The effect of human placental lactogen upon the metabolism of rat and human adipose tissue.

The metabolic effects of human placental lactogen (HPL) on rat and human white fat were tested in vitro. When tested against rat tissue, HPL resembled insulin in stimulating uptake of glucose and incorporation of [14C] glucose into CO2, triglyceride and glycogen, but differed from insulin in stimulating glycerol release and in failing to stimulate the incorporation of [14C] The stimulation of [14C] glucose incorporation and the inhibition of glycerol release by insulin were antagonized by HPL. The effects of HPL on human white fat resembled those on rat white fat,except that glycerol release was not stimulated in human tissue. The possible role of HPL in causing the diabetogenic stress of pregnancy is discussed in the light of these findings.


[Effect of intracerebroventricular injection of 6-hydroxydopamine and 5,6-dyhydroxytryptamine on the phasic secretion of luteinizing hormone (author's transl)].

In ovariectomized rats carrying an estradiol sylastic implant the effect of the intraventricular administration of the serotonin neurotoxin 5,6-dihydroxytryptamine and of the norepinephrine neurotoxin 6-hydroxydopamine on the circadian secretion of the luteinizing hormone (LH) was studied. The decrease of 5-HT after injection of 5,6-dihydroxytryptamine reduced the a.m. and p.m. values and suppressed the phasic rhythm of LH. The diminution of noradrenaline after administration of 6-hydroxydopamine increased the a.m. and did not alter the p.m. values, resulting in a partial abolition of the rhythm.


Single alternation with water reward:effects of sodium amobarbital on two strains of rats selectively bred for high and low emotionality.

The action of sodium amobarbital is studied during the patterning effect in rats selectively bred for low and high emotionality. The drug disrupts patterned running in the goal section of the alley in Maudsley non-reactive but not in Maudsley reactive rats for the last five trial-pairs. Sodium amobarbital also affects the behavior of these strains in a differential manner, in start and run sections, during the first trial-pair. The results show that a function-related physiological change has taken place in the Maudsley strains of rats.


[Sympathetic control on salivary secretion by the parotid gland in rabbit. I. Effects on the unstimulated gland (author's transl)].

The sympathetic influences on the rabbit unstimulated parotid gland were studied. The experiments were carried out in anaesthetized rabbits with the Stenon aduct cannulated. Direct stimulation of the superior cervical ganglion elicits variable salivary flows. The high amylase content in the saliva points to a sympathetic secretory action upon acinar cells. The administration of alpha-adrenergic blocking agents (dihydroergotamine, phentolamine and phenoxybenzamine) clearly reduces and even abolishes the effect of the sympathetic stimulation upon flow. The administration of a beta-adrenergic blocking agent (propranolol) slightly reduces the sympathetic action. However the amylase activity is greatly reduced. All this suggests that the secretory effects on the fluid fraction should predominantly be alpha-adrenergic while on the secretion of enzymes the beta-receptors should play an important role.


Molecular species of phosphatidylcholine and phosphatidylethanolamine in subcellular membranes from rat liver.

Four subfractions of phosphatidycholine and phosphyatidylethanolamine according to the degree of unsaturation of their fatty acids have been separated from lipid extracts of microsomes, and inner and outer mitochondrial membranes. The predominant species found in the three membranes contained one saturated and one unsaturated fatty acid. In microsomes completely saturated species of both phosphatidylcholine and phosphatideylethanolamine were practically nonexistent. In outer mitochondrial membranes species with two unsaturated fatty acids were absent. In the inner mitochondrial membranes, however, disaturated species and those with two unsaturated fatty acids were found.


A method for the estimation of striated muscle mass in small laboratory animals.

A method for the determination of the total muscle mass in small experimental animals is presented. Muscle proteins were quantified in the 1 M LiCl-soluble and distilled water-insoluble fraction of the eyeless, brainless, eviscerated and skinned carcass, as compared with a striated muscle sample from the same animal used as standard and processed in the same way as the whole carcass. The non-muscular tissues left in the carcass do not interfere with the final results. The total muscle mass in adult rats was estimated as 42.0 +/- 2.8% of the in vivo weight.


Competitive kinetics of sugar active transport in snail intestine.

Everted intestinal rings of the snail Cryptomphalus hortensis accumulate labelled sugars against a concentration gradient. The active transport of D-galactose (KT = 3.6 mM) is competitively inhibited by D-glucose (Ki = 8.2 mM) and by 3-0-methylglucose (Ki = 24 mM), but it is not affected by L-arabinose, D-fructose, L-arabinose and D-mannitol penetrate into the tissue at the same rate, they do not develop accumulation gradient, and all of them follow the kinetics of a diffusion process. D-glucose, on the contrary, like galactose, penetrates much more quickly and accumulates against a gradient.


[The Federal Rehabilitation Council - a review of the last decade and prospects for the future (author's transl)].

Ten years have now passed since the foundation of the Federal Rehabilitation Council. Its work has both reflected and guided the development of rehabilitation in the Federal Republic of Germany in the last ten years. The Federal Rehabilitation Council has given its members the opportunity of bringing their services and benefits into line. It has submitted suggestions for improvements of the legislative provisions to the legislative body. Special attention has been given, in this context, to the conclusion of the "special agreements" on behalf of the different rehabilitation agencies designed to ensure the speedy and smooth completion of the rehabilitation process. Furthermore, the Federal Rehabilitation Council has attended to the problems of the disabled and defended the interest of various disability groups. In addition, the Federal Rehabilitation Council has endeavoured to contribute to the international exchange of experience. Special attention has been placed on public education. As rehabilitation will not be allowed to stand still, the Federal Rehabilitation Council will base its future work on this principle.


[Clinical psychology in rehabilitative cardiology - a working model (author's transl)].

The article presents a model for the psychological treatment within the framework of an in-patient rehabilitation programme for patients suffering from heart and circulatory diseases. On the basis of research work investigating the psychological factors of heart diseases, this model describes details of a clinical-psychological intervention and psychotherapeutic/psychosomatic supervision tested over a two-year period at a specialised rehabilitation centre for heart and circulatory diseases.


[The social situation of spinal cord-injured persons -- an empirical study (author's transl)].

Using information from patients, over a period of almost ten years, who were hospitalised with spinal cord injuries at a specialised clinic, the Ludwigshafen Industrial Injuries Insurance Institute Accident Hospital -- Medical Director: W. Arens, M.D. -- this empirical study surveys the vocational and financial as well as the family and interpersonal situation of spinal cord-injured persons in the Federal Republic of Germany. The study was performed by means of mailed questionnaires of which 50% were returned. In addition to the composition of the sample with regard to the type of lesion and social status the study focused on sexual abilities and problems. The identified behavioural disturbances of the studied persons were related to counselling and counselling opportunities. he study was financed in part by the Arbeitsgemeinschaft der südwestdeutschen evangelischen Sozialfachhochschulen (working group of the southwest german protestant politechnics specialising in training for social careers) in Darmstadt, Fribourg/Brsg., Ludwigshafen and Reutlingen.


[The work of local teachers of the deaf at danish audiological institutes (author's transl)].

In Denmark, the audio-paedagogical care of hearing-impaired adults is examplarily organised. A considerable role, within this rehabilitation system, is played by the local teachers of the deaf who, in co-operation with the national audiological institutes, do most of the audio-paedagogical work.


The effect of an intrauterine device on mast cell numbers and distribution in the hamster uterus.

The effect of an IUD on mast cell numbers and distribution in the uterus was studied in castrated, castrated hormone-treated and cycling hamsters. The device had a stimulatory effect on total mast cell numbers in those animals that received no treatment, peanut oil, or estrogen therapy and in all cycling animals. The device also apparently causes mast cells to be redistributed in the different areas of the uterus. The results indicate that the IUD alters the uterine mast cell response to exogenous hormones and cycle times.


In vitro studies on resealed erythrocyte ghosts as protein carriers.

Resealed erythrocyte ghosts have been proposed as in vivo carriers for enzyme replacement therapy of inherited metabolic diseases. In comparative studies of methods for reversible hypotonic haemolysis of erythrocytes, a five-fold increased entrapment of human serum albumin was obtained by use of a dialysis procedure instead of direct dilution. The percentage incorporation of protein was also affected by varying mixing procedure, haematocrit, lysis, and resealing times but not by varying buffer composition or added protein concentrations over a wide range. Higher protein entrapment was observed with time-expired blood compared to fresh blood and this may be ascribed to increased osmotic fragility of the erythrocyte membrane in stored cells. Haemolysed and resealed ghosts prepared by any method used were smaller than normal erythrocytes as measured with a Coulter Counter and with a fluorescence-activated cell sorter, and protein entrapment reduced the ghost size further.


The role of serotonin in Masugi nephritis in rabbits.

In 12 rabbits with induced experimental Masugi nephritis and in 6 control rabbits the level of 5-HT in whole blood and 5-HIAA excretion in urine/24 h were studied. In all animals of the experimental group a significant increase of 5-HT and 5-HIAA was found, which was strictly correlated in time with two-phase immunological reaction occurring in Masugi nephritis. Moreover, the electorn microscope examinations showed a distinct thickening of glomerular basement membrane on the 8th day of experiment, i.e., at the time of maximum 5-HT increase in the blood, which according to the literature, can be interpreted as having been caused, if not exclusively, so at least among others, by direct action of endogenous 5-HT.


Evaluation of 133Xe clearance curves in the study of lingual blood flow in dogs.

Lingual blood flow was studied in dogs by the 133Xe clearance technique under control conditions, during epinephrine infusion in response to the combined treatment with Regitin and epinephrine. The composite washout curves recorded during control conditions could be resolved into three monoesponential components. It is suggested that the steep initial slope (component I)is caused by the fraction of blood that perfuses the A-V anastomoses of the tongue. Component II and III appear to the effect of epinephrine infusion might indicate the closure of arterio-venous anastomoses containing alpha receptors. Regitin pretreatment could prevent the closure of the arterio-venous anastomoses elicited by epinephrine infusion. The beta receptor stimulating activity of epinephrine migh account for the augmentation of blood flow to lingual musculature.


Blood pressure and adipose tissue linoleic acid.

In a natural, "free-living population" of 650 men, surveyed with the purpose of health assessment within an epidemiological design, a strongly significant negative correlation between the relative linoleic acid composition of adipose tissue and blood pressures was found (P less than 0.001). This correlation remained significant when age and weight were statistically controlled for. Thus, dietary, lipid-lowering linoleic acid seems to effect blood pressures as well in a favorable way.


Superselective vagotomy sparing blood vessels in the rat. A useful tool in stress ulcer prevention.

In male Sprague-Dawley rats a microsurgical technique for highly selective vagotomy (HSV; syn. proximal gastric vagotomy) and for superselective vagotomy (SSV; cutting of proximal vagal fibers but sparing the blood vessels) has been developed. Basal acid secretion in both preparations was appr. 60% lower than in sham-operated controls. Acid response to 2-Deoxy-D-glucose (35 mg/kg/h over 4 h) was negative in HSV and SSV rats, whereas in sham rats acid output rose significantly. HSV, during mild stress (= control conditions), renders rats more susceptible to gastric stress ulcerations, whereas SSV with intact mucosal blood flow protects gastric mucosa almost completely. Although SSV, during severe restraint stress, cannot prevent the stress-induced breakdown of mucosal blood flow, gastric ulcerations are reduced to 40% of HSV and sham-operated control rats. SSV appears an elegant tool in stress ulcer research.


[Crossed aphasia with jargon aphasia in two right-handed patients (author's transl)].

Two cases of crossed aphasia in right-handed patients are reported. The oral language of these two patients was characterized by a reduction in its lexical and grammatical content. Their written language, however, was a veritable jargon with anosognosia. The jargon aphasia of the first patient consisted mainly of neologisms. The written language of the second patient was slightly less disorganized and corresponded to an asemantic jargon. The existence of this jargon aphasia gives these two observations an exceptional character in relation to other cases of crossed aphasia in right-handed patients. It supplies new information which can be the basis for discussion on the relations between cerebral laterlization of language functions and manual preference.


[Granulomatous myositis during collagenosis (one case) and suprasellar dysgerminoma (one case) (author's transl)].

Two cases of mainly interstitial myositis with epitheloid and giant cells are reported. In the first case, the late amyotrophic-type paralysis of the two girdles, of the clinical myositis type, was associated with severe myocardial damage, the atrioventricular conduction disorder requiring a pace-maker. This observation would appear to be a true polymyositis of the collagen diseases, in view of the associated skin affection, death occurring within a year, a large increase in serum muscle enzymes and urine creatine, the existence of a rheumatoid factor and striated muscle antibodies, and a large increase in M and G immunoglobulins. In the 2nd case, the amyotrophic affection of the pelvic girdle was associated with progressive blindness, diabetes insipidus, and anterior pituitary insufficiency. Death occurred after two years and autopsy showed a suprasellar dysgerminoma (ectopic pinealoma) without any visceral localization of sarcoidosis. The authors discuss the concept of granulomatous polymyositis, autonomous with respect to the sarcoidosis, and sometimes symptomatic of an inflammatory connective tissue condition or a malignant tumor.


[Bilateral internuclear ophthalmoplegia (author's transl)].

A case is reported of a patient with bilateral internuclear ophtalmoplegia which followed a single limited lesion of the two medial longitudinal fasciculi (M.L.F.), with degeneration of the right internal nucleus. The authors feel that the exact localization of this minute lesions, associated with right internal nucleus degeneration, can assist in supplying replies to some unanswered questions concerning the M.L.F. syndrome.


[Value of computer assisted tomography in the exploration of the sellar and supra sellar structures (author's transl)].

The results obtained in 145 cases of space-occupying lesions in the sellar and suprasellar structures, after exploration with computer assisted tomography, were used to assess the technical and diagnostic value of this procedure. Precise details of the localization and extent of the lesion can be obtained, but not the nature of the lesion in many cases.


[Monocular circumduction nystagmus (author's transl)].

Monocular circumduction nystagmus is a very rare ocular movement. A type of circumduction movement, it is caused by successive movements of all the ocular muscles within the framework of a pendular nystagmus. As a monocular movement, it raises the question of the physiopathological mechanism of such a movement which is so complex and is also limited to one eye. The existence of a monocular form of circumduction nystagmus makes it necessary to revise the mechanism of pendular nystagmus.


[CT scanning of the orbita (author's transl)].

Basing on selected cases, the efficiency spectrum of modern CT apparatus in the diagnosis of orbital disease is described. Besides exact localisation of retrobulbar space-occupying growths, CT scanning enables good identification of pathological processes at the bulbus and those of parabulbar location, at the lacrimal gland, the optic nerve and the ocular muscles. Extraorbital changes are clearly identifiable.


[The X-ray film of the petrosal bone in the special projection according to Chaussée III (author's transl)].

For the purpose of a better appreciation of the x-ray film of the petrosal bone in the special projection according to Chaussée III, the roentgenogram was divided into fifteen individual subsequent pictures and explained step by step. Together with the standard x-ray films, this particular roentgenogram provides a spatial idea of the tympanic cavity and enables accurate assessment of the destruction caused by chronic epitympanal otitis media as well as cholesteatoma. In many cases this eliminates the necessity of performing tomography of the middle ear.


[Efficiency of radiological puncture cytology from the viewpoint of the pathologist (author's transl)].

Optimal puncture and smear technique, close communication between the radiologist and cytologist, and great experience of the cytologist in the assessment of the preparations, are an absolute "must" the ensure high accuracy of x-ray guided fine needle biopsy.


[Technique and use of fine needle puncture for thyroid gland (author's transl)].

Fine needle puncture of cold and warm thyroid gland nodes has its definite place in the diagnostic repertory of thyroid diseases. This method can be performed rapidly and easily. It has a low complication rate and imparts to the physician a maximum of information in association with in-vitro tests and scintigram. Indication and technique of fine needle puncture are described and discussed.


[X-ray controlled percutaneous needle aspiration biopsy of the lungs (author's transl)].

Between 1976 and 1978 percutaneous needle aspiration biopsies of 120 pulmonary and pleural lesions were performed. Cytologic examination of malignant and benign lesions was correct in 64% of the cases, false negative results were obtained in 19%. Complications included: pneumothorax in 21 patients (11 requiring chest tube placement); insignificant hemothorax in 5 and hemoptysis in 1. Needle biopsy of intrathoracic lesions proved to be technically simple and relatively safe. This procedure allows early diagnosis of malignant lung tumours which may improve long term prognosis.


[Technique and results of percutaneous transthoracal fine-needle biopsy of lung lesions (author's transl)].

Find needle biopsy of tumours of the lung and mediastinum represents an accurate method which can be performed pain-free and rapidly without undue effort and cost. It can be repeated at any desired time. Absolute contraindications are very rare. This method can be applied also in outpatients, provided certain precautions are observed. In many cases, it eliminates the far greater risk of exploratory thoracotomy. Both peripheral and central lung tumours, including mediastinal tumours, can be identified and differentiated. More than nine out of ten bronchial carcinomas are clearly identified. In 60--70% of all punctures, the pathologist is successful in accurately establishing the type of cell involved. As far as the patient himself is concerned, the method hardly involves any pain and does not cause much discomfort. A frequent complication is the usually asymptomatic pneumothorax, which occurs in less than 30% of all punctures. In a few rare cases, suction drainage will be necessary. Generally speaking, and in all other respects, fine needle biopsy is a low-risk procedure.


[Technique and diagnostic value of percutaneous transhepatic cholangiography (author's transl)].

Percutaneous transhepatic cholangiographic (PTC) serves to perform antegrade bile duct visualisation in obstructive jaundice. It gives exact information on the extent of the flow obstruction and the permeability of the prestenotic area. In most cases, it is possible to differentiate between stone, inflammation and malignant change, but it as a rule most difficult to diagnose the type of tumour, if any. Basing on the authors' own experience with 152 PTC, technique, indications, contraindications and complications as well as differential diagnostic possibilities are described. The complication rate has dropped very clearly since the Chiba needle was introduced.


[Technique of percutaneous transhepatic drainage of the bile ducts and its spectrum of application (author's transl)].

Percutaneous transhepatic drainage (PTD) -- internal or external -- is an important method in the treatment of obstructive jaundice. Its value rests in the temporary relief of obstructions of the bile ducts before surgery, or in the palliative treatment of patients with inoperable tumours. The article describes the technique, indications, complications and difficulties. The authors' own experience is based on 19 successful percutaneous transhepatic drainages. The method is easy to apprehend and has a low complication rate.


[Indication and diagnostic value of roentgen-guided fine-needle puncture of space-occupying renal lesions (author's transl)].

Roentgen-guided fine needle puncture of space-occupying renal lesions as an important additive radiologic procedure is able to solve differential diagnostic problems of liquid or solid renal lesions in a quick, accurate and safey way. It rules out a solid neoplasm, provides the surgeon with a maximum of preoperative information and helps to avoid operations on aged and other poor-risk patients. After description of the puncture technique we report the result of 217 fine needle punctures of the kidney over 13 years.


[Percutaneous translumbar pyelography -- a method for the diagnostic clarification of obstructive uropathy (author's transl)].

Percutaneous translumbar pyelography is indicated when excretory has failed to demonstrate the cause or site of obstructive uropathy and retrograde pyelography is impossible, undesirable or contraindicated. Under prophylactic treatment with antibiotics translumbar antegrade pyelography is safe, simple and accurate and in selected cases the only diagnostic method to establish exact diagnosis without which appropriate therapy cannot be planned. The method is described and the results of 30 percutaneous translumbar pyelographies obtained from 2603 angiographies over 12 years are reported.


[Phalangeal osteoid osteoma (13 cases)].

Thirteen cases of osteoid osteoma of the phalanxes are reported: 10 fingers and 3 toes. Any phalanx may be affected, with no preference for a particular site, in the young adult. Segmentary tumefaction of the soft parts near the lesion is a more consistent sign than pain, which is often quite minimal. Radiographies demonstrate the increase in the size of the phalanx, whose matrix is condensed. All radiographic techniques must be used to determine the exact location of the nidus, that is always very small (1 to 2 mm), and whose total removal is the only guarantee of cure.


[Biosynthesis of PGE2 and PGF2 alpha in normal and pathological human synovial fluid].

The biosynthesis capacity of PGE2 and PGF2 alpha in normal and pathological (rheumatoid arthritis and osteo-arthrosis) synovialis was studied using the radio-immunological method, simultaneously on homogenized tissues and the microsome fraction, with or without addition of exogenous arachidonic acid. Among the results obtained, the most significant concern rheumatoid polyarthritis: a net increase in PGF2 alpha and especially in PGE2, more pronounced in the homogenized emulsion than in the microsomial fraction. Exogenous arachidonic acid increases the biosynthesis capacity of the PG. The prospective interest of this model is underlined: the possible introduction in the incubation medium of various drugs, making it possible to study the various factors taking part in the biosynthesis of PG (phospholipase A2 and prostaglandin-synthetase).


[Study of cellular elements in synovial fluid in scanning electron microscopy].

Scanning electron microscopy allows a tridimensional morphological study of the cellular elements of the pathological human synovial fluid. The cells are grouped into two populations: macrophage cells and round cells, whose differentiation is more difficult: polynuclears, lymphocytes and synovial cells. The combination of scanning electron microscopy and X-ray diffraction makes it possible to describe and indentify crystals of sodium urate and of triclinical, dehydrated calcium pyrophosphate.


[Value of metrizamide myelography with tomodensitometry for study of the cervical spine].

52 metrizamide myelographies practiced with tomodensitometry were studies (23 normal cases); 6 cervicarthrosic myelopathies; 2 intra medullar tumors; 1 extra medullar tumor; 19 syringomyelias). The technical procedures are discussed for the different diseases. This test has proven highly interesting for the study of syringomyelias and tumors. It allows the presence of narrow canals to be demonstrated, but does not yet indicate discal hernias. The role of tomodensitometry, in relation to other exams, is demonstrated.


[Magnesium and several metabolic osteopathies].

Magnesium is a constituant of the bone minerals. Changes in its intra-bone distribution have repercussions on the distribution of calcium and on the hormonal regulators of calcium. The importance of magnesium in bone pathology is far from being completely elucidated. Certain factors are now commonly admitted, for example the inhibition of the parathyroid secretion during magnesium deficiency. Others merit more complete and thorough study, it being highly unlikely that the bone is unaffected by changes in the organic magnesium content, given the multiple roles that magnesium plays in the bone. In this report, the authors provide well-known data on the physiology of magnesium, and discuss some of the relationships between magnesium disturbances and certain osteopathies.


Tissue eosinophils in ulcerative colitis.

A morphometric method has been used to quantitate eosinophils in the rectal lamina propria. The results from examination of paired biopsy specimens indicate that eosinophil distribution is uniform in the rectum. The number of eosinophils in specimens from patients with long-standing ulcerative colitis is significantly greater than that found in control subjects and increases with increasing clinical activity of the disease. In contrast, when biopsies are obtained from patients in a severe first attack of ulcerative colitis, eosinophil counts are not higher than in controls. The possible significance of these findings is discussed.


Exocrine pancreatic function after total gastrectomy.

The secretion of bicarbonate, lipase, and chymotrypsin into the duodenum in response to exogenous stimulation with secretin, 1 CU/kg-h, plus caerulein, 100 ng/kg-h, was investigated in 12 patients, on an average, 20.7 months after total gastrectomy and in 14 control subjects. The secretion of bicarbonate and lipase was significantly lower in patients than in controls. The reduction in outputs compared with the control values was 47.9%, 38.7%, and 24.2% respectively for bicarbonate, lipase, and chymotrypsin. Eight of the 12 patients (67%) had steatorrhoea. No significant correlation was found between this parameter and lipase output. It is concluded that the exocrine pancreatic function is impaired in the majority of patients subjected to total gastrectomy. The impairment, which particularly affects bicarbonate and lipase, is generally mild to moderate.


ERCP in a small hospital.

A 1-year material of 75 ERCP investigations is reported from a small community hospital serving an area of 40,000 inhabitants. A cannulation success rate of 90.7% was found. No complications were seen. The use of the procedure in a small hospital is discussed.


Parietal cell structure and acid secretion in the vagally innervated stomach and the vagally denervated fundic pouch in cats.

In seven cats provided with gastric fistula (GF) of the main stomach and a denervated Heidenhain pouch (HP) the structure of the innervated and denervated mucosa was examined by light and electron microscopy. In four of these cats dose-response curves for acid output to pentagastrin were determined before and after vagal denervation of the fundic pouch. Vagal denervation reduced the acid response to pentagastrin by decreasing both the secretory capacity and the sensitivity of the oxyntic glands. Accordingly, in the same cat the parietal cells of the HP were less sensitive to pentagastrin than the cells of the innervated main stomach. Light and electron microscopic investigations revealed that the fundic mucosa was thinner, and the size and proportion of the parietal cells was smaller in the HP than in the GF. It is likely that the morphological changes in the pouch were caused by the vagal denervation rather than by the loss of mucosal contact with food. The secretory and morphological changes produced by the vagotomy are not necessarily related.


The physiologic basis for clearance measurements in hepatology.

Three hepatic clearance regimes (flow-limited, general, and enzyme-limited) can be defined from a model of hepatic perfusion-elimination relationships. Substances that can be used for clearance measurements can thus be classified into three categories according to the relation between their kinetic elimination constants (Vmax, Km) and hepatic blood flow. The pathophysiologic and clinical importance of the clearance regimes is discussed with special emphasis on the effect of changes in hepatic blood flow and liver function. The criteria for choosing test substances within each regime are stated. This choice depends on the object of study for a clearance measurement (blood flow, drug elimination, liver function). Only the enzyme-limited clearance regime is suited for direct assessment of quantitative liver function ('true clearance'), while the other regimes depend more or less on blood flow.


A simplified means of measuring the ventilatory response to carbon dioxide (STCO2) compared with the subjective and circulatory response to intrajejunal hypertonic glucose in the prediction of clinical dumpting.

Three methods previously suggested for the prediction of the dumping syndrome in patients undergoing gastric surgery were compared. Neither the subjective response nor the change in forearm muscle blood flow accompanying a preoperative intrajejunal test meal was found to separate potential 'clinical dumpers' from 'non-dumpers'. The ventilatory response to a rising alveolar carbon dioxide partial pressure, estimated by a simplified rebreathing technique, effectively identified those with a predisposition to dumping within the sample. Of the conventional measures of ventilatory response to carbon dioxide, the standardized threshold (STCO2) was found to be the most reliable.


Psychological, social, and surgical factors which influence success or failure after gastric operations.

The degree of a patient's emotional maturity and the supportive value of his home, working, and recreational environments were scored by psychosociological methods preoperatively in a group of 47 patients who were intensively investigated with regard to the dumping syndrome. After surgery, the result of the operation was independently assessed as a success or a failure. At that time, a careful review was performed of each patient's clinical state, with particular reference to postgastrectomy syndromes. Positive associations were found between surgical failure and emotional instability, recorded by an Eysenck personality inventory, and scored social deprivation. Failure also correlated with the sum of the postgastrectomy syndromes and with recurrent pain, heartburn, episodic diarrhoea, and psychiatric illness in particular. The dumping syndrome itself did not contribute to failure.


The role of altered gastric emptying in the initiation of clinical dumping.

The disposition to dumping was measured in 42 patients by finding their STCO2 before gastric surgery. Twenty of these had a low STCO2 and were therefore predisposed to experience dumping symptoms. Only 10 of these patients actually experienced clinical dumping when reviewed 1 year after surgery. At that time gastric emptying studies showed that those with clinical dumping had rapid gastric emptying in combination with a previously measured low STCO2, in contrast to those who did not experience dumping symptoms.


Urolithiasis and hyperoxaluria in chronic inflammatory bowel disease.

The incidence of urolithiasis was registered in 87 patients with chronic inflammatory bowel disease and compared with that of renal oxalate excretion. All patients were studied while on a standardized diet with fixed amounts of fat, calcium, and oxalate. Pyelography had been performed in all. Nine, or 35%, of 26 hyperoxaluric patients had urolithiasis, compared with 14, or 23%, of 61 patients were normal renal oxalate excretion, the difference being statistically insignificant. No significant difference in urinary oxalate or urinary calcium in stone-formers as compared with non-stone-formers could be demonstrated. Oxalate was a more frequent component of calculi in patients with normal renal oxalate excretion than in patients with hyperoxalura. Thus, we were unable to demonstrate an increased incidence of urolithiasis in patients with hyperoxaluria compared with a control group with normal renal oxalate excretion. Our results cast doubt on the concept that enteric hyperoxaluria per se is the cause of stone diathesis in chronic inflammatory bowel disease.


Clinical and pharmacological effectiveness of cimetidine in duodenal ulcer patients.

The plasma concentration of cimetidine was measured in 40 patients with duodenal ulcer after an oral dose of 200 mg cimetidine. The peak plasma concentration was on average 1.33 mg x 1(-1) (S.D. = 0.53) and the area under the plasma concentration curve (AUC) between 60 and 120 min after cimetidine was 1.13 mg x h x 1(-1) (S.D. = 0.48). The percentage inhibition (I%) of maximal acid output (MAO) to pentagastrin during this 60-min period was 49% (S.D. = 19) with a very low, but statistically significant, correlation with the AUC, r = 0.35 (p less than 0.05), thus demonstrating a very great individual variation in sensitivity to cimetidine. In 37 of the patients the time from start of treatment with cimetidine, 1.0 g/day, to disappearance of ulcer symptoms could be assessed, and it was found that neither the individual sensitivity to cimetidine, I%/AUC, nor the gastric secretory capacity, MAO, correlated significantly with the clinical effectiveness of the cimetidine treatment, although 8 patients with a low sensitivity to cimetidine and a high MAO improved more slowly (28 days) than the other 29 patients (13 days) (p less than 0.1).


Nitrofurantoin-induced chronic liver disease. Clinical course and outcome of five cases.

Adverse liver reactions associated with nitrofurantoin treatment are rare but important complications. Both acute and chronic liver damage have been described. The present report describes five patients who developed chronic liver disease after 1 to 3 years of continued nitrofurantoin treatment. Liver histology was consistent with chronic active hepatitis in four patients, while postnecrotic cirrhosis was observed in one case. Follow-up examinations 2 to 3 years after withdrawal of the drug showed marked improvement clinically and in most cases also histologically.


The unstimulated pancreatic secretion obtained by endoscopic cannulation, and the plasma secretin levels in man.

The technique of collecting juice from the main pancreatic duct by siphonage is described. The juice was collected in 5-min fractions under basal conditions for 20 min (32 subjects) and extended to 60 min (6 subjects). Flow rate and bicarbonate concentration were significantly higher during the first collected samples, whereas concentrations of amylase and protein rose during the first 20 min of the study. All variables remained nearly constant after this period. Immunoreactive secretin (IRS) in peripheral plasma was significantly higher immediately after cannulation of the main pancreatic duct, as compared to the pre-endoscopic level. When the catheter was left in the duct and pancreatic juice drained, the IRS stabilized at a level not significantly different from the pre-endoscopic level. Positive correlations were found between flow rate and plasma level of IRS and between flow rate and bicarbonate concentrations. A negative correlation was found between the flow rate and concentrations of amylase and protein. The higher flow rate, plasma level of IRS, and bicarbonate concentration at the beginning of the examination may be due to the presence of acid and/or bile in the duodenal contents shortly after the endoscope enters the duodenum. Later in the procedure the levels have stabilized, which indicates that little or no acid or bile is passing into the duodenum. It is also concluded that secretin may be one factor responsible for the basal pancreatic secretion in man.


Tryptophan metabolism in bladder cancer patients from Copenhagen.

Urinary excretion before and after a loading dose of tryptophan, plasma pyridoxal phosphate concentration and urinary excretion of 4-pyridoxic acid was studied in 44 male bladder cancer patients from Copenhagen. Six patients (14%) had abnormal tryptophan metabolism, decreased plasma pyridoxal phosphate concentration and in most cases low urinary excretion of 4-pyridoxic acid indicating decreased availability of vitamin B6 or decreased formation of pyridoxal phosphate from vitamin B6. It is concluded that abnormal tryptophan metabolism only plays a minor role for bladder cancer carcinogenesis in Copenhagen. It is, however, stressed that such studies do not rule out the possibility that the aromatic degradation products of tryptophan may be cocarcinogens or promotors as other studies have indicated.


Carcinoembryonic antigen in urine in patients with urothelial carcinoma. An expression for the extent of inflammatory reaction of the urinary tract.

The concentration of carcinoembryonic antigen (CEA) in urine and serum was determined repeatedly during one year in 213 patients followed because of previously treated urothelial carcinoma of the bladder. The findings were correlated to grade and stage of previously treated tumour, given therapy, recurrence and the cytological evaluation of a midstream urine specimen. During the period of follow up 43 recurrences were clinically observed. With the exception for the content of inflammatory cells no correlation was found between the CEA levels in urine or blood and the parameters studied. Thus CEA in urine and/or serum cannot substitute for cystourethroscopy, urography and exfoliative cytology in the follow-up of patients previously treated for urothelial carcinoma.


Uraemic arterial disease. An experimental study with special reference to the effect of parathyroidectomy.

A histophatologic study of uraemic arterial lesions was performed in rats. They were made uraemic by 5/6 kidney resection, and the aorta and peripheral arteries were examined after intervals of up to 36 weeks. The characteristics of the arterial lesions were necrosis of medial smooth muscle cells and, in some cases, calcification of the media. The changes appeared first in the aorta, but after long uraemic periods also in peripheral arteries. The incidence and severity of necrosis and of calcification were assessed separately. Parathyroidectomy largely prevented the development of calcification, and to a lesser degree also smooth muscle cell necrosis. The results suggest that secondary hyperparathyroidism plays an important part in the development of uraemic arterial disease.


The aortic content of glycosaminoglycans and hydroxyproline in experimental uraemia.

The effect of experimental renal failure in rats on the various glycosaminoglycan fractions and on the hydroxyproline content of the aorta was studied with special reference to the influence of parathyroidectomy. Renal failure increased those fractions which are known to contain chondroitin sulphate and dermatan sulphate. Parathyroidectomy did not modify these changes. Parathyroidectomy in rats with intact renal function produced an increase of the same fractions. It is concluded that accumulation of sulphated glycosaminoglycans is an early event in the development of uraemic arterial disease. The significance of such accumulation for subsequent development of arterial calcification is discussed. The available data do not permit evaluation of the significance of secondary hyperparathyroidism in the genesis of the observed changes of the glycosaminoglycans.


Morphology of the lymph nodes draining renal adenocarcinoma in relation to immunological functions.

One hundred and thirty-four lymph nodes from forty-seven patients with renal adenocarcinoma and the same number of regional nodes from sixty-one patients with gastric ulcer were ewwuated histologically by using the standardized reporting system introduced by Cottier, Turk & Sobin (1973). Special attention was focused on the morphologic features which correlate with the immunological responses of these lymph nodes. The cellular elements of the antibody response were found to be active more often in the ulcer series than in the cancer series. On the other hand, the constituents of the cell-mediated immune system were depressed more often in the nodes draining renal carcinomas. The significance of the different immune responses evoked by these two diseases is discussed and the conclusion is drawn that there is some degree of derangement of both humoral and cell-mediated immune systems in the regional lymph nodes of renal adenocarcinoma. The applicability of the reporting system used in assessing the morphology of human lymph nodes is to be emphasized.


Chronic papillomatous dermatitis as a peristomal complication in conduit urinary diversion.

In 76 patients with conduit urinary diversion, the skin in the stomal area was studied with regard to complications. No such complications had occurred in 39 cases. Superficial erosive dermatitis was present or had been a transient episode in 27 cases. The immediate peristomal area was found in ten cases to show a different type of complication. This was characterized by hyperplastic, papillomatous skin lesions of a chronic nature. A rubber urinary collecting device for long-term use had been fitted in nine of the ten patients, and none of them had a protruding nipple stoma. The clinical, microbiologic and histologic features of these hyperplastic lesions are described and aetiologic factors are discussed. Change to another type of collecting device was followed within three to six weeks by healing of the lesions.


Metastases to the penis from carcinoma of the prostate. A case report.

In a 68-year-old man metastasis to the penis was diagnosed about two years after transurethral resection of the prostate because of adenocarcinoma. Diethylstilboestrol has been given postoperatively. Initially the metastasis was interpreted as primary cancer of the penis, as biopsy findings indicated a spinocellular carcinoma. Subsequent biopsies, however, showed the same histologic pattern as in the original cancer of the prostate. Up to 1976 about 170 cases of metastasis to the penis were reported in the literature. The prognosis as a rule is very poor. In the present case estramustine phosphate (Estracyt) seemed to improve the patients's general health, but did not affect the penile metastasis. The patient died 18 months after the metastasis had been demonstrated.


Recurrent bladder papilloma in a child with Cushing's syndrome. Case report.

A case of bladder papilloma in a 12-year-old boy with Cushing's syndrome was reported by us in 1975. A walnut-sized papilloma was removed by transvesical extirpation, and bilateral adrenalectomy was performed. Two years later he was reoperated because of recurrent Cushing syndrome, and at the same time he had a recurrence of multiple bladder papillomas. Since removal of residual adrenocortical tissue and hormone substitution therapy his Cushing appearance has disappeared completely. The recurrent papillomas were removed by transurethral electrocoagulation and control cystoscopies have shown no sign tumour recurrence. We suggest a possible neoplastic effect of some tryptophan metabolites(s) in combination with immunosuppression as the cause of the bladder papillomas.


Bladder explosion during uninterrupted transurethral resection of the prostate. A case report and an experimental model.

A bladder explosion during transurethral resection with intraperitoneal rupture of the bladder is reported. Immediate operative repair was successful and the final result satisfactory. Gas formed during in vitro and in vivo prostatic resections was analysed by means of an oxygen electrode and gascromatographs. Hydrogen was dominant but oxygen and several explosive hydrocarbons were demonstrated. The gas formed in vitro was highly explosive. Oxygen content in gas formed in vivo was considerably lower. Admixture of atmospheric air during transurethral resection increases the risk of explosion and should be avoided and the air pocket in the bladder be kept at an absolute minimum.


Crossed, non-fused renal ectopia and ipsilateral ureteral carcinoma. A case report.

A man with crossed, non-fused renal ectopia had carcinoma of the distal ureter, leading to hydro-ureter, hydronephrosis and urinary infection. Crossed ectopic kidneys are more disease-prone than are normal kidneys. Complicating disorders are discussed, the value of thorough urologic investigation is stressed and the incidence of tumour of the upper urinary tract in crossed renal ectopia without fusion is reviewed.


Parents of schizophrenic individuals: what we say is what we see.

The language used to describe the families of schizophrenic individuals is reviewed briefly. It is suggested that this language has negative connotations and is a legacy of past theory interpreting parents as primary causal agents in schizophrenia. If we are to engage the families of schizophrenic patients in cooperative therapeutic endeavors, we must begin to speak to and about those families in more neutral terms.


Schizoaffective illness defies the dichotomy...and keeps DSM-III pondering.

Models proposed to account for patients eventually labeled "schizoaffective" are traced historically. It is demonstrated that these patients represent a distinct clinical entity, and diagnostic criteria are then applied to reevaluate the position of schizoaffective disorder in our current and future nosology. Schizoaffective illness is held to be the example, par excellence, that defies the validity of Kraepelin's original dichotomy.


Overview: the heuristic need for subgroups of the schizophrenic syndrome.

This article is an editor's introduction to the theme of an issue of the Schizophrenia Bulletin devoted to subgroups of the schizophrenic syndrome. The issue includes articles on subtyping from various points of view: neurological, genetic, biochemical, and descriptive. It is hoped that the wide range of findings being applied in ongoing classificatory efforts will produce subgroups with etiologic, prognostic, and treatment validity.


Genetic evidence for the existence of subgroups of the schizophrenic syndrome.

Evidence for the existence of a genetic factor in the etiology of a significant proportion of the people diagnosed as having a schizophrenic disorder is reviewed. It is suggested that whatever is transmitted genetically need not be inherently pathologic and/or pathogenic. It is argued that only people who have certain trait expressions or phenotypes are capable of a schizophrenic decompensation but that these phenotypes, while genetically loaded, are not necessarily pathogenic. An effort is made to show that even those cases in whom genetic factors operate are not homogeneous but represent separate subgroups which differ in their etiopathogenesis. This etiologic heterogeneity, in the development of a characteristic necessary but not sufficient for a schizophrenic decompensation, will almost certainly be associated with differences in the clinical course of the disorder.


An attempted integration of information relevant to schizophrenic subtypes.

The usefulness and validity of traditional subtypes are questionable. The subtypes described in earlier years no longer emerge with the clarity previously described. The four classical subtypes cannot be reliably distinguished and have not been shown to have predictive validity. Subtypes classified along course or prognostic lines may be more clinically useful. Attempts to subdivide schizophrenia along biologic and genetic lines offer promise. Recent efforts to describe new subdivisions of schizophrenia are readily justified, but new descriptive subtypes are likely to prove useful only when validated by biological, genetic, treatment response, and outcome data.


Epilogue: subtypes of the schizophrenic syndrome--their current status.

The expectation that important subtypes exist in dementia praecox (schizophrenia) was built into the earliest conceptualizations of this disorder by Kraepelin and Bleuler. Although the traditional subtypes are still used, more recent biological, psychological, and descriptive-clinical data suggest that quite different approaches to subtyping and subtyping categories may be more valid. No definitive answers to the subtyping problem have yet been reached, but the solution may well involve a complex consideration of biologic, psychologic, and social variables.


[Introduction].

Mental retardation has been much neglected in the past by physicians, especially as far as the clinical, long-term care is concerned. This care can only be adequately performed by a team grouping physician, psychologist, social worker, teacher, educator, etc. The physician must be familiar with the various aspects of mental retardation, including its social implications.


[The concept of mental deficiency. Evolution of theories, attitudes and practices].

In the last twenty years a deep renewal of the conceptions about and the treatments of the mentally deficients has taken place. In an attempt to clarify somehow the confusion in the communication between specialists, the author reminds the classical position on this subject, which relies upon the definition of the idiocy: a state of a severe mental defect, set up early in life, with an organic cause and being incurable for this reason. In spite of the later considerable differenciation at different levels and types, the classical position maintains this definition as the ground of the nosographic class of the mental retardations (debility is considered then as a light idiocy), divided in two sub-classes of either "polygenic heredity" or accidents causing early brain damages. From a clinical point of view, such a theoretical position is difficult to apply, especially in cases of middle and light mental defects. From a theoretical point of view, this classical position has been often attacked: by the evidence of the socio-cultural factors of the intellectual development, by the analysis of the so-called instrumental troubles, by the studies about the early lack of mother-care and the child-psychoses with a defect, by the more recent works on dysharmonic evolvements, etc. All this has lead to major theoretical changes which force to give up the illusion of a "single class" of mental retardations and study therefore each case in the trajectory of its development, not only of the cognitive patterns but also of the whole personality structure. This clinical approach forces to admit organic, environmental (sociological and psycho-sociological) and relational, dynamic factors as well; and, to accept that their combination, replaced in a genetic context of the functioning patterns, establishes a new, properly psychological level of causality. So, even the idea of a "defectology" is non-sense; the factors and the problems in question are the same as in any other psychogenesis. Nevertheless, the study of cases, in which this psychogenesis is caracterized by a mental deficit, is very important.


[The physician faced with the mentally handicapped and his family].

In his work in the field of mental retardation, the physician is exposed to his vivid emotive reactions. He risks either to withdraw in a scientific relation or to identify himself with either family's members. The physician must learn to join with a pluridisciplinary team, to build up his emotional impulses, to answer to the needs of the mental handicapped and his family and to estimate the evolutive potential rather than the deficits. He must be conscious that the handicapped and his family are called, in an imperative manner, to resolve many tasks: they must not only confront themselves with many specialists (doctors, teachers, educators, logopedists, physiotherapists) and many Services, but also overcome the shock of the diagnosis and build, on the existential plan, a new life.


[Dysplastic gangliocytoma of the cerebellum].

A case of dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease) is reported, discovered on a routine autopsy. Clinical and anatomopathological data of the case are compared with previously reported cases. Review of the various proposed pathogenic hypotheses.


[Mental deficiency: organic aspects].

This review of the organic aspects of mental retardation considers this handicap among the other chronic neuropediatric disorders and is one of the numerous possible manifestations of a cerebral damage occurring in a developing nervous system. The relative frequency of the different etiologies is discussed in relation to the severity of the mental handicap. The prenatal causes of mental deficiency which are the most frequent are reviewed and a distinction is made between malformations and pseudomalformations. Particular mention of the fetal alcohol syndrome is made. The role of perinatal medicine in the epidemiology of mental retardation is discussed and the diagnostic approach of a particular child with mental retardation is presented with the personal experience of the author in the pediatric department, CHUV, Lausanne. The possible measures to prevent mental retardation are finally discussed.


[Judicial aspect of mental deficiency].

The author examines the different laws on mental deficiency with particular references to protective measures such as: different forms of guardianship and legal advice. The provisions of the laws on guardianship which do offer an effectual protection, often remain unrecognized.


[Curative-pedagogic aspects of mental deficiency].

Curative pedagogy is nothing else but a theory on education and teaching of the mentally handicapped. The author presents the following seven thesis: 1. Mental deficiency is not a definite state. It should be considered as a "relative" state, bound to its origins but with possibilities of change. It is thus to be considered as a state that can be influenced, modified and within the reach of education. 2. The notion that every child can be educated is inherent to pedagogic theory. The mentally deficient child forces us to examine, more often, our teaching methods. 3. It is only when the doctor and the pedagogue seriously collaborate that it becomes possible to elaborate early developmental programmes. 4. The pedagogue does not remain centered on diagnosis, but allows himself to be directed by the developmental possibilities of the child. 5. Pedagogy is not only concerned with the impairment of intelligence, but seeks a global approach in which the affective relationship is taken into account. This global approach is possible only with a multidisciplinary team. 6. Pedagogy takes into account the parents as well as the child in order to assist them and help them accept the situation. 7. Pedagogic help should not terminate with the end of official schooling, but should remain a permanent support which should be continuously improved.


[The place of institutions for the mentally deficient].

The institutions, more and more adjusted to the age and the specific handicap of the mentally deficients, attempt to provide an harmonious education. In order to do so, they have to resolve many problems: problems of the handicapped children, who are confronted to a new and very different life-style as well as to a large number of adults who will be taking care of them; problems of the parents, who are badly informed about the institutional methods; problems of the public to whom the existence of the medicoeducational centers gives good conscience; problems of the staff, called to work in a pluridisciplinary team and whose effeciency depends on its cohesion. Such teams should also include the parents.


[Parents of the mentally retarded].

The author is expressing the point of view of the parents of mentally handicapped children or adults. Taking charge of handicapped people means that measures appropriate to each case will be taken such as the adequate and repeated information of parents not prepared for the inevitable psychological shock of the birth of a handicapped child. The parents go through several phases in their reactions to this situation, which are recognized by psychiatrists. The collaboration of specialists and families is indispensable to the healthy development of handicapped people of all ages. Treatment requires periodic multi-disciplinary check-ups to foster the best possible development of the remaining faculties.


[Neuro-ophthalmological problems: the diagnostic value of contrast sensitivity].

The evaluation of the individual contrast sensitivity function may prove useful in cases affected by lesions of the optic pathways, even when the usual neuro-ophthalmological tests (i.e. visual acuity, visual field examination) are normal. The contrast sensitivity function represents an alternative method to assess the power of spatial resolution of the visual system: in particular, it enables to measure the sensitivity at high, medium and low ranges of spatial frequencies, this being unique to such a procedure. The possible physiological mechanisms underlying the contrast sensitivity function as well as its pathological changes are reviewed.


[Transsexualism and its therapy].

After a review of the historical development of ideas about transsexualiam and the discussion of possible somatic and psychological causes of this condition, the results of explorations of 12 male and 6 female transsexuals who desired a hormonal and surgical approximation to the opposite sex are reported. Two of the nine patients whose chromosomes were examined were found to suffer from Klinefelter's Syndrome. From the personal history it was apparent that 8 of the 12 male transsexuals had difficulty in identifying with an absent, alcoholic or brutal father. The wish to be a member of the opposite sex could be traced in 10 of the 12 male and all 6 female transsexuals to the first five years of life. 7 of the 12 male transsexuals and 3 of the 6 female transsexuals were found to have attempted suicide or to have had suicidal tendencies in the past. In 9/12 male transsexuals and 5/6 female transsexuals the "change of sex" operation was considered to be indicated. The average age at operation was 28 for the male transsexuals and 26 for the female transsexuals. The follow-up studies were done 2 months to 3 years after operation for the male transsexuals (average 1, 7 years) and 2 to 3 3/4 years post operatively (average 2, 9 years) for the female transsexuals. 7/8 of the male transsexuals from whom we have katamneses and both female transsexuals reported that they felt subjectively better than before the operation. The present legal situation concerning the registration of change of name and sex in various countries is described.


[Psychiatric prognosis in epilepsies].

It was illustrated by examples how psychical disturbances of epileptics can be used as indicators a) for brain lesions which cause the epilepsy too, b) for epileptic activity of the brain itself, and c) for the consequences of epilepsies of long duration. Furthermore, how they can be used as predictors for the success of the epileptic during his life. This course-related arrangement of psychical disturbances which predict a negative prognosis corresponds with measures for prevention of the development of psychical disturbances, for therapeutic diminishing or removal of existing psychical disturbances, and for prophylaxis (or tertiary prevention resp.) of negative psychical consequences or relapses of epilepsy. These measures should improve the life-success of the epileptic patient.


[Hydrocephalic psychopathy. Psychopathology and clinical symptoms in organic psychosyndrome].

In reviewing the literature on the psychopathology "of chronic hydrocephalic psychopathy" attention is called to its complexity which includes also lack of any symptoms. Nevertheless a group can be distinguished showing affective disorders of diencephalic type. Glaus and Walther-Büel examined patients with disturbances of mood and energy due to hydrocephaly who were ascribed to the psychosyndrome of local organic brain foundation after M. Bleuler; according to the aeromegaloid psychopaths they were called "hydrocephalic psychopaths". A new case is discussed who presented a small-delinquency for years with long-during forensic consequences before the discovery of a marked hydrocephaly of unknown etiology; relapses could be avoided by compensation of the forensic measures by medical and psychoagogic care. The difficulties of diagnosis are shown with emphasis on neuroradiologic clarification in suspect cases.


Mortality among Finnish doctors, 1953-1972.

The mortality with respect to the total population of Finnish physicians during the period 1953 to 1972 has been analysed and compared with the corresponding statistics for the general Finnish population, for Finnish foundry workers, and for American physicians. It was found that the overall mortality was lower for male physicians than that for the general population or for foundry workers, but was clearly higher than that for American physicians. Male physicians did not exhibit any major differences from the general population with regard to cardiovascular diseases and suicide, but had a lower mortality from malignant neoplasms, accidents and "other diseases" (including infectious diseases). The explanation of cancer mortality being lower than expected among male physicians was mainly to be found in a deficit in lung cancer. Although female physicians had higher life expectancy than male physicians and the female general Finnish population, they did not show any clear deficit for cancer. In respect of all specialists, surgical specialists had the lowest mortality; general practitioners had the highest mortality. Most of these variations were attributable to differences in coronary mortality, but mortality from lung cancer was also remarkably low among surgeons. Differences of a similar type were also found between occupational sub-categories; private practitioners had the highest, and research workers and central hospital physicians the lowest mortality figures. The lower cancer mortality among male physicians, as contrasted with the general population, is probably attributable to differences in smoking habits; about 22% of male physicians smoked in 1973, whereas earlier studies by others have indicated that the corresponding proportion was about 50% in the general population. In contrast, the differences in mortality between different specialist categories probably arises from other factors, since Finnish physicians reportedly display a relatively homogeneous smoking pattern.


Effect of loneliness on mortality after retirement.

In the present study, the effect of the type and number of available objects on post-retirement mortality was examined. The hypothesis is that the fewer available objects people have upon retirement, the greater will be the mortality after the retirement. The material was divided into three groups: married (assumed to have the greatest object potential), widowed or divorced (second greatest), and single (least potential). The material consisted of men retired on old age pension in 1964. Of these, 792 were married, 119 were widowed or divorced, and 77 were single. No statistically significant differences in mortality between groups on the basis of marital status could be found, although the results tended to favour the hypothesis. The number of suicides and accidents in the group of men dying within two years of retirement exceeded the expected values, but this increase was distributed fairly evenly between groups on the basis of marital status.


Application of diagnostic criteria in the diagnosis of myocardial infarction.

A random sample of all patients with a registered diagnosis of acute myocardial infarction (AMI) was selected from the hospitalisation register of Stockholm County in 1973. The sample consisted of 269 patients. The medical records of these patients were scrutinized concerning the fulfilment of criteria of a diagnosis of AMI. The criteria of AMI chosen were those established in a Sweden cooperative study (6). 33 patients did not fulfil the diagnosis of AMI, corresponding to an estimated proportion of 10%. In 4% this was due to more technical reasons such as the use of incorrect code numbers, and in 6% the diagnosis had been made without the criteria being fulfilled.


Work and disability at the age of 30 years. A sociomedical study of a birth-cohort from Bergen. V. Social background and recruitment to the school system.

The basis of the present study is a cohort of 1570 persons, all live births in 1940 of mothers then residing in Bergen. This birth-control was followed up in the compulsory school system at the age of 14 years. Information from the "parsons' lists" (birth registers) was gathered concerning the parents' social background, while facts about the students' recruitment to the compulsory school system in Bergen were obtained from the local files of the various schools and the files of The National Services for the Mentally Retarded. For the purpose of collecting more detailed information, a sample was taken from the birthcohort. This sample was formed on the basis of a stratification of the cohort according to type of school attended at 14 years of age. By supplementing the group comprising persons attending Special Schools for the Educable Mentally Retarded and the group including persons cared for by the National Services for the Mentally Retarded, a total sample of 262 persons was reached. It is found that recruitment to the school system varies considerably with socio-economic background. Children of higher officials were highly over-represented in Junior High School, while children of workers were noticeably under-represented at this type of school. Children of workers were over-represented in Continuation School, Elementary School classes for slow learners and Special Schools for the educable mentally retarded. However, a proportionally very similar representation of the social groups in the services for the mentally retarded was found.


Inverse association between risk factors for benign and malignant breast lesions.

The purpose of the present study was to compare the risk of breast cancer and the risk of benign breast disease using known risk factors for breast cancer. The series was taken during breast cancer screening of women aged 41-60 in an industrial city in Finland. 158 breast lesions were diagnosed, 27 of which were malignant. Women with breast disease and 534 controls were interviewed to obtain epidemiological data. The prevalence of benign lesions decreased after menopause but the prevalence of carcinomas was essentially the same over the age span 41-60. Several risk factors for breast cancer, such as selected reproductive and hormonal characteristics, were not associated with the risk of benign breast disease. Thus it was concluded that benign and malignant breast lesions are not associated in general, and the decrease in the prevalence of benign breast lesions after menopause is more likely to be due to regression than to transition to carcinoma.


A multiphasic screening programme at the health centre level: the Säkylä-Köyliö project.

The Säkylä-Köyliö Project concerned the investigation and evaluation of different screening programmes and the possibilities for providing the necessary treatment and follow-up at the health centre level. The variables studied consisted of anaemia, bacteriuria, high blood pressure, and mental health problems; an epidemiologic screening for sight and hearing defects and diseases of the musculoskeletal system was carried out as well. The use of health services, together with the relationships between objectively and subjectively determined morbidity, was also studied. A total of 2268 inhabitants of the municipalities of Säkylä and Köyliö, i.e. 93.2% of the 40- to 64-year-old female population and 93.4% of the males in the same age range, participated in the screening programme conducted by the Säkylä-Köyliö Project between 9 September 1973 and 11 January 1974. Only one-fifth (1.9%) of the non-respondents to the first invitation (8.6%) participated in the screening programme after they received a second invitation. This result demonstrates that those who do not participate for some reason cannot, to any great extent, be influenced by a renewed invitation. Since the non-participation rate was insignificant, the material examined may, from the epidemiologic point of view, be considered as representative of the middle-aged population of the two municipalities, which together form a health centre district in Southwest Finland. The high participation percentage also shows that the prerequisite of screening, namely, a positive attitude on the part of the population, was as well fulfilled in the present project.


Physical work capacity of young men in Sweden.

Each year between 1961 and 1975 all male students in a secondary school were submaximally tested on several occasions on bicycle ergometers with regard to estimated maximal aerobic power. The school is situated in central Sweden (Falun). The students were between 16 and 20 years of age. Data from the tests in Falun and data compiled from other sources cannot confirm the hypothesis that young men of today have a lower maximal aerobic power than young men of the 1960s. The results indicate that Swedish boys aged 16 to 20 have, on average, a maximal aerobic power of about 45 ml O2 X (kg x min)-1. The standard deviation is about 8 ml O2.


[Intravascular coagulation: symptom or disease?].

The laboratory pattern of intravascular coagulation is the result of complex mechanisms. The accelerated disappearance of substrates may be partially or completely compensated by increased production, depending on the integrity of liver and bone marrow. Ischemic complications are to be expected almost exclusively in acute cases, because of efficient mechanisms for the elimination of fibrin and other products. The typical laboratory pattern may be produced by loss of plasma from the circulation and extravasal proteolysis of the coagulation substrates. Chronic intravascular coagulation may be compensated, with resultant hyper-coagulability and increased risk of thromboembolic complications.


[Transcobalamine-II-polymorphism: biochemical and clinical aspects of rare variants].

Transcobalamin II(TC II) is an essential transport protein for vitamin B12 in blood. TC II can be split up into isoproteins by polyacrylamide gel electrophoresis. Family studies are compatible with a genetic polymorphism of TC II and a five allele system. Screening of TC II isoprotein patterns in about 1000 individuals yielded two unusual TC II variants: The first case was a black female with severe megaloblastic anemia since infancy. Her TC II was elevated and bound B12, but displayed markedly diminished functional capacity to transfer radioactive cyanocobalamin in cellular systems. Comparison of this patient's TC II isoprotein pattern with known variants showed a distinct difference in electrophoretic mobility, indicating the presence of a sixth allele. The second patient, also presenting with pernicious anemia-like symptoms, was found to possess an unusual TC II variant with reduced TC II serum levels. Corresponding variants were also observed in the patient's asymptomatic children. Thus, abnormal TC II variants probably causing megaloblastic anemias both correlated with unusual isoprotein patterns.


[Cellular immunity: in vitro leukocyte migration inhibition does not correlate with the tuberculin skin test].

The leukocyte migration inhibition test (LMIT) is said to be an in-vitro correlate of cell mediated immunity in vivo. The authors' series of experiments, however, in which they compared skin tests and LMIT (taking the same tuberculin for both tests), showed wed no correlation between the two tests. The discrepancy between these results and those of other authors may be due to the fact that the authors worked under sterile conditions. It is known that contamination even by minute amounts of endotoxin may alter the results of in-vitro tests of cell mediated immunity. The authors therefore question the value of the LMIT as an in-vitro counterpart of the skin test.


[Sequential immunologic, cytochemical and autoradiographic studies on lymphoid cells in the blood of healthy adults].

Simultaneous characterization on a single slide of computer-mapped lymphoid blood cells by sequential analysis of 3 parameters (surface immunoglobulins, AET-SRBC-rosetting, unspecific acid alpha-naphthyl-acetate-esterase) served to distinguish 8 subpopulations. By previous in vitro incubation with 3HdT, the proliferative activity of the latter could also be assessed.


[Diagnostic and therapeutic importance of splenectomy in patients with non-Hodgkin's lymphoma].

Whereas the contribution of exploratory laparotomy in Hodgkin's disease is well characterized, its value in Non-Hodgkin lymphoma (NHL) is not yet defined. This retrospective analysis of 31 cases is a contribution to the ongoing discussion. Laparotomy/splenectomy (LS) was done in 17 patients for diagnostic reasons and in 14 with therapeutic intent. Perioperative morbidity was low. In 17 cases the NHL had infiltrated the spleen. Indications for therapeutic LS were hemolytic anemia, pancytopenia and excessive lymphocytosis with granulocytopenia. The therapeutic benefit from splenectomy was satisfactory, especially in patients with well-differentiated lymphocytic leukemia of type CLL. In contrast, the diagnostic value of LS was minimal, except in patients with first diagnosis of NHL through LS. There was no change in tumor stage in any case. However, 4 false-negative findings contrast with the rapidly adverse course in these patients. Routine LS in patients with NHL does not appear to be justified, but has its value in NHL with primary abdominal localization. Therapeutic splenectomy is of benefit for the majority of patients, particularly those with CLL.


[The fibrin and plasma-protein content of human thrombi].

The protein composition of cell-free thrombus contained in abdominal aneurysms of the aorta was investigated using PAGE and immunoreactivity after solubilization. 1. The dry weight was 18--29%, with minor differences between various locations. 2. 35--40% of the dry weight was extractable with NaCl/citrate and was identified as albumin (80%) and IgG (15%). Trace amounts of fibrinogen immunoreactive material were present. 3. The NaCl/citrate insoluble part was 80% hydrolyzable with plasmin. The predominant fragment was D-D dimer (from cross-linked fibrin). In addition, fragments Dand E were observed. Reduction of the NaCl/citrate insoluble part with 2-mercaptoethanol resulted in almost complete solubilization. PAGE analysis demonstrated alpha-polmers, gamma-gamma dimers and little free alpha-chains, indicating almost complete cross-linking of fibrin. Thus, the major protein were cross-linked fibrin, albumin and IgG.


[Importance of the sialic acid moiety for the heterogeneity in human fibrinogen].

To determine whether the observed heterogeneity of gamma- and B beta-polypeptide chains of human fibrinogen (2 and 1 sialic acid residue per chain) is due to differences in sialic acid content, fibrinogen was desialatgen was compared with normal fibrinogen. The gamma-chain heterogeneity observed in normal fibrinogen was absent in asialofibrinogen, whereas the B beta-chain heterogeneity appeared to be unaffected. Although the variants were indistinguishable on SDS-PAGE, isoelectric focusing in the presence of urea demonstrated heterogeneities of both gamma- and B beta-cahins even in asialofibrinogen. However, fewer bands were recognized in asialofibrinogen. The difference in sialic acid content of the gamma- and B beta-chain variants of human fibrinogen therefore explains on part of the polypeptide chain heterogeneity.


[Pharmacologic remobilization of hyperadhesive granulocytes: a new principle in "anti-inflammatory" therapy].

It is thought that the nonsteroidal anti-inflammatory drugs act through inhibition of cyclooxygenase (CO). The authors show that the pyrazolon derivatives phenylbutazone (P) and sulfinpyrazone (S) affect PMN function in a manner independent of CO inhibition. During inflammation PMN often show increased adhesiveness. Such adhesiveness can be provoked in vitro by high concentrations of chemotaxins. Preincubation (10--20 minutes) of platelet-free human PMN suspensions in heat-inactivated plasma with 100 micrograms P or S per ml completely abolished a submaximal adherence induction on Petri dishes from 4% adherent cells in the absence, to 23% in the presence, of 10(-7) M of the chemotaxin N-f-Met-Leu-Phe (FP). In vivo, premedication of rabbits with P or S prevented the FP-induced neutropenia, e.g. 10 mg/kg of S blocked a 5-minutes agranulocytosis. P and S also abrogated adherence-induced lysosomal enzyme release and FP-stimulated hexose monophosphate pathway (HMP) activity. FP-induced hyperadhesiveness impedes PMN locomotion. Preincubation of PMN with P or S reestablished random motility and allowed chemotactic migration toward activated C (as C5a) in spite of the presence of 'adhesive' concentrations of FP. The potent CO inhibitors indomethacin and aspirin had no effect on FP-induced adherence, enzyme release, neutropenia and HMP stimulation. In 3 selected patients with PMN hyperadhesiveness, correction of this adhesiveness by P paralleled clinical remission. It is concluded that P and S exert their antiinflammatory action at least in part by interfering with PMN hyperadhesiveness and lysosomal enzyme release. These effects are independent of the prostaglandin-thromboxane system, since other CO inhibitors are uneffective.


[Sideroblastic anemia: clinical and hematological study on 57 patients].

Sideroblastic anemias (SA) are a heterogeneous group of hematologic disorders marked by a defect of heme synthesis, disturbance of iron metabolism and the presence of ringed sideroblasts. 57 cases of SA, including 23 primary and 34 secondary forms, are discussed. In the group of secondary SA 13 patients were alcoholics, 3 had received chloramphenicol, 2 had lead poisoning, 2 had received busulfan and 2 had immune hemolytic anemia. In some cases serum ferritin was found to be excessively high. The caryotype of one patient presented deletion of the long arm on chromosome 20. None of the patients with primary SA responded to vitamin treatment, and 3 developed a myeloproliferative syndrome.


[Similarity of the HL-A antigens in parents of patients with acute leukemia or aplastic anemia].

The frequency of common HLA-A and -B antigens was determined in 30 couples with a child suffering from acute leukemia (AL), 34 couples with a child suffering from aplastic anemia (AA) and 58 random couples with healthy children. Increased frequency of couples sharing at least two common antigens was observed in parents of both AL and AA children.


Metabolism of americium-241 in man: an unusual case of internal contamination of a child and his father.

The metabolism of americium-241 has been studied during an 8-year period in an adult male and his son who, at the ages of 50 and 4 years, respectively, were accidentally and unknowingly contaminated within their home by means of inhalation. Chelation therapy with calcium trisodium pentetate was more effective in enhancing the removal of americium-241 from the child than from the father.


Neonatal rat surgery: avoiding maternal cannibalism.

A simple program of handling and care of pregnant rats before delivery makes it possible to carry out surgical procedures on newborn pups without resultant cannibalism or rejection of the operated animals by their mothers.


Cerebral norepinephrine: influence on cortical oxidative metabolism in situ.

Unilateral lesion of the locus coeruleus and the resultant norepinephrine depletion in the ipsilateral cerebrum alters the relationship between cerebral metabolic demands and local delivery of oxygen and substrates. This effect of norepinephrine depletion is demonstrated by slower recovery of the redox ratio of cytochrome a,a3 during increased metabolic demands induced by local cortical stimulation.


Shark heart mitochondria: effects of external osmolality on respiration.

Shark mitochondrial respiration was studied in media with osmolalities between 160 and 1500 milliosmoles. The respiratory control ratio, a marker for functional integrity of the isolated mitochondria, was maximal at 1000 millismoles and decreased during hypotonic or hypertonic exposure. Shark mitochondria function best at their native tonicity, a value that produces abnormal function in mammalian mitochondria.


Dopamine auto- and postsynaptic receptors: electrophysiological evidence for differential sensitivity to dopamine agonists.

The responses of dopamine cells in the substantia nigra to iontophoretically administered dopamine and intravenous apomorphine were compared to the responses of spontaneously active neurons in the caudate nucleus. Dopaminergic cells were six to ten times more sensitive to dopamine and intravenous apomorphine than 86 percent of the caudate cells tested. This differential sensitivity of dopamine auto- and postsynaptic receptors may explain the apparently paradoxical behavioral effects induced by small compared to large doses of some dopamine agonists and may provide a means of developing new types of drugs to antagonize dopaminergic influence in the central nervous system.


Serotonin neurons project to small blood vessels in the brain.

Electrolytic lesions of the nucleus raphe dorsalis and medianus reduce the concentration of serotonin (5-hydroxytryptamine) within rat brain intraparenchymal blood vessels. The concentration of serotonin within these vessels increases or decreases after the administration of drugs that modify the biosynthesis and degradation of serotonin or destroy nerve terminals by an uptake-dependent mechanism. These studies provide evidence for the existence of a serotonin-containing pathway seemingly analogous to the neuronal projection that terminates on small parenchymal blood vessels from noradrenergic neurons of the locus coeruleus.


Correct axonal regeneration after target cell removal in the central nervous system of the leech.

The unique target neuron of a severed axon in the leech was selectively eliminated by intracellular injection of protease. In the absence of the target, the severed axon regenerated normally along its original pathway to the usual site of synapse, where it stopped growing without forming alternative connections.


Calcification of differentiating skeletal mesenchyme in vitro.

Embryonic limb-bud mesenchyme was induced to calcify in culture by the addition of 3 mM inorganic phosphate to the medium. Phosphate enhanced calcification of the matrix produced by mesenchymal or fibroblast-like cells, whereas no calcification was evident in areas where cartilage had developed. However, calcification was induced throughout the cell layer by altering the cartilage matrix properties with certain enzymes or by changing the phenotypic expression of the cells with vitamin A.


Exercise during development induces an increase in Purkinje cell dendritic tree size.

Mice allowed to exercise during the late postnatal period had Purkinje cells with larger dendritic trees and greater numbers of spines than littermates whose physical activity was severly restricted. These changes in Purkinje cells were accompanied by a selective reduction in the thickness of the cerebellar molecular layer. The data provide evidence for cerebellar plasticity during late development and demonstrate that physical activity can modify the development of Purkinje cell dendrites.


Holographic assessment of a hypothesized microwave hearing mechanism.

Exposure of the head to pulse-modulated microwaves induces the perception of a sound. It has been hypothesized that the electromagnetic energy is converted to acoustic energy in the skull and then conducted through the bone. Dynamic time-averaged interferometric holography showed that the predicted motion of head tissue did not occur. An alternative locus for this hearing effect is suggested.


Comparison of total sequence of a cloned rabbit beta-globin gene and its flanking regions with a homologous mouse sequence.

The nucleotide sequence of a cloned rabbit chromosomal DNA segment of 1620 nucleotides length which contains a beta-globin gene is presented. The coding regions are separated into three blocks by two intervening sequences of 126 and 573 base pairs, respectively. The rabbit sequence was compared with a homologous mouse sequence. The segments flanking the rabbit gene, as well as the coding regions, the 5' noncoding and part of the 3' noncoding messenger RNA sequences are similar to those of the mouse gene; the homologous introns, despite identical location, are distinctly dissimilar except for the junction regions. Homologous introns may be derived from common ancestral introns by large insertions and deletions rather than be multiple point mutations.


Synaptic regeneration in identified neurons of the lamprey spinal cords.

Identified reticulospinal neurons whose giant axons were severed after spinal cord transection were filled with horseradish peroxidase. Whole mounts and serial-section light and electron micrographs show axon regeneration across the spinal lesion and the formation of new synapses. Normal swimming activity returns in the spinally transected animals, although the regenerated synapses are in atypical regions of the spinal cord.


Neural axis representing target range in the auditory cortex of the mustache bat.

In echolocating bats, the primary cue for determining distance to a target is the interval between an emitted orientation sound and its echo. Whereas frequency is represented by place in the bat cochlea, no anatomical location represents of primary range. Target range is coded by the time interval between grouped discharges of primary auditory neurons in response to both the emitted sound and its echo. In the frequency-modulated-signal processing area of the auditory cortex of the mustache bat (Pteronotus parnellii rubiginosus), neurons respond poorly or not at all to synthesized orientation sounds or echoes alone but respond vigorously to echoes following the emitted sound with a specific delay from targets at a specific range. These range-tuned neurons are systemically arranged along the rostrocaudal axis of the frequency-modulated-signal processing area according to the delays to which they best respond, and thus represent target range in terms of cortical organization. The frequency-modulated-signal processing area therefore shows odotopic representation.


Hydrostatic pressure reversibly blocks membrane control of ciliary motility in Paramecium.

A hydrostatic pressure of only 68 atmospheres prevented swimming Paramecium caudatum from "avoiding" or reversing direction; 170 atmospheres stopped or decreased forward velocity by more than 75 percent. A decompression of 40 atmospheres invoked a single reversal, even at ,80 atmospheres. In contrast, 170 atmospheres did not significantly affect swimming behavior of paramecium "models" that were reactivated in a solution containing adenosine triphosphate and magnesium ions after their membrane had been disrupted by Triton X-100.


Light and efferent activity control rhabdom turnover in Limulus photoreceptors.

Photosensitive membrane structures in the retinular cells of the Limulus lateral eye are broken down and renewed daily. The first light onset causes a rapid, synchronous disassembly and buildup of the rhabdom in each photoreceptor cell. The entire process is complete within 30 minutes. Blocking the efferent input to the retina from the brain blocks the turnover of the rhabdom, and mimicking the efferent input by optic nerve stimulation restores it.


Radionuclide therapy of hematologic disorders.

32P is effective therapy for polycythemia and primary thrombocytosis. The Polycythemia Vera Study Group is comparing radioactive phosphorus with alkylating agents to determine relative efficacy. Less well investigated is the effectiveness of 32P vs. busulfan in chronic granulocytic leukemia. Endolymphatic administration of radiopharmaceuticals may play a role in the therapy of infradiaphragmatic lymphoma. Among the radionuclides that have at times been used in hematology are 32P, 198Au 24Na, 76As, 89Sr, 52Mb, 54Mn, 91Y, 95Zr, 95Cb, 111Ag, 109Pd, 131I, 185W, and 192Ir. As stated, 32P has proven single most efficacious agent. The hematologic diseases that have been treated include both malignant and benign conditions. Among the malignant conditions are polycythemia vera, agnogenic myeloid metaplasia, thrombocythemia, leukemia, Hodgkin's disease, and multiple myeloma. Hemophilia, and Osler--Weber--Rendu disease are among the benign entities in which the agents have been tried. Polycythemia and thrombocythemia remain those in which the greatest success has been achieved.


Iatrogenic alterations in radionuclide biodistributions.

The biodistribution of radiotracers used in diagnostic imaging is grossly and recognizably altered by a wide variety of drugs and other treatment modalities, such as surgery and radiotherapy. Knowledge of such altered biodistribution is important both in making diagnostic inferences from scans and in dosimetric considerations.


Potential future application with therapeutic agents.

Several new approaches to radiation therapy with radionuclides have been discussed. Iron 55 is selectively utilized in the red cell developmental cycle and in therapeutic doses, can lower marrow and circulating erythrocyte levels with much smaller degrees of effect on other cell lines. A serious complication, noted in animal studies, is the induction of neoplasma, especially osteosarcoma. Selective irradiation of the cell nucleus is possible with 125IUdR. This results in highly efficient cell killing due to the highly concentrated region of ionization. High concentrations of densely ionizing radiation in the malignant cell may also be accomplished with 211At. The use of labeled liposomes is an additional approach to the delivery of intracellular irradiation. None of these approaches is applicable for the practical treatment of human malignancy at the present time. The importance of these approaches is their value as models for future development of methods that can provide highly selective radiation to target sites.


Radiotherapeutic agents: properties, dosimetry, and radiobiologic considerations.

Radioactive nuclides for treatment have occupied an important but somewhat diminishing role in the total practice of nuclear medicine. Although theoretically they should have important potentialities, particularly in the treatment of various forms of cancer, their development in this field has not kept pace with the progress in other treatment modalities in radiation oncology. Indications for the selection of appropriate isotopes for therapy revolve about the emission of beta particles of sufficient energy, which are administered in a chemical form that reaches the tumor. Methods of calculation of doses delivered to sites of deposition are discussed in the text. Radiobiologic considerations include the possibility of early deleterious effects from overdosage, and consideration of chromosomal changes of circulating lymphocytes and their implications. Late effects that have been of great public concern are confined almost solely to possible carcinogenesis, and this effect has been minimal in patients receiving therapeutic levels of radioactive drugs. Genetic and developmental effects, also, have been negligible. Complications encountered more frequently have been leukemia after extensive therapy of thyroid carcinoma, and local fibrosis after direct injection of radioactive colloids into tumor tissue.


The treatment of benign thyroid disease.

The treatment of benign forms of thyroid disease is reviewed. Endemic goiter is a public health problem preventable by the addition of iodine to the food or water supply. Endemic and familial goiters are treated with replacement doses of I-thyroxine, as are sporadic colloid goiters and goiters resulting from chronic thyroiditis. Hyperfunctioning autionomous nodules without thyrotoxicosis and cystic nodules require no specific therapy. Prophylaxis against diffuse or nodular goiter after radiation to the head or neck for therapeutic purposes with thyroxine replacement therapy is debatable. All forms of hypothyroidism, including incipient types, require replacement thyroxine therapy, but this should be undertaken cautiously in older patients and in those with evidence of ischemic myocardial disease. Myxedema coma requires vigorous treatment and detailed supervision because of dismal mortality rates. Iodine 131 is the treatment of choice in diffuse toxic goiter, but alternative forms.


Treatment of malignant thyroid disease.

Surgery is the primary form of therapy in the management of malignant thyroid disease. A near-total thyroidectomy is the preferred approach. Radioactive iodine is used for supplementary ablation therapy and for definitive therapy in differentiated tumors of papillary or follicular cell type. Thyroid-stimulating hormone (TSH) is administered in conjunction with radioactive iodine therapy, since tumor uptake appears to be directly related to endogenous TSH levels. Therapeutic doses of radioactive iodine range from 100 to 200 mCi of 131 I depending on tumor distribution. Adequate thyroid hormone replacement therapy resulting in the suppression of TSH is of considerable value in the prevention of tumor recurrence. Due to the possibility of late recurrence, patients should be followed for indefinite periods by means of diagnostic imaging studies at 1-2 yr intervals. Despite 30 yr of experience, the therapeutic efficacy of radioactive iodine remains controversial. However, in recent years, there has been mounting evidence indicating increased survival and decreased tumor recurrence in radioactive iodine-treated patients. External radiation therapy is reserved for anaplastic carcinoma and lymphoma, and adenocarcinomas that are refractory to radioactive iodine. Chemotherapy experience is limited; however, some reduction in the size of metastatic lesions has been observed after the administration of adriamycin.


Comparison of media for dissemination of information about cancer in rural communities.

A study was done in Orangeburg County, South Carolina, to compare the effectiveness of the various mass media--television, radio, and newspaper--for the dissemination of educational material about cancer. Effectiveness of these media in reaching certain subpopulations defined by race, sex, income, and population density was also examined. The newspaper was found to be generally more effective than other media. This superiority held for almost all subpopulations. Furthermore, it was found that certain subpopulations differed from others in the extent to which they were reached by a particular medium.


Caustic burns of the esophagus: ten-year results of aggressive care.

In 1967, care of esophageal burns from caustic substances was altered to include immediate esophagoscopy, high doses of steroid, and follow-up dilatations plus cine-esophagograms as needed. Previously, this area averaged six repairs of esophageal stricutre each year. Since 1967, there have been no esophageal strictures in 100 patients.


Traumatic rupture of the thoracic aorta.

Aortic transection secondary to blunt trauma is not an uncommon injury. Prompt recognition and treatment of the injury is required to salvage patients with this type of injury. Ten patients with transection of the thoracic aorta at the isthmus have been treated in the past two years at our institution. There have been two operative deaths, one delayed hospital death, and seven survivors. We believe the use of a temporary shunt of heparin-bonded polyvinylchloride during the repair of the aorta offers significant advantages over other methods which have been described.


Treatment of metabolic alkalosis with intravenous hydrochloric acid.

Severe alkalosis requires aggressive treatment. Twenty patients at the Talmadge Memorial Hospital have been treated for metabolic alkalosis by infusion of dilute hydrochloric acid through a central venous line. The treatment was effective and there were no major complications. Intravenous hydrochloric acid is preferred to other modes of therapy for refractory alkalosis, especially in the presence of hepatic or renal failure.