Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability.

Bleulerian psychiatry has considered thought disorder to be a pathognomonic symptom of schizophrenia. Evaluation of the Bleulerian perspective has been severely handicapped by the lack of any standard and widely agreed-on definition of thought disorder. Consequently, the conceptualization of thought disorder has tended to be quite diverse, and evaluation of thought disorder has tended to be quite unreliable. This report presents a set of definitions of linguistic and cognitive behaviors frequently observed in patients. These definitions derive from clinical experience, use an empirical approach, and avoid making inferences about underlying processes of thought. They attempt to define the broad range of language, thought, and communication behaviors observed in patients and are not limited to those considered characteristic of schizophrenia. The reliability of these definitions has been assessed using both tape-recorded and live interviews with patients, and it has been found to be quite good for most of the terms defined.


Thought, language, and communication disorders. II. Diagnostic significance.

This investigation evaluates the frequency of various subtypes of thought, language, and communication disorders in 113 patients with diagnoses of mania, depression, and schizophrenia. It indicates that some types of thought disorder considered important occur so infrequently as to be of little diagnostic value, such as neologisms or blocking. The traditional concept of thought disorder, which emphasizes associative loosening, is also of little value, since associative loosening occurs frequently in mania as well as in schizophrenia. This investigation demonstrates that associative loosening can no longer be considered pathognomonic of schizophrenia. On the other hand, an approach that defines various subtypes of thought disorder and uses a concept of negative-vs-positive thought disorder does often permit a distinction between mania and schizophrenia. It is recommended that the practice of referring globally to "thought disorder," as if it were homogeneous, be avoided in the future and instead that the specific subtypes occurring in particular patients be noted in both clinical practice and research.


Verbal behavior and schizophrenia. The semantic dimension.

Through the use of computer analysis, the content of the speech of schizophrenics is shown to be distinct from that of the speech of nonschizophrenic psychiatric patients. The data shed light on qualities that delineate some aspects of "bizarreness" in speech of schizophrenics, provide some insight into the diversity of postulated "defects" in schizophrenic thinking, and provide further understanding of the diagnostic process in schizophrenia.


Differential EEG patterns in affective disorder and schizophrenia.

We analyzed the EEGs of 27 schizophrenic patients and 132 patients with affective disorder who received diagnoses according to rigorous research criteria. The proportion of abnormal EEGs was twice as great among schizophrenics as among affectives, and when the groups were compared for localized cortical differences, schizophrenics had more temporal abnormalities and affectives more parieto/occipital abnormalities. There was also a trend toward different hemispheric lateralization for the two groups, with a reversal of the relative proportions of left- and right-sided abnormalities. These differences were unrelated to age, sex, severity of illness, or past or present drug administration. These findings are complementary to those of other workers, lend support to the validity of our diagnostic research criteria, and provide additional evidence for neurophysiological differences between schizophrenics and patients with affective disorder.


Serum calcium and magnesium levels in schizophrenia. II. Possible relationship to extrapyramidal symptoms.

The relationship between serum calcium and magnesium levels and neuroleptic-induced extrapyramidal symptoms (EPS) was studied in schizophrenic patients. The 16 patients in whom EPS developed had a significantly lower mean drug-free calcium level than the six patients in whom EPS did not develop. In patients in whom EPS developed, drug-free serum calcium and magnesium levels together correlated significantly with the neuroleptic dosage at which EPS first developed; lower calcium and magnesium values predicted EPS at lower dosages. We have previously shown that both serum calcium and magnesium levels were significantly lower during neuroleptic treatment than in the drug-free state. In this study, a similar trend was observed, but the calcium value tended to be, and the magnesium value was significantly lower at the onset of neuroleptic-induced EPS than during the mean of an entire pimozide trial.


[Studies on biological characterization of mammary tumours of the Sprague-Dawley-rat in the syngeneic tumour-host system. III. Metastatic experiments with primary tumours, transplantation passages and metastatic cells (author's transl)].

The metastatic spread following intravenous application of cells from primary and transplanted mammary carcinomas is described. When using cells from primary tumours the incidence rate was between 0 and 17%, but was much higher in the case of advanced tumours (transplantation passages and metastases).


[Antineoplastic effects of violamycins depending on the number of sugar-components in the molecule (author's transl)].

Violamycin B, an antibiotic-complex, inhibited the growth of Sarcoma 180 in a well defined manner. The products Violamycin A, BII, and BI obtained by gelfiltration, were tested against the lymphoid Leukemia L1210. The results showed an increase of the toxicity and, simultaneously, a decrease of the antineoplastic effect, depending on the number of the sugar-components.


The kinetics of cell proliferation in neuroblastomas.

The proliferation kinetics of 11histologically undifferentiated neuroblastomas were studied with an autoradiographic in vitro method (labelling with 3H-thymidine and double labelling with 3H- and 14C-thymidine). The cytokinetic parameters revealed a marked individual pattern: LI between 3.0 and 27.8%, Ts 7.2 to 17.8 hr, Tc 13.1 to 266.3 hr, Tm 0.6 to 5.1 hr, T(G1 + G2) 4.3 to 247.6 hr. The potential tumour doubling time (without cell loss) ranges from 20.4 to 415.4 hr. The growth fraction is between 0.48 and 0.58. Cytokinetic investigations of human tumours are extraordinarily important. They cannot only characterize the growth behaviour of malignant tumours, but also provide the basis for an individual therapy. The close correlation between proliferation kinetics and tumour therapy are discussed. These relations may also be summarized in a "cytokinetic therapy index", which allows the general prediction of chemosensitivity. This index is in the field of good or sufficient sensitivity in 9 neuroblastomas; in 2 cases the response to cytostatic agents is questionable from the view-point of cytokinetics.


[Induction of tumors in Wistar-rats after oral application of aminopyrine and nitrite (author's transl)].

In a long-term experiment the induction of tumors in rats after oral application of aminopyrine and nitrite by gastric intubation was investigated. The animals treated with aminopyrine and nitrite (test-group) had an incidence of different types of liver tumors of 96% in females and 97% in males. The percentage of liver tumors was increased significantly in the test-group in comparison to all control-groups. Besides the tumors of the liver other types of tumors were stated to a minor degree, but there was no difference between the test-group and the control-groups.


[Incidence and prognosis of metastases in colonic and rectal carcinomas].

In colorectal carcinoma at the time of primary operation a much higher rate of occult micrometastases in the liver is to take in account as it is evident by the frequency of intraoperative found metastases (10--20%. Micrometastases likely can to need 3 to 8 years till they have increased so that the finally stage of generalization is to state. The survival rate of patients with colorectal carcinoma and hepatic metastases -- without therapy of metastases -- is 6 to 8 months and not differs from the survival rate of these patients whose primary tumor was inoperable by local reason. The today usual diagnostic procedures in the postoperative follow up control are able to detect liver metastases in most cases only in an inopportune stage for therapy. Probably the analysis of carcinoembryonic antigen is a progress in this question. The unique chance to block up or eliminate the frequently suspected micrometastases seems to be the general use of a post-operative adjuvant chemotherapy.


[Immune profil in melanoma patients. III. Behavior of immunglobulins (IgG, IgA, IgM) and of whole complement in serum at the beginning and during BCG-therapy (author's transl)].

The levels of immunoglobulins (IgG, IgA and IgM) and of whole complement were measured in blood serum of 41 patients with malignant melanoma of clinical stage I to III after maximum tumour resection. In all three stages no differences to the normal could be obtained except for IgG demonstrating a rising tendency without statistic significance in patients of stage III. The level of whole complement was likewise normal in patients with the clinical stage I and II. A significant rise of the complement was observed in patients with clinical stage III in the last period of the disease. After one year of nonspecific active immunotherapy with BCG in patients of stages I and II no changes of immunoglobulins could be found. The whole complement showed a rising trend to the upper limit of the normal. The results were discussed in view of the present literature.


[Experiences with an enzyme cytochemical test for tumor cells in pleural fluid and ascites (author's transl)].

Experiences with a prescreening test for tumor cells in cytological material (pleural effusions, ascites) are reported. With the aid of alkaline phosphatase positive reacting tumor cells in smears (pleural fluid, ascites) are easily detectable. This test gives a positive result in 65% of patients with different organ tumors whereas with routine cytology tumor cells were found in 72% of this patients. Among different organ tumors highest percentage of positive phosphatase tests are found by bronchial, gastric and ovarial carcinomas (3/4 of cases), to a less degree bycarcinoma of the breast and others (1/2 of cases). All together phosphatase test is positive in 90% of all effusions, containing cytologically diagnosed tumor cells. The adventages, disadventages and the usefullness of this method as a prescreening test are discussed.


[Inhibition of concanavalin A and phytohemagglutinine P mediated agglutination of L 1210 cells by different azomethines and possible relations to their cytostatic activity (author's transl)].

Compounds of a special azomethine type have been tested on their activity against concanavalin A and phytohemagglutinine P mediated agglutination of leukemia L 1210 cells. With exception of two compounds possessing a bis-(beta-hydroxyethyl) amino group at the phenyl moiety in para-position to the azomethine group all substances considerable inhibited agglutination of L 1210 cells. In vitro active concentrations are also obtained in animal experiments at least for a short time at the site of injection (i.p.) The importance of cellular reactions for effectivity in vivo is discussed.


[The importance of nucleolar morphology for the diagnostic cytology of malignomas of the thyroid (author's transl)].

The evaluation of the nuclear morphology for the diagnostic cytology of the various types of goiters with special regard to thyroid malignancy was studied. The material for the light microscopy was obtained from the goiters by means of aspiration biopsy with thin needle and that for electrone microscopy from the excision at the operation. Both the patterns of the nucleoli were compared. The nucleolus of the thyroid cell, like in other cells, is a marker of the RNA synthetic activity. Secondary it signals the intensity of the proteosynthetic activity, that means of secretory or proliferative processes. In thyroid cells, the increased activity has a different nucleolar pattern. For that reason the study of the nucleoli is very useful in differential diagnosis of thyroid malignancy. The cytochemical examination of the nucleoli by means of toluidine blue staining is in accord with the electron microscopic pattern, where the mutual relation of the fibrillar and granular components of RNA can be evaluated.


[The therapeutic situation at the colorectal carcinoma (author's transl)].

With a period of 8--10 months between the beginning of troubles at the patient and the reception in hospital for treatment (= duration of anamnesis) the colorectal carcinoma patients come only still in 25--40% in the stages I and II to the therapy which then can be radical and curative. 20--30% of the patients at the time of diagnosis respectively at the start of therapy already are in stage IV with a 5-year-survival rate between 0 and 1%. An improvement of results is to expect from an earlier diagnosis, development of general arrangements for the decreasing of operative risk, improvement of anastomosis, postoperative adjuvant therapy, and an individual treatment scheduling.


[Neutron therapy in the GDR. IX. About the accuracy of neutron dosimeter systems (author's transl)].

In this report is specified which accuracies must now be achieved in the determination of dose components for neutron therapy of tumors and for evaluation of RBE's after neutron irradiations of various organs from mammals or men. After these introductory remarks the reasons are summarized why the errors in ionimetric measurements of neutron doses are considerably higher than those of gamma-doses. In detail the concept and the errors of the Rossendorf neutron dosimeter system are represented. The latter consists of two spherical homogeneous ionization chambers, each of which is connected to a commercial dosimeter. The results of an intercomparison between our neutron dosimeter and that of DR. Bewley (MRC Cyclotron Unit, Hammersmith Hospital London) carried out at the Rossendorf neutron therapy facility are reported.


Short term bonding behaviour of bioglass coatings on metal substrate.

Bioglass specimens were implanted in 11 dogs for periods ranging between two and twelve weeks in order to study the short term bonding behaviour of bioglass coated on metal. Metal fibre porous coated specimens without bone growth inducive microlayer were implanted as controls. The conclusions reached pertain to the validity of push out test results, bioglass short term bonding and the effect of the dipping procedure to coat bioglass on metal: 1. It is impossible to compare the bonding effectiveness of bonding materials tested under slightly differing circumstances, and a fortiori at different laboratories, 2. there is no sufficient evidence to establish a difference in bone bonding strength with regard to trabecular bone of bioglass and metal fibre porous coated specimens at 2 and 4 weeks; at 12 weeks, however, a higher interfacial failure shear strength is obtained with the control porous specimens, 3. bone bonding may be hampered by compositional differences arising as a result of the processing of a bioglass on metal coating. Technologically it is, however, possible to exclude this problem.


Loosening of a total hip prosthesis at contact allergy due to benzoyl peroxide.

It is reported that a 62-year-old man with total hip prosthesis developed a recurrent sterile fistula and loosening of his prosthesis due to allergy to the bone cement component benzoyl peroxide.


Experimental fixation of bone cement and composite resins to bone.

The aim of this study was to ascertain whether the use of liquid acrylic resin or NeoCryl XK-53 acrylic emulsion or etching of the bone surface with phosphoric acid or the application of both these methods would improve the bonding of CMW bone cement or Concise and Silar composite resin to bone. The test materials were applied to fresh cortical bovine bone. Their bonding capacity was measured by the Instron Universal Testing Machine. The surfaces of the test materials and the bone surfaces were examined by means of optic microscope or scanning electron microscope. The bonding strength of the bone cement and composite resins as such were found to be of the same magnitude. A three- to five-fold improvement was obtained with liquid acrylic intermediary material. Acid etching impaired the bonding.


The constant relationship between forefoot and hindfoot as a basis for treating foot deformities.

In correcting foot deformities the author observed a constant relationship between the forefoot and the hindfoot. If the forefoot is adducted, the heel automatically goes into the varus position. On the other hand, abduction of the forefoot will result in a valgus position of the heel. This rule was investigared and validified by experiments on cadavers: it was shown that the position of the hindfoot is automatically normalized by the correction of the forefoot. Our observations have been confirmed by treating foot deformities in children and adults. Therefore we believe that surgery of the talo-calcaneal joint in cases of foot deformity is unnecessary.


Benign osteoblastoma of the fibula. Case report.

Report on a case of a patient, white, eleven years old, girl and brasilian, who came to the Service complaining of pain in both legs, at the level of the knee joint in a period of two years time. After an accurate orthopaedic examen the focal place was detected at the level of the proximal end of the fibula. The radiogram confirmed the existence of an osteolitic lesion in the superior end of the fibula, right side, in a cortical position and surrounded by a sclerotic area. The surgical removal was performed and the pathological examens confirmed to be a benign osteoblastoma. The postoperative evolution was normal and uneventfull. The radiograms demonstrate that in a three years period the healing of the bone was normal and total. No graft used and the periostal activity was the main source of bone formation.


Epithelioma cuniculatum developing in a neuropathic ulcer of leprous etiology.

Epithelioma cuniculatum is a distinctive tumor of the sole of the foot with characteristics of a low-grade carcinoma. A case is presented, the pertinent literature reviewed and its possibly frequent development in leprous patients discussed.


Independent living: from social movement to analytic paradigm.

Independent Living (IL) is more than a social movement; it is also an analytic paradigm that is re shaping the thinking of rehabilitation professionals and researchers alike. The IL paradigm is contrasted with the rehabilitation paradigm that has dominated disability policy, practice, and research. This article analyzes how the shift from the rehabilitation to the IL paradigm is likely to affect the future of disability research. To gain an appreciation for the IL paradigm, the article first evaluates independent living as a social movement in terms of the movement's constituency, origins, and its relationship to other social movements.


Federal legislative history of independent living programs.

In some respects, passage by the US Congress of the 1978 Amendments to the Rehabilitation Act (PL95-602) marked the beginning of federal involvement in the independent-living movement. For the 1st time a program was created whose primary goal is to help disabled persons to live independently; previous programs have been designed to help such persons become employable. This paper briefly examines the roots of PL95-602 and identifies how this new law represents a major new direction in the rehabilitation movement. The purposes and goals of the advocates of independent living have changed in the past decade and the new law reflects those changes.


Independent living programs: the role of the able-bodied professional.

The Independent Living Program movement was created by the disabled community. It has established a broad coalition of diverse disabilities functioning to provide services on a broader scale than has been traditionally offered by the rehabilitation community. The effectiveness and the strength of the movement lies in consumer control. The able-bodied professional can provide expertise, balance and a vital link with established rehabilitation programs. The integrity of the independent living program movement can only be maintained and developed if these basic concepts are respected.


International efforts in independent living.

Several nations currently share a major concern for provision of services to severely disabled persons. The focus of this concern has been upon those services which promote maximum integration and independence of severely disabled individuals in the community. Recent efforts in this direction by governments, private citizens, and handicapped-consumer organizations in Sweden, The Netherlands, Denmark, England, Canada, and Australia are discussed. Developments in housing and environmental modification, transportation, and self-help training are reviewed for their potential interest to advocates and practitioners of rehabilitation for independent living.


Transportation: a key to independent living.

Accessible transportation is essential if people with disabilities, particularly persons who are severely disabled, are to live independently in the community. The development of transportation services has moved from a focus upon special and separate "dial-a-ride" programs to an emphasis upon making fixed-route, main-stream systems accessible. The current state of the art, supported in large part by federal regulations, features a combination of mainstream accessibility and supplemental special services. Future progress in transportation for disabled people depends largely upon resolution of complex, politically explosive cost-benefit arguments on the federal and local levels, and on community acceptance of disabled persons as people deserving a spectrum of transportation services.


Chronic pain states: their relationship to impairment and disability.

Chronic pain patients (101) were assigned ratings of impairment and disability and were assessed for organic pathology and pain behavior through comprehensive testing procedures. As predicted, higher ratings of impairment and disability were significantly associated with higher levels of both physical pathology and pain behaviors. These results indicate that conditioning and pathologic processes significantly influence impairment and disability ratings. Many patients showed higher disability than impairment ratings, which suggests the possibility of gainful employment in less demanding jobs. However, the current disability system rewards sickness and dysfunction and discourages patients from resuming work.


Rheumatoid arthritis: failure of daily heat therapy to affect its progression.

Seventeen volunteers with symmetrical rheumatoid arthritis (RA) applied heat to 1 hand twice daily for 2 years. Joint swelling, joint tenderness and grip strength were measured at intervals. The proliferative aspect of the disease was assessed by roentgenograms using a scoring system. There was no difference between experimental hand and control hand in any of the factors measured. The patients found the heat soothing and comforting. Thus, daily heat therapy did not accelerate the proliferative lesion in RA and may remain as an adjunct to therapy.


Serial nerve conduction studies in carpal tunnel syndrome secondary to rheumatoid arthritis: preliminary study.

Twenty patients with definite rheumatoid arthritis fulfilling the criteria of the American Rheumatism Association were examined for clinical and electrodiagnostic evidence of carpal tunnel syndrome. Of the 40 wrists studied, 8 (20%) had evidence of carpal tunnel syndrome. All wrists were followed up with serial electrodiagnostic, clinical, and laboratory studies at intervals of 4 months over a period of a year. All patients were seen by a rheumatologist and were put on effective anti-inflammatory drug therapy. At each visit serum drug level and sedimentation rate were estimated. Two of the wrists were splinted. In the 4 affected patients (8 wrists) the drugs were used were aspirin in 3 and gold in 1. All 8 wrists showed a decrease in the abnormally prolonged median sensory latencies. This finding paralleled clinical improvement of rheumatoid disease as shown by symptomatic relief of paresthesia, reduced swelling of joints (including wrists), absence of Tinel sign at the median nerve, and fall of sedimentation rate. The study strongly suggests that serial electrodiagnostic studies should be used as 1 parameter in the follow-up of carpal tunnel syndrome secondary to rheumatoid arthritis. The study also indicates that good anti-inflammatory therapy and splinting can control carpal tunnel syndrome in rheumatoid arthritis. None of the wrists involved needed surgery during the period of study.


Exercise effect on creatine phosphokinase elevation in motor neuron disease.

Creatine phosphokinase (CPK) is usually elevated in inflammatory and degenerative muscle disease but is usually reported as normal in neuropathic diseases. A review of the literature indicates, however, that it is elevated in 50 to 75% of patients who have motor neuron diseases, and that these elevations are usually 5 to 6 times normal. The effect of bedrest and moderate exercise on serial CPK values in a patient with motor neuron disease is assessed. Bedrest for 24 hours decreased his CPK to 0.58 of the baseline value; 5 hours following moderate exercise it increased to 1.71 of the basal value. This phenomenon appears to be a response to exercise stimuli rather than to the disease process itself. CPK values up O 1000 IU/L are compatible with the diagnosis of amyotrophic lateral sclerosis (ALS). In patients whose CPK  values seem atypical, it is best to have them rest 48 hours before repeating the test.


Muscle atrophy in rats following denervation, casting, inflammation, and tenotomy.

One week after unilateral denervation, tenotomy, casting, or joint inflammation, skeletal muscles of adult female Wistar rats were studied to determine the effect of these processes on muscle weights and fiber diameters of the soleus, the red and white regions of the plantaris, plus muscle weights and protein content of the gastrocnemius. All atrophic processes caused greater weight loss of the soleus than of the plantaris or gastrocnemiums. Within the soleus and plantaris muscles, the type-I fiber atrophy was equal to the type-II fiber atrophy except for the white region of the plantaris following tenotomy, where the wasting of the type-I fiber was greater than that of type II. This study also demonstrated that denervation, tenotomy, casting, and inflammation resulted in a greater loss of myofibrillar proteins (content and absolute amounts) than of sarcoplasmic and stromal proteins. Denervation generally was found to have the greatest effect on the parameters evaluated. The findings are consistent with the hypothesis that slow muscle is more dependent than fast muscle on neuronal control, and that nerve controls muscle through the dual role of impulse activity and axoplasmic flow.


Educational and training levels and employment of the spinal cord injured patient.

Questionnaire follow-up data were obtained on a sample of 745 male spinal cord injured veterans. Forty percent reported that they had improved their education subsequent to their disability. Postinjury education was not related to level of injury. Significant relationships between pre- and postinjury marital status and improvement in education were found for those who were single, separated, or divorced. An intact post-injury marriage was associated with improvement in education. Those with a higher educational status and those who improved their education following injury were more likely to have obtained employment following injury.


Family medicine residents in rehabilitation medicine.

In the past 4 years, 26 3rd-year family medicine (FM) residents have rotated through the Monroe Community Hospital Rehabilitation Unit, affiliated with the University of Rochester School of Medicine. These rotations are essentially full-time for 1 or 2 months and involve working side by side with the rehabilitation medicine residents. The intention has been to expose the FM residents to general principles and problems they are likely to encounter when they enter private FM practice. Both residents and faculty have responded enthusiastically. Data gathered on pre- and postrotation attitudes toward rehabilitation medicine indicate favorable attitudes. Comparison showed similarities of interests between physiatrists and FM residents. Given this attitude, similar programs seem appropriate elsewhere.


Diffuse abnormal electromyographic insertional activity: a preliminary report.

The authors observed 10 patients referred for electromyographic examination in whom EMG findings were normal except for the presence of provoked positive sharp waves in essentially every muscle tested. The positive sharp waves were present only following needle electrode insertion. No fibrillation or fasciculation potentials were seen. Motor unit action potentials were normal, as were nerve conduction and repetitive stimulation studies. The quantity of provoked positive sharp waves was found to vary from time to time, from muscle to muscle and from 1 region of the muscle to another. Detailed clinical evaluations for neuromuscular disorders, electrolyte and metabolic abnormalities and underlying carcinomas were negative. Muscle biopsy in 2 patients, including histochemical analysis in one of them, was normal. Results of single-fiber electromyography were normal in 1 patient. The abnormality was found in family members and appears to be of an autosomal dominant inheritance.


Progressive speech deterioration and dysphagia in amyotrophic lateral sclerosis: case report.

Amyotrophic lateral sclerosis (ALS) is a degenerative neurologic disease having both upper and lower motor neuron signs and symptoms. When the speech musculature is involved, a mixed dysarthria and dysphagia usually result. In a 49-year-old man with ALS, dysarthria and dysphagia progressed from mild to severe forms over 17 months. Eleven months after the patient first experienced symptoms, neurologic examination showed fasciculations of the extremities and tongue, limb weakness, and hyperreflexia of the limbs and velopharyngeal mechanism. Tongue strength was one-fourth that of normal. Lingual alternate motions rates for consonant-vowel syllables were also reduced. To enhance lingual strength and swallowing, a tongue-strengthening program was developed for use with articulation training; to augment velopharyngeal function, a palatal lift was fitted; and to increase extremity strength, physical therapy was initiated. Six months after the initial neurologic examination, medical and speech reevaluation showed progressive weakness of the body parts affected initially; continued decline in tongue strength and lingual alternate motion rate; hypoactive reflex activity, indicative of progressive involvement of the lower motor neuron system; and continued deterioration of articulation and phonation owing to the progressive nature of the disease.


Intracranial dissecting aneurysm. Report of a case.

The case of a 47-year-old man who died one month after a history of paroxysmal occipital headaches, vertigo, vomiting, weakness, and sweating is presented. The death was due to a pontine softening caused by a subintimal dissecting aneurysm of the two vertebral, the basilar and the right posterior inferior cerebellar arteries. No etiological factor of the illness could be found. The clinical signs resembled those of a flap-valve tumor of the IIIrd ventricle.


The question of disclosing the diagnosis to terminally ill patients.

The question of disclosing the diagnosis to terminally ill patients was investigated by means of a semi-standardized interview of 56 subjects who had been 'told the truth' about their condition. The effects and interdependence of the factors of age, personality structure (EPI neuroticism scale), duration of knowledge, social contact, and religiousness, on the patient's ability to cope with the information were examined. The process of adjustment was assessed according to the stages proposed by Kübler-Ross (1969). Using the statistical model of path analysis, it was possible to evaluate these individual factors and present linearly their interrelationships. These results can offer medical staff the following guidelines: Three factors (a) advanced years, (b) good social contact, and (c) optimally unneurotic personality structure, provide the optimum conditions for a positive adjustment to the disclosure of a diagnosis of fatal illness. If, however, only one or two of these factors are involved, or if they are evident only to a slight degree, then conditions for telling the truth are less positive. On the other hand, in the case of (a) youth, (b) restricted social contact, and (c) a more markedly neurotic person, particular caution is recommended, since the danger of a negative reaction, and indeed even of suicide, must be reckoned with.


[Interrater reliability of diagnosis, AMP syndromes and AMP symptoms (author's transl)].

Psychic disorders can be classified into three levels: symptom, syndrome, and diagnosis. For each of these levels of reference, interrater reliability has been calculated. For this purpose, 48 patients (25 depressives and 23 schizophrenics) were interviewed by two raters each and the diagnoses were registered on the AMP system (forms 3 and 4). Additionally, each rather made an ICD diagnosis. With ICD numbers of three digits interrater reliability amounted to Kappa = 0.84; with ICD numbers of four digits it amounted to Kappa = 0.65. According to the degree of accuracy, numerical agreement with the AMP syndromes lies between Kappa = 0.61 and 0.85. Single symptoms had the lowest reliability (median: Kappa 0.45 and 0.53). Reasons for these differences and possibilities for improvement are discussed.


High cervical neurinoma (C1/C2) diagnosed falsely as multiple sclerosis because of trigeminal neuralgia.

Remitting paresis of the left leg accompanied by left trigeminal neuralgia led to the diagnosis of multiple sclerosis in a 46-year-old woman. Over the following 6 years, an incomplete syndrome of the spinal cord developed along with bilateral trigeminal pain. Neuroradiological and neurosurgical exploration a neurinoma located ventrolaterally at C1/C2 on the left side. It is emphasized that since trigeminal fibres descend as far as the upper part of the C2 segment, trigeminal neuralgia should not be considered as an exclusively supraspinal symptom.


[Psychophysiology of fire walking. II. Pain perception in pyrovasy (fire walking)].

Our paper is concerned with considerations of pain physiology in pyrovasy and with neuropharmacological effects of the Opiate antagonist Naloxone. These considerations explain the relationship of analgesia and hypersthesia with stress induced behavior and states of consciousness. Apart from psychophysiological aspects we can distinguish from a biochemical and neurophysiological point of view two mechanisms of pain perception in pyrovates: 1. Certain mechanical stimuli brought about by the individual running technique of the pyrovate cause convergence of noxis and non-noxic afferent impulses as well as central inhibition of the effect of noxic stimuli. 2. The long stressful period of preparations induces a temporary surplus of Endorphins elevating the pain threshold.


Visual reaction time as a function of locus, area, and complexity of stimulus.

Reaction time (RT) of normal subjects to square-wave gratings of two different frequencies were related to locus of presentation, area, and stimulus complexity. Each frequency was presented to either side of the horizontal meridian (half size stimulus) or both sides stimultaneously (full size stimulus). The two different frequencies were also flashed simultaneously to both hemifields (compound stimulus). Stimulus position affected RT with the 1 c/deg stimulus, RT being faster for the lower hemifield. With presentation on both sides of the horizontal median simultaneously or of the two spatial frequencies, the resulting RT was equal to that of the faster component. Implications of the results for the functional organization of the visual system are discussed.


[Endocrinological prediction of the responsiveness of depressive patients to lofepramine (author's transl)].

In a pilot study of 15 depressive patients of the neurotic and endogenous type we could show that some neuroendocrinological parameters are apt to predict the thymoleptic efficacy of lofepramine. These parameters, which were measured with a simple global stimulation test (insulin hypoglycaemia combined with injection of TRH and LHRH), were as follows: high basal blood glucose; high hypoglycaemic blood glucose; high decrease of blood glucose in comparison to the basal level; low basal TSH; low increase of HGH and low increase of cortisol after hypoglycemia. A synopsis of these parameters allowed a correct classification of 14 out of 15 patients according to therapy response and therapy resistance.


Cerebral atrophy in Parkinson's disease--represented in CT.

To clarify the importance of brain atrophy in relation to the symptoms of Parkinson's disease, 173 patients were examined by computed tomography (CT). In 51.4% of the CT findings, brain atrophy was considered to be pathological. Statistically significant relations of age and sex were found with regard to the extent and localization of brain atrophy. Cortical atrophy also showed a significant dependence on duration of disease. Linear measurements at the lateral ventricles and the third ventricle lead us to assume that brain atrophy in Parkinson's patients is more prevalent than in normal patients within the scope of age involution.


The course of brain atrophy in Parkinson's disease.

In 110 parkinsonian patients (53 men, 57 woman) aged 38--81 years, computer-tomographic follow-up investigations were done to assess the development of brain atrophy. The control examinations were done after an average of 28 months. At that time an increase in brain atrophic changes of different localization could be observed in 23% of the patients. In addition, it could be demonstrated that the increase in pathologic CT findings is to be observed especially in patients with higher age, a more marked impairment in psycho-organic capacity, more pronounced handicaps in the fine-motorial performances at the beginning of the study. From the neuroradiological point of view, patients with more marked pathologic CT findings upon the first examination, be these ventricular enlargement and/or cortical atrophy, more often showed a progression of brain atrophy.


Effect of vitamin E on human sexual functioning.

To investigate the claim that vitamin E can affect human sexual functioning, 1000-IU vitamin E capsules (alpha-tocopherol) were administered daily for 28 days in a double-blind placebo study. Thirty-five subjects in this pilot study reported daily responses to questionnaires on sexual arousal and behavior. No differences in sexual arousal or behavior were found between the two groups. The one significant difference was that the vitamin E subjects were more likely than the placebo subjects to report either positive or negative nonsexual effects.


Models of female orgasm.

Self-report instruments concerning personality and subjective responses to sexual orgasm were filled out by 281 female university undergraduates. Exploratory and confirmatory factor analyses were used to evaluate the dimensionality of women's subjective responsiveness to orgasm. The results did not support the concept of a unidimensional orgasm process; separate coital and masturbatory factors of orgasmic experience were obtained. Highly internally consistent scales were developed to assess the two factors, and both scales were found to be significantly correlated with indices of extraversion, attitudes toward masturbation, and sexual experience. A path-analytic model was developed which is consistent with the hypothesis that heterosexual and monosexual behaviors act as mediators between extraversion, neuroticism, and attitudes toward masturbation, on the one hand, and subjective coital or masturbatory orgasmic responsiveness, on the other. It appears that attitudes toward masturbation may also have a direct influence on masturbatory responsiveness. Various therapeutic implications of the path model are described. Replications and extensions of the study with older, more experienced populations are necessary.


Intravaginal pressure assessed by the Kegel perineometer.

A first attempt was made to provide norms for intravaginal pressure in normal women measured by the Kegel perineometer. Data obtained from 78 white females and 64 black females indicate that resting pressure approximates 5 mm Hg and pressure with appropriate pelvic musculature contracted reaches an average of 15 mm Hg. The difference between resting and contracted pressures is unrelated to the former. There is a moderate negative correlation between number of vaginal births and contracted pressure in the white sample.


The aging gender dysphoria (transsexual) patient.

Ten aging gender dysphoria patients (eight men and two women, average age 52 years) were the subjects of this study. All had presented to the Gender Identity Clinic at Case Western Reserve University requesting sex-reassignment surgery. A psychiatric-psychological profile of the patients, their sexual functioning, problems with aging, diagnostic issues, and follow-up are discussed. The aging gender dysphoric patient presents in acute crisis, that is, exhibiting marked depression, increased suicidal ideation and behavior, and urgent perception of time. Diagnostic and treatment recommendations for aging gender dysphoria patients and their depressions are provided. Furthermore, guidelines are suggested for differentiating the aging transvestite with transsexual symptoms and the aging transsexual for whom sex-reassignment surgery may be indicated. Specific treatment strategies for an aging population, including sexual surgery, are also discussed.


Noninvasive diagnosis of extracranial carotid arterial disease: a prospective evaluation of pulsed-Doppler imaging and oculoplethysmography.

Two hundred consecutive internal carotid arteries were examined with the Hokanson-pulsed Doppler ultrasonic arteriograph (UA) and the Kartchner-McCrae oculoplethysmograph (OPG). Roentgenographic studies were used to assess the relative accuracy of these two noninvasive tests. Diameter stenoses estimated from the UA and roentgenographic images agreed within +/- 20% in 81% of the studies. The UA detected 61% of all stenoses of 20% to 39% and 89% of all stenoses greater than 40%. A sensitivity of 86% and a specificity of 90% were achieved with the UA compared with a sensitivity of 64% and a specificity of 85% with the OPG. When the UA and OPG agreed (67% of the vessels), the sensitivity was 95% and the specificity was 94%. When they disagreed, the UA was the better test having a sensitivity of 81% compared with 21% with the OPG.


Carotid endarterectomy in the presence of contralateral carotid occlusion: the role of EEG and intraluminal shunting.

Patients undergoing carotid endarterectomy in the presence of occlusion of the contralateral carotid artery appear at greater risk for operative-related stroke or death. We had experience with 37 such patients in a five-year period. Routine intraluminal shunting without EEG monitoring was used in nine patients. Twenty-eight patients had continuous EEG monitoring during surgery. Of this group, 12 patients required intraluminal shunting based on intraoperative EEG criteria. In the early postoperative period, there was one death, and there were no instances of new, fixed neurological deficits. Life table analysis shows that 80% of the patients are neurologically stable in the five-year follow-up period. Electroencephalographic monitoring proved valuable in the detection of patients requiring intraluminal shunting, in the occasional recognition of poorly functioning shunts, and in the determination of the importance of alterations in blood pressure or cardiac rhythm on cerebral blood flow.


Endothelial response to venous injury.

This investigation characterized venous endothelial healing after surgical manipulation. Procedures were performed on jugular and femoral veins in 21 mongrel dogs without systemic anticoagulation. Veins were harvested at varying intervals and vessel structure evaluated with light, transmission, and scanning electron microscopy. Veins that were mobilized or stripped of adventitia demonstrated 25% to 50% endothelial loss at one hour. Endothelial damage was rapidly repaired with complete healing observed in some veins at 48 hours. Tourniquets and clamps resulted in prominent medial and endothelial injury at occlusion sites. Eighteen of 24 transected veins remained patent for the study period. Endothelial healing was unaffected by tension at anastomoses. These observations confirm that venous endothelium receives nutrition by luminal diffusion. The healing process of venous anastomoses is characterized by an early fibrin sleeve sealing the anastomotic site; endothelial bridging of defects can be noticeably delayed by excessive fibrin deposition.


Noninvasive prediction of amputation level in diabetic patients.

Noninvasive laboratory testing was used to predict successful amputation levels in 150 diabetic patients. The cases of 100 patients undergoing forefoot amputation and 50 patients undergoing below-knee amputation were evaluated using segmental systolic pressures and pulse volume recordings (PVRs). The decision for and the level of amputation were based solely on clinical judgment. In patients undergoing forefoot amputation, segmental systolic pressures were falsely high or predicted incorrectly in over half the cases. Segment PVRs were correctly predictive in only half of the cases. In patients undergoing below-knee amputation, segment systolic pressures were falsely high or predicted incorrectly in over one third of cases. Segmental PVRs were correctly predictive in less than one third of the cases. In the diabetic patient, clinical judgment continues to provide the most accurate and reliable information by which the type of amputation and likelihood of its success can be judged.


Aortic and mitral prosthetic valve reoperations: early and late results.

A total of 232 valvular reoperations (123 mitral valve reoperations [RMVR] and 109 aortic valve reoperations [RAVR] were performed in 194 patients with previously implanted prosthetic valves. Early mortality was 10% (12/123) for the RMVR subgroup and 14% (15/109) for the RAVR subgroup (P = NS). Late mortality was 16% (18/111) for the RMVR subgroup and 25% (23/94) for the RAVR subgroup (P = NS). Patients with prosthetic endocarditis or prosthetic stenosis constituted higher-risk subpopulations. Principal determinants of both operative mortality and late attrition were preoperative cardiac functional status and the nature of the pathology mandating valve replacement. Early prosthetic valve replacement is advocated to correct hemodynamic abnormalities before advanced ventricular decompensation ensues, especially when prosthetic valvular endocarditis or prosthetic stenosis exists.


Membrane vs bubble oxygenators: a prospective study of 52 patients.

Controversy continues about the oxygenator preferable for cardiopulmonary bypass (CPB). This prospective study was undertaken in 52 patients undergoing coronary bypass surgery. Oxygenators were alternated each case between model Q-100, Bentley Laboratories Inc, Irvine, Calif, and Travenol Membrane Oxygenator (TMO), Travenol Laboratories Inc, Deerfield, Ill. The Q-100 group required higher CPB O2 flows, but PO2 levels during CPB were similar for both groups. Heparin sodium dosage and activated clotting, bleeding, prothrombin, and partial thromboplastin times were identical in both groups. Blood loss and platelet reduction after CPB were also similar. Postoperative complications in the Q-100 group included one myocardial infarction, and one neurological problem. The TMO group had no myocardial infarction and one neurological problem. The membrane oxygenator took nine minutes longer to set up and was $63 more expensive to purchase. Blood trauma during CPB was less with the membrane oxygenator (lower plasma hemoglobin level), but we conclude that both oxygenators performing adequately during clinical use in open heart surgery.


Surgical principles and polytetrafluoroethylene.

This report describes a 24-month follow-up in 100 consecutive polytetrafluoroethylene (PTFE) arterial grafts. Although initial results were superb, a continued follow-up has showed extremely high closure rates for femoropopliteal and femorotibial grafts. The primary reason for this high attrition rate is thought to be stasis. We believe that PTFE is clearly the best synthetic arterial replacement available, but the material does not approach the autogenous saphenous vein in terms of long-term patency. Therefore, in spite of its many advantages, we do not recommend the elective use of PTFE for peripheral small-vessel bypass.


Significance of popliteal reflux in relation to ambulatory venous pressure and ulceration.

Fifty-one patients (55 limbs) who had had deep venous thrombosis (DVT) extending into the femoral or iliofemoral segment three to five years earlier and ten limbs of ten healthy volunteers were studied. The ambulatory venous pressure (AVP) was measured by inserting a needle in a vein on the foot; the presence of reflux in the popliteal vein was determined by a directional Doppler ultrasonic blood velocity detector. All patients had ascending venography. The results suggest that the most important factor in determining the AVP and ulceration in postthrombotic limbs is the condition of the popliteal valves. Ulceration does not occur even in the presence of occlusion if the popliteal valves are competent. The extent of DVT and recanalization or the failure of recanalization is of secondary importance.


Reconstructive venous surgery.

Experience with 60 reconstructions of large peripheral veins is summarized. No deaths occurred and complications were minimal. Most patients had excellent or good results.


Venous angiography of subcutaneous hemodialysis fistulas.

Venous angiography was performed on 256 subcutaneous arteriovenous dialysis fistulas. The technique involves temporary arterial inflow occlusion, needle injection of contrast material into the venous segment, and rapid sequence roentgenograms as arterial flow is restored. It requires no fluoroscopy or catheterization, avoids trauma to either the brachial or axillary arteries, and can be performed on an outpatient basis. Indications for fistulography included technical complications during dialysis, high-output cardiac failure, aneurysms, sepsis, and other reasons. Studies demonstrated significant stenosis or occlusion, insignificant stenosis, malpositioned needles, excessive fistula flow, aneurysms, thrombus formation, maturation failure, and other and normal findings. Only one study caused fistula thrombosis. Ninety-one percent of the studies provided information useful in the overall clinical management of the patients.


Thoracic aortic imaging without angiography.

Imaging of the thoracic aorta without recourse to angiography has great theoretic appeal. We have used computerized tomography (CT) in the initial evaluation of 297 patients with suspected mediastinal disease. Nineteen of this group had important findings related to the thoracic aorta: aortic dissection (six), descending thoracic aortic aneurysm (nine), suspected aortic trauma (three), and suspected false aneurysm at a coarctation repair (one). In all cases, the aorta and related pathology were readily demonstrated by CT, aided by the intravenous infusion of contrast material. In 13 of 15 cases, aortic dissection and aortic aneurysm could be accurately diagnosed. In two instances of ascending aortic dissection, it was not possible to distinguish the false lumen from mural thrombus in an atherosclerotic aneurysm.


Routine coronary angiography prior to elective aortic reconstruction: results of selective myocardial revascularization in patients with peripheral vascular disease.

Routine coronary angiography to determine the prevalence of severe coronary artery disease (CAD) has been recommended to all patients under consideration for elective peripheral vascular reconstruction at the Cleveland (Ohio) Clinic since April 1978. Those found to have severe, correctable CAD have been advised to undergo myocardial revascularization prior to performance of elective peripheral vascular operations. Forty-one of the 68 patients with abdominal aortic aneurysms (AAA) and 26 of the 71 patients with aortoiliac occlusive arterial disease (AI) had clinical evidence of CAD; coronary angiography demonstrated severe, correctable CAD in 23 patients with AAA and in 14 patients with AI. Twenty-seven patients with AAA and 45 patients with AI had no clinical evidence of CAD; severe, correctable CAD was found in six patients with AAA and in six patients with AI. Ninety-six patients, including 26 who had staged cardiac procedures performed, have had elective aortic reconstruction, with one operative death.


[Protein digestibility and absorption of amino acids in various segments of the digestive tract of pigs. 2. Protein and amino acid balances at the end of the small intestine and of the whole digestive tract (apparent and true protein and amino acid digestibility)].

Growing pigs with ileum and ileocecal re-entrant canulae were given 5 different rations (pig fattening feed 1 and 2, rations with dried skim milk, wheat gluten + lysine and wheat + wheat gluten + lysine). The crude protein and amino acid excretion was quantitatively determined with ileum chyme and feces. The calculation of the amino acid balances (apparent and true digestibility) at the end of the small intestine, at the end of the wholedigestive tract and the isolated colon showed characteristic differences for the individual amino acids. On ileum level the amino acids with relatively high endogenous quotas, threonine, tryptophane, alanine, aspartic acid and glycine showed a distinctly lower, the amino acids arginine, methionine, phenylalanine, glutamic acid, proline and tyrosine a distinctly higher digestibilityhan crude protein. In comparison of the values on the feces level, including the true digestibility, these differences are largely balanced out. At the end of the small intestine the absorption of the amino acids is in the main completed. The disappearance rate of amino acids from the colon shows large differences with reference to the different rations as well as the individual amino acids. They were particularly high for various rations as far as proline, tryptophane, glycine and cystine are concerned. If wheat gluten + lysine rations were given, a net synthesis of methionine in the colon could be proved.


[Nutrient supply of health and sick fluid fed calves].

In the department for calves being fed with fluid feed of a specialised enterprise for calf rearing the daily intake of fluid feed (skim milk improved with milk substitute), concentrated feed and hay of a total of 341 female animals and the daily intake of energy and protein was calculated thereof. The average consumption of nutrients of the 206 healthy calves was compared with some international and national norms for the demand of nutrients. The comparison with some international values of demand and the results of the partial correlation analysis between energy and protein intake and live weight increase showed that the applied nutrition regime (particularly the kind of fluid feed) has resulted in an excessive supply of the calves with proteins and an insufficient supply with energy. This could not be realised from the GDR nutrients norm for the raising of calves published in 1976. Based on theoretical considerations and some recent findings of the science of nutrition we derived values of the protein and energy demand of our own. Subsequently an attempt is made to assess the supply with nutrients for sick calves.


[Motility of the rumen after feeding sheep pelleted rations].

In an experiment with wethers the effect of the feeding with pelleted feed rations and the partial replacement of coarse fodder by non-treated beech sawdust on the motorial activity of the rumen was observed. The rumen motility was measured through a rumen fistula by means of the balloon method with the help of a capacitator primary unit, an electric manometer and a recording instrument. Over a period of 24 weeks the animals consumed 1.3 kg dry matter per day. It consisted of 41.8% meadow hay, 25.3% barley, 15.4% sawdust, 15.0% molasses, 1.3% urea, 0.76% mixed minerals and 0.48% hexametaphosphate in the form of pellets (test group) or the traditional classical form (control group). The feeding of pellets diminished the frequency (P less than 0.001) and the intensity of rumen contractions before and 1, 3 and 5 hours after feeding. Maximal frequency values were registered one hour after the food intake. During this time the number of secondary contractions of the rumen increased; differences of the frequency were, however, not registered, which means that the different physical form of the diet had no influence on the motorial activity of the rumen and that the food intake as such is the decisive factor. The diminished rumen motility in further hours after feeding was effected by treating the feed (grinding and pelleting).


[Possibilities of prediction the digestibility of crude nutrients by fullgrown and growing sheep from the crude nutrient content of the rations. 2. Rations with a higher content of crude fibers (mixtures of straw and concentrated feed as sole feed].

Eight variants of recipes for mixtures of straw and concentrated feed with 10 to 60 per cent straw more or less finely ground (86 to 314 g crude fibre per kg dry matter) and fattening feed for lambs (50 g crude fibre per kg dry matter) were checked concerning the digestibility of crude nutrients for fullgrown wethers and 60 to 80-, 80 to 100-and 100 to 120-day-old lambs which had been ablactated at an age of 60 days. The digestibility for wethers was significantly higher than for lambs, between the age groups of which there were no significant differences concerning the digestibility. In accordance with the results with rations on the basis of concentrated feed as checked and described in the first piece of information, the content of crude fibres in the rations had a negative influence on the digestibility of organic matter, NFE and energy whereas there was a positive relation with the digestibility of crude fibres. The regression functions established for mixtures of straw and concentrated feed concerning the dependence of the digestibility on the content of crude fibres showed a relatively good coincidence in the range of a low content of crude fibres with the corresponding regression functions which were described in the first piece of information for rations of concentrated feed. The equations for the digestibility of crude fibres were an exception. In contrast to this, the quantitative relations between crude fibres and the digestibility as established in the first piece of information for rations with a low content of crude fibres cannot be transferred to rations with a higher content of crude fibres.


Influenza virus infection of a newborn rats: virulence of recombinant strains prepared from a cold-adapted, attenuated parent.

Infant rats were infected with one of a series of influenza A viruses. The growth of viruses in the turbinates or lungs, and the ability of virus infection to potentiate a subsequent bacterial infection by Haemophilus influenzae (HIb), were measured. The three virus strains known to be virulent for man grew to relatively high titres of 10(5.2)--10(6.8) EBID50/ml in the turbinates of infant rats at 48 hours post-infection, and virus infection enhanced subsequent systemic infection following intranasal inoculation of rats with HIb. In contrast, influenza virus A/Ann Arobr/6/60--P17 and the three recombinant viruses prepared from this strain, all of which are attenuated for man, replicated to significantly lower titres of 10(2.6)--10(4.1) EBID50/ml in infant rats turbinates, and failed to promote systemic infection by HIb to the samest that the behaviour of influenza viruses in infant rats may be an indication for virus virulence for man, and thus provide a test which could facilitate the development of live, attenuated virus vaccines.


The replication of virulent and attenuated strains of African swine fever virus in porcine macrophages.

The replication of virulent and attenuated strains of African swine fever virus (ASFV) was studied in pure cultures of swine macrophages. To ensure complete destruction of the macrophage monolayers about 50--100 times more virulent ASFV was needed than attenuated virus although both isolates could be used to establish persistently infected cultures. Interferon did not appear to influence virus yields from such cultures. Fluorescent and electron microscopy studies of infected macrophages suggested that the cycle of infection of the two isolates was different.


RNA'S of influenza C virus strains.

Up to 9 RNA segments with molecular weights (MW) 2.3--9.4 X 10(5) were found in an influenza C virus by polyacrylamide gel electrophoresis at 50 degrees C and three different strains. All contained RNA of the same mobility. Possible coding assignments of the RNA segments is discussed.


Presence of DNA in rubella variant with DNA polymerase activity.

Rubella variant with DNA polymerase which is formed as a result of recombination between rubella virus and a retrovirus of BHK21/WI-2 cells, contains both RNA and DNA in its virion.


[Synaptic organization of the individual layers of field 4 of the cat cerebral cortex].

By means of electron microscopic method, synaptic organization of some layers in the field 4 of the cat brain cortex has been studied. It has been demonstrated that: a) synaptic organization of the cortex becoms more complex from superficual layers towards deeper ones; b) axospinous and axosomatic synapses have identical structure in all the cortical layers, while the structure of axodendritic synapses depends on their localization. A possible physiological estimation of the morphological data obtained has been carried out.


[Central representation of the anterior lateral line nerve in dwarf catfish].

The central distribution of the anterior lateral line nerve (ramus) (NLLa) were studied in the pygmean sheat-fish (Ictalurus nebulosus) by means of the method of Nauta--Gygax. NLLa, as well as posterior lateral line nerve (NLLp), projects topographically on the nucleus medialis of the acoustic-lateral area. Within the nucleus medialis NLLa can be traces in the rostro-lateral parts. A majority of NLLa fibres can be followed ipsilaterally, although a definite contralateral contribution also exists. It is concluded that NLLa, representing the electro- and mechanoreceptors of the head region, distributes predominantly within the rostral part of the medial nucleus, while NLLp, representing the trunk receptors, distributes in the caudal half of the medial nucleus. There is some overlapping within the middle part of the nucleus.


[Effect of alcoholic intoxication on the lymphatic bed of the heart].

Cardiac lymphatic bed was studied in 120 male corpses at the age of 17--55 years, normal and of those died from alcohol intoxication and from cardiac ischemia. The methods of intratissue injection of coloured masses, impregnation after V. V. Kuprianov, histological and histochemical investigations were applied. Data in figures were obtained by means of a grid for cyto-, histo- and stereometric investigations and by a scanning integrant microspectrophotometer sim-2. Statistical data were obtained by a computer "Mir". It was demonstrated that the cardiac lymphatic system responds in a definite way to alcohol intoxication. Four forms of structural state in the lymphatic bed elements were revealed, specific density of its different components was calculated. A certain connection was noted to occur between morphological changes under the effect of toxic doses of alcohol; there was also a reaction of compensatory-adaptive elements of lymphodynamics. A number of pathological changes in cardiac tissues resulting in heart insufficiency were presented. Peculiarities in poisoning phases were demonstrated morphologically.


[Comparative characteristics of the number of axillary lymph nodes in the right and left upper extremities of adult humans].

The aim of the work was to deside whether there exists any regular difference in the number of axillary lymph nodes in the right and left upper extremities of the adult person depending on sex and age. Right and left axillary lymph nodes were studied in 32 female and 34 male corpses at the age of 28--90 years according to age periods suggested by V. V. Bunak (1965). It was stated that there were no statistically important sex and age differences.


[Tactile cells (Merkel cells) during degeneration of cat sinuous hairs].

Degeneration of the tactile cells in epithelium of the cat sinuous hairs after sectioning the infraorbital nerve manifests itself as cytoplasmic vacuolization and induration with electron opaque bodies in it, changes in nuclear configuration and in chromatin density. At all stages of the experiment the tactile cells were practically observed demonstrating various degenerative signs. On the 45th day after sectioning the tactile cells disappeared completely. Structural changes in the tactile cells were preceded by degeneration and complete disappearance of tactile menisci from epithelium of the sinuous hairs. Perhaps, sensitive innervation is necessary to maintain differential status of the tactile cells in epithelium.


[State of the microcirculatory bed of the mesentery in experimental dehydration].

The results of a complex functional-morphological analysis on the state of the mesentric microcirculatory bed have demonstrated a peculiar dynamics in increasing changes of its blood and lymphatic segments. Their degree depends on the stage of dehydration. On the 3d day, the changes revealed are not great and are of redistributive character. On the 6th day dehydration aquires the maximal intensity of changes in vessels and hemodynamics. By the 10th day, maximal level of vascular, intravascular and hemodynamic disorders is evident. Comparing these data and the results of investigations on intracellular and extracellular ion contents, it is possible to suggest a definite staged water elimination from the main depots of the organism. The reserves of extracellular water section are the first to be mobilized at the expense of its interstitial and transcellular links. On the 6th day of the experiment maximal intensity of blood and lymphatic dehydration is noted. Final stages of dehydration are characterized by a pronounced cellular dehydration.


[Neural apparatus of perirenal and parapancreatic tissues during human embryogenesis].

The neural apparatus of the perirenal and parapancreatic fat tissue has been studied in human embryos, fetuses and newborns. Neurohistological techniques of Bielshowsky--Gross, Bielschowsky--Boek, Rasskazova and Ranson have been used . During embryogenesis certain differences are being formed in the structure of neural elements. These differences are characteristic for mature specimens and are especially noticeable in the structure of receptor terminals and ganglia. The neural apparatus of the paranephric fat tissue is forming with greater speed. Neural elements in different parts of the perirenal and parapancreatic fat tissue are not evenly distributed. Their greatest concentration is noted behind the pancreatic head and tail and at the level of the renal inferior pole and hilus.


[Morphology of the principal divisions of heart conducting system of rats].

Light optic and electron microscopic investigation of the sinuauricular node node (spu), atrioventricular node (pzhu) and bundle of His (pzhp) has been carried out in 23 hearts of intact non-inbred male rats. Original techniques of oriented embedding of elements of the conductive system for their electron microscopic identification have been suggested. A morphological classification of specialized cardiac myocytes has been worked out basing on differences in their form and size, number of myofibrils and degree of their regulation. On its base three type of specialized myofibrils have been revealed in the conductive system. Topography of these cells has been described within spu, pzhu and pzhp. The suggested ultrastructural classification of specialized cardiac myocytes is compared with the data obtained for the cardiac conductive system in other types of mammals.


[Rhythm of protein concentration and incorporation of 3H-lysine into hepatocytes in vitro].

"In vitro" incubated slices of the rat liver, by the method of interferometry combined with radioautography, have demonstrated hour's rhythmic fluctuations in protein concentration and 3H-lysine incorporation into proteins. The biochemical method has demonstrated fluctuations in protein synthesis rate in the same cells with an average period of about one hour. The possibility to apply the interferometric method in combination with radioautography for revealing quantitative changes of protein in slices of organic cultures is demonstrated.


[Morphologic characteristics of definitive and provisional structures of normal 17-day-old human embryos].

The structure of the presomite human embryo was investigated at embryogenesis. The embryonic shield is a three-layer gastrula 810 mkm long in the anteroposterior direction and 855 mkm wide (at the level of the primitive nodule). The primitive streak is 200 mkm long; the primitive nodule is well pronounced. All three germ layers are separately followed only in the cranial end of the embryo. The chordo-mesodermal process, 80 mkm long, is seen and is situated anterior to the primitive nodule, between ecto- and endoderm; in its zone, as well as in the area of the primary nodule and the primary streak, along the middle line, the germ layers are in close contact with each other. In the caudal end the mesoderm grows thin, and the external and internal layers come into contact forming the cloacal membrane. Extraembryonic formations are described: amniotic vesicle, yolk sac, amniotic peduncle, allantois and chorionic membrane wall. Together with the extraembryonic ecto- and endoderm, exocoelomic mesoderm participates in the formation of walls of the primitive germ vesicles. The yolk sac wall contains blood islets. Primary blood vessels are detected in the connective tissue matrix of the chorionic layer and in the amniotic peduncle. According to the anamnesis, morphological data and comparing to the data of the literature on presomitic human embryos, the age of the embryo "Krym" is determined as old as 17 days.


[Development of the lymphatic bed of the human esophageal wall].

The lymphatic capillaries are firstly determined in fetuses at the age of 3-4 months in the oesophagus submucous lamina. In fetuses of 5-6 months of age transition of the lymphatic capillaries from the submucous lamina into the mucous membrane proper is noted. In fetuses of 6 months of age perivascular lymphatic capillaries and vessels appear. They form peculiar paths around arterioles, venules, arterial branches and venous tributaries. The lymphatic bed of the oesophageal wall is rather well developed in mature fetuses and newborns. In adult and old persons a partial reduction of the lymphatic bed in the oesophageal wall is observed.


[Lymphatic bed of the main bronchi in normal human subjects and in venous stasis].

The lymphatic bed of the main human bronchi has been studied in normal conditions and at venous stagnation. Different methods both with injections and without injections have been applied. Definite regularities in changes occurring in the lymphatic bed of the main human bronchi at venous congestion have been stated. The changes occurring in the lymphatic bed of the mucous membrane of the main human bronchi seem to be a response to those metabolic processes which develop at decompensative heart diseases.


[Morphologic aspects of cardiac myocyte differentiation in Black Sea--Sea of Azov sturgeon (Acipenser güldenstädti colchicus V. Marti)].

Processes of ultrastructural organization of cardiac myocytes have been studied in the Russian sturgeon (Acipenser güldenstädti colchicus V. Marti) during germinal, prelarval, larval periods of development and in mature specimens. One of the main peculiarities of early cardiogenesis in this representative of Chondrostei fishes is a prolonged, observed during germinal and early prelarval periods, repression in multiplication of myocardial cells. Decreasing amount and size of yolk platelets in cytoplasm of these cells at the end of the germinal period could be connected with their intensive specific differentiation and increasing functional activity. Accumulation of free lipids during this period and their decreasing contents in early prelarval period demonstrate a certain transition to another way of metabolism. The data obtained on ultrastructure in mature specimens corresponds mainly to modern ideas on organization of the cardiac muscular tissue in other species of lower vertebrates.


[Cortico-cortical connections between the auditory fields and the sensomotor area of the cortex].

In 18 cats by means of two methods--anterograde degeneration and retrograde transport of exogenic horseradish peroxidase--cortico-cortical connections of the auditory fields to the cortical sensomotor area have been studied. These connections have been stated to terminate in layers V-III of certain parts of the sensomotor area corresponding to the projections of the foreleg and the head. Initial neurons of the connections studied are pyramidal cells in layers III and II. They are situated in rostral and caudal parts of the fields AI and AII, but within these levels they occur in different areas of the auditory fields.


[Organization of the thalamic and cortical projections of the cat neostriatum].

The investigation has demonstrated that in the cat the nucleus caudatus and the putamen are projected on the cortex and thalamic nuclei of the ipsilateral hemisphere according to a certain topical principle characterized by both similarity in localization of projections of these two structures of the neostriatum and their difference. On the one hand, to the same fields of the cortex and the thalamic nuclei fibres from both structures of the neostriatum go, and on the other hand--a number of cortical zones and thalamic nuclei get projections either from the nucleus caudatus or from the putamen only. Owing to a certain organization of the connections studied, it is possible to consider them as the base of functional heterogeneity of the basal ganglia. Over-lapping of the cortical and thalamic projections of the nucleus caudatus and the putamen might explain common striatal effects on behavioral reactions.


[Sinuses of the dura mater in dogs].

Sinuses of the dura mater were studied in 50 preparations of the venous system in mongrel dogs--10 moist, 40 corrosive prepared from plastics AKP-7 and AKP-15. Sinuses of the fornix--superior, sagittal, straight, transversal, occipital sinusal gutter, and sinuses of the basis--cavernous, intracavernous, petrous-basal, occipital and marginal were detected and their connections were described. Emissary and diploid veins and extracranial venous plexus are demonstrated to mediate a close connection between the sinuses of the dura mater. Common features in the sinusal structure of the human dura mater and those of the animals studied are noted; comparative-anatomical differences which should be taken into account when planning the experiment are presented.


[Morphologic analysis of guinea pig bone regeneration following curettage].

Interrelation of stromal and hemopoietic elements in the regenerative process of the guinea-pig bone marrow at different time after curettage has been morphologically studied. The bone marrow regenerative process in the depleted medullary cavity of the guinea-pig tibial bone passes through several phases following each other: blood clot formation, rough-fibrillary osseous tissue formation, its resorption, development of sinusoids and formation of reticular stroma with subsequent repopulation of hemopoietic elements in it. The leading role in the process of the bone marrow restoration belongs to the reticular stroma creating specific microconditions for hemopoiesis.


[Sequence of RNA and protein synthesis in wound fibroblasts].

RNA and protein synthesis was studied in the mouse granulation tissue fibroblasts on the 3d and 7th days after wound production. An electron-radioautographic modification of the double marker method, based on the supposition that the two biosynthetic processes investigated occur, mainly, in different parts of the cell, was worked out. Synthesis rates were determined in radioautographs obtained after administration of a mixture of labelled RNA and protein precursors to the animals. There was but a slight difference in density of the label over the nucleus and cytoplasm, nevertheless, in some cells either nucleus or cytoplasm were predominantly labelled and, as the investigation of serial sections demonstrated, this phenomenon was not occasional. Existence of similar fibroblasts should be explained by the suggestion that RNA and protein syntheses increase in the cell not simultaneously but successively.


[Determination of the fibrinolytic activity of renal tissue in children].

A method for the determination of the fibrinolytic activity of renal tissue obtained by puncture biopsy is suggested. Three cryostate sections are placed on slides, covered by a film of a mixture of bovine fibrinogen and thrombine in saline (in the control section plasminogen activator is pre-destroyed), placed in a thermostate at 37 degrees C for 24 hours, stained with Ehrlich hematoxylin and embedded in glycerol-gelatine. The fibrinolytic activity is evaluated by calculating the ratio expressing the ratio between the lysis surface and the surface of the kidney cortex section. The advantage of the method lies in the technical simplicity combined with the objective evaluation of the results.


[Possible teratogenic effect of mycoplasmas on the human fetus].

The viscera and brains of 18 stillborns and dying newborn babies infected with mycoplasmas were examined. The etiological diagnosis was done by direct Coons method using antisera against M. hominis and M. pneumoniae. A high percentage (50%) of congenital malformations in mycoplasma-infected babies was observed. Histological and histochemical examinations of the brains and internal organs revealed marked circulatory disorders and degenerative changes indicative of a pathological process which had occurred. Mycoplasmal infection contracted by the fetus in the uterus or during the delivery may be assumed to be pathogenic. Based on the data from the literature and the own observations it is suggested that urogenital mycoplasmas may exert a teratogenic effect on the human fetus.


[Morphological changes in the kidneys during nonspecific ulcerative colitis].

Light microscopy, immunohistochemical examinations and electron microscopy of kidney biopsies showed the different localization of immune complexes in the glomeruli (subepithelial, intramembraneous, subendothelial, and mesangial immune complexes) and various forms of materialization of their harmful effect (induction of immune inflammation or immunosuppression) to be determined by the involvement in phagocytosis and reparation reactions of either podocytes or mesangial and endothelial cells and also hematogenous elements. Therefore, podocyte, mesangioendothelial and podocyte-mesangioendothelial ways of morphogenesis of immunocoplex glomerulonephritis may be distinguished. Each of them is associated with the development of certain clinico-morphological forms of immunocomplex glomerulonephritis which should be considered as distinct entities.


[Case of Nelson syndrome].

A clinical description of Nelson syndrome developing in a woman of 44 is presented. Histologically the tumour of the hypophysis was an adenoma of mixed structure, electron microscopically it was found to consist of corticotropocytes in various stages of the secretory cycle. Adenoma of the hypophysis was diagnosed 4 years after bilateral adrenalectomy.


[Morphology of the Shy-Drager syndrome].

The changes found in the brain and spinal cord and vegetative ganglias in one observation of nerogenic orthostatic hypotension or Shy-Drager syndrome are described. The morphological picture corresponds to a variant of Shy-Drager syndrome with a wide involvement of the nervous system at its various levels. Its is concluded that a thorough examination of the nervous system (including the spinal cord and vegetative ganglia) should be done in all cases of Shy-Drager syndrome and clinically similar diseases accompanied by vegetative disorders, for instance in shaking palsy.


[Morphological manifestations of disorders of renal tissue differentiation in children].

Light and electron microscopy were used to study the renal tissues from 160 children varying in ages from 3 months to 15 years suffering from congenital hereditary, and acquired diseases of the urinary system. Signs of disorders in the renal parenchyma differentiation were observed in 98 patients and detected at the tissue and subcellular levels. Morphological elements of renal dysplasia and little-studied structures are described. Signs of differentiation disorders were accompanied by the development of secondary changes making morphological diagnosis of renal abnormalities difficult. The main differences between the disturbed differentiation and pseudofetal structures appearing due to the development of secondary changes are described.


[Myocardial changes following experimental protein sensitization].

Guinea pigs were sensitized by three subcutaneous injections of 0.1 ml native horse serum at 2-day intervals, 21 days after the third injection the animals developed marked sensitization to this antigen which was manifested by anaphylactic reaction to the subcutaneous challenge with this antigen. At this time, the myocardium of the sensitized animals showed signs of extra- and intracellular oedema, a sharp increase in the number of lysosomes, damage of their membranes, 2 1/2 months after sensitization the animals showed no anaphylactic reaction to the challenge dose of the antigen. There were few lysosomes in the myocardium and their membranes were intact. It is suggested that the intensity of lysosomal membrane damage is associated with the intensity of the anaphylactic reaction.


[Morphologic and histochemical changes in atrial and ventricular myocardium following adrenaline damage].

Changes in the myocardium developing after a single injection of toxic doses of adrenaline were studied. The course of adrenaline damage of the myocardium was shown to be wave-like. The most massive areas of degeneration and necrosis were observed on the 7th--14th day of the experiment. Ischemia developing because of the change of the microcirculation bed and impaired hemodynamics in the myocardium is a very important factor in the pathogenesis of adrenaline damage. The development of degeneration and necrotic areas in the auricles was found to occur later than in the ventricles which may be due to the ultrastructural features of atrial cardiomyocytes: the presence of electron dense granules, the destruction and decrease in the number of which coincide with the most marked signs of the heart muscle injury.


[Mitotic conditions in different variants of lymphogranulomatosis].

The features of mitotic regimen of lymphogranuloma were established in examinations of 50 involved lymph nodes in patients with lymphogranulomatosis: increased mitotic activity and the number of pathological mitoses from lymphoid prevalence to lymphoid exhaust. In all the types of metaphase was the predominant stage of mitosis. Significant differences were found in the mitotic regimen and various subtypes of nodular sclerosis.


[Genetic program aid thanatogenesis].

The paper develops the thesis on the association between the genetic pattern of the organism, the nature of its diseases and the mode of its dying. Four variants of relationships between the gentic and environmental factors are discussed and in each of them the importance of these factors in tanatogenesis is evaluated. The arguments are presented in favour of the concept that genetic pattern of the organism is the most essential inner cause of the diseases and the death in the majority of cases except the situations in which extreme environmental factors are involved.


[Morphology of the latent form of hematogenous osteomyelitis in children].

Morphology of slowly running hematogenous osteomyelitis in children of 2 to 14 years old is described on the basis of the operation material studies (24 cases). In the absence of or scarce symptoms, histologically a chronic inflammatory process with accumulations in bone marrow spaces of serous, fibrinous, purulent, or mixed exudate was observed. Marked processes of alteration were represented by necroses with formation of sequesters, destruction of bone marrow in combination with resorption of the damaged elements. Alterations of bone structure were detected. The lack of correlation between clinical and morphological manifestations is pointed out.


[Systemic hemangioendotheliomatosis].

A rarely occuring systemic hemangioendotheliomatosis with the involvement of the skin, lymph nodes, spleen, liver, bone marrow, and lungs (intra- and extra-vascular endothelial proliferation) in a female patient of 53 years is described. Cytostatic therapy resulted in short-time improvement and was accompanied by disappearance and cicatrization of tumour nodes and marked lymphoplasmocytic reaction. The patient died with signs of cachexia, anemia and leukopenia because of concurrent complications.


[Intestinal schistosomiasis (Schistosoma mansoni)].

An observation of the intestinal form of schistosomiasis due to invasion with Schistosoma mansoni in a patient of 20, a student from Yemen. The diagnosis was established by histological examinations of tumour-like formations on the serous membrane of the sigmoid colon taken during laparotomy for penetrating wound of the abdomen. After a special treatment the patient was discharged in a satisfactory state.


[Role of changes in myocardiocytes in the development of acute heart failure in experimental myocardial infarct].

Some problems of the pathogenesis of the development of acute cardial insufficiency were studied on the material of 2-hour experimental myocardial infarction in dogs. Acute cardial insufficiency developed owing to additional load on the heart (partial stricture of the aorta) after ligation of the posterior circumflex branch of the coronary artery. It was found that 24 hours after the removal of the immediate causes of acute cardiac insufficiency (removal of clamps from the coronary artery and aorta) the symptoms of the contractile weakness of the left heart correlated directly with electron microscopic signs of increased degeneration of intracellular structures and did not depend on the level of energetic processes in cardiomyocytes and the structure and function of sarcolemma. The restoration of the bloodflow in the previously ligated coronary artery for 2 hours did not improve the condition of the cells in the ischemic zone but enhanced reparative processes in the non-ischemized zone of the left ventricle.


[Cerebrospinal fluid in cysticercosis of the brain].

Cerebrospinal fluid (CSF) changes in brain cysticercosis have long been known. Its characteristic features are a mild or moderate pleocytosis with eosinophils, a slight or moderate protein increase with an elevated gammaglobulin concentration, and a positive complement fixation test. Unfortunately all these abnormalities are not always present together and difficulties may be encountered in the diagnosis. This paper presents a study based on the experience acquired in the CSF Laboratory of the Neurological Department of Escola Paulista de Medicina (São Paulo, Brasil) after 35 years' work, and 120.000 CSF specimens examined. The material consists of 147 cases of brain cysticercosis confirmed by necropsy, surgery, subcutaneous or intraocular cysticercus, x ray of the skull, and of 509 clinical observation with suggestive CSF changes. It is the purpose of this paper to appreciate the importance of each of the CSF tests and to observe the CSF abnormalities during the course of this disease. The results of the study of the 79 cases varified by necropsy or surgery showed that the characteristic CSF changes that make the diagnosis of brain cysticercosis were observed in 54 percent of the cases. The eosinophils were present in 82 percent, protein changes in 78 percent, complement fixation test in 70 per cent, hypertension in 55 per cent, and decreased sugar content in 27 per cent of the cases. In two cases the CSF was normal. As the eosinophils and the protein abnormalities may be seen in several other diseases, the complement fixation test for cysticercus should be regarded as the most important CSF test in the diagnosis of brain cysticercosis. The successive CSF specimens withdrawn of 40 patients during the course of this disease have shown that the abnormalities went on for 4 to 18 years observation, suggesting that the parasites were alive. On the contrary, in 11 other cases it was varified the final CSF normalization after 5 to 14 years, suggesting that the parasites were dead. The CSF was normal in 31 out of 42 patients with opaque nodules visible in skull films (calcified cysticercus). In the remaining 11 cases, the characteristic CSF findings were observed in 3, but in 8 cases the only abnormalities were positive complement fixation test or eosinophils. In 14 out of 26 patients with subcutaneous or introacular cysticercus there were the usual CSF changes but in the other remaining cases the CSF was normal. The absence of treatment for brain cysticercosis is consistent with the persistence of CSF abnormalities in the specimens examined during the course of this disease. This calls for an integrated prophylactic to all Latin-American countries in order to exterminate this serious disease for the well-being of the next generation.


Ultrastructure of human intramuscular blood vessels in development.

Muscles from human foetuses of nine weeks to nine months development were examined by electron microscopy. Capillaries, arteries and veins are frequent in the human foetal muscle at all stages of development. At nine weeks the vessels have the appearance of capillaries and basement membrane lies around the endothelial cells forming them. The capillaries are of continuous type which do not have apertures in their walls. Tight junctions are seen at some zones of adjacent endothelial cells of the capillaries. Sometimes, pericytes are also seen. At sixteen weeks vessels having the features of veins and of arteries can be identified between the muscle cells. Regarding the arteries, some of the endothelial cells are united to the smooth muscle cells and the intimal elastic lamina is interrupted where these cells approximate. The significance of this junction may be to anchor the intima to the media.


[Dysautonomic aspects of acute intermittent porphyria. Apropos of 6 cases].

The study of six patients with acute intermittent porphyria is reported. Clinical and biochemical studies have been performed during the long hospitalization of the patiets. The main disautonomic aspects were the arterial hypertension and the tachycardia in four patients, cardiac arrest in three patients and respiratory arrest in five patients. The cause of this problems is probably the involvment of the autonomic adrenergic system. The authors observed also three patients with hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. The prognosis of the acute intermittent porphyria is worse if the patients have disautonomic symptoms; three patients died and two had neurological sequalae (motor tetraparesis).


[Ataxia-telangiectasia. Report of 4 cases].

The clinical, immunologic and radiologic aspects of 4 cases of ataxia telangiectasia are reported. Comparing with a large revision of literature, the authors justify the publication of the report by the scarse occurrence of the disease and by its incidency in 3 brothers of one same family.


[Adrenoleukodystrophy (melanodermic leukodystrophy). Report of an anatomo-clinical case].

The case of a 14-year-old boy with "diffuse cerebral sclerosis", preceded by signs of primary adrenal cortical insufficiency for 7 years with familiar antecedents is reported. This disorder, named adrenoleukodystrophy, has a sex-lin(ed recessive inheritance. The clinical picture is characterized by mental deterioration, gait disturbances, visual impairment, associated with primary adrenal cortical insufficiency. Confirming the data from literature, in our case the pathological study showed myelin degeneration and diffuse gliosis in the cerebral white matter, with no involvement of subcortical fibers. Inflammatory cells are common, and have a perivascular distribution. In the fasciculata and reticular zones of the adrenal gland, "baloon-shaped" cells are evident, most of them presenting a vacuolized and striated cytoplasm. Similar lipidic inclusions have been found in the Schwann cells of the periheral nerves and testis. The findings are compared with twenty cases from the literature.


[Hemorrhage in intracranial metastases of melanoma. Report of 2 cases].

Two cases of intra-cerebral haemorrhage secondary to malignant melanoma metastasis are reported. When dealing with subarachoid haemorrhages, one should think of brain secondaries and a biopsy should always be performed whenever a spontaneous intra-cerebral hematoma is found.


[Thyrotoxic periodic paralysis. Report of a case].

A case of thyrotoxic periodic paralysis based on clinical grounds, laboratory data and therapeutic response as well is reported. The authors comment on the differential diagnosis with the most frequent types of periodic paralysis. The importance of a correct diagnosis and treatment as early as possible is stressed as to prevent further development of permanent paralysis due to irreversible degenerative myofibril changes as stated in literature.


[Surgical treatment of atlanto-axial subluxation by transoropharyngeal approach. Report of a case].

A case of atlanto-axial subluxation in a 17 year old boy with rheumatic disease is reported. The subluxation could not be reduced by cervical traction. Posterior fixation with acrilic and wire was unable to prevent the appearance of signs of spinal cord compression. The odontoid process was removed through a transoral approach leading to neurologic recovery. Treatment of atlanto-axial subluxation is discussed, emphasis being given to the indications for anterior descompression.


[Intraspinal syphilitic gumma causing spinal cord compression. Report of a case].

A case of an syphilitic intraspinal gumma is reported. A 48 years-old woman developed severe spastic crural paraparesis of two months duration, associated with sensory and sphincteric disturbances. Myelography revealed an intraspinal tumor at T3 level. Surgical exploration by dorsal laminectomy showed a syphilitic gumma attached to the spinal cord. Clinical observations and laboratory studies are discussed. Revision and comments on previous reports are presented.


Some characteristics of persistent rabies virus infection in cell cultures.

Fixed rabies virus strain M512 was shown to propagate in BHK cell cultures without interfering with cell growth. Virus specific antigen was detected in the cytoplasm of cells by immunofluorescence technique. A small amount of virus was detected in the supernatant fluid throughout a series of subcultures. The infectivity of the intracellular virus was not affected by the addition of antirabies serum in culture fluid through the extracellular spread of virus was inhibited at the 40th transfer of the infected BHK Cells suggesting the establishment of the persistent M512 infection. Ninety five percent or more cells after cloning from persistently infected cells possessed viral antigen. Based on cytopathic effect, BHK-M512 cells were resistant to superinfection with the homologous virus but were susceptible to the heterologous virus. Interferon was not detected in BHK-M512 cell cultures. The serially passaged BHK-M512 virus gradually decreased the virulence for mice after 40th subculture.


Dengue virus isolation in Indonesia, 1975-1978.

Virus isolations from dengue hemorrhagic fever patients in Indonesia are reported from 1975 to 1978. All 4 dengue serotypes were endemic in Jakarta, but dengue 3 was the predominant virus isolated. This type was also the most frequently isolated virus from patients outside Jakarta and had the widest distribution in Indonesia. The sensitivity of the mosquito inoculation technique for isolation of dengue viruses is discussed.


Otolaryngology manpower revisited.

In the December issue of the Archives, Nickerson et al published an article on the manpower resources of otolaryngology based on a report released in 1975. The conclusion reached by Nickerson and co-workers was that otolaryngology had a manpower pool too big for present and near future needs. This article was followed by a press release by the American Medical Association that endorsed the statements of the Archives article and in which Nickerson et al were quoted that no more otolaryngologists were needed from the training programs for some years. These statements were in sharp disagreement with the findings of the manpower studies carried out by another group in 1973-1975. Because the two surveys employed different statistical approaches, this article has been written to present the methods employed and to discuss the merits of the conclusions reached in each.