The diagnosis of primary hyperparathyroidism.

Certain clinical features arouse suspicion of primary hyperparathyrodism, but a firm diagnosis depends upon laboratory tests. Hypercalcaemia associated with a raised or detectable level of parathyroid hormone (PTH) in the serum is diagnostic. Facilities for obtaining PTH estimations are available everwhere in the United Kingdom through the Supraregional Assay Service.


Postoperative analgesia using continuous infusion of papaveretum.

A technique of postoperative analgesia using continuous intravenous papaveretum with a dosage derived from previous intravenous titration is described. Hourly pain scores, pulse and respiration rates, and blood pressure readings were recorded. The patients were followed up until discharge from hospital. The nature and incidence of various complications were noted.


Contract cholangiography.

Clinical, operative, and conventional radiological criteria may provide insufficient indications for exploration of the common bile duct. The technique of contact cholangiography improves the radiographic definition, especially in the obese, and has resulted in more positive choledochotomies and in fewer negative explorations.


A new approach to a final examination in surgery. Use of the objective structured clinical examination.

In an attempt to overcome the disadvantages of the conventional final examination an objective structured clinical examination (OSCE) was introduced into the final examination in surgery at the University of Dundee. In this approach are tested at 20 stations through which the candidates rotate. At some stations the students are assessed, by an examiner using a check list, on their ability to take a history or examine a patient. At other stations objective questions are used to assess the students' findings and their interpretation, his (or her) management of the patient, and his assessment of laboratory investigations. This approach to the final examination is more reliable and more valid than traditional methods and has practical advantages over them.


Measurement and control of postoperative pain.

Continuous intravenous infusion of morphine in a dosage varied according to the changing needs of the patient is proposed as an ideal method of controlling postoperative pain and reducing postoperative respiratory complications. An original technique for the measurement of pain is described which, when used in conjunction with measurement of serum levels of free morphine, has demonstrated the superiority of this method of pain control. Preoperative psychological tests are considered as possible predictors of pain experienced after operation, and extra counselling is suggested for patients indicated to be at risk.


Glucose homoeostasis following injury.

Metabolic changes following injury have been observed for many years, and John Hunter discussed such changes in 1794. Changes in carbohydrate metabolism have been observed for a similar length of time, and glycosuria and hyperglycaemia have been reported by a number of observers. This paper records and quantitates the extent of hyperglycaemia in patients undergoing surgery of different degrees of severity and relates them to changes in blood insulin, growth hormone, cortisol, and catecholamine concentrations. Further animal studies were performed which suggested that a fall in intracellular glucose utilisation may be a contributory factor. The use of isotope labelling of glucose in man has enabled further studies to be done to clarify changes in exchangeable glucose mass, replacement rate, and space both in the normal situation and in the presence of infusions of glucagon, noradrenaline, glucose, and amino-acids. The hyperglycaemia is clearly the result of a complex interaction of changes in the availability and activity of hormones which control glucose metabolism both within and outside the cell.


Burn wound dressing with human amniotic membrane.

The use of amniotic membrane as a biological dressing for thermal injury is simple and cheap and has been found to be superior to allograft and xenograft. The membrane prevents heat and water loss from the wound surface and acts as a barrier against bacterial contamination, thus aiding the healing process and reducing morbidity. Another clinically significant and important property of the membrane is its ability to offer marked relief from pain. Over a period of 30 months amniotic membrane was used to treat 15 cases of burn in a small hospital, with uniformly satisfactory results. The practical aspects of this method of treatment can easily be adopted by any hospital regardless of its available facilities.


The clinical value of ultrasound in biliary tract and pancreatic disease.

The use of ultrasound in the non-invasive investigation of the biliary tract and pancreas is discussed. Its accuracy in detecting gallstones in the non-acute condition is as accurate as conventional radiography, which is dependent on the excretion of contrast medium by the liver. Ultrasound is not dependent on liver function and has become the best initial investigation in persistent jaundice, acute cholecystitis, acute pancreatitis, and chronic pancreatic disease. In a retrospective study of 75 patients with acute pancreatitis liver function tests were found to be abnormal in 67% and contrast radiography proved to be of limited value. Ultrasonography performed shortly after admission showed an overall accuracy of 82% correct findings. The identification of gallstones in pancreatitis and cholecystitis permits early surgery, which reduces morbidity, improves prognosis, and is now being accepted as the treatment of choice.


Evaluation of dextran with local anaesthesia for short-stay inguinal herniorraphy.

A prospective randomised study of 40 patients undergoing unilateral inguinal herniorrhaphy under local anaesthesia was undertaken. Half the patients received the local anaesthetic (0.25% bupivacaine) mixed with dextran 40 solution. Subjective and objective assessments were made of the postoperative pain experienced in the first 48 h after operation. The use of 0.25% bupivacaine local inguinal block results in a postoperative pain-free period of approximately 10 h. Simple oral analgesics are adequate for postoperative pain relief in 87.5% of patients and are required relatively infrequently. The addition of dextran 40 to the local anaesthetic has no significant effect on its duration of action.


Prostatectomy at a district general hospital.

The mortality and morbidity in 600 patients undergoing prostatectomy at a district general hospital are reviewed. Below the age of 70 years the operative mortality was 1% compared with an overall mortality of 2.3%. Cardiorespiratory disease accounted for the majority of deaths. The increase of postoperative stay due to complications may be reduced by lowering the complication rate and, in the long term, reducing pre-existing cardiorespiratory disease.


Cardiovascular changes during induction of anaesthesia. Influence of three anticholinergic premedicants.

The effects on cardiovascular changes during induction of anaesthesia and intubation of routine premedication with three different anticholinergic drugs, atropine, hyoscine, and glycopyrronium, were compared in a double blind trial. Administration of both atropine and hyoscine, whether intramuscularly or orally, was found to be associated with a high incidence of dysrhythmias. With glycopyrronium the incidence was much lower, but control patients receiving no anticholinergic premedication had no dysrhythmias. The heart rates and blood pressures were similar in all the groups during intubation and cuff inflation. A single dose of suxamethonium was not associated with any bradycardia. The need for routine anticholinergic drug administration should be reconsidered. However, if necessary, glycopyrronium appears to have an obvious advantage over atropine and hyoscine.


Hyperbaric oxygen therapy in acute trauma.

The usefulness of hyperbaric oxygen therapy in the treatment of acute trauma is described. The results in 71 such cases are given.


An improved peroperative test of vagal section.

Twenty patients undergoing vagotomy were submitted to a Burge test and to our modified version of the test using a strain gauge. The Burge test produced 2 false negative results and 3 false positives. The strain gauge test produced 1 false positive result and no false negatives. The strain gauge test appears to be more sensitive and more reliable than the Burge and uses less expensive apparatus.


Verbal participation and outcomes in medical education. A study of third-year clinical discussion groups.

This study looked at several aspects of clinical instruction in small groups such as teacher questioning and student discussion and documented how certain student cognitive outcomes are related to them. Drawing from actual transcripts of over 75 hours in small group sessions, the study examined in detail such things as the logic and level of the questions medical teachers ask, the quality of student responses, the cognitive level of classroom discourse and the effects of instruction on selected outcomes such as the students' ability to think critically and their performance on National Board of Medical Examiners examinations. The instrument used for teaching analysis was a modified version of the Flanders System of Interaction Analysis which incorporated Bloom's Taxonomy of the Cognitive Domain. The cognitive level of the teachers' questions had a significant relationship to the cognitive level of the students' response and discussion. While the students who talked at the highest cognitive level in class were those who scored highest in National Board Examinations (Parts 1 and 2) and the critical thinking tests, the multiple regression analyses showed that classroom activity contributed little to outcomes. The major contributions to outcomes were the aptitude and previous knowledge that the students already possessed.


Seasonal variations in the occurrence of urinary tract infections among children in an urban area in Finland.

The seasonal variations in the incidence of urinary tract infections (UTI) were studied in a series of 992 verified episodes of UTI treated between 1965 and 1974. The incidence was highest during November and lowest during the summer months. Summer episodes, moreover, tended to be the most severe. Seasonal variations were less marked among girls, than amond boys, except in the group of teenage girls in which peak incidences occurred in March and in September. Among the boys, a single peak incidence was recorded in July. The results of the analysis of weather type performed in this study showed that unseasonable types of weather, that is, cold and dry weather in autumn, warm and rainy weather in winter, and warm and dry weather in spring, were accompanied by a clear increase in the monthly number of episodes of UTIs. The difference in the monthly frequency of UTIs between the most and the least favourable types of weather was about two-fold.


Sialic acid secretion of patients with gastric and duodenal ulcers in the dose-response pentastrin test.

The secretion of HCl and sialic acid into the gastric juice was investigated in 13 patients with gastric, 52 with duodenal ulcers and 27 control patients, during the dose-response pentagastrin test. The basal output of sialic acid was clearly highest in patients with gastric ulcers, and the differences between these and other groups of patients were significant. During pentagastrin stimulation a significant initial decrease was found in patients with gastric ulcers with small doses, and the minimum was reached with a dose of 0.1 micrograms/kg/h. After increasing the dose, an increase in sialic acid output occurred in all groups, reaching its maximum with a pentagastrin infusion rate of 1.0 micrograms/kg/h. The basal concentration of sialic acid was also highest in patients with gastric ulcers. In all groups the concentration decreased during the stimulation, which obviously depended on the sialic output not increasing in the same relationship as the volume of gastric secretion.


A new electrical equipment for handgrip testing.

Devices available for isometric handgrip testing revealed constructional deficiences likely to give rise to inaccurate data. A new electrical device was constructed which eliminates the defects in earlier designs. The new equipment consists of a U-shaped handgrip transducer, a measuring device, and a slave monitor for the patients. The patient's maximum handgrip force is determined as a peak voltage, which is stored in analog form. Two comparators help to set the desired handgrip force during the actual testing. The slave monitor's two lamps and analog meter help the patient to apply a force which is maintained at a selected percentage of the maximum force. The device has been shown to operate well in a longitudinal study of drug treatment of hypertension.


Computerised tomography of the pancreas with acute pancreatitis.

Twenty patients with clinically diagnosed or suspected pancreatitis were examined with computerised tomography. Five pseudocysts and one pancreatic abscess were found as a complication of the disease. Computerised tomography is a non-invasive method of diagnosis in acute pancreatitis and is especially valuable in diagnosing the complications of the disease. Slight swelling of the inflamed part of pancreas and occlusion of the peripancreatic fat were found in mild pancreatitis. Swelling of the perinephric fat and the mesenteric fat were found in five cases of severe pancreatitis. This is a new sign, as well as uneven distribution of the contrast agent in the pancreatic parenchyma.


Origin of triploidy in spontaneous abortuses.

Fourteen triploid spontaneous abortuses were studied cytogenetically by sequential Q and C banding and the marker chromosomes were compared with those of the parents. The abortuses comprised all triploid cases in a series of 288 consecutive abortuses of the first 16 weeks of pregnancy occurring in one hospital. In 12 of the triploids the origin of the extra haploid set was conclusively determined, revealing six cases of dispermy, five failures in the first maternal and one failure in the first paternal meiotic division. The results were combined with those of five other studies comprising a total of 48 informative cases. Non-reduction in the second meiotic division seems to be of little or no significance in the origin of human triploidy. Dispermy is the predominant source, accounting for 40--50% of the triploid spontaneous abortuses. Non-reduction in the first meiotic division of the father seems to be the second-most frequent source although in the present material the corresponding maternal non-reduction is much more common.


Phosphoglucomutase polymorphism detected by isoelectric focusing: gene frequencies, evolution and linkage.

Four alleles at the phosphoglucomutase (PGM1) locus in man have been recently demonstrated by isoelectric focusing, and in this study gene frequencies have been estimated for four populations, and significant differences have been indicated between the results. Pedigree analysis of the PGM1 and rhesus loci confirm a weak linkage in males, but none in females. An examination of PGM1 phenotypes in a range of primates shows that a proportion possess a band focusing at the same isoelectric point as human PGM1+1. We propose that all the human and primate alleles may have evolved from a common ancestral PGM1+1 locus.


A variant protein in human parotid saliva detected by SDS polyacrylamide gel electrophoresis and its inheritance.

In 218 parotid saliva samples collected at random from a Japanese population, two phenotypes were observed by SDS polyacrylamide gel electrophoresis. Inheritance was controlled by a dominant allele at an autosomal locus. The frequencies of the genes determining these phenotypes were for the Japanese population studied: Ph+ = 0.026 +/- 0.008, Ph- = 0.974 +/- 0.008.


Genetic study of the Cuiva Indians of Venezuela.

Serum and red cell protein markers were investigated in Cuiva Indians. Our ethnologic studies indicate that the low degree of genetic variability in this population is probably due to genetic drift.


A method for assessing age-standardized weight-for-height in children seen cross-sectionally.

Weight-for-height standards in children are usually constructed on the basis that the expected weight for a given height does not depend on age, an assumption which is unjustified. The present paper investigates regression standards of age-standardized weight for age-standardized height, the standardization being achieved by expressing weight and height as fractions of the 50th centile for age from a suitable growth standard. The precise choice of standard is not critical. Data on 4631 children from five different countries, exhibiting a wide spectrum of growth status, show that throughout childhood until puberty, the following ratio is appropriate as a simple and convenient index of weight-for-height: age-standardized weight/(age-standardized height)2. During puberty a larger power than 2 is required, so the index as specified is inappropriate. Approximate values for the distribution centiles of the index are suggested. The index may be used to assess degree of malnutrition or obesity, for individuals or groups seen on a single occasion. A slide-rule is described which calculates the index directly, given the child's sex, age, height and weight.


The expression of creatine kinase isozymes in human cultured cells.

The BB isozyme of creatine kinase is consistently present in cultured human fibroblasts and shows great variation in activity in long-term lymphoid lines. One mouse line tested, PG 19, had strong activity, but all other rodent lines tested did not express CK BB. Human and mouse CK BB can be expressed independently of each other in human--rodent somatic cell hybrids. There is some evidence that the structural locus for CK BB may be on chromosome 14, but the involvement of other chromosomes, expecially no.17, cannot be excluded. The MM and MB isozymes of creatine kinase were not seen in any human cultured cells.


Sialidosis type 1: cherry red spot-myoclonus syndrome with sialidase deficiency and altered electrophoretic mobility of some enzymes known to be glycoproteins. II. Enzymes studies.

Observations have been made on two brothers who had progressive ataxia, intention myoclonus and visual failure starting early in the third decade of life. Their parents were consanguineous. The brothers showed bilateral cherry red spots at the maculae and bilateral perinuclear cataracts; their intelligence was preserved. Urine was found to contain large amounts of sialylated oligosaccharides; cultured skin fibroblasts showed deficiency of the enzyme sialidase (neuraminidase). Studies on leucocytes and cultured skin fibroblasts showed aberrant electrophoretic mobilities of six enzymes all of which are known to be glycoproteins, and this has been attributed to excessive amounts of sialic acid on the enzyme molecules. The clinical features together with the biochemical findings indicate that these are further cases of the newly described condition Sialidosis Type 1 and it is suggested that the electrophoretic findings might be typical of the condition.


Maternal height and twinning.

Data on maternal height are presented for 307 pairs of newborn twins of known zygosity from Oxford and 267 pairs from Aberdeen and north-east Scotland. The results support the hypothesis that mothers of DZ twins are taller than those of MZ twins. Mothers of MZ twins resemble mothers of singletons in height, whereas mothers of DZ twins are taller.


An alternative model of recombination and interference.

A model of four-strand crossing-over is presented in which all non-randomness is attributed to the non-Poisson distribution of the number of exchanges. Nth order recombination fractions and the coefficient of coincidence are calculated in terms of the model. It is shown that coincidence may be greater or less than unity depending on the prior distribution of exchanges. An obligate exchange is a sufficient condition for coincidence to be less than unity if there is a maximum of four exchanges, but not necessarily if five or more are possible. It is also shown that marginal coincidence is an insufficient concept to explain the behaviour of coincidence over its entire two-dimensional domain.


Human aconitase polymorphism in three samples from northeastern Brazil.

Human aconitase (ACONS) polymorphism was studied in three samples from northeastern Brazil. Two of the samples were collected in the State of Bahia and one in the State of Sergipe. The main characteristic of the samples was given by different degrees of Black admixture. The results showed that the more negroid the samples the higher the frequencies of the alleles ACONS4, ACONS2 and ACONS6. These findings fit well with the known ACONS gene frequencies in present-day Nigerians and with the past history of Yoruba slaves in Bahia.


The beta-glucuronidase release from macrophages activated by immune complexes of varying antigen/antibody ratio.

When unstimulated rat peritoneal macrophages are exposed in vitro to IC formed with BSA and specific rat anti-BSA IgG antibodies, an exocytosis of the lysosomal beta-G occurs. The maximal release of beta-G into the serum-free medium is induced, without cell lysis, by IC after a 6-h contact with the adherent cell population. This phenomenon is dose-dependent, and the percentage of beta-G in the medium is higher with IC in Ab excess than with other types of IC. In this homologous model (rat macrophages and rat antibodies) the Ag/Ab ratio of IC seems to represent an important factor of macrophage activation.


Cytidine-5'-diphospho-choline conjugates. I.--Synthesis and fixation to phosphorylcholine-binding proteins.

The oxidation of the ribose ring of cytidine-5'-diphospho-choline (CDPC) by periodate to produce reactive dialdehydes was used to couple this activated reagent onto various proteins, onto Ficoll 400 and onto Sepharose 4B. Careful control of parameters of the different steps of the reaction enabled us to synthesize conjugates with a graded number of nucleotide residues. Human serum albumin conjugates with a relatively high degree of substitution were used to demonstrate and to measure anti-phosphorylcholine antibodies and the acute phase reactant, C-reactive protein by precipitation or passive haemagglutination techniques. These methods for measuring C-reactive protein in serum of patient suffering from acute inflammation may be useful for clinicians. CDPC-AH Sepharose was used to purify the phosphorylcholine-binding myeloma protein HOPC8 and to separate C-reactive protein from the bulk of serum proteins. Improvements of this technique will certainly lead to the complete purification of C-reactive protein.


Cytidine-5'-diphospho-choline conjugates. II.--Immunogenicity in rats.

Cytidine diphospho-choline (CDPC) derivatives of human serum albumin (HSA) are immunogenic in the rat when injected in adjuvants. They induce a very rapid synthesis of IgM anti-phosphorylcholine antibodies which was followed by the synthesis of anti-CDPC antibodies and of anti-HSA antibodies. The activated nucleotide was able to induce specific skin sensitivity in rats after one skin painting. Gastric intubations of rats with low doses of HSA conjugates 8 days before an infection with the nematode Nippostrongylus brasiliensis were followed by a reduction of the resulting intestinal worm burden.


Visual evoked potentials in the evaluation of "cortical blindness" in children.

Visual evoked responses (VERs) to brief light flashes were recorded from occipital regions in a group of 30 "cortically blind" children aged 4 months to 15 years and were compared with those of 31 children of similar age range who had the same type of central nervous system diseases but without signs or symptoms of blindness. The VERs were analyzed for amplitude, number of peaks, and morphology, following a method used previously by other authors. All the responses had some degree of abnormality, but there were no significant differences between the two groups. The findings suggest that recording of VERs is not always an accurate method for diagnosis of cortical blindness in children since the presence of abnormal responses is not incompatible with normal vision. Only 1 patient with coritcal blindness showed no response.


Receptor for the Fc portion of IgG on the plasma membrane of the hepatocyte.

Applying the immune rosette assay to suspensions of isolated liver cells, 30 to 50 % of hepatocytes obtained from rabbit liver from rosettes with sheep erythrocytes sensitized with IgG. Rosette formation can be inhibited by preincubation of the hepatocytes with aggregated IgG. The interaction between hepatocytes and IgG is not species-specific. Pretreatment of hepatocytes with F(ab')2 fragments of antibody with anti-IgG activity does not interfer with rosette formation. No binding occurs with erythrocytes coated with F(ab')2 fragments, IgM or IgM + complement. These membrane receptors for Fc gamma share many properties with those recognized on macrophagic cells and B lymphocytes; it seems however that on liver cell surface their density and/or their affinity for IgG are inferior to those of mesodermderived cells.


[Role of macrophages in interferon production in mice (author's transl)].

By stimulating or depressing the macrophage system with Corynebacterium parvum or anti-macrophage serum, we were able to establish that macrophages play a role in Poly-I:C-induced interferon production. On the other hand macrophages do not seem to be the cells which produce endotoxin- or NDV-induced interferon, although a slight participation of these cells in the production of NDV-induced interferon cannot be excluded.


[Detection of anti-H-2-antibody-induced cytolysis by ATP measurement (author's transl)].

Measurement of intracellular ATP content by the luciferin-luciferase photometric reaction appears to be an extremely sensitive method for detecting complement dependent cytotoxicity (DCD) mediated by antibodies directed against H-2 antigens. Within the 15 min following the addition of complement, a considerable loss of ATP is observed in the antibody-coated target cells. The reaction is detectable using normal spleen lymphocytes as target cells, completely specific and much more sensitive than the classical dye exclusion test. Preliminary findings from our current study indicate that this simple and very rapid CDC method should be considered for the purpose of HLA ABC and D typing in humans.


The possibility of antiidiotypic activity in multipareous mice.

CBA females pregnant of A/J males were tested for the presence in their sera of antiidiotypic antibodies, capable of combining with antipaternal Ig determinants. Radioimmunoassay tests have shown that in comparison to females pregnant of isogeneic males, allopregnant sera presented values indicating the presence of an antiidiotypic reaction in five out of seven trials. The possible role of antiidiotypic reactions in the control of maternofoetal relationship is discussed.


[Action of mitomycin C on the variability of Actinomyces hygroscopicus in forming a proteolytic complex of hygrolytin enzymes and the antibiotic, hygromycin B].

The lethal and mutagenic effect of mitomycin C in doses of 10 and 15 micrograms/ml on the spores and 24-hour culture of Act. hygroscopicus, strain O878 producing hygrolytin, a proteolytic enzyme and hygromycin B, an antibiotic was studied. It was found that mitomycin C had a high lethal effect on the organism. The lethal effect of the antibiotic depended on the stage of the culture development, mitomycin C dose and exposure time. The 24-hour culture was most sensitive to the effect of mitomycin in a dose of 50 micrograms/ml. Exposure to mitomycin increased the actinomycete variation with respect to the colony morphology and induction of new morphological mutations. Exposure of strain O878 to mitomycin C significantly increased the culture variation with respect to the quantitative features of production of the hygrolytin proteolytic enzyme complex and hygromycin B. The character of the strain induced variation with respect to the features studied was different which indicated the absence of correlation between them. The use of mitomycin C proved to be promising in selection of Act. hygroscopicus with a purpose of increasing the culture proteolytic and antibiotic activity.


[Collector device for apparatus hookup connections in microbiological manufacture].

A collector device developed on the basis of a holding tank is discussed. The working principle of the device, its characteristics and advantages as applied to microbiological industry are described. The use of the collector devices in the assembly diagrams of the apparatus provides reduction of the number of the piping fittings, the pipe-line length, the number of the sealing elements, heat evolution into the environment, and time of the apparatus servicing.


[Comparative study of cephalexin and cephradine distribution in the body of rats].

Distribution regularities of cephalexin and cephradine, 2 semisynthetic cephalospor in antibiotics for oral use were studied on rats. It was found that the cephalosporins had a capacity for satisfactory penetration through the histochematological barriers. The drugs were rather rapidly absorbed from the gastrointestinal tract of the rats into the blood. Their maximum blood levels were determined 1 hour after the administration. The highest cephalosporin concentrations were detected in the kidneys and liver. Still, the level of cephradine in the kidneys was lower and that in the liver was higher than the levels of cephalexin. The lowest concentrations were found in the skeletal muscles. The character of cephradine distribution in the lungs, heart and spleen differed from that of cephalexin; the maximum concentrations of cephradine in these organs were achieved 1 hour after its administration, while those of cephalexin were achieved in 30 minutes. The antibiotics were not detected in the brain tissue. No increase in the concentration gradient with time was observed.


[Comparative characteristics of the antitumor and immunodepressive activity of carminomycin on the L-1210 experimental model].

The antitumor activity of carminomycin was estimated by the number of lymphoma colonies formed in the spleen of DBA/2 mice on their inoculation with the bone marrow cells from mice with transplantable leukemia L-1210. The immunodepressive properties of carminomycin were determined by the number of the antibody forming cells in the spleen of CBA and DBA/2 mice with leukemia L-1210 after immunization with sheep red blood cells. It was found that in a single dose of 1.5 mg/kg carminomycin inhibited the lymphoma colonies by 50 per cent. The maximum immunodepressive effect was observed when carminomycin was used in a single dose of 1.5 mg/kg 48 hours after the antigen stimulation. In this case the number of the antibody forming cells in DBA/2 mice with leukemia L-1210 was lower than that in CBA mice without leukemia.


Reaction of macrophages to cigarette smoke. I. Recruitment of pulmonary macrophages.

Recruitment of pulmonary macrophages was studied in adult male mice which had been exposed 42 to 82 days to cigarette smoke. Scintillation counting procedures revealed that cigarette smoke induces increased DNA activity in pulmonary tissue. No such induction was noted in the liver or spleen--organs which, like the lungs, are also involved in clearance of foreign material. Autoradiographic analysis of lung samples taken at intervals up to 40 days following 3H-thymidine injection revealed an increase in DNA activity reflecting a marked increase in the number of labelled pulmonary macrophages. At times, more than 50% of the total pool of labelled cells were identifiable as macrophages. Therefore, cigarette smoke appears to elicit a recruitment of macrophages specifically to the lungs.


Reaction of macrophages to cigarette smoke. II. Immigration of macrophages to the lungs.

The present study identifies the source of the elevated pulmonary macrophage population in young adult male mice which results when animals are exposed to cigarette smoke. Light microscopic and autoradiographic analysis of pulmonary tissue from smoke-exposed animals revealed that pulmonary macrophages (free, attached, and septal or interstitial) divide only rarely. Further, it was noted that, during the marked progressive increase in the labeled macrophage population in the lungs, the number of silver grains over the nuclei of labeled macrophages did not become significantly diluted. Thus, the markedly elevated macrophage population which results when animals are exposed to cigarette smoke appears, for the most part, to be due to immigration of cells from bone marrow rather than in situ division of resident macrophages.


Biochemical abnormalities in workers exposed to molybdenum dust.

Exposure to molybdenum in dust was measured in a molybdenite roasting plant. This exposure was accompanied by large elevations of serum ceruloplasmin and smaller increases in mean serum uric acid levels in the workers. Absorption of molybdenum from the dust was demonstrated by increases in plasma and urinary molybdenum levels. It remains necessary to demonstrate whether such exposure results in long-term health effects.


Lung cancer among pesticide workers exposed to inorganic arsenicals.

Cancer mortality was studied in 1,393 persons exposed to high air concentrations of inorganic arsenicals for varying lengths of time during the manufacture and packaging of pesticides at a plant in Baltimore, Maryland. Employees consisting of 1,050 males and 343 females were traced for the period 1946 to 1977, and vital status was determined for 86.9% of males and 66.8% of females. The observed number of deaths from all and selected causes was compared with the number expected from the Baltimore City mortality experience in terms of the Standardized Mortality Ratio (SMR). A significantly increased SMR was found for lung cancer and anemias in males. The SMR for lung cancer was especially high in males with presumed high exposure to arsenicals. A dose-response relationship was suggested by the SMR for lung cancer which increased with increasing duration of exposure to arsenicals, but no such relationship was evident for nonarsenicals. Although smoking habits could not be examined in the study subjects, the authors believe that the findings provide additional epidemiologic evidence on the respiratory carcinogenicity of occupational exposure to airborne inorganic arsenicals.


Pulmonary hypertension in silicotic rats.

In male rats, pulmonary hypertension was found 9, 17 to 18, and 30 wk after an intrapulmonary injection of 50 mg quartz dust suspended in saline. Pulmonary arterial blood pressure increased progressively with time, and in the oldest group, the weight of the right heart ventricle was increased.


An inhibitor of lipid peroxidation in rat lungs.

Formation of lipid peroxides in vitro was investigated in the lung, liver, and brain homogenates of normal male rats. Unlike brain tissue, increasing the concentration of lung or liver in homogenates resulted in decreased output of lipid peroxides. Further, lung homogenates exerted an inhibition of lipid peroxide formation by brain and dilute liver homogenates. The factor responsible for such inhibition was located in the postmitochondrial supernatant, was heat stable, nondialysable, could be preserved in frozen state for 60 days, concentrated by dialysis against powdered sucrose, and precipitated by ammonium sulphate.


The water factor and mortality from ischemic heart disease: a review and possible explanations for inconsistent findings with additional data from Manitoba.

The question of the relationship between water hardness and mortality from cardiovascular diseases is far from being settled. Marked discrepancies in the results of various studies in this area exist and there is a great need for closer examination of the reliability of measuring water hardness and other water characteristics. There is also a need for standardizing these measurements and for accounting for certain important questions in designing studies of this nature. This article reviews the results of various studies on the "water factor," points out their discrepancies, presents additional evidence from the Province of Manitoba against the "water factor;" and explains possible sources for discrepancies in the findings of various studies. Based on the evidence so far available, it is too early to universally accept the "water story" and to make recommendations for discouraging the softening of hard water as a measure for preventing cardiovascular disease mortality.


Pulmonary toxicity of methyl methacrylate vapors: an environmental study.

The toxicity of methyl methacrylate vapors was tested using a mouse model. Mice were exposed for prolonged periods (2 hr twice daily for 10 days) to high doses (1,500 ppm) under atmospheric oxygen and carbon dioxide concentrations. Histologic examination of the lungs, liver, heart, and kidney showed no evidence of damage.


A dose-response relationship between chromosome aberrations and hypoxic insults in overripened hamster ova.

An attempt was made to analyze the quantitative occurrence of chromosome anomalies by the exposure of slightly overripened ova (delayed fertilization) to hypoxic insults in golden hamsters. Three groups were established: (1) a control group (PO2 = 152 mmHg); (2) a 4,500 m altitude group (PO2 = 87 m5 hr post-ovulatory aging revealed no striking effect on reproductive performance, as well as on the production of chromosome aberrations. Nervertheless, even in a slightly overripened condition ovum increased in susceptibility to the production of chromosome anomalies after hypoxic exposure equivalent to 4,500 m altitude. The dose-response relationship between hypoxia and the occurrence of triploidies was particularly distinguished. On the other hand, a similar relationship was not so evident in the production of aneuploidies, especially of trisomies. It can, therefore, be surmised that the change in the cytogenetic milieu at the time of the second polar body extrusion has some quantitative relation to the severity of environmental stressors.


Interaction of carbon monoxide and cyanide on cerebral circulation and metabolism.

Significant elevations of carboxyhemoglobin and blood cyanide have been found in fire victims. The nature of the interaction of acute exposures to these agents is unclear. This study was undertaken to describe the of cyanide and carbon monoxide--alone and in combination--on the circulation and metabolism of the brain in anesthetized dogs. Cerebral blood flow increased to 130 and 200% of control with elevations in carboxyhemoglobin to 30 and 51% or with elevations in blood cyanide to 1.0 and 1.5 microgram/ml, respectively. Cerebral oxygen consumption remained unchanged until the higher level of carbon monoxide or cyanide was reached. When carbon monoxide and cyanide were administered simultaneously, cerebral blood flow increased in an additive manner, but significant decreases in cerebral oxygen consumption occurred at the combination of the lower concentrations. These data suggest that carbon monoxide and cyanide are physiologically additive on producing changes in cerebral blood flow, but may act synergistically on cerebral metabolism.


Reactions of ozone with fatty acid monolayers: a model system for disruption of lipid molecular assemblies by ozone.

Ozone concentrations of 0.03 ppm are shown to initiate physical disruption of both oleic and linoleic acid spread monolayers in a few seconds. Approximately equal yields of water soluble products in nitrogen- and oxygen-containing environments as well as in the two acid systems suggest that the dominant reaction pathway involves direct attack on fatty acid double bonds and not oxidative chain reactions. A possible explanation for the observed loss of monolayer material is provided by the Criegee mechanism for ozonide rearrangement following ozone attachment to double bonds. In this scheme polar intermediates are generated which could pass into the aqueous subphase before recombination can occur. alpha-Tocopherol exhibits a protective effect only when present at a high fraction in the fatty acid monolayer (6 mole%). These systems provide an efficient elementary model for studying the physical effects of ozone on lipid membrane structure.


Air pollution and health in three urban communities.

A health study was conducted in three communities in the greater Montreal region; the first two were characterized by relatively high particulate and sulfur dioxide levels, respectively, and a third community without major industrial pollution. In each community, 300 men and women 45 to 64 yr of age were studied. Residents of the two more polluted communities exhibited a higher prevalence of respiratory symptoms and mean lung function evaluated by various tests was lower than in residents of the less polluted community. When intercity differences in age and smoking were accounted for, no statistically significant intercity differences in health status could be shown. Given the limitations of this study, the results provide no evidence to suggest that current Canadian standards for sulfur dioxide adequately protect human health as measured by the indices used in the study, for adults in the age range of 45 to 64 yr.


Influence of documented lead poisoning on environmental modification programs in Newark, New Jersey.

Data from the Newark, New Jersey Childhood Lead Poisoning Program suggest that the major consequence of the program has been early intervention rather than the amelioration of environmental contamination. During 1975 to 1976, the authors investigated housing for 253 black and Hispanic children with blood levels over 60 microgram/100 ml. Of these, 115 had moved or had given incorrect addresses and were lost to follow-up, 22 were in the same homes but did not make themselves available and in 16 instances, the houses were boarded up or had been destroyed by fire. Of the remaining 100 children, 31% suffered from symptoms potentially related to lead poisoning and 57% of the children were still living in the same dwelling in which the child was affected. Only one-fourth of the houses had been properly abated, i. e., the problem of environmental lead had been corrected, and one-fourth of the houses were not investigated at all by health authorities. These data support the concern that lead poisoning will not be effectively combated until the environmental issue is fully addressed.


Tumor size and lymph node metastases in squamous cell carcinoma of the uterine cervix.

Tumor size was accurately measured in 684 patients who had surgical treatment of cervical carcinoma after a small biopsy and received no preoperative radiotherapy. Frequency of lymph node metastases increased as five different tumor size parameters went up, depth of tumor invasion being of particular importance. When micrometastases, macrometastases, and tumor cell emboli were considered, a correlation was statistically verifiable for micrometastases and macrometastases. Such correlations could not be determined for tumor cell emboli. They are to be regarded as a random event.


The neuropsychiatric disorder in systemic lupus erythematosus: evidence for both vascular and immune mechanisms.

As part of a prospective survey of systemic lupus erythematosus (SLE) a detailed collaborative study of the clinical, psychiatric, and laboratory features in 15 patients with nonfocal neuropsychiatric disease has been undertaken. In addition to conventional clinical and psychometric evaluation, electroencephalograph, and cerebrospinal fluid analysis, the study included the assessment of cerebral blood flow with oxygen-15 brain scans and serological testing for the presence of antineuronal and lymphocytotoxic antibodies. Of the 15 patients 12 had psychiatric manifestations, while 13 had various neurological abnormalities. All except 2 episodes of cerebral disease were transient. Striking abnormalities in cerebral blood flow and metabolism were seen in 12 patients, even in the presence of subtle clinical features. Sequential scans showed that improvement in clinical features was accompanied by a reversal of scan abnormalities. All sera contained brain-reactive antibody, either antineuronal IgG antibody (13) or lymphocytotoxic IgM antibody (12) or both (10), though there was an inconsistent association between clinical features and antibody titre. It is suggested that transient disturbances of cerebral vascular function in SLE might allow brain-reactive antibodies from the circulation access to cerebral tissue. In this way the nature of the neuropsychiatric abnormalities would depend on both vascular and immunopathogenic mechanisms.


Mechanical factors and patellofemoral osteoarthrosis.

This paper investigates the possible role of mechanical stress in the development of the osteoarthrotic lesions frequently observed in the patellofemoral compartment of the knee joint. First the location of these destructive lesions was determined by studying the location and pattern of contact in the patellofemoral joint. The study was carried out on 39 cadaveric knees for the range of flexion 0 degrees -120 degrees. It was shown that the lesions were localised to the areas corresponding to the range of flexion 40 degrees -80 degrees. These areas have been shown to be subjected to a low stress for most of the time and to a much higher stress for only part of the time. This mode of stressing this area of the cartilage is a consequence of the style of life of the average Western man in which the most predominant activity is level walking, during which the load and in turn the stress are much lower than they are during other ambulatory activities such as ramp and stair ascent and descent. The same area of the cartilage seems to be subject to a similar mode of stress during sedentary occupations. It is suggested that this mode of stressing the cartilage conditions it chemically, and hence mechanically, to transmit low stresses, so that when the much less frequent but higher stresses are applied it cannot transmit them without sustaining some damage.


Sacroiliac joint abnormalities in paraplegics.

We studied 186 paraplegic patients to clarify the pathogenesis of the sacroiliac (SI) joint abnormalities reported in these patients. Partial or complete fusion of SI joints was noted in 47 patients (25%), and milder degrees of abnormalities of these joints were present in 27 patients (15%). The abnormalities differed from those seen in ankylosing spondylitis and were found more commonly in patients with high levels of cord injury. It is likely that trunk mobility is necessary to maintain integrity of SI joint and that absence of such mobility compromises SI joint structure in many paraplegics.


Acute gouty bursitis: report of 15 cases.

Fifteen cases of acute gouty bursitis were seen among 136 crystal-proved cases of gout. Bursal aspirate yielded yellow or pink fluid in 10, chalky white fluid in 1, and a small amount of bloody fluid in 4. Monosodium urate crystals were present in all. Bursal fluid leucocyte counts averaged 2.9 X 10(9)/1 compared with synovial fluid leucocyte counts that averaged 25.5 X 10(9)/1 in cases of articular gout (P less than 0.05). Gouty, septic, and idiopathic (traumatic) bursitis share clinical features, and detailed bursal fluid analysis is crucial for diagnosis.


Clinical and radiographic features of spondylitic hip disease.

The clinical and radiographic features of hip disease in 76 patients with definite ankylosing spondylitis have been studied. Symptomatic hip involvement occurred late in the course of the disease, with a mean delay after the onset of 12 years in males and 7 years in females. Patients with disease onset before the age of 20 developed hip symptoms at an earlier stage. Associated diseases included uveitis (13%), colitis (4%). Bilateral concentric loss of hip joint space with a relatively undeformed femoral head was the commonest radiological change (61%). Localised loss of joint space at the upper pole (16%) was associated with femoral head destruction and a greater degree of osteophytosis, suggesting coincidental or secondary osteoarthrosis. Bony ankylosis of the hips (10%) was present only in women, and the absence of osteophytes, cysts, and bone lesions of the iliac crests and ischial rami suggests that it is a distinct radiographic manifestation of female ankylosing spondylitis.


Indications for arthroscopy in mon- and polyarticular arthritis.

In many cases clinical and laboratory data and x-rays are insufficient to diagnose the aetiology of synovitis in gonarthritis and to plan adequate treatment. The efficacy of arthroscopy in the management of the knee lesion was studied in mon- and polyarthritis. A classification of 'very useful', 'useful' and 'not useful' was used. On the basis of results reported here we outline the indications for arthroscopy in mon- and polyarthritis.


Antibody-dependent and PHA-induced cellular cytotoxicity in rheumatoid arthritis.

One hundred and thirty nine observations of antibody-dependent cell mediated cytotoxicity (ADCC) were made on 77 with rheumatoid arthritis (RA) and 17 healthy controls. There were no differences in ADCC between these 2 groups or within the RA group with regard to disease activity, duration, seropositivity, or drug treatment. Sixty observations of phytohaemagglutinin induced cytotoxicity were made on 22 patients with RA and 10 healthy controls. Again there were no differences in cytotoxicity between the 2 groups.


Relationship between erythrocyte sedimentation rate and serum C-reactive protein in rheumatoid arthritis.

Serum C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were compared in 241 patients with rheumatoid arthritis (RA). There was a positive linear correlation between the 2 measurements with a high degree of variability. Neither age nor duration of RA had a detectable influence. The relationship between CRP and ESR was, however, altered by treatment with gold, penicillamine, or high doses of prednisone. It is suggested that serum CRP is the more sensitive measurement, but that CRP and ESR do not have identical clinical significance.


Changes with age in the glycosaminoglycans of human articular cartilage.

Human articular cartilage was obtained post mortem from the lateral femoral condyles of 30 subjects aged from under 1 to 70 years. Cryostat sections taken 0--100 micrometers and 900--100 micrometers deep to the cartilage surface were exhaustively extracted to recover the glycosaminoglycans (GAG). After fractionation by cellulose acetate electrophoresis and enzyme depolymerisation individual GAG were determined by alcian blue -0.05 M MgCl2 and disaccharide microassay procedures. Changes with age were observed in GAG concentration and in the proportion of individual GAG. Large alterations occurred during the period of skeletal growth (0--16y). At birth GAG formed about 50% of the dry weight of cartilage, a value that decreased to about 15% in adult cartilage. Chondroitin sulphates (ChS) formed the principal GAG of articular cartilage and accounted for almost all of the GAG of the infant material. The ChS decreased with age and were partially replaced by keratan sulphate (KS), so the KS eventually comprised 12% of the GAG. Hyaluronic acid (HA) was identified and was found to increase linearly with age to form 6% by weight of the cartilage GAG by 60y.


In-vitro mobility of the lumbar spine.

As part of a systematic study of the spine between D11 and S1 the response to stress has been assessed by measuring radiologically the total and segmental mobility of 103 specimens. The method was shown to be reproducible to within 10% of total mobility. No significant sex difference was seen. Total mobility varied widely, but mean total mobility fell with age. All lumbar segments became less mobile up to the fifth decade. Between the fifth and the eighth decade the mobility of the fifth lumbar segment continued to fall, whereas other lumbar segments became more mobile. The mobility of each segment also varied widely, but the mean segmental mobility fell progressively from L5 to D11. However, this smooth pattern of movement was seen in only 16 cases, mostly adolescents and young adults. Among the remainder, in which movement was irregularly distributed, there were 7 cases (4 aged less than 30 years) in which the mobility of at least 1 segment was more than 2 standard deviations above the mean. The cause of this hypermobility was not evident radiologically. It is suggested that segments with abnormally high mobility may be at risk.


Extensive soft tissue calcification (calcinosis universalis) in systemic lupus erythematosus.

A 21-year-old woman with long-standing systemic lupus erythematosus developed extensive calcification of the soft tissues of the thoracic and abdominal walls and extremities early in her illness, and these calcifications gradually disappeared over the course of her disease. The extent of this calcinosis and apparent spontaneous regression are unusual events in systemic lupus erythematosus.


Constrictive pericarditis, pyopericardium, and tamponade with rheumatoid arthritis.

Constrictive pericarditis and pyopericardium with tamponade in a patient and rheumatoid arthritis is described. No fever was recorded despite a litre of pus in the pericardial sac, perhaps because of previous treatment with hydrocortisone. Echocardiography is a diagnostic advance.


Septic arthritis due to Pasteurella multocida complicating rheumatoid arthritis.

A patient with rheumatoid arthritis treated with corticosteroids developed a septic arthritis of her right knee. She had been bitten on her right leg by her pet cat 2 weeks earlier. Pasteurella multocida, resistant to penicillin, was isolated from the septic joint and from the oropharynx of the cat. The arthritis was successfully treated with ampicillin. No attempt to eradicate the organism from the cat was made because of the expectation of early recolonisation.


Ruptured hepatic aneurysm in systemic lupus erythematosus.

We report on a patient with systemic lupus erythematosus (SLE) who suffered catastrophic haemorrhage following rupture of an intrahepatic aneurysm. The association between hepatic artery aneurysm and SLE has not been recorded previously, but we have found evidence from the literature that there may be an association between autoagressive disorders and this surgical emergency.


Treatment of iron deficiency in Nigerians with daily intramuscular Ferastral.

Treatment of severe iron deficiency with iron-poly(sorbitol-gluconic acid) complex (Ferastral) intramuscular 10 ml (iron 500 mg) on alternate days has been shown highly effective and well tolerated. In order to see whether the time of treatment could be shortened, 20 Nigerians with severe iron deficiency (mostly from hookworm infection) were treated with daily intramuscular Ferastral 10 ml until their calculated total requirement of iron was met. The total iron deficit was 877-2763 mg (mean 1875 mg). Supportive treatment included antimalarials, folic acid and anthelmintics. No patient complained of undue pain at injection sites or of any other undesirable side-effects. There was no evidence of hepatic or renal toxicity in any patient, including eight who were followed at intervals up to eight weeks from the start of treatment. The initial haemoglobin (Hb) level was 2.2-7.8 g/dl (mean 4.6 g/dl). Daily regeneration of Hb in the first 14 days was 0.12-0.49 g/dl (mean 0.30 g/dl), and haematological indices were generally normal by eight weeks. Recovery was slow or incomplete in six patients, all of whom had complications other than iron deficiency. Serum iron was measured in five patients, rose to around 8000 micrograms/dl on about day 4, and fell to physiological levels by day 14. The serum unsaturated iron binding capacity fell to nil in five out of six patients on around day 3, and reappeared between days 7 and 10. Five patients who had persistent blood loss from continued hookworm infestation received a further single dose of Ferastral (iron 1000 mg) 10 ml into each buttock after four weeks, and one patient after two weeks. This large dose was also acceptable to patients if given slowly; it was followed by an accelerated Hb regeneration, but no toxicity. Daily intramuscular Ferastral 10 ml until the calculated iron requirements are met (usually in less than five days) is recommended for the treatment of severe iron deficiency. Patients with continued blood loss or Hb less than 10 g/dl after four weeks without other cause of anaemia, may receive a boost of one intramuscular injection of Ferastral 20 ml (10 ml into each buttock).


An examination of the dietary constituents of the cattle-biting louse, Bovicola bovis.

Starved Bovicola bovis were confined until they died, with dried cow blood, dried cow serum, primary hair, secondary hair and calf skin scales stained with 1% toluidine blue. Feeding occurred readily on skin scales, as shown by dark staining of the intestine, and minimally on primary and secondary hair; lice confined with other substances did not feed.


Studies on the ultrastructure, virus-like particles and infectivity of Leishmania hertigi.

Five strains of Leishmania hertigi hertigi isolated in Panama and three strains of L. hertigi deanei isolated in Brazil were studied. Ultrastructural examination of promastigotes grown in culture showed virus-like particles (VLPs), 55--60 nm diameter, in the cytoplasm of all strains. The VLPs were normally either organized in paracrystalline clusters or associated with induced tubules. In some cases the VLPs were associated with dense vesicular bodies. Mitochondria with which the VLPs were associated had enlarged elongate or circular cristae. Elongate 'microbodies' containing rod-like structures were observed in promastigotes grown in culture. Poor infections of promastigotes developed in the midguts of 10% of laboratory-bred Lu. longipalpis following experimental feeding on cultures of L. h. hertigi. VLPs were seen in a promastigote in the midgut of a sandfly five days after feeding. Laboratory mammals proved poor hosts for L. hertigi. Cryptic infections in the visceral organs of immunosuppressed hamsters and immunodeficient 'nude' mice were detectable only by culture. Infections of DS cell and mouse peritoneal macrophage cultures showed amastigotes with a high ribosomal density and deep invaginations of the pellicular layer. VLPs were rarely seen in these amastigotes.


Length of antibiotic therapy in in-patients with primary pneumonias.

Seventy-three subjects with primary pneumonia in a hospital in Northern Nigeria were given antibiotics until they had been afebrile for 24 hours. The average duration of therapy was 2.54 days (about 60 hours), which is considerably shorter than the current recommended practice. Subjects with hepatosplenomegalic schistosomiasis and tropical splenomegaly syndrome required antibiotics for a significantly longer period (3.75 days) than those without either of these conditions. Those with an antigenaemia did not require antibiotics for a significantly longer period than those without an antigenaemia. There were no deaths, no increase in morbidity and in virtually all cases complete resolution of the lung lesion occurred within the expected time. It is suggested that in primary pneumonia it is more rational to stop antibiotics after the patient has been afebrile for 24 hours. This leads to a shorter stay in hospital and to the use of less antibiotic.


Activity of Schistosoma mansoni over a ten-hour period in vitro, and its modification by oxamniquine.

The activity of pairs of adult Schistosoma mansoni maintained in a continuous flow culture system was monitored for ten hours using the ultrasound method of Brown, Norman, Bell and Chavasse (1978). The results of 75 experiments were collated by computer to demonstrate the average effect of oxamniquine on worm activity in vitro at concentrations from 0.2 microgram/ml to saturation. The averaging technique indicates that oxamniquine concentrations down to 0.2 microgram/ml modify worm activity in vitro.


A release-recapture experiment with the malaria vector, Anopheles stephensi Liston, with observations on dispersal, survivorship, population size, gonotrophic rhythm and mating behaviour.

10 118 female and 10 863 male Anopheles stephensi were released on three successive nights at a breeding site near the village of Sattoki, Punjab Province, Pakistan during early May, 1977. A total of 721 (7.13%) females and 505 (4.65%) males were recaptured resting indoors, feeding on buffaloes and swarming. The average distance dispersed for females and males recaptured resting inside 13 cattle sheds within 2.17 km of the release point was 165.5 m and 184.8 m, respectively. The maximum longevity of the marked females and males was 12 and 13 days, respectively (mean longevity 3.24 and 3.26 days, respectively). Population size was estimated for the first five days after release using the Lincoln Index modified to account for survivorship, and Jackson's positive and negative methods. Estimates of population size at the two cattle sheds nearest the release point ranged from 1294.7--2551.7 for females and from 481.6--1374.3 for males, considerably less than the size of the released cohort. Marked males from all three releases were collected while swarming with wild males. Inseminated marked and unmarked females were captured at male swarms. Females mated on the night of release, some within 15 minutes of release. Mating here presumably occurred while the females were transversing the 45 metres from the release point to the site of the buffalo biting collections. Both inseminated and uninseminated females were collected feeding on buffaloes. The first gonotrophic cycle was completed when the females were three to four days old, i.e. two to three days after release.


Disturbed venation, a new sex-linked mutant, in the mosquito Aedes togoi.

Genetic linkage of a new sex-linked mutant, disturbed venation (dv), in Aedes (Finlaya) togoi has been studied by utilizing representative markers, s (straw-coloured larva), ru (ruby eye), and y (yellow larva), of the three linkage groups. The dv allele is recessive, disturbs drastically venation of the wing veins, cu1, m1+2, m3+4, r2, r3, and r4+5, and also affects shape of the wings along with loss of many fringe scales. The wings become shortened, especially in females, and somewhat narrowed in males. Much variation occurs in the expression of dv with its fairly good penetrance, although an increased mortality of the dv homozygotes may occur at pupal stage or during emergence. This allele was located at 5 to 6 recombination units from s and 28.56 units from sex locus (M) in the gene order of s-dv-M.


Abnormal haemoglobins in the Sudan savanna of Nigeria. IV. Malaria, immunoglobulins and antimalarial antibodies in haemoglobin AC individuals.

Haemoglobin (Hb) AC electrophoretic pattern was found in 0.7% of the population at Garki, Kano State, northern Nigeria, an area where malaria is hyperendemic. Twenty-one Hb.AC subjects at all ages did not differ from the rest of the population in their frequency or density of Plasmodium falciparum, P. malaria or P. ovale infections, nor in their IgM concentrations and titres of specific antimalarial antibodies. However, IgG levels in Hb.AC subjects were frequently above the average of the reference population (P less than 0.05), especially during a period of protection against malaria (P less than 0.01). These observations suggest that the Hb.C gene may be maintained in certain environments by an enhanced ability to produce IgG antibodies against an antigen or antigens other than malaria, and that its geographical relationship to malaria may be a coincidence. This hypothesis needs to be tested where Hb.C is seen at high frequency, in northern Ghana and Upper Volta or Gwoza (Nigeria).


A pocket of controlled malaria in a holoendemic region of West Africa.

Yekepa, a mining town in northern Liberia, has been built entirely since 1960 and now has a population of 16 000 inhabitants including 1500 expatriates. Although situated in a holoendemic region with constant human movements in and out of the town, the mining company has succeeded in controlling malaria in Yekepa. Furthermore, there is a constant threat of the vector in the close surroundings to the town. Control is maintained by regular residual insecticide sprayings with DDT, regular larviciding with fuel oil and fortnightly issue of amodiaquine chemoprophylactic to all workers. A Malariometric survey showed that the spleen and parasite rates were 11% and 13% respectively in the controlled areas and 95% and 67% respectively in surrounding regions not subjected to control measures. The dominant malaria parasite in the area was Plasmodium falciparum. No adult vectors were found in the town. In the surrounding villages the average room density of adult vectors was 3.8 and the sporozoite rate in a village very close to the town was 9.2%. The dominant vector of the area was Anopheles gambiae with A. Funestusalso being present. The annual per capita cost, including all control activities, is about 4--5 US dollars.


Habits of malaria chemoprophylaxis and an analysis of breakdowns in a West African mining town.

In a West African community approximately 80% of the non-African personnel were taking malaria prophylactics in the recommended manner. The non-takers stated that they were afraid of side-effects of the drugs and/or under-estimated the risks of the disease. During one year 123 patients with clinically suspected malaria were studied. All patients with positive slides were cured with regular dose of 1.5 g chloroquine base. No chloroquine resistance was therefore demonstrated, although 4-aminoquinoline prophylaxis had been given for almost 20 years to thousands of non-African non-immunes as well as in pregnant women and children in the town. Common reasons for 'breakdowns' were febrile disease other than malaria, false positive diagnosis and improper chemoprophylaxis.


The primary isolation of Leishmania donovani from Iraq on different culture media.

Leishmania donovani was isolated by culturing bone marrow aspirates from kala-azar patients, on three types of culture media. The isolation was successful in 88% of the cases. The effects of pH, D-glucose, L-proline and antibiotic concentration in the isolation were investigated. The semi-solid medium used (pH 7.4) with L-proline, was better than the modified NNN media for the primary isolation.


Malumfashi Endemic Diseases Research Project, X. Schistosoma haematobium and bacteriuria in the Malumfashi area.

No association was found between bacteriuria and Schistosoma haematobium infection in the Malumfashi area, and no male had a confirmed significant bacteriuria. The overall bacteriuria prevalence rate in a separate group of schoolgirls was 0.96%, while in females over the age of 20 it was 1.37%; there was an estimated prevalence of 3.2% in women over the age of 30. These figures for females agree with those from populations which have no experience of bilharzia. No urinary S. typhi carriers were found. The lack of association between urinary bacterial infection and schistosomiasis probably reflects the low intensity of S. haematobium infection in the Malumfashi area of northern Nigeria.


Schistosome infection rates in field snails: Schistosoma mansoni in Biomphalaria pfeifferi from Kenya.

Six collections of Biomphalaria pfeifferi were made in the Nairobi and Machakos areas of Kenya. Individual cercarial shedding (Method A) showed that 6.9% (65/938) of the snails had mature 'patent' Schistosoma mansoni infections (range 3.1--34% in the six collections). Crushing (Method B) about one-third of the remaining snails detected no additional mature infections but yielded 1.4% (four snails from one collection) with secondary sporocysts from immature 'prepatent' infections. Weekly shedding observations for five weeks (Method C) on the remainder of the snails showed that 6.9% (40 snails from four collections--range 1.5--30%) shed cercariae maturing from infections immature at the time of collection. As Method B detected no cercariae, Method A apparently detected all 'patent' infections reliably, despite the stress suffered by the snails before examination. Method C was simpler and more efficient than Method B in the detection of infections which were immature at the time of collection. Judging from the rate at which infections matured in Method C, field snails in heavily endemic areas are subjected to pulses of infection rather than to a continuous flow of miracidia. The 'patent' infection rate was not correlated to the 'prepatent' infection rate. Some of the implications of these findings to mathematical models of schistosome transmission are discussed.


Host-parasite relations in cotton rat filariasis. III. The quantitative transmission of Litomosoides carinii to un-irradiated and irradiated golden hamsters and white mice.

The quantitative transmission of Litomosoides carinii by Liponyssus bacoti to un-irradiated and irradiated hamsters and mice is described. Both young and adult, un-irradiated and irradiated hamsters were highly susceptible to L. carinii but mice (un-irradiated or irradiated) were poor hosts. All hamsters (18 un-irradiated and seven irradiated) became infected. Seven out of nine mice in an un-irradiated series became infected. There was apparently 'age resistance' or 'young susceptibility' in the hamsters. The susceptibility of young hamsters appeared similar to that of new-born Carworth white rats and cotton rats. The pattern of infection in un-irradiated and irradiated hamsters was similar. Results from irradiated animals were insufficient to draw any clear conclusions on the effect of irradiation to susceptibility to infection with L. carinii. X-irradiation apparently did not affect the innate susceptibility cr resistance of hamsters and mice to worms. The duration and intensity of microfilaraemia was apparently higher in irradiated hamsters.


The Society of Thoracic Surgeons manpower survey for 1976: a summary.

The results of a 1977 survey regarding places and types of thoracic surgical procedures performed in the United States are analyzed. Responses gathered from 2,240 thoracic surgeons showed that active thoracic surgeons between 34 and 54 years old performed 195,850 major thoracic or cardiac operations per year. Fifty-four percent of active surgeons responding were in solo practice, 40% practiced in groups of 2 to 5 surgeons, and the reamining 6% were in groups of 6 or more. Community size, regional distribution of services, proportion of professional activities allocated to various procedures, and estimates of additional capacity are also summarized.


Forecasting health manpower requirements: the case of thoracic surgeons.

This paper presents projections of the future demand for thoracic surgery. Estimates of the future supplies of thoracic surgeons are constructed based on three alternative annual Board-certification rates. The consequences of varying supplies of thoracic surgeons, for a given level of expected demand, are presented in terms of expected work-load levels. Since it is costly to society if there are too few thoracic surgeons and since it is an obvious waste of resources if there are too many, no single estimate for an optimal annual increase in the number of thoracic surgeons is suggested. Important inadequacies of data for both forecasting demand and determining work loads are noted.


The treatment of postperfusion bleeding using epsilon-aminocaproic acid, cryoprecipitate, fresh-frozen plasma, and protamine sulfate.

The evaluation of excessive hemorrhage was carried out in 774 patients after cardiopulmonary bypass. Excessive hemorrhage was defined in any adult patient as chest tube drainage of more than 600 ml within the first eight hours after operation. Using the prothrombin time, partial thromboplastin time, fibrinogen level, and tri-F titer tests, it was possible to differentiate medical from surgical bleeding. Hyperfibrinolytic bleeding was the most frequently identifiable coagulation disorder and occurred in 159 patients (20%). All these patients were successfully treated with Amicar (epsilon-aminocaproic acid) alone, or with Amicar supplemented with cryoprecipitate or fresh-frozen plasma. Three patients (0.4%) were noted to have residual heparin and required additional protamine sulfate. Five patients (0.6%) had normal coagulation studies and required immediate reexploration. The overall blood consumption per patient was 2.1 units of packed cells. Whole blood and platelets were not used.


Delayed pacemaker erosion due to electrode seal defects.

Over a 7-year period, follow-up data were available on 163 patients who underwent 209 pacemaker-related operations for initial insertion or revision of previously implanted units. During the follow-up period, 16 pacemaker generator units were remoaved from 16 pacemaker generator units were removed from 12 patients solely because of the development of local skin erosion. This represents a 7.7% incidence of pacemaker generator erosion. Tree units were removed within a 3-month interval following pacemaker implantation and were associated with positive bacterial cultures, theraby indicating an infectious cause. Findings at removal of the remaining 13 pacemaker generators included extensive fibrosis with chronic inflammation, fibroblastic proliferation, and granulation tissue, which was most prominent at the site of insertion of the pacemaker lead into the pacemaker generator unit. Granulation tissue frequently led from this area to the area of skin attenuation and erythema. Inspection of the pacemaker generator units and electrodes demonstrated fluid ingress and tissue ingrowth toward the electrode due to inadequate seal mechanisms. Inadequate seal design of the pacemaker generator and electrode junction leads to tissue ingrowth with fibroblastic proliferatiog chronic inflammation, and eventual pacemaker erosion.


The role of gallium-67 scanning in the clinical staging and preoperative evaluation of patients with carcinoma of the lung.

Gallium-67 scanning was evaluated in 100 patients with proved carcinoma of the lung. It was valuable in separating primary from secondary lung tumors, determining the extent of contralateral hilar or mediastinal lymph node involvement, and detecting distant organ metastases. In addition to multiplane whole-body Ga-67 tomographic scanning, colloid liver scans, bone scans, and computerized axial tomography scans of the brain were obtained to determine the presence of distant metastasis. The gallium scan detected 11 of 12 occult metastases and identified 7 of 7 liver, 9 of 14 brain, 4 of 4 soft tissues, 1 of 4 contralateral lung, and 9 of 11 bone metastases. The whole-body gallium scan accurately detected or excluded extrathoracic metastatic disease in 11 of 12 patients examined postmortem within three months of a gallium scan. An approach is recommended using gallium scanning along with chest roentgenograms for clinical staging and preoperative evaluation of patients with carcinoma of the lung. Specific organ scans should be reserved for the occasional symptomatic patient with a negative gallium scan or for clarification of an indeterminate gallium scan.


Sleeve pneumonectomy for bronchogenic carcinoma.

Carcinomas of the right upper lobe that locally infiltrate the trachea represent a major challenge with regard to removal and reconstruction. Sixteen patients who had right pneumonectomy with carina resection between 1969 and 1977 were reviewed, and some implications of the surgical and anesthetic techniques were analyzed. The short-term results give merit to this extended procedure, and the fact that there is one long-term survivor suggests that some patients can be cured of their disease.


Segmental resection for bronchogenic carcinoma.

Segmental resection was performed on 168 patients with peripheral, Stage I bronchogenic carcinoma from 1957 to July 1, 1978. Seventy-four patients (44%) had adenocarcinoma, 58 (34%) had an epidermoid type, 28 (17%) had an unadifferentiated tumor, and 8 (5%) had a bronchoalveolar variety. Ninety-five resections were done on the left lung, the most frequent procedure being removal of the superior division of the left upper lobe (38 patients). On the right side, 73 resections were done. The anterior segment was removed most frequently (19 patients). There were 3 surgical deaths, for a mortality of less than 2%. Complications requiring prolonged hospitalization were associated with air leak in 10 (6%) of the 168 patients. Survival by actuarial curve is 53% at 5 years, 33% at 10 years, and 25% at 15 years. Forty-five patients (27%) died of metastatic carcinoma. Patients with epidermoid lesions have the most favorable prognosis.


Evaluation of a new cardiotomy blood filter.

A new cardiotomy blood filter with a polycarbonate body, a polyester prefilter, and a nylon screen with 20 mu pores was compared with four other commercially available filters. The Optigard filter was found to function as a "surface filter," which effectively removes blood particles larger than its nominal pore size.


A lung clamp for use with mechanical staplers.

A special lung clamp has been developed for use with mechanical stapling devices. These stapling instruments have been adopted widely for pulmonary operations. A variety of clamps has been used to grasp the pulmonary tissue. The present instrument was designed with vertical grooves and fine tapered spikes with opposing holes in the jaws of the clamp. This particular lung clamp overcomes the problem of slippage previously encountered when performing pulmonary resections with stapling devices.


Ultrastructural characteristics of idiopathic spermatidic arrest.

Previous studies on some cases of idiopathic spermatidic arrest showed an anomaly in glucose metabolism, in particular decreased utilization of glycogen at stage 3 of spermatogenesis, when condensation of the spermatid head commences. Histological patterns seen on light microscopy confirmed the reduced utilization of glycogen at stage 3 of spermatogenesis. Electron microscopy revealed an arrest at stage 3 of spermiogenesis and, at the cytoplasm level of the Sertoli cell, a modification in the smooth endoplasmic reticulum characterized by the presence of dilated cisternae. From a morphological viewpoint, the equivalent of a biochemical modification which characterizes this maturation disorder in the germinal epithelium is hypothesized.


Fine structure of human sperm chromatin.

The fine structure of human sperm chromatin is revealed by electron microscopy. Human sperm chromatin is characterized by fibers composed of discrete spherical organizational units not unlike somatic nucleosomes. During the decondensation process fibers composed of joined spherical units of both 400-A and 150-A diameters were observed.


Effects of ions and K+:Na+ ratio on motility and oxygen consumption of human spermatozoa.

Variations in the osmolarity of the medium altered motility, velocity, and oxygen consumption of human spermatozoa. Variations in the K+:Na+ ratio also altered their motility and velocity. These alterations, which reflect both the composition of the medium and individual characteristics of the donor, are discussed in relation to the diversity of milieu through which the sperm are transported.


Inguinal herniorrhaphy and sperm-agglutinating antibodies in infertile men.

In 10 infertile men with sperm-agglutinating antibodies in serum and a history of inguinal herniorrhaphy the site of the previous operation was explored. Five of the men had an occlusion of the vas deferens and in three others spermatoceles were noted in the epididymis. The occlusion of the vas deferens was in the area of the previous herniorrhaphy. Infertility caused by the development of sperm antibodies may occasionally be a long-term consequence of inguinal herniorrhaphy.


Effect of Freund's complete adjuvant on the immune response of vasectomized rats.

Rats were vasectomized, vasectomized and injected in the epididymis with Freund's complete adjuvant (FCA), or only injected with FCA without vasectomy. All were positive for sperm agglutinins, in contrast to sham-operated or untreated controls. Generally, the highest titers were found in vasectomized or unoperated animals given FCA, indicating that local granuloma formation promotes the production of sperm autoantibody, even in nonvasectomized rats.


Morphology of spermatogenic arrest in man.

Spermatogenic arrest in man was studied by transillumination, phase contrast microscopy, and conventional histology. The spermatogenic arrest occurred at the late pachytene stage, and the degeneration of the germ cells could be studied more accurately with phase contrast microscopy of living cells than with conventional histology. The Sertoli cells rapidly phagocytosed the degenerating cells, which could be seen on transillumination as dark spots along the whole length of the tubule.


Histological lesions in the testis of infertile men with varicocele.

Varicocele frequently causes male infertility and histological lesions at the contralateral testis. The most frequent lesions found in this study included maturation arrest in the spermatidic phase, cellular and acellular thickening of the tubular wall, and degeneration of the Leydig cells. These lesions were typical of varicocele and their simultaneous presence suggests that scrotal temperature and modified endocrine secretion of the interstitial testis play a role in the pathogenesis of this type of infertility.


1-(2,4-dichlorobenzyl)-1H-indazole-3-carboxylic acid (DICA), an exfoliative antispermatogenic agent in the rat.

The oral administration of 50 mg DICA/kg at nine weekly or four monthly intervals produced partially reversible infertility in male rats as judged by the results of serial mating and testicular histology. Oral 500 mg DICA/kg doses administered at the same intervals produced permanent sterility. Single oral doses of 50 or 500 mg DICA/kg elevated mean FSH concentrations on days 2, 3, and 7 but did not affect LH or testosterone. Mean plasma concentration peaked at 74 micrograms/ml 4 hr after a 50 mg/kg dose of uniformly tritiated DICA; 24 hr later, it had declined rapidly to 5.5 micrograms/ml. The drug did not have a strong affinity for any tissue studied including the testis. DICA-induced exfoliation of immature germ cells was first observed 4 hr after administration and led to significantly reduced testis weights by day 2. Neither single doses of 10--250 mg DICA/kg nor five daily doses of 10--100 mg DICA/kg reduced seminal vesicle, ventral prostate, or body weights of male rats. Chronic weekly DICA administration did reduce mean seminal vesicle weight. These studies have shown that DICA is an effective, partially reversible antifertility agent that directly affects the rat testis.


Effect of castor oil and benzyl benzoate used as a vehicle for antiandrogens on the adrenal cortex.

The use of benzyl benzoate as a vehicle constituent in administering cyproterone acetate caused morphological changes detectable at the ultrastructural level in the adrenal cortex. Xastor oil and benzyl benzoate in a 4:1 ratio caused intracellular as well as intercellular changes. In the zona fasciculata there were alterations in mitochondrial shape, size, and matrix. Intercellular changes affected the morphology of macrophages in the zona fasciculata and zona reticularis. It is believed that the castor oil and benzyl benzoate vehicle caused stress-induced changes.


Effect of 2,6-cis-diphenylhexamethylcyclotetrasiloxane on the reproductive organs of male mice.

Mice treated with tetrasiloxane, 20 and 40 mg/kg/day, showed lesions in the reproductive organs, cytological changes in the pituitary glands, and changes in levels of cholesterol, phosphomonoesterases, transaminases, 5'-nucleotidase, lactic and isocitric dehydrogenases, and ATPase.


[Postnatal phagocytic maturation (author's transl)].

Seventy two children were studied including 12 prematures, 31 newborns, 25 infants and 4 preschool children. They were clinically healthy with exception of prematurity factor. The phagocytic index (PI) of their polymorphonuclear leukocytes was investigated against latex particles suspended in autologous serum. In prematures PI levels were from 5.55 to 11.05; in newborns and infants, 11.09 to 15.00; in preschool children, 15.08 to 21.97 and in normal adults 19.21 to 22.70. PI value showed marked increase after the first neonatal month or when children reached a body weight of over 4.250 Kg.


[The presence of a red arch in the nail bed of a reimplanted hand and its prognostic value].

This is preliminary report describing a new clinical sign observed by the author in three cases of severed hands, and in several cases, following re-implantation within eight-hours after the accident. This sign has a useful prognostic value, based on its uniform and constant characteristics, in the evolution of re-implanted hands after severe trauma.


On the fibers of the III, IV and VI cranial nerves of the cat.

The fiber content and diameter spectra of the cranial nerves III, IV and VI were analysed in cat. A semi-automatic technique of measuring fiber diameters is presented and compared to the manual method. The number of fibres was counted in the proximal part of the three main nerves and in each of their distal branches before they enter the EOM. Compared to the muscle weight, the branch to the RB had fewer fibers than all the other muscle branches. The diameter spectra of the proximal part of the three main nerves were compared with the diameter spectra of each of their distal branches. Minor differences were found among them. Only the RB had a striking difference in the spectrum which was skewed toward the large diameters.


[Digestive complications of surgery for aortic coarctation].

The complications of surgery for coarctation have been studied by examining the case notes of 284 survivors. 37 (12%) of them had intestinal complications and 15 other complications. The predisposing factors are the treatment of the abdominal complications are analysed.


[The thyroid gland of the newborn infant and postnatal iodine overload].

Severe iodine-induced hypothyroidism was recently diagnosed in several neonates raising the responsibility of the iodine antiseptic agents routinely used in these patients. Postnatal iodine overload due to cutaneous application of these agents (povidone iodine and fluorescinated alcoholic-iodine solution) was studied in 5 patients. Thyroid function studies were performed in iodine-overload neonates and in control neonates with comparable gestional age. Results indicated strong evidence of cutaneous absorption of iodine from the antiseptic agents used, leading to hypothyroidism in 12 of them. The frequency and the severity of thyroid dysfunction was closely related to the degree of prematurity. Full recovery was observed in all cases after withdrawal of the iodine-containing agents. It is therefore recommended to avoid any postnatal use of iodine preparations in neonates, mainly in preterm infants, and to use iodine antiseptic agents with great caution, when necessary during the neonatal period.


[The relative contribution of the upper and lower segments to growth in boys].

In a longitudinal growth study of 64 boys, the contribution of the upper and lower segments was analysed. The results are compared to an earlier study in girls, and the difference between the sexes was related to the puberty growth spurt. This is later, more prolonged and of greater amplitude in the boys. Lower segment growth contributed to the spurt in 25% of the boys.


[The cerebro-oculo-facio-skeletal syndrome].

A further case of the cerebro-oculo-facio skeletal syndrome is described. The child, the first of healthy parents with no significant family history, died on the 4th day of life because of renal failure and respiratory difficulties. The dysmorphic features were microcephaly, microphthalmia, high nasal bridge, lax skin with a prominent skin fold extending below the eyes, large upper lip, fixed flexion deformities of the limbs, short fingers with campodactyly, talus valgus and longitudinal plantar groove. At autopsy there was renal agenesis, a hypoplastic bladder, bilateral cataract with atrophy of the iris and retina. The relationship between Potter's syndrome and other oculo renal syndromes are discussed. The diagnosis is important because this syndrome is inherited as an autosomal recessive.


[Hypothyroidism caused by isolated TSH deficiency].

Hypothyroidism secondary to isolated thyrotropin (TSH) deficiency was confirmed by low TSH levels during TRF test. Other anterior pituitary hormones were normal. Replacement therapy with thyroxine improved the child's growth but not the intellectual ability. The diagnostic difficulties and the importance of early treatment are emphasised.


[Eosinophilic gastroenteritis in 2 child].

A boy aged 12 years is described who had eosinophilic gastroenteritis, a rare condition in childhood and one that is difficult to diagnose. Eosinophilia in the peripheral blood is a useful diagnostic clue. Although the histological appearances suggest an allergic process, the aetiology is unknown.


[Subacute symmetrical osteomyelitis].

An 11 year old girl who developed subacute osteomyelitis in both distal tibial metaphyses is reported. The diagnosis was difficult and the importance of a bone biopsy in the absence of positive findings is emphasised. Recovery followed prolonged antibiotic therapy. This case is compared with seven similar cases in the literature.


[Urinary tract infections and renal growth after antireflux operations in children].

An assessment has been made of renal growth and of the incidence of recurrent urinary tract infection in 116 children who had bilateral re-implantation of the ureters. Although reflux was prevented, 28% of the children continued to have infections long after the operation. The infections were mostly of the lower urinary tract whereas before the operation there was a significant incidence of acute pyelonephritis. After operation 82% of the kidneys grew normally and in 4,5% growth rate increased which is a smaller proportion than that reported in other series. In contrast 13,5% of the kidneys grew more slowly but they were usually abnormal radiologically before the operation.


[Visual behavior of the premature infant].

Ocular reflexes were studied at birth in neonates of varying gestational ages and then followed every two weeks. It is possible to distinguish reflexes that may be present at birth that are dependent on gestational age and those acquired later. Each reflex corresponds to the establishment of neuronal corrections and thus it is possible to follow the development of neural structures in utero and after birth. Ocular examination of the newborn completes the examination of the central nervous system and a scale of visual age is proposed. The repeated examination of premature infants showed the development of visual function was accelerated.


[Glutaric aciduria. 1 new case].

A 4 year old girl with mild mental retardation presented with convulsions, coma and hepatomegaly. She died rapidly. The main biochemical findings were hypoglycaemia, metabolic acidosis, generalised aminoaciduria, elevation of the plasma and urine alpha-amino adipic acid, massive urine excretion of glutaric and glutaconic acids with traces of alpha-hydroxyglutaric acid. The diagnosis of glutaric aciduria was confirmed by the low activity of glutaryl CoA dehydrogenase in liver tissue. This diagnosis should be considered in children with progressive neurological disorders (dystonia, choreoathetosis) and in children with an illness similar to Reye's syndrome.


[Anhidrosis. Presentation of an unusual case report].

A one month old girl with sudden attacks of fever and dehydration was found to have anhydrosis. Histologically the sweat glands were normal but the electrical resistance of the skin showed there was an abnormality of sweating. The cause of the disorder is unknown but could be due to a defect in the secretion of acetyl choline by the post ganglionic sympathetic nerves or due to a receptor defect in the sweat gland. This new syndrome should be considered in all infants with a high fever of unknown origin.


[Placental chorioangioma, skin angiomas and neonatal cholestasis].

A neonate with a large chorioangioma, multiple skin angiomata and prolonged cholestasis is described. Hepatic angiomata are thought to be responsible for the cholestasis but in some reported cases the jaundice could have been due to extrahepatic biliary obstruction caused by angiomata.


[Oculocraniosomatic neuromuscular disease].

A child with a myopathy that started in the pelvic girdle, non-obstructive cardiomyopathy and retinitis pigmentosa is described. There was a progressive neurological deterioration with external ophthalmoplegia and ptosis. The clinical course could be predicted from the appearance of the muscle biopsy.


[Congenital carotid to jugular aneurysm].

A congenital carotid--jugular aneurysm was responsible for severe heart failure in a two day old baby. The child recovered after surgery. The signs suggesting an arteriovenous fistula (a continuous murmur and thrill, hyperdynamic circulation) may be absent, as in this case, when the child is in severe cardiac failure. The signs should be sought when the circulation improves.


[Acanthosis nigricans, hirsutism and insulin-resistant diabetes].

Three girls, two of them being monozygotic twins, are affected with acanthosis nigricans and hirsutism, which worsened at the time of their puberty. The first one has primary amenorrhea and the twins complain of spaniomenorrhea. Furthermore, laboratory data concluded to diabetes, hyperinsulinism and resistance to insulin. This rare association of syndromes is not accidental but its significance remains unknown.


[The pediatric team in the presence of physical cruelty to and severe affective deprivation of children].

From a study of 50 cases the authors suggest a more suitable approach for paediatricians to the problems of battered babies and children with severe emotional deprivation. A multidisciplinary team is recommended in which everyone is involved and not just specialised personel. The study shows the frequency of emotional deprivation of children in care and the possibility offered by adoption. Local psychiatric support is often needed for parents who do not ask for help. The need to make long term arrangements during hospital admission requires an interdisciplinary team with close links between the paediatric team and other child welfare services.


Long-term outcome of major psychoses. I. Schizophrenia and affective disorders compared with psychiatrically symptom-free surgical conditions.

We conducted a 30- to 40-year field follow-up of 685 patients with schizophrenia, affective disorders, and nonpsychiatric conditions. Long-term outcome was analyzed in terms of the patients' marital, residential, occupational, and psychiatric status. On the whole, psychiatric patients showed a significantly poorer outcome than the surgical controls. On the basis of long-term outcome, schizophrenia, and affective disorders, selected according to the specified research criteria, were significantly different: schizophrenia definitely showed poorer outcome than affective disorders. However, no significant differences in all four outcome variables were found between mania and depression. We hope that the present data on long-term outcome of the typical cases can be used to compare outcome of other psychiatric disorders, such as undiagnosed psychoses, having mixtures of schizophrenic and affective features. In doing this, we hope to charify our understanding of undiagnosed psychoses and their relationship to schizophrenia and affective disorders.


Long-term outcome of major psychoses. II. Schizoaffective disorder compared with schizophrenia, affective disorders, and a surgical control group.

Eighty-five patients with both schizophrenic and affective features at the time of admission to the University of Iowa Psychiatric Hospital between 1934 and 1944 were selected for a 30- to 40-year outcome study. Comparison groups were 200 schizophrenic and 325 affective disorder patients, selected by the Feighner et at criteria, and 160 psychiatric symptom-free surgical patients. We assessed marital, residential, occupational, and psychiatric status to evaluate the outcome of these patients at the time of field follow-up. We used multivariate analysis of covariance to analyze the data by taking admission marital and occupational status into consideration. Patients with schizoaffective disorders had a significantly better outcome than those with schizophrenia, but a significantly poorer outcome than those with affective disorders and surgical conditions. Schizoaffective disorder fell somewhere in between the schizophrenia and mania group. Before final conclusions could be made about the nature of schizoaffective disorders, more research should be done.


Schizophrenia: evidence of a subgroup with reversed cerebral asymmetry.

Normal right-handed individuals often show neuroanatomical asymmetries of the brain on computed tomography (CT), with wider right frontal and left occipital lobes. We examined the frequency of reversals of this normal asymmetry in a group of 57 right-handed, the schizophrenic patients. Compared to 80 normal right-handeders, the schizophrenics had an increased frequency of both frontal and occipital reversals. We then divided the patients on the basis of whether they had CT evidence suggestive of brain atrophy. Those without evidence of atropy had increased frontal and occipital reversals. Those with evidence of atrophy had no increase in reversals. This suggests that reversals of neuroanatomical asymmetry, and by implication abnormalities of lateralization, are relevant to a subgroup of schizophrenic patients with otherwise normal CT scans.