Rectal paracetamol in small children with fever.

37 febrile children aged between 3 months and 6 years were treated with paracetamol in a dose of 15--20 mg/kg by either oral elixir or rectal suppository. The rectal route was found to have an equal antipyretic effect and offers a practical alternative in those children for whom the oral route is not possible.20


Acute infantile thrombocytosis and vitamin K deficiency associated with intracranial haemorrhage.

A 5-week-old breast-fed girl presented unconscious and convulsing with heavily blood-stained CSF under increased pressure. This was associated with oozing from venepuncture sites, a grossly prolonged prothrombin time, and a raised platelet count. The prothrombin time became normal 18 hours after she had been given parenteral vitamin K and a transfusion of fresh plasma and red cells, but the thrombocytosis persisted. A moderate communicating hydrocephalus also remained and was treated, and one year later health and development appeared normal. The thrombocytosis resolved after a few weeks and has not recurred.


Premature menarche without other evidence of precocious puberty.

We describe 4 young girls with recurrent vaginal bleeding in the absence of other signs of precocious sexual development. Investigation showed low oestrogen levels in 2 of them, and basal gonadotrophins were in the upper part of the prepubertal range. We believe that the isolated early menstruation in these patients was possibly related to increased sensitivity of the endometrium to oestrogens.


A boy with low-TSH hypothyroidism.

A case of long-standing mild hypothyroidism is described. This was caused by partial TSH deficiency probably of hypothalamic origin, with no other pituitary hormone deficiencies, although with a decreased response of FSH and LH to LHRH.


Ring 20 chromosome in a child with seizures, minor anomalies, and retardation.

A patient is reported with seizures, developmental delay, and minor physical anomalies. Karyotype showed a ring formation of chromosome number 20. Previously reported patients with this chromosomal aberration have typically had seizures and behavioural disorders with considerable variation in the degree of physical abnormality and mental retardation. A correct diagnosis in such a case is important for accurate genetic counselling.


Penetration of various corticosteroids through epidermis in vitro.

The penetration through the epidermis in vitro of various topically used corticosteroids was compared. The amount penetrating through the epidermis from an ethanolic solution showed good correlation with the polarity of the corticosteroids under study. Hydrocortisone, the most polar corticosteroid, penetrates the epidermis the most rapidly; clobetasone butyrate, the least polar, the slowest. Other corticosteroids, i.e., hydrocortisone-17-butyrate, triamcinolone acetonide, and clobetasol-17-propionate, form an intermediate group whose penetration rates and polarities decrease in the indicated sequence. The corticosteroid generally accepted as having greater clinical efficacy in creams or ointments did not permeate better from an ethanolic solution in vitro.


Ultracytochemical study on eccrine acrosyringium of human embryos. Acid phosphatase activity during formation of lumen.

Ultracytochemical demonstration of acid phosphatase (ACPase) activity during the developing of intraepidermal eccrine sweat duct (eccrine acrosyringium) of human embryos was performed in order to elucidate the functional relationship between multivesicular dense bodies and intracellular cavities formed within the inner cells of eccrine sweat apparatus anlagen and to clarify the ultracytochemical characteristics of the multivesicular dense bodies. ACPase activity was characteristically detected in the unit membrane structures of small pinched-off vesicles within cavities and of immature microvilli lining these cavities as well as in those of multivesicular dense bodies. These findings give strong support to the theory that the multivesicular dense bodies are lysosomes and through their action the autolytic formation of intraepidermal eccrine sweat duct is carried out.


[Traumatically induced junctional activity of nevocellular nevi (author's transl)].

Forty papillomatous nevi, mainly with junctional nests, were partially removed surgically in such a way that a small margin was left intact on one side and the deep nevus cells were retained on the flor of the wound. After healing of the wound, a small layer of scar tissue separated the regenerated epidermis from the deep nevus cells, which were left in the dermis. After very differing intervals, as early as 30 days after the partial surgical removal, typical alterations could be observed in the epidermis above the cicatrical tissue. Most frequently, there was a hyperpigmentation with an increase in the number of basal fluorescing dendritic cells, which could also be found along the uppermost parts of epidermal appendages. Moreover, nest-like conglomerations of pigment-producing cells appeared in the form of junctional nevus cell nests. About 2-3 month after the partial surgical removal "Abtropfung" was visible, indicating a regeneration of the nevus. Fluorescence-histochemical and enzyme-histochemical results revealed that marked alterations can be found not only in the newly formed epidermis above the scar, which morphologically show minor alterations.


[Perforating granulomatous folliculitis in Becker's nevus (author's transl)].

Acneform lesions strictly confined to a Becker's nevus were observed in a 18-year-old man. Histologically, a granulomatous folliculitis with partial destruction of the epithelial root sheath and follicular cysts with focal penetration of keratin into the surrounding dermis were present, ruling out acne vulgaris. The concept of Becker's nevus as a complex nevogenic process, affecting ectodermal, neuroectodermal, and mesenchymal structures, also in terms of dysfunction of the pilary complex, is suggested.


Nature of collagen in dermatofibrosarcoma protuberans.

The nature of collagen from 2 cases of dermatofibrosarcoma protuberans was studied. For this purpose, the tumor tissue was carefully separated from adjacent normal dermis. The collagen types comprised in the tumor were identified by CM-cellulose chromatographic and SDS-gel electrophoretic analysis of the component alpha-chains. Semiquantitative evaluation of the relative type III content was established by separation of the cyanogen bromide peptides on gels of 12% polyacrylamide in SDS. These studies showed that dermatofibrosarcoma protuberans contains alpha 1(I)-, alpha 2-, and alpha 1(III)-chains as well, and corresponding type I- and type III-related CNBr peptides. Comparing the collagen from dermatofibrosarcoma protuberans to that of normal skin, the relatively increased type III content in the case of dermatofibrosarcoma protuberans becomes apparent.


A combined chemical-physical treatment for herpes simplex lesions in guinea pigs.

Determination of the effectiveness of chemical treatments for Herpes simplex type 2 infections has generally relied on a reduction in the rate of mortality. A more natural progression of the disease is seen when non-progressive cutaneous lesions are induced. Treatment of characteristic cutaneous lesions with ultrasound alone, a cream compound designated Herpigon alone, or a combination of ultrasound and Herpigon were compared to determine the time required for lesions to heal and the amount of virus recoverable from treated lesions. Results indicate that the use of Herpigon alone or in combination with ultrasound resulted in a significant reduction in the time required for the lesions to heal. A comparison of the amount of virus present in treated lesions indicated that the combined treatment was most effective in reducing the amount of recoverable virus.


The lipometre: an easy tool for rapid quantitation of skin surface lipids (SSL) in man.

The purpose of this study is to present a rapid, simple, and accurate method for quantitation of SSL in man. The technique which is derived from the works by Schaefer and Kuhn-Bussius, employs a series of clearn ground glass plates, and an apparatus, the Lipometre, for the determination of the variation of light transmission across the plates as a function of the fat deposited on them. Results on 32 adults, males and females, show that the first four iterative samplings, at constant pressure, on the same forehead area follow an identical physical law independently of whether the skin is fatty or dry. This law affords a precise definition of the Casual-Level, its quantification and its correlation with skin patterns. It is consequently possible, either as an investigative or a routine technique, to predict the total amount of SSL with good accuracy within 2 min. The SSL, for non-pathological skins, fall within the range 150 microgram/cm2 to 900 microgram/cm2 which is in good agreement with values quoted in the literature.


The diffuse and macular atrophic dermatosis. A precocious and progressive light degenerative condition.

Two brothers with the "diffuse and macular atrophic dermatosis" making a total of 4 patients are reported. The familial occurrence, numerous large "peau citréine" plaques situated on the dorsum of the upper trunk and congenital phimosis with superficial atrophy of glans penis, represent and additional features reported. The light and electron microscopic findings of the least affected site on the arm, of a "peau citréine" and of an erythemoscleroatrophic plaque, none previously studied, have been reported. Among other items, it was also found that the elastic stain-positive globe-like structures found in an unusually large number throughout the edematous upper dermis represent more advancely transformed "Civatte bodies" containing epidermal filamentous cell material.


[Objective measurement of skin colour with the help of spectral photometry (author's transl)].

The colour of the human skin can be measured exactly by a new equipment which is described here. The method is based on the analysis of the reflexionproperties of the skin in the region of the visible light. On the basis of the measured reflexionproperties the colour of a probe can be computed as a function of physical parameters.


Quantitative thin layer chromatography for the analysis of skin surface lipids. A time-saving method using a new TLC plate.

Recently a new thin layer chromatography plate (Whatman LK 6D) became available which is extremely easy to handle and permits highly reproducible qualitative and quantitative analysis. This plate proved to be of great value for the investigation of skin surface lipids. The use of a fatty acid methyl ester as an internal standard makes it unnecessary to employ additional gravimetrical or photometrical methods for quanitative lipid analysis. The method presented in this paper is simpler and requires much less time than alternative procedures and allows a large number of lipid samples to be processed simultaneously.


[Effect of dermatocorticoids on the activity of hepatic tryptophane pyrrolase in the guinea pig (author's transl)].

The enzyme activity of tryptophane pyrrolase in guinea pig liver can be measurably increased--as in other mammalian species--by systemic administration of corticoids, but this effect is short-lived and achieved only with high s.c. doses of, e.g., prednisolone (Ultracorten-H-hydrosoluble). In contradistinction and rather surprisingly the enzyme activity is variably  but markedly reduced by high-dosed and protracted epicutaneous application (10 times within 2 weeks) of the well-known dermatocorticoids: hydrocortisone, fluocinolone acetonide, and clobetasol propionate. This reaction must be explained by the capacity of these corticoids to inhibit, after their percutaneous absorption, the functional axis pituitary--adrenal cortex--liver, the stimulatory role of which is mandatory for the endogenous basic activity of hepatic tryptophane pyrrolase.


Sister chromatid exchange (SCE) in human lymphocytes. Effect of UV C irradiation and age.

The number of sister chromatid exchanges (SCE) per metaphase was determined in normal human lymphocytes by the Hoechst-Giemsa procedure. UV C irradiation promotes SCE dose-dependent in the range of 0-40 mJ/cm2. No difference of this phenomenon may be observed, compairing young volunteers (20-40 years) with a 60-80-year-old group.


Immunoelectron microscopic studies in IgA linear dermatosis.

The authors investigated three cases of IgA linear dermatosis by immunoelectron microscopy. In two of the cases there were additionally some IgG deposits in the basement membrane zone. The arrangement of the IgA deposits was found to vary. In two cases it was of the dermal and the lamina lucida type at the same time, and in one case it was so close to basal cell membranes as to leave an electronlucent space on the side facing the basal lamina. In the third case, the arrangement (only IgG and complement were studied) was exclusively of the dermal type. In one of the cases the deposits had first, i.e., 1 1/2 years earlier, been confined to the lamina lucida, whereas now they were also seen below the basal lamina, although the clinical condition of the patient had remained unchanged. It would seem that the localization of IgA deposits in the basement membrane zone may vary, depending on the evolution of the disease.


[On the physiology of the growth of nail plate (author's transl)].

By following up histologically a localized storage of melanin in certain layers of the nail plate the differing theories on the cellular kinetics of the growth of human nail plate are checked up. Thus it turns out that the hitherto existing and even contradicting conceptions are not helpful to interpret uniquely the morphological phenomena of the concrete case. A plausible modification is presented.


Sialyltransferase levels and sialic acid concentrations in sera of patients with malignant melanomas.

Serum levels of sialyltransferase and sialic acid were measured in patients with malignant melanomas (n = 49), healthy control persons (n = 20), and patients with non-malignant skin disorders (n = 30). Both parameters were found to be higher in malignant melanoma patients than in healthy control persons, but they were not significantly higher in melanoma patients than in patients with benign skin disorders, unless widespread dissemination of metastases had occurred. The highest values were measured in patients with liver and lung metastases. No general correlation was found between sialyltransferase activities and sialic acid concentrations. Sialic acid concentrations seem to be a better index for tumor spreading than sialyltransferase activities. In early stages of the disease, shedding from tumor cells is not the major source of elevated serum levels of sialyltransferase and sialic acid, respectively.


Elevated sodium levels in the public drinking water as a contributor to elevated blood pressure levels in the community.

Further statistical analyses of previously reported preliminary data upheld results showing elevated levels of sodium in drinking water may exert an adverse health effect on normal, healthy persons. High school sophomores residing in a community with elevated levels of sodium in the drinking water (107 mg/l) exhibited a marked upward shift in blood pressure distribution patterns for systolic and diastolic pressure, when compared with students in an appropriately matched community (8 mg/l). Females exhibited a blood pressure distribution pattern characteristic of persons 10 yr older, while for males the upshift was similar to that of a group approximately 2 yr older.


Effects of electric arc welding on ventilatory lung function.

Respiratory symptoms, spirometry, forced expiratory flows, and the nitrogen closing volume test were studied in 119 welders and 90 controls, matched with respect to age, height, and smoking habits. Respiratory symptoms according to a questionnaire were more prevalent in the welders. No short-term changes of the measured variables during the day or week attributable to welding were found in twenty-one nonsmoking welders. Compared to the controls, closing volume and closing capacity (i. e., closing volume + residual volume) were significantly higher, and total lung capacity and the amplitude of the cardiogenic oscillations in the nitrogen curve were significantly lower in the welders who were nonsmokers or exsmokers, whereas there were no differences among smokers. These findings in welders may be attributable to deposition of welding fume particles in peripheral small airways or alveoli.


In vitro mercury uptake by human acatalasemic erythrocytes.

Human acatalasemic erythrocytes had only 0.01 to 0.06X the uptake found in normal erythrocytes with hydrogen peroxide, and 0.06 to 0.24X the uptake without hydrogen peroxide in regard to their ability of in vitro mercury uptake from air saturated with mercury vapor. Normal erythrocytes with hydrogen peroxide took up 9.3 to 37.4X more mercury than cells without hydrogen peroxide, whereas acatalesemic cells with hydrogen peroxide took up 2.4 to 5.8X more mercury than cells without hydrogen peroxide. Similar results were obtained from normal and acatalasemic hemolysates. In addition, the concentration of hydrogen peroxide affected the uptake of mercury by both normal and acatalasemic erythrocytes. Data indicate that the catalase-hydrogen peroxide system plays a role in mercury uptake, presumably by mercury oxidation, since oxidation states of the mercury were never determined in these studies.


Lead contamination of urban snow.

Lead content of newly fallen snow in an urban area ranges from 34 to 56 ppb. After falling, snow may incorporate major additional amounts of lead by dry deposition of lead aerosols from local sources. The highest concentration found was 2,700 ppb. Ingestion of lead-contaminated snow might pose a health hazard to inner city children.


Acute arsine posioning in two workers cleaning a clogged drain.

On February 6, 1978, two maintenance workers employed by a chemical company in Atlanta, Georgia, became ill after cleaning a clogged drain. Both were hospitalized with acute fulminant hemolytic anemia and renal failure. While the clinical picture suggested arsine or stibine poisoning, preliminary investigation of the plant revealed no obvious source of arsenic, antimony, or hydrogen gas. During the cleaning operation, the men drained a mixing tank that 5 yr before had been used to store arsenical herbicides. To unclog the drain, they added a standard drain cleaner containing sodium hydroxide and aluminum chips, a combination that reacted to release hydrogen gas. This gas combined with the arsenic residue to form toxic quantities of arsine gas (arsenic trihydride). Arsenic was found in the liquid and gas from the drain and in blood and urine of both patients, and of two other workers who worked in the vicinity of the drain. This investigation suggests that drain cleaners which react to release hydrogen should not be used in situations where arsenic or antimony may be present. Furthermore, maintenance men, who may be exposed to the chemicals used in a plant, should be educated, supervised, and screened so that their risk for occupational hazards may be reduced.


Effects of nitrogen dioxide on elastin and collagen contents of lung.

Male Syrian hamsters were exposed to 30 +/- 5 ppm nitrogen dioxide for 22 hr daily for 3 wk. Nitrogen dioxide-exposed hamsters sacrificed at various times during the 3 wk exposure showed a general loss of body weight and an increased dry lung weight when compared with the controls, which were housed in a similar, but nitrogen dioxide-free environment. Analysis of total lung collagen and total lung elastin revealed a net decrease in the moieties within 4 and 10 days, respectively, following commencement of nitrogen dioxide exposure. Total lung collagen returned toward pre-exposure levels by the 14th day of nitrogen dioxide exposure. Total lung elastin did not return toward normal until termination of nitrogen dioxide exposure. Recovery in room air for 3 wk following 21 days of nitrogen dioxide exposure restored the total pulmonary collagen and elastin to valutin and collagen degradation and synthesis differ during and after nitrogen dioxide exposure. Lung collagen loss was observed earlier and was restored to normal values during the continuation of nitrogen dioxide exposure. Lung elastin loss occurred later and persisted during the entire period of exposure but returned to normal after exposure was terminated.


Human exposure to sulfur dioxide and ozone: absence of a synergistic effect.

Studies of the human health effects of exposure to a combination of ozone and sulfur dioxide have produced somewhat conflicting results; the possibility of a synergistic enhancement of toxicity when the two gases are present simultaneously remains equivocal. We evaluated the effects of 0.40 ppm sulfur dioxide, 0.40 ppm ozone, and the combination of these two under one environmental condition (25 degrees C and 45% relative humidity). Subjects alternately walked and rested during a 2-hr exposure. Subjects exposed to filtered air or to 0.40 ppm sulfur dioxide showed no significant changes in pulmonary function. When exposed to either ozone or ozone plus sulfur dioxide, significant decreases in maximum expiratory flow, forced vital capacity, and inspiratory capacity were observed. There were no significant differences in response between ozone alone and ozone plus sulfur dioxide exposures, thus, in our subjects on synergistic effects were discernible.


Mesothelioma and exposure to mixtures of chrysotile and amphibole asbestos.

This paper provides a new analysis of previously published work and draws attention to the possibility that mixtures of amphiboles and chrysotile appear more commonly in the lungs of mesothelioma patients compared to controls than do either of the main types of fiber alone. The possibility that these results may indicate a synergistic interaction between chrysotile and the amphiboles is discussed in the light of the epidemiological data.


Airport noise and teratogenesis.

It has been suggested that exposures to high-noise levels near major airports may cause increased incidence of birth defects in the offspring of parents residing near these airports. Using data gathered in Metropolitan Atlanta during 1970 to 1972, we compared the rates of seventeen categories of defects in high- and low-noise census tracts. No significant differences were observed. However, when we subdivided the category of central nervous system defects into several subcategories of specific defects, we noted a significantly increased incidence of spina bifida without hydrocephalus in the high-noise areas. Because the small number of cases associated with this finding we did a matched case-control study using all cases of central nervous system defects born during the years 1968 to 1976. No significantly increased risk for residents in the high-noise areas was noted in this study. It is our opinion that noise or other factors associated with residence near airports are unlikely to be important environmental teratogens.


Carbon monoxide: a hazard to fire fighters.

Carbon monoxide levels were measured in twenty-five fires in the city of Los Angeles to obtain information about fire fighters exposure to carbon monoxide. Levels as high as 3,000 ppm were observed for some fires. In general, when carbon monoxide levels were significantly elevated (greater than 100 ppm) the smoke was quite heavy and noxious, but in some cases the smoke was heavy and carbon monoxide levels were minimal. In two-story structures, the highest concentrations of carbon monoxide were found on the second-floor level and were usually still elevated after the fire had been "knocked down" but was still smoldering. These data show that fire fighters are exposed to levels of carbon monoxide which could be a serious health hazard and may be related to the high incidence of heart disease in fire fighters.


Polycythemia produced in rats by environmental contaminants.

Polycythemia developed in progeny from mothers who were exposed during pregnancy to a combination of methylmercury chloride plus ethylurea and sodium nitrite. The polycythemia occurred as early as one month of age and as many as 24% of the offspring developed the polycythemic condition. Many features of this condition are similar to those of polycythemia vera in man, such as elevated hematocrits and white and red blood cell counts, splenomegaly, and hyperplasia of bone marrow accompanied by megakaryocytosis.


Clinical validation of automated spirometry used in surveys of large occupational groups: comparison with conventional water spirometry.

An accurate, rugged automated spirometer which provides immediate data is useful both clinically and for screening large groups with various environmental exposures. Because the need for such surveys has been increasing, we compared a computerized mass flow-meter with a conventional water spirometer. The same forced expiration was measured by both instruments in the laboratory and during an occupational survey. Mean values for forced vital capacity (FVC) were 96 cc greater by the automated technique in the laboratory (this equals 2.2% of the value by the conventional method, with a correlation, r, of 0.998) and 97 cc greater in the field (2.3% of the conventional method; r = 0.995). Differences between the two methods in the laboratory and field for forced expiratory volume in one second (FEV 1.0) were +24 cc (0.68%; r = 0.996) and +47 cc (1.6%; r = 0.996) and for forced expiratory flow (FEF)25-75--179cc/sec (4.18%; r = 0.968) and -63 cc/sec (2.1%; r = 0.992), respectively. For FVC and FEV1.0, the differences between paired values were less than or equal to 10% of the value by water spirometry in all instances and less than or equal to 5% in 95.5% and 96% of comparisons, respectively. For FEF 25-75 the differences between paired values were less than or equal to 20% in 97.2% and less than or equal to 10% in 84.7% of comparisons. These findings confirm the validity of the measurements provided by the automated spirometer.


Synergism of methylmercury and selenium producing enhanced antibody formation in mice.

Mice fed 1, 5, and 10 ppm methylmercury plus 6 ppm selenium for 10 wk had a significant increase in antibody synthesis. Since methylmercury singly depresses antibody synthesis and the response was greater than that produced by selenium alone, synergism between methylmercury and selenium occurred. In this case, the synergism is considered to be advantageous to a host, while exposure by other combinations of environmental contaminants may be detrimental. Mercury concentrations in the kidney were markedly elevated when methylmercury and selenium were administered simultaneously compared to when methylmercury was given without selenium supplement. These results indicate that data collected from individual pollutants may not be of value in predicting responses to multiple exposure.


Effect of particle size on lead absorption from the gut.

The relationship between particle size and absorption of lead particles from the gastrointestinal tract of the rat has been investigated. Preparations of metallic lead of particle size between 0 and 250 micron were incorporated in laboratory rat diets and absorption determined by measurement of tissue lead concentrations attined under standard conditions. An inverse relationship was found between particle size and lead absorption; this relationship was most marked in the 0 to 100 micron range. A five-fold enhancement of absorption was observed from the diet with lead particles of mean size 6 micron, compared with 197 micron particle size. Lead absorption from dried pain films containing lead chromate and lead octoate was measured using a similar technique. A marked enhancement of absorption was observed for both paints when particle size was reduced from 500 to 1,000 micron to less than 50 micron.


Augmentation of myocardial ischemia by low level carbon monoxide exposure in dogs.

This study was conducted to determine whether low level exposure to carbon monoxide would increase myocardial ischemia associated with acute myocardial infarction. An hour after coronary artery ligation, eleven anesthetized dogs underwent five sequential respiratory exposures to 5,000 ppm carbon monoxide, producing mean blood carboxyhemoglobin levels of 4.9% to 17.0%. Ischemia, as indicated by the amount of S-T segment elevation in epicardial electrocardiograms, increased significantly at the lowest carboxyhemoglobin level and increased further with increasing carbon monoxide exposure. These changes occurred in the absence of altered heart rate, blood pressure, left atrial pressure, cardiac output, or blood flow to ischemic myocardium. Flow to non-ischemic myocardium increased with carbon monoxide exposure, the percentage increase being approximately double the increase in carboxyhemoglobin level. Thus, low level exposure to carbon monoxide can significantly augment ischemia in acute myocardial infarction, apparently through a reduction in oxygen supplied to ischemic tissue. The data suggest that hypoxia induced by carbon monoxide exposure is more severe than can be accounted for by a simple reduction in oxygenated hemoglobin.


[Hydronephrosis caused by an inferior polar vessel].

We present our statistics and results obtained in the conservative treatment of hydronephrosis in the inferior polar vessel with a kind of operation with certain modifications which we consider to be of practical interest and determined by the following premises:--Disappearance of pain after the operation. --Functional reestablishment and anatomical involution of the deformity. --Conservation of all the kidney tissue and its vascularization. --No possibility of infection due to permanent drainage and catheters.


Intrapleural instillation of quinacrine for treatment of recurrent spontaneous pneumothorax.

We used intrapleural instillation of quinacrine hydrochloride in 20 patients (Group A) with recurrent spontaneous pneumothorax (one bilateral) and compared their clinical course with 19 patients who underwent thoracotomy and scarification or pleurectomy (Group B) and 63 patients treated by tube thoracostomy alone (Group C). In Group A, there was one complication of treatment, a pneumothorax immediately following tube removal, which necessitated repeat tube thoracostomy, and there was one late ipsilateral recurrence 2 years after treatment. These 20 patients with 21 recurrent spontaneous pneumothoraces treated with intrapleurally administered quinacrine have been followed for from 6 months to more than 4 years with only one late recurrence on the treated side. Eight patients in Group B had postoperative complications: 2 patients who had had pleurectomy required reoperation for postoperative bleeding; lobar pneumonia developed in 3; 1 had lack of total expansion of the lung; an intrathoracic hematoma developed in 1; and an ipsilateral pneumothorax necessitating tube thoracostomy developed in 1. In Group C, the rate of recurrence of pneumothorax was 23% during the first year following treatment. Intrapleural instillation of quinacrine is a simple, low-risk, reliable, and effective treatment for recurrent spontaneous pneumothorax, and is equally as effective as thoracotomy and scarification.


[Rhabdomyosarcoma of the spermatic cord: apropos of a case].

The rhabdomyosarcoma of the spermatic cord is a rare tumour of the genital apparatus, of which 80 cases have been published in world literature. In the present paper, we publish a case of pleomorphic rhabdomyosarcoma of the spermatic cord, pointing out the highly malignant nature of this lesion (a 10% survival rate after 5 years) as well as the delay in its diagnosis on some occasions due to confusion with hydroceles, hernias and cord cysts. As far as the treatment is concerned, all the authors agree on the extensive exeresis of the tumour, with a need for a para-aortic lymphadenectomy when there are greater divergences. In spite of these tumours being only slightly radio-sensitive, its usefulness when used locally to prevent relapses has been proved. The experience with chemiotherapy is very limited.


Surgical repair of dissection of the upper descending thoracic aorta and discrete ascending aortic aneurysm.

This report describes successful staged surgical repair in 2 patients with dissection of the upper descending thoracic aorta (DeBakey type III) with coexisting discrete Marfan's aneurysms of the ascending aorta. Initial repair of the descending aortic dissection was done through a left thoracotomy using a transverse aorta--femoral artery shunt in 1 patient and a left ventricular apex--femoral artery shunt without systemic heparinization in the other. Emphasis is placed on the need for pharmacological reduction of blood pressure during aortic cross-clamping as well as the use of a shunt to prevent dissection of the ascending aortic aneurysm. In both patients, subsequent repair of the ascending aortic aneurysm was accomplished using composite graft replacement of the aortic valve and ascending aorta. This operation is advised for such patients even in the absence of notable aortic valve incompetence.


[Urothelial tumor of the renal pelvis in horseshoe kidney].

The authors describe a case of tumour of transitional cells in patient with a horseshoe-shaped kidney, the suspected diagnosis of which was reached with the aid of a selective cinearteriography. They stress the low incidence of the same in the literature consulted which reveals the importance of studying the patients with this malformation in an attempt to prevent complications and in particular, to make an early diagnosis of a possible malignant transformation.


Clinical experience with the Lillehei-Kaster valve prosthesis.

The Lillehei-Kaster valve was used in 215 patients over a 7-year period. The aortic valve was replaced in 81 of them. Hospital mortality was 21% (17 patients). Ten patients were lost to follow-up and long-term mortality was 5% (3 patients). The incidence of thromboembolism was 2.6 per 100 patient-years, and actuarial survival was 96% at 5 and 87% at 7 years. Mitral valve replacement was performed in 108 patients. Hospital mortality was 20% (22 patients), 24 patients were lost to follow-up, and long-term mortality was 13% (11 patients). The combined incidence of thromboembolism was 5.0 per 100 patient-years, and actuarial survival was 81% at 5 years and 75% at 7 years. In both groups, the majority of patients improved clinically. Fifteen patients had double-valve replacement, and 11 had coronary revascularization in addition to valve replacement.


Effect of therapeutic-dose irradiation on left ventricular function in conscious dogs.

Every week, 8 conscious, chronically instrumented dogs underwent left ventricular (LV) function studies before, during, and after cardiac irradiation with cobalt 60 (myocardial dose of 5,000 rads at 200 rads per day through a 5 X 5 cm port). During the weekly LV function studies, left atrial pressures were raised by rapid infusion of balanced saline solution. Heart rate, aortic pressures, left and right atrial pressures, LV pressure, left ventricular end-diastolic pressure (LVEDP), and maximum rate of rise of LV pressure were recorded. Electrocardiograms were made. Cardiac outputs were obtained by thermodilution. Stroke volume, LV stroke work, and LV minute work were calculated. LV function curves were constructed each week. All dogs lost weight and became irritable after approximately 800 rads. The electrocardiograms showed signs of myocardial injury after 1,200 rads. All variables were slightly depressed during the first 8 weeks following irradiation. At the eleventh week, both left atrial pressure and LVEDP increased significantly and LV function declined. There was also clinical evidence of LV failure at rest and after volume loading. This study documents that external cardiac irradiation, in a therapeutic dose and schedule range, causes depression of LV function. These functional changes were partially reversed when the follow-up study was continued to six months after irradiation.


[Nephrectomy in hypertensive unilateral nephropathies].

A nephrectomy has been performed on eight cases of hypertensive, unilateral nephropathies, in patients aged between 20 and 68, with a clear predominance of the female sex, namely 75% of the cases. The results were excellent and the patients maintained a normal tension for a very long period, about two years after the nephrectomy. The authors comment upon the means of diagnosis and treatment. They stress that the future of patients suffering from a unilateral, hypertensive nephrectomy depends upon the possibility of logical and correct surgery in order to prevent malignancy from developing.


Blood conservation during myocardial revascularization.

A prospective study of blood utilization in 50 consecutive patients undergoing elective coronary artery bypass was undertaken. Blood was removed from all patients during induction of anesthesia and reinfused after bypass (mean, 675 ml). Intraoperatively, all discard suction was routed through a regionally heparinized collecting and processing system, and the resulting red cell concentrate was transfused. At the conclusion of bypass, all blood remaining in the pump oxygenator was retained for transfusion. After operation, shed mediastinal blood was collected in a sterile, filtered collection system and transfused. Normovolemic anemia was accepted in hemodynamically stable patients. The mean amount of patients' blood salvaged by the intraoperative system was 259 ml (range, 0 to 724 ml) and by the postoperative system, 194 ml (range, 0 to 564 ml). Ninety-four percent (47/50) of the patients received no bank blood or blood products during their hospital stay. No patients received bank blood intraoperatively or during the first 24 hours following operation. There were no complications attributable to blood salvage techniques.


[The system of complement in active rheumatic fever].

Pathogenesis of inflammation in acute rheumatic fever is still unknown. There is humoral immune response against streptococcal products and streptococcal infection plays a role in etiopathogenesis. When inflammation is due to humoral immune mechanisms, the serum Complement system is the most important mediator. We studied functional aspects of the Complement system in nine patients suffering acute rheumatic fever, all of them with clear humoral immune response against streptococcus. We could not show any abnormalities in Complement. Probably, inflammation during acute rheumatic fever depends on Complement independent mechanisms.


[Endocardial monophasic action potentials obtained by means of suction catheters].

Endocardial monophasic active potentials (M.A.P.) recorded by suction --tip intracardiac catheters constitute a new research-- method in cardiac arrythmias, electrophysiology and pharmacology. The characteristics of MAP at auricular and ventricular levels are analyzed. The limitations of the method in its incapacity to record the MAP of conduction tissues is discussed. This method of recording MAP is evaluated with antiarrythmic drugs of tipes I, II, III and IV. The results are identical to recordings performed with intracellular microelectrodes.


[Phonomechanocardiographic parameters of the ventricular function in the healthy adult].

There are studied several phonomechanocardiographic parameters of ventricular function and the obtained values in a normal patients' lot. It is analyzed the semiology of those data which offer information about pre-charge (apexcardiogramme's "a" index) of the myocardiac contractile state (true isosvstolic phase, ventricular pression's elevation middle velocity, integrated isovolumetric pression, and contracility index) and of its "pump" function (expulsion fraction); in the same way it is discussed the measurement's potential utility of diastolic intervals. It is emphasized the value that these parameters' measurement can have to know cardiac capacity and the affectation this can have by pharmacologic influence or by the ilnes.


[Phonomechanocardiography of constrictive pericarditis].

There were studied 19 constrictive pericarditis cases demonstrated by anatomist study. It was evident, at all of them, systemic veiny hypertension's syndrome. "Extinguished" cardiac noises and "quiet" heart only appeared at the 42% of the cases. 73% of patients were found with important incapacity. Lyan's pericardic protodiastolic crack was registered at the 75% of the cases and only at 2 cases (10.9%) it was found reinforcement of pulmonary noise II. It is agree with the haemodynamic discovery of pulmonary pression's light elevation. Characteristically, precordiogrammes showed great "A" wave, and it was agree with telediastolic pression's elevation of the two ventricles obtained by catheterism. Phlebogramme was characteristic of systemic veiny hypertension by impediment of ventricular filled at all the studied cases. Measurement of cardiac cycle's phases showed diminution at PE, Blumberger's intrasystolic quotient, left expulsion fraction (Carrard's method) and ventricular pression's elevation middle velocity (VPEMV). By the contrary Weissler's index was found elevated. Eventhough found ciphers could be considered like bordering normal values, there is a difference statistically significance in relation with the values that were found in sane subjects. These discoveries were interpreted in the base that the patient's heart with constrictive pericarditis acts at the curve's ascendent part of the ventricular function because it has incapacity to utilize Starling's mechanism. Process' chronicity produces myocardic atrophy by "discuss" and, by this, ventricular function's improvement can be no immediate to pericardiectomy. Apexcardiogramme shows the impedement to ventricular filled with its diastolic morphology which is very similar to intracavitary pression's curve ("square root's image"). It is postuled the hypothesis that these sicks do not develop important pulmonary hypertension, because right ventricle's poor diastolic distension impides generation of major expense and systolic pression and, by other side, the impedement to ventricular filled has repercussion over right auricle and systemic veiny territory much more distensible, with the known clinical consequences.


[Congestive myocardiopathy and early dyastolic closure of the tricuspid valve. Report of a case with acute tricuspidization].

A case with congestive cardiomiopathy and early diastolic closure of the tricuspid valve is presented. This abnormal echocardiographic finding was probably the result of severe tricuspid regurgitation occurring in a restricted right ventricle. The absence of paradoxical septum was determinedly the left ventricular pathology. In this case, echocardiography was more sensitive for the detection of the left sided abnormalities, than the heart cath data.


[Clinical experience with the use of dura mater prosthesis (the 1st 60 patients)].

It is presented the experience in the first 60 patients with duramater's prothesis. It is exposed the methodology which was utilized for these patients, in the same manner, the valve's confection technic. There are signaled the advantages, over mechanic valves, that these prothesis have, specially the no utilization of anticoagulatings, a minor incidence of tromboembolic phenomena, insignificant transvalvular gradient, major resistance to infection, central flux, minor turbulence and lower cost. It is informed about the obtained results with electrocardiographic, radiologic, phonomechanocardiographic, echocardiographic and haemodynamic postoperation studies, evolution after two years has been very good, 90% of the patients shows substantial improvement and only 30% need to take anticoagulants. There were 5 hospital deaths and 1 late death by hepatitis.


[Antihypertensive effect of the vasodilator minoxidil combined with dihydrochlorothiazide and propranolol in resistent hypertension].

The antihipertensive effect of a diuretic (dihidrochlorothiazide 100-200 mgr.), a betablocker (propranolol 20-180 mgr.) and the vasodilating agent minoxidil (25-70 mgr.), administered daily during 10-16 weeks, was asessed in 18 patients with refractory arterial hypertension (RAH). The arterial blood pressure (mm. of Hg.) differences obtained at the end of a 2 weeks diuretic period and at the end of the triple theraphy period was --53.1 +/- 18.1, p less than or equal to 0.001 (mean, standard deviation and significance) and --26.5 +/- 11.8, p less than or equal to 0.001, for clinostatic sistolic and diastolic pressures, respectively and --45.7 +/- 24.1, p less than or equal to 0.001 and --21.6 +/- 40 (p less than or equal to 0.001) for orthostatic sistolic and diastolic pressures, respectively. 66.6% of cases normalized the blood pressure at the end of the protocol. No significant changes were observed in body weight and pulse rate. In 94.4, 66.6 and 16.6% of cases appeared hypertricosis lanuginosa; edema or palpitations, respectively, as theraphy related symptoms. RAH is an entity of poor prognosis and difficult therapheutic management. In this study a significant antihipertensive response was achieved, which was superior to the one obtained in a similar population treated with other regimens in the same clinic. Despite the opposed attitude to continue the treatment exihibited by most female patients, we believe that minoxidil has enriched the therapheutic armamentarium of this dreadfull type of hypertension.


[Arteriovenous fistula and rheumatic cardiopathy].

A case of pulmonary arteriovenous fistula associated with rheumatic mitral heart disease is presented. We have reviewed the literature and no published case with such association has been described. The loud mitral insufficiency murmur hide the continuous murmur of the fistula. The angiographic study demonstrated the A-V fistula. Retrospectively the diagnosis should have been suspected due to cyanosis, slight clubbing, the radiologic findings and the important Qs/Qt shunt. The associated pulmonary embolic phenomena made more difficult the diagnosis.


Methyldopa abolishes neurally evoked contractions of the vas deferens in vitro.

Low concentrations of methyldopa (2 microgram/ml - 20 microgram/ml) reduced neurally evoked contractions of the isolated guinea-pig and the rat vas deferens. These contractions were completely abolished when the vas was incubated with methyldopa (200 microgram/ml - 400 microgram/ml) for 1.5 hr +/- 0.1 hr (guinea-pigs) and 3.0 hr +/- 0.5 hr (rats). Vasa deferentia incubated with methyldopa became supersensitive to noradrenaline and dopamine. Vas deferentia from reserpinized animals showed reduced contractions upon electrical stimulation but became supersensitive to dopamine and noradrenaline. Reserpine pretreatment diminished the response of the vas to tyramine; however, methyldopa restored the responses to a greater magnitude suggesting the formation of methyldopamine and methylnoradrenaline. The possible mechanisms of action of methyldopa is discussed.


Neuro-muscular depressant action of pindolol in comparison with propranolol and procaine.

The action of beta-adrenergic blockers on neuromuscular function has been reexamined using a recent beta-blocker pindolol (Visken), along with propranolol and procaine, on three isolated skeletal muscle preparations from the same species, frog: hyoglossus muscle stimulated through hypoglossal nerve, rectus abdominis and hyoglossus muscles using acetylcholine as an agonist. The depressant action of pindolol and propranolol was found to be non-competitive. The three test-drugs potentiated the depressant actions of d-tubocurarine and succinylcholine. The results point to a local anaesthetic mode of action of beta-blockers. Pindolol which is 10-40 times more potent than propranolol as a beta-blocker but now shown to be only one-fourth as potent in its neuro-muscular depressant action, may have lesser neuro-muscular side effects than propranolol in patients receiving high doses of propranolol for antihypertensive therapy.


[Total transposition of the great vessels associated to a peculiar preexcitation syndrome].

Following the historical introduction concerning the evolution of our present knowledge of the W-P-W syndrome, we discuss a unique case of complete transposition of the great vessels with an unusual type of pre-excitation. We attributed this excitation to an uncommonly placed bundle of Kent, which, to our knowledge, has not been previously reported as coexisting with the aforementioned congenital heart malformation. A review of the literature, a discussion of other congenital heart diseases associated with disturbances of A-V conduction, as well as the clinical and para-clinical data upon which we base our diagnosis are presented.


Purine effects at the neuromuscular junction and their modification by theophylline, imidazole and verapamil.

Interactions between some substances (theophylline, noradrenaline, imidazole, ouabain and verapamil) and adenosine or adenosine triphosphate (ATP) were examined by recording the twitch tension of partially magnesium blocked phrenic-rat diaphragm preparations stimulated indirectly. Theophylline (an inhibitor of phosphodieterases) prevented and reversed the neuromuscular depression induced either by adenosine or ATP, and these substances antagonized the neuromuscular facilitation caused by imidazole (an activator of phosphodiesterases); noradrenaline and ouabain did not modify and verapamil increased that depression. These results indicate that the putative purine presynaptic receptor is not the ATPase, that it does not appear to operate by implication of cyclic AMP, but that it could mediate a process involved in the reduction of transmitter release by regulating the entry of calcium that follows the depolorization of the motor nerve endings.


[Autoimmune hemolytic anemia induced by alpha methyldopa].

We present in this paper two cases of auto-immune hemolytic anemie caused by ingestion of alpha-metildope Coombs' test positive. We suggest to make Coombs test to every patient in whose treatment has been included the use of alpha-metildope.


Cholinergic and adrenergic innervations of the muscularis mucosae in guinea-pig esophagus.

Transmural stimulation of the isolated muscularis mucosae from guinea-pig esophagus induced contraction, which was completely inhibited by the pretreatment with atropine (o.1 microM) or tetrodotoxin (0.1 microM). In the presence of atropine, muscularis mucosae which contracted with histamine 2 microM slightly relaxed by transmural stimulation in 8 out of 20 preparations. The relaxation was inhibited by an addition of guanethidine (10 microM) or propranolol (2 microM). The vagal stimulation or an addition of nicotine also induced contractions of muscularis mucosae which were blocked by hexamethonium (20-50 microM), tetrodotoxin (0.1 microM) or atropine (0.1 microM). Using the formaldehydeinduced fluorescence technique, a few catecholamine-containing nerve fibres were observed in muscularis mucosae or in the wall of small blood vessels of guinea-pig esophagus. From these results, it is suggested that muscularis mucosae in guinea-pig esophagus is innervated mostly with excitatory cholinergic nerves, and sparsely with inhibitory adrenergic nerves, but not with non-adrenergic and non-cholinergic nerves.


Influence of R-805 on the contractility and reactivity of rat myometrium.

It has been found that R-805 reduces and then eliminates the contractile activity of the isolated rat myometrium. R-805 weakens and then abolishes the reaction of the myometrium to polypeptides (oxytocin, vasopressin, bradykinin and hypertensin). In the presence of R-805, exogenous prostaglandin F(2) alpha restores the myometrial reactivity to the investigated polypeptides. On the basis of the obtained results and data from the literature a tentative hypothesis has been put forward as to the mechanism of R-805 action on the myometrial reactivity to polypeptides.


[Mitral insufficiency after a penetrating thoracic wound. Report of a case].

It is communicated an isolated mytral insufficiency case, secondary to thorax's penetrative wound by steel arm. There are commented the clinic discoveries, phonomechanocardiographic, echocardiographic, haemodynamic and operation results of a unique orifice in the mytral's septal valve with important overflow. When perforation was sutured it was necessary reoperate it in order to suture's dehiscence and valve's substitution by a Bjork-Shilley's prothesis. The patient persists asymptomatic 35 months after intervention.


[Arterosclerosis and its prevention. The problem and its natural controversy].

It scarcely has a glimpse about the knowledge of aterosclerosis nature. About preventive recommendations, it has not yet surpassed hypothetic level, but problem is in force and requires to prove hypothetic and theoretical models that have been proposed. Everything that has been said as preventive recommendations has arisen all kind of opinions that constitute the existent controversy. Discussion is composed by the diametrically adverse points of view, in spite of that they are refered to the same data. Positive aspect that can remain is to centralize the knowledge and to comprehend best the problem nature. Controversy is a part of the collective thinking process about the theme. Obviously no one researcher has the complete solution, neither it is a lonely person work. There are exposed at the work some details of the subjacent process implicit into the term of risk factors. In order to comprehend the controversy, it is necessary to take on account the process that has been followed for the concepts formation, by no one manner it can be taken with frivolity and less to under-value it. Most part of researches on the subject agree that infancy and youthfulness are the best ages to make intervene primary prevention. There are revised these concept's bases and it is concluded that it is necessary at our ambient to acquire own experience about the theme, but we have to be very cautious at the best resources' utilization that are to our disposition.


Actometric effects of intravenous cocaine in rats.

Intravenous infusions of cocaine, in dosages which have been reported to maintain self-administration behavior, were administered to cannulated rats. Ten identical infusions were administered at 6 min intervals within a session. The activity occuriring in the initial minute following infusions was compared to that produced by saline infusions. Dosages of 200, 400, 800 and 1200 microgram/kg significantly increased activity. However, this effect was not maintained throughout the session. The tenth infusion no longer increased activity as compared to the initial infusion. Therefore these data would not support the hypothesis that cocaine-induced activity was responsible for maintaining cocaine self-administration behavior in this species. Pretreatment with agents which disrupt the synthesis of dopamine and/or norepinephrine failed to antagonize this initial increase in activity. These data would suggest that the activity effect of cocaine is not dependent on newly synthesized pools of the catecholamines.


Effect of purine compounds on the vascular responsiveness of bovine coronary and lingual arteries.

The vascular effects of several purine compounds were evaluated using isolated arteries from bovine heart and tongue. At almost all concentrations tested, adenosine, AMP, ADP, ATP, guanosine, GMP, GDP and inosine produced significant relaxation of the lingual artery. In general, these compounds were much less effective in the coronary artery. Dipyridamole and nitrobenzylthioinosine (NBMPR), compounds which block the cellular uptake of nucleosides, partially prevented the actions of these compounds in the lingual artery but not in the coronary artery. Erythro-9-(2-hydroxy-3-nonyl) adenine (EHNA), a potent inhibitor of adenosine deaminase also altered the relaxant effect of adenosine. These results suggest that at least part of the action of purine compounds on the vascular smooth muscle of the lingual artery is a result of an intracellular effect.


Comparison of various vasodilator drugs using lower body negative pressure.

The present investigations were designed to enable a differentiation in vivo between various types of vasodilator drugs by studying their influence on mean arterial blood pressure (MAP) in anaesthetized rats, simultaneously subjected to lower body negative pressure (LBNP). In anaesthetized rats the application of various degrees of LBNP caused a proportional decrease in MAP, cardiac output and central venous pressure, whereas heart rate remained unchanged. Reflex tachycardia was not observed as a result of general anaesthesia. The autonomic nervous system does not play a part in the physiological events induced by LBNP, since various pretreatments (vagotomy, adrenalectomy, pharmacological sympathectomy) did not change the response to LBNP. It is concluded that the reduction in MAP due to LBNP is a purely mechanical, haemodynamic phenomenon. Upon combined application of drugs and LBNP, vasodilator drugs which mainly dilate veins (sodium nitrite, isosorbide, nitroglycerine) were more active with respect to their hypotensive action at a LBNP of 5 mm than at 3 mm Hg. However, vasodilator drugs with a predominantly arterial site of action (hydralazine, papaverine, phentolamine, diazoxide) were more potent at a LBNP of 3 mm than at 5 mm Hg. This different behavior may be used to discriminate in vivo between various types of vasodilator drugs. The method is accurate, reproduci0le and relatively easy to perform.


On the possible role of adenosine in the hypoxia-induced alterations of the electrical and mechanical activity of the atrial myocardium.

The effects of adenosine on transmembrane potential and myocardial contractility were compared with those of hypoxia in electrically driven left atrial preparations of guinea-pigs. The amplitude and duration of action potential, contractile force and maximum rate of rise of tension development were decreased by both adenosine and hypoxia. Both the adenosine- and hypoxia-induced changes could readily be prevented by aminophylline, a competitive antagonist of adenosine. Serious changes of transmembrane atrial potential due to long-lasting hypoxia could also be reversed by aminophylline. On the basis of the present results it is assumed that in acute myocardial hypoxia the increased tissue level of adenosine might contribute to the functional impairment of the atrial myocardium.


The effects of cortisol on protein metabolism and on transfer ribonucleic acid methylase activity in rhabdomyosarcoma of rats.

The effects of cortisol on protein metabolism were examined in rhabdomyosarcoma tissue, experimentally provoked in rats by a single intramuscular injection of cobalt powder into the adductor muscle of the hind limb. In vivo treatment of tumour bearing animals with 1 and 10 mg cortisol resulted in a reduced incorporation of [2-14C] glycine into the tumour proteins. In vitro application of 0.01 to 100 micrograms cortisol on tumour slices equally reduced the amino acid incorporation into the proteins. These inhibitions could not be explained by modifications in protein, RNA, DNA content or by changes in the membrane function. The factors inhibiting the amino acid incorporation into tumour proteins could be located in the 105,000 X g supernatant protein fraction. The tumour transfer RNA methylase activity became markedly inhibited by cortisol treatment.


Hemodialysis in the eighth and ninth decades of life.

In a review of 45 patients who started receiving hemodialysis (HD) after the age of 70 years (mean, 75 years), compared with a control of 70 HD patients (mean age, 42 years), the two-year survival for elderly patients was 42% and 58% for controls. In the elderly group, age did not correlate with survival. Nine elderly patients were over 80 years old and had a two-year survival of 41%. The elderly patients had a significantly lower mean predialysis blood pressure (BP) (142/73 +/- 3/1 mm Hg) than the controls (158/88 +/- 2/1 mm Hg) (P less than .001). Only 13% of the elderly patients received antihypertensive medication, compared with 41% of controls (P less than .01). The BP showed a significant negative correlation with age in both elderly ( r - .41, P less than .01) and control (r = .35, P less than .001) patients. Glomerulonephritis was less common in the elderly (9%) than control (31%) groups, and pyelonephritis was more common (29% vs 16%).


Diabetes insipidus and breast cancer.

Diabetes insipidus, resulting from metastatic involvement of the neurohypophysial system, is a rare complication of breast cancer. This review examined the clinical features, metastatic pattern, and radiological and postmortem findings of 39 breast cancer patients with this complication. All patients had polyuria and polydipsia, and all had evidence of advanced metastatic breast cancer. A high incidence of meningeal carcinoma carcinomatosis and/or sellar metastases was observed. In view of the anatomical proximity of the posterior pituitary to the dura mater and the sella turcica, our findings suggest that metastases to the neurohypophysis can occur not only as a result of hematogenous dissemination of malignant cells, but also from direct tumor extension and/or invasion from adjacent structures. Although satisfactory symptomatic relief can be obtained with vasopressin tannate, complete resolution of the diabetic insipidus syndrome was evident only in those patients who had achieved control of the underlying breast disease.


Clinically occult diffuse proliferative lupus nephritis. An age-related phenomenon.

Thirteen patients with systemic lupus erythematosus (SLE) who had normal results of urinalysis, absence of proteinuria, and normal serum creatinine values underwent renal biopsy. Three of 13 patients had diffuse proliferative glomerulonephritis (group 1). Biopsy specimens showed segmental fibrinoid necrosis, diffuse mesangial hypercellularity, and substantial immunoglobulin deposition. Group 2 comprised those patients whose histologic findings did not portend a poor prognosis. Four had mesangial proliferative glomerulonephritis, three had focal proliferative glomerulonephritis, and three had minimal mesangial widening. The values of inulin clearance in group 1 did not differ significantly from those in group 2. Patients in group 1 had a mean age of 19 years, a value significantly lower than in group 2 (41.8 years). Review of previous reports also supports the thesis that this phenomenon is age related. Our study underscores the importance of renal biopsy in patients with SLE despite the absence of clinical evidence of renal involvement, particularly in patients under 30 years of age.


Serious staphylococcal infections with strains tolerant to bactericidal antibiotics.

The clinical response in 20 cases of serious staphylococcal infection was compared with the in vitro resistance or "tolerance" of the infecting Staphylococcus to killing by antibiotics used in treatment. Cases were divided into two groups: (1) patients who initially received nonbactericidal antibiotics (ten cases), and (2) patients who initially received bactericidal antibiotics with or without nonbactericidal antibiotics. Mortality due to uncontrolled staphylococcal infection was 40% (4/10) in group 1 as compared with no mortality (1/10) in group0) in group 1 as compared with no mortality (0/10) in group 2. The duration of positive cultures after start of therapy in group 1 (mean, 6.1 days) was significantly longer than that in group 2 (mean, 1.3 days). The duration of fever after start of therapy in group 1 was not significantly different when compared with group 2.


Myocardial infarction in pregnancy associated with a coronary artery thrombus.

The case of a 36-year-old multigravid woman in whom acute myocardial infarction developed at five months post partum is described. Coronary angiography performed 11 days following myocardial infarction demonstrated a thrombus-like lesion in the coronary artery branch supplying the area of myocardial damage with no other evidence of coronary artery disease. This finding suggests that the development of a coronary artery thrombus is part of the mechanism of myocardial infarction in this case where the phenomenon of angiographically normal coronary arteries following myocardial infarction has bee- described. The mechanism leading to the development of a coronary thrombus in pregnancy is obscure, but may be similar to other clotting abnormalities complicating the third trimester and puerperium.


Severe anemia. Clinical observations in 100 patients with very low hemoglobin levels.

One hundred consecutive patients with hemoglobin concentration less than 3.5 g/dL (hematocrit reading, less than 10%) were admitted to the University of Baghdad Teaching Hospital, Iraq, during a 30-month period. Twenty-eight patients had aplastic anemia, 27 had leukemia or other hemopoietic malignancies, 16 had chronic renal failure, eight had iron-deficiency anemia, eight had hemolytic anemia, seven had thalassemia major, and six had other conditions. Twenty-three patients died within seven days of admission, mostly due to the underlying disease or complications thereof. Heart failure developed in ten patients, and five had retinal exudates and hemorrhages attributed to severe anemia. Arrhythmias and ECG abnormalities were noted in 20 of 68 patients. Blood transfusion was instituted in all but three patients, whose anemia was corrected with specific therapy without blood transfusion. The tolerance of the 100 patients to such severe anemia was remarkable.


Inferior vena cava obstruction. A complication of prostate cancer.

Inferior vena cava (IVC) obstruction, manifested as bilateral, asymmetric, asymptomatic, pitting leg edema and scrotal swelling, developed in two patients with advanced prostatic cancer. Radiological confirmation was obtained in both patients. Inferior vena cava obstruction was the initial manifestation of disease progression and occurred in patients who were ambulatory without evidence of congestive heart failure or concurrent estrogen therapy. Early IVC contrast study is indicated in similar patients in whom asymptomatic bilateral leg edema of obscure origin develops.


Upper extremity lymphedema in filariasis.

Arm lymphedema associated with shoulder pain and axillary lymphadenopathy was diagnosed in a 40-year-old California man. This is an unusual domestic presentation of filariasis, an endemic tropical disease that is often asymptomatic and undiagnosed. Prognosis for recovery is excellent with the diethylcarbamazine citrate treatment indicated for hemoparasitemia.


How big is the normal liver?

Ultrasonographic determinations of the craniocaudal dimension of the liver in the right midcalvicular line were performed on 96 healthy subjects. These values were compared to those obtained in the same individuals by two techniques of percussion, as well as the values for hepatic dullness predicted for those individuals using a popular nomogram. It was found that the traditional nomogram values, and both techniques of percussion, tended to underestimate this dimension of the liver as determined by ultrasound.


Adult bacteremic Haemophilus parainfluenzae infections. Seven reports of cases and a review of the literature.

Seven cases of adult Haemophilus parainfluenzae infections diagnosed by positive blood cultures are compared with cases previously reported in the English literature. Three patients had pneumonia, while the others had epiglottitis with meningitis, pharyngitis, arthritis, and endocarditis, respectively. Nonendocarditic manifestations of adult H parainfluenzae infection were reported in four other cases. In addition to the diseases of our patients, H parainfluenzae also has been isolated from cerebral abscesses. Patients did well with antibiotic therapy and there were no deaths. Patients did well with antibiotic therapy and there were no deaths. Report of antibiotic sensitivity testing of 50 strains disclosed 6% of isolates resistant to ampicillin sodium, with all sensitive to chloramphenicol. If the antibiotic sensitivity of the organism is unknown, then chloramphenicol therapy should be instituted until adequate susceptibility studies have been performed. If the organism is sensitive to ampicillin, then this is the drug of choice.


Results of parathyroidectomy for autonomous hyperparathyroidism.

Autonomous hyperparathyroidism occurred in 15% of 152 patients maintained by long-term home dialysis during the past nine years. Twenty-two patients with elevated serum parathormone levels and progressive bone disease in the presence of normal serum phosphate and calcium levels were treated by subtotal parathyroidectomy. All had parathyroid hyperplasia. Eighteen of the 22 patients are presently alive and undergo dialysis. Symptoms of bone pain, pruritus, and muscle cramps had improved in three fourths of the patients. The serum parathormone level decreased from a preoperative average of 576 muLEq/mL to an average of 188 muLEq/mL postoperatively. All 18 patients, observed for six to 77 months, showed improvement in x-ray films of their bone disease. The autonomous hyperparathyroidism of end-stage renal disease is corrected by subtotal parathyroidectomy, and the effect is sustained.


Circulating levels of vasoactive intestinal polypeptide in liver disease.

In animals, the effects of vasoactive intestinal polypeptide (VIP) include peripheral vasodilation, hyperdynamic circulation, hyperglycemia, and hyperventilation. Because these phenomena are noted in patients with cirrhosis, it has been postulated that VIP might be escaping hepatic inactivation and entering the systemic circulatory system and contributing to these abnormalities. The major purpose of this study is to establish whether or not VIP levels are elevated in patients with cirrhosis. Additional goals are to determine if VIP levels are elevated in acute liver disease and in chronic illnesses with secondary liver involvement. The data demonstrate that patients with cirrhosis and those with acute liver disease or chronic illnesses with secondary hepatic involvement have a wide range of VIP levels with mean values significantly above that of normal individuals and patients with chronic illness and no liver involvement.


Effect of hemodialysis on glucose tolerance in children with chronic renal failure.

Five uremic (7.0 - 15.2 years), non-dialyzed children treated medically (group 1) had an intravenous glucose tolerance test (0.5 g/kg). Blood samples were obtained at frequent intervals and duplicate determinations of plasma glucose (glucose-oxidase method on Somogyi-Nelson protein-free filtrates), insulin and free fatty acids were performed. The same study was performed in eleven children (12.3 - 18.0 years) with chronic renal failure undergoing long-term hemodialysis (group 2), before and two hours after dialysis. Results were compared to a group (group 3) of eight healthy children (7.5 -- 17.5 years). In group 1 a "normal" insulin response was observed in the presence of hyperglycemia and the plasma glucose clearance was in the diabetic range. Twice weekly hemodialysis produced no beneficial acute effects on group 2, based on absolute glucose values or plasma glucose clearance rates, on groups as well as on individual basis; however, a clear hyperinsulinemia was present which was of even higher magnitude three and six months after the initial study. These results demonstrated that chronic hemodialysis had no beneficial acute effects on plasma glucose concentration or plasma glucose clearance rate. However, it may have obvious long term beneficial effects on glucose tolerance by enhancing pancreatic insulin release (to overcome peripheral insulin resistance) to such an extent as to maintain a normal carbohydrate tolerance.


Acute autonomic neuropathy.

Case report of acute autonomic neuropathy. It is the twelfth case reported in literature and the second case associated to positive serological tests for infectious mononucleosis. We are reporting for the first time plasma renin activity, decrease response to repetitive pacing of the S-A node, insulin curve with radio-immunoassay and cardiac catheterization findings.


The form of early development. Continuity and discontinuity in emergent competences.

Conceptions of psychological development devised by Western theorists have assumed connectivity of stages, stability of acquired structures, and continuity of process, and have resisted the possibility that some emerging psychological qualities might have relatively short histories. Empirical studies of the first two years of life suggest that the enhancement of retrieval memory at 8 to 10 months of age, the emergence of a linguistic set at 15 to 18 months of age, and sensitivity to standards of competence prior to the second birthday are emergent human competences that may not necessarily have a historical link to the events of early infancy. Developmental theorists should be as receptive to sequences that are relatively discontinuous as they are to those that are gradual and cumulative.


A comparative trial of home and hospital psychiatric care. One-year follow-up.

The effectiveness of community-based treatment stressing home care was compared with hospital-based psychiatric care. One hundred and fifty-five patients destined for inpatient psychiatric care were randomly assigned to Home Care (76 patients) and to Hospital Care (79 patients). Symptoms, role functioning, and psychosocial burden on the family were similar at admission, one month, three months, six months, and one year. The mean in-hospital stay of Hospital Care patients was 41.7 days compared with a mean stay of 14.5 days for Home Care patients. The difference in the amount of ambulatory care received by patients in the two groups was not significant. The evidence is consistent: community-based psychiatric care is an effective alternative to hospital-based care for many but not all severely disabled patients. The active ingredients of successful community treatment are known, yet the lag in implementing these programs persists.


Novel antidepressants and the biogenic amine hypothesis of depression. The case for iprindole and mianserin.

The introduction of two tricyclic compounds (iprindole and mianserin) that are reported to have antidepressant properties but to be relatively devoid of effects on central amine neurotransmitter systems has raised questions about the amine hypothesis of depression and about the mechanism of action of tricyclics in general. In view of the importance of these questions, a critical review of both the clinical and pharmacological profiles of iprindole and mianserin was undertaken. Iprindole is a relatively weak inhibitor of both norepinephrine (NE) and serotonin, whereas mianserin possesses at least modest potency as an inhibitor of NE uptake. However, the evidence is as yet insufficient to prove the superiority of iprindole over placebo in the treatment of those depressions characterized by endogenous symptoms. In considering the pharmacological profiles of these two drugs together with their clinical profiles, the data are not inconsistent with the hypothesized role of biogenic amines in major depression.


Urinary MHPG levels and tricyclic antidepressant drug selection. A preliminary communication on improved drug selection in clinical practice.

The 24-hour urinary 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG) output was used as the basis for selection of tricyclic antidepressant drug therapy for the depressed patient population treated by one psychiatrist over a period of ten months in a psychiatric clinic. Use of MHPG output level as the criterion for drug selection resulted in significantly better clinical results than had been obtained previously by the same psychiatrist using more traditional selection methods on a similar depressed patient population. A correlation was noted between patients' pretreatment MHPG output levels and three symptoms of depression (guilt, agitation, and diurnal variation) as measured on the Hamilton Rating Scale for Depression.


Suicide in Britain. More attempts, fewer deaths, lessons for public policy.

The steady reduction in suicide deaths in Britain from 1963 to 1971 might superficially be credited to systematic programs to reduce suicidal behavior; but the actual saving of lives does not reflect the real upward trend in total suicidal behavior. The number of would-be suicides was in fact increasing steadily, while the proportion of fatal outcomes was being reduced, probably because the methods most commonly used for suicide had become less lethal and methods of resuscitation had improved. Attempts to reduce the amount of suicidal behavior by psychiatric treatment and by suicide prevention programs (primary prevention) seem therefore to have had little measurable impact so far. Although reduction in deaths (secondary prevention) is a more limited goal, the evidence presented justifies more systematic and deliberate efforts to reduce the lethality of the methods available.


Specific vs nonspecific factors in psychotherapy. A controlled study of outcome.

This study explored the relative contribution of the therapist's technical skills and the qualities inherent in any good human relationship to outcome in time-limited individual psychotherapy. Highly experienced psychotherapists treated 15 patients drawn from a relatively homogeneous patient population (male college students, selected primarily on the basis of elevations on the depression, anxiety, and social introversion scales of the Minnesota Multiphasic Personality Inventory). By traditional diagnostic categories, they would be classified as neurotic depression or anxiety reactions. Obsessional trends and borderline personalities were common. A comparable patient group was treated by college professors chosen for their ability to form understanding relationships. Patients treated by professors showed, on the average, as much improvement as patients treated by professional therapists. Treated groups slightly exceeded the controls. Group means, however, obscured considerable individual variability.


Significance of serum fucose, sialic acid, haptoglobine and phospholipids levels in the evolution and treatment of breast cancer.

Serum fucose, sialic acid, haptoglobine and phospholipids were determined in 167 women with breast cancer stages I--III, 30 with benign lesions of the breast, 42 women in various physiological states of the mammary gland (pregnancy, early childbed and lactation) and compared with 30 healthy women as control. Serial determinations of these parameters during the radio-surgical treatment were done in 28 patients with breast cancer stage III. Fucose and phospholipids levels were significantly increased respectively decreased in the group of patients with breast cancers but unmodified in the others. Sialic acid and haptoglobine -- increased in patients with cancer -- were also elevated in patients with early childbed and benign affections of the breast. The surveillance of these four parameters during the radio-surgical treatment of breast cancer evidenced a good correlation between their modified levels and clinical state of the patients. The increase in fucose, sialic acid and haptoglobine respectively the decrease in phospholipids levels was associated with the clinical evidence of recurrences and metastases.


[Interference microscopic determinations of dry mass of cell nuclei of normal and dysplastic epithelium, carcinoma in situ and cervical carcinoma cultivated in vitro (author's transl)].

Dry mass of cell nuclei was studied in 34 explant cultures of normal epithelium (8), persisting dysplasias (7), Ca in situ (9) and cervical carcinomas (10) by interference microscopic determination. Dysplasias, Ca in situ and carcinomas can be distinguished from normal epithelium by a significantly higher dry mass value. Such a difference does not exist between dysplasia and Ca in situ. The percentage of dispersion of the dry mass is significantly higher in carcinomas than in all other examined tissues. The biological meaning of these results is discussed. The interference microscopic determination of dry mass of the cell nuclei is a suitable parameter for the characterization of properties of cervical carcinomas and their intraepithelial prestages cultivated in vitro.


[On the problem of the "more early" diagnosis of spinal cord tumours in children and infants (author's transl)].

A report is given on 40 spinal cord tumours in children and infants, the diagnosis of which was considerably delayed in part. 28 children were hospitalised because of fixed paralysis, incomplete or complete compression of spinal cord or cauda. Persisting pain in various sections of the spine, often combined with abnormalities in posture and position are suspicious on tumour as long as another cause is proved. X-ray pictures and analysis of lumbarcerebrospinal fluid are in the most cases of decisive importance for a progressing diagnosis. Myeloscintigraphy is specially useful for an early and exclusing diagnosis.


[Clinical administration of BCG-immunotherapy in malignant melanoma (author's transl)].

In the Department of Dermatology of the University of Jena 60 patients with malignant melanoma received the immunotherapy by means of the BCG high-dosis scarification method after maximum surgical removal of the tumour. The results after 3 years of treatment demonstrate that the BCG strain Jena can cause immunostimulation. Rates of remission and survival could be well influenced. No serious side effects were observed.


[Hyaluronic acid in pleural fluids: an additional parameter for clinical diagnosis on diffuse mesotheliomas (author's transl)].

187 pleural fluids of various etiology are examined with the intention to find hyaluronic acid. The colorimetric method of Morgan-Elson was used for this purpose. The mucopolysaccharid was identified in 34 cases: 18 in 30 cases of diffuse mesotheliomas 1 in 74 cases of secondary tumours of the pleura 8 in 20 cases of tuberculous pleurisy 5 in 37 cases of nonspecific pleurisy 2 in 6 cases of purulent pleursy. A level from more than 212 mg/litre was detected in 10 cases of mesotheliomas only. Such a concentration is consequently the proof for diffuse mesothelioma. The diagnostical improvement in other cases of mesotheliomas resulted from a combination of the following parameters: coagulation of protein by the method of Weltmann, cytological investigation of cellsedimentation and measurement of hyaluronic acid. Our experience with the diagnosis of diffuse mesotheliomas is discussed also in account to the results which are published since 1965 from a scientific team working in Lille, France, reporting the value of detection and measurement on hyaluronic acid in pleural fluids.


[Endocarditis in cancer necropsies (author's transl)].

Terminal endocarditis develope in cancer patients almost latently. There is no difference between the so-called "tumor-endocarditis" and other verrucous endocarditis associated with terminal tuberculosis, sepsis or rheumatism. It is more frequent in cases with large or ulcerated primary tumours and multiple metastases than in cases with early cancer. It also develope more frequently in well differentiated cancer (squamous and adenocarcinoma) than in indifferentiated forms of cancer. Terminal endocarditis is often seen in patients with cancer of the gallbladder, pancreas, liver, stomach, rectum, and ovary. In carcinoma of the liver, pancreas and biliary tract the trend to embolism is more reduced through icterus than the trend to terminal endocarditis.


[The lymphocyte transformation test and its relation to the duration of disease in patients with oral carcinomas (author's transl)].

Cell mediated immune reactions take an increasing part for the progress of malignant tumors besides numerous other factors. With support of the lymphocyte transformation test a significant difference was pointed out between orofacial tumors with long course and a control group of healthy persons by means of the interpretation of the PHA (phythemagglutinin)-stimulation. These results are to find indicated also in comparison of the antigen preparation with candidin in tumors with long course.


[Germinating capacity of Clostridium butyricum Jena H 8 in transplantation tumors (author's transl)].

Following parenteral application of spores of Clostridium butyricum their intratumoral germination and oncolysis were demonstrated on a variety of mouse transplantation tumors. The germination and propagation of the clostridia was restricted exclusively to the tumor tissue, they could not be demonstrated bacterioscopically in parallelly run normal tissue specimens. The observed differences of germination and lysis rate are due, in part, to tumor host and transplantate-specific properties.


Cytotoxic action of diethanolamine oleate on Ehrlich exudative carcinoma in mice, compared with the action of polyoxyethylene sorbitan mono-oleate (Tween 80).

The salt of oleic acid and diethanolamine, and polyoxyethylene sorbitan mono-oleate inhibited growth of Ehrlich exudative carcinoma in mice.


The influence of 6-hydroxydopamine and 6-hydroxydopa on the phospholipids content in the brain of rats.

6-hydroxydopamine and 6-hydroxydopa injected intraperitoneally in dose of 50 microgram/g in newborn rats, two and six weeks old caused a drop in content of phosphatidylcholine and phosphatidylserine, and an increase in content of phosphatidylinositol in the brains of two weeks old rats treated with 6-hydroxydopamine in comparison with controls. 6-hydroxydopa administration caused an increase of the content of phosphatidylcholine and phosphatidylinositol and decrease of diphosphatidylglycerol in the brain of two weeks old rats. In the brains of six weeks old rats only a decrease in content of phosphatidic acid was observed after administration of either 6-hydroxydopamine or 6-hydroxydopa. The results are further evidence of a nonspecific toxic action of both compounds.


Influence of chlorpromazine, diazepam, imipramine and pyrazole on ethanol-induced changes in activity of some enzymes in isolated rat liver.

Studies on the isolated rat liver showed distinct interaction of chlorpromazine, diazepam and imipramine with ethanol. Injected intraperitoneally in doses of 20 mg/kg, these drugs distinctly influenced elimination of ethanol, although not as strongly as pyrazole in vitro in the concentration of 20 mg/100 ml. On the other hand, ethanol altered the effect of these substances on the glucose curve, lactate and pyruvate levels, and activities of glutamic pyruvic and oxalacetic transaminases and aldolase.


A temporal profile of changes in myocardial manganese after isoprenaline induced cardiac necrosis in albino rats.

Myocardial-necrosis was produced in two groups of albino rats by subcutaneous injection of isoprenaline in doses of 85 mg/kg and 42.5 mg/kg. The necrosis was confirmed by ECG changes, increased serum activities of AspAT, AlAT, GPT and LDH, and by histological examination. Myocardial manganese after isoprenaline administration was estimated over a period of 5 days. The decrease in myocardial manganese was proportional to the extent of cardiac damage. The possible mechanisms and the importance of these changes are discussed.


Central action of new imido derivatives of succinic acid.

New imido derivatives of succinic acid were screened pharmacologically with regard to their influence on the central nervous system. No relation was found between the character and position of substituents and depressant action on the CNS. However, it was remarked that potentiation of the central influence of DOPA probably depends on the position of the p-chlorophenyl group.


Central action of new derivatives of tetrahydropirimidinedione-4,6.

The central action and LD50 of 11 new 2,5-substituted derivates of tetrahydropirimidinedione-4,6 with an aryl group at C2 were investigated. The most favorable action was exerted by 2-furfurylamine derivatives with an alkil or benzyl group at C5. These compounds acted in doses of 0.0025--0.01 of their LD50 synergistically with chloral hydrate and strongly with hexobarbital, delayed convulsions induced with pentetrazole and potentiated the central action of DOPA in mice pargyline-inhibited MAO activity. They did not antagonize electrogenic convulsions, amphetamine potentiated motility and the action of reserpine, and had no analgetic action. Their LD50s were 670-- 1660 mg/kg.


Acetabular reinforcement in total hip replacement.

In conclusion, based on our experimental and clinical material and analysis of failures, we recommend wire mesh reinforcement and bone graft for patients with mild to moderate protrusio. If the floor is strong but the pillars deficient, then the Eichler ring alone is the best implant. The combined system of wire mesh and Eichler ring should be used in cases of protrusion with a large deficiency of the acetabular floor and for protrusio with pillar weakness. Furthermore a bone graft should be used to reinforce the acetabular floor in addition to any prosthetic device.


[Differential diagnosis of a metastasizing adamantinoma of the tibia and fibula (author's transl)].

A case of an adamantinoma of the tibia and fibula is described in a 10-year-old girl who died after 17 years with pulmonary metastasis. For a long time, an exact diagnosis couldn't be made. Histologically the lesion was called chronic osteomyelitis (Brodie's abscess), synovial sarcoma and spindle cell sarcoma. The revision of the histological sections revealed a fibrous dysplasia-like pattern in the first lesion of the tibia with tiny foci of an epitheloid-like pattern. This had could be the key to the right diagnosis, because sometimes adamantinoma of long bones is associated with a fibrous dysplasia-like pattern. The reason for misinterpretation of the histological features is seen in the typical variable histological pattern of this tumor (basaloids, squamoid, spindled and tubular pattern). In this connection is refered to the necessity to correlate the histological feature with the X-ray in making diagnosis in bone pathology.


[Dedifferentiation of chrondrosarcomas (author's transl)].

The clinical course and the results of radiographic and histological investigations in three patients with dedifferentiated chondrosarcoma are presented. The tumors were characterized by chondrosarcomatous tumor sections of low grade malignancy adjacent to fibrosarcomatous tissue sections. One to two and one-half year after the onset of the first clinical symptoms pulmonary metastases appeared and in one case a subcutaneous mass presented, which had the histological appearance of a fibrosarcoma. Differentiation of a chondrosarcoma customarily has an adverse effect on the prognosis with both the early appearance of metastases and a rapidly fatal clinical course. Cartilagenous tumors of the axial skeleton and the long bones must be extirpated surgically in an early and radical fashion, particularly if there are radiographic signs of proliferation.


Intramuscular neurolysis for spasticity in children.

Intramuscular neutrolysis with phenol has been used for 10 years in the management of spasticity in children. Best results depend on fastidious technique and realistic use of the procedure. Sedation or anesthesia was used in all cases -- 5% phenol in water was used for all procedures. The main indications were spasticity which interfered with function, either actual or potential, or with care. Where uninhibited vestibular or tonic neck reflexes affect muscle tone, or there is dystonia or athetosis, the procedure is less effective than where spasticity alone is present. Duration of relief of spasticity ranged from 1 month to more than 2 years. About one half of the lower extremity muscle treated required tenotomy later. Generally training was required after the procedure to obtain improved function. A representative sample of muscles treated, repeat procedures, and later surgery is discussed. The procedure is recommended for use in the management of spasticity in children as a way of improving function and/or care.


Autonomic hyperreflexia and its differentiation from pheochromocytoma.

Conceivably pheochromocytoma may have to be differentiated from autonomic hyperreflexia as the cause of paroxysmal hypertension. Elevated urinary catecholamine metabolites may occur in both conditions. However, marked elevations of serum dopamine-beta-hydroxylase (DBH) accompanied by relatively slight elevations of plasma catecholamines are observed during hypertensive paroxysms in patients with autonomic hyperreflexia, while marked elevations of plasma catecholamines with little if any change in serum DBH concentration are characteristic of hypertensive paroxysms caused by pheochromocytoma.


Electrode implantation and electrostimulation in rabbits.

The investigators studied functional electrostimulation by means of an implanted electrode placed around the peroneal nerve in rabbits. Current pulses were administered from a stimulating unit outside the body, via a connecting skin plug and subcutaneous leads to the electrode. It is concluded that if this form of stimulation is to be praticable without undesirable results, certain mechanical problems require further study.


Funicular localization in partial median nerve injury at the wrists.

The funiculi of the median nerve at the wrist carrying the motor and sensory fibers innervating the hand were described in 1945 by Sunderland after an extensive anatomic study. In an attempt to confirm clinically the findings of that study, 7 patients with partial median nerve laceration at the wrist are presented. The findings in these patients support the schema developed from Sunderland's study except for the funiculi subserving the 1st and 2nd lumbricals which appear to be more dorsally placed. They also tend to confirm Sunderland's finding that the mixing of nerve fibers from different funiculi and the formation of intraneural plexuses occur more proximal than at the levels of injuries in the patients studied.


Fractures in patients with myopathies.

During the past 4 years, 15 fractures in 10 patients were encountered among 48 hospitalized patients with myopathies. The dominant sites were the femur (supracondylar) and humerus (subcapital). By assessing the total body potassium volume, bone mineral content, serum calcium, inorganic phosphorus, 25-OH vitamin D3, parathyroid hormone, and calcitonin, it is concluded that the proclivity to fracture in myopathic patients is caused by bone atrophy due to a lack of muscle tension related to decrease in muscle volume.


Lumbar fracture-dislocation related to range-of-motion exercises.

Range-of-motion exercises are an established and widely accepted therapeutic modality in the treatment of the person with spinal cord injury and are usually uneventful. Occasionally, however, accidents do occur; among them are fractures and dislocations of limbs. An unusual "slice" fracture of L4, related to range of motion exercises, occurred in a young man who was a quadriplegic and converted him from upper to lower motor neuron bowel, bladder and sexual function. This iatrogenic fracture, although extremely rare, can be prevented if symptoms are properly interpreted.


Adjustment of homosexual and heterosexual women: a cross-national replication.

British homosexual and heterosexual women were evaluated on the same adjustment inventories used with two similar U.S. groups. The results of both studies were quite parallel, and the findings again supported similarities rather than differences in adjustment between homosexuals and heterosexuals.


Sex hormones and female homosexuality: a critical examination.

To ascertain the validity of hormonal theories of human homosexuality, which are based on animal research, this article reviews psychoendocrine data on lesbian and transsexual women. Sex hormone levels were found to be normal in the majority of homosexual women, but about a third of the subjects studied had elevated androgen levels. In women with prenatal androgen excess, heterosexuality appears to be more frequent than bisexuality, and exclusive homosexuality is rare. Two recent reports suggest abnormalities of the neuroendocrine regulation of LH secretion in female transsexuals. Clearly, prenatal or postpubertal hormone levels do not determine the development of sexual orientation, but a facilitating neuroendocrine predisposition cannot be ruled out at present.


Group treatment of single males with erectile dysfunction.

Nine men with chronic erectile dysfunction (three primary, six secondary) who had no regular sexual partner were treated in two 12-session all-male psychoeducational therapy groups. Treatment intervention addressed specific factors which inhibited adequate sexual function with a focus on coping skills to overcome those factors. Pre, post, and follow-up behavioral self-report data and responses on a goal attainment scale questionnaire indicated that the treatment groups were successful for five men with secondary and one man with primary erectile dysfunction. Subjective report and pre- and posttreatment fantasy productions to TAT cards for the first group indicated that all men significantly improved their attitudes about sexuality and their sexual self-concept. The results suggest that this is a viable, cost-effective treatment for secondary erectile dysfunction, but not for primary erectile dysfunction unless supplementary individual therapy is provided.


Coital and contraceptive behavior of female adolescents.

Structural interviews conducted with 532 female clients of a teen contraceptive clinic revealed a moderate level of coital activity i(in terms of both frequency of intercourse and number of partners) which typically began at age 15. Prior use of contraception was sporadic and almost exclusively confined to nonprescription methods. Primary reasons for nonuse of birth control included fear of lessening the pleasure of intercourse and lack of access to contraception. The data indicate that a combination of comprehensive sex education and ready access to birth control is necessary to prevent unintended adolescent pregnancy.