Abnormal platelet functions in beta thalassaemia.

Haemorrhagic tendency, including frequent epistaxis and easy bruising, has been observed in patients with beta thalassaemia major. Disturbances in the coagulation system were also described in this condition, which probably resulted from liver damage associated with this disease. There was, however, no quantitative or qualitative correlation between the haemorrhagic manifestations on the one hand and the abnormalities in the clotting mechanism on the other. Platelet functions were studied in 15 patients with beta thalassaemia major and in 5 with thalassaemia minor. In most of the thalassaemia major patients and in some with thalassaemia minor, diminished platelet aggregation to ADP, collagen, ristocetin and epinephrine was found. These anomalies could not be corrected by the resuspension of the thalassaemic platelets in normal plasma.


Complement receptors in pathological human renal glomeruli.

Glomerular complement receptors (GCR) were demonstrated by the adsorption of C3 coated sheep erythrocytes to cryostat sections of human kidneys. An epithelial localization of the GCR is implied by the binding pattern of the indicator cells. The GCR activity was reduced in all glomeruli where in vivo deposition of immunoglobulin and C3 along the capillary wall was observed. In fourteen out of nineteen biopsies where deposits in the mesangium were seen, reduced GCR activity was also observed, whereas GCR activity was normal in the other five. Immunofluorescence and haemadsorption tests performed on the same section showed that C3 deposits corresponded to areas showing reduced complement receptor activity. Areas outside the C3 deposits adsorbed indicator cells coated with various amounts of C3 similarly to the adsorption to glomeruli seen in normal adult and fetal kidneys. Sclerotic glomeruli showed no GCR activity. The results indicate that the complement receptors play a role for the binding of complement-containing complexes in glomeruli.


The changing incidence of malignant melanoma of the skin in Sweden, 1959-1968.

3289 cases of malignant melanoma of the skin, recorded in the Swedish Cancer Registry between 1959 and 1968, have been studied regarding sex, age, location, month of registration and mortality. The incidence showed a 7% annual increase. the increase was most pronounced on the trunk and legs in both sexes. The highest incidence rise for women was between the ages of 30 and 39 and for men in the age range 40-64. The incidence in women with melanoma on the legs was higher during the summer months June-August. Only a negligible change in mortality was found during the period under consideration.


The influence of cleft length and palatoplasty on the dental arch and the deciduous occlusion in cases of clefts of the secondary palate.

In patients with clefts of the secondary palate, the effect of surgical reconstruction was studied from the time of the palate repair, at the age of 18-24 months, to the age of 5 years. The material comprised 99 children (37 boys and 62 girls). The material was grouped according to the antero-posterior size of the cleft. The changes of the maxillary dimensions were studied on the casts by linear measurements. The occlusion was analysed by descriptive and numerical methods. In the deciduous dentition the smallest intercanine and intermolar dimensions were recorded in patients with large palatal clefts. A the age of 5, the frequency of anterior crossbite was 38% in patients with large palatal clefts, compared with 19--21% in patients with smaller clefts. In boys with cleft palates, the frequency of anterior crossbite was 13% higher than in girls, in spite of the fact that in the material the incidence of large palatal clefts was lower in boys than in girls. In cases of large clefts of the secondary palate, the incidence of anterior crossbite was 12.5 times higher than in a material of non-cleft patients of the same age.


Zygomatic fracture. I. A simplified classification for practical use.

A review of classifications of zygomatic fractures demonstrates an increasing complexity in the choice of proper treatment. To facilitate the choice of treatment a proposal is made of a simplified classification with prediction of post-reductive fracture stability. The author's material, comprising 137 patients, has been accordingly divided and the proposed classification justified by the peroperative findings and by the follow-up results.


Zygomatic fractures. II. A follow-up study of 137 patients.

Out of a total of 137 patients with zygomatic fractures, 87 with post-reductively stable fractures were treated solely with Gillies' procedure. Twenty-eight patients with unstable fractures were treated with transosseous wiring. In 22 patients, in whom the fracture was considered undisplaced, no fracture treatment was given. At the follow-up only 2 of the patients treated by Gillies' procedure presented malunited fractures, and these only minor ones,this reductive method thus being satisfactory in 64% of all cases. Malunion was seen in one-third of the patients treated with transosseous wiring, this treatment thus appearing frequently insufficient. Consequently, accomplishment with Kirschner-pin fixation is proposed. Finally, a schedule for treatment of zygomatic fractures is given.


Follow-up of patients operated on for axillary hyperhidrosis by subcutaneous curettage.

In 161 patients operated on for axillary hyperhidrosis by subcutaneous curettage (322 axillae), Lugol's test indicated re-operation in 24 patients (44 axillae). Recurrences were due to inferior surgical technique. Post-operative complications appeared in 18 cases out of 161 patients (322 operations).


Anophthalmia and agenesis of columnella, prolabium and premaxilla without hypotelorism-a new syndrome? Case reports.

Three patients with a syndrome consisting of anophthalmia, midline upper lip pseudocleft with absent columnella, prolabium and premaxilla, but without hypo- or hypertelorism are presented, together with three borderline cases with an- or microphthalmia and lacking distal half of the nose or cleft lip and palate. The pathogenesis and relations to other facial anomalies are discussed.


Different clinical types of lipomatosis. Case report.

Following a brief review of the literature, three characteristic case histories are reported in order to demonstrate the different appearances of lipomatosis. According to the survey, grouping into three main types is suggested: 1) Diffuse lipomatosis without any sharp demarcation from the surrounding soft tissue, and a tendency to recurrence; 2) Diffuse, symmetrical lipomatosis mainly located to the neck region, and 3) Multiple lipomatosis with well-defined, encapsulated, small lipomas which never recur following removal.


Load on back in concrete reinforcement work.

The demands of work on the back of concrete reinforcement workers was determined through 4,327 observations of the various work postures and the weights lifted. Static loads from forward-leaning and bent-double postures were found to be common. In the preparation of intermediate and thick rods, forward-leaning was required for more than a third of the total work time, while one central assembly task required work in the bent-double posture for 58% of the total work time. The dynamic loads were of less importance, even though weights over 30 kg were lifted about 15% of the time in the preparation tasks and momentary forces approaching 1,000 N were occasionally needed. The bent-double posture, combined with or quickly followed by additional strain from, for example, weight lifting or slipping, was considered the most probable cause for possible signs of accelerated lumbar disc degeneration, while also the forward-leaning postures could be responsible for reversible low-back symptoms.


Radiologically detectable lumbar disc degeneration in concrete reinforcement workers.

Two hundred and ninety-five male Finnish concrete reinforcement workers, aged 19 to 64 years and engaged in heavy physical work including prolonged stooping, were radiologically examined by antero-posterior and lateral views of the lumbar spine while they were standing. The findings of lumbar disc degeneration were classified as none, slight, moderate or severe. The prevalence and degree of radiologically detectable lumbar disc degeneration depended strongly on age and increased especially rapidly from 40 to 44 years on. Lumbar disc degeneration showed an age-independent association to both a history of lumbago (chi2 = 10.5, p less than 0.01) and a history of sciatica (chi2 = 11.8, p less than 0.001). When disc degeneration was compared to reports of stiffness, fatigue, ache, and sharp pain in the back during an ordinary workday, no statistically significant associations were found, while disc degeneration was found to be slightly more common (chi2 = 4.6, p less than0.05) in the men reporting back symptoms as they bent down than in the men who did not report such symptoms. No association between length of exposure to static and dynamic back loads in reinforcement work and the prevalence of lumbar disc degeneration could be established, but definite conclusions on the possible effect of reinforcement work on the lumbar spine could not be drawn from the data.


[Etio-epidemiology of mouth and pharyngeal neoplasms in Switzerland].

Cancer of the upper digestive tract is very common among males in Switzerland in comparison with 19 other industrialized countries. The sex ratio is closely correlated with the mortality rates in men in these countries. Cancers of these sites are relatively more frequent among young adults than for all the other sites. After a brief review of the main risk factors the discussion focuses on tobacco and alcoholic beverages consumption. The distribution of these two risk factors and their relationship to age in a sample of 226 patients in Lausanne is discussed. If compared, the geographical variations in Switzerland of both the occurrence of the disease and the amount of alcoholic beverages consumed suggests an association. Finally, it seems likely that carcinogenic substances exist in some of the Swiss beverages. A research hypothesis related to the difference between the mutagenic properties of the beverages used by cancer patients and by controls is proposed for further study.


[Methodological problems on the preparation and realization of multicientric field studies on mouth and salivary gland neoplasms].

The objectives of multicentric field trials are to provide a base for future revisions of the TNM system in order to ameliorate the existing classifications or to create new ones. The data are collected in a prospective and standardized manner and their evaluation is centralized. Therapy and follow-up in each case are registered at regular intervals and individual treatment is reported according to a standardized and flexible procedure. The particular methodological problem lies in the necessity of aligning the volume and quality of the desired information with the practicability of data collection.


[Dental-stomatological problems before, during and after tumor radiotherapy i n the head and neck region].

Adequate dental procedures and preventive measures prior to, during and after completion of radiotherapy for tumors in the head-neck region are necessary in order to avoid postirradiation complications such as bone necrosis. The measures to be taken are described in detail. Cooperation between radiologist, physician and dentist minimizes postirradiation complications.


[General orientation of the treatment of mouth and pharyngeal neoplasms].

The treatment of carcinomas of oropharynx and oral cavity has changed rapidly over the last 15 years due to the progress of surgical technics and of oncological knowledge. As far as natural history and therapy are concerned, there are two opposing types of cancer: 1. Carcinomas developing from a mucous membrane covering a lymphoid tissue (cancers of the tonsil, some cancers of the palate and the base of tongue). Treatment is usually by radiotherapy, and surgery is mainly resorted to if radiotherapy fails. Therapeutic trials of chemotherapy are in progress. 2. Carcinomas developing from a mucous membrane covering muscles (cancers of the tongue, floor of the mouth and interval cheek) or bone of the mandible (carcinomas of the gingiva, floor of the mouth and gingiva, and retro-alveolar area). The therapy is described. The principles of treatment of the regional lymph nodes are also described.


[Surgical and radiotherapeutic possibilities of treatment of mouth neoplasms].

The basic concept of the treatment of cancer of the oral cavity has not essentially changed in the past few decades. The final results depend mainly on the site and extent of the primary tumor and on the presence of metastases to the regional lymph nodes. In most cases the treatment still includes surgery in combination with radiotherapy, both of which must be coordinated. Complete treatment of the primary tumor and of the lymph node areas is of great importance even in non-advanced cases. Extensive resection of the tumor offers another mode of curative therapy, especially in combination with reconstructive surgery. Chemotherapy appears to be useful in this group of tumors, but only if aggressive cytoxic agents are given. However, it cannot replace the modalities of treatment mentioned above. Patients with speech and mastication disability after therapy usually need special care. Periodic controls are necessary for even longer than five years, to ensure detection of possible recurrences and second tumors.


[Lymphatic metastasis of the neck. Pluridisciplinary approach--surgery].

The main features of tumoral pathology in the neck are metastatic lymph nodes of carcinomas having their origin in the upper respiratory and digestive tracts. Their prognosis will depend directly on the diagnostic approach and correct treatment. The place and modalities of surgery in the treatment of head and neck metastatic lymph nodes are discussed.


[The place of radiotherapy in the treatment of lymph node metastases in the neck from upper respiratory and digestive tract neoplasms].

The management of lymphnode disease is a common denominator in the treatment of all head and neck cancers. Only in a few clinical situations does irradiation or surgery alone yield a satisfactory control rate. The rationale for combination of both disciplines is based on two facts: a) Irradiations (5000 rads in 5 weeks) can eradicate the microscopic disease that a radical surgical procedure cannot remove; b) high doses of irradiation fail to control large cancer volumes (6500 rads in 6-7 weeks to a lymphnode greater than or equal to 3 cm: about 20% recurrence rate). The therapy sequence must be flexible and depend on clinical factors. The radicalism of both disciplines should be reduced in order to diminish the complication rate.


[Surgical treatment of lip precanceroses and neoplasms].

The "plastic" aspect of surgery in precancer and cancer of the lips, and, where feasible, its advantage over radiotherapy are described. The techniques of vermillectomy, Abbé flaps and Estlander flaps are discussed.


[The value of radiotherapy in the treatment of lip neoplasms].

About 80% of carcinomatous lesions of the lip are smaller than 2 cm in diameter, have little tendency to infiltrate, grow in the lower lip, are histologically well differentiated and do not have, or develop later, regional metastases. Of these carcinomas 95% are cured by the various methods of radiotherapy. The criteria for a more serious prognosis, such as expansive growth, deeper infiltration, location on the upper lip and/or the commissures, undifferentiated grading and regional lymphatic metastases, are found only in a minority of patients with carcinoma of the lip. However, even for tumors of the T3 category rates of cure of over 90% are reported, as confirmed by our own results with supervoltage irradiation with fast electrons of the betatron during the years 1961-1970. The techniques and indications of interstitial Curietherapy with iridium-192 wires are described. The treatment of primary lymphnode metastases, which should be confirmed histologically or cytologically before therapy, is described in detail. Neck dissection is superior to irradiation therapy. General elective neck dissection, as normally performed for carcinoma of the oral cavity, is not justified because of the low rate of metastases and the results of elective therapy. A case report demonstrates the poor prognosis in patients with regional fixed metastases.


[Diagnosis and therapy of salivary gland tumors].

The diagnostic and therapeutic approach to tumors of the salivary glands is discussed on the basis of 327 cases of parotid gland tumors seen at the ENT Department of the University of Zurich between 1959 and 1976. In view of the slow growth rate of salivary gland tumors, history and clinical findings cannot be used to identify malignant neoplasms. The histological diagnosis is therefore the prerequisite for correct therapy. Diagnostic errors may result when the total tumor mass is not available for histological investigation. For this reason we advise "surgical biopsy" (total extirpation of the tumor) when a malignant tumor cannot be ruled out by aspiration biopsy or examination of frozen sections. Radical surgical removal plays the major role in the therapy of salivary gland tumors. Highly malignant neoplasms demand a combined oncological approach usually involving surgery and radiotherapy. Familiarity with the temporal bone is necessary for the complete removal of highly malignant tumors of the parotid gland, because of their frequent infiltration of the intratemporal portion of the facial nerve. The application of the modern principles of reconstructive surgery and of microsurgical techniques has widened the scope of radical surgery of salivary gland tumors and considerably reduced the subsequent morbidity.


[Value of needle biopsy for the diagnosis of salivary gland tumors].

Tumors of the salivary glands can be diagnosed preoperatively by fine needle aspiration biopsy. Aspiration biopsy was performed in 328 cases with swelling of a salivary gland. Histologic findings were available for comparison in 186 cases. The cytologic reports yielded a positive tumor diagnosis in 84% of the cases with histologically verified tumors. False negative reports were mainly due to cystic tumors. Information concerning the dignity of the tumor was obtained in 95% of the cases recognized by cytology. The type of the tumor was correctly diagnosed in 90%.


[Retention of shape and function after jaw bone resection for tumor surgery].

Maintenance of form and function after resection of facial bones is of the utmost psychological importance. The potentialities for immediate rehabilitation are demonstrated. Defects in the maxilla are primarily closed by obturators, which must support the soft tissues of the orbit and the cheek, close the defect in the maxilla and restore masticatory function. Secondary reconstruction with split rib grafts is possible even after hemimaxillectomy. In the lower jaw, primary reconstruction with bone grafts at the same time as the resection is the most favourable course. Should the quality or quantity of soft tissues be inadequate, the defect is temporarily bridged with implants which can be replaced later with bone transplants. In all cases adequate mouth opening must be secured and deviation of the mandibular stumps avoided.


[Anti-tumor antibodies in the blood of patients with gliomas].

Anti-tumor antibodies have been searched for with an antibody-dependent cell-mediated cytotoxicity assay in the sera of patients with glioma. Sera from 60 patients and from 25 normal individuals have been tested against cells from 8 human glioblastoma lines. 10 patients (17%) and 5 controls (20%) were found to have antibodies against one or more tumor lines. There were extensive cross-reaction between the positive sera against the different glioma cells, but the reactivity of each serum was different. The specificity of the antibodies thus detected has been investigated. The positive patients' sera were found to have a similar cytotoxic activity against unrelated tumor and normal cells. Moreover, their activity was absorbed by cells from unrelated tumors and normal platelets. These results do not support the concept of a specific humoral response of glioma patients to a possible common tumor-associated antigen.


[Specific characteristics of hairy cell leukemia].

Report on a now 58-year-old female patient who presented in 1969 with the following objective findings: anemia, thrombocytopenia, lymphocytosis and hepatosplenomegaly. The first first diagnosis was lymphosarcoma, but up to 1976 nearly ten other diagnoses were established, e.g. reticulum sarcoma, leukemic lymphosarcoma, CML, ALL, CLL and Waldenström's disease. The patient did not respond to combined chemotherapy, but splenectomy brought about significant improvement in anemia and thrombocytopenia. She is now doing well without cytotoxic treatment. Hairy cell leukemia was diagnosed on the basis of electron microscopic findings in peripheral lymphocytes and histologic findings in bone marrow and spleen. The tartrate-resistant acid phosphatase was positive. Immunologic tests in the hairy cells showed surface immunoglobulins of monoclonal origina and the T-cells were shown to be decreased. The tests for phagocytosis and nonspecific esterase were negative. The hairy cells in this patient exhibited no colony stimulating activity in culture studies with bone marrow from 4 normal donors, as compared with the stimulating activity of normal monocytes in the same assay. In the light of this case report the question is discussed whether the hairy cells are mainly cells with lymphocytic (B-lymphocytes) or monocytic characteristics. On this question the findings in our patient support the hypothesis of a B-cell nature for the hairy cells.


[A case of pseudo-tumoral lymphoid hyperplasia or Castleman's disease].

The relatively rare pseudotumoral lymphoid hyperplasia (benigh lymphoid or reactive lymphoreticular hyperplasia; pseudolymphoma; Castleman's disease) arises from the lymph nodes, usually in the mediastinum. The disease assumes tow histologically and clinically different forms: the first, angiofollicular, is often symptomless, while the second, lymphoplasmocytic, is sometimes associated with a marked chronic inflammatory syndrome. The etiology is unknown, but is probably a reaction of the lymphoplasmocytic system to an antigen, possibly of viral origin. Diagnosis is based on histology. Surgical treatment is curative. A rare form of this unusual disease is reported with reference to the morphological differential diagnosis; the similarities with immunoblastic lymphadenopathy are emphasized.


[Pancreatogenic ascites].

Pancreatic ascites is a rare disease which is often misinterpreted as ascites secondary to alcoholic cirrhosis or to intraabdominal cancer. It can be diagnosed by a high protein and amylase/lipase content of the ascitic fluid. If diagnosis and subsequent surgery occur at an early stage, the prognosis is good. The natural course, therapy, prognosis, and pathogenesis of pancreatic ascites are discussed on the basis of experience with 7 patients.


[Serum and joint levels of cefacetrile during its administration for septic arthritis].

Six patients, five of whom had normal and one impaired renal function, and all suffering from purulent arthritis caused by cephalosporin-sensitive germs, were given a seven-day course of 8 g cephacetrile daily. On the first day, 6 g were administered by continuous intravenous infusion at the rate of 500 mg/h, followed by 2 g over a further 45 min. On days 2 to 7, the patients received 2 short infusions of 4 g each at an interval of 12 h. In four patients with normal renal function, serum half-life ranged from 0.8 to 1.4 h, serum levels during continuous infusion from 19 to 31 microgram/ml, and total clearances from 265 to 434 ml/min. In one patients, these values were 1.6 h, 70 microgram/ml and 131 ml/min respectively (small volume of distribution). The concentrations in the synovial fluid varied from 2 to 29 mcirogram/ml; they were generally lower than the serum levels, but clearly exceeded the minimum inhibitory concentrations for germs commonly present in purulent arthritis. In five patients, the synovial fluid became germ-free and the arthritis was clinically cured. In the case presenting with renal insufficiency, the serum half-life was 5.8 h. During continuous administration, a steady state was not attained; peak serum levels amo9nted to 75 microgram/ml and the total clearance to 61 ml/min. The cephacetrile concentrations in the synovial fluid were very high (26 and 67 microgram/ml). In this case, in which the renal insufficiency associated with mycosis fungoides was present before the treatment, renal function deteriorated futher during treatment while the arthritis improved.


[Congenital chloride diarrhea].

Two siblings aged 18 months and 3 1/2 years with congenital chloride diarrhea are presented. This disease was first described by Gamble et al. and Darrow in 1945 and has not been observed to date in Switzerland. So far, 43 cases have been reported, half of them from Finland. The disease appears to be caused by an inborn defect of chloride transport across the mucous membranes of the distal ileum and colon. This defect leads to chronic liquid diarrhea. The clinical symptoms, diagnostic approach, and therapeutic problems and possibilities are discussed.


[Spontaneous birth of a live healthy child during successful hemodialysis treatment of pregnancy pyelonephritis with acute oligo-anuria].

A 19-year-old nullipara developed uremia due to acute pyelonephritis in the 30th week of pregnancy, necessitating hemodialysis within one week of onset of clinical infective symptoms. Almost daily prophylactic hemodialyses (7 in all) were performed. BUN and serum creatinine levels were maintained below 75 mg/100 ml and 12 ml/100 ml respectively, and the patient's weight was kept constant until delivery in the 32nd week of pregnancy. A live healthy child of 1.7 kg was born with a length of 39 cm and a normal neurologic examination. After 10 hemodialyses, polyuria set in and the maternal BUN and serum creatinine levels were within normal ranges 3 weeks after delivery. The importance of close cooperation between gynecologist and internist is stressed.


[Behavior of gentamicin in the kidney parenchyma. Studies on rats during and after treatment with therapeutic doses].

The injection in rats of 4 mg/kg gentamicin results in accumulation and continued presence of the antibiotic in the renal parenchyma compared with its rapid elimination from other tissues. With repeated injections at 24-hour intervals over a period of 3 weeks, gentamicin concentrations in the cortex reach 356 +/- 139 microgram/g after 1 week of treatment, i.e. levels 50 times higher than the maximum serum levels. They then stay at a saturation plateau before decreasing very slowly to levels of 50 microgram/g 2 weeks and 15 microgram/g 15 weeks after the last injection. The accumulation takes place mainly in the cells of the proximal convoluted tubule. In the medulla, gentamicin behaves similarly but the levels are lower. Weeks after the last injection, urine levels of gentamicin are still appreciable. In spite of this enormous accumulation, the treatment does not result in disturbance of renal function or striking morphological changes. These observations are based on dosages of gentamicin corresponding to those used clinically. Compared to earlier observations based on the supratherapeutic administration of the antibiotic, the present study provides a better understanding of the mechanisms involved in gentamicin nephrotoxicity.


[Programming of freely written anamnesses for the computer].

The case histories of more than 5000 outpatients with respiratory diseases were stored in free text from 1974 untill 1977. The retrieval efficiency was tested using STAIRS-IBM program product with the syntax operators "or", "and", "not", "with", and "adj". Chronic bronchitis in lung cancer patients was chosen as an example. The first word constellation was compiled as a retrieval argument for chronic bronchitis. The second word constellation was used as a retrieval argument for chronic bronchitis subsisting for more than 5 years before the diagnosis of lung cancer. The third word constellation retrieved documents without clear time relationship between chronic bronchitis and lung cancer. The review of each history of the 473 lung cancer patients issued a first group of 219 cases composed of lung cancer patients with histories of chronic bronchitis for more than 5 years. A second group of 180 patients had no history of preexisting chronic bronchitis. This manual selection of cases (reading of all 473 case histories) took 3 months compared to 4 h by computer dialogue selection. 87% of the first group (preexisting chronic bronchitis for more than 5 years) and 74% of the second group (no history of chronic bronchitis) were correctly obtained by the brief computer dialogue. This efficiency of the computer dialogue was further improved without difficulty by slight modifications of the dialogue strategy, so that only approximately 10% of documents remained falsely classified. It can be seen that free text analysis of case histories is possible by the STAIRS-IBM program and enables a doctor to observe new clinically important correlations in a very short time. Final deductions, however, must be followed by careful checking of all individual histories.


[Determination of plasma parathyroid hormone in the differential diagnosis of hypercalcemias associated with malignant tumors].

In 44 patients, all suffering from a malignant disease with hypercalcaemia, plasma parathormone was measured by a radioimmunoassay measuring the intact PTH molecule. The results as a function of plasma calcium were compared with those in 38 patients suffering from proven primary hyperparathyroidism and with those in 9 cases of hypercalcaemia of other origin. PTH was indetectable in 14 cases of malignant disease and normal in 25 cases. In 5 patients only could PTH and plasma calcium not be separated from primary hyperparathyroidism. 3 patients had an increased PTH level when plasma calcium was lowered by treatment of the underlying disease. In patients with malignant disease hypercalcaemia is rarely caused by increased secretion of PTH. In these cases either primary hyperparathyroidism or ectopic secretion of PTH may be the cause of hypercalcaemia.


[Hyponatremia and hypoglycemia after treatment with chlorpropamide. Case histories with review of the literature on 18 cases of chlorpropamide induced hyponatremia].

A case of chlorpropamide-induced, symptomatic hyponatremia in a diabetic patient is reported. The hyponatremia was associated with loss of appetite, nausea, and vomiting. These symptoms caused reduced food intake which provoked severe hypoglycemia with disturbed consciousness. The hyponatremia developed when the chlorpropamide doses were increased from 400 to 600 mg/day. Withdrawal of chlorpropamide was followed by remission of hyponatremia. Chlorpropamide-induced hyponatremia is a rare complication and is due to an antidiuretic effect of chlorpropamide caused by increased secretion of adiuretin and potentiation of the effect of chlorpropamide caused by increased secretion of adiuretin and potentiation of the effect of adiuretin in the tubuli of the kidney. This case report and the analysis of 18 published cases in the literature show the following characteristics for chlorpropamide-induced hyponatremia: (1) Hyponatremia is a rare complication in the treatment of diabetics with chlorpropamide. The patients typically are female and over sixty. The dosage of chlorpropamide usually was 500 mg daily or even more. (2) Hyponatremia is often unrecognized for a long time because the symptoms are not specific. The characteristic symptoms include loss of appetite, nausea, vomiting, abdominal pain, confusional state and, rarely, convulsions and coma. Recovery occurs spontaneously after withdrawal of the drug. (3) The incidence of this type of hyponatremia is increased in cases of preexisting tendency to water retention such as heart failure and renal failure, and in cases of diuretic therapy. In the light of these findings, the authors believe that chlorpropamide is no longer a drug of choice in the treatment of diabetic women, especially in cases of preexisting tendency to water retention and in diuretic therapy. In such cases, a sulfonylurea without antidiuretic effect is to be preferred.


Cytogenetic changes in fish exposed to water of the river Rhine.

The induction of chromosome aberrations in fishes, exposed to Rhinewater, was investigated. The mudminnow, Umbra pygmaea, was chosen for this study, because of its ideal karyotype of 22 large chromosomes. Gill cells were used for chromosome studies. Fish, kept in Rhinewater for 11 days had chromosome breaks in approximately 30% of the metaphases studied. Control fish, exposed to a very good quality of untreated groundwater had breaks in about 8% of the metaphases. Several Rhinewater extracts were tested for their mutagenic potential in the Salmonella-microsome test. The fraction of aromatic compounds was found to be positive. This may indicate that one or more of the compounds present in this fraction were also responsible for the cytogenetic changes found in the fish.


Subpicosecond spectroscopy of bacteriorhodopsin.

Subpicosecond pulses have been used to study the ultrafast dynamics of the photochemistry of bacteriorhodopsin. An optically induced absorption that appears in about 1.0 picosecond at physiological temperatures has been resolved in time. The data can be interpreted in terms of the photochemical formation of bathobacteriorhodopsin and provide support for an excitation mechanisms involving molecular rearrangement in the protein induced by electron redistribution in the chromophore.


Thrombin-induced platelet aggregation is mediated by a platelet plasma membrane-bound lectin.

Throbin-activated human platelets cause agglutination of trypsinized, formalinized bovine erythrocytes. This lectin activity of stimulated platelets was blocked by galactosamine, glucosamine, mannosamine, lysine, and arginine, but not by N-acetylated sugars, other neutral sugars, or other amino acids. Inhibitors of the thrombin-induced lectin activity also blocked thrombin-induced platelet aggregation. It appears that a membrane surface component that has lectin activity mediates platelet aggregation.


Antibodies to purified insulin receptor have insulin-like activity.

Antibodies to insulin receptors purified from rat liver membranes do not complete with [125I]insulin for binding to the insulin receptor but do precipitate solubilized receptors labeled with [125I]insulin. These antibodies have the insulin-like activities of enhancing glucose oxidation and inhibiting epinephrine-induced lipolysis in rat adipocytes. Thus, antibody binds to the receptor at a different site from that to which insulin binds, yet the interaction can initiate an effective biological response. These results indicate that the previously studied insulin-binding sites are the physiological macromolecular receptors for insulin.


Effect of myasthenic immunoglobulin on acetylcholine receptors of intact mammalian neuromuscular junctions.

Degradation of acetylcholine receptors of intact mouse neuromuscular junctions was determined in vivo and in vitro by the release of radioactivity from mouse diaphragms labeled with 125I-alpha-bungarotoxin. Treatment of mice with immunoglobulin from myasthenic patients accelerated the degradation rate to approximately three times normal, in both intact animals and organ cultures. The released radioactivity was in the form of [125I]tyrosine, confirming the nature of the degradative process. Accelerated degradation of acetylcholine receptors at neuromuscular junctions may represent an important antibody-mediated mechanisms in myasthenia gravis.


Human lateralization from head to foot: sex-related factors.

Sex differences in the pattern and maturation of lateral asymmetries of the human brain have been recently found by a number of investigators, suggesting that sex-related factors may differentially affect the two sides of the body. In this study, asymmetries in the size of the two feet were strongly related to sex and handedness, right-handed males having larger right feet and right-handed females having larger left feet, the reverse being seen in non-right-handed individuals. Since these differences were apparent even in children younger than 6 years, the fetal sex steroids may be critical in governing the maturation of both cerebral and pedal asymmetries.


Prediction of learning rate from the hippocampal electroencephalogram.

Samples of spontaneous electroencephalographic (EEG) activity from the dorsal hippocampus of rabbits were recorded immediately before classical conditioning of the nictitating membrane response. Computer analysis revealed a significant predictive relationship between EEG frequency characteristics and the subsequent rate of learning.


Learned taste aversions in children receiving chemotherapy.

Children with neoplastic diseases were offered an unusual ice cream before their drug treatments. Patients experiencing gastrointestinal toxicity due to the drugs were subsequently less likely to choose that ice cream again than controls. This suggests that taste aversions induced by drug-associated symptoms may contribute to the appetite loss experienced by cancer patients.


Genetic method for the preferential elimination of females of anopheles albimanus.

Recent field experiments demonstrated the possibility of using the sterile male method for the control of Anopheles albimanus Wiedemann, the most important vector of human malaria in Central America. Until now there was no practical method for excluding females from the releases of sterile males. A genetic method was developed for the preferential elimination of females during any of the four life stages. This genetic sexing system utilizes propoxur (o-isopropoxyphenyl methyl-carbamate) susceptibility as a recessive conditional lethal a T(Y:2R) translocation, and an In(2R)inversion. The propoxur resistance allele (dominant) was linked to the Y chromosome via a radiation-induced translocation, and genetic recombination was suppressed by inversions. In one of the strains produced, 99.7 percent of the females are eliminated when treated with propoxur, without male loss.


Neuronal generation of the leech swimming movement.

The swimming movement of the leech is produced by an ensemble of bilaterally symmetric, rhythmically active pairs of motor neurons present in each segmental ganglion of the ventral nerve cord. These motor neurons innervate the longitudinal muscles in dorsal or ventral sectors of the segmental body wall. Their duty cycles are phase-locked in  a manner such that the dorsal and ventral body wall sectors of any given segment undergo an antiphasic contractile rhythm and that the contractile rhythms of different segments form a rostrocaudal phase progression. This activity rhythm is imposed on the motor neurons by a central swim oscillator, of which four bilaterally symmetric pairs of interneurons present in each segmental ganglion appear to constitute the major component. These interneurons are linked intra- and intersegmentally via inhibitory connections to form a segmentally iterated and inter-segmentally concatenated cyclic neuronal network. The network appears to owe its oscillatory activity pattern to the mechanism of recurrent cyclic inhibition.


Cognitive development and social policy.

The city of Warsaw was razed at the end of World War II and rebuilt under a socialist government whose policy was to allocate dwellings, schools, and health facilities without regard to social class. Of the 14,238 children born in 1963 and living in Warsaw, 96 percent were given the Raven's Progressive Matrices Test and an arithmetic and a vocabulary test in March to June of 1974. Information was collected on the families of the children, and on characteristics of schools and city districts. Parental occupation and education were used to form a family factor, and the district data were collapsed into two factors, one relating to social marginality, and the other to distance from city center. Analysis showed that the initial assumption of even distribution of family, school, and district attributes was reasonable. Mental performance was unrelated either to school or district factors; it was related to parental occupation and education in a strong and regular gradient. It is concluded that an egalitarian social policy executed over a generation failed to override the association of social and family factors with cognitive development that is characteristic of more traditional industrial societies.


Pattern formation by cultured human epidermal cells: development of curved ridges resembling dermatoglyphs.

In cultures made from disaggregated human epidermal cells, growth to a confluent cell layer is followed by the emergence of patterns resembling those of human dermatoglyphs. These patterns reflect intrinsic properties of kertinocytes. In vivo, only the epidermis of the volar surfaces forms patterns, but in culture, patterns are formed by epidermal cells from other sites as well. Patterns develop by a process of cell movement which first produces ridges and then curves the ridges into figures of increasing complexity, ultimately whorls.


Identification of a C-glucuronide of delta6- tetrahydrocannabinol as a mouse liver conjugate in vivo.

Delta 6-Tetrahydrocannabinol-C-4-glucuronide was found in the livers of mice that had been administered delta 6-tetrahydrocannabinol. Thus, C-glucuronidation of a compound that contains a free hydroxyl group has been demonstrated in vivo.


Blood-brain neutral amino acid transport activity is increased after portacaval anastomosis.

In rats after portacaval anastomosis (an animal model of chronic liver disease), transport of tryptophan and other members of the large neutral amino acid group from blood to brain was markedly enhanced. Increased transport activity was apparently restricted to the neutral amino acid transport system, since brain uptake of glucose, inulin, and tyramine was unaffected while blood-brain arginine transport was significantly reduced. These results strikingly confirm the hypothesis that carrier-mediated blood-brain transport is the limiting factor determining the availability of the neutral amino acids to the brain. The encephalopathy associated with cirrhosis may be the result of abnormal neurotransmitter metabolism and neurotransmission secondary to increased neutral amino acid  transport activity and an increased brain content of members of the neutral amino acid group.


Quantitation of hindered rotations of diphenylhexatriene in lipid bilayers by differential polarized phase fluorometry.

Diffusional motions of 1,6-diphenyl-1, 3, 5-hexatriene (DPH) were observed by differential polarized phase fluorometry. The measurements indicated that the depolarizing rotations of DPH in propylene glycol are isotropic. The results in vesicles of dimyristoyl-l-alpha-phosphatidylcholine indicated that diffusional rotations of DPH are dominated by hindered torsional motions. Combined use of both differential phase and steady-state anisotropy measurements showed that the average rotational angle of DPH, at times long compared to the fluorescence lifetime, is limited to about 23 degrees at temperatures below the transition temperature of the lipid and that these rotations become less hindered above the transition temperature. The evidence that the depolarizing rotations of DPH in a lipid bilayer are different from those in an isotropic solvent calls into question the meaning of membrane microviscosity as determined by fluorescence anisotropy.


Comparison of rhapidosomes and asbestos microfibrils.

Rhapidosomers (cylindrical nucleoprotein rods of bacterial origin) show great structural similarity to the microfibrils of chrysotile asbestos when negatively stained and observed with the electron microscope. If the negative stain is omitted, the asbestos retains its structural detail whereas the rhapidosomes appear to be unstructured bodies. When the microscope is adjusted into a selected area diffraction mode, the asbestos shows characteristic electron diffraction patterns whereas the rhapidosomes appear to be amorphous to electron diffraction.


Copulatory vocalizations of chacma baboons (Papio ursinus), gibbons (Hylobates hoolock), and humans.

The copulatory vocalizations of female baboons (Papio ursinus) are more complex than those of female gibbons (Hylobates hoolock) or human females. Adult males of all these species begin calling later than the female, but subordinate baboon males do not call. Copulatory vocalizations may serve to mutually stimulate the mating partners or to incite male competition.


Lateralization of norepinephrine in human thalamus.

Norepinephrine has a strongly lateralized distribution in the human thalamus. In the pulvinar region the left hemisphere is rich in norepinephrine, whereas in the somatosensory input area the right hemisphere has a higher concentration of this catecholamine. Such naturally occurring left-right differences in concentration of a neurotransmitter represent a new aspect of hemispheric specialization.


Medial preoptic lesions and male sexual behavior: age and environmental interactions.

In all species studied, the medial preoptic area has been found to be necessary for male copulatory behavior. No recovery of sexual function from the medial preoptic area lesions appears to have been reported. This study demonstrates that rats with large lesions of the medial preoptic area exhibit adult male sexual behavior when the surgery is performed prepuberally and the rats have interacted socially with peers.


EXAFS: new horizons in structure determinations.

Although the phenomena of extended x=ray absorption fine structure (EXAFS) were observed as early as the 1930's, EXAFS has only recently, with the utilization of synchrotron radiation, been transformed into a powerful structural technique. The theory and experimental practice of the technique are described and illustrated with data on germanium. Applications to systems as diverse as hemoglobin, polymer-bound catalysts, ions in solution, amorphous solids, and adsorbate atoms on surfaces are reviewed. With the recent approval of funding for new, more powerful dedicated synchrotron sources, the future holds the possibility of a virtual revolution in structure determinations.


Initiation of light adaptation in barnacle photoreceptors.

Intracellular recordings were used to measure the action spectrum of light adaptation in barnacle photoreceptors. The action spectrum closely resembles the absorption spectrum of rhodopsin (lambdamax at 530 nanometers) and is clearly different from that of metarhodopsin (lambdamax at 495 nanometers). These results suggest that absorption of light by rhodopsin initiates both excitation and light adaptation. The previously reported antagonistic process initiated by metarhodopsin does not appear to play a role at moderate light intensities.


Nitrite and nitrate are formed by endogenous synthesis in the human intestine.

Studies of nitrate balance in humans and analyses of fecal and ileostomy samples indicate that nitrite and nitrate are formed de novo in the intestine, possibly by heterotrophic nitrification. These findings significantly alter our previous conceptions of human exposure to nitrite and suggest an even wider role for nitrite in the etiology of human cancer.


Mercury concentrations in Pacific hake, Merluccius productus (Ayres), as a function of length and latitude.

Mercury concentrations in Pacific hake increase with fish size and with the latitude of collection. While the mercury-size trend is consistent with data for other species, the latitudinal trend is opposite to that reported for other fishes over the same geographical area. Consequently, latitudinal trends of mercury concentrations in fishes do not necessarily indicate trends of mercury concentrations in water. Food habits and metabolism may cause the observed variations.


Cystic fibrosis: decreased conjugation and excretion of [14C]spermidine.

Free and conjugated [14C]spermidine were measured in plasma samples from normal individuals and cystic fibrosis patients. Within 4 minutes, the 14C-labeled material in the plasma from normal individuals was 70 percent conjugated compared to no detectable conjugation by cystic fibrosis patients. Further, the patients excreted only 11 to 13 percent of the [14C]spermidine in their urine within 72 hours whereas normal excretion was 60 to 76 percent. In both cases, the labeled material was in a conjugated form.


Is binocular vision always monocular?

Visual sensitivity of one eye was determined under binocular stimulus conditions yielding apparent fusion, stereopsis, monocular dominance, and monocular suppression. Marked losses in sensitivity accompanied monocular suppression but were not evident during stable singel vision. The results are inconsistent with the hypothesis that supression alone mediates binocular single vision.


Intellectual status of working-class children adopted early into upper-middle-class families.

Failure rates observed (13 +/- 6 percent for school failures, 17 +/- 5 percent for scores below 95 on a collective IQ test) were far below those expected from the social class of birth (55 percent, 51 percent) or observed in a control group (56 +/- 8 percent, 49 +/- 9 percent) but close to those expected from the social class of adoption (15 percent, 15 percent).


Nuclear waste: increasing scale and sociopolitical impacts.

The article argues that insufficient attention has been paid to the operational aspects of the U.S. radioactive waste management system when it grows to the scale necessary to handle wastes produced by a fully deployed plutonium economy. Without such information, many of the unsettling speculations which have become part of the public debate and are summarized herein cannot be clearly addressed. The article then outlines the types of information necessary to begin estimating the costs and consequences of radioactive waste management. Finally, an index of social exposure to radioactive hazard is proposed to improve the basis for policy decisions in this area.


6-Mercaptopurine treatment of pregnant mice: effects on second and third generations.

The immunosuppressive drug 6-mercaptopurine is embryotoxic in mice. Of the surviving female offspring of mice treated with low doses of 6-mercaptopurine during pregnancy, despite normal body weight and general appearance, many were either sterile or, if they became pregnant, had smaller litters and more dead fetuses as compared to offspring of mothers that had not received the drug.


Peptide formation in the prebiotic era: thermal condensation of glycine in fluctuating clay environments.

As geologically relevant models of prebiotic environments, systems consisting of clay, water, and amino acids were subjected to cyclic variations in temperature and water content. Fluctuations of both variables produced longer oligopeptides in higher yields than were produced by temperature fluctuations alone. The results suggest that fluctuating environments provided a favorable geological setting in which the rate and extent of chemical evolution would have been determined by the number and frequency of cycles.


Enhancement of conditioned arterial pressure responses in cats after brainstem lesions.

Cats were classically conditioned after the baroreceptor reflexes were abolished by bilateral placement of electrolytic lesions in the nucleus tractus solitarii. The conditioned increases in arterial pressure were more than five times larger than the responses obtained in similarly trained controls. This finding suggests that the baroreceptor reflexes actively inhibit conditioned increases of arterial pressure.


Anxiety change through electroencephalographic alpha feedback seen only in high anxiety subjects.

Subjects who were either high or low in trait anxiety used alpha feedback to increase and to decrease their electroencephalographic alpha activity. The alpha changes were tightly linked to anxiety changes, but only in high anxiety subjects (for whom anxiety was reduced in proportion to alpha increases, and was increased in proportion to alpha suppression). Low trait-anxiety subjects were superior at both enhancement and suppression training, but their alpha changes were not related to anxiety changes. In both groups, anxiety changes were generally unrelated to either resting levels or changes in frontalis electromyograms and respiration rate. These results suggest that long-term alpha feedback training (at least 5 hours) may be useful in anxiety therapy.


Statistical problems in ESP research.

In search of repeatable ESP experiments, modern investigators are using more complex targets, richer and freer responses, feedback, and more naturalistic conditions. This makes tractable statistical models less applicable. Moreover, controls often are so loose that no valid statistical analysis is possible. Some common problems are multiple end points, subject cheating, and unconscious sensory cueing. Unfortunately, such problems are hard to recognize from published records of the experiments in which they occur; rather, these problems are often uncovered by reports of independent skilled observers who were present during the experiment. This suggests that magicians and psychologists be regularly used as observers. New statistical ideas have been developed for some of the new experiments. For example, many modern ESP studies provide subjects with feedback--partial information about previous guesses--to reward the subjects for correct guesses in hope of inducing ESP learning. Some feedback experiments can be analyzed with the use of skill-scoring, a statistical procedure that depends on the information available and the way the guessing subject uses this information.


Monensin and the prevention of tryptophan-induced acute bovine pulmonary edema and emphysema.

3-Methylindole, a ruminal fermentation product of tryptophan, induces acute pulmonary edema and emphysema in cattle, and 3-methylindole is present in the ruminal fluid and blood of cows with a natually occurring form of this disease. Monensin, a polyether antibiotic and widely used feed additive for beef cattle, prevented tryptophan-induced acute bovine pulmonary edema and emphysema. Monensin acted by reducing the ruminal conversion of L-tryptophan to 3-methylindole both in vitro and in vivo. Lasalocid, also a polyether antibiotic, showed similar effects in vitro. These results provide a promising approach to prevention of this major respiratory disease of cattle.


Microcirculation of the spleen: and open or closed circulation?

By injecting plastic microspheres of a specific size (3 to 4 micrometers) into the circulation and following their movement and distribution in the spleen, it was revealed how blood travels from the arterial capillaries to the venous sinuses. This method demonstrated that both open and closed circulation exist in the spleen and that about 90 percent of the blood takes the open route of circulation in the normal unanesthetized rabbit.


Serologically defined (SD) locus in cattle.

Using cytotoxic serums obtained from multiparous cows or by alloimmunization, we have detected 11 lymphocyte antigens controlled by codominant alleles at a serologically defined locus called BoLA-A (bovine lymphocyte antigens). This locus, along with the lymphocyte defined loci previously reported, establishes the existence of a major histocompatibility system of cattle.


Loss of hippocampal theta rhythm results in spatial memory deficit in the rat.

Rats learned, using distal room cues, to run to a goal on an elevated, circular track starting from any position on the track. The goal was one of eight equidistant, recessed cups set around the track, the goal cup being distinguished from the others solely by its position in the room. After learning, electrolytic lesions were made in the medial septal nucleus eliminating hippocampal theta rhythm in some animals but not in others. Rats without theta rhythm were no longer able to perform the spatial task, whereas rats with undisturbed theta rhythm retrained normal performance. Although rats without theta rhythm could not find their way directly to the goal, they recognized its location when they came upon it by chance. This type of spatial deficit appears similar to that shown by hippocampally lesioned patient H.M. Subsequent tests demonstrated that rats deprived of theta rhythm before training could nevertheless learn the task.


The stomach signals satiety.

Inflatable pyloric cuffs and stomach tubes were implanted in rats. With the cuff inflated and a valve to limit intragastric pressure to that accompanying normal satiety, they drank only as much when they had been deprived of food for 12 hours as without inflation of the cuff. However, they overdrank with the cuff inflated when they had been water deprived for 12 hours. When 10 ml of milk was withdrawn from the stomach with the cuff inflated, compensatory drinking occurred. Further, compensatory drinking also occurred when milk escaped from the stomach into the duodenum. Satiety signals thus arise from the stomach.


Evoked response correlate of symbol and significate.

Changing the source and intensity of the auditory signal to six trained cats responding to meaningful auditory stimuli permits exogenous and endogenous processes in the auditory evoked potential to be separated. For short-latency exogenous processes, latency and amplitude depend on the parameters of the physical stimulus. However, the amplitude and shape of longer-latency endogenous processes are essentially independent of the location and intensity of the signal source and seem to be invariant concomitants of the significance of the signal.


Sympathetic nervous control of cerebrospinal fluid production from the choroid plexus.

The rabbit choroid plexus, responsible for the bulk production of cerebrospinal fluid, is well supplied by sympathetic nerves emanating in the superior cervical ganglia. Electrical stimulation of these nerves markedly reduces production of cerebrospinal fluid, measured by [14C] inulin dilution during ventricular perfusion, whereas sympathetic denervation enhances the rate of formation.


Enhanced dexamethasone resistance in cystic fibrosis cells: potential use for heterozygote detection and prenatal diagnosis.

Cultured skin fibroblasts from patients with cystic fibrosis (CF) are more resistant to dexamethasone toxicity than are normal cells. We now report that, when fibroblasts cultured from obligate CF heterozygotes are exposed to dexamethasone, they have an intermediate survival compared to normal and homozygous CF cells. When dexamethasone survival was tested on cells from four patients undergoing amniocentesis, cells from a woman at risk of producing a child with CF showed significant dexamethasone resistance, similar to that of fibroblasts derived from lnown CF homozygotes; the other amniotic cell specimens showed dexamethasone sensitivity similar to that of normal skin fibroblasts. These data suggest that the dexamethasone resistance previously observed in skin fibroblasts may also be useful in the prenatal diagnosis of CF.


Other tastes, other worlds.

The idea of four primary tastes has influenced our concept of the gustatory world of all animals. It has also been the basis for constructing theories of gustatory neural integration. Since natural chemical stimuli are complex mixtures to which responses are multineuronal, difficult questions about integration arise. Answers are usually framed in terms of "labeled line" or "across-fiber" hypotheses. Comparative studies of vertebrate and invertebrate taste reveal in all receptors universal basic parameters that bear on the controversy. Comparative studies also place in more accurate perspective diverse chemically related ecologies and behaviors.


Physiological basis of anisometropic amblyopia.

In the visual cortex of kittens that have received their only visual experience while wearing a high-power lens before one eye, most neurons are dominated by input from the normal eye. Moreover, contrast sensitivity and resolving power are lower for stimulation through the originally defocused eye, mimicking psychophysical results from human anisometropic amblyopes.


Chronically decerebrate rats demonstrate satiation but not bait shyness.

Taste substances applied to the oral cavity result in either ingestion or rejection, each with a characteristic muscular response pattern. These responses are the same in decerebrate and intact rats; the caudal brainstem appears to be the neural substrate of ingestion and rejection responses. The experiment determined whether decerebrates can alter these discriminative responses as a function of food deprivation or toxicosis. Food-deprived decerebrate rats, like intact ones, ingested a taste substance they had rejected when sated. However, these same decerebrates, in contrast to controls, neither rejected nor decreased ingestive reactions to a novel taste after that taste had been repeatedly paired with lithium chloride-induced illness. Although the forebrain may be important for integrating ingestion, some aspects of this control seem to be represented in caudal brain areas.


Ponto-geniculo-occipital (PGO) burst neurons: correlative evidence for neuronal generators of PGO waves.

A newly discovered class of neurons, ponto-geniculo-occipital (PGO) burst neurons, has PGO wave relationships of phase-leading, stereotyped discharge bursts, and the highest reported discharge specificity and coherence; these neurons thus fulfill correlative criteria for output generator neurons for PGO waves. The PGO burst neurons are recorded in a discrete dorsal brainstem area in apposition to the brachium conjunctivum.


Limits to growth in world food production.

The dramatic increases in wheat yields that began in the mid-1930's in the United States will soon begin to level off. The favorable mix of genetics and technology that has characterized this era must build upon an ever higher yield base for the future. At the same time the residue of factors that can lower wheat yields includes a larger proportion of forces not easily shaped or controlled by man. An example is weather. The result is a natural yield ceiling that is already visible and that will impose a limit on future productivity growth.


Visual phenomena induced by relativistic carbon ions with and without Cerenkov radiation.

Exposing the human eye to individual carbon ions (6C+) moving at relativistic speeds results in visual phenomena that include point flashes, streaks, and larger diffuse flashes. The diffuse flashes have previously been observed by astronauts in space but not in laboratory experiments with particles of high atomic number and energy. They are observed only when the nucleus moves fast enough to generate Cerenkov radiation.


Red cell membrane glycophorin labeling from within the lipid bilayer.

Human red blood cell membranes were labeled from within the lipid bilayer by the apolar photosensitive reagent, 5-[125I]iodonaphthyl-1-azide. Glycophorin, the major sialoglycoprotein of the red cell membrane, was purified by two different methods; it contained approximately half of the total label incorporated into membrane proteins. The label was confined to the trypsin-insoluble peptide of glycophorin that includes a sequence of 20, mainly apolar, amino acids. These findings provide direct evidence that the labeled segment resides within the membrane in direct contact with the lipid bilayer, and support the suggestion that glycophorin spans the bilayer through its hydrophobic domain.


Brain edema: induction in cortical slices by polyunsaturated fatty acids.

The presence of polyunsaturated and saturated fatty acids in leukocytic membranes prompted study of their possible role in the induction of brain edema. Polyunsaturated fatty acids including sodium arachidonate, sodium linoleate, sodium linolenate, and docasahexaenoic acids induced edma in slices of rat brain cortex. This cellular edema was specific, since neither saturated fatty acids nor a fatty acid containing a single double bond had such effect.


Aggregation effects on oxygen binding of sickle cell hemoglobin.

Deoxygenation of concentrated solutions (0.33 gram per milliliter) of sickle cell hemoglobin show (i) a "crisis point" where the oxygen binding curve is unusually steep (Hill coefficient of 5 to 6), and (ii) a simultaneous increase in light scattering. Nearly identical oxygen binding curves are obtained upon oxygenation and deoxygenation of these solutions. The influence of aggregation is to shift the curve toward higher pressures.


Research in instrument sharing.

Continued progress in many areas of science depends on access to advanced modern instruments and the data they provide. Costly instruments have been shared in a number of disciplines for many years, and common patterns of shared usage have developed independently. The scientific and financial aspects of large instrument usage are discussed from the points of view of the instrument centers, the users, and the funding agencies. The instrument problem is not one problem but many, and coordinated solutions must be implemented with well-defined goals based on knowledge of the needs of the users and developers of instruments.


Genomic masking of nondefective recombinant murine leukemia virus in Moloney virus stocks.

HIX virus cloned from Moloney leukemia virus stocks is a nondefective, leukemogenic, and amphotropic murine oncornavirus with a recombinant-type major glycoprotein. Although Moloney leukemia virus stocks generally contain little or no free amphotropic virus, dilution analysis of several virus stocks and the examination of virus progeny from individual foci revealed that HIX virus is present and functionally coated with ecotropic Moloney virus envelopes. Because most mice have serum factors that inactivate recombinant viruses, masking may represent a general survival mechanism for HIX as well as other analogous recombinant viruses.


Enkephalin-like material elevated in ventricular cerebrospinal fluid of pain patients after analgetic focal stimulation.

Enkephalin-like activity has been measured in the ventricular cerebrospinal fluid of patients with intractable pain. Electrical stimulation of periventricular brain sites resulted in significant decrease in persistent pain in these subjects. This analgesia, which was blocked by naloxone in 80% of the cases, was accompanied by a significant rise in ventricular enkephalin-like activity, as measured by two different methods. The results present evidence of in vivo release of enkephalin-like material in humans and suggest that stimulation analgesia may be partially due to this release.


Central nervous system dysfunction due to lead exposure.

Central nervous system dysfunction was investigated in workers at a secondary lead smelter by means of performance tests. Correlations between test scores and zinc protoporphyrin levels, a biological indicator of lead toxicity, are statistically significant. This correlation should prove to be useful in current efforts to evaluate effects of lead exposure.


The jet stream microbeveler: an inexpensive way to bevel ultrafine glass micropipettes.

Ultrafine glass micropipettes can be easily beveled in a jet stream of grinding compound suspended in saline. The beveling is gradual and continuous, highly reliable, and can be accomplished with common laboratory apparatus. The beveled electrodes are comparable in performance to those prepared with expensive commercial bevelers.


Biological activity of some oxygenated sterols.

A group of oxygenated sterols has been identified as potent and specific inhibitors of sterol biosynthesis. The ability of these compounds to inhibit sterol synthesis in cultured cells and the ineffectiveness of cholesterol under the same conditions suggest that feedback regulation of sterol biosynthesis may be brought about by an oxygenated sterol rather than by cholesterol. The nature of the regulatory sterol may vary in different cells with their specific requirements for cholesterol as a structural component or as a precursor of other steroid products. The use of oxygenated sterols to block sterol synthesis in cultured cells provides new information regarding the role of sterol in cell membrane structure and function. For example, de novo sterol synthesis is required for DNA synthesis and cell division by some cultured cells. Studies with cultured cells, and with rats and mice in vivo, suggest that oxygenated sterols could be of value in the treatment of several important human diseases.


DNA structure: evidence from electron microscopy.

The contour lengths of phiX174 DNA duplex and RNA-DNA hybrid molecules were measured by several commonly used electron microscopic techniques. The countour length of the hybrid molecules corresponds to a rise of 2.5 to 2.6 angstroms per base pair, as expected for the A conformation, while the length of phiX174 duplex DNA similarly measured corresponds to a 2.9-angstrom rise, very different from 3.4 angstroms of the classic B form. Thus any chromatin structure parameter based on electron microscopy and a rise of 3.4 angstroms must be reappraised. The possibility that DNA in dilute solution also has a rise of 2.9 angstroms and a screw of 10.5 base pairs per turn is discussed.


Electrical stimulation of the amygdala as a conditioned stimulus in a bait-shyness paradigm.

Animals receiving low-intensity electrical stimulation of the basolateral nucleus of the amygdala while drinking plain tap water were injected with toxic doses of lithium chloride to examine whether brain stimulation can serve as a conditioned stimulus in a bait-shyness paradigm. Subjects receiving this pairing greatly reduced their water intake in a retention test, in a similar manner to a group in which saccharin was paired with poisoning. Pairing lithium chloride with stimulation of the amygdala had no effect on subsequent water intake in the absence of brain stimulation. This effect appears to be locus specific, as caudate stimulation could not serve as a conditioned stimulus.


Disulfiram enhances pharmacological activity of barbital and impairs its urinary elimination.

Disulfiram or diethyldithiocarbamate significantly enhanced the sleeping time induced by barbital in rats. At identical time intervals after rats were injected with barbital the concentration of barbital in the blood or brain of animals that had previously received disulfiram was significantly higher than the concentrations in the corresponding tissues of control animals. Urinary excretion of barbital was significantly reduced in disulfiram-treated animals.


Iconic storage: the role of rods.

The hypothesis that rods mediate iconic storage was tested by presenting letters of one color against a field of another. The colors were chosen to be discriminable only by the cones, only by the rods, or both. Under dark adaptation, the rods had little if any effect on partial-report advantage; however, they were important in determining the phenomenal persistence of the stimulus. Under light adaptation, the rods played no apparent role in either type of persistence.


Recurrent disseminated histoplasmosis.

A patient who has had three distinct recurrences of disseminated histoplasmosis over 22 years is presented. Measurements of cellular and humoral immune response to histoplasmin antigens were compared with previously reported data. Although initially sulfisoxazole therapy led to regression of disease, over the past 13 years she has required three courses of amphotericin B, each time with resolution of signs and symptoms. Despite minimal evidence of a cellular or humoral immune response to this organism, the patient has done well. Although disseminated histoplasmosis is often a fatal disease, this woman has tolerated the infection well.


Rocky Mountain spotted fever: gastrointestinal and laboratory manifestations.

Sixty-six cases of serologically documented Rocky Mountain spotted fever (RMSF) from North Carolina are reviewed. Gastrointestinal manifestations were present in 80% of these patients. Because other common expressions of RMSF occasionally do not accompany severe gastrointestinal dysfunction, improper diagnosis and therapy can result. Sixty percent of the patients had hyponatremia and thrombocytopenia. Over 70% of those who had liver or muscle enzyme evaluations had at least one abnormality. RMSF should be strongly considered in the differential diagnosis of patients with a combination of these findings.


St. Louis encephalitis in Memphis-Shelby County, Tennessee, 1975: epidemiologic aspects of human cases.

An epidemic of St. Louis encephalitis (SLE) occurred in Memphis-Shelby County, Tennessee, in the summer of 1975, as part of an outbreak involving large portions of the Eastern United States. A total of 187 suspected cases were reported, of which 62 were laboratory-confirmed or presumptive SLE. The overall attack rate was 8.1/100,000; rates were higher in lower socioeconomic districts. The case fatality rate was 19.4%. Climatologic data and related factors favoring the occurrence of this outbreak are discussed.


Staphylococcal endocarditis in addicts.

We retrospectively reviewed 55 episodes that fulfilled criteria for Staphylococcus aureus endocarditis in 50 drug addicts. The most common presenting symptoms were fever(90%), chest pain(58%), and cough(43%). All patients had evidence of right-sided heart involvement, and a murmur of tricuspid insufficiency was noted in 42%. Evidence of left-sided heart involvement was present in only 5%. The most helpful laboratory aid in facilitating an early clinical diagnosis of endocarditis was the chest x-ray film. Roentgenographic evidence of septic pulmonary emboli was present in 67% of initial chest films and eventually in 87% of all cases. All but five patients completed at least four weeks of intravenous antibiotic therapy. No patients required cardiac surgery and there were no deaths. The apparent predilection of S aureus for the right side of the heart and infrequent left-sided involvement may explain why addicts with endocarditis have a favorable response to antibiotic therapy.


Traumatic coronary artery fistula.

We report certain diagnostic and therapeutic problems presented by patients with traumatic coronary arteriovenous or arteriocameral fistulas, based on our experience with one case and our review of cases which have previously been reported in detail.


Left ventricular aneurysms caused by blunt chest trauma.

This report describes the case of a 25-year-old man who suffered blunt chest trauma with resultant development of an asymptomatic left ventricular aneurysm which was successfully resected. A review of the literature reveals 25 reported cases of left ventricular aneurysm due to blunt trauma since 1892. The clinical findings and complications are similar to those of left ventricular aneurysm from other causes. The prognosis is not clear, but it is not necessarily benign even in asymptomatic cases. Aneurysmectomy has been generally successful and may be the treatment of choice. The surgical risk and prognosis is expected to be better than in left ventricular aneurysm due to myocardial infarction because of the relative infrequency of coexisting coronary artery disease.


Intravenous procaine for general anesthesia in dogs: a new look at an old technic.

New anesthetics have been introduced during the last 25 years which are not without inherent disadvantages. They are expensive, and some produce nephrotoxicity and possibly hepatotoxicity. Although the use of procaine intravenously as an anesthetic has been discarded, probably because of a convulsive effect, it is believed this disadvantage can be controlled by concomitant use of other drugs. Hence procaine, preceded by thiamylal, was administered to dogs to test its anesthetic capability, reversibility, and effects on the cardiovascular and central nervous systems. Blood levels of procaine were measured and correlated with these physiologic responses. Convulsive doses were ten times those producing anesthesia. There were no detrimental effects which would preclude a reevaluation in humans. Intravenous procaine produces definite general anesthesia, and it has the additional advantages of being rapidly hydrolyzed and providing antiarrhythmic effects. It may prove useful in modern anesthesia.


Intercostobrachial nerve entrapment syndrome.

Five patients with intercostobrachial nerve entrapment syndrome are reported. The pain in this syndrome has three aspects: somatic stimulus, perceptual surround, and behavioral response. Each must be dealt with appropriately. The distribution of the pain, its anatomic basis, and its treatment are discussed.


Abdominal pregnancy: pathogenesis, diagnosis, and treatment.

A ten-year survey of abdominal pregnancy was made regarding numbers, diagnosis, and treatment. The hazards of intraperitoneal infusion of concentrated saline, thought to be administered into the amniotic sac, in an attempt to produce abortion is discussed. A favorable result was obtained after laparotomy was done and the correct diagnosis established.


Use of doxycycline in elective first trimester abortion.

Elective first trimester abortion was performed in 263 patients, including 86 control patients and 177 patients receiving doxycycline as prophylactic antibiotic coverage. Abortions were done by the same physicians, using a standard protocol. Control and study populations had similar courses, except that the incidence of major complications and total complications was significantly reduced in the group receiving doxycycline. No untoward reactions to the drug were noted, and patient compliance was excellent. The results suggest that the low morbidity of elective suction abortion is further reduced by prophylactic doxycycline.


Changing normal values for thyroid uptake of radioactive iodine.

The 24-hour radioactive iodine uptake remains a very useful clinical tool for evaluating the thyroid gland; however, the normal values have changed over the years. The traditional values of 15% to 45% are clearly not applicable today and the revised values of 9% to 32% are suspect in some areas where iodine content is rapidly changing in the general diet. The values in a relatively stable population in Ft. Smith, Arkansas, without significant access to a continuous-batch bread with a high iodine content do confirm the national trend of the early 1970's suggesting an overall normal range from 11% to 30%. Values in men were found to be lower with a range from 11% to 23%, whereas in women the values ranged from 13% to 32%. Each nuclear medicine department should be responsible for establishing its own normal range and reevaluating it on a fairly routine basis-certainly whenever known dietary iodine factors change.


Severe sensorineural hearing loss associated with viral hepatitis.

A 41-year-old man who developed a sudden, profound, irreversible, unilateral hearing loss while acutely ill with viral hepatitis is described. Residual damage consisted of a nonfunctional left cochlea, right positional vertigo, and tinnitus. It is postulated that the pathophysiologic defect was due to direct invasion of the endolymphatic structures by type A hepatitis virus.


Leiomyosarcoma of the colon.

Review of 36 cases of colonic leiomyosarcoma in the literature and our case demonstrate that most patients complain of an abdominal mass and a change in bowel habits of short duration. No physical finding has prognostic value. The mitotic activity of the tumor is the best index of survival time. Resection of the tumor mass appears to be the treatment of choice.


Myocardial infarction and normal coronary arteries.

This case report adds evidence against the role of coronary artery spasm as a mechanism in the syndrome of acute myocardial infacrtion in the presence of normal coronary arteries. Myocarditis, the suggested cause of this patient's symptoms, has been frequently overlooked as a cause for this syndrome.


Coronary artery spasm in a patient with unstable angina pectoris.

A 32-year-old male with the clinical syndrome of unstable angina is presented. During cardiac catheterization and coronary cineangiography, the coronary arteries were found to be free of atherosclerosis, but segmental spasm of the right coronary artery was observed. Spasm was reproduced, but to a milder degree, upon the administration of ergonovine maleate intravenously. The patient was discharged on a regimen of oral nylidrin HCL, with symptomatic improvement.


Melanoma in a patient treated for psoriasis.

Psoriasis, ultraviolet light, and coal tar have been associated with the development of cutaneous malignancy. We have described a 32-year-old psoriatic man who developed a melanoma after 16 years of treatment with ultraviolet light and coal tar. This is the only case of melanoma occurring in a patient treated for psoriasis reported in the world literature.


Mycobacterium avium-intracellulare from a Vietnamese refugee.

Mycobacterium avium-intracellulare grew from the sputum of a Vietnamese  woman, a recent immigrant, seen at a tuberculosis clinic in Birmingham, Alabama. The possibility that she had acquired this Mycobacterium in her native Vietname was considered, since current literature, indicates these agents have no predictable geographic patterns of distribution. Data indicate that outside the United States group III mycobacterial isolates are most common in Japan, Western Australia, and parts of Canada. No data are available for Vietnam. US physicians should be alert for possible nontuberculous mycobacteria in the 115,768 Vietnamese immigrants known to have entered the United States in the mid-1970s.


Bone scans in condensing osteitis of the clavicle.

Two additional cases of condensing osteitis of the clavicle are reported. Technetium Tc 99m phosphate bone scans were positive in both cases. Clinical and roentgenographic manifestations may allow nonoperative diagnoses of this entity which mimics metastatic disease on bone scans.


Asymmetric ovarian enlargement in idiopathic precocious puberty.

A patient with precocious puberty is presented in whom the pneumogynogram showed only one enlarged ovary. Because tumor could not be excluded, the patient had exploratory operation six weeks later. Both ovaries and the uterus were enlarged, compatible with the central stimulation seen in idiopathic precocious puberty. Care should be used in interpreting pneumogynograms as evidence of possible ovarian tumor in young girls with precocious puberty who have only modest unilateral ovarian enlargement.


Fatal Aeromonas hydrophila infection of the skin.

A 62-year-old woman developed a fatal Aeromonas hydrophila infection of the skin after dropping a crab trap on her leg. The area surrounding the punctures was erythematous and had several flaccid bullae. A biopsy specimen of the involved skin showed necrosis and suppuration in the dermis and subcutaneous fat. The A hydrophila sepsis resolved after treatment with gentamicin, but the patient developed secondary wound infections and died three months after injury.


Leiomyosarcoma of the rectum.

Leiomyosarcoma of the rectum is a rare malignant tumor with an incidence of 0.1%, occurring more frequently in men than in women and in the fifth, sixth, and seventh decades of life. Microscopically it has a characteristic appearance of interlaced bundles of spindle cells with abundant mitosis and cellular pleomorphism. The clinical picture is related to the presence of the rectal mass, the more frequent symptoms being constipation, rectal pain, rectal pressure, and bleeding. The rectal digital examination will demonstrate the mass which in most cases can be confirmed by rectosigmoidoscopy. The mucosa will be involved in about 30% to 50% of cases. Roentgenography is of little value because of the location of this tumor in the lower part of the rectum. Biopsy will be diagnostic. Treatment is radical excision of the tumor and, in this location, abdominoperineal resection of the rectum is usually required. Local excision is followed by a high incidence of recurrence. Prognosis is poor. Survival rates vary. Recent reports in the literature indicate survivals after AP resection from six months to 6 1/2 years.


Ectopic pregnancy: a 15-year review of 160 cases.

Our review of the incidence of ectopic pregnancy in metropolitan Oklahoma City hospitals from 1960 through 1975 revealed an overall statistically significant increase. Review of the incidence of gonorrhea during the same period for the State of Oklahoma also showed a statistically significant increase. There was a significant correlation between the incidence of ectopic pregnancy and the incidence of gonorrhea. The 160 cases of ectopic pregnancy from University Hospital reviewed in detail included all ectopic pregnancies admitted from 1960 to 1975. Findings revealed 56% were white women with an average age of 26.8 years and average parity of 2.49. Pain (97.5%), amenorrhea (83%), and abnormal uterine bleeding (68%) were the most common presenting complaints, while abdominal tenderness (85%) and pelvic mass (54%) were the common physical findings. Culdocentesis was positive in 78% of the patients. Thirty-nine percent had a history of pelvic inflammatory disease and 8% a previous ectopic pregnancy. Admission diagnosis was correct in 67%. Unilateral adnexal procedure was the treatment in 81%. Fifty-seven percent of the ectopic pregnancies were right-sided, and hemoperitoneum averaged 950 ml. Postoperative complication rate was 55%. Follow-up pregnancy rate was 50%, and future ectopic pregnancies occurred in 6% of these.


The adolescent's first pregnancy: a controlled study.

The records of 1,021 primigravida women who delivered single infants from 1973 to 1976 and who were in the adolescent (ages 10-15) and mature (ages 20-24) age groups were reviewed. It was found that the adolescent patient is more often black and unmarried, and has less prenatal care than the mature woman. There was a higher frequency of hypertensive disorders in the adolescents but this was related to race. The adolescent had fewer breech deliveries and more postpartum endometritis and premature deliveries. There was no significant difference in the fetal, neonatal, and perinatal mortality in the adolescent pregnancies.


Pulmonary gangrene with vascular occlusion.

Characteristic sequential roentgenographic changes have been revealed in three cases of pulmonary gangrene. The microscopic findings of endarteritis obliterans were present in all cases. The present series brings the total of such cases in the literature to 14. Etiologic factors are discussed.


The seductive patient.

Women referred to as hysterical personalities comprise the largest group of seductive patients. We will discuss (1) how to recognize them, (2) how they behave with physicians, (3) the reactions evoked by them, (4) what brings them to physicians, (5) what they are really seeking, and (6) how to cope with them. To supplement information obtained from patients seen in psychiatric practice, information was gathered from 15 practitioners representing surgical as well as medical specialties.


Changes in liver enzyme values after halothane and enflurane for surgical anesthesia.

For over a decade there has been concern about hepatitis related to halothane anesthesia. No dose relationship or other direct cause has ever been established, and jaundice has been found to occur after other anesthetics for surgical operations. Enflurane is a newer halogenated compound with a remarkable record of safety, yet a few cases of hepatitis are reported to be associated with its administration. We have compared effects on the liver of the two anesthetics by testing hepatic serum enzymes and sulfobromophthalein in 12 patients who received halothane and 12 who received enflurane. No significant differences between the two groups were found. Both had similar but minimal elevations of the hepatic serum enzymes and retention of sulfobromophthalein. More than half the patients had enzyme increases over normal levels but reasons for this were not obvious. Since hepatic change may take place in many postoperative patients, it is not surprising to have an occasional one develop hepatitis. The exact cause is unknown and therefore it is impossible to predict the patient who will develop the disease, regardless of the anesthetic.


Complications from unrecognized defects in endotracheal tubes.

Considerable effort has been made to improve endotracheal tubes and make them safer than they have been in the past; yet complications continue to occur, due, in most instances, to inherent defects in the tube. It is not possible to identify these defects in a routine preoperative examination. Three cases are presented illustrating how defects in anode endotracheal tubes almost caused fatalities during anesthesia. Other possible complications and contributing factors causing obstruction of endotracheal tubes are also reviewed. Until some way is devised for the automatic compensation of the increases in volumes and pressures in endotracheal tube cuffs, hourly deflation is recommended to prevent complications.


Total hearing rehabilitation: within-clinic hearing aid dispensing.

Federal (FDA) regulations recently passed require physician clearance before hearing aid sales. Discussed herein are numerous evaluative and rehabilitative procedures necessary for proper hearing aid fittings. A program of total professional management of the hearing rehabilitation process, including the direct dispensing of hearing aids by the otology-audiology team, is described and advocated.


Intraturbinal steroid injection: indications, results, and complications.

Intraturbinal injection of steroid can yield rapid relief of nasal obstruction caused by severe allergic or vasomotor rhinitis, rhinitis medicamentosa, or acutely enlarged nasal polyps. This modality is not meant to replace the traditional means of therapy for these diseases. Despite previous reports of visual loss after intraturbinal steroid, thousands of such injections have been given with no such disastrous complications. The technic should include preliminary topical cocainization of the nasal mucosa, slow injection using a small gauge needle, and steps to allay apprehension and prevent a "needle reaction." In a retrospective study comparing intraturbinal triamcinolone with intramuscular betamethasone, the intraturbinal steroid was judged much more effective. Side effects reported after intranasal steroid were minor in nature. No visual complications have occurred in this series.


Carbon dioxide laser treatment of dermatologic lesions.

Each of the four general classes of laser (gas, solid, liquid, and semiconductor) emits a particular wavelength of light. This beam of light can be focused to a minutely accurate diameter and the depth of penetration can be controlled by the power input. Thus, there is minimal damage to surrounding tissue. A carbon dioxide laser was used to treat congenital hemangioma, verruca vulgaris, and condyloma acuminatum, and to remove tattoos. Of the four types of lesions treated, verruca vulgaris, condyloma acuminatum, and tattoos responded best.


Squamous cell and basal cell carcinomas: preliminary study of 3,817 primary skin cancers.

A series of patients with 3,817 cutaneous carcinomas of different types observed in a private practice setting is reported. Preliminary computerized analyses indicate that 88% of these squamous cell and basal cell carcinomas were less than 25 mm. Scalpel surgery, curettage and desiccation, or radiation therapy was used for most tumors and an overall cure rate of greater than 98% was obtained. A pretreatment biopsy allowed for selection of the most appropriate management and authoritative instructions for long-term follow-up visits and prophylaxis.


Adenocarcinoma of the bladder as seen at Ochsner Medical Institutions.

Adenocarcinoma of the bladder is an uncommon malignancy comprising less than 2% of all bladder tumors. Eleven cases of adenocarcinoma of the bladder were seen from 1947 to 1977 at the Ochsner Medical Institutions. Six of the tumors were urachal in origin, and five involved the base and lateral walls of the bladder. Six patients were treated with total cystectomy, four with segmental cystectomy, and one with radiation therapy only. The average survival time for the patients with urachal adenocarcinoma was 2.8 years and for those with vesical adenocarcinoma, 2.4 years. Although segmental cystectomy is recommended by some, the authors recommend radical cystectomy for all patients with adenocarcinoma of the bladder.


Colposcopic evaluation of DES-exposed progeny at two large medical centers: the squamous neoplasia problem.

Two hundred eight patients with confirmed or suspected diethylstilbestrol exposure were examined colposcopically at two separate medical centers. Cervicovaginal ridges were present in 90 (43.3%) and ectopy was found in 188 (90.4%) of the patients. Evidence of vaginal adenosis was present in 122 (58.6%) of the cases. Seventy-four percent of the patients had abnormal colposcopic findings: 15.4% having columnar epithelium on the surface of the vagina and 66% having abnormal transformation zones (white epithelium, punctation, mosaic). Twenty patients (9.6%) were initially identified histologically as having squamous dysplasia. Subsequent review of the histologic material in these cases could document only two cases of significant squamous dysplasia, both severe, the remainder having immature, atypical metaplasia or possibly very mild dysplasia. This finding emphasizes the problems encountered in histologically differentiating squamous neoplasia from the peculiar metaplasia found in these patients, thereby making it difficult to establish whether these patients are at increased risk for the development of squamous neoplasia.


Bacterial endocarditis in narcotic addicts: analysis of arterial blood gases.

We studied the arterial blood gas determinations done on the first hospital day in 14 narcotic addicts with bacterial endocarditis (group 1) and six addicts with other medical complications of narcotic addiction (group 2). The arterial oxygen tension (PaO2) was 67.3 +/- 3.3 mm Hg (SEM) in group 1, and 75.0 +/- 6.4 mm Hg in group 2, with no statistically significant difference (P less than .20) between the groups. The arterial CO2 tension (PaCO2), 27.8 +/- 1.7 mm Hg, in group 1 was significantly lower (P less than .005) than that of group 2, 40.1 +/- 3.7 mm Hg. The arterial blood pH, 7.47 +/- 0.01 units, in group 1 was significantly higher (P less than .025) than that of group 2, 7.36 +/- 0.06 pH units. Abnormal blood gas values were found in each of the patients in group 1 with a normal admission chest roentgenogram. Arterial blood gas determinations may be useful in the initial examination of ill narcotic addicts.


Primary sclerosing cholangitis.

Two new cases of primary sclerosing cholangitis with a rapid fatal course, particularly the patient in Case 2, are presented. Primary sclerosing cholangitis is a rare condition of unknown cause presenting with extrahepatic biliary obstruction due to a chronic inflammatory obliterative process with the absence of stones, cancer, or previous biliary surgery. This condition is often associated with ulcerative colitis, retroperitoneal fibrosis, and Riedel's thyroiditis. Surgical treatment for promoting bile drainage and long-term corticosteroid therapy are effective palliative measures.


Concurrent primary pneumococcemia, disseminated intravascular coagulation, and sickle cell anemia.

Fulminant pneumococcal infections are rare in teen-agers with sickle cell anemia. A 16-year-old black male with sickle cell anemia was treated as an outpatient for cryptogenic pain crisis, which delayed antibiotic therapy for primary pneumococcal septicemia for seven hours. This patient did not appear ill upon initial presentation but rapidly developed disseminated intravascular coagulation and died.


Myxedema coma and normal serum thyroxine.

A 76-year-old man who developed the clinical syndrome of myxedema coma was found to have a normal serum thyroxine concentration. Further investigation revealed the presence of a low serum T3 level before and after sodium levothyroxine therapy when the serum T4 value was in the hyperthyroid range. In addition, he demonstrated an inability to release TSH after intravenous administration of TRH and was found to have an enlarged sella turcica. A partial defect in peripheral conversion of T4 to T3 is postulated.


Echocardiographic diagnosis of double inlet "left" ventricle: indocyanine green contrast studies as an aid to diagnosis.

A 22-year-old woman with double inlet left ventricle had had two systemic-pulmonary shunting procedures for incorrect or incomplete diagnoses. Echocardiography with indocyanine green contrast studies demonstrated a double inlet "left" ventricle. It also localized the bulboventricular septum and infundibular chamber anterior to the two atrioventricular valves, and demonstrated early communication of contrast from the right atrium to the ventricle and infundibular chamber.


Mycobacterium intracellulare presenting as a sarcoid-like illness.

A combined infection with Mycobacterium intracellulare and histoplasmosis in a patient with end-stage sarcoidosis is reviewed. A healthy skepticism should be applied to all but the most classic cases of sarcoidosis. Prolonged follow-up with repeated attempts to demonstrate a specific causative agent will decrease the possibility of overlooking treatable infections. An initial work-up of a patient with sarcoidosis includes fungal immunologic tests, which if positive can lead to further investigation and the correct diagnosis. Steroids should be reserved for clear indications in sarcoidosis. Any exacerbation of an underlying bronchopulmonary disease should compel a search for an infectious cause. This patient responded to amphotericin and three antituberculous drugs but nevertheless had significant sequelae of her illness.