Temporal course of perceived vowel duration.

The current study explored the temporal course of the perception of vowel duration. A backward recognition masking paradigm was employed in which the subject was to determine which of two target vowels, differing only in duration, was presented on a given trial. The target was followed, after a variable silent intervowel interval, by a masking vowel having one of three possible durations. Subjects were instructed either to identify the long vowel as /i/ and the short vowel as /I/, or were told that the targets were nonsense sounds they were to identify as long or short. For both instruction conditions, identification of the long target improved consistently with increases in the intervowel interval, whereas identification of the short target was equally accurate at the long and the short intervals. Identification of the long target vowel was most accurate when followed by a long masking vowel, whereas identification of the short target vowel was most accurate when followed by a short masking vowel. An information-processing model provided a good description of the quantitative results.


A comparison of the effects of filtering and sensorineural hearing loss on patients of consonant confusions.

It has been found that listeners with sensorineural hearing loss who show similar patterns of consonant confusions also tend to have similar audiometric profiles. The present study determined whether normal listeners, presented with filtered speech, would produce consonant confusions similar to those previously reported for the hearing-impaired listener. Consonant confusion matrices were obtained from eight normal-hearing subjects for four sets of CV and VC nonsense syllables presented under six high-pass and six-low pass filtering conditions. Patterns of consonant confusion for each condition were described using phonological features in sequential information analysis. Severe low-pass filtering produced consonant confusions comparable to those of listeners with high-frequency hearing loss. Severe high-pass filtering gave a result comparable to that of patients with flat or rising audiograms. And, mild filtering resulted in confusion patterns comparable to those of listeners with essentially normal hearing. An explanation in terms of the spectrum, the level of speech, and the configuration of this individual listener's audiogram is given.


Productive voice onset time characteristics of esophageal speech.

The voice onset times (VOT) of a large number of stop-consonant initiated syllables produced by esophageal and normal speakers were measured. Esophageal speakers systematically varied VOT during the production of speech-sound categories with the same manner of production. Average voice onset times associated with the production of prevocalic voiceless stops of esophageal speakers were significantly shorter than those of normal speakers, while takler-group comparisons associated with the production of voiced prevocalic stops were nonsignificant. Voice onset times of both esophageal and normal speakers were differentially sensitive to place of articulation. Findings are discussed in terms of furthering current understanding of how effectively esophageal speakers achieve important phonological contrasts.


Perceptual assessment of normalcy of speech following stuttering therapy.

Stuttering therapy procedures such as rhythmic or prolonged speech have been criticized because afterward the subject may speak fluently but also abnormally. Although assessments of the normalcy of speech behavior have been rare, some recent procedures have included perceptual assessments of certain dimensions of speech behavior. This study reports an evaluation procedure where listeners endeavored to distinguish between intermingled speech samples obtained from treated stutterers and a peer group of normally fluent speakers. Different groups of listeners were asked to judge the prosody, rate, fluency, and naturalness of posttreatment samples from a group of stutterers treated with a prolonged speech procedure, and a matched peer group of noramlly fluent speakers. No significant differences were found between the assessments of stutters and normally fluent speakers. However, when another group of listeners was asked to decide whether the speech samples were from treated stutters or normal speakers, the stutters received significantly fewer normal speaker judgements. Interrelationships between the judgment scales were evaluated along with a forced-choice procedure for assessing the normalcy of individual speech samples.


Effects of stimulus duration and stimulus off time on the auditory and acoustic reflex thresholds.

The effects of stimulus duration and stimulus off time on the thresholds of hearing and the acoustic reflex were investigated in 10 normal-hearing subjects and 10 subjects with sensorineural hearing loss. A 1000-Hz stimulus with on-off times of 500-500 msec and 30-30 msec was used to obtain hearing sensitivity and acoustic reflex thresholds via a tracking method. Auditory threshold was poorer for the 30-30 msec tone than the 500-500 msec stimulus in both groups. Using the different stimuli, no significant difference in acoustic reflex threshold was observed in either group. These results suggest that the addition of a short off time modifies the previously observed effects of both duration and off time on the acoustic reflex and auditory threshold.


Communicative performance of mentally retarded adults in four conversational settings.

A sociolinguistic analysis of the communicative performances and social interactions of four mentally retarded adults was conducted. Role relationships were examined along dimensions of dominance-submission and control in various conversational settings. Audiotape recordings were made of each adult's conversation while engaged in discourse with his speech-language pathologist, peers, parents, and with a normal young child. Relational communication coding schemes involving the analysis of questions and subsequent responses were applied to the data. Results indicated that the retarded adults, though not always able to hold a dominant position in a conversation, were capable of expressing the same types of control as normal adults. The types of control expressed by each subject varied as a function of the conversational setting. Furthermore, differences existed in the types and frequencies of control expressed across subjects. These findings suggest that a sociolinguistic approach provides important information regarding the mentally retarded adult's communicative performance.


Comprehension of pronominal reference by speakers of black English.

This study was concerned with the comprehension of pronoun reference by children from north Texas who used features of black English in their oral language. Forty-eight children were included in the study, eight selected from each chromological age group from four through nine years. Tasks required that the children listen to 15 sentences, five of which included a pronound with unrestricted reference and 10 of which included a pronoun operating under the nonidentity requirement with restricted reference to a subject outside of the sentence. In response to specific questions, subjects were required to point to toy figures that represented the pronoun referents in the sentences. Results showed a significant and uniform increase in comprehension as a function of chronological age, with no subject attaining less than 90% comprehension among the seven-, eight-, and nine-year-old children.


Response of intramuscular Walker 256 rat tumor to sustained-release cyclophosphamide and ARA-C capsules.

Randomly bred Sprague-Dawley rats with the intramuscular form of Walker 256 tumor growing in the right thigh region were treated with sustained-release cyclophosphamide capsules as well as with cytosine arabinoside capsules. A disk-shaped caps-le was implanted subcutaneously adjacent to the tumor mass. Tumor regression, weight gain, and prolongation of lifespan were observed in animals treated with cyclophosphamide capsules of 10 mg or 20 mg total drug content each. However, the walker 256 intramuscular tumor did not respond to ARA-C capsules implanted, and the animals died at the same rate as the controls, with large ulcerated tumor masses and some metastasis. The in vitro diffusion data of ARA-C capsules is shown. Gross and histological changes associated with cyclophosphamide administered in this manner are reported.


Relative frequency and survival results of cancer seen at a county hospital.

The relative frequency of cancer cases (percentage of total malignancies) admitted to Los Angeles County-University of Southern California (LAC-USC) Medical Center from 1942 to 1974 was studied (basal cell and epidermoid carcinoma of the skin were excluded). Among cancers of the digestive system, the relative frequency of cancer of the stomach has definitely declined from a high of 9.5% before 1946 to a low of 2% in 1972. Carcinoma of the colorectum has shown a downward trend in the last decade. Among cancers of the respiratory system, cancer of the lung continues its steady increase from a relative frequency of 7% before 1946 to a high of 20% in 1974. The percentages of malignant lesions of the female organs (breast, uterine body, ovaries) have stayed relatively constant. Cancers of the central nervous system and malignancy of unknown primary site showed an increasing trend over the last 15 years. The 8 most common cancers according to their relative frequency at Los Angeles County Hospital in 1974 are: colon (10%), rectum (5%), breast (15%), lung (13%), prostate (7%), cervix uteri (6%), stomach (3%), and pancreas (3%). In general, survival results of patients in the California Tumor Registry are comparable with those reported in the national study, and survival rates of patients seen at the Los Angeles County Hospital are lower. But 5 year survival rates have improved by more than 3 percentage points for patients with all stages of cancer of the colon, breast, prostate, and cervix uteri diagnosed at the Los Angeles County Hospital in recent years.


Long-term survival with thorotrast cervical granuloma.

Thorium dioxide, a radioactive contrast material, was commonly used for cerebral angiography prior to recognition of its radiation hazard. Extravasation of the material into the extravascular tissue in the neck results in granuloma formation, thorotrastoma, long-term morbidity, and an increased incidence of benign and malignant tumors. We report our experience with the management of 2 patients who underwent cerebral angiography with thorotrast more than 25 years ago. Aggressive surgical excision of involved tissue is warranted to ameliorate symptoms and diminish the risk of malignancy.


Antitumor tests of amygdalin in transplantable animal tumor systems.

Except for oral administration, there was no grossly observed toxicity from carefully administered high doses of amygdalin in the experimental systems used. The compound in high doses was ineffective against the DMBA-induced rat mammary carcinoma and the following transplanted experimental tumors: Sarcoma 180, plasma cell tumor LPC-1, leukemia L1210, Mecca lymphosarcoma, Ridgway osteogenic sarcoma, sarcoma T241, mammary carcinoma E0771, Taper liver tumor, Ehrlich carcinoma (solid and ascites), and Walker carcinosarcoma 256. Amygdalin did not noticeably influence the toxicity or impair the efficacy of these chemotherapeutic agents in their respective systems: Cytosine arabinoside, methotrexate, cytoxan, or 5-fluorouracil in L1210; the latter two in LPC-1; 6-mercaptopurine in Ridgway osteogenic sarcoma; estradiol-17beta or 2alpha-methyldihydrotestosterone propionate in the DMBA-induced rat mammary carcinoma.


Reoperation in symptomatic patients after direct coronary artery revascularization.

Seventy-nine patients underwent 85 reoperations to revascularize the myocardium at intervals from 2 days to 5 years (mean 13 months) after primary direct revascularization procedures. A total of 122 bypass grafts including 43 individual veins, 43 double or triple sequential veins, and 17 internal mammary arteries (IMA) were utilized. Failure of previous bypass grafting was the most common reason for recurrent symptoms, partially due to the high failure rate of radial artery segments used as bypass conduits. One operative and three late deaths have occurred. Coronary arteriography, performed after reoperation (mean 14 months) in 15 patients, revealed a graft patency rate of 68 percent. Significant differences in postoperative complications between the first and subsequent operation could not be demonstrated. Combined nonfatal perioperative infarctions with the first and subsequent operations decreased ventricular function and probably contributed to the improved symptomatic state of some patients. It is concluded that good symptomatic relief and long-term survival can be achieved by reoperation in selected patients who have recurrent symptoms after primary direct myocardial revascularization.


The Marfan syndrome and cardiac surgery.

Of 31 patients with Marfan's syndrome and cardiovascular complications, 25 had ascending aortic aneurysms, five with aortic dissection; 26 had aortic regurgitation, two with aortic stenosis; and eight had mitral regurgitation, five with aortic regurgitation. Surgery included prosthetic aortic valve replacement in 24 patients and aortic valvular bicuspidization in two; 19 had resection of aneurysm with Dacron tube replacement, three had lateral aneurysmorrhaphy, and two had circumferential strip excision with end-to-end anastomosis. Four patients underwent mitral valve replacement. Operative complications occurred in 10 patients. There were nine (29 percent) hospital deaths, but only one death occurred in 12 patients operated upon since 1970. Late complications included prosthetic leak in six patients (23 percent) with reoperation in five; all survived. Five late deaths occurred (16 percent); one was unrelated and one was of unknown cause. Although risk of cardiac surgery remains high, our recent results support an aggressive surgical approach, particularly in patients with advanced or deteriorating cardiovascular complications.


Late sequelae of penetrating cardiac wounds.

Physiological and psychological parameters of 20 survivors of penetrating  wounds of the heart were examined 7 to 52 months after recovery. All survivors had cardiac complaints. The psychological parameters for hypochondriasis, compulsiveness, and internalization were much greater in the patients than in control subjects but were similar to those in victims of violent major abdominal trauma. Physiological abnormalities were present in 19, although no particular pattern or abnormality could be related with certainty to the type of wound, operative procedure, or postoperative course. One recovered and re-employed victim required late surgical repair of a traumatic ventricular septal defect and ventricular diverticulum. Although functional work capacity measured by stress testing was normal in 90 percent, only eight survivors resumed employment. Complete rehabilitation was impaired by a residual traumatic neurosis. Management goals for patients with penetrating cardiac wounds should be broadened to include prevention of psychological disabilities.


Role of pulmonary vascular resistance measurements in preoperative evaluation of candidates for pulmonary resection.

Pulmonary function tests (PFT), arterial blood gases (ABG), lung scanning, and pulmonary artery balloon occlusion with measurement of pulmonary vascular resistance (PVR) have all been used for preoperative evaluation of pulmonary function. These tests, however, do not always accurately predict tolerance to lung resection. We have evaluated a new technique which promises to increase the accuracy of preoperative evaluation of pulmonary function. Utilizing a balloon flotation catheter, we measured PVR at varying cardiac outputs. Forty-five patients underwent this study without morbidity or mortality. Five of 30 patients who subsequently underwent pulmonary surgery died of respiratory failure. All of these deaths were from the high-risk group as determined by PVR. Only one of the five had been judged to be at high risk by PFT and ABG. This technique has the advantages of low morbidity and simplicity and should be especially helpful in the evaluation of those patients who have borderline pulmonary function as determined by the more standard tests.


The significance of multidose cardioplegia and hypothermia in myocardial preservation during ischemic arrest.

A standard experimental protocol was developed to explore the optimal technique for myocardial preservation during 120 minutes of ischemic arrest followed by 30 minutes of reperfusion. Eight different experimental groups were evaluated with the use of an in vivo pig heart preparation. The parameters measured included myocardial contractility and compliance, myocardial blood flow, and endocardial/epicardial blood flow ratio. Myocardial preservation was inadequate after hypothermic arrest alone, cardioplegic arrest alone (at normothermia), and single-dose cardioplegia plus hypothermia. Adequate myocardial preservation was found only after hypothermia and multidose cardioplegia with either potassium (35 mEq. per liter) or magnesium-procaine solutions. Continuous cardioplegia and hypothermia, while providing a moderate degree of myocardial preservation, was not as satisfactory as multidose cardioplegia and hypothermia. No difference in myocardial preservation was apparent when potassium-induced cardioplegia was compared with magnesium-procaine-induced cardioplegia.


Comparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass. I. Pulsatile system employed and its hematologic effects.

A new, commercially available roller pump system able to deliver pulsatile and nonpulsatile flow has been studied in patients undergoing elective open-heart surgical procedures. The pulsatile pump (Stöckert Instrumente) may be used with standard extracorporeal circuit equipment and consistently produces a peripheral arterial pulse pressure of 25 to 30 mm. Hg at mean flow rates of 3.5 to 4.0 L. per minute. Twenty patients, arbitrarily allocated to pulsatile or nonpulsatile groups, have been studied. There were no significant differences between the groups in respect of age, weight, bypass time, pump flow, or mean arterial pressure during bypass. Comparative studies of the hematologic effects of pulsatile and nonpulsatile perfusion were carried out. There was no evidence of increased hemolysis with pulsatile flow, nor was there increased depletion of red blood cells (RBC's) or platelets in the pulsatile group. This pulsatile pump system may therefore be used to produce pulsatile perfusion during cardiopulmonary bypass without the fear of producing excessive blood cell trauma.


Comparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass. II. The effects on adrenal secretion of cortisol.

Previous studies have indicated that a significant reduction in plasma cortisol levels occurs during nonpulsatile cardiopulmonary bypass as a result of adrenocorticol hypofunction. The Stöckert pulsatile pump system described in Part I has been employed in a comparative study of plasma cortisol levels in 20 patients subjected to pulsatile or nonpulsatile perfusion during open-heart surgery. The plasma cortisol response pattern in the nonpulsatile group was identical to the pattern previously described, with no significant rise in cortisol levels during the period of perfusion. In the pulsatile group, however, plasma cortisol levels rose significantly during perfusion, reaching a mean level at the end of perfusion which was highly significantly greater than that in the nonpulsatile group (p less than 0.001). Correction of the plasma cortisol values for the effect of hemodilution was performed and, again, corrected cortisol values indicated a highly significant increase in end-bypass levels in the pulsatile groups (p less than 0.001). These results clearly indicate that the reduction in cortisol secretion during nonpulsatile bypass may be prevented by the use of pulsatile perfusion.


Transbronchial mucus transfer of bronchogenic carcinoma.

The metastatic transfer of cells from a primary bronchogenic carcinoma to other portions of the lung as a result of mucus embolization and inoculation has been demonstrated. Histologic observations indicate tumor implantation and survival in peripheral bronchioles. In these regions mucosal dysplasia and carcinoma-in-situ changes which characteristically accompany a primary lesion are notably absent. Morphologic changes associated with acute bronchitis and focally denuded bronchial mucosa may be implicated.


Hemodynamic assessment of Lillehei-Kaster tilting disc aortic and mitral prostheses.

Twenty-six patients with Lillehei-Kaster prosthetic heart valves, 15 with aortic and 11 with mitral valves, were catheterized to assess their hemodynamic performance. The calculated effective orifice areas were linearly related to but always less than their actual orifice areas. There was no significant difference in the effective orifice area of the mitral or aortic prostheses of similar size. The aortic prosthesis with an annulus diameter of 21 mm. was found to have a mean effective orifice area of 0.77 sq. cm. Our catheter studies have demonstrated no hemodynamic advantages of the Lillehei-Kaster aortic and mitral prosthetic valves over prosthetic valves.


Evaluation of the in vivo function of the Hancock porcine xenograft in the aortic position.

We evaluated the vivo hemodynamic function of the stent-mounted glutaraldehyde-fixed porcine xenograft in 23 patients who had undergone aortic valve replacement from 2 days to 24 months prior to the study. Functional aortic valve orifice areas for the porcine xenograft ranged from 0.58 to 3.0 sq. cm., the average area being 1.36 sq. cm. Six patients had calculated prosthetic valve orifice areas less than 1.0 sq. cm. Valve orifice area did not correlate significantly with valve size or the time interval from surgery to postoperative study. Left ventricular stroke volume showed a significant, positive correlation with calculated xenograft orifice area. Systemic thromboembolism was not encountered. One patient required reoperation for xenograft stenosis caused by dense fibrin deposition on the aortic leaflets. We conclude that use of the stent-mounted glutaraldehyde-fixed porcine xenograft can be associated with significant functional stenosis which may be related to annulus size or inertial properties of the valve. These factors should be taken into consideration when considering use of the stent-mounted glutaraldehyde-fixed porcine xenograft in individual patients.


Autotransfusion of shed mediastinal blood after cardiac surgery: a prospective study.

In a randomized prospective study of patients having cardiac surgery, autologous blood collected from mediastinal tubes was autotransfused preferentially in 63 patients (ATS), whereas 51 patients received bank blood for transfusion (control). Comparison of the two groups showed no significant difference in regard to age, sex, operations performed, or total postoperative bleeding (ATS 813 +/- 121 ml. per square meter versus control 711 +/- 93 ml. per square meter; N.S.) Although mean postoperative blood replacement was similar in the two groups (ATS 4.3 +/- 0.6 units per patient versus control 4.8 +/- 0.6 units per patient), requirements for transfusion of stored bank blood were reduced by 50 percent in the ATS group (ATS 2.4 +/- 0.3 units per patient versus control 4.8 +/- 0.6 units per patient; p less than 0.005). Coagulation studies demonstrated that this blood was defibrinogenated; yet it contains significantly more platelets and clotting factors than does bank blood. In this study, autotransfusion of shed mediastinal blood was safe and simple. It significantly reduced bank blood requirements and resulted in substantial financial savings for the patients and the hospital.


Chylothorax and chylopericardial tamponade following Blalock-Taussig anastomosis.

A case of chylothorax following a right-sided Blalock-Taussig shunt is presented. Chylopericardial tamponade eventually developed, because the mediastinal leakage of chyle was sealed off from the pleural cavity and diverted into the pericardium. Chylopericardium is a rare cause of an enlarged cardiac silhouette on a postoperative chest roentgenogram, but the importance of differentiating it from congestive heart failure is illustrated. When chylopericardial tamponade occurs, treatment consists of (1) aspiration for immediate relief and, if there is recurrence, (2) surgical evacuation of the pericardium with tube drainage or pericardiectomy and (3) ligation of the source of chylous drainage.


An alternative approach to the apex of the left ventricle.

Because of the risk of performing a left ventriculotomy in a patient with a left ventricular mass as well as decreased myocardial function, secondary to a myocardiopathy, my colleagues and I sought an alternate method for removal of the mass. Our decision to follow the procedure to be described in this report provided ideal access to the tumor, and the excellent results obtained in this and a subsequent case established the validity of this alternative to a left ventriculotomy. Although we realize not all masses of this nature need be removed, we present this technique as a useful addition to our armamentarium.


Clinical spectrum of septic pulmonary embolism and infarction.

Management of septic pulmonary embolism now suggests a predictability of the clinical course which often allows an early decision regarding the need for definitive thoracotomy. Sixty patients have been treated within the past 5 years. Antibiotics were employed in all patients, administered whenever possible according to cultures. In 12 patients thoracotomy was required. This involved decortication and varying amounts of pulmonary resection from wedge excision to pneumonectomy. Early appreciation of septic pulmonary embolism and prompt thoracotomy can frequently obviate the need for tardy open drainage procedures with consequent prolonged recovery. Sources of emboli must be controlled. Interruption of the inferior vena cava, vein excision, aggressive control of peripheral abscesses, and excision of the tricuspid valve may be required. Reliance on antiocagulants alone to control emboli is dangerous, and proper surgical intervention and antibiotic therapy reduce the need for long-term anticoagulation.


Surgery for coccidioidomycosis in 52 diabetic patients with special reference to related immunologic factors.

Fifty-two diabetic patients who underwent pulmonary surgery for coccidioiodmycosis were evaluated by a retrospective study which included classification by stage of disease, status of insulin dependency, and reaction to coccidioidin skin test. The insulin-dependent diabetic patient had a fourfold increase in the incidence of more severe (progressive) disease. Perioperative therapy with amphotericin B may be of value in the adult surgical candidate with progressive disease but is not necessary or desirable in the juvenile diabetic patient. Coccidioidomycosis is a disease of relative immunocompromise, and a negative skin test should herald such compromise and support a decision for surgery. Such surgery in the progressive stages should be totally extirpative. The presence of inadequately resected disease may adversely affect subsequent immunologic resistance of the host.


Ventricular septal defect associated with left ventricular outlfow tract obstruction below the defect.

Muscular subaortic stenosis associated with ventricular septal defect (VSD) is a rare but important anomaly. Two types of left ventricular outflow tract (LVOT) obstruction should be distinguished on the basis of morphologic as well as hemodynamic differences, depending on whether the stenosis is localized above (Type I) or below (Type II) the defect. The five cases presented are all in the latter category. In the first two cases the correct diagnosis was not made until after repair of the VSD. Two patients had previously undergone banding of the pulmonary artery (PAB). Marked carotid shudder and a vertical QRS axis in the frontal plane were presented in all cases. For the diagnosis to be established by catheterization, the catheter tip must be maneuvered into the apical part of the left ventricular cavity in order to detect the  stenosis on the withdrawal curve. It is difficult to visualize the stenosis by angiography. The surgical approach through the VSD via a right atriotomy is highly recommended for Type II subaortic stenosis.


Ligation of the patent ductus. Technical considerations at different ages.

Over a 10 year period, 185 patients have been treated for patent ductus, including nine premature infants with a respiratory distress syndrome. Thirty-five other infants have had duct obliteration during the neonatal period, the incidation for surgery being intractable heart failure. Six of 18 adults had calcification or aneurysm in the duct region. three of these required extracorporeal circulation for duct control and closure. The remaining patients were from 1 to 18 years of age and underwent elective duct obliteration. Double ligation of the duct is regarded as the simplest, safest, and quickest technique generally applicable. Special techniques are required for fragile, broad, calcified, hypertensive, and conical ducts.


Early and late results of aortoplasty with a left subclavian flap for coarctation of the aorta in infancy.

Between February, 1969, and December, 1976, 45 consecutive infants younger than 6 months old underwent aortoplasty with a subclavian flap for the relief of coarctation of the aorta. All infants had persistence of the ductus arteriosus, and 58 percent had associated intracardiac anomalies. The over-all hospital mortality rate was 24 percent, nad no deaths occurred in infants with coarctation associated with patent ductus arteriosus only. All the deaths were in the group of patients under 2 months of age who had associated intracardiac defects. Follow-up over a 7 year period shows no clinical, hemodynamic, or angiographic evidence of recoarctation in any of the survivors.


Mitral valve replacement with a porcine heterograft in an infant.

Mitral valve replacement for congenital mitral stenosis has been performed infrequently in infants. In all but two previously reported infants, the valve has been replaced with a mechanical prosthesis. The case history of an infant is reported in whom emergency mitral valve replacement was successfully performed with a porcine heterograft excised from a tubular prosthesis. This approach is an acceptable alternative when a valve of appropriate size is unavailable.


Long-term survival after single aortic or mitral valve replacement with the present model of Smeloff-Cutter valves.

Two hundred fourteen survivors of single aortic (AVR) or mitral valve replacement (MVR) were evaluated. The present model of the Smeloff-Cutter prosthesis was used in these patients, and the series was started in September, 1966, following the last structural change in the valve. Clinical follow-up ended in September, 1976. Bleeding, thromboembolism, and peristent left ventricular dysfunction were the major complications. Thromboembolism occurred at a rate of 0.13 percent per month of patient follow-up. Late deaths occurred in 19.2 percent of patients, half of these within the first year. Acturarial data indicated a 5 year survival rate of approximately 75 percent after both mitral and aortic replacements. Bleeding and thromboembolism were more frequent causes of death after mitral replacement. Myocardial function was of greatest importance in long-term survival after replacement of either valve. Variations in warfarin dosage significantly affected both bleeding and thromboembolic complications.


Myocardial reactive hyperemia caused by initial myocardial anoxia during aortic valve replacement.

Reactive hyperemic response of individual coronary arteries and of the whole heart to anoxia during coronary cannulation was investigated in 10 patients undergoing aortic valve replacement. Reactive hyperemic response in man is identical to that reported in experimental investigations. The duration of hyperemic response was dependent on the length of the preceding period of anoxia; the longer the period of anoxia, the more prolonged was the hyperemic response. No significant collateral circulation between the coronary arteries could be demonstrated during prolonged anoxia of an individual coronary artery. Blood flow debt was almost always overpaid, but the repayment percentage decreased with the lengthening of the anoxic period, being 460 percent after a short period of anoxia (less than or equal to 2 minutes), 230 percent after an anoxic period of moderate length (3 to 5 minutes), and only 160 percent after a long period of anoxia (greater than or equal to 7 minutes). The total mean repayment of blood flow debt of the whole heart was 195 percent.


Sodium nitroprusside and propranolol therapy for management of postcoarctectomy hypertension.

The cause of hypertension following satisfactory repair of coarctation of the aorta remains obscure. Most agree that significant elevation of the blood pressure after operation demands therapy. Previously the combination of trimethaphan and reserpine was utilized, but the incidence of adverse reactions was high. We recently have used the regimen of sodium nitroprusside and propranolol in six patients with gratifying results. This report reviews the problem as well as our use of nitroprusside and propranolol in managing hypertension following coarctation repair.


Use of tolazoline in newborn infants with diaphragmatic hernia and severe cardiopulmonary disease. A preliminary report.

Two newborn infants with congenital diaphragmatic hernia, one of whom died, had significant improvement in arterial oxygen tension (Pao2) after intravenous administration of tolazoline (Priscoline) (1 to 2 mg. per kilogram). In both infants, systemic hypotension developed within minutes of administration of the drug and required pharmacologic and hemodynamic intervention. The response to tolazoline was more dramatic in the infant who survived, and his oxygen requirements were significantly reduced after the use of this drug. The infant who died also had a significant response to tolazoline. Tolazoline appears to be an important pharmacologic agent for use in the postoperative care of infants with diaphragmatic hernia and associated hypoxemia and acidosis.


Surgical management of massive pulmonary embolism.

Between 1972 and 1976, 24 patients have been treated by open pulmonary embolectomy with the aid of cardiopulmonary bypass (CPB). In 17 (71 percent) acute pulmonary embolism occurred 3 to 60 days after a surgical procedure. The remaining seven (29 percent) patients had chronic medical diseases. The interval between clinical manifestation of acute pulmonary embolism and the performance of open embolectomy ranged from 8 to 36 hours. The definitive diagnosis in all patients was made by pulmonary arteriography. Candidates for pulmonary embolectomy were selected by assessment of hemodynamic stuides: shock, arterial Po2 less than 65 mm. Hg, acidosis, pulmonary artery pressure higher than 20 to 30 mm. Hg, and central venous pressure elevated (patients in Class III or IV according to the Greenfield classification). The definitive indication for embolectomy was occlusion of the main pulmonary artery of more than 50 percent as well as occlusion of the right or left pulmonary artery. Of the seven patients operated upon between 1973 and 1974, three (43 percent) died in the early postoperative period. Between 1975 and 1976 the operative mortality rate in 17 patients was 23 percent (four patients). Our results show that prompt diagnosis of acute massive pulmonary embolism and better selection of patients may improve significantly the survival rate after open pulmonary embolectomy with CPB.


The conducting tissues in primitive ventricle with outlet chamber. Two different possibilities.

The conducting tissues have been studied in two cases of primitive ventricle with outlet chamber. In one case the outlet chamber was to the right and in the other, to the left. In both cases there was an anterior node related to the anterior part of the right atrioventricular anulus. In the specimen with a left-sided outlet chamber (l-loop), the bundle passed through the atrioventricular-semilunar fibrous continuity and was intimately related to the posterior artery. Such a relation was absent in the specimen with a right-sided outlet chamber (d-loop), wherein the bundle directly descended on the posterior part of the septum between the main and outlet chambers. The septum is not considered to be the true ventricular septum but rather a hypertrophied trabecula septomarginalis.


High-dose steroids for perioperative management of patients with myasthenia gravis undergoing thymectomy. A preliminary report.

To eliminate the morbidity associated with thymectomy, we used high-dose corticosteroids perioperatively in 32 patients who had Class II and III myasthenia gravis. All patients were extubated within 2 hours after the operation, and none required respiratory support postoperatively. The average stay in the intensive care unit was 20 hours and the average hospital stay, 6 days. Addition of high-dose corticosteroids to the perioperative managment of patients with myasthenia gravis undergoing thymectomy improved the immediate operative results and eliminated the morbidity associated with this procedure.


"False inhibition" of demand pacemaker due to leakage of fluid into the pacemaker lead socket.

"False inhibition" of a demand pacemaker usually occurs with a microfracture of the lead system resulting in a galvanic potential at the site of the fracture or with sensing of myopotential with exercise. An increase in the slope of the leading half edge of the pulse contour is generally considered diagnostic of lead fracture. We report the case of a patient in whom "false inhibition" at rest and an increase in the slope of the leading half edge of the pulse contour were caused by leakage of fluid into the pacemaker lead socket.


Congenital hereditary lymphedema in the pig.

A histopathological investigation was performed in newborn pigs with congenital hereditary lymphedema. The edema varied greatly in degree and extension. Although mostly confined to the hind legs it may involve other parts of the body, and even attain a most severe generalized distribution. It was found due to malformations of the lymphatic system which were general in character in all animals irrespective the grade in their edema. Parallel to the grade of edema however, these lymphvascular abnormalities varied from minor hypoplasia and localized aplasia to a complete agenesis of the whole lymphatic system.


The pathogenesis of congenital hereditary lymphedema in the pig.

The morphogenesis of congenital hereditary lymphedema was studied in pigs. The disorder, which is essentially a general underdevelopment or even total non-development of the lymphatic system proved to be present during the whole period of lymphatic development. It is suggested that a retardation in the differentiation of the lymphatic primordia from the primitive veins is the early event regulated by a chromosomal aberration. The longer this delay the more serious the lymphatic malformations.


The lymphatic spread of ovarian germinal and stromal tumors.

This paper reports the results of lymphography in germinal and stromal tumors of the ovary. The group of patients is made up of 30 cases of germ cell tumors (70% dysgerminomas) and 29 cases of stromal tumors (62% granulosa cell tumors). The overall incidence of metastases was 29%; 37% in germ cell and 21% in stromal tumors. There was bilateral involvement in 41% of the patients with metastases. The para-aortic region alone was involved in 23%, the iliac alone in 18% and both the regions were simultaneously involved in 59%. In 17/30 operated patients (57%) retroperitoneal node biopsies were performed and diagnostic accuracy was 9/10 in the radiographically positive and 6/7 in the negative cases.


Flow and composition of renal hilar lymph during volume expansion and saline diuresis.

Volume expansion of 5-10% body weight in dogs was achieved by infusion of 0.9%, 1.2% or 0.4% saline. The average diuretic response for each group was 9.9 +/- 2.1, 5.5 +/- 0.6 and 3.3 +/- 0.9 (mean +/- S.E.) ml/hr/kg respectively. Flow from single hilar lymphatics increased by an average of 150%, there being no significant difference between the groups. A significant (p less than 0.02) positive correlation was found between the increase in hilar lymph flow and thoracic duct lymph flow. No correlation was found between hilar lymph flow and the extent of the diuresis. Control hilar lymph contained higher concentrations of Na+ (L/P = 1.05) and C1- (L/P = 1.12) (p less than 0.001) and lower concentrations of glucose (L/P = 0.86) (P LESS than 0.001) than did simultaneous plasma. The electrolyte lymph-to-plasma differences were maintained despite increases or decreases in plasma concentrations. The results indicate that changes in hilar lymph flow are related to volume expansion rather than to the diuresis, and that the processes responsible for lymph-to-plasma compositional differences are relatively unaffected by changes in plasma levels.


Comparison of lactate pyruvate and potassium concentration in the cardiac lymph and, arterial and coronary sinus plasma in dogs.

Lactate (LA), pyruvate (PYR) and potassium (K) concentration in the cardiac lymph were compared with those in the arterial and coronary sinus plasma in dogs. In each substance, there was a good correlation between the plasma and cardiac lymph level in the control period. In respect to LA and PYR, the concentration in the cardiac lymph correlated more with that in the arterial plasma than in the coronary sinus one. During the infusion of isoproterenol, LA and PYR in the plasma increased, while K decreased. Each substance in the cardiac lymph changed to the same degree as in the plasma in mean values. Good correlation was also observed between the arterial plasma and cardiac lymph level during the administration of the agent. However, there was no correlation of PYR between the coronary sinus plasma and the cardiac lymph. During the administration of dipyridamole LA in the coronary sinus plasma increased and that in the arterial plasma decreased. LA in the cardiac lymph did decrease as in the arterial plasma. It is concluded that the concentrations of LA, PYR and K in the cardiac lymph can be changed depending upon changes in those in the plasma and the former two parameters seem to change depending upon those in the arterial plasma rather than the coronary sinus one.


Two-dimensional real-time ultrasonic imaging of the heart and great vessels. Technique, image orientation, structure identification, and validation.

Conventional M-mode echocardiography has become established as a diagnostic tool for noninvasive evaluation of cardiovascular diseases. Now the advent of two-dimensional real-time echocardiography has opened a new era of investigation. This paper describes in detail the technique of a complete two-dimensional ultrasonic examination of the heart and great vessels. Four transducer locations were commonly utilized--namely, parasternal, apical, subxiphoid, and suprasternal notch positions. The tomographic sections of the heart obtained along the long and short axes of the heart and great vessels by utilizing the above positions were validated by detailed anatomic and contrast echocardiographic techniques.


Disseminated Strongyloides stercoralis in an immunosuppressed host.

It is important that clinicians be aware that Strongyloides stercoralis can disseminate, because the helminth can exist as an asymptomatic infestation for years in a person from an endemic area and then become manifest when immunosuppressive therapy is given. A case of fatal strongyloidiasis is presented to emphasize this potential for causing serious infection in the compromised host.


Herpes zoster reactivation of phantom limb pain.

A case is reported in which a herpes zoster infection caused recurrence of phantom limb pain in a man whose left arm had been amputated 7 years previously. It is, to our knowledge, the first such case reported, and it shows the importance of peripheral mechanisms in the generation of phantom limb pain.


[Replacement of the iliac veins and the infrarenal vena cava regment with heterologous grafts in animal tests (author's transl)].

A bovine collagen graft was implanted in 30 dogs for the replacement of the femoral vein, the iliac vein and the inferior vena cava. During the observation period up to 210 days six thromboses of the graft were observed. Histological results after 30 days: development of a "neo-intima" with collagen type III, originating from the anastomosis. After 90 to 210 days: Continuous endothelial layer of the graft with appearance of smooth muscle fibers in the neo-intima. From the graft bed there was found resorption of the bovine collagen and replacement by new collagen type III fibers.


[Management of postoperative intestinal fistulas with elemental diet (author's transl)].

From 1973-1976 sixteen patients with clinically manifest post-operative fistulas (7 small intestinal and 9 colonic) were studied. These patients received an elemental diet (ED) as their only nutritional support for 9-44 days. On ED spontaneous closure was observed in 4 out of 7 small intestinal fistulas and in 7 out of 9 colonic fistulas. Hemoglobin and serum albumin increased significantly on ED and nitrogen balance performed on 7 patients was in equilibrium or positive. Advantages of ED over intravenous nutrition in the treatment of intestinal fistulas are discussed.


[Pathological-anatomical aspects of organ-preserving surgical procedures for breast carcinomas (author's transl)].

This study is an attempt to evaluate the necessity of radical surgery based on the incidence of tumor remnants and lymphnode metastases in amputated breast after diagnostic excision. The material included 600 female patients, from 27-86 years old (mean age 58 years) examined at the Institute of Pathology University of Munich between 1969 and 1974. Retrospectively 36% of the specimen would have been free of tumor after en bloc resection, 21% simple mastectomy and 19% after simple mastectomy with additional axillary lymph-node disection. In fact, however, radical mastectomy was necessary in 25% for total removal of the tumor. As no methods for exact preoperative determination of tumor extension are yet known and as there is a high risk of recurrant tumor because of insufficient excision, organ-preserving surgical procedures still will be restricted to a few individual and selected cases of breast carcinoma presuming the patients consent.


[Surgery of gastric cancer in patients older than 70 years (author's transl)].

In this study it is reported about operative mortality and long-term results of surgery of gastric carcinoma in patients over the age of 70 years. The operative mortality in 50 patients with a distal partial gastrectomy was 16%, the mortality in 24 patients with total gastrectomy was 33.3% and in 14 patients with a proximal gastrectomy the mortality was 28%. The main cause of death (40%) was a pneumonia. There was no correlation between frequency of pneumonia and preoperative results of measurement of lung function. Only advanced arteriosclerotic disease in the heart and brain has a fatal influence on mortality rate. In the old patients the long-term results are determined by the staging of the tumor at the time of operation, too. In the 60 patients, who had left the hospital and who are in our control, the half year survival rate was 78.3%, the 1-year survival rate was 58.3% and the 2-years survival rate is exceeding 41.6%. 14 patients of the 17, who are still alive and who are after 2 1/2 years again explored, are in a very good condition. In comparison with the literature it is to conclude that for the indication to surgery of gastric carcinoma there is important not only the real age of the patient but rather the biological and mental condition of the patient.


Eighty percent of cancer is related to the environment.

Five reasons lead us to believe that much of cancer is environmentally related: 1. Beginning with the work of Yamagiwa and Ichikawa in 1915, cancer has been produced in the laboratory under the control of man. 2. The trends of cancer incidence (and mortality) have been sharply up in some cases (lung), and sharply down in others (stomach, uterine cervix). 3. There are large differences in cancer among different parts of the world, and within the United States. 4. Migrants from one part of the world to another take on the rates of the part of the world to which they migrate. 5. Removal of known causes from the environment has been followed by reduced cancer incidence. Environmental causes of cancer lie in both personal environment: cigarette smoking, use of alcohol, sexual habits, perhaps diet; and in the impersonal environment: industrial and occupational pollutants, water and air contaminants, pesticides, flame retardants, diet additives, drugs. A joint effort by persons and by governments can reduce the incidence of cancer.


Lymphocyte-tumor cell interaction in patients with head and neck cancer.

Peripheral lymphocytes from 12 patients with squamous cell carcinoma of the lead and neck were incubated with autologous tumor explants. Four of the 12 patients demonstrated lymphocyte induced tumor cytotoxicity. These lymphocytes adhered to the tumor cells and deposited a radioactive label from their surface onto tumor cells. The deposition of this label was associated with tumor death. Tissue sections from those patients who demonstrated lymphocyte cytotoxicity showed a marked plasmacytic infiltration. This was in contrast to non-responders where only a desmoplastic tissue response was observed with few inflammatory cells.


Lymphoma of the head and neck.

The natural history of 88 cases of non-Hodgkin's lymphoma of the head and neck were reviewed. An analysis is presented of the histopathologic, clinical, and prognostic features of these patients which presented to the Washington University Affiliated Hospitals between 1955-1975. All biopsies were histologically classified according to the criteria of Rappaport and staged accordingly to the Ann Arbor Classification. There were 38 histiocytic lymphomas, 29 poorly differentiated lymphocytic lymphomas, 16 well differentiated lymphocytic lymphomas, and 5 mixed lymphomas. The lesions were equally divided between Waldeyer's ring and other head and neck sites. Most of the lymphomas were extranodal in presentation. Sixty-one percent of all cases presented with disease localized to the site of origin; 17% had extension to regional nodes and 21% had generalized disease (Stage III and IV). In terms of treatment, localized well differentiated lymphocytic lymphoma was treated with radiation therapy. Generalized well differentiated lymphocytic lymphomas were treated with radiation and chemotherapy. Most patients with histiocytic and poorly differentiated lymphocytic lymphoma limited to the site of origin were treated with radiation and all others with combined therapy. Over 90% of patients with Stage I disease were considered cured at the end of three years while the overall survival was 72%.


Significance of node biopsy before definitive treatment of cervical metastatic carcinoma.

A survey was made of 714 radical neck dissections done alone or in combination with resection of a primary malignancy. Sixty-four (8.9%) of the patients had had a cervical node biopsy before diagnosis and definitive treatment. The complications of wound necrosis, local cervical recurrence, and distant metastasis were significantly higher in those patients than in patients who had had no biopsy or who had biopsy only at the time of definitive treatment. When 40 of the 64 patients were matched on the basis of age, sex, histological diagnosis, site and stage of the lesion and treatment protocol with 40 patients who had had no biopsy, this trend toward a higher complication rate when previous biopsy was done continued and was significantly higher for distant metastasis. The authors believe that these findings quantitatively confirm the accepted belief that, except for instances when no primary lesion can be found and the cervical mass must be biopsied for the purposes of diagnosis, such biopsy increases local complications and, by increasing the incidence of distant metastasis, decreases the chance for survival.


Human laryngeal reinnervation: long-term experience with the nerve-muscle pedicle technique.

The nerve-muscle pedicle technique for reinnervation of bilateral vocal cord paralysis has now been applied in 45 cases over the past four years. EMG studies, volume flow loop, pulmonary function studies, and the ability to extubate the patient with good to excellent exercise tolerance for day-to-day activity have been used as parameters to judge success or failure of this procedure. To date there has been a primary success rate of 91.1% (41/45) and a long-term success rate of 88.8% (40/45). There has been one serious complication in the entire series and no significant morbidity other than this. Age of the patient and length of paralysis are not necessarily contraindications to the procedure. These results suggest that the nerve-muscle pedicle technique may be successfully used for reinnervation of bilaterally paralyzed vocal cords without sacrificing residual voice, as is the case with arytenoidectomy type procedures.


The masseter muscle flap.

This little-used muscle flap has four significant applications in radical ablation about the palate, pharynx, and mesopharynx that include the ascending ramus of the mandible, a portion of the tongue and lateral neck, and in radical operations on the parotid gland causing a facial paralysis: 1. It assists in the rehabilitation of the act of swallowing when it is sutured to the lateral hyoid arch, thus elevating the thyrohyoid complex and reinforcing this portion of the upper lateral neck. 2. This flap may be transposed over the upper portion of the internal carotid artery to provide protection for this vital structure. 3. This flap may be transposed into the internal nasopharynx and then dressed with a free split thickness skin graft to close this wound and to augment the nasopharynx, with improvement in speec and swallowing. 4. In facial paralysis it can be used to restore facial movement around the oral commissure and melolabial folds, thus improving appearance in repose and animation.


Temporal arterial ligation in head and neck surgery with absorbable sutures.

Temporary arterial ligation is a useful concept in head and neck surgery for situations dealing with potential recurrent hemorrhage or recurrent vascular neoplasms. In this study, several absorbable sutures, including plain gut, chromic gut, and polyglycolic acid were used to ligate the common carotid artery in dogs. Arterial patency was followed by serial selective arteriograms. Only polyglycolic acid sutures proved to be a reliable material to achieve transient arterial occlusion.


Total laryngectomy and reconstruction of a pseudoglottis: problems and complications.

A modified procedure for the reconstruction of a pseudoglottis after total laryngectomy is examined. The history of this technique, including our experience, is reviewed with emphasis on problems and complications. Indications and justifications for surgery are discussed. Though we can only speculate on the basis of a few cases, we believe that a good voice can be obtained when a pseudoglottis is either primarily or secondarily constructed after laryngectomy. We acknowledge that perhaps the risk of liability tempers our approach and restricts our case selection which, no doubt, in part accounts for our modification of the procedure that was initially performed in Europe. We believe that continued careful application of this technique and its variations will improve the results of modern laryngeal surgery.


Electromyographic correlation of tensor tympani and tensor veli palatini muscles in man.

It is the purpose of this study to attempt a correlation of function, by electromyographic means, of the tensor tympani and tensor veli palatini muscles in humans. Despite the small number of patients tested, it is believed that the similarities and characteristics of the two are unmistakably equivalent. A separate theory for the combined tensor function is discussed in distinction to the stapedius mediated acoustic reflex. The concept of a single tensor muscle, with two anatomic divisions, a common nerve supply, and parallel function, is therefore submitted.


The anatomy and movements of the cricoarytenoid joint.

The cricoarytenoid joints of 45 larynges were dissected and examined with respect to ligaments, articulating surfaces and movements. In this study the capsule of the joint was uniformly thin, and was strengthened by a superficial, medially placed, flattened band of fibers of one or two strata, known as the posterior cricoarytenoid ligament. Three movements of the arytenoid cartilage at this joint were found, the axes and ranges of which were directly related to the shape and position of the cricoid facet. Notwithstanding these differences, the positions of all the vocal folds in extreme adduction or abduction were similar. These findings contradict the traditional concepts of uniformity of the anatomy and movements of the cricoarytenoid joint and also the position and therefore name, of the "posterior" cricoarytenoid ligament.


Benign nasal polyps causing bone destruction in the nasal cavity and paranasal sinuses.

Benign nasal polyposis, when extensive, can cause bone displacement and destruction within the nasal cavity and paranasal sinuses. Consequently it may be difficult to distinguish this entity from a malignant neoplasm.


Relationship between laryngoceles and laryngeal carcinomas.

Because X-ray evaluation of the larynx is an unreliable method of detecting laryngoceles, a study based on the systematic measurement of the ventricular depth in surgical specimens was carried out to determine the frequency of laryngoceles and their relationship to laryngeal carcinomas. The frequency of laryngoceles was found to be about 2% in the normal larynx. The frequency in laryngeal cancer specimens was about 18%. This difference demonstrated the role of cancer in the genesis of laryngoceles. A close relationship between the ventricular diverticuli and the tumors was observed on microscopic examination in half of the laryngeal carcinomas associated with laryngoceles. These carcinomas can be considered to have developed on the laryngoceles. Depending upon the degree of tumor spread and the number of laryngoceles involved, different types of carcinoma developing in laryngoceles can be recognized. This particular form of tumor can be misinterpreted as an ulcerated vestibular tumor, in which case inappropriate treatment may be tried.


Treatment of "trap door deformity.".

We have shown the use of two techniques for preventing or treating undesirable sequelae noted so often following the closure of gouging or beveled U- or V-shaped flaps. These simple expedients have prevented "trap door deformities" in many hundreds of repairs carried out over the the years. Other modalities and precautions are mentioned.


Hearing loss as a sequela of meningitis.

A retrospective study of 547 cases of meningitis was performed. Of these, 236 were bacterial, 304 were viral, and 7 were fungal in etiology. Of 110 survivors of bacterial meningitis over the age of 2 1/2 years, 23 or 21% suffered partial or complete sensorineural hearing loss. The site of auditory injury in cases of partial loss was the cochlea by audiologic criteria. A positive correlation with hearing loss was found for the species of organism, delay before treatment, low CSF sugar, and CSF pleocytosis. Of 7 patients with fungal meningitis, 3 suffered hearing loss with signs of a retrocochlear site. Of 304 cases of aseptic meningitis, none developed a hearing loss. The pathophysiology of hearing loss as a sequela of meningitis and the possible explanations for absence of hearing loss in viral meningitis are discussed.


Bone-conduction electrocochleography: clinical applications.

Cases are presented which show the clinical utility of recording an electrocochleographic response to bone-conducted stimuli. The procedure is fraught with problems of acoustic control and artifact generation, but has distinct although limited values in clarifying masking dilemmas in patients with bilateral hearing loss.


Fetal respiratory distress causing CNS and inner ear hemorrhage.

Fifty-two consecutive temporal bones of infants who died neonatally, or in utero of natural causes, were studied. Complete autopsies were performed. Twenty-eight infants had a variety of pulmonary disorders which resulted in severe respiratory distress prior to their death. Of these, the majority had bleeding intracranially and into the inner ear. There were five major pathways of central nervous system and subarachnoid hemorrhage involvement of the inner ear: 1) the modiolus, 2) cochlear aqueduct, 3) retrograde via the cochlear vein, 4) episodes of spontaneous bleeding into various compartments of the inner ear, and 4) hemorrhage via the otic capsule. The remaining 24 infants died of other natural causes. Two had CNS bleeding with no extension to the inner ear. We propose that there is a syndrome which consists of 1) neonatal respiratory distress, 2) intracranial hemorrhage, and 3) bleeding into the inner ear--an extension of a subarachnoid or subependymal matrix bleeding diathesis.


The true nature of Bell's palsy: analysis of 1,000 consecutive patients.

In a series of 1502 patients seen in our Facial Paralysis Research Clinic 1048 were diagnosed as having Bell's palsy. Review of clinical, epidemiologic, and laboratory data, plus review of the literature, has led to the conclusion that Bell's palsy is an acute benign cranial polyneuritis probably caused by reactivation of the herpes-simplex virus, and the dysfunction of the motor cranial nerves (V, VII, X) may represent inflammation and demyelinization rather than ischemic compression. Spinal fluid analysis suggests that the disease is a phenomenon of the central nervous system with secondary peripheral neural manifestations. With our presently available information, treatment of a viral disease with an anti-inflammatory agent is rational. Prednisone treatment started within the first week of the disease can restore better function to the paralyzed face than is achieved without such therapy, and facial nerve decompression has been unnecessary.


Immunologic detection of acoustic neuroma: preliminary report.

In an attempto to provide preoperative histologic identification of internal auditory canal and cerebellopontine angle tumors, and to attempt to detect small tumors and recurrent tumors, immunologic aspects of acoustic neuroma patients and control subjects were studied. Reactions based upon the interaction of patients' fresh lymphocytes in contact with acoustic neuroma antigens were studied by a leukocyte migration inhibition (LMI) assay and a locally developed refinement, the plasma effect assay. These were performed either preoperatively, postoperative, or both, in 17 patients with surgically confirmed acoustic neuromas and in 24 controls subjects. Preoperative tumor patients had a higher likelihood of having elevated LMI and plasma effect assay values than normals. False positive results were rare and the combination of the LMI and plasma effect assay decreased false negative responses to 20%. Meaningful conclusions must await more extensive testing but it has been demonstrated that tumor associated antigens do exist on the membranes of schwannoma cells and that most patients with an acoustic neuroma mount a cell-mediated immune response against these antigens.


Results of homografts in middle ear surgery.

Anatomical and hearing results following the use of the homograft tympanic membrane and ossicles either in combination or separately are reported for the period 1968 through 1975. The study is divided into two parts, the first covering the primary years 1968 through 1971, and the latter covering the last four years, 1972 through 1975. The original technique was to cover completely the homograft tympanic membrane with a canal skin graft. During the year 1969 new and different techniques were attempted. Unfortunately this resulted in a marked increase of graft failures; therefore, there was a prompt return to the original technique, which has been used without change throughout the study. The graft take rate for the first four years which included 1969 was 92%. There was a slight increase to 96% during the second part of the study. The hearing results show a greater discrepancy for the two periods with 89% of the patients receiving a satisfactory hearing result during the last four years, compared to 77% for the earlier period.


Postinflammatory ossicular fixation in tympanoplasty.

Postinflammatory ossicular fixation in chronic ear surgery is a common problem faced by the otologic surgeon. This thesis presents a review of the evolution of the three forms of postinflammatory ossicular fixation. The surgical techniques used to correct ossicular fixation are discussed. A detailed evaluation of 311 patients diagnosed as having clinical tympanosclerosis is presented.


Infiltrating lipomata of the head and neck.

Recent discovery and subsequent excision of two histologically benign but unusual infiltrating intramuscular lipomas prompted a review of available literature and a collection of lipomatous disorders of interest to the head and neck surgeon. Such lesions may, by their position, cause significant symptoms. Other instances occur wherein their unusual location causes initial confusion in diagnosis. Finally, accurate histologic identification may be obscured by the inclusion of other tissues within the benign fatty tissue.


Functional restoration for recurrent laryngeal paralysis: an experimental study.

The purpose of this investigation was to exclude abductor disturbance and to maintain phonation during recurrent laryngeal nerve paralysis through a new surgical design. This new method consists of implantation of the ansa hypoglossi and sternothyroid muscle pedicle which has been shown to provide sufficient abductor function in a recent publication, and the selective severance of the abductor branch after neurorrhaphy of the recurrent laryngeal which is shown to be a sufficient adductor function in another study. The recovery of sufficient abductor function during inspiration and dyspnea was 67% and 89% of adductor function with phonation. However, after cutting an adductor nerve branch of the recurrent laryngeal nerve in cases of insufficient abduction, the vocal cord on the operated-on side regained abduction during inspiration. The effect of the ansa hypoglossi and sternothyroid muscle pedicle is also discussed.


[Reproducibility of the temperature field created by a cryosurgical applicator].

The relation between the non-reproducibility of the thermal field of the cryoapplicator and conditions of the thermal contact are reduced. Investigations of the thermal field were made on a model of tissue in a 3% aqueous gelatin solution. The results of the study show the nature of the thermal contact between the applicator and the tissue to play a significant part in the non-reproducibility of the cryoprobe thermal field. With any mode of the cryogenic action there exists a temperature differential on the borderline tissue--applicator. In the absence of adhesion this differential becomes quite considerable. To reduce the region of non-reproducibility of the thermal field it is necessary that cryosurgical operations be carried out with the applicator kept frozen to the tissue.


[4-channel electroencephalographic amplifier with integrated microcircuits].

To conduct electroencephalographic investigations of stationary and moving objects a small-sized 4-channel amplifier built with integrated microcircuits has been developed. Each channel includes a pre-amplifier, main amplifier, calibrator, high and low frequency filters and a power pack. The adoption of integrated microcircuits enables it to locate the pre-amplifiers directly on the object of investigations. The device is highly sensitive and secures a greater degree of noise-protection.


[Troca and indicator].

For transthoracic puncture of tuberculous caverns a trochar equipped with a photo-indicator is recommended. A relatively simple design of the instrument enables the surgeon to determine the instant of the trochar's tip penetrating the hollow of the cavern. The trochar-indicator may find wide application at the establishments of the antituberculous service in treating cavitary tuberculosis.


[Simulator for individual auditory training of hard-of-hearing persons].

A device-trainer intended for individual exercises with patients suffering from an intensively pronounced hearing defect is described. The device permits it to reproduce sound signals amplifying them up to 130 dB in the mono-binaural and also in the stereophonic modes and provides for a wide bandwidth. The originals can be presented by using the auditory and vibro-tactile reception.


["Pulse" piezoceramic transducer].

A piezoceramic acceleration sensor "Pulse", devised by the Gorky Scientific-Research Radiphysical Institute is described. The use in the sensor's design of a flexing sensitive element provides for high sensitivity and great power output of the instrument. This helps to easily coordinate the operation of the sensor with that of the recording devices and to record both the low-frequency curves, viz. ballisto-, kineto-, seismocardiograms, tremorograms and the high-frequency ones, such as phonocardiograms, Korotkov's sounds, laryngograms.


[Contactless indicator of the rhythm of implanted pacemakers].

Non-content indicators of the rhythm are employed to exercise operative control over the functions of implanted cardiostimulators. The paper discusses issues concerned with the circuitry and the setup of subassemblies in such indicators, e.g. the sensor, amplifier, pulse expander, oscillator and output stage.


[Possible use of new corrosion-resistant steels in the manufacture of medical instruments].

Demands on metals intended for the manufacture of medical instruments call for the use of corrosion-resisting grades of steel with high strength characteristics. Grades of steel of the martensite class reinforced by age hardening (martensive-aging) and mild grades of steel (chrome-manganese and chrome-nickel) have a number of valuable advantages over the steel of other classes. The possibility of obtaining high strength with low carbon dontent ensures great plasticity, toughness and brittle failure resistance along with corrosion-resistance and the possibility of achieving a substantial simplification in technology of making the instruments. Investigations of martensite-aging grades of steel--ep832,ochX11H9M2d2Tyu, O3X11HMd2yu and O3X13g3Md2 demostrated them to hold good promise for the manufacture of surgical and atraumatic needles, and rod-type stomatological instruments.


[Grid for the simultaneous calculation and determination of the dimensions of myelinated nerve fibers].

To make convenient a simultaneous calculation and measurement of myelinic nerve fibers a network with the known length of the square's side is proposed. The use of such a network in studying the myeloarchitectonics of the nerves helps economize the time needed for this purpose. The network is simple to manufacture and can be prepared at any photolaboratory. The possibility of using it also for other purposes is indicated.


[Use of the UKKM-1M apparatus for the cryopreservation of bone marrow and leukocytes].

The make-up of an installation for programmed congelation of the bone marrow and nuclei-containing blood cells with liquid nitrogen acting the part of a refrigerant is described. Experience gained as a result of a three-year long operation of the unit helped reveal additional conditions of its use that expand the field of its application in freezing other kinds of biological tissues and cells. An important feature of the installation includes the possibility of recording the temperature directly of the tissue undergoing congelation and not that in the freezing chamber.


[New developments in measuring the cerebrospinal fluid pressure level and its controlled extraction].

To measure the spinal fluid pressure and its controlled extraction, including protracted drainage of the fluid-containing communications, a portable arrangement, in which a direct relationship between the extracted spinal fluid and its changing pressure is utilized, is recommended.


[Increase in the information content of thermograms by compensating for tissue heat conduction].

There exist two groups of factors responsible for distorsion of thermograms, these are a subdued temperature relief due to thermal conduction of tissues and equipment-caused distorsions. Such distorsions lower the informativeness of thermograms which hampers the selection of diagnostic signs. A method is proposed which enables it to partially compensate distorsions through application of Viener's method of re-establishing distorted images, based on the use of the à priori information on the distribution of temperature on the surface of the body and on the probable properties of thermal fields. The equipment-caused distorsions are then considered to be insignificant. The proposed algorythm of re-establishment has been tried out on the image of blood vessels in the rabbit's ear and on the factual image of the thermal field, the thermograms of mammary glands.


Synovial membrane histopathology in the differential diagnosis of rheumatoid arthritis, gout, pseudogout, systemic lupus erythematosus, infectious arthritis and degenerative joint disease.

The synovial membrane histologic sections from patients with six common rheumatic diseases were reviewed without knowledge of the clinical diagnosis. After histopathologic evaluation, the synovial membrane characteristics were grouped according to the patient's clinical diagnosis, and included 29 patients with rheumatoid arthritis, 13 with systemic lupus erythematosus, 17 with degenerative joint disease, 10 with acute bacterial arthritis, 8 with gout, and 13 with pseudogout. The only specific characteristics identified were bacteria (infectious arthritis), crystals (gout, pseudogout), and lymphoid follicles (rheumatoid arthritis). Nevertheless, other characteristic features of differential diagnostic utility were recognized, including the intensity and nature of synovial lining cell hyperplasia and of leukocyte infiltration. Light microscopic histopathologic changes in the common rheumatic diseases are not specific, but are of diagnostic utility. Complete and exhaustive review of each pathologic synovial membrane characteristic provides more justification for the routine use of synovial membrane biopsy as an adjunct to arthrocentesis in the evaluation of common rheumatic diseases.


Randomized trial of protected environment--prophylactic antibiotics in 145 adults with acute leukemia.

One hundred and forty-five adults with acute leukemia were randomized to receive remission induction therapy in or out of a protected environment (PE) with prophylactic antibiotics orally (PA) or systemically (SA). Sixty-three patients were randomized in PE and 82 outside a PE. The proportion of patients who survived long enough to receive an adequate trial was higher in the PE (97%) than out (82%) (P = .01). The complete remission (CR) rate was 71% in and 43% out of the PE (P less than .01). Fifty-five patients received PA and 90 received SA. The CR rates were 61% and 45%, respectively. Of the 145 patients, 73 (50%) developed 102 episodes of major infections. Twenty-six of 63 patients in the PE developed major infection compared to 47 of 82 outside a PE (P = .08). The incidence rate of 13% fatal infections in a PE was significantly smaller than the 28% rate outside a PE (P = .04). The number of days with infections at less than 500 neutrophils/mm3 was also significantly lower inside a PE than outside (P less than .01). When comparing patients receiving SA or PA, there was no statistically significant difference in the incidence of infections. Forty-one patients received OAP Chemotherapy and 104 received adriamycin-OAP plus BCG. The CR rate on OAP was 44% compared with 60% on Ad-OAP + BCG. Infection rates were 76% and 40%, respectively (P less than .01). The median survival time was 72 weeks for patients in PE compared with 42 weeks for patients outside a PE (P less than .01). The prophylactic antibiotic regimens were well tolerated by most patients. This prospective randomized study has demonstrated statistically significant advantages for a lowered risk of fatal infection, higher CR rate and longer survival of patients treated in a PE with prophylactic antibiotics compared with patients treated in a conventional hospital room. Also, there was evidence for the superiority of adriamycin-OAP + BCG treatment compared with OAP.


[Effect of cadmium on serum level of total protein and glycoprotein carbohydrate components in rats].

In experimental cadmium intoxication 100 rats were intraperitoneally injected with single doses of 0; 5 1,0, 2,0 5,0 mg Cd++/kg body weight as well as with 14 doses of 0,25 mg Cd++/kg. In the serum of animals the level of total protein and of glycoprotein carbohydrate components was determined. After doses in the range of cadmium concentration from 0,5 to 2,0 mg Cd++/kg body weight, a statistically and significant increase of the serum level of the protein-bound hexose hexoamine and sialic acids was stated. On the other hand the dose of 5,0 mg Cd++/kg caused only the increase of hexose in comparison with values of these constituents recorded in the control group. In animals receiving multiple doses of cadmium and also in those after a single administration of 1,0 mg Cd++/kg, a significant increase of the total protein level was started. The last group revealed the highest concentrations of protein and glycoprotein carbohydrate constituents on the third day after injection of cadmium while after 14 days, amouunts of these compounds approximated the levels estimated in the control group. A univocal evaluation of the obtained results is difficult, however in the mechanism of the quantitative alterations within the glycoprotein components of rats serum, the possibility of cadmium--induced biosynthesis of these compounds should be taken into consideration.


[Physical efficiency of women employed in the knitting industry].

Physical efficiency in 184 spinners of a modern knitting plant has been examined by determining a maximum absorbtion of oxygen (VO2 max) using an indirect method of Astrand--Ryhming. A significant effect of age and consequently duration of employment on the decrease in physical efficiency level has been found. The distribution of efficiency index according to Astrand's classifications is not equal, which may result from a particular stereotype of motorial activity, especially non-occupational one.


[Comparative estimate of methods used in the examination of the sensitizing properties of chemical compounds].

The studies carried out aim at comparing and determining the usefulness of two methods most frequently used to evaluate the sensitizing properties of chemical compounds. In the studies, compounds of known sensitizing properties have been used: potassium dichromate and 2,4-dinitrochlorobenzene. Comparison of the percentage of sensitized guinea--pigs, intensity of sensitizing reaction and the time at which the reaction is being kept up, indicates a greater usefulness of Magnusson and Kligman's method for routine evaluation of sensitizing properties of chemical compounds.


[Experimental silicosis. Evaluation of the silicogenic properties of apatites and phosphorites].

White rats were intratracheally injected with 50 mg of apatite or phosphorite dust. The animals were killed 3, 6 and 10 months after the injection. Fibrogenic properties were evaluated on the basis of biochemical and histopathological studies. It was found that the dusts under examination after 3 months of experiment induced a statistically significant increase of wet and dry lungs weight, of hydroxyproline and lipids content in the lungs, and intrathroacic lymph nodes as compared with the control group. After 3 and 10 months, a further but statistically insignificant increase of hydroxyproline content in lungs and of wet lung weight was observed, as compared with animals in the 3--months experiment. The obtained values of fibrogenic action indices for apatite and phosphorite dusts were quite similar to the values obtained in animals injected with inert dust of titanium dioxide. They were 4--5 times lower than the indices obtained after administrating the river sand--a dust of strong fibrogenic properties. Histopathological studies primarily revealed inflammatory changes in bronchial and peribronchial tissue, and focal emphysematous changes, whereas no features of a progressive development of fibrous changes in lungs. The MAC values of 6 mg/m3 for phosphorite dust of 8 mg/m3 for apatite dust--were suggested.


[Urine phenol test as an index of exposure to aromatic hydrocarbons].

Results of phenol determinations in urine of the workers of petrochemical combine in Płock have been statistically compared over 10 years. Besides this reaction has been checked in other plants and even in non--exposed persons. Phenol content in urine has been found to increase from year to year, despite very low benzene and phenol concentrations on the work--posts. This trend is also apparent in other plants. Considerations of the nature of the reaction lead to the conclusion that the phenol test informs about a total exposure to hydrocarbons of benzene ring, which metabolize to simple phenols. The authors suggest allowable safe values (65 mg/l) and limit values (about 200 mg/l) of these concentrations.


[TCDD (dioxin) toxicity].

Referring to intoxication of people with TCDD (dioxine) in Sevedo near Milan, the authors present a review of literature (primarily results of studies on animals) on the biological results of the effects of this intoxication.


[2,4-D poisoning].

The paper presents 2 cases of intoxication with herbicides--chlorophenoxyacetic acid derivatives. In the cases observed, the following symptoms were shown in the clinical picture; general weakness, dizziness, headache, abdominal pains, nausea. Clinical observation revealed changes in blood circulation with pathological changes in EKG and transitory reduction of RR. We also found some changes in laboratory examination, indicating noxious effects of chlorophenoxyacetic acid derivatives upon parenchymatous organs.


[Effect of industrial pollutants on mucous membrane of the upper respiratory tract].

A survey of literature on upper respiratory tract diseases in workers exposed to irritating and toxic substances in industry has been presented. The effects of dusts of cotton, wood, rock-salt, hydrochloric and sulphuric acids, ammonia and fluorine compounds have been discussed.


[Identification procedures using gas chromatography in intoxications with various solvents].

An identification system of 31 volatile organic compounds has been worked out using gas chromatography with columns of various polarity (SE-30, OV-17, Porapak Q). The efficiency of the system for identifying an unknown solvent delivered with the intoxicated one, or a toxic substance in the material from a person intoxicated (blood, exhalated air, gastric rinsings) has been proved good in numerous cases of acute intoxications hospitalized in the Clinical Division of the Institute of Occupational Medicineur Lódź.


Stimulation of protein synthesis in isolated hepatocytes by somatomedin.

Insulin (1 mU/ml) stimulated the incorporation of 14C-leucine into trichloroacetic acid-precipitable material by isolated hepatocytes from normal and hypophysectomized adult rats and 12-day-old rabbits. Somatomedin (200 ng/ml) purified from human plasma had an insulinlike effect in hepatocytes from hypophysectomized rats and baby rabbits but not from normal rats. This study suggests that, as well as being a site of somatomedin synthesis, the liver may be a target organ for this hormone.


Dietary constituents and somatomedin activity.

Serum somatomedin activity of rats was measured under several dietary conditions by 35S incorporation into chick embryo pelvic rudiment. The mean (+/- SD) serum somatomedin activity (U/ml) was reduced following 3 days of fasting (0.41 +/- 0.12) and increased to prefasting levels in animals fed a balanced diet (0.95 +/- 0.11) for 2 days. The increase in mean somatomedin  activity following 2 days of refeeding a high-protein diet (0.79 +/- 0.09) was greater than that observed with a high-carbohydrate (0.56 +/- 0.10) or a high-fat (0.60 +/- 0.10) diet, but the level was not completely restored to normal. The data confirm the previous finding that fasting reduces serum somatomedin activity and suggest that the protein content of the diet plays a major role in the restoration of serum somatomedin activity following refeeding.


Diminished insulin response in highly trained athletes.

Insulin secretion and glucose tolerance were examined in 6 highly conditioned athletes in comparison with a control group of 115 normal healthy persons. During glucose infusion the athletes showed low insulin secretion although there was no difference in the levels of blood glucose compared to the control group. It is concluded that under physiologic conditions the extent of insulin secretion is not dependent only upon the blood glucose levels. The results show that a lack of insulin response can occur as a consequence of adaption to physical training. A reduced insulin response, therefore, does not necessarily indicate a diabetic or prediabetic state.


Musle protein breakdown rates in humans based on Ntau-methylhistidine (3-methylhistidine) content of mixed proteins in skeletal muscle and urinary output of Ntau-methylhistidine.

Samples of psoas muscle from nine infants (aged 1 day to 14 mo) and of several skeletal muscles from seven adult males (age 19-74 yr) were analyzed for content of protein-bound Ntau-methylhistidine (3-methylhistidine; 3-Mehis). The mean content of 3-Mehis (expressed as mumoles/g mixed protein) was 3.2 (range 2.4-3.7) in infants and 4.2 (range 3.7-4.6) in adults. The daily urinary excretion of 3-Mehis was measured in four young adult males receiving an egg-protein, flesh-free diet. Mean excretion of 3-Mehis was 211 (range 167-252) mumoles/day. From these two sets of data the mean rate of muscle protein breakdown in adult males was estimated to be 50 g/day, or 0.7 +/- 0.1 g/kg body weight/day. These results are compared with reported values for the 3-Mehis content of mixed proteins in muscle of various species, and with published estimates, computed by other techniques, of the rate of muscle protein breakdown in human subjects.


Effect of bombesin infused intrapancreatically on glucagon and insulin secretion.

Synthetic bombesin was infused at a dose of 20 pmoles/kg/min for 10 min into the cranial pancreaticoduodenal artery of anesthetized dogs. Plasma immunoreactive glucagon concentrations in the cranial pancreaticoduodenal vein as well as in the femoral artery were concurrently and slowly elevated. However, the net release of glucagon from the pancreas did not increase significantly during infusion of bombesin. Plasma immunoreactive insulin concentrations in the pancreatic vein were transiently raised, and a delayed rise was noted in arterial plasma IRI. Net release of insulin was significantly augmented during infusion of the tetradecapeptide. Plasma glucose levels did not change after bombesin. These results indicate that the gastrointestinal tetradecapeptide may stimulate secretion of both insulin and gut glucagonlike immunoreactivity in the dog.


Effect of fasting on free and esterified carnitine levels in human serum and urine: correlation with serum levels of free fatty acids and beta-hydroxybutyrate.

Serum levels of free L-carnitine, acylcarnitines, creatinine, beta-hydroxybutyrate, free fatty acids, cholesterol, triglycerides, and glucose were determined in healthy volunteers during a 24-36-hr fast. The effect of oral administration of free L-carnitine (1 g/person) on these parameters was studied. Urinary excretion of carnitine and creatinine was monitored throughout. Serum and urine levels of free carnitine and its renal clearance decreased during the fast. However, the serum concentration and urinary excretion of acylcarnitines increased during the same interval. Following the ingestion of free L-carnitine, both serum and urinary levels of free L-carnitine rose. Within 6 hr of ingestion, 10% of the administered dose could be accounted for by urinary excretion. No significant effect on the other serum constituents under study was seen following the oral L-carnitine dose. A significant negative correlation was found between serum levels of free L-carnitine and beta-hydroxybutyrate and free fatty acids (r equal -0.567, p less than 0.001 and r equal -0.607, p less than 0.001, respectively) during the fast.


Glyceroneogenesis in rat and guinea pig adipose tissue during the fed and fasted states.

While both pyruvate and lactate are good substrates for glyceride-glycerol synthesis in isolated adipocytes from fed rats and guinea pigs, neither alanine nor serine appear to support glyceroneogenesis. Fasting increases the proportion of radioactive pyruvate or lactate incorporated into glyceride-glycerol and reciprocally decreases the proportion incorporated into fatty acids. However, the total incorporation of radioactivity into triacylglycerol is considerably lower in isolated adipocytes from fasted than from fed animals. Addition of glucose to the incubation medium promotes the incorporation of radioactive lactate into both fatty acids and glyceride-glycerol by adipocytes from fasted as well as fed animals. The concentration of alpha-glycerolphosphate is considerably higher in adipose tissue of fed than fasted animals. In general, these results support the presence of a glyceroneogenic pathway in rat and guinea pig adipose tissue. However, it would appear that the physiologic significance of this pathway is less important in the fasted than the fed state, where it may play some role in the esterification of intracellular fatty acids.


Diminished plasma free fatty acid clearance in obese subjects.

Obese subjects were compared with lean subjects to define the previously reported disturbance of plasma free fatty acid (FFA) kinetics in terms of altered net transport (lipolysis) or clearance (esterification). These measurements were made during prolonged constant infusions of 1--14C-palmitate toward the end of sustained glucose ingestion and again 6-8 hr after stopping glucose. Net transport of FFA was suppressed to equally low levels in obese and lean subjects, though at the expense of higher insulin concentrations in the obese. Whereas in the lean subjects the clearance of FFA was significantly stimulated with glucose, the obese subjects showed low clearance rates both during and after stopping glucose. When glucose was stopped, net transport rose more rapidly and to a greater extent in some obese than in the lean subjects. The increased influx of FFA led to a rise in the plasma triglyceride level only in the lean subjects. These studies suggest that clearance of plasma FFA, probably denoting esterification in tissues such as muscle and adipose tissue, is impaired in obesity and cannot be readily stimulated with glucose and insulin. Lipolysis, measured as net transport of FFA, however, is suppressible with glucose and insulin in the obese, though this might be achieved only at insulin levels that are higher than those in lean subjects.


Recent developments in thyroid hormone metabolism: interpretation and significance of measurements of reverse T3, 3,3'T2, and thyroglobulin.

The development of specific radioimmunoassays has allowed measurements of 3,3',5'-triiodothyronine (reverse T3), 3,3'-diiodothyronine (3,3'T2), and thyroglobulin to be performed in serum and in various biological fluids both in normal and in altered states of thyroidal economy. The physiology, kinetics, and metabolic actions of reverse T3, 3,3'T2 and thyroglobulin are reviewed. Presently, it appears that reverse T3 and 3,3'T2 measurements in amniotic fluid and cord serum may potentially be useful in diagnosing fetal or neonatal thyroid dysfunction, and serum thyroglobulin measurements appear to be important as a measure of the efficacy of treatment of patients with differentiated thyroid carcinoma.


The use of live models in the teaching of gross anatomy.

Live models were introduced into the first-year gross anatomy course to provide medical students with an opportunity to apply to the living person what they learned from cadaver dissection. After each major segment of the cadaver dissection, clinical correlation sessions were presented for the students by clinicians using live models for demonstration, examination and correlation. At the completion of the course, an evaluation questionnaire was given to students. Their response indicated that the new teaching technique made anatomy seem more relevant to clinical medicine than using cadavers alone. Live models were rated superior to using cadavers, especially in demonstrating superficial anatomical structures and landmarks. On the basis of student response it was concluded that this programme provided medical students with a unique introduction to living human anatomy.


Follow-up study of male Liverpool graduates.

An attempt was made to trace all the male Medical Graduates from Liverpool University in the years 1950-1954 inclusive, in order to find out where they were working and what work they were doing 20 years later. Of the original group of 288 Graduates, 272 (94.4%) were both traceable and practising medicine. Of these 272, 15.1% were found to be working abroad and 84.9% working in the U.K. (51.5% in the North West and 33.5% elsewhere in the British Isles). Of those abroad (forty-one in number), about one third were in Canada, a further one third in Australia or New Zealand and about one quarter in the U.S.A.--these three areas accounting for 92.6% of all those abroad. The mean time of emigration was 9.6 years after graduation, with over two thirds emigrating between 5 and 14 years after graduation. Of those in the U.K. (231 in number), the majority were in General Practice (50.6%) and a further 32.1% had specialized in Hospital or Academic Medicine. These figures should be treated as orders of magnitude, since there are a number of possible sources of minor error.


Progression of tumours and non-neoplastic disorders as manifestations of a common biological phenomenon.

The thesis is presented that progression, in both neoplastic and nonneoplastic disorders, involves a common biological mechanism. This view derives from the author's unified theory of growth and age-dependent disease. Diseases that show a reproducible age-dependence, satisfying certain statistical criteria, are held to be initiated by random 'errors'--somatic gene mutations--in stem cells of the central system of growth-control. A specifically mutant stem cell propagates a "forbidden clone' (Burnet) of descendant cells and these cells, or their secreted humoral products, attack target cells at one or more anatomical locations. In certain disorders, a single forbidden clone gives rise to the first detectable symptoms and signs but progression of the disease depends on the (random) formation of further forbidden clones that attack additional target cells. This theory is discussed with reference to the neoplastic disorders, familial intestinal polyposis and tumours of the uterine cervix; and the non-neoplastic disorders, Parkinsonism and male baldness. Related problems concerning the fatal crisis in malignant disease and the unifocal/multifocal origin of tumours are also discussed.


The aetiology of cancer: clues from spontaneous recovery.

There is indisputable scientific evidence of a spontaneous regression of cancer in several cases. The implication is that possibly there are other than the suspected aetiological factors involved in the problem of the origin, and even more important, in the cure of cancer.


Physical damage caused by sexual deprivation in girls.

In parts of Europe and in the Americas there are still many girls who are prevented by cultural forces from acquiring sexual experience until they are six years or so past puberty. This period of sexual deprivation probably causes physical as well as functional damage. The functional damage was documented by Kinsey more than twenty years ago, but almost no one seems to be aware of it. The physical damage seems likely as the basis for the functional damage and also as the inevitable result of sensory deprivation as revealed by extensive studies of other sensory systems.


An hypothesis on information, memory and perception.

It is generally held that a sensory receptor serves, in some way to "map" an external event (such as a light or sound signal) onto some internal or neural event (such as a volley of impulses moving along an axon toward the brain). Or schematically (external event leads to neural event). It is postulated in this paper that it is not the external event, but rather uncertainty about the nature of the external event, which produces the neural activity. In place of the traditional map it is hypothesized that we should substitute (rate of change of uncertainty about an external event leads to neural event). It follows from this revised mapping process that one perceives only those external events about which he was initially uncertain. One cannot perceive something about which he is perfectly certain. It is seen that various observed sensory phenomena, such as the process of adaptation and the fading of a fixed retinal image, issue directly from this new hypothesis.