Embryonic development of the pineal gland of the chicken (Gallus gallus).

A study of the embryonic development of the pineal gland of the chicken was performed with the optical microscope. The time of apparition of the first outline, as a derivative of the roof of the third ventricle, was fixed at 3 days. The major portion of the pineal parenchyma is derived from the frontal wall of the outline. All the vesicles and follicles were formed by solid mammilliform projections which subsequently presented a central lumen. In no case was a communication of the follicular cavities with the pineal recess observed. Three categories of vesicles or follicles can be distinguished according to their origin.


[Occurrence of HB-s antigens and antiHB-s antibodies in blood donors at the Gdańsk Blood Transfusion Center].

The blood of 39 005 blood donors was examined, during a period of three years, for HBs antigen and anti-HBs antibodies. HBs antibodies, was found in the blood of 476 donors (1,22%) whereas anti-HBs antibodies were found in 109 cases (0,28%); The results obtained suggest that HBs antigen occurs with higher frequency among young donors, as well as among inhabitants of towns. No correlation of HBs antigen occurrence with sex or with ABO blood groups was found.


[Preparation and clinical assays of Cl esterase inhibitors].

Seven preparation of Cl-estrase inhibitor (Clinh) were prepared from the serum form which factor IX had been absorbed previously. Despite always the same technique and conditions of isolation the degree of Clinh recovery differed, being sometimes fairly low, and ranging from 24% to 56% in relation to the initial plasma. The preparations contained cartain amounts of other proteins from the groups of alpha- and beta-globulins, particularly coeruloplasmin and components of complement C3, C4 and C9. The concentration of these components was low in relation to the concentration of the inhibitor. Some preparations contained also low amount of albumins. The preparation (about 20 thousand Clinh units) was transfused to a patient with congenital deficiency of Cl-esterase inhibitor at the time free of symptoms. The investigation of the blood obtained 30 minutes after transfusion showed complete inhibition of C-L-esterase. Administration of the preparation to the patient at the time of acute oedema caused in 5 episodes rapid regression of oedema or inhibition of its increase, in two cases no evident positive effect was obtained.


[RNA in surface antigen of hepatitis B virus (HBsAg)].

RNA was isolated from HBsAg particles obtained by the method of preparatory immunoprecipitation with anti-HBs antibodies. RNA electrophoresis in polyacrylamide gel showed presence of one fraction with molecular weight about 28 000. The index of RNA sedimentation determined by the method of ultracentrifugation was about 4 S. RNA from HBsAg had no informative features of nucleic acids (m RNA) such as presence of methyl group 5' of the end sequence m7 GpppN ("cap"), translatory activity. It had also no features of tRNA since it was not aminoacylated in the presence of aminoacylo-tRNA synthetases.


Occurrence of calcitonin cells and cysts in the parathyroid of the house shrew, Suncus murinus.

The present report deals with the occurrence of calcitonin cells (C cells) and cysts in the parathyroid IV of Suncus murinus. Histological preparations of the thyro-parathyroid complex reveal that (i) the parathyroid IV exhibits C cells either solitarily or in small groups (compact or follicular arrangement); (ii) the parathyroid IV also exhibits cysts (similar to those of the thyroid), the lining of these may contain either few C cells or it may be a continuous lining of C cells; (iii) the lumina of these cysts are filled with debris and desquamated cells with pycnotic nuclei, and (iv) sometimes few C cells are encountered hanging from the epithelial lining inside the lumen of the cyst.


Contribution to the knowledge of the brain in the newborn.

On 50 brains of newborns of either sex, the exterior and interior morphology was studied. The exterior morphology of the brain was conformable to the configuration of the skull. The insula is relatively large, but extremely inadequately grooved. The subcortical masses are well pronounced but there is in general a very slight difference between the white and gray matter of the brain. The convolutions and grooves of the cerebellum are very distinctly marked, the nucleus dentatus is large and white matter is prevalent. The brain stem is rather well formed, distinctly plastic, this being particularly true for the region of the rhomboid fossa and medulla oblongata.


[Preparation and clinical use of a new factor IX concentrate].

Factor IX concentrate was obtained using DEAE-Sephadex A-50 as an adsorbent. The yield of factor IX in vitro averaged 81%. Each bottle of the concentrate contained 288-512 u. of factor II, 96--360 u. of factor VII, 440--660 u. of factor IX and 256--680 u. of factor X. The results of studies showed trace amounts of factor Xa in the final product, in the range of 0.01--0.04 u/ml. The concentrate was found to be free of thrombin. In the years 1976--1977 the new concentrate was administered 48 times to 10 patients with severe haemophilia B. The in vivo recovery of factor IX was 27--65%. Clinical results of treatment were satisfactory in all patients. No significant changes were observed in platelet count, fibrinogen level and the concentration of fibrinogen degradation products after infusion of the concentrate. The ethanol gelation test was negative in all cases.


Analysis of tadpole growth following gamma-ray irradiation.

This investigation reports observations on the growth of Rana cyanophlyctis tadpoles following a whole body gamma-ray exposure. The effect on the body and hind limb size is perhaps the most significant of the period of latency. A dose of 2,000 R serves as a stressor and activates ACTH secretion in the tadpoles. The resultant somatotrophic hormone (STH) inhibition and subsequent recovery during the following days seem an integral part of the radiation syndrome.


Pre-natal innervation of the human female genital tract.

In the human fetus of 14 weeks, ganglia on either sides of the Müllerian uterovaginal canal contained two types of cells. In the 16th week, axons invaded the basal zone of the stratified squamous epithelium at the sides of the upper vagina. In the 20th week, vesicular nuclei typified the large neurons in the midportion of the cervico-vaginal ganglion. During the 22nd week, capsulated ganglia invaded the wall of the upper vagina forming three concentrically disposed strata. Non-capsulated clusters invaded its lamina propria. At the 24th week, axons were shaded after reaching the superficial zone of the stratified vaginal epithelium. In the 28th week, satellites surrounded the mature neurons and sheath cells enveloped the axons. Ganglia invaded the splitted muscle layer of the upper vagina at 30 weeks. Intraepithelial fibres invaded the whole thickness of the endometrium, the columnar epithelium of the cervix and uterine tube at 40 weeks. Nerve cells were detected among the basal epithelial cells of the lower vagina and its subepithelial plexus.


[Effect of cytostatic agents on the metabolism and ultrastructure of blood platelets in man].

The effect of cytostatic drugs used in the treatment of haemopoietic system diseases: cerubidin, hydroxyurea. cytosine arabinoside and their combinations on the platelet count, platelet ultrastructure, metabolic activity and participation in the processes of haemostasis was investigated. The experiments were done using two concentrations of the drugs: clinical corresponding to the maximal single dose and a fivefold as high concentration, It was found that the investigated cytostatic agents and their cominations in the first concentration had no effect of the platelet count, level of free nucleotides, activity of glucose-6-phosphate dehydrogenase and lactic dehydrogenase, and on the reaction of adenine nucleotides release from the platelets induced with thrombin. Using the higher concentration of the drugs it was observed that cerubidin and the combination of cytostatic agents tested changed the shape and ultrastructure of the platelets.


Modification of the size of developing infarcts in the ligated dog heart by betahistine-HCL.

The effectiveness of beta-histine-HCL in modifying the size of developing myocardial infarcts was tested in the surgically ligated dog. Branches of the left coronary artery were ligated and a 6-hour continuous intravenous infusion of 0.24 mg/kg/min of beta-histine was administered from 0 to 120 min after ligation. The effect of this treatment was evaluated histologically in studies on acute ischemia by the use of the hematoxylin-basic fuchsin-picric acid stain for early myocardial ischemia. The treatment was also evaluated grossly in a study on chronic ischemia where the dogs were permitted to survive for 30 days before sacrifice. In these experiments the size of infarcts found in the beta-histine-treated animals was compared with those found in the saline controls. Both studies showed that the control ligations produced a large uniform area of ischemia or infarction that was greatly reduced or prevented by immediate treatment with beta-histine. Also, beta-histine was capable of significantly reducing the size of developing infarcts for up to 120 min after ligation.


Amplitude desynchronisation of evoked compound muscle action potentials in normal and uraemic subjects.

Compound muscle action potentials of the extensor digitorum brevis were obtained in two groups of normal and uraemic subjects by stimulating the deep peroneal nerve at the ankle and at the capitulum fibulae. Particular attention was drawn to the index of desynchronisation supplied by the amplitude change in the muscle potential evoked by distal and proximal stimulation of the same nerve. Statistical studied confirmed the soundness of this index in the normal and in the pathological condition, and showed a significant increase of the values found in uraemic patients. The complex of the data pointed out the advantage of integrating the usual motor conduction velocity determination with the mentioned desynchronisation index.


Decreased cerebral blood flow after administration of sodium bicarbonate in the distressed newborn infant.

In the course of our studies on cerebral blood flow in newborn infants, we have observed a striking depressing effect of sodium bicarbonate infusion on cerebral blood flow which in some cases may severely aggravate cerebral ischemia. We measured cerebral blood flow before and after the treatment with 1 to 8 meqs of sodium bicarbonate in seven distressed newborn infants. The 133 Xe clearance technique was used. The results showed in six of the seven cases a decrease in cerebral blood flow, which in most cases was reduced to 14 to 22 ml/100 g/min, which is about half the value prior to the bicarbonate infusion. In one case an extreme reduction occurred: cerebral blood flow was reduced to 3 ml/100 g/min, well below the level compatible with tissue survival. The results are discussed with regard to the optimal treatment of the acidotic newborn.


Echo-encephalographic studies in patients with space-occupying lesions in the posterior fossa.

Echo-encephalographic studies were performed on 57 patients treated for space-occupying lesions in the posterior fossa. Preoperative echo-ventriculography (EVG) on 36 patients showed that 32 (89%) had dilatation of the third ventricle. Three of the four patients with normal preoperative ventricle width had cerebello-pontine angle tumors. Papilledema was lacking in many cases with considerable ventricular dilatation on EVG. Postoperative examinations on 49 patients showed in most cases a fairly rapid normalization of ventricular size often already during the first 1-4 weeks after operation. Postoperative EVG monitoring of the ventricular system was particularly useful for detection of shunt dysfunctions and recurrence of tumors. Computerized tomography have to some extent replaced echo-encephalography, but it is concluded that EVG still offers some definite advantages for certain application in the management of patients with posterior fossa lesions.


Capillary permeability in ALS, determined through transcapillary escape rate of 125I-albumin.

Since various macromolecules have experimentally been demonstrated to be taken up by the motor end-plates and subsequently transported through retrograde axoplasmic flow, noxious substances may gain entrance to the lower motorneurons through the same route. Consequently, the function of the capillary barrier in skeletal muscle is of interest in diseases of the lower motorneurons. The transcapillary escape of 125I-albumin was determined in six ALS patients. The values fell within the range earlier reported for normals.


Cerebellar infarction and internal hydrocephalus.

Four cases of acute cerebellar infarction producing hydrocephalus are presented. Only the patient, who is submitted to surgical decompression of the posterior fossa, survives, while the other three die. In the latter the necropsy shows a hemorrhagic cerebellar softening in the territory of the inferior posterior cerebellar artery, causing tonsillar herniation and impairment of the liquor drainage at the level of the inferior part of the 4th ventricle. It is suggested that the infarction and the hydrocephalus further progress in "avalanche effect", which is fatal unless prompt surgical decompression can be carried out.


Differential display of hippocampal and amygdaloid influences on hypothalamic evoked potentials.

Adult female rabbits with bipolar electrodes chronically implanted in the brain were employed to study the changes of the evoked potentials (EP) in the medial basal hypothalamus including the median eminence (ME), elicited by single hippocampal (HPC) or amygdaloid (AMYG) stimulus during EEG afterdischarge induced by electrical stimulation of the lattter two areas. In HPC seizures, the ME-EP from the HPC stimulation was extensively influenced in amplitude and peak-latency, the former decreased and the latter lengthened remarkably. On the other hand, the ME-EP from the AMYG stimulation did not show any noticeable changes either in amplitude or in peak-latency. During an AMYG seizure, the ME-EP from either the HPC or AMYG stimulation did not show any significant changes in amplitude or peak-latency. The results suggest that electrical activity of the neural pathways from the HPC to ME are very dependent on the excitability of the HPC, whereas those from the AMYG to ME seem variable, depending on the activity of the AMYG.


Pathological stimulus-related slow wave arousal responses in the EEG.

A group of 55 patients were studied who showed in their EEGs prolonged episodes of delta activity, in response to either auditory or tactile stimuli or both. This unusual pattern occurred with states ranging from drowsiness to deep coma but never in alert patients. It was found in a variety of conditions, most commonly following head injury. The EEG phenomenon disappeared within 5 weeks and over half of the patients had a favourable outcome.


Function of peripheral nerves and signs of polyneuropathy in solvent-exposed workers at a Swedish steelworks.

A field study was performed at a Swedish steelworks concerning symptoms and signs of polyneuropathy in 42 workers exposed to organic solvents at the plastic coating line of the plant. Examination was done clinically and by simple electrophysiological methods. The workers were exposed to a mixture of solvents, including methyl ethyl ketone (MEK) and trichloroethyelen. Nosed to a mixture of solvents, including methyl ethyl ketone (MEK) and trichloroethylene. None of the solvents used are known to cause peripheral neuropathy. At times very high vapour concentrations of solvents in the air were attained. The exposed workers were compared with at group of reference subjects sampled from other sections of the steelworks, matched for sex, age and duration of employment. Among the exposed workers one plausible and two suspected cases of polyneuropathy were found. None of the reference subjects showed signs of polyneuropathy. Statistical assessment provided some evidence, though weak, of a connection between the exposure to organic solvents and the observed abnormalities. A brief review is made of the present state of knowledge about hazards to the peripheral nervous system from the solvents in question.


Electrophoretic pattern of cerebrospinal fluid proteins in non-neoplastic infantile hydrocephalus.

Lumbar cerebrospinal fluid (CSF) from 28 non-neoplastic hydrocephalic children was studied for total protein and electrophoretic protein patterns. These were classified as normal, degenerative, transudative and gamma-globulinic according to Laterre. We found higher total CSF protein mean values than in normal cases with the same age and abnormal electrophoretic patterns in 72% of the cases, of which degenerative was the most common (54%). Gamma-globulinic and transudative patterns were found in 11% and 7% of the cases, respectively. Several factors which may explain the increase in the total CSF protein in infantile hydrocephalus are described: low age, ventricular block in the noncommunicating hydrocephalus, and probable passage of tissue proteins to the CSF from the damaged brain. The predominance of degenerative patterns may be explained by the enrichment of the CSF in tissue proteins resulting from the white matter damage provoked by the abnormal conditions of production, flow and absorption of the CSF in hydrocephalus. Ventricular CSF was studied in four cases, and the results obtained are in agreement with the above-mentioned findings.


Extremely low placental lactogen hormone (hPL) values in an otherwise uneventful pregnancy preceding delivery of a normal baby.

A case of a normal pregnancy and delivery with extremely low placental lactogen hormone (hPL) values in maternal blood is presented. The low hPL-values were due to the fact that the placenta only produced about 1/25 of the normal estimated output, calculated on the basis of the hPL-concentration in the intervillous spaces. The concentrations of progesterone, the placenta-specific beta-glycoprotein (SP1) and total estriol in serum were normal, while prolactin and chorionic gonadotropin (hCG) were considerably elevated. Glucose levels were normal. At the ultrastructural level the actual placenta under study did not differ from a normal term placenta. In spite of the very low concentrations of hPL there was a good milk secretion, and the mother was still breast-feeding her baby 11 months after the delivery. Basal level of prolactin was at this time normal.


Antepartum administration of terbutaline and the incidence of hyaline membrane disease in preterm infants.

The incidence of hyaline membrane disease in 41 preterm infants born between January 1975 and January 1976 was investigated in a retrospective study. Terbutaline, a beta2-receptor stimulating drug, had been administered to the women in order to arrest premature labour. In spite of the treatment 24 preterm infants were delivered. The incidence of HMD in this group was 1/24. In a group of 17 neonates whose mothers had received no such treatment the incidence of HMD was 5/17. Comparison between the two groups revealed a significantly lower incidence of HMD in the terbutaline treated group than in the controls (p less than 0.05). There were no significant differences in maternal age, gestational age, birth weight or Apgar score between the two groups. The lower incidence of HMD in the terbutaline treated group is suggested to reflect a rapidly induced release of pulmonary surfactants in the preterm infants. Evidence for a similar sequence of events has earlier been shown to occur in animals under standardized experimental conditions.


Midtrimester intra-aminotic administration of prostaglandin F2alpha in combination with an hyperosmolar urea solution: effect upon plasma levels of estradiol, progesterone, and human placental lactogen (HPL).

A study was undertaken in order to investigate the clinical observation that patients who underwent midtrimester abortion using intra-amniotic PG F2alpha in combination with hyperosmolar urea, always aborted a dead fetus. Ten Caucasian primigravidae, aged between 16 and 22 years old and whose pregnancies ranged between 14 and 23 weeks in duration, were studied. The patients were randomly divided into two equal groups. The one group received urea and PG F2alpha intra-amniotically whereas the other received PG F2alpha alone. Blood was drawn for measurement of plasma estradiol, progesterone and human placental lactogen (HPL) prior to injection of the abortifacients and at regular intervals thereafter for a period of 120 min. The five patients who received the combination regime of treatment (urea + PG F2alpha) showed a rapid decline in the plasma concentrations of these hormones and induction of abortion was followed by fetal death within 35 min in all cases. In contrast, the five patients who received intra-amniotic PG F2alpha alone, did not (with a single exception), demonstrate this rapid decline in the plasma concentrations of the placental hormones measured. Also with the same single exception, these fetuses, although stillborn, were alive two hours after inducing abortion.


Intrauterine injection of vitamin K before the delivery during anticoagulant therapy of the mother.

The coagulation factors PP% (Factors II+IV), factor IX and factor X were determined in infants born by mothers receiving anticoagulants. The factors were very low when the mothers did not receive vitamin K before the delivery. No significant improvement in the factors was observed after an intravenous or intraamniotic injection of vitamin K two to four days before the delivery. Vitamin K was injected intramuscularly into four foetuses in utero using an ultrasonic multitransducer scanner. Three of these infants had normal coagulation factors at birth. In the fourth case the factor X was normal and factor IX was significantly better than in the infants of the other groups. The injection had no harmful effects to the infants.


Therapeutic abortion. The 1975 report from Ullevål Hospital.

The results from a prospective study of 1228 therapeutic abortions (the 1975 material) are reported. First trimester pregnancies (1028 cases) were terminated by suction and curettage and second trimester pregnancies by prostaglandins (200 cases). The overall follow-up (4-6 weeks after termination) was 94.3%. The incidence of perforation was 0.5% of the surgical terminations, none of which, however, resulted in any other complications. The mean incidence of re-admission was 3.9%, the main causes being retained products or pelvic infection. The mean incidence of pelvic infection (salpingitis/parametritis) was 1.6%. The highest incidence of pelvic infection was found in early pregnancies (less than 8 weeks) or nulliparous women (2.7%) and the lowest (1.5%) in the induction group.


Caesarean section. A clinical study with special reference to the increasing section rate.

At Huddinge University Hospital 539 Caesarean Sections (C.S.) were made among 8415 deliveries from October 1972 to June 1976, corresponding to an over all C.S. rate of 6.4%. Over these years the rate has increased from 3.5% in 1972 to 9.7% in 1976. The main increase was due to a higher incidence of abdominal deliveries in cases of imminent fetal asphyxia. The maternal complication rate and the neonatal morbidity rate were both 6.5 times higher and the neonatal mortality rate was 4.1 times higher in emergency than in elective surgery. There was neither any mortality nor any morbidity in infants delivered by elective C.S. from healthy mothers at term.


An intravenous 133Xe method for measuring regional distribution of placental blood flow.

A new method for measuring regional distribution of placental blood flow is presented. After 2-5 mCi of 133Xe saline has been injected intravenously, the counts over the placenta are registered with a scintillation camera interfaced with a digital data storage and television readout system. Using "area of interest" technique, time activity curves are obtained for different regions. Analysis of the curves is based on two-exponential curve fitting. In normal pregnancy the mean intervillous flow in 16 healthy women was 125 ml/min/100 ml and myometrial flow 17 ml/min/100 g. The intervillous flow in the central part of the placenta was 55% higher than in the marginal parts. The myometrial flow in the placental area was nearly the same as outside the placenta.


Conjoined twinning in Sweden.

A small "epidemic" of conjoined twinning is reported occurring at the Skövde Central hospital in 1975-76. Three parts were observed, the annual birth number of 2300. During a ten-year period, 10 cases of conjoined twinning were reported to the Register of Congenital Malformations in Sweden, indicating a probable incidence of 1:75000 births. These 10 cases were distributed all over the country. Interviews with the three women who gave birth to the Skövde conjoined twins revealed no common factor which could be of aetiological significance.


On receptors for estrogens (E2) and androgens (DHT) in human endometrial carcinoma and ovarian tumours.

Some human endometrial carcinomas contain receptors for estrogen (E2) and dihydrotestosterone (DHT). Analysis of 50 primary endometrial carcinomas by agar gel electrophoresis revealed a varying receptor pattern, absence of both receptors, sole presence of E2- or DHT- receptor, or presence of both. Highly differentiated tumours often had receptors of both types (7/18) and poorly differentiated tumours most often lacked them (1/10). Primary tumours with metastases (Stages III-IV) seldom had combined receptors, only in 2 cases out of 9. Growth of the tumour down in the cervical canal (Stage II) implied absence of combined receptors in all of the 13 cases studied. In 8 different ovarian tumours, presence of either E2- or DHT-receptors was found in 6. The findings are discussed in relation to hormonal treatment of the disease.


Pregnancy and sarcoma.

Six cases of pregnancy associated with sarcoma are presented. Among these six cases is one patient with vulvar sarcoma which was diagnosed during the 34th week of pregnancy. The literature was reviewed with reference to the effect which pregnancy may have on the growth of malignant tumors. Most authors believe that pregnancy has no deleterious effect on the course of cancer, however, this is not well supported through adequate data. Several reports to the contrary contain evidence that pregnancy may have a deleterious effect on the course of cancer. These discrepancies could be explained on the basis of differences in the natural history and biological behavior of different malignant tumors in relation to the pregnancy.


Cervical adeno-carcinoma and partial hydatidiform mole.

Partial hydatidiform mole was found in a 39-year-old grand-multiparous Jewish woman, having a polypoid cervical adeno-carcinoma. The patient was treated by surgery followed by internal and external pelvic irradiation, with excellent results. Four and a half years after the initial diagnosis she is very well. This is the first reported case of a rare combination. The literature regarding the association between pregnancy and cervical malignancies is reviewed briefly and the possible pathogenetic relationship between hydatidiform mole and carcinoma of the cervix is discussed.


Operative treatment of rectal endometriosis.

27 patients with rectal endometriosis were operated upon in Turku University Central Hospital in 1967-1976. The main symptom was defecation pain especially during menstruation. Eighteen patients had had previous surgery for endometriosis of the pelvic area. A palpable tumor was found on gynaecological examination in every patient. The tumors did not grow through the rectal wall. Three kinds of operative procedures were applied (a simple excision method, a so called "window" operation, and resection of rectum) and the results were good.


Treatment of menopausal oestrogen deficiency symptoms in hysterectomised women by means of 17beta-oestradiol pellet implants.

Ninety-four women having undergone hysterectomy, with or without simultaneous ovariectomy, were treated for menopausal symptoms by means of subcutaneous implantation of sterile pellets containing 20 mg 17beta-oestradiol, 589 implantations in all. The subjective effect was good and lasted generally for about 6 months. The Karyopyknotic index, serum FSH and plasma oestradiol were checked in a few of the patients. The method was judged to be valuable in appropriate cases.


Hypervitaminosis a in early human pregnancy and malformations of the central nervous system.

A case of malformations of the fetal central nervous system following hypervitaminosis A in early pregnancy is reported. The mother was treated with 150 000 IU vitamin A daily during gestation days 19 to 40. Determination of urinary oestriol carried out in the 42nd week of pregnancy revealed a very low excretion (4.2-6.6) mumol/24 h). Induced delivery resulted in a microcephalic child who died after 18 min. The child had multiple malformations of the central nervous system and very small adrenal glands (1.5 g; normal 11 +/- 4 g). The very low urinary oestriol excretion is well explained by the hypoplastic adrenals, which in turn can be related to insufficient ACTH stimulation, a condition similar to anencephaly. The malformations shown in the present case are considered to be related to the high doses of vitamin A given to the mother, and the authors wish to warn against uncritical use of high doses of vitamin A in whomen of childbearing age.


Organ culture studies on human skin and cholesteatoma epithelium. Contact with connective tissue and exposure to vitamin A.

In tissue culture trunk skin from 8-day-old chick embryos showed a consistent change from keratinizing into more columnar non-keratinizing epithelium under the influence of vitamin A acid using concentrations from 10 to 20 IU/ml. Human adult postauricular and ear canal skin, cholesteatoma membrane, and human embryonic skin retained their keratinizing properties when exposed to vitamin A acid at concentrations up to 150 IU/ml, when toxic changes in the epithelium became obvious. Treatment of cholesteatoma ears with vitamin A ear drops is unlikely to effect any change in the keratinizing properties of the epithelium.


Speech pure tone audiometry as a screen for exaggerated hearing loss in industrial claims.

We examined 596 patients referred with possible noise-induced hearing loss, by conventional and cortical evoked response audiometry. Discrepancies between the two tests identified 121 (20.3%) as exaggerating their hearing loss. We then studied the validity of simple conventional tests, which would be available in primary diagnostic facilities, in screening for the exaggrerators we had idenfied. By selecting those whose puretone average (for 0.5 and 1 kHz) was more than 10 dB different from the speech reception threshold, or whose initial puretone threshold at 0.5 kHz was 40 dB or greater, we identified 112 (93%) of the exaggerators, at the cost of additional examination of 209 (35% of the total) false-positive. However, this screening means that 46% of the claimants could be evaluated completely in a primary diagnostic facility, and only a small fraction of the exaggerator should be overlook.


Hearing loss resulting from perilymph fistula. A presentation of two cases.

Two cases of perilymph fistula in the oval window are presented. In such cases hearing loss may be severe and vertigo may or may not be present. Early surgical intervention is recommended, but one should not hesitate to explore a suspected ear, even if considerable time has elapsed.


Skull distortion of bone conducted signals.

A previously essentially unknown type of distortion of bone conduction (BC) signal has been studied on the skulls of four human cadavers. The method was based on a miniature accelerometer, rigidly attached to the cranial bone, converting the skull vibration close to the cochlea into an electrical signal which was analysed with regard to harmonic distortion. The BC signals, pure tones, were presented by means of a high-quality vibrator. The distortion was found to be limited to the lower audiometric frequencies, with a maximum around 500 Hz, and of such a degree as to be able to significantly influence the results of BC audiometry. The distortion is probably caused by nonlinear mechanical properties of the human skull.


Reflex inhibition audiometry. A new objective technique.

The reflexive eyeblink, elicited by a tactile stimulus, is inhibited if an auditory stimulus precedes the eliciting stimulus by 100 msec. With adult subjects the threshold for this effect was found to be sufficiently low to suggest that reflex inhibition may be useful in objective audiometry. A preliminary investigation with infants and children showed that the inhibitory process is present, though variable, in children as young as 6 weeks olds.


Extra internal hair cells. A scanning electron microscopic study.

The extra internal hair cell (EIHC) of the human cochlea was observed by means of a scanning electron microscope. The EIHC was found not infrequently in all turns of the human cochlea. It was located medial to the IHC row. The inner pillar cells showed an abnormal structure. The anatomical relationships between the displaced IHC and EIHC, and the inner pillar cell were classified into five types. The origin of these anomalies is discussed form an embryological viewpoint.


Peripheral vasoconstriction in the rat in response to sound. II. Dependence on rate of change of sound level.

Vasoconstrictions elicited by sound were studied in the non-anaesthetized rat. Arterial pulsations in the tail were recorded by a non-invasive technique. On slightly heating the animal, the tail vessels became dilated. An 80 dB SPL noise burst caused a decrease in pulse amplitude, usually to less than 10% of the pre-stimulus value. It was found that 4 s bursts of 80 dB SPL noise with rise times 1, 10, or 100 ms were equally efficient in producing vasoconstriction. If the rise time was longer, 1 s, the vasconstriction was significantly smaller. It was pointed out that the feedback control of the stimulus noise provided by the acoustic middle ear reflex would contribute to enhancing rapid variations in sound level, and thereby form part of a physiological explanation for the present findings.


Reversible and irreversible changes of the stria vascularis. An evaluation of the effects of ethacrynic acid separately and in combination with atoxyl.

The morphological changes in the cochlea following administration of ethacrynic acid occur initially in the stria vascularis of the basal coils as an increased intracellular vesiculation of the marginal cells followed by inter- and intracellular oedema in the intermediate cell layer. The combined administration of ethacrynic acid and atoxyl (individual doses) can cause irreversible damage to the cochlear hair cells and the stria vascularis, while the administration of each of them separately in the same low dose did not cause hair cell degeneration or persistent morphological changes of the stria vascularis. An increased penetration of atoxyl into the cochlea is likely to occur due to the ethacrynic acid-induced changes in the permeability of the endolymphatic partition so that the earlier known penetration of atoxyl into the cochlea is increased.


[Streptomycin-induced damage of the spiral ganglion].

The neuronal density in the spiral ganglion was investigated in normal and in streptomycin-intoxicated guinea pigs. Streptomycin was administered in a dose of 250 mg/kg for 21 days. 6 weeks after the streptomycin exposure a histological examination revealed a decrease in ganglion cell density in the spiral ganglion, with maximum loss in the apical portion of the ganglion. As mechanisms of the ototoxic effect, a secondary degeneration of spiral ganglion cells after hair cell loss or a primary neurotoxic degeneration are discussed.


The influence of cochlear temperature on the electrical travelling wave pattern in the guinea pig cochlea.

Cochlear microphonics (CM) were recorded in the guinea pig using differential recording from the first and third cochlear turns as well as by using a 10-electrode array inserted in the scala tympani of the basal turn. The excitation profile as represented by the CM was quantified by amplitude and phase data, and was measured at normal temperature (38 degrees C) and a 10 degrees lower cochlear temperature. It appears that the CM pattern shifts toward the base of the cochlea as a result of cooling. This is explained on the basis of an increased compliance of the basilar membrane with an optional influence of increased viscosity of the perilymph.


Ultrasonic irradiation through the round window. Functional and morphological findings in sound-conditioned cats.

Ultrasound  was presented though the round window in 9 sound-conditioned cats at levels approximating clinical usage. Threshold shifts were mild to moderate and confined to 4 kHz and higher. There was total loss of function at 16 kHz in 2 animals. Threshold shifts correlated with cochlear histological findings as shown by reconstruction. There were three main types of lesions: abnormalities of supporting structures, hair cell loss, and lesion of Reissner's membrane. Supporting structure damage was the most frequent. The cristae of the semicircular canals did not show any lesions, though some saccular damage was noted. These changes were not observed in 4 control animals. Some conductive damage was noted as a result of probe placement. High frequency loss can be expected with the round window approach at irradiation levels of 52 mW for 20 min, or stronger.


Computer calculation of movement of body's center of gravity.

The movement of the body's center of gravity was calculated in normal subjects and in vertiginous patients by using a strain gauge platform system and a ditigal computer. The total length of the loci traced by the center of gravity in 40 normal subjects during normal standing for 1 minute was 52.0 +/- 18.5 cm with eyes open, and 81.5 +/- 52.3 cm with eyes closed. The ratio of the total length with the eyes closed compared with that with the eyes open during normal standing for 1 minute was 1.56 +/- 0.56. The time course of the length of the locus was calculated every 10 seconds, and characteric curves were obtained. The dependability of this test appeared to be fairly accurate and the usefulness of this technique for the diagnosis of vertiginous or ataxic diseases is recommended.


Sympathetic nerves and nasal secretion in the cat.

The influence of sympathetic nerves on nasal secretion was examined in anaesthetized cats. The results from experiments in which the Vidian nerve was stimulated supramaximally for 3 min show that vasoconstriction occurs in the nasal cavity during the production of nasal secretion. The amount of nasal secretion produced in the normal cavity on Vidian nerve stimulation was greater than that produced in the sympathectomized nasal cavity but only significantly so at 2 and 5 Hz. It is concluded that at these lower frequencies sympathetic activity induced by Vidian nerve stimulation increases nasal secretion.


Mucocutaneous lymph node syndrome: three cases observed in Hungary.

Three patients are reported whose symptoms were very similar to those described in mucocutaneous lymph nodes syndrome, a disease prevalent in Japan. In one case the disease was complicated by otomastoiditis which prolonged the course and reactivated the symptoms. In the other two cases recovery was uneventful. No epidemiological relation could be demonstrated among the cases. Prednisolone was administered to two patients with immediate antifebrile effect.


The domestic pig as an experimental animal for studies on the nasal cycle.

The resistance to air flow of each nasal passage in the anaesthetized pig was determined by pumping air through the nose and measuring pressure changes in nasal cannulae. A nasal cycle was observed in the marjority of the pigs. Three types of change in nasal resistance were observed and their possible causes are discussed. Section of the right cervical sympathetic nerve abolished the cyclic changes in nasal resistance of both nasal passages. The method described may prove useful in studying the physiology of the nasal cycle.


Perinatal asphyxia and jaundice in newborn infants.

The serum bilirubin concentration was studied in 114 full term and 199 preterm babies suffering from either perinatal asphyxia or idiopathic indirect hyperbilirubinaemia, in order to establish the effect of asphyxia on the serum bilirubin level. Infants with any other disease causing non-physiologic jaundice were excluded. It was found that perinatal asphyxia per se does not exaggerate hyperbilirubinaemia either in full term or in preterm babies. Weight loss correlated significantly with the peak bilirubin concentration in all groups of patients. This would suggest the possible role of feeding and hydration in the genesis of hyperbilirubinaemia.


Dermatoglyphic features in diabetes mellitus.

Dermatoglyphic features of 290 children and 180 adults with diabetes mellitus were investigated. WD occurred significantly more frequently on the fingers, and pattern intensity was low in certain interdigital areas in these patients. A high TRC value was more frequent in both girls and boys with diabetes mellitus than in the controls.


HLA B8 and BW15 antigens in diabetic children.

The simultaneous occurrence of HLA B8 and BW15 and B8 antigens is significantly more frequent in diabetic children than in the general population. BW15 alone shows no significant difference but may be considered as a potentiating factor. The relative risk of the manifestation of diabetes in the highest when HLA B8 and BW15 occur simultaneously. In the nearest diabetic relatives of diabetic children the occurrence of B8 and B8 and/or BW15 antigens is significantly more frequent than in the diabetic child population.


The modern treatment of oesophageal strictures using the Eder-Puestow dilators.

The greatest safety in bouginage of narrow and twisted oesophageal strictures is obtained by employing a flexible oesophagoscope via which a guiding probe is introduced by Puestow's method. The actual bougie may then be introduced over this guide without risk of perforating the oesophagus. When performed under TV-fluoroscopy, this procedure gains added safety. 108 dilations were performed without complications.


Electromyogram of the tensor tympani muscle in man during swallowing.

Experiments were carried out on 2 patients who underwent an operation for chronic otitis media, whereupon the tensor tympani muscle was visualized. A unipolar platinum electrode was inserted into the muscle belly. EMG recordings were made during swallowing and other motor activity. Distinct, pronounced EMG activity was recorded from both patients every time they swallowed. It was concluded that the tensor tympani muscle participates in the act of swallowing and thereby probably contributes to the ventilation of the middle ear.


Point prevalence at birth of ventricular septal defect in Hungary.

An attempt was made to estimate the occurrence of ventricular septal defect in Hungary. The study was based on data derived from three surveys. Point prevalence at birth of isolated ventricular septal defects amounted to 1.33 +/- 0.34%, 1.39 +/- 0.31% and 1.77 +/- 1.12%, respectively. Considering the diagnostic difficulties and other distorting factors, the figure of 1.5% is assumed to represent the actual point prevalence rate. Ventricular septal defect cases constituting part of the complex congenital cardiovascular malformations and of multiple malformations may increase the above 1.5% estimate by another 1%.


The nasal mucosa during long-term treatment with beclomethasone dipropionate aerosol. A light-and scanning electron microscopic study of nasal polyps.

Blind examination by light- and scanning electron miscroscope of a total of 142 biopsies from nasal polyps was carried out before and after continuous intranasal treatment with beclomethasone dipropionate aerosol, 400 microgram/day, for a period of 9-36 months. The degree of tissue oedema, the number of infiltrating eosinophil cells and the number of goblet cells in the epithelium decreased significantly. There was no change in the type of surface epithelium during treatment, and no tendency towards squamous cell metaplasia. The study suggests that beclomethasone dipropionate treatment for a period of a few years will not cause atrophic rhinitis.


D-penicillamine treatment of hyperbilirubinaemia in preterm infants.

In 41 hyperbilirubinaemic infants born before the 38th gestational week intravenous D-penicillamine treatment was applied in doses of 300 mg/kg body weight/day. As compared to 41 infants of identical gestational age and treated under identical circumstances, penicillamine ensured favourable results, especially in babies born after the 33rd gestational week. Some undesirable side-effects have to be taken into account, but they are infrequent if the indication is correct.


Rhinological findings following transantrosphenoidal surgery of the pituitary gland.

Fifty patients with pituitary gland tumours on whom we operated via the transantrosphenoidal route, were rhinologically followed up with a view to revealing any conceivable functional impairments incurred by this method. Our investigations included rhinoscopy, endoscopy of the nasal and paranasal cavities and of the epipharynx, X-ray controls, and probes of the nn. olfactorius and trigeminus. Apart from the technical advantages of transantrosphenoidal pituitary gland surgery, the results also confirmed its benefit to functional performance.


Light and electron microscopy on the sporulation of the oocysts of Eimeria brunetti. I. Development of the zygote and formation of the sporoblasts.

The initial stages of sporulation in oocysts of Eimeria brunetti were examined in samples sporulated at 27 degrees C for 0, 12 and 24 hours. The initial zygote was found to be roughly spherical and to contain a number of polysaccharide granules which were congregated in one region of the organism. The cytoplasm also contained some strands of rough endoplasmic reticulum together with a number of mitochondria, some Golgi bodies, and some electron translucent vacuoles. The nucleus was large, with amorphous nucleoplasm and a nucleous. The cytoplasmic mass of the zygote was limited by a single unit membrane which possessed some micropores. After initiation of the sporulation, the metabolic activity of the organism appeared to increase as evidenced by the augmentation in the cytoplasm of the amounts of rough endoplasmic reticulum, number of Golgi bodies, and the appearance of polyribosomes. However, at this stage, the presence of large spherical bodies (anlagen of the refractile bodies of the sporozoites) constituted the most obvious change in the cytoplasm of the organism. After nuclear division the daughter nuclei were situated well separated in the cytoplasm and the polysaccharide granules were evenly distributed throughout the cytoplasm of the zygote. Eventually four sporoblasts were formed by invaginations of the limiting membrane. Each sporoblast was limited by a unit membrane and contained a nucleus, and the same cytoplasmic organelles as found in the zygote. The development of the sporoblast was initially accompanied by the appearance of a second limiting membrane.


Light and electron microscopy on the sporulation of the oocysts of Eimeria brunetti. II. Development into the sporocyst and formation of the sporozoite.

The later stages of sporulation in oocysts of Eimeria brunetti were examined in samples which had been allowed to sporulate at 27 degrees C for 24, 36 and 48 hours. It was observed that the sporoblasts became ellipsoidal and the nucleus underwent the final division. A nucleus with associated Golgi bodies was not observed at either end of the organism. The cytoplasm was limited by two unit membranes and contained rough endoplasmic reticulum, dense bodies, electron translucent vacuoles and mitochondria. The first evidence of sporozoite formation was the appearance of a dense plaque at either end of the organism. This appeared in the vicinity of the nuclei, and adjacent to the limiting membrane of the soroblast. At this stage the sporocyst wall was still unformed. Then the two sporozoites were formed from opposite ends of the organism by growth of the dense plaques and invaginations of the plasmalemma which thus formed the pellicles of the developing sporozoites. A conoid and subpellicular microtubules were observed at this stage as development continued, a number of vacuoles were found between the nucleus and the conoid. These vacuoles constituted the precursors of the rhoptries and micronemes. At the same stage a large dense body had appeared within the forming sporozoite. As the sporozoite developed, this body, anterior refractile body, is followed by the nucleus and another dense body which formed the posterior refractile body. During this period, the thin sporocyst wall was formed and Stieda and sub-Stieda bodies were now present at one end of the sporocyst. Each mature sporocyst contained two sporozoites.


Chemotypes of Fusobacterium nucleatum lipopolysaccharides.

Lipopolysaccharides (LPS) were isolated from 20 strains of Fusobacterium nucleatum and examined by paper chromatography, gas liquid chromatography and colorimetric methods for the presence of neutral sugars, amino sugars and 2-keto-3-dexoxy-octonate (KDO). The LPS had in common glucosamine, L-glycero-D-manno-heptose, glucose and KDO. The KDO content was low. Galatose, rhamnose and D-glycero-D-manno-heptose were found in some strains. Based on the sugar composition of the LPS, the F. nucleatum strains could be classified into six chemotypes.


Chemotypes of Veillonella lipopolysaccharides.

Lipopolysaccharides (LPS) were isolated by phenol-water extraction from 34 strains of Veillonella, and examined by paper chromatography and colorimetric methods for the presence of neutral sugars, amino sugars and 2-keto-3-deoxy-octonate (KDO). Several preparations were also examined for neutral sugars by gas liquid chromatography. The LPS had in common glucosamine, galactosamine, L-glycero-D-manno-heptose glucose and KDO. Most LPS contained galactose, and a few rhamnose. D-glycero-D-manno-heptose was found in LPS from one of the strains. Based on the sugar composition of the LPS, the Veillonella strains could be classified into four chemotypes.


Bovine protothecosis. A brief report of ten cases.

Prototheca zopfii was isolated repeatedly from milk samples from ten cows (of a herd of 192 dairy cows) with reduced milk yield and indurated mammary glands. The strain was moderately sensitive to streptomycin, polymyxin and gentamycin, but resistant or relatively resistant to other antibiotics and antimycotics commonly used in clinical practice. An attempt to treat the infection with Ethidium bromide, which was found effective in vitro, did not succeed. The number of Prototheca excreted decreased, but a complete cure was not obtained. In histological sections of the udder, Prototheca cells were demonstrated both intracellularly and interstitially.


The cholinergic influences on the oxytocin activity of the hypothalamus and neurohypophysis in long-term dehydrated male rats. Acta Physiol. Pol., 1978, 29 (1): 17-25. Rats dehydrated up to 12 days were injected intraperitoneally with carbachol or atropine sulfate in daily doses of 20 microgram/100 g and 1.0 mg/100 g, respectively. In not dehydrated rats atropine increased the oxytocin activity of the hypothalamus and neurohypophysis; carbachol did not influence the oxytocin potency of the hypothalamus but augmented it in the neurohypophysis. During long-term dehydration both carbachol and atropine intensified the depletion of oxytocin in the hypothalamus as well as in the neurohypophysis.


Effect of increased concentrations of ca++ and mg++ in the fluid perfusing the cerebral ventricles, and hypoxia on evoked tongue jerks.

Effect of increased concentrations of Ca++ and Mg++ in the fluid perfusing the cerebral ventricles, and hypoxia on evoked tongue jerks. Acta Physiol. Pol., 1978, 29 (1): 27-36. The infraorbital nerve, the sensory part of the trigeminal nerve, was stimulated in rats under chloralose anaesthesia. Electric stimuli of 0.2 Hz caused retractive movements of the stretched tongue. These evoked tongue jerks (ETJ) were recorded directly on a kymograph or on a linear recorder. Using a stereotaxic apparatus cannulas were inserted into both lateral ventricles of the brain for infusion of McIlwain-Rodnight's fluid at a rate of about 50 microliter/minute. The cannula for outflow of the perfusing fluid was inserted into the cerebellomedullary cistern. The ETJ was enhanced by 43%, on the average, during perfusion of the cerebral ventricles with solutions with fivefold increased concentration of calcium ions, and decreased by a mean value 24% when the perfusing solution contained a higher concentration of magnesium ions. After 10 min of breathing with increased respiratory dead space, which caused hypoxia and hypercapnia, the amplitude of ETJ diminished by 65%, on the average.


The influence of dietary sodium on urinary prostaglandin excretion.

The influence of dietary sodium chloride on the urinary excretion of prostaglandins (PGs) was studied in unanesthetized female rabbits housed in metabolic cages. Urinary PG levels were determined by radioimmunoassay, bioassay and gas chromatography-mass spectrometry. In the first experiment rabbits were fed at high (2.5%) and later a low (0.25%) sodium chloride diet ad libitum. A 2--5 fold increase in excretion of immunoreactive PGF2alpha (iPGF2alpha) and iPGE2 was noticed when animals were given the low salt diet. Since it could not be excluded that dietary factors other than sodium chloride contributed to the changes a second, more controlled experiment was undertaken. Rabbits were fed 30 g/kg per day of diets offering only in the content of sodium chloride, 2% and 0.37% respectively. On the high salt diet the rabbits excreted 0.1 +/- 0.04 microgram/day of PGE2 and 2.0 +/- 0.5 microgram/day of iPGF2alpha. After equilibration on the low salt diet the PGE2 excretion rate increased to 1.5 +/- 0.3 microgram/day (p less than 0.001) and that of iPGF2alpha to 3.4 +/- 0.4 microgram/day (p less than 0.01). These results thus point to an inverse relationship between renal sodium excretion and the activity of the renal prostaglandin system.


Presence of erythropoiesis inhibitor in the urine of normal sheep and those with transfused polycythemia.

Presence of erythropoiesis inhibitor in the urine of normal sheep and those with transfused polycythaemia. Acta Physiol. Pol., 1978, 29 (1): 37-46. Urine from 18 ewes, normal and with transfused polycythemia, was analysed. The consequences of polycythemia were estimated in the period between 96 and 192h. The 24 h urine portions were separated on Sephadex G 100 columns, and after dialysis, tested biologically on normal mice of the BALB/c and Swiss strains. Changes of the erythropoietic activity in normal mice receiving the particular plasma fractions demonstrated that in the urine fraction IV, a factor with activity characteristic for the erythropoiesis inhibitor, is present in most normal sheep and in all those with moderate polycythemia.


Liver glycogen content and activity of several hepatic enzymes in repeatedly immobilized rats. Acta Physiol. Pol., 1978,  29 (1): 55-60. In adult, male rats subjected to immobilization for 2.5 h daily, on the 7th day, 24 h after a sixth trial, an increased activity of the liver aspartate aminotransferase was found as shown by comparing their data with those of normally fed controls and also of the animals pair fed to the immobilized. Moreover, a net increasing effect of daily immobilization on the liver glycogen content was described.


Effect of low body temperature on gastric secretory activity in the guinea pig under urethane general anaesthesia. Acta Physiol. Pol., 1978, 29 (1): 61-66. The effect of low body temperature on spontaneous and histamine (H) stimulated or Nalpha Nalpha-dimethylhistamine (NDMH)-stimulated gastric secretion was investigated in the guinea pig under general anaesthesia with urethane. In normothermia NDMH had a stronger stimulatory action on acid secretion In hypothermia (30 degrees C and 25 degrees C) only NDMH showed some stimulating effect. The obtained results point to the necessity of strict controlling of body temperature in the experiments performed on animals under general anaesthesia and suggest that the lack of effect at low temperature may be connected with an inhibition of the processes of H side-chain methylation when the rate of metabolic processes in the organism has fallen.


Absorption of amino acids in isolated pig caecum in situ. Effect of concentration of enzymatic casein hydrolysate on absorption of amino acids. Acta Physiol. Pol., 1978, 29 (1): 67-77. The absorption of amino acids in the pig caecum was studied in situ after surgical isolation of the caecum from the remaining digestive tract and fitting of fistula to the isolated bowel sac. It was found that amino acids can be absorbed in the caecum. Amino acids possessing an additional functional group mainly: asparagine, serine, threonine, tyrosine, arginine, histidine, lysine and aspartic acid, were absorbed while the remaining ten determined amino acids were not absorbed under these conditions. The movement of water across the wall of the caecum and the osmotic pressure in the caecum had no effect on the absorption of amino acids. The absorption of water in the caecum is mainly due to simple diffusion.


Capillary supply of the muscle fibre population in hindlimb muscles of the cat.

Comparative analyses of the fibre content (FG, FOG, and SO fibres) and the capillary density (the number of capillaries surrounding individual fibres and the capillary/fibre ratio) were performed in hind limb muscles of the cat. Cross-sections from the tenuissimus, the biceps femoris, the lateral head (LG) and the medial head (MG) of the gastrocnemius and the soleus were cut in a cryostat. The sections were stained histochemically for the NADH2-diaphorase and alkaline (pH 9.4) actomyosin ATPase activity, which enables differentiation of different types of fibres. The endothelium of the capillaries was identified via staining for unspecific alkaline ATPase activity. The number of capillaries surrounding each individual muscle fibre had a positive correlation, first to the oxidative capacity and secondly to the average diameter of the fibres. The thin tenuissimus muscle did not differ in this respect from the thicker muscles. The highest proportion of SO fibres was found in the soleus and the MG muscles. FG fibres of two different types were dominating the fibre mass in the biceps femoris and the LG muscles, while the tenuissimus contained more FOG fibres than these muscles. In general the FG fibres had a larger diameter than the FOG and the SO fibres. The soleus and the MG muscles contained larger fibres than the other examined muscles. FG fibres were surrounded by fewer capillaries than FOG and SO fibres. The soleus and the MG muscles, with a higher percentage of SO fibres and also larger fibres, had the largest number of capillaries around the fibres and the highest capillary/fibre ratio.


A new method of producing chronic gastric fistula and collection of gastric juice in rats.

A method of producing chronic gastric fistula and collection of gastric juice in rats. Acta Physiol. Pol., 1978, 29 (1): 79-86. A kind of material suitable for making different parts of the gastric fistula as well as their shape and size have been established. Organic glass (plexiglas) was used for making the cannula. A twisted-on cap of stainless steel protected the mouth of the fistula. This cap secured also the possibility of directly attaching a vessel for collection of gastric juice to the orifice of the cannula. The vessel was made of plexiglas and owing to its shape and dimensions it did not impede the rat's movements during the investigations. A disc of nylon net glued on to the external wall of the cannula prevented leaking of the fistula and its consequences. The fistula produced in this way showed a considerable durability and the vessel made it possible to investigate gastric secretion in a freely moving animal under physiological conditions or under any chosen experimental conditions.


Relationship between lactate accumulation, LDH activity, LDH isozyme and fibre type distribution in human skeletal muscle.

Lactate concentration, total LDH activity and muscle-specific LDH isozymes were determined in pools of the two main types of human skeletal muscle fibres. Analyses were made from biopsy specimens obtained after intense dynamic exercise lasting approximately 30 s. Lactate concentration, total LDH activity and muscle-specific LDH activity displayed higher average values for FT (fast twitch) fibres than for ST (slow twitch) fibres. In addition, positive correlations were found both between the individual percentage of FT fibres and muscle lactate concentration and between lactate concentration and total LDH activity and muscle-specific LDH activity respectively.


Isometric strength performance and muscle fibre type distribution in man.

Maximal isometric one-leg strength (MIS) was determined in 31 physical education students displaying a wide range in muscle fibre type distribution (21-79% fast twitch (FT) muscle fibres) in their vastus lateralis muscles. A linear positive correlation was found between MIS and the relative distribution of FT fibres (p less than 0.001). This should mean that not only muscle mass involved but also the quality of muscle will be decisive for the ability to develop high isometric strength.


On the chemical nature of the blood borne cardiotoxic material released from the feline small bowel in regional shock.

The cardiotoxic material released into blood from the feline small intestine during a 2 or 3 h regional shock period (inflow pressure to the small intestine 30--35 mmHg during a continuous activation of the regional sympathetic vasoconstrictor fibres at 6 Hz) has been analyzed with regard to three properties: 1. molecular mass determined by molecular filtrations; 2. solubility in a nonpolar solvent (ether); 3. heat stability by heating plasma to 80 degrees C for 30 min. The results obtained suggest that the cardiotoxic material consists of at least two heat stable fractions. One is water soluble with a molecular mass between 500 and 1 000 d and the other is lipid soluble with an unknown molecular mass.


Influence of local noxious heat stimulation on sensory nerve activity in the feline dental pulp.

The present investigation was undertaken to develop an experimental model in which noxious heat stimulation was used to produce increased intradental sensory nerve activity in canine teeth of anesthetized cats. Two techniques were evaluated in which both the method of recording and the nature of the stimulus varied. Slow heating (approx 1 degree C/s) to 47 degree C of the tooth surface (combined with recording from electrodes in open dentinal cavities) did not produce any persistent nerve activity. Repeated periods of brief intense heating (approx 60 degrees C/s) (combined with recording from amalgam electrodes placed on cavity floors) resulted in an immediate response and an afterdischarge (phase 3) generally persisting for 20--60 min. Maximum phase 3 activity was characteristic for the individual cat and ranged from 0.2 to 50.2 imp/s. mean value 10.6 imp/s (S.D. +/- 9.2). A systematically higher phase 3 activity was recorded in lower compared to upper canine teeth (p less than 0.05). The maximum phase 3 response generally occurred after 3-8 stimulations; the median number of required stimuli was 3. Repeated brief heat stimulations combined with the closed cavity recording technique may be used as an experimental model by which the mechanisms behind increases in intradental sensory nerve activity associated with tissue damage can be studied.


Reinnervation of partially denervated rat soleus muscle.

The reinnervation of partially denervated rat soleus muscles by their interrupted, regenerating motor axons has been examined in adult white rats. If reinnervation occurred after the remaining, intact motor axons had sprouted to their full, maximal extent, then the regenerating axons formed synapses preferentially with denervated muscle fibers and not with fibers innervated by sprouts. The sprouted motor units retained their size as if no reinnervation had occurred. On the other hand, if reinnervation occurred early during the sprouting process, the sprouting motor units were never able to attain their maximal size. Further, some muscle fibers became innervated by both sprouted and regenerating axons. These "hyperinnervated" fibers lost their dual innervation within a few weeks. The sprouted axons seemed to be the nerve fibers preferentially eliminated from these hyperinnervated fibers, since during the loss of hyperinnervation the sprouted motor units decreased in size while the motor units formed by the regenerating axons did not change in size. It is proposed that the occurrence of hyperinnervation is influenced by the amount of time sprouting axons have to consolidate their synapses with muscle fibers. Further, it is proposed that on muscle fibers which can become hyperinnervated, the sprouted motor neurons are at a disadvantage in the competition for maintenance because of their larger unit sizes.


The effects of Triton-detergents on the stretch receptor of the crayfish.

The effects of the non-ionic detergents Triton X-45 and Triton X-100 on the action potential and the receptor potential of the stretch receptor neuron of the crayfich Astacus fluviatilis was studied with intracellular recording technique. Membrane currents were measured with voltage clamp technique. Both detergents blocked the action potential in 20--30 min at concentrations of 60--80 microgram. Following blocking of spike electrogenesis the receptor potential evoked by strech was obtained in isolation. With prolonged exposure of the neuron to the detergents there was a slowly developing reduction of the receptor potential and after 60--90 min no response to stretch could be obtained. These effects were produced without any significant change of the resting membrane potential. Following return to normal saline the responsiveness to stretch was completely restored in 80--100 min. Measurements with voltage clamp techinque showed that the passive membrane properties were little affected by the two detergents. The stretch induced current on the other hand was severely depressed and almost abolished with prolonged exposure. The experimental results suggest that non-ionic detergents block the spike electrogenesis and the transducer action by a selective action on the sodium channels of the membrane of the receptor neuron.


Delayed drinking in response to electrical and thermal stimulation of the medial forebrain.

Water intake in response to electrical and thermal stimulation of the medial forebrain was studied in the goat. When the frontal wall of the third cerebral ventricle was included in a field of bipolar electrical stimulation a dipsogenic response was obtained after discontinuation of the stimulation. Release of antidiuretic hormone (ADH) was apparently also elicited. The water intake was roughtly proportional to the amount of current which had been applied during the stimulation period. Water consumption in response to stimulation attenuated the dipsogenic effect of subsequent stimulation, as did also pre-stimulatory hydration by stomach tube. A 2 degrees C elevation of the temperature of parts of the preoptic/anterior hypothalamic region for 40 min periods incuded cumulative drinking starting after 2.5 to 18 min. There were great interindividual differences in the amount of water consumed in response to the thermal stimulation, possibly due to variations in thermo-couple electrode placement. The dipsogenic effect of forebrain warming was inhibited by pre-hydration, and by lowering of the environmental temperature. The delayed thirst responses are discussed in relation to stimulus-bound drinking previously observed in the same and other species. It appears possible that the delayed drinking was a manifestation of artificially induced excitation of juxtaventricular "thirst" receptors.


Disturbed circadian variation of serum thyrotropin in patients with endogenous depression.

The relationship between the degree of depression and the circadian variation of serum TSH, T3 and T4 was investigated in 19 endogenously depressed patients. The difference between the hormone concentrations at 2 p.m. and at 12 p.m. was taken as an estimate of the magnitude of circadian variation. It was found that the circadian variation in serum TSH was inversely related to the degree of endogenous depression. This was mainly due to a diminution or absence of the night increase of TSH in severely depressed patients. A circadian variation of serum free T3 was found in the less depressed patients whereas no diurnal change was found in serum free T4. In severely depressed patients there were no significant diurnal changes in free thyroid hormone concentrations. The results indicate a hypothalamic dysfunction in manic-depressive psychosis.


Assessment of difficulties encountered in psychiatric follow-up studies.

To assess some of the socio-cultural reasons hindering psychiatric follow-up studies in Iran, 107 depressed patients were followed up for a period of about 3 years. Home visits were made, following two successive letters to which only five patients replied. Forty-five patients were interviewed, nine had moved, four refused interviewing, two were dead and the addresses or names of 47 were wrong. Wrong names and addresses, and behind them the illiteracy, change of address and the stigma of mental illness were the major causes of untraceability; the patients are inaccurate in giving their address and they may use one or another of their several names, surnames and nicknames. To make follow-up studies feasible, and as the patients and their relatives are the main sources of information, a more efficient registration system should be developed, with due respect to the characteristics of the population, to ensure having complete and correct names and addresses and to ensure patients' continual contact with the office.


Female alcoholics. III. Development and pattern of problem drinking.

The study provides a social and psychiatric description of development, drinking pattern and concomitant psychiatric disturbances of 100 female alcoholics, admitted to the Department of Alcohol Disease, Karolinska Hospital in Stockholm between 1963 and 1969. Comparisons are made between this group of women and 100 men of the same age, who were admitted during the same period. The criteria for selection were: 1) at least 7 days of in-patient treatment; 2) early cases. The subjects were between 20 and 65 years of age with a mean age of 40. It is shown that the women started drinking alcohol at higher ages than the men. The episodic use of alcohol passed into regular use, which progressed into misuse at significantly higher ages. The duration of the development from the onset to an alcoholic drinking pattern was significantly shorter and so was the duration of abuse at the time of admission. Notably more women than men showed a lonely drinking pattern and cited a specific external cause problem drinking. The women reported more nervous symptoms both in the growing ages and at admission, had received more psychiatric treatment both during childhood and in later life, and showed symptoms of other psychiatric disturbances in combination with alcoholism to a significantly higher degree than the men. Family history of alcoholism showed no differences between men and women, but the incidence of psychiatric illness was considerably higher for the first-degree relatives of the females.


The epidemiology of febrile reactions in haemodialysis.

Febrile reactions were studied in 2 000 consecutive haemodialyses performed in 85 patients. A number of 219 febrile reactions were registered in 49 patients (11%). The overall month-to-month incidence showed little variation. Febrile reactions were not distributed randomly among the patients; those with respiratory tract infection experienced more febrile reactions during periods with infection than during periods without. Similarly, the incidence was higher in patients with than without chronic urinary tract infection. A low incidence was registered both in patients under 40 years of age and in patients having had more than 100 dialyses at the beginning of the observation period. The frequency was the same whether single-pass or recirculating single-pass monitors had been used, and it was not influenced by blood transfusions during dialysis. Thus, our analysis leads to the conclusion that the majority of the febrile reactions registered among the present patients were determined by endogenous factors such as infection, while exogenous factors such as dialysate bacteria and pyrogens seem to have played only a minor role.


Exposure to organic solvents--a missing link in poststreptococcal glomerulonephritis?

Fifteen patients with evidence of acute poststreptococcal glomerulonephritis were asked about their contact with vapours of organic solvents. Six patients reported brief exposure shortly before the onset of glomerulonephritis, 4 fairly long exposure, and 5 none or insignificant. At the latest followup, 3 of 4 patients who were still exposed to such solvents had proteinuria and a low glomerular filtration rate (GFR), and 2 were hypertensive. Of the 11 patients who had never been or were no longer exposed, the GFR was insignificantly decreased in 2, none had proteinuria and none were hypertensive. Fifteen age-and sex-matched controls, who had been infected with group A beta-hemolytic streptococci, T type 12, had not been exposed, or the exposure was insignificant and not related to the streptococcal infection. Exposure to organic solvents or other nephrotoxic agents may be the condition which determines the outcome of an infection with nephritogenic streptococci.


Combination of fibromuscular hyperplasia, renal aplasia, hypoplasia or dysplasia and otosclerosis occurring in the same individual or the same family.

We have found 3 reports of fibromuscular hyperplasia (FMH) of the renal arteries with hypertension occurring in 2 siblings as well as a few instances of renal agenesis and unilateral renal aplasia occurring in the same family. In this paper we report on FMH of the renal arteries in 2 women, one giving birth to a child with renal agenesis, the other to a child with a focally dysplastic hypoplasia of the kidneys. A third family is reported, heavily loaded with hypertension and otosclerosis, in which 2 siblings with FMH and otosclerosis were found. Another 4 patients without known heredity for hypertension, but with FMH combined with renal or urinary tract anomalies, are also reported. The findings are discussed, particularly in relation to the findings in a large material of chronic non-obstructive pyelonephritis, where in those with well maintained renal function, hypertension below the age of 40 was found predominantly in females with a positive family history of hypertension and signs highly suggestive of infected hypoplasia or dysplasia of the kidney.


Urinary excretion of basement membrane antigen in normal persons and patients with febrile proteinuria--quantitated by means of rocket immunoelectrophoresis.

The urinary excretion of a glomerular basement membrane-like antigen was quantitated in 19 adult normal subjects and in 15 patients with febrile proteinuria by means of rocket immunoelectrophoresis. In the normal persons the excretion averaged 59 (S.D.8.9) U/24 hours' creatinine clearance. An increased excretion was demonstrated in 80% of the patients. There was a significant relation between the urinary excretions of albumin and protein in the patients with febrile proteinuria. The basement membrane antigen was also demonstrated in normal human serum, liver and placenta. No unusual basement membrane antigen could be demonstrated in the urine from patients with febrile proteinuria.


Renal cadmium concentration in relation to smoking habits and blood pressure.

The cadmium concentration of renal tissue from 120 patients, who had died at the age of 45-65 years, has been determined by atomic absorption spectrophotometry. The concentration did not differ significantly either between urban and rural dwellers or between male and female subjects. The concentration of cadmium in kidneys from cigarette smokers was about twice as high as in kidneys from non-smokers. Renal cadmium concentration was higher in normotensives than in hypertensives. When smoking habits were taken into account, renal cadmium concentration was found to be 82% higher in normotensives than in hypertensives. The possible roles of water hardness and selenium intake are discussed.


Effect of upright tilting on kinins as compared to renin activity in the renal venous blood from patients with essential hypertension.

The effect of tilting on the release of renal kallikrein as compared to renin was studied by the determination of kinin concentration and plasma renin activity (PRA) in the renal veins in supine position and after 15 min of 45 degrees upright tilting in 10 patients with essential hypertension. Kinin concentration decreased from 0.62 +/- 0.05 microgram/1 (mean +/- S.E.M.) in supine position to 0.51 +/- 0.05 after tilting (p less than 0.01), while PRA increased from 2.84 +/- 0.39 microgram/1/3 h tpo 4.87 +/- 0.66 (p less than 0.001). These results indicate that tilting diminishes the release of renal kallikrein. It is suggested that decreased intrarenal generation of kinins may be of importance for the reduction of diuresis and natriuresis induced by tilting.


Changes in plasma volume and extracellular fluid volume and after addition of hydralazine to propranolol treatment in patients with hypertension.

In 16 patients with hypertension, BP could not be controlled satisfactorily by treatment with propranolol alone (mean dosage 325 mg/day). Plasma volume (PV) (T-1824) and extracellular fluid volume (ECV) (82Br-distribution space) were determined in these patients before and after the addition of hydralazine for three months (mean dosage 135 mg/day). After the addition of hydralazine, PV and ECV increased significantly, by 9% and 3%, respectively. Systolic and diastolic BPs decreased, by 15% and 13%. The mechanisms inducing fluid retention during treatment with hydralazine and the clinical significance of the problem are discussed. It is concluded that the addition of a diuretic to propranolol-hydralazine treatment is often well indicated.


Electrophysiological methods in assessing cardiac effects of the tricyclic antidepressant imipramine.

The tricyclic antidepressant agent imipramine was tested intravenously in 8 healthy individuals with respect to its effect on sinus recovery time, intervals in His bundle electrograms and the duration of the repolarization in the right atrium and ventricle judged from the refractoriness and monophasic action potential duration. Sinus recovery time was unchanged after the drug. The interval between the His bundle deflection and the start of the QRS complex in the standard lead showed no consistent changes but increased to pathological values in two individuals. The duration of the repolarization decreased in the atrium--an effect which could be arrhythmia-provoking or arrhythmia-protecting. The duration increased at the ventricular level. This effect could explain the antiarrhythmic effect on ventricular ectopics observed in other investigations.


The cardiac response to a small i.v. dose of dihydralazine, a safe drug for diagnostic tests?

Dihydralazine, given in small i.v. doses, has been of great value in diagnostic tests for unilateral renovascular hypertension, where it enhances renin release on the affected side. The acute hemodynamic effects of an i.v. dose of 0.1 mg/kg b.wt. were studied in 14 patients with essential hypertension, using a quantitative renographic technique for determination of effective renal plasma flow and radiocardiographic technique for determination of the parameters in systemic circulation. Cardiac index increased from 4.040 to 6.423 1/min.m2 (p less than 0.01), stroke index from 59 to 66 ml/beat.m2 (p less than 0.05), heart rate from 70.4 to 96.6 beats/min (p less than 0.01) and left ventricular work index from 1.04 to 1.49 W/m2 (p less than 0.01), while mean arterial B decreased from 125 to 110 mmHg (p less than 0.01) and total peripheral resistance index from 2927 to 1534 10(5).N.s.m(-3) (p less than 0.01). Effective renal plasma flow and pulmonary plasma volume were unchanged. Peripheral renin activity increased from 0.5 to 1.6 nmol A1/1.h (p less than 0.02). It is concluded that even a small test dose of 0.1 mg/kg of dihydralazine elicits a considerable additional work load on the heart, a circumstance that must be taken into consideration in studies of patients with coronary heart diseases.


Transitory renal failure following rapid administration of a relatively large amount of hematin in a patient with acute intermittent porphyria in clinical remission.

Transitory renal failure occurred in a patient with acute intermittent porphyria in clinical remission following i.v. administration of 1 000 mg hematin. The clinical and biochemical picture suggested "acute tubular necrosis", which was followed by a prompt and complete return of renal function without any late sequelae. The renal failure is thought to have resulted from the presence of circulating free hematin, formed as a result of rapid administration of such a relatively large amount. Such a complication has not occurred in patients given hematin for acute porphyric relapse, in whom much smaller amounts have been infused.


Activated F IX concentrate (FEIBA) used in the treatment of haemophilic patients with antibody to F VIII.

Bleeding episodes in five haemophiliacs with antibody to F VIII were treated by activated F IX concentrate (FEIBA). Relief of pain and haemostasis in affected muscles and joints were recorded in each case. One patient developed a mild attack of disseminated intravascular coagulation with an uneventful recovery. A substantial rise in natural inhibitors of coagulation was seen in two patients, and all but one experienced a rise in F VIII antibody titer.


A family with thromboembolic disease associated with deficient fibrinolytic activity in vessel wall.

Defective fibrinolytic activity is often a contributory factor in deep venous thrombosis. A family with a high incidence of venous thrombosis in association with such a defect is presented. Of 13 family members who had had thrombosis, 12 showed a defective capacity to release fibrinolytic activity from vessel wall after venous occlusion and/or infusion of DDAVP, a vasopressin derivative. The fibrinolytic activator activity of the vessel wall was normal in all cases. This seems to be the first family in which there is evidence of an inherited abnormal fibrinolytic activity.


Analysis of extramedullary erythropoiesis in the spleen by a semiquantitative method using indium-111.

A semiquantitative method for evaluating the splenic uptake of 111In is described. With this method the uptake of indium in the spleen was significantly higher in seven patients with extramedullary erythropoiesis (EME) than in a control group of seven patients with comparable degrees of splenomegaly but without clinical and/or histological signs of EME. The discrimination between these groups could be further improved by also taking the degree of splenomegaly into account. It is concluded that the described technique is a valuable non-invasive aid for establishing the presence of EME in the spleen.


Non-invasive methods for evaluating the importance of heart rate and atrial activity in cardiac pacing. Results of ballistocardiography and digital plethysmography studies in six patients with heart block.

Ultralow frequency ballistocardiography (UFB) and digital pulse plethysmography (DPP) were performed in six patients with an external artificial pacemaker system. UFB was used mainly to evaluate the force of contraction of the left ventricle (IJ amplitude) and DPP for evaluating relative changes in the peripheral pulse volume. Four patients were studied at 40, 50, 60, 70, 80, 90 and 100 beats/min. There was a significant decrease (p less than 0.001) in LJ and pulse amplitudes when the heart rate increased from 40 to 100 beats/min. A positive correlation between relative IJ and pulse amplitude was observed in all cases studied. In beat-to-beat analysis it was found that the importance of the PR interval for the IJ and pulse amplitudes varied between patients. It is concluded that both UFB and DPP may be of value in clinical practice for evaluating hemodynamics in patients with slow spontaneous heart rate. The methods may be of help in selecting the most effective type of pacemaker for the individual patient.


Smoking, lung function, physical performance and latent coronary heart disease in presumably healthy middle-aged men.

During a cardiovascular survey comprising 2014 presumably healthy men aged 40-59 years, latent (previously undetected) coronary heart disease (CHD), lung function and physical performance were related to differences in smoking habits. The survey examination classified 1 832 individuals as "normals" (without clinical signs/symptoms of CHD). Among the others, a strong supicion of CHD was found in 115, of whom 105 had diagnostic coronary angiography. No angiography was performed in another 35 individuals with slight, albeit typical angina pectoris. The remaining 42 men were excluded from this presentation for various reasons. The following findings were obtained: 1) in the 69 men with positive coronary angiography, the extent of coronary atheromatosis was positively related to the number of cigarettes smoked. 2) The smoking habits of the 35 individuals with slight angina pectoris but no angiography did not differ from those of the "normals". 3) Physical performance during a near maximal bicycle exercise test and lung function according to spirometry were strongly and negatively related to smoking (in "normals"). 4) Previous smokers and never-smokers among "normals" had almost identical lung function and physical performance.


Supraventricular tachyarrhythmias in acute myocardial infarction.

Onset of atrial tachycardia, flutter or fibrillation occurred in 11% of 274 consecutive patients with acute myocardial infarction (AMI). Atrial tachycardia started about 24 hours and atrial flutter/fibrillation about 72 hours after onset of AMI symptoms. Left heart failure, diagnosed as pulmonary rales or frank pulmonary edema, was not more common in these patients before onset of tachyarrhythmias than among the rest of the patients. On the other hand, a notching of the P wave in lead CR-was significantly more common in the patients with atrial fibrillation (67%). In most of these cases the terminal P force in lead CR1 was not negative as in so-called left atrial enlargement. These findings suggest that atrial conduction disturbances might be a basis of atrial fibrillation in AMI.


Patients with high-grade atrioventricular block treated and not treated with a pacemaker.

One-hundred and eighty-one patients with chronic and with intermittent high-grade atrioventricular block (AVB) were studied retrospectively. Seventy-one were treated with fixed-rate, 51 with demand-type pacemaker, 59 were treated conservatively. Observation time was three years minimum and 14.5 years maximum. The mean age was about seven years higher, and 8.7% more patients had chronic AVB in the conservatively treated than in the pacemaker-treated group. About 12% more patients had Adams-Stokes attacks in the pacemaker group than in the conservatively treated group. There were 7% more patients with coronary heart disease (CHD) in the pacemaker group, and 10% more with aortic valve disease among the conservatively treated. Totally 4.4% of the patients had a calcification of the mitral annulus fibrosus. The two groups were comparable as regards functional class (NYHA) and heart size. Survival showed 31% more sudden deaths in the conservatively treated than in the pacemaker group. Sudden deaths were not more frequent among the patients with CHD than in those without. Long-term survival showed the more favourable result for the patients with than without pacemaker treatment. There were eight (11.3%) unexplained sudden deaths among the patients treated with fixed-rate pacemaker, only three (5.9%) among those treated with a demand unit. The fixed-rate and the demand units showed a mean longevity of 37.2 and 34.6 months, respectively.


Left anterior hemiblock in acute myocardial infarction. Incidence and clinical significance in relation to the presence of bundle branch block and to the absence of intraventricular conduction defects.

The incidence of intraventricular conduction defects was examined retrospectively in 449 consecutive patients with acute myocardial infarction (AMI). The incidence of left anterior hemiblock (LAH), right bundle branch block (RBBB), left bundle branch block (LBBB) and RBBB+LAH was 12.2, 4.2, 3.8 and 2.5%, respectively. At least 24 patients (5.8%) developed LAH as a result of the AMI. LAH was present in 20% (33/164) of patients with anterior infarction, in 14% (18/131) of those with infarction of undetermined localization, and in 3% (4/143) of patients with diaphragm infarction. The incidence of complete atrioventricular (AV) block in patients with LAH was 6% and in patients with no intraventicular conduction defects 7%. In patients with RBBB, RBBB+LAH and LBBB, the incidence of complete AV block was 37, 45 and 18%, respectively. Severe pump failure occurred with the same low incidence in patients with LAH as in patients without intraventricular conduction defects, but was much more common in patients with complete bundle branch block (BBB). The mortality rate for patients with LAH was 22% and for patients with no intraventricular conduction defects 21%. In patients with RBBB, RBBB+LAH and LBBB, the mortality rates were 53, 55 and 53%, respectively. Patients with complete BBB had a higher age and a higher incidence of previous AMI than the others. Compared to patients with no intraventricular conduction defects, the presence of LAH did not increase the mortality rate, or the risk of developing severe heart failure or complete AV block, in contrast to the serious prognosis in patients with complete BBB.


Thrombosis of the inferior vena cava, disseminated intravascular coagulation and gangrene of the penis. A case report.

Gangrene of the penis following thrombosis of the lower segment of vena cava inferior is reported in a patient who also exhibited clinical and laboratory signs of disseminated intravascular coagulation. Development of the gangrene may have been related to thrombotic occlusion of the right spermatic vein.


Comparison of the results in patients operated upon for ruptured lumbar discs with and without spinal fusion.

A comparative study of 259 patients operated on for ruptured lumbar discs, with and without spinal fusion, has been carried out. Simple removal of the herniated nucleus pulposus was performed in 119 patients while 68 were subjected to combined removal of the herniated disc material and lumbo-sacral fusion. During the first postoperative months the results were similar in the two groups, with a satisfactory result in 89 and 88 per cent of the cases respectively. During the following years a significant difference occurred between the groups. Severe pain recurred in 27% of the patients with simple removal of the herniated disc material and in 15% of those with the combined operation (P less than 0.01). The cause of the recurrence in the patients without fusion was disc herniation in 10% (at the same level in 7% and at a different level in 3%), and adhesions, or osteochondrosis with or without instability in 17%. In the patients with the combined operation the recurrences were caused by pseudoarthrosis in 9%, by disc herniation in 3%, and by other causes in 3%. At the final examination 6--7 years after the first operation, the results were still better in the fused patients, but the difference was no longer significant. Eighty-five per cent of the patients with the combined operation has a satisfactory result with regard to pain as compared with 76% in the other group. Thus, the results show that the combined operation gives better protection against recurrence of pain. However, it is a more extensive procedure and has complications of its own, and it should therefore mainly be used in young patients.


Redundant nerve roots of the cauda equina. A report of five cases.

Five personally examined cases of redundant nerve roots of the cauda equina are added to the 13 hitherto on record. Except for segmental neurological deficits, intermittent claudication-like symptoms of the cauda equina dominated the histories of four of our five cases. The diagnosis was confirmed at surgical exploration, which included laminal and dural decompression. At follow-up (two months--three years) the neurological deficit, or the intermittent claudication, or both, had improved in all our patients. The pathogenesis of root redundancy is obscure. It seems that the symptoms arise through the action of at least two factors viz compression of the spinal content and the existence of one or more redundant roots. Wider use of diagnostic aids and surgical exploration would probably show that redundant roots are more common than hitherto supposed.


Lhermitte's sign in thoracic spinal tumour. Personal observation.

In a case of midthoracic spinal metastasis with a partial transverse cord lesion a typical Lhermitte's sign was elicited by flexion of the head. This is a very rare phenomenon with thoracic spinal tumours.


Transitory block of the arachnoid granulations following subarachnoid haemorrhage. A postmortem study.

The arachnoid granulations of the superior sagittal sinus were examined for blockage by erythrocytes in 43 cases of subarachnoid haemorrhage. Ten cases had survived for more than two weeks after the haemorrhage. Among 33 cases with acute haemorrhage, 17 had evidence of blocking of the granulations. The severity of the block varied from complete clogging of nearly all granulations to slight filling of a few of them. Cases with some days' survival showed evidence of phagocytosis of the entrapped erythrocytes by macrophages. Several of the cases with old haemorrhage had groups of haemosiderin macrophages in the granulations but none showed fibrosis (except for one single villus). It is concluded that clogging of the arachnoid granulations may contribute to the raised intracranial pressure in some cases of acute subarachnoid haemorrhage. However, the observations do not support the hypothesis that the haemorrhage may lead to fibrosis or scarring of the granulations with chronic impairment of the cerebrospinal fluid resorption and subsequent hydrocephalus.


Bulk flow of cerebrospinal fluid through a lumbo-omental pedicle graft in the dog.

Perfusion tests were performed in dogs with a pedicle graft of the greater omentum implanted in the lumbar subarachnoid space to measure its capacity to drain CSF. The CSF pressure was set at different levels in the range 0--50 mmHg and the outflow from a complete CSF space and then from the isolated dural sac was recorded in the same dog with an electronic drop recorder. It was shown that the omental graft could transport as much as 30% of the CSF normally carried by the physiological pathways. The spinal outflow in the controls was virtually non-existent. It is concluded that a bulk flow of CSF occurs through the graft. The results suggest that a lumbo-omental pedicle graft could possibly be used as a biological shunt in the treatment of hydrocephalus.


Communicating exophthalmos: a sign of bilateral orbital roof defects.

The term communicating exophthalmos is suggested for a condition where manual retropulsion of one eye results in proptosis of the other eye. This sign was observed in a patient with bilateral pulsating exophthalmos. The pulsating exophthalmos was ascribed to orbital roof defects in combination with post-traumatic hydrocephalus. It was controlled by a shunting procedure.


[Modified technique in transsphenoidal operations of pituitary adenomas. Technical note (author's transl)].

High pressure lumbar air insufflation and endoscopical surgical technique and control improve surgical results and widen indications for the transsphenoidal approach to pituitary adenomas. These complementary methods require a sitting position for the patient and an axial approach to the sella turcica. By lumbar high pressure insufflation even very big pituitary adenomas may often be brought into the operation field and make possible a complete extirpation by a transsphenoidal approach. This possibility is increased by an operative technique under endoscopic control, the latter contributing considerably to complete tumour extirpation, especially with endocrine-active tumours.