Abdominal aortic aneurysms. II. Long-term follow-up of operated and unoperated patients.

Survival rate, causes of late death, employment, general health, walking capacity and sexual activity were investigated in 87 patients operated on for abdominal aortic aneurysms and 44 unoperated patients. The life expectancy was higher in the operated patients. The higher mortality for the non-operated patients was mainly due to aneurysmal rupture. Both groups of patients succumbed to atherosclerotic diseases, which before death had restricted their physical activity. More non-operated than operated patients left their employment due to the aneurysm disease. Eleven of 31 still living male operated patients had lost ability of erection postoperatively and 18 had abnormal or absent ejaculation. For the 12 still living non-operated patients indication for surgery was again considered and 3 of these patients will be recommended operation.


Bilateral renal artery stenosis/occlusion and renovascular hypertension. Correlation of angiographic findings with blood pressure response after surgery.

In a previous study of unilateral renal artery stenosis the angiograms of patients with a favourable blood pressure response after surgery were found to be characterized by a reduction of renal arterial lumen greater than or equal to 90% and/or renal collateral circulation. Ancillary features were post-stenotic dilatation and a reduction of kidney length greater than or equal to 1 cm (Andersson; Andersson, Bergentz, Dymling, Ericsson, Hansson & Hökfelt). This report deals with 32 patients with bilateral renal artery stenosis who were followed 6--54 months after operation. The preoperative angiograms were analysed retrospectively without knowledge of the blood pressure response. In patients with bilateral fibromuscular dysplasia a good correlation was found between the above-mentioned criteria and a favourable blood pressure respone. In patients with bilateral arteriosclerotic stenosis no correlation was found. It was concluded that renal angiography constitutes a valuable predictive test in bilateral non-arteriosclerotic stenosis. In the presence of bilateral arteriosclerotic stenosis the selection of patients for surgery should be based on other parameters such as kidney function, age and general vascular status of the patient.


Premalignant lesions of the pappilla of Vater and the common bile duct.

Two patients with benign adenomatous papilloma of the papilla of Vater and the common bile duct are presented. Both patients had symptoms from the upper gastrointestinal tract and biliary system. The clinical and roentgenological aspects are discussed and the importance of the correct preoperative and/or peroperative diagnosis and the value of radical surgery is emphasized.


Appendicectomy during pregnancy.

Twenty-four appendicectomies were performed during intra-uterine pregnancy at the Department of Surgery of the University Central Hospital, Turku, in the period 1963--77. Six out of 14 cases of appendicitis occurred in the third trimester. The incidence of appendicitis during pregnancy was 1 : 1 445. In 9 cases the appendices removed were normal. The diagnostic difficulties were greatest during the final phase of pregnancy. The location of palpation tenderness in these cases differed from that in the cases with a normal appendix. Fever was generally slight and was sometimes completely absent. The appendix had perforated in 2 cases in both of which premature delivery occurred on the third postoperative day. The infant died in one of these two cases because of immaturity. The pregnancy of the other patients continued uneventfully to term. Appendicitis and appendecectomy performed in good time generally do not involve risk for the continued progress of pregnancy. Progesterone or isoxuprine may have beneficial effect on the course of the pregnancy.


Hyperparathyroidism--a life-threatening disease in 1978. A case report.

In a patient with hyperparathyroidism (HPT) two neck explorations with identification of three normal parathyroid glands were carried out. Cervical and mediastinal vein catheterization with blood sampling for determination of parathyroid hormone (PTH) confirmed drainage of large amounts of PTH to a mediastinal vein. Two thoracic explorations were negative anterior and posterior mediastinum). The operations were performed during 1971 and 1978 and extensive, progrediating decalcification with brown tumour formation was radiologically demonstrated during that time. Diminished renal function, skeleton pain and mental depression necessitated a last exploration, at which a 2 cm large parathyroid adenoma was found in the left carotid sheath just below the left mastoid process. The adenoma was drained into mediastinal veins through long anastomotic branches.


Extra-abdominal desmoid tumour. Report of three cases.

Three cases of desmoid tumour in a lower extremity are described. Primary radical excision is necessary for this type of tumour, because of its clear tendency to recur. In the described cases surgery was complicated by the proximity of neural structures and blood vessels. Preoperative angiography was useful for determining the size of the tumour and its position in relation to large blood vessels. Pathologic vascularity was found in the tumours, but histologic examination revealed no sign of malignancy. The histologic structure of the tumours corresponded in all respects to benign fibromatosis, apart from a clear increase in the number of mast cells. The tumours showed a tendency to grow between the muscle fibres, though a pseudocapsule was observed at operation in two cases. None of the specimens from the extirpation line displayed any signs of tumour tissue, but this did not preclude recurrence.


Gastric leiomyoblastoma: three interesting cases.

The leiomyoblastoma of the stomach has emerged as a separate entity different from the well known benign and malignant gastric tumours of smooth muscle origin. The histologic picture is very typical but has puzzled many pathologists in the past. It is important to consider the possibility of this tumour at operation because it will influence the type of operation to be carried out. Even with seeminly hopeless spread a curative resection is often possible. Per-operative frozen section diagnosis is imperative. Enucleation alone is inadequate. Wide local excision without removal of the regional lymph nodes is often sufficient. More radical operations have no apparent effect on survival. A total gastrectomy is only indicated in cases of multiple localisations or recurrences. Primary and secondary excision of metastases should be considered. Prognosis is relatively good and is best evaluated by a combination of clinical and histologic criteria.


Colonoscopic appendectomy. Report of two cases.

Colonoscopic appendectomy has been performed in two patients, who had had their appendices inverted into the caecum as an incidental procedure at earlier abdominal surgery.


Adenocarcinoma of the small intestine associated with Crohn's disease.

A case is described of adenocarcinoma of the small intestine with coexisting regional enteritis. The previous reports in the literature are briefly reviewed and a causal relationship is discussed.


[Analysis of the results of treatment of multiple myeloma].

Therapeutic results were analysed in 62 cases of multiple myeloma treated by two-stage method: I. with cyclically non-specific agents (melphalan) in each case. When this treatment was a failure the second step was given: II. cyclically specific and non-specific agents by the M-2 schedule. Good therapeutic response was obtained in 70% of cases. The mean survival time in the whole group was 35 months, and in the subgroup with good prognosis it was 44 months. Most (74%) patients with IgG M-protein responded well to treatment with cyclically non-specific agents, while only 50% of those with IgA M-protein had a good response to them.


[Blood serum antiplatelet activity in acute leukemia and idiopathic thrombopenia studied with the aid of the platelet factor 3 availability test].

The effect of the activity present in the globulin fraction of the serum of patients with acute leukaemias and thrombocytopenia on the isologous platelets was investigated. This activity caused, due to increased availability of platelet factor 3, an acceleration of the endogenous clotting pathway with resulting shortening of the clotting time in the test of platelet factor 3 availability. This test was done in 44 patients with acute leukaemia and 19 with thrombocytopenia demonstrating a high-grade shortening of the clotting time as compared with that in a group of 30 healthy controls. In some cases of complete remission of acute leukaemia an effect of this activity on the autologous platelets was demonstrated. The antiplatelet activity was inhibited by rabbit serum against human IgG and Fc fragment of the heavy chain in IgG. These results suggest that the activity present in the globulin fraction of the serum may be one of the causes of thrombocytopenia in acute leukaemia.


[Physico-chemical and biological studies of plastic materials intended for long-term contact with blood].

The criteria used presently for evaluating the materials for haemotherapy, which are based on chemical, physicochemical and biological extracts of aqueous solutions have been found to differ from the results observed after actual prolonged contact of these materials with blood and its elements. All the investigated plastic materials complied with the required quality standards, and, despite this, some of them, such as natural latex or siliconized rubber, caused considerable adhesion of proteins, release of high amounts of haemoglobin from the erythrocytes, and have been found even most thrombogenic of all 8 plastic materials tested. Investigations by means of scanning microscopy demonstrated that adhesion of fibrinogen and thrombocytes to the surface of the plastic materials depended to a high extent on the smoothness of this surface. It depended also on migration of components specific for each material. This was also the cause of variations in the adsorption of albumin, globulin, and fibrinogen labelled with 125I after their mixing with plasma.


[Lymphocyte acid phosphatase activity in lymphocytic leukemia studied in tissue culture with the use of diffusion chambers].

The reported investigations showed that lymphocytes in chronic lymphocytic leukaemia with low acid phosphatase activity had a rise of this enzyme level during culture in diffusion chamber. This rise is caused by increased number of lymphocytes with activity grades 1 degree and 2 degrees, and from the 6th day of culture also the number of lymphocytes with 3 degrees and 4 degrees activity score rose as well, while at the same time the proportion of cells without acid phosphatase activity fell. In the lymphocytes of healthy subjects a rise in acid phosphatase activity was observed as well under the same culture conditions.


[Thomson's colchicine test in differential diagnosis of lymphocytic leukemia and non-Hodgkin lymphoma].

The studies were performed to estimate the sensitivity of chronic lymphocytic leukaemia (CLL) lymphocytes (32 patients), non-Hodgkin lymphoma (NCL) lymphocytes (3 patients) and normal human (NH) lymphocytes (20 persons) to antimitotic concentration of colchicine in the conditions of the in vitro Thomson's test. Significant differences were observed in this sensitivity test: for CLL lymphocytes the mean values was 79%, for N-HL-lymphocytes 37%, for NH-lymphocytes--12%. These data show the possibility of practical use of Thomson's test in differential diagnosis of increased lymphocytosis. A quantitative heterogeneity of colchicine sensitive (pathological) and non-sensitive ("normal") CLL lymphocyte populations was observed among different CLL patients. There was no correlation between the proportion of the above populations and the patient's age, duration of illness and the magnitude of total lymphocytosis.


[Possibility of using antibodies to lactosylsphingosine in the diagnosis of neoplasms].

A radioimmunoassay was evolved for detection of antibodies reacting with lactosylsphingosine in the serum. Positive results were obtained in cases of digestive tract neoplasms, cervical carcinoma and burns.


Emergency surgery for acute hyperparathyroidism: anesthetic aspects.

Hyperparathyroid crisis with hypercalcemia which is resistant to medical treatment, is a rare clinical condition which requires prompt surgical intervention. Preoperative problems, anesthetic management and postoperative evolution are discussed. A case report is described.


Preoperative autotransfusion for total hip protheses.

The authors describe a method of preoperative autotransfusion for scheduled total hip prothesis. Blood is collected in the patients 10 days before the operation. This blood is retransfused at the end of surgery, done under continuous epidural anesthesia. Of the 15 patients, 85% had a total hip prothesis without receiving bank blood.


Medically equipped emergency ambulance units at "Hôpital Civil de Charleroi". Four years' activity.

In narrow collaboration with the so-called "900 Service", the civil Hospital of Charleroi provides, since 1971, medical attendance for two emergency medical aid flying squads. Five hospital doctors belonging to this "900 Service" alternately assume, night and day, such responsibilities. Their background is reanimation anesthesia. Medical attendance is assumed on the ground of gravity criterions which are appreciated by a switchboard operator working at the Telephone calls' Centre. The number of such emergency medical attendances is gradually increasing: 377 in 1974, 489 in 1975, 973 in 1976, 1661 in 1977, 2135 in 1978. The proportion of "flying" attendances assumed for sheer medical affections is also gradually increasing in regard to those assumed for traumatological causes. The daily average of such "flying interventions" reaches 5.8 with a daily peak record of 15, which unquestionably shows that such an organised medical service is definitely positive. One should concede that a better selection among such emergency telephone calls could make the good results now recorded even better. The way to improve this selection could be achieved if the operator were a physician as this is the case in France with the S.A.M.U. services. In theory, such an improvement could  be reached through a Regional Centre for Emergency Medical Aid, such a Centre being activated by both local medical and hospital forces interdependent in the pursuit of the same goal i.e. "Cases of Emergency".


Ro21-3981/ketamine anesthesia for the treatment of poor risk patients.

Two consecutive anesthetics were given to a young severely debilitated patient, who had recently had bone marrow transplantation. On both occasions a combination of a new benzodiazepine, Ro21-3981, and ketamine was used, the first with the patient breathing oxygen spontaneously, and the second under relaxation and artificial ventilation with pure oxygen. The findings suggest that this technique provides cardiovascular stability during anesthesia and rapid return to consciousness, free from emergence phenomena. The technique facilitated the early transport of the patient away from the recovery facilities.


Pubertal neurocranium growth in thymectomized rats.

Differences in neurocranium growth at puberty were studied in rats of both sexes thymectomized and sham-thymectomized at 2, 4, 6, 8, 10, 12 and 14 days of age and in controls of matched age and sex; skull length, width and height, and skull base length and face length were measured. The neurocranium of the thymectomized rats was significantly smaller than that of the sham-thymectomized and control rats of both sexes and in all age-groups.


[Radio-anatomic study of the median artery].

A study of the median artery has been done on 40 forearms, using anatomical and radiological methods. Of the points studied, the following are of particular interest: the mode of origin and the systematization of the various types.


Fine structural analysis of the effect of trypan blue on the visceral endoderm of the mouse egg cylinder.

The effects of a maternal injection of trypan blue on primitive streak mouse embryos were studied with electron microscopy. Commercial trypan blue was purified by descending paper chromatography, and pregnant females received an intraperitoneal injection of the collected blue fraction on the evening of the 7th day of gestation. Ultrastructurally, the changes in the visceral endoderm were apparent 10 min after the injection and included an increase in the number of fuzzy-coated vesicles in the apical cytoplasm. By 20 min the apical cytoplasm of the extraembryonic visceral endodermal cells was filled with many fuzzy-coated vesicles and numerous vacuoles of various size and electron density. 30 min after the injection, the extraembryonic visceral endodermal cells were relatively smooth lacking a microvillous border and evidence of endocytic activity was rare. Many embryonic visceral endodermal cells were observed in various stages of degeneration although the underlying embryonic ectoderm appeared unaffected. Morphologically, it appears that trypan blue exerts its first effect by altering the endocytic activity of the visceral endoderm.


Electromyographic study of the subclavius muscle.

The electromyographic study of the subclavius muscle (SM) was performed in 31 different movements, in 12 subjects (10 male and 2 female) aged from 17 to 28 years. The action potentials were obtained with an electromyograph Teca TE 4. Our findings suggest that the SM acts mainly on the stability of the sternoclavicular joint; with more or less intensity according to the degree of the clavicular interaction with the movements of the peripheral parts of the superior limb. The SM seems to act as a substitute for the ligaments of the sternoclavicular joint.


Quantitative study on the fetal cervical dorsal root ganglion and observations on its relationship with the spinal nerve complex in the albino mouse.

In mouse fetuses aged 12, 14, 16, 18 and 20 days, the cervical dorsal root ganglion was studied quantitatively. The main growth in volume of the interneuroblastic spaces was between the 12th and 16th day of pre-natal life while the main increase in volume of its neuroblasts occurred in the subsequent 4 days. Thus, it was postulated that the growth and branching of the neuroblastic dendrites, growth of the neuroglial elements and the vascular ramifications inside the ganglion occurred mainly between the 12th and 16th day of pre-natal life. Different modalities in the spatial relationship between the dorsal root ganglion and the different components of the spinal nerve were met with. At times, the trunk of the spinal nerve was located inside the ganglion. At that site, the posterior primary ramus emerged from it and appeared as a branch of the ganglion. The ventral root sometimes passed close to the fibrous capsule of the ganglion. In other cases, it passed inside the ganglion, dividing the ganglionic neuroblasts into dorsal and ventral groups. These either remained ensheathed by one fibrous capsule or became divided into two separate masses that remained connected to each other by the fibrous dural sheath.


[The optic nerve in the cat. I. Quantitative aspects in the adult cat].

A quantitative study was carried out on the adult cat optic nerve near the eyeball by systematically measuring the perimeters of all the axons seen through the optic microscope. The main purpose of this study was to define the topographical distribution of these axons in function of their size. Statistical studies show the existence of an area of maximal concentration of large axons in crescent form situated in the temporal zone of the nerve. The neurophysiological implications are discussed.


[The optic nerve in the cat. II. Qualitative aspects of maturation in the adult cat].

54 healthy cats were studied. In almost all cases, two types of degenerative signs could be seen: in the primary optic pathways, but also in the posterior funiculi and the spinal-cerebellar tracts, lesions of wide-diameter axons seen by their initial demyelination, accompanied by intense neuroglial reactions, and, on the other hand, a Wallerian degeneration of smaller axons situated in the axial part of the nerve. The percentage of these abnormalities must still be evaluated. Their eventual consequences and nature are discussed.


Levels of liver glycogen during normal and radiation-induced metamorphosis in Rana cyanophlyctis.

This study shows that significant changes in the pattern of glycogen deposition are brought about by irradiation with 2,000 R gamma-rays. The sharp fall during the 1st week can be attributed to its emergent mobilization. However, glycogen stored in the liver during the 2nd and 3rd week prior to the resorptive process substantiates the fact that tadpoles complete metamorphic transformations in spite of sublethal irradiation.


[Veins of the human cerebellum].

(1) The veins of the human cerebellum, which may be classified into internal and external venous channels, correspond, in this respect, to the veins of the cerebral hemispheres. (2) The external cerebellar veins are arranged in three groups which, in turn, correspond to the three cerebellar surfaces and which communicate extensively. Accordingly, the terminal segments of the cerebellar veins overlap, which implies that no one-to-one relationship exists between the mouths of the individual veins and their respective distributions. (3) The terminal segments of the cerebellar veins are the superior petrosal sinus, the tentorial venous sinuses, the great vein of Galen and the internal vertebral plexus. (4) The tentorial venous channels may form a collateral venous arrangement. (5) The internal cerebellar veins consist of the nuclear veins and the medullary veins. (6) The medullary veins form a cortex-perforating group and a group located in the basal medullary region. The latter form a venous arborization of blood vessels not described thus far. This group of veins opens chiefly into the vein of the lateral recess of the fourth ventricle.(7) Attention is called to a 'venous watershed' corresponding to the one that exists in the cerebral hemispheres. (8) The veins of the dentate nucleus are composed of several venous channels draining its external surface and one single vein draining its internal surface. The latter has not been described thus far. The external veins of the dentate nucleus open into the venous star and the cortex-perforating veins. The internal nuclear vein, on the other hand, emerging from the hilum of the dentate nucleus, runs along the superior cerebellar peduncle. Thus, the term 'vena centralis nuclei dentati' appears to be appropriate to designate this vessel. It ultimately opens into the precentral cerebellar vein. (9) In certain places, various-colored substances used for injection form mixed pools.


[Morphodynamics of the thoracic lymphatic vessels in the dog in experimental pericarditis].

The changes in the veins of a lymph node in experimental pericarditis appear together with those in the organ tissues and characterize the morphodynamic process.


[Anatomical considerations in sternal puncture].

The thickness of the manubrium, the width and thickness of the body of the sternum at the level of second intercostal space as well as the thickness of the spongiosa and outer and inner compact layers have been measured in 67 human cadavers. Consequently, it is recommended that sternal puncture be made at the level of the second intercostal space in the adult and at the manubrium in children. Depth of puncture should not exceed 4 mm. Sternal puncture can thereby be done with greater confidence of avoiding penetration of the sternum, a potentially serious complication.


Observations on the topographical relations of spinal nerve roots in the rat.

The spinal cord along with the ventral and dorsal roots (C1-S4) were dissected out in 10 male and 5 female CF rats. The vertebral levels of origin and exit of the spinal nerve roots and termination of the spinal cord were recorded. It was observed that from the mid-cervical to the sacral region, the roots arose increasingly at cranial levels compared to their levels of exit. This disparity was at its maximum in the lumbar and sacral segments. The spinal cord terminated between the third and fourth lumbar vertebrae. There was no sexual dimorphism either at the level of termination of the cord or at the levels of origin and exit of origin and exit of the various nerve roots.


[Neurotoxicity of formyl leurosine. An experimental and clinical study (author's transl)].

Leg paralysis and wallerian degeneration of sciatic nerve fibres have been produced in rats by intraneural injection of 0.5, 1 or 5 micrograms of vincristine (VCR) or formyl leurosine (FLR) dissolved in 5 microliters of saline. Nerve lesions were dose-related, and were similar for equal concentrations of the two drugs. Six patients received one to three 5-day courses of FLR. The total dose of FLR administered ranged from 15 to 131 mg (mean 83 mg). Clinical signs of peripheral neuropathy were absent in four patients, and limited to orthostatic hypotension in one case and transient depression of reflexes in another. Motor conduction velocities measured in four peripheral nerves, and muscle evoked potentials remained unchanged throughout the treatment in all patients.


Transepidermal water loss in newborn infants. III. Relation to gestational age.

Using a method described earlier, the evaporation rate (ER) was studied at different humidities in 12 newborn infants born after 25 to 30 weeks of gestation and 10 infants born after 32 to 35 weeks. Transepidermal water loss (TEWL) was estimated in 32 infants born after 25 to 39 weeks of gestation. The ER values were highest in the infants with the lowest gestational age and the susceptibility to changes in ambient humidity was also greater at lower gestational ages. An exponential relationship was found between TEWL and gestational age. TEWL being 15 times higher in infants born after 25 weeks of gestation than in full-term infants.


Some characteristics of transcutaneously monitored oxygen partial pressure in normal newborns.

The transcutaneous oxygen partial pressure (PtcO2) was monitored in 50 healthy, normally and spontaneously delivered newborns. Measurements were performed during the first to fourth day of life. The electrode temperature was 44.5 degrees C. The mean PtcO2 level recorded during about 45 min was 9.2 kPa (S.D. 1.4) recorded from the minute-to-minute values. The PtcO2 level normally oscillated to a certain extent and the oscillations were closely related to the breathing pattern of the patient. When the patient fell asleep during measurement, the normal oscillating pattern was replaced by a "silent pattern". During crying, the PtcO2 level showed four main reaction aptterns. A decrease in the PtcO2 level could be observed during breast-feeding. One child, recently fed, vomited a small amount of breast milk after a short period of crying and apparently had a laryngospasm, shown by a sudden drop in the PtcO2 level without any other signs of discomfort. The study shows that PtcO2 (and thus also PaO2) very sensitively reacts to changes in activity. This implies that earlier used methods for determination of PaO2 might give values that are not representative for the steady state as the sampling method per se might influence the recorded PO2 value.


Arterial blood pressure elevations during motor activity and epileptic seizures in the newborn.

In nine distressed newborn infants, mean aortic blood pressure and motor activity were recorded continuously during the first two or three days of life. Six of the infants had been asphyxiated at birth, the remainder having idiopathic respiratory distress only. The results showed that mean arterial blood pressure varies synchronously with motor activity, reaching maximum values much higher than previously suspected: about 90 or 100 mmHg were recorded in several infants. In three cases focal and/or generalized epileptic seizures occurred during the recording. It was found that in these circumstances too blood pressure increases dramatically, even if the motor component of the seizure is insignificant.


Neonatal convulsions. Incidence and causes in the Stockholm area.

The causes and short-term prognoses of neonatal convulsions in infants less than four weeks of age were studied in 77 full-term infants born in Stockholm in 1970--1976. In half of the infants (48%), hypoxia was considered to be the probable main etiology, while infection and metabolic disease including hypoglycemia and hypocalcemia were the next commonest cause, 12% for each condition. The etiology was unknown in 29% of the infants although 15 of those 22 included in this group had other additional diagnoses. The total mortality was 13%. At one year of age, 19 of the surviving 64 infants (30%) had severe psychomotor retardation. Of 11 infants with normal mental development at 12 months of age 6 had cerebral palsy and 5 epileptic seizures. Thirty-four (53%) of the infants still had no signs of sequelae. The poorest prognosis was found in the group with hypoxia as the main probable etiology. The incidence of neonatal convulsions was 1.5 per 1 000 full-ferm deliveries. In a similar study from Gothenburg which was performed 10 years earlier the incidence was 3.7 per 1 000. Corresponding figures for perinatal mortality rate were 13.5 and 23.8.


Sodium excretion in relation to sodium intake and aldosterone excretion in newborn pre-term and full-term infants.

The importance of aldosterone for the control of salt balance has been examined in pre-term infants (gestational age 28--34 weeks) and in full-term infants. The post-natal age has varied from 2--21 days. Eight-hour urinary specimens have been analysed with regard to sodium, potassium and aldosterone. The daily sodium intake has been recorded following determination of milk intake and analyses of sodium in breast milk. Due to variations of sodium content of breast milk, the daily sodium intake in pre-term infants was lower than in full-term infants during the first 10 days of life. The sodium excretion was significantly higher in pre-term infants than in full-term infants during the first six days of life. During the first week of life the sodium balance is negative in pre-term infants and positive in full-term infants. Aldosterone excretion is high during the first week of life and increases further from the 2nd to the 3rd week of life in both pre-term and full-term infants. The correlation between aldosterone excretion and urinary potassium/sodium quotient is 0.87 in full-term infants, 0.57 in pre-term infants aged 13--20 days and does not exist in pre-term infants aged 2--10 days. It is suggested that the high sodium excretion in newborn pre-term infants can in part be explained by an unresponsiveness to aldosterone at this developmental stage.


Mycoplasma pneumoniae infection. A retrospective review of 103 hospitalised children.

The clinical aspects of Mycoplasma pneumoniae infection in 103 children under 12 years admitted to hospital over an eight-year period were reviewed retrospectively. Respiratory illnesses occurred in 87 (85%) cases. The prevalence of lower respiratory tract involvement was similar in both pre-school and school children. Cough was the commonest symptom at all ages. Coryzal symptoms and wheeze were common in pre-school children. Most infants had signs of pharyngitis or otitis media. Non-specific symptoms--fever, lethargy, malaise, anorexia and vomiting--were common accompaniments in children older than one year of age. Non-respiratory illnesses in 16 (15%) patients included gastroenteritis, convulsions, non-specific skin rashes and limb pains. The duration of stay in hospital ranged from two to 30 days (median five days) with apparent clinical recovery and resolution of chest X-ray abnormalities within three months in 78 (76%) patients seen for review.


The spectrum of cow's milk allergy in childhood. Clinical, gastroenterological and immunological studies.

Seventeen of 52 children suspected of having cow's milk allergy had this diagnosis confirmed after milk challenge in hospital. A broad spectrum of reactions was obsserved including skin eruptions, respiratory symptoms and gastrointestinal disturbance. Not all patients with gastrointestinal symptoms showed small bowel mucosal damage. Only patients with skin reactions had positive skin tests. IgA deficiency and IgE elevation were common. Four patients had symptoms within 3 days of birth. Twelve children tolerated cow's milk by three years of age. Cow's milk allergy can cause a variety of symptoms. Challenge with milk for several days may be required before allergic manifestations can be demonstrated.


A prospective study of cow's milk protein intolerance in Swedish infants.

1 079 of 1 548 newborn infants were followed during their first year. 328 were prospectively contacted once a month. 751 were followed up at child welfare clinics. Altogether 20 were diagnosed as being cow's milk protein intolerant (1.9%). Symptoms from the gastrointestinal tract and the skin predominated. Only 2 had respiratory symptoms. Ten had their symptoms within one week after the introduction of cow's milk, 3 of them at their first cow's milk-containing meal. A further 4 already had symptoms when fed only human milk. The others (6 infants) showed symptoms after more than one week on a cow's milk containing diet. Before 2 years of age, 13 had recovered. Twelve of the cow's milk protein intolerant infants also showed adverse reactions to other foods, soy-protein intolerance being the most common (7 infants). A family history of allergy was found in 35% (116) of the 328 infants and in 70% (14) of those with cow's milk protein intolerance.


227 road accidents to children.

In a 9-month period, 227 children attended the Accident and Emergency Dept. of the Children's Hospital, Sheffield, after accidents on the road--about 12% of all new attendances. 169 were accidents to pedestrians, 31 to cyclists and 27 to passengers. Of the 169 pedestrian accidents, 157 were hit by moving vehicles, 72 (45.9%) suffering serious injury, with two dead. 45% of the pedestrians, 22.6% of the cyclists and 11.1% of the passengers were admitted. 29.6% of the 227 had severe head injury (concussion with or without a fractured skull). 22% of the 227 had a fracture or fractures. 55 children had had previous accidents. Compared with 225 previously described skateboard injuries and 200 playground equipment injuries, those injured on the roads were much more serious, though with fewer fractures. 37% of the road accidents were serious, compared with 10.7% of those injured on skateboards and 7.5% of the play equipment cases; 40.9% of the skateboard injuries but only 22.0% of the road accidents involved fractures, but 29.6% of the latter, 6.0% of the play equipment injuries and 0.9% of the skateboard injuries involved serious head injury. 4.0% of the skateboard injuries, 10.0% of the play equipment injuries, but 45.0% of the pedestrian road accident cases necessitated admission.


Physical health screening of school-children. Extended health care responsibilities for school-nurses.

All 410 ten- and twelve-year-old children of a school district underwent two repeated physical examinations within the school services, the first by the school nurse, the second by the school doctor. The aim was to compare their assessments to see if physical class examinations could be delegated to the nurse in future in order to release doctor's time. More than half of the children were found to have slight deviations from normal, most common of the spine and in the skin. The nurse detected many more deviations than the doctor but their assessments showed good agreement concerning functionally important deviations. Newly detected functionally important deviations were noted in 8 children (2%). The routine physical examination could perfectly well be delegated to the school nurse who has the necessary prerequisites to take this responsibility and screen out those children in need of a doctor's assessment, in this study 20%. She would release valuable time for the doctor who could then apply himself to the real health problems of the children of today: chronic diseases, behavioural and school problems, many of which frequently are concerns beyond the boundaries of traditional medical care.


Self-control with urinalysis in juvenile diabetes.

Urinary glucose excretion reflects the blood glucose levels and is therefore recommended and used as a relevant and practical method for self-control in juvenile diabetes. The purpose of this study was to estimate the attitudes of diabetic children and their parents towards such daily urinalysis. In 1975 69 juvenile diabetics 6--18 years old and their parents were studied and three years later another 69 patients were added. Standardized interviews and questionnaires were used. Only 3 out of 138 patients refused to test their urine regularly and to write down their results in the diary. The results indicate that a great majority of the patients and the parents easily accept the self-testing method and regard it as a valuable tool in the management of the disease. Almost nobody experienced the urine tests as a psychological problem.


Diagnosis of Hirschsprung's disease.

A prospective study of the accuracy of various diagnostic methods used in the detection of Hirschsprung's disease (syn. congenital intestinal aganglionosis, CIA) in 60 consecutive infants and children was done during the period 1972--76. Every patient underwent a barium enema, a rectal mucosal biopsy, which was prepared for both the demonstration of ganglia and for the assessment of acetylcholinesterase activity (ACE), and anal manometry was performed. In evaluating the clinical history, special emphasis was placed on signs of neonatal ileus. In the group of 10 patients with a definite diagnosis of CIA the results were almost uniform. In the 'non-CIA' group the search for ganglia in biopsy material proved non-confirmatory in nearly half of the cases studied due to the fact that specimens were taken too superficially. The findings pertaining to ACE, barium enema and the results of manometry were at variance or inconclusive of a final diagnosis in 10, 16 and 22% of the performed studies, respectively. The value given to neonatal history proved to be of the same order, i.e., 20% proved to be falsely positive.


Effect of pregnancy anaemia on cellular growth in the human placenta.

The effects of pregnancy anaemia on cell number and size in human placentae were investigated. Total organ weight, protein, RNA and DNA contents were determined in 54 fresh placentae from anaemic women (haemoglobin less than 110 g/l) and another 32 placentae from women without anaemia (haemoglobin greater than or equal to 110 g/l). The placental weight was significantly reduced in pregnancy anaemia. The decrease in total placental DNA in anaemic women suggested that the reduced placental weight was due to a decrease in cell number. However, these placentae also showed evidence of compensatory cellular hypertrophy as indicated by increase in both weight per cell and protein per cell.


Increased osmotic fragility of erythrocytes in chronically jaundiced rats after phototherapy.

Littermate homozygous (jj) and heterozygous (Jj) Gunn rats, were irradiated with blue fluorescent light for 18 hours continuously. The incident irradiance was 1.5 mWatts/cm2 in the 420--480 nm band pass. The influence of the irradiance on circulating erthrocytes was studied by testing their osmotic fragility before and after the irradiance. The non-jaundiced, Jj, animals did not exhibit any increase in the osmotic fragility of their erythrocytes. The osmotic fragility of the erythrocytes from jaundiced, jj, animals was the same as the Jj animals prior irradiance. However, the fragility of the erythrocytes from the jj animals was significantly increased after the 18 hours of irradiance. The results indicated that the photodynamic action of bilirubin may be present in vivo.


Reflex sympathetic dystrophy in two young females.

Reflex sympathetic dystrophy in paediatric patients is a rarely recognized pain syndrome probably of neurovascular origin. The manifectations in two young females consisted of disabling pain and localized hyperesthesia in lower extremities without evident trauma. Sympathetic block followed by active mobilization and, in the patient with atrophic changes, lumbar sympathectomy, resulted in complete recovery. Reflex sympathetic dystrophy should be considered in the differential diagnosis of pain and tenderness in an extremity.


Systemic air embolism. A possible complication of artificial ventilation.

A baby of 1 100 g and a gestational age of 28 weeks with severe idiopathic respiratory distress syndrome was treated with pressure limited artificial ventilation and positive and expiratory pressure. After 30 hours the infant deteriorated and the chest radiograph showed air in the carotid, subclavian and aortic artery.


Occurrence and characterization of "avium-like" Mycobacteria isolated from animals in Sweden.

431 cultures of "avium-like" mycobacteria (ALM) were isolated from wild and domestic animals during 1974--76 at the National Veterinary Institute, Stockholm. Of these, 50 isolates from pigs were studied by growth-chromogenicity, pathogenicity, and biochemical tests. Furthermore, thin-layer chromathography was performed, and on some isolates serotyping. All 50 isolates belonged to Runyon's group III and were pathogenic for chicken; none was capable of splitting oleic acid from Tween 80. 47 gave tellurite reduction within a period of three days; one was arylsulphatase-positive after three days and a further four after 14 days. The biological and biochemical tests permit assignation of the 50 isolates to the M. avium-intracellulare complex. The lipid patterns of the isolates examined were analysed by thin-layer chromatography. Thirty-five of the isolates showed a lipid pattern similar to that of A 2 of the fowl reference strain; three belonged to lipid type A 1 and four to A 3. Eight could not be typed. Of 22 isolates, 14 could be assigned to M. avium serotypes.


Multiple sclerosis and common viral infections in Iceland.

Sero-epidemiological studies on a few common virus infections, including measles, rubella, mumps and varicella-zoster, were carried out on patients with multiple sclerosis (MS) and controls matched for age, sex, and residences since birth. The frequency of antibodies against measles was significantly higher in the MS patients. Where measles preceded the onset of MS, the time interval varied from 3 to 32 years. In two cases, known MS patients contracted measles 9 and 3 years after their onset of MS. Furthermore, three MS patients were vaccinated against measles as adults. Two of these took part in a WHO measles vaccine trial in 1962, 18 and 6 years after the onset of MS. Both of them were seronegative prior to vaccination.


A rubella haemagglutination inhibition test not requiring removal of non-specific inhibitors. 1. Elaboration of the test.

The rubella haemagglutination inhibition (HI) test can be simplified and the probelm of non-specific inhibitors circumvented by allowing the haemagglutinin to react with erythrocytes before addition of the serum specimen. The elaboration of the test procedure is described, and preliminary studies indicate that the new method may prove useful both in the diagnosis of rubella infection and for determination of immunity status.


Toxoplasma Gondii: scanning electron microscope studies on the small intestine of infected and uninfected cats.

The mucosal surfaces of villi from the small intestine of cats infected with Toxoplasma gondii were studied with the scanning electron microscope and compared with those from uninfected control cats. In uninfected cats villi were predominantly leaf shaped and were lined with ridges; goblet cell openings could be seen. The enterocytes had a hexagonal surface outline and were dome-shaped. Infected cats had both normal and abnormal villi. Injured villi were shortened and attained a broad leaf shape, often with blunt edges. Enterocytes containing oocysts were enlarged, and microvilli were resolvable only on these surfaces. Ruptured cells from which parasite discharge had occurred were seen. Oocysts were observed and possessed a smooth coat.


Effects of a sugar mixture on blood alcohol parameters and impairment in the intact rat.

The effects of a sugar mixture containing 43% glucose and 36% fructose on ethanol metabolism and on ethanol-induced impairment were studied in intact rats. When ethanol was given orally mixed with the sugars there was a significant reduction in the area of the blood alcohol time curve accompanied by a decrease in the peak ethanol concentration and a slowing in the rate of ethanol absorption. The whole curve followed a lower course and the time for complete removal of ethanol from the body was markedly reduced even though the slope of the elimination phase (beta) was not significantly increased. Ethanol-induced impairment as measured using a tilting plane device was significantly less when ethanol was given mixed with the sugars and paralleled the reduced area and duration of the blood alcohol curve. The magnitude of the effect observed on blood alcohol levels and impairment was dependent on the dose of sugars administered in relation to the alcohol dose. When the sugars were given orally after absorption and distribution of ethanol were complete the slope of the elimination phase (beta) was increase by 30%. These findings point to an increased rate of ethanol metabolism in rats in the presence of sugars. The action of the sugars prevails only for the first few hours after administration thereafter the rate of ethanol metabolism returns to normal.


The influence of selinium on methyl mercury toxicity in rat hepatoma cells, human embryonic fibroblasts and human lymphocytes in culture.

The effect of methyl mercury and two selenium compounds have been studied in cell cultures. Methyl mercury in concentrations above 1 microM had a pronounced inhibiting effect on the growth of rat Morris hepatoma cells. Glucose and lactate uptake in relation to cell protein was appreciably stimulated by the organic mercury compound. Selenite in low concentration (0.5 microM) and seleno-di-N-acetyl glycine in thousandfold higher concentrations offered considerable protection against these effects of methyl mercury. The same selenite concentration (0.5 microM), which did not affect cell growth, caused an appreciable protection against methyl mercury (6 microM), even if it was added 3 days after methyl mercury. The methyl mercury inhibited the growth of human embryonic fibroblasts and the DNA-synthesis in the human lymphocytes. However, no protective effect of selenite were observed in these cell types. These results suggest that selenium compounds exert their protective effect through cell specific processes rather than by a direct chemical reaction between selenite and methyl mercury.


Inhibitory effect of ethanol on 5-hydroxytryptamine (serotonin) uptake in human blood platelets in vitro.

Ethanol in concentrations higher than 10(-2) M (or about 0.5% W/W) inhibited the uptake of 14C-5-hydroxytryptamine (serotonin) in human blood platelets in an artificial, protein-free medium, by a non-competitive mechanism. The inhibition was not influenced by the alcohol dehydrogenase inhibitor methylpyrazole (10(-3) M). In concentrations up to 0.1 M, ethanol had no effect on 5-HT efflux from the platelets. At higher concentrations, ethanol increased efflux. Inhibition of 5-HT uptake was found to increase progressively in the sequence methanol - ethanol - propanol - butanol.


Embryotoxicity and teratogenicity of styrene and styrene oxide on chick embryos enhanced by trichloropropylene oxide.

The effects of TCPO (trichloropropylene oxide) on the embryotoxicity and teratogenicity of styrene and styrene oxide and chick embryos were investigated. The compounds were injected into the air space of the eggs in a total volume of 25 microliter on the third day of embryogenesis. TCPO increased embryotoxicity and teratogenicity of styrene and styrene oxide. Our results present evidence that the epoxides possess embryotoxic and teratogenic properties in chick embryos.


Mechanism of hyperosmolarity inhibition of vascular contractility.

Studies were made of the responses of the vascular bed of cat hind leg to intraarterial injection of noradrenaline, angiotensine, tyramine and vasopressine, as well as of carotid occlusion upon increasing the tissue osmolarity through intraarterial hypertonic infusion. The limb was perfused at constant blood flow. Hyperosmolarity inhibited the contractile effects of all stimuli studied. The inhibition of the contractility was greater in the case of tyramine and identical in the case of the remaining vasoconstrictor agents. Increased KCl content or the addition of L-ascorbic acid to the hypertonic solution with preservation of the same hyperosmolarity reduced the inhibition of the contractile responses to noradrenaline and angiotensine. The restoration of the contractility was much more pronounced upon simultaneous increase in the KCl content and addition of L-ascorbic acid. No recovery of the contractile effect of tyramine was observed. The mechanism of hyperosmolarity inhibition of the vascular contraction is discussed. In all vasoconstrictor stimuli the inhibition is connected primarily with disruption of the transmembrane exchange of Na+ and Ka+. In some vasoconstrictor agents, e. g. tyramine, there is disturbance in the specific mechanism connected secondarily with vascular contraction.


Participation of the cardiopulmonary baroreceptors in the buffering of fast changes in the arterial pressure.

Acute experiments on cats are carried out to study the effect on the value of the pressor and depressor responses of the systemic arterial pressure (SAP) of the rise in the central venous pressure (CVP), occurring upon the administration of some hyper- and hypotensive agents. The responses of SAP to intravenous injection of different doses of noradrenaline and acetylcholine are determined at rest, after vagotomy, during intravenous infusion of dextrane solution and after vagotomy during infusion. It is shown that when the hypertensive agent causes a rise in CVP in addition to its pressor effect, the pressor response is subjected both to carotid and to aortic buffering as a result of the increased SAP, as well as to cardiopulmonary buffering due to the rise in CVP. In the case of the hypotensive agent the rise in CVP does not influence the value of the depressor SAP response, since the changes in the activation of the cardiopulmonary and arterial baroreceptors are in different directions. Evidence is presented in support of the assumption that the cardiopulmonary inhibition is transmitted along extravagal afferent ways in addition to being transmitted along the vagal nerves.


On the effect of preceding atrial- atrial and His-atrial intervals on the atrioventricular nodal conduction time in rabbit heart.

The study of conduction in the atrioventricular node is often associated with two characteristic time intervals. The first of these intervals reflects the time between two successive atrial excitatory complexes. The second interval reflects the time from the moment of the appearance of the excitation at the output of the atrioventricular node to the next atrial complex. In different publications the value of the conduction time is associated predominantly either with one (atrial-atrial) or with the other (His-atrial) preceding intervals. The present paper makes an attempt at comparative estimation of the effect of preceding atrial-atrial and His-atrial intervals on current conduction time. The experiments are carried out on rabbit heart preparation, using micro- and macroelectrode technique. Stimulation programmes guaranteeing the imposition of rhythm with fixed atrial-atrial and His-atrial intervals are used. It is concluded that there is no strictly determined connection between the value of any of the above intervals and atrioventricular conduction time.


Firing frequency of single motor units upon voluntary control of the isometric tension in human muscles.

Selective surface electrodes were used to study 120 motor units (MUs) from m. biceps brachii of six subjects in experiments for grading the rates of increase of isometric muscle tension until its maximum value. Correlation dependences were sought between the rate of increase of the tension, the force of maximum tension and the initial firing frequency of the activated MUs. A positive correlation was established between velocity and force in a narrow range of the average velocities. The initial firing frequency of the MUs was in positive correlation relation with the rate of increase of the tension, though only according to summated data. This connection may not be manifested for the single MUs. The pattern of the activity of the single MUs is considered to be only statistically connected with the activity parameters of the entire muscle.


On the changes in the atrioventricular conduction time under the effect of acetylcholine.

The aim of the present investigation is to study the effect of acetylcholine on the atrioventricular (AV) conduction time in preparation from rabbit heart right atrium. The artrial electrogram and the action potentials of the His-cells are recorded by means of bipolar electrodes and microelectrodes. The effect of acetylcholine is assessed by the simultaneous changes in the period of the atrial complexes and in the atrioventricular conduction time. The significance of the prolonged period of the atrial complexes for the compensation of the acetylcholine effect on the node area of the conduction system is pointed out. A considerable increase in the refractory periods of the atrioventricular node is found.


Effect of sodium selenite on experimental hypertension in rat.

Prophylactically applied sodium selenite lowers blood pressure of rats with renal hypertension and suppresses rise in blood pressure following infusion of angiotensin II, and it diminishes the epinephrine toxicity by half.


Neuropharmacological activity of newly-synthethized derivatives of 3,3-diethyl-2,4-pyridinedione. III. N-Acyl derivatives of 3,3-diethyl-2,4-pyridinedione.

Neuropharmacological screening of five newly-synthesized derivatives of 3,3-diethyl-2,4-pyridinedione was carried out on albino mice. It was found that the N-acyl derivatives have a central depressive effect which is different in character compared with the effect of diethylpyridinedione. The compounds possess no hypnotic effect. All compounds potentiate hexobarbital sleep, while 1-(4-nitrobenzoyl)-3,3-diethyl-2,4-pyridinedione, 1-carbophenoxy-3,3-diethyl-2,4-pyridinedione inhibit the amphetamine-stimulated motor activity. 1-(4-nitrobenzoyl)-diethylpyridinedione manifests good analgetic effect (in the test with intraperitoneal administration of glacial acetic acid), while diethylpyridinedione increases the number of the abdominal spasms. The compounds studied manifest no anticonvulsive activity in corazol convulsions.


Screening pharmacological studies of four dihydroisoquinoline derivatives.

Screening studies are carried out of the pharmacological activity of 3,4-dihydropapaverine (DHP) and three of its newly-synthesized derivatives: 6'-iodo-DHP, 6'-bromo-DHP and 6'-iodu-DHP methiodide. All compounds studied manifest central depressive action which is manifested in general depression, potentiation of hexobarbital anaesthesia, without inducing sleep when independently applied, as well as inhibition of the spontaneous and amphetamine-induced motor activity of mice. 6'-Iodo-DHP and its methiodide manifest analgesic effect. All four compounds studied reduce the blood pressure of urethane-anaesthesized cats, but they do not change the noradrenaline and the acetylcholine effects. The hypotensive effect of the compounds is preserved even after atropinization of the cats. The compounds studied manifest no antitussive effect. DHP-derivatives eliminate the spasms in guinea-pig colon, induced by BaCl2 and nicotine, while DHP has no effect on them. 6'-Iodo-DHP methoiodide inhibits the hypertensive nicotine effect on cats. DHP and 6'-iodo-DHP methoiodide manifest vasoconstricting action upon perfusion of the blood vessels of isolated rat hind legs.


Metabolic properties of nerve endings isolated from rat brain.

Energy metabolism was studied in nerve endings isolated from 3-week-old rat brain. Concentrations of glycogen, glucose, ATP, phosphocreatine and lactate were lower in synaptosomes than in the intact brain. The consumption of these endogenous substrates, the ability to generate high-energy phosphate, and the production of ammonia were determined in aerobic and anaerobic conditions. Unlike nerve tissue in general, synaptosomes preferentially utilized endogenous ATP and phosphocreatine stores which, on incubation in the absence of exogenous substrates, were emptied long before glycogen stores were exhausted. The optimal medium for respiratory studies was found to have electrolyte concentrations equal to the extracellular fluid. The synaptosomes had an endogenous respiration rate of 6.3 nmol O2 mg prot. min, measured with an oxygen electrode, and it probably reflects consumption of their glycogen stores. Glucose usually had no effect on the respiration rate of synaptosomes, but sometimes increased it slightly. However, after incubation in the presence of arsenate synaptosomes showed an increase in respiration when glucose was added. ADP, when added with glucose, also stimulated respiration. Pyruvate and succinate always increased respiration, succinate usually having the stronger effect. The present results show that isolated nerve endings are metabolically intact, which justifies their use in research on neurotransmission. In addition, opposite to the present consensus, synaptic transmission does not seem primarily to depend on the availability of glucose but rather on local stores of high-energy phosphate compounds.


Increase in local cerebral blood flow induced by circulating adrenaline: involvement of blood-brain barrier dysfunction.

The influence of intravenous infusion of adrenaline (8 micrograms.kg-1.min-1) upon local cerebral blood flow (CBF) in paralyzed and artifically ventilated rats was measured autoradiographically with 14C-iodoantipyrine as the diffusible tracer. At this dose, adrenaline invariably increased local CBF even though blood pressure was close to normal at the time of the CBF measurement. In average, local CBF increased to 400% of control. In 6 of 9 animals the increase in flow was inhomogenous with randomingly distributed areas of very high flow rates. Experiments with i.v. administration of Evans blue prior to infusion of adrenaline showed that areas of Evans blue extravasation appeared in 3 of 4 animals. Although areas of extravasation often corresponded to areas of high flow rates the former were much more circumscribed. Furthermore, very high flow rates were found in areas showing no sign of blood-brain barrier dysfunction. It is concluded that the increase in CBF was at least partly due to a pressure-mediated passage of adrenaline across the blood-brain barrier but that such a passage can occur in the absence of macroscopically visible extravasation of protein.


Effects of cholera toxin on villous tissue osmolality and fluid and electrolyte transport in the small intestine of the cat.

The effects of cholera toxin on tissue osmolality and on net transport rates of water, sodium, chloride and potassium as well as on unidirectional fluxes of water and sodium were studied in vivo. In all experiments the toxin caused a net secretion of water, sodium, chloride and potassium. The unidirectional sodium transport from tissue to lumen was increased while the flux in the opposite direction was reduced 180 min after cholera toxin instillation. Cholera toxin produced only a small reduction in the villous tissue hyperosmolality, created by the intestinal countercurrent exchanger. This reduction was far too small to explain the observed net secretion of fluid and solutes induced by the cholera toxin. Other mechanisms underlying the cholera secretion are discussed.


Changes in lipoprotein-lipase activity and lipid stores in human skeletal muscle with prolonged heavy exercise.

Lipoprotein-lipase (LPL) activity and intracellularly stored triglycerides were determined in muscle biopsies taken before and after an 85 km skiing race from 7 volunteers. The triglyceride stores were larger in slow twitch than in fast twitch fibres (proportions 5:1 before the race). The LPL activity increased and the triglyceride stores in slow twitch fibres decreased during the race. The best trained subjects had the largest TG stores before the race and their TG stores also decreased most during the race. These subjects also had very small increase of LPL activity. The least trained subject on the other hand showed a 6-fold increase of LPL activity. The high post-race LPL activity in less trained subjects indicates a higher capacity for uptake of fatty acids from serum TG as compared to the more trained subjects.


The effect of ingestion of amino acids, glucose and fat on circulating neurotensin-like immunoreactivity (NTLI) in man.

The effect of ingestion of amino acids (Vamin N), glucose, and fat (Intralipid) on the concentration of neurotensin-like immunoreactivity (NTLI) in plasma was determined in 6 healthy male volunteers. After ingestion of Intralipid (55 ml, 200 mgxml-1) there was a significant increase in the plasma concentration of NTLI. The calculated integrated total NTLI response (6.7 +/- 2.5 nM over 180 min) was statistically significant. Although isocaloric amounts of Vamin and glucose also increased the plasma concentration of NTLI, these increases were not statistically significant. The data indicate that fat is an important stimulus for the release of NTLI from the small intestine. It is suggested that neurotensin, or a metabolite, in blood may be a hormone involved in the postprandial inhibition of gastric motility and gastric acid secretion elicited from the small intestine.


Tachycardia during egg-hypothermia in incubating ptarmigan (Lagopus lagopus).

Incubating birds regulate the egg temperature by varying their posture and the distance between eggs and brood patch. In the present study, we show that this homeostatic process is further assisted by varying the brood patch blood flow according to the temperature of the eggs. When female ptarmigan resume incubation of cooled eggs (e.g. after a period of foraging), they immediately develop pronounced tachycardia (4 times noraml in wild, 2-3 times in captive birds). Tachycardia is maintained, although at decreasing intensity, until the eggs have obtained normal temperature. The eggs are heated 30 to 50% slower in females where tachycardia is inhibited by a beta-receptor blocking agent.


Delirium tremens. Some clinical features. Part I.

Twenty patients with delirium tremens and related states were investigated from the time of admission until the acute state was over. Using strict diagnostic criteria the material was divided into two groups according to the severity of the clinical condition; nine patients had fully developed delirium tremens (grade 3), 11 patients had a less severe clinical state, known as "Predelirium" (grade 2). The material was found to be representative for the condition under discussion. Patients with grade 2 were admitted during the day and the evening, but not during the night; patients with fully developed delirium tremens (grade 3) were admitted during both the day and the night, and this difference is discussed. The two groups had the same pattern of alcohol abuse, but patients with proper delirium tremens had had a drinking bout preceding the acute state; this was not seen among patients with a less severe clinical state. Patients with grade 2 had had symptoms like sleep disturbances and gastro-intestinal disturbances for 12-24 hours before the admission, whereas grade 3 patients had had such symptoms for about 48 hours. Patients with grade 2 stopped drinking when the first symptoms of the acute state appeared, whereas patients with fully developed delirium tremens continued to drink in spite of their condition. These anamnestic were supported by the finding that significantly more patients with proper delirium tremens had alcohol in the blood--several even concentrations about 2 g/l--at the time of admission compared to patients with a less severe clinical state. This lack of "latency period", which previously has been described as a typical feature in the development of delirium tremens, is discussed. It is concluded that due to the methodology used, it has been possible to point out some of the differences between the milder, often harmless, conditions and the potentially serious, fully developed delirium tremens.


Delirium tremens. Some clinical features. Part II.

Twenty patients with delirium tremens (grade 3) and a less severe clinical state (grade 2) were investigated thoroughly from the time of admission until recovery from the acute state. A lumbar puncture was performed in the majority of the patients immediately after admission and then repeated after recovery from the acute state. The cerebrospinal fluid was found to be both macroscopically and microscopically normal, as was the spinal fluid pressure. The clinical course was without complication, none of the patients were severely dehydrated. All the patients were treated with barbital, a long acting barbiturate. The duration of the acute state and the total amount of drug necessary in the treatment were equal in the two groups of severity. However, patients with proper delirium tremens needed significantly fewer barbital doses during the first hours after treatment was initiated than did patients with a less severe clinical state. The opposite was seen about 12 hours later. These findings are discussed in relation to the high blood alcohol concentration seen at the time of admission in the majority of the patients with proper delirium tremens, but not in patients with grade 2. It is concluded that barbital exerts its effect due to cross-dependence properties with alcohol. The majority of the patients had moderately elevated blood pressure, pulse rate and rectal temperature at the time of admission; these variables were to a great extent normalized within 48 hours after admission. No differences in those physical signs were seen between patients with fully developed delirium tremens and patients with less severe clinical states. The patients' condition during the acute state was followed by means of a delirium tremens rating scale. Physical symptoms were similar in various degrees of severity of the clinical condition. 18-24 hours after admission the differences in mental symptoms between patients with grade 3 and patients with grade 2 had disappeared, 48 hours after admission the patients' condition was to a large extent normalized. Methodological problems in using a rating scale in conditions as delirium tremens are discussed. The results are discussed in relation to aetiology and pathogenesis of delirium tremens. It is concluded that it may be that a qualitative, and not only a quantitative, difference exists between a severe withdrawal reaction and fully developed delirium tremens, and a hypothesis about a "point of no return" is suggested.


Psychiatric illness in a neurological out-patient department in North East England. Use of the General Health Questionnaire in the prospective study of neurological out-patients.

342 patients referred to a neurological out-patient department in North East England between November 1975 and November 1976 were studied prospectively using two methods of psychiatric case identification, by clinical interview and by use of the General Health Questionnaire. The population of psychiatric patients identified by clinical techniques is different from that identified by the GHQ and it is concluded that GHQ cannot be used for routine screening in the neurological clinic. Clinical data were compared with a previous retrospective study. Clinical assessment revealed 27% with psychiatric disorders whilst GHQ showed a probable psychiatric morbidity of 48% with a cut off score of 11/12 and 21% with our best cut off score of 26/27. Statistical problems with this method are discussed and the results of this study compared with others using the same questionnaire. Aspects of organic and psychiatric disorder in a neurological clinic are discussed.


A follow-up study of 29 borderline psychotic children 5 to 20 years after discharge.

Twenty-nine children who during 1956 through 1970 were hospitalized for borderline psychosis were followed up in 1975. Twelve of them had received inpatient psychiatric treatment for 1-3 years. Seventeen were sent home for local, nonspecific help. At follow-up 67% of the treated group were no longer considered psychotic, compared with 70% of the untreated group. The two groups differ somewhat in a series of parameters, the treated group showing more severe psychopathological symptoms. The differences do not reach significant levels. No useful prognostic criteria were obtained from the study. The prognosis seems to be much better than for other types of psychosis in children.


Prescribing patterns in psychiatric hospitals in Israel.

A survey conducted by pharmacists working in four psychiatric hospitals in Israel to assess the prescribing of psychotropic drugs revealed that polypharmacy was common: patients were receiving up to 11 different drugs and up to six different psychotropic drugs. The average number of psychotropic drugs per patient was two. The most popular combinations of drugs used were; one containing an antipsychotic drug(s) and an antiparkinson drug(s) and the other was a combination of more than one antipsychotic agent. Up to 30 doses per day were taken orally by one patient. Drugs that could have easily been administered on a once-a-day time schedule were often administered several times a day. Differences in prescribing patterns in the various hospitals and often times on different wards of the same institution could more easily be attributed to different educational backgrounds, habits and personal beliefs and perhaps the physician's experience as well, rather than to the types of patients treated.


Fertility and sibship size in a psychiatric patient population. A comparison with national census data.

Fertility and sibship size of 2,518 psychiatric inpatients during 1968-1975 were compared with national census data and examined according to psychiatric diagnoses, psychiatric diseases in first-degree relatives, early psychic disturbances, duration of disease, and school achievement. Fertility is markedly reduced in all diagnostic subgroups, though particularly in schizophrenia. While psychic disturbances before the age of 15, as an index of a severe disturbance of personality, reduced fertility even further, no significant correlation was found with the duration of the patients' actual disease. Less than ordinary schooling, but also higher qualifications led to a further reduction in fertility. This is particularly so in schizophrenia. Schizophrenics have their children at a later stage of their reproductive career. The psychological and biological consequences of this fact for the transmission of schizophrenia are discussed in detail. No change of fertility relative to the normal population was detected during the observed 8 years. There is suggestive evidence that patients stem from families smaller than expected from the national data. The inherent methodological problems are discussed. The results do not favour the hypothesis of a balanced polymorphism as a mechanism which could explain the constant incidence of psychoses in spite of the severe selection pressure against them.


Lithium treatment and kidney function. A survey of 237 patients in long-term treatment.

Kidney function has been examined in 237 patients who in the autumn of 1977 were in lithium treatment at the Psychiatric Hospital in Risskov, most of them as outpatients. The average age was 42 years. The patients had been given lithium treatment for 0.5-17 years, mean duration 5 years. The mean lithium dosage was 33 mmol/day and the mean 12-hour serum lithium concentration 0.85 mmol/l. Glomerular filtration rate was assessed through determination of 24-hour creatinine clearance and serum creatinine, in some cases iothalamate clearance. Water excretion was assessed through determination of 24-hour urine volume and in some cases urine osmolality after 26 hours of fluid deprivation. Creatinine clearances, serum creatinine concentrations, and urine volumes were subjected to multiple regression analysis with various clinically relevant predictor variables. Affection of glomerular filtration rate was only moderate and progressed slowly. The data indicate that the risk of renal insufficiency and terminal azotemia is remote even when lithium is given for many years. A large number of the patients had altered water excretion with polyuria or lowered urine concentrating ability or both. Due to the extra fluid loss these patients are apt to develop dehydration, and they may then be in danger of lithium poisoning. We hypothesize that lithium-induced changes of kidney function may become less frequent and less pronounced if patients are maintained at serum lithium levels somewhat lower than those employed in the group studied here. We recommend careful monitoring of serum lithium levels, regular control of kidney function, and extra caution when physical illness or additional drug treatment may lead to disturbance of fluid and electrolyte balance.


Effect of Bordetella pertussis vaccine on the course of lymphocytic choriomeningitis (LCM) virus infection in suckling mice pretreated with dianhydrodulcitol (DAD).

In earlier experiments Bordetella pertussis vaccine was found to enhance and dianhydrodulcitol (DAD) to weaken cellular immune response to intracerebral LCM virus infection in suckling mice. B. pertussis vaccine proved to inhibit the restrictive effect of DAD produced on the immune response in mice when 2-to-4-days-old animals were pretreated with DAD and subsequently, at the age of 16 to 18 days of life, treated with B. pertussis vaccine then infected with LCM virus. Consequently, B. pertussis vaccine enhanced the immune response previously affected by DAD.


Stimulation of the cellular immune response to lymphocytic choriomeningitis (LCM) virus infection in suckling mice.

Death occurred earlier and its rate was higher in one-week-old mice treated with phytohaemagglutinin (PHA) and subsequently inoculated intracerebrally with LCM virus than in their virus infected but untreated littermates. Thus PHA treatment contributed to the outcome of LCM virus infection in the form of lethal meningitis. The course of LCM virus infection in 1-week-old PHA treated mice was similar as in the untreated 2-week-old mice. This indicates that PHA treatment accelerated the development of cell mediated immunological capacity in suckling mice.


Hexagonal crystalline arrays of adenovirus type 1 hexons.

Separated, highly purified and concentrated adenovirus type 1 soluble hexon capsomers were crystallized by dialysis against 0.5 M acetate buffer. The crystallization process was followed electron microscopically. In the early phase of the crystallization, groups of a few hexons began to appear, then the two-dimensional crystal lattices grew gradually to a size of 1-2 micron. Simultaneously three-dimensional crystals of tetrahedral and prismatic shapes developed. The hexons in the two-dimensional crystal lattice formed regulator dense arrays corresponding to the hexagonal packing. Analysis of the crystal structure revealed 15-20% local irregularity (short range disorder) and about 10% deviation in the values of the lattice constant if determined from three different directions. The average lattice constant values showed considerable differences in different preparations. Angles formed by non-parallel hexon rows deviated by a few degrees from the regular hexagonal order. Consequently, the position of the hexons in dense two-dimensional crystals was found slightly skew and irregular, although each unit stayed within a certain distance as compared to its equilibrium position defined theoretically in the network. Dislocations were frequently found to disturb the regular arrays. The extra hexon row developing between two rows deverted them from their original direction. At these sites the crystal lattice slanted and the dense array of the hexons loosened. High resolution electron microscopy revealed fine linking structures between the hexons. In several cases the aggregated hexons failed to show a ring-like appearance, they were situated in lying--profile--position and the hexon-building polypeptide fibres became visible. The diameters of the hexons and the distance between them were measured in three directions and the size of the hexon-building polypeptides was determined as well.


Absorption of colostral immunoglobulins in suckling piglets.

The three portions of the small intestine of 18 neonatal piglets were examined by using the so-called scroll technique evolved by the authors and in cross sections. The chemical constitution and the immunoglobulin content of undigested protein droplets being under absorption were studied. An intensive absorption of immunoglobulins was demonstrated in the body of each cuticulated cylindric epithelial cell of the mucosa covering the jejunum and the proximal two-third of the ileum. Absorption was the most intensive, though variable by area, in the jejunum. It was demonstrable 4 hr after birth and reached the highest intensity between 8 and 12 hr, then tended to decline. In the protein droplets alpha-amino acids, neutral mucopolysaccharides and protein-bound Ca2+ were detected. Alkaline phosphatase activity was demonstrated around the droplets. Immunofluorescence and immunoperoxidase reactions proved the presence of immunoglobulins, first of all of IgG, in droplets. Electron microscopically, the microvilli of the involved epithelial cells were swollen, sometimes neighbouring ones were pushed away from each other; in the same areas, an electron-dense substances (colostrum) covering the enterocytes was streaming through the tubulovascular network of cells to the perinuclear region, where it appeared in spherical droplets.


Histological and histochemical studies on the innervation of the respiratory organs of Calotes versicolor Daud. (Agamidae, Lacertilia).

A study on the innervation of the respiratory organs of Calotes versicolor has been made using cholinesterase and silver reduction techniques. The tracheal and bronchial plexuses have been described. A number of nerve terminations along with synapses are reported. ChE activity has been observed on the periphery of the alveoli which is believed to be of importance in controlling the acetylcholine level, acting as a general tissue enzyme to prevent excessive accumulation of acetylcholine. Vascular nerve supply has been found to be largely of vagal origin.


Observations on the distribution of the omentum in the one-humped camel (Camelus dromedarius).

The greater omentum of the camel has been studied for the first time. Although the camel belongs to the suborder Artiodactyla, the greater omentum exhibits a striking similarity to that of Perissodactyla.


The morphology of the vertical and transverse intrinsic musculature of the tongue in the 15-week human fetus.

The attachments, courses and interrelationships of the transverse and vertical intrinsic muscle masses of the tongue were examined in 28 fifteen-week fetal specimens. Observations were made from 30-micron sections cut through the tongue in one of the three standard planes of section. Both sets of muscululature are qualitatively well-developed by this time period in fetal life. The transverse fibers were found to occupy the entire length of the tongue. They attach to the lamina propria of the lateral aspect of the body of the tongue and, in the root, to perimysial and adventitial connective tissue. In addition, some fibers were observed to be confluent with the mm. palatoglossus, tonsilloglossus and pharyngis superior. Medially, transverse fibers were found for the most part to terminate in the dense ventral aspect of the median septum. Vertical fibers are present from a point slightly posterior to the tip of the tongue to the level of the foramen cecum, beyond which they become sparse. All vertical fibers attach superiorly to the dorsal lamina propria. In the free part of the body, their ventral attachment, likewise, is to lamina propria. In the middle part of the tongue and, to a greater extent, in the root (as the inferior and lateral free surface decreases) these fibers attach in either the fascial plane underlying the transverse component or to the perimysium of longitudinally-running muscle bundles.


Cueing properties of the decrease of white noise intensity for avoidance conditioning in cats.

In the main experiment two groups of 6 cats each were trained in active bar-pressing avoidance to a CS consisting of either a 10 dB or 20 dB decrease of the background white noise of 70 dB intensity. The two groups did not differ in rapidity of learning, however cats trained to the greater change .in background noise performed avoidance responses with shorter latencies than did cats trained to smaller change. Within-groups comparisons of cumulative distributions of response latencies for consecutive Vincentized fifths of avoidance acquisition showed the greatest changes in the region of latencies longer than the median latency of instrumental responses. On the other hand, the effects of CS intensity found in between-groups comparisons were located in the region of latencies shorter than the median latency of either group. Comparisons with data obtained in a complementary experiment employing additional 17 cats showed that subjects trained to stimuli less intense than the background noise level were marked by an exceptionally low level of avoidance responding with latencies shorter than 1.1 s, which was lower than expected from the probability of intertrial responses for this period of time. Due to this property of stimuli less intense than the background, the distributions of response latencies were moved to the right, in effect, prefrontal lesions influenced a greater part of latency distributions than in cats trained to stimuli more intense than the background.


Auditory frequency generalization in normal and prefrontal dogs trained in varieties of active avoidance reflexes.

Twelve dogs were trained to avoid shock with response contingent termination of a 1000 Hz tonal CS on all trials, whereas 12 additional dogs received the same training except that on 50 percent trials there was a fixed CS duration and no shock. Initial acquisition revealed that CS prolongation resulted in longer response latencies compared to subjects trained with response contingent CS termination. Both training groups were then assigned to subgroups (n=4) that received either lateral or medial lesions of the prefrontal cortex or a rest pause of 10 days. Postsurgical reacquisition indicated a medial deficit in response latencies for both training groups whereas performance levels of normal and lateral groups were comparable. Two generalization tests to tones of 600-, 800-, 1000-, 1200-, and 1400-Hz followed. During the sampled test only one block of the five test frequencies occurred with the regular 15 training trials, while the tonal frequencies were presented on all 20 daily extinction trials during massed generalization testing. No evidence of extinction was observed during the sampled generalization test in either training group. However, during massed testing, all subjects trained with response contingent CS termination showed an overall extinction influence, which was most pronounced in the medial subgroup, although the laterals showed frequency control as well. In the group trained with CS prolongation the controls had clear, discriminative performance, while little stimulus control or extinction influence were found in the medial or lateral subgroups. Comparison with alimentary data indicated much broader tonal frequency generalization in dogs trained in avoidance. However, when the procedures reduced avoidance levels, double dissociation of medial and lateral lesion effects on stimulus control and susceptibility to extinction emerged.


Adrenergic modulation of the hypothalamic cholinergic mechanism in the control of emotional-defensive behavior in the cat.

Effects of drugs influencing the activity of the hypothalamic noradrenergic system on the carbachol-induced emotional-defensive response were investigated. Intrahypothalamic injections of noradrenalin, amphetamine and reserpine did not produce any changes in cats' behavior. Injections of carbachol into the same hypothalamic loci, following the injections of noradrenalin, amphetamine or reserpine evoked all the characteristic symptoms of emotional-defensive behavior. However, a strong decrease in the number of growls and the duration of growling was observed when reserpine injections preceded the injections of carbachol into the same hypothalamic areas. Adrenergic alpha and beta agonists (methoxamine and isoprenaline) as well as antagonists (phentolamine and oxprenolol) when injected alone had no influence on the cats' behavior. Their effect on vocal responses evoked by subsequent injections of carbachol was not statistically significant. Results show that emotional-defensive behavior cannot be triggered by an activation of the hypothalamic noradrenergic system. However, emotional defensive behavior induced by cholinergic stimulation of the hypothalamus may be modified by changes in the activity of the hypothalamic noradrenergic system.


Influence of adaptation to altitude hypoxia on the behavior of rats in a conflict situation.

Adaptation to altitude hypoxia under conditions of conflict between thirst and defensive motivation was studied. The subjects adapted to altitude hypoxia made three times more attempts to drink from a water bowl despite receiving an intense shock. Adaptation to altitude hypoxia increased the stability of an initiated drinking reaction over intense shock. In adapted animals that began to drink, the drinking response changed to defensive behavior with twice the shock intensity as in control animals. In the absence of conflict, there was no difference in the satisfaction of the thirst and the defensive motivation in animals adapted to hypoxia and in controls. Hence, the effect of adaptation to hypoxia consists in making the animals more capable of inhibiting the responses to defensive motivation under conditions where it is necessary to satisfy another vital motivation.


Single-unit activity in cat's isolated midbrain.

The midbrain was isolated by two brainstem transections, pretrigeminal and premesencephalic. In the isolated midbrain, particularly within the reticular formation, EEG activity was greatly depressed. On the other hand, single-unit spike activity remained at a high level. The spatial density of active reticular units and the rate of their spontaneous activity were at least not smaller than those in the midbrain of the cat with only a pretrigeminal transection. Thus the flat EEG record is not necessarily a sign of the absence of neural activity.


[The influence of body-height at birth to further body-height development (author's transl)].

It is significantly showed, that great infants have also in further life average a long body-height. From body-height at birth can be estimated the body-height-development. The great infants are great to time of school-absolvation. This also proves right for boys and girls.


[Neuropediatric follow-up studies of preterm born babies with birth weight below 1600 g (author's transl)].

Neuropediatric follow-up studies during 18 months of preterm born babies with birth weight below 1600 g show a normal development in 70%. Better perinatological and neuropediatric long-term care are taken as causes of the improved developmental prognosis of children at risk in recent years.


[Social diagnosis and prognosis in childhood. Experience from Czechoslovakia II].

The function of the family as a social system was assessed by involving 3 criteria: Structure, stability and socio-economic status of the family, personality of the parents, brother and sister, childpersonality, parents interest towards the child, parents care for the child. The criteria were evaluated in a Score: The sum of the points allowed the family situation, to be assessed and rendered it possible to derive suitable measures of social-organisations in care of risk families.


[Seasonal variation of menarche and month of birth (author's transl)].

Seasonal variations in the occurrence of menarche in 1226 Japanese girls are not uniform, when they were divided into two groups by their season of births. Summer trough (May-July) was inapparent in girls born in summer (May-October), and winter trough (February-March) was less deep in girls born in winter (November-April). No differences were found in fall trough (September-November) between both groups. Girls born in summer (or winter) seem to be resistant to some summer (or winter) factors, which inhibit the occurence of menarche.


[On adaptation of adolescents to the vocational training in the point of view of schooldoctors (author's transl)].

Since 1969 bibliographie informes that growing numbers of apprentices and young workers are absent from work in spite of their obviously good health-state. All reported results of several studies and investigation-programms show that in most of the described cases problems of juvenile adaptability are linked with. Difficulties arise when young people change over from school education to vocational training. At first the paper deals with the differently used terminus adaptation. Three empirical principles from available studies may be deduced. They are interpreted under the point of view of school-doctors, works-doctors and vocational-school-instructors. Recommendations for school-doctors finish the paper.


[Present problems of gonorrhoea occuring at youth (author's transl)].

In 1977 juvenile minors infected by gonorrhoea represented the group being the secondly frequent one. Female juvenile minors are especially endangered. Reasons of this raising and measures for reducing the frequency of the disease are taken into consideration.


[Rehabilitative pedagogic aid for imbecile children with an auditory defect (author's transl)].

Basing on the results of diagnostic activities during eight years in a neuropsychiatric institution the image of the multiple injury imbecility plus auditory defect is introduced. Problems of rehabilitation of children injured in this way are discussed. A pretest-posttest control group procedure is followed by the discussion of the model of a stationary advancement by the help of rehabilitative pedagogy. In the front we consider an atmosphere with gestures and simultaneous speech, which is able to give a chance of communication to the multiple injured child.


[Quantification of environmentally influenced differences in physical and mental development of infants by a phenomenologic-mathematical separation of the body length growth into growth spurts (author's transl)].

Retardation phenomena in the physical development--especially in the increase of body length--of infants taken care of in social institutions (day-nursery, week-nursery, residential nursery) in relation to those growing up in the family will be represented in a quantitative-analytical form on the basis of a phenomenologic-mathematical model. This kind of modelling consists in the separation into 7 successive growth periods (growth spurts) of the whole growth process during the time interval from conception until the age of 3 years. For the time interval from birth until the end of 3 years we have 4 such growth spurts. The second one (fifth in the former numbering) determines mainly the growth during the 2nd year of the individual's life and makes evident the delay in the mean increase of body length of infants taken care of in social institutions, which is most evident for children who grow up in a residential nursery. The quantitative statements derived from the mathematical model concerning the physical development will be confronted with the known facts concerning the retardation in the mental-psychial development--especially in the ontogenesis of speech--of the same groups of children. There is an astonishingly close accordance of the values of time delays in reaching the levels of the physical and of the psychical development. The model may help to perceive and to diagnose the complex of causes responsible for these retardation phenomena from a social-medical and biological point of view. On the other hand this may also give a critizism and assessment of the real relevance of the biomathematical separation of the growth process into single growth spurts practiced here.


[Comparison of anthropometric and radiometric skull measurements of the first two years of life. 1st Part: Method of measurements and problems (author's transl)].

In 150 healthy boys and girls (1; 1,5; 2 years) seven anthropometric and several radiometric parameters (lengths, angles, planes) of the skull were determined. The methods are defined: anthromopetric measurements of the head taken after Martin (1959), radiometrics after Schmid and Filthuth, planimetric data collected after Wechselberg and Wessely.


[Comparison of anthropometric and radiometric skull measurements of the first two years of life. 2nd Part: Results (normal values) of kephalometric data -- results of linear metrics of the skull and planimetric results of x-ray analysis (author's transl)].

Statistical criteria allow the results of researches on head resp. skull measurements of more than 1200 infants of Erfurt to be taken as normal values, yielding slightly larger figures as up to now in use. Optimum appreciation of growth requires combination of all methods mentioned.


[Percentiles of the neck-girth in children and adolescents (author's transl)].

Correlative calculations as to the circumference of the neck in age-conformingly developed children have revealed that neck circumference exhibits the best correlations to body weight, followed by body surface, body height, age and cervical skin thickness. The graph of the 50. percentile demonstrates sex-different course with single discontinuities of level, which are characteristic in the beginnings of school-resp. of puberal ages. The positions of the 1-s-deviations beside the 50. percentiles are almost symmetrical. An essential result of this investigations is the correction of the wide spread opinion of an age dependency of neck circumference. Instead of this, nearly linear correlation exists between body weight and neck circumference.


[Adaptation of children to hospitalization].

Infants especially of about 1 to 4 years of age are opposed to an unknown environment and to unusual demands when they are admissed to hospital. Literature informes about some characteristic troubles during the first time of adaptation. In addition to those kinds of transitory adaptional difficulties, physical and mental retardation of development may appear when infants become long-time patients. The socalled psychic hospitalism has to be valued as a sign of underprotection and differs from adaptional troubles as a symptom of full strain. The survey shows adequate measures how physicians and nurses may deal with both of the problems in order to ease adaptation and to prevent psychic hospitalism.


[Definite contact with the outer world as a factor in hospitalism prophylaxis--on education and learning in pediatric hospitals (author's transl)].

Being a useful means against negative psychic consequences of hospitalization, the "walk" in the near or distant surroundings of the hospital is analysed and methodically described. The immanent playing and occupation therapy as well as the stock of experience additionally acquired are integrating educational and learning aids. By the example of the observation of nature the use of the so-called "creative moment" in learning processes is demonstrated.


[Possibilities and limits for palsied children in the general polytechnical school (author's transl)].

Some children with cerebral palsy attend the ten-form general polytechnical school. To this end, several prerequisites have to be fulfilled and other essential arrangements to be developed in cooperation with specially trained teachers. The learning conditions have to be fitted to the improving abilities of children during the educational process. Factors of influence and cooperation modes are discussed.


[Effects of levamisole in the treatment of a group of patients with atopic asthma and depression cellular immunity].

We investigated the possibility of decreased cellular immunity (C.I.) in a substantial group of atopic asthmatic patients with respiratory tract infections during autumn and winter. Two-hundred and ten atopic asthmatic patients were selected, and the following tests for cellular immunity were performed. Skin tests with 11 bacterial and fungal antigens. Normal average value of the skin reactions is 2.5 mm. E rosettes with sheep erythrocytes. Normal value for patients of this age is 60 +/- 8%. Immunoglobulins A, G and M and complement fractions C3 and C4 were determined by radial immunodiffusion. IgE was determined using PRIST (Phadebas, Pharmacia). IgE was elevated in all except two of the patients. IgG, IgA and IgM, C3 and C4 were normal. Twenty five of the 85 patients had some depression in cellular immunity (decreased E rosettes and/or decreased skin reactions). Patients with depressed cellular immunity were given 2.5 mg Levamisol three times a week for three months. Their progress was evaluated clinically and immunologically and a positive correlation was found between clinical improvement and increased C.I. in 18 of the 25 patients. We consider Levamisol to be useful in approximately 8.5% of all asthmatic patients.