medical and surgical specialties was conducted by the University of Southern California School of Medicine, Division of Research in Medical Education. In this second report of a series presenting findings for internal medicine, general internal medicine and 10 subspecialties of internal medicine are compared using a care classification scheme designed for the study. On the basis of characteristics of the individual patient encounter, this care classification scheme distinguishes several dimensions associated with the concept of primary care. Five empirically derived types of care rather than a simple "primary" or "non-primary" dichotomy are described, and the distributions of each type for the 11 subspecialties examined are noted. Types of care (according to the care classification) are examined by the time per patient, the complexity of physician services, the severity and chronicity of problems, and the degree of specialization associated with providing different types of care. Estimates of the number of annual encounters, and the number of annual encounters for three of the five types of care, with the proportion of each accounted for by each subspecialty, are given.


National study of internal medicine manpower: III. Subspecialty fellowship training 1976-1977.

Questionnaire II of the National Study of Internal Medicine Manpower was directed to all of the 1502 subspecialty training programs in the United States and Puerto Rico. The overall response rate was 86%. For the years 1972-1973 through 1976-1977 the number of fellows in subspecialty training grew at an average rate of 10.6% per year, or one and one-half times greater than the growth rate of 7.2% in the number of first-year residents in training for the same time period. In 1976-1977 there were 5826 fellows in subspecialty fellowship training, of whom 26% were foreign medical graduates. Stipends for subspecialty fellows in 1976-1977 amounted to $90 million, 40% of which was derived from direct federal funds and 33% from hospital revenues. Most of the subspecialty fellowship programs were in large teaching hospitals, which are closely affiliated with the nation's medical schools. The 1976-1977 professional activities of former subspecialty trainees who had finished their training between 1972 and 1976 were distributed roughly in thirds between research-teaching, teaching-practice, and practice. We discuss public policy implications of the data.


National study of internal medicine manpower: IV. Residency and fellowship training 1977-1978 and 1978-1979.

The National Study of Internal Medicine Manpower gathered data on the number of residents in training in internal medicine and the number of fellows in subspecialty training, for 1977-1978 and for 1978-1979. In the latter period, there were 16720 residents in all years of training. The 7.2% average annual increase in the number of first-year residents during the earlier half of the 1970s slowed in 1977-1978 and 1978-1979 to 4.6% and 4.2%, respectively, reflecting a similar decline in the number of medical school graduates. The most important finding of the study is that the steep rise (10.6% per year) in the number of subspecialty fellowship trainees characteristic of the years 1972-1973 through 1976-1977 has abated. The number of fellows in subspecialty training has remained essentially constant in the past 2 years. Thus, although the number of residents continued to increase and the number of fellows remained constant, the number (and percentage) of internists in training who intend to practice general internal medicine rose.


Pigmentary paravenous chorioretinal degeneration: fundus appearance and retinal functions.

A case of pigmentary paravenous chorioretinal degeneration initially diagnosed as retinitis pigmentosa is presented. The focal macular visual evoked response (VER) was normal. Both rod and cone components in the electroretinogram showed reduced amplitude with normal peak time. The psychophysical threshold in the dark adaptation was nearly normal in some parts of the retina and extremely elevated in other parts of the retina. Fundus appearance and retinal function studies suggest that the impaired area in the retina and choroid is localized in this disease.


Acute retinal necrosis.

Three cases of acute retinal necrosis are presented. Acute retinal necrosis is an unusual syndrome which is the result of severe contusion to the globe. It is characterized by large irregular retinal holes with pieces of necrotic retina in the adjacent vitreous, retinal edema and hemorrhage surrounding the holes, underlying choroidal disruption, and vitreous hemorrhage. The incidence of acute retinal necrosis is difficult to determine but it does not appear to be common entity. Although acute retinal necrosis may be associated with a retinal detachment, other retinal breaks are usually responsible for the detachment. The necrosis results from the direct force of the injury striking the globe although a contrecoup mechanism may explain cases of nasal necrosis. Treatment is necessary for associated retinal detachments and acute lesions but may not be necessary if adequate fibrosis is present when the lesion is first seen.


Superficial keratitis in treated systemic lupus erythematosus.

A 25-year-old woman with decreased visual acuity and irritation of both eyes was found to have superficial keratitis with keratitis sicca. Her medical record indicated that she had systemic lupus erythematosus. Systemic steroids were necessary to cure the keratitis.


Retinociliary vein associated with a craniopharyngioma.

A 60-year-old white man had a diagnosis of craniopharyngioma made in 1945. Three operations for partial tumor removal were performed in 1951, 1957, and 1962. Ophthalmoscopy and fluorescein angiography revealed bilateral optic atrophy and a large retinociliary vein in the left eye. The present report is the only example of a retinociliary vein documented with photography and fluorescein angiography. It is not possible to ascertain whether this retinociliary vein is an acquired malformation or a congenital development anomaly. The extreme rarity of this entity, though, suggests that this retinociliary vein developed as a result of obstruction, by the craniopharyngioma, to the retinal venous outflow during early development.


Response of the cornea to far ultraviolet light: an ultrastructural study.

Quantitative changes were measured and ultrastructural alterations were detected in rabbit corneas after exposure to a far ultraviolet irradiation (UV). Low dose exposure (105 - 8 x 105 erg/cm2) resulted one day later in a thicker epithelium and loss of the intercellular permeability barrier. In corneas exposed to higher doses (5 x 106 erg/cm2), the epithelium was considerably thinner one day later, whereas 4 days later it was of normal thickness and the endothelial cells became degenerated. The highest UV dose exposure used (a total of 20 x 106 erg/cm2 given in 4 equal daily doses) resulted in (1) swelling of the stroma and disorganization of the collagen fibers; (2) disappearance of the basement membrane; (3) degeneration of the endothelial cells; and (4) considerable reduction of epithelium thickness.


Spontaneous regression of a choroidal hemangioma following pregnancy.

A 30-year old white woman was seen with a 2 month history of decreased vision in the right eye. She was 5 months pregnant at this time. Examination showed a large, slightly elevated choroidal hemangioma along the superior temporal arcade. Overlying subretinal fluid involved the superior part of the macula. After the delivery of the child, the tumor regressed. This exacerbation and regression of a choroidal hemangioma during pregnancy and delivery were documented with fundus photography and fluorescein angiography.


Synchronous determination of retinal circulation times in both eyes.

Retinal circulation times of 44 healthy subjects (88 eyes) were measured simultaneously on both eyes by means of synchronous bilateral fluorescein angiography. "Circulation time" was defined as the time from the first arterial filling to the first fluorescence of the corresponding vein close to the disc margin. We found 1.2 sec for the superior temporal vessels, 1.3 sec for the inferior temporal, 1.3 sec for the superior nasal, and 1.4 sec for the inferior nasal vessels of the right eye. For the left eye these values were 1.2 sec, 1.2 sec, 1.4 sec, and 1.4 sec, respectively. No significant differences between the 2 eyes were demonstrable. It is concluded therefore that in cases of monocular disturbances of retinal circulation the other eye can serve as a reliable standard when measurements are performed simultaneously on both sides. The many uncertainties of successive examinations caused by uncontrollable systemic circulation changes are thus eliminated.


System of notation for photocoagulation in the presumed ocular histoplasmosis syndrome.

Using a notation system for evaluation of photocoagulatin of the choroidal neovascular membrane (CNVM) in presumed ocular histoplasmosis syndrome (POHS) demonstrated several advantages, which are: (1) a projector system which allowed excellent magnification of the CNVM and its distance from the foveal avascular zone (FAZ); (2) direct study of fluorescein angiographic negatives; (3) good comparison of pretreatment of posttreatment lesions in relation to FAZ; (4) a precise measurement of the surface area of each CNVM and its distance from the FAZ; and (5) an accurate and rapid way of recording and comparing data. This notation system appears valuable as a means of standardizing the examination and photographic findings from multiple institutions. Results of photocoagulatin of the CNVM are presented. Photocoagulatin of the entire CNVM appeared more effective than partial photocoagulatin of the CNVM.


[Surgery for laryngeal stenosis in infants in liable in case of failure to produce a worse condition resulting on a definitive disability (author's transl)].

The proper treatment for these stenosis is the "evolutive calibrage" which takes advantage of the normal growth of the larynx with no risk of aggravation.


[Management of sialorrhea in mentally retarded children by salivary denervation (6 cases) (author's transl)].

Sialorrhea in mentally handicapped children makes rehabilitation difficult and may provoke dyspneic spells. We have interrupted in 6 cases the parasympathetic innervation to the major salivary glands by a bilateral intratympanic neurectomy of Jacobson's nerve and chorda tympani. Results were satisfactory in 2/3 of cases.


[Cochlear mechanics: new experimental data (author's transl)].

The goal of this research is to confirm or disprove the presently accepted theories concerning the cochlear mechanism using: -- enlarged mechanical models of the cochlea, reproducing the known anatomy as accurately as possible, -- true sinusoidal stimuli or transient, -- objective documents (photographs and films).


[The origin of acoustic neurionoma. An ultrastructural study of operated neurinoma incipiens (author's transl)].

The origin of eighth nerve neurinoma has been studied by several authors with the light microscope, particularly on serial sections of decalcified temporal bone. The microsurgical approach of small neurinomas has led the present authors to an ultrastructural study of this problem. In the cases in which the origin could be seen, the tumor appeared to arise from the ganglion vestibulare (Scarpae). This fact is correlated with the neural crest origin of the ganglion, and with its ultrastructural characteristics in the normal human.


[The treatment of sub-glottic stenosis by continuous dilatation. Long term results (author's transl)].

From 1973 to 1977, 15 patients with laryngeal stenosis were treated by a method of continuous dilatation in the ENT department of the "Enfants Malades" Hospital. The results were viewed with regard to the importance of the complications, the chance of decanulation, the carrying time of the canula, adaptation to effort, functional respiratory tests, the value of language, intellectual and psychic repercussions, and repercussions on the social life. In this series the method of dilatation seems remarkably reliable.


[Effects of neurectomy of the tympanic plexus on secretion of the parotid gland in man. Histopathological, histochemical and clinical study (author's transl)].

This study involved five patients suffering from bilateral chronic parotiditis and then with a persistent unilateral fistula of the parotid gland. Two types of parotid biopsy were examined: the first taken during surgery and the second six months later. All of the specimens underwent histopathological and histochemical investigations. Definitive degeneration and atrophic type changes were seen in all the parotid fragments removed six months after selective neurectomy of the tympanic plexus. Six months after surgery, all of the patients were cured.


[Immediate improvement in facial paralysis after surgical decompression (author's transl)].

17 cases of severe facial paralysis were studied before and after microsurgical decompression, by quantitative electromyography (electromyogram integrated in volts) at the site of the zyogmatic arch. -- In 76% of cases, no significant improvement was measured. -- An immediate, frank improvement occurred infrequently (12%), was short-lived and did not have any influence on the final result.


[Auricular tuberculosis with regressive facial palsy after surgical intervention (author's transl)].

The authors have observed the complete regression of a facial palsy in a tuberculous otitis by precocious decompression of the nerve and anti-tuberculous medical treatment.