Absence of oesophageal mucosal folds in systemic sclerosis.

In a controlled study of barium swallow radiographs in systemic sclerosis, longitudinal oesophageal mucosal folds were absent in eight of 30 patients and in one of 30 control subjects (P less than 0.03). Patients without mucosal folds developed Raynaud's phenomenon at an earlier age than those who retained their mucosal folds (P less than 0.05). A loss of oesophageal mucosal folds did not necessarily signify more severe visceral or cutaneous disease.


Perforated oesophagus: review of twenty-eight consecutive cases.

Oesophageal perforation is a potentially lethal condition which requires early diagnosis and prompt surgical management. The radiological features in 28 patients with oesophageal perforation have been reviewed and correlated with the aetiology and site of perforation, underlying oesophageal abnormality and the time interval between occurrence and diagnosis. Twenty-five patients (89%) had detectable abnormalities on the chest radiograph. The commonest abnormalities were air in the cervical or mediastinal soft tissues and air or fluid in the pleural cavity. The factors influencing the different radiographic signs are discussed. Studies with a suitable contrast medium are necessary to show the site and extent of the perforation, the extent of any associated abscess cavity and the position of the perforation relative to any primary oesophageal disease. Of 26 patients who had a barium swallow a leak was demonstrated in 21 (81%). In the five patients in whom no leak was demonstrated the examination was performed more than 24 h after the perforation.


The effect of glucagon on infusion cholangiography.

The study was undertaken to assess the effects of glucagon on biliary tract opacification during intravenous cholangiography. Two series of infusion cholangiograms were obtained at two investigating centres designated A and B. In series A, 41 patients had ioglycamide infusions at a rate of 0.2833 g min-1 over 1 h. In series B, 31 patients had ioglycamide infusions at a rate of 0.3886 g min-1 over 30 min. Radiographs were taken in both series, immediately at the end of the infusion, 10 min later and 30 min after the infusion. Two mg of intravenous glucagon was injected into alternate cases in both series A and B immediately after the first radiograph was taken at the completion of the ioglycamide infusion. Two observers in each series than assessed the radiographic opacification of the biliary system without prior knowledge of which patients had received the glucagon. Delineation of the biliary system was considered better in both series in those patients who received glucagon when compared with the controls. Gallbladder opacification was definitely increased in series A in those receiving glucagon, and a similar tendency was shown in series B. The amount of contrast in the upper intestine was increased in series A in the glucagon group, but not in series B. It is concluded that glucagon improves visualisation of the biliary tract, especially the gallbladder at infusion cholangiography.


Combined fine needle percutaneous transhepatic cholangiography and hypotonic duodenography in obstructive jaundice.

The information obtained at percutaneous transhepatic cholangiography in patients with obstructive jaundice is not always conclusive about the nature of the obstructing lesion. Hypotonic duodenography performed immediately after transhepatic cholangiography may assist in such cases by demonstrating the presence or absence of duodenal involvement. This ensures that the appropriate surgical procedure can be planned before operation. Our experience using the combined techniques in nine patients is reported.


Soft-tissue measurements at the index finger: age and sex characteristics.

Measurements of the soft-tissue width and phalanx width of the index finger were made in 402 normal individuals (270 women and 132 men, age range 20--89 years) in order to establish age-sex characteristics. Men have a significantly larger total finger and phalanx width than women in all age groups. In both sexes a statistically significant increase with age in phalanx width and total finger width is found. The soft-tissue index and soft-tissue thickness is not influenced by age.


Radiogrammetry of the soft tissue at the index finger in acromegaly.

Measurements of the soft-tissue width and phalanx width at the index finger were made in 30 acromegalic patients and compared with values obtained in a large control population. The width of the phalanx, total finger width and soft-tissue thickness are significantly larger than expected and the soft-tissue index values are significantly lower than expected. An important overlap between normal and acromegalic values is found for the soft-tissue index and width of the proximal phalanx. The measurement which best discriminates acromegalics from normal is the total finger width. The soft-tissue thickness parameter is also very sensitive for the detection of acromegalic changes and has the advantage of not being sex and age dependent.


The anterior costal margin mass in patients with thalassaemia major.

In thalassaemia major, extramedullary haematopoiesis in the form of tumour-like masses, usually occurs in the posterior mediastinum. We present three cases in which such masses were found at the anterior part of the ribs. The radiological signs of this latter location, which is the second most common after the mediastinum, are described.


Inferior caval venography in the assessment of renal carcinoma.

Inferior caval venography by a non-catheter technique was carried out in 30 cases of renal cell carcinoma. Occlusion of the renal vein was shown in 15 of these and occlusion of the inferior vena cava in a further three. Deformity of the vena cava by adjacent growth was found in nine instances. Renal arteriography was performed in 27 of these patients and the demonstration of the renal vein by this method has been compared with that of caval venography. The incidence of collateral veins on the arteriogram and the finding of impaired renal function as an index of renal vein occlusion has been discussed.


The urinary tract in haemophilia.

Scant attention has been paid to changes in the urinary tract in haemophilia, although haematuria, renal colic, the passage of clots and clot retention have long been known. Twenty-eight haemophiliac subjects were investigated with a total of 59 radiological examinations of the urinary tract including 41 intravenous urograms (IVU). In 10 patients (36%) abnormalities were demonstrated in the urinary tract, six patients showed changes of hydronephrosis, one a non-functioning kidney and in two patients blood clots were shown in the collecting system. These abnormalities were more common in clinically severe haematuria, while normal urographic appearances were common in clinically mild cases. The cause of hydroephrosis was extrinsic from compression, either renal or ureteric, or instrinsic from clot retention. In some cases the cause was not known. It is suggested that in these the hydronephrosis may result from organisation of the haematoma with peri-ureteric fibrosis.


Grey scale ultrasonography and arthrography in evaluation of popliteal cysts.

Ultrasonography will reliably detect popliteal cysts of clinically significant size and improvements in ultrasound imaging have enhanced the value of ultrasound in relation to arthrography in the assessment of cyst rupture. Forty-eight knees in 25 patients suspected of having a popliteal cyst were examined by ultrasonography followed immediately by arthrography. Popliteal cysts were demonstrated in 40% (19/48) by ultrasound and in 46% (22/48) by arthrogram. Arthrography detected small cysts not seen with ultrasound, but altrasonic scanning showed cysts which did not fill on arthrography. A ruptured cyst or deep venous thrombosis was suspected in 10 patients. Rupture was confirmed in two patients by arthrography, in both of whom soft tissue changes and attenuation of the distal margin of the cysts were shown by ultrasound.


The radiology of external carotid-internal carotid anastomosis.

Surgical anastomosis between branches of the external and internal carotid arteries may be beneficial in selected cases of transient ischaemic attacks and reversible ischaemic neurological deficit. It is the responsibility of the radiologist, at the time of initial angiographic evaluation, to recognise patients who might benefit from this procedure. Postoperatively, angiography is valuable in assessing the surgical results. This report describes the investigations necessary for the adequate evaluation of these patients in both the pre- and post-operative state.


Computerised tomography of intracranial tuberculomata.

The CT appearances of 14 tuberculomata are described. In 10 of these there is a similarity of appearance which may permit a definitive or high probability diagnosis. The features are: a mass lesion approximately isodense with brain substance surrounded by an intense unbroken ring of contrast enhancement. Calcification may be present within the ring giving a 'target sign'. Two of the other cases were 'tuberculomata en plaque' which had features similar to each other.


The acute radiation syndrome. A memorial to William Michael Court-Brown.

The pattern of symptoms in 189 patients irradiated with a large single dose to one half of the body are described. Radiation sickness developed in 83 and 39% of upper half-body irradiation and lower half-body irradiation treatments respectively and the incidence is not reduced by sedatives or anti-emetics. Following treatment there is a latent period up to 90 min before a phase of acute upset and nausea and vomiting starts. This phase persists for about 6h with an average of six bouts of vomiting and is then followed by recovery.


A review of thirty-three cases of ovarian dysgerminoma emphasising the role of radiotherapy.

The records of 33 cases of ovarian dysgerminoma seen in Manchester between 1943 and 1977 are reviewed, including details of presenting features, age distribution, treatment and survival. The five-year survival rate is 85%. All the Stage I cases and all patients under the age of 20 years at presentation have survived. The cases of the five patients who died are analysed in detail. From this series and review of other series it is concluded that young patients with unilateral Stage I desease who have had a total resection should be carefully followed and radiotherapy reserved for recurrent disease. This does not appear to affect their high chance of cure and enable patients who remain disease-free to retain one functioning ovary. All other patients should have surgery followed by radiotherapy to the whole abdomen. Analysis of the five deaths suggested that, even in Stage III disease a surgical attempt should be made to remove the bulk of the tumour and that the abdominal radiotherapy dose should not be less than 3000 rad in 20 treatments in 28 days.


The Leeds results for radiotherapy in HBO for carcinoma of the head and neck.

Follow-up data at five years are reported for 24 patients with squamous cell carcinoma of the head and neck, included in a randomised prospective MRC study of radiotherapy in hyperbaric oxygen (10 fractions) or air (15 or 20 fractions). Although few, the data show a significant gain in local control (P less than 0.001) and survival (P less than 0.05) with the use of hyperbaric oxygen but no increased tissue reactions or morbidity.


Some radiological abnormalities of the cervical carotid artery and their clinical significance.

Two hundred and fifty-four patients who underwent carotid angiography for common neurological and neurosurgical disorders were reviewed. The incidence and angiographic features of loops, coils, kinks and atheroma are analysed. Loops are common (34%), coils and kinks are not uncommon (7 and 6.6% respectively). The aetiology of these conditions and their clinical importance are discussed. Loops and coils have a developmental basis and do not by themselves cause cerebrovascular ischaemic attacks or influence the patchy development or atheroma. Kinks are acquired and are frequently seen in association with loops but their cause has not been established.


Verapamil acute self-poisoning.

A previously healthy girl, without heart disease, who ingested 2400 mg of verapamil developed hypotension, trifasicular block pattern, mental confusion, mild metabolic acidosis, and hyperglycemia. She recovered with symptomatic and supportive therapy. A discussion is presented about the action mechanism of the drug.


Severe poisoning in a child caused by a small dose of clonidine.

A girl aged 1 year 9 months ingested a single tablet of 0.3 mg of clonidine. She became soon drowsy and unconscious with bradycardia and severe hypotension. Bradycardia was antagonized promptly by atropine, and blood pressure was corrected by giving intravenous fluids. The level of consciousness fluctuated for 6 to 8 hr from alertness to unconsciousness. Serum concentrations of clonidine were only about two times higher than the mean therapeutic values in adults in the treatment of hypertension. Thus small doses of clonidine seem to be potentially dangerous for small children.


Estimation of colchicine in a poisoned patient by using high performance liquid chromatography.

A rapid method was developed for the estimation of colchicine in plasma. The method was used to determine colchicine levels in a fatal case of colchicine self-poisoning.


Arsenic exposure in multiple environmental media in children near a smelter.

A nationwide survey of heavy-metal exposure in children living near primary nonferrous metal smelters demonstrated high urine arsenic levels in children living near a copper smelter in Ajo, Arizona. Airborne smelter emissions and drinking water were the apparent sources of exposure. To determine whether increased arsenic absorption had produced adverse health effects, we conducted an evaluation of 132 Ajo children 5 to 18 years old and compared results with those of 47 children from a comparison town with low arsenic exposure. Environmental testing showed that Ajo's municipal water supply contained arsenic in concentrations of 0.09 mg/l (the EPA standard is 0.05 mg/l); arsenic concentrations in dust averaged 342.2 microgram/g. Urine arsenic levels in Ajo children correlated positively with amount of tap-water consumed (r = .32, p less than. 0002) and with distance of residence from the smelter (r = .20, p less than .02). Tap-water drinkers had significantly higher urine arsenic levels than bottled water drinkers (t = 4.21 p less than .001). Mean urine arsenic levels were significantly higher for children in Ajo (4.75 microgram/100 ml) than for children in the comparison town (1.17 microgram/100 ml). Hair arsenic levels correlated poorly with arsenic exposure. Despite the study population's chronic exposure to elevated environmental levels of arsenic, no clinical or hematologic abnormalities attributable to arsenic were found.


Effects on the offspring of chronic low exposure carbon monoxide during mice pregnancy.

This research is primarily concerned with the effects of chronic low doses of carbon monoxide on fetal development. Carbon monoxide was administered daily by inhalation to female Swiss Webster mice from the beginning of gestation until term. Daily weights were recorded and carbon monoxide blood levels determined every 4 days. The number of offspring in each litter was recorded. At weaning, two males and two females from each litter were randomly picked for maze running studies. When the mice were 6 weeks old, they were tested daily, ten trials per day, in the maze until learning had occurred. The number of days required to learn the maze and the number of incorrect trials were recorded. While there was no significant increase in the number of days needed to learn the maze, there was a significant increase in the number of errors made by the experimental group during this time. This indicated that an increased effort was needed to learn the maze.


Myocardial infarction and marijuana.

Myocardial infarction in the virtual absence of risk factors occurred in a 25-year old man shortly after smoking a cigarette containing marijuana. Subsequent coronary arteriography was normal.


Additional conclusions on diazepam injectable precipitate: GC-MS confirmation.

The precipitate which forms upon dilution of diazepam injection with aqueous vehicles is shown conclusively to be diazepam and not benzoates. The results are based on GC-MS analysis of the precipitate as compared with a synthetic mixture of benzoic acid-diazepam.


Special classroom placements for EMR children: guidelines for community mental health personnel.

Community mental health personnel have become increasingly involved in public school interventions for mildly retarded children. Previous research, legal findings, and ethical principles regarding the most common intervention, special class placement, are reviewed. Advantages and disadvantages of special placement are presented. Finally, a process model is proposed as offering guidelines to the mental health professional who is involved in establishing treatment programs for EMR children in the public school.


Social workers in primary prevention: action and ideology in mental health.

Primary prevention and a public health model have been among the distinguishing innovations of the community mental health movement. Social work practice, however, has historically been involved in community intervention and environmental manipulation to offset social and psychological jeopardy. Given a long tradition of commitment to activity and techniques which are now hailed as mental health's "third revolution," this study explores the role of social work in primary prevention. Data are from a survey of three community mental health centers in which professional staff completed the Gottesfeld Critical Issues of Community Mental Health questionnaire, a time-distribution form, and a prevention questionnaire. In addition, all staff working in primary prevention were interviewed in depth. The total sample of this study of mental health professionals was 84. This study points to some interesting contradictions found between social work action and ideology in primary prevention. Also, social workers are compared with other professionals in order to isolate some primary prevention tasks and attitudes that appear unique to each.


Family psychotherapy with the homosexual family: a community psychiatry approach to homosexuality.

The author points out that homosexual families are not being treated by family psychotherapy despite an indicated need. This situation is inconsistent with good community psychiatry and behooves the mental health workers to become aware of and to work through his unrecognized negative feelings which are interfering with provision of services. Among the main resistances are the lack of familiarity and comfort with the family psychotherapy technique, inability to resist a greater gratification that comes from focusing on sex rather than on a less titillating relationship issue, and judgmental and condemning attitudes toward homosexuality that come from intrapsychic and societal sources.


Relationship of sociodemographic and drinking variables to differentiated subgroups of alcoholics.

The results suggest that the sociodemographic variables of age, living arrangements, number of dependents, the drinking variable, and the client's perception of the type of drinker he is are the most strongly related to the derived typology. The exact relationship of these variables, as well as the variables that were moderately related to the typology, is not apparent. There is a pattern, however, that appears to run through the categories of the classification. The evidence suggests that for alcoholics to be in their prime earning years, living with their spouses, perceiving themselves as alcoholic, possessing marketable skills, and a recent history of abstinence seems to increase the likelihood of psychological need satisfaction. The antithesis--to be alcoholic, less than 30 or older than 50 years old, living by oneself or with parents, perceiving oneself as a social or problem drinker, and possessing a recent history of drinking--seems to decrease the likelihood of psychological need satisfaction. There seems to be a relationship between drinking behavior and psychological need satisfaction. As a group, the members of Clusters Two, Three, and Four are unable to abstain for longer than a week; Clusters Two and Three both possess physiological problems of adjustment. The members of Clusters One and Five tend to be able to abstain for longer periods. Cluster One is devoid of physiological difficulties, whereas Five has borderline problems. The physiological subscale of the Human Service Scale assesses the absence of symptoms associated with poor health (Realges & Butler, 1976). It appears that aberrant drinking does not necessarily result in self-perceived physiological-health complaints. These results are at variance with the belief that ethanol ingestion by an alcoholic and the resulting pathological complications are the predominant difficulties encountered by these persons. Thus it seems to us that a distraught life situation (that is, the lack of social and demographic assets--marriage, education, and so on) contributes to self-perceived severity of psychological need deprivation and not solely aberrant drinking. Therefore, in terms of recovery from alcoholism, these results argue against a unidimensional approach toward the treatment of alcoholism; that is, an approach that focuses solely on the drinking as "the" problem. A more strategic approach would include a thorough medical, psychiatric, psychological, social and vocational evaluation of the alcoholic's life situation, which in turn would permit mobilizing the efforts of a multidisciplinary team whose goal would be to maximize the resources and enhance the life situation of the alcoholic. It is hoped that the results of this study serve to increase our understanding of those factors that influence aberrant drinking.


Consultation and education in rural community mental health centers.

This paper reports on the status of consultation and education in the rural community mental health center: First, it describes the rural programs on several organizational dimensions as compared to nonrural programs. Second, it identifies several distinctive characteristics of rural programs. Third, it presents a case illustration of a successful consultation-education service. Finally, it discusses strategies for strengthening consultation and education in the rural setting. The paper is based on the findings of a study of prevention programs in community mental health centers in Region III (Pensylvania, Delaware, Maryland, Washington, D.C., Virginia, and West Virginia).


Awareness, use, and consequences of evaluation data in a community mental health center.

A major aspect of the effort of the Mental Health Systems Evaluation Project of the Northwest Denver Community Health Center's has involved studying the utilization of program evaluation data by community mental health center managers and clinicians. The intent of this effort was twofold: to assess the impact of program evaluation feedback in the community mental health center per se; and to investigate factors that influenced this impact. The impact of such input was assessed initially at the level of "subjective utility." Later attempts involved more extended or interactive forms of input and impact assessment. Basic findings to date suggest that program evaluation data are most likely to have impact when directed at the managers most closely involved with the service at issue, and when presented, preferably simply and personally, in ways that insure an understanding of the data and its implications by those receiving it.


The efficient numerical solution of biological simulation problems.

A subroutine called DESOL for the numerical solution of ordinary differential equations of the type arising in biological simulation problems is described. DESOL is about as efficient as current high quality integrators, but because of its compactness it can be easily used on small computers. The subroutine has excellent stability properties and functions with very little required input from the user. In addition, it has features which aid in debugging associated programs. Several test and example problems are given, as is the derivation of the major formulae used in the package.


Computer programs for nucleic acids studies. Atomic coordinates of helices and their graphic display.

For the purpose of calculation of NMR and other physiocochemical properties of nucleic acids, a computer program in FORTRAN language has been written. This program provides the printout of the Cartesian and cylindrical coordinates of all atoms of a double-stranded helix of nucleic acid in either A, A' or B conformation with any specified base sequence up to 50 nucleotides or longer. In addition, the interatomic distances between any two atoms or distances (with both perpendicular and parallel components) from the centers of the base rings to any atom in the helix can be calculated. This information has been used for the calculation of the ring current effects of the 1H chemical shift of two short helices. Satisfactory agreement has been found in the comparison between the present data and that obtained from model construction and from the table prepared by Arter and Schmidt. The structure of the helix can also be illustrated in graphic form on a Tektronix 4006 CRT terminal. The presentation can be manipulated, such as selection, enlargement, translation and rotation.


Computer simulated modeling of biomolecular systems.

This paper describes the algorithm of a program used to simulate three dimensional models of molecules. In addition to open ended molecules the program also enables simulation of structures with constraints in the form of cyclic regions or fixed location of particular atoms. Several molecules can be handled in a single run and each molecule can have any number of contraints. Further, any number of conformations can be obtained for each constrained region. The program can be used for research in several areas of molecular biology, e.g., structure determination, conformational analysis and topographic comparisons.


A computer program for topographic analysis of biomolecular systems.

This program essentially generates a picture of a space filling molecular model. By precise simulation of the intersections between atoms, leaving out the 'hidden line', a good perspective is produced. Additional three dimensional information is provided by simulating reflection spots on the surface. This program has been used to visualise three dimensional surface features of biologically important molecules (e.g., valinomycin). With slight modification the program can be used to visualise enzyme active sites and receptor surfaces. It can also be used to create animated motion pictures of molecular dynamics.


Discriminant analysis: methods and program.

Because of the disparity in the results obtained using different methods of discriminant analysis, we have written and used a unique program to test them. These methods can be divided into two groups corresponding to a classical probabilistic approach (i.e., Bayesian methods) or a topological approach (i.e., Sebestyen method).


A general program for estimation of haplotype frequencies from population diploid data.

The program which is written in FORTRAN estimates haplotype frequencies in two-locus and three-locus genetic systems from population diploid data. It is based on the gene counting method which leads to maximum likelihood estimates, and can be used whenever the possible antigens (one or more) on each chromosome can be specified for each person and for each locus, i.e., ABO-like systems and inclusions are permitted. The number of alleles per locus may be rather large, and both grouped and ungrouped data can be used. Log likelihoods are calculated on the basis of various assumptions, so that likelihood ratio tests can be carried out.


Density estimation applications for outlier detection.

Nonparametric estimates of joint, conditional and marginal probability densities can be used to estimate the relative probability of a data point's recurrence. Outlier, unusual or abnormal values of a random variate tend to be those which are unlikely to recur. As part of an interactive graphical system, a procedure has been implemented which enables a biomedical researcher to view both the estimated probability and the numerical value of a data point's coordinates. This display circumvents the problem of interpreting a normal range in two or more dimensions and can thus be more easily generalized than most alternative outlier detection procedures.


LOGIT: a program for dose-response analysis.

We describe a FORTRAN computer program for fitting the logistic distribution function: (formula: see text) Where x represents dose or time, to dose-response data. The program determines both weighted least squares and maximum likelihood estimates for the parameters alpha and beta. It also calculates the standard errors of alpha and beta under both estimation methods, as well as the median lethal dose (LD50) and its standard error. Dose--response curves found by both fitting methods can be plotted as well as the 95% confidence bands for these lines.


TFLUX: a general purpose program for the interpretation of radioactive tracer experiments.

TFLUX is a computer program which simulates radioactive tracer experiments using intact cells under steady-state conditions. It is designed for the naive computer user to use, providing English-like input. An example is described in which compartmentation and flux through the citric acid cycle in Dictyostelium discoideum are simulated.


An interactive toxicological data handling system for a PDP-12 computer.

This paper describes a program developed for the cataloguing, storage and retrieval of toxicological data. The user can, through dialogue with the program, enter and update data, and request reports with statistical analyses. The system is written in the FOCAL-12 language for a PDP-12 laboratory computer, and is suitable for a larger number of moderately-sized experiments.


A computer system for neurosurgical patient monitoring.

The variables monitored in intensive care units are generally late indicators of neurologic deterioration. A system based on a LINC-8 computer was therefore developed for on-line monitoring of evoked potentials, electroencephalography (EEG), and transcranial and transthoracic impedances as well as conventional parameters. Somatosensory evoked potentials are recorded at either 30 min or 1 h intervals. One minute epochs of EEG are analyzed every 10 min using a peak-detection algorithm. Impedances and conventional parameters are also monitored at 10 min intervals. In a study of 50 patients, the technical feasibility of this type of monitoring with a small laboratory computer has been demonstrated. In some instances, evoked potentials and EEG show changes prior to detectable neurologic changes. The study suggests that this type of monitoring can provide a valuable adjunct for evaluation of physiologic function in neurosurgical intensive care.


Localization in interstitial dosimetry utilizing the CT scanner.

A simple method utilizing CT scanners which were readily available is described in which alignment of the isodose curves can be made directly on the printout of the CT scan. This has obvious practical and theoretical advantages. In particular, the dose to vital structures, such as spinal cord and other critical viscera, can be well described.


Pre-enhancement ring density in resolving intracerebral hematomas.

Pathologic material is presented demonstrating a pre-enhancement ring density in later stages of hematoma resolution on CT. This pre-enhancement ring density is due to aggregates of hemosiderinladen macrophages.


Computed tomography in the diagnosis of intracranial meningioma.

The CT findings in 53 meningiomas are reported. Based upon the plain and post-contrast CT pattern and density characteristics, the diagnosis of meningioma was accurately predicted in 28 of 35 convexity, parasagittal, subfrontal, middle fossa and sphenoid wing lesions (80%). In 2 calcified nonenhancing meningioma, the diagnosis was suspected by CT findings. CT was extremely accurate in detecting 16 juxtasellar, intraventricular, tentorial and posterior fossa meningiomas, but the CT pattern was less specific such that differentiation from other neoplastic or vascular lesions was not always possible. There were only 2 false negative cases; these occurred when contrast infusion had not been performed.


Computed tomography in the diagnosis of intracranial vascular malformations.

Thirty-one patients iwth intracranial vascular malformations were studied by computed tomography (CT), including arteriovenous malformations (AVM) (24), Sturge-Weber syndrome (3), vein of Galen malformation (2) and venous angioma (2). Non-contrast CT showed abnormalities in 27 cases consistent with hemorrhage, calcification, low-density cystic spaces, and post-contrast scan showed abnormal enhancement in 25 of 31 cases. In 14 of 25 cases, the enhancement pattern showed evidence of abnormal vessles to indicate the presence of vascular malformation prior to angiography, whereas in 11 cases the enhancement pattern was not sufficiently characteristic.


Computerized tomography of retroperitoneal lymphadenopathy: benign or malignant.

A distinguishing feature has been noted to help differentiate between malignant retroperitoneal nodes and nodes which contain reactive hyperplasia. This sign is the presence of a cleavage plane between the mass of nodes and the great vessels which are easily visible in benign disease. This distinction is in reference to malignant nodal disease where the contours of the vessels are obscured. The ability to make a diagnosis of benign disease on CAT scan has enabled us to choose the appropriate course of therapy and, in some patients, allowed us to avoid exploratory laparotomy for diagnosis.


Double-exposure technique in computerized tomography of the spine.

The authors present a technique for recording both soft tissue and bone on the same reproduction of CT images of the spine. Enhancement around the edge of osseous structures is a valuable aspect of this technique.


Chrome sensitivity in Israel.

Fifty-two Israeli Jewish patients suffering from chrome sensitivity (C.S.) were investigated with regard to their ethnic origin, age of onset of the dermatitis, occupational history and socio-economic level. Forty-eight patients suffering from various skin conditions and drawn from the outpatient dermatological clinic were used as controls. The socio-economic status of C.S. patients was found to be very low, regardless of ethnic origin. Ninety-four percent of the patients were non-Ashkenazi Jews and a significantly increased proportion of those (24%) were of Kurdish descent. There were no major differences in their occupations. Patients of Kurdish origin manifested the disease at a significantly earlier age than other non-Ashkenazi patients, although the socio-economic conditions of the different ethnic groups of patients were similar.


Nickel allergy and osteomyelitis in a patient with metal osteosynthesis of a jaw fracture.

A 27-year-old female, after a fracture of the mandible treated with osteosynthesis and after a difficult extraction, developed osteomyelitis with fistulation and sequestration. Sequestrectomy and extraction of the teeth in the osteomyelitic area did not clear the patient of symptoms. A patch test to nickel turned out to be positive. After removal of the stainless steel cerclage in the mandible, clinical and radiographic changes returned to normal within 2 and 8 weeks, respectively. It is concluded that, whenever acute treatment does not take priority, patch tests comprising nickel, cobalt and chromium should be performed in patients who are candidates for metal osteosynthesis.


Lanolin and derivatives chemistry: relationship to allergic contact dermatitis.

This paper summarizes lanolin, the composition of its esters, acids and alcohols, its chemical and physical modifications, and refining. It discusses lanolin, its constituents and derivatives, and their relationship to allergic contant dermatitis.


The Duhring chamber. An improved technique for epicutaneous testing of irritant and allergic reactions.

For assessing skin reactions to irritants and allergens, chambers which confine the test substance to the site of application are much superior to conventional patch tests. Because the concentration and volume do not change appreciably, the method allows for quantification and yields more reproducible results. A new aluminum chamber has been designed which is more useful than its predecessor, the Finn chamber, mainly because of its increased capacity. Data are given to show that the intensity of irritant and allergic reactions is dependent on the quantities applied.


Temperature-dependent nickel release from nickel alloys.

Nickel release from Danish one krone coins and metal buttons from jeans has been measured at 20 degrees C in distilled water and at 35 degrees C in distilled water and synthetic sweat. The temperature elevation increased the nickel release from the coins and two of the nine metal buttons investigated. Obviously the sensitivity to temperature elevation differs from one alloy to another.


Isomorphic skin reaction with DNCB in SLE and DLE.

DNCB sensitization was studied in 76 cases of systemic and 44 of discoid lupus erythematosus and in 101 immunosuppressed and tumor patients as controls, as well as in 40 contact-sensitized eczematous and 115 unselected patients. Sensitization of patients with discoid LE and that of mixed patients are of the same order, while it is lower in the systemic LE group. The highest incidence was found in the polysensitized positive control group; the lowest in the immunosuppressed and tumor patients. DNCB sensitization showed clear age dependency in the different groups. At the site of the DNCB exposure, isomorphic reactions were found in 43% of discoid and 25% of systemic LE patients. Histological and immunofluorescence studies supported the findings of the clinical picture, i. e. the appearance of isomorphic reactions at the site of the exposure cannot be related either to the intensity of the early reaction or with the developing intensity.


Skin sensitivity to denture base materials in the burning mouth syndrome.

The significance of sensitizing compounds in the denture base for the etiology of the burning mouth syndrome (BMS) has been studied in 53 denture-wearing persons, seven males and 46 females. Epicutaneous patch tests were performed with standard concentrations of benzoyl peroxide, dibutylphthalate, dimethyl-p-toluidine, formaldehyde, hydroquinone, methylmethacrylate, p-phenylendiamine and with cadmium sulfate, potassium dichromate, cobalt chloride and nickel sulfate. Furthermore, patch testing was performed with filings from the denture mixed with the patient's own saliva. In cases with an inflamed oral mucosa, the presence of hyphae of Candida albicans was assessed by a smear technique. Positive skin reactions were observed in 15 persons to dimethyl-p-toluidine, hydroquinone, formaldehyde, methylmethacrylate, p-phenylendiamine, potassium dichromate, cobalt chloride and nickel sulfate, including three cases with reactions to filings from their dentures, and one patient who after subsequent testing showed skin sensitivity to balsam of Peru. In 12 cases an etiological connection could be traced between the oral symptoms and the denture base, indicating that contact sensitivity to base materials or to allergens and microbial antigens on the denture plate plays a greater role in the pathogenesis of BMS in edentulous persons than previously suggested.


Allergy to various components of topical preparations in stasis dermatitis and leg ulcer.

Patients suffering from stasis dermatitis and leg ulcers (192) were found to give an allergic reaction in epicutaneous tests to one or more components of topical preparations in 69.2% of cases. The most common reactions were obtained with neomycin 34.0% and its component framycetin 31.2%, wool alcohols 22.9%, balsam of Peru 21.4%, chlorquinaldon 16.7%, bacitracin 13.1%, chinoform 10.9%, dequalin 9.9%, formaldehyde 4.2% and parabens 3.6%. The incidence of allergic reactions reflects local use of preparations containing various allergens as well as their capacity to produce alllergy. Allergy may in some cases interfere with effective topical therapy. Debrisan dextran polymer beads were found to be suitable for treatment of ulcers of multiallergic patients without risk of contact allergy.


Hot water as a tubal occluding agent.

Experimental studies in living rabbits and autopsy human oviducts are presented which demonstrate a reasonable possibility that one could introduce hot water into the proximal portion of the human oviduct with a hysteroscope or balloon catheter, to destroy the epithelium of the first portion of that structure, leading to its occlusion, while still maintaining safety for the woman because the water would cool to tolerable temperatures before it entered the peritoneal cavity. Before trying the procedure in human beings, research on non-human primates is clearly needed.


Differences in effect of copper and ProgestasertR IUDS on fibrinolytic activity of the endometrium in the rabbit.

Rabbits, which have two separate uteri, were used to assess intraindividual differences in the endometrial fibrinolytic activity in the two uteri, one containing a copper IUD and the other a progesterone-releasing IUD (ProgestasertR). A higher activity was demonstrated in the uterus containing the copper-IUD. Enhanced fibrinolytic activity in the endometrium has been held responsible for the increased menstrual blood loss in women using different IUDs. Thus, the present experimental study supports the clinical observation that women using ProgestasertR-IUD have less bleeding complaints than those using copper-IUD.


Timing of the IUD insertion.

The relationship between the time in the menstrual cycle when a TCu-200 or Cu-7-200 is inserted and subsequent IUD-related events was evaluated. For women who had either TCus or Cu-7s inserted, the pregnancy, expulsion and medical removal rates were similar for insertions performed at any time of the menstrual cycle.


Termination of pregnancy in the rat by RMI 12,936.

Administration of a steroid RMI 12,936 (2 MG) ON DAY 8 OF PREGNANCY RESULted in an interruption of gestation within 5 days. No significant changes in progesterone (delta 4P), 20 alpha-dihydroprogesterone (20 alpha-DHP) and pregnenolone (delta 5P) were recorded during the course of termination of pregnancy by RMI 12,936. However, a significant rise in serum delta 4P and hypertropic corpora lutea were evident on day 13 of pregnancy when all treated females showed dead conceptus. The placental tissue was still present at the time of pregnancy termination. On the other hand, serum LH levels was significantly suppressed 24 hr after the treatment and maintained at a very low level. The reduction of LH might be due to a lowered hypophyseal sensitivity towards LH-RH. The occurrence of in utero dead fetus without interference of delta 4P production suggests that in the rat RMI 12,936-induced termination of pregnancy is due to its embryotoxic rather than luteolytic effect. Although the treated females did not return to normal estrous cycles for a period of 2 weeks after pregnancy termination, they were sexually receptive. Successful mating resulted in normal pregnancy which occurred 30-35 days after RMI 12,936 treatment.


Use and acceptance of the "Paper Pill" among an urban clinic population.

A randomized, crossover study comparing the acceptability of two presentations of the same oral contraceptive, a paper formulation and the conventional tablet, was carried out among two-hundred-and-seventy women attending two urban family planning clinics in Mexico City. During the first three cycles of use, the percentage of women discontinuing the medication for side effects was almost identical in the two groups. Although the paper formulation failed to demonstrate any major advantage in terms of continuation or acceptability, it was preferred by a majority of the women who began oral contraception with its use.


Low-level, progestogen-releasing vaginal contraceptive devices.

Silicone rubber vaginal contraceptive devices of four different formulations, which release predetermined, controlled doses of three progestogens at four distinct levels, were designed and fabricated, and tested in 90-day clinical trials. Data obtained with 70 of the devices indicated that in vivo release rates (microgram/day +/- S.D.) for the formulations were: progesterone, 1400 +/- 30; norethindrone (two levels), 49.4 +/- 2.4, 196 +/- 21; d-norgestrel, 21.6 +/- 1.4. Clinical studies with these devices indicate that the women usually ovulate (with the exception of the high-dose norethindrone-releasing devices) while sperm penetration of the cervix was inhibited by all four fromulations, most consistently by the norgestrel-releasing devices.


The antifertility activity and toxicity of alpha-chlorohydrin derivatives in male rats.

The antifertility activity and toxicity of alpha-chlorohydrin, six derivatives and glycidol were investigated in male rats. At a dose of 5 mg/kg injected intraperitoneally each day for 14 days, only alpha-chlorohydrin produced complete infertility. When rats were injected with the derivatives at a dose equivalent to 5 mg/kg of alpha-chlorohydrin on a molar basis, the phosphorylated and amino acid derivatives produced complete infertility within 7 days; however, there were some signs of toxicity. Compound II also produced complete infertility and appeared less toxic. AY - 22,352, compounds III and IV and glycidol had no antifertility activity, although spermatozoan motility was reduced by injection of glycidol.


The role of the interstitium of the renal cortex in renal disease.

Morphometrical investigations (point-counting method) showed that in different inflammatory (endocapillary -- acute -- GN, mesangioproliferative GN, membranoproliferative GN) glomerulonephritides and in non-inflammatory glomerular diseases (perireticular amyloidosis), there are statistically significant correlation between serum creatine concentrations at the time of biopsy and the enlargement of the cortical interstitium by fibrosis. Similar results were obtained in investigating different grades of benign nephrosclerosis with transition into secondary malignant nephrosclerosis conditioned by hypertension and in chronic diffuse sclerosing interstitial nephritides of different etiologies. As hypothesis, we assume that a narrowing of the postglomerular vessel network by interstitial fibrosis take place. This could lead to an increase resistance of the renal cortical blood flow. In spite of an elevated effective filtration pressure, the slowing of the glomerular blood flow may lead to the reduction of GRF and to an increase of the serum creatinine concentration. Additionally, in the case of interstitial fibrosis the tubules look atrophied. This could be the consequence of the reduced GFR as a sign of inactivity. On the other hand, tubular atrophy could result from malnutrition in the case of interstitial fibrosis. The resorptive capacity of these atrophied-looking tubules could be lowered and the GFR could be diminished by the so-called Thurau mechanism.


Angiographic results in interstitial, vascular and glomerular kidney diseases.

In earlier stages of parenchymal kidney diseases different changes are to be seen in angiography. No single sign appeared to be pathognomonic for glomerular nephritis, vascular disease or interstitial nephropathy. But the disproportionate frequency of some angiographic features assumed discriminatory value. Morphometry of the renal arteriograms discriminated statistically significant interstitial, vascular and glomerular diseases. The correct angiographical diagnosis was made in 76%.


Balkan (endemic) nephropathy.

The clinical and pathological features of Balkan (endemic) nephropathy are discussed and correlations of incidence with excess late summer and autumn rainfall outlined. Cultures of a strain of Penicillium verrucosum var. cyclopium isolated from maize collected in an endemic area were fed to rats and lesions were produced in the straight third segment of the proximal kidney tubules. Extensive degeneration and nuclear changes were seen and on prolonged feeding further nuclear enlargement (to greater than 6n) and the formation of multinucleate cells occurred. The relevance of these findings to the clinical disease in man, especially the occurrence of urinary tract tumours, and the evidence supporting mycotoxin involvement, are discussed.


The pathogenesis of reflux nephropathy.

In an experimental study, the scars of chronic pyelonephritis have been shown to be caused by infected intrarenal reflux. Intrarenal reflux occurs in the presence of vesicoureteric reflux and a renal papilla having special morphological characteristics predisposing to this phenomenon. Such papillae occur predominantly in the polar regions of the kidney where large pyelonephritic scars are most commonly seen. The clinical implications of this pathogenic mechanism are discussed.


Canine viral enteritis. II. Morphologic lesions in naturally occurring parvovirus infection.

The morphologic lesions associated with naturally occurring canine parvovirus infection are described. The disease is characterized by necrosis of crypt epithelium in the small intestine and of lymphoid tissue in Peyers patches, lymph nodes, spleen and thymus.


Dermatohistopathologic changes in bovine congenital porphyria.

Congenital porphyria was diagnosed in 4 crossbred cattle. All had pink-brown discoloration of the teeth and amber colored urine, which fluoresced bright orange with exposure to ultraviolet light. Elevated levels of uroporphyrin and coproporphyrin were found in the urine of all 4 cattle. Skin biopsies taken from 2 of the cattle revealed subepidermal blister formation and thickening of upper dermal blood vessel walls with deposition of a PAS-positive, hyaline-like material.


Besnoitiosis in wild and domestic goats in Iran.

Besnoitia cysts and lesions were observed in the skin, blood vessels, epididymis and testes of two wild goats (Capra aegagrus) and in the subcutaneous tissues of two domestic goats (Capra hircus) in the Fars Province of Iran. The seminiferous tubules in the wild goats showed aspermatogenesis, degeneration and atrophy of germinal epithelium.


Embryotoxic effects of pine needles and pine needle extracts.

A heat stable toxin present in needles of ponderosa pine was found to be soluble in methanol, ethanol, chloroform hexanes and 1-butanol. The embryotoxic effects of fresh green pine needles and a chloroform/methanol extract were determined by measuring embryo resorption in pregnant mice. Autoclaving the needles and extract for 1 hour prior to feeding enhanced the embryoresorptive effect by 28% and 32%, respectively. The results of this study revealed that the embryo resorptive dose (ERD50) of heat stable toxin for 1 mouse was 8.95 gms. for fresh green pine needles and 6.46 gms. for autoclaved green pine needles. In addition to embryocidal effects, feeding of the toxin resulted in significant weight loss in adult mice.


Lymphoreticular neoplasia in a dog resembling malignant histiocytosis (histiocytic medullary reticulosis) in man.

Malignant histiocytosis was diagnosed in a 4-year-old-dog. Major clinicopathologic findings included multiple cutaneous tumors, peripheral lymphadenopathy, hepatomegaly, lytic bone lesions, anemia, thrombocytopenia, and monoclonal IgA gammopathy. Pathologic findings included multi-systemic infiltration of erythrophagocytic malignant histiocytes. Chemotherapy was unsuccessful.


Industrial fluoride pollution. Chronic fluoride poisoning in Cornwall Island cattle.

An aluminum plant on the south bank of the St. Lawrence river, southwest of Cornwall Island, Ontario, Canada, has emitted 0.816 metric tons of fluoride daily since 1973; considerably higher amounts were emitted from 1959 to 1973. The plant has been designated as the "major source of fluoride emissions impacting on Cornwall Island." Chronic fluoride poisoning in Cornwall island cattle was manifested clinically by stunted growth and dental fluorosis to a degree of severe interference with drinking and mastication. Cows died at or were slaughtered after the third pregnancy. The deterioration of cows did not allow further pregnancies. Fluoride concentrations in ash of biopsied coccygeal vertebrae increased significantly with age and were dependent on distance from and direction to the aluminum plant. Fluoride in bone ash of a 7-month old-fetus exceeded 500 ppm; fluoride thus was passed transplacentally. Analyses of fluoride in ash of bones obtained at necropsy of cattle from 4 months of age to 4 to 5 years of age showed increased amounts with age. Cancellous bone retained far higher amounts than cortical bone, a reflection of the normally higher metabolic rate of cancellous bone. Concentrations exceeding 10,000 ppm fluoride were recorded in cancellous bone of a 4-to 5-year-old cow. The target cells for fluoride in chronic fluorosis were shown to be the ameloblasts, the dental pulp cells and the odontoblasts and, in bone, primarily the resorbing osteocytes and also the osteoblasts. Atrophy and necrosis of the ameloblasts were responsible for enamel defects. The existing enamel showed brown discoloration from fluoride deposits. The pulp cells underwent fibrous and osseous metaplasia and necrosis of the ectopic bone occurred. The odontoblasts were atrophic and the dentin showed brown discoloration. The resorbing osteocytes were inactive and osteosclerosis resulted. This was especially pronounced in areas of normally great apposition, i.e. in the metaphyses. The epiphyseal plate became squeezed between petrotic bone and growth was stunted. Resorption of alveolar bone surrounding the deciduous teeth was severely retarded or arrested. A delay in eruption of permanent teeth occurred; it was up to 3.5 years in incisor teeth. Interference with the resorbing osteocytes in fluorotic bone was also demonstrated by loss of collagen birefringency in such bone. Failure of bone resorption also caused retention of trabecular bone in the cortices; this was observed even in a 4-t0-5-year-old cow. In areas where modeling into osteonic bone had begun, fluoride deposits were extremely heavy but this bone showed numerous soft osteons in microradiographs. The toxic effect of fluoride on osteocytes also resulted in the death of the cells. Such osteonecrosis occurred mainly in gnathic bone. There was atrophy of the osteoblasts. Osteopenia thus resulted from osteonecrosis and osteoporosis. Subperiosteal exostoses were not observed in long bones. The degree of fluorosis in Cornwall Island cattle was severe...


The Trendelenburg position: hemodynamic effects in hypotensive and normotensive patients.

The effect of the Trendelenburg position on systemic and pulmonary hemodynamics in critically ill patients is not generally appreciated. This study examined the hemodynamoc effect of 15-20 degrees head-down tilt in 61 normotensive and 15 hypotensive patients with acute cardiac illness or sepsis. In normotensive patients, the head-down tilt increased the preload of both right and left ventricles, increased cardiac output slightly, decreased systemic vascular resistance, and did not change the mean arterial pressure. This effect was probably mediated by baroreceptor stimulation. In hypotensive patients, the Trendelenburg position did not increase preload, slightly increased afterload, and decreased cardiac output. This study failed to document any beneficial hemodynamic effect of the Trendelenburg position in critically ill normo- or hypotensive patients.


Partial obstruction of endotracheal tubes in children: incidence, etiology, significance.

We examined 99 endotracheal tubes removed from 81 pediatric patients to determine the incidence of partial endotracheal tube obstruction and predisposing factors. The overall incidence of obstruction was 20.2% (20/99); 14 of the 20 obstructed tubes were occluded less than 50%. General anesthesia during the period of intubation was the only factor significantly associated with an increased incidence of obstruction (p less than 0.05). There was no correlation of obstruction with duration of intubation, the presence of a Murphy-eye side hole, or small tube size. Among the 71 tubes from patients who received general anesthesia, a tube size of 4 mm or less was associated with an increased incidence of obstruction (p less than 0.05). Pressure-flow curves for three different sizes of endotracheal tubes were constructed to determine the increase in resistance produced by different degrees of obstruction. At flow rates that approximated those found in children during quiet breathing, the resistance of tubes that were 50% obstructed was 4 times greater than that found in unobstructed tubes.


Physiological significance of oxygen dissociation curve shifts.

The oxygen delivery system consists of multiple components balanced to provide optimal oxygen supply to all tissues and arranged such that an abnormality in one component is compensated by adjustments in others. Analysis of pertinent data indicates that leftward shifts of the oxygen dissociation curve (ODC) in normal animals and persons elicit adaptive changes in other components which sustain normal oxygen supply. By contrast, several recent studied indicate that leftward ODC shifts, when occurring in combination with other abnormalities of oxygen delivery, produce or aggravate hypoxia. These data suggest that the brain and heart are the organs particularly at risk. It is concluded that leftward ODC shifts, due to massive transfusion of stored blood and to hyperventilation of unconscious patients, are most likely to be hazardous in the presence of poor perfusion, coronary artery disease, or cerebrovascular disease.


Plasma and saliva concentrations for a new formulation of erythromycin stearate.

Erythromycin saliva and plasma concentrations were determined in 10 subjects after the first and fourth doses of a new formulation of erythromycin stearate ('Erythrocin'), 500 mg 8-hourly, taken immediately before food. Consistent absorption occurred and the steady state plasma levels compared favourably with the minimal inhibitory concentrations of erythromycin for common respiratory pathogens. There was a significant positive correlation between steady state saliva and plasma levels.


Indoprofen, a new non-steroidal anti-inflammatory drug, in the treatment of osteoarthrosis: report on a multi-centre study in 1629 patients.

A multi-centre trial was carried out in 1629 patients with osteoarthrosis in 233 clinical centres to investigate the therapeutic efficacy and tolerability of indoprofen in this clinical condition. The results from assessments of both subjective and objective variables were comparable to those obtained in Phase 3 studies. Moreover, 87.2% of patients expressed a 'good' or 'very good' opinion on the product's efficacy after treatment, usually with 3 tablets (600 mg) daily for 4 weeks. The benefit/risk relationship was confirmed as very favourable on account of the marked activity of the drug and the acceptable frequency of adverse reactions, which were mainly subjective and slight and confined to the gastro-intestinal tract.


An evaluation of a post-operative vacuum drainage system.

The effectiveness of a plastic bottle vacuum drainage system ('Steritex vacu-drain') was evaluated in 50 randomly selected patients undergoing major surgery. The incidence of post-operative wound infection was 6%. The drainage system was found to be effective and acceptable to both patients and personnel involved in its management.


An evaluation of the bile acid binding and antacid properties of hydrotalcite in hiatus hernia and peptic ulceration.

The bile acid binding and antacid properties of hydrotalcite were studied in 25 patients with hiatus hernia or peptic ulceration. Hydrotalcite was found to have significant bile acid binding properties in the presence of free acid in the stomach. There was a definite antacid effect in both pathological entities. These results suggest that hydrotalcite may be an effective therapeutic agent in upper gastro-intestinal ulceration, warranting further investigation in lesions which are thought to involve both hydrochloric acid and bile acids in their pathogenesis.


Short-term topical treatment of vulvovaginal candidiasis with the combination of 5-fluorocytosine and candicidin.

A combination of 5-fluorocytosine (1000 mg) and candicidin (5 mg) was compared with clotrimazole (100 mg) in the treatment of 112 non-pregnant volunteers with vulvovaginal candidiasis. Seventy-two (75%) of the 96 patients treated with 1 or 2 vaginal tablets of the combination product and 10 (62%) of the 16 women treated with clotrimazole for 6 days were cured. The efficacy of the treatments was assessed mycologically and clinically 1 week and 1 month after the therapy. Both treatments were well tolerated and no side-effects could be detected. It is concluded that a short-term vaginal treatment with a 5-fluorocytosine and candicidin combination is effective in vaginal moniliasis, and the brevity of the treatment is an advantage compared with others now available.


Hormone relationships in breast cancer: the role of receptor-binding proteins.

The introduction of receptor protein studies as markers for hormone dependence of breast carcinomas has had a profound effect on the management of advanced disease. All breast carcinomas, regardless of stage, should have receptor binding protein studies for estrogen and progesterone by the sucrose gradient method or by the dextran-coated charcoal method as a good alternative. A simpler test is needed. In cases of primary advanced disease or in recurrent disease, receptor binding protein studies effectively identify the subgroup of hormone-dependent tumors that should be managed by surgical hormone ablation or endocrine manipulation. These tests are even more effective in identifying patients that should not receive hormone therapy and respond better to chemotherapy. In primary, potentially surgically curable disease, receptor studies may serve as a therapeutic guide to adjuvant hormone or chemotherapy. In all breast cancers, ER and PgR receptor studies should be performed and the information should be stored for possible future use. If possible, tisssue should be stored in a freezer in anticipation of future tests and for confirmation of hormone dependence in the event of recurrence.


Lichen sclerosus et atrophicus generalisata, alopecia areata, and polymyalgia rheumatica found in the same patient.

A sixty-eight year old woman with lichen sclerosus et atrophicus since the age of fity-two, alopecia totalis since the age of thirty-six, and polymyalgia rheumatica since the age of fifty-eight is presented. Besides alopecia totalis, the patient has typical lichen sclerosus et atrophicus changes on the trunk, upper arms, and thighs, and at the first visit an ulcer on her left breast. An immunologic link between her three diseases is suspected. As shown in this case Wood's light is of great value in depigmented skin changes.


Solar urticaria. Report of an unusual case.

Solar urticaria is a relatively rare dermatosis. In reported cases, skin lesions appeared soon after sunlight irradiation, usually within a few minutes, and consisted of a wheal localized to the exposed area with a surrounding flare. The case presented herein is quite different from the others in its clinical manifestation. The time required for the formation of the wheal was far longer and there was neither surrounding flare nor pseudopodia. Also, the degree of local edema was directly proportional to the length of exposure time, up to three hours. A diagnosis of solar urticaria had not previously been made in this patient because he did not show wheal formation except after unusually long exposure.


Pseudofolliculitis--revised concepts of diagnosis and treatment. Report of three cases in women.

Three cases of pseudofolliculitis are described in black American women, bringing the total number of cases described in the literature to five. Pseudofolliculitis pubis, pseudofolliculitis axillae, and pseudofolliculitis faciale (for women with facial involvement) are new diagnoses we propose to add to the nomenclature. Topical retinoic acid may be the treatment of choice. It appears that this is not a rare disease in black women.


Bowen's disease of the plantar arch.

Bowen's disease has previously been associated with the development of other malignancies particularly in patients with a history of arsenic exposure. A review of the literature is combined with a discussion of current theories regarding arsenic exposure, lesion differentiation, and prognostic implications. This report of a bowenoid lesion of the plantar arch emphasizes the importance of close follow-up of patients with Bowen's disease, especially on unexposed surfaces.


A cure for recurrent furunculosis.

A therapy for recurrent boils using antibiotic ointment over the entire integument is described herein. Rather than eradicating the individual nidus of infection, the skin is allowed to muster its own defenses, resulting in fewer, and eventually no, eruptions.


Human cutaneous topography a new photographic technique: observations on normal skin.

We describe herein a convenient and inexpensive technique for photographic examination of the surface of the skin. With this method, the fine lines of the skin appear as furrows or folds. The furrows demarcate units of epidermal structure which we have designated polyangular units. These, in turn, are arranged in a mosaic pattern. This technique was used to define the topography of normal young adults. Surface features fall into four major patterns: 1) dermatoglyphic, 2) hair bearing, 3) frictional, and 4) flexural.


Minocycline therapy of aquarium granuloma. Case reports and literature review.

Two patients with Mycobacterium marinum infections from home tropical fish aquariums are presented herein. Both patients showed dramatic improvement with minocycline therapy. In vitro susceptibility results also confirmed minocycline, doxycycline, and tetracycline efficacy using disc diffusion and dilution methods.


Paper jumpsuit: an adjunct for psoriasis therapy.

An inexpensive, disposable, durable paper jumpsuit is described as an adjunct to inpatient or outpatient psoriasis therapy.


Segmental pulmonary angiography in the critically-ill patient using a flow-directed catheter.

Selective pulmonary angiography was performed using a flow-directed, balloon-tipped catheter in 20 consecutive intensive care unit patients requiring heart catheterizations on the right side for hemodynamic monitoring. No morbidity was encountered from this procedure. Adequate quality balloon-occlusion angiographs were obtained with a portable chest roentgenogram in 17 (85 percent) but appeared normal in only 12 (60 percent), seriously limiting the usefulness of this technique in the diagnosis of occult pulmonary embolisms. With this technique, the catheter tip was found to be in a segmental pulmonary artery anterior to the left atrium (zone I) in 30 percent of the patients. From these findings, we conclude that not infrequently the catheter tip was situated in zone I anterior to the left atriums. Slective pulmonary angiography using a flow-directed, balloon-tipped catheter proved useful in demonstrating the precise location of the catheter tip. When this is the case, the catheter tip should be relocated to a segment below the left atrium (zone III) in patients requiring positive end-expiratory pressure because the "wedge" pressure measured in zone I may not accurately reflect left atrial pressure.


Radionuclide scintiphotography in defining postoperative pulmonary vasoconstriction. Succesful results after tolazoline administration in a four-month-old infant with congenital heart disease.

99mTechnetium macroaggregated albumin has successfully been used to define severe postoperative pulmonary vasoconstriction in a four-month-old boy with D-transposition of the great vessels who had undergone a Blalock-Hanlon surgical atrial septectomy. Radionuclide imaging documented clinically suspected pulmonary vasoconstriction and led to the successful use of tolazoline (Priscoline) to reverse the vasoconstriction with improved pulmonary blood flow patterns.


Does abdominal breathing affect regional gas exchange?

Does the use of the abdomen during inspiration alter gas exchange to the bases of the lungs? Most previous investigators have concluded that this technique does not affect regional ventilation. However, if gas concentrations are used as an index of gas exchange, if the subject has normal lungs, is seated and performs the maneuver with the assistance of a physiotherapist, the answer is an unequivocal yes. This study does not pinpoint the exact mechanism by which this alteration is accomplished, but suggests that changes in thoracoabdominal shape influence regional blood flow. It does not indicate whether this effect is beneficial or detrimental. Whether the large number of patients with obstructive lung disease who attempt this maneuver in an unsupervised manner alter gas exchange in any way is uncertain. However, the data do suggest that some patients might be affecting their lung function, and we should learn more about the precise mechanisms.


Ventilation response and drive during hypoxia in adult patients with asthma.

We studied ventilation and inspiratory muscle activity during progressive isocapnic hypoxia in adult asthmatic patients to determine whether the decreased hypoxic ventilatory response previously identified is due to the mechanical abnormalities of the respiratory system or to low respiratory center output. The mouth pressure produced by inspiratory muscle activity, a reflection of respiratory center output, was measured at 100 msec of inspiration against an occluded airway at functional residual capacity. At end-tidal oxygen tension (PETO2) of 80 mm Hg, inspiratory muscle activity was greater in asthmatic patients than in normal subjects for the same level of ventilation, but at PETO2 of 40 mm Hg, both inspiratory muscle activity and ventilation were lower in asthmatic patients. Consequently, the changes in inspiratory muscle activity and ventilation per mm Hg change in PETO2 were lower in the asthmatic patients. To generate the same ventilation during progressive hypoxia, more inspiratory muscle activity was needed by asthmatic patients. We concluded that the decreased hypoxic ventilation in asthmatic patients resulted from both decreased respiratory center output and from mechanical abnormalities of the respiratory system.


Falsely high refractometric readings for the specific gravity of pleural fluid.

For 128 pleural fluids, the relationship between the protein content and the reading for the specific gravity obtained from a refractometer calibrated for urinary specific gravity was analyzed. The refractometer gave falsely high levels for the specific gravity of the pleural fluid. A reading for 1.019 (rather than 1.016) corresponded to a concentration of protein of 3.0 gm/100 ml, and each deviation of 0.005 (rather than 0.003) coresponded to a concentration of 1 gm/100 ml; however, determinations of the concentration of protein in the pleural fluid directly from the refractometer's scale for protein (calibrated for serum) was rapid and accurate. Calculation of the protein content of the pleural fluid from the reading for specific gravity on the refractometer is erroneous and sometimes misleading.


Electrophysiologic properties of methyldopa in man.

There is little information on the effects of methyldopa on the human conduction system. His bundle ECGs were obtained in 11 patients before and after the intravenous infusion of 100 mg of methyldopa. Antegrade refractory periods were obtained with the extrastimulus method. The significant results were as follows: the sinus rate was 71 +/- 4 beats per minute before, and 65 +/- 3 beats per minute after methyldopa (P less than 0.01). The mean A-H interval at a paced rate of 120 beats per minute was 113 +/- 14 msec before, and 135 +/- 18 msec after, methyldopa (P less than 0.05). The mean atrioventricular nodal functional refractory period was 430 +/- 23 msec before and 452 +/- 24 msec after methyldopa administration (P less than 0.001). The mean effective refractory period was 385 +/- 29 msec before, and 388 +/- 27 msec after methyldopa (P less than 0.01). The sinus node recovery time in the control state was 989 +/- 55 msec and 1102 +/- 66 msec after methyldopa infusion (P less than 0.05). Thus, methyldopa can impair conduction through the atrioventricular node and depress the sinus node.


Unusual combination of pulmonary sequestration and funnel chest.

Cases of pulmonary sequestration and cases of funnel chest are frequently accompanied by other anomalies, although the combination of pulmonary sequestration and funnel chest is rare. In this study, we report ten cases of pulmonary sequestration, nine of which had the combination of pulmonary sequestration and other anomalies; four evidenced the unusual combination of pulmonary sequestration and funnel chest.


Aneurysm of the left sinus of Valsalva draining into the right atrium.

We report the case of an arteriovenous fistula connecting the aorta to the right atrium, due to a ruptured aneurysm of the left sinus of Valsalva. Clinical, echocardiographic, and angiographic aspects of this unusual lesion are discussed and correlated. Emphasis is put on the diagnostic value of the echocardiogram; a characteristic dense echo parallel to the posterior aortic wall is seen, along with signs of right ventricular volume overload. Combined with the case history and auscultatory finding (a continuous murmur on the right sternal edge), this may lead to the correct diagnosis by noninvasive means.


Gastric rupture complicating post-extubation laryngeal edema and the use of a manual resuscitation bag.

This report describes a patient who developed gastric rupture as a result of post-extubation laryngeal edema and the use of a manual resuscitation bag. The association between oxygen administraton and gastric rupture is reviewed.


Recurrent miliary tuberculosis secondary to infected ventriculoatrial shunt.

The placing of a ventriculoatrial anastomosis because of elevated CSF pressure secondary to tuberculous meningitis resulted in repeated dissemination of Mycobacterium tuberculosis from the anastomosis. The consequent clinical picture showed recurrent appearance and clearing of miliary tuberculosis of the lung in spite of antituberculosis chemotherapy. While this possibility was considered early, the diagnosis was not established until the shunt was replaced shortly before the patient's death.


Prostaglandin E1 infusion in the hypoplastic left heart syndrome.

Aortic infusion of prostaglandin E1 in a moribund infant resulted in marked clinical improvement. Appropriate studies were conducted and the diagnosis of hypoplastic left heart syndrome was made. Although the outcome was unaltered, the improved clinical condition allowed us to exclude potentially curable defects such as aortic coarctation and interruption.


Echocardiographic features of mitral obstruction due to bacterial endocarditis.

We describe a patient with mitral valvular obstruction due to vegetative endocarditis. The diagnosis was made before surgery by M-mode and two-dimensional echo-cardiograms, which revealed a mass of echoes obstructing the mitral orifice. This was confirmed subsequently at surgery. Both modes of echocardiography are of value in the noninvasive diagnosis of mitral valvular obstruction due to vegetative endocarditis, a condition which may be amenable to surgery for valvular replacement.


Corrective socialization in foster care of children.

While the phrase, "interminable foster care" is becoming a damning cliché in the dialogues of juvenile courts and child welfare organizations, many children are growing up in foster homes. Human love must move us to approve and enrich these foster families; childhood is too brief and important to be knowingly allowed disapproved or impoverished experience. This paper describes the foster situation: families, children, and the involved professionals. It then presents a teachable developmental theory weaved from threads of numerous known theories, and describes a process whereby "interminable" foster experience was used therapeutically for a group of handicapped homeless children.


The awesome burden upon the child who must keep a family secret.

This paper describes a series of young patients hospitalized in a psychiatric facility because they presented symptoms indicative of a psychotic disorder when, in fact, the youngsters were dealing with the strain of keeping a family secret hidden. Case presentation oriented to how the burden prohibited proper psychological development and the manner of how these secrets came to light are offered. The commonality of patients exhibiting this phenomenon is discussed.


Games parents play with normal and high-risk infants.

Game playing during early infant-parent interactions provides a context for learning conversational turntaking and contingent responsivity. The types and frequency of "universally" recognized infant games were observed during face-to-face interactions of normal and high risk infant-parent dyads when the infants were four months old. Approximately six different games were played for approximately one-third of the interaction time. Except during interactions with normal male infants mothers and fathers played games equally as often. The high-risk infant-parent dyads engaged in game playing less frequently than the normal infant-parent dyads. These differences are discussed in the context of the high-risk infants being "difficult" babies and relatively less responsive.


A retrospective analysis of the TATs of children at risk who subsequently broke down.

A retrospective evaluation of stories told to three Thematic Apperception Test (TAT) cards by children at risk isolated six characteristics that were associated with functioning six to 10 years later. The characteristics included lack of individual initiative, denial of mother-child relationships, denial of negative outcomes, and lack of autonomy. The TATs of children at risk (due to one parent's hospitalization for a psychotic illness) who subsequently suffered major decompensation themselves (requiring hospitalization or intensive outpatient therapy) could be discriminated from those of children at risk with apparently normal development. The TAT characteristics were independent of the level of adjustment at the time the TATs were administered, not related to the child's IQ, socioeconomic status, race, or other family characteristics, and moderately negatively correlated with story length.


Consulting to children in crisis.

Although community consultation is common for psychiatrists, such activity is usually carried out on an elective rather than emergency basis. In a world troubled by community disaster situations--children are often at risk. Psychiatrists, through the use of skillful crisis consultation, can be of great help to these young people. This report describes the effort of a mental health consultation team to meet the needs of a large population of children under acute stress.


Conservation of repeated DNA sequences in aneuploid human tumor cells.

A series of human neuroectodermal tumors, all containing more than the normal diploid DNA, and each with its own distinct chromosome mode, were studied using restriction enzyme cleavage and specific DNA sequence hybridization. Methods described were quite sensitive and quantitative and as few as 40 molecules with a given restriction site were reproducibly detected in total nuclear DNA. Analysis of several fluorescent gel bands associated with different chromosomal domains revealed no changes between any of the tumor and normal cells. Specific probe hybridization, using purified complex repeating sequences, indicated fidelity of base sequence, as well as preservation of the relative amounts of each of a number of minor related multimers in both the tumor and normal cells. Centromeric regions containing arrays of such sequences may be maintained in these tumor cells and furthermore it is possible that some of these cells are polyploid with respect to DNA sequences, rather than aneuploid as their chromosome profiles suggest.


The nucleolus organizers of Plethodon and Aneides located by in situ nucleic acid hybridization with Xenopus 3H-ribosomal RNA.

The main clusters of ribosomal genes, or nucleolus organizers, have been located by in situ nucleic acid hybridization of Xenopus laevis 3H labelled ribosomal RNA to mitotic chromosomes in squash preparations of intestinal epithelium from 7 species of Plethodon and 3 species of Aneides. The species used were chosen on account of having well known karyotypes and genome sizes. The Plethodon species covered a range of genome size of 20--69.4 pg. The locations of those nucleolus organizers that could be detected by autoradiography after in situ hybridization varied from species to species, and in Aneides there were differences between two populations of the same species. On the other hand, some distantly related species of Plethodon, with widely different genome sizes, had nucleolus organizers at corresponding positions. The results are discussed in relation to ideas on karyotype stability, homosequentiality and chromosome repatterning.


The activity of two heat shock loci of Drosophila hydei in tissue culture cells and salivary gland cells as analyzed by in situ hybridization of complementary DNA.

Complementary DNA was made to poly A+ nuclear or polysomal RNA isolated from heat shock tissue culture cells of Drosophila hydei. A number of loci other than the four major heat shock loci are labelled after in situ hybridization of these cDNA preparations, while solution hybridization indicated that only about 10% of the cDNA was specific for heat shocked cells. Removal of the fraction of cDNA which could react with 25 degrees C RNA and subsequent in situ hybridization of heat shock specific cDNA indicated that locus 4-81 B, a major salivary gland heat shock locus, is also active at 25 degrees C in tissue culture cells, while locus 4-85 B is specifically activated by heat shock in tissue culture cells. This latter locus is not seen to be clearly puffed in salivary glands, but was shown to be active in that tissue both by direct autoradiography of salivary gland chromosomes after 3H-uridine labeling and by hybridization of cDNA to chromosomal RNA.


Circadian patterns of growth hormone and cortisol secretions in narcoleptic patients.

Narcolepsy, a disorder which is clinically characterized by recurring episodes of sleep during the day, frequently associated with nocturnal disrupted sleep and polygraphically by sleep onset REM periods, has been studied in regard to the relationships between GH, cortisol secretion and sleep. Ten narcoleptics were polygraphically recorded during 24 h after one night's adaptation. Blood samples were taken every 20 min for GH and cortisol immuno-assays. Three narcoleptics were recorded twice 2 months later and 2 normal subjects served as controls. The following results were obtained: GH secretory pattern was different in narcoleptics and controls; two groups were identified: the first one showed a very low basal GH secretion with rare and small secretory peaks not clearly linked with sleep. One subject of this group recorded twice showed a similar pattern. The second group exhibited a higher basal secretion with many peaks without any well-defined relationship to sleep stages. The pattern was again consistent in two recordings of 2 subjects in this group. Furthermore GH secretion rose significantly (p less than 0.01) between 2100 and 0000 with no apparent relationship to sleep stages. The cortisol secretory pattern showed a significant rise (p less than 0.01) between 0400 and 1000 and was not different in narcoleptics and controls. In narcolepsy the monophasic sleep-wakefulness cycle is disrupted. The GH secretion pattern is modified whereas the circadian pattern of cortisol secretion is normal and independent of the sleep-wakefulness cycle of the narcoleptic patient.


Circadian changes in adrenal dopamine-beta-hydroxylase activity: dependency of change at darkness onset, and the effect of pinealectomy, on animal strain and age.

In a previous study we found a daily darkness- and pineal-dependent rise in adrenal dopamine-beta-hydroxylase (DBH) activity in 4-month-old S1 rats. The present investigation shows that aged (12 to 14-month-old) S1 rats do not have such a change in DBH activity. Similarly in the relatively younger (100-day-old) rats of a different (Holtzman) strain such a change was not found. Also pinealectomy did not seem to have any effect on adrenal DBH in either of these two strains of rats, young or old at times just before and after the onset of darkness. In both S1 and Holtzman rats, the concentration of copper-sensitive endogenous inhibitors of DBH remained unaltered following the surgical extirpation of pineal. Photoperiodic change from light to dark also had no significant effect on the inhibitor content in these two strains of rats. It is concluded that there are age and strain dependencies in the behavior of adrenal DBH activity at the daily onset of darkness.


Oscillatory nature of DNA, RNA, protein and lipid metabolisms in antigen-stimulated lymphocytes.

The primary immune response in inbred strain C3H/He to SRBC, or BSA is induced. The DNA, RNA, lipid precursor uptakes and total proteins are studied for 14 successive days following immunization, in splenic lymphocytes. Significant variations are noticed in the course of immune response of stimulated lymphocytes concerning their DNA, RNA, lipid and protein metabolisms respectively. The results reveal that there are several wave-metabolisms. The kinetic studies further indicate that course of different metabolisms would be of oscillatory nature. The activity peaks of synthesis may vary according to different antigens. Oscillatory systems would be 'excited' by antigenic stimulation. These results and hypotheses are discussed here.


Treatment of pneumatosis cystoides intestinalis with high FIO2: report of two cases.

We have successfully treated two patients with symptomatic pneumatosis cystoides intestinalis using a high FIO2 delivered by face mask, with administration interrupted at meal times. While we advocate oxygen therapy for this disease, caution must be taken to avoid the complications of high PaO2, namely proliferative and fibrotic lung changes. Close attention should be paid to the development of increasing cough, dyspnea and shortness of breath. As the frequency of the diagnosis of pneumatosis cystoides intestinalis increases, the success of high inspired oxygen as therapy should be recognized.


Squamous-cell carcinoma of the proximal colon: report of a case and review of the literature.

A case of an undoubted squamous-cell carcinoma arising at the hepatic flexure in the colon of a middle-aged man is reported. Review of the literature and exclusion of cases not strictly comparable suggest that pure squamous-cell carcinoma of the colon is rare, this being only the fifteenth such tumor reported, and only the second recorded case of such a tumor of the hepatic flexure. Possible pathogenesis is suggested.


Rectal carcinoma with solitary cerebral metastasis: report of a case and review of the literature.

A 54-year-old man underwent abdominoperineal resection for carcinoma of the rectum. Three months later, neurologic signs and symptoms developed. A brain scan, as well as angiographic studies, demonstrated a space-occupying lesion in the right parietal area. A solitary tumor was removed at craniotomy. Histologic examination revealed a metastatic adenocarcinoma with a rectal primary tumor. For two years the patient remained well, but then signs of local perineal recurrence developed. Treatment with cobalt irradiation and chemotherapy was unsuccessful. Autopsy revealed local recurrence with numerous distant metastases; however, examination of the brain failed to show a recurrent metastatic focus.


An unusual malformation of the vermiform appendix simulating endometriosis: a case report with discussion of differential diagnosis.

A 48-year-old nulliparous woman with a long history of pelvic endometriosis underwent a gynecologic operation, and a swollen and indurated appendix was removed because of suspected endometriosis. Pathologic examination revealed no endometriosis, but examination of the distal appendix showed structural disorganization of its entire wall, with lack of proper differentiation of its normal coats and irregular overgrowth of fibroadipose, fibromuscular, and neural elements. Differential diagnoses, including endometriosis, carcinoid tumor and neurofibromatosis, are discussed.


Mucocele of the appendix: diagnosis and surgical management.

Cystadenomas of the appendix are an unusual clinical entity. Despite a recognized constellation of findings, the diagnosis is not usually made prior to surgical exploration. A 65-year-old man is reported in whom preoperative evaluation, including sonography and angiography, resulted in the correct diagnosis confirmed at surgery. The appropriate use of newer diagnostic modalities will establish the preoperative diagnosis and facilitate surgical intervention. Appendectomy is curative for this condition, as neither regional nor distant lymph node metastases or hematogenous spread have been reported. When symptoms due to pseudomyxoma peritoneai occur, a continued aggressive surgical approach is justified.


Prevention of intussusception in Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome is a familial disease characterized by mucocutaneous pigmentation and intestinal polyposis. Small-intestinal intussusception is a common complication. Preservation otion technique to prevent intussusception is described.


Guidelines for use of flexible fiberoptic colonoscopy in management of patients with colorectal neoplasia.

Flexible fiberoptic colonoscopy, to have the maximum effect upon the management of patients having, suspected of, or at risk of having colorectal neoplastic disease, must be applied in accordance with substantial guidelines. Schemes for the application of colonoscopy have been designed for the early and accurate diagnosis of benign and malignant polypoid lesions. Colonoscopy has proven effective in confirming radiographic findings and the removal of pre-malignant and superficially malignant lesions. When applied in accordance with appropriate guidelines, flexible fiberoptic colonoscopy should provide not only secure surveillance in those individuals at high risk, but also should reduce appreciably the morbidity and mortality of colorectal neoplasia.


Surgery plus freezing as a technique for treating pilonidal disease.

Pilonidal disease in 12 patients was treated by a technique of incision and cryosurgery. All patients had complete healing and no recurrence after the 12 months of follow up. The advantage of abbreviated hospitalization is obvious and the early return to activities of daily living greatly appreciated by the patient. This procedure is recommended as a means of thoroughly treating disease with little morbidity.


A randomized controlled trial to compare anal dilatation with lateral subcutaneous sphincterotomy for anal fissure.

A prospective randomized trial has compared manual dilatation of the anus (MDA)during general anesthesia with lateral subcutaneous spincterotomy (LSS) during local anesthesia for the management of anal fissure in 156 patients. The two groups were similar with respect to age, sex and symptoms. There was no difference in the duration of time off work or early complications of treatment but, four months after operation, 93 per cent claimed to have been improved by MDA compared with 78 per cent after LSS (P less than 0.05). Recurrent fissure was recorded in 13 patients after LSS (29 per cent) compared with four (10 per cent) after MDA (P less than 0.02). There was a significant reduction in anal pressure at four months (P less than 0.02) after MDA, (123 +/- 31 to 97 +/-33) and LSS (127 +/- 36 to 104 +/- 32), but the anal pressure remained unchanged by operation in all patients where pressures were measured with recurrent fissure. These data indicate that MDA gives better results than LSS for treatment of anal fissure and that successful treatment is associated with a reduction in anal pressure.


The morbidity and mortality of colostomy closure.

Restrospective analysis was done of 304 patients who underwent colostomy closure at Henry Ford Hospital between 1967 and 1977. A mortality of less than 0.3 per cent and a morbidity rate of 14 per cent, with an average hospital stay of 15 days, is hereby reported. Wound infection was the most common complication with an incidence of 9.5 per cent. Late complications during the study period were less than 3 per cent. In our experience, if and intraperitoneal closure technique with resectiona and anastomosis is used, colostomy closure can be a safe procedure with minimal mortality and morbidity. We believe colostomy closure should be considered as nothing less than a major colonic resection.


The outpatient management of acute hemorrhoidal disease.

A procedure for the outpatient management of acute hemorrhoidal disease is presented. Treatment, using local anesthesia with hyaluronidase, is directed to (1) relieve pain, (2) decrease edema, (3) treat appropriately the internal hemorrhoidal disease, and (4) treat the external thrombosis if present. Adequate treatment of the acute disease will, in a significant proportion of patients, avoid further surgical intervention. Eperience with results of this modality of treatment in patients is presented.


Duodenocolic fistula: an unusual complication of duodenal diverticulum.

The management of two patients with benign duodenocolic fistula is reported. In both patients, laparotomy clearly demonstrated the origin of a fistulous tract arising from a duodenal diverticulum. Microscopic examination of the diverticula failed to disclose the presence of either gastric or pancreatic tissue.


An intra-abdominal foreign body presenting as a colonic tumor: review of literature and report of a case.

A case is reported in which a patient seemed to show the clinical picture of a colonic tumor, but was found to have a retained laparotomy pad from an exploratory operation which had been performed nine years earlier. This case of an intra-abdominal foreign body demonstrated many interesting and instructive clinical, radiologic, and surgical features with approaches to the diagnosis and management of this condition.


Rectal anatomy following Ripstein's operation for prolapse studied by cineradiography.

Eleven patients operated on for rectal prolapse, according to the method described by Ripstein, were examined pre- and postoperatively with cineradiography of the rectum. The patients were asked to fill in a questionnaire to evaluate their histories of constipation. There is no apparent anatomic explanation for postoperative constipation. One patient had a rectal stricture and another, a recurrence in the shape of an intussusception.


A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. VI. The central abscess: a new clinicopathologic entity in the genesis of anorectal suppuration.

The central abscess is a new clinicopathologic entity which plays an important role in the pathogenesis of anorectal abscess and fistula. Eight cases are presented. The abscess occupies the central space, which lies between the longitudinal muscle and the base loop of the external sphincter. The anatomic pattern and the clinical manifestations of the abscess are discussed. The abscess extended, in some cases, to the subcutaneous space and perianal skin, to the anal canal proper, or to the intersphincteric spaces. This is due to the fact that the central space communicates with all of the other perianal spaces along the central septa. A new theory in the pathogenesis of anorectal suppuration and fistula is put forward. It is believed that all anorectal abscesses or fistulas originate as central space infection which spreads to the other perianal spaces. Proper diagnosis and early drainage of the central abscess prevent further spread of suppuration to other spaces.


Does motilin regulate canine interdigestive gastric motility?

Our objective was to determine whether motilin increases the frequency of cyclic interdigestive motor activity in the canine proximal stomach. In 4 conscious dogs with autotransplanted proximal gastric pouches and gastrointestinal electrodes, intravenous infusions of motilin (0.6 microgram/kg body wt/hr) increased the frequency of the interdigestive cycles by 30% both in the pouch and in the main gastrointestinal tract. However, the 3-min interval between the end of a cycle in the pouch and the end of a cycle in the duodenum was unchanged by motilin. In control experiments, without motilin infusion, the concentration of endogenous motilin in the plasma during the intense contractile phase of the cycles (overall mean 385 pg/ml) was greater in each dog (P less than 0.01) than the concentration during the quiescent phase (overall mean, 256 pg/ml). The concentration of plasma motilin was also greater in the contractile phase (mean, 717 pg/ml) than in the quiescent phase (mean, 587 pg/ml) during exogenous infusions of motilin in two of three dogs (P less than 0.01). We concluded that motilin increased the frequency of cyclic interdigestive motor activity in the canine proximal stomach and that the increase was not dependent on intact proximal gastric extrinsic innervation.