[The electrocardiogram of the normal child].

The EKG findings of 202 normal children, aged 1 month to 10 years were reviewed in order to determine criteria for diagnosis of ventricular hypertrophy. QRS voltage in right and left precordial leads are very variable and do not constitute adequate criteria for the diagnosis of ventricular hypertrophy the same is true with QRS duration, which increases progressively from 50 to 60 msec from the first to the fourth year of life, and to 70 msec over that age. The values found are smaller than those previously reported in the literature. Measurement of initial intrinsicoid deflection time in leads VI, aVF and V6 apparently have important clinical significance. This is a constant finding in normal hearts in lead VI, where deflection time is 18 to 20 msec. Therefore, times above 25 to 30 msec are sugestive of right ventricular hypertrophy when RBBB is not present. Intrinsicoid deflection time in lead V6 in children under one year of age was 20 msec, while between age one and ten it varied between 20 and 31 msec. Such variations show how left ventricular tissue increases after the first years of life, and also that times above 5 msec over those found for any age group are indicative of left ventricular hypertrophy.


Suppression of voluntary ingestion of morphine by inhibition of dopamine-beta-hydroxylase.

Male Wistar rats were exposed to a free choice between water and a morphine-sucrose solution. Following stabilization of baseline levels of consumption of morphine, the animals were injected for 5 consecutive days with either FLA-57 (45 or 60 mg/kg i.p.), a non-toxic dopamine-beta-hydroxylase inhibitor or its vehicle. The FLA-57 treated animals significantly attenuated their preference for morphine during the injection and post-injection periods although there were no significant differences related to the dosages used. These treatments produced a concomitant reduction in central norepinephrine levels suggesting that norepinephrine may be involved in the mediation of the reinforcing properties of morphine consumed by laboratory rats. The possibility of common neural mechanisms regulating the pharmacological actions of both morphine and ethanol are discussed.


[Pulmonary diffusion capacity in patients with previous myocardial infarct (with respect to the influence of smoking and pulmonary congestion)].

Pulmonary diffusive capacity by the carbon monoxide method was evaluated in 43 patients two years after myocardial infarction, and without evidence of other types of heart disease. The patients did not have primary lung disease or clinic bronchitis. Special interest was given to the effects of cigarrette smoking and moderate pulmonary congestion. A significant decrease in diffusion capacity was observed in smokers and former smokers compared to none smokers. In moderate pulmonary congestive the oposite effects was registered. pO2 was decreased in half the patients with old myocardial infarction but there was no significant statistical correlations with D1co values. Mean values for pO2, pCO2, pH, EB did not show statistically valid differences among the subgroups under study. Different factors which may influence the evaluation of diffusion capacity are discussed.


Differential effects on temperature of chlorpromazine injected into PO/AH and medulla oblongata of the rat.

Hyperthermic responses developed after injections of chlorpromazine into the preoptic/anterior hypothalamic (PO/AH) region of unrestrained rats. Sites near hte posterior border of the anterior hypothalamus were the most sensitive. Injections of chlorpromazine into the medulla oblongata did not alter rectal temperature in intact rats but caused hypothermic responses when the PO/AH region had been destroyed. These results provide additional evidence for a secondary temperature control in the medulla which ordinarily responds minimally to drugs and which may be suppressed by an intact primary control in the PO/AH region.


[Rupture of the free wall of the heart as cause of death in acute myocardial infarct].

Twenty four cases with myocardial rupture among 259 patients with autopsy after death due to myocardial infarction, were compared with patients with acute myocardial infarction and death secondary to other causes. Myocardial rupture occured during the first 72 hours in 58% of the patients and all cases within the first five days. Two thirds of the patients were males and 46% were 70 years of age. There were 24 myocardial ruptures (9.5%). Previous history of arterial hypertension and un-remittent anginal pain were predisposing factors for rupture (p=0.05). Other previously reported bad prognostic factors such as persistent hipertension after acute infarction, severe exercise before infarction and history of Diabetes Mellitus were not statistically significant in this study. Ruptured myocardium was not influenced by a previous history of myocardial infarction, hospitalization delay in the C.C.U., administration of anticoagulants, digitalis or pressor amines. There was no significant difference among the groups compared in enzyme curves or magnitude of leucocytosis. Electromechanic dissociation, sinus bradycardia, nodal rhythm followed by idioventricular rhythm and asystole, were observed following myocardial rupture.


Effect of p-chloramphetamine on the inactivation of monoamine oxidase in rat brain by 3-amino-2-oxazolidinone, 2-hydroxyethylhydrazine and pheylisopropylhydrazine.

p-Chloroamphetamine protected against the irreversible inactivation of monoamine oxidase in rat brain and liver by 3-amino-2-oxazolidinone, an agent that leads to monoamine oxidase inhibition through conversion to an active metabolite, probably 2-hydroxyethyl-hydrazine. In contrast, p-chloramphetamine did not protect against the inactivation of monoamine oxidase by 2-hydroxyethylhydrazine itself or by phenylisoprophylhydrazine. The effect on 3-amino-2-oxazolidinone may have been due to interference with its metabolism rather than to occupancy of active sites on monoamine oxidase by p-chloroamphetamine. Some implications of these findings relating ot the use of 3-amino-2-oxazolidinone in evaluating reversible monoamine oxidase inhibitors and to the pharmacological effects of p-chloroamphetamine are discussed.


[Clinical value of a new method of therapeutic control of heparin].

A modification of thrombosis time (TT) for therapeutic control of heparin (TTDT), is described. A useful dose of heparin increases plasma TT, which on dilution with fresh plasma rich in platelets (250 +/- 50 x 10(9)/1) at a dilution of 1:4 to 1:8 (+/-20%), causes the increased plasma TT to return to normal values. Three coagulation tests used simultaneously were tried: plasma recalcification time, partially activated thromboplastin time, and TT, used simultaneously in 30 samples of platelet rich fresh normal plasma with different concentrations of heparin (0.05 to 1.0 mu/ml). Results show that modified TT is the most sensitive and reproducible test to detect varying heparin dosage. Fifty two patients without coagulation deficiencies and with various clinical thrombi, and 22 with generalized intravascular coagulation (CID) treatment with 100mu of heparin XK of body weight every 4 to 6 hours, were studied. Results are described. Advantages of TRDT for therapeutic control of heparin are discussed.


Effects of acetaldehyde on electrical and mechanical activities of guinea-pig taenia coli.

The effect of acetaldehyde on the electrical and mechanical activities of the isolated segment of taenia coli from guinea-pigs has been studied using a sucrose-gap method. Application of acetaldehyde produces relaxation of the muscle, which is accompanied by reduction or cessation of spontaneous spike activity and hyperpolarization of the membrane. The hyperpolarization becomes smaller with lowering the temperature. These actions of acetaldehyde are not modified by adrenergic and cholinergic receptor blocking agents nor by tetrodotoxin and ouabain. Acetaldehyde also reduces the evoked activities produced by KCl, BaCl2, acetylcholine or electrical stimulation. The nonadrenergic inhibitory junction potential is reduced by acetaldehyde. When external Ca++ is replaced with Sr++ or Ba++, the action of acetaldehyde is suppressed. Addition of Mn++ eliminates the action of the aldehyde. Acetaldehyde relaxes the muscle when administered after fully developed membrane depolarization induced by K2SO4.


Studies on myocardial histamine. Effects of catecholamine-depleting drugs.

Hearts of rats, mice and guinea-pigs were assayed in parallel for histamine and norepinephrine. Reserpine decreased the histamine content in the hearts of rats and mice but not in guinea-pigs. alpha-Methyltyrosine decreased the histamine content in both rat and guinea-pig hearts. 6-Hydroxydopamine increased myocardial histamine content in the rat but not in the mouse.


[Right aortic arch associated with congenital heart defects].

The author's experience in the association of right aortic arch and congenital cardiac malformations is reported. We found 56 cases out of 1200 congenital cardiac malformations which constitutes 4.6%. In the classification of Knight and Edwards, type I right aortic arch was the most frequent (96%) and it was associated principally with Tetralogy of Fallot (46%), transposition of the great vessels (14.3%), truncus arteriosus (12%), tricuspid atresia (10.7%) and complex cardiac malformations associated with the syndrome of visceral heterotaxy (10.7%). In type II and type III we found only one case of each and these were associated with pulmonary valvular stenosis, atrial septal defect and ventricular septal defect. It is noted that the right aortic arch has never been associated with total anomalous pulmonary venous return nor with mitral or aortic valvular malformations.


Cardiovascular and metabolic actions of an adenosine analogue (2'3'-o-methoxy-ethyliden-adenosine-5'-ethylcarboxamide) in the conscious dog.

The haemodynamic and metabolic actions of 2'3'-o-methoxyethyliden-adenosine-5'-ethylcarboxamide (744-98) were investigated in conscious dogs after i.v. and oral administration. 744-98 led to a marked dose-dependent increase in coronary blood flow, together with a slight increase in renal blood flow. In the standing position high doses of the drug revealed an adenosine-like negative chronotropic action, together with marked hypotension. Metabolic effects were observed with the higher coronary-active doses only. The increase in arterial glucose and decrease in free fatty acid levels are considered to be caused by a glucagon-releasing and adenosine-like action of 744-98. The haemodynamic and metabolic changes were observed both after i.v. and oral administration, showing a ratio of approximately 3:1 in favour of the parenteral route.


Effects of intraventricular and intraspinal 6-hydroxydopamine on blood pressure of apontaneously hypertensive rats.

Six-hydroxydopamine (6-OH-DA) was administered intraventricularly to 6-week-old and 5-month-old spontaneously hypertensive rats (SHR), and was administered into the spinal cord of 6-week-old SHR. Intraventricular administration of 6-OH-DA into 6-week-old SHR prevented the development of hypertension for at least 12 weeks; pressor response of the perfused hindquarters to noradrenaline was the same in 6-OH-DA-treated and vehicle-treated animals. Intraventricular administration of 6-OH-DA into 5-month-old SHR with established hypertension produced only a transient fall in blood pressure. Local injection of 6-OH-DA into the spinal cord produced a marked reduction only in spinal cord noradrenaline but did not affect the development of hypertension in SHR. These findings suggest that brain adrenergic neurons may participate in the development of hypertension in SHR but noradrenergic projections in the spinal cords are not essential for this process.


[Hypotension, mental disorders and changes in catecholamine excretion observed during the administration of disulfiram in a case of pheochromocytoma].

A case of pheocromocytoma treated with disulfiram during ten days in described. Hypotensive and psychiatric effects were observed, which disappeared upon discontinuation of the drug. Urinary amines decreased while the drug was used, and upon interruption of its administration dopamine increased, as a rebound phenomena probably due to availability of tissue dopamine previously blocked by DBH inhibition. The effect of simultaneous administration of alpha-methyldopa is considered.


Effect of flunarizine on calcium-induced responses of peripheral vascular smooth muscle.

Flunarizine, a difluoro derivative of cinnarizine, is a potent inhibitor of Ca2+-induced constriction of isolated arteries; this inhibition has a gradual onset and a prolonged duration. The present study demonstrates that flunarizine inhibits Ca2+-induced responses in the rat tail and the rabbit ear arteries, but not in isolated cat papillary muscle; flunarizine does not depress the spontaneous rhythmic activity of the rat portal-mesenteric vein. This dissociation between the arterial preparations on the one hand, was less pronounced with cinnarizine, and was not seen with verapamil and papaverine. The present experiments thus suggest that flunarizine inhibits peripheral vasoconstriction by selectively decreasing the rate of stimulated Ca2+-influx, without affecting the myogenic activity of the vascular smooth muscle cells.


Antagonism by morphine and pethidine of the contractile effects of PGE2 on isolated uterus of the rat.

Morphine antagonizes the twitches evoked by administration of PGE2 on spontaneous contractile activity in the isolated uterus of the rat. This action is dose-dependent. Concentrations as low as 2.6 nM completely abolished contractile activity of PGE2 added to the bath at a concentration of 0.5 ng ml-1. In contrast to morphine, pethidine partially antagonized the stimulatory action of PGE2 at much higher concentrations.


Management strategies for urinary and vaginal infections.

Detailed history, physical examination, laboratory and follow-up data were obtained from 821 women coming to a primary care clinic over a two-year period with the symptoms of urinary tract (UTI) or vaginal infection. Using all available information, each patient retrospectively was given one of several mutually exclusive diagnoses. Vaginitis without UTI was diagnosed in 70% of patients, UTI without vaginitis in 12%, UTI and vaginitis in 2%. The conditional probability of the several possible diagnoses was calculated, given various combinations of clinical data; a diagnosis of vaginitis was twice as likely as a diagnosis of UTI in a patient with dysuria. On the basis of these calculations we identified efficient clinical strategies for when to perform a pelvic examination, a urinalysis, and a urine culture, and when to diagnose UTI presumptively on the basis of urinalysis.


Digoxin metabolism in patients.

In 100 patients receiving digoxin to control heart disease, metabolic reduction of the lactone ring of digoxin was investigated. An average of 12.4% +/- 11% (range 2.2% to 52%) of the lipid-extractable cardenolides in a 24-hour urine sample contained the reduced lactone ring. Fifty-three excreted more than 10% while seven excreted more than 35% of these metabolic products. Reduction was not influenced by age, sex, dose, or blood level of digoxin. One patient who excreted 52% reduced products in the urine had 40% reduced digoxin-metabolites in the blood; the main metabolite was dihydrodigoxin. We found no influence of other drug therapy or concurrent disease on reduction of digoxin in this group.


Calcium-uric acid nephrolithiasis.

A small fraction of patients with nephrolithiasis form mixed stones containing calcium and uric acid or pass both calcium and uric acid stones; 23 of 539 patients we have studied fall in this category. These mixed stone formers tend to have unusually frequent stone recurrences. Although the patients are often considered to have a variant of uric acid nephrolithiasis, a high proportion harbor calcium as well as uric acid disorders. The usual treatment for uric acid lithiasis may fail to prevent calcium stone recurrence, unless concomitant calcium disorders are simultaneously corrected. Dual treatment may be very effective in preventing continued stone disease.


Streptococcus bovis bacteremia and underlying gastrointestinal disease.

Twenty-six adults with Streptococcus bovis endocarditis and ten with bacteremia alone were studied to determine possible portals of entry. Of 36 patients (17 with endocarditis, eight with bacteremia alone), 25 had gastrointestinal lesions or manipulation. In 22, the gastrointestinal tract appeared to be the source of S bovis bacteremia. Four patients had either carcinoma of the colon (two) or potentially malignant villous adenomas (two) when first seen because of S bovis bacteremia. None of these, nor two other patients with benign colonic polyps, had bowel-related symptoms or signs prior to admission. Since S bovis is a normal intestinal tract inhabitant, bacteremia may frequently be associated with bowel lesions. Streptococcus bovis bacteremia may provide an early clue to the presence of serious and clinically unexpected gastrointestinal disease. Gastrointestinal tract evaluation should be part of S bovis bacteremia patient management, with or without endocarditis.


Diagnostic value of ascitic fluid lactic dehydrogenase, protein, and WBC levels.

Three characteristics of an exudate, ie, an ascitic fluid lactic dehydrogenase (LDH) level of greater than 400 Sigma units (SU), an ascitic fluid-serum LDH ratio of greater than 0.6, and an ascitic fluid-serum protein ratio of greater than 0.5, were studied in a prospective fashion to determine their usefulness in the differential diagnosis of ascites. The ascitic fluid LDH level did not exceed 400 SU in any patient with uncomplicated chronic liver disease, whereas in patients with malignant, tuberculous, or pancreatic ascites it exceeded 500 SU in 12/19 patients. The finding of two of the three characteristics indicated a nonhepatic cause for the ascites whereas the absence of all three strongly suggested uncomplicated liver disease as the sole cause. The ascitic fluid WBC count was also useful in that values exceeded 500/cu mm in bacterial and tuberculous peritonitis whereas it was low (297 +/- 49/cu mm) in chronic liver disease.


Duodenal ferritin content and structure: relationship with body iron stores in man.

The relationship between serum ferritin and duodenal ferritin was examined in normal subjects and in patients with iron deficiency, secondary iron overload, or idiopathic hemochromatosis (IHC). A positive correlation between serum ferritin and duodenal ferritin concentrations was found in all groups. In the iron-overload conditions, duodenal ferritin concentration was lower at all levels of serum ferritin in comparison with normal and iron-deficient subjects. Patients with secondary iron overload did not differ from those with IHC, which indicates that any decrease in duodenal ferritin concentration was secondary to the excess body iron stores. Purified duodenal ferritin from normal subjects and patients with iron-overload conditions showed the same two distinct isoferritins by isoelectric focusing. After the oral administration of iron, two additional isoferritins were detected. These resembled the major isoferritins of liver.


Effect of phosphate or magnesium cathartics on serum calcium: observations in normocalcemic patients.

The administration of commercial phosphate cathartic in conventional doses to normal subjects prior to barium enema resulted in a striking increase in serum phosphorus levels followed by a decline in serum calcium levels in all subjects. Changes were highly significant (P less than .01) when compared with control subjects who were prepared for the same procedure with magnesium citrate. Levels of serum potassium also decreased significantly (P less than .01) but not serum sodium, chloride, bicarbonate, or magnesium.


Complications associated with arteriovenous fistulas in patients undergoing chronic hemodialysis.

Over a two-year period, 100 venous angiograms were performed on 75 patients because of difficulty with vascular access. Seventy percent of the patients had decreased arterial flow or increased venous resistance. High output failure, sepsis, and aneurysm formation were also found. Venous angiography of the fistula demonstrated significant stenosis in 40% of the cases as well as total occlusion by thrombus in 9%, aneurysm formation in 7%, and abnormal fistula needle placement or anatomic abnormalities in 20% of the cases. Definitive diagnosis with the aid of venous angiography permitted specific surgical intervention in 62% of the cases, and identified new sites for needle placement in 18% of the cases, thus prolonging fistula life and reducing the need for new fistula placement. Our experience with local cellulitis of the fistula site and sepsis is also discussed.


Renal involvement in Behçet's syndrome.

A retrospective study of 77 cases of Behçet's syndrome showed that, of the 33 patients in whom urinalysis was done (including three with systemic amyloidosis reported earlier), 17 had pathological results. A prospective study of 51 of these patients uncovered eight additional subjects with urinary abnormalities, bringing the total to 25. The urinary abnormality was, as a rule, discrete, consisting of proteinuria and/or microhematuria. These occurred in some patients persistently, in some intermittently, in some alternatingly, and in some simultaneously. The initial finding was proteinuria in 10 patients, hematuria in 11, and both in 4. Over the years, eight showed only hematuria, seven only proteinuria and ten, both. The urinary sediment contained neither leukocytes nor casts. Pyelographies were unrevealing when performed and rectal biopsies uncovered no new instance of amyloidosis. These data suggest that a benign renal lesion occurs in Behçet's syndrome, whose pathological substrate, though not yet defined, is not amyloid deposition.


Remission of chronic lymphocytic leukemia after smallpox vaccination.

A 78-year-old man with untreated chronic lymphocytic leukemia (CLL) was revaccinated for smallpox. A severe local reaction and generalized rash followed that responded to treatment with vaccinia immune human globulin. After recovery, the leukocyte count fell to normal and all evidence of CLL disappeared. He remains in complete remission three years after smallpox vaccination.


Tropical pyomyositis and myoglobinuria.

A 24-year-old Samoan woman had rhabdomyolysis, myoglobinuria, and acute renal failure, secondary to tropical pyomyositis. The pathogenesis, clinical manifestations, and management of pyomyositis and myoglobinuric renal failure are reviewed.


Methotrexate-induced renal failure and ineffectiveness of peritoneal dialysis.

Acute renal failure developed in a 47-year-old man during the second course of a high-dose methotrexate sodium (MTX) treatment for chondrosarcoma of the pelvis with pulmonary metastasis. Uninterrupted peritoneal dialysis for seven days had a negligible effect on plasma MTX. Although high-dose leucovorin calcium prevented severe myelosuppression and mucositis, the patient died 12 days after receiving MTX. Renal histological studies showed severe tubulointerstitial damage consistent with MTX toxicity. Better alternatives for removing MTX in patients with renal failure are clearly needed.


Amyloidosis secondary to drug abuse and chronic skin suppuration.

Amyloidosis has not been included in the wide spectrum of medical complications associated with drug abuse. Chronic visceral infection is a recognized cause of amyloidosis, but chronic suppuration of the skin is not a well-appreciated cause of this condition. Furthermore, to our knowledge, chronic skin suppuration secondary to parenteral drug abuse has not been reported as a cause for systemic amyloidosis. We report a case in which subcutaneous injections of narcotic tablets led to chronic skin suppuration and systemic amyloidosis.


Salicylate-induced hypoglycemia and ketoacidosis in a nondiabetic adult.

A 78-year-old nondiabetic woman was admitted to the hospital with salicylate-induced hypoglycemia. Ketosis was present with a moderate metabolic acidosis and primary respiratory alkalosis. The patient's mental status improved immediately following intravenous administration of glucose. The case illustrates salicylate's hypoglycemic activity, and that the metabolic acidosis may have exacerbated symptoms of cerebral glucopenia.


Fever, tachycardia, and hypertension with acute catatonic schizophrenia.

Fever, tachycardia, and hypertension developed concurrently with the administration of thiothixene during an acute episode of agitation in a case of catatonic schizophrenia. No cause for the fever or hyperkinetic state was found, and the syndrome resolved spontaneously one week after antipsychotic drug therapy was halted. This case appears to be an example of "acute lethal catatonia" or the neuroleptic "malignant" syndrome, both of which may be due to disturbances of dopamine function within the CNS. Such cases are rare, but may be dramatic in their presentation; however, antipsychotic drugs must be withheld during the duration of the disorder.


Acute respiratory distress caused by erythromycin hypersensitivity.

Severe respiratory distress developed in a patient after ingestion of two tablets of erythromycin (Erythrocin) stearate. Complete atelectasis of the left lung was found. The patient was treated intravenously with 200 mg of prednisolone sodium tetrahydrophthalate. On the same day the patient's condition improved dramatically and repeated chest roentgenograms disclosed an almost complete expansion of the atelectatic lung. Using the indirect mast cell degranulation test and the inhibition of direct mast cell degranulation test, we have shown the presence of IgE and non-IgE antibodies (heat stable) against erythromycin. This suggests that an allergic reaction of type 1 and type 3 participated in the course of the clinical picture.


Multiple plasmacytomas with thoracic and biliary involvement.

The course of a patient who had nonsecretory multiple myeloma was characterized by extraosseous plasmacytomas that were initially limited to pleural lesions with effusion and subcutaneous masses. Subsequently, we noted the development of obstructive jaundice caused by a mass at the head of the pancreas, which was diagnosed by abdominal ultrasound and responded to radiation therapy, and bilateral pulmonary nodules, which were visualized by fiberoptic bronchoscopy. Forceps biopsy of an endobronchial lesion showed plasmacytoma similar in histologic features to her original osseous lesions. The pulmonary nodules responded to cyclophosphamide and prednisone. During her course, she had three forms of intrathoracic myeloma: rib lesions extending into pulmonary tissue, pleural disease, and multiple endobronchial masses. The biliary and pulmonary manifestations of plasmacytomas are rarely seen. Diagnosis by noninvasive procedures and rapid response to conservative therapy were important in this patient's care.


[Meat quality in swine. 5. Relationships between blood parameters and meat quality].

The responses of haemoglobin, haematocrit, glucose, and lactate to natural strain and their relationships to pork quality were studied in several experiments with 155 animals. Stress associated with blood-taking following snout-loop fixation, evacuation, transport, and stunning led to excessive excitation which, in turn, caused deflection of the above parameters. Their correlations with criteria of pork quality are unimportant. Assessment of individual strainability of the neuromuscular system on the basis of the above stresses and blood parameters, therefore, does not seem to be promising at all. This result has been confirmed by repeated testing of the above criteria between evacuation and bleeding. The animals tested responded quite variably. Their pork qualities were both "normal" and "impaired".


[Determination of nitrates in feed and blood samples].

Nitrate and nitrite compounds in feedstuffs were readily and immediately absorbed from the digestive tract right after intake. Nitrate, therefore, is reflected in the blood, depending on intake quantity. Nitrate concentrations recorded from the blood are superior to values established from feedstuffs in substantiating conclusions as to intake quantity. A diagnosis of nitrate intoxication, based on feedstuff testing, should be confirmed by blood testing. Two methods are proposed for quantity determination of nitrate levels in feedstuffs and blood. The presence of hypomagnesaemia should be ruled out in any differential diagnosis undertaken for suspicion of nitrate intoxication.


[Necrotizing enteritis in nursing piglets (Clostridium perfringens type C enterotoxemia) in industrialized swine breeding facilities].

Outbreaks of necrotising enteritis, caused by Clostridium perfringens, Type C, among piglets on five industrialised breeding units are reported in this paper. Original diagnosis was confirmed by clinical, pathologico-anatomic, histological, and bacteriological tests as well as by the detection of beta toxin from the intestinal matter of piglets after death. Cl. per fringens, Type C, was successfully isolated from 71.9 per cent of all animals that had died of necrotising enteritis. Three forms were differentiated by pathologico-anatomic findings: 1. haemorrhagic-necrotising enteritis with excessive bleeding of the intestinal wall and blood loss into the intestinal lumen; 2. necrotising enteritis with small scattered foci of bleeding; 3. necrotising enteritis without any bleeding. The first form usually developed concomitantly with peracute and acute disease in the first three days of age, whereas the third form was primarily recorded from piglets that had died, following subacute disease, between the fourth and ninth days after birth.


[Value of electroencephalography in veterinary medicine. Methods of electroencephalographic recording in cattle].

No significant differences were found to exist between the potentials of the two cerebral hemispheres in clinically intact cattle. Six Frisians were tested, and frequencies obtained from scalp recording were not significantly higher than those recorded from the Lamina interna. The average rise was 1.21 Hertz or 4.06 per cent on the basis of 29.79 Hertz mean frequency. The amplitudes, however, declined on average by 4.36 microvolt per wave, that is by 18.4 per cent. These changes were significant in 50 per cent of the probands. The technique of recording cerebral potentials from the scalp of cattle appears to good information in the context of cortical rhythms. Faulty recording may cause amplitude variation, with different amplitude heights in different animals. The technique of scalp recording has proved applicable to a wide variety of examinations.


[Behavior of blood glucose in piglets up to the 10th day of life with reference to colostrum consumption and birth mass].

The following results were obtained from studies into the behaviour of blood glucose in 439 piglets: -The first experimental group included 48 piglets exposed to follow-up checks in the first ten days of age. Glucose values prior to the first intake of foremilk were higher than those measured afterwards in ten animals (20.8 per cent). The second experimental group included 391 piglets tested under production conditions, and a result identical to the one above was recorded from 48 animals (12.3 per cent). The conclusion is that rise of blood glucose does not take place in all piglets after the first intake of foremilk. -Blood glucose concentrations were found to go up discontinuously up to the tenth day of age, depending on birth weight and feed intake as well as on glycolytical and gluconeogenetical capacities. -Average glucose values between 50.23 and 67.37 mg/100 ml plasma were recorded from newborn piglets prior to first foremilk intake in four groups differentiated by weights a birth between 800 g and 2,200 g. A relationship was statistically secured between blood glucose concentration and birth weight of newborn piglets. The correlation factor appeared to depend on the weight at birth.


[Quantifiable morphokinesis in members of the hypothalamo-adenohypophyseogonadal axis of hormonally castrated boars. 2. Studies on norgestrel treated boars].

Norgestrel treatment of boars differed from analogous chloromandinone acetate treatment in that no significant morphokinetic effect was recordable from all parts of the hypothalamic-adenohypophyseal-gonadal axis. The morphometric parameters as well as the histological pattern obtained of the anterior lobe of the pituitary gland appear to prove that in boar the antigonadotropic effect of norgestrel is lower than that of chloromadinone acetate, with dosage and duration of treatment identical.


[Reactions of the domestic pig to exhausting motor stress of middle intensity].

The VO 2max value was established from twelve pigs, followed by checks of their responses to endurance stress (walk 0.7 m/sec, ambient temperatures between 22 degress C and 24 degrees C, relative humidities between 67 and 78 per cent). Also measured were the rectal temperature, heart rate, respiratory rate, haemoglobin level of the blood, haematocrit, mean corpuscular haemoglobin concentration, plasma volume, blood volume, total haemoglobin, plasma glucose concentration and plasma lactid acid concentration. A differentiation could be made between one group weighing between 53.3 +/- 2.47 kg and enduring 97 +/- 9 minutes and another weighing 60.0 +/- 1.38 kg and enduring 36 +/- 6 minutes. The  two groups differed from one another for their plasma and blood volumes, their values being 42.6 +/- 3.8 ml/kg and 67.5 +/- 7.5 ml/kg or 33.5 +/- 3.4 ml/kg and 52.2 +/- 5.9 ml/kg. The groups produced quantitatively different responses to endurance stress. The demands implied in endurance were widely met by the circulatory system, while the energy transfer was characterised primarily by aerobic energy collection.


[Metabolism and excretion of 32P-aminophon in lactating cattle].

P-labelled aminophon, 0,0-di-u-butyl- (1-n-butylaminocyclohexyl) -phosphonate, an agricultural defoliant and siccant, was applied orally in oily solution to lactating cows, 5-6 mg/kg bodymass, resp. The halflifes of degradation in blood serum in vitro are 95 min, of the extractable metabolites in blood, milk and urine 17-20 h. The 0-and 0, N-dealkylcompound of aminophon were found as the preferred metabolites.


[Effect of aspirin and indomethacin on changes caused by Pateurella multocida toxins in calves].

Acetylsalicyclic acid acid (50 mg/kg die) and indomethacin (1.5 mg/kg die) were administered to calves three days prior to intravenous application of endotoxin. Such treatment resulted in delayed occurence of clinical symptoms and higher survival rates, as compared to untreated controls. Parameters relating to coagulation physiology, changed by endotoxin, were not controllable with statistical security by administration of acetylsalicyclic acid indomethacin.


[Study on diarrhea in young calves. 2. Pathomorphological studies in clinically healthy calves and in calves with diarrhea].

Pathological-anatomical and histological investigations were performed in 49 calves aged from 1 to 18 days, 26 of them being affected by diarrhoea, 23 being without clinical signs. In both the groups above all rhinitis, gastritis and typhlocolitis could be observed, thus the affection could be characterized as rhinogastrocolitis. Significant differences only existed between diarrhoea affected and clinical incospicuous calves concerning the macroscopic signs of the colon, periportal infiltrates of the liver and thymus in involution. The peak of inflammatory reaction is in general reached at the 7. to 10. day of life. In concordance with bacteriological findings the results refer to an affection not due to coli infection. Virus etiology may not be excluded and has to be examined in further studies.


[Characteristics of Staphylococcus aureus strains from pathological processes in swine].

120 Staphylococcus aureus strains from different and sporadic pathological process in swines have been investigated on biochemical properties and phage patterns. 98 strains (82%) exhibit coagulation of human plasma, no coagulation of bovine plasma, crystal-violet-type C, hemolysin-type beta, no formation of fibrinolysine and sensitivity for phages of group I, III and M. Only in few strains we observed reactions with phages of group II. 26 from 66 strains were resistant to antibiotics, and among them 24 showed resistance to oxytetracacline.


[Sub-tentorial cerebral abscesses in children; a report of 22 cases].

Twenty-two cases of sub-tentorium cerebral abscesses were observed in children. The first clinical symptoms were those of intracranial hypertension, disorders of consciousness, specially somnolence, fever and low general condition. Focal neurological signs were frequent but appeared later. A cerebral abscess should be suspected when such symptoms occur in children with heart disease or with respiratory infection. Simple investigations like examination of the fundi, X-ray of the skull and EEG give valuable clues. In case of such a clinical picture, lumbar puncture is useless and often dangerous. The best diagnostic test is a cerebral scintigram.


[The bacterial flora of the appendix in children].

Qualitative bacterial samples were taken from 53 appendices which were purulent, or had lymphoid hyperplasia or were normal. The results did not demonstrate a specific bacterial flora responsible for appendicular disease in childhood.


[Genetic transmission of Lowe's oculo-cerebro-renal syndrome in girl].

A girl who had all the clinical laboratory features of Lowe's syndrome is described. In the literature there are at least 5 other females recorded. They could arise by the preferential inactivation of the normal chromosome (lyon's hypothesis) or alternatively an autosomal dominant mode of inheritance with weak penetrance could be postulated.


[Mucolipidosis type I. Sialidosis due to alpha-2-6-neuraminidase deficiency with neurological symptoms].

A case close to mucolipidosis I was observed and the description of this mucolipidosis has to be revised since there were initially some confusions with mannosidosis. Three types of abnormalities appear to be important in its distinction from the other types of oligosaccharidoses: presence on the fundus of a cherry-red spot; in the bone marrow, reticulo-histiocytic cells, whose central nucleus is surrounded by multiple optically empty droplets; very elective overload of the Kupffer cells. 3a neurological syndrome with cerebellar ataxia appears in the evolution. However, it is not present in our patient nor the electroencephalogram changes. This latter point does not authorize the definite identification of our case with Spranger and Wiedemann description of mucolipidosis I especially as the neuraminidase deficiencies are certainly heterogenous.


[Biochemical tests during measles].

In order to evaluate the role of measles in the development of vitamin A deficiency, biochemical parameters were compared in four groups of patients: a) 31 children in the first week of measles, b) 10 of these children who returned two weeks later, c) 9 patients hospitalized with other infections and d) 6 healthy controls. The average levels of serum iron, carotene, total proteins, albumin and beta-globulins did not differ significantly between these groups. However, during the first week of measles the following significant differences were found: a) an increase in alpha-2 and alpha-1-globulin levels (p less than 0,01), b) a decrease in gamma-globulin level (p less than 0,001), c) a decrease in vitamin A concentration (p less than 0,05) without clinical signs of deficiency. In the 10 patients who came again 2 weeks after the rash these parameters had returned toward control levels.


[Renal atrophy in a child].

An acquired small kidney in a girl of 10 is reported. Interstitial pyelonephritis was the main cause for the shrinkage of the kidney, but very localised areas of renal dysplasia have also been found in this kidney, which happened to be completely destroyed in 34 months. In this meanwhile, the child had recurrent febrile urinary tract infections (clinically acute pyelonephritis). No malformation of the lower urinary tract was found in this child.


[Banti's syndrome complicating angiomatosis].

A boy, aged aged 11, developed sucessively splenomegaly, portal hypertension with hepatic fibrosis and finally pulmonary arteriovenous shunts which were responsible for chronic hypoxia. The authors discuss the classification of syndromes with hepatosplenomegaly that cause Banti's syndrome, and the pathogenesis of multiple pulmonary arterio-venous fistulae in certain liver diseases. The existence of multifocal abdominal, pulmonary and cutaneous vascular malformations suggests that there may be a diffuse vascular abnormality.


[Mycoplasma pneumoniae infection associated with ectodermosis pluriorificialis: a report of two cases].

Two children (4 and 12 years old) presented with a Stevens-Johnson syndrome. The symptoms and their evolution were remarkably similar. In both cases, a Mycoplasma pneumoniae infection was suspected after a serolgic study. This etiology, still unfamiliar, must be suspected in presence of severe stomatitis in children.


The production and biology of polyethylene wear debris.

Polyethylene in the form of a concave bearing surface at the hip wears very slowly, and clinical and histological evidence suggests that the volume of debris so released is well tolerated. However, significantly greater volumetric wear rates are produced when (1) polyethylene is used as the convex component of a joint and (2) abrasives such as PMMA or bone enter the joint. Further, large quantities of polyethylene debris lead to the replacement of bone at the bone-cement interface by soft tissue. Evidence is presented which strongly suggests that this mechanism can produce joint component loosening.


[Treatment of coxa magna in Perthes disease by pelvic osteotomy (author's transl)].

In M. Perthes a progressive deformation and flattening of the epiphysis is caused by the stress in the hip. In the beginning stages a varisation osteotomie gives a sufficient reduction of the joint pressure and a modelling of the enlarged head by the acetabulum is possible. In later stages a detoriation of the head deformity with fixed adduction contracture can be caused by varisation osteotomie. Enlarging the acetabulum laterally and ventrally and medializing the hip-joint by means of a Chiari pelvic-osteotomy reduces the joint pressure so far, that a restitution of the hip joint with round and congruent joint surfaces can be expected. A lateralisation of the deformed femoral head with a secondary insufficiency of the acetabulum should also be treated by an additional pelvic osteotomy, if in the arthrography the lateral part of the head does not enter the acetabulum in abduction position. In secondary osteochondritis in hip luxation the treatment should be equal. Even an advanced secondary osteoarthritis after M. Perthes could be stopped by pelvic osteotomy over years.


[The fixation of the flail chest with tension band wires (author's transl)].

A new technique of internal fixation of the flail chest was tested successfully in sheep. After reduction a 0.8 mm wire is passed twice intramedullary across the fracture and twisted under tension with two loops on the external side of the rib. This wire neutralizes bending and rotational forces and produces axial interfragmental compression. Combined with tension band wire fixation of an eventually fractures sternum it produced sufficient stability even in the very thin parasternal part of ribs. No respiratory support was necessary postoperatively. The method is simple and needs no special equipment.


[Repair of defects in the Achilles tendon with the peroneus brevis muscle (author's transl)].

The authors report a dynamic plastic repair of the Achilles tendon in cases of neglected rupture: The peroneus brevis muscle is used to bridge the gap. The muscle remains intact at the proximal end, its tendon is dissected immediately above its insertion, then pulled through the calcaneus by a bore-hole and fastened to itself and to the ends of the Achilles tendon. If a plantaris tendon exists, it may be used to strengthen the defect by resecting it as far as possible proximally and then fanning it out to cover the gap. The distal end of the peroneus brevis tendon is sutured side-by-side to the peroneus longus tendon. This technique was first applied in 1968. During the last 5 years 8 patients underwent repair of the Achilles tendon by this method at the Department of Orthopaedic Surgery at the University of Kiel. In all cases the results obtained were good or excellent. The patients were very content and returned to a comparable level of preoperative activity. They were able to go as well on tip-toes as on the heels, though dorsal extension in several cases was slightly restricted. Calf atrophy up to 3 cm was found in several cases, which, however, was due partly to preoperational influences. In two cases wound healing complications occured without disturbing the functional results. The authors can recommend their technique, which seems to be superior to other methods especially in difficult cases with large gaps and unfavourably anatomic conditions.


[The therapy for pyogenic coxitis and its stabilisation with the fixateur externe (tubular system) (author's transl)].

The treatment of the destructive, unstable state of infection on the hip often takes an unfavourable course, because alloarthroplastic techniques are ruled out on principle, while the hip arthrodesis itself creates biomechanical problems under the incomparably more favourable aseptic conditions. The protracted trimming arthrodesis with immobilisation by pelvic plaster cast remains precarious with regard to the painful stress and the sedation of the infection, and it always includes the danger a damage causing immobilisation of the knee joint. The jointparts destructed by the infection are equivalent to an infected pseudarthrosis; for its stabilisation the fixateur externe is indicated, by analogy to the approach used on the extremities. The biomechanical problems are similar to those occuring with the internal fixation of hip arthrodesis: neutralisation of dislodging forces on the long leg lever, reliable anchorage of the means of osteosynthesis on the pelvis and axial compression on the broadest possible contact surfaces of the anthrodesis. A special installation of the fixateur externe (tubular system of the ASIF) is pointed out, which meets almost all requirements. The external osteosynthesis joins lateral ilium and femur shaft, compressing the hip area. For securing the stability it is necessary to include both of the iliac crests and a diagonal brace in the outer construction. The external fixation for stabilising the hip represents a large-scale technique which, by its nature, is inferior to internal osteosynthesis. But for the treatment of active pyogenic coxitis neither the arthrodesis by copra-head-plate nor the screw joint in connection with intertrochanteric osteotomy is suited. The advantages in contrast to the classical therapy with pelvic plaster cast are obvious. The operating method is explained on a model and presented in a casuistry on 3 people operated on so far. If the head-neck-segment is lost completely after septic head necrosis, a careful debridement and the Girdlestone-plastic usually lead to an infection sanitation, but mostly at the cost of an unstable hip on the considerably shortened leg.


[The relative elongated patellar ligament after identation of the lateral retinacula (author's transl)].

The treatment of the lateralisation of the patella can be done by lateral indentation of the retinaculum patellae (method of Viernstein). Caused by the medialisation of the patella eventually the patellar ligament can be realtively elongated. This leads to insufficiency of the extensors and therefore to prearthrosis of the knee joint. To avoid this and to conserve the sportive ability we recommend the displacement of the tuberositas tibiae to medial and distal.


[Indicis tendon transfer. technique and results (author's transl)].

We examined 38 patients out of 41 with indicis tendon transfer, performed at the Department for Hand Surgery of the University of Munich during the past eight years; the patients had suffered a subcutaneous rupture or an open traumatic separaton of the extensor pollicis longus tendon. In five cases the function fo the operated had was found deteriorated by other causes. Of the remaining 33 patients 26 showed an excellent function and five patients a good function of the operated thumb. Deficient functional results were discovered with two patients. Almost in all cases extension of the index finger was found reduced in force; none of the patients, however become aware of it. In performing the tendon anastomosis care must be taken to apply proper tensions to the tendons joined.


[2nd Generaltion of the Munich hip-joint-simulator (author's transl)].

In addition to the improved, universal unsable, electronic-hydraulic directed hip-joint-simulator type "MUNCHEN I", a new simulator with simplified construction has been developed. This mechanical hip-joint-simulator is marked by a dual drive of movement and strain mechanism, that has been realized by a toothed belt drive. The adjustable, three-axial movement simulates level walking. According to its special, easier design the new simulator is highly adapted for comparative testing of total hip endoprostheses regarding the fields of quality improvement or standardization testing.


[Isolated rupture of the anterior cruciate ligament. Clinical and experimental study (author's transl)].

The isolated rupture of the anterior cruciate ligament is possible. 5 own cases are described and compared with those of other authors. The mechanism of the injury is a forced inward rotation- and varus-stress of the knee joint under full pressure as a deceleration-twisting motion. Our own experimental measuremens on the ligaments of hte knee joint with strain gauges are proving this fact. The suspeced diagnosis of an isolated rupture of the anterior cruciate ligament is strengthened by a painful snapping or popping within the knee joint in the moment of the injury, a fast increasing swelling of the joint and a feeling of instability. Normaly an anterior dawer sign is not found. The treatment of choice is the suture of the ligament because unrepaired isolated anterior cruciate ligaments can lead to an increasing instability of the knee joint with time.


Automated measurement of patient activity on a hospital rehabilitation ward.

Change in patient activity is frequently an important clinical variable, yet these changes are difficult to monitor and document empirically. Patients on a rehabilitation ward in a Veterans Administration hospital during a three-month period participated in a direct measure of their daily motion by wearing digital pedometers. The resulting data suggest that changes in patient activity can be easily quantified without disrupting ward routine and that the data can serve to strengthen clinical estimates of change which can assist staff in their analysis and interpretation of patient progress.


Electromyographic feedback and physical therapy for neuromuscular retraining in hemiplegia.

Electromyographic feedback was compared with physical therapy for its relative effectiveness in training motor activity in patients with hemiplegia. A cross over design was used, so that each patient served as his own control. Strong reinforcement for attentional direction and for successful response to established criteria was used with both modalities. Electromyography through auditory and visual display was found effective in improving electromyographic activity, but more limited in training effective function as measured by active range of motion. In some cases it was counterproductive. Using an instrumental modality permits attention to only a limited number of motor elements involved in a motion, and is even more limited with respect to the interplay of activation and inhibition of those components. The activity of physical therapy, using tactile, proprioceptive, visual and communicative modalities, has the capacity for attending and drawing attention to many motor elements, as well as to the complexities of activation of some components concomitantly with the inhibition of others during the training process. Electromyographic feedback was felt to be especially useful in its ability to enhance figure-background discrimination and bypass possible areas of sensory obtundation.


Low intensity physical conditioning: effects on patients with coronary heart disease.

The effects of 12 weeks of low intensity physical conditioning on serum lipid levels, body composition, and cardiorespiratory function were studied among patients with coronary heart disease. Twenty-three men, 45 to 59 years old, volunteered to participate. Three were excluded for medical reasons, and one voluntarily discontinued exercise. The conditioning program included a 10-minute warmup, 15 to 30 minutes of walking-jogging at an individually prescribed intensity corresponding to 70% to 75% of maximum heart rate (HRmax), and a 5-minute recovery period. The conditioning resulted in a decrease (p less than 0.05) in heart rate and blood pressure during standard submaximal work (200 kg/m/min). Maximal heart rate increased (p less than 0.05) by five beats per minute. Symptom-limited maximal oxygen uptake increased 12.8% (p less than 0.001) when expressed per unit body weight. Body weight remained essentially unchanged (-0.34 kg), while fat-free weight and fat weight increased (+0.68 kg, p less than 0.05) and decreased (-1.02 kg, p less than 0.05), respectively. Serum lipid levels remained unaffected by the conditioning regimen. Low intensity exercise is effective in cardiac reconditioning and should be favored at least during the initial stages of a training regimen in view of the decreased orthopedic problems, added safety, high adherence level and tolerable working rate.


Optimal back-pack load for short distance hiking.

Twenty young men marched 6 and 12 km with a well-fitted back-pack load of 30 or 35 kg. Each subject served as his own control. No significant increase in mean heart rate, rectal temperature, or decrease in mean VO2 max and serum levels of glucose and muscle enzymes were recorded in the groups marching 6 km with 30 and 35 kg. Significant differences in the increases in mean heart rate, the decreases in VO2 max and the changes in blood glucose were noted between the two groups carrying 30 and 35 kg for 12 km. These significant differences were also supported by the subjective feelings of the volunteers. The present study shows the optimal back-pack load for healthy young men, marching at 6 km/hr on a paved level road to be 30 kg for 12 km and 35 kg for 6 km without considering the task too difficult and with no significant decrease in VO2 max. The results are relevant to hiking, rescue assignments, and military missions.


Arthrography-assisted intra-articular injection of steroids in treatment of adhesive capsulitis.

Following shoulder arthrography to establish the diagnosis of adhesive capsulitis, we injected steroids via the in situ arthrogram needle. Subsequent intraarticular steroids, if needed, were given at the outpatient clinic using landmarks established at the time of arthrography. Out of 18 patients treated, function sufficient to permit resumption of usual work and self-care activities returned to 16. In 11 patients, recovery was associated with painless total shoulder movement gather than a return to glenohumeral motion. This therapy appears perferable to other forms of intraarticular injection and is an alternative to surgery when physical therapy has failed.


Musculocutaneous nerve injury after heavy exercise.

Three cases of musculocutaneous nerve injury distal to its innervation of the coracobrachialis muscle are reported. The syndrome typically features painless weakness of the biceps brachii and brachialis muscles, sensory loss in the distal volar forearm, a history of recent vigorous upper extremity resistive exercise, and resolution of the problem on resting the affected extremity. In all three reported cases the dominant arm was involved. The condition should not be confused with C-5 or C-6 radiculopathy, brachial plexopathy, or rupture of the biceps brachii muscle belly or tendon.


Styles of sexual expression in women: clinical implications of multivaritanalyses.

Two different multivariate techniques were applied to self-reported trait and behavioral data concerning sexual behavior from a sample of North American women. Canonical correlation delineated three styles in which certain demographic attributes and cognitive indices of sexual arousal were related to forms of sexual expression. The first style was characterized by respondents who experienced high rates of intercourse and orgasm in a cohabitation arrangement but who did not necessarily report satisfaction with their sexual responsivity. A second style was characterized by older women currently without partners who expressed a liking for erotic literature and media, direct genital stimulation, and frequent masturbation but who were dissatisfied with their sexual responsivity. The third style, which included respondents most satisfied with their sexual responsivity, was characterized by women who were more aware of physiological changes during sexual arousal and who enjoyed gently seductive erotic activities, breast stimulation, and genital stimulation. A discriminant analysis showed that those women who were most highly satisfied with their sexual responsivity experienced frequent intercourse and orgasm consistency, enjoyed gently seductive erotic activities and breast stimulation, but were unresponsive to erotic literature and media. A second discriminant analysis showed that women who achieved orgasm most consistently were older, were more aware of physiological changes during sexual arousal, reported higher frequencies of masturbation and intercourse, and were less likely to be aroused by erotic preliminaries. These results are discussed within the context of the literature on the treatment and prevention of sexual dysfunction.


Massage parlors and their customers.

Journalistic and sociological studies of massage parlors and massage parlor customers do not serve the development of scientifically sound generalizations. They begin with the assumptions that massage parlors are brothels renamed and that the customers are problematic individuals seeking impersonal sexual exchanges. This standard view of the parlors and customers is here challenged and an alternative approach suggested. The results of an empirical examination of the customers of a West Coast massage parlor are summarized. Data were obtained by a massage parlor worker--an unnamed coauthor--who recorded information about every personal customer during her initial period of work. Both demographic and voluntaristic factors are specified. Included are ethnic origin and occupation, the proposition, the offer of financial reward, the sexual activity desired, and the sexual activity that resulted. A comparison of two views on the nature of the customer demonstrates the limitations the standard view imposes on the potential examination of massage parlors in general. Massage parlors are not brothels renamed and the massage parlor customers are not sex-seeking problematic individuals. Given the results of the empirical examination, the basic complexity of the parlors and their customers is seen as the key aspect on which scientifically sound generalization may be built.


Equity and extramarital sexuality.

Equity theory has recently been found to be a useful framework for understanding the effects of imbalances in intimate "contractual" relationships such as marriage. Equitable couples seem to be happier, more satisfied with their relationship, and more confident that it will last than are their more mismatched, i.e., inequitable, counterparts. Furthermore, inequitable couples predictably act to "set things right" in their marriage. They either restore actual equity to the relationship or psychologically set their relationship in balance. If neither works, they may "leave the field." Extramarital sex may be viewed as an equity restoration mechanism in that (1) it may be used by the deprived partner to achieve actual equity, (2) it may indicate a partner's readiness to leave the relationship because he feels he can "do better," or (3) it may represent a desire to achieve equity in an alternative relationship(s) when inequity pervades the primary one. The hypothesis that the inequitable/underbenefited group should be more likely than the equitable group or the inequitable/overbenefited group to have engaged in extramarital sex was tested using data from a large-scale Psychology Today questionnaire. The results indicated that men and women in inequitable/underbenefited relationships had more extramarital affairs and began their extramarital activities earlier than did men and women in equitable and inequitable/overbenefited relationships. Alternative explanations of this finding, sex-role demands and length of the relationship, are explored and discarded as untenable.


Self-concept and sexuality of spinal cord injured women.

Differences in perceived self-concept and sexual response before and after spinal cord injury were examined. Twenty-four women between the ages of 20 and 40 completed a questionnaire and participated in a brief taped interview. Most of the women viewed themselves as very or somewhat attractive and had been involved in a sexual relationship since injury. The majority viewed sexual relationships as very enjoyable, although many commented that changes in bowel and bladder function had inhibited sexual expression. The need for more effective sexual counseling was highlighted. A trend was noted for an interrelationship between sexuality and self-concept in adapting to acquired disability.


Stimuli eliciting sexual arousal in males who offend adult women: an experimental study.

The sexually arousing effects of short film scenes showing a naked actress's seductive behavior were phalloplethysmographically measured in 14 sexual deviates. These were males who had offended adult women, predominantly exhibitionists. Controls were 14 normal men. Deviates responded positively to the scenes and differentiated strong and weak seduction scenes similarly to normals. Consequently, the question arises of why deviates avoid their victim's erotic cooperation and why they do not offend their regular sexual partners. Post hoc analysis of five scenes which elicited a strikingly higher response in deviates than in normals suggested that these scenes contained reduced seductive behavior but unrestrained presentation of the genitals. This finding further encourages the laboratory study of stimulus conditions for abnormal sexual arousal which occurs during the sexual offense.


Gender role and psychological adjustment.

Three hundred and sixty-six university students (158 males and 208 females) completed a three-part questionnaire. The first two parts consisted of self-report inventories to assess psychological adjustment (Eysenck's Neuroticism Scale and Lanyon's Alienation Scale). The third part assessed gender role (Bem's Sex Role Inventory). Androgyny was scored as per both the Bem (1974) system and the Spence et al. (1975) system, and the groups obtained by these two systems were separately analyzed for differences in psychological adjustment scores. Feminine individuals (regardless of biological gender or system of classification) obtained less adjusted scores, and this was especially significant for males. It was also found that the Spence et al. system had more predictive power than the Bem system for classifying individuals.


Serum testosterone and sexual activity and interest in men.

There is considerable interest in the relationship between testosterone and sexual behavior in men, but the few available data bearing on this issue are inconclusive. This study is an attempt to clarify the relationships among various components of sexuality and serum testosterone concentration through examination of these variables in a large homogenous group of men. Serum testosterone concentration was determined in two blood samples taken 1 week apart from 101 young adult men. Subjects reported their frequencies of various sexual activities and level of sexual interest. Testosterone concentrations in the two blood samples were highly correlated, indicating considerable intraindividual consistency. There was considerable variance among subjects in both mean testosterone and reported sexual activity. Testosterone concentration did not correlate with the sexual activity and interest variables. These results provide evidence that differences among men in circulating testosterone concentration within the normal range do not account for differences in sexual activity and interest. It is also unlikely that variations in sexual activity account for differences in testosterone concentration.


Plasma testosterone level and sexual behavior of couples.

Eleven couples, ages 21-31 years and married for at least 1 year, were studied intensively over a three menstrual cycle period from both an endocrine and a sexual behavioral standpoint. Each subject was interviewed individually and had a blood sample drawn twice weekly. Interviews were rated independently by two psychiatrists for degree of sexual initiation, responsivity, avoidance, couple interaction, and mood. Wives rated themselves also for degree of sexual gratification (responsivity). Plasma levels of testosterone and cortisol were determined for both husbands and wives while progesterone and estradiol levels were determined additionally for wives. Husband's initiation scores were significantly correlated with their wives responsivity (clinically rated) scores for 10 of the 11 couples; wives' initiation scores were significantly related to their husband's responsivity scores for 8 of the 11 couples. When either set of correlation coefficients was treated as a new variable and intercorrelated with the husband's average testosterone levels, a significant relationship was obtained. Intercourse frequency, while not related to either partner's average testosterone levels, was related to wives' testosterone levels at their ovulatory peaks. The wivess' self-rated gratification scores correlated significantly with their own plasma testosterone levels. Inspection of each wife's plasma testosterone profile across the three cycles indicated that a dichotomy coccurred, with some women showing a high baseline level and others showing a low baseline level. When wives were dichotomized on this basis, it was found that high baseline testosterone level was significantly related to high self-rated gratification score and to ability to form good interpersonal relationships.


Adult sexual orientation and attraction to underage persons.

A random sample of 175 males convicted of sexual assault against children was screened with reference to their adult sexual orientation and the sex of their victims. The sample divided fairly evenly into two groups based on whether they were sexually fixated exclusively on children or had regressed from peer relationships. Female children were victimized nearly twice as often as male children. All regressed offenders, whether their victims were male or female children, were heterosexual in their adult orientation. There were no examples of regression to child victims among peer-oriented, homosexual males. The possibility emerges that homosexuality and homosexual pedophilia may be mutually exclusive and that the adult heterosexual male constitutes a greater risk to the underage child than does the adult homosexual male.


Subjective sexual experience in college women.

A random sample of 100 undergraduate women were interviewed about their subjective sexual experience. Sexual sensations during masturbation, oral sex, intercourse, and intercourse with concurrent clitoral massage were summarized and differentiated. Sensations labeled "orgasm" by a majority of the subjects were identified, and the suggestion was made that experiences other than that outlined by Masters and Johnson may be considered orgasmic by women in a more general population. Some support was found for Singer and Singer's typology of orgasm at a subjective level. Most subjects who experienced multiple orgasms found them no more satisfying than single ones. Clitoral and vaginal orgasms may be distinguished subjectively, but no clear preference for one or the other emerged from a consensus of the subjects. Orgasm rate was significantly related (p less than 0.001) to satisfaction during intercourse and oral sex, but not during masturbation. Some evidence was found supporting the role of social learning in developing sensitivity in the clitoris and vagina and possibly the breasts.


Age and sexual culture among homosexually oriented males.

It is here argued that the thesis has been overgeneralized that the culture of homosexually oriented males is heavily youth oriented. It is suggested that any "youth orientedness" is due to their largely single "marital status" rather than to sexual orientation. Utilizing data from 243 males from the Detroit area, several qualifications to the thesis of youth orientedness are indicated. It was found that a majority of males aged 18-24 prefer a male partner who is older, a majority of those aged 25-34 years prefer a same-age person, and 50% of theose over 35 prefer a younger partner. These relationships were found to be especially strong among those segments of the sample who attend gay bars infrequently or who are of lower occupational levels. Also, higher occupational status was found to be associated with preference for the younger, independent of age. It is suggested that, because of the heterogeneity of the male homosexual community, the degree of emphasis of youth will be found to vary with social setting.


An involvement and overtness measure for lesbians: its development and relation to anxiety and social zeitgeist.

The relationships among anxiety, degree of overtness in homosexuality, involvement in homosexuality, and occupational status were investigated to test prevalent hypotheses relating homosexuality and neuroticism. Sixty-three acknowledged lesbians completed the Manifest Anxiety and Defensiveness Scale (MAD), the Lesbian Degree of Involvement and Overtness Scales (DIOS), and a biographical data sheet. Reliability and validity indices for the DIOS are presented. Some findings were that anxiety was not related to degree of involvement in homosexuality, that anxiety was related to degree of overtness in low- but not in high-status lesbians, and that the social Zeitgeist at the time of first lesbian activity was related to degree of overtness but not to degree of involvement in homosexuality. The results are discussed in terms of the relationship between social desirability and a hostile society. Additionally, comparisons of anxiety levels in homosexual and heterosexual women are presented and discussed. The results are interpreted as lending support to the emerging view of the homosexual as nonneurotic.


Sexual interviewing, evaluation, and therapy: psychoanalytic emphasis on the use of sexual fantasy.

Sexual fantasy in initial interviews and during psychotherapy and psychoanalysis is explored for its contribution to understanding psychopathology, both sexual and nonsexual. The focus is on distinguishing between the sexual and the seemingly sexual. "Sexual" behavior and fantasy are regarded as having sexual pleasure and orgasm as the predominant goal. Seemingly sexual behavior and fantasy have a predominant goal that is not sexual, even though a sexual mode is used. Predominant goals in the seemingly sexual are emphasized such as coping with intense aggression and problems of self-esteem, self-definition, self-cohesion, and the maintenance of object relations. Sexual fantasy and behavior can be especially useful for repairing negative self- and object images and the associated intensely negative affects. This does not imply that all more primitive patients are incapable of experiencing intense sexual pleasure and orgasm. On the contrary, borderline patients, with extensive use of splitting mechanisms at the level of dyadic object relating, may have intact sexual functioning.


[Tracer studies in rats with 15N labeled wheat for the determination of endogenous and exogenous fecal nitrogen].

In an experiment with growing Wistar rats of 100 g live weight the N-values and the 15N-frequency of the nitrogen in feces, urine and the experimental carcasses were determined after feeding 15N-labelled wheat. Proceeding from CZARNETZKI's multicompartment model (1969) for N-metabolism in monogastric animals, the measured data were used to calculate the endogenous and exogenous fecal N-proportion of total nitrogen. In agreement with earlier studies the intestinal nitrogen loss was found to rise as the protein intake increased. In this experiment, the intestinal nitrogen loss went up from 8.2 mg N/animal and day (N-free diet) to 33.9 mg N/animal and day at a daily nitrogen intake of 240 mg/animal and day. The true digestibility of the wheat protein (determined by taking into account the rise of fecal N loss) was 97.2% this value being 8.4 units higher than the true digestibility calculated by the conventional regressive method of fecal analysis with a constant value being taken for fecal N loss. In connection with earlier findings, this experiment allows to draw the conclusion that the true digestibility determined conventionally by regression analysis does not reflect the actual digestibility of the protein.


[The performance-related lysine requirement of fattening pigs. 2. Relationship between energy consumption and live weight gain].

With growing pigs (barrows) in the 40 to 120 kg live weight range, a narrow linear relationship of y = 21.06 + 0.7935x(R = 0.9599 sb = 0.0315) was established between daily live weight gain (y in g/kg 0.75) and daily energy consumption (x in feed equivalents (swine)/kg 0.75). The interpolation of the liveweight equilibrium produced a maintenance requirement of 26.5 EF(s) or 93 kcal NEF(s) per kg 0.75. 126 EF(s) or 441 kcal NEF(s) were needed for every 100 g extra live weight gain. The relationships found between energy consumption and gain agree very well with the NEF(s) requirement norm of growing pigs as derived by SCHIEMANN.


[Sources of the afferent pathways of the motor cortex in cats revealed by using the peroxidase method].

By means of the method based on the retrograde axonal transport of exogenic horse-radish peroxidase, there have been stated the sources of afferent pathways of the motor cortex and the structure of neurons sending their axons to the given region. The marked neurons have been found in ipsilateral (SI, SII, Pr, Limb.) and contralateral cortex (MI, Limb.), as well as in the diencephalon (LP, VPL, Hp), the mesencephalon (NR, SN, TM) and the pons (TP). The complex investigation (the peroxidase method and electron microscopy) allowed to get an idea on morphological substrate of disynaptic pathways.


[Choline acetyltransferase in the nerve plexuses of the basilar artery of the cat brain].

Localization of choline-acetyltranspherase (CHAT 2. 3. 1. 6) and acetylcholinesterase (ACHE 3. 1. 1. 7) in the neuronal plexus of the main artery in the cat brain has been studied. It has been stated that CHAT is mainly revealed in preterminal and terminal fibres of the plexus, while AXE--along the whole length of the fibre. ACHE activity is higher than that of Chat.


[Connections between the globus pallidus and putamen and the hypothalamus and subthalamus].

In 16 adult cats with electrolytically destructed external and internal parts of the globus pallidus and in 8 cats with destructed putamen direct strio-pallido-hypothalamic and strio-pallido-subthalamic pathways have been studied. Degeneration of the axonal preterminals and terminals have been examined in preparations treated after Nauta--Gygax, Nauta--Laidlow, Finck--Heimer with simultaneous additional staining of the nuclei with cresyl violet after Kawamura--Niimi. Direct pallido- and putamen-hypothalamic pathways to nuclei of the grey tubercle, posterior and lateral nuclei of the hypothalamus were stated. Direct pathways from the putamen to the subthalamic nucleus have been revealed, however, these pathways are represented in less degree than those of pallido-subthalamic connections. Direct pathways from the external portion of the globus pallidus and putamen to the subthalamic nucleus are more pronounced and represented by greater numbers of projections than those of strio-pallido-hypothalamic origin.


[Connections between the globus pallidus and putamen and the cerebral cortex].

The results are represented on investigation of the projections of the globus pallidus and putamen on the brain cortical fields. In 17 cats a unilateral electrolytic destruction of the exterior and interior globus pallidus, and in 8 cats--unilateral electrolysis of the putamen were performed. The brains were treated after Nauta--Gygax, Fink--Heimer, Kawamura--Niimi. Direct connections between the external globus pallidus with prepiriformic, orbital (field 43), temporal (fields 20, 22), frontal (field 6), precentral (field 4), postcentral (field 2) cortical areas were revealed, and projections of the putamen on the frontal (field 6), precentral (field 4), postcentral (field 2), orbital (field 43) cortical areas were demonstrated. Less fibres connect the putamen with temporal and parietal areas. No convincing evidence was obtained to demonstrate direct connections of the entopedunctular nucleus with the brain cortex.


[Ultrastructural basis of trophic interactions in the central nervous system].

Cytological aspects of metabolic processes between capillaries and nerve cells, as well as between different elements of neurons were studied electron microscopically. The sensomotor cortex, hippocampus, anterior tubercles of corpora quadrigemina, geniculate body were studied in rats, adult cats and 4-day-old kittens. Metabolic ultrastructure was demonstrated by means of vesicles formed by micropinocytosis, in the endothelial wall of the capillary, in the synaptic plaques, in the growth cones. Coincidence of pinocytic processes with active synaptic zones, especially in the developing nervous system, was revealed. The phenomena of intraneuronal metabolism by means of cytoplasmic fragments (clasmatosis) in the area of synapses were described. Endogenic (formed in the zone of the lamellar apparatus) and exogenic (pinocytic) trophic vesicles were compared. In young animals the exchange of the trophic vesicles was demonstrated to precede the synaptic transmission, while in adult animals it seemed to supplement a short-lasting synaptic interconnection.


[Morphometric features of changes in the neurons of the jejunum in the aging body].

It is common observation that in aged people, the number of processes in long-axonal and equal-axonal neurons decreases. Quantitative ratio of these neurons changes, as well. While at mature age long-axonal/equal-axonal ratio is 3 : 1, at old age it makes 1 : 2. In dogs, unlike in human beings, the old age influences neither the number of processes, nor the quantitative ratio of the neurons mentioned.


[Sensory endings in the intramural ganglia of the stomach. Light optical and electron microscopic study].

Puppies and young dogs at the age of 3 days up to 2 months were used in the investigation. In total stomach preparations neuronal structures were stained with methylene blue after A. S. Dogel. Routine electron microscopic studies were carried out. Within the structure of intramuscular vegetative plexus of the stomach a sensory plexus was demonstrated, its terminals forming receptive bushy structures in all the tissues. Especially numerous the sensory endings were in neuronal cords and ganglia. The sensory endings innervated all the elements in ganglia. Ultrastructure of receptor terminals situated in the intramural ganglia of the stomach corresponded to that of terminals in tissue mechanoreceptors described for skin, auriculum, carotid sinus and trachea. Peculiar multilayer lamillar structures formed by cytoplasmic axonal processes of lemmocytes around lance-shaped, arranged in rosary fashion receptor varicosities were described. Contact of receptor terminals with the neuronal cell body was demonstrated. Functional nature of the tissue receptors described was discussed.


[Comparative morphologic features of receptors of central and local origin in the steppe turtle].

Quantitative comparison of morphological features in the receptors of central and local origin has been performed with methylene blue in the small intestine of the tortoise (Testudo horsfieldi). Comparison is made between bushy receptors of central and local origin (formed by the dendrites of cells II, Dogel's type). Despite their common plan of composition, there exist certain differences between these two types of receptors: in the receptors of local origin, unlike the receptors of central origin, terminal plaques, the diameter of the abducent fibre and the size of division areas are large; polymorphism of the terminal plaques is more pronounced. Such indices as length of terminal branches and dimensions of angles between diverging branches are larger in the receptors of central origin.


[Structure of the neuropile of the abdominal brain of polychaetes].

By means of vital staining of neuronal elements with methylene blue, new data were obtained on the structure of neuropil in the abdominal brain of Polychaete (Nereis diversicolar). Neuronal composition and interrelationship between sensory, motor and associative areas are clarified. Dorsoventral differentiation of the neuropil is analyzed; common level of intraneural relations of Polychaetes in the line of Annelida is determined.


[Comparative characteristics of the cholin- and adrenergic innervation of the arteries of the cerebral dura in several mammals and man].

Cholinergic and adrenergic neuronal apparatus of the nasal (anterior), medial and caudal (posterior) meningeal arteries was studied in rats, guinea pigs, rabbits, cats, dogs, pigs, cows and in man by means of histochemical methods of Koelle and Falck. Dural arteries in the above mentioned animals and man were stated to be surrounded with a paravasal and two adventitial plexus--superficial and profound. The greatest concentration of cholinergic and adrenergic conductors was observed on the medial meningeal arteries. The least density of the conductors had the nasal arteries. The mammal and human caudal arteries occupy intermediate position by their number of cholinergic and adrenergic conductors per area unit. A definite increase in concentration of cholinergic and adrenergic nerves was observed in the successive line of the animals: rat--guinea pig--rabbit--cat--dog--pig--cow. The greatest density of cholinergic and adrenergic nerve fibres was observed in human meningeal arteries.


[Various patterns in the development of the periganglionic vascular bed of respiratory tube ganglia during human embryogenesis].

The investigation has been performed in 118 serial sections of human embryos. The development of vascular bed in ganglia of the respiratory tube at early embryogenesis has been studied. The main attention has been paid to the formation of periganglial vascular bed. Loop-like and arc-shaped connections between the developing vessels and galglia and rearrangement of periganglial vascular bed during embryogenesis are described. Three stages in the development of blood supply to the ganglia of the respiratory tube are noted: I stage--avascular (embryos are 17-30 mm long); II stage--formation of periganglial vascular bed (embryos are 33-50 mm long); III stage--formation of intraganglial vascular bed (embryos are 55 mm long and more). Within I and II stages, reorganization phases in the vascular bed are described. A suggestion is made that the vascular factor of the development and differentiation of ganglial elements starts acting since the formation of periganglial vascular bed; before this, the mesenchima surrounding the neuronal plexus performs their trophic.


[Structural features of varicose dilatations of vasomotor nerves (according to data from a three dimensional reconstruction)].

Ultrastructure of varicous dilatation of the axons composing small neuronal fasciculi in the sympathetic plexus of the rabbit coronary artery has been studied. According to the data of three dimensional reconstruction, space structure of three neuronal fasciculi has been restorted. Axons of every fasciculus form varicous dilatation at the same area along their course. A lemmocytic process, accompanying the axon as a thin cylinder at the intervaricous part flattens, in the area of varicous dilatations. and embraces all the axons, thus forming a peculiar functional unit of the neuronal fasciculus. From the data obtained and those of literature, it is possible to suggest that not only single axons situating in the nearest approximation to smooth muscle cells, but also single neuronal fasciculi having in their composition axons with varicous dilatation might effectively influence the smooth musculature of the vascular wall.


The bilingual brain.

The localization of two languages in the lateral cortex of the dominant cerebral hemisphere was determined by the technique of mapping sites where electrical stimulation altered naming in two biligual patients. Sites in the center of the language area of each patient were involved in both languages. Peripheral to this, in both frontal and parietal cortex, were sites involved in only one of the languages. In each patient, each language in part used different areas of brain.


Transient emboligenic aortoarteritis. Noteworthy new entity in young stroke patients.

The clinical and postmorten anatomical data in a group of ten patients with occlusive cerebrovascular disease in the 15- to 40-year group were studied. The occlusion of the peripheral supply artery in the brain in all cases was found to be due to thromboemboli generated from focal thrombotic lesions situated proximally in the aorta and elastic arterial trunks arising from it. These central thrombotic lesions were caused by a transient form of focal aortoarteritis that primarily affects medial elastic tissue underlying the thrombi. This is a new disease entity, distinct from Takayasu's and other forms of segmental aortitis. The pathogenesis of occlusive cerebrovascular disease in the young remains obscure in a majority of cases. In this context, the definition of this new entity is an important contribution to the understanding of nonatherogenic occlusive cerebrovascular disease.


Active multiple sclerosis. Enhanced computerized tomographic imaging of lesions and the effect of corticosteroids.

Computerized axial transmission tomography (CT) of the brain is useful for imaging lesions in multiple sclerosis (MS). Active demyelination may be demonstrated with CT contrast enhancement (CTE) as regions of increased x-ray density. We report a series of patients with active MS who typify these changes. Corticosteroid therapy reduces the intensity of this phenomenon presumably by reestablishing the integrity of the blood-brain barrier; if corticosteroid therapy is instituted prior to the CT contrast study, the focal enhancement may be obscured. A transient vascular permeability defect is the basis for CTE during the acute exacerbation in MS. The possibility of MS must be kept in mind when one or more foci of increased density occur in the absence of mass effect during CTE. Appreciation of these features may prevent misdiagnosis.


Acute multiple sclerosis with contrast-enhancing plaques.

In a case of clinically fulminant multiple sclerosis (MS), contrast-enhancing lesions were visible by computerized axial tomography (CT). The patient died less than three weeks after the study, making neuropathologic correlation possible. It appears that areas of contrast enhancement correlate in acute MS with early demyelinative lesions, and enhancement is related to breakdown of the blood-brain barrier. That such a disturbance is important in the pathogenesis of demyelination in MS has been suggested by other data as well. The characteristic CT findings of MS must therefore include enhancing lesions that reflect disease activity and that may be the only CT abnormality.


Antibody response to arboviruses. Absence of increased response in amyotrophic lateral sclerosis and multiple sclerosis.

Complement fixation and hemagglutination imhibition tests were conducted on the serums of patients with amyotrophic lateral sclerosis and multiple sclerosis using a variety of arboviral antigens. Seventy-eight complement fixation and 15 hemagglutination-inhibition viral antigens were used representing togaviruses, orbiviruses, rhadoviruses, bunyaviruses, arenaviruses, and several ungrouped agents. The serological results did not indicate any relationship between these viruses and either amyotrophic lateral sclerosis or multiple sclerosis.


Paradoxial response to dopaminergic agents in parkinsonism.

A patient with the classical stigmata of parkinsonism was treated on three separate occasions with levodopa, a combination of levodopa and carbidopa, and lergotrile mesylate, a direct-acting dopamine-receptor agonist. All three treatment regimens resulted in dose-related increases in parkinsonian features. To our knowledge, this response has not been previously described. Lergotrile did not alter CSF homovanillic acid concentration. It is suggested that this rare paradoxical motor response to dopaminergic agents may be associated with dysfunction of the postsynaptic dopamine receptor site.


Forced downward ocular deviation. Occurrence during oculovestibular testing in sedative drug-induced coma.

A total of 32 consecutively encountered patients, comatose from sedative-hypnotic drug overdose, were studied by caloric (oculovestibular) testing with ice water. A variety of induced lateral eye movements was observed. The most striking finding was that the induced lateral eye movements were followed (in 24 of 32 cases) by delayed forced downward deviation of one or both eyes. The phenomenon of forced downward ocular deviation during oculovestibular testing of comatose patients should suggest the diagnosis of sedative-hypnotic drug overdose.


Midification of tardive dyskinesia and spasmodic torticollis by apomorphine. Possible role of dopamine autoreceptors.

A group of 16 patients afflicted with involuntary movement disorders received subcutaneous injections of the direct dopamine agonist, apomorphine hydrochloride. Paradoxically, these injections were generally followed by a reduction of dyskinesia; this was most noticeable in patients with tardive dyskinesia and was only mild in some patients with spasmodic torticollis. Preferential stimulation by apomorphine of inhibitory dopamine presynaptic receptors (so-called dopamine autoreceptors) is proposed as the most likely explanation for the observed antidyskinetic effect of this drug. The results of this study also suggest that direct dopamine agonists may be used clinically to attenuate CNS dopaminergic transmission, especially when use of antidopminergic drugs such as the nuroleptics is contraindicated, as in the case of tardive dyskinesia.


Subcortical leukomalacia. Relationship to development of the cerebral sulcus and its vascular supply.

The development of the microvascular architecture of the cerebral cortex and white matter was studied in the preterm, term, and older infant, using postmortem cerebral angiography and metal impregnation studies. During the first few months after birth, a relatively avascular triangle forms in the white matter at the depth of the sulcus. Subcortical leukomalacia occurs in this triangle as well as in border zones between the major cerebral arteries.


Subarachnoid hemorrhage complicating acute poststreptococcal glomerulonephritis.

A 6-year-old boy with seizures and signs of meningeal irritation was found to have a spontaneous subarachnoid hemorrhage. Investigations, including a renal biopsy, were diagnostic of an underlying acute poststreptococcal glomerulonephritis. The patient recovered and is asymptomatic three years later. This case shows that spontaneous subarachnoid hemorrhage can occur in children with acute poststreptococcal glomerulonephritis and should be suspected when meningeal manifestations are prominent.


Hemifacial spasm. A vascular cause.

A review of the literature as well as recent surgical observations indicate that hemifacial spasm may be caused by normal or pathological vascular structures that cross-compress the facial nerve. The critical area of compression is invariably found at the brain stem exit zone of the seventh cranial nerve. In this area the central glial investment of the facial nerve changes to peripheral or schwannian myelin. It is suspected that this anatomical junction zone may be of pathophysiologic significance when directly compressed or irritated. A retromastoid craniectomy and vascular decompression operation is highly successful in relieving hemifacial spasm while at the same time preserving facial nerve function. This is in contrast to most commonly used destructive operations for hemifacial spasm. Microsurgical techniques, however, must be employed or high morbidity and mortality may occur from the retromastoid approach.


Internuclear ophthalmoplegia. I. Saccades and dissociated nystagmus.

Saccades (horizontal and vertical) and dissociated nystagmus were quantitatively assessed in four patients with internuclear ophthalmoplegia. Two patients had bilateral medial longitudinal fasciculus (MLF) lesions associated with multiple sclerosis and two had unilateral lesions associated with brain stem vascular disease. Adducting saccades made on the side of an MLF lesion were slowed in each patient (P less than .01). At the same time, abducting saccades in the contralateral eye had normal velocity, but consistently overshot the target. After the overshoot, the eye returned to the target with an exponentially decaying course. With large angular deviations (usually more than 15 degrees), the abducting eye developed nystagmus characterized by slow components that moved toward the midposition with an initially high velocity followed by a segment of slower velocity. The adducting eye had either no nystagmus or a low-amplitude nystagmus characterized by a rounded junction between the fast and slow component. The saccade abnormalities and waveform of the dissociated nystagmus can be explained by a pulse-step mismatch at the agonist motoneurons.


Internuclear ophthalmoplegia. II. Pursuit, optokinetic nystagmus, and vestibulo-ocular reflex.

Smooth pursuit, optokinetic nystagmus (OKN) and the vestibulo-ocular reflex (VOR) were studied in four patients with internuclear ophthalmoplegia (two with bilateral and two with unilateral lesions). Horizontal smooth pursuit by an adducting eye on the side of a medial longitudinal fasciculus (MLF) lesion was normal in three of four patients; vertical pursuit was abnormal in all four. The horizontal VOR gain of slow components made by an adducting eye on the side of an MLF lesion was normal in all four patients. The vertical VOR gain was decreased in the two patients tested. It is concluded that either there are pathways independent of the MLF for horizontal pursuit and vestibular signals that are not available to vertical signals, or vertical pursuit and vestibular eye movements require a higher rate of oculomotor neuron firing than equal-velocity horizontal eye movements.


Substantial spontaneous long-term improvement in subacute sclerosing panencephalitis. Six cases from the Middle East and a review of the literature.

Of 118 cases of subacute sclerosing panencephalitis identified in an extensive follow-up study in the Middle East, six patients were found by personal interview to have experienced substantial spontaneous long-term improvement. To our knowledge, this rate of 5% for such improvement is presently the most accurate estimate available. Relative to the onset of clinical illness, the conditions of two patients are still improving four to five years later, two are stable four to six years later, one relapsed and died recently after eight years, and one is currently in relapse after 11 years. The condition of five patients had not progressed beyond stage 2 before improvement began. All patients had characteristic clinical and electroencephalographic features. Two patients had brain biopsy specimens showing panencephalitis without inclusions. Five patients had highly elevated levels of serum and CSF measles antibodies. In this article, the course of illness and extent of disability are described, published reports of improvement are reviewed, and the possibility of subclinical illness is discussed.


Bromocriptine in parkinsonism. A long-term study.

Bromocriptine was given in a controlled trial to 86 parkinsonian patients. Eight of 30 previously untreated patients with early and mild disease showed sustained benefit for two years and did not develop "on-off" effects or dyskinesias. Only two of 23 patients unable to tolerate or failing to respond to levodopa benefited from bromocriptine. Thirty-three patients with residual disabilities despite maximum tolerated doses of levodopa were also given bromocriptine: although benefit accrued, treatment was abandoned because of unacceptable side effects, and there was no improvement in the 11 with severe "on-off" disabilities. Although it was found that benefit from 70 mg daily of bromocriptine was comparable to that from 750 mg of levodopa with carbidopa, bromocriptine seems to offer no advantage to the majority of patients who have received or are receiving levodopa and/or carbidopa.


Block design performance following callosal sectioning. Observations on functional recovery.

A patient with complete surgical section of the corpus callosum was tested on a constructional task 17 months post-operatively. The left and right hands were separately tested under conditions of free visual exposure and lateralized visual field exposure. The results suggest that the typically observed improved performance of the right hand with increasing postoperative time is attributable to the acquisition of homolateral control over the right hand by the right hemisphere. The implications for left-right brain organization and the syndrome of constructional apraxia are considered.