Diabetic mortality in Edinburgh.

A prospective study of mortality in 3,113 diabetics was carried out in Edinburgh over a period of eight years; 1,272 patients (41 %) died. Death rates for females equalled those for males and, in relation to the general population, there was a considerable excess mortality which was greater for females. Statistical analysis indicated that the important mortality risk-factors are age, duration of diabetes of greater than ten years and treatment. The risk of oral therapy or insulin were approximately equally greater than that of diet therapy and probably reflected severity of disease. Using international coding for diagnosis, 27 % of deaths were classified as directly due to diabetes and 49 % to vascular disease. Reclassifying the terminal cause of death left only 26 patients (2 %) recorded with diabetes as the direct cause of death. Three hundred and thirty five males (66 %) and 561 females (73 %) died of vascular disease. There was a predominance of myocardial infarction in males and cerebrovascular disease in females. These percentages were a little lower when post-mortem information was available. These results provide additional evidence that diabetes reduces life expectancy by inducing premature vascular disease and that the effect is greater in women than in men.


High molecular weight substances with insulin immunoreactivity.

Substances which react with anti-insulin antibodies, but have a higher molecular weight than insulin are described. They have been studied by various authors in pancreatic adenomas, pancreas extracts, serum and cell-free systems. Proinsulin was the first of these products to be discovered, followed by its precursor, pre-proinsulin, and subsequently by a whole series of substances of ill-defined composition and more or less similar properties, grouped under the heading of "high molecular weight immunoreactive insulin" (HWIRI).


Fluorescein angiography in borderline diabetics.

Fluorescein angiography was performed in twenty three men with impaired oral glucose tolerance (borderline diabetics) and sixteen matched, normoglycaemic controls. Retinal abnormalities (microaneurysms and leakage of dye) were observed in 18.7% of the controls, 41.6% of sustained borderline diabetics and 54.4% of initially borderline diabetics who subsequently "worsened to diabetes". Qualitatively the abnormalities were similar in each group. Although the difference in frequency between the sustained borderline diabetics and the controls does not achieve conventional statistical significance, other studies quoted support the conclusion that moderate impairment of glucose tolerance is associated with a raised frequency of minor retinal abnormalities. The significance of these remains to be determined.


Retinal fluorescein angiography and hemoglobin A1C in borderline diabetes.

In a controlled study fluorescein angiography of the retina and measurements of hemoglobin A1C were carried out in subjects with slightly abnormal two-hour glucose tolerance and controls with normal glucose tolerance. Fluorescent dots were present in 50 per cent of the series with a reduced glucose tolerance. Leakage from retinal vessels was noted in 20 per cent. In the control group fluorescent dots were present in 25 per cent, of whom none showed leakage. In neither of the series did any subject display ophthalmoscopically visible signs of diabetic retinopathy. In the subjects with abnormal glucose tolerance the mean concentration of hemoglobin A1C was 5.88% +/- 1.15 (SD) and in the control group 5.11% +/- 0.85 (SD) (P less than 0.05) . No correlation was demonstrable between the number of fluorescent dots, hemoglobin A1C and age in the group with abnormal glucose tolerance, but a relationship was noticed between a hereditary disposition to diabetes mellitus and presence of fluorescent dots. Smoking appeared not to have any influence. The result of the present study indicates that incipient retinal microvascular changes and evidence of an early breakdown of the blood-retinal barrier may be present in subjects before diabetes becomes manifest.


Netilmicin: clinical evaluation of efficacy and toxicity of a new aminoglycoside.

The efficacy and toxicity of netilmicin, a new semisynthetic aminoglycoside, was clinically evaluated in fifty-two patients with moderate to severe infections with Gram-negative rods or Staph. aureus. Average duration of treatment was 14 days and mean total dose 2,960 mg. One-hour mean value of netilmicin serum concentration was 6.4 microgram/ml and mean trough value 1.2 microgram/ml. Forty-four patients were cured or improved. In twenty-one of them the effect could be attributed to netilmicin alone; the other twenty-three had a combined therapy. No improvement took place in five, but four of them could not be regarded as netilmicin failure. One patient with Pseudomonas aeruginosa infection was possible failure. The sensitivity of the causative bacteria to netilmicin was studied and compared with amikacin, gentamicin, sisomicin and tobramycin. Vestibular function and hearing acuity was thoroughly examined by electronystagmography and audiography. Drug-related VIIIth nerve damage could not be confirmed in any of our patients. Five patients showed a rise of serum creatinine of 30 mumol/l. This shows that netilmicin, similar to other aminoglycosides, is a potential nephrotoxic drug. Netilmicin appears to be an efficacious aminoglycoside and the oto- and nephrotoxicity is low, if careful attention is paid to the renal function and the serum concentrations of the drug.


Amoxycillin injection in the treatment of pyogenic meningitis in children.

An open trial of the use of amoxycillin injection in the treatment of pyogenic meningitis in children showed similar results to previous trials here of penicillin-chloramphenicol combinations. It is felt that, in developing countries at least, treatment of pyogenic meningitis in children should be with the latter combination, but where rapid and accurate bacteriology is available amoxycillin may be valuable non-toxic alternative to chloramphenicol with similar activity to ampicillin.


A month-by-month long-term study on carbamazepine:clinical, EEG and pharmacological evaluation.

Carbamazephine plasma levels were monitored for a twelve-month period in twenty epileptic patients. Seizure frequency decreased remarkably on inclusion of the drug in the therapy and attainment of plasma levels of 7-9 microgram/ml. A faster breakdown rate in children was confirmed, while carbamazepine-10, 11-epoxide was present for carbamazepine levels above 4-5 microgram/ml. EEG tracings did not show substantial modifications; this variable was thus considered to be of little value in assessing the clinical picture. Side-effects were minimal. Carbamazepine is increasingly becoming the drug of first choice in the management of both generalized and partial epilepsy, while better and more rapid results are obtained in monotherapy.


Domperidone in the treatment of dyspepsia: a double-blind placebo-controlled study.

Domperidone, at a dosage of 20 mg t.d.s before meals, in a double-blind, crossover, placebo-controlled trial reduced the level of the symptoms of dyspepsia by 76% compared to a 16% reduction with placebo. This difference was statistically significant (p less than 0.001). Thirteen of the fourteen patients in the study preferred domperidone to placebo. Four patients in the active treatment period and one in the placebo complained of mild side-effects.


A schedule for combined intravenous and oral dosing with mexiletine.

A combined intravenous and oral dosage regime for mexiletine has been evaluated in volunteer subjects. Therapeutically effective plasma concentrations of the drug were achieved rapidly and maintained over a four-hour period. Side-effects were minimal and the scheme would be suitable for the anti-arrhythmic protection of patients being transported to hospital and for the treatment of patients receiving hospital or, even, domicilliary care.


Ontogenetic development of pentobarbital-induced EEG pattern and sleeping time in rats.

The latency of onset and the duration of sleep induced by pentobarbital was studied in rats from 9 to 35 days of age, as well as in adult rats. Sleep latency was prolonged and sleep duration shortened with increasing age and maturation. Electrocorticographic changes after pentobarbital administration were studied in rats of 5-45 days of age and in adult rats. In rats 9 days of age or less the electrocorticogram manifested only depression of activity, whereas from the 12th day onward all characteristic barbiturate-induced phenomena were registered: spindles, slow waves, and isolated spikes with suppression of background activity. Spindles were the most conspicuous of the pentobarbital-induced phenomena and were the 1st to appear as a function of age, occurring only in the frontal areas of 12 days of age but in both frontal and occipital areas at 15 days of age. Frequency of the elements comprising spindles increased with from 2.5-3.5 c/sec in 12-day-old rats to 5-10 c/sec in adult animals. Barbiturate spindles could be used as a model for rhythmic thalamocortical phenomena even at early stages of development.


Differential extinction of 2-way active avoidance in young and adult rats.

Three experiments examined age-related differences in extinction of active avoidance in rats through manipulation of the stimulus context. In Experiment I, 36 weanlings and 36 adults acquired comparable avoidance levels to a tonal conditioned stimulus (CS), and novel stimuli consisting of either the presence of a naive rat or a light were presented during 2 tests in extinction. Results indicated more pronounced disruption of extinction in the pups, compared to adults, with the animate novel stimulus having the greater effect. Eighteen pups of 22 days of age and 18 adults in Experiment II were trained to avoid shock with a CS consisting of simultaneous tone and light onset. During extinction responses did not terminate 1 of the CS elements, but rather produced continuation of either the tone or light for an additional 5 sec. Continuation of the tonal element resulted in greater disruption of extinction trials than the light in the adults, although the pups had faster, but nondifferential, extinction rates. A 3rd experiment presented 36 pups and adults with either 0-, 5-, or 10-sec delays of tonal CS reactivation after extinction responses. Both 5- and 10-sec delays resulted in increased numbers of extinction trials in the adults, but the pups failed to respond differentially to any of the delay intervals. Results of all of the experiments were considered in light of species-specific behaviors in avoidance extinction relative to environmental and associative saliencies between ages.


The effects of preparturient avoidance conditioning on postnatal caretaker behavior and offspring catecholamine levels and behavior in C57BL/6J mice.

Avoidance conditioning during pregnancy, changes in caretaker behavior during lactation, and changes in offspring catecholamine levels and behavior were investigated in C57BL/6J mice. Three equal groups of mice were employed. One group was avoidance conditioned prior to pregnancy and continued to avoid shock during pregnancy; a 2nd group was avoidance conditioned during pregnancy; and the 3rd group served as untreated controls. Offspring were crossfostered after birth. During lactation the proportion of time the caretaker spent on the nest was observed. At weaning pups were individually housed. Offspring dopamine concentrations were measured in the corpus striatum at birth and at days 22 and 42 of age. Their performance was evaluated in the open field at Day 42 of age. The results showed that mice receiving avoidance conditioning prior to parturition were more likely to cannibalize their offspring at parturition than were control animals. Furthermore, preparturiently avoidance conditioned mice spent less time on the nest if they reared offspring from biological mothers who had been avoidance conditioned when compared to similarly treated caretakers who reared offspring from untreated control biological mothers. Regardless of postnatal experiences, adult offspring from avoidance conditioned biological mothers had significantly reduced levels of dopamine in tissue from the corpus striatum and were significantly less active in the open field when compared with offspring from control biological mothers. Behavioral results support the findings of others that the prenatal environment plays an important role in shaping the later behavior of offspring. The decrease in dopamine levels suggests that avoidance training as one form of psychosocial stimulation during pregnancy can be disruptive to the development of the dopamine regulatory mechanisms.


Neonatal treatment of hamsters with barbiturate alters adult sexual behavior.

Male and female hamsters were given 50 micrograms pentobarbital, 100 micrograms pentobarbital, or 100 micrograms d-amphetamine on postnatal Days 2-4. When tested for masculine sexual behavior in adulthood, males treated with 100 micrograms pentobarbital showed behavioral deficits when tested with testes intact as well as after castration and treatment with testosterone propionate. Deficits shown by 50 micrograms pentobarbital males were overcome by testosterone replacement. When tested for feminine sexual behavior, males treated with 50 micrograms pentobarbital showed enhanced lordotic responses whereas males treated with 100 micrograms d-amphetamine showed no differences from controls when tested for female sexual behavior or when tested for male sexual behavior. Drug treatments had no effect on adult masculine or feminine sexual behavior in neonatally treated females. The results of this study show that pentobarbital can inhibit normal masculinization of the male when given during behavioral sexual differentiation.


Early selective visual experience and pattern discrimination in hooded rats.

The early visual experience of hooded rats was restricted to either vertical or horizontal stripes. In a discrimination task pairing a gray surface and stripes of either the same orientation or an orientation orthogonal to that experienced during rearing, the rats made significantly fewer correct choices with the orthogonal orientation. However, the relatively lower overall performance of the vertically reared-horizontally tested animals was a major factor in the main effect of testing condition. We conclude that functional of the rat visual system through early selective visual experience is possible.


Contrast effects in the rat: a developmental study.

Two experiments investigated and development of positive and negative contrast effects in the consummatory behavior of juvenile and adult rats. Over a 4-day session, animals were given alternating 30-sec presentations of 2 bottles containing either 32 or 4% sucrose solutions. In Experiment I, different groups of rats were tested both cross-sectionally and longitudinally using a cohort-sequential design. Cross-sectionally, animals at all ages exhibited both types of contrast and demonstrated increasing positive contrast effects with greater age. Discrepancies between the longitudinal and cross-sectional samples were found to be due to the repeated testing procedure of the former design. Experiment II replicated the positive and negative contrast effects in the juvenile animals, indicating that the processes responsible for contrast effects are operating in the rat at a very early age.


Counterregulatory hormonal responses to rapid glucose lowering in diabetic man.

To define whether rapid rate of fall in blood glucose stimulates counterregulatory hormonal responses in diabetic man, blood glucose in eight hyperglycemic diabetic subjects was rapidly lowered by intravenous insulin administration. Despite precipitous declines in blood glucose, plasma epinephrine and growth hormone remained virtually unchanged. In contrast, norepinephrine and cortisol increased significantly (P less than 0.025) in the face of hyperglycemia or euglycemia, while glucagon was suppressed (P less than 0.025). A transient modest fall in mean arterial pressure and a rise in pulse rate were noted. No correlation was observed between glucose disappearance rate or decrement in glucose concentration and the hormonal responses. After sham insulin administration, no change was observed in plasma epinephrine, norepinephrine, and cortisol levels. These findings suggest that rate of fall in blood glucose per se is not a primary signal for counterregulatory hormonal response. Cortisol but not growth hormone release during falling blood glucose in diabetic subjects can occur despite elevated blood glucose levels. The etiology of norepinephrine and cortisol change is unclear.


In vitro studies of the substrates for energy production and the effects of insulin on glucose utilization in the neural components of peripheral nerve.

An "endoneurial" preparation from a rabbit tibial nerve fascicle was used to study the ability of peripheral nerve axons and Schwann cells to derive their composite energy requirements from glucose, D-beta-hydroxybutyrate, or albumin-bound palmitate, and the effects of insulin in vitro on their composite glucose utilization. Samples incubated with 5 mM glucose for 2 h maintained a stable O2 uptake and P-creatine and ATP concentrations, and they exhibited a slight increase in P-creatine/creatine ratio (the electron microscopic appearance of the preparation was previously shown to be unaltered under these conditions). The rate of glucose oxidation required to account for the O2 uptake accounted for 61% of the glucose uptake. In samples incubated without substrate for 2 h, a marked fall in tissue glucose was associated with a 50% decrease in O2 uptake and with decreases in P-creatine, ATP, and in the P-creatine/creating ratio. In medium lacking glucose but containing 5 mM DL-beta-hydroxybutyrate, a stable rate of D-beta-hydroxybutyrate uptake was observed, and acetoacetate production accounted for only a small fraction; significant decreases in O2 uptake or ATP were prevented, and, although P-creatinde and the P-creatine/creatine ratio fell, they remained significantly higher than after incubation without substrate. An efficient blood-nerve barrier to albumin is known to exist. Medium containing albumin-bound palmitate with molar ratios or palmitate/albumin of 1 or 2 (highest FFA concentration, 1.32 meq/L) failed to prevent decreases in P-creatine, ATP, and in the P-creatine/creatine ratio during incubations without glucose; the associated O2 uptakes suggested that the tissue is susceptible to respiratory uncoupling and depression son exposure to albumin-blund palmitate as compared with non-neural tissue. Insulin (100 or 1000 microU/ml) had no detectable effects on glucose utilization in the endoneurial preparation during 2-h incubations with 5 mM glucose or (U-14C) glucose. In contrast, in epineurial tissue from rabbit sciatic nerve, insulin (100 micronU/ml) increased (U-14C) glucose incorporation into CO2 and total lipid. The neural components of peripheral nerve are probably dependent on glucose as their major substrate for energy production and respiration under most physiologic conditions in which elevated plasma ketone body concentrations are absent; their composite glucose utilization is not subject to acute, direct regulation by insulin in concentrations that might reasonably be derived from plasma insulin of pancreatic origin.


Reduction in portal vein blood flow by somatostatin.

Intravenous somatostatin boluses produced striking diminution in portal vein blood flow in dogs (maximally 40--55%). This effect was of rapid onset, without observable changes in hepatic artery flow, systemic blood pressure, pulse or central venous pressure. The duration of action was short, but could be sustained by continuous intravenous infusion. These observations are consistent with an endocrine role of somatostatin in the regulation of nutrient balance.


High prevalence of diabetes in young Pima Indians: evidence of phenotypic variation in a genetically isolated population.

Medical records of the Pima Indian population aged 0--24 yr were reviewed for a diagnosis of diabetes before initiation of glucose tolerance testing. None of 1556 subjects below age 15, but 6 of 657 aged 15--24, had a previous diagnosis. Of the six known diabetics, five had been treated with insulin and four had had ketoacidosis. Subsequently, plasma glucose levels were determined after a 75-g oral carbohydrate load in 1712 subjects aged 5--24 yr, which is about 78% of the eligible population. Previously diagnosed diabetes and asymptomatic hyperglycemia were more frequent in subjects 15--24 yr old than were reported in other populations. Glucose intolerance in young Pimas was associated with obesity. In Pima offspring, the presence of diabetes in both parents was related to glucose tolerance in those above but not below the age of 15 yr. Both asymptomatic hyperglycemia and insulin-requiring diabetes occurred frequently in young Pimas, suggesting that these syndromes represent the clinical spectrum of a single disease in the Pima Indian.


Genetic susceptibility to diabetes mellitus: the distribution of properdin factor B (Bf) and glyoxalase (GLO) phenotypes.

The distribution of phenotypes controlled by two loci on chromosome 6 has been studied in a series of 239 patients with type 1 (insulin-dependent) and 297 patients with type 2 (non-insulin-dependent) diabetes mellitus. At the properdin factor B (Bf) locus there is a significant increase in the frequency of the BfSu and BfF1 alleles for type 1 patients, and the combined inc;rease in frequency of BfS1 and BfF1 in those patients is highly significant. The relative risk for F1 is 6.2 and for F1 and S1 combined is 5.3. These results confirm the association with F1 reported recently by Raum and co-workers in Boston. The two rare alleles BfS1 and BfF1 are in significant negative disequilibrium with HLA B8. For the glyoxalase (GLO) locus there is a slight but nonsignificant increase in the frequency of the GLO2 allele, but a significant disturbance in the distribution of the GLO phenotypes for type 2 patients. These results for the GLO alleles may be due to stratification in our series of type 2 patients. Further studies are in progress to test this hypothesis.


Somatomedin activity and diabetic control in children with insulin-dependent diabetes.

To test the hypothesis that somatomedin activity is influenced by diabetes and its metabolic regulation, the relationship between somatomedin activity and diabetic control as assessed by hemoglobin A1C was investigated in 40 children with insulin-dependent diabetes. An inverse correlation between hemoglobin A1C and serum somatomedin activity was statistically significant. The data suggest that abnormalities of linear growth, which can occur in children with poorly controlled diabetes, may involve abnormalities in net somatomedin activity.


A multicenter inquiry into the etiology of pancreatic diseases.

A multicenter study on the etiology and diet of patients with pancreatic diseases has been realized with the collaboration of 36 centers in 19 countries having widely different climatic and racial conditions. 2,478 cases were studied: acute pancreatitis (AP), 222 males, 208 females; calcified chronic pancreatitis (CCP), 801 males, 134 females; non-calcified chronic pancreatitis (NCCP), 525 males, 155 females; pancreatic cancer (PK), 69 males, 14 females; controls, 281 males, 62 females. The analysis of mutual information and the factorial analysis of correspondences have been used. With regard to chronic pancreatitis, the 19 countries could be classified into 4 classes presenting relative similarities. (A) Southern Europe: The diet is rich in carbohydrates, protein and lipids, alcohol intake is primarily in the form of wine and the pathology is dominated by CCP. There are much fewer women than men with chronic pancreatitis. (B) Northern Europe, to which may be added Argentina and Chile, is characterized by a protein- and lipid-rich diet, a beer-based alcohol consumption and a distinct prevalence of AP and NCCP. The prevalence of males with chronic pancreatitis is less marked than in southern Europe. (C) Japan has a lipid-poor diet and a low frequency of CCP and NCCP. (D) A fourth group is mostly composed of tropical countries with mixed races. It may be divided into 2 subclasses: (a) India is the most characteristic country of the first type with low fat, low protein diet, no alcoholism, high frequency of CCP (at an early age); (b) Brasil and South Africa are representative of the second subclass with very high alcohol intake in the form of spirits and a high frequency of CCP.


Differences in serum bile acid composition between unoperated cirrhotic patients and patients with portacaval or mesocaval shunt.

Serum bile acids were determined in 13 cirrhotic patients with portacaval shunt and in 15 with mesocaval shunt. 20 nonshunted cirrhotics were used as controls. Serum bile acid levels were higher in portacaval (26.7 +/- 14.3 micrograms/ml) than in mesocaval shunt patients (16.9 +/- 8.1 micrograms/ml) and controls (14.1 +/- 11.5 micrograms/ml). The cholic/chenodeoxycholic ratio was lower after portacaval shunt than after mesocaval shunt (0.36 +/- 0.15 and 0.63 +/- 0.26, respectively). It is hypothesized that these findings may be consistent with a larger hepatic blood flow present in mesocaval shunted patients and with chenodeoxycholic absorption in the upper small intestine.


Radiation pancreatitis: a clinical entity?

2 cases of pancreatic disease in patients with malabsorption following small bowel radiation injury are reported. It is suggested that the pancreatic disease present in these patients occurred as a result of previous radiotherapy.


Effect of a feeding schedule on crypt cell proliferation in the small intestine of the rat.

Using a stathmokinetic technique, the mitotic rate in the small intestinal crypts of two groups of male Sprague-Dawley rats was studied. The first group was fed solids for 3 h daily only. The second group was fed solids ad libitum. In the first group it was found that the mean daily weight of food consumed rose quickly to normal 24-hour levels but the mean daily weight of the rats fell rapidly and did not approach the original level throughout the experiment. There was no significant difference in the mitotic rate of the small intestinal crypt cells between the two groups.


Chronic administration of pentagastrin. Effects on pancreatic protein and nucleic acid contents and protein synthesis in rats.

Groups of rats were injected with either saline or pentagastrin (0.5, 1 or 2 mg/kg/day) for 14 days. Pancreatic weight, DNA, RNA and protein contents as well as the ability of the pancreatic polyribosomes to synthesize protein in a cell-free system were investigated. In all three pentagastrin-treated groups the weight of the pancreas was found to be significantly higher (33-73%) than in the control. DNA, RNA and protein contents were significantly increased by 47, 98 and 85%, respectively, in the group that received the highest dose of the hormone. With respect to ribosomal protein synthesis, while the pentagastrin dose of 1 and 2 mg/kg/day resulted in 25 and 72% augmentation, respectively, the dose of 0.5 mg/kg had no influence on protein synthesis. It is concluded that chronic administration of pentagastrin (2 mg/kg/day for 14 days) causes hyperplasia and hypertrophy of the pancreas.


Prolonged manometric study of the gastroduodenal junction in man.

A study of the motor activity of the gastroduodenal (GD) junction has been carried out on 8 subjects by using an original probe provided with a suction cup, that allows not only a duodenogastric (DG) pull-though, but also a prolonged recording of the pyloric, antral and duodenal motor activity, in basal condition and after intraduodenal instillation of HCl 0.1 N and intravenous infusion of cerulein. The position of the probe was controlled with fluoroscopy and transmural potential difference. The DG pull-through did not show a zone of high pressure at the GD junction, but the prolonged study showed, during HC1 and cerulein administrations, a significant increase of the pyloric tonus.


Effect of somatostatin on normal and gastric-stimulated cell proliferation in the gastric and intestinal mucosae of the rat.

The effects of an 8-hour infusion of somatostatin, saline, gastrin or a mixture of gastrin + somatostatin on DNA synthesis and mitotic activity of gastrointestinal progenitor cells were explored in conscious rats, using in vivo labeling with 3H-thymidine and radioautography. Infusion of somatostatin (day or night) was shown to transiently reduce nuclear uptake of 3H-thymidine and cell division in both fundic and antral progenitor cells. Cell DNA synthesis in the gastrin + somatostatin-stimulated stomach was lower than in the gastrin-stimulated stomach. In the intestine, nocturnal infusion of somatostatin decrease DNA synthesis whereas diurnal infusion decreased cell division but no effect was observed on gastrin stimulation. Evidently, somatostatin may inhibit, perhaps indirectly, the cell proliferation in digestive mucosae and antagonize the trophic activity of gastrin but only in fundic and antral mucosae.


Gastrointestinal motility and absorption of calcium during infusion of somatostatin in the rat.

The effect of somatostatin on gastric evacuation, small bowel propulsion and gastrointestinal (GI) absorption of calcium was studied in conscious rats. Nonabsorbable 125I-PVP was deposited in the stomach or in the duodenum and the distribution of the radioactivity along the excised GI specimen was recorded after 15 min. 47Ca in chloride from was administered simultaneously and the amont of radioactivity remaining in the GI speciment at sacrifice could easily be measured. Intravenous infusion of synthetic somatostatin (50 micrograms.kg-1.h-1), which resulted in a manifest although not extreme hypersomatostatinemia had no effect either on gastric evacuation, small bowel propulsion or GI absorption of calcium. The findings do not indicate that somatostatin has a direct effect on GI motility or absorption of calcium.


Role of homocytotropic antibodies in pathogenesis of gastric ulcer.

Praomys (Mastomys) natalensis were sensitised by peritoneal injection of ovalbumin mixed with aluminium hydroxide. The animals developed homocytotoropic IgE and IgG 1 antibodies. When presensitised animals were challenged with ovalbumin in the gastric wall, a gastric ulcer appeared. This ulceration, induced by an immunological release of histamine, could be inhibited by the administration of disodium cromoglycate. The present model is useful for producing a gastric ulcer in a determined site. It supports the theory of a possible allergic component in the pathogenesis of the human disease.


Study of parotid and mixed saliva in the diagnosis of chronic pancreatitis.

A study on the diagnostic value of the parotid and mixed saliva assay after stimulation with 1% pilocarpine hydrochloride was carried out in 36 controls and 26 patients affected with chronic pancreatitis. No statistical difference between the two groups was found as far as saliva volume, bicarbonate and amylase (concentration and output) are concerned. No correlation was found between the results of the saliva test and those of the secretin-pancreozymin test or endoscopic retrograde pancreatography. These data excluded any diagnostic role of the saliva test in chronic pancreatitis.


Compartmental analysis of the plasma clearance of tetrabromsulphthalein and dibromsulphthalein in the normal dog and in patients with liver disease.

A comparison has been made of the plasma clearances of the anionic dye analogues, tetrabromsulphthalein (BSP) and dibromsulphthalein (dBSP), analysed by means of a two-compartmental model. In the normal conscious dog all three transport rate constants and initial and steady state plasma clearances were greater with dBSP than BSP. On the other hand the equivalent liver volume (ELV) and storage capacity were lower with dBSP. In patients with various hepatic disorders dBSP values were greater than those obtained with BSP apart from rate constant b (liver to plasma). Patients with advanced liver impairment in general exhibited lower hepatic uptake, clearance and storage of both dyes compared to patients with mild forms of liver disease. The ratio of ELV values for BSP and dBSP appeared to be related to overall hepatic function, with ratios greater than 1 in the normal dogs and less than 1 in the patients.


Plasmapheresis in Crohn's disease.

6 patients with Crohn's disease for 1-14 years have been treated with plasmapheresis for periods of up to 6 months. The symptoms of the one newly diagnosed patient were controlled by plasmapheresis alone, and 5 steroid-dependent patients were able to reduce their steroid requirements. During the study period, 13 clinical relapses were managed without increasing steroid dosage. There was evidence of circulating soluble immune complexes in all the patients and these levels were lowered by plasmapheresis. A possible role of plasmapheresis in the management of Crohn's disease is discussed.


Etiology of hepatitis B surface antigen (HBsAg)-negative chronic hepatitis.

A study was undertaken to elucidate the etiology of HBsAg-negative chronic hepatitis. Form 37 individuals with HBsAg-negative chronic hepatitis, 11 had liver membrane autoantibody (LMA) and were thus classified as autoimmune. 6 patients had anti-HBc, 1 of which was also positive for LMA. The majority of individuals with HBsAg-negative chronic hepatitis had antibodies to hepatitis A antigen (anti-HAV), in general at low titer. We conclude from our data that hepatitis A and hepatitis B virus infections are unlikely to play a significant role in inducing or maintaining HBs-Ag-negative chronic hepatitis. The etiological role of non-A non-B hepatitis agent(s) is difficult to estimate and must await the detection of appropriate markers for type non-A non-B hepatitis.


Gastric emptying after vagotomy and pyloric ring stretch. A preliminary report.

Using a radioisotope technique, gastric emptyping of a solid meal was measured in 10 pre-operative duodenal ulcer (DU) patients, 10 post-operative truncal vagotomy and pyloroplasty (TV+P), and 8 post-operative truncal vagotomy and pyloric stretch (TV+S) patients. Results show that after the first 20 min, although gastric emptyping after TV+S shows a tendency to reduction in rate compared with TV+P, the difference never reaches statistical significance (p greater than 0.01). When compared with control DU patients, the TV+S group again exhibits a statistically insignificant (p greater than 0.10) tendency to reduction in rate after the first 20 min, whereas the TV+P group shows no such tendency. The significance of these findings is discussed in relation to the use of a pyloric ring stretch as an alternative to pyloroplasty.


Incidence of large bowel cancer in Côte-d'Or (Burgundy).

The present study is based on the registry of digestive cancers set up for the French department of Côte-d'Or (455,727 residents). Large bowel cancer represents half of the gastrointestinal tract cancers recorded in the course of 2 years (1976-1977). The crude annual incidence rate was 52.2 per 100,000 for males, 41.7 per 100,000 for females. The age-standardized incidence rate for cancer of the rectum is one of the highest reported. The incidence rates for cancer of the colon are in the intermediate range. Half of the large bowel cancers were rectal cancers, nearly always adenocarcinoma. Coexisting benign polyps were seen in 21% of the cases at the time of diagnosis of carcinoma and were more common in males than in females. 54% of cancers of the colon and 62% of cancers of the rectum underwent curative surgery.


Action of tiadenol and clofibrate on biliary excretions of cholesterol and bile salts in rats.

Biliary excretion of cholesterol, phospholipids and bile salts, and the excretion of labeled cholesterol injected intravenously were studied in rats treated for 1 or 3 weeks with the hypolipidemic drugs tiadenol and clofibrate. Total biliary cholesterol concentration and output decreased in treated rats, and the cholesterol solubility ratio increased. The excretion of labeled bile salts increased with both drugs; the excretion of labeled cholesterol increased with clofibrate and tended to decrease with tiadenol. The ratio of labeled bile salts/labeled cholesterol was higher with tiadenol than with clofibrate.


Antisecretory actions of aminophylline in the rat and dog.

The effect of aminophylline on gastric acid secretion has been studied in the rat and dog. Aminophylline was shown to possess antisecretory activity when given either by oral or parenteral administration in an acute gastric fistula rat preparation. In the chronic gastric fistula dog aminophylline at 50 mg/kg intragastrically induced a small but significant stimulation of basal acid secretion. This dose of aminophylline also significantly inhibited acid secretion induced by gastrin tetrapeptide, and 2-deoxy-D-glucose but did not block acid secretion induced by histamine.


Oral domperidone in chronic postprandial dyspepsia. A double-blind placebo-controlled evaluation.

32 patients with chronic postprandial dyspepsia were selected for a 4-week controlled double-blind trial of domperidone and a placebo. The patients received either domperidone or a placebo at a dose rate of two 10-mg tablets t.i.d. before meals. A questionnaire was completed at the start of the study, and after 2 and 4 weeks of treatment. Excellent or good improvement was obtained in 71% of the domperidone-treated patients compared to only 13% of the placebo-treated cases. Domperidone was also significantly superior to the placebo when both drugs were compared to previously used medications. Side effects were not reported. It is concluded that domperidone has a beneficial effect on chronic postprandial dyspepsia.


Abnormalities of jejunal mucosal enzymes in ulcerative colitis and Crohn's disease.

Jejunal mucosal function and structure was examined in 31 patients with ulcerative colitis and 29 patients with Crohn's disease with ileal, ileocolonic or colonic involvement; A significant reduction of the specific activity of disaccharidases (lactase, sucrase and trehalase) in jejunal mucosal homogenate occurred in patients with inflammatory bowel disease. Similarly, alkaline phosphatase was reduced in ulcerative colitis. Several dipeptidases such as glycyl-leucine, leucyl-glycine, glycyl-glycine and valyl-proline hydrolase activities were lower in patients with inflammatory bowel disease than in controls. Histological changes in jejunal mucosal biopsies occurred in 71% of patients with ulcerative colitis and 61% with Crohn's disease. These changes ranged from mild abnormalities of villus architecture to marked reduction of villus height. Most patients with a reduction in mucosal enzymes had concommitant morphological changes in jejunal mucosal biopsy. The results of this study indicate that functional and structural abnormalities of the jejunal mucosa frequently occur in patients with inflammatory bowel disease without radiologic evidence of proximal small bowel involvement.


The cholyl glycine-1-14C breath test in various gastrointestinal disorders.

The cholyl glycine-1-14C breath test was evaluated in a variety of gastrointestinal disorders. 138 tests were performed in 106 patients. Methods of data expression were evaluated and the cumulative 8-hour value was used. In 27 control patients the upper limit of the normal was found to be 78. A good correlation was found between the peak values and the cumulative 8-hour values (r = 0.95, p less than 0.01). The reproducibility of the test was good (r = 0.985, p less than 0.05). Abnormal results were found in 12 out of 13 cases with resection of the ileum and 11 out of 14 cases with Crohn's disease of the distal small bowel. The test was normal in cases with diseases of the proximal small bowel (celiac, Whipple's and Chron's diseases). The test was also normal in patients with colitis. It was abnormal in some of the cases after cholecystectomy and in most cases with carcinoma of the pancreas. The breath test was useful in monitoring the results of treatment in bacterial overgrowth of the small bowel. False negative results were observed after antibiotic treatment. The method seems to be more sensitive than the Schilling test in diagnosing disease of the distal small bowel.


Embryonic appearance of alpha, beta, and gamma crystallins in the periodic albinism (ap) mutant of Xenopus laevis.

The appearance of the crystallins during lens development in the periodic albinism (ap/ap) mutant of Xenopus laevis has been studied. Using antibodies specific for total crystallins, alpha + beta crystallins, and gamma crystallins in the immunofluorescence technique, the first positive reaction for all could be demonstrated in the Nieuwkoop-Faber Stage 31 lens rudiment. The antibody to alpha + beta crystallins exhibited differences in intensity from cell to cell in the early rudiment, while the reaction to the other antibodies was uniform throughout the rudiment. As lens differentiation progressed, immunofluorescence was restricted in all cases to the lens fiber area, up to and including Nieuwkas positive, however, for total lens crystallins. These results are at variance with earlier studies on lens development and the crystallins in wildtype (+/+) X. laevis, where a positive reaction for gamma and total crystallins could be detector total lens crystallins. That this divergence in the mutant is due to a pleiotropic effect or directly to the inductive failure of the endomesoderm to initiate melanogenesis, is discussed.


Developmental capacity of aneuploid Xenopus species hybrids.

Diploid as well as triploid Xenopus interspecific hybrids generate aneuploid eggs because of the presence, at meiosis, of univalent chromosomes which are presumably distributed at random. Zygotes obtained from such eggs, fertilized by either normal or UV-irradiated sperm, were analysed for their developmental capacities. All monosomics die in the course of embryogenesis, whereby optimum capacities correspond closely with those observed in monosomic mammalian embryos, especially in mice. In contrast, hyperdiploid Xenopus are relatively viable: although many die exhibiting the 'haploid syndrome' or various other abnormalities, 8% of them reach metamorphosis, and 1-2% become adults. Of the latter, the karyotype was established in 13 individuals. Among them, 8-16 supernumerary chromosomes were found to be present.


Cell contacts between chorda-mesoderm and the overlaying neuroectoderm (presumptive central nervous system) during the period of primary embryonic induction in amphibians.

Using transmission and scanning electron microscopy we were able to show that during primary embryonic induction in amphibians (Triturus alpestris) the interspace between the inducing chorda-mesoderm and the reacting ectoderm (presumptive medullary plate) of mid-gastrula stages is traversed by cell projections starting from cells of both tissue layers. In addition intimate membrane contacts between the main bodies of the ectodermal and chorda-mesodermal cells could be observed. It could be ruled out that cytoplasmic bridges (anastomosis) exist between cells of inducing chorda-mesoderm and reacting ectoderm, which would allow a free transfer of inducing substances without passing through membranes, as Eakin and Lehmann [1] have postulated. The possible role of cell to cell contact for neural induction is emphasized.


The synthesis of hyaluronic acid by ectoderm during early organogenesis in the chick embryo.

This study demonstrates that the dorsal ectoderm of the stage 14 chick embryo synthesizes hyaluronic acid. About 49 to 52% of the H3 glucosamine-labeled glycosaminoglycan that is synthesized by explanted ectoderm can be identified as hyaluronic acid on the basis of its susceptibility to Streptomyces hyaluronidase or isolation of chondroitinase ABC digestion products. In addition, autoradiographic evidence shows that the ectoderm, unlike adjacent tissues like epithelial somites or neural tube, incorporates glucosamine into hyaluronidase-sensitive material which becomes largely extracellular and localized in the subectodermal cell-free space. Ultrastructural evidence shows that there is a fine fibrillar matrix between the ectodermal cells and in the subectodermal spaces when tannic acid is included in the primary fixative. This material resembles authentic hyaluronate, similarly fixed, and is absent when tannic acid is omitted from the fixative or when embryos have been previously treated in ovo with Streptomyces hyaluronidase. The concomitant reduction in the intercellular and subectodermal cell-free spaces after in ovo treatment with Streptomyces hyaluronidase supports the hypothesis that the dorsal ectoderm plays a morphogenetic role by contributing hyaluronate to the forming extracellular spaces. It is proposed that ectodermally derived hyaluronate might influence the morphogenesis of subjacent tissues such as the dermatome and neural crest.


Regeneration of vitamin A deficient rat tracheal epithelium after mild mechanical injury. Growth kinetics and cellular differentiation.

Mild mechanical abrasion of tracheal epithelium of Vitamin A deficient rats removed the superficial cells and spared basal cells which divided to repopulate the damaged area. The proliferative cells passed through a period of DNA synthesis with the greatest numbers of thymidine incorporating cells in samples labelled 22 h after injury. A peak of cell division occurred at 32 h and there was no further DNA synthesis or cell division. The area of wounding exhibited squamous metaplasia while normal pseudostratified muco-ciliary structure was retained by adjacent epithelium which had not been injured. The data indicates that squamous metaplasia in the respiratory epithelium in longstanding Vitamin A deficiency is due to redirected differentiation of basal cells and is seen only after mitotic activity has occurred.


Quantal division and a postmitotic state in myoblast differentiation.

The reversible arrest of myoblast differentiation by ethidium bromide (EB) has been used to examine the nature of the transition from the proliferative state to terminal differentiation resulting in fusion into muscle fibers. If EB is introduced at the time that myoblasts are shifted to medium that induces fusion, all apparent cytodifferentiation is suspended. When such EB arrested myoblasts are released from EB inhibition they fuse without reentering the cell cycle. If EB arrested myoblasts are released into proliferation promoting medium rather than medium that induces fusion they neither fuse nor proliferate. In this case they remain quiescent in the proliferating medium for an extended period, however, if these myoblasts are subsequently shifted to medium that induces fusion, they fuse without reentering the cell cycle. Apparently the myoblasts have become postmitotic and competent to fuse into muscle fibers during their initial exposure to fusion inducing medium, even though cytodifferentiation has been blocked. Exposure of these postmitotic fusion competent myoblasts to proliferation promoting medium does not stimulate them to reenter the cell cycle but does prevent fusion into muscle fibers. These results are most consistent with a quantal division model of myoblast differentiation rather than a gradual transition from the proliferative state to a state in which fusion occurs.


[Precursors of arteriosclerosis in childhood. Protocol and firsts results concerning plasma lipids and carbohydrate tolerance in 520 school children at Pordenone (Italy) (author's transl)].

The cardiological centers of Pordenone and Cittadella (Italy) organized by the Institute of Clinica Medica II of Padua University, have carried out a study on the "Precursors of arteriosclerosis in children", according to a WHO protocol. In this paper some results of the Pordenone study are reported, concerning serum cholesterol (TC), triglycerides (TG) and blood glucose 1 h after 1 g/Kg glucose per os. 520 school children, males and females, aged 6, 9, 12, 15 years, entered the study. Mean serum TC resulted significantly higher at age 12 as compared to the other age classes. Serum TG progressively increased with age. Mean serum TC and TG in our italian children and adolescents were silimar to those reported in studies from other countries. Blood glucose resulted significantly higher in children than in adolescents. The distribution of the blood glucose values was bimodal. After having arbitrarily fixed cut-off points for serum TC, TG and blood glucose, the prevalence of hyperlipidemia and hyperglycemia was determined. The prevalence figures have shown that at the pediatric age it is possible to identify subjects at "risk" of developing arteriosclerosis.


[Transposition of the great arteries: anatomic types of left ventricular outflow tract obstruction (author's transl)].

A postmortem investigation has been carried out in 48 heart specimens with transposition of the great arteries (TGA) to evaluate incidence and type of left ventricular outflow tract obstruction. The frequence of pulmonary stenosis in our series (23%) is similar to those reported from previous studies. Cases have been divided in two groups according to presence or absence of ventricular septal defect. In cases with intact ventricular septum the obstruction was determined by asymmetric hypertrophy of the septum (1 observation) and by abnormal attachement of clefted anterior mitral leaflet to the interventricular septum (2 observations). In the specimens with ventricular septal defect, 4 presented a stenosis due to malalignment of the infundibular septum, associated with valvular stenosis in 1 case and with valvular stenosis and fibrous subvalvular ring in 2. Another case presented a stenotic pulmonary valve and a parachute mitral valve. The remaining 3 showed a cleft of the anterior leaflet of the mitral valve. The high incidence of infundibular malalignment obstruction is underlined together with its association with A-P or L-position of the aorta. This peculiar relation of the great arteries could be angiocardiographically employed as indicative for the presence of this type of left outflow tract obstruction in TGA.


[Clinical, hemodynamic and cineangiocardiolographic findings in congestive cardiomyopathy].

Sixteen patients affected by congestive cardiomyopathy were studied by means of right and left cardiac catheterization and cineangiocardiography. Cardiac output and mean pulmonary circulation time were determined by the radiocardiographic method. Left ventriculograms were obtained in all the patients in the 45 degrees RAO projection; the left ventricular end diastolic and end systolic volumes were calculated both by the area-length and by the slice method. Among the several hemodynamic data (stroke index, mean pulmonary circulation time, left ventricular end diastolic pressure, left ventricular volumes and ejection fraction) the most early impaired and therefore usefull for an early diagnosis, were: the left ventricular end-systolic volume, the left ventricular end-diastolic volume and the left ventricular ejection fraction.


[The effects of intravenous mexiletine on cardiac performance (author's transl)].

The effects of intravenous Mexiletine (Kö1173) on cardiac performance has been studied in 20 patients affected by myocardiosclerosis (10 patients were classified in the 1st or 2nd NYHA classes, 10 cases in the 3rd or 4th ones. Mexiletine (1.5 mg/Kg) was given intravenously over a period of 1 minute. The effect on myocardial function has been evaluated by means of the systolic time intervals (STI). The drug caused non-significant changes of the left ventricular ejection time (LVET); on the contrary it caused a significant increases of the pre-ejection period (PEP), isometric contraction time (ICT) and the PEP/LVET ratio. These alteration became evident after 5--10 minutes and disappeared about 30 minutes after administration of the drug.


[Supraventricular tachyarrhythmias. Therapeutical efficiency of bunaftine administed in rapid bolus (author's transl)].

The authors exhibit the results obtained in 25 patients sumministring bunaftine in 3 mg/Kg in 1-2 min in rapid bolus i.v. By means a continuous ECG registration they could state that the antiarrhythmic effect is simultaneous with the distribution of the drug, obtaining the restoration of the sinus rhythm in about 90% of the patients. The Authors remark the lack of meaningful collateral effect by means a pre-treatment with diazepam-cortisone, according to their method.


[Electronmicroscopic studies on the skin pigmentation of the red bellied toad Bombina bombina (L.)].

The various colours of the red-bellied toad Bombina bombina are caused by 3 types of chromatophores, the red xanthophores, the white iridophores and the black melanophores. In the brownish skin and in the black spots of the dorsal region all types of chromatophores are found. But in the epidermis of the black spots there are more grana of melanin than in the other region of the back. The 3 types of chromatophores are not present in the skin of all parts of the body. The dark blue colour of the belly is caused only by melanophores, whereas in the ventral parts with light blue colour there occur melanophores and iridophores. The white spots of the belly contain only iridophores, the red spots have iridophores and xanthophores.


[Maturing of fibrils and intraosseous osteogenesis as a basis for the development of lamellae and the osteon structure].

We investigated in continuation of lightmicroscopical (phasecontrast, polarized light) and statistical studies concerning the formation of lamellae and osteons electromicroscopical the nature of fibrils in different areas of the cross section of the metacarpus from a cattle fetus of 520 mm SSL. During the maturation of fibrils in a subperiostal trabecal the diameter of fibrils increased (465 to 470 A). The period (316 or 536 A) contains primarily only a broad band and a small interband. Subsequently the interband increased (221 or 215 A), but the band decreased (324 or 271 A). In the centre of trabeculae the fibrils formate microlamellae. The fibrils split later on in the medial part of the cross section in microfibrils with irregular oreintation and appear lightmicroscopical as intermediate tissue (blasse Mittellinie). At the same time new fibrils are synthesized around the osteocytes and their canaliculi. As the result of a kind of remodeling the fibrils arrange in a parallel order forming packages which appear lightmicroscopical as fibrous felts. These fibrous felts exhibits partly an periodical arrangement with a small band (164 A) and a wide interband (287 A). In a following stage in the fibrous felts lamellae are developed, the length of which increased around the medullary cavity. Firstly after the development of lamellae the definite bone fibrils are reconstituted (diameter: 530 A; band: 348 A; interband: 212 A). Apparently the osteocytes are responsible for these procedures in a stage specific synthetic and lytic activity. The modification of the nature of fibrils results probably after the dissolving of the structural glycoproteins, which stabilize the tropocollagen molecules. A reconstitution of the structural glycoproteins after formation of the lamellae induce the reconstitution of bone specific collagenfibrils. The regulating mechanism for the codification of these structural development are unknown.


[Histometric volume determination in aging human thyroid glands and possible errors of this method].

We made histometric volume analyses of hematoxylin and eosin stained paraffin sections of 43 human thyroid lobes by means of the electric integrating apparatus Eltinor 4 A (Optische Werke Rathenow). We investigated ageing changes of the relative amounts of epithel, colloid and connective tissue in the total volume. The volume density of colloid rises up to the 3rd decade, thereafter it shows a small decrease. On the contrary, the amount of epithelial cells decreases until the 3rd decade. The data concerning connective tissue exhibit an increasing trend up to senility. During such measurements errors appear, which are called, among others, total error, systematic and statistic error. We estimated these errors and demonstrated possibilities of their diminution.


[The evolution of the relations between brain development, secondary temporomandibular joint and facial development in mammals].

Comparing the development of the face in mammals and sauropsida only in mammals the maxillary process reach forward to fuse with the medial nasal fold. This is the supposition for the maxillary and mandibular process to fuse forming the cheeks. The phylogenetically relations for these developmental events are discussed.


[The problem of sugar resorption in the small intestine: histochemical studies by means of the Gomori method].

The role of alkaline phosphatase during active absorption of sugars is experimented with Gomori's histochemical method. Experiments on empty intestine show that the surgical intervention does not alter the phosphate content of the wall of the small intestine. Absorption experiments with 10% and 5,4% (isotonic) glucose solutions demonstrate a marked decrease in the alkaline phosphatase content of the wall of the small intestine. In half of the cases only, absorption experiments with a 10% mannitol solution determine a small decrease in the alkaline phosphatase of the wall of the small intestine. In 90% of the cases, there are lesions of the intestinal epithelium.


[Comments and the diagnosis of vitality of early pregnancy in threatening abortion].

In a series of 79 consecutive patients examined by sonar and assays of human chorionic gonadotrophin in the first half of pregnancy 41 ultimately aborted. On analysis of the sonar and post abortion findings it was found, that the aborted pregnancies fell into 3 clearly defined groups: blighted ova, missed abortions and hydatidiform moles. Strict diagnostic sonar criteria of abnormality were established for these groups. Assays of human chorionic gonadotrophin have shown to be useful guides. But the overlap between their normal and abnormal ranges does not permit their use as sole arbitors of which pregnancies should be terminated.


[Prognostic and therapeutic implications of the antenatal care of multiple pregnancies].

From January 1967 to April 1978, 175 twin deliveries occurred among 19,935 deliveries (.88%). A comparison to the literature a low perinatal mortality of 4.57% (adjusted 2.84%) was noted. The reason for the 3 to 5 fold increase in perinatal mortality compared to single on pregnancies was investigated. Review of the records showed conditions specific for twin pregnancies. The treatment necessary to improve the prognosis for twin pregnancies was discussed. It is suggested that the perinatal mortality of 2% for twin pregnancies can be achieved with intensive antenatal care for twin pregnancies.


[The ramining cervical stump (author's transl)].

The subtotal hysterectomy is no longer indicated for the treatment of female genital disease with rare exceptions. It has been known for a long time that the remaining cervical stump has very few advantages but many potential risks. Among our patients who had cervical stumps removed 32 of 69 cases had malignant changes in the cervical stump. Decensus and prolapse was the next common abnormality. If adnexal tumors or cervical cancers do not indicate an abdominal approach for the removal, the vaginal approach for the removal of the cervical stump ist preferred since this is easier and less risky.


[New considerations in therapeutic abortions using a second generation prostaglandins (author's transl)].

The results of 98 therapeutic abortions in the first and second trimester of pregnancy using F prostaglandins are reported. The prostaglandins were eigher administered by fractionated extra-aminotic PGF2 alpha, intramuscular 15-methyl PGF2 alpha or extra-amniotic or intracervical single shot 15-methyl PGF2 alpha. The induction abortion time of 13 hours and 15minutes for the single shot and 14 hours and 28 minutes for the intramuscular administratic with the prostaglandin derivatives is shorter than with natural prostaglandins which showed a mean induction to abortion time of 19 hours and 30 minutes. The blood loss was low in all groups at approximately 75 mls. Side effects are least with the single shot method (11%). Two patients had nausea, two patients had vomiting, three patients had flush or lower abdominal cramps. The intramuscular administration showed the highest frequency of side effects (80%). In the first trimester the single shot method always leads to sufficient cervical dilatation although the abortion rate was low at 59%. During the second trimester a high abortion rate is found. Therefore this method can be recommended for therapeutic abortions.


[Present day status in therapy of toxemia of pregnancy (author's transl)].

Since the causes of toxemia of pregnancy are unknown, therapy is still symptomatic and is now determined by the most recent knowledge of the pathophysiology of the disease. Rest, a balanced, predominantly protein-rich diet and avoidance of stress are recommended as prophylactic treatment of toxemia of pregnancy in patients with a predisposition of the condition. Early recognition of the symptoms of toxemia of pregnancy is of great importance. Treatment of mild cases consists of bed rest, possibly supplemented by sedatives and a preponderantly proteinrich diet. Administration of diuretics is obsolete and sodium restriction is no longer recommended. Antihypertensives are seldom indicated. Overweight women are no longer maintained on specially low calorie diets. Severe cases of toxemia of pregnancy must be trated as inpatients under intensive care. Principles of treatment are: 1. Prevention of seizures (by sedation). 2. Improvement of the general condition of the women (especially circulation and renal function). 3. Delivery at an opportune time for mother and child. Treatment of eclampsia follows largely the same principles. In these cases, immediate delivery is required regardless of the condition of the fetus.


[Recurrent carcinoma in situ of the uterine cervix (author's transl)].

Among 228 patients who had previous treatment for carcinoma in situ of the cervix, most by hysterectomy, 3 recurrences in vaginal stumps were detected in women age 36, 46, and 56. In another case a carcinoma in situ of the cervix was found in a 25 year old patient who had a diagnostic and therapeutic conization because of desire for childbearing. The histology of the cone showed no residual carcinoma. Concommitent to the recurrent carcinoma in situ of the cervix a carcinoma of the vulva was detected. Recurrences of carcinoma in situ could occur because of incomplete resection of primary lesion. Wrong classification in the laboratory is possible if the invasion is missed on the microscopic examination and the case therefore receives the wrong treatment. Recurrences which are not true recurrences could arise from multicentric atypical foci of the squamous epitheleum of the -ower female genital tract. These considerations lead to the following recommendations: 1. When the suspected diagnosis carcinoma in situ of the uterine cervix is made a large enough cone biopsy which is appropriately marked is obtained and a complete microscopic examination of the cone must be obtained. 2. A hysterectomy with a large vaginal cuff is the treatment of choice. 3. A careful workup of the operative specimen in the microscopic laboratory is expecially essential. 4. A patient with such previous treatment for carcinoma in situ of the uterine cervix must be urged to continue with regular preventive examinations for cancer. The vaginal stump must be regularly re-examined both by colposcopy and by cytology.


[Religion and marriage (author's transl)].

Marriage according to religious denomination is no longer important because of the philosophical changes in recent times. Reproductive behaviour is no longer dependant on religion for the same reasons. Faith in the naturalness and ordainment by God of the roles of the sexes is no longer prevalent. From 1960--1976 the number of marriages in the Federal Republic of Germany decreased by 30%. The number of divorces increased by 122%. Mixed interdenominational marriages remained steady at between 20--25% of all marriages. Marriages of partners of the same denomination decreased from 76.5 to 68.6%. The marriages oe changed by man and individualized this trend is positive. Intervention of the states leads to conditions which should be avoided, namely that the interhuman relationships become insecure a fact which can be easily abused by demagogues.


[The behaviour of serum-coeruplasmin in women with intrauterine pessary containing copper (author's transl)].

In 50 women before and 10--35 weeks after insertion of a Copper-T-200 serum concentration of Caeruloplasmin was assayed. A decrease of serum concentration with statistical significance (p less than 0,0001) was determined. In 22 women before and 4--5 weeks after removal of a Copper-T-200 serum concentration of Caeruloplasmin was assayed. An increase of serum concentration with statistical significance (p less than 0.01) was determined.


[Long-term outcome of sterilization as a function of the indication, marital status, age, number of children and concurrently performed therapeutic abortions (author's transl)].

On the basis of questionnaires 1084 sterilized women were interrogated concerning their satisfaction with sterilization. 769 (70.9%) fully completed questionnaires could be evaluated. 96.4% of women were satisfied with their sterilization. 1.3% of patients requested reversal of sterilization. Non satisfactory results occured mainly in women where the indication for sterilization was on non-social basis, in single women and in cases where an interruption of pregnancy was performed at the same time. No correlation was found between age or parity and the satisfactory outcome of sterilization.


[Determination of the plasma ribonuclease activity as a diagnostic aid in the diagnosis of ovarian cancer. Results of a double blind study (author's transl)].

The determination of the plasmaribonucleases was reported by Sheid and co-workers in 1977 for the diagnosis of carcinoma of the ovary. The authors investigated the accuracy of this test with a modified method in a double blind study encompassing healthy controls. Blood samples from 62 patients with ovarian cancer were tested. The results were accurate in 56 cases. In 6 cases the test results were doubtful. The difference in the ribonuclease activity was significant between patients with ovarian cancer and healthy patients or patients in remission from ovarian cancer. The results were not dependant upon the FIGO staging of the disease. Our results encourage the recommendation to use this test as a diagnostic aid in carcinoma of the ovary.


[Determination of low blood glucose levels in newborns with the reflectance photometer (author's transl)].

The paper reports the examination of a new test strip Reflotest-Hypoglycemie, which was developed specifically for the hypoglycemic range. In 2 series of 110 respectively 120 samples of capillary blood taken from premature and full term infants the blood glucose concentrations were determined using Reflotest-Hypoglycemie and the hexokineasured with the test strip agree well with the results of hexokinase method in a range less than 50 mg/dl. Bilirubin and hematocrit values do not affect the glucose test. Glutathion and ascorbic acid interfere with the test strip method but this error is neglectable because of physiological low concentrations of these substances.


[History and course of pregnancy in a group of cerclage patients. A comparative study (I) (author's transl)].

The previous history and course of pregnancy in 357 women with variable births, in whom cerclage had been performed during 1966-1976 at the Freiburg University Gynaecological Hospital, were compared with a group of 380 women without cerclage, the age, parity and period during which birth had occurred, being identical. The high average of the patients with cerclage (29.3 years), the low percentage of primigravidae (17.1%), the threefold increased rate of abortions and early births (28.4%) as well as the high perinatal mortality (21.5%) during the preceding pregnancies, confirmed these women as a "risk" group. After cerclage, births before the 38th week were reduced from 41.1% to 24.6% (p less than 0.001.) 52.3% of the premature births occurred between the 36th and completed 37th week.  Perinatal mortality dropped to 5.6% (p less than 0.00l.). A clinically relevant gestosis was less frequent (0.8%;p less than 0.00l.). The fact that the rate of premature births in the cerclage group (p less than 0.001) continued to be elevated, is mainly attributed to the frequency of rupture of the amnion before the 38th week (21.0%).


[Ultrasonic biometry of the fetal crown-rump length between 7 and 20 weeks gestation (author's transl)].

In 370 examinations on 258 patients with known gestational age crown-rump length (CRL) of the fetus was determined by sonar between 7 and 20 weeks. From the results the mean and "2 SD" limits of CRL were derived by means of a non linear regression analysis. The measurements were further analysed to determine gestational age for a given CRL. Besides a velocity curve of CRL growth was calculated. It showed a maximum of 1.8 mm per day at 14 weeks. It was confirmated that sonar measurements of crown-rump length are very useful to estimate maturity of the fetus. The accuracy was found to be best in early measurements (+/-6 days at 7 weeks -+/-11 days at 20 weeks). In regard to clinical decisions reading errors have to be taken into consideration. To avoid them control examinations should be carried out.


[A new therapeutic approach for terminating intact and disturbed pregnancies: three years of experience with the prostaglandin E2-derivative sulprostone (SHB 286) (author's transl)].

Sulprostone, a new synthetic prostaglandin E2-derivate has been tested for artificial abortion in 628 women with intact or disturbed pregnancies in all stages of gestation. Compared with other prostaglandins used for this purpose systemic side-effects were low and success-rate was high. Systemic routes of application (constant intravenous drop infusion, intramuscular injection) were evaluted to be more successful and conventient than the local ones (extra- and intraamniotic). Suppositories showed no clinical success. Based on our expereince recommendations for the treatment with sulprostone are given: Intramuscular injections for inducing early abortion or menstrual regulation (less than 6th week of pregnancy) without necessity of curettage and for cervical rpiening (less than 12th week of pregnancy) prior to curettage, constant intravenous drop infusion for induction of abortion in second and third trimester pregnancy.


[Investigation of the epidemilogy of fungal vaginitis in 1000 patients (author's transl)].

In the out-patient department and antenatal clinic 1000 patients were examined for yeast of the genital tract by the nickerson-medium. In 10.3% of the patients the cultures showed yeast. The wet-mount preparation examination under phase contrast microscopy was compared to the nickerson-medi-m culture. Patients with a past history of yeast infections or patients with an intrauterine device showed a statistically significant increase in the rate of yeast vaginitis compared to the control groups. Patients who had antibiotics or were treated with corticosteroids showed a higher incidence of yeast vaginitis than normal controls. Controls had a 9% incidence. The number of cases was too small for statistical analysis. The incidence of yeast vaginitis in patients on combined or sequential oral contraceptives was the same as in the control groups. The pregnant patients and obese patients did not show an increased incidence of yeast. High risk patients for yeast vaginitis are defined in which a culture for yeast is jusitfied. Especially antenatal patients in the last trimestre are a high risk group because of the possibility of neonatal thrush.


[HCG-determinations in serum and mammary cyst aspirates in women with benign breast tumors (author's transl)].

Results of HCG-determinations in human serum and cystfluid of benign mammary tumors are presented. HCG was determined gy RIA in 40 samples from 30 patients with different forms of fibro-cystic mastitis. In 60% of the cases positive results were obtained. It is still unclear, whether the demonstrated substance is native HCG, a free beta-subunit, a mixture of both or a different substance with immunologic properties similar to those of HCG.


[Fetal death in utero 15 weeks following amniocentesis -- a legal case (author's transl)].

This is a report about fetal death in utero in a case of monozygote, monochrionic, monoamnionic twin pregnancy (46,xy) 15 weeks after amniocentesis. The public prosecutor was occupied with the case by the patient. The accusation run as follows: Stab wound with following death in utero of one twin and thereby damage of the second twin also with following death in utero. Directly after delivery the first diagnosis by aspect of the fetuses was: transfusion syndrome. The following endoradiography of the blood vessels of the umbilical chords and placenta confirmed the first diagnosis (anastomosis). Additionally both chords were entangled and knotted variously. It was concluded that the extremely smaller fetus died from malnutrition (transfusion syndrome) whereas the taller fetus died from acute asphyxia (knotted chords in monoamnionic twin pregnancy). The forensic investigation was, as aspected, without any pathological findings concerning sequelae of stab wounds but revealed the lack of one chordvessel of the smaller fetus and the typical histological findings of an aspiration lung of the taller fetus.


[Induction of labour in cases of intrauterine fetal death by cervical dilatation with a balloon and oxytocin titration (author's transl)].

In twelve cases of intrauterine fetal death labour was induced by combined treatment with an intra-cervical balloon and oxytocin infusion. The average induction-delivery time was approximately 11 hours. Acceptance of this method for induction of labour by the patients was satisfactory and the side effects were minor.


[Radioimmunoassay of beta sub unit HCG following hydatidiform mole or chorionic carcinoma (author's transl)].

The radioimmunoassay of Beta Sub Unit HCG in the serum heralds a marked improvement in the diagnosis of gestational trophoblastic disease. In nine cases of hydatidiform mole and three cases of chorionic carcinoma serial examinations of the Beta Sub Unit HCG were performed. When the immunologic pregnancy test became negative following a hydatidiform mole or following treatment of chorionic carcinoma, the HCG excretion remained above detectable values for several more weeks. The decrease of Beta Sub Unit serum HCG was either linear or in fluctuations. The detection of fluctuations or a secondary rise in the Beta Sub Unit HCG titre permits the early diagnosis of invasive trophoblastic disease following hydatidiform mole or of insufficient treatment or recurrence in cases of chorionic carcinoma. Our results suggest that the optimal follow-up with Beta Sub Unit serum HCG is by weekly determinations until four consecutive determinations remained negative. This is followed by two determinations at bi-weekly intervals and thereafter monthly follow-up examinations.


[The population law (author's transl)].

Population Law is not the same at all times and in all places. Each economic stage of development has its own population law. The different development of the means of production changes the conditions. Future conditions of economy are going to be significantly different from those in the past. First the reduction of the number in population, second the changing age structure of the population, third the saturation with many material goods, fourth the decrease of the domestic growth of the gross national product and distribution, fifth in creasing environmental problems with resistance to tolerate polluting industries, sixth changes in the world economic division of preoduction with an increased production of manufactured products from developing countries, and seventh growth in the population lead to a sifting effect which pushes the weaker groups of the population into a subproletareate.


Aggression during competition: effects of age, sex, and amount and type of provocation.

Three experiments were designed to examine the expression of instrumental and hostile aggression by 6- to 10-year-old children during a competitive game. The rate at which a child pressed a button which allegedly interfered with his opponent's progress on the task was the measure of instrumental aggression. Pressing a second button presumably caused one's opponent to hear an aversive noise and served as the measure of hostile aggression. The task was designed in an attempt to isolate (a) frustration from attack as the instigator of aggression and (b) instrumental from hostile aggression as the desired outcome. In all three experiments the measures of instrumental and hostile aggression were generally highly correlated except under provocation conditions during which the number of attacks exceeded the number of frustrations. This suggested that the task was successful in tapping two different classes of aggressive responding. In Experiment 1 older children (N = 161 males and females) expressed more of both instrumental and hostile aggression than did younger children, and males were more aggressive than females on both measures. However, neither measure of aggression varied as a function of level of provocation. This finding was discrepant from the authors' previous research which had focused solely on instrumental aggression. Apparently, the introduction of attack and the opportunity for hostile responding changed the experimental situation. In order to focus more directly on this issue, Experiments 2 (N = 60 males) and 3 (N = 56 males) used various combinations of attack and frustration with 9- and 10-year-old males. Attack, prior to frustration, elicited the greatest amount of hostile aggression. Frustration, with no attack, resulted in the highest level of instrumental aggression. The complex relationship between these sources of provocation and instrumental and hostile aggression was discussed.


[Cytogenetic effects induced in vitro in human peripheral blood lymphocytes by neutrons. II. Relative biological effectiveness of neutrons having different energies].

Human lymphocytes were irradiated in vitro during Go stage by graded doses of thermal neutrons and neutrons having an average energy of 0.04; 0.09; 0.35; 0.85 and 14,7 MeV as well as by 60Co gamma rays, and RBE of neutrons relative to gamma-rays was calculated for the frequency of total and different types of aberrations. It was found that the RBE has the most value at the low doses and decreases when the exposition dose increases. 0.35 MeV neutrons have the maximum RBE in comparison with neutrons having other energies. When comparing the RBE values calculated for different types of chromosome aberrations, it was found out that dicentrics and dicentrics plus centric rings had more RBE than acentric aberrations (pair fragments and minutes).


[Quantitative analysis of sister chromatid exchanges in the cell].

Assuming a random nature of distribution of sister chromatid exchanges (SCE) in a karyotype, the formulae have been obtained allowing the calculation of the number of SCE that are overlooked because of a limited resolving power of the SCE detection method. The results obtained mean that the actual number of SCE is more than the observed one, the part of overlooked exchanges being increased with the heightening of the SCE level. Taking into account overlook exchanges, the formula has been obtained that makes possible the calculation of the expected number of SCE observed in any group of chromosomes. These results were applied in the analysis of the SCE distribution among chromosomes. A better conformity has been obtained between the expected results and the observed ones, than under the assumption that the observed SCE are distributed in proportion to the lengths of chromosomes. The obtained formulae are of use in interpreting the lack of the observed SCE in small chromosomes and the excess of them in large ones.


[Correlation of heredity and environmental factors in the etiology of Vilyui encephalomyelitis. I. Patient frequency in families].

Viljuisk encephalomyelitis (VE) is a severe neurologic disease characterized by slow progressive dementia', oligobradykinesia, low spastic paraparesis and speech disturbances. It develops in persons of 20-50 years old. VE occurs in a small region of middle Viljui, but for last years the focus has considerably expanded. Etiology of VE is still obscure. 194 families with VE patients were examined. The data obtained contradict the hypothesis of simple recessive inheritance of VE. The value of the heredity coefficient, calculated on the basis of the Falconer - Edwards model, is 22-29% for relatives of the first relation degree. It suggests the existence of individual hereditary determined susceptibility to VE. 14 secondary cases were observed in affected families among adopted relatives (adopted children, husbands and wives of patients) with a rate exceeding random possible frequency. These observations have been evaluated as an evidence of horizontal transmission of the disease from patients with chronic forms to healthy persons. Obligatory condition for the transmission consists in a long-term contact (as a rule, more than one year). According to all known characteristics VE should be refferred to slow infections.


Nucleotide sequence of the EcoRI-F fragment of adenovirus 2 genome.

Using the DNA sequence method of Maxam and Gilbert the entire nucleotide sequence of the adenovirus 2 EcoRI-F fragment was determined. Information contained in that nucleotide sequence, which is 1743 base pairs long, is interpreted with respect to the mapping and processing of the three mRNAs partly encoded by the EcoRI-F fragment. A method to rapidly determine the cleavage site of restriction endonucleases is also reported.


A new site-specific endonuclease showing phenotypical crypticity in a tumorigenic strain of Agrobacterium tumefaciens.

AtuBVI, an endonuclease showing new site-specificity, has been isolated from the tumorigenic strain IIBV7 of Agrobacterium tumefaciens, and is undetectable in the non-tumorigenic sister strain IIBNV6. AtuBVI degrades IIBV7 DNA in vitro and should, therefore, be regarded as being phenotypically cryptic in the bacterial cell; it also shows anomalous behavior under cerain incubation conditions. These properties point to a possible role for this enzyme in the insertion of exogenous Ti-plasmid DNA into plant tissues during tumorigenesis.


The nucleotide sequence of the transforming HindIII-G fragment of adenovirus type 5 DNA. The region between map positions 4.5 (HpaI site) and 8.0 (HindIII site).

The nucleotide sequence of the region between map positions 4.5 (HpaI-site) and 8.0 (HindIII-site) of adenovirus type 5 (Ad5) DNA has been determined. This stretch of DNA is part of the transforming HindIII-G fragment, which is 2809 nucleotides long. The sequenced segment was found to have a long open reading frame for protein biosynthesis, starting 23 nucleotides from the HpaI site and extending all the way to the HindIII-G site, which could code for a protein of at least 44 000 daltons. The possible correlation beteen the coding capacity of the HindIII-G fragment and the "transforming" proteins specified by it will be discussed in the light of the recent data on the splicing of early mRNAs.


Electrophoretic mobility of high-molecular-weight, double-stranded DNA on agarose gels.

A new theoretical model for the migration of high-molecular-weight, double-stranded DNA on agarose gels is presented. This leads to the prediction that under certain conditions of electrophoresis, a linear relationship will exist between the molecular weight of a DNA molecule, raised to the (-2/3) power, and its electrophoretic mobility. Agarose gel electrophoresis of the fragments of bacteriophage lambda DNA produced by several restriction endonucleases confirms this relationship, and establishes some of the limits on its linearity. For this work, a polyacrylamide slab gel apparatus was modified for use with agarose gels. This apparatus has several advantages over others commercially available for agarose gel electrophoresis, including the abilities to run a larger number of samples at one time, to use lower-concentration gels, and to maintain better temperature stability across the width of the gel. The validation of the relationship developed here between molecular weight and electrophoretic mobility should make this a useful method for determining the molecular weights of DNA fragments.


Primary structure of an EcoRI fragment of lambda imm434 DNA containing regions cI-cro of phage 434 and cII-o of phage lambda.

Digestion of phage lambda imm434 DNA with restriction endonuclease EcoRI yields 7 fragments. The shortest among them (1287 bp) contains the right part of the phage 434 immunity region and the phage DNA portion proximal to it. The complete primary structure of this fragment has been determined using the chemical method of DNA sequencing. Hypothetical amino-acid sequences of proteins coded by the cro gene of phage 434 and the cII gene of phage lambda, as well as NH2-terminal amino-acid sequences of the cI protein of phage 434 and the O protein of phage lambda, have been deduced solely on the basis of the DNA sequence. The fragment studied contains also the pR and probably prm promoters and the oR operator of phage 434. The sequence coding for them differs from the respective DNA sequence of phage lambda.


Physical mapping of the globin gene deletion in (delta beta (0)) -thalassaemia.

We have constructed a physical map of restriction endonuclease cleavage sites in the (delta (+) beta)-globin gene region in the DNA of patients with (delta beta(0))-thalassaemia. This map shows that a 10 kb deletion has occured in (delta beta (0))-thalassaemia to remove the entire beta-globin gene and the 3' portion of the delta-globin gene. The 5' terminus of the deletion is in the large intron of the delta-globin gene and the 3' terminus 1.8 kb to the 3'-side of the beta-globin gene. A similar deletion of about 7 kb has been described previously in the DNA of patients with Hb Lepore; the 5' terminus of the deletion is also in the delta-globin gene but the 3' terminus is in the beta-globin gene. Comparison of the foetal (gamma) globin gene expression in adults with (delta beta(0))-thalassaemia and Hba Lepore suggests that the 3' extragenic regions of the beta-globin gene contain DNA sequences involved in the regulation of gamma-globulin gene expression.


Do you know the treatment of choice in peripheral arterial occlusive disease?

Five early warning signs can alert you to the presence of acute arterial occlusive disease, which can come on abruptly. It is crucial to differentiate between embolism and thrombosis, since treatment of the former is relatively simple, whereas the latter requires a more complicated surgical procedure.


Treatment of depression in the elderly.

Depression is often overlooked, misdiagnosed, or inadequately treated in older patients. Since depressions secondary to drug use or organic diseases are common in the aged, complete physical and laboratory evaluation is essential. Fortunately, depression can be alleviated if you know the therapeutic options. Selection of the best one should be made carefully in elderly patients.


Pitfalls in the early diagnosis of diabetes.

The glucose tolerance test remains the most acceptable approach to the early diagnosis of mild diabetes in adults in the absence of significantly elevated fasting blood sugar levels. Current reappraisal of what is a "normal" fasting blood glucose level is necessary to avoid the error of false-positive diagnosis of diabetes.


Emergency evaluation of head injuries in the elderly.

The first hour after head injury in the elderly is the most critical. Airway obstruction and impaired cardiovascular reflex mechanisms are the major initial problems. A patient with an extracerebral hematoma may need emergency trephination. You must look for the specific clinical indications or use a CAT scan to identify surgically accessible lesions.


Drug/alcohol interactions: avert potential dangers.

Alcoholism is not uncommon among older people, but "binge" or facilitative drinking is more characteristic of this age group. Alcohol interacts with many drugs frequently prescribed for older patients--antidepressants, sedatives, hypnotics, tranquilizers, and others--and the combination can sometimes be fatal.


The effect of insulin on elder phenylketonuric patients.

The effect of insulin on blood phenylalanine, tyrosine and catecholamine levels was investigated in six phenylketonuric patients and eight normal controls. The plasma phenylalanine-tyrosine ratio was lower after insulin injection in five of six patients. In four patients the plasma catecholamine concentrations increased. The tyramine level was remarkably high one hour after insulin injection. Urinary homovanillic acid was elevated in four patients. It appeared that insulin treatment produced some therapeutic effects in patients with smaller phenylalanine-tyrosine ratios or elevated catecholamine levels.


Computed tomographic findings in subacute sclerosing panencephalitis.

We used a computed tomography to look for evidence of cerebral changes in a three-year-10-month-old girl with SSPE. The area of decreased density on CT corresponded to inflammatory and demyelinative lesions in the brain. CT scans seem to be a useful tool for more accurate assessment in the diagnosis of SSPE.


Mortality and causes of death in the aged with organic brain symptoms.

By various mental status rating methods, 363 aged residents at a nursing home (aged 80 years on the average) were previously evaluated with regard to chronic brain syndrome (CBS), and now at two and four years thereafter, the relation between mortality and the degree of CBS was statistically tested. The results showed that the severer the CBS, the higher the mortality, with significant difference. In 136 autopsy cases, the primary cause of death was investigated. The results showed no significant difference in the cause of death, either between dementia and non-dementia groups or between groups of mild, moderate and severe CBS.


An autopsy case of protracted necrotic encephalitis with marked atrophy of unilateral temporal lobe.

Clinical and neuropathological findings in a case of an unusually protracted encephalitis have been described. The patient was a 44-year-old man who experienced mental deterioration, right abducens and facial paresis, right and, subsequently, left hemiparesis, and consciousness disturbance with an intermittent low grade fever and occasional headache during one year and three months. Electroenphalograms showed periodic lateralized epileptiform discharges. Virus titers including herpes simplex virus were all normal. Neuropathological examinations revealed marked atrophic changes in the right temporal lobe, insular lobe and hippocampus with minimal inflammatory signs. The distribution of the lesions was almost identical with that of acute necrotic encephalitis or herpes simplex encephalitis despite its unusually protracted course.


A 10-year follow-up study of 97 epileptics.

1) Of 267 patients with epilepsy who were examined in our clinic during the period between 1964 and 1966, 97 were investigated in a 10-year follow-up study. The patients were selected according to the following criteria: the age of onset of seizures was 10 years or older and the follow-up period was 10 years after the onset of seizures. Of the 97 patients, 36 were followed up by mail. 2) In the adult 10-year follow-up study, seizures disappeared in 43.3%, decreased in 34.0%, remained unchanged in 16.5%, and were aggravated in 6.2% of the 97 patients. Comparing the five-year follow-up study with the present study, the rate of cases which were free of seizures for three years was 22.7% in the five-year study and 43.3% in this study. The seizures were controlled for at least three years in 22.9% of the cases with partial seizure and in 63.3% of the cases with generalized seizure. The worst prognoses were found in cases with versive seizure in which the seizure was unchanged and/or aggravated in 4 (44.4%) of 9 cases. Of 16 cases with psychomotor seizure, 25% were unchanged or aggravated. 3) Comparing the impaired consciousness seizure with the psychomotor seizure, there was a tendency for the psychomotor seizures to remain as a single type of partial seizure, while the impaired consciousness seizure tended to develop easily into a secondarily generalized seizure. 4) Of the 97 patients, three were personality disorders in 19 cases (19.6%), episodic psychotic state in 2 cases (2.1%), and mental retardation in 6 cases (6.2%). Disorders of mood, irritability and explosiveness associated with personality disorders were improved in three of six cases whose seizures disappeared. Personality disorders were found in half of those cases with partial complex seizures. No correlation was found between mental symptoms and the prognosis of seizures. 5) The EEG was improved in 15 (27.8%) of a total of 54 cases, unchanged in 35 (64.8%) and aggravated in 4 (7.4%). In comparing the prognosis of clinical seizure with changes in the EEG, the seizures improved in 40 (74.1%) of the cases, whereas the EEG improved in only 15 (27.8%) of 54 cases. Most of the clinical seizures were controlled or decreased, whether the EEG improved or not.


Electron-microscopical study on senile plaques in Alzheimer's disease.

The cerebral cortex taken post mortem from a case of Alzheimer's disease was examined especially with regard to the relation between blood vessels and senile plaques. Many senile plaques had central cores, composed of such matter as degenerated blood vessels and basement membranes with abundant amyloid fibrils. The components of senile plaques seemed to be degenerated neuronal and glial tissue compressed by developed basement membranes and amyloid fibrils. From this we would like to emphasize that senile plaques seem to be caused by amyloid fibrils and degenerated capillaries.


Amyotrophic lateral sclerosis with temporal lobe atrophy.

Clinical and neuropathological findings are reported on a 48-year-old man who developed progressive bulbar palsy, muscle atrophy of four extremities, and hyperreflexia. Duration of the illness was about 19 months. Moderate personality changes were observed during his hospitalization. Neuropathological examination revealed the presence of an ALS: severe loss of the large motoneurons in the spinal anterior horns, and degeneration of the corticospinal tract, more prominent on the left side. The hypoglossal, the facial, and the motor trigeminal nuclei were also involved, but the oculomotor, the trochlear and the abducens nuclei were well preserved. There was bilateral, but more pronounced on the right, atrophy of the temporal poles consistent with the lesions of the temporal types of Pick's disease. This case indicates the simultaneous occurrence of degenerative diseases of the CNS, and the correspondence of laterality between the temporal lobe and the spinal cord may suggest a common etiology of these two types of disease processes.


[The necessity of preventive gynecological studies in the aged].

According to epidemiological data the majority of the old women suffers from mammary cancer or gynecological malignoma. In cervical uterine cancers this ratio reaches more than 30% and in uterine body, ovarial and breast cancers more than 60%. Thus, it is significantly clear, that gynecological preventive medical examinations are so important. For cervical cancer cytology and for breast cancer mammography and thermography are valuable and satisfactory methods. Because of the lack of a practicable preventive examination method for corpus cancer and ovarial carcinoma it is evident, that regular clinical investigations are of vital importance in this field. Vulva and vaginal cancers are to be mentioned as real old women's neoplastic disease, because it starts mostly between 7th and 9th decade of life.


[Peritoneal lavage for the early diagnosis of intraabdominal injuries in blunt traumas. Personal results].

Peritoneal lavage has been found to be a simple, uncomplicated method of examination providing much information in cases of blunt abdominal trauma. It permits decision to start surgical procedures in adequate trauma at short notice and is performed routinely at our clinic in patients suffering from craniocerebral trauma, even in the absence of clinical symptoms of intraabdominal lesions. The advantage of the method is little need of time, personnel and surgery as well as the fact that it can be applied also by relatively unskilled doctors and does not really require a specialist. The precision of the method is high. An important factor for successful application is the use of sufficient quantities of a lavage solution.


[New pathways in the treatment of psychologically drug dependent adolescents].

Based on a one-and-half year experience in a small group setting with drug dependent adolescents the change of group structure, the functioning of the group for its members, the leader's position within the group and the therapeutic relationship are analysed. In its beginning the group develops what can be called a "symbiotic group structure". Its transformation into that of a "working group" is the main task of therapy. The underlying processes can be compared with those of the beginning individuation in early childhood. Ego development begins, as M. Mahler and other modern investigators have shown, with the perception of one's own body and its representation in early ego formation. Using self awareness techniques, as we have done, is in this context a theoretical as well as practical well founded approach to the problems of psychic dependence.


[Ureteral polyposis].

In connection with a case report a review is given on the clinical aspects of ureteral polyposis. The symptomatology of this condition differs considerably. The most frequent symptom is gross hematuria. Ureteral polyposis will be verified in most cases by a retrograde ureteropyelogram. Resection of the tumor bearing ureteral segment should be performed in order to exclude a malignant tumor.