[Basalioma of the face: problems of treatment and rehabilitation (author's transl)].

The authors communicate the results of their experiences with 96 basaliomes. 62.5% of patients were men. The mean age was 62 +/- 1.38 years. Basaliomes were most frequent on certain sections of the face: 49 were situated in the ear region, 19 in the eye region and 24 on the nose. We observed only one basliome on the upper lip, and five others in the temporal and occipital region. 26 out of 96 patients were already treated outside, some of them even several times, before coming for our treatment. Our best results were obtained by surgical operation and this for of the following reasons: 1. Results are as good as with other methods. 2. Better cosmetic results were obtained by methods of plastic surgery. 3. Costs are reduced because of short treatment. Therefore most basaliomes were operated (77 = 80.2%). In 17 cases combination with radiotherapy was necessary because of the importance of the tumor. Two patients were only radiated because they refused surgical treatment. We observed relapse in 11 cases, 4 of them were reoperated, 6 were reoperated and radiated and one of them was only radiated. So we obtained on overall cure-rate of 98.9%. Because of high frequency of basaliomes on nose, ears and eyes certain surgical procedures related by us showed good results and didn't need hospitalisation of the patients. We recommend to hospitalise patients with angular basaliomes of the eye always, because they often have a deep extension, and the defects created by operations are difficult to be treated by plastic surgery. We think that our methods of therapy could be taken as an example.


[Carcinoma of the hypopharynx as late sequel to x-ray exposure (author's transl)].

Two cases of x-ray induced carcinomas of the hypopharynx after radiation treatment of a struma some decades ago are described. Therefore widespread application of x-ray radiation in the treatment of benign tumours should be avoided. On account of a serious local damage of the skin in both patients the administration of an immoderate dosage must be supposed. This observation seems to be especially remarkable because these patients have been irradiated in the forties which is much earlier than other x-ray induced carcinomas reported in the literature.


[Indication and treatment results in elective neck dissection (author's transl)].

Only in about 17 per cent of 129 patients was elective radical neck dissection (RND) carried out in a seven-year-period from 1970 to 1976. In spite of clinical negative lymphatic-nodes-palpation-findings there were 10 observations of histological sured metastases from 22 patients. There occurred especially often tonsil-lateral larynx-entry-and tongue carcinoma of tumour stage T3 as primary localisation. Because of the high seize-rates in the resection-preparations we recommend inclusion of operation in so-called tumour findings more than before in treatment plan.


[The reconstruction of the hypopharynx and the cervical esophagus (author's transl)].

Since 1973 16 reconstructions of the hypopharynx and cervical esophagus were performed. The restoration of swallowing was achieved in 7 cases after partial resection of the pharynx, 9 times after total laryngo-pharyngectomy and twice after laryngo-pharyngo-esophagectomy. The indication for surgery and criteria for the surgical methods to be applied are discussed. It is possible to combine the reconstruction of the pharynx with building up a neoglottis with Staffieri's technique for restoring voice function. As a one stage procedure to the hypopharynx and cervical esophagus after total laryngo-pharyngectomy the methods of Loré as well as the reconstructive techniques using regional flapes are useful. The larynx-hypopharynx-esophagusresection of Ong and Lee (1960) whould be prefered if the rumour involves the orifice of the esophagus, because an extensive submucosal growth of the carcinoma is to be expected. A two stage procedure is preferred when recurrences of cancer especially after x-ray therapy have to be treated, or a bilateral radical neck-dissection has to be done. This concept offers smaller risks and is finally also faster. A method is demonstrated using a bridge flap for the protection of the carotid artery and the reconstruction of the posterior wall of the pharynx using a deltopectoral flap for rebuilding the lateral and the anterior walls of the pharynx.


[Primary functional reconstruction of the floor of the mouth following surgery for cancer (author's transl)].

The authors tell of their experience with the reconstruction of the floor of the mouth following surgery for cancer. They feel that especially in older patients with bad general condition the simplest surgical methods of reconstruction are the best.


[Immediate reconstruction of the fractured anterior wall of the frontal sinus (author's transl)].

Report on 83 cases of frontal sinus wall fractures. All cases including those with cerebrospinal liquorrhea, early meningitis and brain tissue prolaps were operated on as early as possible, and the anterior wall of the frontal sinus reconstructed immediately by means of multiple wire osteosyntheses. The follow up shows that even very small bone fragments are built in again, and no resorption ensues. X-rays and bone-scintigramms show that these membranously preformed bone fragments reunite well and consequently underly other healing conditions than chondrally ossified bones. Until now, no endocranial complications at all have appeared. The procedure although primarily timeconsuming, has proven to be superior to the Riedel obliteration method with following plastic restoration of the profile as regards the cosmetic results and the length of treatment.


[The effect of sympathectomy on the cochlear oxygen pressure (pO2) under conditions of haemorrhagic hypotension (author's transl)].

Oxygen partial pressure was measured in the endolymph area of the cat cochlea under conditions of hemorrhagic hypotension. The experiments took place after unilateral upper cervical sympathectomy and under control conditions. The pO2-measurements were carried out with the aid of polarographic micro-coaxial needle electrodes according to Baumgärtl and Lübbers (1, 2, 3). In animals which had not been sympathectomized, the cochlear pO2 decreased continuously parallely to blood pressure, with the beginning of bleeding. After sympathectomy pO2-decrease in cochlea only occurred at substantially lower aortal blood pressure. This allows the following conclusions: 1. Under conditions of hemorrhagic shock the blood flow of the inner ear is not as much included in central circulation as brain and heart. 2. The blood pressure dependence of the inner ear blood flow depends on the sympathetic innervation, it can practically be abolished up to a blood pressure of 65 mm Hg by denervation. 3. It is being discussed, which therapeutic consequences can be drawn from the evident influence of the sympathetic innervation on the inner ear blood flow.


[Paraganglioma of the nodose ganglion of the n. vagus].

A case of a 47-years-old female patient treated for a vagal body tumor is presented. The origin, clinical appearance and special diagnostic and therapeutic problems created by this rare tumor are discussed.


[Atresia of the larynx, a rare cause of postnatal respiratory distress (author's transl)].

An infraglottic atresia of the larynx with normally developed vocal cords necessitated postnatally an emergency tracheotomy after intubation attempts had failed. Laryngeal atresia is a very rare malformation. As in our example, it is in most cases accompanied by a tracheo-hypopharyngeal fistula which has to be interpreted ontogenetically. The survival chances of the newborn with this malformation are generally very poor.


[Direct laryngoscopy under difficult conditions (author's transl)].

The direct view into the glottis can be difficult due to long teeth in the upper jaw or abnormities of the neck vertebrae. It is recommended in these cases to use either a mediastinoscope with a lateral slot or the McIntosh laryngoscope, which is commonly used for intubation. The latter can be attached to the chest stay of the normal laryngoscope by using a special joint. The tip of the McIntosh laryngoscope is inserted into the valleculae instead of loading up the epiglottis as is done with the normal laryngoscope. Recommended aids for ciopsy or polypectomy are the 30 degrees-optical system of bronchoscopy or the gastroscope, each with its forceps.


[Papillomas of the mucous membranes of the larynx and pharynx. Relations between enzyme histochemistry and histological classification (author's transl)].

If there is a histochemical demonstration of acid phosphatase and lactat dehydrogenase with cryostat-microtom-sections of 30 papillomas of the mucous membran of larynx, pharynx and cavum oris you often can find strong activities in tissue with frequent atypical epithelial cells. Intensive appearances after reactions of NADH-tetrazolium-reduktase are correlated with strong hyperplasies and proliferations of the epithelial tissue. Cell groups in the stroma, which are immuncompetantly are showing an moderate activities of acid and alkaline phosphatase, esterase and NADH-tetrazoliumreduktase.


[The value of exfoliative cytology in the larynx as a screening procedure (author's transl)].

The examination of 258 patients shows that exfoliative cytology in the larynx has no validity as a screening procedure. Cytology must be considered inferior to histologic examination by the high percentage of false negative results in laryngeal malignancies.


[Amylase activity, protein concentration and flow rate of unstimulated human parotid saliva (author's transl)].

Unstimulated parotid saliva was collected of 90 persons without diseases of the salivary glands. Amylase activity, flow rate and protein concentration were determined in the 90 saliva samples. Saliva was collected under standardized conditions by means of a catheter introduced into the secretory duct. Amylase activity as well as flow rate and protein concentration are log-normally distributed in both unstimulated and stimulated parotid saliva. The donors' age had an influence on flow rates but not on amylase activity or protein concentration. The values obtained in the described manner of "healthy" persons (with respect to salivary glands) will be used as controls in clinical studies with persons suffering inflammatory and noninflammatory salivary gland diseases.


[The influence of menstruation cycle on human parotid saliva composition (author's transl)].

The influence of different sexual hormone levels during menstrual cycle on the composition of human parotid saliva was investigated. During mid-cycle there were significantly enhanced concentrations of ionized calcium, total calcium, inorganic phosphate and sodium in parotid saliva. The changes in chloride concentrations were parallel to that of sodium and the excretion of postassium was inverse to that of sodium. The maximal out-put of total protein and alpha-amylase was found during midcycle and menstruation.


[Changes of tube ventilation after nasal septal reconstruction and turbinotomy (author's transl)].

The influence of endonasal operations on tube dysfunction was examined. Because of rhinomanometric proved reduced ventilation a nasal septal reconstruction, in some patients combined with turbinotomy, was performed. Before the operation and then up to two years after the operation tube function was registrated using tube manometry. Compared with the praeoperative results 12 patients out of 37 showed an improvement in tube function. After the operation 7 out of 28 patients were able to provide active equalization of a negative pressure in the middle ear and thus required the ability for physiological middle ear ventilation. In some cases the optimal tube manometric results were achieved not before the end of the observation period of two years. This investigation leads to the conclusion that in cases of reduced ventilation a nasal septum reconstruction should precede a tympanoplasty in order to improve tube function. An improvement of tube function only by permanent ventilation over a period of 2 years can not be obtained, as could be proved by statistic analysis.


[Local pO2 measurements in the cochlear perilymph of guinea pigs in oxygen and oxygen/carbon dioxide breathing (author's transl)].

After breathing a mix of 10% CO2 and 90% O2 or hyperbaric O2 (2 bar absolute) an appreciable rise of pO2 can be demonstrated by D.C. polarography in the scala tympani of the guinea pig chochlea. When test animals are made to breathe 100% pure O2 at normal pressure the rise of pO2 is significantly less pronounced. The observations made in these animal experiments suggest that the inhalation of CO2O2 currently constitutes the only valid inhalation treatment in acute inner ear deafness. Further compression of hyperbaric O2 is associated with a clear-cut rise of pO2. It should, however, be remembered that hyperbaric oxygen may produce toxic effects in various body tissues.


[Wilson's liver disease in children and adolescents (author's transl)].

Hepatic symptoms are usually the first in Wilson's disease of children and adolescents, while neurologic symptoms and the corneal ring are still missing. Liver lesions due to copper accumulation may develop throughout years without clinical symptoms or biochemical abnormalities. Hemolytic jaundice or gastrointestinal bleeding are the presenting symptoms in some cases. In spite of being a rare syndrom Wilson's disease ought to be considered after hepatitis B or autoimmune liver disease have been excluded as causes of juvenile cirrhosis of the liver. If life-long treatment with D-penicillamin is started in an early stage of Wilson's disease, prognosis is rather good.


[Arteriohepatic dysplasia (author's transl)].

Case reports of 55 patients with arteriohepatic dysplasia are evaluated (51 cases reported in the literature, 4 own cases). The main features of this syndrome are dysmorphous facial structure, peripheral pulmonic stenoses, intrahepatic cholestasis, and growth retardation secondary to the liver impairment. In addition, the patients may exhibit vertebral anomalies, retarded mental and sexual development, ocular and renal anomalies. The syndrome probably is inherited as an autosomal dominant trait with variable penetrance and expressivity. Therapeutically cholestyramine in high dosage, phenobarbital and fat-soluble vitamins may be tried.


[Needle biopsy in childhood and infancy hepatic disease (author's transl)].

Experiences are reported gained from 764 liver biopsies in children ad infants. Indications and contraindications are the same as in adults. The normal liver of infants and young children exhibits some particular differences as compared to the adult liver. Formation of giant cells is a striking pathological finding in various early childhood liver diseases. Needle biopsy is imperative in children with longstanding jaundice when it has to be decided, if surgery is to be done or not. Histology yielded the decisive diagnostic information in 80% of the cases in our hands. Needle biopsy may yield important or decisive information in the other liver diseases of childhood as well.


Reduced heart rate response to exercise in ischemic heart disease: the fallacy of the target heart rate in exercise testing.

When exercise testing 159 patients with prior myocardial infarction, we identified 39 who were limited by fatigue. This group was all in sinus rhythm; none were taking drugs likely to impair the chronotropic response of the heart; none experienced chest pain or developed ischemic ECG changes. In 18 of this group, maximal heart rate achieved with exercise was 2SD or more below the age predicted value, and their heart rate response to exercise was reduced compared to that of the other 21 whose maximal exercise heart rates were within 2SD of age predicted values. A subgroup of 8 subjects with reduced exercise heart rates was studied before and after vagal blockade. In the 4 subjects whose infarction was inferior, the reduction in heart rate response was more profound and persisted after vagal blockade, suggesting either reduced pacemaker responsivness, due to ischemia or infarction, or autonomic imbalance as possible mechanisms. All 8 showed alinear increases in ventilation at higher power outputs and mean blood lactate postexercise was 7.5 mM/I without vagal blockade. Our findings suggest that a reduced heart rate response to exercise, already shown to imply added coronary risk, may be subdivided aetiologically and possibly prognostically. The use of a "Target Heart Rate" in such patients offers no safety margin, and maximal exercise capacity will be grossly over-estimated if extrapolated from the submaximal heart rate response. A cardiovascular limitation to exercise may be detected by an alinear increase in ventilation.


Cardiac output during rest and exercise in desert heat.

Cardiac output and stroke volume were measured in two environments and at metabolic rates ranging from rest to the maximum rate that could be sustained for 25 minutes. One environment was indoors at about 23 degrees C, the other outdoors in desert sunshine and low water vapor pressure. The age range of the one female and four of the male subjects was from 19 to 40; the fifth male subject was 85 years old. Cardiac output was the same in the two environments; stroke volume was less at higher metabolic rates in the heat. The cardiac output for the old man was about one-tenth less and stroke volume about 20 ml less than that observed for the same work 50 years earlier.


Cardio-respiratory and perceptual recovery from a marathon run.

Seven male runners (21--42 years) were examined before and after the 1976 Boston Marathon to provide data concerning the cardio-respiratory and perceptual recovery from the performance. Treadmill runs, 30 min in duration, were administered 1 week prior to the marathon and 2--3, 6--7 and 13--15 days following. Treadmill speed was held constant and based on each runner's planned race pace. Maximal performance data were collected 1 week before and 2 weeks after the race. Data were analyzed using a 2-way ANOVA (4 thirty min run data collection periods and 3 exercise time points--5, 15 and 30 min) and "t" tests. Treatment effects were not observed for either HR or VE, however, perceived exertion (RPE) was significantly elevated 2--3 and 6--7 days post-marathon and VO2 was significantly lower at 13--15 days. HR and RPE showed significant time effects indicating a non-steady state response. None of the maximal test variables were significantly displaced. All variables were returned to pre-marathon levels by 13--15 days except VO2 which was lower. Aerobic capacity was not a limiting factor in the recovery from a marathon run. Muscle soreness and stiffness seem to be related to the increased perceptual ratings following a marathon run.


Alterations in pulmonary function consequent to competitive marathon running.

This study was designed to investigate the mechanisms underlying the significant reductions in vital capacity after marathon racing originally reported over 50 years ago. Spirometric, maximum expiratory flow-volume (MEFV), DLCO and residual volume (RV) measurements were made on 13 runners (11 males and 2 females) 1--2 weeks prior to the marathon, immediately after finishing the race, and again the next day. An average 0.48 L (8.6%) reduction in post-race forced vital capacity (FVC) was accompanied by an equivalent increase in RV. Thus, total lung capacity did not change, and the reduction in FVC was a result of an expiratory rather than an inspiratory limitation. Post-race FEV1 and FEF200-1200 remained unchanged while FEV1-2, FEF1 and FEF2 were reduced 19.7, 26.7 and 23.3%, respectively. Mean DLCO was unchanged. Pulmonary function on the following day was similar to that observed on the control day. These data indicated that after the race, expiratory flow was unaffected at high lung volumes, but was decreased at low lung volumes (within the effort-independent portion of the MEFV curve). The results are compatible with small airway closure occurring at an increased lung volume, which would result in a decreased FVC and an increased RV.


Medical aspects of power generation, present and future.

It can be seen that the radiation emissions of nuclear power plants are small indeed, compared to natural background radiation and other man-made sources of radiation. For example, the poulation is exposed to 100 times more radiation from television sets than from nuclear power reactors. The assumed risks to the people in this country from nuclear power reactors are also small compared to the normal risks which are tolerated in this society. The complete elimination of all hazards is a most difficult if not impossible task. If we need and desire a certain level of electrical energy, if we must choose between alternative sourves of the energy, then it is apparent that the total impact on our health from nuclear power generation of electricity, under normal operations and in consideration of catastrophic accident probabilities, is significantly less than that of continuing or increasing use of fossil fuels to generate electricity.


Physiological characteristics of trained Australian paraplegic and tetraplegic subjects.

Sixteen male Australian paraplegic and tetraplegic subjects competing at the 1977 FESPIC games underwent a physiological assessment. The assessment included a neurological examination, anthropometry, spirometry, maximum oxygen consumption using a wheelchair and motor driven treadmill and a 5 minute post exercise blood lactate. Eight subjects had won gold medals at international competitions for the disabled, and, at the time of testing, two of the subjects were world record holders in track and field events. Spirometry was consistent with other reported values with FVC and FEV1.0 being 4.94 and 4.25 l respectively. The cardiorespiratory data revealed a mean VO2max 2.04+/-0.64 l min-1, and 33.0+/-9.4 ml kg-1 min-1; VE STPD, 60.75+/-22.64 l min-1; maximum heart rate 179+/-20 b min-1 and post exercise lactate 11.73+/-1.94 mM. It was concluded that many physiological variables measured on the Australian subjects at rest and during maximum work were comparable to other trained disabled athletes.


Muscle fiber composition and performance capacities of women.

The purpose of the present study was to determine whether the fast-twitch (FT) fiber composition in muscle was a) correlated with performance capacities, b) related to the trainability of the subjects, and c) whether the FT fiber composition could be predicted with standard laboratory tests. From twenty-four young women (ages 24.3 +/- 3.0 yrs) muscle biopsies were obtained from the vastus lateralis of both the left and right legs. In addition, each subject completed four laboratory tests: i) a maximal oxygen intake test on the cycle ergometer, ii) a high-kp power test, iii) a low-kp power test, and iv) a Sargent jump. Prior to training the correlations between %FT fibers and each of the tests (r equal to or less than 0.19) were not significant (P less than 0.05). After training anaerobically (N = 20) significant improvements (P less than 0.05) occurred in a) the high-kp test (delta = + 0.12 +/- 0.02 kpm/sec.kg) b) the low-kp test (delta = + 0.10 +/- 0.01 kpm/sec.kg) and c) the Sargent jump (delta = + 2.5 +/- 1.1 cm). However, these training-induced changes (delta) were not correlated with %FT fiber composition (r equal to or less than 0.35), nor were the post-training performances on the tests correlated with the %FT fibers (r equal to or less than 0.12). Performance capacities before and after training were not significantly different in groups with a low %FT fiber composition (35.8 +/- 1.6%) or a high %FT fiber composition (63.6 +/- 2.2%). None of the performance tests either singly, or in combination in a multiple regression equation, provided a suitable prediction of the FT muscle fiber composition. The results of this study indicate that athletic performances and/or susceptibility for training cannot be determined a priori from simple measurements of muscle fiber composition.


The effect of beta-blockade in ski-jumpers.

Nine ski-jumpers from the Finnish Olympic team were given 40 mg of oxprenolol or placebo on a cross-over double-blind basis when participating in four internal competitions. Six ski-jumpers improved their performances when on oxprenolol. The improvement was mainly seen in the lengthening of the jumps. The tachycardia, apparently evoked by the emotional and physical strain associated with the actual jump, approached rather extreme levels (up to 170 beats/min) immediately after landing. The enhancement in the heart rate was effectively prevented by a gentle beta-blockade. The most common unwanted effect recorded was numbness in the legs after climbing up to the tower platform, reported 9 times out of 18 possible occasions after oxprenolol but never after placebo. The fact that three of the jumpers (out of 9) performed worse when on oxprenolol makes the toxic/benefit ratio (1:2) unacceptably high for the medication.


The energy cost of cross-country skiing among elite competitors.

The energy costs of skiing with the diagonal stride technique was investigated in 15 members of the men's and women's national cross-country ski teams and in 5 recreational skiers. Oxygen uptake was measured directly by means of a portable bag-method for each subject during level skiing at 3 different skiing speeds. The oxygen cost of double poling vs. diagonal stride techniques was also measured in 3 subjects during level skiing. Although a strong linear relationship was found between VO2 and speed of skiing (r = 0.868, p less than 0.001), there was considerable variation even among elite competitors. The VO2-skiing speed relationship was parallel to that obtained for running, but the O2 cost of skiing was found to be 10--12 ml/kg in excess of that predicted for level running at the same speed. On flat terrain, the O2 cost of the double poling technique as used in fast skiing was found to be higher than that for diagonal striding.


Basketball: the mechanics of hanging in the air.

A theoretical technique to permit basketball players to "hang in the air" prior to the release of a shot is presented. The purposes of this study were (a) to determine whether skilled players used such a technique when delaying the release of their shot and (b) to determine whether such players could be readily taught to "hang in the air" using this technique. Six current members of the Iowa basketball team were filmed, executing jump-shots. During each trial the players "faked" or "pumped" to delay the release of the shot. Qualitative analysis of the film revealed that none of the players demonstrated the coordinated limb movement involved in the theoretical technique. Prior to a second filming session, two former Iowa varsity players practiced a predetermined sequence of body movements. Each player performed eight trials and the results were analyzed quantitatively. The vertical displacements and the vertical velocities of the center of gravity, vertex of the head and mid-point of the hips were plotted against time. Results clearly indicated that the players were able to maintain the same vertical position of the head and hips (and thus, the trunk) for about 0.2 sec at or near the peak of the jump. It was concluded that a skilled player could be taught, in a relatively short period of time, to "hang in the air" using the techniques presented.


Relationships of stroke rate, distance per stroke, and velocity in competitive swimming.

Competitive swimmers were asked to swim at a constant velocity (v) for short distances. They wore a collar to which was attached a fine non-elastic steel wire. The wire passed over two wheels of a device attached to one end of the pool. One wheel generated an impulse for every cm of forward movement and another wheel produced an electrical signal which was directly proportional to V. Measurements of distance and time were begun at definable points in the stroke cycle and were discontinued at the end of a predetermined number of strokes. In all of the four competitive strokes, front and back crawl, butterfly, and breaststroke, the V increased as a result of increasing the stroke rate (S) and decreasing the distance per stroke (d/s). In the front crawl, the male and female swimmers who achieved the fastest V had the longest d/S at slow S. The faster male swimmers also had greater percent decrease of the d/S at their maximal V than did the less skilled persons. The back crawl was similar to the front crawl except that maximal S and V were less. Increases of V of the butterfly were related almost entirely to increases in S. Except at the highest V, d/S was decreased somewhat. In the breaststroke increased V was also associated with increasing S, but the d/S decreased much more than in the other stroke styles. Fluctuations of velocity during the stroke cycle were least in the front and back crawl (+/- 15--20%) and greatest in the butterfly and breaststroke (+ 45--50%). The results were compared to the S observed and the values for V and d/S calculated for a large group of swimmers competing in the 1976 U.S. Olympic Trials. The implications of the findings for coaching swimmers are discussed.


Performance evaluation of Olympic weightlifters.

The comparison of weights lifted by athletes in different bodyweight categories is a continuing problem for the sport of olympic weightlifting. An objective mechanical evaluation procedure was developed using basic ideas from a model proposed by Ranta in 1975. This procedure was based on more realistic assumptions than the original model and considered both vertical and horizontal bar movements. Utilization of data obtained from film of national caliber lifters indicated that the proposed method was workable, and that the evaluative indices ranked lifters in reasonable order relative to other comparative techniques.


A mathematical model of hiking positions in a sailing dinghy.

A mathematical model of the human body designed to calculate the resultant muscle torques required at the hip and knee joints for specific hiking techniques is presented. Data for the model were obtained from ten male subjects who adopted three basic positions: Position 1 with the knees located at the inside edge of the sidedeck, Position 2 with the knees at the middle of the sidedeck, and Position 3 with the knees at the outside edge of the sidedeck. Each resultant muscle torque was expressed as a percentage of each subject's maximum voluntary hip flexion or knee extension torque. It was found that where Positions 1 and 2 were equally effective in keeping the boat upright, Position 2 was superior to Position 1 in regard to the per cent of maximum muscle torque required. The superiority of Position 2 over Position 3 depended on the individual's relative muscle strength at the hip and knee joints. The stronger the hip flexors with respect to the knee estensors, the more desirable was Position 2 and vice versa.


Effects of selected test variables on the evaluation of football helmet performance.

The most important variables in helmet test methods (headform, impact surface, velocity) were studied by systematically changing the test variables and measuring the effect of these changes on the output responses (peak acceleration and severity index) of helmeted headforms. The degree of correlation between variables was also measured. The metal headform yielded consistently higher results than the humanoid headform but the differences between the two were much greater during impacts at the back site. Also, correlation between humanoid and metal headforms was significantly higher for top impacts than for rear impacts. These discrepancies between top and rear impacts were attributed to difficulties in the neck mounting system with the humanoid headform which causes inordinate bending during impacts. The soft impact surface yielded lower responses than the hard surface for both headforms, correlations between soft and hard surfaces were high in all cases. A small change in impact velocity (4.5 to 5 m/sec) resulted in a substantially higher output response. Correlation between velocities were much lower for the back impact site than the top.


Growth hormone response to continuous and intermittent exercise.

We tested the hypothesis that human growth hormone (hGH) secretion during exercise is related to anaerobic metabolism, and therefore blood lactic acid (LA). Ten males (20 to 30 years) were observed during 40 min of continuous cycle ergometer exercise (CE, 45% of the minimum load which elicited VO2max), and during 20 bouts of intermittent exercise (IE, 1 min on/off at 2x the CE work rate). Continuous and intermittent exercises were used as these are known to result in different LA responses. Resting hGH was 1 to 2 ng/ml. After a lag period, hGH was significantly elevated by 15 min of exercise and thereafter rose continuously in both IE and CE. During IE hGH tended to be higher (12.1 +/- 1.4) than during CE (9.7 +/- 1.6 ng/ml, X +/- SEM), but the difference was not significant. In both exercise conditions free fatty acids demonstrated an initial fall and then a continuous secondary rise with higher peak values during CE (0.52 +/- .06) THAN DURING IE (0.39 +/- .05 mEq/l). Pyruvate (PY) and lactate rose initially during CE, but then declined before reaching steady levels. During IE, LA and PY increased continuously reaching values 3x greater than during CE. Alanine rose progressively during CE and IE, but was significantly higher during IE (442.2 +/- 29.3 vs. 367.9 +/- 30.9 muM). Glucose also tended to be higher during IE (4.67 +/- 0.32) than during CE (4.25 +/- 0.28 mM). Considering CE and IE either together or separately, no physiologically significant correlation was found between hGH and metabolite concentrations, rectal T, or O2 deficit. The results are interpreted to mean that hGH response to work is not directly related to "anaerobiosis".


"Crash induction" in patients with full stomach.

The rationale of "crash induction" in patients with full stomach is reviewed. The technique does not precipitate regurgitation in normal patients having competent cardia, provided respiratory obstruction and IPPV are avoided during induction. On the other hand, in patients with incompetent cardia such as intestinal obstruction or hiatus hernia, excessive material may accumulate in the lower oesophagus. The accumulation will be suddenly released with the cricopharyngeal relaxation subsequent to "crash induction". The stomach and oesophagus should be adequately decompressed pre-operatively, and precautionary measures such as backward cricoid pressure must be taken during induction.


Aspects of differential role perception of Israeli medical school students.

Attitudes of first year Israeli Medical School students are investigated using the Semantic Differential technique to differentiate their perceptions of the roles of doctor, patient and the mentally ill. Students also selected from among thirty-four behavioural traits those roles considered most characteristic of doctor and/or patient. A high degree of certainty and of role stereotyping is found of doctor image. This may be associated with past experiences as child-patient, with idealizations and identifications and with future aspirations. There is less consensus with the role of patient but there are clear attitudinal boundaries among students between roles. The doctor is perceived as an idealized, if authoritarian, person meeting with a rather negatively but more flexibly perceived person of the patient. Behavioural traits selected by the students are consonant with this finding. The results are discussed in the context of identification patterns and the educational process.


Medical education: a student perspective.

Discussions with a sample of final year students generated a questionnaire designed to elicit a phenomenological account of their experiences at medical school. Sources of dissatisfaction and stress were identified and the students also offered recommendations for improving the system.


A pilot experiment on the inter-examiner reliability of short essay questions.

Although long essay questions have been shown generally to have a low inter-examiner reliability, they are still much used in undergraduate medical examinations, evidently because examiners feel that essays have greater inherent validity than some of the modern 'objective' techniques such as multiple choice questions (MCQs). Evidence exists in the literature to suggest that the reliability of short (c. 10 minutes) essay questions may be higher. A pilot experiment is reported in which students answered six questions requiring a short essay or extended notes (10 minutes per question): these 'SEQs' were each marked by two examiners. With the exception of one question, agreement between examiners was good. The implications of the experiment are considered to be: (a) that SEQs may well have a useful role in a broadly-based examination system; (b) there is a need for more experimentation with this type of question, which can arguably have greater validity than the (highly reliable) MCQ; and (c) that dual marking of all essay scripts is most desirable.


Communication skills and undergraduate medical education.

This paper reports some aspects of teaching communication skills based on experience with over 100 pre-clinical students in each of two years. Students interviewed patients selected by general practitioner tutors from their practices and 214 interviews, recorded on videotape, were subsequently analysed. Without having been given detailed instruction, approximately two-thirds of each class of second year students (mean age 19 1/2 years) sustained a consultation for 5 minutes or more. Over one half of the students elicited the salient features of the patients' problems within this short time. Anxiety exhibited by the majority of students could be seen to influence the interviews in several ways. These manifestations and the ways in which the interview was affected are briefly described. When some of the patients were subsequently interviewed by postgraduate trainees in general practice, the consultations differed in a number of respects. These differences are described, and the possible significance of the observations is discussed in relation to medical education.


Interviewing skill: the effects of ultra-brief training for general practitioners. A preliminary report.

Concepts of interviewing skill and of appropriate training and evaluation are briefly reviewed. It is hypothesized that if goals and skills relevant to a specific clinical interview can be identified and modelled in advance then even very brief training can improve outcome. An experiment is described in which three randomly selected general practitioners conducted, separately, test interviews with the same role played 'patient'. These interviews were repeated after a 'goal focusing' exercise and again after a modelling and instruction exercise. All interviews were telerecorded and subsequently blindly rated for impact on the 'patient'. The results suggest powerful training effects. The drawbacks of the study, such as lack of controls, are discussed. The similarity of evaluation raters who were 'behaviour' orientated and those who were 'psycho-dynamics' orientated is noted and it is suggested that agreed concepts of effective interviewing may be within reach.


Use of recording booklets to evaluate teaching in general practice.

Recording booklets have been introduced for students during their course of general practice teaching at the University of Glasgow. The booklets guide the students with patients in the community who have chronic and complicated diseases. Each case history in the booklet was marked and this provided an evaluation of the teaching. This showed an improvement in the students' overall ability but was most marked in the areas of social history and problem list, thus fulfilling the aims of the teaching.


A new undergraduate teaching course in geriatric medicine.

The construction of a new teaching course in geriatric medicine is described. Course objectives are established, and teaching arrangements designed to meet these objectives. The course takes place late in the medical curriculum when students have some knowledge of clinical medicine, therapeutics and pathology. Particular features of the course include residential attachments in hospital departments of geriatric medicine and coordinated teaching with the departments of general practice and mental health. The attainments and methods of assessment are then discussed.


Characteristics of graduating medical students who were matched and unmatched to hospital training posts.

The purpose of this paper is to examine similarities and differences between graduating medical students who do and do not match through the National Internship and Resident Matching Programme (NIRMP). Data from graduates of 3- and 4-year undergraduate curricula were examined separately. A two way analysis of variance was used; the two independent variables were (1) whether the student was a 3- or 4-year medical graduate, and (2) the students' matched vs unmatched status. The dependent variables used in this study were in the following five categories: (1) demographic and academic performance upon entrance to medical school, (2) academic performance during medical school, (3) future practice preferences projected during medical school, (4) internship/residency choices, and (5) clinical performance during internship/residency. On the basis of the data presented, it is clear that there are few differences between matched and unmatched students that could be detected in over seventy-five measures examined. Within the unmatched group, however, the 3-year graduates differ in some respects from their 4-year colleagues. It is likely, therefore, that a different constellation of factors appears to be operating in these two unmatched groups but not within the matched groups.


Comparison of admission criteria and medical school progress: preliminary results from a simple computer system.

The MFSEL system is designed to collect the data on entrants to the Glasgow medical course that was available to the Admissions Committee at the time of selection, and compare it with performance in medical school (and possibly later). The data collection has been made by the Admission Committee's secretary and the programming by a medical member with little previous experience and a minimum of professional help. Computing and data preparation costs have been low. Preliminary analyses indicate that selection has not been biased by the sex, class, or medical parenthood of entrants, and that the Scottish Sixth Year Studies examinations are a reliable predictor for student performance.


Diet and atherogenesis.

Diet is probably correlated with the prevalence of atherosclerosis in the more prosperous countries of the world. Attempts to discover the responsible items of diet would be facilitated if systematic, statistical comparisons were made between the diets in some high and low risk areas. A particular area which might lend itself for this survey is the block of five countries consisting of Austria, Czechoslovakia, Hungary, Poland and Romania. The first three of these constitute a high risk area, with mortality from ischemic heart disease of the order of 250 per year per 100,000 population, the last two a low risk area with mortality of the order of 75. Many relevant conditions, like standard of living, expectation of life, climate, etc. are reasonably similar in the five countries. Items of diet, the consumption of which is consistently higher in the high risk than in the low risk countries could constitute a short list of suspected atherogens.


Electrolysis between the feet and the ground and its probable health effects.

This paper describes experiments which show that a person with bare feet on the ground or with conducting sole shoes, sets up between his feet a redox cell, and that current of a significant magnitude flows up one leg and down the other. It suggests that this electrolytic activity could have very wide significance in various aspects of health.


The american alligator (Alligator mississipiensis): a new model for investigating developmental mechanisms in normal and abnormal palate formation.

Despite numerous investigations, there are still many unsolved problems concerning normal and abnormal palatal development. The American Alligator is here put forward as a new model for the investigation of a variety of developmental phenomena associated with palatogenesis. The structure of the palate of the adult Alligator is reported. This animal exhibits a unique combination of reptilian and mammalian features in its craniofacial anatomy and so its craniofacial development should be of considerable interest.


The neuromuscular and vascular hypotheses of muscular dystrophy: a possible link via adenine nucleotides and phosphate.

A hypothesis is presented that an abnormality of nucleotide synthesis or metabolism might be a primary functional defect underlying Duchenne muscular dystrophy. One aim of this hypothesis is to demonstrate that it is possible to explain a variety of observations in dystrophy, neuromuscular and vascular, on a single hypothesis.


The omnivorous approach to cholesterol problem.

Because of the erroneous views on man's dietary status, there is a general misunderstanding of the cholesterol problem. To help correct this, it is pointed out that man is an omnivore, and suggested that an omnivorous diet basically is normocholesterolemic and any deviation from omnivorous practices is the common source of both over-protecting against, and acquiring of, hypercholesterolemia.


Medication in acute myocardial infarction -- does it do as much harm as good?

Despite the apparent success of coronary care units in preventing death from ventricular fibrillation, the mortality from acute myocardial infarction is the same whether the patient is treated at home or in such a unit. No adequate explanation for this apparent paradox has been proposed. The evidence is therefore examined that there are detrimental effects of coronary care units and that these may balance the beneficial effects. In particular, it is suggested that antiarrhythmic medication, by virtue of its frequent side-effects, may increase mortality from non-arrhythmic causes.


X-ray or gamma-ray leukemogenesis in mouse.

A theoretical model is given for leukemogenesis in mouse by X-Ray or gamma-Ray. The first step is a double strand break in the viral part of the genome which leads to constitutive production of the viral protein responsible for transformation by derepression of its operator control region. The second step is binding of viral protein to the regulator gene of a two repressor system in which binding to the regulator gene of the first repressor leads to synthesis of the second which will repress the expression of the leukocyte maturation gene. Results are compared with the experimental results of Major and Mole on CBA mice. The agreement is good.


Theoretical mechanisms for synthesis of carcinogen-induced embryonic proteins. V. The steroids.

Since the induction of neoplastic cells by steroids has been well documented, an attempt is made to formulate a mechanism for explaining the resultant embryonic features of such tumour cells. Special emphasis is given to estrogen receptor complexes and their effect on chromatin proteins. Specifically a mechanism is presented for estradiol-17-beta and its ability to alter the gene expression (derepression) of mammary gland epithelial cells. In this model we explore the possible effects of small differences in receptor or repressor proteins associated with estrogens to translate quantitative steroid administration into qualitative cellular responses.


A rationale for the loss of growth control during experimental bladder carcinogenesis.

A rationale is presented which provides an explanation for the loss of growth control which is associated with the early phase of experimentally-induced bladder cancer. Two early events which occur in the urothelium following exposure to carcinogen, the focal loss of alkaline phosphatase activity and the initiation of cell proliferation, are both proposed to be the result of a defect in the interaction between glucocorticoid hormone and urothelium. The possible causes for this defect are discussed in terms of a defect in, or an interference with, the glucocorticoid-receptor mechanism.


Resonance induced alterations of intracellular biophysical properties.

A treatment of cancer by the application of external electromagnetic energy at a resonant frequency capable of the generation of heat intracellularly to induce selective thermal death of cancer cells is described. This process also allows for the detection of cancer cells by the use of differential resonant frequencies including nuclear magnetic resonance and electron spin resonance techniques. This process permits the selective treatment of cancer cells by the compartmentalized alteration of biophysical properties in the cancer cells and the detection of cancer cells by determination of their biophysical properties. The process comprises an ability to determine the respective resonant frequencies of cancer cells and normal cells at a cellular level. An external alternating electromagnetic field is then applied at the resonant frequency of the cancer cells which differs from the resonant frequency of the normal cells. The cancer cells absorb significant energy at this resonant frequency whereas the normal cells absorb minimal energy at this frequency. Generating the heat intracellularly instead of extracellularly results in the cell's membrane, which is an effective thermal barrier, enhancing the process by keeping the heat within the cell instead of outside of the cell. This process is enhanced by the nuclear differences between cancer cells and normal cells and by the energy changes characteristic of structural and conformational changes in the deoxyribonucleic acid and the histones of the nucleus including their interrelationship. This process promises great efficacy in the diagnosis and the treatment of neoplastic and also perhaps of artherosclerotic diseases.


Immunological tolerance and dogma.

Immunization and tolerance induction are complementary rather than antagonistic aspects of immune responsiveness. Adult normal organisms may become tolerant to proteins ingested as food. This has been known for a long time but has failed to influence immunological thinking. It is argued that the notion of oral tolerance is incompatible with current immunological paradigms and demand their revision.


Possible adverse side effects from treatment with laetrile.

Individuals who have a diminished capacity to detoxify cyanide to thiocyanate because of either a genetic predisposition (e.g. as occurs in those with Leber's Optic Atrophy) or a diet low in sulfur containing amino acids are predicted to be at increased risk to developing adverse side effects from laetrile, a cyanide containing substance used in cancer treatment.


Cancer chemotherapy - a new approach.

A considerable body of evidence indicates that interference with amino acid metabolism could be used as a basis for a concerted attack on tumor growth. Tumor cells are known to concentrate amino acids; the same transport mechanisms cause them to concentrate amino acid analogues as well. Furthermore, the growth of many tumors if affected by deficiences of certain amino acids. This apparent vulnerability of tumors points to a new approach to in vivo testing and clinical trials of amino acid analogues for efficacy against tumor growth. This approach consists of creating a dietary deficiency of an amino acid, replacing the amino acid by a toxic analogue which would be selectively concentrated by the tumor, followed at the appropriate time by restoration of the normal dietary level of the natural amino acid to allow growth of normal tissues.


Role of modifying alleles in the heritable colorectal cancer syndromes with polyps.

It is proposed, based on in vitro studies on hereditary colorectal cancer syndromes (adenomatosis of the colon and rectum, ACR), that the presence/absence of specific abnormal culture phenotypes within and between such ACR kindreds will demonstrate the interaction of a modifying allele with its proposed major polyposis gene, influencing expression of this major gene, at least in vitro. Such in vitro evidence would suggest that the variability of clinical phenotype was due, at least in part, to such gene-gene interaction and this should be considered as well as the influence of enviornmental agents on the development of both pre-malignant lesions and clinical cancer in such cancer-prone families.


Cell death and free radicals: a mechanism for hydroxyurea teratogenesis.

Hydroxyurea is a drug which causes birth defects in a variety of animals. Its pharmacologic actions include rapid killing of proliferating cells and profound inhibition of the synthesis of DNA. The mechanism whereby hydroxyurea produces teratogenesis is unresolved although it is related to the pharmacologic actions. Careful reading of the scientific literature discloses several putative mechanisms for the teratogenic action of hydroxyurea, which account for the inhibited synthesis of DNA, but do not explain the rapid onset of cell death. This paper presents a hypothesis that hydroxyurea causes rapid cell death through the initiation of uncontrolled free radical chain reactions. In vitro biochemical experiments have demonstrated the ability of compounds containing a hydroxylamine group (such as hydroxyurea) to form H2O2 and intermediate free radicals in biological fluids. Free radicals propagate themselves through chain reactions and can react swiftly and indiscriminately with the macromolecules quickly by inactivating enzymes, cross-linking DNA, and altering membrane functions through lipid auto-oxidation. Preliminary experiments utilizing an antioxidant to counteract the free radical effects appear to support the hypothesis that the rapid cell death is caused by aberrant free radical reactions.


Is the cancer process caused by deletion of one or more differentiation genes normally activated by steroid hormones?

The hypothesis is proposed that: 1. Aflatoxin B1 and polycyclic hydrocarbon carcinogens cause the deletion of genes necessary for the production of a substance required for differentiation of the cell and activated by a steroid hormone possibly a corticosteroid. 2. Such genes could include genes for production of: glutamine transaminase, glutamine synthetase, genes involving vitamin A metabolism. 3. Deletion of any of these genes could cause the cell to remain in an undifferentiated and replicating state.


Conjoint use of laetrile and megadoses of ascorbic acid in cancer treatment: possible side effects.

Individuals who have a reduced capacity to detoxify cyanide to thiocyanate are at increased risk to experience adverse side effects from laetrile, a cyanide containing substance used in cancer treatment. Since megadoses of ascorbic acid may markedly diminish body stores of cysteine, a sulfur containing amino acid which facilitates the detoxification of cyanide, it is predicted that persons consuming megadoses of ascorbic acid will be at increased risk to experience the adverse side effects from laetrile treatment.


Managing the data from respiratory measurements.

Clinical decisionmaking depends upon properly interpreting the significance of physiological and other clinical data. Our experience, summarized in six case studies, suggests that no one variable is sufficient for making clinical decisions. Rather, different parameters are relevant in different situations. This article summarizes two techniques for improving the effectiveness of clinical decisionmaking in the ICU using quantitative physiological monitoring data. First, mathematical modeling has been used for measuring the volume of gas in the lungs of patients receiving mechanical ventilation. The technique analyzes the transient response to oxygen change; thus it is suitable for routine use in the ICU. Second, symbolic processing has been used for interpreting the clinical significance of measured data. This symbolic processing is used for recognizing artifact in measured data, determining expected physiological meaning of measured data in different clinical situations, identifying physiological status, and identifying therapy that may be appropriate for meeting therapeutic goals or correcting physiological problems in patients in the intensive care unit.


The process of product selection in the medical instrument market.

Medical instrumentation is supplied by commercial organizations. Because the costs and risks of bringing new or advanced products to the market are high, the selection and evaluation process is critical. Moreover, the peculiarities of the medical instrumentation market add extra costs and risks. Major factors to be considered include the presence of a need, market acceptance, financial and technical viability, development time, internal resources, and the effect of FDA regulations. During the 5 to 7 years required to develop a new product, the difficulty of overcoming problems and the state of the market must be continually monitored. FDA documentation may necessitate 2 more years of effort. Market introduction includes proper market education, an appropriate plan of action, and constant monitoring of market reaction. Despite all these precautions, 70% of new products do not reach the market or do not survive in the market.


Optimized search for parameters useful in the interpretation of fetal heart rate data.

A comprehensive computerized perinatal data management system was used to acquire and process FHR data and to link this information to a set of control and outcome variable for 1000 deliveries. Multivariate correlation analyses and stepwise linear regression techniques were used to study the interrelationships between risk factors of pregnancy and labor, monitored data, obstetric interventions, and outcome. It was found that while some FHR characteristics, such as moderate-to-severe bradycardia, lack of beat-to-beat variability, and severe variable decelerations were significantly associated with poor outcome, others, such as accelerations, early decelerations, mild bradycardia, and mild-to-moderate tachycardia, were positively correlated with good outcome. Several statistical models for outcome prediction were developed using FHR data alone and also in conjunction with small subsets of control variables.


Venous occlusion plethysmography for the detection of venous thrombosis.

Venous occlusion plethysmography (VOP) was originally developed to study the physiology of the arterial circulation in the extremities. Improvements in plethysmographic instruments have now made bedside evaluation of peripheral hemodynamics feasible. In recent years, VOP has been employed for the detection of deep vein thrombosis. Combined analysis of the venous volume increase and the subsequent venous outflow in 3 sec, and measured by impedance plethysmography, has produced a 95% correlation with venography in detecting thrombosis of the popliteal, femoral, and iliac veins in 390 limbs. The method is inadequate for detection of isolated calf thrombi.


Intestinal haemorrhage in Antarctica. A multinational rescue operation.

Three nations cooperated in the aerial evacuation from an Australian Antarctic station of a patient with gastrointestinal haemorrhage, after conservative treatment. The combined operation is described, and reference is made to the difficulties in medical management arising from polar isolation. Attention is drawn to logistic improvements which would alleviate this situation.


Symptoms and early management of germinal tumours of the testis.

The symptomatology and delay in diagnosis in a series of 502 germinal tumours of the testis were surveyed. Pain is much more commonly a feature than is usually appreciated and often leads to the condition being treated as inflammatory for much longer than it should be. Most surgical textbooks are not helpful in this regard. Delay in exploring the testis, and, particularly, delay in initiating follow-up therapy after orchidectomy, were associated with a higher stage of disease and poorer results, most clearly seen in nonseminomatous tumours. As the incidence of testicular tumours seems to be rising, a high index of suspicion in any abnormality of the testis in a post-pubertal male is advocated. Exploration through an inguinal incision for any mass or enlargement of the body of the testis not associated with dysuria and pyuria is essential. If a tumour is found, supplementary treatment must be given without delay. Judicious X-ray therapy, surgery and cytotoxic drugs can save most patients. Seminoma, in particular, can be cured, even in the advanced case.


Intern training in New South Wales.

The process of intern training in New South Wales is at present undergoing critical examination. This article is a brief review of the status of intern training in Australia and New Zealand as revealed by a survey of accredited hospitals and the medical boards. Also reported are the results of a questionnaire widely distributed to the medical profession in New South Wales which sought its views on the nature of, and problems with, the internship.


Guidelines for the management of oral anticoagulant therapy in patients undergoing surgery.

The management of patients who require surgery while being treated with oral anticoagulants is a difficult balance between the risks of bleeding and those of recurrent thromboembolism. The urgency and the extent and site of surgery are important considerations, as are the strength of the indication for anticoagulants and the degree of anticoagulation. A practical approach is outlined for various situations that may be encountered.


Duration of effect of different diuretics.

Twenty-four patients with hypertension were treated with chlorothiazide, chlorthalidone, and frusemide. Each diuretic had a significant and similar antihypertensive effect. After cessation of the administration of diuretics, the antihypertensive effect persisted for a longer time with chlorthalidone than with the other two drugs. The full antihypertensive effect of chlorthalidone and chlorothiazide was still present 24 hours after the administration of the drugs was ceased, and the full effect of chlorthalidone was present 72 hours after the administration of the drug was ceased. Side effects related to a rapid diuresis were more common with frusemide. The study indicated that chlorthalidone could be given at 48-hour or 72-hour intervals, and that other diuretics may be given once daily to exert their full antihypertensive action.


Clomiphene-induced pregnancy in a patient with diabetes insipidus and hypothyroidism.

A patient with diabetes insipidus and hypothyroidism developed anovular menstrual cycles. Ovulation, which was followed by pregnancy, was induced by the administration of clomiphene. In the later stages of pregnancy, an increase in the dosage of vasopressin was necessary to achieve a satisfactory control of the symptoms of diabetes insipidus. Labour was induced before the estimated date of confinement by the intravenous administration of oxytocin and an intra-partum haemorrhage necessitated delivery by the lower-segment caesarean section. The post-partum period was uneventful. Lactation was suppressed on request from the patient.


Preregistration training of medical graduates in Queensland hospitals, 1977.

This paper reports a survey of the 1976 graduates of The University of Queensland Medical School which was conducted as they completed their preregistration training. Study of the residents' perceptions of the adequacy of their training during the year revealed no significant difference between hospitals in terms of training in patient management. The nonmetropolitan hospitals were rated significantly higher than the metropolitan hospitals for training in procedures.


Biochemical and haematological changes in Sydney's the Sun City-to-Surf fun runners.

Before this study was undertaken, biochemical and haematological changes in collapsed fun runners have been interpreted only by comparison with changes observed in trained marathon runners, or by comparison with normal subjects. This study was undertaken to establish the pattern of biochemical and haematological changes to be expected in non-collapsed fun runners as a result of competition, and to use this pattern as the basis for comparison with changes observed in collapsed fun runners after similar competition. Forty-three fun runners (28 males, 15 females) who competed in the 1978 City-to-Surf run volunteered as non-collapsed "controls", while 10 runners (nine males, one female) who collapsed during the 1978 City-to-Surf run became "casualties" for comparison. Blood for detailed analysis was collected from the controls two weeks before the 1978 City-to-Surf run, immediately after the run and one month later; blood from the casualties was collected immediately after the run, and one month later. As a result of competition, three patterns of changes were observed, namely, haemoconcentration; tissue damage and altered organ system function; and alteration in carbohydrate metabolism. More intense tissue damage probably accounts for disproportionate changes of some variables in male controls compared with female controls, and in casualties compared with controls. Casualties differed most from controls in degree fo depression of serum bicarbonate levels, and degree of elevation of blood urea nitrogen, serum creatinine, uric acid and bilirubin levels. A wide scatter of blood sugar levels immediately after run both in controls and in casualties reflects the stress of prolonged exertion.


Reducing the hazards in Sydney's the Sun City-to-Surf runs, 1971 to 1979.

The hazards experienced by fun runners in Sydney's The Sun City-to-Surf run are principally physical, environmental and medical. The organizers of the event, advised by a representative of the Australian Sports Medicine Federation (N.S.W.), have progressively increased the implementation of the recommendations which were made after the inaugural run in 1971 in the areas of improved organization, competitor education, medical support, recording of competitor data, and conducting the event in cool weather. To ensure the maximum safety of the runners, the number of whom has increased from approximately 1650 in 1971 to 16200 in 1979, additional measurees have been taken. These were (i) the introduction of "spotters" with experience in sports medicine to identify and advise exhausted runners before they collapse; (ii) staffing the run's medical centre with medical and nursing specialists in intensive care; (iii) improved management of heat exhaustion; and (iv) conducting education seminars after the run to make recommendations for improving subsequent events. Since 1971, there has been a progressive reduction in the number of casualties. The incidence of casualties treated in the medical centre fell from 1.76% in 1971 to 0.1% in 1979; and the incidence of those requiring further treatment in hospital fell from 0.42% in 1971 to 0.01% in 1979. None of the participants had suffered severe complications of heat exhaustion. Improvements in the management of heat exhaustion (the most common cause of collapse) which made the use of iced water (hiterto traditional method of cooling casualties with hyperthermia) unnecessary have reduced the risk of using electrical equipment in wet surroundings. The over-all reduction in the incidence and morbidity of collapse casualties is due to a combination of factors. These factors and possibilities of further reduction of hazards are discussed.


Management of heat exhaustion in Sydney's the Sun City-to-Surf run runners.

Heat exhaustion (collapse with rectal temperature of, or higher than 38 degrees C) is the most common major medical complication of fun runs and is caused by dehydration and impaired heat loss with, or without, hypoglycaemia. All patients with heat exhaustion after the City-to-Surf runs from 1977 to 1979 were managed in a medical centre established at the finish of the course. Several methods of management of heat exhaustion are evaluated. Patients were allocated retrospectively to four primary treatment groups: (i) treated with ice-wet towels only; (ii) treated with ice-wet towels and intravenously administered fluids; (iii) treated with intravenously administered fluids and ice-cold packs applied to the neck, axillae, and groins; and (iv) treated with intravenously administered fluids only. There was no death or prolonged morbidity in any treatment group. In Group 1 (n=11), the mean initial rectal temperature was 40.2 +/- 1.5 degrees C. There were insufficient data to assess the mean time taken for the temperature to fall to 38 degrees C. In Group 2(n=16), the mean initial rectal temperature was higher than 40.9 +/- 1.1 degrees C. In three patients, the temperature failed to fall to 38 degrees C within 90 minutes. For the remainder, the mean time taken for the temperature to fall to 38 degrees C was 30 minutes. In Group 3 (n=16), the mean initial rectum temperature was higher than 41.2 +/- 1.0 degrees C. One patient, who had been febrile immediately before the run, was discharged with a temperature of 38.8 degrees C. For the remainder, the mean time taken for the temperature to fall to 38 degrees C was 36 +/- 10 minutes. In Group 4 (n=13), the mean initial rectal temperature was 39.6 +/- 1.1 degrees C and the mean time taken for the temperature to fall to 38 degrees C was 21 +/- 16 minutes. Heat exhaustion in fun-run casualties may be safely and effectively treated by rapid intravenous infusion of fluids with, or without, application of cold packs to the neck, axillae, and groins. The application of ice-wet towels is contraindicated.


Comparison of lateral subcutaneous sphincterotomy with anal dilatation in the treatment of fissure in ano.

A comparison of the outcome of the treatment of fissure in ano by a lateral subcutaneous sphincterotomy (LSS) and by an anal dilatation (AD) has been made retrospectively through a questionnaire sent to patients who were operated upon between three months and five years beforehand. The questionnaire was completed by 86 patients who underwent the LSS, and 74 patients who underwent the AD. The two groups were comparable in age, but there were slightly more males in the LSS group. The results appear to favour the LSS, the patients in this group recording a recurrence of pain and problems of incontinence significantly less often than those in the AD group.


Cutaneous leishmaniasis in Western Australia.

A case of cutaneous leishmaniasis, which was successfully treated with metronidazole, is reported from Western Australia. Transmission is unlikely to occur in this country, but it is important to be aware that it may present in migrants or in travellers from endemic areas up to four years after inoculation of the parasite.


Proctocolitis caused by concurrent amoebiasis and gonococcal infection. The "gay bowel syndrome".

The simultaneous occurrence of amoebic proctocolitis and gonococcal proctitis in a male homosexual in Sydney is reported. Attention is drawn to the occurrence of multiple or sequential venerally transmitted intestinal infections among male homosexuals.


Nerve calcification caused by leprosy in northern territory aboriginals.

Three cases of nerve calcification caused by leprosy (Hansen's disease) in Aboriginal patients from the Northern Territory of Australia are reported. This is a rare manifestation of the disease and is the result of direct involvement of peripheral nerves with abscess formation and is usually seen in tuberculoid or borderline types of leprosy.


Comparison of labetalol, clonidine and diazoxide intravenously administered in severe hypertension.

Diazoxide, clonidine and labetalol, administered intravenously in fixed doses, were used to treat 30 episodes of severe hypertension in 27 patients. Labetalol in a fixed dose of 100 mg proved ineffective treatment. Diazoxide 300 mg and clonidine 300 micrograms were comparable in effectiveness. Drowsiness was a common side effect with administration of clonidine (in six of 10 patients) and severe hypotension occurred in one patient who was given diazoxide.


Ciramadol. A new analgesic.

Ciramadol (WY 15705), a new analgesic and narcotic antagonist was studied on oral-dose form in 16 patients (15 of whom were suffering from malignant disease) to evaluate the analgesic dose and toxicity. Patients with mild or moderate pain experienced effective relief with doses of from 20 mg to 60 mg (mean dose, 47 mg). In patients with moderate to severe pain, effective pain control was not achieved (mean dose, 82 mg). There was no consistent effect on blood pressure level, heart rate, or respiratory rate. Mild or moderate sedation occurred in eight patients. Nausea and vomiting occurred in two patients.


[Clinical implication of serum insulin determination. Diagnosis and prognosis in patients with apparent secondary failure of treatment with sulfonylureas (author's transl)].

Serum insulin was measured after maximal stimulation in 213 patients with apparent secondary failure of treatment with sulfonylureas. The maximal increase of serum insulin was 327% of baseline in patients treated with oral drugs alone and 175% in patients switched to insulin. The control of diabetes in the patients treated with oral drugs alone was investigated 2 to 3 years later by a questionnaire and correlated to the insulin values measured earlier. Following conclusions were drawn: Sulfonylurea treatment is indicated if the increase of serum insulin is more than 300%. If the increase of serum insulin is below 200%, insulin treatment is necessary now or in the near future. The determination of serum insulin after maximal stimulation in patients with apparent secondary failure of sulfonylurea treatment has a diagnostic as well as a prognostic value.


[Endoscopic diagnoses in patients with positive Hemoccult-test: critical consideration and negative Hemoccult-test (author's transl)].

Totally 170 patients with positive (n = 29) and with negative Hemoccult-test (n = 141) were examined by coloscopy. There were 29.0% false-negative Hemoccult-test results (carcinomas 5.6%, polyps 23.4%). Almost all patients with a endoscopically diagnosed carcinoma or polyp of the large bowel had clinical signs. It is concluded, that the Hemoccult-test is indicated only in patients, who do not show clinical symptoms, and that a negative Hemoccult-test result does not exclude a tumor of the large bowel.


[Yersinia arthritis (author's transl)].

Clinical picture and differential diagnosis of Yersinia arthritis are shown by means of three own observations. It is an acute oligoarthritis affecting especially knee- and ankle-joints. The involved joints are very painful, swollen and warm. There may be a history of enteritis or suspicion of acute appendicitis because of lower abdominal pain, but this is not obligatory. The laboratory parameters of inflammation (ESR, C-reactive protein, white blood count, serumproteinelectrophoresis) are changed significantly. Diagnosis is made by serum agglutination reaction (Widal-reaction) against ceesurface antigens (O-antigens) of Yersinia enterocolitica. Almost only people with the HL-A antigen B27 tend to get arthritis during Yersinia infection. The differential diagnosis has to consider reactive arthritis during Salmonella or Shigella infections, acute sarcoidosis, Reiter's disease and rheumatoid arthritis.


[On the dermal form of erysipeloid in slaughter house workmen (author's transl)].

We described the incidence and clinical course of the dermal form of erysipeloid in 125 workmen of a central slaughter-house in Bukarest. The highest frequency of the illness was observed in summer and autumn (83 cases), especially in the group aged 21 to 50 years (96 cases). Most of the cases of erysipeloid are occupationally acquired by various persons engaged in handling meat, often butchers and workmen in meat, skin, and bone processing factories. The most frequent localisation of the process was at the index fingers and thumbs of both hands.


[Heitis terminalis promoting cancer (author's transl)].

The increasing number of publications about the incidence of cancer in small intestine with Crohn's disease shows Ileitis terminalis as an affection promoting cancer. Main problems are early diagnosis and differential diagnosis concerning intestinal stenosis caused by Crohn's recidivation or blind loop after resection. Regular scrutiny of patients with Crohn's disease is of special significance; because of the few present case reports early resection as prophylaxis is not justified.


[Pacemaker's twiddler syndrome (author's transl)].

This report demonstrates the results of five observation of the Pacemaker's-twiddler-syndrome, which will not necessarily end in the complete malfunction of the pacemaker unit. Therefore we classify the Pacemaker's-twiddler-syndrome as a partial and a complete form. The partial form is characterized by still effective cardiac stimulation, whereas the complete form can not stimulate the heart muscle because of the retracted electrode. Also methods of early detection and prevention of the Pacemaker's-twiddler-syndrome are discussed.


[Meproscillarin in patients with renal failure and concomitant heart failure (author's transl)].

Meproscillarin is a glycoside with a high bioavailability (about 70%) and an elimination independent of the renal function. It was to be investigated whether a good cardiac effectiveness can be demonstrated during oral long-term application of meproscillarin to patients with renal failure. 29 patients with renal failure of varying degree and concomitant heart failure were daily given an oral dose of 0.75 mg of meproscillarin over 14 days. The effectiveness of the glycoside was measured as change of the electromechanical systole (QS2c) and the quotient of the diameter of heart and thorax (C/T) from the 1st--15th day. The plasma levels of the glycoside were determined on the 1st, 8th, and 15th day. There was a significant shortening of QS2c (by mean = 27 ms, P less than 0.005) and a marked decrease in the size of the heart (P less than 0.0025); heart rate and PQ-interval were only insignificantly influenced. Plasma levels of 0.95 ng/ml were found after 8 days of treatment compared to 1.25 ng/ml after 15 days. As the pharmacokinetics of the glycoside is practically not influenced by the renal function, meproscillarin represents an alternative in the treatment of patients with heart failure and impaired renal function.


[Treatment with anticoagulants in glomerulonephritis (author's transl)].

Four patients with different forms of glomerulonephritis were treated with the anticoagulant heparin (Liquemin) or phenprocoumon (Marcumar). Following the results in these cases and the experiences of other research groups, which have been published in the last few years, we have tried to lay down a scheme for treatment with anticoagulants in glomerulonephritis. Such a treatment is recommended in peracute or rapid progressing glomerulonephritis, in forms of the disease of which is  known that they have a poor prognosis, and in situations in which the risk of simultaneous thromboembolic complications as a result of a nephrotic syndrome represents a further argument for the use of anticoagulants.


[Surgical or endoscopic papillotomy? (author's transl)].

Endoscopic papillotomy has become a competitive method to the surgical technique. Endoscopy took over many cases formerly treated surgically. The indications to either procedure are defined. The alterations of papilla and peripapillary region of choledochus are treated by endoscopy. The surgical method is indicated in gallbladder diseases, in further accessory operations and in failing of endoscopic proceeding. The complication rate of endoscopic papillotomy is 6.7 p.c. and about 20 p.c. under the rate of the surgical method. The relation of mortality rate is given with 1.5 p.c.: 3.8 p.c. in favour of endoscopy. Indications, advantages, disadvantages and complications of both methods are discussed, using the own case material of 211 surgical and 714 endoscopic papillotomies.


Cutaneous lymphoma in an infant: case report.

A case of lymphoma in an infant in whom the skin was the only apparent organ involved is reported. Response to combination chemotherapy was excellent and no recurrence has been observed in the 13 months since diagnosis.


Childhood leukemia and lymphoma: correlation of clinical features with immunological and morphological studies.

Malignant cells from 49 children with lymphoid neoplasms other than Hodgkin disease were evaluated by surface marker and morphologic studies. We classified the patients into three groups: 36 patients (74%) with acute lymphocytic leukemia; 7 (14%) classified as convoluted lymphocytic lymphoma/leukemia; and 6 (12%) with small noncleaved follicular center cell lymphoma/leukemia. Diffuse marrow involvement was present at diagnosis in some patients in the latter two groups, but their clinical course was not characteristic of the patients with acute lymphocytic leukemia. Male predominance, poor prognosis, and high incidence of central nervous system disease characterized patients in the convoluted lymphocytic and follicular center cell lymphoma/leukemia groups. Clinical presentation in these two groups differed. Proliferations of convoluted lymphocytes were associated with mediastinal masses and proliferations of follicular center cells with intraabdominal tumors. The high incidence of CNS disease in children with neoplasms of convoluted lymphocytes and follicular center cells suggests that these processes have a predilection for the CNS and that patients with them may benefit from CNS prophylaxis.


Ovarian involvement in neuroblastoma.

A case of neuroblastoma involving the ovaries bilaterally at diagnosis is reported. A review of previous cases of neuroblastoma at Johns Hopkins Hospital revealed no previous occurrence of ovarian metastatic disease at diagnosis, but involvement in about one-third of cases at autopsy. This appears to be a more common site of metastatic disease than has been previously recognized. The significance of this site of metastases in neuroblastoma is unknown.


Medical student training in medical oncology.

The evaluation of a medical school course in Medical Oncology assessed the experience in which medical students act as interns. The direct involvement of the student as a physician in managing patients with cancer furthered the students' knowledge of cancer, improved their competency in dealing with patients with cancer and their families, and developed the students' insight and attitudes toward the problems of cancer.


Histoplasmosis mimicking childhood non-Hodgkin lymphoma.

Cell surface markers are becoming increasingly important in the diagnosis of malignant lymphoid diseases. We present a case of pulmonary histoplasmosis with a pleural effusion. The differential diagnosis included non-Hodgkin lymphoma because the pleural fluid cells were cytologically identical to convoluted lymphoblasts; the cells also formed rosettes with sheep erythrocytes at 37 degrees C, suggesting that they were malignant thymus-derived lymphoblasts. Since cultures of pleural fluid were negative for bacteria and fungi, the correct diagnosis of histoplasmosis was made only after conventional histology identified Histoplasma capsulatum organisms in pleural nodules. Thus, until we have a better understanding of the significance of cell surface markers, we should continue to rely on conventional histology for the diagnosis of lymphomas.


Chromosome 1 abnormalities in relapse and terminal stages in childhood leukemia.

Seven of 114 children with leukemia were shown to have abnormalities of chromosome 1. These included trisomy of parts of chromosome 1 as well as translocations of chromosome 1 to other chromosomes. The abnormalities were found during a relapse or terminal stage, after which the patient was refractory to therapy in all cases.


Chromosome classification system based on banding technique.

This paper deals with a classification method for human chromosome samples. A new method is proposed based on the integrated intensity profile obtained by scanning a microphotograph of chromosome sample prepared by the banding technique. Theoretical as well as experimental investigations are made. As a means of representation, Legendre polynomial series is found suitable for describing the characteristics of the chromosome in its classification. The proposed method aims at a simplified realization of a classification system. A preliminary system is constructed which consists of a ligth-pen and a television system. The proposed system is quite simple compared with the traditional ones and still exhibits satisfactory performances in the recognition rate, number of required parameters per sample, and some other important features.


Lesions of the canine penis and prepuce.

In 185 dogs treated for penile or preputial problems, 197 lesions were observed including 86 tumors (of which 84 were transmissible venereal tumors), 40 cases of balanophosthitis, 38 wounds, 14 urethral calculi and one urethral stenosis. In addition, 14 cases of paraphimosis, one phimosis and 4 fractures of the os penis were seen. This report discusses the clinical signs, treatment and results of penile-preputial disease.


Radiation-induced dominant lethal mutations in oocytes of Musca domestica.

Dominant lethal mutations induced by gamma-radiation were measured in stage-7 and stage-14 oocytes of Musca domestica. At both stages the data are consistent with the multi-hit theory on radiation induction of dominant lethals. This conclusion is supported by fractionation experiments which indicate that both S7 and S14 oocytes are capable of repairing, in different periods of time, a similar amount of dominant lethal damage.


Dose-response curves for radiation-induced gene mutations in mouse oocytes and their interpretation.

Previous work, in which female mice had been given fractionated doses of 20 X 10 rad X-rays, had confirmed and extended Russell's observations that the dose-response relationship for specific-locus mutations in mature-mouse oocytes is curved at low doses. The present work was intended to study the relationship at relatively high doses. Adult female mice were given doses of 200, 400 or 600 rad x-rays at 52 or 72 rad/min, and mated immediately. Offspring conceived in the first 7 days (i.e. using oocytes which were mature at time of treatment) were scored for specific-locus mutations. The data indicate that the departure from linearity of the dose-response curve is marginally significant at the 5% level. A quadratic dose-response curve (y = c + aD + bD2) and a square-law relationship (y = c + bD2) both give a good fit to the data. Both curves fit data of other authors obtained at low doses or dose-rates. These results could be interpreted either in terms of dose-dependent repair phenomena, or by considering specific-locus mutations as two-track events. In view of knowledge of other phenomena concerning mutation and cell killing in mouse oocytes, such as the variation in sensitivity of different cell stages, the interpretation in terms of repair phenomena is preferred.


DNA crosslinking, sister-chromatid exchange and specific-locus mutations.

Chinese hamster ovary cells were treated with the DNA-crosslinking chemicals, mitomycin C (MMC) and porfiromycin (POR), and their monofunctional derivative decarbamoyl mitomycin C (DCMMC). After exposure, the cells were studied for the induction of sister-chromatid exchanges (SCEs) and mutations at the hypoxanthine phosphoribosyltransferase and adenine phosphoribosyltransferase loci. The frequency of SCEs varied significantly in successive sampling intervals, requiring the weighting of each interval by the percentage of second-division mitosis in that interval to obtain the mean SCE frequency for each dose. All 3 compounds were potent inducers of SCEs but weakly mutagenic. All 3 chemicals by concentration were approximately equally effective in inducing SCEs or mutations. When the induced SCEs and mutations were compared at equal levels of survival, DCMMC was slightly more effective than MMC or POR in inducing SCEs and somewhat less mutagenic. These results indicate that the DNA interstrand crosslink is not the major lesion responsible for the induction of SCE or mutation by these compounds.


G2 chromosomal radiosensitivity in Fanconi's anemia.

Both the peripheral lymphocytes from 4 patients affected with the inherited disease Fanconi's anemia (FA), and tissue-culture fibroblasts from skin biopsies from 3 patients similarly affected were found to be about twice as sensitive to the induction of chromatid-type chromosomal aberrations by X-rays administratered in the G2 phase of the cell cycle as cells from normal controls. Using tritiated thymidine labelling of peripheral lymphocytes and of cultured fibroblasts, it was determined that 3 affected patients and 3 normal controls all had similar percent labeled mitoses (PLM) curves, so the increased induced aberration yields seen in the FA cells do not appear to be simply a consequences of a longer than normal G2 phase of the cell cycle.


Nonrandom distribution of chromosomal aberrations induced by three chemicals.

The G-band locations of 3244 breakpoints induced by cis-platinum (II) diamminedichloride (PDD), 1460 breakpoints induced by cytosine arabinoside (ara-C), and 1257 breakpoints induced by triethylenemelamine (TEM) in human lymphocyte chromosomes were identified. The breakpoints induced by each of these chemicals demonstrated a significantly nonrandom distribution within the human karyotype. The overall pattern of the interarm distribution was dependent upon the chemical used, but certain chromosomes arms exhibited similar responses to all 3 chemicals. Comparison of the frequencies of breakpoints within individual G-bands indicated that (1) certain bands were susceptible to damage induced by all 3 chemicals; (2) certain bands were resistant to damage by all 3 chemicals; (3) certain bands demonstrated variable susceptibility to induced damage dependent upon the chemical agent; and (4) other bands demonstrated near expected frequencies of damage (by length) to all 3 agents.


Fate of fragments and properties of translocations of holokinetic chromosomes after X-irradiation of mature sperm of Tetranychus urticae Koch (Acari, Tetranychidae).

After irradiation of mature sperm in males of Tetranychus urticae, early cleavage stages were scored for chromosome fragments. As expected from the presumed holokinetic nature of the chromosomes, the majority (94.29%) of the fragments pass mitosis without difficulty. A minority of the fragments is affected by loss (4.76%) or missegregation (0.95%), leading to loss of fragments from cells in a large fraction of fragment-containing eggs after a few divisions. Lethality induced by the irradiation treatment can probably be ascribed to these losses. When meiotic configurations of F1 females are analysed, translocations turn out to be the most frequent type of aberration, often accompanied by recessive lethal mutations, thus adding an extra amount of lethality to the already high number of non-viable haploid offspring of heterozygous F1 females. The frequently occurring infecundity of the F1 females may be caused by mechanical problems in early stages of meiosis (before oviposition), when multivalents are not able to perform the specific turning movements typical for this type of chromosome. According to calculations, univalents in meiotic stages are thought to represent translocated chromosomes rather than independent fragments.


Kinetics of human lymphocyte division and chromosomal radiosensitivity.

Human blood from normal donors was irradiated with 200 R during the Go phase, and the X-ray sensitivity of early and late dividing lymphocytes in culture was expressed as percentage of induced dicentrics. Cells in first or subsequent divisions were individualized by BrdU-Giemsa techniques. Lymphocytes in the first division at 40, 44 and 72 h after the start of culture had a lower sensitivity to radiation than lymphocytes making their first division at 48, 52 and 56 h. It was observed that: (a) the combination of radiation followed by BrdU did not increase the clastogenic action of X-rays, (b) X-rays in the dose and duration used in our cultures did not increase the frequency of SCEs, and (c) minor changes in culture conditions probably influenced the frequency of SCEs.


Anthramycin-induced sister-chromatid exchange and caffeine potentiation in the chromosomes of Indian muntjac.

Cell-cycle kinetics, sister-chromatid exchange (SCE) and chromosome aberrations have been studied from the skin fibroblasts of the Indian muntjac after treatment with 100 micrograms/ml of caffeine and 0.05 microgram/ml of anthramycin. The cultures were incubated for a period which was sufficient for the completion of two consecutive cell cycles and both the drugs appeared to produce a slight inhibitory effect. When anthramycin-treated cells were however post-treated with caffeine, the cells did not proceed beyond one cycle and exhibited a mitotic block. The SCE frequency in the control and the experiments with caffeine and anthramycin was 8.63, 18.32 and 34.88 per cell respectively. The SCEs were randomly distributed amongst all chromosomes unlike a non-random distribution within the X chromosomes. Caffeine and anthramycin produced only 0.5% and 3.1 cells with chromosome aberrations respectively. Potentiation of chromosome aberrations was observed when the anthramycin-treated cells were post-treated with caffeine. Caffeine potentiation presumably results from an inhibition of the cells to cycle and a failure to repair the effect of the mutagen on DNA.


A comparison of cytotoxicity, ouabain-resistant mutation, sister-chromatid exchanges, and nascent DNA synthesis in Chinese hamster cells treated with dihydrodiol epoxide derivatives of benzo[a]pyrene.

Chinese hamster V79 cells were treated with either (+/-)-7 beta, 8 alpha-dihydroxy-9 alpha, 10 alpha-epoxy-7,8,9,10-tetrahydrobenzo[a]pyrene (B[a]P-diol epoxide I) or (+/-)-7 beta,8 alpha-dihydroxy-9 beta,10 beta-epoxy-7,8,9,10-tetrahydrobenzo[a]pyrene (B[a]P-diol epoxide II) and the nascent DNA was labeled with [Me-3H]thymidine. The cells were harvested for determination of cytotoxicity, sister-chromatid exchanges (SCE), ouabain-resistant (Or) mutations and the size of newly synthesized daughter-strand DNA. Both isomers caused dose-dependent decreases in survival of cells and in the size of nascent DNA. Increases in the frequencies of SCE and of Or mutation were found in cells treated with either isomer. However, B[a]P-diol epoxide I caused 10--20-fold more Or mutations and 50-100% more SCE than did B[a]P-diol epoxide II at equal molar dose levels. In contrast to the marked difference in the frequencies of both SCE and Or mutations caused by both compounds, the isomers induced similar reductions in the size of the nascent DNA at equal dose levels. In comparing the molecular and biological effects of the two isomers the reduction in the size of nascent DNA was more closely related to cytotoxicity than to the induction of SCE or Or mutations.


The effect of caffeine on cytotoxicity, mutagenesis, and sister-chromatid exchanges in Chinese hamster cells treated with dihydrodiol epoxide derivatives of benzo[a]pyrene.

The effect of caffeine on Chinese hamster V79 cells after treatment with the highly mutagenic (+/-)-7 beta,8 alpha-dihydroxy-9 alpha, 10 alpha-7,8,9,10-tetrahydrobenzo[a]pyrene, and the weaker mutagen (+/-)-7 beta,8 alpha-dihydroxy-9 beta,10 beta-epoxy-7,8,9,10-tetrahydrobenzo[a]pyrene, B[a]P-deiol-epoxide II, was studied at both the biological and molecular levels. Caffeine, at nontoxic dose levels, caused a synergistic reduction in cell survival induced by both isomers and also inhibited DNA elongation as measured by alkaline sucrose-gradient analysis of nascent DNA. However, caffeine did not affect the induction of either ouabain-resistant mutants or sister-chromatid exchanges by either isomer. These results suggest that enhanced cell killing by caffeine in benzo[a]pyrene-diol-epoxide treated V79 cells may be related to caffeine's inhibitory effect on DNA elongation. However, inhibition of DNA elongation by caffeine did not influence the resulting induced levels of mutagenesis or sister-chromatid exchanges.


Mutagenicity of 8-methoxypsoralen and long-wave ultraviolet irradiation in diploid human skin fibroblasts: an improved risk estimate in photochemotherapy.

Cell killing and the induction of mutation were studied in dividing and non-dividing human skin fibroblasts as a result of treatment by 8-methoxypsoralen (8-MOP) and long-wave UV irradiation (UVA). The cytotoxic effect was highly dependent upon the duration of the UVA exposure. The frequency of mutations increased linearly with the UVA dose at concentrations of 10 and 0.25 microliter 8-MOP/ml, the latter representing the concentration in the skin during PUVA treatment. The number of mutations induced per unit dose (= per microgram 8-MOP/ml per joule UVA/m2) was calculated: for dividing cells this value was 3.3 X 10(-8) per cell and for non-dividing cells 0.6 X 10.8(-8) per cell. On the basis of these values the expected number of induced mutants in the human skin per session of photochemotherapy is 1.2 X 10(-5), and per 30 years of maintenance therapy 1.3 X 10(-2) per cell. A comparison was made between this frequency and the frequency to be expected from spontaneous mutation. In addition the significance of absence in patients of SCE induction by photochemotherapy is discussed.