Brachial plexus and radicular neurography in relation to cortical evoked responses.

An application of somatosensory potential recording suitable for clinical neurodiagnostics is described. Evoked responses were recorded with surface electrodes at four levels between wrist and scalp: Erb's point, seventh cervical spine, inion, and the somatosensory area of the scalp. The normal latency and latency difference values based on 16 healthy subjects are presented as well as those of four examples of pathological cases with lesions at various levels in the nervous system. The method presented offers novel possibilities for solving problems of differential diagnosis, especially at the level of the brachial plexus.


Interobserver agreement in assessment of ocular signs in coma.

There is interobserver agreement in the assessment of various ocular signs found in coma patients. As measure for observer agreement the parameter kappa (K) was determined for (in-)equality of pupils, reaction of pupils, spontaneous eye movements, and oculocephalic responses. The agreement in the assessment of the pupils to light and in the assessment of (in-)equality of pupils appeared to be satisfactory, but more disagreement occurred in assessing spontaneous eye movements and oculocephalic responses.


Axonal underdevelopment from axotomy in kittens.

Permanent axotomy, by hind limb amputation in kittens, is found by morphometric evaluation at 9 months after amputation to result in failure of ventral and dorsal root myelinated fibers (MFs) to attain adult calibers. The positions of the median diameter and of diameter peaks were unequivocally displaced to smaller diameters, but more so for dorsal than for ventral roots. When fiber spectra of amputated roots were compared with those of kittens at the time of amputation, the median diameter, the position of peaks of diameter histograms, and the diameters of largest MFs were clearly at larger diameters, an indication that axonal development had continued (especially for motor fibers) for some time after amputation. These studies have shown that whereas in adult cats, permanent axotomy results in axonal atrophy, in kittens axonal development continues, but stops short of reaching adult values. As axonal caliber presumably ultimately relates to perikaryal synthesis of protein, one must infer either that the signal to decrease protein synthesis is slow in arriving at the perikarya or that the decreased axonal flow of materials resulting from such a signal is slow and thus allows continued axonal growth for a period after amputation.


Axonal atrophy from permanent peripheral axotomy in adult cat.

The peripheral axons of lower motor and spinal ganglion neurons were permanently transected and not allowed to regrow to target tissue in adult cats by amputation of the hind limb at the hip. The number and sizes of L-7 lower motor neurons at two levels (cell bodies of lateral group motor neurons and myelinated fibers [MFs] of ventral root) and of L-7 spinal ganglion neurons at two levels (cell bodies of L-7 spinal ganglion and MFs of dorsal root) were morphometrically evaluated in groups of cats at 3 months, 9 months, and 18 months after amputation and compared with the number and sizes of neurons in controls or with those on the opposite side. The number of neurons decreased only minimally after amputation. The diameter of neuron cell bodies was only equivocally reduced. By contrast, the median diameter and the peak diameter of both large and small MFs of dorsal and ventral nerve roots were significantly (approximately 30%) less than those of controls. This reduction in diameter of MFs is judged to be related to chronic axonal atrophy rather than to selective loss of large fibers. Permanent transection of distal axons should therefore prove to be a good model of chronic axonal atrophy.


Ultrastructural and cytochemical observations in a case of dominantly inherited hypertrophic (Charcot-Marie-Tooth) neuropathy.

Ultrastructural and cytochemical studies were carried out on the sural nerve of a 6 1/2 year old girl with dominantly inherited hypertrophic (Charcot-Marie-Tooth) neuropathy. Electron microscopy revealed a paucity of myelinated fibers, with inappropriately thin myelin sheaths and onion-bulb formations associated with those fibers that were myelinated. In some cases the nodal axolemma was folded so as to form irregular excrescences. At other nodes, the non-myelinated gap was enlarged. Following staining with ferric ion and ferrocyanide, dense precipitates were observed on the cytoplasmic surface of the axolemma at some nodes of Ranvier, as in normal peripheral axons. At other nodes, staining was attenuated or absent. The latter result is similar to our findings in the dy/dy dystrophic mouse. These results are consistent with the hypothesis that, in dominantly inherited hypertrophic neuropathy, there are abnormalities of structure of the axolemma, in addition to an abnormality of the myelin sheath.


Involvement of transverse tubules in induced myotonia.

A single oral dose of clofibrate (30 mg/100 gm body weight) given to 250-300 gm male rats produced myotonic discharges from both the gastrocnemius and soleus muscles 2 hours after feeding. Rats fed the same dosage for 14 consecutive days exhibited electromyographic discharges consistent with profound myotonia. Fibers removed from the superficial region of the gastrocnemius muscle served as the source of fast twitch fibers for histological studies. Slow twitch fibers were observed in the soleus muscle. After a single clofibrate feeding localized T-tubule dilation was observed in a small percentage of myofibers in both muscles. In rats fed clofibrate for 14 days, approximately 30% of the fibers of the gastrocnemius and soleus muscles had dilated T-tubules. The motochondria of the soleus muscles of these rats were characterized by dilated intercristal matrixes containing electron densities. No mitochondrial changes were observed in the fibers of the gastrocnemius muscles taken from the same rats.


Ataxia-telangiectasia with a 32 year survival. A clinicopathological report.

The clinicalpathological findings in a 32-year old woman with ataxia-telangiectasia are presented. This is the oldest patient with this disease to be studied thoroughly clinically and at autopsy. Multiple small gliovascular malformations in the brain and spinal cord and telangiectasis of the liver were found. Other advanced lesions of ataxia-telangiectasia are illustrated. The vascular malformations of the central nervous system and liver are unique. The patient died of a malignant lymphoproliferative disorder and had five other malignant and benign neoplasms.


Effects of rape victim resistance, assault outcome, and sex of observer on attributions about rape.

Perceptions of sexual assault were investigated as a function of sex of observer, nature of victim resistance, and assault outcome. Two hundred twenty-nine subjects were randomly assigned by sex to six resistance x outcome conditions. Hypotheses that women and men apply sex-role stereotypes in evaluating the rape situation were supported: (a) subjects were more certain that rape had occurred as the victim resisted more; (b) subjects attributed greater responsibility to the victim for completed that for attempted rape, while the reverse pattern was found for the assailant; (c) women attributed more responsibility to the assailant than did men; and (d) men attributed less fault and more intelligence, and women attributed more fault and less intelligence to the rape victim as she resisted more forcefully. Attributional terms; fault, blame, and responsibility were found not to be interchangeable. Rape attributions are discussed within the contexts of identification with victim's situation and perceptions of victim's control. Implications for choice of self-defense strategy and treatment of rape victims are also considered.


Autonomic arousal as a cognitive cue in stressful situations.

The need for further investigation and integration in a real world situation is demonstrated in a critical review of the literature on autonomic feedback and attribution of arousal in stressful situations. In the present study, actual autonomic arousal, arbitrary feedback of arousal, and attributions for arousal were manipulated in a dental clinic where the subjects were awaiting oral surgery. The main prediction was that cognized arousal (due either to perception of actual arousal or to arbitrary feedback about arousal level) in the absence of a nonemotional attribution for that cognized arousal would lead to  higher subjective report of anxiety and to greater avoidance than would be found with either of these conditions unmet. The results on the subjective report measure generally supported this hypothesis. In addition, arbitrary feedback about arousal level did not interact with the actual arousal manipulation; nor did it produce changes in pulse rate or blood pressure, further supporting a cognitive interpretation of the effects of autonomic arousal on subjective report. However, the study illustrates difficulties in inducing beneficial beliefs in the real world. And the manipulations generally did not affect the behavioral measure, probably due to the expected consequences of that behavior.


Death anxiety, dissent, and competence.

A total of 64 male undergraduates were administered a multistage interview which was structured to assess (a) their level of overtly expressed death anxiety, (b) covert (GSR) arousal to death stimuli (c) self-perceived competence, and (d) agreement with or dissent from life threatening national policies. The analyses that followed were concerned with examining the relationships among these variables. In previous studies of this kind it had been typically found that (1) self-perceived competence and magnitude of expressed death concern are inversely related and (2) overt expressions of death concern and covert physiological arousal to death cues are inversely related. Psychodynamic formulations centering on the ego-defensive nature of inhibited expressions of death anxiety have been cited to explain these past data. The current investigation proposed that the magnitude of expressed death concern would bear an inverse relationship to both felt competence and covert death arousal only when the level of overt concern was not contingent upon the individual's attitudes concerning the imminence of real life threatening circumstances in the environment. The rationale behind these predictions inheres in the notion that the neurotic components of strongly expressed death anxiety derive from its lack of anchoring in "real" external threats. Conversely, the expression of low death fear can only be regarded as "defensive" when real threats are perceived and acknowledged. The obtained results strongly support this rationale and the discussion centers on the impact of social conditions on psychodynamic processes.


Amplitude of the oral temperature circadian rhythm and the tolerance to shift-work.

The aim of the study was to test the hypothesis of a relationship between the tolerance to shift-work and the amplitude of the oral temperature circadian rhythm. Forty eight shift-workers (Rhône-Alpes Region) volunteered for this chronophysiological investigation: a) 23 steel-industry workers (SI); shift-duration: 7 days (weekly rotation); b) 25 chemical-industry workers (CI); shift-duration 2 days. The subjects' ages were roughly similar with regard to groups (SI and CI) as well as sub-groups (good and poor tolerance of shift-work). The tolerance was evaluated conventionally, according to both the existence and intensity of 3 types of medical complaint: (1) digestive troubles: gastritis, colitis, peptic ulcer etc.; (2) persisting fatigue, unusual nerviness, etc.; (3) sleep alterations. The poor tolerance was observed mostly in subjects shift-working for 10 years or more. Regular large-scaled and retested medical Hg thermometers (1/20 Celsius precision) were used. Data were recorded 2-hourly, at fixed clock hours in order to obtain individual time series. Both conventional and cosinor statistical analysis show that, in both groups, the oral temperature circadian amplitude is larger in subjects tolerant to shift-work than in subjects that have become intolerant.


Supra-normal susceptibility to acoustic trauma of the rat pup cochlea.

1 Young and adult rats were exposed to a continuous 120 dB SPL white noise for 30 min. 2 Animals exposed before the 40th postnatal day showed drastic and permanent threshold shifts (PTS) at high frequencies (between 6 and 20 kHz). 3 After 60 days of age, only temporary threshold shifts (TTS) were noticed, which lasted 7 days. 4 Thus the sensory structures of the rat cochlea showed a supra-normal susceptibility to acoustic trauma, during and just after their anatomical differentiation. 5 These results support previous data obtained on hamsters and guinea-pigs and are discussed in terms of anatomo-functional relationships.


Release of endogenous serotonin from "encéphale isolé" cats. I - Technical aspects.

Ventricular perfusion, push-pull cannulae at the caudate level and cortical superfusion were used in "encéphale isolé" cats in order to estimate endogenous 5-HT release. The amine was measured using the radioenzymatic assay. These different methods are described and compared. Technical aspects and advantages of cortical superfusion under physiological conditions are discussed.


Release of endogenous serotonin from "encéphale isolé" cats. II - Correlations with raphe neuronal activity and sleep and wakefulness.

The discharge pattern of single neurons localized in raphe nuclei dorsalis and centralis superior was recorded in "encéphale isolé" cats, during sleep and wakefulness episodes occurring spontaneously or triggered by vago-aortic stimulation. In both nuclei, a similar and progressive decrease in frequency of discharges is generally observed during shifts between wakefulness, the transitional phase of sleep and paradoxical sleep. In addition, the release of serotonin (5-HT) has been studied with push-pull cannulae (caudate nucleus level) and superfusion techniques (cortical associative area) in relation to the different stages of consciousness. The results showed a clear diminution of endogenous 5-HT released during spontaneously occurring or vago-aortic triggered sleep.


Thyroid hormones and adipose tissue development.

The effect of thyroid hormones on the cellularity of the retroperitoneal adipose tissue (R.P.A.T.) was investigated in rats that were 3, 6 and 12 weeks old. Two groups of rats were respectively made hypothyroid by the antithyroid compound propylthiouracil, or hyperthyroid by thyroxine. The number of adipocytes was less in the hypothyroid rats than in the controls; it was higher in the hyperthyroid rats without any concomitant increase in the weight of their R.P.A.T. Moreover, there was no significant correlation between adipose cell number and adipose tissue weight within any group of T4 or control rats. In all groups of rats, the number of adipose cells in the R.P.A.T. was larger in males than in females; the difference was highly significant in 12 week old control rats.


Lactate kinetics estimated by single injection and continuous infusion of [14C-(U)]-lactate in rats.

1 Identical values of the rate of lactate turnover determined with [14C-(U)]-lactate were found with single injection or continuous infusion techniques in anaesthetized and mechanically ventilated rats. 2 The mean transit time and total minimal body mass of lactate determined graphically (Katz et al., 1974 a, b) were higher with single injection than with continuous infusion of the tracer.


Correlation of biological activity and high-pressure liquid chromatographic retention index for a series of propranolol, barbiturate, and anthranilic acid analogues.

The antiarrhythmic activity of propranolol analogues, the inotropic activity of propranolol analogues, the anti-inflammatory activity of anthranilic acids, the hypnotic activity of barbiturates, and the inhibition of cell division by barbiturates were correlated with either octanol--water partition coefficients or with high-pressure liquid chromatographic retention indices. The retention index, which was a scale based on the relative retention of the drug and a series of C3--C23 2-ketoalkanes, was found to give higher correlations with biological activity than was found between octanol--water partition coefficients and biological activity. Only in the case of the anthranilic acids was the retention index found to give the lower correlation.


Synthesis and evaluation of the thiosemicarbazone, dithiocarbazonate, and 2'-pyrazinylhydrazone of pyrazinecarboxaldehyde as agents for the treatment of iron overload.

Three prototype tridentate ligands (i.e., pyrazinecarboxaldehyde thiosemicarbazone, sodium pyrazinecarboxaldehyde dithiocarbazonate, and pyrazinecarboxaldehyde 2'-pyrazinylhydrazone) were prepared and evaluated for their relative abilities to remove iron from model systems designed to mimic particular aspects of chronic transfusional iron overload. These compounds were synthesized by condensation of pyrazinecarboxaldehyde with the appropriate substituted hydrazide. Iron-binding properties were determined, and the ability to remove iron from the proteins transferrin and ferritin was ascertained. An in vivo model system employing iron-loaded mice was used to demonstrate that all three compounds were effective at reducing tissue iron levels.


Synthesis, redox characteristics, and in vitro norepinephrine uptake inhibiting properties of 2-(2-mercapto-4,5-dihydroxyphenyl)ethylamine (6-mercaptodopamine).

In an attempt to further characterize the structural features of 6-hydroxydopamine analogues that are associated with in vivo neuronal degeneration, the synthesis of 6-mercaptodopamine was undertaken. Although reaction conditions leading to the 1,4 addition of thiols to the model quinone 4-methyl-o-benzoquinone were achieved, attempts to obtain 6-thiolated dopamine analogues by this route failed. The synthesis of 6-mercaptodopamine was achieved by the regioselective thiocyanation of O,O-dimethyldopamine, followed by bis-O-demethylation and reductive cleavage of the S-cyano group. Unlike 6-hydroxydopamine, 6-mercaptodopamine was resistant to autoxidation at pH 7.4. Cyclic voltammometric analysis, however, indicated that electrochemically generated oxidation species of 6-mercaptodopamine are unstable and undergo spontaneous reaction, presumably intramolecular cyclization. In vivo tests revealed that 6-mercaptodopamine inhibits the uptake of tritium-labeled norepinephrine by isolated rat heart atria, although to a much lesser extent than 6-hydroxydopamine.


Synthesis and biological activity of carboxyl-terminus modified prostaglandin analogues.

A series of PGE2, 16,16-dimethyl-PGE2, and PGF2 alpha analogues modified at the carboxyl terminus with tetrazole, amide, acylurea, imide, and sulfonimide functionalities was evaluated for uterine stimulant, bronchodilator, hypotensive, gastric antisecretory, and diarrheal activity. These compounds were prepared by modification of the Corey prostaglandin synthesis utilizing as a key step condensation of known hemiacetals with the ylide derived from the requisite substituted phosphonium salts. Structure--activity relationships suggest that a proton at the C-1 position appears necessary for agonist activity and the acidity of this proton has a relatively greater influence on activity than pendant steric bulk. Noteworthy are the tissue-selective bronchodilator activity of N-acetyl-PGE2-carboxamide and the selectivity for uterine tissue of N-methanesulfonyl-PGE2-carboxamide, 2-decarboxy-2-(tetrazol-5-yl)-16,16-dimethyl-PGE2, N-acetyl-16,16-dimethyl-PGE2-carboxamide, and N-methanesulfonyl-16,16-dimethyl-PGE2-carboxamide.


Synthesis of spiro[isobenzofuran-1(3H),4'-piperidines] as potential central nervous system agents. 5. Conformationally mobile analogues derived by furan ring opening.

Synthesis and antitetrabenazine activity of 4-[2-(arylmethyl)phenyl]piperidines and 4-(benzyloxy)-4-phenylpiperidines, prepared as simplified and possibly more readily synthesized analogues of 3-phenylspiro[isobenzofuran-1 (3H),4'-piperidine], are reported. Several 4-[2-(arylmethyl)phenyl]piperidines display antitetrabenazine activity comparable to imipramine or amitriptyline but are two- to fourfold less active than analogous 3-arylspiro[isobenzofuran-1(3H),4'-piperidines]. Structure--activity relationships for 4-[2p(arylmethyl)phenyl]piperidines are generally similar to the profile established for 3-arylspiro[isobenzofuran-1(3H),4'-piperidines]. Significant antitetrabenazine activity is associated only with derivatives where the arylmethyl group is ortho to the piperidine ring. 4-(Benzyloxy)-4-phenylpiperidines and 4-[2-(arylmethyl)phenyl]-4-piperidinols and the corresponding methyl ethers and esters display weak to modest antitetrabenazine activity. 4-[2-(Arylmethyl)phenyl]-1,2,3,6-tetrahydropyridine derivatives, at best, exhibit modest antitetrabenazine activity, with the exception of 4-[2-(phenylmethyl)phenyl]-1,2,3,6-tetrahydropyridine which is approximately equipotent with amitriptyline. The results of these investigations allow certain speculations to be made with respect to the role of the furan ring in the 3-arylspiro[isobenzofuran-1(3H),4'-piperidines] and antitetrabenazine activity.


Quinolone antimicrobial agents. 2. Methylenedioxy positional isomers of oxolinic acid.

The synthesis and antimicrobial activity of the methylenedioxy positional isomers, 1-ethyl-1,4-dihydro-5,6-methylenedioxy-4-oxo-3-quinolinecarboxylic acid (9) and 1-ethyl-1,4-dihydro-7,8-methylenedioxy-4-oxo-3-quinolinecarboxylic acid (17), of oxolinic acid (18) have been accomplished. Isomer 9 was prepared by the reaction of N-ethyl-6,7-methylenedioxyisatoic anhydride with sodioethyl formylacetate [L. A. Mitscher, H. E. Gracey, G. W. Clark III, and T. Suzuki, J. Med. Chem., 21, 485 (1978)], while isomer 17 was prepared by thermal cyclization of diethyl 2-[(2,3-methylenedioxyanilino)methylene]malonate [D. Kaminsky and R. I. Meltzer, J. Med. Chem., 11, 160 (1968)]. Both of the new isomers are less active in vitro when compared to oxolinic acid (18) itself.


Dibenzotropone- and dibenzosuberonecarboxylic acids with bronchodilator activity.

The syntheses of 44 5H-dibenzo[a,d]cyclohepten-5-one derivatives bearing a carboxyl gropu at the 1, 2, 3, or 10 position and various substituents at the 7, 8, or 9 position are described. Some of the compounds showed significant bronchodilator activity in guinea pigs and protected the animals against a histamine challenge administered either by aerosol or intravenously. The most active compounds were 10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5-one-2-carboxylic acids bearing a methyl or halogen substituent at the 9 position. These compounds were approximately as active as aminophylline by intraperitoneal administration.


Substituted 3-amino-1,1-diaryl-2-propanols as potential antidepressant agents.

Following the discovery that 3-(dimethylamino)-1,1-diphenyl-2-propanol hydrobromide (1) possesses potent reserpine-prevention activity in mice, a series of analogues of 1 was synthesized and evaluated as potential antidepressant agents. Several routes to analogues of 1 were evaluated, the most generally applicable of which was the regiospecific ring opening of a suitably functionalized 1,1-diaryl-2,3-epoxypropane (obtained in three stages from the corresponding benzophenone) with the appropriate amine. The more interesting compounds of the series were evaluated for their propensity to cause undesirable peripheral anticholinergic effects, all compounds tested being markedly less active than imipramine on this parameter. On the basis of its good activity in biochemical and pharmacological animal models of depression, together with its relative lack of anticholinergic side effects, 1-(3-chlorophenyl)-3-(dimethylamino)-1-phenyl-2-propanol hydrochloride (20, BRL 14342) was chosen for further evaluation.


Potential antiarthritic agents. 2. Benzoylacetonitriles and beta-aminocinnamonitriles.

Benzoylacetonitrile and beta-aminocinnamonitrile are shown to possess potent antiinflammatory activity in the rat adjuvant arthritis model. In a series of phenyl-substituted analogues, only o-, m-, and p-fluorobenzoylacetonitrile and m- and p-fluoro-beta-aminocinnamonitrile retained activity. Additionally, beta-amino-2- and beta-amino-3-thiopheneacrylonitrile and beta-oxo-2- and beta-oxo-3-thiophenepropionitrile exhibited similar activity. These agents are not believed to be acting via prostaglandin synthetase inhibition. The metabolic profile of benzoylacetonitrile is also described.


Hypolipidemic activity of phthalimide derivatives. 1. N-Substituted phthalimide derivatives.

The general lipid-lowering action of the N-substituted phthalimide derivatives reported herein, as well as the activity of potassium phthalimide, implicates the phthalimide moiety as possessing hypolipidemic activity in rodents. Compounds containing substituents with chain lengths of four carbon or oxygen atoms showed the best hypolipidemic activity in the series tested. Tests involving 1-N-phthalimidobutan-3-one demonstrated a dose-dependent hypolipidemic action free of estrogenic side effects, with no apparent deposition of cholesterol in body organs, and with a high therapeutic index. Further work on the hypolipidemic activity of phthalimido, as well as other imido compounds, is underway.


Synthesis and biological evaluation of 9,11-azo-13-oxa-15-hydroxyprostanoic acid, a potent inhibitor of platelet aggregation.

The synthesis of a prostaglandin endoperoxide analogue, 9,11-azo-13-oxa-15-hydroxyprostanoic acid (AOHP), is described. AOHP was found to block effectively both the thromboxane synthetase and the PGH2/TxA2 receptors in human platelets. It inhibits the platelet aggregation induced by arachidonic acid, 9.11-methanoepoxy-PGH2, PGH2, and TxA2 but does not affect the ADP-induced aggregation in aspirinated platelet-rich plasma. Some of the intermediates for the synthesis of AOHP also are effective in inhibiting platelet aggregation.


Antibacterial N-[omega, omega'-bis(alicyclic and aryl)-sec-alkyl]poly(methylene)triamine and -tetramine hydrochloride salts.

A series of antibacterial N-(omega, omega'-(cycloalkyl, bicyclo[2.2.1]heptyl, and alkyl-substituted phenyl)-sec-alkyl]poly(methylene)triamine and -tetramine hydrochloride salts were synthesized in an effort to develop efficient, nonsystemic inhibitors, particularly for Pseudomonas aeruginosa. In the 1,5,9-triazanonane group, 3 of 16 compounds were effective at 8--10 micrograms/mL against pseudomonads. Efficiency appeared more dependent upon lipophilicity of the nitrogen substituent than other characteristics represented by the three types of rings. A parabolic relationship was observed for the entire set between the hydrophobic parameter, pi, of the lipoidal moiety and minimal inhibitory concentration. One of 16 tetramines, 1-[1,5-bis(3,3-dimethyl-2-norbornyl)-3-pentyl]-1,5,9,13-tetraazatridecane tetrahydrochloride (26f), ranked similarly. An additional two compounds in each series were superior to several commercial cationic detergents in the control of the Gram-negative bacteria. None was inhibitory at up to 200 micrograms/mL for Proteus vulgaris.


Bufotenine esters.

Bufotenine (5-hydroxy-N,N-dimethyltryptamine) has been reported to be behaviorally inactive or only very weakly active in man and animals; this may be a consequence of its low partition coefficient and resultant inability to penetrate the blood--brain barrier. The acetyl, propionyl, butyryl, isobutyryl, and pivalyl esters of bufotenine were prepared for future pharmacological evaluation. Unexpectedly, it was found that these esters all possess a relatively high affinity for the serotonin receptors of the isolated rat stomach fundus preparation. A semiquantitative chromatographic measurement of ester hydrolysis suggests that extensive hydrolysis of the esters to bufotenine does not occur under the conditions of the affinity assay.


Synthesis and antileukemic activities of furanyl, pyranyl, and ribosyl derivatives of 4-(3,3-dimethyl-1-triazeno)imidazole-5-carboxamide and 3-(3,3-dimethyl-1-triazeno)pyrazole-4-carboxamide.

From the reaction of silylated 4-(3,3-dimethyl-1-triazeno)imidazole-5-carboxamide (DTIC, 5) and 3-(3,3-dimethyl-1-triazeno)pyrazole-4-carboxamide (DTPC, 9) with 2-chlorotetrahydrofuran, we have isolated in both cases a single tetrahydrofuran-2-yl derivative. However, when silylated DTPC was reacted with 2-chlorotetrahydropyran, two tetrahydropyran-2-yl compounds were obtained, and these were shown to be positional isomers on the basis of 1H NMR and UV data. These furanyl and pyranyl derivatives were tested for antileukemic activity (L-1210, in vivo) and the results were compared with the results obtained for the corresponding ribosyl derivatives of DTIC and DTPC.


Thermoregulatory nonshivering thermogenesis in men, with special reference to lipid metabolism.

The existence of thermoregulatory nonshivering thermogenesis, with special reference to lipid metabolism, was investigated in men. Acute cold exposure (10 degrees C, 60 min) produced a marked increase in heat production, with concomitant elevation of plasma free fatty acid (FFA) level, modest increase of ketone body concentration and lowered respiratory quotient (R.Q.). The correlation of heat production to plasma FFA levels was significantly positive; that is, subjects with higher heat production showed higher plasma FFA levels. Moreover, correlation of either heat production or plasma FFA levels to R.Q. was significantly negative, respectively. On the other hand, exposure to cold after an administration of nicotinic acid, which has a suppressive effect on FFA mobilization from adipose tissue, resulted in less cold-elevated heat production, a significant fall of plasma FFA and ketone body concentrations, and no change in R.Q. Although no visible or only slight shivering was observed in control cold exposure study, greater shivering occurred in the nicotinic acid cold exposure study. These results appear to indicate that nonshivering thermogenesis as a source of heat production achieved by enhanced utilization of lipids is also present in men.


Membrane potential of squid axons: effect of internal and external ion concentration.

Transmembrane resting potentials of squid axons were measured with variation of intracellular salt concentrations. It was found that the dependence of resting potential on the extracellular K-ion concentration was practically unaffected by the change of ionic strength in the intracellular phase, and the relationship of membrane potential and the logarithm of extracellular K-ion concentration was a straight line with a slope of about 50 mV/10-fold extracellular K-ion concentration. Also, the degree of change in resting potential due to the change of intracellular K-ion concentration was not affected appreciably by the extracellular solution with various K-ion concentrations, and the membrane potentials were insensitive over a wide range of intracellular K-ion concentrations. It was also indicated that the observed transmembrane potentials are not explained by a conventional membrane potential theory.


Electrical excitability in the rat clonal pituitary cell and its relation to hormone secretion.

Membrane electrical properties of the clonal anterior pituitary cell (GH3), were studied using intracellular recording techniques. The resting potential in the GH3 cell was -48.0 +/- 1.1 mV (mean +/- S.E., n=39) in normal saline. The input resistance estimated from the linear portion of the current-voltage relationship was 453 +/- 30 Momega (n=21). The maximum rate of rise of the action potential was 7.0 +/- 1.1 V/sec (n=12) at room temperature (23-25 degrees C). The action potential had both Na and Ca components. The Ca component was abolished by addition of 4 mM Co2+. Sr2+ could substitute for Ca2+ in supporting spike initiation. As the concentration of Sr2+ was increased, the maximum rate of rise of the action potential increased. After replacement of Ca2+ with isomolar Ba2+ the membrane potential shifted to -6.1 +/- 1.1 mV (n=11). In the Ba solution, prolonged action potentials were evoked by a depolarizing current pulse after maintaining the membrane potential more negative than -50 mV. The release of both prolactin and growth hormone was enhanced by increasing the external K+ concentration to 50 mM in the presence of Ca2+. Sr2+ could substitute for Ca2+. Ba2+ enhanced the release of both hormones, even if the K+ concentration was unaltered. The facilitatory effects of high K+ and Ba2+ were markedly suppressed by addition of 2-4 mM Co2+. These results may suggest that the potential-dependent increase in the membrane permeability to Ca2+, responsible for initiation of the Ca spike, plays a significant role in stimulation of hormone secretion in GH3 cells.


The number of active motor units and their firing rates in voluntary contraction of human brachialis muscle.

To make clear the control mechanism of force generation in human muscle, the electrical activity of the brachialis muscle was studied at various levels of contraction force by recording single motor unit discharges as well as mass electromyograms (EMGs). The firing rate of motor units increased with force along an S-shaped curve. At low levels of force, motor units increased their firing rates steeply with force. At intermediate levels of force, each motor unit increased its firing rate linearly with force at lower rates. As the maximum of force was approached, the firing rate increased very steeply, reaching as high as 50 Hz or more. By applying a new method of statistical processing to mass EMGs, the number of active motor units and the size of action potential were estimated at each level of force. The number of active motor units increased monotonously with muscle force. Motor units recruited at high levels of force had larger amplitudes of action potentials than those recruited at lower levels. Calculations were made to determine how the relative contribution to an increase in muscle force is varied between recruitment and the increase in firing rate. The contribution of recruitment gradually decreased with the increase in force. Up to about 70% of the maximum force, recruitment is the major mechanism for increasing the force of contraction.


Properties of X- and Y-cells in the rabbit retina.

Bevelled glass microelectrodes were used to record spike potentials extracellularly from the ganglion cells of the rabbit retina. Good responses were obtained from the isolated retina or eye-cup preparation for at least 12 hr. Using a contrast reversal stimulus, 63.8% (67/105) of the units showed linear spatial summation (X-cells), and 21.0% (22/105) showed nonlinear spatial summation (Y-cells). The X- and Y-cells in the rabbit retina had physiological properties which were similar to those in cat retina. Directionally selective cells (15.2%) were found to respond poorly, if at all, to the contrast reversal stimulus.


Physicochemical study of receptive mechanism of laryngeal water fibers in the rabbit.

The effects of various cations on the water unit activity were studied by recording unitary discharges in the superior laryngeal nerve fibers of the rabbit. Chloride salts of Li+, Na+, K+, Cs+ depressed the water response, while sulfate salts of Li+, Na+, NH4+, K+ facilitated it. Cations were less effective in stimulating action than anions. The depression of the water response in the laryngeal nerve has been thought to be caused by permeation of the stimulating anions through the receptor membrane and/or by destruction of the water structure on the membrane surface induced by adsorbed anions (SHINGAI, 1977 a). In order to differentiate these two possible actions of anions, the effects of benzenesulfonate and trichloroacetate were examined, because these anions were expected to be impermeant through the receptor membrane and to have a water structure-breaking effect. These anions showed no effect on the water response in concentrations below 320 mM. Measurements of the viscosity and the density of the electrolyte solutions showed that benzenesulfonate had a strong water structure-breaking effect. These results suggested that impermeant anions having water structure-breaking actions do not influence the excitability of the water receptor and that the depression of the water response by anions in the stimulating solution is caused by a hyperpolarization generated by permeation of the anions through the receptor membrane.


Measurement of heat production in dog submandibular gland.

In dog submandibular glands, we measured changes in metabolic heat production during a secretory period which was induced by electrical stimulation of the chorda tympani. When measured with fine thermocouples, the temperature of both the gland itself and venous blood from the gland increased by 0.1-0.7 degrees C at the maximum. The blood flow was about 0.3 g.min-1.g-1 wet weight of gland at a resting period and increased to 1-3 g.min-1.g-1 at the maximum of secretory response. The resting heat production in vitro, measured by a microcalorimeter, was 3.3 mW.g-1 at 27 degrees C and 7.8 mW-g-1 at 37 degrees C. The specific heat of the blood and the salivary gland, measured by a microcalorimeter, were 3.97 and 3.91 J.g-1, degrees C-1, respectively. The change in conductive heat loss, measured by a thermopile under stimulated conditions, ranged from 4 to 6 mW.g-1 at the maximum. Metabolic heat production during secretion in vivo (37 degrees C) was estimated from temperature changes in the glandular tissue and blood, blood flow, specific heat and resting heat production. Values obtained were in the range from 15 to 80 mW.g-1 at the maximum. Heat production increased rapidly within the first 20 sec to reach a maximum and then declined with time, but slow heat production continued. On the basis of the present results together with those from former studies on ionic transport in the salivary gland, we discussed the relation of heat production to transport of substances during secretory processes.


Biphasic time course of inactivation of potassium contractures in single twitch muscle fibers of the frog.

The time course of the inhibition of peak tension (inactivation) of potassium contracture induced by conditioning depolarization with 10, 15, 20 and 30 mM K+ was examined, using single twitch fibers from the frog semitendinosus muscle. The time-dependence curve of the inactivation was biphasic, consisting of the first phase and the second phase. The first phase was characterized as follows: 1) the time course and the extent depend on the degree of conditioning depolarization; 2) the inactivation proceeds exponentially and finally reaches a steady level; and 3) the rate is markedly increased by lowering Ca2+ in the external medium. It could be considered that the first phase of the inactivation is an analogical phenomenon with the inactivation of sodium conductance in a squid giant axon. The second phase of the inactivation induced by conditioning with 20 and 30 mM K+ reached its full inactivation independently of the degree of conditioning depolarization. On the basis of these results, the terms inactivation 1 and inactivation 2 were given to the first phase and second phase, respectively, of the time-dependence curve of the inactivation of potassium contracture.


Arterial and cardiopulmonary baroreceptor and chemoreceptor influences and interactions on ear sympathetic nerve discharge in the rabbit.

1. The effects of changing intravascular pressures on integrated ear sympathetic nerve activity (ESNA) were studied in anesthetized artificially ventilated rabbits by inflating aortic and inferior vena caval perivascular balloons under conditions of normal arterial Po2 and during arterial hypoxia. 2. At normal Po2 ESNA was unaffected by arterial and cardiopulmonary baroreflex influences. The small inhibition of ESNA observed during rises in arterial pressure after vagotomy was also present after section of the carotid sinus and aortic nerves, and after cutting both vagi as well. 3. During hypoxia there was marked inhibition of ESNA, which was minimally influenced by vagotomy but abolished by section of the carotid sinus and aortic nerves, suggesting that it was chemoreceptor-mediated. There was a pressure-related rise in ESNA which was abolished by vagotomy and considered to be due to a central nervous chemoreceptor-cardiopulmonary baroreflex interaction.


Effect of exercise and thermal stress on subcutaneous protein transport.

Radioiodinated albumin was injected into the subcutaneous tissue of the thigh of human subjects and its disappearance rate from the injection site and the blood levels of the tracer were compared between exercise loaded, heat loaded experiments and the control utilizing two-compartment analysis. The time course of radioactivity in the blood was expressed as the equation p(t) = A(e-alpha t - e-beta t). In the exercise experiment, the half-time of beta and the time required to reach the maximum level was significantly shorter than in the heat experiment and in the controls. The decay of radioactivity at the injection site was set to the equation s(t) = Be-gamma t + Ce-delta t by the least square method. The value of gamma, which had a half-time of about 24 hr, was significantly shorter in the exercise than in the control experiments. From these results, it was concluded that the rate of mobilization of subcutaneous protein via lymph flow is faster under an exercise load than the control, and that the rate under heat load does not deviate from control experiments.


Effects of pyrogen on the medullary temperature-responsive neurone of rabbits.

Effects of intravenously injected endogenous pyrogen on the unit activity of temperature-responsive neurones (TR neurones) of medulla oblongata were investigated in urethanized rabbits with an intact or lesioned preoptic/anterior hypothalamic area (PO/AH). TR neurones of the medulla responded to pyrogen in the same manner as did those of the PO/AH; the firing rate in the warm-responsive neurones were depressed and the cold-responsive neurones augmented. However, one-fourth of the medullary TR neurones did not respond to pyrogen in the PO/AH intact group (the control group). Following lesion of the PO/AH, the relative frequencies of TR neurones affected by pyrogen decreased as compared with those in control, and such was suggested to be more apparent in TR neurones discharging at rates of 10 imp./sec or more. Effects of the PO/AH-lesion were also seen in that the magnitude of the facilitatory or inhibitory effect of pyrogen was reduced in the PO/AH-lesioned group as compared with the control group. In some TR neurones an antipyretic agent (Sulpyrine, 48--151 mg/kg) was found to abolish responses to pyrogen.


Effects of distension on mesenteric blood flow and O2 saturation of venous blood in the dog intestinal loop.

Arterial and venous blood flow and oxygen saturation of the venous blood in the mesenteric vessels arising from single mesenteric artery and vein to the intestinal loop in anesthetized dogs were measured simultaneously with systemic arterial blood pressure during distension of this loop. Mesenteric arterial blood flow decreased to the zero level, while mesenteric venous outflow increased to about twice the quiescent level at the onset of elevation of intraluminal pressure. However, during distension, the decreased arterial blood flow tended to increase, but the increased venous flow was reduced to one half of the quiescent level. Oxygen saturation of venous blood diminished initially and then increased progressively during distension. At the end of distension venous outflow stopped temporarily. After suspension of distension, arterial and venous flow and oxygen saturation increased beyond the quiescent level. These results may suggest that there is a by-pass or A-V anastomosis which cannot be compressed mechanically by elevation of intraluminal pressure.


Optical monitoring of spontaneous electrical activity of 8-somite embryonic chick heart.

Using an optical method for measuring membrane potential, we monitored spontaneous action potential activity in the embryonic chick heart at the very early developmental stages, and found that spontaneous electrical activity was present at the developmental stage of 8 somites before the initiation of the heartbeat.


Creatine metabolism in skeletal muscle of noradrenaline-treated rats.

Prolonged noradrenaline treatment did not affect the urinary creatine excretion, creatine radioactivity, and the creatine contents of all muscles studied. Radioactive creatine uptake by skeletal muscle was significantly lower in noradrenaline-treated rats than in controls, while those by heart and diaphragm were not affected by noradrenaline.


The male rape victim: evaluation and treatment.

The medical literature offers little guidance in the evaluation of male victims of sexual assault. The statutes are a confusing patchwork of conflicting and sexually biased laws. Children and adolescents probably represent the majority of patients, and are typically engaged by subterfuge, often with adults known to the child. Forcible assault, common in adult victims, is not characteristic in the pediatric age group. The evaluation and treatment of the sexually abused male victim is similar to his female counterpart. Physicians and emergency department staff must be knowledgeable regarding their responsibilities to these patients, and concerned with the medical, legal and psychological ramifications of sexual assault.


Transient ST elevation associated with tension pneumothorax.

In a 52-year-old man, a spontaneous right tension pneumothorax was associated with transient bradycardia, hypotension and electrocardiogram (ECG) changes consisting of precordial ST elevation suggestive of acute myocardial injury. Immediately after chest tube placement, the ECG reverted to near normal. Serial cardiac enzymes and isoenzymes showed no evidence of myocardial infarction. To our knowledge, this is the first reported case of this association. The ECG changes may be related to the hypotensive state induced by the tension pneumothorax with resulting decreased coronary artery blood flow and myocardial ischemia that resolved without infarction.


Subclavian artery injury and fracture of the scapula.

A fracture of the scapula is frequently associated with other significant injuries. In the case described, a motorcycle accident victim sustained multiple injuries, including a scapular fracture associated with a tear of the subclavian artery, demonstrated by angiography and confirmed at operation. A literature review revealed no similar case.


Epidemiology of cardiac arrest and resuscitation in a suburban community.

A surveillance system identified all out-of-hospital victims of cardiac arrests who received emergency aid in King County, Washington, as well as the etiologic condition and cardiac rhythm causing each arrest. During an 18-month period, 649 cardiac arrests occurred (annual incidence 7.2/10,000). Primary heart disease was the cause in 81%. Ventricular fibrillation was the associated rhythm in 57% of cardiac arrests. Based upon the incidence of cardiac arrest in the community and the likelihood of resuscitation under optimal conditions, we estimate the maximum incidence of lives saved to be 2.0/10,000 annually.


Accidental "cranial" defibrillation.

A case of accidental shock to the head, caused by a cardiac defibrillator, is presented. The shock resulted in minor burns and symptoms similar to those of postelectro-convulsive shock therapy (ECT). A physician participating in an advanced life support course, and familiar with the equipment, was the victim. An assumption that the demonstration equipment was not real seems to have been the cause of the accident. Suggestions for prevention of further episodes are discussed.


Benzocaine-induced methemoglobinemia.

Intense cyanosis in a previously well, 30-month-old, white girl was found to be due to the ingestion of benzocaine. A wide variety of chemical compounds present in many proprietary products, when ingested, can cause this presentation in individuals with structurally normal hemoglobin and normal activity of methemoglobin reductase. The phenomenon appears to be dose-related. Immediate recognition and initiation of appropriate therapy will effect a rapid reversal of the methemoglobinemia, and in some cases, may be life-saving. Caution should be exercised in the use of benzocaine-containing preparations.


Emergency medicine core content.

The Emergency Medicine Core Content represents the central body of knowledge of emergency medicine and is presented as an itemized list of clinical diseases, major clinical symptoms, administrative entities, and physician skills. It comprises the nucleus of the actual practice of clinical emergency medicine. Finally, it describes the educational scope of postgraduate training and continuing medical education in emergency medicine. The Core Content should be differentiated from a training curriculum. A training curriculum defines the experiential and educational means to attain this core body of knowledge. The Emergency Medicine Core Content was derived in part from the Committee on Board Establishment (COBE) conditions and skills list. Its present form represents a total reorganization of the COBE list with appropriate additions and deletions. All diseases and symptoms were included on the basis of four criteria: conditions which pose immediate life or limb threat; conditions which potentially require inhospital treatment; conditions which give rise to significant discomfort to the patient and conditions with medicolegal implications. The Emergency Medicine Core Content has been widely circulated and has input from numerous individuals and committees. All critiques were closely reviewed and employed to derive the final document as it now exists.


Echocardiographic incidence of pericardial effusion in patients resuscitated by emergency medical technicians.

The incidence of echocardiographically determined pericardial effusion was assessed in the early postmanual cardiopulmonary resuscitation (CPR) period in a group of patients resuscitated by advanced emergency medical technicians (EMT-P) from the Rescue Division of the Tampa Fire Department. The survival rate from out-of-hospital sudden death is comparable to that reported in other series. Twenty-six survivors of out-of-hospital sudden death had echocardiograms performed an average of 2.5 days (range 0-10) postCPR to determine the amount of pericardial effusion. Eight of the 26 (31%) patients had received intracardiac drugs during CPR administered by the EMT-Ps when physician-directed by radio. Of the 26, three (12%) were found to have very minimal pericardial effusions; all deemed insignificant. All three had alternate explanations for physiological or pathological causes of their effusions. One had received intracardiac drugs, but the pericardial effusion could be explained by congestive cardiomyopathy. Another had congestive cardiomyopathy, and the third had sustained a severe steering wheel injury to the chest. Thus, manual CPR with or without the use of intracardiac drugs does not appear to cause significant pericardial effusions in survivors of sudden cardiac death.


Spirometric evaluation of acute bronchial asthma.

Spirograms were obtained before and after emergency therapy in 85 episodes of acute bronchial asthma in 82 patients. The clinical status of all patients after emergency treatment was reevaluated 48 hours later. Patients could be divided into three groups: I) admissions; II) patients discharged but with later respiratory problems; and III) patients who were discharged and did well. The mean pre- and posttreatment one second forced expiratory volume (FEV1.0) was significantly different among all three groups. FEV1.0 less than or equal to 0.6 liter before treatment, or an FEV1.0 less than or equal to 1.6 liter after emergency treatment, was associated with an unfavorable course. Eighty-eight percent of Group I patients (admissions) had either an initial FEV1.0 less than or equal to 0.6 liter, or a posttreatment FEV1.0 less than or equal to 1.6 liter. Among all patients whose initail FEV1.0 was less than or equal to 0.6 liter, 80% were either admitted or had subsequent respiratory problems; 75% of all patients whose posttreatment FEV1.0 was less than or equal to 1.6 liter were either admitted or developed subsequent respiratory problems. Moreover, 90% of patients who had both a pretreatment FEV1.0 less than or equal to 0.6 liter and a posttreatment FEV1.0 less than or equal to 1.6 liter were admitted or had subsequent significant airway obstruction. We conclude that spirometry can identify asthmatic patients who require admission or who will have significant airway obstruction within 48 hours after discharge from the emergency department.


Formation and action of prostaglandins in the kidney.

The kidney has a high capacity to produce a spectrum of different acting prostaglandins (PG). In vivo and in vitro studies have shown that renal formation of PG's, possibly in the vasculature of the cortex represents an essential step in the mechanisms regulating the secretion of renin. PG's formed in the cortex seem to participate also in the control of renal vascular resistance and glomerular filtration rate. PGE2 formed in the medulla modulates the hydroosmotic action of antidiuretic hormone and influences the kidney's capacity for urine concentration. Renal PG formation is reduced by high NaCl intake and enhanced by low NaCl intake and in hypokalemic states. These findings make renal PG's good candidates for participation in the regulation of salt and water balance and in the control of blood pressure. Due to the close connection with the renin angiotensin system, alterations in renal PG formation might be involved in the etiology of high and low renin states. Thus, an impairment in the renal cortical production of vasodilating and renin-stimulating PG's could constitute the common denominator for both the reduced renin secretion and the increased vascular resistance which have been reported to be associated in essential hypertension.


Intracellular elemental concentrations in renal tubular cells. An electron microprobe analysis.

In order to be able to examine the processes involved in transepithelial transport in tissues, which are not composed of a single cell type, methods are required, which permit analysis at a cellular level. The technique of electron microprobe analysis permits the intracellular concentrations of many elements to be determined simultaneously in various portions of the cell. The application of this method to renal cortical tissue has shown that the best estimates of the cytoplasmic concentrations are to be obtained in regions close to the nucleus, farthest from the basolateral infoldings and microvilli, which separate the intracellular environment from the extracellular space. The nuclear concentrations of Na and K do not differ from those in the surrounding cytoplasm, although those of P and Cl are somewhat higher in cytoplasm. The intracellular element concentrations in the different cell types vary somewhat, proximal tubular cells contain higher concentrations of Na and Cl and lower ones of P than distal tubular cells. Following ischaemia, a manoeuvre know to result in a disturbance of intracellular electrolytes, Na was observed to rise and K to fall only in the non-surface cells of kidneys exposed to the air, but in all cells, if the kidneys were kept air-free in an atmosphere of N2. The proximal and distal tubular cells showed a variable resistance to ischaemia, the distal tubular cells being much more resistant. Despite the severity of the electrolyte disturbance following ischaemia, the intracellular composition was completely restored one hour after re-introducing renal blood flow.


Gradual carotid artery occlusion in the treatment of inaccessible internal carotid artery aneurysms.

The authors discuss 21 cases of large or surgically inaccessible internal carotid artery aneurysms treated with gradual occlusion of the cervical portion of the internal carotid artery. Eighty-five per cent of the patients experienced relief or marked improvement of their symptoms after treatment. Two early cases developed postligation ischemic deficits that partially resolved. After the introduction of expansion of circulating blood volume and induced hypertension as adjuncts to graded carotid occlusion, no ischemic complications occurred.


Risk of intracranial aneurysm surgery in the good grade patient: early versus late operation.

To evaluate the risk of definitive intracranial microsurgical aneurysm obliteration as a function of the timing of the operative intervention, we retrospectively reviewed 106 consecutive patients in good clinical condition who underwent such surgery. The patients who were operated upon within the first 8 days of their most recent subarachnoid hemorrhage formed the "early" group; the patients operated upon between the 9th and 31st day were considered to have undergone "late" surgery. On the basis of their clinical outcome the patients were allocated to one of four outcome categories ("good," "fair," "death") both at the time of their hospital discharge and at their most recent clinical re-evaluation, a minimum of 6 months after discharge from the hospital. There was no significant difference in the operative mortality in each group (early surgery, 5%; late surgery, 4%); additionally, no significant difference was noted in the incidence of either intraoperative complications or postoperative morbidity. A suggestive but statistically insignificant increase in the incidence of postoperative cerebral ischemic events was seen in the "early" surgery group (8% vs. 4% for the "late" surgery group). The potential significance of these findings for the timing of intracranial aneurysm surgery is discussed.


Cervical spondylotic radiculopathy producing motor manifestations mimicking primary muscular atrophy.

Cervical radiculopathy unaccompanied by pain or sensory disorder but manifested only by paresis, atrophy, fasciculation, and reflex loss is unusual. Three such cases are presented. Considerable diagnostic difficulty may arise in distinguishing patients presenting with these features from those who have primary motor neuron disease. Two additional case reports demonstrate that this distinction is not always possible. Diagnosis, management, and prognosis are discussed. Differentiation between motor neuron disease and spondylosis will avert needless surgery in the former group and will result in beneficial, sometimes curative surgery in the latter group.


Intraventricular fiberscopic observations in adult hydrocephalic patients.

A flexible ventriculofiberscope was used to diagnose intraventricular pathological conditions in eight adult hydrocephalic patients. In each case the entire procedure was recorded on videotape for documentation, review, and teaching. Four representative cases are presented to illustrate the use and value of this technique.


Suprascapular entrapment neuropathy: a clinical, anatomical, and comparative study. Part 2: anatomical study.

Two hundred eleven adult scapulae were examined and quantitative data pertaining to the dimensions of the suprascapular notch were obtained. Six types of suprascapular notch were observed. Transitions tended to occur between Types II, III, and IV. A classification function was developed utilizing the measured values of the dimensions of the suprascapular notch, which might help in assigning the scapulae to these transitional types. Dissections of the suprascapular area were performed in 15 cadavers. Static and dynamic relationships of the suprascapular nerve to the suprascapular foramen were examined.


Suprascapular entrapment neuropathy: a clinical, anatomical, and comparative study. Part 3: comparative study.

The suprascapular ligament seems to serve no defined function in the human. A comparative study was undertaken to elucidate its function. The suprascapular region was dissected in species representing seven existing primate families and six subprimate families. A striking dichotomy of pattern was observed. In the New World primates, the suprascapular ligament appeared to be continuous with the coracoclavicular ligament; the former merely served to increase the area of bony attachment of the coracoclavicular ligament. In the Old World monkeys and subprimate mammals, the suprascapular ligament was entirely absent. The human anatomy was comparable to that found in the New World primates. This dichotomy of pattern seems to be related to the function of the upper extremity in the different classes of mammals.


Temporary microvascular clips.

Selected commercially designated temporary clips (Acland, Biemer, Kleinert-Kutz, Variangle, and Yasargil) were applied for 1 hour to rat common carotid arteries. Scanning electron and light microscopic studies revealed varying degrees of endothelial damage. The authors believe that further improvements are needed in the design of temporary clips.


Acquired middle cranial fossa fistulas: normal pressure and nontraumatic in origin.

To the accepted classification of three types of normal pressure, nontraumatic cerebrospinal fluid (CSF) fistulas, we would add "acquired." This type of CSF fistula tends to occur from the middle cranial fossa because of the enlargement of "pitholes" that are normally present in its anterior medial aspect. The enlargement of these bony defects is due to normal intracranial pressure variations that, not uncommonly, create meningoceles and meningoencephaloceles. A portion of the floor of this area is aerated in up to 10% of the normal population by the lateral recess of the sphenoid sinus, the pterygoid recess. Thus, this area has the potential to act as a pathway between the middle fossa and the paranasal sinuses, allowing cerebrospinal fluid to pass into the sinuses. Isotope and computerized tomographic studies are helpful in the localization of such a CSF leak. Tomography of the base of the skull, however, is essential for the ideal definition of possible routes of fistulization. If there is any question of the presence of a middle fossa fistula, these studies can show whether the floor of this area is pneumatized and whether there are any defects in the floor. The treatment of such a fistula should include generalized reinforcement of the floor of the anterior middle fossa by a middle fossa approach. If any doubt exists as to the site of leakage (anterior or middle fossa), the minimal surgical procedure should include exploration of both areas via a frontotemporal craniotomy.


Traumatic false aneurysm and carotid-cavernous fistula: a complication of sphenoidotomy.

Severe head injury with resultant basilar skull fracture is the most common etiology for traumatic false aneurysm of the cavernous carotid artery and for traumatic carotid-cavernous fistula. We present a case of false aneurysm and fistula that occurred as a complication of sphenoidotomy, fortunately a rare etiology of these two serious problems. Because of the current resurgence of trans-sphenoidal surgery, it is of utmost importance that all neurosurgeons possess an accurate and detailed knowledge of the anatomy of the carotid artery and its intracavernous route.


Angiographically cryptic cerebrovascular malformations.

Three cases of angiographically cryptic cerebrovascular malformations are presented and a review of the cases in the English literature is tabulated. The typical patient is a 30- to 40-year-old woman with a history of seizures and headache. There is no antecedent history suggesting hemorrhage. On nonenhanced computerized tomographic scans, these lesions are denser than normal brain. They enhance with contrast administration. The angiogram demonstrates an avascular mass. The history, physical findings, and radiographic studies suggest brain tumor. An accurate diagnosis requires operation and pathological examination of the lesion.


Meningiomas of the pineal region and third ventricle.

The clinical presentation, radiological findings, and surgical management of two cases of meningioma arising from the velum interpositum without dural attachment are described. The true nature of these tumors was not suspected despite extensive preoperative diagnostic evaluation. A total removal was effected in both cases with the use of the operating microscope and a posterior fossa approach to the pineal region. A review of similar cases from the English literature is presented.


Extradural hematoma associated with traumatic middle meningeal artery pseudoaneurysm: report of two cases.

Two new cases of extradural hematoma associated with traumatic middle meningeal artery pseudoaneurysm are presented. Sixteen such cases have previously been reported in the literature. A 22-year-old man and a 17-year-old woman each developed marked neurological deficits after head injury. In each case percutaneous common carotid angiography demonstrated a conspicuous aneurysmatic sac on the middle meningeal artery, as well as displacement of major intracranial vessels and a surrounding avascular area. At operation the extradural clot was removed and the middle meningeal artery sac was verified. Both patients recovered uneventfully. Histological analysis of one of the specimens was performed.


Management of cancer pain: an overview.

This paper provides an overview of the current status of the management of cancer pain. The concept of "total care" of the patient with cancer incorporates an effort to eradicate or suppress the underlying malignancy, but when this is no longer feasible emphasis is shifted to symptom control to maximize the quality of remaining life. Even though the malignancy cannot be eradicated, an important first step in pain control is the diagnostic identification of the source of pain because it is preferable to treat the pain specifically rather than symptomatically. Alleviation of the patient's "total agony" requires treatment of the emotional as well as the physical component of pain. In addition, successful management is facilitated by attention to the social needs of both patient and family. Pharmacological therapy is the keystone of pain management; this includes the use of psychotropic agents and narcotic analgesics given orally on a regular schedule to prevent pain, rather than treating the pain after it has appeared. The hospice approach embodies the principles of pharmacological therapy and social, spiritual, and emotional support for the patient and family. These noninvasive methods have been shown to be effective in an increasing proportion of patients with advanced cancer, resulting in a decline in the need for neurosurgical intervention. However, in some patients conservative management fails and neurosurgical intervention should be considered. For those who are candidates for neurosurgical intervention, a wide variety of procedures is available. The selection of specific procedures depends on the source and severity of the pain and on the life expectancy and general condition of the patient.


Artificial vision for the blind by electrical stimulation of the visual cortex.

Artificial vision for the blind may be feasible by interfacing a television camera with electronics stimulating the visual cortex. The status of a major collaborative effort involving the College of Physicians and Surgeons of Columbia University, the University of Utah, and the University of Western Ontario is reviewed. Results have been very encouraging, although much work remains to be done.


Status of the legal definition of death.

A review of the existing models of legislation and state statutes pertaining to the definition of death is presented. Twenty-four states have statutory provision for brain death. Concern still exists about the need for and the form of statutory definitions. Medical criteria are not considered in detail, but the proposals of others are mentioned. It seems desirable that the community of neurosurgeons consider the legal and medical aspects of brain death and participate in the formulation of medical guidelines and education and the preparation of statutes.


Increased intraventricular pressure without ventriculomegaly in children with shunts: "normal volume" hydrocephalus.

Five patients with shunt-dependent hydrocephalus were observed to have apparently normal ventricular size despite marked increases in ventricular pressure after shunt malfunction. Elastance (dP/dV) was determined in four of these patients by removing increments of cerebrospinal fluid and measuring the resulting pressure. These patients without ventricular enlargement and with markedly increased ventricular pressure had high elastance. This group of patients with "normal volume" hydrocephalus had distal shunt occlusions, in contrast to previously reported patients with cephalic shunt obstructions after ventricular decompression. Initial shunting in early infancy, prolonged shunt dependency, and lack of recent shunt revision were common factors in these patients. Markedly elevated pressure with normal volume is a threatening clinical entity, requiring prompt surgical intervention


Checkerboard visual evoked response in evaluation and management of pituitary tumors.

As a routine part of the evaluation of patients with pituitary tumor, visual evoked responses (VERs) to checkerboard pattern reversal were recorded from 83 patients with tomographically documented pituitary tumor. VER tests were correlated with examinations of visual acuity, color perception, and visual fields and with computerized tomographic scan evidence of suprasellar extension of the tumor. The purpose of the VER recording was to determine the presence of visual system compression by the tumor and thus contribute to the decision of whether surgery was necessary. Each of the patients who had suprasellar extension of the tumor sufficient to produce a visual field abnormality also had an abnormal VER. In addition, some patients with suprasellar extension had normal visual fields but abnormal visual evoked responses. Thus, the VER provided earlier evidence of suprasellar extension causing visual system compromise than did conventional visual tests.


Serial computerized tomographic scanning and the prognosis of severe head injury.

Serial (two or three) computerized tomographic (CT) scans were performed on a series of 58 patients with severe head injury. The protocol called for scans to be done upon admission and on Days 3 and 7 after injury. New lesions (i.e., lesions not visualized on the initial CT scans but appearing on subsequent scans) were a frequent finding, occurring in over half of all patients. For the purposes of this study a new lesion was classified as edema involving two or more lobes, extra-axial hematoma, parenchymal hemorrhage, or infarction. Significant correlation was found between good outcome and the absence of new lesions and between bad outcome and the development of new lesions (p less than 0.001). Several patients did well in spite of the development of new lesions, but these patients were unique in that most had small, unilateral parenchymal hematomas located at or near the frontal or temporal poles. In most cases, patients who did poorly in spite of not developing new lesions had severe injuried visualized on their initial scans (massive intracerebral hematoma, hemorrhage of the corpus callosum) or succumbed to medical complications. The pertinent literature is reviewed, and other CT findings associated with a poor prognosis are noted. The authors suggest that serial CT scanning may be used to make prognostic assessments in severely head-injured patients and may be of value in increasing the confidence in and accuracy of assessments made on clinical grounds alone. (Neurosurgery, 5: 566--569, 1979).


Treatment of increased intracranial pressure: a comparison of different hyperosmotic agents and the use of thiopental.

Long term intracranial pressure (ICP) monitoring was carried out in over 200 patients with various intracranial abnormalities; a fiberoptic epidural intracranial pressure monitor was used. Ninety of these patients had significantly elevated ICP or exhibited pressure waves requiring therapy. Initial therapy consisted of hyperventilation with a respirator and administration of hyperosmotic agents. Comparison studies utilizing 30% urea, 20% mannitol, and furosemide intravenously and 30% urea and 10% glycerol orally were randomly done. In 45 patients two or more of these agents were used at different times in the same patient for comparison of effectiveness. When equimolar amounts of intravenous urea and mannitol were used, similar effects on increased ICP were obtained. There was no significant reduction of increased ICP with the use of furosemide alone. No rebound effect was observed with either mannitol or urea. Orally, urea was more effective than glycerol in equimolar amounts. Again no rebound was observed. In 14 patients who required doses of hyperosmotic agents more frequently than every 4 hours, continuous infusion of thiopental was used in conjunction with the hyperosmotic agents to control pressure. This regimen resulted in good ICP control in 12 patients. A rational protocol for the medical management of increased ICP utilizing hyperosmotic agents and, in refractory cases, hyperosmotic agents plus thiopental has resulted in effective control of ICP in 96% of our patients throughout their course without the need to resort to decompressive surgery. (Neurosurgery, 5: 570--575, 1979).


Effect of proximal occlusion on anastomosis patency in dogs.

This study compared the superficial temporal-middle cerebral artery (STA-MCA) anastomosis patency in animals with and without proximal embolic middle cerebral artery (MCA) occlusion. Sixteen dogs underwent STA-MCA bypass in association with silicone embolization of the MCA via an internal carotid injection. Animals re-explored 3 to 5 days postoperatively with evaluation of anastomosis patency by Evans blue injection and direct cutting of the STA demonstrated that 10 of 10 dogs with proximal MCA emboli had a patent STA-MCA anastomosis, whereas only 2 of 6 animals without an embolus lodged in the proximal middle cerebral artery had a patent connection. The likelihood of the anastomosis remaining open seems to be greatly influenced by the potential flow gradient between the extracranial and intracranial circulations (Neurosurgery, 5: 596--597, 1979).


Cushing's disease with cyclic hormonogenesis and diabetes insipidus.

A cyclic excess of cortisol secretion was detected in a patient with diabetes insipidus and diabetes mellitus. The cycles of hypercortisolism were of 7 days' duration, but during the nadir of these cycles urinary excretion of corticosteroids and 17-ketosteroids was within the normal range. The radiological appearance of the sella turcica was normal; however, computerized axial tomography of the head revealed a small tumor immediately superior to the sella turcica. At operation a small chromophobe adenoma superior to the diaphragma sellae and involving the hypophysial stalk was partially resected. Postoperatively, the patient continued to have 7-day cycles of increased corticosteroid excretion, but the amounts excreted were less than they had been preoperatively. Other patients have been described in whom Cushing's disease has been due to cyclic hypercortisolism. These cycles have been remarkably regular in individual patients, but of variable duration in different patients. Furthermore, cyclic hormonogenesis probably occurs in a variety of endocrinopathies. (Neurosurgery, 5: 598--603, 1979).


Primary amebic meningoencephalitis with cerebral and cerebellar abscesses: case report.

A case of fatal primary amebic meningoencephalitis is reported. We need to remind ourselves that, if the usual laboratory tests fail to show any microbial or fungal agents either in the CSF or in fluids or tissues obtained at operation, it is imperative that a warm wet slide preparation be made. Primary amebic meningoencephalitis is a very rare disease, and it is only by prompt recognition of the amebae that we can make an early diagnosis and institute the appropriate therapy.


Delayed traumatic intracerebral hematomas after surgical decompression.

Delayed traumatic intracerebral hematomas found after an initially unrevealing computerized tomographic scan have been reported occasionally. Such hemorrhage may occur in an area of brain contusion with cerebral vessel injury. Four cases of intracerebral hematoma appearing after evacuation of a different traumatic intracranial mass lesion are reported. This suggests that an intracranial mass lesion may tamponade cerebral venous oozing in an area of brain contusion and delay the accumulation of intracerebral blood, accounting for the late discovery of a parenchymal hematoma. (Neurosurgery, 5: 653--655, 1979).


Acute therapeutic modalities for experimental vasogenic edema.

Experimental vasogenic cerebral edema was created in rabbits with a cold-induced left occipital cortical lesions. Intracranial pressure (ICP), intracranial elastance (Em), water content, hemispheric brain tissue volume, electrolytes, electroencephalograms, behavior, and gross pathology were studied. Various therapeutic modalities were employed alone or in combination to reduce ICP acutely: acetazolamide, furosemide, mannitol, pentobarbital, lorazepam, and dexamethasone. All therapies except dexamethasone were effective in reducing ICP. Peak ICP reduction occurred at 27 +/- 9.8 (SD) minutes with mannitol and at 71.4 +/- 15.5 minutes with acetazolamide, with the remaining agents and combinations falling between these two extreme values. Em improved by 31.7 +/- 17.02% in all therapuetic trials except those employing acetazolamide and lorazepam. With therapy, there was a reduction in the water content of the hemispheres, but the difference from that in the untreated, lesioned animals was not statistically significant. In the lesioned left hemisphere, sodium content was increased by acetazolamide (p less than 0.005), furosemide (p less than 0.025), pentobarbital (p less than 0.05), and the combination of dexamethasone, pentobarbital, and mannitol (p less than 0.005). Significant reduction was noted in the lesioned group for the potassium content of the left hemisphere in the dexamethasone (p less than 0.05), pentobarbital (p less than 0.025), and combination groups containing these agents (p less than 0.005 to 0.025). (Neurosurgery, 5: 656--665, 1979).


Chronic monitoring of intracranial pressure using an in vivo calibrating sensor: experience in patients with pseudotumor cerebri.

A number of reliable methods are available for the short term monitoring of intracranial pressure (ICP). However, the danger of infection and the need for external connections make the use of these methods for extended periods inappropriate. Most previously described devices for chronic monitoring of ICP are of limited value because of uncertain drift from zero-point readings. The Hittman-Meyer ICP sensor approaches the ideal for a long term monitoring device. It is fully implantable and is accurate over a wide range of pressures and for extended periods. It is designed so that in vivo calibration may be performed in a noninvasive fashion. We report the use of this device in eight patients with pseudomotor cerebri. It has functioned accurately for periods ranging up to 14 months after implantation and has proven to be a valuable aid in the management of these patients. (Neurosurgery, 5: 666-670, 1979).


Needle biopsy under computerized tomographic control: a method for tissue diagnosis in intracranial lesions.

Thirteen patients with intracranial lesions were submitted to a twist drill needle biopsy under computerized tomographic (CT) control, with sedation and local anesthesia. (The patients' ages ranged from 12 to 81 years.) The final diagnoses were glioblastoma in 7 patients and 1 case each of anaplastic astrocytoma, low grade astrocytoma, thrombosed arteriovenous malformation, cerebral infarct, 3rd ventricular epidermoid, and degenerative disease of the brain. Definitive diagnosis was obtained in all but 2 patients with this technique. Appropriate therapy was subsequently instituted in 11 patients without further operation. Transiently increased weakness of the previously affected limbs was the only untoward effect (4 patients). Intracranial hematoma after this procedure was seen in 1 patient in this series, as detected by the postprocedure CT scan, but there was no change in the clinical course. All patients were treated with dexamethasone for 24 to 48 hours before and for several days after the procedure to avoid decompensation of intracranial dynamics because of edema. The procedure, including appropriate level CT scans of the lesion area, was performed in approximately 1 hour in all patients. (Neurosurgery, 5: 671--674, 1979).


Cardiac arrhythmias associated with subarachnoid hemorrhage: prospective study.

This is a prospective study of cardiac arrhythmias in patients with acute subarachnoid hemorrhage (SAH) secondary to ruptured aneurysm. Twenty per cent of the patients had serious, life-threatening arrhythmias. However, 100% of the patients had some kind of cardiac arrhythmia. The arrhythmias occurred during the first 48 hours after SAH. Such arrhythmias occur in patients without overt, pre-existing heart disease, hypoxemia, or electrolyte imbalance. A prolonged Q-T interval is frequently observed in patients with SAH who develop serious ventricular arrhythmias. (Neurosurgery, 5: 675--680, 1979).


Treatment of acute focal cerebral ischemia with intermittent, low dose mannitol.

The object of this investigation was to study the effects of intermittent, low dose mannitol therapy on conscious cats after acute left middle cerebral artery (MCA) occlusion. A simple implanted device was applied to the proximal left MCA of 40 adult cats using microsurgical techniques. In the acute experiments, 10 cats were untreated and 10 cats received mannitol (0.5 g/kg intravenously) immediately before occlusion and again 3, 6, and 9 hours later. They subsequently underwent intra-arterial perfusion with colloidal carbon and buffered paraformaldehyde 12 hours after occlusion. The plasma osmolality immediately before perfusion was 316 +/-2 (SD) milliosmoles in untreated cats and 331 +/- 5 milliosmoles in treated cats. Gross swelling, impaired carbon filling, and breakdown of the blood-brain barrier (BBB) to fluorescein were seen in the left MCA territory of 8 untreated cats and 1 treated cat. The mean percentage of gray matter cross sectional area where severe ischemic neuronal alterations predominated was 45 +/- 12% in untreated and 14 +/- 16% in treated cats (p less than 0.01). The mean capillary luminal diameter in the left sylvian cortex was 4.5 +/- 1.0 mu in untreated cats (control, 6.5 +/- 1.0 mu) and 5.5 +/- 1.0 mu in treated cats. In the subacute experiments, 10 cats were not treated and 10 cats received mannitol as in the acute experiments. The cats were killed with a large bolus of sodium pentobarbital 48 hours after left MCA occlusion. Gross swelling and breakdown of the BBB were less severe in treated cats. The mean cross sectional area of infarcted tissue was 55 +/- 12% in untreated cats and 33 +/- 21% in treated cats (p less than 1.0). The findings of this study indicate that intermittent, low dose mannitol therapy delays the onset of ischemic cerebral injury and may reduce the size of the eventual infarct or convert a potential infarct into a so-call "transient ischemic attack." (Neurosurgery, 5: 684--691, 1979).


Device for extradural monitoring of intracranial pressure: technical note.

An ICP-monitoring device utilizing an extradural method is described. Clinical and laboratory use has shown it to be easily installed, safe, accurate, and reliable. It can be used with currently available transducers and monitoring equipment. It is hoped that this simple device will encourage the increased use of ICP monitoring.


Pneumocephalus after ventriculoatrial shunt.

Pneumocephalus developing after a ventriculoatrial shunting procedure is described. This was found to be caused by a defect in the posterior wall of the frontal sinus, possibly secondary to chronically increased intracranial pressure. A review of the pertinent literature revealed only two other similar cases.


Trigeminal neuralgia and multiple sclerosis: demonstration of the plaque in an operative case.

Trigeminal neuralgia is unique to humans. The most common cause seems to be an injury to the myelin of the trigeminal nerve root entry zone as it extends for several millimeters lateral to the pons. Jannetta has developed an elegant retromastoid microsurgical approach to this region. He has identified a compression-distortion phenomenon of this nerve root entry zone, usually from an anomalous position of the superior cerebella artery. Trigeminal neuralgia can also occur in association with multiple sclerosis, when the plaque lies in this same location. The historical evidence for this explanation is reinforced by the electron microscopic demonstration of the plaque in this region in a patient with multiple sclerosis who was suffering from tic douloureux. (Neurosurgery, 5: 711--717, 1979).


Invasive pituitary adenoma with abscess formation: case report.

A case is presented and 10 cases are reviewed in which abscess formation developed in an intrasellar tumor. The diagnosis was made preoperatively or before autopsy in only 1 patient. The mortality rate was greater than 50%. The most common presentation was headache, fever, and visual disturbances with an abnormal sella and sterile cerebrospinal fluid (CSF). Nonconstant findings included meningeal signs and leukocytosis of the CSF. Trans-sphenoidal removal of the tumor and drainage of the abscess with appropriate antibiotic therapy is recommended. (Neurosurgery, 5: 718--722, 1979).


Eosinophilic granuloma mimicking a pituitary tumor.

The authors present the case report of a patient in whom hypopituitarism, diplopia, and visual field defects were due to eosinophilic granuloma. Radiographic studies were suggestive of a pituitary tumor and subsequent histological evaluation showed replacement of the anterior pituitary by histiocytic cells. Eosinophilic granuloma should be included in the differential diagnosis of an intrasellar mass.


Full-thickness eye wall resection of choroidal neoplasms.

Sclerochorioretinal (full-thickness eye wall) resection was performed in 19 eyes with choroidal neoplasms. Thirteen of these eyes have retained useful vision, ranging from 20/25 to counting fingers. Six eyes had intraoperative and postoperative complications that have led to enucleation. During follow-up, ranging from 1 1/2 years to 6 years, none of these patients had had local or systemic metastasis. Full-thickness eye wall resection, in suitable cases, provides an alternative method of managing choroidal neoplasms.


Late diagnosis of choroidal malignant melanomas in eyes with clear media and low visual acuity.

Five patients seen in a one-year period with advanced malignant melanoma of the choroid in eyes with low visual acuity and clear media are reported. The low visual acuity appeared clinically to be antecedent to the malignant tumor; although in certain cases it may have been related to the occult melanoma, this was not appreciated clinically. Because of the low visual acuity, these patients did not have vision symptoms referable to the melanoma, and the malignancy was diagnosed late in its course. All five cases had extrascleral extension of the tumor at the time of surgical treatment; three are dead of metastatic disease, and two have undergone orbital exenteration with only brief follow-up periods. This experience suggests that eyes with clear media and low vision owing to presumably unrelated causes should undergo periodic examination to rule out the presence of a growing malignant melanoma and to prevent its late diagnosis.


Iridocyclectomy technique and results.

The technique and results of 30 iridocyclectomies performed by the senior author are reviewed. Although the total number of cases is small for statistical purposes, its main value is that all the operations were performed by one surgeon, which means a uniform criteria for the indications, surgical technique, management of complications, immediate and postoperative decisions, follow-up control, and direct discussion of the histopathology with the pathologist. Three techniques were used: (1) routine excision only of uveal tissue in 15 cases, (2) cyclectomy, ie, plus excision of deep scleral wall in four cases, and (3) block excisions of cornea, sclera, affected iris, and ciliary body followed by a reconstructive penetrating graft in 11 cases. Twenty-one cases were melanocytoma; one, metastatic tumor; one, nevus; two, cysts; and three, foreign body granulomas. Prognostic features such as cell type, largest diameter above 10 mm, tumor thickness, tumor at edge, iris or ciliary body origin, location, and preoperative glaucoma are discussed, and some practical conclusions are advanced. The follow-up control for 21 melanoma cases in the series is five to ten years or more in 11 cases and up to four years in ten cases. The visual results are also analyzed.


Clinical and follow-up studies of melanocytomas of the optic disc.

Forty patients with melanocytoma of the optic disc were evaluated to determine their clinical variations and behavior. Follow-up examination of 1 to 19 years was obtained in 27 patients. Of the 27 lesions, four (15%) showed a slight increase in size, and one tumor (4%) decreased in size. The remaining 22 tumors (81%) have not yet demonstrated ophthalmoscopic changes. In spite of occasional growth, the melanocytoma is a benign tumor that requires no treatment.


Complications associated with extended wear of soft contact lenses.

The major complications with extended wear lenses are due to hypoxia and lens deposits. Certain patients tend to deposit proteins and lipids on the lens surface with daily wear and at a greater frequency during prolonged wear. A build-up of these deposits can be associated with decreased vision, conjunctival irritation, and giant papillary conjunctivitis. Frequent lens cleaning and the frequent use of concomitant topical artificial tears will hopefully reduce the incidence of lens deposits and their complications. Superficial circumlimbal vascularization occurs in a large percentage of patients who have worn lenses for weeks at a time. Corneal edema, ocular irritation, and decreased vision are also the hallmarks of a decreased oxygen supply to the cornea. A thin-loose-fitting lens will increase the percentage of patients who are able to successfully use extended wear lenses by increasing the amount of oxygen available to the cornea. Cessation or reduction in duration of lens wear will decrease the frequency and severity of this complication. Conjunctival and corneal infections are real risks; lens loss, breakage, deformation, or discoloration also occur during extended wear.


Complications associated with contact lens solutions.

The complications that have been seen when hydrophilic lenses are cared for by chemical decontamination are reviewed. The findings that help to differentiate lens-induced changes from chemical-care-produced changes are presented. Incompatibilities between care methods are illustrated. The complications are discussed in terms of changes produced in the cornea, conjunctiva, flora of the cul-de-sac, and lens.


Complications associated with spin-cast soft contact lenses.

The only spin-cast soft contact lens manufactured in the United States is the Bausch & Lomb Soflens. There have been no significant complications reported with this high-quality lens. Essentially, the complications seen with the spin-cast lens have been the same as those seen with any of the lathe-cut hydrophilic lenses. The two most common complications have been poor centering of the lenses and deposits on the lenses.


Management of infections associated with soft contact lens.

This study suggests that there is a higher incidence of infectious corneal ulcers with soft contact lenses than with hard contact lenses. Pseudomonas aeruginosa was the most commonly identified organism associated with soft contact lens corneal ulcers. Early and aggressive management can improve the prognosis of this disease. A plan of therapy and management is recommended and discussed.


Ocular abnormalities occurring with vitiligo.

One hundred twelve patients with vitiligo were examined for ocular abnormalities. Discrete areas of depigmentation with associated pigment hyperplasia clinically appearing to involve the choroid and retinal pigment epithelium were observed in 44 patients, and active uveitis was seen in nine patients. The changes observed suggest that the spectrum of diseases that includes Harada's disease and the Vogt-Koyanagi syndrome may be broader than previously appreciated. Patients with these syndromes may represent the most severe examples of vitiligo and uveal inflammation. The occurrence of symptoms of night blindness in 12 patients and a family history of retinitis pigmentosa in two of these may signify a possible malfunction of the retinal pigment epithelium. Further evidence for a pigment epithelium disorder is suggested by the high incidence of an unusually prominent choroidal pattern in these patients.


A method for delivery of ocular medications.

Many patients have difficulty placing medications into their eyes. Using a pair of inexpensive plastic sunglasses, a patient designed a simple device for instillation of ocular drops.


A new eye shield based on an optimized pinhole array.

The new eye shield described here incorporates the principles of a compound array that provides a significant improvement in vision (from hand movements to 20/100 or better) in a nonaccommodative eye, while retaining all other properties (protection, ventilation, reduction of glare) of eye shields used currently. It is recommended for routine use in patients after intraocular surgery and pupillary dilatation.


The Copeland intraocular lens: five to ten years later.

Fifty-seven eyes with extracapsular surgery and Copeland lenses and the same number of intracapsular cataract extractions without lenses are described. All properly chosen lens cases have 6/12 vision or better. Forty percent required capsulotomy because of 6/12 vision or less. Possible cystoid macular edema occurred in two cases. No endothelial changes were present that were not present preoperatively. Five lenses dislocated. Two glaucomas appeared. There was no retinal separation, endophthalmitis, or lens removal for lens-induced irritation.


Excision of uveal melanomas: a 15-year experience.

A 15-year experience with excision of selected uveal melanomas indicates that the human eye does not tolerate a dissection of an intraocular tumor exceeding 10 mm in diameter. Twenty-seven out of 35 eyes retained useful vision. Three cases required enucleation after excision, two of these owing to tumor recurrence. Only one tumor death has occurred, five years and four months after excision.


Intra-medullary pressure and intra-osseous phlebography in paraplegia.

Intra-medullary pressure and intra-osseous phlebography have been studied in the femurs of ten paraplegics. These methods are reliable for studying bone circulation. Results show that there exists an increase of intra-medullary pressure of more than twice the normal value and signs of delayed blood flow as well as a diaphyseal reflux in the bone. The blood gases are also modified (O2 saturation; pO2 and pCO2). These signs indicate that there is a venous stasis. These circulatory disturbances are due to an autonomic nervous system lesion. Furthermore it seems that these vascular modifications below the neurological lesion have an influence on the osteoporosis in paraplegia.


A residential and employment centre for the spinal disabled in Perth, Western Australia.

In 1969 a Residential and Employment Centre for the spinal disabled was established in Perth, Western Australia, entitled the Quadriplegic Centre. In the past 9 years this has expanded to provide residential accommodation for 75 persons with anticipated accommodation for a total of 95 residents by the end of 1978. In the employment area the number of employees has risen from 10 in 1970 to 190 in 1977, and their production has risen from $10,700 to over half a million dollars Australian in the same period.


Microcirculation and blood volume in rats before and after spinal cord injury.

Blood flow, cardiac output, blood pressure, indicator mixing time and blood volume were measured in rats before and after spinal cord injury. After cutting off the spinal cord blood flow decreases markedly in the paraplegic area but also in the main organs of the animals. Only the blood supply of the lung increases by this manipulation. As blood volume and the blood pressure is decreased and the indicator mixing time delayed the situation of the spinal cord injury can be compared with the situation after acute blood loss. Therefore it is proposed to include circulatory disturbances into the conception of the acute spinal shock situation.


Spinal cord injuries in children in British Columbia.

Fifteen children who sustained traumatic spinal cord injury in British Columbia over a 13-year period have been reviewed. The aetiology, incidence of spinal fracture, length of hospitalisation and subsequent spinal surgery, and their self-care, transfer and ambulatory abilities, bowel and bladder management, schooling, employment and place of abode have been determined.