[Effect of metyrapone on bile flow and bile acid excretion in Wistar rats].

The influence of metyrapone on bile flow and excretion of mono-(MBA), di-(DBA) and trihydroxy-(TBA)-bile acids was investigated in adult male Wistar rats after single and repeated pretreatment. MBA were not found in the rat bile. Metyrapone administration (200 mg/kg b.w. i.p.) 1 h before onset of a 3-hour bile collection period diminished bile flow and excretion of DBA and TBA. The relation TBA/DBA was changed towards DBA. Similar results were found after repeated administration 12 h after the last metyrapone injection (4 x 50 mg/kg b.w. i.p. per day for 4 consecutive days). But 60 h after the last metyrapone administration bile flow and the excretion of TBA were enhanced and the TBA/DBA ratio was changed towards TBA. The possible influence of metyrapone on bile acid hydroxylation is discussed and compared with metyrapone action on hydroxylation of foreign compounds.


[Pharmacologic influence on secondary generalized fibrinolysis].

Secondary generalized hyperfibrinolysis was induced by thrombin infusion or batroxobin injection in rats. To follow intravascular fibrinolysis quantitatively, an electroimmuno-assay was used for determination of the fibrin degradation products formed. Anticoagulants (heparin, hirudin), antifibrinolytics (EACA, PAMBA, AMCA), and synthetic (APPA) and naturally occurring (aprotinin) protease inhibitors were studied with regard to their influence on secondary fibrinolysis. The potency and duration of action of the antifibrinolytics tested correspond to their antifibrinolytic activity measured in vitro and to their pharmacokinetics. Formation of degradation products is initiated after the appearance of fibrin monomer or fibrin, respectively. Due to their antithrombin action heparin, hirudin, and APPA prevent the thrombin-induced fibrin formation and thus the induction of secondary fibrinolysis. In contrast, formation of fibrin monomers caused by batroxobin is not influenced by thrombin inhibitors so that in this case formation of degradation products is not prevented.


The importance of arginyl residues for phosphorylation of rat liver cell sap proteins.

Arginyl residues in phosvitin, histone and cell sap protein were blocked by 1,2-cyclohexanedione, resulting in markedly impaired phosphorylation of histone and cell sap. Interestingly, the phosphate incorporation into phosvitin was not changed by this treatment. Intact arginyl residues in the protein kinase substrates seemed to be essential for more than half of the cell sap phosphorylation at 5 mM ATP. Furthermore both phosvitin kinase and histone kinase activities in cell sap were inhibited by arginyl residue blockade, indicating that these enzymes had functional arginyl residues.


[Subdiaphragmatic pacemaker implantation of pacemakers - results of 1150 implantations].

Permanent pacemaker are presently used on patients with chronic disease of the cardiac conduction system, with recurrent Adams-Stokes attacks, and with bradycardia. 1865 pacemakers have so far been implanted in the unit for special thoracic surgery in the University of Heidelberg from 1965 to 1978. In 1.150 (or 61%) patients the pacemaker was implanted using the subdiaphragmatic method. A lower transverse pericardiotomy was performed and the battery was located in the rectus abdominis sheath. In the remaining 715 (or 39%) patients, the electrodes were introduced transvenously and implanted in the endocardium. The battery unit in this case was located beneath the pectoral muscle. The transvenous approach was the method of choice until 1971; from that time onward the subdiaphragmatic approach gradually replaced it as the method of choice. Between 1971 and 1978 80% of the pacemakers were implanted directly into the myocardium whereas only 20% were introduced transvenously. The subdiaphragmatic method completely eliminates the frequent complications of the transvenous approach, such as dislocation of electrodes and others so that it now is our method of choice.


[Bone metastases as a traumatologic problem].

The authors have attempted to cast some light on a problem that has confronted the surgeon for some 200 years: should a patient with terminal cancer, bone metastases and pathological fractures be treated surgically? In recent years the number of patient with pathological fractures has paralelled the increase in incidences of malignancies. Such pathological fractures are being noted at ever younger age. This paper concerns the author's five year experience with 53 patients operated on for pathological fractures at the Trauma Clinic in Ljubljana. The type of therapy chosen was determined jointly by the surgeon and oncologist strictly on an individual basis. The survival time of patients following surgery for pathological fractures was relatively long (especially with breast cancer patients /21 months postoperatively). This disprooves the thought that pathological fractures signify the beginning of the terminal phase of patients with malignancies. The authors note that the fracture to be operated on must be fixed and stable and the patients general condition of course must be permitting.


[Open injuries of the knee].

The authors discuss the therapeutic approach to 9 cases with open injuries of the knee which they have encountered during the past 5 years. All patients were hospitalized in a state of serious traumatic shock and all had multiple injuries. All 5 cases were operated on within 2--3 hours of the injury. The authors used the following postulates in treating this type of trauma: prevention of traumatic shock, early meticulous primary surgical treatment of the wound, closure of the joint with the drainage of the synovial cavity and periarticular space, strict immobilization, reinacting the extensor mechanism, fixation of the condylar fragment and the administration of antibiotics. The surgical treatment was restricted to only the minimal, patelectomy (3 cases) sec. McLaughlin, and in one case the medial condyle was fixed to the femur. Postoperative infection was not noted. All five patients returned to full working capacity and exhibited only minimal loss of extension at the knee.


[Correlation of gastroscopic, pathohistologic, cytologic and cytochemical analysis of ulcer lesions and other pathologic changes in the gastric mucosa. Preliminary study].

This paper concerns our first experience of correlation analysis between the gastroscopic, pathohystologic, cytologic and cytochemical findings of different organic gastric lesion on gastroscopy. The authors' experience is based on 78 patients in whom 450 biopsies were performed. For an adequate analysis, 135 samples of pathohystologic anc cytological examinations were useful and only 80 samples for cytochemical analysis. From these examinations it is possible to conclude that the cytochemical reactions of the group of patients with inflammatory lesions and intestinal metaplasia showed changes in the level of enzyme aminopolypeptidase together with the presence of acid mucopolysacharides. In the group of patients with lesions showing an ulcer, carcinoma or suspect malignancies, the changes occured in the composition of enzymes such as acid phosphatase, DNP Diaphoresis and nonspecific esterases. With such combined examinations the percentage of correct diagnoses was increased in comparison with conventional method of gastroscopy and biopsy.


[Blunt injuries of the abdomen in Gorenjsko during the past 3 years].

This paper concerns blunt injuries of the abdomen in Gorenjsko (a Region of SR Slovenija northern of Ljubljana) treated during the past 3 years. Of the total 131 hospitalized patients, 51 (or 43.5%) were operated on. In 5 (8,8%) an explorative lapartomy was performed in which no pathological substrate was found. The most frequent lesions were found in the spleen, liver and small intestine. The paper stresses the importance of an early and correct diagnosis of such injuries. In making the exact diagnosis aside from the physical evaluation, the most important procedure is lavagage of the abdomen which the authors used in all cases suspect for acute abdomen and obtained excellent results. In 20% of the patients surgery was performed within 2 hours of their of hospital admission. Injuries of the liver were treated with necrectomy, ligature of the bleeding vessels, suturing of the biliary canals, and establishment of drainage. Ligation of the hepatic artery and hepatic resection was performed in two cases. Injuries of the pancreas were also treated with necrectomy, hemostasis and drainage. In one case with a posttraumatic pseudocyst of the pancreas surgery was performed with an isolated intestinal loop according to Roux-Herzen. In conclusion the author insists on a prompt diagnosis in which abdominal lavage plays an important role. Using such an approach the morbidity is significantly reduced.


[Regeneration of defects in a small portion of the urinary bladder mucosa in experiments with guinea pigs].

Regeneration of the vesical mucosa begins from the remains of the bladder at the trigonum and urethra, and the author studied this regeneration in 30 rats. Epithelial regeneration began on the third day after formation of the defect. On the fifth day the entire defect was covered with transitional epithelium whose thickness did not exceed 1--2 cell layers. During the fifth week regeneration was complete. This experiment confirms the claim of Baker et al. the regeneration of the mucossa of the urinary bladder (except for the remaining mucosa of the trigonum and urethra) occurs via differentiation of pluripotential mesenchyme cells into transitional epithelium. During the experiment, the rats were given garamycin prophylactically. The very short regeneration time was probably due to the absence of any inflammatory process.


[Agenesis of the gallbladder -- case report and a short review of the literature].

Agenesis of the gallbladder is a rare anomaly of the biliary system. Only 200 cases have thus far been reported in the world medical references. The authors have presented a case with a congenitally absent gallbladder and cystic duct. The diagnosis was made exclusively with peroperative cholangiography, because preoperative radiologic attempts mimics an obstructed cystic duct. The incidence of congenital absence of the gallbladder and cystic duct is between 0.01 and 0.015%. The case presented here was operated on with a preoperative diagnosis of an obstructed cystic duct. The agenesis was verified during surgery using peroperative radiomanometry and cholangiography. The importance of this anomaly lies in its recognition because it can be accompanied by choledocholithiasis. In as much as choledocholithiasis is coexistant it must be treated with the standard surgical procedures.


[Traumatic rupture of the subpelvic region of the ureter in a child].

Ureteral ruptures in children are more frequent because of the inadequate support provided by the retroperitoneal tissue and consequent mobility of the kidney. The authors have noted a new observation concerning trauma of the subpyelar segment of the ureter in a 9 year old boy. The diagnosis was established three days following the injury with the aid of intravenous urography. The defect was repaired with surgery in which a termino-terminal anastomosis was performed. Renal angiography is of little help in discovering ureteral lesions. Whereas retrograde pylorography can be helpful in such a case. The early diagnosis and reparation immediately following the injury gives the best results, whereas late reparation of such a lesion can lead to a halt in renal function. The authors believe that intravenous urography is one method which can help in making an early diagnosis and should always be used in trauma cases presenting macro and microhematuria.


Anovulation and oviductal hyperplasia in rats treated with clomiphene citrate 5 days after birth.

Five day old female rats were administered either 500 micrograms clomiphene citrate or propylene glycol. Vaginal opening occurred significantly earlier in the clomiphene treated group as compared with the control group. Clomiphene treated rats showed permanent sterility associated with anovulatory vaginal cycles in which the stage of vaginal cornification predominated. Furthermore, clomiphene treated rats exhibited a high incidence of pyosalpinx (or oviductal abscess). The possible mechanisms responsible for the anovulatory sterility and the pyosalpinx induced by neonatal clomiphene treatment are discussed.


Solubilization of thyroxine-5'-deiodinase activity from rat liver microsome fraction.

The greater part of T3 is converted from T4 in liver or kidney. The majority of this activity exists in microsomal fraction. In the present study, we investigated whether this activity can be solubilized from rat liver microsomal pellet with various concentrations of deoxycholate (DOC). The extent of solubilization was compared with that of protein, rotenone insensitive NADH cytochrome c reductase or NADH cytochrome b5 reductase, which have been shown to associate with microsomal membrane rather than luminar contents. When 0.05% of DOC which was capable of releasing luminar contents of microsomal vesicles was applied to microsomal suspension, only a limited part of NADH cytochrome b5 reductase, rotenone insensitive NADH cytochrome c reductase or T4-5'-deiodinase activity was solubilized. When the concentration of DOC was increased to 0.125%, 41% of T4-5'-deiodinase activity was solubilized. Solubilization of protein, NADH cytochrome b5 reductase or rotenone insensitive NADH cytochrome c reductase was increased abruptly to 66%, 58% or 63%, respectively. The highest specific activity was obtained at 0.125% DOC. These results suggest that the T4-5'-deiodinase is associated with microsomal membrane instead of luminar contents.


Adrenocortical function in hypophysectomized dogs with parotid gland transplants in direct contact with the basal hypothalamus.

Adrenocortical activity was studied in three groups of dogs: control-normal, hypophysectomized (hypox), and dogs with a piece of parotid gland grafted into the sella turcica immediately after removal of the whole hypophysis (hypox + graft). Cortisol plasma level (Fk) was estimated by the competitive protein binding method. The mean base-line Fk for 21 normal dogs was 0.8 +/- 0.1 microgram/dl; for 12 hypox dogs 0.03 +/- 0.01 microgram/dl, and for hypox + graft dogs 0.5 +/- 0.2 microgram/dl. After mild or severe stresses the normal and hypox + graft dogs showed an increment in Fk; hypox dogs showed no change. Adrenal glands of hypox dogs revealed striking diminution in fasciculata and reticularis layers, whereas hypox + graft dogs approached normal. Light microscopy studies of the parotid gland graft showed signs of cellular differentiation. Groups of proliferating cells forming follicular structures were present mainly in the part of the parotid tissue closely associated to third ventricle presenting different staining affinities.


Calcitonin in extrathyroidal tissues of man.

Prior studies have demonstrated detectable immunoreactive calcitonin in the serum and urine of totally thyroidectomized humans, suggesting that the hormone may be secreted by extrathyroidal tissues. Accordingly, a study of the immunoreactive calcitonin content of human tissues was undertaken, utilizing autopsy material from 23 patients. Significant amounts of calcitonin were found in many extrathyroidal tissues, ranging up to 40 ng/g wet weight. The hormone was detectable with two antibodies having different region specificities for calcitonin. Gel filtration and subsequent radioimmunoassay demonstrated that extrathyroidal tissue has calcitonin fractions of the same molecular size and charge characteristics as do the serum and thyroid. The finding of large amounts of extrathyroidal calcitonin may explain why thyroidectomy in man is not accompanied by marked changes in calcium metabolism.


[Gastric emptying in patients with chronic gastritis. Its relation to serum gastric levels].

Forty eight patients were evaluated to ascertain a correlation (if any) between gastric acid secretion, fasting and post prandial serum gastrin levels, gastric biopsy (antrum and fundus) and gastric emptying time after a standard test meal. The following conclusions were obtained: a) 57.8% of patients with atrophic gastritis and achlorhydria had evaluated serum gastrin levels; b) most patients with high gastrin levels had normal antrum on biopsy or showed only minimal inflamatory changes, while those with normal gastrin levels disclosed more pronounced histological changes; c) patients with achlorhydria had slower gastric emptying rates, and this was more evident among those with higher gastrin levels (though differences were not statistically significant). Further studies are required for a better understanding of the relationship between gastric emptying rate and gastrin levels in patients with chronic gastritis.


Effects of diphenylhydantoin (DPH) on distal colon motility.

Diphenylhydantoin (DPH) induced changes in distal colon motility in the 37 subjects investigated. In subjects with sigmoidal hyperactivity plus rectal hypoactivity, DPH suppressed or reduced sigmoidal phasic activity. In subjects showing no sigmoidal activity predominance, DPH induced increases of sigmoidal and/or rectal motility. Sulpiride (an "atypical" dopaminergic blocking agent) antagonized DPH-induced changes. Our results strongly suggest that DPH-induced distal motility changes are mediated by the dopaminergic and noradrenergic systems.


[Endoscopic cytological diagnosis of the upper digestive tract].

207 cases of oesopha-gastric endoscopic exfoliative citology was realized during 1976-1977, 126 was malignant and 81 non-malignant. The high general diagnosis posivity in oesophagus (96,9% without erroneous posivity, and a posivity of 88,8% en stomach, with 4,2% erroneous posivity are remarked. The quick diagnosis, the easy technique and the unexpensive process, both the needed of high professional capacity, are realized. The incidence of tumoral localization, macroscopic and histologic characters on diagnosis security are comented.


Sodium nitroprusside as a hypotensive agent in intracranial aneurysm surgery.

Sodium nitroprusside (SNP) was used to induce hypotension during intracranial aneurysm surgery in 67 patients. The effects of SNP infusion (0.1 mg/ml) on blood pressure were rapid and it was easy to adjust blood pressure to desired levels in most patients. When SNP was stopped, the blood pressure returned instantly to the initial level. In eight patients an increase to about 25% or more above prehypotensive level was seen, counteracted in two patients by administration of small doses of halothane. There was a mean increase of 36% in heart rate. Total doses of SNP were 0.05--120 mg (mean: 10.8), corresponding to 0.08--6.8 micrograms/kg/min (mean: 1.9). No metabolic acidosis indicating cyanide intoxication was observed. Tachyphylaxis was seen in three patients, and SNP had to be discontinued in one. It is concluded that SNP gives a rapid and effective hypotension but tachyphylaxis and subsequent danger of cyanide intoxication exist. Therefore, in some cases SNP has to be replaced by or combined with some other hypotensive agent to achieve the desired effect. As there is a risk of impairment of cerebral autoregulation after the use of SNP, it is important to avoid sudden and prolonged blood pressure fluctuations, and to continue with controlled hyperventilation in the postoperative period to reduce the risk of brain oedema and high intracranial pressure.


Prediction of postoperative hypoxemia in smokers and non-smokers.

Age, weight, spirometric variables, peak expiratory flow and airway closure assessments were correlated to postoperative gas exchange in 40 cholecystectomized subjects grouped according to smoking history. Pao2 was significantly lower in the smoking group both pre- and postoperatively, but the decrease in Pao2 following operation was of the same magnitude irrespective of smoking history. In non-smokers, the preoperative relationship between expiratory reserve volume and closing volume (ERV-CV) showed the highest correlation to postoperative alveolar-arterial oxygen difference P(A-a)o2 (r = -0.88, P less than 0.001) and to the increase of P(A-a)o2 following operation (r = -0.67, P less than 0.001), whereas age was found to be the best preoperative predictor of postoperative gas exchange in smokers.


Cameco anaesthetic ventilator with a modified Mapleson D circuit.

A modified Mapleson D circuit has been used in connection with a Cameco anaesthetic ventilator during neuroradiological procedures in general anaesthesia. In order to increase mobility of the patient, two or three lengths of corrugated rubber tubing were used to connect the patient to the ventilator. Blood gas analysis was carried out in 20 patients after ventilation to steady state with both circuits. The respiratory minute volume and fresh gas flow were preset in Bain's (Bain & Spoerel 1975) predictions. No significant difference could be detected in respect to Paco2 or Po2, whether 2 or 3 lengths of tubing were used. Mean values of Paco2 were higher compared with the results of Bain (0.37 kPa s.d. 0.50). It is concluded that this system gives maximum mobility of the patient during the radiological procedure and offers reliable adjustment of Paco2, even in patients with apparent increase of intracranial pressure.


Renal function and fluoride formation and excretion during enflurane anaesthesia.

Central circulation, renal function, and fluoride formation and excretion were studied in nine patients during enflurane anaesthesia and surgery. Cardiac output and mean systemic arterial pressure remained unchanged compared with preoperative control values. During anaesthesia and surgery, urine flow rate, inulin clearance, PAH clearance and fractional sodium excretion were 60, 65, 55, and 45% of control values, respectively. Mean peak plasma level of fluoride was 20.0 microM. It was reached 4 hours after termination of anaesthesia. Fluoride clearance (CF) decreased from 23.9 ml . min-1 to 2.7 ml . min-1 during anaesthesia. Postoperative, CF increased to 41.6 and 76.0 ml . min-1, respectively, during two consecutive measurement periods. There was no correlation between plasma fluoride levels and depression of any renal function variable.


Patient controlled analgesic therapy in the early postoperative period.

Fourteen patients with postoperative pain were allowed to self-administer preset doses of pethidine intravenously via a logic-controlled motor syringe. Plasma samples were collected during anaesthesia and the postoperative self-administration period, and the concentrations of pethidine and nor-pethidine were determined. Separate single-dose studies in eight patients yielded pharmacokinetic parameters which made possible computer simulations of continuous plasma concentration curves for the anaesthesia and postoperative self-administration period. The consumption of pethidine showed great interindividual variations with a mean consumption for the entire group of 26 mg per hour. The patients established steady-state plasma concentrations with far less than the maximum amount of pethidine allowed. The mean measured plasma concentration of pethidine which provided adequate analgesia was 738 +/- 149 ng/ml. Simulated and measured plasma concentrations were in close agreement. The individual mean drug consumption per hour during self-administration correlated closely with the individual elimination rate of pethidine. No serious side effects were observed. Thus, patient-controlled analgesic therapy offers an individualized analgesic supply to meet an analgesic demand which is governed by each patient's appreciation of pain.


Microscopic studies on the transition between the sigmoid sinus, the superior bulb of the jugular vein and the first portion of the internal jugular vein.

The author studied the structure of the tissue components of the tunicae of the terminal segment of the sigmoid sinus, particularly at the level of the transition between the sigmoid sinus, the superior bulb of the jugular vein and the first portion of the human internal jugular vein; it was established that the transition between the sigmoid sinus and the first portion of the internal jugular vein occupies the whole extension of the superior bulb of the jugular vein up to the inferior third of the first portion of this vessel. These vascular walls exhibit a structure similar to that of the dura, i.e. the tunica adventitia is formed by fascicles of collagenic fibers which describe discontinuous spirals, more open proximal to the beginning of the first portion of the internal jugular vein. Approximately in the inferior third of the first portion of the internal jugular vein, there appear fascicles of smooth muscle fibers which are arranged similarly to those of the venous walls. The tunica intima of these vascular segments exhibits an endothelium resting on a network of elastic fibers which may play the role of an internal elastic lamina. From the bony border of the jugular foramen there originates a connective system whose fascicles of collagenic and elastic fibers incorporate to the wall of the internal jugular vein after describing a stretch in spiral around the vascular lumen.


Changes in sweat glands morphology in cattle before and during heat stimulation.

The morphology of apocrine sweat glands in two breeds of cattle, the White Fulani and Friesian was studied histologically using biopsy midside skin samples obtained from the animal at 6.00 a.m. (period 1), 2.30 p. m. (period 2) and 4.00 p. m. (period 3), respectively. Sweat glands with three morphologic types of epithelium were observed. Type 1 consisted of flattened low cuboidal epithelium. Type 2 had tall cuboidal epithelium with cell apical borders slightly indented and the gland lumen narrower than in type 1. A third group of glands had tall columnar epithelial cells (type 3) with bleb-like protuberances on their luminal surfaces. There were also corresponding changes in the morphology of myoepithelial cells from an elongated form in type 1 to a contracted form in types 2 and 3. The morphology of secretory cell surfaces was found to vary with the sampling period; a greater percentage of type 1 glands was seen in period 1 and a preponderance of types 2 and 3 glands (in varying proportions) in periods 2 and 3. Breed differences in the distribution of type of epithelium at various sampling periods were observed. These results are discussed in relation to the functional activity pattern of the sweat glands on stimulation by heat.


Prenatal intestinal histology and histochemistry in the goat.

The mucosa of the small and large intestine of goat fetuses exhibited villi which had disappeared after the 32.5-cm curved crown rump (CVR) stage. At places, the stratified epithelial lining persisted among the normal columnar epithelium with goblet cells. The concentration of goblet cells increased with age, while the thickness of the epithelium decreased. The crypts of Lieberkühn were tortuous at the base. Brunner's glands appeared at the 14.2-cm CVR stage. Peyer's patches appeared at the 24.5-cm CVR stage in the ileum. The muscularis mucosae differentiated in the large intestine in group II (16.2- to 24.5-cm CVR length) and progressed caudocranially. The striated border of the intestinal epithelium presented with alkaline phosphatase activity; this border and the goblet cells also stained for mucin. Glycogen was demonstrable in the epithelium with greater concentrations in the duodenum and jejunum in group I (11.5- to 14.6-cm CVR length), and in the ileum and large intestine in group III (30.8- to 39.5-cm CVR length).


Ultrastructure of the atrioventricular node of the big brown bat, Eptesicus fucus.

This investigation describes the ultrastructure of the atrioventricular node of Eptesicus fuscus. Two conducting cells types (nodal and transitional) are indentified which differ in location, myofibrillar content, and types of intercellular junctions. Centrally located nodal cells display variable staining intensity and contain disorganized myofibrils which rarely form sarcomeres. Desmosomes and nexus-like junctions connect the nodal cells. Transitional cells, situated peripherally, exhibit distinct sarcomeres and are attached to the adjacent cells through desmosomes and underdeveloped intercalated discs. Longitudinal arrangement of the mitochondrial cristae is frequently seen in both cells types. In the connective tissue stroma, numerous capillaries (with micropinocytotic vesicles), axons, and possibly axonal terminals, some filled with vesicles, are observed. A large ganglionated nerve trunk is present on the nodal periphery. True nexuses and neuromuscular junctions are not observed. It is suggested that nodal cell types previously reported in different vertebrates under various names are merely simple variations of the two basic types of conducting cell--nodal and transitional. No interspecific differences are observed between these cells of the big brown bat compared with those in other vertebrates.


Contribution to the etiological explanation of the piriformis syndrome.

The author investigated in 130 anatomical specimens the topographical relations of the sciatic nerve and the musculus piriformis in order to explain the clinical syndrome of the m. piriformis. The author found that in 6.15% of cases the nervus peroneus communis passes between the tendinous parts of the m. piriformis, and he considers this variation of practical significance for the development of the 'piriformis syndrome'. In unward rotation of the thigh, the m. piriformis is extended and the tendons of the divided muscle are tightly pressed together thus pinching the nerve between them. Pinching of the nerve causes the characteristic sciatic pain. In such a case, the patient can be relieved by cutting one of the tendons.


Histogenesis of human extraparenchymal Leydig cells.

From 64 consecutive autopsies of patients with neither testicular nor hormonal pathology, 26 showed extraparenchymal Leydig cells, located mainly in the epididymis and in the spermatic cord. The ultrastructural study of these specimens plus those obtained from 2 patients affected with functional testicular tumors leads to the following conclusions: (1) The origin of ectopic Leydig cells is not interstitial Leydig cells having infiltrated the testicular nerves and migrated along them towards ectopic locations. (2) The ectopic Leydig cells are considered to develop from undifferentiated precursor cells, located extraparenchymally, mainly inside and beside the testicular nerves. These precursor cells are similar to those observed in the testicular interstitium and have an ovoid shape and some cytoplasmic projections. The cytoplasm contains vesicles of smooth endoplasmic reticulum, lysosomes, lipid droplets and abundant microfilament bundles. The transformation from these cells into mature Leydig cells implies a progressive differentiation of the cytoplasmic components involved in steroid biosynthesis.


Ultrastructural changes in adrenergic neurons following chemical sympathectomy.

The paper describes the ultrastructural changes of the sympathetic neurons following guanethidine administration in mice. The main characteristics changes, after prolonged administration (1-10 weeks) of guanethidine (Ismelin, Ciba-Geigy, Basel, Switzerland) at doses of 30-50 mg/kg/day i.p. and i.m. were: (1) Mitochondrial damages: swelling and deformation of the mitochondria, with disruption and dispersion of the cristae and condensation or dissolution of the matrix. Membranolysis of the outer and inner mitochondrial membranes. (2) Neural processes: swelling and disorganization of the internal architecture in the postganglionic axonal and dendritic synaptic varicosities. (3) Adrenergic vesicles: disappearance of the granular vesicles in the early stage of the experiment, increase of the coated vesicles in the later stage of treatment. The effect of guanethidine is specific for the postganglionic adrenergic neurons, but the observed destruction is not caused solely by guanethidine; other chemical substances induce the same or similar degeneration in the sympathetic ganglion.


Scanning electron-microscopic observations on the surfaces of chorionic villi of young and mature placentas.

Mature placental material of full-term spontaneous births and 4-, 6-, 8- and 10-week-old placentas obtained from curettage cases were fixed in glutaraldehyde and osmium tetroxide for SEM examination. In young placentas, the ramifications of the chorionic villi start in the form of buds. The buds are transformed into tendrils with swollen extremities. These swellings resemble buds ready to bloom. The villi intertwine in different positions; both the villi and their tendrils are covered with dense layers of microvilli. In mature placentas, the surfaces of the chorionic villi and their ramifications are covered with microvilli. However, in comparison with the microvilli of young placentas, the microvilli here are less numerous and shorter. Invaginations were clearly visible on the surfaces of the villi; younger and newly budding microvilli, similar to those observed in young placentas, were seen in the invaginated regions. We had the impression that the mature placentas must regenerate in order to meet the increasing physiological requirements of the fetus.


[Facial nerve palsy in syphilitic meningitis. Treatment of syphilitic meningitis (author's transl)].

The authors are presenting a case of meningitis with facial nerve palsy due to early syphilis. The frequency, symptomatology and treatment of this meningeal invasion during the septicaemic phase of secundary syphilis are discussed.


[Post-traumatic mutism. A report of five cases (author's transl)].

After a review of current concepts about post-traumatic mutism, the authors describe five patients with this unusual symptom. The study extends on a long follow-up period. Differential diagnosis and possible neurological and psychopathological factors are discussed. Analysis of their personal observations leads the authors to think that there is a relationship between the length of coma and the duration of mutism. Frontal and/or bilateral lesions seem to be more likely to produce post-traumatic mutism, as does the existence of emotional disturbances or depressive symptoms in past history.


The functions of the right hemisphere and the brain regions involved in figural matching.

A search for the source within the right hemisphere of its primacy on tests of figural matching was made. Patients with right and left hemisphere damage were studied and comparison was made of response to a shape matching task flashed to the right or the left hemisphere. When the right hemisphere is damaged performance seriously declines whether the patient is tested on the right or the left hemisphere. Studies of the specific location within the right hemisphere indicated widespread but subtotal involvement implicating the frontal, temporal and parietal regions of this hemisphere.


[Spinal epidural and subdural hematomas during anticoagulant therapy (author's transl)].

The authors report two cases of spinal hematoma during anticoagulant therapy: one epidural and one subarachnoid with spinal infarction. They stress the importance of the large extension of these hemorrhages and their indication for immediate surgical intervention.


Plasma progesterone, serum estriol and plasma HPL determinations during the last trimester to detect changes before spontaneous labor. Comparison of progesterone assay using RIA and CPB.

Conflicting results have been published regarding changes in plasma progesterone during the last trimester of pregnancy. Some have demonstrated a fall in plasma progesterone before labor, and this has been taken as a possible explanation of the onset of labor. It has been suggested that the various results could be due to differences in methods for progesterone determination. In this study the progesterone levels were determined by both RIA and CPB. In 11 women the plasma progesterone, human placenta lactogen, and serum estriol were measured weekly during the last trimester of normal pregnancies and immediately after delivery. All samples were analysed radioimmunologically. In order to compare the radioimmunoassay and competitive protein binding techniques (RIA and CPB), the progesterone levels were determined by both methods. This was also done for 80 successive plasma progesterone routine samples drawn from women who were not pregnant or who were in the early stages of pregnancy. Both methods showed a significant rise in the plasma progesterone level during the last 6 weeks before spontaneous labor. However, the values obtained were lower when assayed by CPB than by RIA, presumably because of a higher specificity and a cross reaction in RIA. Serum estriol exhibited increasing values throughout pregnancy, but without a significant rise during the last few weeks. Plasma HPL settled at a constant level during the last few weeks before labor.


Segmental epidural analgesia for labor and delivery.

A study to evaluate segmental epidural analgesia in labor is described. Bupivacaine (0.25 per cent) was used during the first stage of labor and for the second stage, either 3 per cent - Chloroprocaine delivered through the catheter (Group I) or 1 per cent Lidocaine as a perineal infiltrate (Group II) was used. There were 124 full term patients of whom, 36 were nulliparous and 88 were multiparous. The effects of segmental epidural analgesia on maternal blood pressure, pain relief, preservation of lower limb motor power, duration and progress of labor, and fetal outcome were evaluated. Pain relief during the first stage of labor was satisfactory in 114 (92 per cent) of the patients. There were no significant changes in maternal blood pressure, motor power in lower limbs, efficiency of uterine contractions  and internal rotation of the presenting part when analgesia was effective. The use of 2-Chloroprocaine for second stage pain relief required low forceps delivery in 84 (91 per cent) patients, as compared to 14 (44 per cent) patients that had 1 per cent Lidocaine local infiltration. Fetal outcome, was excellent in all cases in that the one minute Apgar score was never lower than 7.


Amniotic fluid phosphatidylinositol and phosphatidylglycerol. II. Diabetic and preeclamptic pregnancies.

139 samples of amniotic fluid from diabetic women collected during 34-39 weeks of pregnancy showed higher levels of lecithin, phosphatidylinositol (PI) and phosphatidylglycerol (PG) indicating an accelerated surfactant synthesis  as compared to that observed in normal pregnancies (13). In ten infants with respiratory distress syndrome (RDS) delivered from diabetic mothers the lecithin/sphingomyelin (L/S), PI/S and PG/S ratios were generally low. Only four samples showed definitely immature L/S ratios, whereas the amniotic fluid content of PG in all samples was unmeasurable or low. In 56 samples of amniotic fluid collected during the third trimester from preeclamptic pregnancies PI/S and PG/S ratios after 36-37 weeks were comparable with those of normal pregnancies. In 11 neonates with subsequent RDS the L/S ratios were immature, and PG was critically low or lacking in the majority of the samples. No convincing association between the PI content and development of RDS could be observed in any of the groups.


Ratio of amniotic fluid cortisol and maternal serum cortisol (AFC/MSC) as an index of fetal lung maturity.

Fifty-eight samples of amniotic fluid from pregnant women between the gestation period of 34-42 weeks were analyzed for total cortisol levels. Thirty-four simulatneous maternal serum total cortisol levels were also measured. Amniotic fluid cortisol (AFC), maternal serum cortisol (MSC) and the ratio of AFC/MSC were correlated with L/S ratio. AFC alone and AFC/MSC ratios correlate with L/S ratios (r=0.36, p less than 0.01, and r=0.46, p less than 0.01, respectively). MSC and L/S ratios had no correlation. AFC/MSC had less individual variation as compared to AFC alone. The AFC/MSC could be divided by an arbitrary line at 0.1 and values less than 0.1 signify immature fetal lungs. Values of 0.1 and greater signify mature fetal lungs.


Vaginal bleeding in the last two trimesters of pregnancy. A clinical and ultrasonic study.

Ninety-seven cases of vaginal bleeding during the second and third trimesters of pregnancy are presented with special reference to the follow-up observations and perinatal parameters after the first bleeding and ultrasonic determination of placental site. The perinatal mortality rate was 11 per cent and the rate of premature deliveries 23 per cent. In the cases of recurrent bleeding episodes (N = 33), the corresponding frequencies were 22 and 35 per cent. Placenta previa of some degree was diagnosed by ultrasound during the first episode of bleeding in 36 cases. Although the placenta was observed to "move" upwards from the internal os of cervix in 20 of these patients during the last few weeks of pregnancy, final placenta previa (N = 16) was the most common definite etiological factor behind the bleeding. The high frequency of perinatal complications associated with these pregnancies emphasizes, despite reliable localization of the placenta, the importance of a careful follow-up until delivery.


Acute deep vein thrombosis (DVT) after cesarean section.

In 169 consecutive women undergoing cesarean section, of which 90 were performed as an emergency and 79 electively, the frequency of deep vein thrombosis was evaluated with a non-invasive diagnostic technique - strain gauge plethysmography. Three patients developed thrombosis (1.8 per cent), all after acute surgery. No specific background factors were associated with the development of thrombosis. In 26 of the 79 patients (33 per cent), who were plethysmographed before operation, a biphasic venous emptying indicated venous outflow obstruction by the pregnant uterus.


Pregnancy and delivery after conization of the cervix.

Of 327 patients who had undergone conization of the cervix in 1968-74 in the Department of Obstetrics and Gynecology, Turku University Central Hospital, 249 replied to a questionnaire. Eighty-nine of these had had total of 112 pregnancies after conization. Conization had only minimal influence on the pregnancies and none on the deliveries. Over 90 per cent of the newborns delivered were full term and without anomalies. The incidence of spontaneous abortions also did not differ from normal.


Effect of althesin anesthesia on blood loss during therapeutic abortion. A comparison with local and thiopental anesthesia.

During recent years, the use of steroid anesthesia has rapidly increased. In our hospital, a number of surgical procedures have been performed under Althesin anesthesia, and in some cases the peroperative bleeding seemed to be rather profuse. Blood loss was studied in 90 healthy women in the first trimester of pregnancy undergoing therapeutic abortion using different types of anesthesia. The patients were divided into three equal groups according to the duration of pregnancy. In each group, 10 patients underwent operation under local anesthesia, 10 under thiopental anesthesia and 10 under Althesin. In all three groups, blood loss was the smallest when local anesthesia was used (Fig 1). Amounting to only one third to one half of that occurring under thiopental anesthesia. Under thiopental anesthesia the blood loss gradually increased with increasing gestational age with moderate variations. Alternatively, in this investigation, Althesin anesthesia was characterized by pronounced blood loss, particularly in the ninth and tenth weeks of pregnancy, and in some cases by rather profuse bleeding. We find that Althesin anesthesia should be used for gynecological surgery only in departments which are equipped to control profuse bleeding and possible cardiovascular complications.


Pregnancy complications following legally induced abortion.

The frequency of pregnancy and delivery complications in women whose previous pregnancy had been terminated by a legally induced abortion is evaluated in a prospective and a retrospective study. Bleeding before 28 weeks of gestation and retention of placenta or placental tissue occurred more frequently after legal abortion that in a control group matched for age, parity, and socio-economic status. Other pregnancy and delivery complications did not occur more frequently after legal abortion. It is of particular interest that the study could not demonstrate an increased frequency of low birth weight among women whose previous pregnancy had been terminated by legal abortion.


Delayed reproductive complications after induced abortion.

An investigation was undertaken regarding subsequent pregnancy in 619 women who had their preceding pregnancy terminated by legal abortion, compared with an age- and parity-matched group of 619 women who continued with the pregnancy to delivery. The groups were compared for complications such as first and second trimester abortion, cervical incompetence, pre-term delivery, ectopic pregnancy and sterility. The total complication rate was 24.3 per cent in the abortion group, and 20.2 per cent in the controls. No significant difference was found between the two groups for any of the parameters examined, except for a significantly higher rate of complications amongst women who had not had a previous delivery: 25.5 per cent as opposed to 13.2 per cent in the control group.


Pregnancy in a non-communicating, rudimentary uterine horn. A reason for failed therapeutic second trimester abortion.

Anatomical aberrations in the female genital tract are due to maldevelopment of the Müllerian duct system. Various degrees of malformations are described (9). Some of these malformations are discovered during the investigation of amenorrhea, persistent dysmenorrhea or infertility, while others are discovered in connection with obstetrical problems. The incidence of uterine malformations is quoted as 1:1 500-2 000 (8, 11), the incidence of uterus unicollis bicornis being as rare as 1:100 000 (3). There is no unified nomenclature for the rare types of genital malformations. Semmens describes a group consisting of functional uteri of single Müllerian origin, labelled uterus unicollis bicornis with one rudimentary horn (8). Most rudimentary horns are hollow and allow the expansion of an up to 20 weeks pregnancy (3). Few cases of pregnancy in a rudimentary horn have been seen, causing complications during pregnancy and delivery, and when performing therapeutic abortions (2, 3, 4, 5, 6, 12).


Abscess formation of a Gartner's duct cyst with cervical communication in a case of bicornuate uterus associated with an ipsilateral renal agenesis.

One case of abscess formation of a Gartner's duct cyst communicating with the cervix of a bicornuate uterus is presented in a case of ipsilateral renal agenesis. The embryonic origin and the incidence of associated genital and urologic malformations are discussed. Marsupialization is recommended as an adequate method of treatment.


In-situ carcinoma of the uterine cervix showing superficial endometrial spread.

Superficial spread of invasive carcinoma cervix over the endometrial surface is extremely rare and may follow radiation therapy (3, 5). Ferenczy et al. (1) have reported an instance of carcinoma in situ of ecto cervix spreading on the endometrial surface via the endo-cervical canal. This paper reports another in situ lesion of the cervix showing superficial endometrial spread.


The mitotic activity of bone marrow and thymus after combined antigenic challenge and trauma.

A significant increase in the mitotic rate of cells in thymus and bone marrow occurs 2--3 days after the infliction of various traumas or the injection of antigenic erythrocytes. This cell response probably occurs in order to produce the cells which are needed for the defence of the body after injury. The present investigation shows that the cell response after a fracture is abolished if the rats are fractured 3 days after injection of antigenic erythrocytes.


Tension and creep phenomena in peripheral nerve.

Tension introduced into peripheral nerves during their surgical repair may reduce the success of this procedure. Two mechanical factors are important; the tension required to effect a repair, and the rate at which this tension changes after surgery. These two factors have been investigated in the rat sciatic nerve. The results show an increasing resistance to elongation of the nerves with increasing tension. Under a constant elongation the tension in the nerves reduces by about 30 per cent in the first 10 minutes and by a small amount in the following 20 minutes.


Familial osteochondritis dissecans and carpal tunnel syndrome.

A short-statured family -- mother, son and daughter -- each with osteochondritis dissecans (O. D.) of the elbow and two with O.D. of the knee is described. The mother and her siblings had, in addition, carpal tunnel syndrome.


Remodelling after distal forearm fractures in children. II. The final orientation of the distal and proximal epiphyseal plates of the radius.

In 39 children the steric orientation of both the distal and the proximal epiphyseal plates of the radius was evaluated 4 months to 10 years after distal forearm fractures that had healed with residual angulation. A residual fracture angulation was found to induce a change in orientation of both the distal and proximal epiphyseal plates. The final result of the reorientation was a normalization of the inclination of the plates in relation to the long axis of the bone. The proximal epiphyseal plate attained practically a normal orientation. The distal epephyseal plate tended towards overcorrection. In two of the four cases with a primary angulation exceeding 20 degrees considerable normalization occurred, but a "normal" state was not reached. This indicates an upper limit for angulations permitting normalization of the orientation of the distal epiphyseal plate of the radius.


Brachymesophalangy and loose bodies in the metacarpophalangeal joints.

A family with autosomal inherited brachymesophalangy is presented. Some of the family members also had loose bodies in the metacarpophalangeal joints. This condition is similar to osteochondritis in other joints. New loose bodies may be formed after operative removal and arthrotic changes may occur. The patients were not able to perform hard physical work with their hands.


Postural effects on nystagmus response during caloric labyrinthine stimulation in patients with adolescent idiopathic scoliosis. II. An electro-nystagmographic study.

An electro-nystagmographic study of postural effects on the nystagmus response has been performed in 40 patients with adolescent idiopathic scoliosis aged from 10 to 16 years. The control group comprised 29 healthy children of the same age. Caloric labyrinthine stimulation was done in the supine and erect position. The results were analysed with the aim of finding out whether an increased scoliotic deformity might influence the labyrinthine response. For comparison of the nystagmus response in the two different positions a quotient of the values (degrees/second) obtained from cold water stimulation in the erect and supine position was calculated. In the control children the labyrinthine response in erect posture was half of the response in supine posture. In erect posture the scoliotic deformity increased. This obvious change in the spine did not increase the caloric response from the convex side labyrinth. The predominance of the convex side labyrinth observed in the supine position was thus not seen in the erect position. The results of this study did not support the assumption that a postural deformity in the spine can influence a calorically induced labyrinthine response.


Social rehabilitation following hip fractures.

A prospective 6 months' study of 518 patients with hip fractures was undertaken. The patients were classified into four social function groups on admission to hospital and again at the follow-up, according to their dependence on home-help and other services of the social welfare system. This dependency increased with the age of the patients. Life tables for the case material showed that the mortality depended more on pre-fracture social function than on age. At the follow-up, the risk of death or increased social dependency among primarily independent patients was found to be 38 per cent compared with 48 per cent among slightly dependent patients and 62 per cent in moderately dependent patients. A total of 17 per cent of the surviving patients admitted from home became nursing home patients. The pre-fracture social assessment determined the end-result to a greater extent than the age at the time of fracture. About 75 per cent of the patients discharged to their homes maintained their social function compared with 68 per cent of the patients discharged to a convalescent home and 47 per cent of the patients discharged to rehabilitation clinics.


Treatment of pathological fractures.

The treatment of 30 patients with 34 pathological fractures is reported. Twenty-six femoral fractures and one ulnar fracture were fixed internally, whereas five fractures of the humerus, one of the radius, and one of the clavicle were treated non-operatively. Twenty-two of the patients were discharged from hospital (21 were mobilized) and eight died in the postoperative period. All patients became free of pain, and bony union occurred in 12 of the fractures. Thirteen per cent of the patients lived less than 1 month whereas 20 per cent lived more than 24 months after fracture. Previously published figures and our results indicate the place of prophylactic nailing of certain femoral metastases, perhaps also in connection with local irradiation of the metastases.


Computed tomography of the ankle.

Transverse computed tomography of injured ankles gives additional information compared with conventional roentgen diagnostic techniques. In transverse sections the distal tibio-fibular joint and the suprasyndesmotic region can be examined with regard to incongruence and synostoses. It is also possible to examine the relations between the talus and the malleolar facets in different ankle positions. The technical problems and advantages are discussed.


Calcification of aging articular cartilage in man.

Calcification of the articular cartilage was studied ultrastructually using normal femoral heads obtained from necropsies of persons ranging in age from 11 months to 80 years. Mineral crystals which appeared during the initial stages of deposition were morphologically divided into two types. Type A crystals were slender, twisted and curved, measuring from 100 nm to 360 nm in length. Type B crystals were short, needle-like and slightly curved, measuring from 30 nm to 160 nm in length. Type A crystals were found mainly in the developing epiphysis during childhood. Type B crystals were generally found in the calcified zone of adult articular cartilage. Both types of crystals initially appeared in close proximity to extracellular membrane-invested electron dense particle called "matrix vesicles", and gradually increased in number to form calcified cartilage matrix. The morphological differences between type A and B crystals might be caused by biochemical alterations of the cartilage matrices and/or biomechanical changes in the joints of children and adults.


Indomethacin-induced inhibition of haversian remodelling in rabbits.

The effect of indomethacin on haversian remodelling in the radius was studied in 16 rabbits. An osteotomy and a saw-cut almost through the bone were made in the middle and distal parts of the right radius, respectively. In order to obtain biological osteosynthesis in the osteotomy and the saw-cut the rabbits were not treated in any way during the following 3 weeks. They were then given either indomethacin or placebo suspensions per os, 10 mg/kg/day for 2 weeks, followed by 5 mg/kg/day for 4 weeks. The extent of haversian remodelling was estimated by calcein and oxytetracycline fluorochrome labels given at the start of the indomethacin treatment and 3 weeks later, respectively. After 2 weeks of indomethacin treatment (10 mg/kg/day) the indomethacin plasma levels were about 0.18 microgram/ml 24 hours after the last dose. Indomethacin treatment significantly (2P less than 0.019) inhibited haversian remodelling as estimated by fluorochrome labelling.


Effects of cyclophosphamide on mechanical properties of bone and skin in rats.

The effects of several different doses of cyclophosphamide on weight increase, longitudinal bone growth and mechanical properties of bone, intact skin and skin wounds, were studied in 30 young, male rats. The cystostatic effect was evaluated by counting white blood cells (WBC) in arterial blood at the end of the medication period. Compared with the control animals, the longitudinal bond growth, the mechanical properties of the distal femoral metaphysis and the skin wounds were most noticeably affected by the drug. Diaphyseal torsional strength of the femoral bone and tensile strength of intact skin were less affected.


The periosteal control of long bone growth. An experimental study in the rat.

Longitudinal growth of immature rat femurs was studied in diffusion chambers after circumferential periosteal division and stripping. After 14 days significant (P less than 0.02) overgrowth of the periosteally divided femurs had occurred. The reason for the observed growth stimulation is discussed.


Serum calcitonin and bone mineral content in patients with osteogenesis imperfecta.

Serum calcitonin and bone mineral content in the forearm, measured by photon absorptiometry, were investigated in 21 patients with osteogenesis imperfecta tarda. The bone mineral content was significantly reduced as compared with normal controls, whereas the bone mineral content corrected for bone width was normal in adult patients but subnormal in children and young adults. Serum calcitonin did not differ significantly from that in normal individuals and no relation was found between serum calcitonin and bone mineral content.


A biomechanical comparison of the effects of constant and cyclic compression on fracture healing in rabbit long bones.

In a biomechanical study, the strength of healing experimental fractures in rabbit tibias was compared for two different healing environments. During the healing period large constant compression was applied to one leg, while the other leg was subjected to cyclic compression forces. Rabbits were sacrificed at 3, 4, 5, 6, and 8 weeks after the operation. The healing bones were tested in a dynamic torsion testing machine. Results indicate that on an average basis the cyclic compression treated bones exhibited higher torque and energy absorption to failure, but lower stiffness as compared with the constant compression treated bones, during the 30 to 50 days' healing period. These differences were statistically significant. Additionally, it was estimated that a 27 per cent saving in healing time may be realized for a bone treated with cyclic as compared with constant compression.


Scanning and radiology of the carpal scaphoid bone.

The value of isotope scanning in patients with suspected fracture of the scaphoid bone of the wrist was examined. For this purpose comparable examinations were made of 50 patients using both radiography and isotope scanning. With a normal scan, the suspicion of fracture or other bone diseases can be excluded. Increased focal activity corresponding to the region of the scaphoid bone indicates the possibility of a fracture, even if a fracture cannot be seen in the initial X-rays.


Osteoid osteoma of the distal phalanx of the thumb.

An osteoid osteoma of the distal phalanx of the thumb in a 14-year-old girl is described. Apart from the rare site of the lesion, other unusual features included early closure of the epiphyseal plate, enlargement of the involved segment of the thumb, and hypertrophy of the nailbed. The radiographic appearance was unusual in that it simulated a soft tissue mass eroding the bone from without.


Experimental tests concerning the biomechanical behaviour of pertrochanteric osteosyntheses.

The biomechanical behaviour of pertrochanteric fractures stabilized by means of an angled plate or flexible condylar nails was characterized by mechanical testing. The stability and the types of motion occurring under dynamic load in the vicinity of the fracture and the effect on the implant were examined. The mechanical test results corroborated clinical experiences. In the case of extramedullary anchorage of implants, stability under load is possible only if an intact cortex on the medial side of the fracture guarantees the bearing of compressive load. With flexible condylar nails, however, it is possible to achieve a permanent load capacity up to approximately 100 kp, even if medial support is lacking, by putting the fracture in a valgus position so that the load-bearing arm is shortened. It was also possible to estimate the actual loading on the operated leg within the immediate postoperative phase by means of the "stabilization effect".


Rehabilitation after hip fracture in the elderly.

Sixty-eight patients with hip fracture, mean age 79 years, from the city of Lund, were studied with special reference to functional and social rehabilitation at follow-up 1 year later. As compared with patients coming from institutions for permanent care, patients coming from their own homes had a significantly better prognosis in terms of survival, mobility and ability to cope with activities of daily living (ADL). However, patients returning home needed increased domestic help. Patients living with someone returned home sooner than those living alone. Although many of the patients who returned home could walk without support or with a walking-stick, more than one half did not go out shopping. More active measures, e.g. early home visits by a rehabilitation team, might give the patients more self-confidence and independence. Immediate weight-bearing did not appear to impair healing of the hip fracture or increase the risk of necrosis of the femoral head.


Post-traumatic bone mineral loss in tibial shaft fractures treated with a weight-bearing brace.

The bone mineral content in the upper ends of the tibia and the fibula was measured in 27 patients with tibial shaft fracture. The loss of bone mineral associated with the fracture did not differ between patients who were allowed weight-bearing in a functional below-knee brace and patients treated with a long leg plaster cast without weight-bearing.


Strength of plantar flexion and function after resection of various parts of the triceps surae muscle.

Nine patients who had undergone resection of various well defined parts of the triceps surae muscle because of tumour were examined. The function was estimated from the patient's history and the muscle strength was measured statically and dynamically using a Cybex II dynamometer. Two patients reported slight symptoms. The loss of strength was less than one might expect from theoretical calculations. The strength of the operated limb showed a particular pattern depending on the part resected. From this pattern it was concluded that the soleus is more active when the foot is dorsiflexed and the gastrocnemius more active when the foot is in plantar flexion, and that the gastrocnemius is most important in quick movements of the foot.


An evaluation of operative procedures in the treatment of hammer toe.

Eighty per cent of 63 patients who had undergone 136 surgical corrections of hammer toes in the 6 years prior to this study were improved by operation. In adults proximal phalangectomy was the most successful procedure to relieve symptoms and is suggested as the operation of choice. Flexor to extensor tendon transfer was successful in children but not in adults. It is proposed that the operation be performed in an out-patient basis whenever possible.


Hyperbaric oxygen and stellate ganglion blocks for idiopathic sudden hearing loss.

Ninety-one patients suffering from idiopathic sudden hearing loss are presented. Twenty-two patients were given medical treatment (vasodilators, steroid hormones and vitamins) alone (group 1). Forty-nine patients were treated with stellate ganglion block (SGB) plus oxygen hyperbaric therapy (OHP) (group 2) and 20 patients were treated with SGB plus OHP along with medical treatment (group 3). The SGB plus OHP treated patients were given bupivacaine, which induced Moor's anterior approach of SGB and then exposed to oxygen at a pressure of 2.4 ATA for 90 min. In group 1, 69% of the patients treated within one week after onset exhibited over 10 dB pure tone average improvement, with only 33% patients treated one to two weeks after onset experiencing over 10 dB. However, 74% of the patients in group 2 and 100% of the patients in group 3 who were treated within two weeks after onset exhibited over 10 dB improvement. More significantly, of the patients which experienced complete loss of hearing, 83% in group 2 and 100% in group 3, exhibited over 10 dB improvement, compared to only 33% in group 1. Moreover, 8 (40%) patients in group 3 recovered to within 20 dB of their normal hearing levels. In group 2, 17 patients were treated two to six weeks after onset and 12 (71%) patients had over 10 dB improvement. SGB plus OHP therapy was shown effective in the treatment of sudden idiopathic hearing loss even when patients were treated more than two weeks after onset.


Long-term results of open cavity and tympanomastoid surgery of the chronic ear.

The results of surgery for chronic middle ear infection in 307 patients (347 ears) are reported. All ears were operated on according to one of two procedures: (i) the operative cavity was left open after removal of the posterior canal wall, or (ii) a tympanomastoidectomy with intact canal wall was done. When necessary, removal of disease in the tympanum with or without reconstruction of the sound-conducting mechanism of the middle ear was performed. Cholesteatoma was present in 56% of the ears. Open cavity surgery with no reconstruction was done in 53%. In the remaining 47%, tympanomastoidectomy was performed and in approx. half of these ears reconstruction was undertaken. The postoperative follow-up period averaged 9 years. Residual cholesteatoma was found in 9%. In 4% of the ears undergoing tympanomastoidectomy a retraction pocket cholesteatoma developed. During the follow-up period 13% of the ears required revision surgery. Nineteen per cent of the ear with open cavities were discharging and, in addition, crusts were observed in 13%. In the tympanomastoidectomy group, discharing ears were seen in 26%. As a rule, hearing was not affected by surgery. The mean elevation of the pure tone threshold was 6.5 dB on account of sensorineural loss, while the speech reception threshold shift was 11 dB. The results testify to the importance of removing the posterior canal wall in ears with chronic middle ear infection associated with cholesteatoma.


Critical bands following the selective destruction of cochlear inner and outer hair cells.

Critical bandwidths and absolute intensity thresholds were measured in cats before and after kanamycin treatment which induced selective inner and outer hair cell losses. Hair cell losses were measured from cochleograms constructed from surface preparations of the organ of Corti. Results suggested that, for the test frequencies and stimulus intensities employed, critical bandwidths were not affected for frequencies tonotopically located in cochlear regions where only outer hair cells were lost. Critical bands were widened or not measurable only when inner hair cell losses exceeding 40% were also associated with complete loss of outer hair cells. The experiment suggests that cochlear frequency selectivity can be mediated by inner hair cells alone.


Effects of kanamycin on the auditory evoked responses during postnatal development of the hearing of the rat.

The ototoxic effects of kanamycin were studied in rats during the early postnatal period and at an adult age. Brain stem potentials as well as auditory cortical potentials were used for the estimating of ototoxic damage. The auditory potentials decreased promptly and markedly in the animals which were treated daily with 400 mg/kg body weight of kanamycin starting from the 11th day after birth. In these animals, the auditory potentials were almost completely abolished within 10 days after the beginning of the kanamycin treatment. However, when the same amount of kanamycin was applied earlier or later than that, i.e., avoiding the period of the initial appearance and the greatest development of auditory functions (from the 11th to the 15th day after birth in the rat), the auditory potentials were not apparently damaged. In light and scanning electronmicroscopy, marked ototoxic changes were observed which underlay the functional damage. The meaning of these findings is discussed.


Ototoxic effects of the interaction between kanamycin and ethacrynic acid. Cochlear ultrastructure correlated with cochlear potentials and kanamycin levels.

The effects of the interaction between kanamycin (KAN) and ethacrynic acid (EA) on the ultrastructure of the guinea pig cochlea were studied 3, 4, 6, and 24 hours following administration of EA (40 mg/kg) to animals pretreated 2 h earlier with KAN (400 mg/kg). Appropriate saline (SAL) controls were included giving 4 treatments: KAN/EA, KAN/SAL, SAL/EA and SAL/SAL. The outer hair cells of the organ of Corti showed nuclear and plasma membrane changes at 3 h and were completely destroyed at 24 h. The inner hair cells were unaffected. Severe swelling was seen in the stria vascularis of both KAN/EA and SAL/EA animals at 3 h and was gone by 24 h. KAN/EA had a greater effect on the stria than had SAL/EA. These results were consistent with the time course of the effect of the drugs on the a.c. and d.c. endocochlear potentials. KAN concentrations in perilymph were unaffected by treatment with EA.


Elimination kinetics of furosemide in perilymph and serum of the chinchilla. Neuropharmacologic correlates.

This study was done to determine the comparative elimination kinetics of furosemide from chinchilla perilymph and serum, and to correlate perilymph concentration with changes in endocochlear potential. The elimination kinetics of furosemide (FU) were determined in sera and perilymph obtained from chinchillas injected with 100 mg/kg i.v. of FU. Concentrations of FU exhibited a linear decay pattern in serum and perilymph over the initial 60 minutes. The rate of decline of furosemide levels in perilymph was about four times slower than the rate of fall in serum. Chronic treatment (25 mg/kg i.p. every 12 hours) did not appear to influence the level of drug at 60 minutes after a dose of FU (100 mg/kg IV). Chinchillas were also studied following doses of FU ranging from 25--200 mg/kg i.v. to see the effect on endocochlear potential (EP). A positive correlation was found between FU dosage, the maximum millivolt reduction of EP and the time to initiation of recovery of EP. The perilymph concentration of furosemide when the EP began to recover was 5 microgram/ml (1.5 x 10(-5) M). Knowledge of furosemide kinetics may ultimately be applied to prevent ototoxicity in patients.


Screening tympanometry during the first year of life.

150 healthy children were regularly investigated with tympanometry during the first year of life. Normal middle ear pressure was found in nearly all children at birth. At the age of 6 months, 62% of the ears had a pressure of 0-99 mmH2O. In 37% the pressure was between -100 and -350 mmH2O and 1% had flat curves. At the age of 9 months, the tympanograms further deteriorated and at 12 months, only 40% of the ears had a pressure of 0 to -99 mmH2O, 28% had a pressure of -100 to -199 mmH2O, 19% a pressure of -200 to -350 mmH2O and 13% had flat curves, indicating secretory otitis. At 1 year, the tympanograms were worse than in any other age group investigated so far. The dominant cause of the reduced middle ear ventilation was catarrhalia, the frequency of which increased during the period from 6 to 12 months.


The role of the pars flaccida in the mechanics of the middle ear.

The role played by the pars flaccida in the functioning of the middle ear is not altogether clear. The aim of our research was to study the movements of pars flaccida in altering the air volume in the middle ear. By using a sond placed either in the tympanic bulla or in the Eustachian tube in the rat, the middle ear can be insufflated or aspirated with exact volumes of air. Pars flaccida reacted promptly to the changes, while pars tensa remained immobile. A large air volume caused perforation of the pars flaccida. It seems that pars flaccida's function may consist in maintaining a constant middle ear pressure within certain limits, by changing its position.


In vitro preservation of human pituitary tumours in organotypic differentiation.

Three types of human pituitary adenomas--growth hormone producing, prolactin producing, as well as endocrinologically inactive ('chromophobe') tumours--were explanted to an in vitro system for organ culture. After one month, surviving hypophyseal cells demonstrated preserved hormone activity and no dedifferentiation of cell characteristics. During the first weeks in culture, close similarity existed between in vivo and in vitro conditions with regard to cell survival/cell morphology and physiological function/hormone release.


Ultrastructural findings of the nasal mucosa of "ozaena" in atrophic rhinitis.

Alterations in the nasal mucous layer of atrophic rhinitis "Ozaena" patients have been investigated. The vast majority (99%) of these patients were women. Morphological findings in healthy nasal mucosa demonstrated the different functional stages of the glandular tissue cells with the healthy epithelium. On the other hand, nasal mucosal material taken from the patients displayed prominent epithelial deterioration, decrease in and loss of cilia, increase in goblet cells with squamous epithelial metaplasia. A decrease in secretory granules and membrane deterioration in the apical region of the secretory cells was also clearly visible. It is possible to postulate that the ultrastructural changes seen in the secretory and storage cycles of glandular tissue of the nasal mucosa from patients seem to arise as a reaction to the superficial epithelial deterioration of the nasal mucosa together with the resulting deterioration of physiological conditions.


Bacterial adherence to epithelial cells in the nasopharynx in children.

The presence of attached bacteria to epithelial cells from the nasopharyngeal surface of the soft palate, from the adenoid surface and from the secretions covering the adenoid was studied in 10 children undergoing adenoidectomy. Large numbers of bacteria were seen to attach to mature normal squamous epithelial cells from the soft palate and in the secretions, whereas attachment to adenoid epithelial cells was rare. Using differential interference contrast microscopy, bacteria-carrying epithelial cells were seen to have their surface covered by microridges characteristic of normal mature squamous epithelial cells. Sections of adenoid tissue showed bacterial infiltration of adenoid tissue to be virtually nonexistent in the patient group.


Amyloidosis of the larynx.

Amyloidosis of the larynx is a rare disease, accounting for less than 1% of all benign laryngeal 'tumours'. Three cases of this type of lesion are reported--one of the vocal cord, one of the false vocal cord and one of the subglottis and trachea. In 2 of the patients the amyloidosis was localized, while the third was later found also to have an epipharyngeal solitary plasmacytoma with amyloid deposits and in addition amyloidosis of the nasal cavity. However, the amyloidosis in this patient may still be regarded as being localized, as the clinical examination and laboratory tests afforded no evidence of generalized disease. Amyloidosis of the larynx may be manifested as a localized tumour or as a diffuse infiltration. The symptoms and signs will, of course, depend on the site of the amyloid deposit. When the vocal cords are involved hoarseness may result, and this was the most prominent sign in the present cases. The treatment of laryngeal amyloidosis is primarily by endoscopic excision. Amyloid substance has specific staining properties. The Congo red reaction with a green birefringence in polarized light and Phorwhite BBU using fluorescence microscopy are regarded as the most reliable staining reactions. Electron microscopy has revealed a typical fibrillar structure of amyloid.


Cuff pressure and microvascular occlusion in the tracheal mucosa. An intravital microscopic study in the rabbit.

A method is described for the intravital microscopic observations of rabbit tracheal mucosa microcirculation during compression with a thin, transparent high volume cuff. The cuff pressure (CP) required to cause complete ischemia in the mucosa over the cartilages was measured and a correlation was found to the mean arterial blood pressure (MAP). Ischemia was not observed below CP-MAP ratios of 0.40 for untreated animals or below 0.44 for animals where the MAP had been elevated by adrenalin. However, marked reduction of the microvascular blood flow was present at lower CP-MAP ratios, 0.2-0.3, which at a MAP of 75 mmHg corresponds to cuff pressures of 15-20 mmHg. It is therefore advocated that endotracheal cuff pressures are kept below these values to avoid ischemic tissue injury.


Studies of the effect of peroral fenylpropanolamin on the functional size of the human maxillary ostium.

The effect of peroral fenylpropanolamin on the functional size of the human maxillary ostium was studied in 20 patients suffering from acute rhino-sinusitis. The size of the maxillary ostium was measured by a manometric procedure over a 2-hour period. During the introduction of a known airflow into the sinus for a short while, the pressure increase was compared with a nomogram obtained by model experiments. The introduction of the cannulas into the maxillary sinus caused a swelling of the mucosa in the ostium in the placebo group and initially also in the group receiving fenylpropanolamin, but, after 60 minutes, the latter group had a mean functional ostial size greater than the initial one. These differences were not statistically significant. This seems to be the first objective study of the size of the ostia in the human paranasal sinuses during treatment with a peroral decongestant.


Carcinoma of the parotid gland following sialography with thorotrast. Report of two cases.

Two cases are presented of malignant tumour of the parotid gland following sialography with Thorotrast, 28 and 45 years previously. Both cases were histologically established as squamous cell carcinoma and the presence of Thorotrast in the tumours was confirmed by autohistoradiography. It is suggested that the tumours may have developed from metaplastic ductal epithelium after many years of exposure to the alpha radiation from Thorotrast deposits in the gland.


Myopathy induced by clofibrate treatment in normolipaemic patients.

On the basis of the occurrence of myopathy in a clofibric acid treated child with diabetes insipidus, three other children with the same diseases were examined in order to find indications for a myopathic side-effect of the drug. When the children were found to have increased creatine phosphokinase activity and EMG changes, two of the authors took clofibric acid themselves. In both test persons subclinical myopathy was produced. After stopping the drug, transitional hypertriglyceridaemia occurred. These side-effects should serve as a warning of an uncritical application of clofibric acid and its esters.


HLA-antigens and some autoimmune features of juvenile diabetes mellitus.

A group of 67 juvenile insulin dependent diabetic patients and their 167 healthy first degree blood relatives were HLA-typed. In the patients the frequency of HLA-A9 and B8 antigens was significantly increased as compared to healthy controls, while in the family members only the presence of HLA-B8 was significantly increased. All diabetics carrying HLA-B8 antigen had frequently higher 125I-insulin-antibody complex levels than those lacking the antigen. Prevalence of some autoantibodies to human thyroglobulin, microsomal thyroid and antigastric mucosa antigen were investigated and compared to healthy controls. Increased antibody titres were more frequent in diabetics and their blood relatives than in the healthy controls, and more frequent in those carrying the HLA-B8 antigen than in those lacking it.


Nutritional assessment of infants and preschool children using two different anthropometric criteria of classification.

A comparison of two criteria for assessing malnutrition in infants and children has been carried out in a sample of 184 healthy infants and children grouped according to two different anthropometric criteria: considering the quantity of body mass for linear dimension by the ratio W/H; and considering the degree of wasting according to weight for height (WH). Biochemical studies were also carried out in each child and correlated with body systems of classification. Total amino acids in serum and eryhtrocytes, the non-essential/essential amino acid ratio in serum and erythrocytes, total serum proteins and the albumin/alpha globulin ratio were investigated. The results showed that both criteria were closely related, the linear regression between them was highly significant (r = 0.931). Nevertheless, the W/H criterion classified as undernourished a higher proportion of children, because it included those of delayed biological age though not malnourished. On the contrary, WH only classified as undernourished those who probably have actual malnutrition. Biochemical studies showed significant correlations with both criteria but higher r values were found for W/H in some cases. Thus, classification on the basis of WH including the analysis of the degree of wasting and of stunting, is satisfactory for individual and community assessment, but it should include the classification of overweights. It must be stressed that both systems, being based on weight as the basis of classification, do not consider body composition and therefore can only assess whole body mass and thus only approximate the nutritional status.


Lower airway diseases in childhood: a review with emphasis on X-ray signs.

Lower airway diseases play an important role despite the most sophisticated therapeutic measures. Consequences of modern life, air pollution and many byproducts of our civilisation act in favour of airway diseases. Complicated is the problem by the changing symptoms, the changing virulence of the pathogenic microorganisms, by the unstable immune activity of the organism. Besides new syndromes are detected or separated from old diseases according to the development of the diagnostic tools. This paper reviews the actual situation of the subject.


A comparative study of two diets in the treatment of primary exogenous obesity in children.

One hundred four children, six to fourteen years of age, with primary exogenous obesity were randomly distributed in order to be subjected to two different diets, ketogenic (low carbohydrate) and hypocaloric, for eight weeks. Body weight, serum triglycerides, cholesterol, a glucose tolerance test, blood glucose and plasma insulin determination were performed before and after both diets. The results revealed significant differences in body weight and triglyceride concentrations with the two diets although they were more remarkable with the ketogenic diet. There were significant differences in the fasting insulin levels, insulinogenic index, and insulin concentration after a glucose tolerance test in the patients subjected to a ketogenic diet.


Histopathology, histochemistry and acetylcholinesterase activity after repetitive administration of fluostigmine to albino rat.

Histopathological, histochemical and biochemical investigations were performed on the brain, sciatic nerve, skeletal muscle, heart, liver and kidney of rats which were given 5% of LD50 dose of DFP for 10 days. A decrease in AChE activity, degeneration of neurons and necrotic changes in the nuclei of hypothalamus, degeneration of myelin sheaths in sciatic nerve, a decrease in succinic dehydrogenase activity in the myocardium, and a minimal decrease of acid phosphatase activity (AcPh) in the liver were found. The biochemical determination of AChE level indicated about 30% AChE activity in erythrocytes and tibialis muscle, and 40% in the brain 1 hr after the last dose of the inhibitor and 80% and 50% respectively on the 7th day after poisoning in relation to normal values.


Oxytocic activity of plasma and posterior pituitary lobe after ovariectomy and implantation of stilboestrol or progesterone tablets in female rats.

The purpose of this work was to compare the oxytocic activity of plasma and posterior pituitary lobe extract in rats after sham operation, ovariectomy and after subcutaneous implantation of stilboestrol or progesterone tablets in ovariectomized rats. On the 5th day after ovariectomy or implantation of hormones, sample of 2 ml of blood were obtained under urethane anaesthesia from the cephalic end of the right external jugular vein, and the animals were killed by decapitation. The posterior pituitary lobe was removed and homogenized in 0.9% NaCl solution acidified with glacial acetic acid. The oxytocic activity of plasma and extracts of the posterior pituitary lobe was determined by the method of Van Dongen and Hays on fragments of lactating rat mammary tissue. On the 5th day after ovariectomy or implantation of stilboestrol the oxytocic activity was found to be significantly increased in the plasma and posterior pituitary lobe, and after progesterone implantation it was decreased in the posterior pituitary lobe.


Properties of reversible graded inhibition of phrenic nerve activity by pulmonary afferents.

Reversible graded inhibition of phrenic nerve activity (PNA) was observed during short, low volume lung inflations in chloralose anaesthetized, paralyzed cats. The strength of the inhibitory effect rose with the volume of inflation in a manner suggesting non-linearity. The volume threshold for the first detectable inhibition decreased with increasing delay between onest of inspiration and lung inflation. The differences between the threshold curve for different air flows were not significant. The recovery of PNA from transient inhibition was not immediate and this shows that lung inflations might activate a central inhibitory mechanism, the action of which could outlast the activation period of lung receptors. It is suggested that pulmonary stretch receptors (PSR) are responsible for the observed reactions. The present results indicate that the theory of "all or none" action of PSR on inspiratory activity is not valid for all experimental conditions, and that PSR are capable of continuous control of PNA pattern.


Influence of oral glucose load upon blood glucose level in relation to the time of day.

Blood glucose levels were estimated at different times of day in fasted rats and after 30, 60,90 and 120 min, since oral glucose load. Circadian variations in basal glucose levels and in the levels after glucose load were observed with the highest values noted between 11 a.m. and 7 p.m., and the lowest ones about midnight. These variations were most prominent when the measurements were performed 60 min after glucose load. Circadian variation in glucose tolerance was also revealed with the best tolerance at about midnight while the worst one was noted at noon and in the afternoon.


Method for comparative studies of the revascularisation processes in the bone tissue, using 85Sr.

85SR was used for the local blood flow measurements in bones. A method for dynamic analysis of the magnitude of local blood flow based on 7-min analysis of the area under the logarithmic curve was presented. The radioactivity of the tibial diaphysis was followed by a gamma-scintillation dectector focused on the area of approximately 10 mm 0. The revascularisation process during bone repair after the osteotomy of the tibial diaphysis fixed intramarrowally was observed on 14 rabbits, two and four weeks after the osteotomy. In the first two weeks following the osteotomy the process of revascularisation was significantly enhanced in a comparison to the second two weeks.


Motor reactivity of isolated heart of the grass-snake (Natrix natrix L.).

Stimulation of the vagus nerve with a volley of electric impulses changed the action of grass-snake heart producing a negative chronotropic and inotropic effect. The effect of vagal stimulation was not different from the effect of acetylcholine administration and it was absent in the presence of atropine and hexamethonium. It was not possible to demonstrate sympathetic nervous fibres in the stimulated segment of the vagus nerve and trials of finding a separate nerve increasing the heart rate were unsuccessful. Parasympathicotonic agents caused bradycardia and a fall in the amplitude of cardiac contractions, and in sufficiently high doses they arrested the heart in diastole. The action of muscarine-like agents was stronger than that of nicotine, and the anticholinergic action of tubocurarine was weaker than that of atropine. Catecholamines exerted a positive inotropic and chronotropic effect which was completely blocked by propranolol in some tests only.


Physical exercise effect on erythrocyte metabolism.

A group of 27 canoeists from the national team and 35 subjects beginning training in a sports discipline were subjected to investigations for determination of glucose utilization by erythrocytes, and the level of lactic acid in these cells and in serum. Furthermore, erythrocyte count and haematocrit value were determined in them. Both groups performed submaximal and maximal work on cycle ergometer. In the trained sportsmen the erythrocyte count and haematocrit value were higher already before exercise. During the exercise the increase in these values, as well as the rise in erythrocyte and serum lactic acid levels were again greater than in untrained freshmen. This difference was caused by the fact that the trained sportsmen performed twice as much work. Glucose utilization by erythrocytes (in vitro) was greatest after maximal exercise in both groups. The differences observed between both groups became manifest during exercise with a greater rise in glucose utilization by the erythrocytes obtained from the trained group. Fifteen minutes after the exercise this utilization fell in both groups below the value obtained before exercise. During the same time erythrocyte count and haematocrit returned to their initial levels.


Ledakrin effect on free fatty acid and glycerol mobilization from epididymal adipose tissue of rat in vitro.

It was demonstrated that Ledakrin, an antitumour drug, causes mobilization of free fatty acids and glycerol from the epididymal adipose tissue of rat in vitro. The disproportion observed in the release of glycerol and free fatty acids following Ledakrin administration suggested a biphasic effect of this drug, with initial stimulation and later inhibition of the processes of lipolysis and lipogenesis. Blockade of adrenergic membrane receptors (with propranolol or regitine) abolished the lipolytic effect of Ledakrin.


Effect of psychotropic drugs on the development of experimental gastric ulcer produced by different stress-inducing factors in rats.

The anti-ulcer activity of three different doses (1/10, 1/30 and 1/90 of LD50) of imipramine, amitryptyline, chlorpromazine, amphetamine, ephedrine, chlordiazepoxide and meprobamate was studied in two types of stress-produced gastric ulcers in rats. It was found that these drugs given in doses of 1/10 or 1/30 LD50 inhibited in the same degree the development of gastric ulcer-produced by the method of Senay, in spite of differences in their psychotropic activity. On the other hand, when the method of Rossi was used for ulcer production the ulcer-preventing activity of these drugs has been varied. Thymoleptics were most effective and ataractics least effective against ulcers produced by the method of Rossi.


Laryngeal carcinoma. II. Analysis of treatment results using the Ellis model.

An analysis of 308 patients with carcinoma of the larynx was performed with respect to local recurrence and complications in relation to treatment level. The patients received primary irradiation with some difference in absorbed dose but with an equal fractionation schedule. Analysed in subgroups, correlations between local recurrence and treatment level were either demonstrated or strongly indicated. This is confirmed in a comparison with approximately 1 500 cases collected from the literature. Correlations between complications and treatment level were not found, but nevertheless indicated with respect to late edemas, which again are supported by comparison with approximately 800 cases collected from the literature. The risk of pharyngo-cutaneous fistula after total laryngectomy seems to be rather independent of irradiation level, although slightly dependent on field size. An optimum level of treatment has been estimated and brought into use since January 1978.


Undifferentiated giant and spindle cell carcinoma of the thyroid. Report on two combined treatment modalities.

Undifferentiated giant and spindle cell carcinoma of the thyroid is a rapidly fatal disease. Most patients die from local tumour progression and with distant metastases. A combination of debulking surgery, irradiation and combination chemotherapy is reported. An improvement of the local results of treatment was observed. A combination of irradiation and chemotherapy resulted in local control in only one of 8 patients. Therefore, debulking surgery was added in the next 5 patients and a local control was achieved in 4.


Clinico-pathologic correlation in non-Hodgkin's lymphoma. II. Clinical and prognostic significance of nodularity.

A retrospective review of 302 patients with non-Hodgkin's lymphoma is reported. The tumors were classified according to a modified Lukes & Collins scheme and their growth pattern was analysed. Nodular growth was scored in 3 degrees. Nodularity was found to be correlated with certain clinical features and of great relevance for prognosis. The growth pattern was also correlated with cell type, but even within a certain cytologic type, nodular tumors were associated with better survival than diffuse tumors.


[Critical review of the literature on psychogenetic factors in cancer diseases (author's transl)].

The author reviews the literature on various psychic ethiopathogenic approaches of cancer and reminds the main methodological critics. He comes to the conclusion that these criticisms are similar to those in psychosomatic medicine. He believes the monistic psychobiological theory to be the most pertinent at present. The technic of associative investigations, of a dialectic nature, is proposed as a methodological instrument in the frame of psychosomatic research in cancer.


Effect of a low-fat diet on bile salt excretion and diarrhoea in the gastrointestinal radiation syndrome.

Nine patients with diarrhoea and bile salt malabsorption after pelvic irradiation for malignant gynaecologic tumours were treated with a low-fat diet (40 g of fat per day) for 3 to 6 months. Faecal excretion of bile salts decreased in all patients concomitant with relief of symptoms.


[Mental troubles in bismuth encephalopathy: a case report (author's transl)].

The authors describe one case of bismuth encephalopathy, insisting particularly on neuropsychological and neurolinguistic troubles. They analyze, the related literature in reference to the clinical picture in its prodromic phase, state phase, differential diagnosis, course and potential neuropsychological complications.


[Experience of a "sensibilisation group to the relationship" with medical students (author's transl)].

The authors describe an experience of sensibilisation to the relation through utilisation of role game with medical students. The game, which scenario is elaborated by the participants, is realised in small groups, and the discussion is an emotional experience of the played situation. The magnetic recording of the game and its audition in a big group permit congrontation between various modes of reaction to the same situation, and bring some new insight to the students on their being and feeling. Even tuestionnaire and most of them discover emotional dimensions of the relationship.


Carcinoma of the uterine cervix. Results of treatment in 2 248 cases.

Data on the survival of 2 248 patients with cervical carcinoma, treated between1966 and 1972 at 3 oncologic centers in Cuba, are presented. Intracavitary radium application combined with external 60Co irradiation was the main treatment method. The most frequent complication was radiation proctitis, but fistulas occurred only in 1.6 per cent.


A double blind comparison of viloxazine and amitryptyline in involutional and endogenous depression.

Thirty-two hospitalized patients with either endogenous (n = 15) or involutional (n = 17) depression were entered into a double blind study to compare the effectiveness and acceptability of viloxazine with amitriptyline. The severity of the depression was assessed before starting treatment and at day 7, 14 and 28 using the Hamilton Rating Scale. Spontaneously reported side effects were recorded. Patients received viloxazine 50 mg three times a day during the first week followed by 100 mg three times a day during the next three weeks or amitriptyline 25 mg three times a day during the first week followed by 50 mg three times a day during the following three weeks. Viloxazine and amitriptyline were equally effective in endogenous depression, but viloxazine was significantly more effective than amitriptyline in patients with involutional depression. Nausea and vomiting were the main side effect of viloxazine during early treatment necessitating the withdrawal of two patients. Anticholinergic side effects were reported during amitryptyline treatment, but were absent in patients on viloxazine. It is concluded that viloxazine is an effective antidepressant and particularly useful in the treatment of involutional depression.


Radiation doses in low-dose pelvimetry using rare-earth screens.

A 'low-dose technique' of obstetric pelvimetry, using rare-earth screens and a reduced ambition level of image quality, yields an estimated absorbed dose to the maternal and foetal gonads of 0.9 and 0.01 mGy, respectively. The resulting risk for 'hereditary ill health' and the risk for induction of leukemia from the absorbed dose to the foetal red bone marrow, have been calculated to be at a very low level.