Errors in velocity measurement by the Pitot principle in fluids with slowly propagated pressure waves.

An attempt has been made to develop a velocity probe using the Pitot principle for the measurement of fluid velocities in cerebrospinal fluid. Pressures were measured using conventional transducers and amplifiers and the pressure difference signal has the predicted relationship to the square of fluid velocity in the steady state. However, in the clinical situation where slowly propagated pressure waves accompany cerebrospinal fluid movement the pressure difference incorporates an indeterminate term unrelated to velocity, and this imposes severe limitations on the technique. Measurements and discussion are presented.


The small volume plethysmograph. An improved instrument for measuring the setting shrinkage of composite dental restorative materials.

The small volume plethysmograph provides a continuous record of the volume of small specimens of composite polymeric dental restorative material as they set. Decreases, from initial volumes of around 100mm3, which occur over several hours can be measured to within +/- 0.1 mm3. The specimen is immersed in mercury which it displaces into a capillary tube. A decrease in specimen volume reduces the height of the mercury column in the capillary tube, and this change is sensed by a strain gauge pressure transducer whose output is recorded. Experience has proved the instrument to be stable and accurate with a linearity over its working range of +/-  0.06mm3.


The fibrous structure of bone determined by x-ray diffraction.

The fibrous structure of both primary and secondary type cortical bone is determined. The three dimensional fibrous orientation is expressed quantitatively by pole figures of the (002) diffraction. Whilst both types of bone exhibit one major axis of fibrous orientation which is aligned on average with the long axis of the femur, primary type bone exhibits a planar orientation which is consistent with a fibrous spread within the laminations but not from one lamination to the next. Secondary type bone exhibits a degree of preferred orientation with rotational symmetry about the main fibre axis.


A dynamometer for biomechanical use.

A dynamometer has been designed for measuring isometric forces in human body limb segments. The dynamometer constrains the chosen segment, and measures two orthogonal components of the force reaction between the segment and the dynamometer in a plane perpendicular to the long axis of the segment, plus the torque reaction parallel to the long axis of the segment. The testing and operating characteristics of the dynamometer are described, and it is concluded that in view of its versatility and accuracy, the dynamometer may be suitable both for research and for clinical use.


A nonlinear model for studying oscillations in the blood pressure control system.

The idea that physiological systems sometimes include oscillations as part of their control function is a relatively new idea; the paper discusses the role of such oscillations in the regulation of arterial blood pressure and how they can be studied by modelling techniques. A nonlinear model is proposed which can be related directly to the physiology. This is seen as an important step because mainly previous studies of biological oscillations have used lumped equations, e.g. the Van der Pol equation, which do not possess the property. On the basis of the model, the oscillatory behaviour of the blood pressure control system is analysed by the application of the dual input describing function technique, a powerful analytical method which has wide application to the study of nonlinear oscillatory phenomena in physiology. The final section of the paper considers the digital simulation of the model by Z transform techniques and how the simulation can be used to study the interaction of respiratory and blood pressure control systems.


The transfer of selected image data to a computer using a conductive tablet.

The processing and analysis of images in a computer often requires the selection of particular features of a complex image for more detailed study. Sometimes such decisions are empirical, in which case it would be extremely difficult to describe a rigorous algorithm for detecting these features automatically in a computer. In this situation graphic tablets can be very useful as they allow an operator to use experience in deciding which features are to be transferred into a computer. A tablet is described which uses a conductive glass plate and pencil probe. A number of subroutines are available in a general purpose program for conventional processing, calculation and displays to be effected by simple option selection on the tablet for specific applications in cell growth, modeling and three dimensional reconstruction of serial sections, special programs were developed which could include appropriate subroutines. The categorisation of subsections by an operator was particularly useful in allowing different methods of analysis and display to be applied to each. For example they could be displayed separately or given different dentisy levels by choosing the appropriate option in the program.


Quantitative analysis of the phonocardiogram for dectection of murmurs.

A method is proposed for quantification of the phonocardiogram (PCG) signal into two parameters representing time and frequency domain characteristics of the signal into two parameters representing time and frequency domain characteristics of the signal. For this purpose the energy curve and power spectrum of the signal are used. Results of application of the method to PCG signals of 8 normal and 39 pathological cases are presented. The study shows that the parameters of PCG signals with murmurs differ from those of normal signals and hence aid detection of murmurs. The algorithms involved are simple and a microprocessor-based automatic PCG analysis system using the proposed technique is being contemplated.


Constraints and fixation for implanted joint replacements.

Observations made on both cemented and uncemented joint prostheses after about two years of use show a layer of fibrous tissue next to the bone. The fibrous layer smooths over surface features up to 1mm in size, and must be assumed to be weak in tension and shear. Prosthesis-bone interfaces should therefore be designed to transmit all forces acting on the prosthesis as compressive stresses. The forces acting across prostheses are controlled by the constraints exerted by the articulating surfaces; if the useful ligaments present are allowed to do their job of transmitting tension, the articulating surfaces can be designed to transmit only such forces and moments as can safely be transmitted across the prosthesis-bone interfaces.


Pressure dependence of "the area micrometer" method in evaluation of cruciate ligament cross-section.

The intricate geometry of the cruciate ligament and the lack of adequate description of the methods used to obtain its cross-sectional area have complicated the normalization of the load-elongation data in terms of stress and strain respectively. An experimental study was undertaken to quantify the dependence on the applied pressure of cross-sectional area in canine ligaments. Twenty-two canine preparations were compressed with a non-rotating spindle blade micrometer (Mitutoyo, 122), whose thimble breakaway tongue develops a constant force of 1.96 N. By the use of matching pairs of plexiglass blocks of various widths, the applied pressure on the ligament could be varied between 0.041 and 0.355 MPa. Data from all the ligaments were reduced to a single curve which illustrates a decrease in the normalized cross-sectional area by 25% for pressures ranging from 0.04 to 0.36 MPa. For all pressures between 0.20 and 0.35 MPa the normalized cross-sectional area remained constant.


Load actions transmitted by implants.

The authors consider the mechanics of load transmission between a "conventional" femoral head replacement prosthesis and the shaft of the femur. The three dimensional loading pattern is now well known and the changes of interface stressing through a load cycle is considered. The actual stress situation depends on features of the implantation technique, the mechanical properties of all the materials involved in the relevant friction coefficient. From analysis of systems at the extreames of these limits, the authors suggest probable service conditions.


A model of bioelectrode motion artefact and reduction of artefact by amplifier input stage design.

Motion artefact voltages result from mechanical disturbances of bioelectrodes. For dry electrodes the effect of parameters related to the amplifier input stage on the artefact voltage is studied. The results indicate that the artefact voltage consists of two components termed delta R component and delta U component according to the motion-affected element. The delta R component is strongly dependent on the amplifier input resistance Rl and the input bias current lB. For negligible delta R artefacts Rl should be larger than 1 G omega and lB should be less than 50 pA when using bioelectrodes.


Fracture behaviour of commercial surgical acrylic bone cements.

The resistance to slow growth of three commercial acrylic bone cements has been evaluated. It was found that small additions of 1 micrometer diameter barium sulphate particles reduced the resistance to slow crack growth of Simplex P and CMW acrylic bone cements, while a small addition of the antibiotic Gentamicin had no detectable effect on cracking in Palacos R bone cdment.


Biomechanics of the femoral component of total hip prostheses with particular reference to the stress in the bone-cement.

Two-dimensional finite element analyses were used to determine the normal and shear stress distributions at the prostheses-cement and cement-bone interfaces in the femoral component of a total hip replacement. Various combinations of stem, cement and bone stiffnesses were investigated. In particular the influences of stem taper, cement stiffness, prosthesis stiffness and the effect of a plateau, on the cement stresses were examined and compared. It was particulary noticeable that the normal direct stress across the cement in the proximal region of the stem, both literally and medially, as generally compressive. It was found that the more flexible the cement the more uniform were the stress distributions. Furthermore, these stresses increase as the stiffness of the stem decreases.


[Investigations on the distribution of serum LDH isoenzymes of patients with carcinoma laryngis (author's transl)].

The distribution of lactate dehydrogenase (LDH) isoenzymes in healthy blood donors and in patients suffering histological identified tumor (neoplasms) laryngis was investigated. The values of 110 healthy persons (controls) proved to be comparable with the average data described in literature. The LDH distribution pattern of 90 tumour affected persons showed significant differences comparing with controls. The alteration appears as absolute increase in LDH-1 (H4) isoenzyme parallel with progressive decrease in the hybrid enzyme rations containing M subunits (LDH-2, LDH-3, LDH-4), and the LDH-5 consisting of four M sununits was undetectable. The conclusions drawn from our investigations seem to be in agreement with Warburg's conception, supposing that in malignant tumours the aerob glycolysis increases. The determination of LDH isoenzyme distributions for diagnostic purposes in clinical practice is recommended.


[A contribution to cytopathology of the pleomorphic rhabdomyosarcoma in the larynx (author's transl)].

Malignant mesenchymal tumors of the larynx are rare. They represent about 1% of all malignant tumors in the larynx. Among sarcomas the pleomorphic rhabdomyosarcoma seems to be exceedingly rare. Only 4 cases of pleomorphic rhabdomyosarcoma have been described in the larynx. Another case is reported including the description of the smear.


[The influence of experimental vestibular stimulation on directional hearing (author's transl)].

Interaural differences of time and intensity do not explain the good directional hearing capacity of persons with one deaf ear or asymmetric hearing loss. These persons estimate the direction of sounds by head movements. The alteration of sounds depends on the amplitude of the head movement, on the degree of turning the head and on a normal vestibular system. The influence of vestibular stimulation on directional hearing and the resulting virtual alterations on the direction of sound could be demonstrated.


[Tullio-phenomenon (author's transl)].

Applying sound waves to one ear, reflectory head- and bodymovements as well as nystagmus and vertigo are produced. We could study a Tullio-Phenomenon in a patient with a latero-basal fracture of the skull, who showed an otoliquorrhia from the medial wall of the tympanon. After surgical procedure the Tullio-Phenomenon could no longer be achieved.


[A caloric vestibular test with increased positive evidence (author's transl)].

A decrease of the variance of a caloric test would increase the importance of the statement of this test. An important source of variance are the differences concerning the timecourse of the induced heat wave, determined by the different anatomic conditions in the petrous bone, particularly the pneumatisation. A constant temperature gradient is obtained by the irigation in a pessimum position with the head flexed 30 degrees to the front. This temperature gradient evokes immediately a constant maximum vestibular stimulus after having reflected the head 90 degrees to the back. Comparing this new method with the traditional irrigation, one can state an important reduction of variance. The dependence of the nystagumus response on caloric irrigation of the petrous bone demands a X-ray-examination according to the technique of Schüller before starting with the caloric examination. In case of differences between the right and left sides the described test would be necessary in our opinion.


[How to seize and rate a social hearing handicap caused by hearing disorders (author's transl)].

A psychological test to size the quantitative social hearing handicap was developed by High and Fairbanks as a normative anemnesis. The splitting of the social hearing handicap index (SHHI) in the components of deafness and selection ability shows the importance of the selection ability for social hearing. Comparing the pure tone audiogramm with the SHHI of 54 patients demonstrates the low correlation of the audiogramm with the SHHI and especially its selection component. Only when the hearing loss is severe the selection component will correspond to the threshold.


[Sisi-test - a faulty test method? (author's transl)].

Doubts of reliability of SISI-test are based on lack of understanding and knowledge of what this test can disclose and where it should be placed in an audiologic test battery. Examination of normal hearing medical students with the SISI-test showed much better results than comparable test figures of other authors. There is a distinct difference with regard to the test intensity as well as the test frequency. Results show that their is no reason to disqualify the SISI-test.


[A contribution to the elevation of the erythrocytes sedimentation rate in sudden deafness (author's transl)].

Report on 77 patients with sudden deafness, of whom 59 (77%) showed elevated erythrocyte sedimentation rates (ESR). Beside the ESR the patient-collective was subdivided into age, sex, audiogramm-findings and conception of therapy. A discussion follows and conception of therapy. A discussion follows about the possible reasons of the ESR-elevations as virus diseases or the pharmacogenic influence of the ESR by low molecular dextrans.


[Salmonellosis in Dakar: bacteriological, clinical, epidemiological and therapeutic aspects. Ten years records (author's transl)].

A study on salmonellosis in Senegal has been carried out in Dakar at the University Hospital of Fann from 1966 to 1976. The authors describe the various methods of isolating the germs (mainly hemoculture and coproculture) and the techniques used for bacteriological research (antibiograms, tests on plasmidic resistance). The results of these investigations, which took the whole of 10 years, are presented below, in accordance with their different aspects: - bacteriological: 1 335 strains of Salmonella have been isolated. Significantly, S. typhi is predominant (56,6 p. 100). But 7 serotypes represent 90 p. 100 of the total strains which are now in existence in Dakar; - clinical: the aspects of these diseases vary: typhoïd fever, encephalitis, diarrheic syndrome, especially among infants, and purulent meningitis, which is generally severe; - therapeutic: 880 strains have been tested with 10 antibiotics. Two groups of Salmonella serotypes are opposed: those which are sensitive (S. typhi, S. typhi murium, S. enteritidis, S. paratyphi C), those which have become resistant (S. stanleyville, S. havana, S. ordonez). The most frequent antibiotype of this kind is ASKCTSu. This is a phenomenon of plasmidic resistance, demonstrated by in vitro experiments; - epidemiological: the lysotypes of 86 strains have been determined. Two epidemiological features must be described: either a stable endemic situation with sensitive strains - or epidemics, lasting several years, with resistant serotypes. Different therapeutic schemes can be used: chloramphenicol for typhoid fever, or sometimes cotrimoxazole, or ampicillin for meningitis. In diarrheic syndrome, symptomatic treatment is enough. Then, the authors give their comments on the special characteristics of salmonellosis in Dakar: - the influence of environment on the various clinical aspects of these diseases: very serious cases of meningitis, typhoid fever, which is more severe than in France, and complications when treatment has gone wrong at the beginning; - antibiograms, which are essential, in order to choose the adequate therapeutics; - and the different aspects of epidemillogy, which are linked to the sensitivity of the serotypes to the most active antibiotics. The existence of several resistant serotypes in Senegal is a real danger: plasmidic resistance could be transferred to S. typhi. In such a situation, epidemiological surveillance of salmonellosis is absolutely necessary, and control of enteric diseases, characterized by foecal transmission, must be carried out, with the techniques available in the country.


[Thyphoid fever in Tananarive (Madagascar): a review of 20o cases (author's transl)].

A clinical and biological study of 200 cases in Tananarive. The conventional clinical form is still frequent because patients have no immunity and report too late to the hospital. The main complications concern the heart and the digestive tract. Hemoculture is the main clue for the diagnosis. Biochemical and specially enzymatic unconventional data whichs have been recently reported are frequently observed. No resistance to chloramphenicol has yet been detected in Tananarive.


[Typhoid fever in Vietnam. I. Bacteriological study (607 Salmonella strains isolated from 1961 to 1975 at the Grall Hospital of Saigon)].

From 1961 to 1975, researches on salmonellosis have been carried out in Hospital Grall, in Saigon, mainly during two periods (1961-1964, then 1971-1975). 607 strains of Salmonella have been isolated for these 15 years (558 S. typhi and 49 Salmonella, among several other serotypes). As typhoid fever is most important, the authors have studied this disease very carefully. The most efficacious technique of isolating is hemoculture. With coproculture, the results are disappointing. Scarcely, some strains have been found in samples of various origins. Indirect diagnosis methods are less interesting. They may induce only a presumptive diagnosis. S. typhi is always predominant : 86,5 p. 100 from 1961 to 1964 and 96,1 p. 100 from 1972 to 1975. Diffusion of this germ during the second period is linked to the occurring of resistance to chloramphenicol. Some other serotypes are observed scarcely. The lysotypes have been determined for almost all the strains (202, then 323, during the two phases of this study). From 172 to 1975, 24 different lysotypes have been found. Lysotype I + IV is predominant (59 p. 100), but the incidence of D 6 and of 46 (6,8 p. 100) is somewhat high, if it is compared to the others. Lysotype 46 has been observed only since 1971. It has been spreading up to now in South East Asia. Stretching of this lysotype, out of its original focus, is an important epidemiological character. In 1972, resistance of S. typhi to chloramphenicol appeared and it has been increasing mostly during the following years. From 1972 to 1975, 211 strains on 288 were found resistant (highest point in 1975 : 85,4 p. 100). It was a multiresistance to 4 antibiotics (antibiotype : CTSSu). This pehnomenon of plasmidic resistance was investigated in Institut Pasteur (Paris). Many lysotypes have been involved in resistance (14 among 24). Clinical study has been realized for 189 patients. During the typical period of the disease, fever is the major symptom. More scarcely, other clinical features are observed. Various complications have been related. The evolution of the disease has been generally satisfactory, as far as mortality (less than 2 p. 100), sequelae (1 p. 100) and relapses (2 p. 100) are concerned. Clinical course has not been modified by resistance of the germs.


[Shigellosis in Tananarive (Madagascar) I - Epidemiologic and clinic features (author's transl)].

Reviewing 67 cases of human adult shigellosis observed in Madagascar, the authors emphasize some epidemiologic and clinic features : high frequency during rainy season, usual dysenteriform aspect or diarrhoeas with fever, hemorragic forms, severity according to anterior state of colon and rectum, severity if cases associated with amoebiasis or schistosomiasis (Schistosoma mansoni).


[Children typhoid fever in Saigon (Vietnam) : epidemiological and biological aspects (author's transl)].

A review of 130 children cases of typhoid fever in Saigon (Vietnam). Leuco-neutropenia is far from regular but thrombopenia is frequent. The typhoid bacillus is generally cultivated from blood during the first two weeks of the evolution. There is evidence in most S. typhi strains of a plasmid resistance for streptomycine, chloramphenicol, tetracycline and sulfamides. Strains of the various other enterobacteria of the intestinal flora are generally resistant for many more antibiotics than S. typhi.


[The role of immunization against bacterial enteric infections (author's transl)].

The author reviews critically the available vaccines against salmonellosis and shigellosis, the more sophisticated vaccines against these two infections and cholera presently under experimentation and using parenteral or oral dispensing. To contribute to public health planning, with particular reference to developping countries, the authors points on the necessity to evaluate carefully the merits of the different techniques aiming at controling bacterial enteric infections. Sanitation seems to be the most effective and the less expensive technique.


[Surgical approach to the so-called infectious perforations of the small intestine in Africa south of the Sahara (author's transl)].

Non traumatic perforations are frequent in Africa South of the Sahara and most often due to salmonellosis. From 50 cases recorded in Dakar, the authors study the main problems raised by diagnosis (specially in non reactive peritonitis requiring iterative controls), surgical tactic and procedure, and intensive care. In 86 p. 100 of the case they report on, the authors performed a suture completed by passive drainage. However, and in spite of the risk of leaking, resection had to be done either immediately or because suture failure. As patients were presented generaly in very bad condition, intensive cares were complex but essential. Death rate ranged between 25 p. 100 and 50 p. 100.


Antiplague antibodies against Yersinia pestis fraction-I antigen in serum from rodents either experimentally infected or captured in harbor areas of Japan, 1971--1977.

Antiplague indirect hemagglutination tests were investigated with Yersinia pestis fraction-I antigen and sera from experimentally infected rodents. The same tests with sera treated with acetone or acetone-2-mercaptoethanol were performed in parallel. Technical conditions were determined to insure the specificity and reproducibility of the reactions. Utilizing the methods studied, we carried out serological surveillance of plague with sera from wild rats (Rattus rattus and R. norvegicus) captured in the harbor areas of Japan during the period from 1971 to 1977. Four samples (all from R. norvegicus) out of 1,645 obtained in Kobe were positive. The public health significance of the data obtained is discussed.


Isolation and characterization of heat-resistant (HR) mutants of Newcastle disease virus.

Heat-resistant (HR) mutants (MR 70 and HR 74) of Newcastle disease virus (NDV) which exhibited significantly higher thermostability in their infectivity than wild-type virus were isolated and characterized. They differ from each other in their plaque morphology; HR 70 produces small turbid plaques, whereas those of HR 74 are large and clear. Cytopathogenicity of these mutants is much lower than that of the wild-type virus in cultured cells such as CEF, LLCMK2 and HeLa cells. Moreover, these HR mutants exhibited extended mean embryo survival times. Synthesis of cellular RNA's and proteins in cells infected with HR mutants was not significantly reduced under conditions in which synthesis of these macromolecules was strongly reduced in cells infected with wild-type virus. No significant differences were observed between HR mutants and wild-type virus in their other phenotypic characteristics such as the capacity for interferon production, growth characteristics at a low multiplicity of infection, and cleavage of viral glycoproteins in infected cells. From these findings, it was suggested that the inhibitory effect of virus infection on cellular macromolecular synthesis is a possible determinant of cytopathogenicity of NDV.


Cariogenic virulence of Streptococcus mutans AHT mutants with altered in vitro adherence abilities in hamsters.

Plaque-forming ability and cariogenic virulence of Streptococcus mutans AHT mutants having varying in vitro adherence abilities were studied in hamsters reared on a high sucrose diet over a period of 64 days. The parent wild-type strain produced heavy plaque and extensive carious lesions on molars. However, mutants M1, M2, and M13, which have lost the ability to form adhesive deposits on glass when grown in sucrose broth, and mutant M9, which adheres firmly to glass but in an extremely small amount, could not be recovered from the mouths of animals even after repeated inoculations at weekly intervals throughout the experimental period. Mutant M35, which produces a large amount of loosely adhering deposits in vitro, became established and persisted on molars, but its recovery was extremely low. None of the mutants, including M35, significantly produced plaque and caries in hamsters. Possible causes of this inability to form plaque and the avirulence of mutants are discussed.


Continuous survey of the distribution of RNA coliphages in Japan.

In order to demonstrate the stability and continuity of RNA coliphages (phages) in their natural habitats, we investigated the amount and group types of RNA phages in sewage samples collected continuously from domestic drainage in Japan proper and islands in the seas adjacent to Japan (abbreviated simply as islands, hereafter) over a 5-yr period from 1973 to 1977. It was found that the frequencies of isolation of RNA phages were fairly high and constant. The group types of RNA phages isolated were also stable in the three cities. Choshi, Niigata, and Toyama in Japan proper. The average for the three cities was group II:III = 3:1. The investigation in islands revealed that the frequencies of isolation of RNA phages were fairly high as in the case of the above three cities in Japan proper and the group types of RNA phages isolated were also stable. That is to say, group II phages were predominant on Rishiri Island, Rebun I., Iki I., and Tsushima I., which are located relatively near to mainland Japan, while group III phages were predominant on Amamiohshima I., mainland Okinawa, Ishigakijima I., and Iriomotejima I., which are located south of Kyushu. It can thus be said that the RNA phages in the domestic drainage of Japan proper and islands remained more or less stable over at least the 5-yr period, and an apparent difference in the geographical distribution of RNA phages in Japan exists between Kyushu and Amamiohshima I.


A place for oncology in medical undergraduate teaching.

Cancer is a common disease, and it is argued that integrated teaching of the problems of the cancer patient deserves a place in the undergraduate medical curriculum. A model is presented which has now been used for 3 years and appears to be operating successfully at the Middlesex Hospital Medical School.


Development and exploratory trials of a cognitive preference inventory for medical students.

A medical cognitive preference inventory was developed and tested with two samples, one in Israel and the other in the United States. Acceptable levels of internal consistency of the whole test and of its three subtests were demonstrated. Direct and indirect evidence for the validity of the test was provided. The potential uses of the test for student selection and evaluation as well as for programme evaluation were discussed. Two forms, E and F, each consisting of eighteen items, are recommended for use with medical students. A combination of these two forms is designed as form G. Administration of one form to half of a sample and the other form to the other half, followed by pooling the individual scores, thereby obtaining results comparable to those of form G, is recommended when time to administer the inventory is limited.


Practical work in a behavioural sciences course.

This paper describes a recent change in the practical component of the Behavioural Sciences course at Dundee Medical School. Results obtained from an evaluation of the change appear to show that students' learning was enhanced by the new form of practical work.


Towards a rational approach to student evaluation by examinations.

The major functions of examinations are noted and a scheme of multiple choice testing is outlined which distinguishes between the certification function and the grading function of examinations. This scheme has been in operation since January 1976 in the Department of Anatomy, University of Cape Town, and preliminary results are presented which show: (i) greatly enhanced reliability (ii) unimpaired validity when the multiple choice procedures described were used.


The diagnostic utility index.

A method for quantifying the value placed on diagnostic accuracy is described. Named the Diagnostic Utility Index (DUI), it was completed by fifty subjects (including pathologists, physicians and medical students). Analysis of the responses reveals that attitudes to diagnostic perfectionism differ from one disease to another. It is suggested that the DUI may be useful in the clarifying of subjective factors which influence medical attitudes to the diagnosis and investigation of disease.


A human sexuality course for Oxford University medical students.

A human sexuality course for clinical students in Oxford was held based on the format of similar courses held in the U.S.A. with one-and-a-half days of films and lectures followed by discussion in small groups. The course was largely successful and evaluation of attitudes and knowledge revealed that significant preliminary changes resulted. Students who failed to complete the course had more inhibited attitudes towards sexuality and less sexual information compared with those who attended the whole course. Advice is given to those intending to hold such a course elsewhere, including how more inhibited students, who probably are most in need of such teaching, might be encouraged to participate.


The evolution of a course in human sexuality University of Edinburgh, 1972-1978.

A short undergraduate course in human sexuality has been developed over a period of 7 years. The objectives, initially concerned with cognitive learning, shifted to affective aspects of the topic, introduced through a format of sexually explicit films and small-group discussions. Continuing evaluation of successive courses by students has been particularly valuable in identifying helpful and unhelpful behaviour in group leaders, and has been used in their training. The evaluations also demonstrated that students saw a need to develop their interviewing skills. The course, therefore, now seeks to combine affective learning with other topics of direct relevance to clinical practice.


Patients' reactions to a two-way mirror in general practice.

From a survey of 200 patients in two general practices it would appear that the patients' reaction to the use of a two-way mirror is on the whole not unfavourable. The results suggest, however, that in the very personal setting expected of general practice people suffering from psychiatric problems (especially depression) should be given every opportunity to decline consultation in front of the mirror and if any patient becomes upset, then the mirror should be 'turned off' immediately. Internal examinations should not take place when the mirror is in use.


Regulation of the immune response by polyamines.

Regulation of the immune system is accomplished, in part, by numerous soluble factors and small molecules. One such class of regulatory substances may be the polyamines which are present in a variety of tissues. Stimulation of the immune response often occurs by crosslinking of lymphocyte surface proteins, followed by the production of some transmembrane signal. The activation pathway may be interrupted if certain necessary steps are blocked. It is proposed that polyamines exert regulatory influences by modulating crosslink formation; a step catalyzed by the enzyme transglutaminase. A model is outlined which describes the events initiating lymphocyte activation and the role of polyamines in this process. Certain drugs which might mimic the actions of polyamines are also discussed. During evolution of the control of growth processes in cells, relatively simple molecules (the polyamines) may have assumed a pivotal role in initiating and terminating the proliferative response. This idea has been applied to regulation of the immune system.


The fundamental role of hyaluronidase in tissue.

The interstitial ground substance plays an essential role in the physiological processes of the capillary and the cell. Together they form a fundamental unit of function in which the cell is the most important part. Therefore the fundamental unit is called: THE CELLULAR UNIT. It is proposed central role and that this enzyme is indispensible for normal healthy cells as well as for the reactive mechanism in critical situations. The reactive mechanisms can be divided into a local reactive mechanism and a general reactive mechanism. The local reactive mechanism has a function of RESTORATION. The general reactive mechanism is especially for PROTECTION AGAINST ISCHAEMIA and REDISTRIBUTION OF TOTAL BODY NUTRIENTS in order to stimulate the restoration. These two mechanisms may have important clinical consequences.


A new right ventricular cardiac assist device.

At present no good method of assisting the right ventricle of the heart exists. This paper presents a new and effective approach to assisting the right ventricle of the heart which can be utilized independently or during cardiac surgery. Through implementation of this method, and timed inflation and deflation of several types of balloon catheters in the pulmonary artery, distal pulmonary arterial flow is augmented with subsequent unloading of the right side of the heart. This approach will be of great benefit in the treatment of atherosclerotic and congenital heart disease as well as in many cases of pulmonary hypertension.


Congophilic microangiopathy in the pathogenesis of Alzheimer's syndrome (presenile dementia).

In a large proportion of cases of Alzheimer's presenile dementia the major causal mechanism is compromise of the blood-brain barrier as the result of Congophilic microangiopathy occurring in a relatively young age group. This allows chronic access of serum proteins, perhaps of a selective neurotoxic type, to the cerebrum. The effect on neuronal cells in specific locations, e.g. hippocampus, is to induce the formation of paired helical filaments, autophagia of filamentous protein (filarin) and neuronal degeneration. The partially digested filarin is further enzymatically cleaved by microglia to produce the amyloid core of the neuritic plaque.


The naeglerial causation of rheumatoid disease and many human cancers. A new concept in medicine.

Man and terrestrial animals live in an environment containing free-living amoebae on the surface soil, in pools, fresh water lakes, rivers and streams. They form cysts, which float in the air and which are continually inhaled and found in the nasopharynx and their trophozoites are present in human and animal faeces. Amoebae of the genus, Naegleria, have been demonstrate; in all human tissues, both healthy and in larger numbers in those taken from cases of rheumatoid disease, in all human cancers and in the unaffected tissues of cancer patients. They can be killed in vitro by a series of different anti-amoebic substances and treatment of active cases of rheumatoid disease by any of these, either causes cessation of disease activity or a temporary exaggeration of symptoms followed by their lessening or disappearance (Herxheimer reaction), indicating the presence of an amoeba in the affected tissues as the causative organism of the inflammation in this disease in subjects genetically sensitive to the organism. Every internal organ may be involved in the inflammatory response in cases of rheumatoid disease and this also ceases with the above treatments. Many of these internal lesions are premalignant, so that infection with the organism either in sensitive subjects or with pathogenic species, appears to be the primary cause of cancer in many cases. The presence in the body of Naegleria represents the source of the constant antigenic stimulation thought to be responsible both for rheumatoid disease and for the development of lymphomata and myelomatosis.


Should the concept of the recommended dietary allowance be altered to incorporate interactive effects of ubiquitous pollutants?

Using ascorbic acid as a model, this paper proposes that the concept of the RDA should be broadened to take into account the effects of ubiquitous pollutants on human health, a factor presently not incorporated in RDA derivations. It is now widely accepted that ascorbic acid nutritional status markedly affects the toxicity and/or carcinogenicity of greater than 50 pollutants, many of which are ubiquitous in the air, water, and food environments. At the present time, the data do not warrant changing the ascorbic acid RDA in light of the knowledge of pollutant interactions.


Inverse relationship of the velocities of perceived time and information processing events in the brain: a potential bioassay for neural functions: a hypothesis.

The velocity of elapsing time is not a constant but a relativistic component in the space-time continuum as postulated by Albert Einstein in his general and special relativity theories. The hypothesis presented here is that there is a biological corollary to relativity theory. It is postulated that biological time perception is also not a constant but is related by an inverse relationship between the velocities of neural processing events and perceived elapsing time. A careful analysis of this relationship may potentially offer a sensitive bioassay to determine the integrity of regional brain function under normal conditions and in the presence of specific disease processes. The mechanism for the biological basis of this theorem depends on the presence of a neural circuit developed through evolution which monitors overall brain efficiency and is coordinately linked to neural time perceiving circuits. Several test approaches are presented to validate the hypothesis of biologic time relativity compared to the rate of neural processing.


Male, female heart disease-relationship with vehicle travel.

The author, by analysing the statistical facts available regarding the relationship between the incidence of male and female ischaemic heart disease, has endeavoured to clarify the cause and the mechanism by which the stress leading to ischaemic heart disease is established.


Phenytoin, hemorrhage, skeletal defects and vitamin K in the newborn.

The vitamin K-dependent hemostatic factors are present in reduced quantities at birth and may decrease further in the first few days of life. Administration of vitamin K1 on day 1 prevents hemorrhagic disease of the newborn. Maternal ingestion of anticonvulsants puts the newborn at greater risk from hemorrhage, possibly as a result of induction of fetal microsomal enzymes with a resultant increased oxidative degradation of vitamin K which gives rise to a vitamin K deficiency and other concomitant clinical results, for example skeletal defects. Evidence for this sequence of events is presented and the widespread effect of vitamin K deficiency on the fetus is discussed.


Trigeminal neuralgia. Surgical treatment by microvascular decompression of the trigeminal nerve root.

The surgical management of trigeminal neuralgia has always been less than ideal. Evidence accumulated over the last 10 years suggests that the condition is caused by vascular compression of the trigeminal nerve root at the brain stem. Removal of this compression by means of micro-neurosurgical techniques has so far been very effective in relieving the pain of trigeminal neuralgia while maintaining normal facial sensation. A series of 10 patients who underwent this procedure is presented. All patients lost their pain, and during the follow-up period of six to 18 months, there have been no recurrences. This experience further demonstrates that the microvascular decompression is a very useful procedure in selected patients.


Survey of alcoholism treatment services in Victoria. Relationship of alcoholics drug use to their use of medical facilities.

A cooperative survey of 370 individuals presenting for treatment at nine Victorian alcoholism treatment centres showed that men and women in this population of alcoholics did not differ significantly in indices of their lifetime consumption of alcohol or tobacco per kilogram of body weight, despite considerable difference in their present use of these drugs. Physical disability was associated with extended tobacco consumption both in men and in women. Little relationship existed between use of medical services and the extended use of alcohol, though high present consumption was associated with increased general hospital admissions in men.


Retinal migraine and the pill.

A case is presented in which onset and cessation of retinal migraine attacks were clearly related to prescription of a contraceptive pill. Retinal migraine is briefly discussed and the importance of recognizing this rare complication of oral contraceptive use is emphasized.


Successful birth after previous tubal ectopic pregnancies.

A case, in which tubal conservation in an ectopic pregnancy resulted in the birth of a living infant, is described. It is hoped that tubal conservation in ectopic pregnancies, which was previously thought to be unwise, will be considered in future.


The effect of intranasal beclomethasone dipropionate on adrenal function.

The effect of intranasal beclomethasone dipropionate on adrenal function was assessed in patients with allergic rhinitis. Beclomethasone dipropionate is an effective preparation and therapeutic doses of 400 microgram/day do not cause adrenal suppression after 12 weeks of use.


"Christmas eye". Acute corneal erosion.

The term "Christmas eye" is one I have coined to describe a type of acute corneal erosion which seems to occur only between late November and mid January, in country areas of New South Wales. Since 1970, I have seen 20 cases, all monocular, in people from an area bounded by Wellington, Mudgee, Grenfell, Cowra and Young. Twelve patients were adult males, three were adult females, and there were five children (one female, four male). The incidence varies; six cases presented in 1976, and none in 1978.


[Changes of the pain threshold induced by analgetic drugs (author's transl)].

In two groups (i.v. and p.o. application) of 6 healthy subjects we tested the changes of the individual pain threshold induced by Flupirtine, Pentazocin and placebo under double blind conditions. The experimental pain was caused by radiant heat for isolated C-fiber-stimulation. The results of p.o. application showed an average increase of the pain threshold of +1,27 degrees C by Flupirtine, +0,81 by Pentazocin, and a slight decrease of -0,68 degrees C by placebo. The figures under i.v. application were +2,04 degrees C for Flupirtine, +1,01 degrees C for Pentazocin and +0,16 degrees C for placebo.


[Lobar pneumonia (author's transl)].

129 cases of lobar pneumonia were analysed. The frequency of occurrence in autopsy material was 2.5%, and has not increased or decreased appreciably in the past 20 years. Men and women were affected with approximately the same frequency up to the age of 40, thereafter male mortality is considerably higher. The diagnosis of a lobar pneumonia was made clinically in only 16 percent of the cases. The anatomical appearance of the illness has not changed compared to the findings of earlier studies, however chronic clinical courses are common, occurring in about 15% of the cases. The lobar pneumonia was the direct or indirect cause of death in all instances. There has been a remarkable change in the causative agents in favor of gram negative organisms.


[Tracheobronchopathia osteochondroplastica--a rare condition in lower respiratory tract (author's transl)].

In a 55 years old male patient bronchoscopy was carried out because of suspected bronchial carcinoma. Chest X-ray showed a lesion in the periphery of left lung, an episode of hemoptysis was reported 4 weeks prior to the examination. During bronchoscopy we found numerous small tumours on the mucosa of distal trachea and left main bronchus. The findings suggested a widespread malignant process, whereas histological examination of biopsies showed tracheobronchopathia osteochondroplastica. In the case described we could not find amyloidosis of tracheal wall or disorders in somatotropine secretion. Pathogenesis and clinical features of the disease, which is in a high percentage detected by chance or post mortem, are discussed.


[Beta-receptor blocking drugs and the bronchial system. A comparative study of pindolol and metoprolol (author's transl)].

Effects of the beta 2-receptor stimulating drug fenoterol were investigated after administration of beta-receptor blocking agents in 12 patients with obstructive respiratory disease and a hyperreactive bronchial system (positive acetylcholine test). In a double blind trial pindolol (universal beta-receptor blocking drug) and metoprolol (a cardioselective substance) were compared after administration of equally effective doses of 5 and 100 mg respectively. Whole-body plethysmography showed that both beta-receptor blocking drugs caused no bronchial constriction; the bronchodilating effects of fenoterol were not reduced. These findings must cast doubt on the differentiation between cardioselective and non-cardioselective beta-receptor blocking agents as far as practical therapeutic implications are concerned.


Epidemiologic studies of cancer in minority groups in the western United States.

Of 13 cancers that tend to occur at lower rates in aboriginal Americans or in the native lands of Japanese, Chinese, and Spanish-speaking persons than in United States whites, rates for all but one (laryngeal) have increased in migrants to the United States. In addition to leukemia, these 13 cancers include neoplasms that have been related, at least in part, to a diet high in animal fats or proteins (colon and rectum cancer); reproductive and endocrinologic factors and a diet high in animal fats or protein (prostate, ovary, corpus uteri, breast, and testis cancer); chemical carcinogens (lung, larynx, bladder, and pancreas cancer); and a common infectious agent that, like polio viruses, causes clinically overt disease with a frequency directly related to age of patient at initial infection (Hodgkin's disease). Of 9 cancers that occur at higher rates in aboriginal Americans or in one or more of the native lands of migrants than in United States whites, the rates of 5 tend to decrease in migrants. These include cancers that may be related to food preservation (stomach cancer); products of microorganisms that may contaminate foods (esophagus and liver cancer); and infectious agents (nasopharynx, cervix uteri, and liver cancer). In addition, rates of cancer of the thyroid are high in aboriginal Americans; those of the gallbladder are high in individuals of native American ancestry and in Japanese; incidence of salivary gland tumors is high in Alaskan natives and Colombians; and rates of kidney cancer are high in Alaskan natives. Five types of epidemiologic studies are described that should be conducted in the migrants and in their countries of origin and adoption to elucidate further the etiology of various neoplasms.


The epidemiology of cancer in Chile.

Despite the fact that cancer is underreported in most of Latin America, available data suggest that it is a major cause of death throughout the area. The most frequent sites among males are the stomach, lung, and prostate; among females, the cervix, stomach, and breast are affected most often. Only Cuba has a nationwide registry; Brazil, Colombia, and Peru have registries limited to areas. Within this context, Chile ranks second in the world in age-adjusted mortality rates from stomach cancer. Other leading sites are the lung, cervix, and breast. Stomach cancer exhibits high- and low-risk areas in Chile, with distinct epidemiologic characteristics. A case-control and nitrate ecology study funded by the United States National Cancer Institute is underway, and the Japanese International Cooperation Agency is launching a 3-year mass screening program.


Incidence and etiology of primary liver cancer in the Pacific Basin.

The incidence of PLC in the Pacific Basin varies from 0.9/100,000 (age-standardized) in women in New South Wales, Australia, to 34.2/100,000 in Singapore Chinese men. Proportional incidence data suggest that other areas of the Pacific Basin, such as Hong Kong, Taiwan, Indonesia, and Papua New Guinea, may have PLC incidence rates as high or higher than those in Singapore Chinese. Infection with hepatitis-B virus has been associated with PLC in some areas, and aflatoxin contamination of food has also been demonstrated. The extent to which these or other factors explain  the geographical variation in liver cancer rates in the Pacific Basin is uncertain.


Incidence and etiology of lung cancer in the Pacific Basin.

Incidence of lung cancer in the Pacific Basin was either compiled from published reports or computed by the authors. The results showed a great variation in age-standardized annual incidence rates of lung cancer among 10 countries and 17 areas in the Pacific Basin where tumor registry statistics are available. For males the incidence rates ranged from 10 to over 70 and for females from less than 5 to over 30/100,000 population. The reason(s) for the great variation is unclear. Ionizing radiation, carcinogenic chemical substances (e.g., chromium, arsenic compounds, asbestos, etc.), or air pollution are unlikely to be responsible. Because cigarette smoking is known to be a major cause of lung cancer, the authors have suggested that surveys on cigarette smoking be conducted among various populations in the Pacific Basin so that etiologic significance of cigarette smoking for the noted variation can be assessed. In Hawaii such a survey is underway, and a preliminary analysis was made to examine the association between lung cancer and cigarette smoking among five races.


Epidemiology of prostate cancer with special reference to the role of diet.

A prospective epidemiologic study of prostate cancer was conducted in Japan. The 10-year follow-up study of 122,261 men aged 40 years and above, who constitute 94.5% of the census population of 29 Health Center Districts, revealed a significantly lower age-standardized death rate for prostate cancer in men who daily ate green and yellow vegetables. This association is consistently observed in each age-group, in each socioeconomic class, and in each prefecture. Selected epidemiologic phenomena, such as the upward trend of the prostate cancer death rate in Japan, intracountry variation of death rate, the significantly lower incidence rate in Japan compared with that of the United States, and elevated risk in Japanese migrants to Hawaii, appear to be explained by the variation in diet and change in amount of green and yellow vegetables ingested. The possible role of vitamin A is considered as a factor in preventing and inhibiting growth of prostate cancer. Most of the other factors studied appear noncontributory, except for marital status; a higher risk was observed in "ever married" men.


An epidemiologic approach to host factors in the etiology of cancer.

We examined the contribution of host factors in carcinogenesis by evaluating the frequency distributions and secular trends in available epidemiologic data of mortality and morbidity around the world. In most developed countries, the age-adjusted death rates of cancer of all sites have levelled off in recent years and the intercountry difference in mortality is small. Deaths from cancer account for approximately 20% of total deaths in these countries. It is believed that the difference in cancer mortality of all sites between the developed and developing countries can be explained by the different levels of mortality from infectious and parasitic diseases, including deaths from tuberculosis. A certain upper limit for the number of cancer deaths in each population is strongly suggested by the unaltered cumulative mortality rate from cancer and tuberculosis up to 85 years of age in a defined birth cohort in the developed countries. The apparent age dependency in cancer mortality as well as some other essential epidemiologic implications in carcinogenesis, the commonly observed proportion of cancer deaths of around 20% of total deaths, and the well-known etiologic importance of environmental factors which determines the site-specific cancer mortality and morbidity lead one to consider the definite existence of "susceptibles to cancer" in each population. However, the concept of susceptibles to cancer is different from the usual one of hereditary predisposition to so-called "intractable diseases," which have low incidence rates.


Atypia in adenomas in three populations with different risk for large bowel cancer: Cali, São Paolo, and New Orleans.

A double-blind study of atypia in colorectal adenomatous polyps was done with autopsy material from Cali, Colombia (low colon risk), São Paulo, Brazil (intermediate risk), and New Orleans, Louisiana (high risk). An interobserver reproducibility of 82% was obtained. The prevalence of atypia in polyps increased with the cancer risk and also with the size of polyps, but some exceptions to the rule were found. The frequency of atypia increased steadily with age in Cali, but it plateaued after age 50 in the higher risk populations.


Evaluation of  a mass screening program for stomach cancer.

To evaluate a mass screening program for stomach cancer, we followed 32,789 subjects for 6.1 years by means of a record linkage to a population-based cancer registry. The results show that the mortality from stomach cancer among those studied decreased by 9% as compared with the expected number calculated on the basis of the sex- and age-specific rates among the general population. When the study subjects were limited to those aged 40-59 years, the decrease in stomach cancer deaths became more marked, i.e., a 26% decrease was observed. Because this study is not a controlled trial, the results must be interpreted with the reservation that some biases were present in the study subjects.


The hormonal basis of breast cancer.

Both animal experiments and certain well-established breast cancer risk factors suggest that risk to the disease is fundamentally determined by the hormones of the pituitary-gonadal axis. Although international comparisons of urinary estrogens have given support to this ypothesis, case-control studies and international comparisons of plasma estrogens and prolactin have not. Methodological problems and sampling biases probably account for the inconsistency of these investigations. Taking advantage of the known familial increased risk to breast cancer, we conducted comparative studies of teenage daughters of patients with breast cancer, including a group of girls whose mothers had bilateral breast cancer when they were less than 50 years old. The results of these studies revealed that these high-risk girls appear to have elevated levels of estrogens, prolactin, and progesterone.


Epidemiologic characteristics of breast cancer in three menopausal stages: preliminary findings.

A preliminary analysis of data from 1,477 patients with breast cancer and 2,695 control women examined potential characteristics of high risk for breast cancer to determine whether prediction differed depending on whether the women were premenopausal, paramenopausal (intermediate), or postmenopausal. Since information was not yet available on real or presumed menopausal status, women were characterized by age: women less than 45 years as premenopausal; women from 45 through 54 years as paramenopausal; and women 55 years and older as postmenopausal. Height, weight at age 20, number of stillbirths, number of abortions, and history of cancer of any site in the subject's mother did not affect the risk of breast cancer. Generally, highest level of education, number of pregnancies, and number of live births seemed to predict risk of breast cancer. Weightbody mass index, age at menarche, and age at first pregnancy may predict breast cancer risk differently depending on the menopausal stage in which onset occurs.


Epidemiologic aspects of biliary tract cancer in Japan.

According to the vital statistics accumulated in Japan from 1958 to 1975, the mortality of biliary tract cancer 1) is low under age 50 and thereafter increases in parallel with age and reaches its peak in the eighth decade; 2) is higher among females than males (especially gallbladder cancer), but cancer of the bile ducts predominates in males; 3) has shown an increasing trend in recent years (1958-75), especially among older persons; and 4) varies geographically. Mortality from this disease is particularly high in the northern parts of Honshu (the main island). Correlation analyses and a factor analysis between food consumption (1964) and the mortality from biliary tract cancer (1972-74) for 46 prefectures in Japan revealed that although expenditures for some foods (dried noodles and pork) are possibly related to the mortality rate of biliary tract cancer, expenditures for others (fat and protein-rich western-type foods) are negatively associated with this cancer. These possible associations need further clarification by more refined epidemiologic and laboratory studies. Possible effects of diagnostic procedures or techniques on secular trends and geographical distribution are also discussed.


Some epidemiologic observations on cancer in Hong Kong.

The average incidence by age-group per 100,000 for both sexes and the age-standardized incidence rates for the 10 most common cancers in Hong Kong for 1974 were determined. A comparison between the incidence and death rates for these 10 cancers indicated that a good coverage of the actual incidence has been achieved by the Cancer Registry for cancers of the nasopharynx, bronchus, esophagus, colon, rectum, breast, cervix, and bladder, but it was incomplete for cancers of the liver and stomach. A study of their age-specific incidence curves showed a sharp rise in the curve after age 20-24 in cancers of the nasopharynx and liver (males), after age 25-29 in cancers of the cervix and breast (females), and after age 35-39 for the remaining tumors studied; thus a difference in the period of life at which carcinogenesis was initiated was indicated. Epidemiologic observations on nasopharyngeal, esophageal, hepatocellular, and uterine cervical carcinoma were compared, and it is believed that epidemiology is the key to the solution of the cancer problem in Hong Kong.


Descriptive epidemiology of cancer in Japan: current cancer incidence and survival data.

The Research Group for Population-Based Cancer Registration in Japan, which has been collecting cancer incidence and mortality data from participating registries annually since 1974, has also been estimating cancer incidence rates for the whole of Japan by sex, age, and site. Data from the third survey have now been analyzed. Marked changes have been observed by the Osaka Cancer Registry in incidence rates of some sites during this period. Five-year relative survival rates for registered cancer cases have been calculated by the Osaka Registry for the first time in Japan.


Cancer incidence in Malaysia.

No population-based cancer registry exists in Malaysia; thus our main sources of incidence data were biopsy series. We determined the frequency of cancers by body site, sex, and ethnic group from biopsy records of the Division of Pathology of the Institute for Medical Research in Kuala Lumpur for the years 1969-71. We then made comparisons of leading sites with data from the Singapore Cancer Registry. Relative risk values for 21 sites indicated significant differences among ethnic groups for cancers of the nasopharynx, larynx, lung, bone, skin, cervix, ovary, prostate, and penis and for lymphomas.


Observations on cancer etiology in China.

Major variations in cancer by site and sex are being discovered in the People's Republic of China. Nasopharyngeal carcinoma, the most common form in Kwangtung Province, accounted for 43.0% of biopsied cancers in males. Liver cancer is predominant along the coast near Shanghai and appears to be a major cause of mortality in many other parts of the country. The mortality rate of esophageal cancer, the primary cause of all mortality along the eastern slopes of the Taihang Mountains in North China, varies by 100-fold in areas short distances apart; this geographical variation is paralleled by a carcinoma of the gullet in domestic chickens. Several foods, particularly a type of pickled vegetable, contain high concentrations of nitrosamines and nitrites, which are thought to be etiologically important.


Cancer in Papua New Guinea.

Among the Melanesian population of Papua New Guinea, cancer of the oral cavity associated with betel nut chewing is the most commonly reported. Liver cancer is also common and is closely associated with chronic hepatitis-B infection. Burkitt's lymphoma occurs along coastal areas with a high rainfall and intense malaria transmission. The descriptive epidemiology of other cancers in Papua New Guinea is also discussed.


Current status of cancer registries in Australia.

Since 1975, considerable progress has been made in the development of population-based cancer registries in Australia. Each of the six federated states has accepted the principle that population registries are of major importance in cancer control. The registries in New South Wales (established in 1972) and South Australia (established 1977) are fully functional; in addition, a national pediatric registry was established in 1977. Cancer incidence data by site are available for the New South Wales registry, and a preliminary analysis has been done of melanoma for variation by geography and country of birth, and of lung and colorectal cancers for variations by country of birth. A 3-year study of cancer of the renal pelvis in New South Wales and the relationship to analgesic consumption was started in 1977; a second study on contacts among patients with hematologic cancers has been completed.


New Zealand Cancer Registry report.

In 1976, a question regarding cigarette smoking was included in the New Zealand national census. Preliminary results from a 10% sample show that of the 2.2 million persons surveyed aged 15 years and over, 97.2% answered the question. Of each 100 males, 38 reported they had never smoked regularly, 22 were former smokers, and 40 were current smokers. In each 100 females, 57 had never smoked regularly, 12 were former smokers, and 31 were current smokers. The age and sex of all respondents, their cigarette smoking status, and the number of cigarettes smoked by current smokers on the day before the census were determined. A cigarette smoking question has now been incorporated in the New Zealand standard cancer notification form. Standardized rates for cancer of selected sites were determined for Maoris and non-Maoris. During the 25-year period from 1949-73, the incidence of malignant melanoma of the skin in non-Maoris increased markedly. In females aged 45-54  and in males 55-64 years, the age-specific rates increased almost sixfold. The increases for other age-groups, although substantial, have not been as large. Between 1958 and 1974, threefold increases in standardized incidence rates have been reported for cancer of the lung in Maori males and females and in non-Maori females, but for non-Maori males the rates have less than doubled.


Smoking and drinking patterns among different ethnic groups in Hawaii.

We examined ethnic differences in smoking and drinking habits among the five major ethnic groups in Hawaii (Caucasians, Japanese, Chinese, Filipinos, and Hawaiians) by means of questionnnaire data obtained from a representative sample of 8,636 Hawaii residents. For men, lifetime cigarette use was greatest among Caucasians and lowest among Chinese and Filipinos. For women, smoking cigarettes was highest among Caucasians and lowest among Chinese. Although overall smoking patterns showed some relationship to lung cancer incidence, the observed rates could not be fully explained. Beer consumption was greatest among Hawaiians of both sexes and least among the Chinese; most consumers of spirits (hard liquor) were Caucasian. Total alcohol consumption was similar among Hawaiians and Caucasians and was considerably greater than among the other 3 ethnic groups. Alcohol consumption patterns among men did not correlate well with esophageal cancer incidence, even when the analyses were restricted to smokers; among women, however, the correlation was high. For these sex- and ethnic-specific groups whose alcohol consumption was generally low, there was a negative association of amount consumed with mean annual family income. For the groups with higher proportions of drinkers, mean annual family income was higher among those who drank moderately (less than 5 ounces/wk) than among those who either drank more heavily or not at all.


Cancer mortality among Chinese, Japanese, and Indians in British Columbia, 1964-73.

We compared age-adjusted mortality rates for cancer of selected sites for Chinese, Japanese, and native Indian residents of British Columbia during the years 1964-73 to the corresponding rates for the white population. Mortality from all cancers of the Chinese did not differ significantly from that of whites. Elevated rates are seen for cancer of the nasopharynx in both sexes, of the liver and esophagus in males, and of the lung in females. Chinese males had a lower mortality than whites from stomach, prostate, and bladder cancer and brain tumors, whereas females had a lower mortality from tumors of the colon, breast, and ovary; both sexes had a lower mortality from leukemia. For Japanese males and females, the mortality rates for all cancers combined were similar to those of the white population. The rates for cancer of the stomach and gallbladder were higher in both sexes; males also showed a higher rate of liver cancer. Prostate and breast cancer mortality rates were lower. Native Indian males had a lower mortality rate from all cancers combined; the difference was significant for stomach, colon, lung, and prostate cancers, and for leukemia. Native Indian  females showed a lower rate for ovarian cancer and a higher rate of tumors of the gallbladder and uterine cervix, but their overall  cancer mortality was similar to that of whites.


Cancer incidence trends in white women of the San Francisco Bay Area.

The 10% increase in the incidence of all cancer observed in the total white population of the San Francisco Bay Area during 1970-75 is mostly due to the 19% increase in cancer among white females. The latter is largely a result of increased incidence of cancer of the corpus uteri, breast, and lung, and of malignant melanoma. Cancer of these four sites constitutes 85% of the increase in white women. The rise in uterine corpus cancer is limited to women over 50 years of age. An incidence peak in 1974 of breast cancer was followed by a substantial decrease in 1975. The 50% rise in female lung cancer is an extension of the increase that began in 1965. The almost 70% increase in melanoma among women since 1975 accompanies a comparable increase in melanoma among males after a decade of stable incidence rates.


[Reactor safety and human failure].

Reactor safety is given by the reliable solution of 3 tasks: on-time shutdown, continuous decay-heat removal, safe containment. After describing the general strategy of their solution even under upset conditions the most important engineered safeguards of pressurized water reactors are summarized. The important problem of human failure is discussed in some more detail. For the example Harrisburg some difficulties, but also some technical countermeasures are illustrated.


[Food contamination and consumer protection].

For years consumers have been irritated by publications of the press about "poison in food". Therefore an attempt is made to give objective information about the contamination of food. Hazardous substances can occur in food as natural components or they can be added in the course of production. Furthermore they can be formed during processing and storage or they can be contaminants of the environment. The legislative efforts to establish a sufficient protection of the consumer in this respect are shown.


Congenital abnormalities in newborn lambs following Akabane virus infection in pregnant ewes.

To clarify the pathogenicity of Akabane virus for ovine embryos, pregnant ewes were inoculated intravenously with the virus. As a result, all of them were affected with viremia and showed an increase in neutralizing antibody 2 weeks after inoculation. The virus was recovered from many organs of embryos which were inoculated with it at 29--45 days of pregnancy and sacrificed 9--30 days later. In particular, some of these embryos which were sacrificed 15 days after inoculation were found suffering from systemic infection. A large quantity of virus was recovered from the organs all over the body of them. No virus, however was recovered from any organ of embryos which were inoculated with the virus at 81 days of pregnancy and sacrificed 30 days later. Abnormal changes were observed in neonatal lambs born from ewes inoculated with the virus at 30--50 days of pregnancy. They were especially severe when the virus was inoculated at 30 days of pregnancy. They consisted of ankylosis of the limbs, scoliosis, hydranencephaly, porencephaly, stillbirth with dwarfism, and death after birth with dwarfism and weakness. Nothing abnormal was found in any neonatal lambs born from ewes inoculated with the virus at 91--101 days of pregnancy. When embryos exceeded 64 days of intra-uterine life more than 29 days after virus inoculation, it was possible to detect immunoglobulin, IgM or IgG or both, and antibody from the serum. Attempts failed to detect either immunoglobulin from embryos less than 59 days of intrauterine life. No IgA was detected from the serum of any embryo. In almost all the neonatal lambs born from ewes inoculated with the virus at 28--101 days of pregnancy, neutralizing antibody was detected from the serum at the time of birth.


An attenuated strain of Akabane virus: a candidate for live virus vaccine.

An attempt was made to attenuate the high virulent OBE-1 strain of Akabane virus by adaptation to low temperature. In it the virus was subjected to passage through HmLu-1 cell cultures at 30 degrees C. Cloning was carried out on the virus which had undergone 20 passages through these cultures to select a strain adapted to low temperature. Finally, ten clones were obtained. As a result, nine strains of clone in which virus replication was poor in HmLu-1 cell cultures at 40 degrees C were obtained. Of them, five strains of clone produced uniform plaques. Of these strains, one, or the TS-C2 strain, was selected. It was considerably lower both in peripheral infectivity to suckling mice and in intracerebral infectivity to 3-week-old mice than the OBE-1 strain. Calves and pregnant cows inoculated with the TS-C2 strain by the intracerebral, intravenous, or subcutaneous route were free from pyrexia, leukopenia, and viremia. Virus recovery was negative from various organs and fetuses. All the animals inoculated, however, were found to have neutralizing antibody produced. The results mentioned above suggested that the TS-C2 strain might have been so attenuated as to be available as a candidate strain for a live virus vaccine.


Immune response of various animals to Akabane disease live virus vaccine.

When various animals and routes of inoculation were examined for antibody response to Akabane disease live virus vaccine, the intracerebral (ic) inoculation of mice induced a better antibody response than the subcutaneous (sc) inoculation of calves, guinea pigs, hamsters, mice, or rats. Immunogenicity was compared among lots of this vaccine by performing ic inoculation of mice and sc inoculation of calves and guinea pigs. As a result, there was no distinct significant difference between any two lots of the vaccine, regardless of the animal species used. There was a tendency that the larger the dose of inoculation of the virus, the earlier the production of neutralizing (NT) antibody took place in calves inoculated with the vaccine, and the higher the antibody titer and the rate of taking a turn for positivity for antibody became in these calves. When calves immunized with the vaccine and cows in the field possessing NT antibody were given booster inoculation with the vaccine, the antibody titer showed a significant increase in almost all the calves and cows that exhibited an NT antibody titer of 4 or less at the time of booster inoculation. There were, however, no changes in antibody titer in such calves and cows as presenting an NT antibody titer of 8 or more. Calves and pregnant cows immunized with the vaccine were prevented from viremia and fetal infection when challenged by inoculation with virulent virus.


Isolation of Selenomonas spp. from lesions and non-digestive organs of cows, pigs and man.

Selenomonas spp. were isolated for the first time from lesions and non-digestive organs which were apparently normal in 2 cows, 6 pigs, and 1 human being. Identification as Selenomonas was based firstly on electron microscopical observation and secondly on fermentation products. They were divided into 3 major groups by biological properties, as well as by the patterns of these products. It has been confirmed that the habitats of organisms of the genus Selenomonas are generally digestive organs, including the rumen of the ruminant, the cecum of the guinea pig, and the oral cavity of man. The existence of these organisms in lesions and non-digestive organs in such animals and man, however, has been unknown as yet. Moreover, it has been completely unknown about the habitat of these organisms in swine. The findings obtained suggested the possibility of invasion of Selenomonas into other parts than the digestive organ in some animals and the presumable existence of the organism in the swine digestive organs. The role of Selenomonas as a secondary invader into some animals was proposed.


Pathological changes of xanthinurolithiasis in calves.

Pathological examination was carried out on a male and a female beef calf 3 months old involved in an outbreak of xanthinurolithiasis. This outbreak has been found among indigenous Japanese Black calves in an area of the Kyushu region since 1971. Involved in it, calves were retarded in growth, with the back curved, exhibiting depression and anorexia. A characteristic gross change was the accumulation of yellowish white or yellowish brown sand-grain-like calculi in the urinary passage. Histologically, a number of calculi, as birefractive crystals, were contained mainly in the collecting and distal uriniferous tubules in the renal medulla. In the uriniferous tubules epithelial cells surrounding those crystals presented such reaction as to form syncytia, and the surrounding connective tissue proliferated. Biochemical examination revealed that the calculi were composed of xanthine.


A quantitative histological study of the effects of acute triethyl lead poisoning on the adult mouse brain.

The effects of a single injection of triethyl lead chloride on the mouse brain was studied 1, 3, 5, 7 and 30 days postinjection using quantitative histological techniques. The total number of glia in the anterior commissure was significantly reduced following injection but by 30 days postinjection had returned to normal. The number of neurons and the number of glia in the indusium griseum did not change significantly. The number of mitotic cells in the subependymal layer fell slightly from 1 to 3 days postinjection then returned to normal 5 days postinjection. The number of pyknotic cells in the subependymal layer did not appear to change following injection. In the anterior commissure the number of mitotic cells fell significantly from 1 to 3 days postinjection and then increased significantly at 5 days postinjection. A similar increase in mitosis was found at 5 days postinjection in the indusium griseum. At 7 days postinjection a significant decrease occurred in pyknotic cells in the anterior commissure and indusium griseum.  Changes in the percentage of each type of glial cell present were found 30 days postinjection. This suggests that although the total number of glia may return to normal the number of each type of glial cell present changes following injection of triethyl lead. There was no evidence of cerebral oedema following triethyl lead injection either at the light or electron microscopic level.


A quantitative lifespan study of changes in cell number, cell division and cell death in various regions of the mouse forebrain.

A quantitative study of changes in total cell number was carried out in the indusium griseum and anterior commissure from fetal life to old age in the mouse brain. The changes in the number of mitotic and pyknotic cells were recorded in the indusium griseum, anterior commissure, subependymal and ependymal layers over the same period. The number of neurons which are produced and which migrate to the indusium griseum are in excess of the number eventually required and the surplus neurons are lost by cell death in late gestation and early postnatal life while synaptogenesis and neuronal differentiation is taking place. This neuronal loss is associated with a rapid turnover of glia. Most first generation glia, or their immediate precursors, are produced prenatally, in parallel but one day behind neurons. There is no large burst of mitotic activity in the postnatal brain which gives rise to the myelination gliosis which is probably largely a migratory phenomenon. Cell division continues throughout life in all parts of the brain studied. The greatest mitotic activity is centred in the subependymal layer where mitotic cells substantially outnumber pyknotic ones. There is a gradual decrease in mitotic activity in the subependymal layer up to 9 months of age with fairly constant mitotic activity thereafter. Mitotic activity in the indusium griseum levels out at 3 months postnatum with mitotic and pyknotic cells present in roughly equal numbers thereafter. Mitotic activity in all parts of the anterior commissure levels out at 6 months postnatum and remains constant thereafter. Mitotic and pyknotic cells are present in similar numbers except for a peak in pyknotic cells at 9 months. Cell number in the indusium griseum and anterior commissure is fairly constant between 3 and 9 months, but glial number begins to decrease in all parts of the anterior commissure from 12 to 22 months. In the indusium griseum the number of glia increased slightly between 6 and 22 months. The number of neurons fluctuated during the first week after birth then remained constant until 18 months. There was a significant decrease in the number of neurons between 18 and 22 months.


The blood-nerve barrier and reconstitution of the perineurium following nerve grafting.

Sural nerve autografts were performed on intact rat sural nerves and on sural nerves excised proximal to the site of grafting. The effect of the presence or absence of regenerating axons upon reconstitution of the perineurium at the graft junctions and upon re-establishment of the blood-nerve barrier to horseradish peroxidase (HRP) were studied over the succeeding 3--24 weeks. Compartmentation of the nerve fascicle occurred at the graft junctions where the perineurium was damaged. Each compartment contained Schwann cells with or without axons and was surrounded by elongated fibroblast-like cells which resembled perineurial cells in the longer surviving animals. It was concluded that, (a) compartments form in a nerve at the site of perineurial damage even in the absence of axons; (b) although compartmentation may be a mechanism for perineurial regeneration and reconstitution of the blood-nerve barrier, blood vessels and the cell layers forming compartments at graft junctions remain permeable to HRP for at least 6 months; and (c) the intact perineurium around the distal stump of a denervated nerve is permeable to HRP but the endoneurial blood vessels are not.


Experimental obstructive hydrocephalus in the rat: a scanning electron microscopic study.

Hydrocephalus was induced in 12-day old rats by the cisternal infusion of a concentrated kaolin suspension. The animals were killed at day 20 and the ependymal lining of all the ventricles prepared for scanning electron microscopy. The dilation of the ventricles was moderate to gross in all cases. The ependyma of the lateral ventricles was similar in both control and experimental animals. Ependymal damage was present in six out of the twelve hydrocephalic rats. Two had fibres visible on the ependymal surface. Four had tears covered with small round cells, believed to be responsible for the repair of the ependyma. The third ventricle, cerebral aqueduct and fourth ventricle enlarged by incorporating folds of ependyma, present in control animals, into the ventricular walls. The circumventricular organs present in the third and fourth ventricles were not damaged by the dilation of the ventricles, even in severe hydrocephalus.


A basic program to correct for split cell error in particles classified by the logarithm of their profile areas.

A program is presented, written in the BASIC computer language, to correct the errors which occur when cell profiles are counted in thin sections of tissue. Given the numbers of profiles in each of M size classes, and the thickness and area of the sections examined, the program calculates the number of cells in each of these classes per mm3 of tissue. The mathematical method is briefly described and it is shown that a useful level of accuracy may be obtained when the correction procedure is used in the study of non-spherical cells.


[Arteriovenous fistulas].

Three cases of arteriovenous fistulae observed in recent years at the University of Rome's 3rd Surgical Clinic, and of different site, entity are aetiology, are presented. The recent international literature is reviewed and the more outstanding clinical and therapeutical features of this form are discussed.


[An unusual case of atherosclerotic aneurysm of the trunk of the superior mesenteric artery, successfully treated with surgery].

A case of atherosclerotic aneurysm of the superior mesenteric artery is reported. This was located about 15 cm from its origin and immediately distal to the middle colic artery in a patient who had been operated on 4 years previously with aorto-iliac substitution for aneurysm of the same nature with ligature and section of the inferior mesenteric artery at the origin. Interruption of the latter created further technical problems solved with a serie of anastomoses that permitted the introduction of a good direct flow from the superior mesenteric respectively to the right colic and into an ileal branch which became a bridge or, rather, a "new mesenteric" assuring excellent pulsed flow into the underlying ileal branches, one of which anastomized at the ileocolic. This enabled direct, valid, pulsed flow to be resumed.


[Common bile duct calculosis and stenosis of Vater's ampulla. Results of surgical treatment of 307 cases].

A systematic account is offered of a personal series of patients operated for calculosis of the common bile duct, with or without stenosis of Vater's ampulla, over a period of 15 yr. Reference to the clinical and anatomopathological features of these cases is followed by a description of the criteria followed in the choice of the surgical approach. Recent and earlier results are illustrated and some comments are made with regard to the methods employed: ileal choledochotomy, transduodenal papillosphincterotomy, and choledochoduodenostomy). A preference is expressed for papillosphincterotomy in all cases where the correct indications are present.


[Findings on changes in the blood lipid pattern induced by jejuno-ileal bypass in severely obese subjects].

Changes in the lipid picture of 28 grossly obese subjects induced by jejunoileal by-pass are described. The results indicate that this operation brings about a marked reduction in total cholesterol and triglycerides, and hence a distinct regression of risk factors with regard to atherosclerosis.


[Long-term effects of gastric resection on the inferior esophageal sphincter].

The manometric profile of the oesophagogastric junction has been studied in patients subjected one year earlier to partial gastric resection. A reduction in maximum basal pressure (--49.8%) and length of the lower oesophageal sphincter (--35.45%) were noted. These figures agree with what was observed one month after operation in a previous study. It is concluded that gastric resection lead to a non-transitory reduction in sphincter function.


[Technical innovations in femoro-tibial reconstructions].

The literature on reconstructive femoro-tibial surgery includes distal by-pass implantation, personally considered the most interesting and most debated part. Four cases treated with double femoro-popliteal and popliteo-tibial reconstruction, three with the jump-by-pass technique and one with the sequential-by-pass technique are reported. Of these cases, three are complete with fluximetric and angiographic examination before, during and after the operation. Final results are considered satisfactory, notwithstanding certain inconveniences which were dealt with as they arose. Long-term follow-up permits some optimism for the future of this surgery, although the technical difficulties are by no means negligible.


[2 cases of death caused by hepatic insufficiency after jejuno-ileal bypass for obesity].

Reference is made to 2 cases of fatal liver failure following jejuno-ileal by-pass for obesity, in which necropsy shown micronodular and the rarer fragmentary necrosis, in addition to serious steatosis. Liver alterations following by-pass are usually reversible and respond to the infusion of medicaments. The indication for surgical re-establishment of continuity, in which, if timely, leads to normalisation of liver shape and function, must be chosen without hesitation when changes, albeit reversible, appear to threaten life and resist treatment, and in all cases where biopsy points to progression towards irreversible sclerosis.


[An unusual case of aneurysm of the artery of the quadriceps].

A case of gastrocnemia artery aneurysm observed before the appearance of clinical complications is reported. This localization is up to date unreported. The clinical behaviour and the angiographic investigation did not allow to identify the site of the arteriopatic lesion. This was possible only with surgical treatment.


[Cervical thymic cysts. Considerations on a case].

The Authors report a case of cervical thymic cyst. The only distinguishing feature is the presence of thymic tissue, containing Hassall's corpuscles, in the wall. From review of literature rarity of this swelling is manifest, and so is difficulty of preoperative diagnosis. As far as pathogenesis is concerned, long consideration has failed to resolve the question of their developmental or degenerative origin. Treatment consists of excision of the cyst and its accompanying tract. Prognosis is usually good.


[Papillomatosis of the gallbladder with carcinoma].

A case of widespread papillomatosis of the gallbladder, accompanied with an area of carcinoma in the presence of calculosis is reported. The question whether papilloma of the gallbladder should be regarded as a precancerous lesion, and what rôle concomitant lesions play in the pathogenesis of papilloma and its degeneration, are briefly discussed. It is felt that calculosis represents a considerable risk factor in the malignant transformation of papilloma, and the surgical treatment of all polypoid affections of the gallbladder is advised.


[Acupuncture as a part of a program of detoxification and weaning from opiates: 25 cases].

Presents results of a detoxification and habit loosing program carried out in 25 morphine-like substances addicts (mainly heroine) aged 19-26. The therapeutic treatment based on gabaergic drugs (l-glutamine, sodium valproate and piridoxine), low doses psychodrugs (tricyclics and benzodiacepines) and acupuncture, began in 13 subjects at the hospital and continued at the outpatients' service, while 12 subjects were treated only at the outpatients' service. Follow up: 6 subjects of the hospitalized group free from the addiction (5 subjects from more than 1 year after their discharge); 3 subjects of the outpatients' group abstinent from no more than 4 months after discharge. Biochemical mechanisms involved in this therapeutic program are extensively discussed.


[The physician-patient relationship in the acupuncture treatment of psychosomatic headaches].

Authors take in exame the acupuncture treatment in a group of subjects suffering from periodical cephalalgia about psychosomatic nature. Particular attention comes put considering the importance of relation MD-patient that one fixes in acupuncture, such as to consent a better elaboration about somatic symptom. MD always must be attentive in valutation of meaning about presented disturb and eventual latent message.


[Unusual use of reflexotherapeutic technics for control of pain in cases of phantom limb. Spinal and supraspinal theory].

Treatment of selected cases of amputees suffering from phantom-limbs pains by means of unusual techniques of reflexotherapy is reported. Nose, hand and foot acupuncture and classical auricolotherapy demonstrate in the patients here reported the beneficial effect of these methods. Nosologic, pathologic, clinic results and the anatomo functional mechanisms through which the therapeutic action of reflexoterapy can be explained are discussed. Spinal and trigeminal-reticulo-spinal pathways (central biasing mechanism) are postulated as inhibitory control system for somatic afferences.


[Electro-acupuncture in thoracic and cardiovascular surgery].

Electroacupuncture hypoalgesia was used in 377 operations of thoracic and cardiovascular surgery. Studies were performed also on electroencephalographic patterns during the application of this method. With the positive results, limitations of the method are discussed.


[Possibilities of control of regulation of the function of arteriovenous anastomoses and of capillary blood flow by means of acupuncture].

Acupuncture was carried out on a patient with rheumatoid arthritis and microangiopathy of the lower limbs. Photoplethysmographic waves appeared at the right inferior limb where before they had been absent; at the left inferior limb normalization of postural reflexes was achieved, suggesting that acupuncture is effective in vasodilatation of capillaries and preterminal arterioles and in the reactivation of the arterio-venous blood flow.


The value of the association of radiological methods with echographic examination in the study of intraocular foreign bodies.

The standard X-ray preserves its value in verifying the presence of a foreign body (FB). The echography is valuable in verifying the site of a FB when it remains uncertain in respect to the sclera after X-ray localization. Computerized tomography scanning offers useful information about the physical nature of the FB.


[Keratomycoses].

(1) In the presence of a torpid corneal ulcer, resistant to antibiotics and accompanied by dirty exudates and a hypopion, one must always think of a keratomycosis. (2) A mycotic examination with direct microscopic examination, culture and sensitivity test should immediately be made. (3) At the present time the best antimycotics are miconasol and econasol.


Effects of urea treatment in combination with curettage in extensive periophthalmic malignancies.

46 patients with 47 cancers of the eyelids and the canthi, large or very large in their great majority, were treated with local urea injections in combination with thorough curettage. In 7 of the above patients, the caruncle and the conjunctiva were also affected. This treatment was effective in 100% of our cases. The full recovery of the skin which had been destroyed by the cancer, without any remnants of scar or other disfigurement, is a very remarkable phenomenon; the functional condition of the lids remained quite normal as well. So we can affirm that in extensive periophthalmic carcinomas, in which cure with conventional methods is very difficult or almost impossible, as in some reported cases, the afore-mentioned treatment gives the most beneficial results, without any of the disadvantages of these methods.


[Experiences in animal experiments with hydrogel keratoprosthesis of different water content].

Satisfactory results could  be obtained in former animal experiments with keratoprostheses made by 38% hydrated hydrogel plastics (PHEMA). There still existed some doubts concerning alterations by aging of this material, possibly resulting in setting free toxic or allergenic substances as well as raising the risk of infection. Therefore, keratoprostheses containing 38 or 20% water were implanted in rabbit eyes. The follow-up period of 44 animals was 6 months. No essential differences in the postoperative course of both types of keratoprostheses could be observed. With the only exception of a growth of tissue over the optical cylinder in 1 case no serious complications, e.g., extrusion of the implant, occurred. Regarding the greater resistibility of the less hydrated hydrogel, this more durable plastic seems to be the more adapted material for keratoprotheses.


[Metastatic choroid tumors before and after radiation].

By means of fundus photographs of metastatic choroidal carcinomate in 20 patients it is shown that the slightly prominent yellowish-grey (rarely more intense whitish-yellow) areas appear to be either lobular, composed of various nodes, or more homogeneous and solitary. Illustrations are presented of mammary carcinomata (14x), bronchial carcinomata (3x) and uterine carcinomata (3x). The bilateral metastases, occurring in 5 cases, appear all over the eye-ground; the left eye was more frequently affected. Scarring from irradiation (or the use of cytostatics) is followed in the region of the tumour either by pure depigmentation, an almost regular patchy or punctate pigmentation, irregular displacement of pigment such as follows a severe choroiditis disseminata, or a dark, almost regular pigmentation. The X-ray radiation of a choriodal metastasis of a uterine carcinoma led to necrosis of the chorioidea, the pigment epithelium, and the peripheral retina.


Wendell L. Hughes Lecture. Wound healing.

The four major aspects of wound healing are discussed. In the inflammatory phase, necrotic tissue and foreign debris are removed while precursors of collagen synthesis accumulate. In the following fibroblastic phase, collagen is laid down and tensile strength increases. Concomitantly, contraction occurs to a varying degree along the wound surfaces. Finally, remodeling occurs and a mature scar evolves. Some clinical applications are presented.


Uniocular nystagmus in monocular visual loss.

Uniocular nystagmus was studied by electro-oculography in ten patients with monocular visual loss caused by ocular and optic nerve lesions. In these patients, visual loss was congenital or acquired in childhood or adult life. In all patients the oscillations were present in the primary position of gaze and were vertical, pendular, and of variable and low frequency (less than, or equal to, 1.0 HZ) and amplitude (usually less than 5 degrees). Refixation saccades, smooth pursuit, optokinetic nystagmus, and vestibuloocular responses to rotation in the horizontal and vertical planes were within normal limits. The irregularity, low frequency, and low amplitude of this form of nystagmus cause it to often be missed during casual clinical examination, but easily differentiate it from other causes of uniocular nystagmus.


Keratophakia: a preliminary evaluation.

The results of 18 cases of combined cataract extraction and keratophakia are presented. Initial results indicate that these procedures may replace the use of alloplastic materials for the correction of aphakic ametropia either as a primary or a secondary procedure.