Long-term changes in the activity of superior colliculus neurons isolated from corticofugal influences.

In acute experiments on nonnarcotized, immobilized cats, spike activity was studied in superior collicular neurons which were isolated from direct, descending cortical influences. Animals were taken for experimentation at various periods (from 3 to 20 months) after the operation which disconnected the cortical connections which projected from one hemisphere. An increase was noted in the regular forms of activity, and there was a decrease in the frequency of group discharges. Evoked activity of the cells was suppressed during the early periods after disconnection of corticocollicular connections. Later (after 9--12 months) its gradual restoration was observed. More than 70% of the neurons again began to respond to adequate stimuli. The sensitivity to moving photic stimuli was restored in only 17% of the neurons studied.


Adverse side effects of metrizamide in myelography.

The adverse side effects in a series of 439 myelographies with metrizamide were analyzed. The most frequent side effect was headache, which could be differentiated as early onset headache, related to hydrodynamic modifications in the spinal fluid following lumbar puncture, and late onset headache related to a metrizamide effect. The frequency of late onset headache was at least 27%, but all together 46% of the patients had postmyelographic headache. Meningeal irritation was seen in 5%, sometimes in a severe form, mimicking a septic complication. Spinal irritation and epileptic fits were rarely seen. Striking was the occurrence of an acute psycho-organic syndrome, frequently observed after cervical myelography which was performed with a higher than usual dose of iodine. We can not confirm the general opinion that the central nervous system had a good tolerance for metrizamide.


Arterial supply for the upper cervical nerves and the cervicocarotid anastomotic channels: systematization of radiological anatomy.

A simplified map of the cervicovertebralcarotid channels is presented with a description of the arterial supply to the cervical nerves. The aim of the work is also to open the field for endovascular therapy of malignant lesions distal to carotid ligation with greatest security, and to discuss a new approach to some upper cervical neuropathies.


Role of hyperactive determinant structures in the creation of functional complexes of seizure activity in the cerebral cortex.

Foci of enhanced excitability, with independent discharge patterns, were created by subconvulsive strychninization in experiments on cats. A focus of more powerful excitation created with the same strychnine played the role of determinant despatch station (DDS). Its importance is that it determines the character of activity of the other foci of excitation, strengthens excitation in them, combines them into a single functional complex, and determines the character of activity of the whole complex. This complex can be destroyed by suppressing the DDS with pentobarbital. Blocking individual destination stations included in the complex does not lead to its destruction.


Effect of lithium chloride on the neurosecretory system of the rat hypothalamus.

The response of the hypothalamic-pituitary neurosecretory system (HPNS) of rats to a single and repeated injection (200 mg/kg each time) of lithium chloride was studied by quantitative cytochemical analysis. The response of the HPNS was found to depend directly on the dose of lithium given and to consist of activation of synthesis and liberation of neurosecretion after a single dose of LiCl or inhibition of hormone formation in the hypothalamus and exhaustion of the reserves of neurosecretion in the neurohypophysis after a course of injections. In the recovery period (7--30 days after stopping the course of injections of LiCl) the previous state of the HPNS was gradually restored.


RIHSA cisternography in cerebral tumours.

RIHSA cisternography was abnormal in all of 24 patients with supratentorial tumours. The most common finding was asymmetry caused by ipsilateral obstruction of the sylvian fissure and the subarachnoid space around the convexity. Another frequent finding was partial or total obstruction at the tentorial notch, often in combination with reduced or absent activity along the superior sagittal sinus. These disturbances of CSF flow may explain the pathogenesis of raised CSF pressure with cerebral tumours.


Obstructive hydrocephalus following Pantopaque myelography.

A case with delayed development of obstructive hydrocephalus most probably caused by Pantopaque myelography is reported. At autopsy it was found that the foramina of Magendi and Luschka were occluded by granulation tissue in which the most common findings were multinucleated giant cells containing calcareous and unstained vacuoles, frequently surrounding empty hollows, many lymphocytes and plasma cells. As compared with two other similar cases and several animal investigations this shows that the reaction of the tissue is typical of a Pantopaque reaction.


Cauda equina syndrome and arteriovenous fistula.

Traumatic arteriovenous fistulae, resulting in delayed damage to the cervical spinal cord and roots, are well documented. This report concerns an iliac arteriovenous fistula with damage to the cauda equina.


Intracerebral extravasation of contrast medium after head injury.

A case of intracerebral extravasation of contrast medium is reported. In cases of head injury this occurrence is rare and is manifested by persistent images on both frontal and lateral views of the angiogram. This indicates severe cerebral trauma with active hemorrhage and the prognosis is generally bad. A possible mechanism seems to be contrecoup.


Amyloid tumor of the orbit.

A patient with an amyloid tumor of the orbit was studied by computed tomographic scanning. The tumor density was 10 delta units unenhanced and 72 units enhanced.


Aneurysmal bone cyst of the temporal bone.

Aneurysmal bone cysts occurring within the calvarium are uncommon. The following case report describes the radiological and pathological findings of a temporal bone aneurysmal bone cyst with intra- and extracranial manifestations. The pertinent literature is reviewed.


The superficial recurrent ophthalmic artery supplying an occipital arteriovenous dural malformation.

Brief comment is made about a rare large arterial supply to an occipital arteriovenous intradural malformation.


[New therapeutic prospects in lead poisoning: alpha-mercaptopropionylglycine].

The action of alpha-mercaptopropionylglycine has been studied in 27 subjects occupationally exposed to lead. In addition to improved efficiency of liver function, the results show a tendency to normalization of the various porphyrinic metabolism parameters considered. A significant increase was observed in erythrocyte dehydratase ALA activity together with an equally significant diminution in urinary excretion of delta-aminoleuvlinic acid. Urinary coprorphyrin and erythrocyte protoporphyrin IX values were also down. The tendency of metabolic changes to normalize as a result of the toxic action of lead suggests the use of alpha-mercaptopropionylglycine in the treatment of lead poisoning.


[Results of the use of a new aminoglycoside antibiotic, sisomicin, in gram negative bacterial respiratory infections].

Clinical efficacy of a new aminoglycoside antibiotic, sisomicin, was evaluated in 14 patients with acute chest infections (12 cases with pneumonia and 2 with bronchitis). They were selected taking into account the isolation of sisomicin-sensitive Gram-negative bacilli in a sputum specimen collected prior to therapy. Local predisposing factors were present in 4 patients whereas general predisposing factors were present in 4 patients whereas general predisposing factors were recognizable in 9. Klebsiella was isolated in 5 cases, E. coli in 5 cases, Proteus in 4 cases, P. aeruginosa in 2 cases, Ct-trobacter and Providencia each in one. In all patients the bacteriological finding was negative after the cycle of therapy; clinical outcome was uniformly favourable (11 patients healed, 3 got better). No significant adverse effects due to the antibiotic was noted.


[Incidence of cryoglobulinemia in a series of cases of chronic liver diseases].

The prevalence of cryoglobulinaemia in a series of patients with chronic liver disease from the Campania area has been studied. The series included: 14 cases of chronic persistent hepatitis (CPH), 70 cases of chronic active hepatitis (CAH) and 113 cases of liver cirrhosis. Liver function tests were carried out on the serum of each patient and cryoglobulines were studied. Liver biopsy was carried out when indicated. About a third of the patients were under the effect of previous treatment with anti-inflammatory steroids and-or azathioprine. Cryoglobulines were found in 4 of the 197 patients (2%); of type IgG in 3 cases: 1 of CAH, HBsAg negative and 2 of inactive cirrhosis of which one with HbsAg in the serum; of type IgM in 1 case of CAH, HBsAg negative. The data are discussed on relation to other reported data.


[Concentration and reinfusion of ascitic fluid in liver cirrhosis].

46 concentration-reinfusion treatments were performed on 36 patients, suffering from refractory ascites for liver cirrhosis. The procedure was well tolerated, improved the status of the patients and enabled diuretic to be effective again, in some cases for as long as two years. The usefulness of infusing autologous, non-denatured proteins in high dosage is stressed. The Authors belive that hepatorenal syndrome, severe hypokaliemia or hyposodemia and encephalopathy are the elective indications for the treatment.


[Visual evoked potentials and the E-UFA test. Laboratory contribution to the diagnosis of multiple sclerosis].

Visual evoked potentials (VEPs) and electrophoretic mobility test of erythrocytes (E-UFA test) were compared in 50 multiple sclerosis (M.S.) patients as diagnostic tests. Abnormal VEPs were recorded in 35 patients. E-UFA test was found positive in 31 cases. With respect to Mc Alpine diagnostic criteria, 26 out of 33 definite M.S., 6 out of 9 probable M.S. and 3 out of 8 possible M.S. cases had abnormal VEPs. A positive response in E-UFA test was observed rispectively in 16, 8, 7 patients. Complessively 48 cases (96%) had an abnormal response to the one and/or to the other of the two tests, which apper complementar in early diagnosis of M.S.


[Extraosseous Ewing's sarcoma].

A 18 years old female patient was admitted to our clinic with a diagnosis of non-Hodgkin malignant lymphoma originating from the subcutaneous tissue of the left paravertebral region. Notwithstanding cycles of polychemotherapy and radiotherapy, clinical conditions rapidly worsened with rapid appearance of an increasing number of cutaneous neoplastic infiltrations. Due to the rapid spread of the malignancy -- as shown by lung X-rays and bone marrow biopsy -- the patient died 8 months after the onset of the disease (2 months after admittance). At autopsy, tumor cell infiltrates were found not only in the bone marrow and lung but also in the liver, adrenals, gonads and spinal cord. Histological and cytochemical features -- both in bioptic and autopic tissue specimens -- were quite similar to those of Ewing's sarcoma of bone. On the whole, of these clinical and histopathological features, this can be considered a case of "extraskeletal Ewing's sarcoma" as described by Angervall and Enzinger and recently by E. H. Soule et Al.


[Epidemiologic study on the distribution of rubella antibodies in the female population of the Marches].

The results of an investigation to make evident the degree of immunity against rubella virus in women living in the Marche are described. The percentage of women deprived of natural immunity is unequal in two groups of different age. The authors discuss about problems of vaccinic prophilaxis, specially for the "high risk" populations.


[Peculiar electrocardiographic findings in space medicine].

An account is given of some peculiar ECG pictures observed during two studies performed at the Air Force Aerospatial Medicine Research Centre. The first study covered in-flight heart rate recordings in trainee pilots and can be regarded as an early example of dynamic ECG, as also employed in the rehabilitation of heart patients and in sport for both diagnostic and preventive purposes. It was performed four years ago. The second study, run on subjects undergoing protracted high centrifugal acceleration, revealed: tachycardia, bradycardia, pulmonary P, repolarisation disturbances, alterations in the level of the ST segment, etc. An aetiopathogenetic assessment is made of these alterations and some personal observations are added. It is suggested that dynamic ECG could be more widely employed in experiments in this field as a powerful research tool.


[Fatigue in pilots, especially in helicopter pilots. Etiopathogenetic, preventive and therapeutic factors].

The main results of recent research into fatigue in pilots are summarised, with particular reference to helicopter pilots. Attention is also directed to current views concerning prevention and treatment of fatigue syndromes in pilots.


[Current nosographic and clinical validity of flight phobias].

Recent trends in the development of aeronautical psychopathology are examined. It is shown that flight phobias, far from decreasing in the sense of morbility or on the pathogenetic plane, are observed with increasing frequency. Current psychopathological assessments of such phobias are described, and the influence of the surroundings, flight itself, and the subject's underlying personality in their determination is examined. The diagnostic and aetiopathogenetic approaches most in vogue in the literature are culled in the proposal of a new distinction into "during" and "consequent" operative phobias as a means of overcoming purely terminological conflicts, and as a medicolegal aid in evaluating and investigating the fear picture in depth.


[Optical and non-optical aids for the vision-impaired older patient].

Increase of contrast and enlargement of retinal image may lead to an improvement of reading ability of the elderly visually handicapped patient. Pros and cons of available low visual aids are discussed based on the examination or 266 patients of over 60 years of age. High-power addition was sufficient in 27% of the patients. A hand-magnifier of standmagnifier, as well as a telescopic reading unit, or so-called 'prism-loupe' sufficed in 36% of cases. The closed circuit television ('television loupe') was advocated in 17% of cases. The immobility and relative high costs of this apparatus, however, was in a sense prohibitive for further extension of use of this unique instrument, devised for the highly visually handicapped patient. In 20 per cent of cases it was impossible to improve reading ability altogether.


[Is there such a thing as presbyacusia?].

The term presbyacusis is misused in many cases. Aging is accompanied by a number of known and probably unknown processes that are more or less harmful for our hearing aquity. We all carry to our senium the cumulation of harms done to our hearing aquity in lifetime (Schmidt, 1966). Such as noise trauma, metabolic derangements, infections, and so on. Further investigations will make it possible in the future to come to a specific diagnosis that will lead to a better understanding of pathogenesis and pathology.


[Hearing rehabilitation, possibilities and limitations].

The increase of hearing loss in the aged looks like a natural process. The handicap problems caused by this process have not to be accepted as such. A hard of hearing aged may be helped by a hearing aid if he is willing to learn again how to communicate. Just in the learning period professional support has to be given, in the field of handling the hearing aid, training lipreading and learning a number of hearing tactics.


High-risk prematurity--progestin treatment and steroid studies.

Studies have been undertaken regarding the efficacy and modus operandi of 17 alpha-hydroxyprogesterone caproate (17 alpha-OHP-C) in preventing premature labor in high-risk patients. In a total of 70 patients, the treated patient population had a prematurity rate (12.8%) and a perinatal mortality rate (5%) which were significantly lower than those of the total placebo or untreated patient group (40.9 and 25%, respectively). In addition, sequential plasma steroid values were determined in 21 patients, 10 of whom delivered prematurely. The results indicate that low plasma progesterone (P) and 17 alpha-hydroxyprogesterone (17 alpha-OHP) levels precede the onset of preterm labor by weeks. Successful treatment with 17 alpha-OHP-C was characterized by elevated P levels. Plasma estradiol (E2) and cortisol (C) values did not vary with time of delivery or treatment. These findings support the progesterone block theory as an important mechanism affecting preterm delivery in this high-risk population.


Intrapartum fetal cardiac arrhythmias.

Fifteen cases of fetal cardiac arrhythmia were detected by direct fetal electrocardiogram (FECG) during intrapartum fetal monitoring. The frequency of arrhythmia of 12.4/1000 monitored births. Thirteen of the arrhythmias were supraventricular. Atrial bigeminy was the most commonly observed arrhythmia, followed by atrial trigeminy. Two cases of ventricular arrhythmia were noted, one of which was a case of ventricular tachycardia. Arrhythmias were not related to drug treatment or to stage of labor. Variable decelerations occurred in association with arrhythmias in 73% of the cases. There were no nuchal cords seen at delivery, nor were there any instances of intrapartum fetal distress, fetal acidosis, or low Apgar scores associated with any arrhythmia. All arrhythmias resolved spontaneously without treatment. The neonatal course was uncomplicated in all cases. Intrapartum fetal arrhythmia is best detected by direct FECG. Appropriate management should include close observation for ominous fetal heart rate (FHR) patterns and fetal acid-base-studies. At present, there is no indication for drug treatment of intrapartum arrhythmia.


Routine radiographic screening of the chest in pregnant women: is it indicated?

Experience with routine antepartum chest radiographic screening from July 1, 1976, through June 30, 1977, in a city-county hospital which serves a predominantly black indigent population was reviewed. The 5422 routine screening chest radiographs produced an extremely low yield of pathology (11 cases), and only 3 of the 11 cases were not suspected from the history or physical examination. Only 2 cases of active pulmonary tuberculosis were discovered, and both patients were recent immigrants from countries with a much higher incidence of tuberculosis. This low case finding probably reflects the general decline in incidence of pulmonary tuberculosis in the United States and suggests that routine screening chest radiographs (done primarily to exclude tuberculosis) are no longer indicated in our pregnant population.


Current concepts of management of rupture of the gravid uterus.

Fifteen cases are reported of spontaneous rupture of the gravid uterus occurring at the Naval Regional Medical Center (NRMC), Portsmouth, Virginia, over a 21-year period. Forty-seven percent of the patients had previously undergone a cesarean section. Thirteen percent of the patients had received oxytocin prior to the rupture. Fetal mortality associated with these ruptures was 13%. No maternal deaths occurred. Forty percent of the patients had repair of the defect, with 60% undergoing some type of hysterectomy. Preventive measures, early diagnosis, and prompt treatment are emphasized.


Plasma estradiol window and urinary estriol glucuronide determinations for monitoring menotropin induction of ovulation.

The plasma estradiol response is maximal 8--10 hours following mentropin injection. To obtain closer control, a menotropin protocol using 5 PM--8 PM injections and 8 AM blood sampling with a plasma estradiol window of 1000--2000 pg/ml was evaluated with simultaneous calibration of a urinary estriol glucuronide radioimmunoassay. One hundred twenty-eight paired urine and plasma samples were assayed in 48 cycles. In 26 cycles with paired samples on the day of human chorionic gonadotropin (hCG) injection, there were no cases of severe hyperstimulation, 2 cases of moderate hyperstimulation, and 11 pregnancies (42% of cycles given hCG). A window of between 40 and 100 micrograms/day of urinary estriol glucuronide corresponded to the 1000--2000 pg/ml plasma estradiol window by regression analysis. The pregnancy and hyperstimulation rates were compared with those observed in protocols previously published. Radioimmunoassay of urinary estriol glucuronide is faster and simpler than radioimmunoassay of plasma estradiol.


Sex steroid levels during treatment of endometriosis.

Ovarian endocrine function in endometriosis was studied in 19 women before, during, and after treatment with danazol. Striking abnormalities were seen during treatment. Serum estradiol (E2) and testosterone (T) levels increased markedly, while follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin were unaffected. Direct interference of danazol in the assays for E2 and T was excluded by in vitro experiments. The most likely explanation for the isolated alterations in peripheral hormone levels is that danazol affects the carrier proteins in the circulation. However, other explanations are also possible and cannot be excluded at this stage.


The conservative surgical management of unruptured ectopic pregnancy.

With the earlier and more accurate diagnosis of ectopic pregnancy based on rapid beta-subunit pregnancy tests and the use of ultrasound and laparoscopy, the percentage of diagnosed unruptured ectopic pregnancies is rapidly increasing. This, coupled with the earlier treatment of pelvic inflammatory disease, the use of IUDs, and increasing numbers of tubal plastic surgery, caused the authors to evaluate the problem of conservative management of ectopic pregnancy. In this study 98 patients at the Yale-New Haven Hospital who had ectopic pregnancies between 1972 and 1977 are evaluated. Fifty of these patients underwent a salpingectomy or salpingo-oophorectomy. Forty-eight patients underwent salpingostomy. This represents an increase in the conservative surgery rate from 8 to 35.5%. The overall term viable pregnancy rate was 40%, along with a 10% repeat ectopic rate. There was no advantage as far as term viable pregnancy when comparing salpingostomy and salpingectomy. Conservative surgery did not increase the repeat ectopic rate. Salpingostomy is therefore recommended in unruptured ampullar ectopic pregnancies in order to preserve reproductive function. If current trends continue, this will be an increasingly important problem. The statistics are based on a 73% follow-up, with all patients actively trying to conceive.


Dysmenorrhea: treatment with an antiprostaglandin.

Painful menses, one of the most frequent gynecologic complaints, is incapacitating for many women. It has recently been proposed that increased endometrial prostaglandin production and prostaglandin-induced myometrial contractility may be responsible for dysmenorrhea. In this prospective, double-blind, 3-way, crossover study, relief of pain by an antiprostaglanding drug, ibuprofen (400 mg), was compared with propoxyphene (64 mg) and placebo in 22 women with severe primary dysmenorrhea. Ibuprofen was significantly more effective in 18 patients when compared to the other 2 treatment regimens (P less than 0.001), while propoxyphene was superior to placebo in 13 patients (P less than 0.05). Prostaglandin E and F synthesis rates in endometrial biopsy specimens taken on the second day of treatment in 2 patients during each treatment cycle were lowest during ibuprofen in one case but showed no definite pattern in the second.


A case of automobile trauma during pregnancy.

Accidental injury is an important complication of pregnancy. In North Carolina the rate of maternal deaths secondary to accidents has remained constant since 1966; however, because of a reduction in other causes, the percentage of maternal deaths due to accidents has doubled (11.4%). As a result, it is appropriate to reassess the evaluation of injuries sustained in automobile accidents. A case of automobile trauma to a pregnant woman at term is presented, and a plan of management involving fetal monitoring is recommended.


Fetal scalp electrode complications: cerebrospinal fluid leak.

A newborn with cerebrospinal fluid leakage secondary to a fetal scalp electrode is presented. Although infrequent complications from fetal scalp electrode monitoring may be significant. Personnel using these monitoring devices should be alert to possible complications.


Maternal and neonatal implications of congenital complete heart block in the fetus.

The detection of congenital complete heart block (CCHB) in a fetus should alert the obstetrician that the welfare of both the mother and the newborn infant may be in jeopardy. An awareness of this uncommon cause of fetal bradycardia and judicious intrapartum monitoring can avert hasty and unnecessary cesarean section for suspected fetal asphyxia. Neonatal consequences may range from no effect to life-threatening congestive heart failure. The apparently healthy mothers of these infants may be at increased risk for the subsequent development of collagen vascular disease. Three recent case reports demonstrate the spectrum of neonatal and maternal disease that may accompany CCHB. The significance of abnormal serology suggesting a propensity for collagen vascular disease in an otherwise healthy parturient is discussed, and a program for follow-up is proposed.


Dermatomyositis and female malignancy.

All cases of dermatomyositis-polymyositis in women seen between 1970 and 1977 at Baylor Affiliated Hospitals were reviewed. Twenty-five patients were identified with this diagnosis. Of these women, 5 were found to have a malignant tumor: 3 ovarian carcinomas, 1 cervical intraepithelial carcinoma, and 1 colon carcinoma. Pertinent histologic and clinical findings in patients with dermatomyositis-polymyositis are discussed. The high prevalence of malignancy in these patients, previously recognized, is discussed. A case report is presented.


MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) given during pregnancy.

A 26-year-old woman with Hodgkin's disease was treated with multiple-agent chemotherapy at 26 weeks' gestation. She responded well to therapy. Labor was induced at 38 weeks' gestation, and a normal male infant was delivered with no complications. The patient and infant continue to do well at 8 months following delivery. This is one of the first reports of multiple-agent chemotherapy used in early pregnancy.


Kaposi's sarcoma of the vulva: a case report and brief review.

A report of a case of Kaposi's sarcoma of the vulva is presented. A complete response of the tumor was obtained after 1 treatment cycle using a triple-drug chemotherapy regimen of actinomycin D, vincristine, and 5-(3,3-dimethyl-1-trazeno)imidazole-4-carboxamide (DTIC). Death occurred due to severe erythema multiforme, which was indirectly related to a complication of the chemotherapy.


Paraneoplastic hypercalcemia in ovarian tumors.

Two cases of paraneoplastic hypercalcemia secondary to ovarian tumors are presented. Both cases were secondary to ectopic parathormone (PTH) production. Other mediators postulated to cause this syndrome are prostaglandins, vitamin D-like sterols, non-vitamin D sterols, vitamin A, cortisol, and "osteoclast-activating factor.' The key treatment modalities for acute hypercalcemia are hydration and diuresis with furosemide; phosphates, steroids, antiprostaglandins, and hemodialysis may also be of value. Calcitonin is theoretically the most attractive treatment modality, but the rapid development of resistance limits its use to acute management. Mithramycin is most effective for long-term palliation of hypercalcemia if tumor-directed therapy is unsuccessful. Review of the literature confirms the previously made observation that mesonephromas are disproportionaately represented in association with this syndrome.


Torsion of the normal fallopian tube in pregnancy.

Two cases of torsion of the normal fallopian tubes during the third trimester of pregnancy are presented. The etiology and clinical features of this complication are discussed. Although uncommon, it should be included in the differential diagnosis of abdominal pain in pregnancy.


Massive exudative ascites produced from a tubal pseudocyst in chronic pelvic inflammatory disease.

A case of massive exudative hemorrhagic ascites occurring as a serious complication of chronic pelvic inflammatory disease (PID) is presented. The clinical manifestations, simulating diffuse carcinomatosis in a young female patient, are described.


An unusual case of male pseudohermaphroditism.

In vivo and in vitro studies were conducted on a male pseudohermaphrodite. Levels of gonadal steroids in peripheral blood suggested low activity of steroidogenesis which was consistent with the high levels of gonadotropins found. In vitro incubation studies with testosterone, human chorionic gonadotropin (hCG) and follicle-stimulating hormone (FSH) indicated that both gonadotropins increased the endogenous accumulation of testosterone (P less than 0.05) and the rate of conversion of testosterone to androstenedione (P less than 0.025). Estradiol accumulation was increased only in the presence of hCG. These data suggest that the aromatase and 17 beta-hydroxysteroid dehydrogenase enzyme systems in the gonads of this patient may be influenced by gonadotropins.


Avoidance of permanent colostomy in pelvic malignancy using the surgical stapler.

The potential for reducing the number of gynecologic oncology patients left with a permanent colostomy may be achieved by the use of the end-to-end anastomosis (EEA) automatic surgical stapler. This instrument allows a rectocolonic anastomosis at a very low level (below the levator muscles), which is very difficult and poorly performed by hand-suture techniques. This report presents the author's experience with 6 patients in whom a low rectocolonic anastomosis was performed with the EEA surgical stapler.


Local alcohol injection of the vulva: discussion of 35 cases.

During the past 20 years the senior author has, in selected cases, used alcohol injection of the anogenital area for the treatment of intractable pruritus. The initial experience of this treatment in 30 cases that had failed to respond to other appropriate local therapy was reported 6 years ago. During the past 5 years an additional 35 procedures have been performed. The results are similar to those reported previously and indicate that if the cases are carefully selected and have had appropriate but unsuccessful conservative treatment, the results of alcohol injection may prove to be satisfactory.


Intestinal anastomoses after radiation therapy by surgical stapling instruments.

The use of automated stapling instruments in 17 patients requiring intestinal surgery following irradiation therapy for gynecologic malignancies has been reviewed. Fifteen of these patients also had other medical problems thought to inhibit optimal anastomotic healing: malnutrition, persistent intraabdominal cancer, uremia, hypoalbuminemia, and recent antineoplastic chemotherapy. Although these conditions severely test a method of intestinal anastomosis, no patient had a complication involving the intestinal anastomosis. The use of these stapling instruments reduced both the operating time and the contamination of the peritoneal surfaces by bowel content, thereby improving the postoperative recovery of these patients. The favorable results and the secure anastomoses justify the continued use of stapling instruments in gynecologic oncology patients with prior irradiation therapy.


An inexpensive operating microscope.

A fiberoptic colposcope was converted through minor alterations into an instrument suitable for use in gynecologic microsurgery. Magnification up to 24x may be obtained, and the extreme mobility, price consideration, and reduction in space at the operating table make it an attractive alternative to a bulky, expensive operating microscope.


Review of epidemiologic studies of endometrial cancer and exogenous estrogen.

Epidemiologic literature on the association of exogenous estrogen and endometrial cancer is reviewed. Descriptive studies have documented fluctuations in the incidence of endometrial cancer, mainly of localized disease, associated with estrogen use. Etiologic studies have established an association between estrogen use during menopause and the occurrence of endometrial cancer. Although the association appears to be a valid one, several biases may have falsely increased the magnitude of this association. The association also appears to be strongest for local disease and weakest for the most invasive disease, which implies that the etiology for the more invasive endometrial cancers is largely unaccounted for by estrogen use. A need for a prospective study to define other potential risks and benefits of estrogen therapy is clear. However, appreciation of factors known to modify the risk of endometrial cancer from exogenous estrogen can help the clinician to use these preparations judiciously.


The childbearing center: an alternative birth setting.

A number of reports have noted the trend toward home deliveries. With the aim of providing an alternative to unattended home delivery, an out-of-hospital unit for women at low medical risk was opened in New York City in October 1975. Physical care is provided by a team of nurse-midwives, obstetricians, pediatricians, and ancillary health personnel. Childbirth education is an integral part of the program. Women are carefully screened both initially and during the course of pregnancy, and transfers are made to hospital services when required. In the first 31 months of the program, 244 births were managed in the unit. No life-threatening emergencies have occurred. Experience to date indicates that a unit of this kind can safely offer care to a low-risk obstetric population.


[Formation of the cortical reaction in the process of oocyte maturation in the starred sturgeon].

The chronology of maturation process and cortical reaction development was studied in the Volga sevryuga oocytes. The germinal vesicle breakdown was first noted at 14 tau 0 following the injection of hypophysial suspension to the female and observed in the vast majority of oocytes at 17 tau 0; different phases of the I maturation division were found at 21 to 25 tau 0 and metaphase II at 33 tau 0. The ability to respond by cortical reaction to the activating stimulus (glass needle pricking) was first observed at 17 tau 0, i.e. soon after the germinal vesicle breakdown, but the appearance of the ability for cortical reaction was not connected causatively with the latter process. The cortical reaction in the maturing oocytes (17 to 25 tau 0) is characterized by the following features: in some oocytes the rate of the wave of granule breakdown is much lower than in the mature eggs; in ca. 80% of oocytes with the normal rate of cortical reaction the process of release of the contents of cortical granules in inhibited in the animal pole region and accordingly the contact of cytoplasm with the membranes is preserved in this region for a long time.


[Proliferative activity and the kinetics of the cell populations of chick embryo blastoderm in the period of gastrulation and early organogenesis. I. The proliferative activity and nature of the transition by mitotic cycle cells].

The intensity of entry of cells of different rudiments of the chick embryo in mitosis and S-phase at the stages of gastrulation and early organogenesis was studied by means of statmokinetic method and thymidine autoradiography. Regular changes in the percentage of cells entering mitosis and S-phase during development were found. The fluctuations of one index do not coincide often with those of another. The values of these indices within the limits of one rudiment may be interrelated in different ways. These interrelations change in their turn from one stage to another. A suggestion is put forward to the effect that the regular changes found represent a form of expression of parasynchronous proliferation pattern, related to the regular changes of the composition of cell polations due to unequal pasage of cells through the mitotic cycle.


[Ultrastructural signs of the absorption of substances by the ependyma of the III ventricle in rats in the perinatal period].

The distribution of pinocytic vesicles, relief of apical surface and intercellular contacts were studied by means of electron microscope in ependyma of ventral region of III ventricle during perinatal period in rats. Morphological evidence was obtained for the fact that substances are absorbed by ependyma via pinocytic vesicles from the liquor beginning at least from the 16th day of prenatal development. During the postnatal period the intensity of absorption in the ventrolateral region of infundibulum of III ventricle and along the periphery of its extended part is higher than in the ventral region. At the same time the number of evaginations of the apical surface increases, especially in the ventrolateral region of infundibulum and along the periphery of its extended part. As a result, numerous depressions are formed on the ependyma surface, thus creating favourable conditions for the absorption of substances, circulating in the liquor. Changes in the apical surface configuration is provided by a special system of filaments. The apical parts of cells during perinatal period are girdled by a zone of specialized contacts, including cleft contacts, zones of adhesion and zones of closure. The latter, as known, limit markedly the penetration of substances.


[Electron microscopic study of the mitochondria in the apical meristem of a wheet shoot in ontogeny].

The mitochondria of apical meristem cells in the wheat (Triticum aestivum L.) shoot were studied during ontogenesis using electron microscope and morphometrical methods. Changes in their structure were followed from the juvenile mitochondria of the seed embryonic ear cells. The parameters of the "average" mitochondrion, such as profile area, outer membrane length, were shown to differ relatively weakly during the periods with different meristem activity. Changes in the internal structure of the mitochondria having the developed system of crystae in the actively growing apices and those with weakly developed crystae in the resting seed or low active "waiting meristem" are much more pronounced. The relative volume of mitochondria, their number per unit of cytoplasm volume and total length of membranes suffer relatively insignificant changes during the vegetative phase and increase markedly during the prefloral phase when the apex is preparing itself for generative differentiation.


[Analysis of the mechanisms determining the varying relationship of the sperm from the marine and freshwater forms of the three-spined stickleback to the salinity of the medium].

The causes of differences in the reaction of spermatozoa of the fresh-water (morpha leiurus) and marine (m. trachurus) forms of three-spined stickleback Gasterosteus aculeatus to the high sea water salinity (the upper limit of spermatozoan motility being 18% and 52%, resp.) were investigated. The experiments with solutions of pure NaCl, CaCl2, MgCl2, KCl, LiCl (25 g/l) have shown that the movement of spermatozoa of m. leiurus is inhibited by NaCl only. The inhibition of chlorine channels of the plasma membrane by a specific inhibitor furosemide has shown that the activity of spermatozoa of m. leiurus is suppressed by the high Na+ concentrations. The experiments with ATP have revealed no differences in the activity of Na pump between the spermatozoa of mm. trachurus and leiurus. Amyloride, an inhibitor of Na channels, at a concentration of 1.10(-5) M relieved the inhibiting effect of the high Na+ concentrations on the activity of spermatozoa of m. leiurus. The differences in the reaction of spermatozoa of two forms of the stickleback appear, to be determined by differences in Na channels of the plasma membrane.


[Haptoglobin study of sheep during the development process].

The development of haptoglobin blood system was studied in the sheeps during intrauterine development and early postnatal period. The haptoglobin content was shown to decrease with the foetus age, two peaks of its reliable increase having been, however, noted -- on the 55th and 105th days of development. After the birth the haptoglobin concentration in blood is relatively low, increases gradually and attains by the 8th month of life that in adult animals. In the blood serum of 45--120 days old foetuses two phenotypes of fetal haptoglobin were found; the adult haptoglobin is present only beginning from the 1st month of life.


[Biological method of determining the capacity of mulberry silkworm eggs which remain unpigmented for development].

To determine the stage of the silkworm eggs which did not acquire grey colour due to the serose membrane pigmentation and, as a result, preserved yellow colour, it is suggested to activate such eggs to parthenogenetic development of ameiotic or meiotic type. The eggs lost at the early developmental stages after activation will remain yellow, whereas those arrested at metaphase I begin to develop and acquire the dark colour on the 3rd day. Examples are given for the effective utilization of the method.


Reconstruction of absent lacrimal puncta.

A previously described technique to isolate absent lacrimal puncta is reemphasized. The procedure has been modified, whereby the entire punctal and vertical canalicular walls are removed with a Holth sclerectomy punch and by silastic intubation of the passages. This has led to increased permanent patency of the lacrimal puncta and a greater, successful resolution of epiphora. A modified pigtail probe with a narrowed tip has been developed to facilitate passage of the silastic tubing without it slipping off the probe.


Treatment of the lacrimal excretory system after resection of medial canthal and eyelid tumors.

A simplified method of lacrimal excretory system repair is presented. If part of a canaliculus is resected during removal of an eyelid tumor, the remaining section of the canaliculus can be exteriorized to the lacrimal lake. A silicone tube is threaded into the canaliculus and allowed to remain in place for one to two weeks. If both canaliculi and the common canaliculus are removed during resection for a medial canthal tumor, a silicone tube can be threaded into the nasolacrimal duct and brought out the area of the medial canthal angle. Conjunctiva which is wrapped around the tube can then form a new drainage canal into the remainder of the lacrimal excretory system.


The O-to-Z plasty.

Closure of circular defects in the eyelids and canthal areas, as well as the face and neck regions, can present a challenging problem for the ophthalmic plastic surgeon. The O-to-Z plasty devised by Dr. Marvin Quickert is an excellent procedure for dealing with medium-sized circular defects in these regions. It is most commonly used after removal of benign or malignant tumors. In this procedure, skin is undermined from subcutaneous tissue and muscle around the entire circular defect. Two parallel incisions are made along normal lines of cleavage tangential to the circular defect. This allows the skin edges to be advanced and closed along a diagnol converting the defect to a Z closure. The advantage of this procedure is that it allows a smooth firm closure without a "dog-ear" defect. In addition, skin grafts can be avoided in closing many small- and moderate-sided circular defects.


Principles of cryosurgery.

The mechanism by which a cryogen destroys cells is complex. The formation of a hemispherical iceball composed of thermogradients, each of which maintains a temperature proportional to its distance from the application point, initiates the cryoinjury. The cardinal rule of cryosurgery includes a rapid freeze, which produces highly damaging intracellular ice formation and closely-packed thermogradients, coupled with a slow thaw. Multiple freeze/thaw cycles are most destructive, producing ischemic necrosis. Histological and clinical aspects are discussed, as well as complications and follow-up procedures.


Basic concepts and an overview of cryosurgery in ophthalmic plastic surgery.

In cryosurgery, a rapid double freeze using liquid nitrogen spray coupled with a slow thaw generates optimum cell destruction. Important factors in using the cryosurgical technique include temperature monitoring of the lesion, the type of instrumentation, the type of cryogen, and the nonhomogeneity of human tissue. Physiological processes occurring subsequent to cryogen application cause tissue necrosis. Cryosurgery is indicated for treatment of some basal cell carcinomas and occasional squamous cell carcinomas; most other lesions should be treated by surgical excision at the present time. The authors are involved in research to determine means of observing tissue destruction, temperature monitoring and control methods, and evaluation of post-thawing processes.


Cryosurgery in ophthalmic practice.

Cutaneous cryosurgery is useful in an ophthalmic practice in the treatment of basal cell carcinoma, trichiasis, and other benign cutaneous disorders. Indications and techniques for using liquid nitrogen and nitrous oxide instruments are discussed.


The use of liquid nitrogen cryospray for treatment of trichiasis.

Cryosurgical destruction of eyelashes has been successful using a double freez-thaw liquid nitrogen spray technique. While other cryogens are successful in treating trichiasis, they are contraindicated in the treatment of malignant eyelid lesions. If the clinician intends to treat both these entities, it would be simpler to use a liquid nitrogen unit; otherwise, two separate cryosurgical instruments would be required. The liquid nitrogen treatment requires two cycles of a rapid freeze to -15 degrees C coupled with a slow thaw and has given us a 90%+ success rate. Contraindications in treating trichiasis with cryotherapy include paralytic lids and heavily pigmented patients. In general, we do not treat trichiasis involving less than one-third of the lid, especially with young, healthy-appearing lid margins.


Possible complications secondary to cryotherapy.

Various complications are possible with cryosurgery that the cryosurgeon should be aware of. These include technical problems with the use of liquid nitrogen, skin temperature monitoring, improper patient selection, immediate secondary complications including hyperemia, erythema, bullae formation and edema, and long-term complications including depigmentation, pseudoepitheliomatous hyperplasia, loss of lashes and meibomian glands, lid deformities, scar formation, and destruction of the lacrimal system. Ocular damage has occurred following treatment of conjunctival and corneal lesions, however, not in the treatment of eyelid lesions.


Corneal infections by Rhodotorula.

Rhodotorula, isolated from a human keratitis, was experimentally and microscopically found inactive, so that the question arises if micro-organisms found in a given eye lesion are always pathogenic. The answer is probably no.


Vitreoretinal hemorrhages after ingestion of fava beans in a G-6-PD-deficient subject.

A case of vitreo retinal hemorrhages following a hemolytic crisis by fava beans in a G-6-DP-deficient patient is reported. Intravascular coagulation due to thromboplastin-like substances liberated by the diseased RBC could be the cause. The possibility of vitreoretinal hemorrhages of this nature in young subjects from the areas where G-6-PD deficiency is endemic is stressed.


Considerations upon failures in retinal detachment surgery.

The authors analyze the failures obtained in the management of the rhegmatogenous retinal detachments with a procedure associating a trapdoor with diathermy, buckle inclusion with an equatorial cerclage and subretinal fluid delivery. On the basis of the results the limits and indications of such a procedure are outlined.


Heredoataxia (spinocerebellar degeneration), ERG alterations, temporal aspects.

Electroretinographic recordings with 'implicit time' study of 6 patients with different forms of heredoataxia and without clinical ophthalmologic abnormalities were done. ERG showed diminished photopic amplitude of the 'b' wave with delayed photopic 'implicit time' in the presence of increased scotopic latencies. The retinal temporal dysfunction of the ERG in heredoataxia is probably a constant feature. Because the ERG registration, with amplitude and 'implicit time', is required for precise diagnosis, the constant association between retinal alteration and heredoataxia has probably been missed in the past.


Olfactory neuroblastoma.

Olfactory neuroblastoma is an uncommon malignant tumor arising from olfactory epithelium. Generally considered to be a tumor of slow growth, it varies in aggressiveness and may cause death by distant metastasis or local invasion. The pathologic diagnosis is difficult, and this tumor is often erroneously diagnosed. Nine previously unreported cases are presented, and a review of the various treatment modalities and course of the disease is given. Maximum therapeutic succes is best achieved by radical excision followed by a full course of radiation. Because of the high incidence of local recurrence (46%) and slow growth, patients should be followed up closely for life.


Anterior cervical pain syndromes.

The paucity of clinical findings in patients with glossopharyngeal neuralgia, superior laryngeal neuralgia, styloid process syndrome, hyoid syndrome, or carotidynia presents an enigma to the patient and the physician. Manifest symptoms appear extraneous or incongruous unless the essential element is identified. Common to all these syndromes is the radiation of pain over the neck and face, starting from the anterior cervical area of the neck. Case histories of seven patients are presented. The rationale of underlying pathophysiologic mechanisms is discussed and supported by relevant recent basic pain research, and conceptual speculations are presented.


Iontophoresis treatment.

Iontophoresis can be used as a method of treating herpes simplex virus and aphthous gingivostomatis. Idoxuridine has been used for herpes simplex virus, and corticosteroids and antibiotics have been used for aphthous stomatitis. Levamisole hydrochloride has been used for both herpes simplex virus and recurrent aphthous stomatitis. A lidocaine and adrenaline mixture is used with iontophoresis for myringotomy procedures and equalizing tubes. Also, anesthesia of the skin and subcutaneous tissues with lidocaine hydrochloride by iontophoresis are useful for minor surgical procedures ("ouchless surgery").


A fatal case of Legionnaire's disease following a total laryngectomy.

Legionnaire's disease (LD) has been responsible for the death of many patients in several outbreaks in the United States and abroad. The Legionnaire's bacterium is still unclassified. Deoxyribonucleic acid studies of its genes have not yet found a near relative. A case of a 63-year-old man who had a total larynegectomy for cancer of the larynx is reported. He had an extensive postoperative pneumonia, secondary to LD. The diagnosis was made while the patient was alive, but he died on the 35th hospital day in spite of erythromycin treatment.


Correlation of pharyngeal fistulization with preoperative radiotherapy, reduced serum albumen, and dietary obstruction.

The clinical courses of patients on the Head and Neck Service undergoing radical procedures were reviewed in retrospect. Factors that appeared to influence the courses such as preoperative radiotherapy, reduced serum albumen, and preoperative oropharyngeal obstruction were correlated with fistulization rate, flap necrosis, and other complications. The study included 105 radical procedures performed over a seven-month period. Sixty-six of these operations included laryngectomies, laryngopharyngectomies, and composite resections. The overall complication rate was 37%, with major complications accounting for 9%. A fistula rate of 20% was found in the pharyngeal group and ranged from 12% in the nonirradiated patients to 44% in the irradiated group. Thos patients with preoperative obstruction secondary to tumor bulk had a complication rate of 58%. Patients with reduced serum albumen levels had a higher complication rate of 55% compared with 35% for the group with normal albumen levels. This study suggests that preoperative replenishment of protein, particularly in the obstructed patient or in those with reduced serum albumen levels, would correlate with a more favorable clinical course.


Pediatric jaw fractures: indications for open reduction.

Jaw fractures in children are generally managed without major surgical intervention. Closed reduction usually is sufficient to restore normal anatomy and function. The one inviolate principle is early treatment. During the past three years, four pediatric jaw fractures that required open reduction were treated. This mode of treatment was necessitated by the limitations imposed by pediatric dental anatomy and by the type of fractures encountered. In at least 24 months of follow-up, no dental problems have been seen.


Temporal bone fractures in children.

Fifty children with temporal bone fractures were treated during a 40-month period. The diagnosis and management of temporal bone fractures in children is reviewed. The author's cases are classified as to longitudinal and transverse fractures, and the figures are presented for age distribution, sex, cause, loss of consciousness, CSF otorrhea, hearing loss, permanent tympanic membrane perforations, and facial nerve involvement. The author has followed a conservative method of management. Permanent impairment was not frequent, although all the patients with transverse fractures suffered total loss of hearing in the involved ear.


Recurrent laryngeal nerve localization using a microlaryngeal electrode.

Damage to the recurrent laryngeal nerve is a frequently seen complication in head and neck surgery. A system for intraoperative monitoring of the recurrent laryngeal nerve is presented. The key to this system lies in the use of a microlaryngeal electrode and inserter. Application of this system to various situations is described.


A classification of the anomalies of the first branchial groove.

Anomolies of the first branchial groove cleft are common and variable. There has been, however, a tendency in the literature to refer to only one or two types as the first branchial cleft syndrome. A classification of first groove anomalies is offered to clarify this topic. Anomalies can be divided into aplasia, atresia, stenosis, and duplication.


Laryngeal abscess.

The laryngeal abscess is an uncommon lesion since the onset of the antibiotic era. A review of the literature failed to find any recent articles on abscess of the larynx. Three case histories of the laryngeal abscess, all of which progressed to rapid airway obstruction and required emergency tracheotomy, are presented.


Completion laryngectomy.

From 1965 to 1975, 452 total laryngectomies were performed at the Washington University Medical Center, St Louis. Forty-two or 9% were completion laryngectomies. Completion laryngectomy is defined as the removal of the remaining larynx following an antecedent partial laryngectomy. These 42 cases are retrospectively analyzed with regard to original conservation surgery, clinical presentation, histopathology, and salvage rate. The most common indications for completion laryngectomy were (1) local recurrence, (2) local recurrence with associated severe upper respiratory obstruction, and (3) fistula control. The overall salvage rate following completion laryngectomy was 55% (23 patients). The highest rate was in patients with previous hemilaryngectomy (69%), followed by subtotal supraglottic laryngectomy (44% and partial laryngopharyngectomy (14%). There is a high incidence of stomal occurrences (24% or ten patients) associated with completion laryngectomy, particularly in patients with antecedent hemilaryngectomy. Most indications for completion laryngectomy appear early; however, all patients must be carefully followed up after conservation surgery.


The study of IgE in the diagnosis of allergic disorders in an otolaryngology practice.

Within months after the identification of IgE as the reaginic antibody and principal trigger of immediate hypersensitivity reactions, several radiomunnoassays were developed for its detection in serum. Observations and results obtained with the use of two commercially available in vitro assays in the screening diagnosis of inhalant allergic disease are reported. Over 80% of suspected atopic patients tested had detectable specific IgE to at least two allergens. Both total and specific IgE determinations served useful roles in the recognition of clinically significant allergic disease. Results obtained with these procedures correlate well with information previously obtained only by skin test endpoint titration.


Otologic complications of radiation therapy.

Radiation therapy has proved to be a valuable modality in the management of patients with nasopharyngeal tumors. Routine follow-up of patients in the tumor clinic of the University of Illinois Eye and Ear Infirmary appeared to indicate an increasing incidence of otologic pathology. For this reason, a retrospective study focusing on the otologic findings in patients whose radiation therapy for nasopharyngeal tumors included the external auditory canal, middle ear space, or eustachian tube was performed. The results of this study are discussed in relationship to total radiation dosage, time of survival after therapy, and pretreatment otologic status. The complications covered a spectrum from intermittent serous otitis media to osteoradionecrosis of the external auditory canal. Possible contributing factors are discussed, and preventive neasures are suggested.


Adolescent gynecology for the pediatrician.

This article outlines some of the most common problems that a physician treating the female adolescent will encounter in his practice. It is important for the primary care pediatrician to initiate the gynecological examination in the adolescent. Few special instruments are required, no new techniques need be mastered, and if the pediatrician is patient and shows his concern, he will rapidly develop competence and find that this examination is as important as the evaluation of any other organ system in the care of the adolescent female.


Fenestration tympanoplasty: an adjunctive technique for hearing restoration.

Two-staged fenestration tympanoplasty is a form of total tympanoplasty type V that incorporates the mastoidotympanomastoidectomy (radical mastoidectomy) and revives the Lempert horizontal semicircular canal fenestration operation. It is valuable when the usual and customary single or two-staged tympanoplasty procedures fail to conserve or restore hearing in the operative management of otitic disease. Two-staged fenestration tympanoplasty is also indicated in audiometric failure tympanoplasties, in oval window surgery failures in the absence of supporting ossicles and in the presence of a fibrosed or sclerosed oval window, and in severe otitic oval window-round window-posterior tympanic recess-tympanic orifice eustachian tube infection, which can only be completely removed by the mastoidotympanectomy. Total tympanoplasty type V as described here has produced serviceable hearing for human conversation and the speech frequencies to the 15-dB to 25-dB levels, and a 20 dB average in 19 of 21 patients operated on for a 90% success rate.


Pediatric office nutrition.

The pediatrician continues to devote more time to office evaluation of patients. The office assessment of nutritional status will be extremely rewarding to the physician who acquires several simple measuring devices and who instructs his assistants in the proper use of those devices. The nutritional evaluation of the patient emphasizes the physical examination, anthropometric measurements and the use of laboratory studies. The information gained from these areas may allow for early correction of growth abnormalities before permanent stigma or residuals can develop.


The management of the hyperactive child: an overview.

Hyperkinesis has been increasingly recognized as a medical problem of great significance in everyday practice. Not infrequently, a child has been labeled hyperkinetic at an early age, with a battery of tests, psychological evaluations and multiple medications, in addition to the family frustration and anxiety that follow the diagnosis of hyperkinesis of the offspring.


Psychological mechanisms in child-abusing parents.

This article discusses the psychological mechanisms in child-abusing parents, with emphasis on who in the family maltreats the child, the mother-child symbiosis, disturbances in the mother-child relationship that leads to abuse and offers an insight in the etiology of this socio-medical problem of today's world.


Continuous medical education for the pediatrician. A commentary.

This commentary discusses the issue of continuous medical education in pediatrics from the perspective of a practitioner who desires to see the recertification process as a rewarding practical experience, inexpensive, adjusted to the needs of his community and, most particularly, a process designed and delivered by the medical institutions and experts of his state and county, independent of the national organizations and boards.


Family problems in the new suburbs.

The social situation for families with children is undergoing rapid change in Sweden today, in the direction of a two-provider household economy and an urban-suburban way of life. These changes affect the amount, continuity and content of the social relationships between children and adults, leading to more formal contacts with shorter duration to a greater number of adults.


Children in traffic. Some methodological aspects.

Road accidents in children is a health problem of major importance all over the world. Different programs of prevention have been tested. Such programs must be based on data from epidemiological studies. This paper is aimed to shed some light on the way in which basic methodological problems in epidemiological research influence the results and the possibility of drawing conclusions from them.


Recognizing a child at increased risk of abuse.

Data from two studies are presented. Both highlight characteristics which help identify children at increased risk of child abuse. The first study demonstrates that the abused child when compared with unharmed children in the same family is more likely to have been the product of an abnormal pregnancy, labor, delivery and neonatal period. He is more likely to have been separated from his mother and to have been ill in the first year of life. His mother too is more likely to have been sick during that year. The second study shows that it is possible to identify 'at risk' families around the time the baby is born. When compared with controls, five factors are more common: mother aged under 20 at birth of first child, evidence of emotional disturbance, referral to the social worker, admission of baby to special care nursery, and early concern over mothering.


Day care and respiratory infection.

Medical opinion on day care for young children since the 1940s is reviewed with emphasis on risks of respiratory illnesses. Recent knowledge about respiratory infections and the dissemination of viruses among day care children has (1) ascertained the importance of simple preventive measures; (2) modified the value of strict isolation of each child with respiratory symptoms, and (3) emphasized that medical treatment should be kept for complicated illnesses and a few particularly infection-prone children. Child health services, parents and day care personnel should develop principles for the care of children with minor respiratory illnesses, mainly leaving the responsibility for the sick child with the parents.


Perinatal hazards and future development.

From the longitudinal Copenhagen Child Health Study some results from a follow-up of 9,182 newborns to 1 year of age are presented. 9.7% of low birth-weight children had at that time defined neurological symptoms, compared to only 1.7% of full birth-weight children. At middle school-age perinatal hazards had some influence on the children's health and development, but the social class seems to be still more important. Parents in the lower social classes had a behavior-adjusting or laissez-faire attitude to the child instead of being behavior-conducting--as the school attempts to be--and the mothers have heavy work outside the homes. Improvement of prenatal and neonatal care is still important, as a complement to decided political effort to develop equality in education, economy and social security.


Minimal brain dysfunction in preschool age--risk for trouble in school?

In general health examinations of 2,447 4-year-old children in a certain area of southern Sweden, comprising 95.1% of the total population of that age, 52 children (2.1%) were diagnosed as having minimal brain dysfunction. After 7--9 years the children were reexamined and their parents and teachers were interviewed. Although no specific treatment, like stimulant drugs, was given, the children were much improved as they grew older: their hyperactivity had diminished, their behavior did not cause as much trouble, and their remaining neurological disturbances were small. However, the children manifested more problems in elementary school than other children, both regarding behavior, learning, slight neurological disturbances and visual disorders. Thus, the small group of children with minimal brain dysfunction symptoms in preschool age seem to run a certain risk of having trouble in school, although the symptoms are less conspicious as they grow and mature.


Abuse of alcohol, drugs and tobacco during pregnancy--consequences for the child.

There is an increasing awareness that alcohol and drug abuse and smoking are not only harmful for the consumer but will also, when taken by a pregnant woman, adversely affect her unborn child. The consequence of the abuse will result from a combination of specific toxic effects of abusing substances and a nonspecific effect from the often very unstable environment of an alcohol- or drug-dependent mother. Poor prenatal care is a common finding in alcohol and drug abuse leading to a high incidence of complications during pregnancy and delivery including premature labor and small-for-gestational-age babies. An increased perinatal mortality has been reported following all types of abuse including tobacco use, probably as a consequence of poor prenatal care as well as of a toxic effect on the fetus. Withdrawal symptoms after birth are most prominent in opiate addiction. The already intrauterinely damaged child will if it stays with its parents often continue to be exposed to several abverse environmental factors. However, symptoms such as mental retardation following alcohol abuse and hyperactivity and emotional disturbances following drug exposure during intrauterine life have also been found in children who have been taken from the parents and placed in foster homes immediately after birth. This means that children of abusing parents both in their custody and in foster home will have to be regarded as risk children that should be subjected to careful medical and psychological follow-up.


Psychosomatic disorders in childhood: Who? - When? - and How?

Psychosomatic disorders are likely to be due to an interplay between biological predisposition and psychosocial stress. They are among the commonest chronic or recurrent disorders of childhood. Who gets PSD? It is commonly a family disorder, with a background of disturbed personal relationships. When? A chronology of PSD (age and disease) should be studied further. Many children do not "grow out of it". How? A biological abnormality (eg. autonomic) may underlie PSD, but pscychosocial factors are undeniably important.


Health needs of the adolescent.

In recent years, considerable effort has been devoted to the study of those core elements necessary to define a reference standard of health for adolescents. In our program, indices of adolescent disability were developed based on an analysis of 12 years of data from approximately 75,000 teenage patients. In-hospital (14,000), ambulatory (15,000), and community based (50,000) adolescent contacts offered differing indices of disease. Targeted screening efforts produced significant epidemiologic data and generated recommendations for adolescent ambulatory screening standards which were then applied to such community experiences as school health programs and urban group home settings. Both demonstrated significant levels of disability in excess of 50% of the populations studied. Alternatively, review of more complex problems observed within a hospital setting specific for adolescents revealed significant chronic disability. Clearly the health requirements of the adolescent are extensive but effective interventions must be based on carefully considered indicators of unmet needs.


Ambulatory long-term treatment of childhood diabetes mellitus.

Increasing evidence is accumulating to show the beneficial effect of a good balance of diabetes in protecting against diabetic microangiopathy. The pediatrician's responsibility is to recommend and supervise the best use of the three basic cornerstones of the longterm-treatment, insulin, diet and exercise. The review deals with insulin therapy focusing on insulin treatment "tailored" to the stage of the disease. Twice-daily insulin is in most cases preferable to a once-daily regimen. The risk of over-insulinization is stressed. An essential part of long-term treatment is to instruct the child and/or the parents repeatedly on the various aspects of diabetes, particularly the meal plan, and to pay enough attention to psychic factors.


Vaccinations against bacterial infections.

The achieved or achievable standard of vaccination measures against bacterial infections is discussed with reference to 3 groups of vaccines. The first group involves well established and commonly used vaccines such as BCG and DPT vaccines. The second group includes newer vaccines or vaccines that are under development, for instance vaccines against meningococci, pneumococci, H. influenzae and enteropathogenic E. coli. The third group covers vaccines whose realisation at present appears to be difficult or hardly feasible, for instance vaccines against enterotoxins of enteropathogenic organisms, against lues, gonorrhea or, example, against organisms of hospital infections.


Recent views on infant nutrition.

Particular problems under discussion in the field of infant nutrition today are the following. (1) The frequency of breastfeeding including the effect of promotion to uncrease it. (2) The protein requirement of low birth weight infants including relevant parameters for evaluation of the requirement. Recent studies indicate that the protein requirement of low weight is only slightly higher (or may be the same) as that supplied by breast milk. (3) The tolerance for intake of certain nutrients in early infancy - mainly protein and minerals - in relation to the development of organ functions, including homeostatic disturbances that may arise when the tolerance is exceeded. Adverse effects of a too high protein intake are particularly acidosis and increased osmolar load on kidney function. Excess mineral adds to the renal solute load, implying a threat to water balance. (4) The introduction of Beikost, when and why, and (5) Atherosclerosis as a problem for the pediatrician. The need for identification of risk factors, especially screening for hyperilipidemia, in early life and for recommendation of dietary measures instituted in early childhood has to be further studied.


Neonatal necrotizing enterocolitis: review and current concepts.

Necrotizing enterocolitis poses a serious threat to the increasing number of "at risk" neonates. Its clinical picture is characterized by abdominal distension, gastric retention, bile vomitus, and bloody stools. Abdominal roentgenograms demonstrate loops of intestine with intramural gas. Many of the neonates with necrotizing enterocolitis have been successfully managed by aggressive medical treatment. A review of the clinical course of 64 neonates with necrotizing enterocolitis in the acute phase suggests that either persistence of abdominal distention, development of edema and erythema of the abdominal wall, or pneumoperitoneum are indications for surgical intervention. Seven neonates presented with colonic stenosis several months after the management of the acute phase of necrotizing entercolitis.


Extinction and synesthesia in patients with spinal cord injuries.

Extinction and synesthesia were studied in 50 patients with spinal cord injury with various levels and extents. Extinction was found in 20 (40 per cent) and synesthesia in 6 (12 per cent) of the 40 males and 10 females. No correlations were found between either of the two phenomena and parameters of patient's age, lesion's age, lesion's level and extent, or accompanying head injury. The latter occurred in 22/50 patients (44 per cent), diagnosed by a history of amnesia. Extinction was tested by synchronous double stimulation unilaterally and bilaterally, symmetrically and asymmetrically. It was more frequent unilaterally than bilaterally. The modalities of superficial sensibility were prone to be extinct but those of deep sensibility (pallesthesia from bone conduction and kinesthesia) were not. Extinction of tactile responses did not imply that all other skin modalities (pain, temperature, pressure, skin pallesthesia) will also be extinct in an all or nothing fashion. Modalities could become extinct either singly or in combination. Extinction in spinal man was presumed to be caused by a reduction of perception in hypesthetic areas and was of diagnostic value insofar as its segmental distribution suggested the longitudinal extent of a cord lesion. This concept is in accord with the results of monkey experiments by Eidelberg and Schwartz (1971). Synesthia in spinal man is not identical with synchiria of the monkey. It is not in a reciprocal relationship with extinction and both phonemena co-existed in four of the six patients. Synesthesia is elicited by a stimulus delivered to the normesthetic skin above the level of the lesion with two responses: one well localised at the site of stimulation and the other unilaterally or bilaterally in anaesthetic parts of the body. Five of the six patients reported volitional phantom movements of somatic (toes) and/or visceral (micturition-defaecation) structures. Such sensations are elicited by remembering the engrams of pre-traumatic experiences in areas of the body image connected with motor function. Synesthesia could be understood as a sensory counterpart in areas of the body image when ascending impules of actual perception are mixed with impulses modulated at the artifical synapse of the rostral cord stump creating a phantom sensation.


Reflections on the intensive care of acute cervical spinal cord injuries in a general traumatology centre.

Fifty-one cases of cervical spinal cord injury were reviewed. The importance of the immediate comprehensive care after onset may be achieved successfully even in a General Traumatology Centre. The great majority of these patients were treated by orthopaedic methods as far as their vertebral injury was concerned. Mortality related to the spinal cord injury is 7.8 per cent. The methods used and our development are based on principles established by Sir Ludwig Guttmann; they have been shown to be durable and important.


Two years of bed procurement for patients with spinal cord lesions. A report on progress and experiences at the Bed Procurement Service at the Industrial Injuries Insurance Institute for Research in Traumatology at Frankfurt/Main.

The total number of beds provided in all specialised centres for the treatment of patients with acute spinal cord lesions in the Federal Republic of Germany is still insufficient. Therefore the attempt to transfer those patients to a centre from another hospital immediately after the lesion has occurred is very difficult. In order to assist physicians of the hospitals (where the patient has been first admitted) in the time-consuming task to find a vacancy in a specialised unit, the Central Association of the Industrial Injuries Insurance Association of the Industrial Injuries Insurance Institutes set up a 'Bed Procurement Bureau for Patients with Spinal Injuries' on 2 August, 1976. The heads of the units concerned set up a special study group in close connection with this clearing-agency in order to elaborate reliable data about the present situation of care for recently paralysed people, and to discuss further problems as well as planning programmes. They meet every 6 months. The organisation of the clearing-agency, the experiences gained within the first 23 months of activity since the opening, the spinal units situation at the present time, and their further development are reported.


Experiences with high tetraplegics.

Of the 1468 patients with traumatic spinal cord injury who were admitted to the Texas Institute for Rehabilitation and Research (TIRR) between 1959 and 1977, 67 patients were complete tetraplegics with motor levels of C4 and above. The age, sex, motor level, aetiology of injury, and initial and final vital capacity of these patients are analysed. A substantial gain in vital capacity was attained in all C4 motor tetraplegics regardless of their initial vital capacity. Twenty patients with motor levels of C3 and above have been admitted to TIRR since 1963. Five of these 20 C3 and above tetraplegics have had bilateral phrenic stimulators implanted. The mortality rates and causes of death in these groups of patients are presented. Survival curves are presented on 615 traumatic spinal cord injuried patients as compared to a standard matched group. Survival curves are also presented for the two groups of high tetraplegics who were admitted to TIRR from 1963 through 1969 and from 1970 through 1977.


The technical aids of tetraplegic patients.

A twenty-minute film shows how tetraplegic patients can compensate their disability thanks to very simple means. The independence of tetraplegic patients is considered with non-sophisticated equipment that are to be used every day in every department of occupational therapy.


'Walking' appliances for paraplegics and tetraplegics.

A range of 'walking' appliances suitable for child, adolescent and adult paraplegics and tetraplegics is described and some of the technical considerations discussed. A valuable development to the appliance in the form of a rising wheelchair is also breifly discussed.


A method of rehabilitating the C6 tetraplegic hand.

One of the important aspects of total rehabilitation of the C6 tetraplegic is the fitting and application of flexor-hinge hand orthoses. It has been proved that through the use of these orthoses the tetraplegic is able to maintain a high standard of independence in work and every day life activities. Successful fitting is dependent on two major aspects: (a) accurate fitting; (b) functional training in the use of the orthosis. These two aspects are discussed in the paper. A case history of two tetraplegics is also given to illustrate the degree of functional independence achieved with flexor-hinge hand splints.


Techniques for improving the strength and fitness of spinal injured patients.

Physiological data on athletes and animals has been used to design this training programme and to suggest new perspectives for trainin the spinal cord injured. The training routines proposed are designed to improve endurance and strength and modern weight training equipment has been modified for this purpose.


Stabilisation of the cervical spine using a Bio-Con collar.

The Bio-Con collar is described. The collar is fully adjustable and the head and cervical spine may be immobilised to any degree of flexion or extension desired. The head is held in position by means of a rigid head frame fitted with a chin and two occipital pads. By the virtue of the fact that this is attached to a firm base by means of adjustable metal pads the cervical spine is effectively immobilised.


A functional splint for the C5 tetraplegic arm.

An orthosis for a C5 complete tetrapletic providing active extension and pronation of the forearm is presented. It overcomes and prevents the occurrence of the flexed and supinated C5 tetraplegic arms. Technical data and a case report is included.


Quantitated flexor response in acute spinal cord injury patients.

Flexor reflexes were compared with phasic stretch reflexes in 12 acute spinal cord injury patients with upper motor neuron lesions. Initial flexor reflex activity appeared later than initial stretch reflex activity in the majority of cases whereas maximal flexor reflexes developed at about the same time as maximal stretch reflexes. A quantitative method for evaluating flexor and stretch reflex activity at bedside is presented.


Neurological sequelae of reduction of fracture dislocations of the cervical spine.

A retrospective study of 302 cases of cervical spine facet interlocking with neurological signs is presented. These are reviewed as regards aetiology and neurological recovery. There appears to be a neurological advantage in reduction of facet interlocking in this series.


The dynamic mechanical response characteristics of spinal cord tissue: a preliminary report.

In the absence of an adequate description of the response of spinal cord to dynamic insult, work is in hand to determine the dynamic characteristics of canine spinal cord tissue. In-vitro experimentation is described. A vibration technique using a low amplitude (0.5 mm), variable frequency (1--40 Hz) forcing frequency is used to describe the resonant property of the tissue in a supporting environment. The canine spinal cord is demonstrated to respond as a non-linear, soft, viscoelastic element suceptible in the frequency range 14--22 Hz.


Spinal cord injury: an epidemiologic perspective.

This study examines, from an epidemiologic perspective, a series of 359 consecutive admissions to a Model Regional Spinal Cord Injury Center located in the south-eastern United States. An extensive data set which captures medical, demographic, social and psychological information, on each patient, has been statistically analysed. The appropriateness and utility of epidemiologic methodology applied to the phenomena of spinal cord injury is demonstrated and the findings resulting from the analyses are discussed.


An analysis of circadian rhythmicity of heart rate in tetraplegic human subjects.

Eight tetraplegic human volunteer subjects from the Veterans Administration Hospital in Houston, Texas, had their heart rates monitored at half-hour intervals for 24 hours. Autocovariance analysis demonstrated circadian rhythms of heart rate in four chronic tetraplegic subjects and one acute tetraplegic subject. The remaining three subacute tetraplegic subjects demonstrated no circadian rhythmicity of heart rate. It is postulated that central denervation of the heart from the sympathetic division of the autonomic nervous system in cervical cord injury results in loss of circadian rhythmicity in heart rate until the vagus of the parasympathetic division obtains control, sympathetic spinal cord centres re-establish control, or an orderly interaction of both occurs. Further study appears indicated.


A table tennis glove for tetraplegics.

A new table tennis glove to enable a tetraplegic to hold a table tennis bat is described and discussed. It is much easier to apply than to bandage the bat to the hand.


[Gamasid mites (Gamasoidea) of the Taimyr Peninsula].

1591 specimen of small mammals, 467 nests of those, 250 birds and 38 nests had been investigated in 1972--1977. 19 182 specimens of gamasoid mites of 41 taxon had been found. Morphological and ecological adaptations of two mass species, Haemogamasus ambulans and Hinstionyssus isabellinus had been studied.


[Ultrastructural studies of Haller's organ in the argasid tick, Argas tridentatus (Argasidae)].

Haller's organ in A. tridentatus consists of a capsule and an anterior group of sensilla. The capsule is the hollow in the cuticle on the dorsal surface of the first tarsus, where 4 pored hairs of olfactory sensilla are situated under the cover of the roof, formed by an anostomosis of the upper brunches of pleomorphs (capsule's bottom non-sensory cuticular outgrowths). The canal of the accessory ampullaceous sensillum opens in a capsule near the bottom. The anterior group of sensilla consists of two parts: proximal part, containing pored grooved and thin hairs, is homologous to the anterior grouf of ixodid ticks, and distal one which has no homologues in ixodids. Fine structure of all the sensilla in the mentioned parts of Haller's organ is described in detail.


[Fertility of the flea, Xenopsylla gerbilli Minax, that parasitizes the great gerbil (Aphaniptera)].

It has been established experimentally that the fecundity of females of Xenopsylla gerbilli minax is wavy in its character from the beginning to end of their reproduction (peaks are replaced by falls). In spring and summer the egg laying proceeds on the 2nd--3rd day after the first bloodsucking of fleas and lasts to the end of their life. In autumn the first eggs develop on the 4th--6th day and do not develop at all at the end of the life. In winter months the egg production is somewhat slowed down but with the coming of spring become more intensive. Progeny obtained from one female during the experiment varies, depending on the conditions of the maintenance, from 20 to 130 individuals.


[Changes in the numbers of the causative agent of intestinal yersiniasis (Yersinia enterocolitica) in Xenopsylla cheopis (Aphaniptera) fleas in the process of blood digestion].

In infected fleas the agent of intestinal yersiniosis underwents a complex cycle of quantitative changes after each feeding. A species belonging of blood consumed greatly affected the dynamics of the agent abundance. The general peculiarity of the development of microbes in insects, which fed on various animals (white mice, Sirian hamsters, white rats and guinea pigs), is characterized by the decrease in the abundance of the agent during the first hours after feeding. This was followed by an active multiplication of microbes replaced by a new fall after which the abundance maintained on the level close to the initial one. A comparison of obtained results with the data on the digestion in fleas has shown that the phases of the primary dying off and depression of the agent falls within the intensive-decay of the food clot. The active multiplication proceeds at the end of digestion that may be promoted by the decrease in the fermentative activity and abundance of products of blood decay easily assimilated by microbes. The next fall in the agent's abundance and the absence of multiplication are associated with the exhaustion of the nutrient medium in the process of absorbtion and vital activity of microbes.


[Euzetrema caucasica sp. n. (Monogenea, Polyopisthocotylidea), a parasite of the Caucasian salamander].

A new species of monogeneans, Euzetrema caucasica sp. n., from the urinary bladder of Mertensiella caucasica (Waga, 1876) is described. The new species differs from E. knoepffleri Combes, 1965 by greater sizes of the disc, median and marginal hooks and anterior suckers. Certain suggestions are made on the biology and life cycle of Euzetrema.


[Developmental cycle of the thorny-headed worm, Acanthocephalus lucii (Echinorhynchidae)].

The organogenesis of Acanthocephalus lucii was followed and its developmental periods established. In the organism of the intermediate host Asellus aquaticus the larva of A. lucii has three developmental stages: acantor, preacantella and acantella. At the average daily temperature of 25 degrees the developmental period from the egg to acantella completes within 19 days, at 22 degrees--in 32 days, at 19 degrees--in 51 days, at 18 degrees--in 60 days, at 15-16 degrees--in 72 days and at 15 degrees--in 89 days. In the intestine of fishes the worms become mature in three weeks after the infection. The excretion of eggs by females into the environment begins in 36-39 days after the worms have reached sexual maturity. The whole development of the worm in the definitive host lasts 57 to 60 days.


DNA template activity in the arterial wall of hypertensive rabbits.

With a new method employing acridine organe (AO) as an ultracytochemical probe DNA template activity could be visualized within cell nuclei of the thoracic aortic wall of rabbits. After experimentally produced chronic renal hypertension nuclei with a relatively high number of AO chromatin interaction products were found in the endothelium, in the intimal region, in the outer third of the media, and in the adventiia indicating increased DNA template activity. This representative distribution pattern of DNA template activity was not found in comparable regions of the thoracic aorta of normotensive rabbits. The results are consistent with the current concept that cellular response to environmental stimuli occurs via activation of previously repressed genes.


Isolation and characterization of desmosine(s) containing peptide fractions of normal and diseases human aortic elastin.

Normal and diseased human aortic elastins were isolated and highly purified. They were subsequently submitted to elastase and thermolysin digestion followed by partial acid hydrolysis to increase crosslinkage. The peptide fractions containing these highly cross-linked desmosines were extensively purified either by ion exchange chromatography or by gel-filtration. Their amino acid composition was determined. Detailed investigation of the purified peptide fraction from normal human elastin containing desmosines was carried out using different N-terminal and C-terminal procedures, thus permitting the probable covalent structure of the desmosine containing peptide(s) to be proposed. Irrespective of their origin (healthy or pathologic), the elastin samples all revealed the same amino acid composition with a very high alanine content in the cross-linking peptides. This work is submitted as proof that changes in amino acid composition are essentially due to "dilution" and contamination by structural glycoproteins and not to structural changes in amino acid compoistion in the vicinal cross-links positions. We find that not only "clustering" alanine residues but also glycine, proline, valine, leucine and tyrosine residues are located in the immediate vicinity of both desmosine and isodesmosine residues.


[Distribution and species makeup of the horse botflies in the Buryat ASSR and Mongolian Peoples's Republic (Oestridae, Gastrophilidae)].

In Burjatia and Mongolia the infection of horses with rhinoestrosis and gastrophilosis accounts for 97.8-99.2% and 98.9-99.5%, respectively at the infection intensity 34 to 721 and 55 to 1473 larvae. The sheep botfly is represented by one and the horse botfly by six species; they have one generation a year. The flight of the horse botfly begins from the second decade of June and ends in the second decade of September; the flight of the sheep botfly begins in the third decade of June and ends in the first decade of September. The pupil stage lasts 20 to 61 days.


[Biosynthesis of glycoconjugates in the arterial wall. VI. Purification and molecular mechanism of N-acetylglucosaminyl transferase].

Aortic intima N-acetyl-glucosaminyl-transferase has been purified by chromatography and isoelectric focusing, allowing her resolution into two insoenzymes, GN 1 (pHi = 4.2) and GN 2 (pHi = 8.5). The phenomenological analysis of this isoenzymes, involving two substrates and two products, showes one mechanism: Bi-Bi random.


[New trematode genus of the family Didymozoidae from a mackerel in the Indian Ocean].

A new trematode of the genus Paranema tobothrium triplovitellatum gen. et sp. n. from the body cavity of Scomber scombrus from the Indian ocean is described. The individuals of the new genus are not incysted. Testes paired, ovary twisted, unbranched, vitelline gland bifurcates, uterus forming three turns.


[Fatty acid makeup of the cestodes, Eubothrium crassum and Diphyllobothrium dendriticum].

The fat-acidic composition of E. crassum and D. dendriticum was investigated. Lipids of E. crassum differ in greater unsaturation as compared to these of D. dendriticum as well as in greater amount of acids of type omega 3, whereas acids of type omega 6 and stearic acid were found in extracts of E. crassum in less quantity than in D. dendriticum. This phenomenon is characteristic of organisms living under conditions of low temperatures.


[Finding of the subarctic leeches, Acanthobdella peledina and Cystobranchus mammillatus, in the Lake Baikal basin and the reasons for their absence in Lake Baikal itself].

Acanthobdella peledina was first found in the basin of Lake Baikal on the fluvial form of the Balkal grayling Thymallus arcticus baicalensis and Coregonus lavaretus pidschian from the Upper Angara. Cystobranchus mammillatus, a parasite of burbot, is widely distributed in the tributaries of Baikal. The absence of these subarctic leeches from Baikal itself is explained by their rheophily.


[Biology of Cucullanus cirratus Müller, 1777 (Nematoda, Cucullanata)].

For the first time the description of the IInd and IIIrd stage larvae of C. cirratus from the submucous membrane of cod fish is given and the possibilities of the direct life cycle of C. cirratus are discussed. The scheme of the life cycle of C. cirratus is as follows. Eggs come out into water with faeces of the host at the stage of 2-4 blastomeres. 10-14 days after this the Ist stage larva hatches. After 4-5 days the Ist stage larva converts into the IInd stage by undergoing the first moulting. With food the IInd stage larva enters the stomach of cod fish. There it penetrates the submucous membrane of the stomach and converts into the IIIrd stage larva. After that the IIIrd stage larva migrates into the intestine where it undergoes the IIIrd and IVth moultings and reaches the adult stage.


The effect of feeding on fat deposition in early infancy.

Trained nutritionists surveyed 92 female infants and their mothers in Western Massachusetts at monthly intervals from birth to age 6 months. A diet history, a three-day record of food intake and 11 anthropometric measurements were obtained at each home visit. Skinfold measurements showed an earlier plateau than in other published studies. There were no significant differences in fat thicknesses when infants were classified by method of feeding until age 2 months, but formula-fed infants with solids started before age 2 months had the largest mean skinfolds which peaked at age 3 months and then decreased and became similar to those of the other groups by age 5 months.


Chronic nonspecific diarrhea: dietary relationships.

Chronic nonspecific diarrhea (CNSD) is the most common cause of prolonged diarrhea without failure to thrive. Although it is most commonly seen from ages 6 to 36 months, CNSD may persist until 54 months of age. Forty-four patients with this syndrome had complete dietary histories, and were divided into four groups on the basis of their intakes and responses to its modification. Each of the four groups had significantly less fat in their diet at the time of presentation than did ten non-CNSD patients (P less than .005) presenting similarly. In three of the groups, daily fat consumption was increased, irrespective of the adequacy of their initial intakes. In all 38 patients in these groups, this dietary modification was associated with the resolution of symptoms. The fourth group, with initially normal dietary fat ingestion, did not respond to dietary therapy. The overall success rate of the regimen in this patient population was 82%. Carbohydrate, fiber, and caloric contents of the diets did not appear to play as significant a role as fat intake.


Methylphenidate in hyperkinetic children: differences in dose effects on impulsive behavior.

This research tested the hypothesis that in hyperactive children a low dose of methylphenidate (0.3 mg/kg) would produce scores superior to those with a high dose (1.0 mg/kg) or placebo on the matching familiar figures test (MFF), a primary index of impulsivity. The hypothesis was based on an earlier finding that the highest percentage of correct responses on a short-term memory task were found in hyperactive subjects who were receiving 0.3 mg/kg of methylphenidate whereas at 1.0 mg/kg the percentage correct returned to the placebo level. The hypothesis was verified in that the low dose reduced the number of errors on the MFF significantly more than did placebo or the high dose. This work demonstrates that, for both learning and impulsivity in hyperactive children, the lower dose of the two doses of methylphenidate studied produced the preferable effect.