Choroidal and ciliary body malignant melanomas.

53 cases of choroidal and ciliary body melanomas have been followed for a minimum of 5 years. 26 patients had enucleation after an initial period of observation, mainly because of growth. Survival rates of these patients compared to other series treated by initial enucleation are unaffected. Small melanomas which did not grow did not cause death in this series. The results of this series thus far indicate that patient survival is not jeopardized by initial observation and that useful vision is preserved for many patients.


Vascular obstructive alterations related to chorio-retinitis.

Different stages of retino-choroiditis, many of toxoplasmic origin, may develop vascular alterations. One of these pictures has been observed in relation to old scars of retino-choroiditis, where focal vasculitis may affect the venous return circulation sometimes leading to intraocular hemorrhages and retinal holes of variable severity. The natural history of this process is described, as well as the clinical characteristics and the results of treatment. Generally, the disease has a favorable course and a good prognosis. 18 cases are reported.


Other advances in chorio-retinal surgery. A comparative study of sponge infections.

During a period of seven years out of 900 explant operations done in New York 31 sponges had to be removed. In Bonn during the same period a comparable 27 explants out of 1000 operations had to be removed. Clinical infection occurred as early as one week and as late as seven years after the operation. The infection of the sponge manifested as: fistula, granuloma or a subconjunctival haemorrhagic mass. 2/3 of the infections were due to staphylococcus epidermis which acts as a pathogen in the presence of a foreign body. Bonn's requirement of a sterile conjunctiva preoperatively and the use of prophylactic antibiotics postoperatively did not significantly reduce the rate of infection.


Vitrectomy techniques in treatment of macular pucker following retinal reattachment surgery.

Vitrectomy techniques to remove epiretinal membranes causing macular pucker and reduced vision were used to treat 11 consecutive eyes with macular pucker after otherwise-successful retinal reattachment surgery. A technically successful result with visual improvement was achieved in each case. An iatrogenic retinal tear occurred in eye, and recurrent retinal detachment requiring an additional operation occurred postoperatively in 2 eyes. Despite such risks, and the fact that the best postoperative acuity achieved was 20/40, the use of vitrectomy methods in removal of epiretinal membranes in selected cases of macular pucker can provide significant improvement in vision.


Retinal detachment surgery without cryotherapy.

The authors have performed 43 retinal detachment operations omitting the use of cryotherapy or any other type of retinal adhesion. Only a full thickness buckling procedure has been performed with drainage of subretinal fluid in some cases. The cases were carefully selected and the follow-up period has been from 1 to 3 1/2 years. Redetachment has not occurred if the original hole was free of traction (round holes) but has so far occurred in 3 cases where traction was present.


Vitrectomy and lensectomy in the management of intraocular foreign bodies--magnetic and nonmagnetic.

The Girard Ultrasonic Fragmentor makes it possible for the surgeon to remove opaque vitreous and cataractous lenses in order to be able to visualize directly intraocular foreign bodies, both magnetic and nonmagnetic. This greatly facilitates the removal and prevents many of the complications of the removal of intraocular foreign bodies. The technique can be performed either through the anterior chamber or the pars plana.


[How to remove a nonmagnetic intraocular foreign body para plana?].

After several unhappy experiences, the author thinks that the conditions for a successful extraction of an intraocular foreign body are: a clear lens and a clear vitreous, a proper microscope with the slitlamp beam in the axis of the observation, a three-mirror contact lens in order to have a good view of the periphery, early surgery to avoid adherences and neovascularization, special forceps to grasp the foreign body, a good hemostasis and a subtotal removal of the vitreous. Failures are reported and their causes discussed.


Pars plana vitrectomy after intraocular foreign bodies.

Pars plana vitrectomy after intraocular foreign body injuries led to a good or at least useful vision in 60% of the cases. Without exception, these were eyes which were practically blind or eyes which according to our experience would have been blinded without vitrectomy. Retinal detachments which have arisen preoperatively have a decisive negative effect on the prognosis: there is a low rate of healing in consequence of traumatic, contusional and metallotic retinal lesions and high MPP rate. Increasing surgical experience, so-called secondary vitrectomy 'in time' as well as improved and more refined vitrectomy instruments lead to better results.


An alternative method of gas-fluid exchange through the limbus in giant tears and other complicated retinal detachments.

An alternative method of gas-fluid exchange through the limbus in patients with giant tears and complicated retinal detachments is presented. The indications for the combined surgery of scleral buckle, vitrectomy, and gas-fluid exchange are suggested. The results of this type of surgery in 5 patients with giatn retinal tears, and in 12 patients with complicated retinal detachments, are reported. Most failures were caused by massive periretinal proliferation.


[Spontaneous choroidal detachment: two cases].

Study of two patients with spontaneous detachment of the choroid. In addition to detachment of the choroid, case 1 had a flat anterior chamber. Corticotherapy gave some improvement but after 3 months, surgical management was necessary. In case 2 enucleation was performed on the basis of positive echographic findings. Histological findings, the main clinical features and the therapeutical approach are discussed.


[Recovery of rod and cone systems after retinal detachment surgery].

The paper reports on the threshold values for light perception of circumscript retinal areas for different adaptation levels in patients successfully operated for retinal detachment. The examinations were carried out by means of the Tübingen projection perimeter, using the method of static perimetry in a meridian containing an approximately equal area of healthy and of formerly detached retina. The main aim of this examination was to establish whether both retinal photoreceptor systems recover within the same time after the operation. There is various evidence that the restitutions of the rod and cone systems do not occur at the same time.


Visual acuity following retinal detachment surgery.

A poor visual acuity following an anatomical cure of a retinal detachment was in this series always associated with a change in macular morphology, the commonest maculopathy being the appearance of a cellophanemembrane. Factors influencing the visual prognosis are duration and extent of the detachment, involvement of the macula, the age of the patient and the presence of pre-operative periretinal membrane formation. The type of buckling procedure is not related to the visual outcome and while the conversion of the procedure into an intra-ocular operation, either by way of drainage of subretinal fluid or by intra-vitreal injection, can cause serious complications we suggest that uncomplicated drainage of subretinal fluid has not been a cause of macular pucker in this series but that this conditions is related to the indication for drainage, namely a varying degree of rigidity of the retina due to periretinal membrane formation.


Retinal detachment following phacoemulsification.

We reviewed the characteristics of 100 retinal detachments which followed phacoemulsification. The characteristics of retinal breaks and the configurations of the detachments were in general similar to cases of retinal detachments following intracapsular surgery. There was a suggestion that detachments occurring within 6 months of cataract surgery appeared to be statistically different from those occurring more than 1 year following phacoemulsification. The former group of detachments tended to be more 'phakic' in nature than those occurring relatively late. The surgical reattachment rates in these eyes compared favorably to previously published figures on the repair or retinal detachment following intracapsular surgery.


Influence of retinal detachment surgery on eye motility and binocularity.

Material, orientation and topography of episcleral buckling procedures are examined concerning the motility and the binocular functions of the eyes after retinal detachment surgery. The preoperative binocular state is of peculiar interest because also congenital palsies and heterophorias may be followed by a postoperative disturbance of the binocular vision. Some points that may contribute to a reduction of the amount and duration of these disturbances are discussed.


[Analysis and treatment of eye motility disorders following retinal detachment surgery].

Despite the most careful retinal detachment surgery saving the eye muscles and the fascial structures, an extraocular muscle imbalance may occur. This can be expected especially when for scleral buckling procedures large implants or exoplants were used, or had to be placed under a rectus muscle. In some cases, however, postoperative diplopia results from decompensation of preexisting heterophoria or congenital ocular motor imbalance. A clear-cut differential diagnosis to separate these entities is essential for therapeutic considerations.


Pars plana vitrectomy for diabetic retinopathy. A report of 8 years' experience.

Vitrectomies have been performed on 299 cases of dense diabetic vitreous hemorrhages and been followed for 6 months. A successful visual result was obtained in 61% of the cases. The vitreous remained clear in 71% of the cases, and the maculas were attached in 66% of the cases 6 months following surgery. 168 cases of traction macular detachments underwent vitrectomy, and had 6-month follow-up examinations. Significant visual improvement was obtained in 26% of the cases, with stabilization of the preoparative vision in an additional 37% of the cases. The vitreous cavity was clear in at least 64% of the cases, and the macula attached in at least 52% of the cases. 86 cases had both dense vitreous hemorrhages and traction macular detachments, and had 6-month postoperative examinations, with significant visual improvement having been obtained in 31% of the cases, and stabilization of the preoperative vision in an additional 33% of the cases. The postoperative vitreous cavities were clear in 59% of the cases, and the maculas attached in at least 45% of the cases.


[Uveal effusion--microphthalmos--severe hypermetropia].

Report of a case of uveal effusion with nanophtalmus and hypermetropia in a 40-year-old woman. This case is similar to those described in the literature as uveal effusion and nanophthalmus. It shows that the syndrome may be unilateral and not accompanied by glaucoma. The most characteristic traits of the syndrome are thickening of the sclera and peripheral retinal vascular anomalies. The syndrome seems to be secondary to a lesion of the vorticose system and to poor circulation conditions in the intrascleral part of this system.


Spontaneous choroidal detachment and rhegmatogenous retinal detachment.

A 74-year-old woman was found to have a choroidal mass and a retinal detachment. Diagnosis of a spontaneous choroidal detachment combined with a rhegmatogenous retinal detachment could be established. An initial, apparently good surgical result soon changed to a detachment with marked vitreous traction.


[Postoperative choroidal detachment and chorioretinal surgery].

Clinical study of postoperative choroidal detachment in about 60 patients. The following parameters have been analyzed: frequency, age of the patient, type of detachment, evolution and surgical technique. The prognosis has been discussed. The question is to know whether choroidal detachment is a minor accident or a major complication. The authors try to give an answer, keeping in mind the different parameters analyzed. A research on therapeutic possibilities has been carried out.


Central serous retinopathy. A generalized disease of the pigment epithelium.

Among cases of central serous retinopathy, patients have been isolated with retinal pigment epithelial (RPE) and sensory retinal detachments. An analysis of 104 cases occurring during the period from 1972 to 1977 indicates that this disorder is frequently bilateral and that it is associated with different disturbances of the epithelial cell layer, i.e. foci of leakage, transmission defects and serous detachments. Based upon the angiographic studies in 76 cases, we propose the following classification for cental serous retinopathy: I. Unilateral Retinopathy. (A) Uniocular involvement: (1) with focal leakage but no other RPE changes; (2) with focal leakage and other RPE changes; (3) with focal leakage, RPE changes and an exudative retinal detachment. (B) Binocular involvement: (1) mild; (2) moderate; (3) severe (with an exudative retinal detachment in the affected eye). II. Bilateral Retinopathy. (A) Mild; (B) moderate, (C) severe (in association with bilateral exudative retinal detachments). This classification emphasizes the fact that central serous retinopathy, whatever its etiology, represents a generalized affectation of the pigment epithelium and should be construed as a potentially serious disorder requiring thorough evaluation and follow-up care.


Retinal telangiectasias associated with longstanding retinal detachment as a prognostic sign.

The authors present 26 cases (28 eyes) of rhegmatogenous retinal detachment, lasting more than 6 months, in which retinal telangiectasias appear in the periphery of the retina as a secondary phenomena, seemingly related to hypoxic factors. A comparison is made with a control group of 25 cases of longstanding retinal detachment taken at random in order to establish statistical differences. Considerations regarding their pathogenesis and their value as a prognostic sign are made.


[Artificial food. 2. Possibilities of production of artificial foods].

The research program elaborated in the Institute of Element-Organic Compounds of the Academy of Sciences of the USSR (INEOS) for the processing of proteins to liquid multi component-food-systems and their transformation into a gel-like condition became a kind of an independent scientific discipline. Thus production processes for different forms of artificial food on the basis of proteins of different origin could be developed.


[Improving the nutritive value of rapeseed meal, using production process principles].

With regard to studies on production process variants designed to improve the nutritive value of rapeseed meal, the authors describe the principles underlying the modified diffusion extraction procedures used (with and without rapeseed husking). Furthermore, they briefly outline the chemical methods applied to the determination of the nutrient composition and glucosinolate content of rapeseed meal variants as well as the methodology of their feeding and nitrogen balance experiments on growing albino rats and broilers. The results obtained with 13 analytical variants and 8 biological variants confirm once more the beneficial nutritive effects obtained with the reduction of the glucosinolate content of rapeseed meal in monogastric animal species. However, these results do not permit to appraise unequivocally the repercussion of rapeseed husking on the diminution of the content of paraplastic substances in rapeseed meal. The diffusion techniques used for reducing the glucosinolate content in rapeseed meal have been found to be effective.


[Choice of anesthesiological technic in ambulatory practice by means of psychodiagnostic tests].

Psychodiagnostic tests have been used in a study on patients undergoing general anaesthesia for minor surgery, the purpose being to evaluate patient recovery and autonomy prior to discharge. The patients considered were submitted prior to operation to the Peg board test, tre Trieger test and the Writing test to obtain standard reference values. These tests were repeated every 10-15 minutes from the end of operation as soon as patients recovered consciousness and were able to cooperate. The comparative study showed that patients who had been anesthetized with Ethrane recovered more rapidly, followed by those treated with Fluothane, Propanidide and Althesin.


[Study of recovery from anesthesia by means of graphic tests of writing and drawing].

As part of an investigation of the quality of the return to consciousness after anaesthesia, a comparison was made between recovery times in 60 patients divided into three groups, subjected to general anaesthesia and shallow maintenance with halothane, mixed short shallow neuro-analgesia, and short analgesia anaesthesia. Psycho-aptitudinal recovery was evaluated with three graphic tests. The results indicate that recovery times are much shorter for shallow neuro-analgesia, and particularly for analgesic anaesthesia by comparison with ordinary shallow techniques coupled with maintenance in O2 + N2O + Halothane.


[Dexamethasone-21-phosphate in the treatment of cerebral edema. Evaluation of the effects on diuresis, natremia and natriuria].

An evaluation was made of variations in blood and urinary sodium following the administration of 24 mg/day desamethasone-21-phosphate for at least 9 days, starting from admission, as cerebral antioedemigenic therapy in 30 patients with nerve traumas. The changes observed were within normal limits. This absence of interference with the hydro-electrolyte balance is a strong point in favour of the use of the drug in the treatment of cerebral oedema. The exact mechanism of action of this type of glycocorticoid, however, is still unknown.


[The hypotensive pneumothorax syndrome].

In the light of a further case of hypotensive pneumothorax, an account is given of the physiopathology of the syndrome with special reference to the importance of endothoracic pressure imbalance as a cause of functional insufficiency of the lung on the healthy side. Support is given to the therapeutic principles, i.e. emergency normalisation of pressure values in the pleural cavity on the impaired side, and resolutive toilet of tracheobronchial trunk.


[Myasthenia gravis. Indications, aims and methods of intensive therapy].

Some recent views on pathophisyology of "myasthenia gravis" are presented. The Authors explain the typical damage of myasthenia gravis, i.e. the progressively reduced muscolar function on the basis of an autoimmune derangement affecting the motor-end plates. The most commonly used types of treatment, both medical (i.e. antiChE, A.C.T.H., steroids and immunodepressant drugs) and surgical (thymectomy) are reviewed. The very important role of Intensive Care for the treatment either of myasthenia gravis "per se" or of possible consequences of some drugs (A.C.T.H. steroids) is also stressed. Finally the Authors present their results about their experience on 36 patients affected by myasthenia gravis and admitted to I.C.U. once (29 patients) or twice or more (7 patients). The Authors describe some practical problems presented by patients during their stay in I.C.U.


[Pancreaticogastrostomy in duodenocephalopancreatectomy. Operative technical note].

The technique used to carry out pancreaticogastrostomy after duodenocephalopancreatectomy in 4 cases is described. The technique is better than pancreaticojejunostomy, which is associated with a high incidence of postoperative complications, such as abscesses, fistulae, haemorrhage, and autodigestion at the site of anastomosis.


[Recent acquisitions in surgery of the extrahepatic biliary passages].

Recent advances in the diagnosis and surgical management of cases involving the extrahepatic bile ducts are illustrated. Particular stress is laid on the universally recognised importance of preoperative cholangiography, the usefulness of the flexible choledochoscope, and the employment of cold light to visualise calculi undetected by cholangiography. The scope of and indications for direct surgery on the papilla, derivative operations, and reconstruction of the duct are discussed. Lastly, reference is made to the use of endoscopic sphincterotomy, and the suitability of continuous perfusion of the ducts in the destruction of calculi.


[Choledochal prostheses with lyophilized and siliconed dura mater. Experimental research; preliminary results].

Personal experience with the application of choledochal prosthese in freeze-dried, siliconed dura mater is reported. The experimental model set up permitted the implantation of such a prosthesis in the rat. Retrograde cholangiography and histological examination revealed the total patency of the prosthesis in the long term, and complete epithelialisation.


[Multifocal carcinoma of the small intestine].

A recently observed case of carcinoma of the small intestine is report because of its rarity and the exceptional nature of polycentrism in these neoplasias. Interest in the case was also due to the onset of carcinoma in a patient who had already undergone gastrosection, a condition which permitted endoscopic diagnosis. The literature did not throw up any other cases of small intestine carcinoma with localization at the afferent loop of a previous gastroenteroanastomosis.


[Selective ligation of the hepatic artery in treatment of post-traumatic hemobilia. Case report].

A case of post-traumatic haemobilia in a 15-yr-old boy is presented. The clinical picture is described, together with the treatment adopted (selective ligation of the right hepatic artery). A brief account is given of the reasons underlying the choice of this approach. Stress is laid on the essential and soundness of selective angiography in the evaluation of such cases.


[Angioma of the parotid gland in children. Considerations on 3 cases].

Three cases of haemangioma of the parotid observed in infants are presented and their aetiopathogenetic and anatomopathological aspects are stressed. An examination of the pros and cons of conservative, surgical, radiation, and pharmacological management leads to the conclusion that surgery is the treatment of choice, provided a suitable technique is employed.


[Aberrant breast carcinoma (Clinical case)].

A case of carcinoma on aberrant mammary tissue associated with fibrocystic mastopathy and masked carcinoma of the breast with lymph node metastasis at the homolateral axilla only is reported. It is recommended that all subcutaneous nodes in zones surrounding the breast should be removed. If they prove carcinomatous, Halsted's radical mastectomy of the homolateral breast should be performed.


[Treatment of gastroduodenal ulcers perforated into the free peritoneum. Apropos of 122 cases].

The treatment used in 122 patients suffering from perforation of gastroduodenal ulcer in free peritoneum is presented. 77 were subjected to straightforward suture of the perforation. Hemigastrectomy was carried out in 43 and in 2 superselective vagotomy associated with removal of the duodenal ulcer and duodenoplasty. Mortality in the series was 11.04% after suture but allowance must be made here for the serious condition of the patients who underwent this form of operation. Of the patients treated with straightforward perforation suture, 36.5% were reoperated for the reappearance of ulcerous symptomatology, while the remaining 63.7% were cured. On the basis of this experience, it is considered that superselective vagotomy associated or otherwise with pyloroplasty, and subtotal gastrectomy are indicated in patients in good general condition and in whom ulcer perforation symptomatology goes back less than 12 hours.


[Bilaterally strangulated bilateral obturator hernia. Plastic surgery, using the round ligaments].

An unusual case of bilateral obturaptor hernia with double ileal strangulation is reported. An account is given of obturator hernia, its pathogenesis, and surgical management. Of the various possibilities that exist in this respect, the simplest and most resolutive, it is submitted, is that in which the ligamentum teres uteri is employed to close the hernial porta.


[Lipoma of the anal canal].

Lipoma of the colon is a rare tumour that is often asymptomatic, and frequently discovered casually. Most examples are isolated and submucosal. An unusual case in a site not hitherto reported in the literature is described. Its clinical and radiological picture is explained and the more significant features are examined.


[A very unusual case of enterogenous cyst of the mesosigmoid in an adult].

A case of enterogenous cyst of the mesosigmoid, exceptional for its abrupt onset and rapid course is reported in a woman of 65. Preoperative diagnosis at this age in practically impossible, but the operation and refined histological development is always unpredictable and never negligible. Although there was no presence of aetiopathogenetic originality, presentation and study of the clinical case had the purpose of informing the surgeon that surprises must always be notified, just as must any exceptionally rare anatomopathological finding.


Nitrite as a food additive.

Nitrite is used for its colouring, antimicrobial and flavouring effects as a food additive for several meat, fish and cheese products. Nitrite combines readily with secondary amines to form carcinogenic nitrosamines. Nitrosamines are found in many food products after nitrite addition and sometimes even without addition. Nitrite is regarded as an effective growth inhibitor for Clostridium botulinum and thereby its production of the lethal toxin. Today this is considered to be the main reason for addition of nitrite to food products. It should be possible to limit the addition of nitrite to a few special food products where Cl botulinum really represents a hazard to human health, i e to canned meat that is not sterilized by heat and some cured and fermented products. In Norway the use of nitrite is limited to products where growth of clostridia is possible, but in a few products nitrite is also allowed as a colour stabilizer. It is reasonable to expect that other countries will decide upon similar regulations. The naturally occurring nitrates in vegetables have to be included in the discussion due to the possibility of microbial reduction to nitrites.


Surveillance of the antibody status to current influenza strains in the Norwegian population. 1: Method of serum sampling and evaluation of the A/USSR/77 (H1N1) impact in various age groups in 1978.

Every autumn approximately 900 randomly selected sera from various regional bacteriological laboratories are received at the NIPH and assayed for the presence of haemagglutination-inhibition antibodies to current influenza strains. After three years of preliminary investigations the system is now working successfully. It is possible, in retrospect, to assess the impact of various influenza strains in different age groups and regions of the country. In particular, after the reappearance of the H1N1 subtype (the "Russian influenza") in Europe in January 1978, the sera collected in Norway during a 3-week period in October 1978 clearly showed that those under the age of 25 years, and especially teenagers between 13 and 16 years of age, were struck by this virus. This was unexpected since there was hardly any influenza morbidity associated with this "new" strain recorded in the winter of 1978.


Relationship between the drainage of the subretinal fluid in retinal detachment surgery and the appearance of macular pucker.

In a series of 470 rhegmatogenous retinal detachments, the relation between the incidence of macular pucker and puncture of the subretinal fluid was studied. We found macular pucker in 7.1% of the cases where a drainage was performed and only in 3.2% of the cases where it was not. In 85% of these cases, the macular region was preoperatively detached.


Hypotensive synergism of propranolol and adrenalin.

The effect of combined treatment with an oral beta-blocking agent (propranolol tablets 40 mg twice a day) and a local alpha- and beta-agonist (epinephrine eyedrops twice a day) was studied in 10 healthy volunteers. Propranolol was given in a double-blind randomized manner, while adrenalin was given unmasked. Propranolol and adrenalin proved to have an additive reducing effect on the intraocular pressure. The effect of propranolol alone was stronger than that of adrenalin.


Interaction between anterior and vitreous chambers.

As part of the search for a bioengineering model of the eye, the interaction between instantaneous changes of pressure in the anterior and vitreous chambers are studied. A description of the experiments as well as data evaluation is given. The results indicate a linear relationship between the chambers and a diaphragm effect of the system lens-iris-zonula-ciliar body.


[Mulitiple myxoma of the eyelid].

Case report of a man aged 41 with several myxomas of the lids. At the age of 10 years a myxoma of the nose, primarily interpreted as myxosarcoma, was removed surgically and irradiated. 7 years later a myxoma developed on his right lower lid and 31 years later 3 more myxomas appeared on his left upper lid. The histology of this rare kind of lid tumour is described and the unusual course discussed.


Sweat gland tumour of the eyelid with conjunctival involvement.

An 87-year-old woman presented with a rapidly growing tumour at the nasal side of the upper eyelid. The clinical diagnosis was basal cell carcinoma. During surgery, the impression of malignancy was accentuated by the finding that even the conjunctiva had been invaded. Histological examination revealed an eccrine acrospiroma with, indeed, many mitoses but, on the other hand, a completely benign aspect. Besides, there was no recurrence after 1 year.


Mediastinal embryonal carcinoma with bilateral choroidal metastases. Fluorescein angiographic and histopathologic study.

28-year-old sportsman developed chest pain, dyspnoea, haemoptysis and swelling of the right leg. 8 weeks later he also complained of blurred vision. Ophthalmoscopy revealed subretinal infiltrates diagnosed as tumour metastases by fluorescein angiography. The patient died 10 weeks after the first symptoms. At autopsy large mediastinal embryonal carcinoma was diagnosed, and both eyes revealed choroidal metastases. This rare tumour usually involves young men and is invariably fatal within a few months. Exceptional bilateral choroidal metastases constituted the presenting sign.


Exophthalmos caused by an invasive pituitary adenoma in a child.

The authors present a case of exophthalmos caused by invasion from a hypophyseal tumour, rare both for this type of metastasis and for the patient's young age. Histological study of biopsy material enabled the tumour to be classified. Comparison of clinical and microscopic data helps towards a better understanding of the behaviour of invasive adenomas.


Congenital ocular motor apraxia--familial occurrence.

The occurrence of congenital oculomotor apraxia in two children of the same family is described. The improvement of the ocular dysfunction in the older sister gave some hints to the benign nature of the condition and its tendency to recover with age. The possible pathophysiological mechanism underlying this anomaly is discussed.


[Ptosis surgery: anterior approach for levator aponeurosis shortening (author's transl)].

A simplified method for ptosis surgery has been used in 33 patients. The levator aponeurosis is exposed by the anterior approach. It is folded or excised and reattached to the anterior surface of the tarsus, matching the level and the contour of the two upper lids. The cosmetic appearance of the lid is improved by the skin closure technique. This method for ptosis surgery meets the anatomical and physiological needs best. It has given very satisfactory functional and cosmetic results.


Trabeculectomy with scleral wick. Technique and early results.

A variation to standard trabeculectomy is described, whereby the trabecular tissue flap is not completely excised, but dissected free, hinged at its nasal end and sutured diagonally across the scleral bed, to act as a wedge between the scleral flap and its bed, in an attempt to decrease the tendency of the sclera to scar into a watertight barrier. In addition, it is suggested that the trabecular flap acts as a wick that aids in the filtration of the aqueous humour. The technique has been used in 24 eyes with good to excellent, short-term, post-operative intraocular tension control in all but 2 patients. Mil complications like transient flat anterior chamber or blood cells in the aqueous occur at rates comparable to other filtering procedures.


Neonatal or juvenile leucocoria.

The differential diagnosis between the diseases which cause leucocoria is discussed. Among them congenital cataract, persistence of the primary vitreous, retrolental fibroplasia, retinoblastoma, Coats' disease, von Hippel's disease, inflammatory pseudoglioma, Norrie's disease, and organized intraocular haemorrhage are mentioned.


Massive periretinal proliferation in retinal detachment in relation to diabetes mellitus.

The relationship between the 'diabetic state' and massive periretinal proliferation (MPP) in idiopathic retinal detachment was examined. In 18 (3.5%) of 508 cases of idiopathic retinal detachment, MPP occurred before or after retinal detachment surgery. In 24 cases of retinal detachment, a diabetic or suspected diabetic state was found. 11 of the 24 were receiving treatment for diabetes and never developed MPP, while 5 of the 13 patients who were not being treated had MPP. This suggests that MPP in retinal detachment may easily be induced by the diabetic state and prevented by treatment for diabetes. Additional causes of MPP in retinal detachment were giant tears, massive vitreous hemorrhages at operation and frequent recurrence.


Scleral pockets and lyophilized sclera in retinal detachments.

For our buckling operations in retinal detachment, we prefer lyophilized sclera because it is well tolerated without tissue reaction, and very easy to handle. Its inertness is demonstrated by histopathological examination of sclera fragments taken during reoperations.


[Vascular changes within the proximal optic nerve in children suffering from glaucoma].

Paraffin-embedded sections of eyes enucleated because of hydrophthalmos (23 cases) or retinoblastoma (59 cases) were examined for vascular changes within the proximal optic nerve. Globes of adults, enucleated because of secondary glaucoma (146 cases), were studied for comparison as well as 19 myopic and 11 microphthalmic eyes enucleated for other reasons, and 19 autopsy eyes of newborns. Microscopic examination revealed an accumulation of dilated thin-walled blood vessels within the septae of the proximal optic nerve of 6 eyes with hydrophthalmos and 11 eyes with retinoblastoma; sometimes the vascular changes appeared somewhat similar to an angioma racemosum. A common finding in all 17 cases was an elevation of the intraocular pressure. There were only 2 cases among the eyes studied for comparison showing dilatations of the optic nerve capillaries: 1 was in a stillborn baby with general hyperemia, and the other was a case of secondary glaucoma in an adult. 9 similar cases have hitherto been published describing vascular dilatations in the optic nerve of children suffering either from glaucoma or retinoblastoma; none of the authors had related these changes to an increased intraocular pressure. It seems likely that hemodynamic changes play an important role in the pathogenesis of these vascular reactions in the proximal optic nerve of infants with flaucoma. A lower arterial blood pressure in infants as well as anatomical and morphological features may be further factors of significance.


GH secretion in open-angle glaucoma.

Open-angle glaucoma is frequently observed in patients with acromegaly suggesting that the somatotropic hormone might facilitate a condition of glaucoma. The open-angle glaucoma patients studied, displayed higher plasma human growth hormone (HGH) levels than control subjects 60 min (30.3 +/- 1.7 against 16.8 +/- 2.7 ng/ml; p less than 0.001) and 90 min (19.0 +/- 1.9 against 9.3 +/- 1.2 ng/ml; p less than 0.001) after intravenous administration of arginine (25 g in 30 min). The authors support the hypothesis that the increased plasma HGH level may interfere with the regulation of ocular pressure by modifying the flow of aqueous humor from the eyeball via changes in the sclero-corneal trabecular meshwork; these changes are also found in diabetic subjects. The interplay between HGH and changes of carbohydrate metabolism (frequently occurring in glaucomatous patients) may be at the root of the variations of intraocular pressure in open-angle glaucoma.


Intraocular hemorrhage in sudden increased intracranial pressure (Terson syndrome).

We examined 19 cases with SAH, 4 of which presented intraocular hemorrhages (retinal, subhyaloid and in vitreous). The mortality rate was 50% when the intraocular hemorrhages were present compared to 20% when they were absent.


Metastatic calcification to the peripheral fundus in chronic renal failure.

Report on massive deposition of calcium hydroxypatite in the eye of a 20-year-old woman who died as a result of chronic renal failure. Massive accumulation of this material within the previtreal space lead to an unusual finding in the peripheral fundus.


[The perimetry of the blind spot. A comparison of kinetic and static, computerized stratgies].

The reproducibility of perimetric results on the blind spot has been investigated under controllnt well-trained perimetrists on 178 eyes of 107 patients; the same eyes and patients were examined twice with the computer perimeter as well. Perimetric results obtained from 158 eyes were considered for statistics. There was qualitative agreement based on the alternative 'normal' or 'pathological' in kinetic perimetry in 74% of the double examinations and in 89% in computer perimetry. Identical size of the blind spot in repeated examinations was found in 34% with the Goldmann perimeter and in 78% with the computer perimeter. Observer variability of the static computer perimetry of the blind spot was compared with the variability of the results on the rest of the central visual field.


Notes on the genetics of congenital glaucoma.

Relying on the analysis of 81 non-Gypsy families with congenital glaucoma from the entire territory of Slovakia, the authors discuss the share of the genetic component in the etiology of the disease. The characteristics of the families of this series resembled those of comparable series as far as the percentage of familial occurrence, the percentage of bilateral occurrence (73.56%), the percentage of parental consanguinity (4.87%) and in the prevalence of males with a ratio of 1.55:1 are concerned. The incidence of the disease in Slovakia varies around 1 per 22,000 live-born infants. In the non-Gypsy population of Slovakia, the authors assume a multifactorial etiology.


Effects of topically applied bupranolol on the intraocular pressure. Effects on the untreated eye.

Topically applied bupranolol, a beta-adrenergic blocking agent, has been shown to have a marked effectiveness in lowering the intraocular pressure of the normal and glaucomatous eyes. The effects were not only seen in the treated eyes but also in the untreated, contralateral eyes. The contralateral response was independent of the ongoing diurnal variation of the intraocular pressure. Instillation of the drug into the nasal cavity induced decrease of the intraocular pressure in both eyes, the extent of which was comparable to the contralateral response induced by ocular instillation. These observations suggest that the contralateral response is caused by systemically absorbed drug, probably due to the action on the central locus regulating the intraocular pressure. Instillation of pilocarpine did not show any similar contralateral response.


Some inorganic constituents of the subretinal fluid.

The inorganic constituents of the subretinal fluid (SRF) were analyzed using atomic absorption spectrometry. Four main elements (Na, K, Ca, Mg) were determined in 41 samples; Cu was determined in 36 samples and Zn in 24 samples. The results are presented graphically, taking into account the concentrations of each element in the SRF and the number of cases. In 9 cases, the concentrations of the inorganic elements were also determined in blood serum; it was established that the SRF is richer in Mg than blood serum and poorer in the other elements. No correlation was found between the concentration of the inorganic elements in the SRF and the clinical picture of retinal detachment.


Inheritance in the etiology of convergent squint.

From a study of 195 unselected cases of idiopathic squint, the authors distinguish three types of squint (simple, accommodative, and with amblyopia). Both sexes are equally affected, the age of onset is later in accommodative squint than in the other two types. The percentage of familial cases (65.4%) is comparable whatever the type of squint involved, the sex of the subjects or the age of onset. The family study and the complex segregation studies show that the hypothesis of dominant autosomal inheritance with incomplete penetrance is the most probable for the three types, but they do not affirm that three distinct entities are involved.


[Meridional amblyopia in humans. A simple clinical test].

The term meridional amblyopia (MA) defines an amblyopia in one meridian, orthogonally to which the visual acuity is normal. This applies to astigmatics. The clinically simple application of a test is described, and the results from examinations of 50 patients with astigmatism are reported. If the first optical correction is performed later than at the age of 6 years, an MA is bound to develop. An early and exact prescription of spectacles is therefore necessary.


[Hypopituitarism and hyperlipidemia. Protective effect of growth hormone deficiency against atherosclerosis (author's transl)].

Twelve cases of hypopituitarism (Sheehan's syndrome, pituitary adenoma, idiopathic) associated with hyperlipidemia (type IIb in general) are reported. It is suggested that: 1 - Growth hormone deficiency seems to have a protective effect against atherosclerosis in hyperlipidemia because there are no cardiovascular signs in 10 cases with a history of growth hormone deficiency lasting from 5 to 57 years and a patent hyperlipidemia (lasting a mean of 23 years), and there is stabilisation or improvement of ischemic signs in 2 other cases. 2 - Lipid abnormalities are frequently seen in hypopituitarism even after thyroid replacement therapy. 3 - The hyperlipidemia can be familial or can result from growth hormone deficiency alone.


[Selective distal spleno-renal shunt. A report of 14 patients (author's transl)].

Fourteen cirrhotic patients underwent distal splenorenal shunt to prevent recurrent hemorrhage from oesophageal varices. No post-operative mortality was observed. Transitory chylous ascites occured in 1 patient, portal thrombosis with concomitant early rebleeding in another one. Hypersplenism was improved post-operatively. Porto-caval encephalopathy was not observed. With a follow-up between 3 and 27 months, one single patient died from hepatic failure, variceal bleeding did not reccur in long term survivors.


[Systematised interstitial emphysema in neonatal respiratory distress. Four cases (author's transl)].

Localisation in one lung only or in one lobe only of lesions of interstitial emphysema is surprising in a diffuse disease such as hyaline membrane disease in premature infants. In the four patients in which this unusual course was seen, cure was obtained in different ways: spontaneously in one case, by excision of a diseased lobe in two cases and by selective temporary intubation of the contralateral main bronchus in the final case. Current methods of treatment of neonatal respiratory distress favour this type of course, without any precise cause being evident. Excision surgery is often avoidable by transient ventilation of the contralateral lung only by selective intubation of the main bronchus.


[Use of Polish synthetic latex LBS 3041 for anatomical studies of blood and lymphatic vessels].

The Polish synthetic latex LBS 3041 produced in Chemical Works "Oświecim" was examined for anatomical purposes. The latex was stained with pigments "Vulkan", pasts of general use "Pastokol" and commercial pigments to emulsive dyes. There was established a much better penetration into small blood vessels by latex LBS 3041 than by latex LBS 3060. On the account of the resistance of the examined latex to the coagulating activity of acetic acid, the hardening of the stuff after the injection of the specimens occurs through the cooling of preparations in the refrigerator.


In vitro activity and pharmacokinetics of cefaclor in normal volunteers and patients with renal failure.

In both Mueller-Hinton agar (MHA) and antibiotic medium no. 1 (AB1) cefaclor was more active than cephalothin or cephalexin against Enterobacteriaceae. Its activity was equivalent to cephalexin against S. aureus in MHA. Cefaclor was particularly active against P. mirabilis. The activity of this antibiotic was greated in AB1 than in MHA. The inoculum effect was pronounced for cefaclor when compared with cephalothin, but cefaclor retained greater activity even against the higher inoculum. In volunteers with normal renal function, cefaclor produced slightly lower blood levels than those reported for cephalexin. Absorption after eating was decreased and delayed. Despite severe renal failure, substantial urine levels of antibiotic were still achieved. In contrast to cephalexin, plasma half-life for cefaclor was only moderately prolonged by renal failure (two-to-threefold) and only minimally shortened by haemodialysis. Adequate concentrations of cefaclor in sputum, active against common respiratory pathogens, could not be consistently demonstrated after the oral administration of a 1 gram dose of cefaclor.


Serum and sputum levels of cefaclor.

In a cross-over study, 10 healthy adult volunteers received 1 g cefaclor and 1 g cephalexin orally 1 hour after a standard breakfast. Serum levels of cefaclor rose somewhat faster and were higher than those of cephalexin in the first 60 minutes. At the end of the second hour the serum concentration of cephalexin was 50--100% higher. The area under the serum level curve averaged 45 hr-micrograms/ml for cefaclor and 60 hr-micrograms/ml for cephalexin. Calculated pharmacokinetic constants indicate that the absorption rate of cefaclor was nearly the same as that of cephalexin. The serum half-life of cefaclor was 1 hr. The urine recovery of cefaclor for 9 hours averaged 65%, whereas cephalexin resulted in a urine recovery of 85%. To evaluate sputum levels, 15 adult patients with bronchial carcinoma and secondary bronchitis or pneumonia were treated with 0.5 g of cefaclor orally 4 times daily. The mean individual sputum levels were 0.44 micrograms/ml (after the first dose) and 0.54 micrograms/ml (after repeated administration). In 10 other patients, after a single 1 g dose of cefaclor mean sputum levels after 1 hour and 3 hours doubled, whereas peak concentrations in sputum after 2 hours did not differ significantly. These results suggest that cefaclor will be useful in respiratory tract infections caused by sensitive bacteria.


Cefaclor in the treatment of susceptible infections in infants and children.

Cefaclor is a new oral cephalosporin with in vitro activity against a wide variety of organisms including S. aureus, S. pneumoniae, S. pyogenes and H. influenzae (including ampicillin-resistant strains). Seventy-nine patients ranging in age from 2 months to 14 years with soft tissue infections (17 cases), otitis media (17), and streptococcal pharyngitis (45) were studied. They received cefaclor orally at a dose of 40 mg/kg per day in three or four divided doses for a minimum of five days. Results were generally good with favourable clinical and bacteriological responses obtained in 90% of cases. Most patients became afebrile within 48 hours after starting cefaclor. Two patients with H. influenzae cellulitis and bacteraemia defervesced within 24 hours and their blood cultures became negative promptly. Hepatic, renal and haematopoietic studies showed no adverse reactions except for an occasional increase in the eosinophil count with no clinical counterpart of hypersensitivity. Pharmacokinetic studies revealed that following a 10 mg/kg oral dose, peak serum levels of 8 micrograms/ml were observed at one hour, followed by a rather rapid tapering off so that at the end of four hours, virtually no cefaclor was detectable in serum.


Cefaclor in the treatment of infections of the ears, nose, and throat.

Clinical experience and laboratory tests in 52 patients (14 to 77 years of age) who had moderate to severe ear, nose, and throat infections were evaluated in this study of cefaclor, a new cephalosporin antibiotic, The drug proved to be effective in the treatment of these infections, and the incidence of side effects was low. Patients received oral doses of 500 mg every 8 hr for three to five days after all signs of infection had disappeared. Therapeutic results were assessed as very good in 31 patients, good in 17, and unsatisfactory in one. Three were unevaluable. The rapid onset of the therapeutic effect obtained with cefaclor in these patients was particularly striking. Some side effects occurred, but they were essentially transient and minor. Cefaclor should become a major antibiotic for the treatment of infections of the ears, nose, and throat.


Cefaclor therapy in acute exacerbations of chronic bronchitis.

Twenty-four patients with acute exacerbations of chronic bronchitis were treated with cefaclor at a dose of 500 mg every 8 hours for 10 days. Studies included volume, appearance and bacteriological examination of sputum, and haematological and virus serology tests. The response to therapy was judged on the reduction in sputum volume or the conversion of its character from purulent to mucoid. Nineteen of 24 patients improved and in 4 of 5 failures, positive serology for influenza virus was found. Growth of Pseudomonas occurred in one sputum. Minor side effects were seen in 3 patients, and no haematological or biochemical abnormalities were found.


Clinical and laboratory studies with cefaclor: efficacy in skin and soft tissue infections.

Clinically relevant, recent isolates of common Gram-positive pathogens were examined for their in vitro susceptibility to cefaclor. Group A streptococci and pneumococci were uniformly sensitive (MICs 0.06--0.12 micrograms/ml) to both cefaclor and cephalothin. Cefaclor was 5--10-fold less active than cephalothin against group B streptococci. S. aureus strains were uniformly more susceptible to cephalothin than to cefaclor, but among isolates from children, almost all were sensitive to the latter drug. In clinical studies of patients with skin and soft tissue infections, cefaclor proved effective. Over 90% of patients with staphylococcal bullous impetigo, streptococcal and mixed streptococcal-staphylococcal forms of pyoderma were cleared after 7--10 day courses of treatment. In addition, twice-daily therapy, examined more recently, proved as effective in these forms of infection as did the conventional dose schedule. No significant adverse reactions were noted. Cefaclor appears to be an effective orally absorbed cephalosporin for common skin and soft tissue infections.


Cefaclor--summary of clinical experience.

Cefaclor, a new semisynthetic cephalosporin antibiotic for oral use, was studied by 62 clinical investigators in 6 countries in 1493 adult and paediatric patients. The pooled data reveal that satisfactory clinical responses were obtained in 80% of urinary tract infections, 87% of upper respiratory infections, 90% of cases of otitis media, 99% of lower respiratory tract infections, and 96% of skin and skin structure infections. Administration of this antibiotic was associated with a low incidence of adverse reactions including gastrointestinal (2.6%) and hypersensitivity reactions (1.5%). Of particular clinical interest were the outstanding results obtained in the treatment of otitis media and lower respiratory tract infections.


An association between sub-arachnoid haemorrhage and influenza A infection.

The sera of 25 patients with confirmed sub-arachnoid haemorrhage were assayed by complement fixation for 14 viruses. Twenty (80%) showed elevated titres to influenza A virus compared with 3 out of 25 (12%) of control subjects matched for age, sex and district and 3 out of 17 (17%) of a group of patients with other neurological disorders. A seasonal variation in the notification of sub-arachnoid haemorrhage appeared to be related to changes in the incidence of influenza A infection.


Clinical and biochemical findings in ten patients with benign myalgic encephalomyelitis.

Ten patients in whom the clinical findings were consistent with the syndrome variously described as 'benign myalgic encephalomyelitis', 'epidemic neuromyasthenia', 'Royal Free disease' and 'Icelandic disease' were investigated for blood levels of myoglobin and various enzymes. Although there is no clinical resemblance between the two diseases, the biochemical pattern bears a close similarity to that found in Duchenne muscular dystrophy (DMD) though differing sharply in that no rise in creatinine kinase levels was found. These findings are discussed with particular reference to recent suggestions that the permeability of cell membranes may be impaired by changes in intracellular energy mechanisms.


The nitrogen to creatinine ratio in untimed samples of urine as an index of protein catabolism after surgery.

The loss of nitrogen after surgery is said to be related to body size as well as to the magnitude of the metabolic effects of surgery. Urine nitrogen should be 'corrected' for body size before it can be taken as a guide to the severity of surgery in the individual. Twenty-three patients were studied after elective abdominal surgery of moderate severity, when they were having only 3 litres of dextrose saline daily. The 24-hr urine nitrogen excretion (mean of days 3 and 4) was correlated with 3 indices of body size, body weight (r = 0.614), fat-free mass (r = 0.743) and 24-hr creatinine excretion (r = 0.780). Nitrogen excretion was corrected for body size by calculating the ratio of nitrogen to each index. For each index the s.d. of this corrected nitrogen excretion at the mean value of the index was less than the s.d. of the uncorrected data. The nitrogen : creatinine ratio in an untimed urine sample was closely related to the ration in the 24-hr urine (r = 0.914). These results demonstrate that nitrogen excretion after surgery is related to body size and can be corrected for body size by calculating the nitrogen : creatinine ratio in an untimed urine.


Axillary hyperhidrosis - topical treatment with aluminium chloride hexahydrate.

Forty-two patients with axillary hyperhidrosis on the waiting list for surgery were treated with topical saturated solution of aluminium chloride hexahydrate in absolute alcohol. There have been 7 failures. Three patients were unable to cope with the treatment and 4 more experienced severe local irritation or soreness; these 4 were submitted to local surgery. This is a simple and effective treatment for the majority of cases of severe axillary sweating.


Cholestyramine in the peritoneal cavity of the rat.

The effects of cholestyramine in the peritoneal cavity of the rat are described. Cholestyramine causes mild peritonitis with adhesion formation between the liver and the omentum. In the management of biliary peritonitis, a lavage solution containing a suspension of cholestyramine would appear to be contra-indicated by these experimental studies.


Ocular reaction to timolol maleate.

A patient prescribed timolol maleate for the control of hypertension developed dryness of the eyes. The symptoms improved on withdrawal of the drug. Vigilance for such adverse reactions must be observed in the use of any beta-adrenoreceptor blocking agent.


Report on a child with stricture following foreign body of long duration in the bronchus. Discussion on the management of bronchial foreign bodies.

A case report and the management of a 10-year-old girl who had inhaled a foreign body into the right intermediate bronchus at some unknown (but certainly not recent) time previously is given. A stricture at the site of the impaction of the foreign body was found. The excision of the stricture and repair of the bronchus with pericardium is described together with a 3-year follow-up report. The diagnosis and immediate management of foreign bodies in the bronchus are discussed and the importance of differentiating organic and non-organic foreign bodies is stressed. The management of bronchial strictures is discussed as is the result obtained in the above reported case.


Control of hypercalcaemia in thyrotoxicosis.

Two thyrotoxic patients with significant hypercalcaemia are described. The hypercalcaemia failed to suppress with hydrocortisone, propranolol and calcitonin but serum calcium fell rapidly to normal with carbimazole treatment. Both patients were subsequently treated surgically and at operation no evidence of parathyroid disease was found. Thyroid disease must be controlled before co-existing parathyroid disease is diagnosed in hypercalcaemic thyrotoxic patients.


Fatality after hepatic angiography in Zieve's syndrome.

A patient with Zieve's syndrome is described. Following hepatic angiography, the patient became shocked and eventually died. The hazards of hepatic angiography are discussed and its use in ill patients questioned.


An isolated case of Legionnaires' disease.

A single sporadic case of Legionnaires' disease which showed some unusual features is described from a young male who had never been out of the United Kingdom. The relevant literature is briefly reviewed.


Coeliac disease presenting with a leuco-erythroblastic anaemia.

A 49-year-old Irishman presented as an emergency with watery diarrhoea and a leuco-erythroblastic anaemia. Investigations showed that he had coeliac disease but no evidence of bone marrow infiltration. His leuco-erythroblastic picture disappeared on treatment with iron and folic acid.


[Total water content in cardiac patients].

In the present study total body water was determined in a group of cardiac patients, using titriated water. The study was performed in a service of internal medicine of an important hospital in Mexico City. Of the 30 patients originally evaluated, only 23 could be considered cardiacs; of these 47.83% had an excess of water, 39.13% had a normal amount and 13.04% were dehidrated. The patients belonged to both sexes and their ages were anywhere between 14 and 82 years. Very often, other aliments or conditions were present which had a bearing on the total body water. The test is innocuous and the bother to the patient is minimal constituting a valuable auxiliary to the clinician.


[Amniotic fluid, amniocentesis, postmaturity].

The exchange among the elements of amniotic liquid is a dinamic process which keeps stable the concentration of their components, showing a variable relation with the maternal plasma in the differents stages of gestation. Thus the formations of the kidneys modifies the amniotic liquid with the urine excretion and then, factors as swallowing; the secretions of the skin and bronchi are factors which are implicated in its production. The amniocentesis is important in the study of high risk fetus, particulary with a prognostic value in the pregnancy sensitized to the Rh factor. The non cultivated celle give us information about the sexual chromatine and enzymes, to get a quick diagnosis, but this has to be confirmed with a culture cells for a final diagnosis, especially in diseases caused by inborn errors of metabolism.


[Hepatic abscess caused by Salmonella].

In Mexico liver abscesses are frequent and most of them are produced by amibas. Sometimes the ethiology is caused by bacterias and its ethiological diagnosis is difficult therefore the specifics treatment takes longer and this may increase mortality. In this issue, the clinical laboratory scand caracteristics are presented on six patients having liver abscess caused by Salmonella as well as its evolution and reaction to treatment.


Effect of residual renal function on minimum dialysis requirements.

In two groups of haemodialysis patients, the effect of residual renal function (RRF) on motor nerve conduction velocity (MNCV) was prospectively studied. Patients belonging to Group I had stable GFR of greater than 1 ml/min while Group II patients had gradually declining GFR. As a result, the dialysis index for middle molecules, DI(MM), remained above 1.0 in Group I despite dialysis schedules as short as 6 hr/wk. DI(MM) in Group II fell gradually below 1.0 as renal function deteriorated on equally short dialysis schedules. None of the five patients in Group I developed neuropathy during 1.2-4.1 years of reduced dialysis. However, all four patients belonging to Group II developed significant (p less than .01) slowing of MNCV when their GFR declined below 0.5 ml/min. Neuropathy in this group was arrested or reversed by increasing DI(MM). It is, therefore, proposed that residual renal function is a major determinant of dialysis requirements.


Haemodialysis in schizophrenia: a double blind study - preliminary report.

The therapeutic effects of haemodialysis were evaluated in schizophrenic patients using a double blind procedure. Twelve patients were diagnosed as acute schizophrenics according to Feighner's criteria for psychopathology. After obtaining informed consent, the patients were randomly assigned to active haemodialysis (AD) or sham dialysis (SD). An 8 days "drug washout period" was followed by AD or SD treatment of 4 weeks (two 5 hours sessions per week) and psychopathological evaluations were performed regularly in a blind fashion using the Brief Psychiatry Rating Scale (BPRS) and the Comprehensive Psychopathological Rating Scale (CPRS). Nine of the 12 patients were improved by both extracorporeal procedures with or without active dialysis. No significant difference appeared however between both groups in the rate and degree of improvement of nuclear symptoms of schizophrenia. Nevertheless, AD was significantly more efficient in relieving affective symptomatology, suggesting the potential involvement of some endogenous dialysable substance (s) in the pathogenesis of mood disturbances in schizophrenia.


Evaluation of the participation of parietal peritoneum in dialysis: physiological, morphological and pharmacological data.

Bidirectional fluxes of Na+, K+ and Ca++ were estimated under in vitro conditions through isolated patches of rat peritoneal membranes (parietal and visceral). Morphological (TEM) and functional (changes in fluxes) data are presented to show that mesothelium lining the parietal peritoneum forms a barrier than limits diffusion of ions across this membrane. In addition, it was found that Furosemide and nitroprusside change the permeability of the mesothelium for sodium or potassium, respectively.


Continuous ambulatory peritoneal dialysis (CAPD) in the treatment of end-stage renal failure.

Our experience of CAPD in 21 patients over a total period of 118 patients months has been evaluated and compared with intermittent peritoneal dialysis (IPD). CAPD was associated with greater clearance of urea creatinine and phosphate, higher concentrations of haemoglobin, improved control of hypertension and saline overload, and better patient acceptance than IPD. It is concluded that CAPD is an effective form of dialysis with many advantages over IPD, although the incidence of peritonitis is still twice that IPD.


Advantages of continuous ambulatory peritoneal dialysis to the diabetic with renal failure.

Among the diabetic patients we have treated with dialysis blood pressure and blood sugar control have been poor and vascular disease progressive. Intermittent peritoneal dialysis did not improve these problems compared with haemodialysis. Continuous ambulatory peritoneal dialysis was undertaken in three patients as a last resort and electively in another two patients. Insulin was given by the intraperitoneal route and none was used systemically. Self-care was taught from the first using the spouse if visual problems were present. Serum creatinine levels fell and haemoglobin levels rose. Blood pressure was controlled without diet or drugs. Blood sugar levels were controlled without symptomatic hypoglycaemia or rebound hyperglycaemia. The procedure had a demoralising effect on helper spouses, and self-care had to be achieved even with severe visual problems. The advantages of continuous ambulatory peritoneal dialysis to the diabetic with renal failure are greatly improved control of blood pressure and blood sugar.


Comparison of solute permeability and rejection characteristics of normal and flux cellulose haemodialysis membranes.

Permeability and rejection properties of new, high flux cellulose membranes and fibres have been compared with Cuprophan PM 150. The greater solute and water flux is explained in terms of larger "pores", which permit greater transport of large molecules.


Intestinal recycling and substitution of haemofiltrate in dogs.

Haemofiltrate was administered into the duodenum of 5 ambulatory dogs through an implanted silastic catheter at a rate of 5-10 ml/min. None of the dogs presented signs of discomfort or suffered from regurgitation or diarrhoea. All 5 dogs had solid stools, enhanced diuresis and no change in body weight over a time period of 8 hours. Filtration rates between 5 and 10 ml/min were obtained in 7 dogs after connecting an Amicon in-line Ultrafilter with an external a.v. shunt. The intestinal recycling rate via the duodenal tube as a rule was 2 ml/min lower than the free flow ultrafiltration. Recirculation of autologous haemofiltrate in 5 uraemic dogs indicated unselective reabsorption of all electrolytes and small molecules. In 5 experiments with intestinal substitution of ultrafiltrate by a potassium-free Ringer's lactate solution, correction of acidosis and decrease in plasma potassium, creatinine and BUN was achieved.


Removal of uraemic toxins by haemofiltration with different membranes. The benefit of regenerating haemofiltrate using a newly developed system.

Based on earlier results which indicate that certain uraemic toxins (verified by an in vitro assay system) are larger than 10,000 daltons - a new system for treatment of endstage renal failure, SElective DUal Filtration ARtificial Kidney (SEDUFARK) has been developed. This system consists of a multimembrane filter/dialyser unit making removal of small molecules (mol wt less than 200) and substances in the mol wt range 10,000 - 40,000 possible without exchange of body fluids. Evaluation of pre and post treatment uraemic plasma with the bio assay showed that SEDUFARK was superior to conventional haemofiltration (CHF) with polyacrylonitrile (PAN) or Gambro Lundia Major High Flux 1.36 m2 (CPN) membranes as filters.


Haemofiltration - critical evaluation of clinical benefits.

To delineate the worth of chronic HF in end stage renal failure, since 1976 we have treated 9 patients with dialysis-resistant hypertension, 6 patients with dialysis intolerance, 7 patients with hypertriglyceridaemia and 7 patients with polyneuropathy. We found an improvement of polyneuropathy and volume-sodium dependent hypertension and symptoms of dialysis discomfort markedly diminished. No amelioration was detected in anaemia, hypertriglyceridaemia and volume-independent hypertension. Hyperphosphataemia was poorly controlled despite increased amounts of aluminium hydroxide. PTH values increased and renal osteopathy seemed to deteriorate.


Influence of the plasticiser di-2-ethylhexyl-phthalate on drug metabolising enzymes in the liver of uraemic rats.

After bilateral or subtotal nephrectomy male rats were given intraperitoneal injections of the plasticiser di-2-ethylhexylphthalate (DEHP) at differing time intervals in doses that do not affect the liver of normal rats. 200mg DEHP/100g body weight had no influence on the parameters measured. After administering 7 x 200mg/100g body weight for 14 days, liver weight and in vitro activity of the mixed function oxidation system increased significantly. In addition, the hexobarbital sleeping time decreased, indicating a stimulation of the activity of drug metabolising enzymes in vivo. Similar results were obtained after the administration of 56 x 50mg DEHP/100g body weight for 19 weeks. It is concluded that uraemic rats are more susceptible to inducing effects, but that the DEHP toxicity is of little importance.


Two year sequential haemodynamic data on polytetrafluoroethylene (PTFE) grafts used for haemodialysis.

Forty-one PTFE grafts were studied prospectively with measurement of intragraft pressure and flow. As well, cardiac function was assessed by measuring cardiac output, ejection times and ejection fraction. It was shown that graft failure was associated with changes in graft pressures and flow. No untoward effects of graft flows of 1-2L/min were found on cardiac function.


Thermography: an alternative to angiography for vascular access survey in haemodialysis.

Results obtained by thermography and angiography in surveying vascular access have been compared in 33 haemodialysis patients, including 23 with Cimino arteriovenous fistulae and 10 with homografts and heterografts. In 23 of 30 patients, blood flow stealing through collateral veins, or venous stenosis was detected by thermography and confirmed by angiography. Thermography seems a quick and simple method in routine conditions, restricting angiography to selected patients for whom a surgical revision of the fistula or of the graft is needed.


The effect of transplantation on dialysis dementia.

Seven patients with dialysis dementia are described. Three patients, symptomatic from dementia at the time of transplantation, had a rapid exacerbation of their symptoms with deterioration to death. Four patients, asymptomatic at the time of transplantation, developed symptoms of dementia after surgery. Two of these had a rapidly fatal illness while the remaining two had a mild illness. One subsequently died from a myocardial infarction while the other gradually improved sufficiently for her to return to work. This experience indicates that transplantation is to be avoided in patients with dialysis dementia.


Plasma inhibitors of the erythrocyte hexose monophosphate shunt in uraemia.

Sulphaemoglobin production, induced by an oxidative stress (ascorbate and cyanide) has been studied in uraemic patients. Results are expressed as the ratio of optic density of sulphaemoglobin (620nm) to optic density of total haemoglobin (540nm). The mean (+/- SEM) ratio found was 0.35 +/- 0.03 in 28 controls and 0.56 +/- 0,03 in 51 uraemic subjects (p less than 0.001). Cross incubation tests demonstrated that the anomaly was caused by a plasma factor. In vitro studies - guanidinic compounds added to control erythrocyte suspensions before incubation - suggest that this factor might be guanidinic propionic acid.


Are erythropoietin levels in uraemic patients on haemodialysis dependent on the kidney disease and the duration of haemodialysis treatment?

Determinations of immuno-detectable Erythropoietin (idEP), haematocrit (Hct), reticulocyte counts (RC) and serum iron (SI) in uraemic patients with different kidney diseases (KD) and various lengths of chronic haemodialysis treatment (HDT) revealed firstly that all patients had normal idEP, except for analgesic nephropathies who had significantly higher idEP levels; secondly that over six years of haemodialysis idEP increased by about 40% but without concomitant Hct improvement and thirdly that there were no clear interdependencies between Hct, SI, RC and idEP in uraemic patients. In conclusion, inhibitors of erythropoiesis seem to be a major pathogenetic factor in renal anaemia besides a relative deficit in idEP.


Recovery of kidney function following prolonged acute renal failure.

Twenty-two patients with prolonged acute renal failure (ARF), successfully treated by haemodialysis, were analysed. The clinical course was oliguric in 16 and non-oliguric in 6 cases. Twenty-seven haemodialyses on average (15-54) during a mean duration of 66.9 (30-172) days were needed for recovery of kidney function. Overall, maximum improvement of renal function was achieved within 116.4 (51-259) days, in oligo-anuric cases within 80.1 (51-208) days, in non-oliguric cases within 160.3 (90-259) days. In the latter group pre-existing renal damage was probably the cause of the more extended duration of acute renal failure.


Treatment of renal amyloidosis with dimethylsulphoxide (DMSO).

Amyloid fibrils can be dissolved by dimethylsulphoxide (DMSO) in vitro and in vivo. This prompted us to investigate the therapeutic value of DMSO in renal failure caused by amyloidosis. Two patients with renal failure caused by secondary amyloidosis due to rheumatoid arthritis, showed a remarkable improvement of renal function. The effect of DMSO in amyloidosis secondary to rheumatoid arthritis seems to depend on its anti-inflammatory action, resulting in a decrease in amyloid formation. No evidence was found for an increase in amyloid degradation. The effect of DMSO in primary amyloidosis was inconclusive.


Postprandial serum creatinine increase in normal subjects after eating cooked meat.

Ingestion of meals containing cooked meat caused a marked postprandial increase in serum creatinine concentration, whereas ingestion of raw meat had no effect on serum creatinine. A peak mean value was seen 3 hours after the start of meals. No change in creatinine clearance was observed. Analysis of serum creatinine by conventional autoanalyser and by an ion exchange method ('true creatinine") showed a high degree of correlation, making a possible effect of non-creatinine chromogens unlikely. It was shown that creatinine is produced from creatine when meat is boiled.


Evidence of high polymeric IgA levels in serum of patients with Berger's disease and its modification with phenytoin treatment.

High levels of polymeric IgA were found in the serum of patients with IgA glomerulonephritis. In four of the patients the IgA percentage distribution was established by ultracentrifugation in sucrose density gradients before and after six months of phenytoin treatment. A decrease in polymeric IgA, adopting a pattern similar to the controls, was observed. These findings may have both pathogenic and therapeutic implications.


Plasma separation in Goodpasture's syndrome and multiple myeloma.

1. Plasma separation using membranes is equally as effective as plasmapheresis using a cell separator. 2. In Goodpasture's syndrome pulmonary haemorrhage improves very quickly with plasma separation. In patients with multiple myeloma, hyperproteinaemia is easy to correct. 3. Plasma separation is well tolerated, both subjectively by the patient and objectively by the circulation. 4. Since the membranes are permeable not only to IgG but also to IgM, circulating antigen-antibody-complement complexes must also be easy to remove using the plasma separation method.


Renal reflux, scarring, cystometrography and tissue types.

Four families with a variety of renal tract abnormalities including reflux, cortical scars, atrophy and duplex systems are described. Cystometrograms in eight with reflux and scars did not show any evidence of outflow high pressure systems. Tissue typing was carried out in a proportion of affected and unaffected family members, and with the addition of another reported family that had been tissue typed, showed an increase in A9, B8 and homozygosity in the families with these abnormalities. A retrospective survey of transplanted patients with tissue type A9 showed a higher prevalence of pyelonephritis and associated abnormalities than other diseases leading to end stage renal failure.


HLA Bw35 antigen and mesangial IgA glomerulo-nephritis: a poor prognosis marker?

Familial cases of mesangial IgA glomerulonephritis (MGN) have raised the possibility of a genetic control in this disease. In 50 patients with MGN, diagnosed on renal biopsy, and in 105 controls, we have compared the distribution of HLA antigens (A and B loci). We found a significant increase in the frequency of HLA Bw35 antigen in the patient group compared with controls (36% versus 13%: p less than 0.02). There was no significant difference between the Bw35 positive and negative MGN subgroups, in clinical, serological, and pathological data. Both subgroups had elevated mean serum IgA levels (154% of normal), and also mean serum IgM levels (146%). However, the follow-up data exhibited a significantly worse prognosis (p less than 0.01) in the Bw35 positive subgroup: 9 out of 18 patients versus 4 out of 32 progressed to chronic renal failure (serum creatinine greater than 1.5 mg/dl). We have established a genetic linkage between the HLA complex and the occurrence of MGN. The Bw35 antigen may serve as a marker (risk of disease = 4), in particular for poor prognosis cases.


Oxalic acid concentration in serum measured by isotopic clearance technique. Experience in hyper- and normo-oxaluric subjects.

In a family from which two children suffered from primary hyperoxaluria the renal clearance of (14C) oxalate was studied. The (14C) oxalate/creatinine clearance ratio ranged from 1.76-2.63 (mean: 2.03) and appeared to be independent of glomerular filtration rate (GFR). The calculated plasma oxalate concentrations in normo-oxaluric subjects ranged from 0.1-0.9 mumol/L, whereas in hyperoxaluric subjects values between 3.2-16.3 mumol/L were found. The mean biological half-life of (14C) oxalate was 2.7hr in subjects with normal renal function and increased proportionally with renal functional impairment. Recovery of (14C) oxalate ranged from 87-112% (mean: 101%). All urine (14C) activity was found in the oxalate fraction.


Thiazide diuretics in renal hypercalciuria.

Forty-six renal hypercalciuric normocalcaemic patients were treated with hydrochlorothiazide (50mg/day) and amiloride (5 mg/day), both to reduce new stone formation and to suppress parathyroid hyperfunction. A reduction of hypercalciuria and suppression of parathyroid hyperactivity were observed in 41 patients, while in the other five patients no evidence of parathyroid suppression was found and hypercalcaemia developed. Four of five patients underwent parathyroidectomy which was followed by a normalisation of biochemical signs of hyperparathyroidism. These results suggest that the appearance of hypercalcaemia in renal hypercalciuric patients during hydrochlorothiazide/amiloride treatment may be of diagnostic value in unmasking pharmacologically non-suppressible normocalcaemic hyperparathyroidism.


Production and action of a natriuretic hormone in isolated rat kidneys: necessity of prostaglandins for its release.

A natriuretic factor prepared from plasma of salt loaded rats is active on a totally isolated cell free perfused rat kidney. The progressive increase in fractional sodium excretion with the amounts of injected factor shows a dose-response curve. The inhibition of prostaglandin synthesis does not modify the kidney response to the natriuretic factor. The isolated kidney is able to produce this factor but the inhibition of prostaglandins suppresses its production. Therefore, we conclude that the presence of prostaglandins is a prerequisite for the production but not for the action of the natriuretic hormone.


Evidence for aluminium accumulation in renal failure.

There is increasing evidence that aluminium accumulation in patients with impaired renal function has pathological consequences. The serum aluminium content of 45 patients with chronic renal failure was found to be significantly elevated when compared with normal subjects. A further rise in serum aluminium concentration was seen in patients with chronic renal failure when they were taking aluminium-containing phosphate binding agents. Patients with stable but moderately impaired renal function who are taking aluminium-containing phosphate binders for several years may be at risk from aluminium accumulation and the development of osteomalacia and encephalopathy as seen in patients on intermittent haemodialysis.


Drug metabolism in birds.

Papers published over 100 years since the beginning of the scientific study of drug metabolism in birds were reviewed. Birds were found to be able to accomplish more than 20 general biotransformation reactions in both functionalization and conjugation. Chickens were the primary subject of study but over 30 species of birds were used. Large species differences in drug metabolism exist between birds and mammals as well as between various birds, these differences were mostly quantitative. Qualitative differences were rare. On the whole, drug metabolism studies in birds have been neglected as compared with similar studies on insects and mammals. The uniqueness of birds and the advantages of using birds in drug metabolism studies are discussed. Possible future studies of drug metabolism in birds are recommended.


Central hypotensive action of bridge analogues of clonidine.

The experimental compounds St-1913, St-1966 and St-1967 in which the bridging nitrogen atom, as found in clonidine, has been replaced by a methylene (--CH2--) function, an oxygen or a sulphur atom, respectively, have been investigated with respect to their acute hypotensive effects in anaesthetized cats. Attention was paid to a possible contribution of the central nervous system to the hypotensive action of the drugs by means of vertebral arterial infusions. Although less active than clonidine, St-1913 and St-1967 are centrally acting hypotensive drugs. Central alpha-adrenoceptors are presumably involved in a similar manner as in the mechanism of clonidine. The hypotensive potency of St-1966 was much lower compared to the aforementioned drugs. A central origin for its depressor effects could be established. However, central alpha-adrenoceptors probably do not participate. In spite of its structural similarity with clonidine the mechanism of action of St-1966 appears to be different.


Relationship between urinary excretion rate, steady-state plasma levels and diuretic response of furosemide in the rat.

The purpose of the present study was to determine if furosemide's active transport process could be saturated at therapeutic concentrations and to define a relationship between furosemide in a measurable sampling compartment and its diuretic effect. The experiments utilized Sprague-Dawley rats, ranging in weight from 248 to 313 g, anesthetized with sodium pentobarbital (60 mg/kg). The femoral artery and vein as well as the bladder were cannulated, and samples were taken to measure inulin and furosemide concentrations. 28 rats were infused, after a suitable loading dose (0.5--1.5 mg/kg), to steady-state plasma furosemide levels over the therapeutic concentration range 0.8--25.1 micrograms/ml. Total renal clearance (corrected for kidney function as measured by inulin clearance) showed a negative correlation with plasma concentration (r = -0.655 p less than 0.001), and a good correlation was found between urine flow rate and the urinary excretion rate of furosemide (r = 0.777, p less than 0.001). Steady-state plasma levels of furosemide showed a poor correlation with urine flow rate (r = 0.377, p greater than 0.10).


Tryptic action across a membrane.

Tryptic action occurs when a layer of bovine serum albumin adsorbed on a nickel-plated slide and protected by a Formvar membrane 120 A thick is treated with dilute trypsin solution. But experimental evidence indicates that the trypsin molecules to not cross the membrane. Thus the proposal that trypsin can exert its enzymatic action without intimate contact with the substrate, first set forth in 1948 but later abandoned in favor of a "forced diffusion" hypothesis, now appears the correct interpretation. Analogously, antibodies can be specifically immobilized on one side of a membrane separating them from adsorbed antigens located on the other side.


Physical plasma in biological solids: a possible mechanism for resonant interactions between low intensity microwaves and biological systems.

Observed semiconductor properties of biological material in vitro indicate possible involvement of semiconduction in biological processes. Since in inorganic semiconductors solid-state plasma occurs, it is hypothesized that in organic semiconductors solid-state plasma similarly occurs. Some results of experimental investigation of resonant effects of microwaves in biological systems are considered in the light of that hypothesis. The conditions necessary for the existence of physical plasma in biological solid structures are discussed, and certain parameters of physical plasma in these structures are evaluated. Its is proposed that microwave radiation may support or damp plasma oscillations, thereby stimulating or suppressing biological functions.


A new application of ellipsometry: assessment of carcinoembryonic antigen interaction with lectins at a liquid-solid interface.

Lectins were specifically adsorbed on a metallized glass slide coated with carcinoembryonic antigen. The degree of interaction was rapidly determined by measuring the thickness of the adsorbed lectin layer with an ellipsometer.


Search for superconducting regions in lysozyme.

The rate of electron transfer between a spin-labeled lysozyme molecule and a platinum electrode was measured in aqueous solution in the presence and absence of an external magnetic field of approximately 100 mT. The rate showed no significant change. This behavior is unlikely to be consistent with the regions of superconductivity in lysozyme proposed by Ahmed et al.


[Problems of symptomatology and epidemiology of early-summer meningoencephalitis (tick borne encephalitis)].

Three forms related to different age groups are discussed. Special attention is devoted to laboratory analyses in support of clinical diagnosis. A representative sample of sera from the healthy population of Thuringia showed 6.97 per cent positive sera. The difference between the exposed agricultural and forestry workers and industrial workers is significant. Moreover, there is a relationship between the extent of wooded country and the presence of microfoci.


[The neuroradiological diagnosis of the basilar impression in routine viewing of full size radiographs of the skull].

After a survey of the literature and the representation of the problems of the varied, frequently bony malformations of the cranivertebral transitional region, the basilar impression, neuroradiological measured values obtained by the authors for the craniocervical region are given. From the great variety of measuring methods three procedures, line after McGregor, bimastoid line and height index after Klaus, because of their informative value and simple application, were superimposed. The limiting values were obtained from the sum of mean value and standard deviation. The measured values used were obtained from 2,000 full-size skull radiographs and processed for statistical purposes. By means of this measuring pattern it is possible to assess quickly the transitional region of the general skull radiographs with respect to the presence of a basilar impression.


[Modified recording procedure for the determination of I/t-curves with arterial pulse recording and acoustic signal generation].

I/t-curves were derived by means of a piezo-electric transducer. To receive the minimum responses more than just optically, an amplifier, which was coupled to a transducer, generated an acoustic signal. This modified technique serves to objectivity of the minimum response, which is important in the recording of the I/t-curves. As has been shown in a great number of tests, this procedure has proved to be useful in practice.


[Rest and function rheoencephalographic parameters for the identification of cerebral vasculopathy].

In patients with a cerebral vascular process, parameters for the loss in distensibility and the remaining regulation with of sclerotically changed cerebral vessels were obtained by employing a special complex rest and function rheoencephalographic investigation method.


[Changes in psychological performance parameters of concentration and critical flicker-fusion frequency with advancing age and in relation to diffuse cerebral arterial affections of the circulation].

Psychometric performance parameters and the critical flicker-fusion frequency are studied in various groups and in patients with chronic cerebral circulation trouble. Test d2 proves to be effective in the measuring of such impaired performance. There is a higher degree of correlation with Paul's addition test. A correlation between the performance parameters and the patient's age can be statistically substantiated. Among patients up to one third in the age group 55 and over show and affection of the cerebral performance turbances in spite of the absence of pathological clinical findings. The figure is twice as high in the group of patients undergoing treatment. The increased occurrence in old age shows the significance of pathological processes. There appears to be no relationship between critical flicker-fusion frequency and performance and stress factors. Individual correlations would support other physiological relations, such as an at present only hypothetical link with the psychic state (nervousness) of the test person. Our tables are suitable for practical purposes.


[Prognosis, chronification and therapeutic relations in unsatisfactorily improved secondary faulty developments with cardiovascular affections].

In a group of 36 neurotic women with unsatisfactory psychotherapy results, prognostic criteria, chronifying factors in the course, therapeutist-patient relations, test data, and social and clinical criteria were ascertained for an assessment of success by neutral examiners and statistically correlated. The significance of common prognostic criteria is relativised and the therapeutist-patient relation is determined as an influencing factor through which prognostic and chronifying factors are translated into the therapeutic process. The relevance of the paranoid scale of the MMPI as an objective prognostic sign is particularly noted.


[Investigation into the effect of fluphenazine hydrochloride (lyorodin) in children with behaviour disorders by means of psychophysiological parameters].

In a group of 44 children with behaviour disorders, the mode of action of the phenothiazine preparation fluphenazine hydrochloride (Lyorodin) was tested by means of psychophysiological methods of measurement (critical flicker-fuse frequency and measurement of the response time). In some of the comparative examinations before and after administration of the drug significant differences were found. A defined psychic stress resulted in changed measured values in both methods. Children with cerebral injuries showed a lower degree of reaction after the administration of the preparation than children not encephalopathically affected.


[Theoretical and practical aspects of position and function of the outpatient department in the sectored psychiatric care system].

After discussion of the sectoring scheme, its advantages and the necessity for its realisation, important tasks of the sectored outpatient department are described. These include the mediating function of the OPD between local authorities and the whole psychiatric care system, concerns of early rehabilitation (Volovik) and psychotherapy, basic organisational and structural conditions of outpatient services, public relation activities, and continued training, co-operation with other authorities the necessary uniting of special outpatient department and psychiatric advisory centre.


[University clinics and specialized hospitals in psychiatric work].

Starting from the importance of theoretical thinking to the development of sciences, the insufficient interrelation between theory and practice in psychiatry is dealt with. This is mainly due to the fact that the traditional model of thinking does not offer a basis for topica problems of psychic and social conditions, rehabilitation, epidemiology and the organisation of the system of the care of psychic patients. The causes originating in the dichotomy in the development of psychiatry in university and specialised hospital are pointed out and possibilities of problem solutions on a theoretical and institutional level are discussed.


[Therapeutic neglect omission of individual treatment of secondary defective developments].

The increasing application of group psychotherapy involves the danger that secondary defective developments which cannot be cured within the group, will be neglected. For these, a specific psychotherapy is necessary and particularly urgent since these cases show a tendency towards becoming chronic. Such cases include obsessional neurosis, situation phobia, nosophobia, occupation neurosis, expectation neurosis, psychogenic impotence, anorexia nervosa, and compulsive vomiting. Secondary defective developments in the majority part of patients who consult a psychotherapist. As fear neuroses, they have to be separated from wishful neurosis (hysterical neurosis). There is an urgent need for psychotherapists to be trained and given continued training in the treatment of secondary defective developments so as to be able to treat such patients.


[Phlegmatic temperament from the psychiatric angle].

Unlike the other five deadly sins of the Church, sloth is not attributed to an instinct or an impulse but to an anancastic form of reaction. A phlegmatic person is characterised by a lack of egoistic or altruistic instincts while feelings of nausea or fear are increased. Among phlegmatic persons those of clinical importance are epileptoid psychopaths, oblomovists and those exhibiting (forms of) phlegmatic temperament combined with obsessional or hysterical neurosis.


[Controlled drinking as therapy target in the treatment of alcoholics].

The question of re-acquired controlled drinking as a therapy target in the treatment of alcoholics should be studied under the concrete social conditions of the GDR by specialists in treatment and prevention together with the practitioners, on the basis of an exact programme. Some proposals for the practical proceedings are submitted.


[The forensic-psychiatric expert opinion on offenders under the influence of alcohol. Structure and problems].

The authors recommend and comment on the following structure for forensic-psychiatric expert opinion on offenders under the influence of alcohol. (I) Statement as to the presence of psychopathological impairment apart from acute intoxication, and, if present, what impairment. (II) Assessment of the actual impairment due to intoxication at the time of the offence. (III) The interaction of the factors set out in (I) and (II). (IV) Assessment of personal responsibility for the state of intoxication.


[Propensity of alcoholics to develop epileptic seizures].

The frequency of cerebral cramp-seizures of alcoholics is higher as stated in literature. Alcoholics with a withdrawal syndrome are liable to cerebral cramp-seizures. A cerebral cramp-seizure indicates an unfavourable prognosis of the disease.


[Value of CT and lymphography in the staging of lymphomas (author's transl)].

The contribution of CT is evaluated in association with conventional diagnostic investigations in the staging of lymphomas. The data obtained by means of CT are an integration of those obtained by means of lymphography. On the other hand CT offers elements which cannot be obtained by others methods, especially concerning the retroperitoneal region. This diminishes the average of patients who must undergo laparoscopy and laparotomy. Moreover CT allows to follow the evolution of the disease and to control the results of the treatment.


[Radiological localisation of parathyroid adenomas (author's transl)].

Cervical esophagography in anterior-posterior view with 100 mm spot-camera and rapid sequential filming is useful in the localization of parathyroid adenomas. In 2 of 3 consecutive patients with hyperparathyroidism adenomas were successfully localized preoperatively.


[Kinetics of the biliary system (author's transl)].

A dynamic study of the hepato-biliary system was carried out by means of HIDA-99mTc and of a gamma-camera. The study was performed in basal conditions and after administration of a fatty meal. Normal subjects and patients suffering from various diseases of the biliary system were examined. The method is simple and well tolerated. Three mechanisms are invoked and discussed concerning the kinetic reactions of the gall bladder and the biliary ducts.


[The single ventricle: plain film and contrastographic radiologic findings (author's transl)].

The radiologic findings on the plain film are investigated in a series of 9 patients with single ventricle. In 3 of them the cardioangiographic patterns are described. The possible association of malformations is stressed. The value of the cardioangiographic investigations is discussed in planning a possible surgical treatment of the disease.


[Routine double-contrast radiographic examination of the esophagus].

The authors evaluate the opportunity of extending the double-contrast technique to the X-rays examination of the esophagus, with particular regard to physical and chemical features of barium compounds used at present for the X-rays study of digestive tract. The authors expose the results of this kind of X-rays examination in the most important fields of esophageal pathology. Personal experience actually demonstrate the opportuny of extending the double-contrast technique to routine practice, as a first approach to the double-contrast study of the upper digestive tract.


[New radiological aspects of the intestinal mucosa in celiac sprue: injection of barium into the intestinal glands].

The radiologic findings are described of mucosal folds thickening in coeliac sprue in patients with short clinical history. Moreover attention is pointed on the flattening of the valves and the thinning of the intestinal walls which appear in dilated segments in cases with evident clinical findings. Finally in patients with long standing clinical manifestations and histologic positive controls, a thin spiculation of intestinal outlines and a dotted mucosal surface are visible, probably due to the filling of the Lieberkühn glands with contrast medium.