Clinical use of glucagon and insulin in therapy of fulminant hepatic failure.

We have reported 5 cases of fulminant hepatic failure who were treated with a combination of glucagon and insulin. Marked improvement of hepatic coma was characteristically noted in all cases.


Analysis of pure pancreatic juice in patients with chronic alcoholism.

To elucidate early biochemical changes of pancreatic juice and their reversibility in chronic alcoholics, pure pancreatic juice was collected from 23 chronic alcoholics by endoscopic retrograde catheterization of the papilla. Samples were collected at 1 minute intervals for 20 minutes after intravenous injection of secretin (Eisai, 1 U/kg) and for 10 minutes after CCK-PZ injection (Boots, 1 U/kg). Volume, bicarbonate concentration, protein concentration and three hydrolases were determined. Following results were obtained. (1) Five patients showed hypersecretory state. Four of the five patients showed hyperconcentration of protein. (2) Seventeen patients showed hyposecretory state. Lipase secretion was most frequently affected (94%). Maximal bicarbonate concentration was the next to be affected (82%). Amylase and chymotrypsinogen secretion were less frequently affected (65%). Flow rate was least frequently affected (24%). (3) It was suggested that exocrine dysfunction in chronic alcoholics is reversible in an early stage and that sequence of events with advancement of the stage is hypersecretion, hyperconcentration of protein, normalization of water secretion with a decrease in lipase secretion and maximal bicarbonate concentration, a decrease in amylase and chymotrypsinogen output, and finally a decrease in flow rate.


Studies on pancreatic duct system. II Comparative study of histological features, and three-dimensional reconstruction of pancreatic ducts.

Three-dimensional reconstruction of pancreatic ducts were made from specimens of pancreases from chronic pancreatic injury dogs following adjuvant injection, one patient with chronic non-alcoholic pancreatitis, and 2 patients with chronic alcoholic pancreatitis. The ductal alterations of alcoholic pancreatitis showed more apparent changes than those of non-alcoholic pancreatitis. The lesions in experiment such as uneven surface, irregular dilatation, tortuosity, and anastomosis, resembled to those of alocholic calcifying pancreatitis. Although gross appearance of the reconstructed ducts in advanced cases of experimental pancreatic injury revealed some resemblance to that of alcoholic calcifying pancreatitis, histologically, the epithelial changes of the former were different from those of the latter. Thus we concluded that more complicated factors than those considered in experiment play a role in combination in the pathogenesis of bead-like dilatation of the pancreatic ducts of chronic pancreatitis.


[Long-term observations on use-effectiveness of copper-IUD's (author's transl)].

Long-term observation of the use-effectiveness and safety of 745 Copper-IUD's has demonstrated: 1) The pregnancy rate decreases distinctly after 2 years; until now no pregnancy has been observed after 4 years continuous use. 2) The endometrium responds first with an inflammatory reaction, later it shows signs of deficient secretion, but after a longer period seems to become normal again. 3) Contamination of IUD's begins early, mostly with bacteria of vaginal origin, later the number of sterile IUD's increases. -- A septic abortion after pregnancy with an IUD in situ has not occurred amongst our cases. 4) The rate of copper elution continues steadily, but in spite of demonstrable corrosion there is no obse-vable decrease of contraceptive effectiveness. Copper-IUD's can remain as long as 5 years in situ, if no untoward side effects (pain, bleeding, infection) occur. It may be advisable to remove them after that period as corrosion may affect devices at present commercially available.


[Emergency cerclage. Definition, technical procedure and prognosis (author's transl)].

Report on 27 cases on emergency cerclage. Six infants survived. Among these were four with birth weights over 2500 grams. The high abortion rate of 59% and the high perinatal mortality of the live born infants (5 of 11) make it imperative to be highly selective in this procedure. In emergency cerclage during labor or maternal pyrexia is contraindicated. Local and systemic antibiotic profolaxsis is recommended. Proposals for the definition technique and post-operative care in cases of emergency cerclage are discussed.


[Early and late complications after tubal ligations with the tupla-clip (author's transl)].

Following three years of the use of the tupla-clip we were able to send questionnaires to 115 women. The mean age was 33 years with 2--3 children. 57% of the tubal sterilizations were done for medical reasons, 7% for social reasons and 56% for personal reasons. 15% of the sterilizations were done concommitant to pregnancy. Among 243 tupla-clip sterilizations 2 pregnancies occured as early complications. The 115 women were asked regarding somatic complaints, psychic side effects, and social difficulties. The personal evaluation of this sterilization method was reported as good by 68%, doubtful by 26%, and negative by 6% of the patients. Technically this method of tubal sterilization is secure, fast, and the complication rate is low.


[Caudal anaesthesia in obstetrics (author's transl)].

The advantages of caudal anaesthesia in obstetrics far outweigh the few disadvantages. The perinatal mortality of premature infants is reduced under caudal anaesthesia. Breech deliveries are easier under caudal anaesthesia. In these cases regional anaesthesia is considered an obstetrical indication. It is possible to carry out all vaginal and abdominal procedures with this anaesthesia. The elimination of pain during labor and delivery permits a more intensive experience of labor and delivery for the mother under caudal anaesthesia.


[Partial "rooming-in"--a model from the I department of gynecology and obstetrics, university of Vienna (author's transl)].

A model of a modified "rooming-in" is presented, which enables a longer and more intensive contact between mother and child. Mobile transport-baskets as used also for example in supermarkets etc. enabled us to perform this system of a partial "rooming-in" without any architectural modifications in our clinic and therefore with very low costs. In spite of all these limitations the effect of this "rooming-in" is sufficient. We proved this statement by an inquiry which showed the result, that partial "rooming-in" is preferred a total "rooming-in" by about 75% of our maternity patients.


[The operated adenocarcinoma of the cervix uteri (author's transl)].

Out of a total of 1092 women operated because of cervical carcinoma, 4.8% had an adenocarcinoma of the cervix. Compared with patients with squamous cell carcinoma, there was no difference in signs and clinical pattern with those patients who had adenocarcinoma of the cervix. Treatment results, too, corresponded with those of patients with squamous cell carcinoma of the cervix.


[Prophylactic oophorectomy (author's transl)].

The controversy of prophylactic oophorectomy is discussed. The literature is reviewed and the personal observations of the last 20 years are described. The following conclusions are drawn: The operative risk is not increased by oophorectomy. Hysterectomy does not diminish the function of the remaining ovaries. Pathology of the ovaris is not influenced by hysterectomy. The incidence of ovarian cancer is the same in patients following hysterectomy at it is in patient's without hysterectomy. A review of our cases showed that 700 prophylactic oophorectomies are necessary to prevent one case of ovarian cancer. The later occurence of menopause is an argument against prophylactic oophorectomy prior to age 55.


[Is increase of the population a moral value? [author's transl)].

There is no complementary action of the partial competition between economic, demographic and rational factors in free capitalistic societies. Natural increase of the population means an increase of economic and cultural vitality for a state but can also mean a weakening. Increase of the population is in itself no normal value. Modern technology has forced man into a new life cycle by confronting him with ecologic, economic, and demographic limits to growth. Man reacts by decreasing the birth rate or by discontinuing procreation completely. The responsibility for the reproductive behavior can only be taken over by the state as long as this responsibility is in agreement with the private interest of the person. Demographic and social politics should nd. In questions of reproductive behaviour the decision of the individual and his possibility for individual action should be supreme.


[The so-called massive edema of the ovary. A case report and review of the literature (author's transl)].

One case of massive ovarian edema is reported in addition to other 20 cases published in the literature. A 17-year-old nulligravida girl had severe abdominal pain of 2 hours' duration. On laparotomy, the right ovary was enlarged and oophorectomy was performed. The ovary measured 5 x 7 cm. The external surface was gray and blue. Cut surfaces showed a soft, watery brown and yellow tissue without distinct tumoral mass. Microscopically, there was a diffuse interstitial edema of the ovarian stroma, a dilatation of lymphatic and venous channels with preservation of ovarian structures. The cause of massive ovarian edema remains unclear. The most probable explanation is partial torsion, possibly recurrent, of the mesovarium with an impairment of the lymphatic and venous drainage. Since this nonneoplastic lesion occurs in children and young women, it should be recognized at the time of laparotomy and treated conservatively.


[The influence of epidural anestesia of the incidence of vaginal operative deliveries. Study of 6,110 deliveries with 4.590 epidrual anesthesias (author's transl)].

6,110 labors and deliveries are reviewed. 4,590 were done under epidural anaesthesia. The incidence of vaginal operative deliveries was not increased by epidural anaesthesia. The technique, complications and advantage of epidural anaesthesia are discussed.


[The bacterial contamination of epidural catheters with areobe and anaerobe germs in obstetrics (author's transl)].

Following anaesthesia the tips of 105 epidural catheters were investigated for aerobe and anaerobe bacteria. In one case aerobe germs (staphycoccus epidermidis) and in three cases anaerobe germs (propioni-bacteria were isolated. In two further cases aerobic growth was suspected but not confirmed in sub-cultures. The contamination rate was therefore 0.9% aerobe and 4.8% by anaerobe bacteria. Even in the face of a clinically uncomplicated course the presence of bacteria on the catheter tip is considered to be a potential risk for infection. As a preventive measure the skin disinfection procedure was changed and the disinfectant is left for sic minutes instead of three minutes.


[Fulminant course of a granulosacell carcinoma in a young woman (author's transl)].

The article describes the clinical course of a non-hormone-producing granulosacell carcinoma in a 21 year old woman, and reviews the recent clinical literature.


[Preoperative administration of antacids to prevent Mendelson's syndrome in pregnant women receiving general anesthesia (author's transl)].

Preoperative administration of 15 mls of the antacid Andursil to women undergoing surgical procedures in GA during pregnancy does reduce the risk of aspiration pneumonitis (Mendelson-Syndrome) from 1:3,5 to 1:15,5. The data show that the number of risk patients is increased in early stages of pregnancy and--surprisingly--in patients undergoing elective surgery. Pains and costs of prophylactic antacids are negligible. Neonates of LSCS patients receiving an antacid are not at an increased risk. As a conclusion the prophylactic administration of oral antacids to all pregnant women having a GA is recommended.


[The relationship of maternal obesity, excessive weight gain in pregnancy and pre-eclampsia].

The records of 2,671 pregnancies were reviewed regarding maternal obesity, excessive weight gain in pregnancy and pre-eclampsia. Pre-eclampsia is significantly more frequent in maternal obesity. Correlation between excessive weight gain in pregnancy and pre-eclampsia is only found for the signs of edema and hypertension. Edema and excessive weight gain in pregnancy are related to each other, since edema frequently induces the excessive weight gain. Overall, maternal obesity perior to pregnancy is much more important in the development of pre-eclampsia than excessive weight gain during pregnancy.


[Carcinoma of the breast and pregnancy (author's transl)].

The prognosis of carcinoma of the breast which was detected during pregnancy or during the breast feeding is discussed. Personal cases are described and the literature is reviewed. The prognosis of carcinoma of the breast following complete treatment is investigated when the prognosis may be influenced by a pregnancy. In contra-distinction to the older view the prognosis is only worsened when the axillary lymph nodes show cancer. Without spread to the axillary lymph nodes there is no difference in the survival rates. In cases with complete treatment for carcinoma of the breast the pregnancy appeared to have a favorable influence on the prognosis. In our own few cases axillary lymph nodes in pregnant women worsened the prognosis more than in non-pregnant women.


Hyperkinetic impulse disorder: a developmental defect of motivation.

An integrated, testable, bio-psychological theory which proposes that hyperkinetic impulse disorder (H.I.D.) is determined interactively by polygenically inherited and environmental factors is presented and examined in the light of the literature. The theory holds that H.I.D. is a developmental disorder of intrinsic motivation, characterized by poor appreciation of the contingencies between behavior and environmental events. Characteristics of H.I.D. children, including apparent overactivity, impulsivity, impersistence, inattention, and underachievement in academic and social skills, are accounted for, and implications for treatment and management are spelled out.


A critique of research in psychoanalytic theory.

The relationship between psychoanalytic theory and the experimental method is examined, with particular reference to the empirical studies on the oral and anal phases of development. The deficiencies in the design and conceptualization of many studies are discussed, as well as confusions in the writing of psychoanalytic theory. A central issue in bringing the experimental method to psychoanalytic theory is the question: What is being tested? A list of all projective and objective tests used to assess orality and anality is provided.


An enrichment for temperature-sensitive mutants in Tetrahymena thermophila.

The parameters for the killing of Tetrahymena by 5-bromodeoxyuridine(BUdR) and near-ultraviolet light have been determined. Significant preferential killing by UV of cells that have incorporated BUdR was obtained when the cells were irradiated in a nonnutrient buffer. UV alone was found to be toxic to cells irradiated in growth medium. Mutants defective in division at a restrictive temperature were isolated from mutagenized cultures that had been treated with BUdR and UV and from mutagenized cultures that had no such treatment. Results indicate that the number of temperature sensitive (ts) growth mutants can be increase five to six times using the BUdR/UV treatment. Data are presented that indicate differences in the frequency of occurrence of various types of ts mutants, with and without enrichment. A mutant that immediately stopped macromolecular synthesis and cell division upon being placed at the restrictive temperature was more resistant to BUdR/UV treatment than wild type by 1000-fold. Using the above techniques, BUdR-resistant mutants altered in the phosphorylation of thymidine have been isolated.


The Ah locus: biochemical basis for genetic differences in brain tumor formation in mice.

Allelic differences at the Ah locus are showen to exist in the mouse brain. This finding probably explains inbred mouse strain differences in polycyclic hydrocarbon tumorigenesis of the brain described more than 35 years ago and may be important in understanding the etiology of genetic differences in certain human intracranial neoplasms.


Child psychiatry-pediatrics consultation-liaison services in the hospital setting: a review.

The historical background of the child psychiatry-pediatrics consultation and liaison field is summarized. Two recent national surveys of consultation and liaison programs are presented; one survey was sent to departments of pediatrics, while the other covered divisions of child psychiatry. The development of a multidisciplinary, multidepartmental consultation and liaison group in a children's hospital is described and offered as a possible paradigm. Finally, the author discusses the problems revealed by the surveys and offers some possible solutions.


Psychology interns on a consultation-liaison service.

This paper develops a rationale for training psychology interns on a consultation-liaison service to deal with the psychologic problems of medically ill patients and to work with their health care providers. General and specific goals are delineated to summarize training objectives for these interns at the end of three and six months on the service. The overall objective of the service in offering such a program is to train psychologists to feel competent and comfortable in meeting the psychologic needs of the medically ill. The service seeks to train psychologists primarily as clinicians and secondarily as researchers in the health care area.


Alcoholism consultation and general hospital psychiatry.

The author explores the relationship between consultation-liaison psychiatry and alcoholism as it presents in the general hospital. He discusses cases that illustrate specific problems, reviews the studies of alcoholism prevalence in the medical and surgical services of general hospitals, and emphasizes the liaison and consultation roles of the general hospital psychiatrist around alcoholism diagnosis, management, and treatment referral.


The house officer and the dying patient: attitudes, experiences, and needs.

A survey of house staff who care for dying patients was conducted at a large medical center and demonstrated that house officers are aware of their discomfort in dealing with dying patients and their families but believe they do not avoid them. They strongly agreed with the use of the "no code' designation and believed the quality of life was the most important factor in making that decision. The house officer who has concerns about a dying patient is most likely to talk with another house officer. The survey highlights the needs of house staff for experienced resource people and informal programs dealing with the care of dying patients.


Current attitudes of medical students and house staff toward terminal illness.

A survey questionnaire about attitudes toward terminal illness was administered to all medical students, interns, and all medical, surgical, and psychiatric residents at the Downstate Medical Center. The majority of students and new physicians surveyed reported that patients with terminal illness should be told their diagnosis--a reversal of attitudes as compared with those revealed by studies done before 1970. Most of the respondents also expressed the view that they would want to be told of their own fatal illness. The attitudes at different levels in medical school, internship, and residency did not differ significantly despite the differences in formal education and clinical experience of the respondents. Implications of these findings are discussed with particular emphasis on the need to teach an individualized approach to the dying patient.


With the eyes of the mind: autoscopic phenomena in the hospital setting.

Autoscopy is a rare syndrome in which a person hallucinates a vision of himself, while retaining insight into the unreality of the phenomenon. Although a number of illnesses are associated with autoscopy, the most common causes are stress and fatigue. The medical, psychiatric, literary, and historical contributions to the understanding of autoscopy are reviewed and three recent cases presented. It is emphasized that illness, injury, and hospitalization are important precipitants of the syndrome, particularly in persons with highly developed visual memories.


Humanizing the student--cadaver encounter.

In a recently accredited medical school, the curriculum, which emphasizes the psychologic and social aspects of disease, includes innovative features aimed toward training students to provide humanistic health care in underserved areas. As part of this curriculum, an educational experiment was designed to explore issues concerning the medical student's first exposure to a cadaver. The authors describe the experiment as it evolved over a three-year period, and they discuss its value based on student evaluation and faculty opinion.


Models for evaluating teaching in consultation-liaison psychiatry: III. Conclusion-oriented research.

This paper reviews the purposes and methodologic requirements of conclusion-oriented research for evaluating outcomes of consultation-liaison (C-L) teaching in psychiatry. Requirements for replicating educational methods and outcomes, and for demonstrating cause-effect relationships between program inputs and program outcomes include: careful definition of educational methods; selection of valid and reliable outcome measures; and use of sound experimental designs. Barriers to meeting these methodologic criteria in C-L settings are identified, and methods for overcoming them are suggested. In addition, useful guidelines are provided for the educator wishing to conduct conclusion-oriented C-L research to determine teaching effectiveness.


Cognition and the disease process: genesis, maintenance, and treatment.

The present paper is directed toward the conceptualization of disease states and their management from the cognitive point of view. The role of cognitive sytlesand self-statements in the pathogenesis of disease and the execution of coping styles is presented. A review of the literature on the cognitive treatment of medical disorders has documented the utility of such approaches with several medical problems, but a need for more rigorous empirical efficacy remains. The necessity of analyzing the coping processes elicited by specific disease states is viewed as essential to the understanding of the patient and the design of intervention strategies. Finally, a cognitive analysis of patient compliance to treatment regimens is presented.


Refusal of treatment: suicide or competent choice.

Increasingly, patients are exercising the right to refuse treatment. Patients who have been chronically ill or those who consider themselves terminally ill are most apt to do so. Accordingly, liaison psychiatrists are asked to determine whether refusal of treatment is an act of suicide or a competent choice. This is difficult to assess in the absence of delirium or overt psychosis. It is suggested that the dynamics and affective tones of the patients' reaction to the health care system as well as to family and friends are of major significance in this determination. The actual process of exploring these areas with patients making this choice is often therapeutic in restoring the patients' sense of control or authenticity. Often this process enables them to continue treatment and avoid the impulsive interpersonal anger that characterized the suicidal act.


Cognitive impairment associated with acute or chronic disease.

Cognitive impairment in connection with acute or chronic disease may complicate the disgnosis, management and treatment of general hospital inpatients. Consulting psychiatrists may be called upon to evaluate cognitive and intellectual impairment associated with organic brain syndromes versus psychiatric disorders due to other causes. To assist the psychiatrist in formulating a differential diagnosis, the standard mental status examination and various objective neuropsychologic tests can be used. In addition, the author suggests a method of cognitive measurement using content and form analysis of five-minute speech samples. Impaired cognitive function may be caused or exacerbated by conditions such as alcohol abuse or psychoactive drug abuse which may not be revealed by the patient during the history taking.


Conservation-withdrawal versus depression.

Conservation-withdrawal should be included in the differential diagnosis of the withdrawn, apathetic medical patient. The clinician's awareness of the conservation-withdrawal phenomenon can avert the unnecessary use of psychotropic medications and avoid the alienation that arises between the patient and his primary physician when an unwarranted psychiatric diagnosis is applied. Recognizing the distinction between conservation-withdrawal and clinical depression permits the primary physician to utilize his own skills in supporting his patient.


[Mutagenic alterations of antibody biosynthesis].

The investigations of changes of antibody affinities were carried out with 182 immuned CBA mice under the influence of the mutagens. The mice were injected with ethylene imine and its derivatives, 6-azauridine, cyanurchloride, theobromine, glyoxal, at a dose of 100 mg/kg 2 days before, simultaneously and in 2 and 5 days after the immunization. The indices of the functional affinity of antibodies (the mean constant of true association, the standard free energy, the concentration of the hapten binding sites, the heterogeneity index, the level of IgG and its Fab- and Fc-fragments) were determined within 5, 10 and 20 days. Three groups of changes of antibody affinities in immuned mice were observed under the influence of mutagens: a) disassotiative changes with acute fall of affinities; b) erase changes; c) variable changes with discrete and corrective displacement of some affinities indices. Analysis of the data obtained suggests the existence of two forms of the mutagen immunodepression: 1) real immunodepression with a parallel fall of primary and secondary indices of antigen-intibody interaction; and 2) functional immunodepression with a fall of secondary indices. Polyfunctionality of the inhibition effect of alkyl mutagens is demonstrated.


[Population genetics approach to the problem of the nonspecific biological resistance of the human body. I. Statement of the problem and basis for the approach. Distribution parameters of anthropometric markers of normal and ill newborn infants and nurslings].

Distributions of two metrical characters-the weight and the body length at birth are considered in several groups of healthy, diseased and dead newborns and infants. Significant differences in statistical parameters of these distributions (mean, standard deviation, skewness and kurtosis) are demonstrated for normal and malformated children. The increased number of children with minimal deviations from the mean values of characters (adaptive norm) is observed among healthy newborns, while in groups of diseased and dead children the frequency of individuals with extreme (especially low) values is increased. The principle of classification of individuals based simultaneously on two characteris is suggested and the problem of "average phenotype" classification by the number of characters is discussed.


[Genetic structure of an isolated group of the indigenous population of northern Siberia, the Nganasans (Tavginians) of Taĭmir].

Demographic data of genetic interest were studied in presently living population in comparison with preseding generations of Nganasans. Decrease of sex ratio in the whole population has been revealed along with the reduction of reproductive and, possibly, effective size. The number and variance of livebirths per female were 7.29 and 9.86 respectively. Crow' index of the opportunity for selection (I) and its components (Im and If) were estimated. I was found to be 1.17, whereas Im and If--1.56 and 0.18 respectively. Linear pattern of settling in the past as well as the type of migration between adjoining subpopulations depended on culture and economy of arctic reindeer hunters as well as landscape character.


The pathology of flexor tendon repair.

This paper discusses the problems of failure after tendon repair. For a long time the subject has been dominated by the problem of adhesion formation. Recent work has shown that this is not inevitable, and consideration of other factors, particularly the nutrition of tendon tissue is leading to the possibilities of other methods of treatment.


The pattern of joint involvement in hands with arthritis at the base of the thumb.

A study of the incidence and grading of osteoarthritis in all the other thirty-two joints in the hands of twenty-one patients with osteoarthritis of the carpometacarpal joint of the thumb.


Causes of locking metacarpophalangeal joint of the thumb and its non-operative treatment.

The non-operative method of reduction of locking metacarpophalangeal joint of the thumb is described, and illustrated by four case reports. Experimental studies in the hands of a fresh cadaver are also described. Locking of the metacarpophalangeal joint of the thumb can be produced by slight external forces, insufficient to damage strong tissues. Incarceration of the sesamoid bone is anatomically impossible, but incarceration of the proximal portion of the volar plate is believed to be the true cause. This incarceration can be reduced easily by our non-operative method along with intra-articular injection of local anaesthetics.


Injuries of the proximal interphalangeal joint of the fingers.

A consecutive group of ninety-three patients with ninety-six affected joints, have been reviewed retrospectively to provide information regarding the incidence and longer term effects of injuries to the proximal interphalangeal joint of the fingers. The patients have been grouped according to the severity of the injury, judged clinically and radiologically. From this review it would appear that these injuries are somewhat less common than is suggested in the literature. The severity of the trauma would seem to influence the result in that some thirty per cent with dislocation or fracture-dislocation did badly and of these forty-three per cent had open injuries. Some experimental work on fresh cadavers, to investigate the damage to the ligaments in the more common dorsal dislocation, has been included. From our findings, suggestions have been made regarding the treatment of these injuries.


Clinodactyly. A review of a series of cases.

A review of 50 patients with clinodactyly is presented in which six patients required surgery for a combination of functional and cosmetic problems. It is suggested that patients with a delta phalanx at the proximal phalangeal level should have a reversed wedge osteotomy early, while those with brachymesophalangism requiring surgery have a closing wedge osteotomy performed late. Delta phalanges in the triphalangeal thumb should be excised early and the joint reconstructed. An ulnar abduction deformity was noted in a minority of patients with clinodactyly. This deformity is relieved when the clinodactyly is corrected.


Habitual extensor tendon dislocation.

Dislocated tendons are frequently seen in the rheumatoid hand. Habitual dislocation is rare. Five patients, all sero-negative with this problem, are described. The causation of the deformity and its treatment is discussed in relation to other cases reported in the literature. An extensor loop operation is recommended.


Rupture of the extensor pollicis longus--a crush injury.

It is suggested that rupture of a previously normal tendon of extensor pollicis longus after Colles fracture may be due in some cases to crushing of the tendon between the styloid process of the third metacarpal and the dorsal tubercle of the radius, when the wrist is forced into extreme extension.


Stenosing tenovaginitis affecting the tendon of extensor digiti minimi at the wrist.

We report a patient with stenosing tenovaginitis affecting the sheath of the tendon of extensor digiti minimi. The similarities to typical de Quervain's disease are discussed.


Thumb reconstruction after amputation at the interphalangeal joint by gradual lengthening of the proximal phalanx. A case report.

A case of thumb amputation at the interphalangeal joint and reconstruction by gradual lengthening of the proximal phalanx is described. As a result of the treatment the amputation stump was lengthened 2cms which means a 70 per cent increase of the original length of the proximal phalanx. The quality of sensibility of the stump has been preserved.


A new pattern of needle for microsurgical repair of nerves.

This paper describes the design for a microsurgical stainless steel atraumatic needle for primary suture of small peripheral nerves in which the epineurium is friable. The needle (manufactured by Dixey Instruments, U.K.) is curved with a spearshaped point and a small cutting edge on the concave surface. The rest of the body of the needle is round. We have found with histological evidence that there is an improvement in accuracy of suture placement on previously used needles in experimental and clinical microsurgery of peripheral nerves.


The effect of intermittent pneumatic compression on the hand after fasciectomy.

Thirty-nine patients undergoing surgery for Dupuytren's contracture were included in a fully randomised, matched, prospective trial to evaluate the effect of intermittent compression on the post-operative hand. The study revealed a definite improvement in the treated, over the control patients. There was a distinct decrease in oedema with almost immediate return to normal hand function in the group treated by compression. Other benefits accrued from the earlier subsidence of pain in treated hands requiring reduced or no analgesia and from the earlier expression of fluid discharge from the wound thus preventing haematoma formation and the consequent ills.


Isolated pathological fracture of the capitate bone. A case report.

Isolated fracture of the capitate bone is rare, but an isolated pathological fracture due to leprosy has not been previously reported. Although varying degrees of trauma is implied to be associated with fractures, this case illustrates a pathological fracture of the capitate apparently due solely to a specific disease. Fracture has occurred without a history of trauma and there has been no displacement of the fragments on x-rays over a period exceeding ten years even though it has been subjected to unrestricted activities by the patient who has clinically inactive disease.


Interpositional microvascular vein grafting.

The application of interpositional microvascular vein grafting in replantation surgery, a detailed account of the technique developed and utilised in the microvascular research and training laboratory, and clinical experience with this technique are described. Vein grafting is of particular value to eliminate tension in anastomoses, bridge vascular defects, and has made feasible the salvage of severe crushing and avulsion amputation in the hand.


A mechanised microirrigation system.

A mechanised microirrigation system for microvascular surgery, which is operated by a foot pedal, utilises a large sterile reservoir, and allows control of flow rate and volume, has been designed for use in the laboratory and operating room.


A case of epilepsia cursiva whose running fits were precipitated by psychogenic factors.

We presented a case of epilepsia cursiva starting with generalized convulsion, then developing as the patient grew older, into frequent attacks of psychomotor seizures including running fits, in which psychogenic causes may have played a vital role in precipitating the seizures.


Epilepsy above 70 years of age--four cases with spike and wave complex.

The authors have reported clinical features, EEG and CT findings of four cases with senile genuine epilepsy, with late onset after 50 years of age. One of these was similar to the case of petit mal status episodes with myoclonous in a woman of 77 years, which Terzano et al. reported in 1978. Three of our cases were non-focal major epilepsy. We confirmed the existence of primarily generalized epilepsy, occurring late in life. At present, with only a few reports of senile epilepsy with spike and wave complex being available, we should make further efforts to obtain well-defined features of senile genuine epilepsy.


A case of prolonged confusion after temporal lobe psychomotor status.

A 36-year-old man with prolonged confusion developed after psychomotor status was reported. He had no past history of epileptic seizures or psychotic disorders. The status continued for 20 hours, and twilight state and a slight fever lasted for about 10 days. Thereafter gross impairment of memory and disorientation became remarkable, and, in addition, strong psychic and autonomic disturbances developed, such as visual and auditory hallucinations, excessive excitement, disturbance of sleep, polyphagia, polydypsia, polyuria and hyperhidrosis. The CT scan, carotide angiography, CSF examination, and complement fixation tests for viruses were all within normal limits. The EEGs showed a slowing of the background activity, 0.6--0.8 Hz periodic high voltage wave discharges and random spikes in each temporal area. The clinical symptoms and EEG findings gradually improved without remarkable damage.


Electroencephalographic study of status epilepticus.

The authors have reported EEG findings during attacks of status epilepticus and clinical symptoms in four cases which were considered as temporal lobe status or its marginal group.


Serum levels of phenytoin and phenobarbital in epileptic patients treated with mixture antiepileptic tablets, Comital-L or Hydantol-F.

Serum levels of both phenytoin and phenobarbital were determined by homogenous enzyme immunoassay in 59 epileptic patients treated chronically with either Comital-L or Hydantol-F tablets. The majority of the patients receiving Comital-L tablets showed low serum levels of phenytoin and high serum levels of phenobarbital, while patients treated with the usual daily dosage of Hydantol-F tablets showed adequate therapeutic serum levels of both phenytoin and phenobarbital. From the results obtained, the dose ratio of phenobarbital to phenytoin in Comital-L tablet seemed inappropriate to obtain adequate therapeutic serum levels of both drugs simultaneously. Since the dosage of each anticonvulsant drug used concurrently should be established individually, the use of such fixed-dosage mixture tablets of antiepileptic drugs as Comital-L or Hydantol-F in daily clinical practice should be reconsidered from the viewpoint of serum level monitoring of antiepileptic drugs.


Status epilepticus in childhood: a retrospective study of initial convulsive status and subsequent epilepsies.

A retrospective study was carried out on 261 patients with various epilepsies who had undergone convulsive status epilepticus prior to the subsequent onset of epileptic seizures. 1. Convulsive status epilepticus was found more in partial epilepsy and secondary generalized epilepsy at about the same rate, and evidently less in primary generalized epilepsy. On the average, three-fourths commenced their convulsive disorders with initial status epilepticus. 2. There were free intervals of years following initial status and preceding subsequent epilepsy. The interval was evidently shorter, less than two years, in a majority of patients with secondary generalized epilepsy, whereas the interval was mostly longer, more than six years, in patients with partial epilepsy. 3. The permanent deficient sequelae resulting from initial status were most closely associated with secondary generalized epilepsy. This was also exemplified by the higher rate of atrophic change on CCT. On the contrary, such permanent sequelae were less marked in partial epilepsy especially of complex seizure. 4. It was concluded that secondary generalized epilepsy resulted in cases with more severe brain damage within a relatively shorter interval, whereas complex partial seizure resulted from less severe damage with an obviously longer interval following convulsive status epilepticus.


Psychomotor status: case reports and proposal for classification.

Two cases with psychomotor status were reported. Case 1 is considered to have been seized with subjective seizure status which lasted 10 hours. Case 2 most likely suffered the typical psychomotor status which satisfies all of Heintel's criteria. The relationship between ictal patterns and EEG recordings was discussed and the classification proposed.


Congenital malformation among infants of epileptic mothers treated during pregnancy--the report of a collaborative study group in Japan.

A multi-institutional collaborative study was conducted on the risk of congenital abnormalities among infants of pregnant epileptics. The 902 pregnancies collected by July, 1977, were divided into the treated group, the non-treated group and the unknown group. The malformation rates among live births of the first and the second groups were 11.5% and 2.3%, respectively; however, it was estimated that the rate would have been 6.75% among the treated group if trimethadione-treatment had been avoided. The effects of maternal background and antiepileptic treatment were analyzed fully in connection with the possibility of congenital malformation.


Teratogenic risks of antiepileptic drugs in respect to the type of epilepsy.

The incidence of malformations and/or miscarriage-stillbirths was unequivocally higher in offsprings born to mothers with secondary generalized epilepsy or complex partial seizures. Although it was difficult to separate the possible role played by antiepileptic drugs from that of predisposed severity of epilepsy, the teratogenic risks due to medication appeared to be more plausible. Polypharmacy and overdose regimen should be avoided by all means especially during the earlier period of pregnancy.


Medicosocial aspect of people with epilepsy in Japan--a survey from standpoint of epilepsy center.

Medicosocial aspects of 2,000 patients with epilepsy were outlined on the basis of international classification of epilepsies and epileptic seizures. 1. The incidence of secondary generalized epilepsy was higher compared with that reported previously. It was possible that we have been dealing with rather intractable epilepsy. Non-convulsive epileptic seizures should be treated as intensively as convulsive attacks. 2. Contrary to primary generalized epilepsy, secondary generalized epilepsy and partial epilepsy, a part of which was complex partial seizures, were more prone to be associated with psychological difficulties. 3. The rate of normal mentality was apparently proportional to the actual ease of employment among adult patients. Fortunately, the general attitude of education toward younger people with epilepsy was seemingly generous. However, the marital status of both sexes was far from satisfactory. The stigma might have been felt more by adult patients than younger ones. 4. It appeared to be conceivable that two-thirds of the people with epilepsy are treatable to a certain extent by adequate regimens while one-tenth are obliged to stay in residential centers for a lengthy period of time. Thus, various rehabilitation activities are indicated for one-fourth of the patient population. Actual strategy for rehabilitation of epileptics should be individually designed in accordance with the natural history of each epilepsy.


Therapy and prognosis of status convulsivus in childhood.

The record of 67 cases under 15 years of age who were hospitalized during status convulsivus from 1975 to 1978, the 348 cases who visited the hospital for the first time with epilepsy (Oct. 1977 to Sept. 1978) and the 32 cases who were hospitalized during status epilepticus from 1969 to 1974 and who are being followed up as outpatients were studied. The frequency of status epilepticus was 8% among epileptic children. There was no difference in the frequency of incidence between male and female. Patients with mental retardation, however, were revealed to have status epilepticus twice to three times more frequently as compared to cases without mental retardation. The major seizure types of status epilepticus in childhood were generalized tonic clonic convulsion and unilateral clonic convulsion. In 25% of the cases, status epilepticus was the first ictal manifestation. The major cause of status convulsivus was epilepsy, followed by encephalitis and encephalopathy, but cases due to brain tumor were rare. The drug of first choice for status convulsivus is diazepam. If there is any difficulty in controlling status convulsivus with diazepam, it may be worthwhile to consider what the problem is, causes of status convulsivus, seizure type, or basic disease of the patient. The effective dose of diazepam was within the range of 0.3--0.5 mg/kg. When the effect is not sufficient, the dose of diazepam should be increased to 1 mg/kg while watching the general condition of the patient. Factors affecting the prognosis of status convulsivus were its cause, duration, onset age and effectiveness of therapy during the acute stage. The frequency of cases who suffered disability after status epilepticus was 56%. (transient disability 43%, permanent disability 13%) The most frequent type of transient disability was hemiplegia. Most epileptic children who had repetitive status convulsivus revealed psychomotor retardation before first status. Factors which cause repetitive status seem to be hemispheric brain damage or diffuse corticocentrencephalic damage.


[Surgical therapy of arterial occlusions. Indication and results of revascularization in 5370 peripheral arteriosclerotic occlusions].

The results of 5370 revascularizations in peripheral arteriosclerotic occlusive diseases are reported. The operative mortality in 532 carotis interna desobliterations with ischaemia stage II was 2.3%. In stage I of 98 prophylactic operations we lost no patient. Instead of the transthoracic reconstruction we now prefer the extrathoracic bypass because of the lower risk involved. The abdominal aortic aneurysm always is an indication for resection because of the danger of rupture. In cases of 100 operated patients with aneurysm we had a mortality rate in the elective stage of 5.3%, in stage of covered rupture of 47.1% and in ruptured aneurysm 85.7%. The complications in vascular reconstruction of the lower extremity are low. The mortality rate after implantation of aortic bifemoral prosthesis is 3.7%, after an unilateral aortic-femoral prosthesis 2.8% and after all operations below the inguinal ligament 1.0%. Also the femoro-tibial occlusions could be revascularized in bypass-technique with a risk of 1.5% and good early results of 90.3%.


[Chemotherapy of bronchial carcinoma].

Prognosis of bronchial carcinoma remains poor despite improved early diagnosis and campaigns of informing the public about the risk factors. In the majority of histological entities chemotherapy cannot change this situation. However, in case of oat cell carcinoma a high rate of responders together with prolongation of survival rate can be achieved by chemotherapy. The best results are obtained with combined chemotherapy and early radiation therapy.


[New aspects of conventional tomography with special reference to automatic exposure control].

Automatic exposure control in tomography requires control of dose output whereas in survey technique dose is controlled. Automatic exposure not only facilitates work load but also improves image quality by balancing regions of differing density. High control-frequency and -sensibility are essential requirements; otherwise unsatisfactory findings i.e. erraneous images may result in particular when the time for a tomographic cycle is short. These high requirements exceed the performance margin of conventional automatic exposure control systems in which dose control is achieved by control of tube heat. A combined tube-current- and voltage-control with regard to primary voltage phase as used in units designed lately serves all routine use needs and delivers high quality tomograms.


[Therapy of hyperlipoproteinemia type IIa and IIb with etiroxate-HCl. Dose-response comparison].

In the clinical study presented etiroxate hydrochloride was shown to have a pronounced cholesterol-lowering effect. The percentage decrease of cholesterol values during treatment with 40 mg daily was significantly greater than that during 20 mg daily. The mean decrease was 41.2% in patients with initial cholesterol values greater than 350 mg/100 ml and 25.9% in those with initial values less than 350 mg/100 ml. However, it must be emphasized that 20 mg daily also produced a mean decrease in the serum cholesterol values of more than 20%. With initial values below 350 mg/100 ml the difference in the cholesterol decrease between the two dosage groups is not therapeutically relevant. Therefore treatment in patients with hypercholesterolaemia or type IIa and IIb hyperlipoproteinaemia should begin with 20 mg daily. The results suggest that raising the dose to 40 mg daily is only appropriate when a satisfactory decrease in serum cholesterol cannot be achieved with 20 mg daily. The preparation does not consistently lower the triglycerides, but in some cases the effect is very pronounced. A careful diagnosis must be made before administering etiroxate hydrochloride and continuous medical supervision and checks for side-effects are necessary throughout treatment.


[Arthroplasty of the upper ankle joint. Possibilities and limitations].

It is out of the question that alloarthroplasty of the upper angle joint must today belong to the therapeutic repertoire of the orthopedic surgeon. The anatomical situation of the upper ankle joint brings considerable problems for the total replacement and then also for the surface replacement. At the time being models are already available, which, seen on the whole, have already brought quite reliable results. Requirement for the success of the operation is the technically perfect insertion of the surface replacement or of the total joint and furthermore the insertion of the replacement under appropriate conditions, whereby the operation in an aseptive room ("Reinraum") has proven itself effective also on the upper ankle joint.


[Arthroscopic evaluation of cartilage lesions in the knee joint].

Arthroscopy constitutes an important supplementary method for investigating and diagnosing affections of the knee joint. Despite the low risk and little trouble it causes to the patient it should only be used if radiological and repeated clinical examinations do not permit any evaluation of the disease. Arthroscopy is the method of choice in case of cartilage damage because from the appearance of the altered cartilage conclusions may be drawn about the occurrence and kind of the trauma. This examination method is valuable not only in diagnosis, it is also used to follow up the result of surgical interventions. Small pieces of cartilage that cannot be fixed may be removed by means of the arthroscope, so that examination and therapy can be done in one single operation. In most cases, cartilage damage is caused by laxity of ligaments.


[Treatment of fractures of the radius head].

Conservative treatment of fractures of the distal radius often results in malunion. The reasons are discussed. The method of the percutaneous Kirschner wire transfixation for stabilization of the fracture is described. We have seen good results with this method and employ it because of its easy performance and safety. 32 patients with different kind of fractures of the distal radius were treated thus with satisfactory results. Advantages and disadvantages of the Kirschner-wire method are discussed.


[Bone and joint replacements with bioceramic endoprostheses].

Construction principles, mechanical and animal experiments with various types of endoprostheses consisting of dense alumina are reported as well as the first results in man. A stable implantation of this biocompatible material is possible, if the primary attachment by means of special construction features and subtile operation technique is ensured. The definite dixation of the implant is provided by the ingrowth of newly formed bone tissue in circular running indentations. Therefore the use of bone cement, one of the critical points in replacement surgery, can be avoided. In tumor surgery the replacement of the proximal humerus by a ceramic prosthesis has proven to be successful. Equally satisfactory results could be achieved in the therapy of osteoarthritis of the hip with a metal-ceramic composite endoprosthesis.


Intra-aortic balloon pumping in coronary artery disease.

Cardiogenic shock and severe left ventricular failure after acute myocardial infarction, refractory angina pectoris at rest either of new onset or superimposed on stable angina pectoris, or occurring in the post infarct (less than 2 weeks) period, and the suspicion of a slowly evolving infarction are the main indications for intra-aortic balloon pumping at the Thoraxcenter. 76 patients were treated with intra-aortic balloon pumping for cardiogenic shock after acute myocardial infarction and left ventricular failure, 42/76 (55%) could be weaned, 9 (12%) died within 3 months, 33 (43%) survived over 3 months, to date 29 are alive. 42 patients with refractory angina at rest were treated with intra-aortic balloon pumping. Pain relief was prompt in 41 (98%), who subsequently underwent coronary artery bypass grafting. Total myocardial infarction rate was 11% (5/42), total mortality rate was 7%. Perioperative myocardial infarction rate was 8% (4/42) and perioperative mortality was 7% (3/42). Pain relief was prompt in 14/17 patients (82%) with post infarct refractory angina. In 3 patients pain persisted despite intra-aortic balloon pumping, all sustained a myocardial infarction, 1 died, 2 other patients were excluded for surgery. 12 patients underwent coronary artery bypass grafting, none died, none developed acute myocardial infarction, 3 have mild stable angina. In 8 patients a slowly evolving myocardial infarction was suspected. Pain relief was prompt in 7/8 (88%) after institution of intra-aortic balloon pumping. Intra-aortic balloon pumping improves prognosis in cardiogenic shock after myocardial infarction, and abolishes refractory ischemic pain.


Early and long-term prognosis after vasodilator therapy in the acute phase of myocardial infarction.

Cautious administration of vasocilator agents with careful hemodynamic monitoring may improve cardiac function in many patients with severe pump failure and cardiogenic shock complicating myocardial infarction. However, the immediate prognosis tends to improve only in a specific subset of patients, that is, those with left ventricular stroke work index above 10 g.m/m2 and elevated left ventricular filling pressure. In the presence of very severe pump failure, cardiogenic shock, stroke work index of less than 10 g.m/m2 and grossly elevated left ventricular filling pressure, vasodilator therapy alone does not tend to improve in-hospital mortality. Furthermore, the long-term prognosis in the survivors with severe pump failure complicating myocardial infarction remains unfavorable. The poor prognosis of these patients is probably a result of the extensive myocardial necrosis sustained at the onset of infarction.


[Echocardiographic results in female athletes, nonathletic women and patients with arterial hypertension (author's transl)].

Echocardiographic studies and radiological measurements of heart volume were performed in 30 female track athletes, 17 female shot-putters or javelin throwers, 12 nonathletic women and 8 female patients with arterial hypertension. The following observations were made: The hearts of the female athletes undergoing endurance training were in the whole larger than the hearts of the nonathletic women, although the ratio of internal diameter to wall thickness was unchanged. There was a relative increase in the ratio wall thickness to internal left ventricular diameter in the female shot-putters and javelin throwers compared to the nonathletic females. This is interpreted as being a result of the static training imployed. In all female patients with severe arterial hypertension the heart wall thickness was increased, the internal heart diameter was dependant of the stage of the illness. Using echocardiography it is possible to draw conclusions as to the ratio wall thickness to cavity diameter. This is not possible with radiological heart volume studies.


[Medico-legal studies on the deaths from coal-mine accidents. 1. Cadaveric phenomena (author's transl)].

The authors have investigated the cadaveric phenomena on 30 persons killed in coal-mine accidents being kept in pits for a long time after death. The conclusions are as follows: The appearance and progress of cadaveric phenomena in pits depend on the postmortem interval alone, not on the immediate causes of death which have been found to be of seven classes in coal-mine accidents. The phenomena on cadavers kept in pits are the same as those in the air of normal temperature on earth. The reason may be that there are both accelerative factors and suppressive factors among various environmental factors in pits after occurrence of accident and they offset each other to make no difference between cadavers in pits and those on earth.


[Studies on phenotype, development, and viability of human spontaneous abortuses with acrocentric trisomies and polyploidies: with reference to the relationship of the viability to the origin of extrachromosomes (author's transl)].

The specimens to be presented consist of 65 trisomics and 37 polyploids which were obtained from a cytogenetic survey of human spontaneous abortion with various chromosome banding techniques. The phenotype of the 102 abortuses was analysed macroscopically before and after fixation of the tissues. The developmental age was estimated with the crown-rump measurement and from stage of Streeter's horizon on embryos and fetuses, or from the size of the placenta when an embryo was lost. The degree of phenotypic abnormality and the developmental age were used on determining the viability of abortuses. This viability was examined in each type of chromosomal anomlies. Three of 4 13-trisomics and all of 4 21-trisomics showed normal phenotype and advanced development, while most of 14-trisomics, 15-trisomics and 22-trisomics had the various severe phenotypic anomalies such as blighted ovum and disorganized embryo, and less developed. These findings suggest that abortuses with the chromosomal anomalies which can be found in the newborns longer survive than those with other anomalies. In other words, these anomalies have a better viability among abortuses. Eleven trisomics and 11 polyploids were ascertained for the origin of extra chromosomes by sequential QFQ- and RFA-banding. Of 7 abortuses with trisomy 21 studied, 4 originated at the maternal meiotic non-disjunction and none was of paternal origin. On the other hand, several published studies have shown that the paternal origin is not uncommon in Down children. Therefore, as far as trisomy 21 is concerned, it is concluded that the trisomy 21 of paternal origin has much better survival rate than that of maternal origin. In triploidy, the present study could not define the relationship between the viability and the origin, since 9 of 10 abortuses studied and all of 4 triploid newborns so far reported are of paternal origin.


[Morphological studies of the omental milk spots in the mouse: light and electron microscopy (author's transl)].

In adult dd-mice of both sexes ranging in age from 2 to 8 months, the omental milk spots were studied by light and electron microscopy. 1. Omental milk spots could morphologically be classified into two types, namely, type I and type II. 2. Type I spots were seen on the margin of the fatty tissue along the omental artery and vein. This type of spots were supplied with capillary vessels. 3. Type II were scattered on the omental peritoneum, particularly in abundance on the dorsal layer of the omentum. The spots of this type generally had no vascular supply. Type II milk spots on the dorsal layer were significantly more numerous in females than in males. 4. The two types of milk spots were composed mainly of macrophages, lymphoid cells and lymphocytes, although the constituents were different in proportion between the two types. The type I spots had abundant macrophages especially in the superficial zone. Lymphoid cells and lymphocytes were relatively abundant in the deeper zones. The type II were also abundant in macrophages which were scattered diffusely in the spots. 5. Macrophages had slightly PAS positive cytoplasm which contained PAS positive granules and vacuoles. Macrophages in the superficial zone of the spot were large with abundant lysosomes and vacuoles. Lymphoid cells were more or less similar in appearance to lymphocytes, but their cytoplasm was more abundant than that of lymphocytes, and had lysosomes and bundles of microfilaments. In addition, large macrophages were also distributed diffusely within the fatty tissue along the omental vessels and between the opposed peritoneium of the omentum. They had abundant light cytoplasm with numerous projections on the surface. The organelles were generally well developed. The cytoplasm had abundant lysosomes, coated vesicles and small tubules. Lymphocytes were generally small lymphocytes. 6. The endothelial cells of capillaries in type I spots were fenestrated. 7. The functional significance of the two types of spots was discussed on the basis of the structure.


[Sex difference in the mouse milk spots, with special reference to its development and formation (author's transl)].

As reported previously, the omental milk spots in the mouse are morphologically classified into two types; type I and II. Type II milk spots are distributed on the dorsal layer of the omentum, and they are more numerous in females than in males. The type II milk spots appear at first at 10 days of age, and then gradually increase in number equally in both sexes until 2 months. After 2 months, however, the density of the spots is significantly greater in females than in males. In male mice which have been gonadectomized at 1 month, the type II spots show remarkable increase in density, and they are as frequent as those in normal females. Administration of testosterone to gonadectomized males and normal females causes a significant decrease in density of the spots. Estriol, progesterone and gonadotropin exhibit no significant effect on the density of the spots. From the results obtained, it can be concluded that the existence of testis, namely testosterone, plays a major role in development of sex difference in type II milk spots.


Glucose, insulin and somatostatin infusion for the determination of insulin resistance in liver cirrhosis.

Twelve patients with liver cirrhosis and ten normal subjects were studied. Using a constant intravneous infusion of glucose, insulin and somatostatin over 2 1/2 hours we determined the stteady state plasma glucose level (SSPG) in order to measure insulin resistance. The results demonstrated that the cirrhotic patients were insulin resistant compared to normals and that plasma glucagon does not account for the insulin resistance in these patients.


Effect of pentobarbital and urethane on the release of hypothalamic somatostatin and pituitary growth hormone.

Hypothalamic somatostatin release was investigated in the rat to elucidate the mechanism of anesthetic action on growth hormone (GH) release from the pituitary. Intraperitoneal injection of sodium pentobarbital (5 mg/100 gm B.W.) significantly elevated serum GH levels and increased hypothalamic somatostatin concentration from basal values of 0.98 +/- 0.01 to 1.21 +/- 0.06 ng/mg wet wt. In contrast, urethane (150 mg/100 gm B.W., IP) administration lowered serum GH levels and hypothalamic somatostatin concentration (0.64 +/- 0.04 ng/mg wet wt.). However, the mean concentration of pancreatic somatostatin showed no change in either case. In rats receiving passive immunization with 0.5 ml rabbit antiserum to somatostatin (SRIF-AS), serum GH levels were significantly increased (67.5 +/- 12.3 ng/ml) and did not differ from those in the group treated with normal rabbit serum (NRS) plus pentobarbital (101.3 +/- 18.5 ng/ml). However, serum GH levels in rats injected with SRIF-AS plus pentobarbital were increased to higher values than in rats given SRIF-AS alone. When urethane was administered to rats after passive immunization with SRIF-AS, urethane-induced suppression of serum GH levels was markedly inhibited (5.5 +/- 2.0 vs. 33.5 +/- 7.5 ng/ml). These results suggest a possibility that the changes in serum GH levels observed with pentobarbital or urethane administration may be induced at least in one part by somatostatin released from the hypothalamus.


Effect of thyroxine treatment on metabolic responses to a single insulin injection.

Metabolic responses to a single i.v. injection of cristalline insulin (0.2 i.u./kg b.w.) were compared in control and T4-treated dogs both at rest and after prolonged physical exercise. The post-insulin decrease in blood glucose was significantly correlated with the pre-insulin BG concentration. Thus, the insulin-induced fall of BG was greatest in T4-treated dogs at rest, in which significantly higher BG levels were found in comparison with controls, and smallest in the same dogs after exercise, i.e. at the lowest initial BG concentrations. The post-insulin hypoglycaemia caused marked increases in the plasma FFA level in control dogs, both at rest and after physical effort, and in T4-treated dogs at rest. They were accompanied by elevations in the plasma adrenaline levels. In T4-treated dogs given insulin after exercise decreases both in the plasma FFA and A concentrations were found. In the majority of the control and T4-treated dogs insulin injected at rest caused an increase in blood LA levels, being more pronounced in the latter. Insulin injected after physical exercise did not change blood LA level in T4 treated dogs, and it caused its decrease in the control animals. The results of these investigations show that both T4-treatment and physical exercise, performed prior to insulin injection, modify the metabolic response to insulin and post-insulin hypoglycaemia.


The chloride phosphate ratio as the screening test for primary hyperparathyroidism.

Serum chloride and phosphate concentrations were measured in 79 hypercalcemic patients. The chloride values were higher (mean 106.7 mEq/l) and phosphate lower (mean 2.08 mg/100 ml) in the 53 hyperparathyroid patients, where as the chloride concentrations were lower (mean 99.3 mEq/l) and phosphate higher (mean 4.07 mg/100 ml) in the 26 patients with hypercalcemia from other causes. The chloride phosphate ratio ranged from 19 to 32 in the subjects with hypercalcemia from other causes with 90 per cent of values less than 30. In patients with primary hyperparathyroidism we found 96 per cent of the values more than 34. From our experience with chloride phosphate ratio it seems to us that this ratio is a very useful and simple preliminary test for distinguishing patients with primary hyperparathyroidism from patients with hypercalcemia from other causes, with normal renal functions.


Changes of maternal and fetal pituitary-adrenocortical functions during human labour.

The results of maternal 11-hydroxycorticoid (11-OHCS) determination on blood obtained from four stages of 44 spontaneous labour cases showed a strong and time-related maternal adrenocortical activation during vaginal delivery. The high 11-OHCS level in the cord blood and the increase of the 11-OHCS concentration in the amniotic fluid suggested the same response of the fetal adrenal. However, in 14 cases of elective caesarean sections the 11-OHCS levels in the cord blood and the amniotic fluid did not rise in spite of the elevated maternal plasma 11-OHCS content.


Adipose tissue cellularity in hypo-and hyperthyroid rats.

To determine adipose tissue cellularity in hypo- and hyperthyroidism, male rats were thyroidectomized after weaning (T) and injected daily with either 0, 0.1, 1.8 or 25 microgram of L-thyroxine/100 g body weight for 40 days. They were compared with intact controls (C). Both epididymal fat-pad weight and adipocyte diameter were reduced in T+0, T+0.1 and T+25 animals. When corrected per unit of body weight, the diameters of adipocytes from T+0 and T+0.1 animals were larger than in the other groups. Those same animals have reduced absolute adipocyte number but not when corrected per unit of body weight. The fat-pad protein concentration varied conversely with the fat cell diameter. These findings indicate that thyroid hormone deficiency reduces the proliferation of fat cells in parallel with body growth while hyperthyroidism causes reduction in the size, but not the number, of fat cells which corresponds to its depletion of fat storage.


An imidazole derivative (Econazole) as an antifungal agent in cell culture systems.

Econazole, an imidazole derivative, was tested as an antifungal agent in different cell culture systems. In comparison with Fungizone, Econazole has the following advantageous properties: higher stability, higher solubility, better antifungal activity against contaminants of cell cultures and a wider range between minimal inhibitory to cytotoxic concentration with Aspergillus fumigatus, Candida albicans and Penicillium sp., activity against gram-positive bacteria and lower price. Econazole exerts no antiviral effect and can therefore be used for virus isolation from heavily contaminated material. The antagonistic effect of serum on the antifungal effect of Econazole and Fungizone was comparable as was the inhibitory effect of both antimycotics on Mycoplasma growth. In view of the above mentioned properties Econazole lactic acid can be recommended as an antifungal agent for cell culture systems at a concentration of 1 microgram per ml.


Major metabolic pathways and hormone production in unstimulated monolayer cultures of the rat anterior pituitary.

In cell cultures derived from anterior pituitary glands of rats, enzyme activities of cell homogenates and hormone (GH, PRL, LH, and FSH) content of the culture media were measured. Sex differences in enzyme activities representing major metabolic pathways (citrate cycles, pentose cycles, and glycolysis) were demonstrated both in freshly dispersed cells and in 8-day-old cultures; in cultures of both sexes enzyme activities increased during cultivation. In cultures derived from female rats, cell protein doubled by the 12th day and remained constant for up to the 24th day in culture, whereas enzyme activities showed changes suggesting that cell metabolism shifted to anaerobic glycolysis during cultivation. In the culture media the presence of four pituitary hormones was demonstrated for as long as 3 weeks of cultivation with variable secretion dynamics; the release of gonadotropic hormones diminished gradually whereas that of GH remained constant and PRL levels increased with time. These results indicate that under strictly defined culture conditions pituitary cells may function in spite of profound metabolic changes.


Corticosteroid-dependent differentiation of human marrow preadipocytes in vitro.

A unique population of human bone marrow-derived, adherent fibroblastlike cells differentiates to adipocyte morphology when grown in vitro in the presence of horse serum and hydrocortisone sodium hemisuccinate. Over the initial 8-weeks growth at 37 degrees C, 7% CO2, these cells accumulate Oil Red O-positive lipid and form colonies of over 100 cells, which persist in confluent cultures for over 30 weeks. Similar to cultures derived from mouse marrow, corticosteroid-induced adipocyte differentiation is associated with long-term granulopoiesis. Human marrow preadipocytes, as well as human, mouse and rat embryo fibroblast cell lines, failed to differentiate to adipocyte morphology in the presence of insulin. In contrast, the 3T3-L1 insulin-dependent preadipocyte cell line was not induced to differentiate in the presence of hydrocortisone. These studies demonstrate that human marrow preadipocytes are dependent upon corticosteroid for differentiation in vitro.


Mast cell membrane antigens and Fc receptors in anaphylaxis. I. Products of the major histocompatibility complex involved in alloantibody-induced mast cell activation.

Mast cell membrane antigens, coded by the K, I and D regions of the major histocompatibility complex of the mouse, were investigated for their presence at the cell surface and their participation in alloantibody-induced anaphylactic degranulation (DAAD). Anti-H-2 K, as well as anti-H-2 D antibodies were found to elicit DAAD. Recognition, on the mast cell membrane, of any product of the K or the D regions, either as the whole molecule, or as public or private antigens only, or even as a single private specificity, enabled alloimmune sera to trigger mast cell degranulation. By contrast, anti-Ia antibodies failed to elicit DAAD. By the autoradiographic technique, peritoneal mast cells were found to constitute a single homogeneous population, bearing H-2 D-coded antigens, although in smaller amounts than other peritoneal cells, but no Ia antigens or, if any, in much smaller amounts than other peritoneal cell type. These findings bring new evidence that mast cell alloantigens do participate in anaphylactic alloantibody-induced mast cell degranulation, by allowing bridging of (one?) Fc receptor with H-2 molecules.


IgE and IgG1 antibody production by a soluble product of Ascaris suum in the guinea-pig.

Third-stage larvae of Ascaris suum cultured to the fourth stage in a chemically defined culture medium produced a substance, the 'ACF antigen', which was allergenic in the guinea-pig. When three different concentrations (3.1, 31 and 62 micrograms) of the ACF antigen were given intraperitoneally, only the highest concentration induced a primary IgE specific antibody response (1:100 titre) as determined with the passive cutaneous anaphylaxis reaction. Upon secondary exposure all concentrations demonstrated a strong IgE response (1:50,000 peak titre) with very little IgG1 activity (1:100). The secondary IgE responses began to rise on the fourth day, peaked on the sixth day and returned to relatively low levels by the fourteenth day (1:100). The intramuscular administration of the ACF antigen did not induce the extremely high titres of IgE as found with the intraperitoneal injection, but rather a low level response (1:500 peak) which did not differ greatly from the IgG1 response.


The heterogeneity of Fc receptors on human peripheral mononuclear blood cells.

Fc-receptor positive peripheral blood mononuclear cells (PMBC) behaved differently after a temperature shift from 4 to 37 degrees. Two types could be distinguished. Type I FcRI+PMBC were transformed to FcR-while type II FcRII+PMBC retained their FcR as measured by EA rosettes. The supernatants of the PMBC or the shed receptor purified on a Sepharose 4B-aggregated human IgG column blocked the EAR formation of FcRI+PMBC but had no effect on EAR information of FcRII+PMBC. An investigation was made into the reason why rosette formation by Fcrii+ cells could not be inhibited by FcRI. As an explanation, the role of differences in affinity or subclass specificity was excluded while the binding site(s) on the IgG molecule for FcRI and II proved to be different. The FcRII+PMBC had a greater cellular avidity for sensitized erythrocytes than FcRI+PMBC. The different states of FcR-s in the cell membrane are discussed as a possible source of heterogeneity.


Effect of stimulation and blockade of mononuclear phagocyte system on the delayed footpad reaction to SRBC in mice.

The delayed footpad reaction to sheep erythrocytes (SRBC) was studied in mice whose mononuclear phagocyte system (MPS) was blocked or stimulated. Colloidal carbon or carrageenan was used for the blockade of MPS and Corynebacterium parvum or diethylstilbestrol used for the stimulation. The optimal dose of SRBC for the induction of the delayed footpad reaction was lower in MPS-blocked mice than in non-treated mice, whereas a high dose of SRBC was required for the induction of the strongest delayed footpad reaction in MPS-stimulated mice. These results suggest that non-specific phagocytic function of MPS modulates subsequent immune responses after administration of antigens.


Fc-mediated immune precipitation. I. A new role of the Fc-portion of IgG.

By comparing the amounts of precipitate formed by the reaction between human serum albumin (HSA) and isomolar solutions of rabbit anti-HSA F(ab')2 fragments and of the corresponding intact rabbit anti-HSA IgG, respectively, it was found that the Fc portion of IgG was of great importance for the precipitin reaction. In the present antigen-antibody system, about half of the antigen was precipitated by this mechanism. This effect was called Fc-mediated precipitation  and was most clearly expressed in the biologically important zone of low antigen excess and the zone of equivalence. It was found that the pepsin digestion did not change the ability of the F(ab')2 fragments to bind the antigen in comparison to intact IgG. Furthermore, turbidimetric analyses indicated that the Fc portion was involved in the overall mechanism of the precipitin reaction throughout the range of the precipitin curve.


Fc-mediated immune precipitation. II. Analysis of precipitating immune complexes by rate-zonal ultracentrifugation.

The formation of immune complexes was studied by analytical rate-zonal ultracentrifugation using isomolar solutions of rabbit anti-human serum albumin IgG and of the corresponding F(ab')2 fragments. The F(ab')2 fragments retained full ability to react with the antigenic determinants and to form genuine antigen-antibody complexes. Thus, the difference between the IgG and the F(ab')2 systems was supposed solely to reflect the lack of the Fc portion. The complexes formed with F(ab')2 fragments in the zone of low and moderate antigen excess were found to be distinctively mor soluble than those formed with intact IgG. The data indicated that there were two kinds of precipitating immune complexes, namely antibody-rich and antigen-rich complexes. In the antibody-excess zone and the first part of the equivalence zone the immune complexes precipitated due to their antibody richness. Antigen-rich complexes formed in the zone of low antigen excess precipitate only in the presence of antibody-rich insoluble complexes. It is believed that this type of precipitation was due to an Fc-Fc interaction. This new function of the Fc portion of IgG was designated Fc-mediated immune precipitation.


Activation of mouse complement by different classes of mouse antibody.

The capacity of mouse IgM, IgGl, IgG2 and IgA anti-dinitrophenyl (DNP) antibodies to activate mouse or guinea-pig complement was studied, using a sensitive haemolytic assay and two-dimensional immunoelectrophoresis to detect cleavage of mouse C3. Three monoclonal IgM antibodies, and a heterogeneous IgM fraction, lysed trinitrophenylated erythrocytes in the presence of guinea-pig C, but failed to produce lysis in the presence of mouse C. and only activated mouse C3 very inefficiently. A monoclonal IgGl antibody did not produce haemolysis in the presence of guinea-pig or mouse C, but cleaved mouse C3 via the alternative pathway. Two IgA myeloma proteins (M315 and M460) had similar properties. A heterogeneous IgG2 antibody fraction produced haemolysis in the presence of both mouse and guinea-pig C, and was shown to activate both the classical and alternative pathways of mouse C.


Antibody affinity and clearance function studies in high and low antibody affinity mice. The effect of protein deficiency.

The effect of dietary manipulation on the relationship between macrophage clearance function and antibody affinity has been investigated in genetically selected high and low affinity mice. The results confirm that protein deprivation reduces the clearance rate of polyvinylpyrrolidone (Kpvp) and the relative affinity (Kr) of antibody to human serum albumin in mice normally producing high affinity antibody. Although protein deprivation of mice of the low affinity line reduced Kpvp, the mean Kr was not altered. Furthermore, although the two lines had significant differences in Kr values there were no demonstrable differences in macrophage clearance function as assessed by clearance of PVP, radiolabelled aggregated IgG and preformed antigen-antibody complexes. Analysis of values of Kr and Kpvp in individual animals indicated that these two parameters are not correlated. These experiments, provide further evidence for the profound effect of dietary manipulation on the immune response and suggest that in these genetically selected mice at least, the genetic control of antibody affinity is exerted at a level other than that measured by macrophage clearance function tests.


Induction of cell-mediated cytotoxicity by lipoprotein containing histocompatibility antigens.

Lipoprotein was isolated from tumour cells by sonication and ultracentrifugal flotation on KBr gradients. It contained H-2 antigen detectable by antibody binding and induced a primary or secondary cell-mediated cytotoxic response in vitro which was H-2 specific. In a syngeneic model only a secondary cell-mediated response was stimulated and no competitive inhibition of the effector step of cell-mediated lysis could be demonstrated. The implications of these findings are discussed.


Inhibition of IgE binding to tissue culture cells and leucocytes by pentapeptide.

The specific binding of radiolabelled IgE to a tissue culture lymphoblastoid cell line (Wil-2WT) was confirmed. The binding of IgE and Hamburger's IgE-derived pentapeptide Asp-Ser-Asp-Pro-Arg (HEPP) to Wil-2WT cells and to human leucocytes was compared. HEPP inhibition of IgE binding to leucocytes averaged 24% but with Wil-2WT cells only 12% inhibition was observed with double the amount of HEPP. Using myeloma IgE to inhibit the binding of tritiated HEPP to leucocytes and Wil-2WT cells confirmed the specificity of the peptide binding as well as the greater affinity of HEPP for leucocytes (basophils) compared to Wil-2WT lymphoblastoid cells. Based upon the extent of binding and the maximum inhibition attainable with HEPP it is suggested that the receptors for IgE on Wil-2WT cells, basophilic leucocytes and mast cells are not identical but that they share specificities in common. A new hypothesis for the mechanism of action of HEPP is proposed.


A hand grip dynograph and weighing machine : twin application of a simple principle.

A hand grip dynograph and weighing machine have been developed by applying the relationship 'force/area = pressure'. Force is applied to a relatively constant area provided by the partially inflated bladder taken from the compression cuff of a sphygmomanometer. Under such circumstances, the rise in pressure is proportional to the force applied, and after calibration, the pressure reading can be used to deduce the force. Thus the force, be it in the form of hand grip strength, or in the form of body weight, can be measured. The maximum isometric hand grip tension measured by the reported device and a standard instrument are well correlated (r = 0.86). The relative load isometric endurance tests performed on the two instruments do not compare favourably (r = 0.23). The estimations of body weight performed on the device described here and a standard machine are very closely related (r = 0.98). The devices are simple, sturdy and inexpensive. Their applications are discussed.


Diuresis during fluid infusion : buffer nerve and spinal influences on it.

The rate and cumulative volume of diuresis were measured sequentially for each incremental infusion dose of 5 ml/kg body weight till a 100 ml/kg or more dose was reached. Normal saline (NS), Ringer-Locke (RL) and tender coconut water (TCW) were infused in three groups each of paraldehyde (PLD), and chloralose and urethane (C & U) anaesthetised dogs. The slow infusion rate of about 0.5 ml/kg/min was used. The RL infusion was repeated in vagotomised and/or carotid sinus (CS) denervated dogs and spinal dogs with or without intact vagi. During the NS and RL infusion schedules in PLD anaesthetised dogs produced much less urine than C & U groups. The order of minimum to maximum diuretic effect caused by these fluids were RL, NA and TCW in PLD groups and NA, TCW and RL in C & U groups. The study indicates that the type of anaesthesia and the composition of infusion fluid determines the rate of infusion induced diuresis. PLD anaesthesia has antidiuretic effect, which is not overcome by vagotomy. In C & U anaesthetised dogs the vagotomy and CS denervation performed separately greatly increased the rate of infusion induced diuresis but the diuresis largely decreased when combined surgery was performed. The diuresis in spinal dogs was very low, though in the vagotomised-spinal dogs, the rate of diuresis was more than in the spinal dogs.


Endurance capacity for continuous effort in terms of aerobic and anaerobic fraction of oxygen supply.

Studies have been conducted on 13 young healthy adults of average fitness on endurance work of varying durations lasting for 2-31 minutes using bicycle ergometer. Aerobic-anaerobic fractions of oxygen supply during each effort was determined. The data from Astrand and Rodahl on aerobic O2--supply and duration in maximal efforts from 1-120 minutes on a highly trained subject have also been considered. The plot of log endurance time against log (aerobic/anaerobic ratio) exhibits a slight departure from linearity, indicating independent contributions from aerobic and anaerobic fractions of oxygen supply. An equation was derived of the form: T - Au1k1u2--k2 where u1 end u2 are the aerobic and anaerobic fractions respectively which has been found to yield highly significant correlation coefficient between log-estimated and log-observed endurance time (0.9996 for Astrand and Rodahl's data on a single subject and 0.9640 for the present data on 13 subjects). This index is, therefore, quite suitable for the assessment of endurance capacity in terms of a single physiological parameter, and is likely to be superior to indices in current use.


Influence of hormones on accessory sex glands in males.

Administration of testosterone, oestrogen, progesterone and prolactin for seven days affected the epididymal lipids markedly whereas seminal vesicular and prostatic lipids were less affected. The increase in total lipids of caput epididymis by testosterone, oestrogen and progesterone was due to an elevation in neutral and phospholipid contents. However, progesterone alone caused an increase in total lipids of the cauda epididymides while oestrogen and prolactin decreased the same. In seminal vesicle and prostate, testosterone elicited a significant rise in total lipids. However, an opposite trend was obvious by the other three hormones. Testosterone alone was effective in elevating the total lipids, phospholipid, cholesterol and glycerides in prostates. Prolactin does not affect the prostatic lipids markedly. The significance of the lipid changes are discussed in relation to various physiological activities of sex accessories.


Effect of garlic on normal blood cholesterol level.

The effect of raw garlic on normal blood cholesterol level in males of the age group of 18-35 years was studied. The subjects, who never ingested garlic before, were given 10 g of garlic daily with their diet for two months. Fasting blood samples were investigated in respect of cholesterol before and after two months of garlic intake. Initially the blood cholesterol level ranged between 160-250 mg% which decreased significantly in all the subjects of experimental group after two months of ingestion of garlic. The slight decrease or increase in the blood cholesterol level of control group was not significant. The raw garlic can be advocated for daily ingestion in order to lower one's blood cholesterol level even if it is within normal limits.


Effect of pregnancy and thyroidectomy on the rat spleen.

Pregnancy caused a significant increase (P less than 0.001) in the ascorbic acid and cholesterol concentrations in the spleen as compared to the controls, indicating a rise in its metabolic functions. When thyroid gland was removed either from the non-pregnant animals or at different stages of gestation from pregnant animals, there were significant (P less than 0.001) fall in the levels of these biochemical parameters as compared to the corresponding intact groups. These findings indicated that splenic functions undergo certain changes during pregnancy and the thyroid hormones significantly influence them.


Influence of increased anatomical dead space no functional residual capacity of lungs and the lung clearance index.

A study of the influence of added anatomical dead space on the functional residual capacity of the lung was carried out on a total number of 40 healthy subjects of ages ranging between 21 and 50 years. The functional residual capacity was found to decrease as additional dead space was introduced in the breathing circuit. This decrease was associated with an increase in tidal volume, lung functions, as given by the lung clearance index, were found to deteriorate with each addition of dead space. There was also an increase in pulse rate in all age groups.


Possible mechanism of hydrocortisone induced eosinopoenia.

Hydrocortisone (HC) injection in rabbits induced eosinopoenia (reduction in absolute eosinophil count) which could be successfully abolished by beta--adrenoceptor antagonists, a propranolol, sotalol, practolol and H 35/25 but not by alpha--adrenoceptor antagonist, phenoxybenzamine. Reserpine per se produced eosinopoenia followed by eosinophilia. However, reserpine pretreatment failed to abolish HC-induced eosinopoenia. It is suggested that the eosinopoenia is mediated through beta--adrenoceptors, which could not be differentiated into beta 1/beta 2--adrenoceptor subtypes as has been possible for other beta-adrenoceptor mediated responses.


The Portsmouth method of external fixation of complicated tibial fractures.

A New method of external fixation for complicated fractures of the tibia is described. The use of acrylic cement to secure the tibial transfixing pins to the external bar and the ability to apply compression across the fracture site are the salient features of this technique, which is simple to use and inexpensive.


Proximal femoral fractures in psychiatric patients.

During an 8-year period, 122 inpatients of a psychiatric hospital sustained fractures of the proximal part of the femur. They were treated by operative as well as by conservative methods and their subsequent mobility, morbidity and mortality have been reviewed. The results suggest that these patients are best managed within their familiar environment, that femoral head replacement arthroplasty is appropriate for high fractures and that the prevention of bedsores in conservatively treated patients is of great importance.


Histamine receptors in guinea-pig isolated urinary bladder.

Spasmogenic action of histamine, 2-(2-aminoethyl) pyridine (H1 receptor agonist) and 4 methyl-histamine (H2 receptor agonist), have been studied in guinea pig isolated urinary bladder in the presence of mepyramine (H1 antagonist) and metiamide (H2 antagonist) to identify the presence of H1 and H2 receptors. The study suggested the presence of H1 as well as H2 receptors in this preparation.


External rotation and abduction fractures around the ankle joint treated by internal fixing using AO instrumentation.

One hundred and three displaced malleolar fractures of the ankle joint were treated by one orthopaedic firm between 1968 and 1974. Originally, 150 patients were reviewed, but 47 patients were excluded from the series for the following reasons: associated fractures of the lower tibia (10), associated fractures of the talus (3), inadequate follow-up (15) and patients lost to follow-up (19). Only patients who were followed up for at least one year were included in the series. The purpose of this study is to present the results obtained by treating displaced malleolar fractures using AO instrumentation.


Antispasmodic activity of the tertiary base of Daucus carota, Linn. seeds.

A nitrogen containing base responding to Mayer's test and Dragendorff's reagent for tertiary bases has been isolated from the seeds of Daucus carota Linn. The effects of the base as its bromide have been studied on smooth muscles of ileum, uterus, blood vessels and trachea of different species of animals. The tertiary base has been found to have papaverine like nonspecific smooth muscle relaxant and spasmolytic activity, but its activity was found to be about one-tenth of that of papaverine.


Effect of some drugs on human appendix in vitro.

Muscarinic action of acetylcholine was demonstrated in the human isolated appendix. Histamine-induced contractions seemed to the mediated by H1 receptors. Nicotine and DMPP-induced contractions were mediated through their action on ganglion cells. Experiments with adrenergic drugs suggested the presence of beta receptors.


Avulsion of the cranial margin of the scapula: a report of two cases.

Two cases of avulsion of the cranial margin of the scapula are presented. A review of the literature shows that the injury is usually part of more serious shoulder trauma, but the results of conservative management are excellent.


An analysis of the pattern of facial injuries in a general accident department.

Over a period of one year 20 549 new patients attended an accident and emergency department. Of these patients, 15 555 were victims of accidents, including 875 who had sustained facial injuries. This latter group comprised 609 patients with soft tissue trauma and 266 with skeletal injury. The frequency, aetiology, age and sex distribution of the facial injuries were analysed and compared with other published statistical surveys of facial injury. It is concluded that facial injuries constitute a significant proportion of the work of a civilian accident unit and that any accident service must have adequate facilities for the management of these injuries.


Acute blunt traumatic rupture of the diaphragm in a child.

Diaphragmatic rupture due to blunt trauma is rare in childhood. The possibility of such injury must be borne in mind whenever blunt abdominal and chest trauma is encountered. This paper reports a case of diaphragmatic rupture in a child with multiple injuries sustained in a road accident.


Pneumoperitoneum associated with pneumothorax or pneumopericardium: a surgical dilemma in the injured patient.

Three cases of 'idiopathic pneumoperitoneum' following injury are reviewed. Two cases occurred several days after initial injury and were associated with post-traumatic pneumothorax and artificial respiration. It is likely that artificial respiration induced pneumoperitoneum in these cases. The third case of pneumoperitoneum occurred one hour after initial injury and was associated with bilateral pneumothoraces and pneumopericardium. Congenital abnormalities and tension pneumothorax were thought to account for this case of 'idiopathic pneumoperitoneum'.


Traumatic closed avulsion of the upper ureter.

Six cases of avulsion injury to the pelvi-ureteric junction due to blunt abdominal trauma are reported. Primary repair was done in three cases and nephrectomy in the rest. The special problems in the diagnosis and treatment are discussed. Pelvi-ureteric junction rupture due to blunt external trauma is a distinct clinical entity. The early diagnosis of the injury is rendered difficult by the paucity of early clinical signs and symptoms. A high index of clinical suspicion and early intravenous pyelography in suspected cases will improve the percentage of cases diagnosed. The treatment of choice is primary repair by ureteropelvic anastomosis. In selected cases where primary anastomosis is not possible procedures such as ureterocalycostomy or the use of an ileal segment may be feasible. As the injury commonly occurs in young children, renal preservation is of paramount importance and nephrectomy should be performed only as a last resort.


The value of the Hoffmann skeletal fixation in the management of cross-leg flaps, particularly those injuries complicated by open fractures of the tibia.

The Hoffmann external fixator has been used to immobilize lower limbs for the application of cross-leg flaps in the presence of tibial fractures. The legs and the fracture are held rigidly in the optimal position during and after the operation, with ease of adjustment and excellent access to the flap. There is relatively less weight on the legs than when using a plaster cast, and with the joints free, the patient is much more mobile in bed.


A method of internal fixation of supracondylar fractures of the femur.

From 1968 to 1977 13 supracondylar fractures of the femur in patients aged 16 to 82 years were treated by fixing the fracture with a Wright knee plate. The technique described is bone suture rather than rigid fixation. Reasonably good functional results were obtained in all cases.


Early weight bearing in the treatment of fractures of the tibia.

The paper describes a simple and effective practical method of dealing with the fractures of the tibia by means of a long-leg walking plaster-of-Paris cast. The results are assessed in a series of 44 patients, 28 of whom were treated by early weight bearing, while the remaining 16 were treated by traditional closed methods. A simple system of grading tibial fractures is described in order to facilitate valid comparisons. The results conclusively show that the early weight bearing regime results in the fractures uniting in half the time of the late weight bearing series. Details of two cases in each grade of the early weight bearing series are given.


Treatment of subcapital femoral fractures by primary total hip replacement.

Primary total hip replacement for displaced subcapital fractures may be performed with an acceptable mortality. The majority of a series of patients who were reviewed after operation experienced few symptoms and 87 per cent were able to walk independently. These results compared favourably with other forms of management, and deterioration was seldom observed.