Effects of actinomycin D on brain RNA synthesis and discrimination learning in the goldfish (Carassius auratus).

Intracranial injection of actinomycin D 2 microgram inhibited about 70% of the brain RNA synthesis from 3 hr to 4 days after injection in the goldfish. Under these conditions, fish were given 4-day-training of visual discrimination between a card with vertical stripes and one with horizontal stripes. Fish injected intracranially with actinomycin D showed deficits in between-day retention (long-term memory) but not interruption of within-day acquisition (short-term memory). It is suggested that brain RNA synthesis is necessary only for the formation of long-term memory but not short-term memory.


Neural pathway mediating somatic evoked responses in the caudate nucleus of cats.

The course of somatic afferents to caudate nucleus (CN) was investigated. In curaized cats discrete lesions in intralaminar nuclei, n. centralis medialis (NCM) affect evoked response (ER) in CN to radial nerve stimulation. NCM lesions totally abolish these somatic responses, while after subthalamic lesions ER appear only when a high stimulus intensity is used. Lesions in the specific relay nuclei, ventralis posterior lateralis (VPL) have no effect on somatic ER in CN. Barbiturates (10 mg/kg) abolish somatic ER in CN. Stimulation of the ponto-mesencephalic reticular formation (RF) in a region where visual and somatic responses are recorded shows lowest threshold values for eliciting evoked responses in NCM and CN. The potentials in CN to RF stimulation are restricted to this nucleus and disappear in the internal capsule.


Blood glucose levels in portal and peripheral circulation and their relation to food intake in the rat.

Rats weighing about 450 g were provided with permanent catheters in the portal vein and the right auricle. This method allows blood sampling from the portal and peripheral circulation at the same moment in the nondisturbed unanesthetized rat. In the ad lib condition the portal glucose level was higher than that in the general circulation before, during, and after the meal. After a fast of 22 hr premeal portal vein levels were equal to those of the general circulation. During the meal the portal glucose levels rose to about 150 mg per 100 ml whereas those of the general circulation did not exceed 130 mg/100 ml. Experiments with glucose infusions systemically and intraportally show that, under conditions of mild deprivation, the level of glucose in the portal vein plays no or only a very minor role in the termination of feeding.


Increased feeding in response to bilateral injection of insulin antibodies in the VMH.

In order to investigate the role of insulin in the VMH in regulation of food intake in the rat, a specific antibody against rat insulin was injected in the VMH. The insulin antibody caused transient hyperphagia, when administered in the nighttime. This result is discussed in view of the glucostatic theory of the regulation of food intake.


Vendor differences in starvation-induced gastric ulceration.

The incidence of starvation-induced gastric lesions was observed in Sprague-Dawley rats obtained from four different vendors (ARS/Sprague-Dawley, Hilltop, Holtzman, and Charles River). Food was withheld for 5 days from rats weighing 150, 200, 260 or 330 g. Glandular lesions occurred in 150 g rats; rumenal lesions occurred in 200+ rats. ARS/Sprague-Dawley rats developed more glandular lesions, whereas Hilltop rats developed more rumenal lesions.


Involvement of the ventromedial and anterior hypothalamic nuclei in the hormonal induction of receptivity in the female rat.

Bilateral lesions of the ventromedial hypothalamic area virtually eliminated the estrogen-induced display of sexual receptiveness in the female rat. Such lesions usually diminished sexual responsiveness to combined estrogen-progresterone stimulation, although not all lesions were equally effective in this regard. Damage to the anterior hypothalamic area was without apparent effect on the hormonally-induced display of receptivity, suggesting that previous observations to this effect are probably related to incicental damage to the ventromedial hypothalamic area incurred during placement of the lesions. This study complements other work indicating that the ventromedial hypothalamic area is relatively rich in estradiol concentrating cells and that estrogen implants to this area induce sexual receptivity in spayed female rats. Together, these studies affirm that the ventromedial hypothalamic area plays a critical role in the hormonal induction of receptivity in female rats.


Measurement of blood pressure in unrestrained rats.

A method that allows continuous recroding of blood pressure in rats and other small animals is described. Surgical, recording, calibration, and catheter construction techniques are explained. The techniques allow blood pressure recording from free-roving rats for relatively long periods of time but do not require complicated maintenance procedures to insure catheter patency.


Simple, reliable and inexpensive telemetry system for continuous monitoring of small animal core temperature.

A core temperature telemetry system is described which includes a transmitter and circuitry for signal reception, noise elimination and computer interfacing. The system is inexpensive (less than $50), easily constructed, reliable, portable, and has proven to be sensitive to rapid fluctuations in core temperature.


Taste and olfaction in human obesity.

Earlier studies have shown differences between normal weight and obese humans in responsivity to external and internal stimuli. This study shows that normal weight and obese subjects do not differ in hedonic response to sucrose (taste) and benzaldehyde (odor). However, a perceptual typing of individuals based upon hedonic response is possible for both gustatory and olfactory processes. Ratings of pleasantness for the sweet taste of sucrose appear to generalize to the food-related odor of bitter almonds. The method of magnitude estimation as applied to the study of taste and olfaction in man may reveal relationship between changes in internal state and hedonic behavior.


A solid state sine-wave stimulator.

A line-frequency sine-wave stimulator of solid-state construction is described. Switching transients are avoided by starting and stopping the stimulating trains at exactly zero volts. Train repetition frequency and duration are controllable, the latter down to one-half cycle. External control of both frequency and duration is possible.


Effects of electroconvulsive shock on food and water intake in the rat.

Forty-two male rats were habituated to laboratory conditions for four weeks under constant light conditions. Food and water intakes were recorded daily. Following the habituation period half of the animals were given electroconvulsive shock (ECS) and half Sham-ECS (SECS). ECS treatments produced significant decrements in both food and eater intakes which returned to baseline levels after three days.


Long-term follow-up of 90Yttrium-treated knee-joint arthritis.

The results are reported of the treatment of 33 patients with long-standing, therapy-resistant synovitis and effusion of the knee by intra-articular injection of 90Yttrium. In 25 patients with bilateral gonitis the effect of the treatment was compared with the effect of local corticosteroid therapy to the contralateral knee. The irradiated group showed statistically significantly better therapeutic results at 3, 6, and 12 months and the effect weakened in proportion to the length of the follow-up period. At the final check-up at 3.5 years, 52% of this group showed improvement, as against 26% of the controls. The difference in radiological deterioration at the end of the observation period between the two groups was not significant. Local remission in the treated joint in spite of high general activity was recorded in 7 patients. In 4 patients, in whom the results were unsatisfactory, severe articular destruction and instability were noted prior to therapy. Assessment of the correlation between clinical diagnosis and therapeutic results shows that the treatment seems to be most successful in patients with rheumatoid arthritis and unsatisfactory in patients with psoriatic arthritis. General reactions were observed in 1, and local reactions in 2 patients. Irradiation therapy seems to be the treatment of choice in patients over 40, with long-standing knee arthritis of rheumatic origin.


Hereditary diffuse articular chondrocalcinosis. Dominant manifestation without close linkage with the HLA system in a large pedigree.

Thirty-nine members of one family, covering three generations, were HLA-typed. Twenty-five suffered from primary diffuse articular chondrocalcinosis, and all had the same dominantly transmitted autosomally controlled disease. This was characterized by acute articular attacks, which always started before the age of 35, and radiologically by typical cartilaginous and fibrocartilaginous deposits associated with para-articular calcifications. The lesions were both peripherally and axially generalized. None of the 28 HLA antigens tested seemed related to the disease, nor did the disease segregate with an HLA haplotype.


Effects of cortisol on glycosaminoglycans synthesized by normal and rheumatoid synovial fibroblasts in vitro.

Cultivated rheumatoid synovial fibroblasts synthesize hyaluronic acid which has a changed molecular weight distribution in Sepharose 2B gel chromatography, when compared with normal synovial fibroblasts. Cortisol has no effect on the molecular weight distribution of either normal or rheumatoid hyaluronate. However, it does reduce the hyaluronic acid synthesis, by more than 50% in both cell types at low, near physiological plasma concentrations of the steroid.


Gold compounds in rheumatoid arthritis. Report of a symposium.

A vast accumulation of clinical experience and controlled studies justifies the use of gold compounds in selected cases of rheumatoid arthritis. The striking therapeutical efficacy observed in some patients has stimulated active research to clarify the pharmacokinetics and mechanisms of action of gold compounds. Based on this knowledge, the possibility of selecting gold-responsive patients may be enhanced, and the frequency of adverse reactions decreased. Liberal indications and inexperience in administration and control have given gold therapy mixed reputation. A symposium in Umeå, Sweden, summarized present knowledge and current concepts among Scandinavian rheumatologists on the rational use of gold compounds.


Morphological findings in joint cartilage after osmic acid treatment.

Punch biopsy specimens from the cartilage of the lateral condyle of the femur in 29 patients suffering from rheumatoid arthritis were taken during surgical synovectomy of knee joints and investigated by light or electron microscopy. Eleven patients had never received osmic acid injections in this particular joint, whereas 18 had had such injections 1-24 months prior to surgery. By light microscopy only minor differences could be seen between controls and cartilage treated with osmic acid, whereas with electron microscopy, increased amounts of dark-staining cell debris were visible in samples taken after osmic acid treatment. The perilacunar matrix appeared normal. There was no irregularity of collagen fibres at the surface of the cartilage. It is concluded that osmic acid causes limited superficial damage to the cartilage. The question whether this is of any clinical consequence in the form of subsequent degenerative joint disease, must be solved by clinical follow-up studies.


Platelet count and disease activity in juvenile rheumatoid arthritis.

Blood samples from 41 children with juvenile rheumatoid arthritis (JRA) were studied. The platelet count was tested for possible relationship and correlation with a number of clinical and laboratory parameters. High platelet count was associated with active disease, presence of secondary amyloidosis, and poor functional capacity. The platelet count was positively correlated with the erythrocyte sedimentation rate, anemia, and granulocytosis. The platelet count thus seems to provide an additional parameter of disease activity in patients with JRA.


Death rate and causes of death in RA patients during a period of five years.

Patients with rheumatoid arthritis, 500 males and 500 females, aged 40 years or over, together with an age and sex matched control population, were observed over a 5-year period. During the follow-up 176 RA patients and 107 controls died. The most common causes of death in RA patients were cardiovascular diseases (86 patients), renal failure (33 patients), infections (23 patients), and malignant neoplasms (21 patients); in the controls, the corresponding data are cardiovascular diseases (53), malignant neoplasms (30), infections (9), and accidents (8).


Spondylosis in the whale--an anatomicoradiological study of an osteophyte.

This report describes a macroscopic and radiological study (on a dry specimen) of a whale vertebra having an osteophyte of spondylosis similar to those present in man and other mammalians. This osteophyte has a remodelled and dense structure different from that of the normal neighbouring bone of the vertebral body (which has the particular bone structure of a cetacean). The study of the osteophytes and the bridges of sponylosis in the marine mammalians offers particularly favourable conditions for a better dissociation of the pre-existing vertebral body and the extrinsic bone which was newly developed under the influence of mechanical factors.


Cephalexin levels in serum, synovial fluid and joint tissues after oral administration.

Cephalexin (1 g) was administered orally every 6 hours to 13 patients with rheumatoid arthritis and chronic knee effusions without bacterial arthritis. Samples were taken from blood, synovial fluid, synovium, cartilage and bone. The concentrations found in these samples after one oral dose were high enough to have a possible therapeutic effect in bacterial arthritis sensitive to cephalexin.


Ventilatory lung function following two years of tobacco abstinence.

Spirometry, maximal expiratory flows and the nitrogen closing volume test were studied in 59 subjects following their attempt to give up smoking. Seventeen subjects were tobacco abstinent for at least 5 months. This group showed significant improvement of vital capacity (VC), forced expiratory volume in 1 sec (FEV1) and the slope of phase III. Nine of these subjects remained ex-smokers for at least 24 months. However, no significant improvement of any of the measured variables could be established in this group. This may be due to the small number in the group and the circumstance that they were older and had worse lung function before smoking cessation compared with those who resumed smoking.


Studies on the mechanism of insulin action. IV. The isolation and determination of a low insulin receptor activity.

After passing the membrane protein dissolved in 1% DOC over a Sepharose 4B column, a peak with insulin receptor binding activity has been shown in the void volumn. After treating this single peak fraction with 6M guanidine HCl and again passing over a Sepharose 4B column preequilibrated with guanidine HCl, four absorbing peaks at 280 nM have been observed. In addition to the first peak representing the void volume, the 4th absorbing peak has been found to display an obvious binding activity as well. This low molecular biologically active unit has also been demonstrated by means of gel electrophoresis. Its molecular weight has been determined with Sepharose 6B to be about 50,000 daltons.


Epidemiology of acute viral hepatitis in Singapore.

A total of 194 cases of acute viral hepatitis were notified between June and December 1976. Thirty-five (22.6%) out of 155 patients were positive for HBs Ag by counter-immuno-electrophoresis. The ethnic-specific morbidity rates per 100,000 were Chinese, 9.51; Malays, 3.20; Indians, 8.30 and others, 1.13; and the age specific attack rates were high in the 15 -- 24 and 25 -- 34 age groups, being 15.05 and 15.77 per 100,000 respectively. The male to female ratio was 3.04:1. Cases were not confined to areas with poor environmental sanitation. There were very few secondary cases. Unrecognized anicteric or subclinical cases probably play an important role in the transmission of viral hepatitis in the community. The possibility of transmission of hepatitis A by contaminated food was discussed.


A comparative study of Trichomonas vaginalis prevalence in Filipino women.

A comparative study of Trichomonas vaginalis prevalence among Filipino women is presented herein. A total of 288 women randomly drawn from various sources, including Social Hygiene clinics, Health Centers, and Family Planning Centers in the Metropolitan Manila Area were examined for T. vaginalis. Nineteen or (6.8%) were found positive either by wet mount or stained smear methods. Prevalence was significantly higher among the group of single than married women and five times higher among the waitress/hostess group than in the housewife/other group. Infection was related to parity and is significantly higher among nulliparous women. Likewise, a significant relationship was observed between prevalence of infection and gravidity. Prevalence decreases with increasing gravidity. No relationship in prevalence was observed between the use and non-use of contraceptives, and the method of contraceptive used. There was no significant association between the presence of the parasite and symptoms.


Observations on the application of counterimmunoelectrophoresis for the seroepidemiology of human cysticercosis.

An immunoepidemiological survey for cysticercosis was carried out in an endemic focus of Irian Jaya by use of a counterimmunoelectrophoresis (CIEP) technique. All individuals with palpable subcutaneous cysticerci were serologically positive by this technique as were 77.3% of the individuals giving a history of epileptiform seizures and 22.5% with no clinical complaints. The possible application of CIEP for epidemiological surveillance is discussed.


Urinary excretion of thiamine in pre-school children in Northeast Thailand.

Urine samples of 85 Thai pre-school children ages below 5 years were taken for thiamine determination related to creatinine. The thiamine status of these children investigated was found to be normal. No difference in the urinary thiamine levels was observed between male and female subjects.


Pulmonary nocardiosis in a patient receiving immunosuppressive agent.

A 20-year-old woman receiving corticosteroid treatment for systemic lupus erythematosus developed pulmonary nocardiosis with hydrophneumothorax. The organism identified as Nocardia asteroides resisted to sulfonamide and cotrimoxazole but sensitive to chloramphenicaol and streptomycin in vitro. She seemed to respond to chloramphenicol but subsequently had peritonitis and succumbed later.


Vitamin B12 and vitamin B12 binding proteins in liver diseases.

Serum vitamin B12 and vitamin B12 binding proteins (transcobalamins, TCS) were determined in patients with malaria, amoebic liver abscess, carcinoma of the liver, infectious hepatitis, cirrhosis and chronic myelocytic leukemia (CML) as well as in 60 blood donor subjects. Serum vitamin B12 in patients with infectious hepatitis, cirrhosis and CML were higher than that of the normal subjects. The values of unsaturated vitamin B12 binding capacity (UBBC) in patients with carcinoma of the liver, infectious hepatitis, cirrhosis were lower while that of patients with CML were higher than that of the normal subjects. A markedly increased TCI and decreased TCII was observed in patients with CML while these changes was much less in patients with other liver diseases. The difference was possibly due to a flooding of vitamin B12 from damaged liver cells into the circulation and the decreased synthesis of transcobalamins in patients with liver diseases while the increased granulocytes, the source of TCI, was much increased in patients with CML.


Control trial of soil-transmitted helminthic infections with pyrantel pamoate.

Pyrantel pamoate at dosage of 10 mg per kilogramme body weight was given to each villager at 4-6 weeks intervals for three times. The infection rates of hookworms among those who received and did not received the drug decreased from 60.5% pre-treatment to 19.6% after the third treatment and then increased to 32.4% one year after the third treatment. Infection rates of A. lumbricoides and Strongyloides spp. among the villagers who received and did not received the drug decreased from 27.5% pre-treatment to 2.2% after the third treatment and then increased to 20.1% one year later for the former, while the latter decreased from 6.5% pre-treatment to 2.3% after the third treatment and 0.4% one year later. The infection rate of T. trichiura was found to increase as pyrantel pamoate had no effect on this nematode. The authors suggested that to obtain more satisfactory results the anthelmintic drug used must likewise be effective against T. trichiura particularly in areas where this nematode is a public health problem. It was also suggested that the duration of treatment should be prolonged.


Capillaria hepatica infection of wild rodents in Peninsular Malaysia.

Capillaria hepatica infection in wild rodents collected from the States of Kelantan, Selangor and Johore in Peninsular Malaysia since 1973 is reported. A total of 1,258 rodents consisting of 20 species of house, field and forest rats, and 7 species of squirrels were examined for the parasite and 17 species consisting of 111 murids and 1 flying squirrel were found infected. The house rat, Rattus norvegicus had the highest prevalence rate, followed by 3 species of field rats, R. tiomanicus, R. argentiventer and Bandicota indica. The prevalence of infection was low among forest rats with the exception of Lenothrix canus. Only 1 flying squirrel, Hylopetes spadiceus was found with the parasite. The prevalence of infection in relation to the host behaviour and habitats was discussed. C. hepatica appears to be widespread throughout Malaysia with a wide range of hosts among rodent species. Some new host records are presented herein.


Failure of irradiated Echinostoma audyi and Hypoderaeum dingeri to sensitize Lymnaea rubiginosa snails.

Attempts to induce acquired resistance in Lymnaea rubiginosa snails against the echinostomes Echinostoma audyi and Hypoderaeum dingeri by means of irradiated miracidia were unsuccessful, although Lie and coworkers using similar methods had recently sensitized Biomphalaria glabrata against Echinostoma lindoense (1975a). In contrast to the B. glabrata-E. lindoense system, in Lymnaea rubiginosa the amebocytic response to irradiated parasites was slow: irradiated E. audyi sporocysts were encapsulated 15 to 28 days and H. dingeri sporocysts 20 to 27 days postexposure. No obvious enlargement of the amebocyte-producing organ was seen. No resistance was demonstrable to subsequent homologous challenge. Development of acquired resistance to a trematode infection in snails may be related to the speed with which the snails destroy the irradiated sporocysts.


Intestinal and blood parasites in the Banggai Kabupaten, Central Sulawesi, Indonesia.

A survey for blood and intestinal parasites was carried out in the Banggai Kabupaten Central Sulawesi, Indonesia. A total of 336, stool specimens were obtained from 182 males and 154 females ranging in age from 2 to 90 years. Hookworm, Trichuris trichiura and Ascaris lumbricoides were the most common helminths encountered. Schistosoma japonicum was noticeably absent in the population sampled. The following intestingl protozoa were detected: Entamoeba coli, E.histolytica, Iodamoeba bütschlii, Giardia lamblia, Chilomostix mesnili and Endolimax nana. A total of 650 blood smears were examined and both Plasmodium falciparum and P. vivax were found in 5 % of the populations sampled. In addition, Brugia malayi microfilariae were detected in 3% of the blood smears examined.


Parasites of man in remote areas of Central and South Sulawesi, Indonesia.

A biomedical survey was conducted in 10 villages in remote, high mountain valleys of Central and South Sulawesi, Indonesia to learn whether Oriental schistosomiasis was endemic and to determine the prevalences of other intestinal parasites, malaria and filariasis in those areas. Although persons with Oriental schistosomiasis were found in three villages of South Sulawesi, follow-up inquiries revealed that these had recently migrated from a known schistosomiasis area in Central Sulawesi. Other intestinal parasites diagnosed were Ascaris lumbricoides (14%), Trichuris trichiura (7%), hookworm (68%), Entamoeba histolytica (3%), Entamoeba coli (17%), and Giardia lamblia (5%). Enterobius vermicularis, Strongyloides stercoralis, Trichostrongylus sp., Physaloptera sp., Diphyllobothrium sp. heterophyid, echinostome and dicrocoelid-like termatodes, Endolimax nana and Chilomastix mesnili were detected infrequently. Malaria parasitemias due to Plasmodium falciparum, P. vivax and P. malariae were detected in 4% of the sampled populations, Malayan filariasis was diagnosed in 21% of the subjects examined.


Brugia malayi in seven villages in South Kalimantan, Indonesia.

Seven villages in South Kalimantan were visited in 1971 and night peripheral blood smears from 2,764 people examined for microfilariae. Brugia malayi was found endemic in all villages with microfilarial rates of 12--46% (average 25%) and the median microfilarial density (MfD50) of 6 to 15 microfilariae per 20 microliter of blood. The microfilariae showed a typical subperiodic pattern. The disease was more common in males than females and the prevalence increased with age. Clinical manifestations of filariasis were found in 20% of 1,099 persons examined. Mansonia species are considered important vectors and cats important reservoir hosts. In addition to B. malayi, Dirofilaria repens and an unknown microfilaria were found in cats in the area and strains of the B. malayi and D. repens have been established in the laboratory.


The changing pattern of heart disease in South African Blacks.

All autopsies on Black patients who died of heart disease at Baragwanath Hospital were examined for the years 1959, 1960 and 1976. The commonest form of heart disease encountered in South African Blacks is undoubtedly hypertensive heart disease and by far the majority of these cases are of essential hypertension. There appears to have been a slight rise in the incidence of hypertension. Rheumatic heart disease is extremely common, and affects young people, who often have advanced valvular lesions by puberty. The incidence of idiopathic cardiomyopathy does not seem to have altered materially, although there has perhaps been a slight drop, which may be accounted for by the tendency of clinicians to place cases of congestive cardiac failure with mild hypertension in the hypertensive group rather than in the idiopathic cardiomyopathy group. There was a significant alteration in the incidence of myocardial infarction; in 1959 and 1960 these cases comprised less than 1% of all cardiac deaths but in 1976 they comprised nearly 12%. There has also been a dramatic fall in the incidence of cardiovascular syphilis.


[Professional freedom and Act 101 of 1965].

Act 101 of 1965 replaced Act 13 of 1928 because the latter had become obsolete. Act 101 makes many new demands on and restricts certain privileges of the medical profession. New ideas, particularly if they restrict previous privileges, are resented. Also, new ideas do not necessarily denote progress. I am of the opinion that these curtailments are detrimental to public benefit. However, to provide positive suggestions to ease the situation is extremely difficult. All those concerned with public welfare should once again review public requirements. Ultimately, Act 101 prescribes for the whole population--is it then unreasonable to curtail medical professional freedom? Under the present circumstances this does not seem to be the case. However, sections of the Act may hamper doctors in the performance of their duties.


An XXYY male presenting with aggression: a case report.

An abnormally tall 21-year-old Caucasoid male was referred for psychiatric assessment for pathological aggression and mental subnormality. He showed many of the phenotypic features of Klinefelter's syndrome. Cytogenetic studies revealed a 48,XXYY karyotype. The significance of the association of this karyotype with aggressive behaviour is discussed.


Billowing mitral valve syndrome in association with absent left pericardium: a case report.

A patient with congenital complete absence of the left pericardium had a late systolic murmur and an intermittent non-ejection systolic click. A post-exercise ECG showed ST-segment depression and T-wave inversion, compatible with that described in the billowing mitral leaflet syndrome. Left ventricular cine-angiography confirmed prolapse of the mitral valve. It is suggested that an associated billowing mitral leaflet syndrome may be responsible for chest pain, variable auscultatory features and abnormal ECGs in some patients with absent left pericardium.


Keratolytic winter erythema or 'oudtshoorn skin': a newly recognized inherited dermatosis prevalent in South Africa.

A hitherto undescribed inherited dermatosis, traceable to certain 19th-century inhabitants of Oudtshoorn, CP, has been transmitted as an autosomal dominant to a large number of their present-day descendants. The disease consists of intermittent and recurrent centrifugal peeling, with redness, of the palms and soles in particular. In more severe cases similar patches are found extending up the limbs to the buttocks and the trunk generally. The inconvenience is usually moderate, but it may be incapacitating. Some temporary relief, but so far nothing permanent, can be offered through treatment.


Gastric volvulus unassociated with hiatal hernia.

Although para-oesophageal hiatal hernia is the commonest cause of gastric volvulus, other causes of gastric volvulus require emphasis and 16 cases of gastric volvulus unassociated with hiatal hernia are reported. Delayed presentation following diaphragmatic injury was common. It is recommended that a thoracolaparotomy be performed in these patients to facilitate reduction of the volvulus, and division of intrathoracic adhesions under direct vision. In the secondary type of gastric volvulus accurate diagnosis is mandatory. Failure to recognize and treat associated disease will result in recurrence of the volvulus. A rational approach to the management of gastric volvulus is proposed.


Fetal wastage and 'bad obstetric history' in a developing country.

An analysis of a prospective study of 82 patients with 'bad obstetric history' is presented. Sixty-four babies were born alive, 11 did not survive, and 7 mothers were lost to the study. The patients had had a total of 402 pregnancies (including the pregnancy under study). The study revealed the difficulty of pin-pointing the causes of or factors involved in the previous fetal loss. Organic and socio-economic factors combine to cause abortion, premature labour or stillbirth. It is pointed out that enough emphasis has been placed on bad obstetric history as an important cause of fetal wastage. Even in simple maternity wings lacking modern sophisticated equipment for monitoring patients during the antenatal period or in labour commendable results can be obtained, at the cost of a long stay in hospital to improve the general state of health.


Myxoedema presenting with ascites: a case report.

A 61-year-old woman who presented with gross ascites is described. She had many of the clinical features of hypothyroidism, including a pericardial effusion and a normocytic normochromic anaemia. The ascitic fluid was exudative in type. The diagnosis of primary hypothyroidism was confirmed by the finding of low serum thyroxine and tri-iodothyronine levels, low 131I uptake, and high serum thyroid-stimulating hormone levels. The patient responded well to carefully graded thyroxine therapy.


Amyloidosis of the conjunctiva--an unusual complication of trachoma: a case report.

A 25-year-old Shona woman with chronic bilateral trachoma developed bilateral, painless, massive conjunctival tumefactions over a period of 2 years. Subtotal removal of the masses yielded tissue which showed the typical staining characteristics of amyloid and contained a heavy plasmacytic infiltration. Systemic examination revealed no other abnormality. The trachoma provided the setting in which the amyloid reaction developed.


Appendiceal injuries: a report of 3 cases.

Three patients with traumatic injuries of the appendix are reported. Penetrating injuries produce clinical signs early and allow prompt diagnosis and treatment, as opposed to blunt injuries. The clinical details of the 3 patients are presented to illustrate this.


Radiation exposure in xeroradiography of the breast.

A survey of the radiation exposure during xeroradiography of the breast for normal clinical exposures is presented. Average values obtained from the measurements made on a number of patients are presented and compared with measurements made by other workers. An estimate of the radiation dose received by the breast during the clinical exposures is also made and the parameters affecting the doses are discussed.


Fungal infections in the cancer patient.

Fungal infections are increasing in frequency, especially among patients with haematological malignancies. The fungi which cause most of the infections in cancer patients are Candida spp. and Aspergillus spp. These fungi seldom infect individuals with normal host defence mechanisms. Many factors predispose patients to fungal infection, including neutropenia, lymphopenia, gastro-intestinal ulceration, intravenous catheters and adrenal corticosteroid therapy. Candida spp. cause 5 major types of infection: dermatitis, thrush, gastro-intestinal, primary organ and disseminated infection. Aspergillus spp. and Phycomycetes cause pulmonary, disseminated or rhino-cerebral infection. Cryptococcus neoformans usually causes meningitis but may cause pneumonia or disseminated infection. The diagnosis of fungal infection is often made only at postmortem examination, because it is difficult to isolate the aetiological agent from sites of infection. Amphotericin B remains the mainstay of antifungal therapy, but is seldom effective in the patient with compromised host defences. Successful management of these infections in the future will depend upon improvement in diagnostic capabilities as well as the introduction of more effective and less toxic antifungal agents.


An inexpensive apparatus (airflometer) to assess lung function.

The Airflometer is presented as an inexpensive instrument suitable for lung function testing in general clinical practice. Utilizing the close correlation between the Airflometer (AFM) reading and the forced expiratory volume in 1 second (FEV1), we have produced a nomogram from which the AFM reading for normal males and females can be predicted.


The effect of somatostatin on epinephrine-induced free fatty acid release in normal man.

Epinephrine and saline or cyclic somatostatin were infused into normal persons to study the effect of somatostatin on free fatty acid (FFA) release. Somatostatin had no effect on epinephrine-induced hyperglycaemia. It enhanced basal and epinephrine-induced FFA release, while the release of both immunoreactive insulin (IRI) and immunoreactive glucagon (IRG) was inhibited. We suggest that the rise in FFA levels may be due to either inhibition of IRI or another effect of somatostatin on fatty acid metabolism.


[Indices of energy metabolism in burned patients during septicotoxemia and their dynamics in the course of blood transfusion].

Spirography of oxygenabsorption at external respiration was performed. Free oxygen tension (PO2) in muscular tissue, its dynamics at the O2 inhalation, capillary blood flow through the speed of the elimination of inhaled hydrogen from the tissue were studied by means of polarography. The investigations were performed on 33 burned cases during the septicotoxemia stage before 30 minutes and 24 hours after the hemotransfusion of 120 ml and 250 ml of the whole blood. The statistical but reliable rise of the previously decreased blood oxygen consumption occurred at the transfusion of 120 ml of blood. There are no reliable changes in the other indices i. g. PO2 and capillary blood flow. At the hemotransfusion of 250 ml of blood the rise of all the indices takes place. Hence at the selection of blood transfusion dose it is necessary to take into account the condition of the energy processes and of the capillary blood flow in the tissues of the burned.


[Surgery of pancreatic adenomas].

Twenty four patients were operated upon for pancreatic adenoma (9 males and 15 females), in one of them malignant adenoma being noted. As evidenced by the authors' findings resection of the gland with adenoma is the method of choice. In single cases enucleation is felt to be permissible if adenoma is localized superficially in the head and body of the gland. The immediate issues of the operation are as follows: 22 patients were discharged in a satisfactory condition, 2 patients died. Complications were noted in 6 patients. Late results in 18 patients for the period from 8 to 22 years are good.


[Detection of latent forms of hepatic and renal functional disorders in chronic cholecystitis and pancreatitis].

149 cases of chronic cholecystitis (65), cholecysto-pancreatitis (40), and pancreatitis (44) were examined by means of biochemical and radiioisotope methods. The acute stage of the disease was observed in 76 patients, 73 patients were in the intermission period. It was found that in chronic cholecystitis and pancreatitis renal and hepatic functional disorders do occur but their latent clinical course is detectable only by means of renography and hepatography, which should be taken into account at the establishment of the diagnosis, treatment and prognosis of the given diseases.


[Diagnosis and treatment of internal biliary fistulas].

In the paper the diagnostic and therapeutic policy employed in 11 patients with internal biliary fistulas, most frequently caused by cholelithiasis, is analysed. Some aspects of the preoperative diagnosis are eluciadated, and it is concluded that patients with internal biliary fistulas are to be treated surgically: cholecystectomy, suturing of defects in the gastric and intestinal wall, the drainage of bile tracts.


[2 variants of angular enterostomy].

To accelerate the self-healing of an intestinal fistula the author developed 2 variants of enterostomy based on the principle of valvular closure of the serous canal after the removal of the tube. The serous canal around  the tube forms from the lateral walls of both bends of intestinal loop a fold in the shape of an angle. In the first variant the tube enters the intestinal lumen along the intestinal loop curvature line; in the second - through the lateral wall of one of the intestinal loop bends. The angular jejunostomy was applied as feeding fistula in 49 cases. The angular ileostomy was carried out on 24 cases to obtain the decompression of the small intestine. There were no cases of complications or fatal outcome resulting from the application of the angular enterostomy method.


[Late results of the resection of the ileocecal angle].

The results of the treatment of 40 cases operated upon for various ileocecal angle pathology are stated. The immediate and late results have been traced. The clinical observation and experimental data have shown the direct correlation between gastrointestinal functional shifts following the ileocecal angle resection and the length of resected segment.


[Methods of coloplasty following rectal and sigmoid resection using Gartmann's technic].

According to the authors' data, a repeated surgical intervention, aimed at the restoration of normal passage of the intestinal contents, is possible after the Gartmann's operation. 10 to 12 months should be considered as an optimal interval between the first and second operations. The authors believe that coloplasty associated with end-to-end anastomosis (when the rectal stump is long enough) - a modification of Soavé and Duhamel coloplasty (in case of a short rectal stump) - is a method of choice. The results of Bondar's operation are not so good.


[Phleboarchitectonics of hemorrhoids].

Complex histological and injection methods, including roentgenovasography and morphometry, in different age group persons in intraoperative and autopsy materials, total of 333 observations (225 cases with hemorroid and 108 control cases) have demonstrated direct relations of rectal arteries and veins with cavernous bodies of the rectum at sites of the selected localization of internal hemorrhoidal nodes (predominantly at the 2d--4th and 8--10th hour divisions on a clock-face). It was shown that insufficiency of locking mechanisms of portacaval and arteriolar-venular anastomoses of rectal cavernous bodies resulting from impeded blood outflow and hypervolemia underlie the structural basis of hemorrhoid pathogenesis.


[Variations of venous lesions of lower extremities associated with varicose veins].

374 varicose extremities in 238 patients were examined. In 344 (92%) out of 374 extremities valvular incompetence and dilatation of the basal trunk of the great saphenous vein over its length were found. In 212 (56.7%) extremities dilatation of the first median anastomosis between the great and small saphenous veins was found. The upper medial inflow in the leg gets injuried in 36.1% of cases, and the superficial tibial vein in 28%. Lateral varicosity occurred in 0.5% of cases. Injuries to the lateral branches without dilatation of basal trunk constituted 5.6%. There were no cases of dilatation of femoro-popliteal vein.


[Use of oxyglucocycline in surgical practice].

A new antibiotic -- oxyglycocycline was applied in 107 cases of different surgical diseases. In 52 patients the antibiotic concentration in the blood and tissues was studied, and it was shown that the therapeutic concentration of the drug remains in the blood and tissues for 12 hours. Good tolerance to the drug was proved. There were no unfavourable effects upon the organism related to the use of the antibiotic. Oxyglycocycline is recommended for broad use in surgical practice being a good therapeutic and prophylactic preparation in case of surgical infection.


[Use of laser impulses in the treatment of melanoblastoma of the skin].

Favourable results of the treatment of skin melanoblastoma by means of pulse laser radiation are reported in 34 patients and of melanoblastoma skin metastasis in 13 patients. The follow-up lasted up to 5 years. There were no cases of local relapse. Metastasis in the regional lymph nodes were found in 5 patients (17%). Before the start of the treatment the latters had not shown any metastasis.


[Follow-up of patients with malignant neoplasms of the maxillofacial region].

The results of postoperative treatment of 102 cases operated upon for malignant neoplasms of the maxillofacial region are set forth. In 58 among them some concommitant diseases were observed involving mostly the cardiovascular system. During the operation, however, no complications in all the patients were noted except for the development of hypotension in time of anesthetizing in one case. Prophylaxis and treatment were performed depending on the phase of the postoperative period.


[Repeated surgery in congenital hydronephrosis in children].

During the period from 1963 to 1976 28 patients among the congenital hydronephrosis cases underwent a repeated operation, which was performed within the terms from 13 days to 8 years after the first intervention. Most often the repeated nephrectomy became necessary due to the occurrence of marked changes in the tissues and renal functional loss. The failure of the first surgical correction resulted from tactical errors and gave rise to the development of severe pyelonephritis.


[Modern principles in the inhibitor therapy of acute pancreatitis].

The authors' experience with antienzymic treatment of 214 patients having acute pancreatitis is summarized. A method for calculating a dose of antienzymic substances by general activity of trypsin in blood and peritoneal exudate is suggested. By means of radioindication it was found that the maximum accumulation of the inhibitors in the pancreatic gland was dependent on the methods of their injection. It has been shown that the basic therapeutic effect of the inhibitors is to inactivate proteolytic enzymes. The injection of the inhibitors, depending on the form of pancreatitis, intravenously, intraperitoneally and in the celiac artery would eliminate enzymic toxemia in early stages of the disease, prevent the transition of edematous acute pancreatitis into hemorrhagic or necrotic one and avert autolysis of the pancreas.


[Associated maxillofacial and cerebrocranial injuries].

By analyzing the experience with the treatment of 192 cases of jaw fractures the authors show that in 23.9% of cases these fractures are associated with a cerebrocranial trauma. In such cases the spinal puncture is of great diagnostic and therapeutic value. The treatment of such cases should be complex, depending on the severity of the patient's condition, spinal fluid analysis findings and intracranial pressure.


[Unsolved problems of acute injury of major blood vessels of the extremities].

The experience with the treatment of 312 acute blood vessels trauma consecutive cases is generalized in this article. The problems dealing with differential estimation of reconstructive surgery, indications for reconstructive operations on patients with traumatic shock, blood loss and severe ischemia of the injured extremity are considered. Experimental studies on 35 dogs and clinical observations over 95 (30.4%) cases of traumatic shock and blood vessels injury permitted to reveal some peculiarities of homeostasis alterations when the ischemized extremity gets involved into the blood flow, and to show the grounds for using the differential tactics under such conditions.


[Single dynamic compression during osteosynthesis using plates].

Special plates for the osteosynthesis and instantaneous compression of bone fragments with a contractor are described. The construction of the plates makes it possible to perform the compression on the operating table. The longitudinal grooves aid in approaching the fragments during the treatment process and do not interfere with the physiological compression due to both -- the reflectory tonic muscular contraction and the effect of the dynamic compression upon the extremity under loading. The combination of the instantaneous and dynamic compression while using the immersion osteosynthesis was carried out on 45 cases of bone fractures and 38 cases of long tubular bones pseudoarthrosis.


[Postoperative analgesia in children operated upon under conditions of neuroleptoanalgesia].

The carried out study proved great possibilities and prospects of sensography for an objective estimation of the pain sensation alteration in the postoperative period. In children, operated upon under the conditions of neuroleptic analgesia (NLA), a prolonged and effective postoperative analgesia was noted. Its duration depends on the localisation and character of the operation and on the combination of NLA preparations with narcotics as well. The combination of NLA with sodium hydroxybutyrate provides the deepest and longest postoperative analgesia and increases its incidence, which is no less important.


[Anesthesia and distant results of surgical treatment in patients with stomach cancer].

Based on the study of  the late results of surgical treatment in 373 patients with gastric cancer, subjected to radical subtotal gastrectomy, it was found that a group of patients operated under fluothane anesthesia shows the highest survival rate. As evidenced by the authors' findings the use of ether narcosis results in 16--27% reduction of yearly survival during the first five years. The most poor results were noted in a group of patients operated under neuroleptanalgesia.


[Immunoprophylaxis and serodiagnostic studies of abortion in cows caused by bacteria of the Mimeae group and the genus Yersinia].

Tested was the prophylactic effect of a vaccine against abortions in cows caused by bacteria immunologically related to R Brucella organisms. Results pointed to the substantial drop in the number of abortions in the vaccinated animals. Reported are also results of serologic investigations by the complement-fixation test with cows showing abortions and sterility.


[Mercury content in fish].

Studied was the content of mercury in certain fish species from ocean and the Black Sea catch (mackerel, scad, and merluccius), sold on the home markets. The study of samples of merluccius revealed that the average level of mercury was 0.088 ppm, the deviations being from 0.036 ppm up to 0.16 ppm. In mackerel samples mercury averaged 0.075 ppm, with deviations of 0.04 ppm to 0.013 ppm. And in scad mercury was shown to vary from 0.03 ppm to 0.085, an average of 0.059 ppm. Mercury in the investigated species of fishes was considerably lower than the standards of the World Health Organization and the Food and Agriculture Organization and the maximum admissible tolerance in USA, Canada, and France.


[Histopathology of Q rickettsiosis in sheep].

Examined was material taken from five sheep (ewes) and two weaned lambs having naturally contracted Qu rickettsiosis. Described are the clinical symptoms of the disease and the morphologic changes. The diseased animals showed rise in temperature (39.5--40.5 degrees C), loss of appetite, and depression. Some of the weaned lambs manifested slight cough and digestive troubles. Part of the animals showed nervous symptoms--tic movements of the head and limbs. Morphologically, the liver was edematired, of lower compactness, and the spleen was enlarged, the meninges being hyperemic and peppered with pinpointed hemorrhages. Histologically, a strong diffuse activation and proliferation of the liver capillary endothelium was established along with necrobiosis of the liver epithelial cells and a diffuse leukocyte infiltration. Established was also hyperplasia of the reticular cells and the lymph follicles of the spleen and the bronchial lymph nodes. The epithelial cells of the kidney tubules were involved in vacuolar dystrophy, and in the medular section there were fibroblastic proliferations with hyperemia. Inflammatory changes in the brain were also found.


[Estrogenic activity of some lucerne varieties].

Studies was the estrogenic activity of lucerne--the local population Dounavka, the zonated French variety Du Puits, the promising Bulgarian variety. Pleven 1, the population Boinitsa, and the French variety Du Poitou. The estrogenic activity was determined by the biologic method based on the increase in the uterus weight of infantile mice after treatment with estrogens. Paper chromatography tests were also carried out to establish the presence of genestein and cumestrol. The study comprised three consecutive years, the extent of estrogenic activity being dependent on the amount of annual precipitations and the yields of green mass and dry matter. The study revealed that there were variations in the estrogenic activity of the investigated varieties and populations of lucerne within a wide range depending on the year of use and the green mass and dry matter obtained. High was it in the local population Dounavka, the French variety Du Poitou, and the Bulgarian variety Pleven 1. Comparatively lower was the estrogenic activity in Du Puits, and the local population Boinitsa. In all varieties and populations studied genestein was found in the first swath, and cumestrol--in the second swath. The remaining swaths showed differences in the content of genestein and cumestrol in the individual varieties and populations.


[Relationship between placental weight and the weight of sheep and of lambs at birth].

In 1972--1973 a study was carried out on the sheep flock at the Barley at Institute, Karnobat, to establish the correlation between the weight of placenta and the weight of ewes at impregnation and at giving birth, on the one hand, and the correlation between the weight of placenta and the weight of lambs at birth, on the other hand. The influence of the age of ewes on the weight of placenta was also followed up. Studies were organized with two breed groups of sheep--the newly developed ewe for Southeast Bulgaria, and the Karnobat ewe. It was found that weight of placenta correlated with the weight of lambs at birth in both groups. The dependence was evaluated as well as expressed in twin lambs and as average in single lambs. Both at impregnation and at lambing there was a very good correlation between the weight of placenta and the weight of ewes, which, in the second case, though demonstrated too, was more slightly expressed. The age of ewes was shown to have a statistically significant effect on the weight of placenta in the new fine-wooled sheep breed, which is being developed for the region of Southeast Bulgaria.


[Diagnostic value of serological methods and of the allergy method in studying pullorum disease-fowl typhoid in poultry].

It was established that the positive allergy reaction was best expressed at the forty-eighth hour following the introduction of the allergen. The diagnostic value of the allergy reaction was not shown to surpass that of the serum agglutination reaction. It proved to be close to the value of the other serologic methods of examination (the whole-serum and whole-blood agglutination tests). The allergy method of investigation could be used as a tentative method, resp., reaction test for the detection of infected foci, however, the complete recovery of the infected poultry farms could be achieved with the use of the serologic methods of investigation. The latter could be applied at intervals of 10 to 20 days to detect the carriers of infection.


Diagnostic routes in cases with single involvement in eyes suspected of sarcoidosis.

The ocular involvement of sarcoidosis is particularly important in Japan, because 1. the frequency of the eye involvement is as high as 20 to 40%, higher than in other countries- 2. the presence of this involvement proved to be an influential factor relating to the whole sarcoidosis lesions of a patient, and 3. the patients with this involvement will become blind unless adequately treated. In diagnostic routines of ocular sarcoidosis, chest X-rays will give the most useful information of the disease. If the chest X-ray findings are normal, it is not easy to make a diagnosis of a case whose ocular findings are very suspicious of sarcoidosis. This paper will give several case experiences in which we could successfully make a diagnosis, using mediastinoscopical biopsies though the X-rays had no findings.


Fine-needle aspiration biopsy of spleen in diagnosis of sarcoidosis.

To determine the frequency of splenic involvement in sarcoidosis fine-needle aspiration biopsies of the spleen were performed in 77 patients with verified sarcoidosis. Splenic sarcoidosis was documented in 53% of the patients; in 67% of those with and in 47% of those without known extrathoracic manifestations. The majority of the patients had a normal spleen size. The results indicate that splenic involvement is common in sarcoidosis and even in the early stage of the disease. The splenic aspiration biopsy is a simple, safe, rapid and reliable diagnostic procedure.


[Our experiences with the gallium-scintigraphy in case of sarcoidosis of the lungs (author's transl)].

The comparing examinations of patients suffering from a sarcoidosis of the lungs by the help of roentgenograms, scintigraphies of lung perfusion of 67-gallium and bioptic examinations admit to conclude as follows: In the stages I and II the activity-accumulation of radioactive gallium corresponds nearly to the alterations becoming visible in the X-ray-graph. Consequently, increases of lymph nodes and active granulomatous interstitial or centriform infiltrations may be presented. In case of a successful treatment the activity-incorporation is not to be proved anymore. As to time the alterations also coincide with the radiogram. In single cases the epithelioid nodule may be proved bioptically and microscopically when the active process already has stabilized spontaneously or by a treatment. In these cases the radioactive gallium is incorporated no more. The proof of 67-Ga-activity has a special signification in case fibrotic alterations have already appeared. The examinations prove that a granulomatosis may continue to exist when already distinct X-ray-symptoms of a fibrosis are present. Consequently, the granulomas may appositionally develop and cause an additional fibrosis. Therefore, in case of an existing infiltration of the lungs the combination of a definite lesion in the form of a fibrosis and a persisting formation of granulomas rather means a rule than an exception. A perfusion scintigram may be altered pathologically by a granuloma as well as by a fibrosis. Disorders in perfusion caused by granulomas are reversible.


[Comparative study on x-ray and scintigraphie pictures and blood gases in sarcoidosis (author's transl)].

Scintigraphic examination of the lungs in sarcoidosis has been used as a supplement method of the functional examination. Perfusion scintigraphy enables to locate places with lowered regional perfusion in the form of spotted fall outs. In some cases of hilar lymphonodular forms of sarcoidosis we can already find some diffuse spotted fall outs of perfusion even if parenchymatous changes are still not visible. Up to now we have not seen any lobar or alar fall outs of radioactivity, as they can be found in central types of bronchogenic carcinoma. In sarcoidosis with micro- or macronodular X-ray shadows the scintigraphic defect in its extent sometimes does not correspond to these changes. On the basis of our material the mutual relation between scintigraphic pictures on one hand and blood gases on the other hand could not been neither confirmed nor eliminated.


Bone lesions in sarcoidosis.

Roentgenographs from hands and feet have been made from 97 out of 162 patients suffering from a gangliopulmonary sarcoidosis. In 34 patients bone alterations have been stated. In cases of an advanced gangliopulmonary sarcoidosis the bone alterations were more frequent. In 23 cases the findings showed osteolytic characteristics. In 4 of the cases they consisted in circumscribed foci of condensation. In 7 cases osteolyses and condensations appeared in combination with one another. Up to now there are no data in literature about bone condensations in case of a sarcoidosis. Their classification into the aspect of this disease is recommended with due reserve.


Gastric sarcoidosis in Japan.

Seventeen cases of gastric sarcoidosis have been reported in Japanese literature. Age distribution was from the 3rd decade (6 cases) to the 6th decade (3 cases) and the sex ratio was 2 females to 1 male. Preoperative diagnosis included 10 cases of gastric carcinoma and 6 cases of gastric ulcer. Sites of the granulomas were limited to the mucous membrane in 4 cases, from serosa to the mucous membrane in 9 cases and from the muscle layer to the mucous membrane in 1 case. As there are granulomas in the mucous membrane in all cases, it appears that granulomas may spread from the mucous membrane to outside and they can possibly be detected by biopsy. There were no BHL in any chest X-ray. Kveim test was positive in only 2 out of 11 cases. Prognosis is very good. There has been a question whether the gastric granuloma is a local or a generalized manifestation. From our findings, we will report in detail, it may not be a local reaction, but a gastric manifestation of generalized sarcoidosis.


[A longterm rational control of the course of sarcoidosis in ambulatory practice (author's transl)].

In longterm rational controls of clinically significant disseminated sarcoidosis of the lungs 1. standardized X-ray-graphs record the change-over of the granulomatous sarcoidosis stage to a fibrotic one, discrete X-ray-alterations put up to optimistic interpretation, 2. standardized function parameters verify the frequently resting decrease in pulmonary function. In controls over 3-5 years the curve of forced exspiration already signalizes dangerous delayed effects of sarcoidosis (deficient load-arterialization?) in spite of an apparently roentgenological improvement. This statement becomes decisive for individual and industrial-medical prognoses. Herefore 3 examples: A picture of structure and function of disseminated sarcoidoses of the lungs before and after a treatment lasting for years (corticosteroids) with standardized controls. A standard X-ray-graph is to be evaluated only in combination with standard function parameters. Pay attention to the signal restriction in --2 sigma.


[2nd European Symposium on Sarcoidosis. Various methods of corticosteroid therapy].

In order to achieve good results with the corticosteroid-therapy in not spontaneously regredient sarcoidoses a longterm treatment (12-24 months) by considerable corticosteroid-doses proves to be necessary; thereby the problem of side-effects by steroids will arise, especially in young women frequently developing a Cushing-syndrome. By our endeavour to prevent this unpleasant phaenomenon we carried through an alternating attempt with two variant kinds of intermittent treatment. The first method relates to 4 successive days in the week (as it is proposed by P. Krakowka) and the second procedure relates to each 2nd day. The second treatment has proved to be the better one. Side-effects appeared in 31. 9 per cent in case of a daily treatment by steroids, in 27.3 per cent after the application of the method of 4 days a week, and in no one case after an application each second day. The results of the treatment by corticosteroids are equal in all the three groups.


Indication and duration of the prednisolone therapy of chronic pulmonary sarcoidosis--a prognostic-therapeutic screening as a result of a controlled trial.

Report on a controlled therapeutic trial with prednisolone of chronic pulmonary sarcoidosis. The patients comprised three groups differing from the dose of prednisolone and the duration of the treatment. 194 clinically and histologically proven cases were completely treated. Two years after ending the treatment the relapse rates were about 20 to 30% in each group. This corresponds well with the rate of spontaneous regression. These results are an indicator that in most cases the underlying pathogenic process of immune deficiency is calming down during treatment and this leads to a possible change in therapeutic indication:--treating all patients for only one year, --taking into account that a relapse will occur in about one third of all cases,--avoiding supertreatment of the other two thirds with a not harmless and costly drug.


[Epidemiology of sarcoidosis in Poland (author's transl)].

The numbers of patients registered in chest clinics and of those treated in hospitals or sanatoria enable to calculate the index of sarcoidosis: 7.1/100000 inhabitants in 1973 and 7.7/100000 in 1974. The comparison with the data of the years 1963, 1967, 1968 and 1969 shows an increase of sarcoidosis. Highest frequency has been observed among the age group 30--40 years. Women are slightly predominating (56 p.c.).


[Aldactone in the treatment of sarcoidosis of the lungs (author's transl)].

Earlier experimental findings and isolately clinical experiences too made to suppose spironolacton and their derivatives to have an immunosuppressive effect. Under this point of view and in connection with it the conception to apply cortisone in a combination as low as possible or even to avoid it al all, aldactone has been applied by way of trial in the therapy of the sarcoidosis of the lungs. After an experience over three years the therapeutical results are compared with the earlier treatment methods only basing on cortisone and the possible effective mechanism is discussed. Merely spontaneous regressions are not supposed to be in all cases showing a good therapeutical effect; the successful application of aldactone in the treatment of lung fibrosis is also speaking in favour of it.


The incidence of sarcoidosis in Czechoslovakia in the years 1971-1975.

In Czechoslovakia the yearly incidence of sarcoidosis has been followed-up from the year 1971 on the whole territory, in each of 112 districts separately. All together it makes no difference what diagnostic procedure has corroborated the diagnosis or whether the patient at the time when sarcoidosis was ascertained did or did not have any disturbances. The number relative to 100000 inhavitants of each district varied greatly up to the end of 1975, from 0 to 32 per 100000 people. In 10 districts it was higher than 6:100000. As the very districts with the highest incidence in 7 out of 10 districts adjoined the districts with the zero incidence it seems to be logical to resume that the zero incidence in none of the 21 districts was a real one. The sex and age distribution, the number of persons with histologically verified diagnosis, the intrathoracic and extrathoracic localisation of sarcoidosis and the distribution of the stages of intrathoracic sarcoidosis have been followed-up in 1442, respectively in 1839 patients observed in the last five years period. The necessity of a new prospective cooporative controlled study of the incidence of sarcoidosis in some European countries seems to be evident.


[On case finding of sarcoidosis by mass-x-ray examinations (author's transl)].

In the district of middle-Slovakia with 1.400.000 inhabitants preventive mass-X-ray examinations of the population over 15 years were made to find tuberculosis patients. Suspicious cases got a solid investigation in the hospital departments for tuberculosis and respiratory diseases or in special lung clinics. Every year nearly 500000 radiophotographs are produced for mass-X-ray, before start in profession, for people with higher risk of disease, for boys liable to military service and persons with tuberculosis contacts. As we could confirm in the investigation of suspicious cases the diagnosis "Sarcoidosis" in some departments we follow up its incidence and prevalence since 1971. In our district we detect about 50 new cases every year. That corresponds to an incidence of 3.5 per 100000 inhabitants. There are great differences between the single departments from 0.65 to 15.2 per 100000 inhabitants. This counts for a regional distribution. Since five years we similar follow the prevalence, which had an average of 14.9 per 100000 in 1971 in our district and of 27.7 per 100.000 in 1975. The prevalence of sarcoidosis differs between 12 and 51 per 100000 inhabitants in the single department of our districts.


A local outbreak of sarcoidosis in Northern Japan.

The annual chest X-ray surveys conducted in Hokkaido during a 5 year period from 1972 to 1976 disclosed that the Furano basin located in a central mountainous district had an extremely high discovery rate of the cases with sarcoidosis. Miniature films sized 70 x 70 mm were ready by two or more sarcoidologists. The cases suspicious of sarcoidosis were requested to attent nearby general hospitals for histological examinations. The number of the cases diagnoses as sarcoidosis were 16 out of about 30000 examinees in the Furano basin, 2 out of about 37000 in Sapporo City, the capital of Hokkaido, and one out of about 100000 in other 7 areas. The Furano basin had a significantly higher rate of discovery than Sapporo City or the other 7 areas. Due to the rural localisation, 6 of the 16 Furano cases were confirmed by biopsies, but the remaining 10 were carefully diagnosed with clinical and laboratory findings as they could not come up to general hospitals. Three of the Furano cases belonged to 3 generations in a family. Even if only the 6 histologically confirmed cases were observed, the rate in Furano is still higher than in the other two districts. Thus an intensive epidemiological investigation has been conducted in this district.


[Considerations about the incidence of sarcoidosis in the Lettish SSR (author's transl)].

In the Lettish SSR sarcoidosis was discovered in 292 women and 192 men in the period from 1958 to 1975. The average annual incidence rate per 10000 inhabitants was 3.09 in females and 2.04 in males. Contrary to this general predominance of females over males the incidence rate for boys was 4 to 5 times higher than for girls in the youngest age group ranging from 10 to 19 years. In the age group from 20 to 29 years there was also still noted a distinctly higher relative incidence in males but it was smaller in comparison with the younger group. The reasons for these age depending sex differences are unknown. The possible importance of endocrine processes for the pathogenesis of sarcoidosis is discussed.


Epidemiological data on sarcoidosis in Italy.

Due to reports on histologically confirmed cases of sarcoidosis coming from diagnosis centres in various Italian regions there are appreciable differences in the frequency of this disease. Sarcoidosis occurs most frequently in north Italy, less frequently in the southern part of the country, and very rarely on the Italian islands. Most of the cases were diagnosed in stage I (70%), involving a small number of Löfgren syndrom cases. 20% of the cases concerned stage II and 5% stage III. Extrapulmonary localizations were reported rarely.


[Sarcoidosis and profession (author's transl)].

This paper is basing on hitherto not published results of a dynamic community-related epidemiologic study, passed by data processing on sarcoidosis within the territory of the district of Cottbus (860000 inhabitants). The completely registered new cases of sarciodosis during the years 1961-1975 (1647 cases) have been recorded using the following epidemiologic parameters: profession, age, sex, education, residential district, personal status and so on. The classification according to professional groups was carried out correspondingly to an appropriate modification of the professional catalogue of the WHO. Under consideration of the hitherto very contradictory data in literature--the result of our investigation points to the importance of this epidemiologic parameter. Conclusions could be drawn also as to morbidity, pathogenesis and prophylaxis results. The correlation between profession, education and residential district allows interpretations on the causes of regional differences in the incidence of sardoidosis in rural districts. In the district of Cottbus there is an accumulation of sarcoidosis in rural districts respectively in professional branches prevailing there.


Notification of Sarcoidosis in Denmark--the "true" incidence?

Although the central nation-wide registration of sarcoidosis in Denmark has provided valuable informations, the estimation of incidence is too low because a) far from all cases are detected owing to the often silent and transient nature of the disease and b) there has been a significant deficiency in the notification of known cases.


[Is there sarcoidosis in countries with a high prevalence of tuberculosis? (author's transl)].

A review is given of the literature concerned with the relatively rare occurence of sarcoidosis in countries with a high prevalence of tuberculosis and informations on clinical status, diagnostic, stage distribution and evaluation of 28 personally observed patients presented. The possible reasons of the only recently more frequent detection of sarcoidosis are discussed. Easily realisable measures as screening (test of tuberculine) for earlier detection are recommended.


[Frequency and distribution of sarcoidosis in GDR (author's transl)].

The epidemiological development of sarcoidosis in GDR is discussed in consideration of age, sex, case-finding, and various forms of disease. In several districts of GDR incidence of sarcoidosis is different. Till now no proof exists for the assumption, that these differences are based on objective causes. The curves of incidence and prevalence in relation to age and sex are discussed and interpreted.


[Statement of the bioptic diagnostic in intrathoracic sarcoidosis--team work of 6 lung hospitals of the GDR (author's transl)].

A nearly nation-wide team-work of six chest hospitals was made with 4284 patients to analyse all performed diagnostic procedures up to the present. Its frequency and diagnostic importance in relation to the radiographic stages of the disease were examined. Especially the procedure of bronchologic examination, having been partly underrated with the morphological ascertainment of sarcoidosis, are now purposefully analysed. This showed that also with perbronchic punction-biopsy and bronchoscopic excision morphologically confirming of the diagnosis was possible at a high percentage. On the other side the right diagnosis was made clinically before bioptic procedures in the majority of the patients. The overall conclusion is that, according to the experiences made in our hospitals, the relatively harmless bronchologic procedures are in general sufficient to obtain bioptic verfication of the diagnosis "sarcoidosis". Other bioptic operations like mediastinoscopy or lung biopsy can be restricted to cases with reasonable doube of the diagnosis.


Diagnostic value of biopsy in gangliopulmonary sarcoidosis.

In order to be well determined the diagnosis of sarcoidosis needs multiple evidence of clinical, radiological, immunobiological and humoral order, and a histopathological confirmation too. Our casuistry covered 173 observations: Stage I with 94 (54.33%) cases, stage II with 68 (39.3%) cases, and stage III with 11 (6.4%) cases. In 136 patients one or several biopsies were performed  with a histopathological result for sarcoidosis in 107 cases (61.8%). According to their character, biopsies could be divided into three groups: Group I comprised 39  biopsies of some easily accessible lesions (skin lesion, peripheral adenopathy, tonsils a.s.o.). 25 of them were concludent for sarcoidosis (64.1%). Group II was made up of 118 biopsies of some hardly accessible lesions (hepatic biopsy puncture, bronchoscopy, pre-scalene node biopsy). Of these biopsies, 22 pleaded for sarcoidosis (18.6%). In group III entered 67 deep biopsies (mediastinoscopy, hiloscopy, thoracotomy with pulmonary biopsy). All of them confirmed sarcoidosis. If to the concludent histopathological result for sarcoidosis (61.8%) we add the one given by the Kveim test (15.1%) (in cases without biopsy or with a non-concludent biopsy) the percentage of biopsy confirmation rises to 76.9%).


[Bronchoscopic biopsies of sarcoidoses in the stage I and II (author's transl)].

The material of the present study includes 96 cases of intrathoracic sarcoidosis, phase I and II. Diagnosis was established bronchoscopically in 63.5% of patients examined. The best results were obtained by trans-bronchial needle-biopsy at bronchoscopy. In phase I, this method established the diagnosis in 76.5% of cases, in phase II in 48%, and in the whole material (phase I and II together) in 64.4%. Biopsy of the bronchial mucous membrane gave a lower percentage of diagnosis: in phase I--32.5%, in phase II 48.7%, and in the whole material--40.2%. Needle-biopsy of the lymph nodes and two or three bronchial biopsies simultaneously proved to be the method of choice: Sarcoidosis was diagnosed in 80% of cases in which these two methods were used. Bronchoscopic methods are effective, well tolerated and do not entail any serious complications.


Cytological investigation of biopsy performed in sarcoidosis.

One of the most frequent appearance of sarcoidosis is the enlargement of mediastinal lymph-nodes. The clinical picture first of all must be distinguished from the malignant processes and seldom from lymph-node tuberculosis. At our clinic material was obtained for cytological examination in two ways: through mediastinoscopy in the course of which we had opportunity of histological evaluation too and by means of transbronchial thin-needle puncture respectively and only cytological examination was performed with this material. We carried out investigations in 155 patients sent to our clinic on account of the suspicion of sarcoidosis. According to the course of disease or rather other examinations 123 out of 155 patients suffered from sarcoidosis and in 112 of these cases that is in 91% the diagnosis was verified by the help of cytological examination. In the smears epithelioid cell groups were generally found in large number but Langhans' giant cells could be produced only in 21 cases. In 70 of 123 patients mediastinoscopy and in 53 transbronchial thin-needle biopsy was accomplished. Through cytological investigation of material obtained mediastinoscopically we attained nearly 100% positivity rate and 80% by the help of thin-needle biopsy. Although forasmuch as the transbronchial puncture does not need special intervention because it can be carried out in the course of routine bronchoscopy we think the application of the procedure reasonable not only in finding metastasis if it involves the hypertrophy of mediastinal lymph-nodes. In this way we spare the patient from further examinations. The cytological finding, of course, must be always fitted in clinical picture but on the basis of our experience the close cooperation between the clinician and cytologist assures the avoidance of wrong diagnosis.


The value of modern morphological methods (histochemistry, immunopathology) in sarcoidosis.

Correlative studies concerning the value of modern of morphological methods in correlation to the clinical picture were undertaken in patients with sarcoidosis. The investigations comprised immunopathological and histochemical studies of mediastinal lymph nodes, normal lymph nodes and lymphnodes by inflammatory lung diseases. The metabolic state of the granulomas in sarcoidosis is expressed by enzymehistochemical investigations and shows a strong activity of enzymes of the pentose cycle, cancer cycle, anaerobic glycolysis, respiratory chain and of hydrolytic enzymes. Of special interest is the activity of aminopeptidase in the granulomas, found only positive in progressive stage of the disease. With the aid of some hydrolases (acid phosphatase, nonspecific esterase) information is given about phagocytotic activity in granulomas. Antibody formation (anti-human-IgG, -IgA and -IgM) is visible in fresh cases around granulomas in the cytoplasms of large lymphoid cells, in some cases also in the walls of vessels. With longer duration of the disease immunoglobulins were found extracellulary first in little focal areas and later as a dense homogen material around the granulomas. In long existing cases only a weak or negative fluorescence was observed in this material, expressed by light microscopy as hyaline transformation. The value of this methods is given in additional information concerning the metabolic activity (especially phagozytosis) and immunological state (antibody formation) of the disease as an important factor for a well-timed and effective therapy.


[Bioptic investigations of intrathoracic sarcoidosis in occupationally injured persons (author's transl)].

Diagnostics of intrathoracic sarcoidosis in people with an occupational injury or an annoyance of respiratory organs are frequently connected with additional difficulties. The first roentgenological manifestations of a silicosis caused during the period of dry drilling especially in ore metal mining, are frequently bilaterally increased shadows of the hilum without any worth mentioning findings in the parenchyma. The radiograph of diffuse restiform and speckled shadows in people exposed to dust without a sufficient load or in younger age always demands a search for sarcoidosis. Granulomatoses of the lungs caused by organic dusts, berillium and other things may develop difficulties not only in the interpretation of clinical data but also in the bioptic findings for instance after an endoscopic antalgic biopsy of the bronchomucosa. The authors summarize their experiences with the application of bioptic methods (skin biopsy, according to the Kveim-test, scalenobiopsy, explorative thoracotomy) in workers suspected to suffer from a sarcoidosis, who--as to their profession--had been influenced by noxious substances in respect to their lungs. Two typical cases are briefly discussed. The signification of the synopsis of clinico roentgenological, industriohygienical and bioptical data is stressed especially in case of a suspicion on the combination of pneumoconiosis and sarcoidosis.


[Clinical, biochemical and morphological characteristics of asymptomatic and oligosymptomatic types of chronic glomerulonephritis].

The results of our study confirm that an early and certain diagnosis of the asymptomatic and oligosymptomatic forms of the chronic glomerulonephritis is possible only using comprehensive clinical and biochemical investigation methods and partly the renal biopsy. Only with regard to the clinical manifestation the disease has an asymptomatic or oligosymptomatic course. Some laboratory findings have been changed from the beginning of the disease. The degree of these changes as well as the further existence of the asymptomatic or oligosymptomatic form depend on the pathomorphological type of the disease. But even in the cases with a favourable development a gradual reduction of the renal function was observed. The pathologically decreased values of haploglobin and sialic acid reveal the clear activity of the pathological process. These facts emphasize the necessity to perform systematically prophylactic and therapeutic measures in all cases with asymptomatic or oligosymptomatic chronic glomerulonephritis.


[Determination of homeostatic kidney function in the diagnosis of chronic glomerulonephritis].

The latent and hypertonic forms of the course of compensated nephritides more frequently make difficulties concerning the differential diagnosis between a chronic glomerulonephritis and a chronic pyelonephritis. According to the results achieved the determination of the renal processes furthering homoeostasis gives the possibility to demarcate the two diseases. A certain reduction of the creatinine clearance (to less than 90 ml/min) and of the maximum water diuresis (to less than 10.0 per 100 ml glomerular filtrate) is suitable for the latent form of the chronic glomerulonephritis. On the other hand, a reduction of the ammonia secretion (to less than 35 per 100 ml glomerular (filtrate) and of the total H+-ion secretion (to less than 50 per 100 ml glomerular filtrate) in the determination after Alkinton is characteristic for the chronic pyelonephritis. In the hypertensive form of the course of the chronic glomerulonephritis in contrast to the same form in chronic pyelonephritis a reduction of the maximum water diuresis to less than 7.5, of the clearance of the "osmotically free" water to less than 6.0, of the titrable acidity to less than 25 is the result. Here the ammonia quotient transgresses 45%. In chronic pyelonephritis the titrable acidity in considerably increased and the ammonia genesis relatively decreased (to less than 45%).


[Uremic tendencies for hemorrhage and hemodialysis].

By means of a simple heparin test which reflects the actual processes in the contact of the blood with heterogeneous surfaces we can securely regulate the heparinisation in each phase of the dialysis, which, as I tried to explain, brings considerable consequences for the clinic.


[Short-term hemodialyses using large surface dialysers].

Twice a wekk the dialysis was carried out for four hours, since a lack of personnel and institutions excluded a therapy repeated three times a week. The patients should optimally be treated for three hours three times a week. Patients dialysed by this means show favourable values of blood pressure under a minimum antihypertensive medication. They are less anaemic and in most cases more active than those patients who are dialysed twice a week. The use of the short time dialysis with capillary kidneys of a large surface increased the number of the patients treated and improved the functional capacity of the chronic dialysis programme.


[Information value of the compartimental analysis of potassium metabolism for clinical medicine].

1. The special information value of the dynamic compartment analysis consists in functional evidence concerning the potassium metabolism. 2. Basis of the dynamic compartment analysis is an open central 3 compartment model. 3. The rate of metabolism which is determined by size of the pool and constant of speed is the most important parameter. 4. The mathematical modelling of the tracer course renders visible the compartmental effects of inflow and outflow of the speed constant. 5. Disturbances of the very quickly and quickly exchanging constituents of the potassium metabolism reflect themselves perhaps directly as a functional loss of the permanent and latent functional capacity of the organism.


[Electron-microscopy studies of capillaries of the dialyser C-DAK 4 with reference to multiple use].

The results of the examinations show that the integrity of the wall of the capillary is not impaired by the process of purification, but, on the other hand, functional changes by thrombotic occlusion as well as disseminated deposits of protein may be expected. The temporary regime of dialysis mus consider this fact in order to achieve a constant effect. But on principle from the clinical experience and on the basis of these results of examinations a manifold use of the dialysator of the capillary in carrying out the purification measures mentioned may be recommended.


[Multiple nodular hyperplasia of liver associated with oral contraceptives (author's transl)].

Two cases of multiple nodular hyperplasia of liver in patients with intake or oral contraceptives for several years are described. In one case the tumours appeared simultaneously, in the other case succesively. Macroscopically the nodular hyperplasia was misdiagnosed as metastasis. Microscopially the nodes presented an intense inflammatory infiltration of the septa, in one case with tuberculoid granulomas. The lesions showed a marked vascularity. Extremely dilated sinusoids could be seen in the needle biopsy of the macroscopically unchanged liver, a phenomenon occasionally seen in cases treated with oral contraceptives.


[Extraneural metastases of anaplastic gliomas (author's transl)].

8 cases are reported of anaplastic cerebral gliomas with metastases outside the neuraxis, which were seen among about 1600 gliomas. The series included 4 males and 4 females ranging in age from 5 to 58 years at the time of death. There were 2 children with anaplastic ependymomas, one adult with oligodendroglioma, and 5 young or middle-aged adults with astrocytomas grade III or IV. All patients had one or more craniotomies, and 5 had radiotherapy before the appearance of remote tumor deposits. The survival times ranged from 7 to 31 months in cases with gliomas grade II, and from 8 to 18 months in high-grade astrocytomas. All tumors showed invasion of the meninges and/or ventricle walls, and in 4 cases they transgressed the dura and surrounding bone or soft tissues. In 6 autopsy cases there was widespread dissemination of gliomas through the CSF pathways. Remote metastases involved regional or distant lymph nodes in 7, the lungs in 2, the vertebrae, lungs, pleura, parotis and mediastinum in one patient each. The possible pathways for distant spread of intracranial gliomas and the factors which are considered responsible for their rare occurrence are discussed.


[Is surgical-tocolytic prevention and therapy of cervical insufficiency justified without prenatal diagnostic care?].

We report on our results of the combined operative-tocolytical prophylaxis and therapy of cervical insufficiency from the department for gynecology and obstetrics of our hospital to decrease the mortality of newborn. The possibility of such treatment without optimal antenatal apparatus-control will be discussed.


[Activity of various serum enzymes during normal and complicated early pregnancy].

It was concluded, that the enzymatic control of the development of early pregnancy [equal to of normal course] by the estimation of the activity of GOT, GPT, Ald, ChE, alpha-HBDH and CPK in plasma has no clinical significance. However the different activity of some enzymes in abortion and early gestosis confirm the practical value of these estimations. The obtained results were discussed.


[Determination of pregnancy duration following terminated hormonal contraception].

The duration of pregnancy as assessed by the rule of Naegele was significant different between patients who became pregnant following termination of oral contraception and patients, who had not taken oral contraceptives. The intervall between stopping the pill and pregnancy was two month. We found a relatively high pregnancy rate in the first three month. The clinical significance is discussed.


[Optimal labor induction using PG F2alpha in diabetes mellitus].

By means of the COMPLEX-Method an optimisation problem based on biological data was solved. The optimal PG F2a-velocity of infusion in starting labour of diabetic patients was determined under the condition of the shortest possible duration of birth.


[Surgery of concussion foci in the cerebral hemispheres].

On the basis of observations in 144 patients operated on because of severe cerebral concussions, the importance of primary and secondary removal of the concussion focus is stressed. The diagnosis is made by means of EEG, angiography, and echo encephalography. Examinations of the concussion region with clearance etc. showed that the immediate vicinity of the cerebral lesion exhibits a considerably reduced blood flow which, due to the stimulus of the concussion, will further decrease within the following days. After six days, the blood supply stabilises in the zone of the oscillating reaction. The enlargement of the zone of necrosis intensifies the intracranial increase in pressure and can only be avoided by the removal of the concussion. Resection is carried out subpial in order to isolate the cerebral tissue from the dura mater. Lethality: With solitary concussion foci 22%, in case of combination with intracranial haematoma 60%, with multiple foci 67%, total 46%.


[7-year experience in endovascular surgery].

A total of 800 operations were carried out by employing Serbinenko's method. Access route via carotid or via femoralis. Sinus carvenosus fistulae (40 patients) respond very well. Arterio-venous angiomas (47 patients) are treated in stages. Bag-shaped aneurysms (14 patients) can only in exceptional cases be treated reconstructively, i.e. by keeping the main vessel open. In eight patients, a profuse epistaxis was well controlled, in 3 cases reconstructively. The method permits the true separate examination of various cerebral vascular regions (chemical, physical, angiographic, flow examinations, vital staining of cerebral tumours). A controlled supply of cytostatics is also possible.


[Experiences with hypophyseal adenoma patients].

The treatment of 126 patients presenting surgically treated and histologically determined suprasellar hypophyseal adenomas is described and the catamnesis followed up in some cases over a period of ten years after the transfrontal operation. Particular value is attached to a comparison of pre- and post-operative disturbances of acuity and field of vision. Moreover, the experience gained in the treatment of the first decade is compared with that of the second decade. I. The results of the treatment of a hypophyseal adenoma will be the better, the earlier it is detected. Disturbances of the gonadal function in particular can be traced back over many years. When primary or secondary amenorrhoea is present, gynaecologists should more often think of the existence of a hypophyseal adenoma. --2. The restoration of the working capacity of the patients operated on largely depends upon the restitution of the vision and an optimum hormonal substitution according to requirements. Thus, an early recognition of the lesion and the surgical method which must be further improved by employing modern techniques, are decisive.


[Value of Dimer-X myelography in the diagnosis of lumbar intravertebral disk lesions].

On the basis of 500 myelogramms carried out with hexaiodated, water soluble, and rapidly absorbable Dimer X, the experiences gained in the diagnoses of damages of the lumbar intervertebral disks are presented. It can be stated that Dimer-X myelography has proved to be very useful for the recognition of space-narrowing processes in the lumbar region. No serious complications were observed. Most of the troubles, including, for example, transitory headache and the like, correspond to those sometimes found after simple lumbar punctures.


[Intravital microscopic studies of the pial vessels in the animal experiment].

In cats, a direct observation of the brain surface was made possible by fenestration. The pial vessels were observed by means of intravital incident-light microscopy. Particular attention was paid to blood pressure, blood pH, pCO2 and pO2. Mainly with diffuse vasodilation (hypotension) the capillaries stood out as a close network. Normally, interarterial anastomoses were rarer than intravenous ones. Arteriovenous anastomoses were not found. The interarterial blood column rarely came to a standstill, the intervenously this was observed frequently. Two kinds of intervenous anastomoses were found: short connections between veins running close to each other and long venules between vessels of different outflow systems.


Microsurgical treatment of peripheral nerve injuries.

In the period from 1972 to 1976, 536 patients with injuries of the peripheral nerves were treated at the Neurosurgical University Clinic Lyublyana. The treatment was performed according to the principles of microsurgery. Preoperative and postoperative supervision included EMG, electroneurography and nerve conduction speed. Subdivision: N. facialis 6, plexus brachialis 78, n. radialis 58, n. medianus 189, n. ulnaris 212, n. ischiadicus 17, n. femoralis 3, n. tibialis 12, n. fibularis 37. On the plexus brachialis 50 funiculolyses and 28 raphies were carried out. Immobilisation for 10 days. The length of the transplants showed no negative influence. After-observation was necessary for three and more years, especially in case of plexus injuries. Complete restoration was only found in children. Sensitivity in 80% more than Seddon III, 17% III and 3% less than III. Motor function in 60% IV, 20% III, 12% II and 8% less than II.


[Comparison of myeloscintigraphy and myelography with positive contrast media (Dimer-X) in the diagnosis of intervertebral disk prolapse].

When comparing myeloscintigraphy with positive myelography (Dimer X) in the diagnosis of the lumbar prolapse of intervertebral disks, identical findings were obtained in 17 out of 24 cases. Of these, both methods showed pathological findings in 12 cases and normal conditions in 5 cases. Only in 5 pathological myeloscintigrams normal Dimer X myelograms were obtained and in 2 myeloscintigrams judged as normal the positive myelograms were pathologic. With a good correlation of the two methods in typical cases the Dimer X myelogram, however, offers the advantage of the possibility of examining in several planes under constant reference to the vertebral column. Owing to the good tolerance, myeloscintigraphy should be used in screening diagnoses and in cases where also thoracic parts have to be included in the examination.


Human central nervous system lesions following radiation therapy.

With the increasing number of high-energy irradiation sources, the cases of radiolesions of the CNS are also increasing. The irradiation effects on nerve and tumour tissue and the various kinds of irradiation damage are discussed. They become manifest as (a) acute radionecrosis (rare) and (b) late reactions which are subdivided into delayed lesions and the more frequently occurring late necrosis proper. In early and early-delayed lesions, morphologically local spongy demyelination with loss of the oligodendroglia and astrocytic reaction are seen while vascular damage is characteristic of late irradiation damage. The author's observations include clinic, pathology, and time/dose dependence of the irradiation damage of brain and spinal marrow. The tolerance values of the spinal cord and the relative biological effects of the irradiation are dealt with. In spite of a good knowledge of clinic and pathology of the radiolesions and the improvement of irradiation techniques, the widely differing individual reactions of the CNS to ionising rays remain partly unclear.


[Anastomosis of the facial and hypoglassal nerve using coagulated plasma. Our first experiences].

The authors present their first experience in the construction of an anastomosis between the facial and hypoglassal nerves. This anastomosis was made in 3 patients; in one of them who had a lesion of n. facialis, the anastomosis was made 8 months following the time of the lesion, and the result was very good. In the other 2 patients the results were satisfactory, even though the procedure was carried out 9-10 years following the injury to this nerve. The authors stress the importance of the promptness of the operation, and the postoperative rehabilitation course.


[Partial pancreatectomy in modern surgical practice].

In modern surgery, the pancrectomy is an operation indicated in a wide number of cases. Indications for such a procedure that were once limited to malignant lesions of the papilla of vater and the head of the pancreas now include chronic pancreatitis, some benign lesions of the duodenopancreatic area, and serious cases of acute necrotizing pancreatitis. Thanks to Modern surgical technique especially in anesthesia, reanimation, and postoperative care, the mortality rate in the partial pancrectomy is Recured to a rational number. Nonetheless, postoperative exiturs cannot be neglected. As a result it is necessary to consider strict indications for a pancrectomy. Only under such conditions can satisfactory therapeutic results be achieved.


[Benign tumors of the stomach].

The authors discuss seven cases of benign tumors of the stomach. The diagnosis was based mainly on x-ray findings. Even though in suspicious cases, a fiber gastroduodenoscopy was indicated. During surgery, three adenomat--ous polyps were found; three Leionas and one Neurnoma. The tumors were excized by gastrotomy. In two of the patients a Billroth I resection was performed. One of these two patients was operated on urgently due to serious bleeding without the aid of X-rays. This patient, a woman, withstood the operation well as did all of the remaining patient.