Children can't fly: a program to prevent childhood morbidity and mortality from window falls.

"Children Can't Fly" is a health education program developed by the New York City Department of Health to combat the high incidence of child mortality and morbidity due to falls from windows. The success of the program, begun in 1972, in drastically reducing death and injury persuaded the New York City Board of Health to amend the Health Code in 1976 to require that landlords provide window guards in apartments where children ten years old and younger reside. The law is the first and only one of its kind in the nation. The program has four major components: 1) reporting of falls by hospital emergency rooms and police precincts, followed up by counseling, referral, and data collecting by public health nurses; 2) a media campaign to inform the public and elevate their awareness of the hazards; 3) community education for prevention through door-to-door hazard identification, counseling by outreach workers, community organization efforts with schools, tenant groups, clinics, churches, health care providers, etc; 4) provision of free, easily installed window guards to families with young children living in high-risk areas. Significant reduction in falls resulted, particularly in the Bronx, where reported falls declined 50 percent from 1973 to 1975. The program is one solution to an urgent urban problem which other cities might consider to avert the loss of life and limb, and the corollary financial burden for hospitalization, rehabilitation, and maintenance of the injured and permanently disabled.


Prevention of childhood household injuries: a controlled clinical trial.

Injuries claim the lives of more children each year than the next six leading pediatric disorders combined, and produce injuries that require medical attention for one in three children. In the preschool age group, 91 per cent of these accidents and over one-half the resultant fatalities occur in the home. This paper reports the results of a controlled clinical trial conducted to evaluate the implementation of a health education program intended to reduce the risk of childhood household injuries. The study population was randomly assigned into two demographically comparable groups. Only the experimental group mothers received an educational intervention consisting of a tutorial, home safety-proofing assignments, and follow-up. The homes of the two groups were later assessed for hazards during an unannounced visit by an interviewer who did not know to which group each home belonged. A home safety score mean for the two groups was almost identical. The program stimulated heightened interest and stated intent to improve, but did not result in actual reduction of household hazards. Active health education, as used and evaluated in this study, appears to have limited effectiveness when applied to home safety. Approaches such as "passive" measures may offer greater potential for household injury reduction.


Moderate alcohol use during pregnancy and decreased infant birth weight.

Maternal alcoholism during pregnancy may result in severe prenatal growth deficiency. In this prospective study, the relationship of moderate maternal alcohol consumption to infant birth weight is explored. Subjects were 263 paying members of a health maintenance organization who delivered single live children. Their alcohol consumption before pregnancy, and in early and late pregnancy, was estimated. In order to control for smoking, which is strongly related to both infant birth weight and maternal alcohol use, the sample was selected so that similar proportions of smokers were represented in both light and heavier drinkers. Multiple linear regression was employed. A regression equation was computed for each of the three periods in which drinking was estimated. Independent variables entered into the equation were maternal age, height, parity, daily cigarettes, alcohol use in the period, and gestational age and sex of child. The regression of birth weight on these variables revealed a significant relationship (p less than or equal to .01) with alcohol consumption in two of the periods. Ingestion of an average of one ounce of absolute alcohol daily before pregnancy was associated with an average decrease in birth weight of 91 grams; the same amount ingested in late pregnancy was associated with a decrease of 160 grams. The associations were independent of the other variables entered into the equation, and in particular, of tobacco use.


Contraceptive method continuation according to type of provider.

A study was undertaken at the main PROFAMILIA clinic in Bogota, Colombia to compare the effectiveness of nurses and physicians in the delivery of family planning services. Contraceptive method continuation was the major outcome variable in this analysis. Clients were randomly assigned to physicians or nurses on their first visit and for the duration of care. On all revisits, data were collected pertaining to method prescribed, side effects, pregnancy, and method changes. There was a field survey at eight months to locate clinic drop-outs and determine their contraceptive use status. There were no significant differences in method continuation between clients who received services from physicians and those who received services from nurses. At nine months, the overall continuation of the first method prescribed was 79.1 per cent in the physicians' group and 75.8 per cent in the nurses' group (t = 1.057, p greater than .20). When controlling for first method used, the IUD users in the physicians' group had a continuation rate of 86.1 per cent and in the nurses' group 84.0 per cent (t = 0.556, p greater than .50). Of the pill users who received services from physicians, 78.1 per cent were continuing at nine months and 74.3 per cent of the pill clients in the nurses' group were continuing at nine months (t = 0.573, p greater than .50). There were no differences in pregnancy rates, side effects rates, and method change rates between the two groups. It may be concluded that these nurses were as effective as physicians in the delivery of family planning services.


Population density and the rate of mental illness.

An examination of age specific rates of psychiatric admissions within Brooklyn, New York, indicated that population density may function as an intervening variable in the production of mental illness. Measures of household and family contact were found to be significantly correlated to four rates of hospital utilization. These same measures carried unique components that were also significantly related to service use. Other measures of density such as people per acre and structures per acre were found to be unrelated to the rates of psychiatric utilization. The results of this study suggest that if density does produce mental illness its likely mechanism of action will be routed through household contact.


The effects of measurement errors on some multivariate procedures.

The effects of random errors of measurement on a variety of basic multivariate procedures are discussed. For some procedures, the effect is one of attenuation (i.e., simply reducing the estimated strength of association). For others, the effect may be to alter the apparent direction of association. Some proposed solutions to the problems caused by errors of measurement are presented, and areas requiring further research are pointed out.


IgM and antibody measurement in the diagnosis and management of Gambian trypanosomiasis.

Serum and cerebrospinal fluid (CSF) IgM were measured in 182 patients at various stages of Gambian sleeping sickness and correlated with antibody levels measured by enzyme-linked immunosorbent assay (ELISA). Each of these tests in serum gave a 30% false negative result, but when both were used this fell to 12%. Measurements of IgM in CSF were raised in 87% of patients with advanced disease and in none of the early cases. The IgM levels fell slowly to normal by 12 months after treatment. A high level at this time, or a rise after treatment, was helpful in diagnosing relapsed patients. Antibody levels in CSF were of no use in diagnosis or prognosis, and were raised in many controls.


Filaria in the vitreous of the eye of man in peninsular Malaysia.

An active worm was seen in the right eye of a 62-year-old man in Malaysia. The worm was behind the lens and attached at one end to some vitreous fibers. It was tentatively identified as an immature Dirofilaria immitis. There appear to be only five previous authentic reports of filariae in the vitreous.


Bancroftian filariasis in Puerto Limón, Costa Rica.

In four neighborhoods of Puerto Limón, a Caribbean coastal city in a tropical rainforest area of Costa Rica, examination of 1-ml samples of night blood from 1,142 randomly selected, and 1,196 associated, persons by the Knott and filter-chamber techniques revealed microfilariae of Wuchereria bancrofti in about 3% of the 2,338 samples. The frequency of infection was higher in males (3.9%) than in females (1.9%), higher in persons of black (4.1%) than of white (1.0%) race, and highest in persons aged 10-19 (4.0%) and over 50 years (4.8%), lowest in those under 10 years (1.1%). The median microfilaria density was 3.5, the highest 45, per 20 lambdas of blood. Microfilaremia was distinctly periodic. Dissection of 663 female Culex pipiens fatigans from 42 houses of infected persons revealed filarial larvae in 25; only 1 larva was third (infective) stage. Of 64 infected persons, 11 had clinical findings suggestive of filariasis. Elephantiasis was seen in 21 others. Other forms of symptomatic filariasis without microfilaremia, though presumed to be present, were not assessed specifically.


Mother-child relationship in human schistosomiasis mansoni. I. Parasitic antigens and antibodies in milk.

Immunoglobulins, anti-Schistosoma mansoni antibodies, complement components and schistosome antigens were investigated in milk from mothers infected with S. mansoni. No significant differences of immunoglobulins or complement component levels were observed between infected and control mothers. Anti-S. mansoni antibodies were detected in the milk of 8 out of 25 infected mothers. A significant relationship was observed between serum and "4", were demonstrated in milk from infected patients by the double diffusion micromethod. The function of these immunologically active substances transmitted by milk from mother to child is discussed.


Schistosoma mansoni tegumental appendages: scanning microscopy following thiocarbohydrazide-osmium preparation.

Scanning photographs of the surface of normal adult male and female Schistosoma mansoni are given. The specimens were prepared using a thiocarbohydrazide technique which facilitates the binding of osmium. The resultant deep penetration of osmium preserves surface detail for electron reflection. The schistosomal tegument is characterized by a variety of surface bosses and spines. The function of certain of these is thought to be tactile or as chemoreceptors. Numerous tegumental pores surrounding setae in surface tubercles are shown. Clefts in the inner aspect of the gynecophoral canal are also seen. The excretory pore in both male and female is shown, along with a cluster of receptors at the terminus of the gynecophoral groove. Such grouped receptors may function to indicate position of the worm in copula.


Edwardsiellosis in man and animals in Panamá: clinical and epidemiological characteristics.

Edwardsiella tarda was isolated during etiologic and epidemiologic investigations of diarrheal disease agents in man and for Enterobacteriaceae in various species of wild-caught animals in Panamá. A total of 50 strains were recovered from approximately 14,000 specimens cultured between 1965 and 1972. In this period, Edwardsiella was isolated from ten individuals with a clinically diagnosed diarrheal syndrome, while 20 of some 3,000 persons from rural areas were asymptomatic carriers of these organisms. Edwardsiella tarda was also associated with two fatal cases of extraintestinal infection in man. In both cases liver abscess was a predominant feature. Edwardsiella was not demonstrated in either symptomatic or asymptomatic persons from urban areas. Edwardsiella tarda was present among some of the wild fauna of Panamá; various species of animals including snakes, toads, monkeys, and opossums harbored this organism.


Replication of dengue-2 virus in Aedes albopictus mosquitoes. An electron microscopic study.

Sequential electronmicroscopic studies of Aedes albopictus mosquitoes infected with dengue-2 virus showed replication of virus particles and vesicular structures confined to cells having an active, rough, endoplasmic reticulum. Small granules not found on the surface of virions produced in mammalian cells were seen on the envelopes of the virus particles. There was no evidence of nuclear involvement as described in infected mouse neurones, and there was no apparent impairment of cellular function. Substantial viral replication was confined to cells of the salivary glands and nervous tissue, with lesser involvement of midgut, hemocytes, epidermal cells, fatbody, and foregut.


Identification and neutralization of biological activities associated with venom from the brown recluse spider, Loxosceles reclusa.

Venom from the brown recluse spider, Loxosceles reclusa, reacted with human erythrocytes to form venom-sensitized erythrocytes. These cells were agglutinated specifically by high dilutions of adsorbed rabbit antivenin or were lysed by normal blood group compatible human sera. The specific rabbit antivenin prevented venom from attaching to erythrocytes, from interacting with serum complement, and from producing dermonecrotic lesions in rabbits. Results of experiments involving heat inactivation and adsorption to erythrocytes provide circumstantial evidence to suggest that the three biological activities of venom could be associated with a single component or few components with similar properties. The component interacting with serum complement is immunologically distinct from a factor in cobra venom which possesses similar biological activities.


Human infection with Trichostrongylus lerouxi (Biocca, Chabaud, and Ghadirian, 1974) in Iran.

Examination of specimens collected after anthelmintic treatment revealed that among 50 persons infected with Trichostrongylus species in each of three regions of Iran (northern, central, and southwestern), T. lerouxi Biocca, Chabaud, and Ghadirian, 1974 was found in 22%, 14%, and 8%, respectively. The corresponding mean numbers of T. lerouxi were 5.0, 4.5, and 2.3 per infected person. These findings bring to nine the number of Trichostrongylus species reported in man in Iran.


Radiomanometric guides to common bile duct exploration.

The accuracy of operative cholangiograms can be increased by radiomanometry. This study identified 17 patients among 198 studied whose choledocholiths would have likely been missed by routine cholangiography. These are almost invariably small stones the fate of which would be conjectural if left behind. In the present study, if the cholangiogram was negative and the passage pressure within normal limits, calculi were seen only once. If the cholangiogram was positive for choledocholithiasis and the passage pressure elevated, stones were almost invariably found (95 per cent). Such accuracy cannot be expected from either roentgenography alone or determination solely of pressure relationships.


Detection of occult gallbladder disease by duodenal drainage.

Examination of gallbladder bile in the sediment of duodenal drainage obtained after magnesium sulfate stimulation was used to evaluate the presence or absence of gallbladder disease in thirty-four patients with symptoms suggestive of cholecystitis and normal or equivocal oral cholecystography. Ten patients had positive tests and nine of these had cholecystectomy. All nine had pathologically confirmed cholecystitis and seven of nine had cholelithiasis. Three patients with negative test results had laparotomy and normal gallbladders. The remaining twenty-one patients with negative tests have been followed up to three years, and none have returned with evidence of biliary tract disease. The results of this study suggest that duodenal drainage (Meltzer-Lyon test) is a valuable adjunctive diagnostic study in patients with gallbladder disease symptoms in whom normal or equivocal oral cholecystograms are obtained.


Clinical indications and accuracy of gray scale ultrasonography in the patient with suspected biliary tract disease.

One hundred patients with suspected biliary tract disease underwent gray scale cholecystosonography (GSCS) and had diagnostic confirmation by oral cholecystogram (OCG) and/or operation. Ultrasonography demonstrated the gallbladder in 94 of the 100 patients; 2 patients had had previous cholecystectomy and 3 of the 4 remaining patients had documented stones with no confirmation of a nonvisualizing OCG in the other patient. Among the 88 patients with OCG, GSCS findings correlated in 91 per cent (2 per cent false-positive; 7 per cent false-negative). Among the 43 operative patients, GSCS was proven correct in 91 per cent (no false positive; 9 per cent false-negative). Of 12 patients with jaundice GSCS correlated with operative findings in 75 per cent (no false-positive; 25 per cent false-negative). Diagnostic errors occurred in patients with very small biliary calculi, particularly when a single stone was impacted in the cystic duct. Failure to identify the gallbladder with ultrasound signifies probable cholelithiasis in the patient without previous cholecystectomy. On the basis of this experience, we conclude that (1) GSCS is most useful when jaundice or acute illness precludes conventional studies; (2) GSCS provides an inexpensive, quick, accurate means of diagnosing cholelithiasis with a very high specificity (97 per cent) and moderate sensitivity (88 per cent); and (3) GSCS is the optimal diagnostic procedure for evaluating the biliary tract in the acutely ill, jaundiced, vomiting, allergic, and/or pregnant patient.


Surgical injury of the common bile duct.

Review of our experience with twenty-two bile duct injuries and the literature leads us to the following conclusions: (1) Most biliary strictures follow surgery and can be avoided by adequate exposure, accurate dissection, use of hemostatic clips rather than clamps and ties, and the liberal use of operative cholangiography. (2) Injuries diagnosed at the time of surgery should be repaired by end-to-end anastomosis over a T tube if length is adequate or by Roux-en-Y choledochojejunostomy if length is inadequate. (3) The diagnosis of biliary injury should be suspected when jaundice, biliary fistula, or cholangitis occur in the postoperative period. (4) IVC, PTC, ERCP, or fistulography should be used when possible to delineate the site of injury or stricture and assist in planning the operative repair. (5) Surgery should be performed as soon as the diagnosis is made and the patient is in satisfactory condition for operation. (6) Early reoperation may be necessary to establish drainage and prepare for a later definitive procedure. In some cases, definitive repair can be performed this time. (7) Most late strictures should be repaired with a choledochojejunostomy to a defunctionalized limb of jejunum when resection and primary end-to-end repair cannot be accomplished.


Peutz-Jeghers syndrome: experience with twenty patients in five generations.

Peutz-Jeghers syndrome is a familial disease characterized by spots on the lips and intestinal polyposis. A review of the history and the anatomic features of the disease are presented. One of us (AJM) has the largest personal series in the literature with twenty patients in five generations. Pedigree charts and aspects relating to the development and interrelationships of spots and polyps are explained. A previously unreported instance of colon intussusception is presented along with a discussion of the clinical presentation and the malignant potential.


Comparison of Nissen fundoplication and Belsey Mark IV in the management of gastroesophageal reflux.

Our experience for the past four years with antireflux surgery has been reviewed. The Nissen fundoplication resulted in symptomatic improvement in 87.5 per cent of cases as compared with 64 per cent who were improved after the Belsey Mark IV procedure. Objective evaluation as measured by the standard acid reflux test (SART) revealed recurrent reflux in 9 per cent of those who underwent fundoplication and in 47 per cent of those treated with the Belsey repair. Mortality rates were similar. These results indicate that Nissen fundoplication is superior to the Belsey Mark IV procedure in the management of gastroesophageal reflux.


Surgical management of penetrating injuries of the esophagus.

Although well protected and infrequently injured, penetration of the esophagus has a reported mortality of 10 to 30 per cent. The results of the management of seventy-seven patients with noniatrogenic penetrating injuries of the esophagus were reviewed. The region of esophageal injury was cervical in forty-five patients, intrathoracic in twenty-one patients, and intraabdominal in eleven patients. Gunshot wounds accounted for 75 per cent of the injuries. The overall mortality was 23 per cent. The highest morbidity and mortality was among patients with intrathoracic injuries, due to both difficulty in exposure and complexity of associated injuries. Because of the high incidence of late complications in intrathoracic injuries, cervical diversion and tube gastrostomy or complete esophageal exclusion must be considered early. Fundoplastic procedures were used in four patients with distal esophageal injuries. Although the overall mortality from truncal penetrating wounds has improved in recent years, the mortality from esophageal injuries remains high, reflecting a need for advancement in initial operative management.


Symptomatic nonparasitic liver cysts.

Based on our experience with four cases of liver cysts and review of the literature, the following conclusions are reached: (1) Diagnosis can be established with routine and special radiologic studies. (2) Laparotomy is indicated for patients with symptoms or uncertain diagnosis. (3) Surgical management should be guided by cyst size, location, and content. (4) Definitive surgical treatment is indicated only for cysts larger than 10 cm.


Severe jaundice after rupture of abdominal aortic aneurysm.

Eight patients after operation for ruptured abdominal aortic aneurysm developed severe jaundice. The jaundice became clinically apparent by the sixth postoperative day, and the average peak total bilirubin level reached 28.4 mg/100 ml, alkaline phosphatase level 8.6 BL units/l, and SGOT 95 Karmen units/ml. In addition to the hepatic dysfunction, all patients developed acute renal failure, seven of eight patients experienced hypovolemic shock, and six of eight patients had respiratory insufficiency requiring ventilatory support. The overall mortality was 83 per cent. The most probable causes for the severe jaundice were increased bile pigment load and hepatocellular dysfunction due to ischemic hypoxic injury of hepatocytes secondary to shock. Morphologically, a picture of cholestasis existed with severe bile-staining of hepatocytes and intracanalicular and intraductal bile thrombi. No evidence of recent or resolving hepatic necrosis was observed.


Preoperative selection of patients for lumbar sympathectomy by use of the Doppler index.

Yao and Bergan [8] have shown that an ankle systolic index of more than 0.25 is associated with a high rate of success from lumbar sympathectomy. This association has been borne out in our small series. We have also suggested that diseases that obviously compromise collateral circulation might be a relative contraindication to sympathectomy. Although incomplete, literature on collateral flow in relation to sympathectomy tends to confirm this idea. Consideration of such diseases as a contraindication to sympathectomy might further increase the success rate after sympathectomy. Regardless, ankle systolic index alone appears to be a reliable objective, non-invasive method of selecting patients with an increased chance of success from lumbar sympathectomy.


Hepatic angiographic changes after trauma.

Selective hepatic arteriography has a limited role in determining the extent and prognosis of injuries to the liver after surgical exploration and treatment. In this small series of thirty asymptomatic patients, there was no difference in the type or extent of injury or in the postinjury convalescence in patients who had abnormal or normal hepatic arteriograms. Angiographic abnormalities of avascular filling defects, pseudoaneurysms, arteriobiliary fistulas, contusions, and occlusions of the hepatic artery were demonstrated in our patients. The demonstration of these hepatic arteriographic abnormalities did not affect the convalescence of our patients if they were asymptomatic. Although hepatic arteriography can be helpful in establishing a diagnosis of hepatic trauma and in defining the extent and location of such injuries, arteriographic abnormalities are not the only criteria for the diagnosis of liver injuries. Arteriography is an ancillary technic to be used in relation to the clinical course of the patient.


Surgical treatment of primary hyperparathyroidism.

Our reported experience with ninety-seven hypercalcemic patients having resected adenomas with no recurrent hypercalcemia or hypocalcemia had led us to continue a conservative approach. Twelve patients with multiple parathyroid gland involvement proven by biopsy were treated with three and one-half gland resection and autotransplantation.


Major surgery in patients with chronic renal failure.

To determine the risks of performing major surgical procedures on patients with chronic renal failure, the charts of twenty-nine hemodialysis patients who underwent thirty-eight elective and nine emergency operations were reviewed. Preoperative preparation included adequate hemodialysis of the patients, 88 per cent of whom were dialyzed within 24 hours of surgery. Azotemia was well controlled prior to administration of anesthesia. The average preoperative hematocrit was 26 per cent, and only one patient was hyperkalemic preoperatively. There were no intraoperative complications attributable to the patients' impaired renal function. Postoperative complications were frequent and are discussed in detail. Hemodialysis was done immediately postoperatively in five patients and on the first postoperative day in twenty-three additional patients with no problems. There were only two deaths (4.3 per cent) in the series. With careful monitoring during the perioperative period, major surgical procedures can safely be performed on patients with chronic renal failure.


Operative management of chronic coccidioidomycosis.

Nine of fourteen patients with chronic coccidioidomycosis were treated operatively for therapeutic and diagnostic indications. Complications were minimal and no reactivation or spread of the disease resulted. This series emphasizes the role of the surgeon in the diagnosis and management of chronic coccidioidomycosis and demonstrates the need for the surgeon to be familiar with its natural history and diverse presentations.


The use of pyloric exclusion in the management of severe duodenal injuries.

Repair of severe duodenal injuries often constitutes a technical challenge, and a variety of special technics have been described. For the past seven years we have utilized temporary pyloric exclusion and gastrojejunostomy to produce "diverticulization" of the duodenum. This procedure was utilized in seventy-five patients selected from 175 consecutive patients presenting with duodenal trauma. The mortality was 19 per cent and the rate of fistula formation was 5 per cent in this series and 14 per cent and 2 per cent, respectively, in the overall series. Follow-up studies of gastric physiology and functional anatomy show no evidence of alteration of these parameters. We thus believe that patients presenting with severe duodenal trauma and often multiple devastating associated organ injuries can be adequately treated with this procedure with a significant decrease in mortality and with marked improvement of postoperative morbidity.


Unsuspected nonmedullary carcinoma of the thyroid in patients with hyperparathyroidism.

All patients with hyperparathyroidism seen in a large referral military hospital within a twenty month period underwent neck exploration by one of us (HN). Three patients were found to have an unsuspected solid thyroid nodule measuring 0.5 to 1.5 cm. All were widely excised by thyroid lobectomy and isthmectomy and found to be follicular or papillary carcinoma of the thyroid. These three patients join thirty-one previously reported clinical cases documenting an association between parathyroid adenoma and nonmedullary carcinoma of the thyroid. Because of the high potential for malignancy in this clinical setting, we urge careful examination and palpation of the thyroid gland during neck exploration for hypercalcemia in order to detect and cure "early" malignancies of the thyroid.


Malignant hyperthermia.

Malignant hyperthermia of anesthesia is a severe complication and must be treated vigorously. The anesthetic should be stopped and the core body temperature reduced. Systemic complications must be anticipated, hopefully prevented, and appropriately treated. Appropriate laboratory studies must be obtained. A comprehensive family survey may alert the physician to a tendency toward this problem. Temperature monitoring during surgery may give an early warning of malignant hyperthermia developing. I would suggest that routine temperature monitoring during surgery be considered by the anesthesia department during each general anesthetic administration.


Spontaneous hepatic rupture in pregnancy.

Hepatic rupture as a late complication of toxemic pregnancy is a rare yet lethal condition requiring rapid recognition and surgical management. The clinical triad of toxemia, right upper quadrant pain, and sudden hypotension is the diagnostic hallmark of presentation. Most patients present near the time of delivery and are found to have subcapsular hematomas of the right hepatic lobe with free rupture into the peritoneal cavity and resultant exsanguinating hemorrhage. The association of toxemia and disseminated intravascular coagulation with secondary microembolic damage to the liver and other organs has been discussed. Basic surgical principles in the managment of hepatic subcapsular hematomas, and the prolonged postoperative course and frequent complications in these patients have been stressed.


The asymptomatic bruit.

A review of 144 carotid endarterectomies performed in 108 patients at the Oklahoma Health Science Center over the past six years showed an acceptable operative morbidity and mortality in group of patients with an asymptomatic midcervical bruit who underwent prophylactic carotid endarterectomy prior to anticipated elective surgery. Long-term follow-up showed these patients to be free of neurologic symptoms of fatalities in 100 per cent of long-term survivors and suggests that carefully selected patients with an asymptomatic bruit may undergo carotid endarterectomy to prevent future neurologic complication.


Adrenal tumour secreting vasoactive intestinal peptide and noradrenaline.

A patient with a ganglioneuroblastoma secreting both noradrenaline and vasoactive intestinal peptide is described. Their vasoactive effects are antagonistic and pre-operatively the patient was normotensive. Manipulation of the tumour provoked hypertension and after excision marked hypotension occurred which responded to the administration of metaraminol and blood. This case emphasises the need for thorough investigation of patients with amine or peptide-secreting tumours which have atypical features.


A case of tachydysrhythmia. Refractory to propranolol and responsive to neostigmine.

A case of atrial fibrillation, with a fast ventricular response, which developed under enflurane anaesthesia is described in a patient previously treated with digitalis and propranolol. The intravenous administration of propranolol was ineffective whereas that of neostigmine and atropine, 2 hours later, was successful and reduced the ventricular rate to normal values.


An anti-pollution modification for the Cape-Waine anaesthetic ventilator.

Most anaesthetic equipment needs to be modified to fulfil anti-pollution recommendations. A method of modifying a Cape-Waine Anaesthetic Ventilator is described in detail showing what parts need to be replaced or removed. A list of the new parts required together with their cost is given and the modification can be made by suitably trained hospital staff or the manufacturers.


The use of words.

The advantages of English as the language of communication for science and medicine by both the written and spoken word are discussed. A plea is made for clarity and brevity.


An autotransfusion apparatus.

An autotransfusion apparatus is described in detail and its use is illustrated with short case reports.


[Intraoperative autotransfusion, technical management and its influence on blood circulation, on kidney and electrolytes (author's transl)].

From February 1975 until July 1976 12 patients who elective surgery and 15 trauma victims received intraoperative autotransfusion. The effects of this method on these patients were controlled by monitoring the behaviour of circulation and of important laboratory parameters. The procedure was well tolerated: 1. Only three of 29 patients showed evidence of cardiac insufficiency (lowering of ST. elevated T-peak, low blood pressure, high central venous pressure) which disappeared after reducing the rate of infusion. --2. Blood pressure, pulse rate and central venous pressure were stable at the end of the operation. --3. There was no renal insufficiency under dopamine (210 microgram/min) and 15% manitol (250 ml i.v.). --4. Serum creatine showed only minor changes from the initial level during the time of observation. --5. The same was true for beta2-microglobulin. --6. Serum urea rose slightly during 7 days. --7. There were minor changes of electrolytes without hypocalcaemia or high potassium. --8. The observed changes showed no relation to the method of anticoagulation and to time or volume of autotransfusion.


[Intraoperative autotransfusion and haemolysis (author's transl)].

In 29 patients (12 vascular and 17 trauma cases) receiving autotransfusion the effects of haemolysis caused by the Bentley ATS-system were examined. The following parameters were monitored: 1. Overall haemolysis rate and fractions in serum and urine, --2. Total and direct bilirubin in all patients with or without preexisting icterus, --3. Plasma-proteins: Albumen, haptoglobin, haemopexin, transferrin and C3-activator. --In both groups extremely high rates of free haemoglobin in serum were found in some cases. The peak of haemoglobinuria was observed several hours after the autotransfusion or at the end of the operation. The different plasma proteins showed increased activity to cope with haemolysis within the first 24 h. After one week they still showed overshooting levels in some cases which permitted conclusions concerning the extent of the reactions. The transformation of free haemoglobin in bilirubin has to be strongly suspected. The changes of the parameters were not in relation to the volume of autotransfusion. No irreversible complications due to haemolysis caused by the autotransfusion systems were observed.


[Intraoperative autotransfusion and its influence on the blood-clotting-system (author's transl)].

In 12 vascular and 17 trauma cases the changes in the coagulation system due to intraoperative autotransfusion (IAT) were examined immediately after the IAT as well as 24, 48, 72 h and one week later. The following parameters were monitored: 1. Platelet count. --2. Prothrombin-time, partial-thromboplastin-time, factors II, V, VII, X and thrombin-clotting-time. --3. Fibrinogen, alpha-1-antitrypsin, alpha-2-macroglobulin, antithrombin III and plasminogen in 5 trauma cases. --4. Euglobulin-Lysis-Time. --After the IAT a loss of platelets, factors I, II, V, X, plasminogen and antithrombin III was found. Alpha-1-antitrypsin and alpha-2-macroglobulin remained unchanged or showed a slight increase. 24 h after treatment with Ugurol and heparin, fresh frozen plasma, fibrinogen and Cohn I-fraction in selected cases, an increasing normalisation of most parameters was seen, except for the plasma proteins active in coagulation. They showed a combination of "consumption coagulophathy" and "hyperfibrinolysis" up to the 7th day. Under treatment outlines above even marked laboratory changes remained without any clinical significance. Thus our results confirm that IAT does not cause any additional irreversible damage to the coagulation system. Therefore IAT can be considered as method of choice for the emergency treatment of massive bleeding.


[Comparative studies on the ultrastructure of human lung and sceletal muscle in shock. II (author's transl)].

The ultrastructure of skeletal muscle biopsies was investigated and compared to lung biopsy material of the same patient in shock. We found almost complete conformity of ultrastructural changes in the micro-vascular system. Capillary endothelia of both tissue types react in a similar way with a more or less distinct swelling of endothelial cells and rarefaction of cell structures as well as constriction of the vascular lumina. Despite an intact structure of the capillary endothelia there is development of oedema in the perivascular areas with escape of plasma components, erythrocytes and granulocytes into the muscle interstitium. Finally, more distant tissue regions are becoming oedematous. While mainly lysosomal enzymes from the large number of infiltrating granulocytes, as well as fatty globules, are made responsible for the damage in the shock lung, the damage of the capillary region in the sceletal musculature is almost certainly caused by hypoxia. We consider muscle biopsy a suitable method to obtain a better knowledge of the microcirculatory situation and of the reaction of ultrastructures in shock.


Body fluid compartments.

The terms mole, molality, molarity, osmole, osmolality, osmolarity, osmolar gap and anion gap are defined and their clinical usefulness indicated. The following body fluid compartments are described: total body water (TBW), extracellular fluid (ECF), intracellular fluid (ICF), transcellular fluid TCF), plasma volume, red cell volume and interstitial fluid volume. Isotope-dilution techniques are briefly discussed and representative normal values for the various compartments according to sex and age are indicated. The physiological mechanisms that maintain the distinctive ionic compositions of the various fluid spaces are briefly outlined. New concepts of the function of the gel matrix and of the lymph drainage of the interstitium are presented. Opposing models to the sodium-potassium membrane pump are briefly described.


Sodium metabolism.

This brief review attempts to summarize important basic concepts of sodium metabolism including sodium ion distribution, sodium balance and the renal regulation of sodium excretion. Finally, an attempt has been made to relate these basic concepts to the mechanisms and management of common clinical situations of abnormal salt balance.


Principles of pre-operative fluid therapy and resuscitation.

The pre-operative preparation of a patient for elective surgery requires correction of all major electrolyte abnormalities, osmolality and body fluid compartment excesses of deficits. For the emergency surgical procedure however, only stability of the cardiovascular system is required before the induction of anaesthesia. To facilitate rapid correction of the abnormal haemodynamic state a set of physiological principles are described which aim to simplify therapy.


Intra-operative fluid and electrolyte requirements.

The intravenous administration of Hartmann's solution at a rate sufficient to maintain the hourly urine volume between 0.5 and 1.0 ml/kg/hr is recommended during major operations. Intra-operative extracellular volume expansion followed by the administration of sodium containing fluids for 48 hours postoperatively decreases the incidence of haemodynamic instability and acute renal failure and results in normal water and sodium excretion by the kidney throughout the peri-operative period. Abnormal extracellular volume may exist prior to induction of anaesthesia particularly in patients with pre-existing cardiovascular, renal and hepatic disease. In these patients the suggested fluid regime should be administered with care and may require diuretic therapy. If the operative blood loss in adults is less than one litre, no blood may be necessary. If the loss is between one and 2 litres packed red cells may be sufficient, whereas with a greater loss, filtered whole blood, coagulation factors and platelet infusions may be required. When possible, transfusions of stored autologous blood is recommended for elective operations.


Postoperative intravenous therapy.

The physiology of the post-operative surgical patient is discussed. The reasons for the controversy between high and low volumes of fluid post-operatively are examined and a regime of relative fluid restriction is recommended. The requirements of the post-operative patient are discussed and a regime for post-operative therapy proposed.


Calcium, phosphorus and magnesium turnover.

The body content of calcium, phosphorus and magnesium is important, not only from the structural or supporting aspect, but also from the aspect of cellular function. Membrane integrity, nervous tissue conduction, neuromuscular excitability, muscle contraction, hormone secretion, intermediary metabolism and synthesis, to mention but a few activities, are all influenced by these elements. The normal body content and turnover of calcium, phosphorus and magnesium are outlined, together with a brief description of their physiological roles, emphasizing intracellular functions rather than their predominance within the skeleton. Regulatory mechanisms, particularly for calcium, involving vitamin D and its metabolites, parathormone, and possibly calcitonin, are discussed within the context of maintaining normal body content and turnover. Homeostatic mechanisms maintaining plasma concentrations in health and disease, as far as they have been identified, are also outlined. Lastly, disorders of calcium, phosphorus and magnesium turnover are considered from the aspect of altered plasma concentrations of these substances. Throughout emphasis is given to common problems and their practical management. Metabolic bone disease and uncommon disorders of bone and bone mineral are not discussed specifically.


Acute respiratory failure in a regional respiratory unit.

One thousand, six hundred and sixteen patients with acute respiratory failure were managed in a regional respiratory unit. The patients are classified according to cause, the need for artificial ventilation and results.


Post-operative respiratory resistance.

Respiratory resistance was studied pre-operatively and post-operatively in a group of patients undergoing abdominal surgery. Respiratory resistance was shown to be markedly increased post-operatively in patients with chronic bronchitis and slightly increased in non-bronchitic patients.


A versatile computing system for sampling, manipulation and display of biological signals using high-level language.

A medium sized minicomputer system is presented as an attractive way of balancing the cost of computing equipment with that of programme development. A versatile circuit has been coupled to a computer system and programmes have been developed to control the functions of this circuit. With such a system it is possible for relatively untrained biological workers to use FORTRAN programming language to control sampling of analogue signals, manipulation of data and finally graphical presentation of results. The system is proposed for use both in anaesthetic research and in on-line monitoring of critically ill patients.


[The holistic base of functional morphology (author's transl)].

Following v.d. Klaauw a functional component (fc) is the complex of a function and its constituent morphological features. The relation between form and function within a fc and, especially, the interrelations (pattern, compromise, integration) of the fc's constitutes the field of holistic functional morphology. The methodology of this approach is discussed.


[Functional anatomy of the feeding apparatus of the mallard (Anas platyrhynchos L.) structure, movement, electro-myography and electro-neurography (author's transl)].

A causal model for the functioning of the beakapparatus of the mallard during straining is formulated on a qualitative basis. The starting point for this model is an abstraction of the analysed structure of the muscle, bone, ligament system. The system was studied by electromyography and cinematography of the movements. It was attempted to quantify the model. Connections with neurography are shown.


The use of equidensity photographic method in electron microscopy.

The equidensity photographic method has been adopted for the sake of electron microscopy. The use of this method at processing the electron micrographs allows to emphasize, divide off and as the case may be, to distinguish in colours objects displaying minimal difference in their contrast which is otherwise not perceptible. It is thus possible to obtain new information from electron micrograph which by the usual "negative-positive" method remains unrevealed.


[Kinematic transmission-coefficient and the four-bar-system as a function-parameter and a form model for the mandibular depression-apparatus in Teleostei (author's transl)].

Through chains of ligaments and bones, which can be reduced to four-bar-systems (fbs), contraction of the sternohyoid and of the opercular levator muscle result in mandibular depression. Comparatively the opercular fbs transmits movement more efficiently than the hyoid fbs which, consequently, transmits force more efficiently.


[Stream mechanics and endothel regeneration (author's transl)].

The regeneration of rabbit aortic endothelium was studied by autoradiography using 3H-thymidine. A decrease in the 3H-thymidine labelling index and in the mitotic rate with advancing age were found but no significant differences in the endothelial cell turnover between aortic segments with and without flow-mechanical stresses.


[Electron microscopic investigations of the phagocytosis and digestion of foreign erythrocytes by peritoneal macrophages (author's transl)].

The erythrophagocytosis begins after 30 up to 60 min. The hemolysis is detectable 30 min later. After that myelin figures are formed which are digested up to 36 h. After 24 h the digestive vacuoles and the cytoplasm show ferritin molecules. After 14 d the digestion is finished.


[Electron microscopic investigations on the influence of lymphocytes of sensitized and non-sensitized guinea pigs on the visceral yolk sac epithelium of the rat (author's transl)].

Rats on day 19 of pregnancy were intrauterinely injected lymphocytes from guinea-pigs, sensitized or not sensitized to trophoblast antigens of the rat placenta. In the first case locally severe cytolytic effects were observed on the yolk-sac surface, in the second case--the controls--no immune reaction was evident.


[The influence of an overdose of vitamin A on the rat fetal membranes in the last third of the pregnancy (author's transl)].

The ultrastructure of the rat fetal membranes (yolk-sac) was examined following an intrauterine overdose of vitamin A (Retinol palmitate). Three and six hours after the injection drastic lesions of the yolk-sac surface cells were to be seen, obviously mainly due to the numerous leaky lysosomes present in the yolk-sac epithelium.


[The coronary vessels and the efficiency of the heart of domesticated and wild mammals and birds (author's transl)].

The investigations were made on 150 mammals (11 species) and 28 birds (3 species) from the 3 climate zones. The result gives that the temperature, behaviour and domestication influenced the efficiency of the heart. It is evidenced the connection between the ecological factors and the heart function.


[The changes in the structure of the blood and lymph vessels of the serous layer of the gastro-intestinal tract of the rabbit in metastases of the Brown-Pearce tumour (author's transl)].

Metastases of the experimentally induced Brown-Pearce Tumour show a typical pattern in the distribution of blood and lymph vessels in the serous layer of the gastrointestinal tract of the rabbit. There were investigated with the corrosion, histological and electron microscopical techniques.


[Low frequency vibration on human hollow bone (author's transl)].

With the aid of a stable fixation and a hammer system was removed the bone in vibrations which was registered. The vibrations have relations to the regions of the bone and have a practical connexion to the knowledge of the fracturation of the bone.


[High frequency vibrations of human hollow bone (author's transl)].

For study of the functional structures in hollow bone were applicated longitudinal waves in form of ultrasonics. The findings have a great signification for the practical medicine, because we can demonstrate the elastic modul of the bone, the absorption of the longitudinal waves in the bone by a thickness more than 5 cm and the transformation of the ultrasonic amplitude in the bone.


[Histochemical investigations on the fish kidney (Gasterosteus aculeatus L.) (author's transl)].

The kidney of the stickleback has a double function in the spawn period, the excretion and secretion. This functions limited a different enzyme pattern (phosphatases and oxidoreductases) in the different parts of the kidney.


The dorsal motor nucleus of the vagus nerve of the cat: localization of preganglionic neurons by quantitative histological methods.

The dorsal motor nucleus of the vagus nerve (DMX) of adult cats and young kittens was studied by quantitative light microscopic methods. In normal animals, the DMX was found to contain no distinct subgroupings of neurons, based on somatic volume or Nissl pattern. Retrograde perikaryal responses to axotomy of neurons in the DMX were found to be of a more subtle nature than those seen in other types of neurons. Quantitative methodology applied to the axotomy than could be obtained by routine microscopic observations. Changes which occurred included a slight chromatolytic reaction, and a decrease in the volume of the nucleus followed by an increase in somatic volume. These morphological alterations were affected by the factors of age of the animal, time after axotomy, and length of the intact proximal axon stump. More pronounced perikaryal changes occurred when the vagus nerve was recut at a more proximal level five days after the first vagotomy. Interpretation of the data yielded the conclusion that most if not all neurons of the ipsilateral DMX contribute axons to the cervical vagus nerve. In addition, at least 10% of the neurons on the side contralateral to vagotomy showed signs of retrograde reaction. It was therefore concluded that there exists in the vagus nerve a population of axons with cell bodies located in the contralateral DMX.


Contact sites between lymphoid cells of the bursa of Fabricius, in vivo and in vitro.

Contact sites between lymphocytes and between lymphocytes and macrophages were demonstrated by electron microscopy in the lymphoid follicles of the bursa of Fabricius. When compared with nonspecialized regions of the cell membranes, these contact sites were characterized by a decreased intercellular distance, subplasmalemmal densities and coated pits. Microfilaments, microtubules and coated vesicles of the subjacent cytoplasm were frequently associated with these contact sites. When the same cells were isolated and introduced into culture, they formed cluster-like assemblies in which cells were closely approximated along broadly contacting surfaces. The morphology of the sites appeared to involve primarily the plasma membrane (including coated pits) and the cell coat. These observations indicated that the same cells of a given lymphoid tissue can form one type of contact site in vivo and another, dissimilar type of contact site, in vitro.


The ultrastructure of follicle cells in fetal guinea-pig ovaries.

The development of the follicle cells in fetal guinea-pig ovaries has been examined in the electron microscope. The findings were as follows: at days 34 and 38 there were broad intercellular clefts within the germinal cords. However, a continuous layer of thin cytoplasmic processes from the follicle cells separated the germinal cords from the stromal compartment. The germinal cords were everywhere limited by a basal lamina. During all the period examined coated vesicles, possibly emptying their contents into the region of the basal lamina, were observed in the follicle cells. At days 42, 46 and 50 the cellular membranes were closely apposed with an intercellular distance of about 200 A. Complexes of deeply interdigitating folds of the membrane of neighboring follicle cells were observed. The follicle cells forming part of the primordial follicles at days 54 and 58 were characterized by a disappearance of these folds and by the appearance of bundles of microfilaments in the cytoplasm. These were especially numerous at day 66. At days 34 and 38 gap junctions were observed between the follicle cells, but not between the follicle cells and the germinal cells. During the entire period examined junctions resembling desmosomes without filaments were observed between the follicle cells as well as between the follicle cells and the germinal cells. The ultrastructure of the follicle cells is considered in detail and the functional significance of the findings discussed.


Neonatal muscle: an electron microscopic study.

A spaced serial section, electron microscopic study of the extensor digitorum longus of the 2-day-old rat was undertaken to determine whether all cells wedged between the basement membrane and the sarcolemma of a muscle fiber, regardless of their morphology, were true myosatellite cells. The muscle was relatively immature, containing groups of cells enclosed in a common basement membrane (clusters) and exhibiting primitive myoneural junctions. Cells of the muscle line included in the clusters were primary fibers, satellite fibers, myotubes in different stages of development and myosatellite cells. In single ultrathin sections, some early myotubes lacked myofilaments and were difficult to distinguish from myosatellite cells. Spaced serial sections revealed that all myosatellite cells have heterochromatic nuclei and a high nuclear/cytoplasmic ratio, and that all pale staining nuclei were found in cells with a lower nuclear/cytoplasmic ratio, containing variable quantities of myofilaments. In addition to the cells of the muscle line, mast cells, fibroblast-like cells and other "unclassified" cells were entirely or partially enclosed within the cluster's basement membrane. This study demonstrated that location alone or location and the morphological appearance of cells in a single ultrathin section failed to provide sufficient criteria to properly classify all of the cells found in neonatal muscles clusters.


Effect of estradiol benzoate on the pituitary-gonadal axis in the intact male rat.

Adult male rats were treated with 50 microgram of estradiol benzoate daily for 28 days. The sex organs and pituitary weights showed changes classically associated with estrogen treatment. Both plasma and testicular testosterone levels diminished to almost trace level 24 hours after the first estrogen injection and remained at that level throughout the experimental period. The pituitary LH levels and concentration showed a progressive decline; however, the plasma LH levels remained unchanged throught the experimental period. These findings suggest that in intact adult males, estrogen affects testicular testosterone production directly. These observation suggests the necessity for reevaluation of the current concepts concerned with testis-pituitary feedback mechanisms.


A possible haploid effect in acrosome malformations of human spermatozoa.

Acrosome malformations of spermatids and spermatozoa in the testes of two infertile patients were investigated with the light and electron microscope. The first visible abnormalities appear at early spermatid stages. The detailed morphological analysis of the malformed spermatids shows that in most cases only the differentiation of the acrosome granule is interfered with. This may be the origin of the malformations of the mature spermatozoa. The fact that almost half the early spermatids lack the acrosome granule suggests that the original cause is genetic and that the genes are expressed in the haploid phase.


Formal genesis of giant cells in the germinal epithelium in the rat thioglucose model.

The formal genesis of polymorphnucleated giant cells in the testis has been studied in the rat thioglucose model. The giant cells derive mainly from clumped spermatids (greater than 90%) which have lost their contact to Sertoli cells. The process of spermatogenesis and spermiogenesis as well as the synchronisation of germ cell maturation apparently depend on intercellular bridges of the germ cell populations. Lightmicroscopic findings have shown that with the formation of polymorphnucleated giant cells these links are lost.


Testicular capillary blood flow in the impubertal lamb and the ram during the breeding and non-breeding seasons.

The testicular capillary blood flow was measured by the 133Xenon clearance technique in the Ile-de-France lambs and rams in Spring and Autumn. Anaesthetized animals were maintained in the supine position and 133Xe was injected into the testicle through the scrotal skin. In the adult, the blood-flow (ml/min./100 g) depended upon the season: 8.3 +/- 1.0 vs 12.7 +/- 0.7 in May and October (P less than 0.001). In the impubertal lamb (50 days old) regardless of the period of the year, the blood flow was the same as in the adult in the breeding season (11.4 +/- 1.2 vs 12.7 +/- 0.7). In prepubertal lambs (120 days old) the rapid increase in testicular weight was not correlated with an increase in the blood flow (9.4 +/- 0.7).


[Ultrastructure of human heterotopic Leydig cells].

It was demonstrated by light and electron microscopical methods that Leydig cells also exist outside of the testis. In the spermatic cord and near the intraabdominal testicular vessels cells were observed with the characteristics of intratubular Leydig cells. Such characteristics were intranuclear precrystalline inclusions, mitochondria with tubular interior structures and lipid droplets, and a well developed smooth and rough endoplasmatic reticulum. The last two items can be regarded as signs of hormonal activity. The extratesticular Leydig cells in the spermatic cord are located within nerves that contain myelinated axons forming monoaxonal Schwann cell units. Possible they are sensory nerves originating in the receptors of the tunica albuginea. Synapses between axons and heterotopic Leydig cells were not found. The degree of the cytological differentiation leads to the conclusion that these cells may serve, for instance after orchidectomy, as substitutes for the Leydig cells inside the testis.


Effects of cyproterone acetate on spontaneous contractility of the rat epididymis.

The spontaneous contractility of the rat epididymis was recorded in vivo and the effects of cyproterone acetate were studied. At 7 days after cyproterone acetate daily administration the records of the epididymal contractility did not show significant differences from the records obtained in control animals. On the contrary, in animals injected during 11 days the amplitude and frequency of epididymal contractions showed a significant decrease, and this activity completely ceased at 14 days of treatment.


Acid phosphatase of the rat epididymis. III. Histochemical and biochemical responses in experimental conditions.

The specific activities of three acid phosphatases were followed in the epididymis of growing rats. All activities were constantly rising but revealed two steeper parts probably corresponding to the increase of androgen secretion and the arrival of spermatozoa in the epididymis. Simultaneously an increase in the histochemical staining was obtained in all epididymal segments. Both biochemical and histochemical studies showed that castration reduced the activity of all acid phosphatases and this could be restored with testosterone-estradiol treatment. Estradiol had no effect on the activities in the castrated animal, but in the normal animal it caused an elevation of Enzyme I activity. In the histochemical study estradiol seemed to restore the acid phosphatase activity. Enzyme I reacted slower than the others to both castration and hormone treatment. Increased elimination caused by ligation of the epididymis caused a reduction in the activity of all enzymes within four days. It was greatest in the area of the corpus. This study, however, rendered no further elucidation for the assumption that acid phosphatases participate in the elimination of excessive and defective spermatozoa.


Morphological and histochemical observations on the prenatal and postnatal testes of the field rat (Millardia meltada).

The foetal testis of the field rat (Millardia meltada) shows seminiferous tubules and interstitium consisting of mesenchymal cells and differentiated Leydig cells associated with blood vessels. The tubules during the prenatal period show gonocytes and Sertoli cells. After birth, their diameter decreases but again increases progressively after postnatal days 9 and 10. Spermatogonia appear among the gonocytes on postnatal day 1 and primary spermatocytes on day 8. Secondary spermatocytes and spermatids are not seen up-to-day 23. Several hypertrophied Leydig cells are seen in the foetal testis on day 17 but are greatly increased in number on days 18 and 19. A few hours after birth the Leydig cells show a rapid decrease in their number. These fluctuations in the Leydig cells of prenatal and neonatal testes have been correlated to the rise and fall in testosterone production during these periods. The Leydig cells show the histochemical characteristics of actively steroid-secreting cells, which consist of the presence of diffuse lipoproteins and a few lipid granules consisting of phospholipids; no cholesterol and/or its esters could be demonstrated. Such lipids are not present in the cytoplasm of undifferentiated mesenchymal cells. The seminiferous tubules do not show any appreciable development of lipid changes.


[Present trends in the development  of pest control methods with reference to environmental protection].

Problems are discussed which result from the present change in principles of parasite control. The main task is maximum limiting the damage caused by certain parasite species. But ecological stability should be disturbed at minimum level. Likewise the introduction of physiologically active alien substances in the ecosystem should be minimal. The solution of this task for practice is joined with research on natural regulation systems in populations and biocenoses, for such system determine the degree and number of species. Three main steps for this solution were shown: Ist: Evaluation of the scope of control; IInd: Evaluation of the strategy of control; IIIrd: Evaluation of a measures program to realize the chosen strategy.


[Small mammal helminths in Neusiedlersee region].

153 small mammals belonging to 22 species were investigated during the year 1975. On this occasion, 29 different species of helminths were found. Parallel-infection of one host by different helminths was common. All age-groups and both sexes of hosts were infested. Pathological symptoms like eosinophile infiltration of the lungs and splenomegalia were generally observed as accompanying phenomena of endoparasitic infestations. Often, there were no distinct symptoms even if the intensity of the infection was comparatively high. Minor infections may pass without clinical phenomena. Amongst the investigated hosts Hymenolepis diminuta, Cyticercus fasciolaris (larva of Hydatigera taeniaeformis), Strongyloides ratti and Hepaticola hepatica were the most widespread species of helminths.


[Incidence of Upupicola upupae in the crest of the hoopoe].

Hopoes belonging to waves of migrants through the Balearic Islands in August and September showed high rates of infestation by Upupicola upupae (77--85 p. c.). The parasite species was almost exclusively confined to the long and mobile feathers of the bird's crown. And at this time of the year the Mallophaga had put their egg cases on the crest feathers, too. A mean of 7 feather-lice was found at this localisation in 8 positive cases sampled. As some of the birds were moulting just these parts of their plumage, a relative high loss of the lice egg masses had to be expected. Evidently, in these cases, the lice didn't adaptively synchronise laying with the period during which moulting occurs. The wings of hopoes are conspiciously barred glossy-black and white. Here the relative dark coloured lice were sitting predominantly in a dark feather area. In these places they were much less visble than on a neighbouring white area. Thus the parasites hide themselves according to their colour.


Air leak syndromes as complications of respiratory disease in infancy and childhood.

Pneumothorax, pneumomediastinum and subcutaneous emphysema are potential complications of a variety of pediatric illnesses. A review by the authors confirms the reports of others that asthma is the primary medical cause of pneumothorax and subcutaneous emphysema and that a variety of inflammatory and obstructive lesions can be associated with extra-vasation of pulmonary air. Pneumothorax infrequently complicates asthma. Asthma-associated pneumomediastinum rarely requires vigorous therapeutic intervention and massive subcutaneous emphysema may necessitate tracheostomy. Pressurized delivery of sympathomimetic aerosols have been condemned by some as an unnecessary cause of iatrogenic air leak. The data of the authors indicate that this form of therapy rarely causes air leak syndromes. The pathophysiology of extravasation of pulmonary air is reviewed.


Smoking and allergic history as correlative risk factors in pulmonary function performance.

Pulmonary function data were compared with smoking history and past personal and family history of asthma, hay fever and eczema in apparently healthy males age 30 to 39. Mean values for FEV1 and MMEF were significantly lower in smokers with a positive allergic history compared to non-allergic smokers.


Chronic and recurrent urticaria: new concepts of drug-group sensitivity.

From further studies on identification of etiologies in chronic and recurrent urticaria, two conclusions stand out: (1) that multiple, differing drugs and chemicals may form a single family group, with cross-hypersensitivity to other substances within the group and (2) that many patients tend to develop hypersensitivity to substances in multiple groups.


Wasp sting anaphylaxis with cerebral infarction.

A cerebral infarction occurred in a 37-year-old man following wasp stings. Computerized axial tomography documented the neurologic lesion.


[The dermal amyelinic system and its endings in psoriasis].

After having reviewed the classical notions of normal skin innervation, the authors study the dermal amyelinic system in 12 patients suffering from psoriasis, using the cholinesterase method and the method of Bielchowski-Gross Jabonero. They successively describe the superficial network with the crooked isolated neurite rising to the tip of the papillae, the perivascular system which spreads out with the vessels themselves, and the hyperplastic perisudoriparous network with its peripilary endings. These findings clearly differ from those of Weddel. The amyelinic system appears to be little changed in psoriasis. The circumscribed nature of the morphological changes, however, should not deny it a role in the physiopathology of this dermatosis. A few recent hypotheses in this regard are discussed.


[Role of antigens and adjuvant substances in the histological response in experimental granulomas (immunogenic granuloma)].

The injection in rabbits of vaccinal antigens combined with immunity adjuvants (in particular calcium phosphate) causes a local lesion in which it is possible to recognize histologically, after a transitory afflux of polymorphonuclear leukocytes, a central area of adjuvant deposit, a middle area of histiocytes and monocytes, and a peripheral immunogenic area of lymphocytes and plasmocytes. These two cellular zones are rich in highly fluorescent cells in the presence of an antiglobulin serum with an embedding technique which respects to the upmost the structures and immunoreactivity of the cells. These histological features are not completely observed on the separate injection of antigen or adjuvant. They must be interpreted, after a fleeting non-specific reaction, while taking into account the still poorly understood method of action of the inorganic adjuvant and spread of the antigen in the organism.


[2 cases of encephalitis in immunodepressed patients].

The authors report two new cases of encephalitis occurring in association with immunity deficiency. The first concerns a child suffering from Bruton type congenital hypogammaglobulinemia. Histological examination of the brain under light microscopy shows important lesions of panencephalitis with parenchymal atrophy : the latter was more marked in the cerebellar lamellae. Ultra-structural examination showed numerous nuclear bodies in the nuclei of the macroglial cells and tubular inclusions situated in the cytoplasm of the capillary endothelial cells. The second case is that of a man of 44 years of age who had undergone a kidney transplant for malignant arterial hypertension, who after 3 months immunodepressive treatment suffered from temporo-spatial confusion together with a pyramidal tract syndrome. He died after 3 weeks evolution of the disease. Microscopical examination of the encephalon showed the presence of microglial nodules with aspects of neurophagia, suggestive of a polioencephalitis. These lesions were situated in the temporal cortex and the brain stem. The lymphocytic reaction was very slight in the second case.


[Electronic microscopic study of a sacral chordoma. Characterization of various development stages of the tumor cells].

The electron microscopic study of a sacral chordoma, the cells of which contain variable amounts of glycogen, allowed to characterize different stages in the evolution of the tumoral cells. The young cells contain almost no glycogen ; progressively it becomes more abundant and fills up almost the whole cytoplasm. At the end of the evolution glycogen disappears while the cell becomes vacuolated. This suggests that enzymatic lysis of this polysaccharide could be the cause of the vacuolation which finally produces the physaliferous cell. Comparison between the cells of the chordoma and those of the normal notochord shows some morphological similarities in the development of these cells. These different data may be useful for a classification of the various types of chordomas.


Clinical, morphologic, and clinicopathologic findings in Beagles treated for two years with melengestrol acetate.

Melengestrol acetate (MGA) was administered orally to groups of 10 female and 3 male Beagles at doses of 0, 1, 2, or 8 microgram/kg of body weight/day for 2 years. Treatment was continuous at the same dose rate in the first 3 groups, but in the 4th group, the dose for bitches was reduced to 4 microgram of MGA/kg/day during the 2nd year. Matings were made within MGA-dosage groups and among 10 additional bitches treated at 1 microgram of MGA/kg/day and the dogs treated at 8 microgram/kg/day. Doses of 8 and 4 microgram of MGS/kg caused progestational effects on the uterus resulting in expected histopathologic changes, dystocia, and pyometritis. Leukocytosis, normocytic, hypochromic anemia, and increased alkaline phosphatase values were the results of systemic and uterine effects consistent with the indirect and expected pharmacologic action of progestational agents in the bitch. Doses of 1 and 2 microgram of MGA/kg in dogs and bitches and 8 microgram/kg in dogs produced no significant differences in clinical observations, hematologic findings, blood chemical analysis, urinalysis, organ weights, or gross and microscopic observations at necropsy.


Determination of estrogen receptors in canine mammary tumors.

Dextran-coated charcoal assay with Scatchard plotting was used for the quantitative determination of high-affinity estradiol receptors (ER) in 10 canine mammary tumor cytosols. Mammary tumors diagnosed histopathologically as adenocarcinomas appeared to have a higher incidence of ER than those diagnosed as mixed mammary tumors. These receptors have a high affinity for estradiol with dissociation constants as determined by Scatchard analysis ranging from 1.2 to 2.0 X 10(-11) M. These dissociation constants are similar to those previously reported for the receptor-estradio interaction from target tissues in other species. The specific binding of the receptor for the hormone was diminished in the presence of an antiestrogenic compound. Our data suggest that canine mammary tumors with significant ER levels would respond favorably to antiestrogen therapy. With the demonstration of ER sites in canine mammary adenocarcinomas as presented herein, the potential for chemotherapeutic management appears to be encouraging.


Influence of glucagon on exocrine pancreatic function as determined by the Lundh test in dogs.

Exocrine pancreatic function was investigated by means of the Lundh test model in dogs with chronic duodenal and gastric fistulas. The test was standardized and the effect of glucagon on exocrine pancreatic secretion was evaluated. The mean tryptic activity detected in 18 tests in 6 dogs was 32.25 +/- 5.25 muEqH+/minute/ml, which is considerably higher than that observed in man. The administration of glucagon was followed by a significant decrease (30.8%) in the volume of the duodenal contents and a more pronounced depression of the enzyme concentrations (trypsin 59%, chymotrypsin 53.3%). It is concluded that the Lundh test affords a valuable experimental model for the investigation of exocrine pancreatic function in dogs.


The brown dog tick Rhipicephalus sanguineus and the dog as experimental hosts of Ehrlichia canis.

Adult Rhipicephalus sanguineus ticks efficiently transmitted Ehrlichia canis to susceptible dogs for 155 days after detachment as engorged nymphs from a dog in the acute phase of ehrlichiosis. Adult ticks that had similarly engorged on a dog in the chronic phase of ehrlichiosis failed to transmit E canis to susceptible dogs. Infected but unfed adult ticks may be of greater importance than the chronically infected carrier dog as a natural reservoir of E canis.


Variation of canine and feline frontal-plane QRS axes with lead choice and augmentation ratio.

The intraindividual variability in mean electric axis referable to choice of ECG leads and augmentation ratio was investigated by means of a digital computer program. Although, in theory, the choice of leads for determining the QRS axis should make no difference, the maximum intraindividual variation in axis angle was about 50 degrees for canine and feline subjects. The angle conputed for the lead combinations I and III and I and aVF will usually fall within 5 to 10 degrees of the mean of all lead combinations, but larger variations are seen at time. The application of an "augmentation ratio" for the augmented unipolar leads was most helpful when it was individually computed. Further methods of lead-vector improvement are discussed.


Feline interferon response to 2-amino-5-bromo-6-methyl-4-pyrimidinol (U-25,166).

U-25,166 induced high serum interferon levels in cats at concentrations at least 40 times less than the maximum tolerated dose. Although certain cats responded to U-25,166 by consistently producing higher interferon levels than did other cats, this relationship was not observed if the same animals were injected with Newcastle disease virus or polyriboinosinic:polyribocytidylic acid (poly I:C). Using a biweekly treatment regimen, cats remained responsive to interferon induction by U-25,166 over an 18-week period in which 9 doses of the compound were given. Cats given the compound daily, however, soon became hyporesponsive to interferon induction. Interferon was induced in cats given U-25,166 orally as a suspension or in capsules, but circulating interferon levels were low in cats given the drug by subcutaneous injection.


Surgical approach for pinealectomy in the calf.

Pinealectomy was performed on 7 calves, and a sham operation was performed on 3 calves. Two pinealectomized calves died immediately. The 5 remaining pinealectomized and 3 sham-operated control calves are presently involved in experimental studies. The surgical technique for exposure of the pineal gland was a rectangular (rostrotentorial) craniectomy between the median line and the horn bud. Removal of portions of the frontal and parietal bones, measuring 6 cm by 4 cm, provided adequate exposure. Positioning the head was important in order to gain the best access to the pineal gland. Water deprivation, hypertonic solution, elevation of the head, and hyperventilation prevented brain edema during the operation. The dura mater was sutured and glucocorticoids were administered to prevent postsurgical brain edema. Bone graft or plate was not placed over the craniectomy site. The soft tissue flap was repositioned over the dura mater and sutured in place--the periosteum and muscle comprising 1 layer and the skin a 2nd layer. Postsurgical complications were observed only in the 2 calves which died and were the result of hemorrhage and leukomalacia.


Rate of change of halothane concentration in a large animal circle anesthetic system.

The slow rate of change of inspired halothane concentration which results in a conventional large animal circle anesthetic delivery system when low carrier gas flow rates are used was confirmed, using a model system. To obtain a 63% change in inspired halothane concentration in the 32-L large animal circle anesthetic machine at fresh gas inflow rates of 3, 6, and 12 L/minute required 10.7, 5.3, and 2.7 minutes, respectively. At a given inflow rate, increasing the rebreathing bag size from 20 to 40 L prolonged the time for equilibration between the gas flowing into the anesthetic circuit and the inspired gas. The extent to which an adult horse further slowed the rate of rise of inspired anesthetic concentration was also demonstrated.


Management program for improving sow and gilt performance by feeding dichlorvos.

Treated sows were on a special management program which consisted of feeding 1,000 mg of dichlorvos to the sow each day for the last 30 days of gestation. The dichlorvos was delivered as a slow-release formulation. The late gestation treatment signigicantly (P less than 0.01) improved the productivity of the sows by improving the performance of their litters. The litters from treated sows were superior in 4 ways: (1) increased number of pigs born alive per litter (2.3%); (2) increased pig birth weights (9.6%); (3) improved survival of pigs born alive; and (4) improved growth rate to market weight. The litters from treated sows were 11.6%, 16.5%, and 12.4% heavier than control litters at birth, weaning (35 days), and market (160 days), respectively.


Absorption, distribution, and excretion of imidocarb dipropionate in sheep.

Spectrophotometric and thin-layer chromatographic methods for determination of imidocarb in biological specimens are described. Following intravenous injection of imidocarb (2.0 mg/kg) into 3 sheep, plasma concentrations, initially averaging 10.8 microgram/ml, decreased to an average of 1.9 microgram/ml within 1 hour and then to less than 1 microgram/ml within the next 4 hours. When imidocarb (4.5 mg/kg) was injected intramuscularly (IM) into 7 sheep, peak plasma concentrations averaging 7.9 microgram/ml were achieved within 4 hours and then rapidly decreased to 4.6 microgram/ml within the next 2 hours. Plasma values then decayed very slowly by first-order kinetics and trace amounts were still present 4 weeks after treatment. Imidocarb was bound to plasma proteins and the apparent volume of distribution was estimated to be slightly higher than the total body water. The concentrations of the drug in the plasma and in the erythrocytes were approximately equal. Detectable amounts were present in all examined tissues 4 weeks after IM administration Twenty-four hours after IM administration, the highest concentrations were in kidney, liver, and brain. The 14C-labeled imidocarb could be detected in all regions of the central nervous system examined, in the hypophysis, and in the pineal body. Metabolic or biotransformation products were not detected by the methods used. Of the administered IM dose, 11 to 17% was excreted in the urine within 24 hours; thereafter, the excretion rate was low, and detectable amounts were still present in the urine for 4 weeks. Renal clearance of imidocarb was less than glomerular filtration rate, indicating net tubular reabsorption. The relatively high concentration of imidocarb in the bile suggests that the bile is an important route of excretion. High concentrations were also found in the mild of lactating ewes, but the drug could not be detected in the plasma of lambs fed milk from these ewes.


Application of the direct leukocyte-migration agarose test in cattle from a Mycobacterium paratuberculosis-infected herd.

Using johnin as the specific antigen, the direct leukocyte-migration agarose test was applied to 10 cows from a Mycobacterium paratuberculosis-infected herd. Nine of the cows did not have signs of paratuberculosis; 1 cow was clinically affected. The cows were slaughtered and, on the basis of histopathologic and cultural examinations of the intestines, were classified as infected or noninfected. Six of the healthy cows from which the bacterium was not isolated and the clinically affected cow reacted with migration indices lower than those of 3 healthy animals that were found to harbor the bacterium. It is suggested that the long incubation period of paratuberculosis could to some extent be due to immunologic tolerance.


Regional blood flow to the stomach and small intestine in ponies.

Studies on regional blood flow to the stomach and small intestine were performed in 9 anesthetized ponies. Carbonized microspheres (15 +/- 5 micron in diameter) labeled with 85Sr were injected into the left atrium to determine blood flow distribution. In 4 ponies, the regional flows to mucosal-submucosal layers of the stomach and the small intestine were also measured. The nonglandular region of the stomach received the least blood per 100 g of tissue, and the duodenum received the greatest. The regional blood flow to the duodenum was significantly higher than that to the glandular stomach region, jejunum, and ileum.


Modified metabolic-inhibition test for detection of antibodies to Mycoplasma hyosynoviae in swine serum.

A modification of the metabolic inhibition (MI) test was used for detection of antibodies against Mycoplasma hyosynoviae in convalescent swine serum. Supplementation of the MI system with 1% unheated normal rabbit serum, as well as 6% unheated normal guinea pig serum was required for detection of MI antibodies in early phase, postinfection serum and markedly improved detection of MI antibodies in late phase, postinfection serum. Factor(s) supplies by rabbit serum was not supplied by unheated normal swine serum.


Ultrastructure of hyaline microthrombi in myocardial capillaries of pigs with spontaneous "mulverry heart disease".

Three 5-week-old pigs from an Indiana farm died of the cardiac form ("mulberry heart disease") of selenium-vitamin E deficiency. Grossly, the hearts had prominent hydropericardium and extensive serosal and myocardial hemorrhage. Histopathologic study demonstrated marked myocardial edema, congestion, and hemorrhage, with numerous capillary hyaline microthrombi that stained red with the periodic-acid Schiff rocedure. Ultrastructural study revealed that these thrombi were composed of elongated, dense masses of intertwined fibrin strands with occasional entrapped erythrocytes.


Hematologic values in normal pygmy goats.

Pygmy goat blood was analyzed to determine hematologic base-line values. Male, female, and castrated male goats were used in this investigation. Influence of age on these variables was also studied. Most of the hematologic values of pygmy goats were similar to the reference values reported for several other ruminant species and for man. Values significantly different from reference values in man were as follows: Erythrocyte counts were slightly higher than for human beings. The relative lymphocyte count was comparable to that in infants, but significantly greater than values in adult human beings. Also, although not of statistical significance, hemoglobin levels in goats were slightly lower than in both infants and adult human beings, and the leukocyte count was just slightly higher than the usual values for infants and adult human beings. Thus, of 9 hematologic variables, only 1 was significantly different from those in man, and 2 were slightly different. The fact that pygmy goats have hematologic responses similar to those of man, and the similarity of hematologic values to reference values in man, further enhances the pygmy goat for use as an experimental animal.


Serum biochemistry values in normal pygmy goats.

Blood serum of pygmy goats (both sexes, and castrated males) was analyzed to establish biochemical reference values. Influence of age on reference values was also studied. Serum biochemical analyses were made for urea nitrogen, creatinin, bilirubin, lactate dehydrogenase, aspartate aminotransferase, alkaline phosphatase, glucose, uric acid, and total lipids. These serum values for pygmy goats were similar to those reported for man, except as follows: Aspartate aminotransferase activities were slightly higher than those reported for man. Glucose concentrations in pygmy goats were slightly lower than in human beings, and uric acid levels were significantly lower than the values for man. Female and castrated male goats had lower total lipid concentrations than did human beings, whereas intact males had higher concentrations. Thus, of the 9 measured variables for pygmy goats, 5 were comparable to human values. This, together with other attributes, including the small size which conduces to economics of maintenance and enhances the desirability of using pygmy goats in research.


Determinants of blood amino acid concentration after hemorrhage.

Many mechanisms, including alterations in muscle metabolism, cellular damage, decreased blood volume, and hepatic disfunction, are influential in producing the observed progressive rise in the concentration of amino acids in arterial and venous blood during persisting hypovolemic shock. The rapid rise of venous and arterial concentrations of amino acids and the increase in venoarterial concentration difference suggest that hypovolemia causes a net release from muscle of a potential substrate for energy metabolism. The blood flow through peripheral tissues, however, is reduced to such an extent during hypovolemic shock that the net rate of release of amino acids is not greater than preshock release and may be less. Therefore, the homeostatic advantages served by the alteration in protein metabolism during the more chronic stresses of starvation or after injury may not obtain during acute hypovolemia.


Acute hemorrhagic pancreatitis in the dog. 5. The effect of antidiuretic hormone on pancreatic exocrine secretion.

Acute hemorrhagic pancreatitis was created in dogs using the closed duodenal loop technique. After 18 hours, a a constant rate of pancreatic exocrine secretion was stimulated with secretin. A direct relationship was observed between the percentage inhibition of secretin-stimulated pancreatic exocrine flow and the dose of antidiuretic hormone administered to dogs with acute hemorrhagic pancreatitis. The acute hemorrhagic pancreatitis reduced the sensitivity of the exocrine pancreas to secretin and antidiuretic hormone.


[Mental disorders and professional determinants. Study of the time relationship between the beginning of professional life and the first disorder in teachers].

Analysis of the temporal relation between the beginning of mental illness and the beginning of professional life, according to a comparative anamnestic method applied to a group of teachers (N. = 94) and a matching control group of psychiatric paired out-patients (N. = 95). The results show that the distribution of illness prior to professional activity is linked with the diagnostic category and not with professional determinants, psychosis proving to be more impairing than neurosis. A high-risk age group for first incidence of psychotic disease was found.


[Erotomania or the delusional conviction of being loved. Contribution to the psychopathology of the love life].

Identified and described 150 years ago, the delirious conviction of being loved, or erotomania, is probably more frequent (in his less spectacular forms) in the private practice, than in the psychiatric services. The critical examination of the literature permits to classify this peculiar clinical-psychological entity as paranoid psychoses, or as sensitive characteropathias of the the Kretschmer-type, finally as an exaggerated-rediculous form of the intra-specific struggle for the conquest of a sexual partner. The pathogenesis of erotomania is yet under discussion. The psycho-analytic conception invoking the rejection or denegation of a latent homosexuality is yet not demonstrated. Six personal cases (three women, two of them being married, and three single men) are related as a contribution to the study of the yet debated problem of erotomania.


[Experimental psychosomatic medicine. Blisters].

Following a survey of the literature on the production of blisters by hypnotic suggestion, the author presents his own case. He discusses the physio-pathology of this phenomenon in the light of present day physiological theories, and contests generally admitted opposition in psychosomatic theory between conversion as concerns the voluntary system and striated muscles, and somatisation, involving non-striated muscles and the autonomus system.


[Ethology of the family (natural models of family physiology)].

The Ethology of the Family allows in a first step to collect naturals models of family organisations. It results an extreme diversity where all family forms exist: maternal, paternal, biparental, solitary. However we can find in this notion of socialitary peogramme where a certain mode of social operation is inscribed in the genetic code.


[Post-traumatic disease-language. Geneaological analysis and time structure].

A part from head traumas all physical injuries, slight though they can be, can turn out to be the starting-points of neurotic syndrome of intolerance. The traumatic shock in the temporal meaning of the word (temporal event), more than the trauma itself, has disturbing and disynchronizing effects which are pathogenic. The post-accidental traumatic syndrome develops from the effects achieved by the temporal event. Such effects are supported afterwards by the creative psychopathological expression. The creative expression is structured into a speech-disturbance through a twofold account, 1) an account of the symptoms and words to describe and explain such symptoms, 2) an account of the narrative comments, at once subjective and expressed about the symptoms. The genealogical and temporal analysis of post-traumatic speech-disturbance shows the articulation of the various episods of the psychopathological creation.


[The Guidance Center. Evaluation after a year of activity].

The C.H.U. of Grenoble started a child Guidance Clinic for assuming the education of handicapped children from 2 to 6 (years of age). A whole organization for medical advice, training for walk, psychotherapy, orthophony, together with a day hospital can be found there--the working of whith is provided by a pluridisciplinary team of 15 members (among whom educators, psychanalistes, psychiatristes, psychologistes, pediatristes). The parents may profit by interviews with the educators, with a conjugal adviser, or by parents groups who meet twice a month. An average of 25 children are registered, and 15 are present, among whom most are trisomic 21, or psychotics. The day price is 257 F and 100% returned by the social Security. At last, besides the therapeutic function, the clinic also plays a pedagogic part by receiving probationers coming from different places.


[In favor of rehabilitation of the entity of "folie hysterique"].

The disappearance of hysterical madness, in the second decade of our century, was related to the emergence of the tentacular concept of schizophrenia. The case of Marie-Christine, a young girl whose delirium calls to mind the imaginary in witchcraft, prompts us to question upon the pertinency of abandonning the nosological entity "hysterical madness". We are attempting to show that, thanks to the Lacanian contribution in the theory of psychose, it is now becoming possible to distinguish between the latter and hysterical madness, this through the various and different aspects of the onset of the illness, of the fundamental mechanism, of the characteristics of the delirium, of the transference, of morbid anxiety.. That is why, to us, there seems to be a perceptible difference between the delirious hysteric who cannot manage to inhabit his sexed body, and the psychotic who has not succeeded in getting a grasp on the symbolic. Moreover, it seems that there is a close continuity from ordinary hysteria to hysterical madness, so that in the latter the delirium would not be the illness itself but only a symptom.


[Treatment of drug addicts based on creative values].

From the correlations between childhood and different modes of thinking it appears possible to extract a type of profile of drug addicts. This profile is characterised by an individualised childhood and by a very autonomous mode of thinking, obtained by experience thoughts. Such children, sensitive and creators, are not made for dominant behaviours and ideals. When these are imposed upon them, they learn to like them in spite of them and consecutively profoundly feel a need for "other things" which brings about the tendency to drugs. When the adolescent is properly cared for, it is sufficient to reveal to him his latent talents and to give him confidence in himself so that he can find his stability. Typology, inconvenience, prevention and therapeutic of a large number of addicts would thus be tackled depending on a psychotechnic based on this mode of thinking.


Vertical partial laryngectomy for glottic carcinoma with posterior subglottic extension.

Posterior subglottic extension of glottic carcinoma has been a contraindication for partial laryngectomy because of the proximity of the cricoid cartilage. Resection of the upper portion of the posterior aspect of the cricoid is necessary for adequate tumor resection but is complicated by persistent aspiration. This paper presents a method of reconstruction following partial posterior cricoid resection.


Glottic squamous cell carcinoma (T(2)): a retrospective study.

Seventy-three patients with T(2) glottic squamous cell carcinoma were treated primarily with a full course of cobalt radiotherapy. This series covered the time period between 1960 and 1972 and, therefore, all patients were eligible for five-year follow-up. Only seven patients, or 9.6%, have died of or with recurrent laryngeal carcinoma. Fourteen patients suffered recurrence of disease after radiotherapy and 12 of this group underwent salvage surgery. Surgery was successful in controlling recurrent disease in 7 of 12 patients, 3 of whom are still alive and free of disease. Forty-two patients, or 57.5%, are alive and free of disease five or more years after diagnosis. Twenty-four patients died without evidence of disease; 11 lived more than five years and 13 died in less than five years. On the basis of these findings, we feel that the best treatment for T(2) glottic squamous cell carcinoma is a full course of cobalt radiotherapy followed, when necessary, by salvage surgery.


New insights into the causes of postoperative aspiration following conservation surgery of the larynx.

This study was conducted specifically to determine and document the various possible causes of postoperative aspiration. Such information may assist in better selection of candidates as well as provide insights that facilitate improvement of operative techniques for conservation surgery for cancer of the larynx. The major significant information derived from this study is the recognition and delineation of the part played by paralysis of the superior and recurrent laryngeal nerves as causes for aspiration following conservation laryngeal surgery.


Neck dissection: radical or conservative.

Four hundred and forty-five neck dissections for epidermoid carcinoma over a 10-year period are reviewed as to local recurrence of neck disease. Three hundred and forty-seven dissections were radical en bloc procedures and in 98 a modified conservative technique was utilized. Cervical lymph node classification was applied and a comparison made of the two techniques. A review of the anatomy of cervical fascias and the technique of conservative neck dissection is given. Evaluation of this series of cases indicate that the control of local disease in the neck in the N0 and N1 groups is is accomplished as well with conservative dissection as with radical neck dissection. The number of conservative neck dissections for N2 disease was too limited for accurate comparison. There were no conservative neck dissections done for N3 disease. We suggest that conservative neck dissection be utilized for subclinical and N1 disease and that the classic en bloc dissection be reserved for N2 and N3 situations.