Ultrafiltration without dialysis for removal of fluid and solutes in uremia.

A review is presented of the use of sequential ultrafiltration and dialysis to facilitate asymptomatic fluid removal in dialysis patiens, and the use of ultrafiltration as a method to remove uremic compounds. In sequential ultrafiltration and dialysis, the two physical principles in hemodialysis are separated in time. Hypotension and other side-effects which may be encountered when the two procedures take place simultaneously are eliminated or minimized by sequential treatment. Hemofiltration is an entirely new form of treatment, which mimics the performance of the human kidney better than hemodialysis. The blood is purified by ultrafiltration and fluid replacement either before or after the ultrafilter device. Preserved well-being or improvement in clinical condition have been reported after prolonged treatment with hemofiltration in spite of relatively inefficient elimination of small molecules as urea and creatinine. The most consistent beneficial effect of hemofiltration appears to be better blood pressure control in severely hypertensive patients than with conventional hemodialysis.


Comparative haemodynamic effects of clonidine administered intramuscularly or intravenously to anaesthetized rats.

1. The acute haemodynamic effects of clonidine, 0.001-1.0 mg/kg, administered intramuscularly or intravenously, were studied in anaesthetized rats. 2. The direct pressor potency of clonidine was 100-fold greater following intravenous administration than after intramuscular injection, but hypotensive efficacy was equal by either route.


Unsolved technical problems of maintenance dialysis.

The present paper describes some of the technical inadequacies in the clinical practice of dialysis. Problem areas of hemodialysis, i.e., those related to blood access, dialyzer and delivery system, are treated in depth. Corollaries with peritoneal dialysis are obvious. Research priorities, in particular development of a more sophisticated delivery system, are suggested. The intent of this discussion is to outline a rational progression in improvement of care of the end-stage renal disease patient.


A study of the interaction of practolol with acetylcholine, histamine, serotonin and bradykinin in the guinea-pig, and with bean-sprout juice in the mouse.

1. The interactions of practolol with acetylcholine, histamine, serotonin and bradykinin were studied on the trachea and lung of the guinea-pig, an animal whose sensitivity to bronchoactive endogens is known to be similar to that of human asthmatic bronchi. 2. Practolol, like propranolol, potentiated the action of the first three agonists mentioned above, but, unlike propranolol, it did not potentiate the bronchospastic effect of bradykinin. 3. Practolol, in fact, antagonized the action of bradykinin, but this effect was unlike that produced by nonsteroidal anti-inflammatory drugs. 4. The possibility that beta-adrenoreceptor antagonists might show adverse interactions with certain foodstuffs was investigated, an is discussed. 5. It is suggested that the feasibility of the continued use of practolol (or the newer cardioselective beta-blockers) in asthmatics necessarily depends on the type of allergic reaction involved, and so it is not possible to generalize. Any drug or food that might cause a bronchospastic effect synergistically in the presence of a beta- adrenoreceptor antagonist, even a cardioselective one, should be regarded with suspicion.


Separation of two conjugates of clofibric acid (CPIB) found in the urine of subjects taking clofibrate.

1. Two main conjugates of CPIB (2-[chlorophenoxy]-2-methylpropionic acid) are present in the urine of subjects taking clofibrate. The metabolites can be separated by thin-layer chromatography (TLC). 2. Both conjugates are hydrolysed by dilute alkali, but only one is hydrolysed by the enzyme beta-glucuronidase. In eighty-five urine specimens this conjugate accounted for an average of 54.5% (range 25-70%) of the total CPIB, while 2.6-12.45% (mean 5.1%) was present as free CPIB.


Coping with disability and the surgical experience: body image of scoliotic female adolescents.

Twenty-five adolescent girls undergoing surgery for correction of idiopathic scoliosis (curvature of the spine) were administered the Rorschach Ink Blot Test preoperatively, and the House-Tree-Person Test preoperatively, postoperatively, and at one year follow-up. In the figure drawing test younger girls scored significantly higher than older girls in both the preoperative and postoperative periods. The older adolescent's sensitivity of issues of physical attractiveness and bodily functioning increased her painful awareness of the deformity. With other measures, girls who denied their deformity significantly differed from nondenyers in their ability to cope with the stress of surgery; they had greater feelings of vulnerability and perception of the self as the object of an aggressive attack. Such denying, highly anxious patients need greater psychologic preparation prior to surgery. The limited motility of the postoperative scoliotic patient distorts body image perception and promotes feelings of passivity and helplessness.


Requesting the autopsy: a pediatric perspective. Psychosocial and professional aspects of the autopsy in caring for the dying child and his family.

Many physicians find the request for autopsy to be one of the most difficult and unpleasant aspects of pediatrics. Lack of preparation, their own emotional reactions, and ambivalence about the necessity of autopsies contribute to this. This article offers an approach to the autopsy that emphasizes its importance to families and to pediatrics, and suggests a role for the physician at the time of the child's death that is both professionally and personally gratifying.


Intentional poisoning of two siblings by prescription drugs. An unusual form of child abuse.

The two cases described in this report are examples of a bizarre form of a child abuse. Intentional poisoning with prescription drugs was used by the mother to simulate an underlying disease in her two children. Combined with misleading history and interference with laboratory procedures, she confounded physicians for years, and led to unnecessary hospitalizations, treatment and multiple laboratory procedures for these children. This report may alert physicians to earlier recognition of this form of child abuse.


Propranolol withdrawal and thyroid hormones in patients with essential hypertension.

The effect of abrupt withdrawal of propranolol on serum concentrations of triiodothyronine (T3) and thyroxine (T4) was investigated in 5 patients with uncomplicated essential hypertension. The patients had been treated from 2 to 18 mo before the study was begun. Doses varied from 160 to 480 mg propranolol daily. Four of the patients studied developed tachycardia, sweating, or tremor within 2 to 6 days after withdrawal of propranolol. In 1 patient reversible ischemic ECG changes were recorded. The serum concentrations of free T3 increased in the 4 patients suffering from withdrawal symptoms. The mean increase on the day the symptoms started was 51% (range, 22 to 74, 2 p = 0.01). This increase in serum-free T3 correlated positively with the serum propranolol concentration on the last day propranolol was given (r = 0.91, 2 p = 0.03). In the one patient, who did not develop withdrawal symptoms, the serum concentration of propranolol was very low, and the free T3 level remained unchanged. No significant changes in serum concentrations of free T4 or total thyroid hormones were found in any of the patients. We suggest that the propranolol withdrawal symptoms are, at least partially, caused by an increase in the thyroid hormone, T3.


Bronchodilating effect of terbutaline aerosol.

We compared the efficacy of terbutaline with that of metaproterenol, isoproterenol, and placebo aerosols in 16 asthmatic patients. Terbutaline, metaproterenol, and isoproterenol produced equivalent improvements in flow rates. At 5 hr, the effect of terbutaline on tests of small airways, FEF25%--75%, and FEF50%, was greater (p less than 0.05) than that of metaproterenol and isoproterenol. Terbutaline produced no significant change of heart rate or blood pressure.


Furosemide kinetics in renal failure.

Furosemide kinetics were studied in normal volunteers and patients with renal failure. Comparison of results from intravenous bolus and intravenous infusion in normal subjects showed no significant model dependency of estimations of furosemide clearance, although the average clearance by fitting to a one-compartment model was 16% higher than that obtained by fitting to a two-compartment model. Normal subjects had a total body clearance of furosemide of 1.53 +/- 0.11 (SE) ml/min/kg, a volume of the central compartment of 2.61 +/- 0.37 L, a volume of the peripheral compartment of 2.48 +/- 0.24 L, and a half-life of 0.8 +/- 0.06 hr and they absorbed 68.9% +/- 7.1% of a solution of furosemide given by mouth. The corresponding values in patients with renal failure were 0.27 +/- 0.03 ml/min/kg, 8.02 +/- 0.96 L, 14.1 +/- 3.57 L, 14.2 +/- 2.30 hr, and 43.4% +/- 8.0%, all differing significantly different from the normal. The bioavailability of 500-mg tablets of furosemide in the renal failure patients was 43.4% +/- 7.4%, equivalent to the absorption of the dose given to the same patients in the form of a solution.


Relation between plasma concentration of indomethacin and its effect on prostaglandin synthesis and platelet aggregation in man.

The dose and plasma levels of indomethacin correlated with inhibition of prostaglandin synthesis as measured both by urinary excretion of the major metabolite of prostaglandin E2 (PGE-M) and by the release of prostaglandin E2 from thrombin-stimulated platelets. Considerable intersubject variability was observed in the suppression of PGE-M excretion. In some patients 37.5 mg indomethacin daily, usually considered subtherapeutic, caused suppression. Maximal suppression (greater than 90%) occurred in some after a daily dose of 75 mg, whereas 150 mg was required to achieve this level of inhibition in others. Suppression of the excretion of PGE-M by 60% occurred when the end of the dosage interval plasma levels of indomethacin were in the range 0.05 to 0.3 microgram/ml, which implies that a somewhat higher average steady-state concentration during the dosage interval was required to achieve this effect. A similar degree of inhibition of the release of PGE2 on thrombin-stimulated platelets was associated with the same range of plasma levels. Upon discontinuation of the drug, the levels of indomethacin in plasma decreased exponentially; inhibition of the release of PGE2 from platelets by indomethacin declined linearly with time and in parallel with the logarithm of the diminishing plasma levels.


Kinetics of netilmicin in man.

The kinetics of netilmicin (N-ethyl-sisomicin), an investigational aminoglycoside, have been determined in man following intravenous and intramuscular administration of a dose of 2 mg/kg. After intravenous injection the serum elimination of the antibiotic obeys two-compartment open model kinetics. Distribution and elimination constants are in the range reported for other aminoglycosides, with the exception of the volume of distribution at the steady-state, which appears to be greater than that of sisomicin and of tobramycin. Urinary excretion data suggest that this antibiotic undergoes some degree of tubular reabsorption and appears to be cleared partially by extrarenal processes. After intramuscular administration, the absorption of netilmicin follows first-order kinetics and its physiologic availability is complete.


Effects of methaqualone on blood platelet function.

To study the mechanism whereby toxic doses of methaqualone cause a bleeding tendency in humans, the effects of methaqualone, diphenhydramine, and the combination of methaqualone plus diphenhydramine on blood platelet function were investigated. Exposure of human platelets in platelet-rich plasma in vitro to final concentrations of methaqualone ranging from 1.1 to 4.5 X 10(-4)) M resulted in nearly complete inhibition of the secondary phase and significant inhibition of the primary phase of adenosine diphosphate (ADP)--induced aggregation. Both the slope and height of collagen-induced aggregation responses were reduced significantly in vitro by the drug. When methaqualone final concentrations of 1.1, 2.3, and 4.5 X 10(-4) M were studied in the presence of diphenhydramine (1.1, 2.3, and 4.5 X 10(-5) M, respectively), the degree of inhibition of ADP-induced aggregation was only slightly greater (not significant) than that observed with methaqualone. The platelets of rabbits injected intravenously with methaqualone, 10 mg/kg, demonstrated a significantly decreased ability to aggregate with ADP and collagen 30 and 60 min after administration of the drug. These results suggest that a drug-induced defect of blood platelet function may play a role in the bleeding associated with methaqualone toxicity.


Computed tomographic scanning in liver disease.

The non-invasive diagnostic technique of computed tomograph (CT) has been assessed in 100 patients with established liver disease. CT can differentiate extra- from intrahepatic cholestasis and may define the obstructing lesion in the former group. It is of value in detecting infiltrations with fat or iron, and provides useful information in patients with cirrhosis and metastatic deposits. At present it appears of less value in the diagnosis of non-fibrotic parenchymal liver disease.


Evaluation and follow-up of pancreatic arteriograms. A new role for angiography in the diagnosis of carcinoma of the pancreas.

Of over 300 pancreatic arteriograms done in this hospital group adequate follow-up was possible in only 103 patients, with carcinoma in 35 of them. Based on the prospective report there were three false negatives and seven false positive carcinoma diagnoses, an overall accuracy rate of 90.3%. A retrospective review could eliminate all but one false negative and one false positive diagnosis. Angiographic findings are reviewed separately for periampullary and truely pancreatic carcinoma. Subselective catheterisation and adequate opacification of the arterial network of the pancreas allows the reliable demonstration or exclusion of even 1--2 cm carcinomas, provided the clinical presentation of the patient has not been that of jaundice or pancreatitis. Taking into account the availability of newer non-invasive imaging techniques, clinical situations are listed in which the angiographic diagnosis of carcinoma is no longer required. The new purpose of angiography in pancreas carcinoma diagnosis is the demonstration of small and still curable lesions, the prerequisite for this being a much earlier clinical suspicion of the disease and an earlier referral for angiography.


The use of prostaglandin F2-alpha in selective pancreatic and left gastric angiography.

Prostaglandin F2-Alpha has been used in 10 superselective angiographic studies of the pancreas and 10 left gastric studies. Injection of Prostaglandin into the dorsal pancreatic or gastroduodenal artery increased opacification of small pancreatic vessels and better demonstrated the angiographic changes in three cases of carcinoma of the pancreas. Injection of the drug into the left gastric artery increased opacification of the left gastric vein, allowed identification of the direction of flow of the contrast medium and enhanced demonstration of gastro-oesophageal varices. It is concluded that Prostaglandin improves the quality of pancreatic and left gastric angiographic studies.


The placement of the umbilical venous catheter in the newborn and its relationship to the anatomy of the umbilical vein, ductus venosus and portal venous system.

The importance of lateral as well as AP views for the correct placement of the umbilical venous catheter is stressed. The position of the catheter is related to the anatomy of the ductus venosus which is demonstrated by contrast injection. Air in the portal venous system is not always indicative of a serious process.


Suprapubic micturating cystourethrography in infants.

Contrast medium may be safely and easily placed in the bladder by suprapubic puncture. Samples of clean urine may be obtained at the same examination. The technique and its advantages are described in detail.


Assessment of the double contrast barium meal: method and application.

A method of assessing and comparing double contrast barium meals has been devised. The use of the linear analogue scale has been found to be a consistent method of recording and measuring radiological impression of mucosal coating and gaseous distension. By this means the effectiveness of various currently available barium and gas preparations has been assessed in 125 patients. Appreciable differences in mucosal coating achieved by different barium preparations were detected. Satisfactory gaseous distension of the stomach and duodenum was produced in the majority of patients by all of the methods tested, and the following measurements are suggested as an index of good distension: gastric fundus 10 cm, gastric midbody 7 cm, duodenal loop 4 cm. The relationships between mucosal coating, gaseous distension and areae gastricae have been shown to be tenuous. It is suggested that the methods we have used are very suitable for repetition in other centres for the comparison of any of the many barium and gas-producing agents which continue to come on to the market.


A radiological and pathological correlation of the mucosal changes in ulcerative colitis.

The double contrast barium enema, in most cases performed by the 'instant' technique without bowel preparation, has been compared with the pathological examination of the colon following resection in 37 patients with ulcerative colitis. Radiology has been found to underestimate the histological extent of disease. This supports the use of the term 'extensive colitis' to denote total histological involvement even if the abnormal mucosa seen radiologically extends proximally only to the hepatic flexure. Ulceration is clearly distinguished from a granular mucosa, and implies severe active disease histologically. Subdividing the granular appearance did not prove useful. Polypoid change may occur in the acute stage from ulceration or in the healed state from mucosal tags. Guidelines are suggested to differentiate these, however intermediate stages are commonly found. It is suggested that the radiologist reports polypoid change and tries to assess the state of the background mucosa separately. It is concluded that with qualifications radiology can usefully fulfil its clinical role in assessing the extent and severity of ulcerative colitis.


Percutaneous lymph node aspiration biopsy: experience with a new technique.

Experience with post-lymphographic percutaneous fine needle aspiration lymph node biopsy is described in 13 patients with suspected metastatic malignant disease. All aspirations were performed using an anterior transabdominal approach under local anaesthesia with fluoroscopic guidance. In most patients more than one lymph node was biopsied. Four patients with confirmed metastatic disease had a positive biopsy in the appropriate lymph node. Seven patients with negative biopsies had the absence of metastatic disease confirmed by surgery or follow-up roentgenograms. One patient with a negative biopsy was lost to follow-up. There were two patients with negative biopsies in whom representative lymphoid tissue was not aspirated. No evidence of metastasis was found in these patients at surgery. No serious complications were encountered.


Radiotherapists and cancer education.

This paper argues three main points. First, that education has a vital part to play in the train of events that might lead to the cure of more patients with cancer in certain sites. Secondly, evidence is presented to show that the type of education that is needed must be of a special, and carefully devised kind. And, thirdly, it is argued that of all medical specialists involved in cancer treatment radiotherapists are uniquely placed to stimulate and to support cancer education programmes.


Clinical dosimetry of the rectum in cathetron applications for treatment of carcinoma of the uterine cavity.

Rectal dose measurements have been carried out for 60 patients undergoing Cathetron therapy for the treatment of carcinoma of the uterine cervix at the Cancer Hospital, Indore. The measurements show that the maximum rectal dose occurred around 8 cm from the anal verge. In most of the cases (approximately 75%) the maximum rectal dose lies between 50 and 85% of the dose at point A. The combined biologically effective doses from intracavitary and external beam therapy regimes in this centre and the clinical complications have been compared with those of other centres. Although no immediate serious rectal complications have been observed, it is desirable to check the rectal dose using monitoring source pencils, so that the applicators and rectal retractor can be readjusted, if necessary, to minimise the dose.


A fluoroscopic burn to a patient's right hand sustained in removing a sewing needle--a 22-year follow-up.

Severe radiation burns to the skin and deeper tissues resulting from diagnostic radiology have fortunately been very rare in the United Kingdom. It is hoped they will now be only of historical or academic interest. For this reason a very severe radiation burn to the right hand of a young woman, caused by prolonged fluoroscopy in removing a metalic foreign body, is described. This resulted in a severe sloughing of the skin of the dorsum of the hand that had to be grafted. Subsequently progressive bone necrosis occurred and the hand has never been fully useful since the accident. It is noteworthy that a surgical assistant also sustained radiation burns to the fingers.


Pharmacologic considerations in the design of toxicology experiments.

Final assessment of product acceptance must be based on value judgments that include (a) social, (b) economic, and (c) environmental factors as well as risk factors, and not on simple safety statements about the end product. The goal of toxicologic experiments should be to provide sufficient data to allow benefit-to-risk judgments about products. Benefit-to-risk judgments need to be made on a broad data base which includes: manufacturing, distribution, and use factors. Safety assessments begin with concerns associated with initial manufacture of raw materials and end with concerns related to disposal of the end products of use. Current experimental design needs to include biopharmaceutic considerations of the dose form, pharmacokinetic aspects, and pharmacodynamic factors as well as pathologic concerns. These factors stress the point that toxicology is a quantitative science because toxicity resides in the dose and dose form and not in the chemical entity.


Lichen nitidus. A study of forty-three cases.

Among forty-three cases of lichen nitidus studied, twenty-one patients were Caucasian, twenty-one were Negro, and one was Spanish-American, ranging in age from five to fifty-eight years. The arm, forearm, trunk, and genitalia were sites most commonly involved. Clinically, the eruption usually appeared as tiny papules. Histologically, the papules showed a parakeratotoic "cap," epidermal atrophy, liquefaction degeneration of the basal layer, and a dermal infiltrate of lymphocytes, epithelioid cells, and sometimes giant cells.


Familial Behcet's syndrome.

Behcet's syndrome is reported in two families (one English and the other Egyptian). A mother and two of her sons of the English family and two brothers of the Egyptian family are described. The contradictory opinions concerning the incidence of the familial occurrence of this syndrome are partly due to uncertainty about the nosologic relationship of recurrent aphthal and Behcet's syndrome. The question of whether this syndrome should be included in a large group of aphthoses or be regarded as a true clinical entity is discussed.


Moraxella bacteremia. Report of a case resembling gonococcemia with cutaneous manifestations.

A case of a Moraxella osloensis bacteremia mimicking a case of gonococcemia, complete with cutaneous manifestations, is presented. The importance of confirming all positive smears with inhibitory and noninhibitory culture media is stressed.


Giant cutaneous angiomyxoma.

A case of giant cutaneous angiomyxoma, an unusual cutaneous tumor, is reported. To the best of our knowledge, it is the largest of its kind that has been recorded. The purpose of this report is to acquaint the reader with this rare cutaneous neoplasm and its management.


Neurodermatitis--a concept.

The skin is an obvious "shock organ" for emotional stresses, as well as the other organ systems. Lividity, blushing, blanching, "goose flesh" are common observations. Personal emotional stress is carried in the mind of the patient, but often, after a period of time, this stress becomes manifest as skin disease. This delay interval is usually two to four weeks, if the histories are accurate. The patient can often be benefited by accepting the relationship of emotional stress and skin disease, along with appropriate treatment.


Intermittent use of griseofulvin in tinea capitis.

A total of 247 patients with tinea capitis were divided into two groups and treated with griseofulvin in two different ways: the first group received the drug every other day, and the second received it twice a week. The dosage was 5 mg/lb, with a maximum of 1 gm/day in both cases. In the first group, 99 percent of the patients were completely cured within seven weeks. Of those who received the griseofulvin twice a week, 91 percent were completely cleared within eight weeks. None of those in either group showed any signs of side effects from the medication.


Fragility and spiralization anomalies of the chromosomes in three cases, including fraternal twins, with Fanconi's anemia, type Estren-Dameshek.

Fraternal twins, offspring of consanguineous parents, developed pancytopenia, the boy at 7, the girl at 12 years of age. A third patient became anemic at 3 years. All three are free of associated malformations. In blood cultures the incidence of chromatid breaks, exchanges, and chromosome-type aberrations was elevated to 24%, 18%, and 28%, respectively. In addition, in a low number of mitotic cells unusual observations, pointing to profound disturbances of chromosome structure, were made. It is suggested that these patients have a genetic defect impairing the normal process of mitotic chromosome condensation and decondensation.


Rearrangements involving four chromosomes in a child with congenital abnormalities.

This report describes a complex structural rearrangement between chromosomes X and 1 and a 7;13 translocation (together involving six break points) in a child with multiple congenital defects. Both parents showed a normal chromosome complement, suggesting that the changes may have originated either in a gametic nucleus or at a very early stage of zygotic development.


A homologous tandem translocation [45,XX,-13,-13,+t(13;13) (q12;q34)].

Chromosomal investigation of a young girl with mental and motor retardation and congenital anomalies revealed a translocation between both members of pair No. 13. Banding analysis showed that the translocation was "tandem," leading to monosomy for segments in both the long and short arms of No. 13.


A long unidentifiable extra chromosomal segment--a possible duplication of human 7q.

Limitation of current techniques in identifying extra chromosomal segments arising de novo is illustrated by a putative case of a duplication of the long arm of chromosome 7. The propositus, demonstrating multiple congenital anomalies and severe mental retardation, had a large extra segment of chromatin on chromosome 7q that was absent in his parents. The banding pattern of this segment resembled that of the long arm of chromosomes 7, 8, or 9. Various procedures indicated that the additional material did not include the secondary constriction of 9q. The phenotype of the propositus did not fit well with that of trisomy 8.


Meiotic analysis of a pericentric inversion, inv(7) (p22q32), in the father of a child with a duplication-deletion of chromosome 7.

In a family in which a large pericentric inversion of chromosome 7 is segregating, two of the four progeny of inversion heterozygotes show severe psychomotor retardation and have the karyotype 46,XX,rec(7),dup q,inv(7)(p22q32), derived from crossing-over within the inversion. Meiotic analysis in one of the heterozygotes revealed no evidence of inversion loops in well-spread pachytene cells. In approximately 20% of cells in diakinesis, the presumptive bivalent 7 had only one chiasma. Two alternatives to the reversed loop mode of meiotic pairing of inversions are proposed. Review of the literature supports the view that "small" pericentric inversions have a much better genetic prognosis than "large" pericentric inversions.


Prenatal diagnosis in 100 structural rearrangements of the chromosomes.

Among 900 couples referred for prenatal diagnosis, the indication was a parental balanced structural chromosome anomaly in 94, of which 39 were Robertsonian translocations, 38 reciprocal translocations, and 17 pericentric inversions. Six fetuses were unbalanced. The methods of ascertainment of the anomaly in these couples and the gametic segregation transmitted to the concepti are analyzed. A de novo unbalanced structural anomaly was detected in fetal cells in 6 diagnoses performed in couples referred for indications other than chromosomal.


The meiotic behavior of triploidy in a human 69,XXX fetus.

Meiotic studies were made on the fetal ovaries of a triploid fetus, 69,XXX. The association modalities of the three chromosomes in human triploidy are the same as those described in several plant species; i.e., trivalents, bivalents and univalents can be found in the same nucleus. In most cases of trivalent configuration, the association occurs between pairs.


Murine ovarian teratomas and parthenotes as cytogenetic tools.

The origin of murine ovarian teratomas and their use to estimate centromere-to-gene distances is discussed. As an example of how such a system can be used, the distance from the centromere of chromosome 7 to the Gpi-1 locus was determined by analyzing the Gpi-1 phenotypes in 47 ovarian teratomas from Gpi-1a/Gpi-1b females. The percent recombination was estimated to be 10.6. It is suggested that ovarian teratomas and parthenotes may be used for half-tetrad analysis.


Cytologic evidence for preferential inactivation of the paternally derived X chromosome in XX mouse blastocysts.

A total of 941 mouse blastocysts obtained from two types of crosses in which one of parents carried Cattanach's X/autosome translocation was studied cytogenetically by quinacrine mustard fluorescence. The rearranged X (Xt) and the normal X (Xh) were distinguished by size. Karyotype analysis was successful in 721 embryos, of which 205 were heterozygous for Cattanach's translocation. A single heterochromatic and brightly fluorescent X chromosome was identified in 154 metaphase spreads from 89 blastocysts consisting of 32--96 cells. The paternally derived X chromosome (Xp) was heterochromatic in 87% and 88% of the informative cells from the crosses XnXn x XtY and XtXn x XnY, respectively. This preferential choice of Xp at the blastocyst stage might have an important bearing upon the preponderance of cells with an inactive Xp in the chorion and yolk-sac splanchnopleure.


Comparative analysis of karyotypes in European shrew species. I. The sibling species Sorex araneus and S. gemellus: Q-bands, G-bands, and position of NORs.

The karyotypes of two closely related species of the genus Sorex (Mammalia, Insectivora) were compared with each other by G- and Q-banding techniques and by Ag-AS staining (GOODPASTURE and BLOOM, 1975). By comparing the G-banded karyotypes, it could be ascertained that the basic differences in karyotype between the two species lie in three pericentric inversions, three paracentric inversions, and one reciprocal translocation. This is in near agreement with FORD and HAMERTON (1970), who assumed that both species differ by three pericentric inversions and one tandem translocation. Furthermore, the karyotype of S. araneus (race C) presented by HALKKA et al. (1974) has been compared with the S. araneus of the present report. Considering the species with respect to karyotypic evolution, it is supposed that S. araneus and S. gemellus derive from a common ancestor.


Studies on the function of H-Y antigen: dissociation and reorganization experiments on rat gonadal tissue.

On circumstantial evidence, H-Y antigen is assumed to be responsible for the differentiation of the undetermined gonadal anlage into a testis. A direct approach to test the function of H-Y antigen is provided by Moscona-type experiments. Applying a modified technique of in vitro reassociation of cell suspensions, we obtained the following results: (1) dissociated newborn rat gonads, both testis and ovary, reorganize into histotypic structures; (2) under exposure to anti-H-Y antiserum, testicular cells reassociate into ovarian follicular-like organization; (3) anti-H-1 antiserum by itself does not prevent the testicular cells from forming tubular structures. It is concluded that H-Y antigen acts as a differentiation between preferably or exclusively on the cell elements participating in the formation of the seminiferous cords.


Autoradiographic study of RNA synthesis during meiotic prophase in the human oocyte.

The incorporation of 3H-uridine in oogonia and oocytes during meiotic prophase I was studied in three human fetuses 13, 18, and 19 weeks old. Following a 40- or 60-min pulse, intense nuclear and nucleolar labeling was observed in oogonia. During the preleptotene chromosome condensation stage, the heteropycnotic masses were unlabeled, while numerous silver grains were seen on the filaments persisting around these masses. During leptotene, chromosomal and nucleolar RNA synthesis was significant, but less than that in the oogonia. The rate of incorporation declined rapidly during zygotene and fell to a very low level at early pachytene. Throughout pachytene no nucleolar RNA synthesis was observed. Chromosomal RNA synthesis progressively recovered during middle pachytene, was of moderate intensity at late pachytene, and increased again at early diplotene. Nucleolar RNA synthesis was very intense at early diplotene, at the same time as nucleolar size and basophilia increased.


BSu restriction of DNA from cases exhibiting sex-chromosome abnormalities.

The restriction endonuclease BSu, an isoschizomer of the enzyme HaeIII, cleaves human DNA to yield classes of fragments that are characteristic of the DNA of individuals having a Y chromosome. The fragments concerned are therefore diagnostic of the presence of Y-chromosome DNA and have been studied here with the intention of confirming the origin of various translocations thought, on other grounds, to involve the Y. The absence of the fragments from DNA of a case exhibiting absence of the fluorecent region of Yq suggests that the DNA concerned maps predominantly to Yq. Normal gender in the absence of the BSu fragments indicates that they do not function in sex determination.


Human somatic chromosome chains and rings. A preliminary note on end-to-end fusion.

Chain and ring chromosome configurations were detected in a small percentage of the lymphocytes of a patient suffering from Thiberge-Weissenbach syndrome. Precise recognition of the chromosomes involved in the rearrangements did not indicate a systematic order of end-to-end fusions. A relationship between these configurations and the chromosome arrangement in the interphase nucleus is possible.


The identification of a repeated DNA sequence involved in the karyotype polymorphism of the human Y chromosome.

We show that individual men are polymorphic for the amount of two different repeated DNA sequences. The amount of one of these sequences is proportional to the length of the brightly fluorescent heterochromatin on the Y chromosome. There are no detectable alterations in sequence between polymorphic individuals. Female DNA contains sequences complementary to those found on the Y, but at a much reduced level.


Cytogenetic aspects of phylogeny in the Bovidae. I. G-banding.

An extensive G-banding study of karyotypes of 12 species of Bovidae has been undertaken in an attempt to trace homologies and patterns of evolution of karyotype phenotypes throughout the family. G-banding profiles revealed a considerable degree of chromosome-arm homology throughout the group, which also extended into the related superfamilies, the Giraffoidea and Cervoidea. The conservation of banding patterns in chromosome arms strongly indicates that Robertsonian translocation type rearrangements have provided the major source of interspecies karyotype differences, with inversions and reciprocal and tandem translocations providing relatively minor contributions. Examples of individuals carrying newly arisen Robertsonian translocations are not infrequent, and in one instance there was evidence that two similar rearrangements had arisen independently in two species. Despite the extensive changes in karyotype organization, subfamilies within the Bovidae were characterized by the presence of common rearrangements, and those involving autosomal pairs 11 and 12 of the ox, as well as the X chromosome, separate the Bovinae from the Caprinae and Hippotraginae.


Cytogenetic aspects of phylogeny in the Bovidae. II. C-banding.

Constitutive heterochromatin in the Bovidae, as revealed by C-banding, was mostly located in the centromeric regions. Considerable variation was, however, evident in the size of the C-bands both within and between subfamilies. Some evidence was found for a reduction in the amount of centromeric heterochromatin in bi-armed relative to acrocentric autosomes, and these findings are discussed in relation to karyotype evolution in the group.


Assignment of the gene for lactic dehydrogenase A to mouse chromosome 7 using mouse-human hybrids.

We have studied somatic cell hybrids between either mouse peritoneal macrophages or spleen cells and HT-1080-6TG human fibrosarcoma cells for the expression of mouse lactic dehydrogenase A (LDH-A). The hybrids were also studied for the expression of mouse glucose phosphate isomerase (GPI-1), the gene for which has been assigned to chromosome 7. Concordant segregation of the expression of mouse GPI-1 and LDH-1 was observed in 61 independent hybrid clones. These results indicate that the gene coding for LDH-A is located on mouse chromosome 7.


The significance of volume-adjusting the maximal midexpiratory flow in assessing the response to a bronchodilator drug.

Forced expiratory spirograms were obtained before and for six hours after 25 subjects ingested ephedrine and placebo in a double-blind crossover study. Significant changes in the forced vital capacity (FVC) and the forced expiratory volume in one second (FEV1.0) were noted on days when ephedrine was administrated, while the mean forced expiratory flow during the middle half of the FVC (FEF25-75%) failed to indicate significant bronchodilation. When FVC increases after therapy with a bronchodilator drug, one is no longer measuring flow during the same volume segment and driving pressure (static transpulmonary pressure [Pst]) as before administration of the bronchodilator drug. Volume-adjusting the FEF25-75% after therapy to the same volume and Pst over which flow is being measured in the tracings before bronchodilator therapy yielded highly significant increases in flow after administration of the bronchodilator drug.


Effectiveness of oxygen therapy in hypoxic polycythemic smokers.

Eleven hypoxic (arterial oxygen pressure [PaO2] less than or equal to 61 mm Hg), polycythemic (hematocrit reading greater than or equal to 54 percent) patients were studied to determine the effect of the carboxyhemoglobin level on their response to therapy with supplemental oxygen. Five nonsmokers with a mean carboxyhemoglobin level of 2.8 percent showed an excellent response to therapy with supplemental oxygen, with a decrease in hematocrit reading from 57 percent to 48 percent (P less than 0.0025) as the PaO2 increased from 53 mm Hg to 69 mm Hg (P less than 0.01) and the arterial oxygen saturation (SaO2) increased from 86 percent to 94 percent (P less than 0.0025). Six smokers with a mean carboxyhemoglobin level of 13 percent showed an incomplete response to therapy with supplemental oxygen, with a decrease in hematocrit reading from 62 percent to 57 percent (P less than 0.0025) as the PaO2 increased from 53 mm Hg to 69 mm Hg (P less than 0.0025) and the SaO2 increased from 82 percent to 88 percent (P less than 0.001). In spite of similar values for the PaO2, the smokers had higher hematocrit readings before and during therapy with oxygen (P less than 0.01), presumably due to superimposed desaturation by carboxyhemoglobin. We concluded that polycythemia in hypoxic smokers is due to additive effects of hypoxia and a high carboxyhemoglobin level. The former is responsive to therapy with oxygen, while the latter is not. To achieve a "complete" response to therapy with supplemental oxygen, hypoxic polycythemic smokers should quit smoking.


Pulmonary hypertension in sepsis: measurement by the pulmonary arterial diastolic-pulmonary wedge pressure gradient and the influence of passive and active factors.

To examine the relative roles of passive factors (flow; filling pressures of left side of heart) and active factors (acidosis; arterial unsaturation) in the genesis of pulmonary hypertension when associated with sepsis, 37 patients with sepsis and 24 patients without sepsis were examined. Pulmonary hypertension was measured by the pulmonary arterial diastolic-pulmonary wedge pressure gradient (PAd-PWP gradient) and correlated reasonably with a standard formula for calculated resistance ([PA--PWP]/CI, where PA is mean pulmonary artery pressure and CI is cardiac index). In 22 of 37 patients, sepsis was associated with a significant degree of resistance to flow in the pulmonary circulation, as measured by the PAd-PWP gradient: and the higher the PAd--PWP gradient, the greater the likelihood of early death. None of the examined passive or active factors appeared to be adequate to explain pulmonary hypertension when present. By the use of previously derived formulae to estimate the compliance of the elastic pulmonary arteries, factors affecting this part of the pulmonary microcirculation could not be held accountable for apparent pulmonary hypertension. Therefore, the presence of pulmonary hypertension in sepis appears to be an active, rather than a passive, phenomenon and unrelated to arterial oxygen saturation or acid-base imbalance. Although the exact cause is unknown, pulmonary hypertension in sepis is associated with a high mortality and may be clinically followed by measurement of the PAd-PWP gradient.


Comparison of two methods of postoperative respiratory care.

After abdominal surgery, 64 patients were managed with one of the following two techniques of respiratory care: (1) deep breathing by way of a new device, an incentive spirometric three-ball, flow-measuring device (Triflo); and (2) standard episodic intermittent positive-pressure breathing (IPPB) every four hours. Both series of patients received therapy with a bronchodilator drug by nebulization. All patients had preoperative spirometric measurements followed by five consecutive days of therapy and spirometry. Chest x-ray films were obtained for all patients. There were no significant differences between the two methods of respiratory care, but 57 percent (17/30) in the group receiving therapy with IPPB developed pneumonia, atelectasis, or bronchitis, while only 29 percent (10/34) did so in the group using the incentive spirometric device (P less than 0.05). Spirometric differences were minimal, although the trend favored the incentive spirometric device. Principal conclusions were as follows: (1) deep breathing under the conditions of this investigation was equal to episodic therapy with IPPB; and (2) from an economic standpoint, IPPB, as it is currently practiced, may be disadvantageous when compared with the incentive spirometric device.


A comparison of the Jones and Stead-Wells spirometers.

A comparison was made between the noncounterweighted Jones and Stead-Wells spirometers, and "conversion factors" were determined for the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC). A cross-sectional study produced a high correlation between the instruments for these two measurements, yielding quadratic and linear regression equations ("conversion factors") for FEV1 and FVC, respectively. Standard deviations of measurements were similar for both spirometers. Results from a longitudinal study agreed with the "conversion factors" predicted from the cross-sectional study; however, significant day-to-day variability was observed by both spirometers. Neither spirometer met all of the technical recommendations proposed by the Committees on Environmental Health and Respiratory Physiology of the American College of Chest Physicians; however, the Stead-Wells water-sealed spirometer complied more often than the Jones waterless spirometer (Pulmonor). In addition, the open-circuit procedure used for the Jones spirometer required more corrdination in the subject than did the closed-circuit procedure employed in this study for the Stead-Wells spirometer; however, with application of the "conversion factors," both instruments, yield comparable data and prove adequate for spirometric studies.


Combined chemotherapy for squamous cell carcinoma of the lung.

One hundred sixty-seven patients with extensive well-differentiated and 120 patients with extensive poorly differentiated squamous cell carcinoma of the lung received chemotherapy as part of a randomized study by the Veterans Administration Lung Group. Chemotherapy was administration at random using one of the following four regimens: (1) cyclophosphamide alone; (2) cyclophosphamide plus 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU); (3) doxorubicin (adriamycin) plus cyclophosphamide; and (4) doxorubicin plus CCNU. With data on survival as the criteria for evaluation, it has been shown that combined chemotherapy using doxorubicin plus cyclophosphamide achieves greater median survival for patients with squamous cell cancer of the lung than single-drug chemotherapy using cyclophosphamide, under the conditions of this study; however, prolongation of life is still minimal, and better treatment is required. About 20 percent of the patients receiving any of the four regimens developed serious toxic effects from therapy with the drugs.


The absence of a relationship between serum precipitins and pulmonary disease in a community.

To study the role of serum precipitins in respiratory illness in a community, sera obtained from 3,047 residents of Tucson, Ariz., were tested for the presence of precipitating antibody to a battery of antigens. Positive reactions were obtained in 54 subjects (1.8 percent), a lower incidence than has been reported previously. The majority of these subjects were older than 54 years of age, an age distribution significantly older than the entire sample (P less than 0.01). Pulmonary function among the subjects with positive precipitin reactions was not significantly different from that of the asymptomatic nonsmokers of the entire sample. None of the subjects who were lifelong residents of Arizona had serum precipitins to any of the thermophilic actinomycetes antigens which were used in the testing. These antigens have been found in association with extrinsic allergic alveolitis, most frequently among patients living in the north central United States and were derived from strains of Micropolyspora faeni, Thermoactinomycetes candidus and vulgaris. Each subject with precipitins to one or more of the tested antigens was matched by age, sex, and socioeconomic class with two subjects from the sample who had negative precipitin reactions. The groups did not differ in their prevalence of respiratory symptoms or abnormalities of pulmonary function. We conclude that the presence of precipitating serum antibodies among subjects in a community is not indicative of the presence of immunologic pulmonary disease but merely reflects previous exposure to the tested antigen. In addition, individuals whose sera contain precipitating antibody appear to have no increased tendency to develop other types of pulmonary disease.


Symptomatic deep venous thrombosis of the arm associated with permanent transvenous pacing electrodes.

From October 1970 to May 1977, a total of 212 pacemakers were implanted at the Milton S. Hershey Medical Center of Pennsylvania State University, Hershey. During this period, we encountered five patients with symptomatic thrombosis of the subclavian vein, a rate for this complication of approximately 2 percent. Although this complication was reported only rarely prior to 1976, we believe that symptomatic subclavian thrombosis after insertion of a transvenous pacemaker electrode occurs more frequently than previously suspected. The etiology, pathogenesis, and treatment of this interesting condition are discussed.


Pharmacokinetics of theophylline in hepatic disease.

The disposition of theophylline was examined in eight male cirrhotic (six proven by biopsy) patients without heart failure. An oral dose of 100 mg of theophylline per square meter of surface area was administered, and samples of serum and saliva were collected from 0 to 60 hours and were assayed by high-pressure liquid chromatographic techniques. Controls were 57 young normal subjects and 25 age-matched patients. The body clearance of theophylline in cirrhotic patients was low, averaging 18.8 +/- 11.3 ml/kg/hr (+/- SD) vs 53.7 +/- 19.3 and 63.0 +/- 28.5 ml/kg/hr in the control patients and the normal subjects, respectively. The half-life of theophylline in cirrhotic patients was prolonged wiht a mean of 28.8 +/- 14.3 hours compared to 6.0 +/- 2.1 hours in normal subjects. Patients with cirrhosis proven by biopsy had significantly lower values for body clearance and longer half-lives than subjects without biopsies. The values for body clearance correlated well with the serum level of bilirubin (r = -0.81) and the serum level of bile acids (r = -0.81). The slow and variable metabolism in cirrhotic patients necessitates a reduction in the maintenance dosage of aminophylline to 0.20 to 0.45 mg/kg/hr and monitoring of the serum level during therapy.


Poisoning caused by inhalation of hydrogen chloride, phosphorus oxychloride, phosphorus pentachloride, oxalyl chloride, and oxalic acid.

Eleven people accidentally inhaled a significant amount of a gaseous mixture of hydrogen chloride, phosphorus oxychloride, phosphorus pentachloride, oxalyl chloride, and oxalic acid. Clinical observations and laboratory tests were recorded from the time of admission throughout hospitalization. The main abnormalities were found in the respiratory tract and consisted of clinical and physiologic evidence of obstruction of the airways, mild interstitial and alveolar edema, a defect in diffusion, and inequalities of ventilation and perfusion that produced hypoxemia. All of these cleared within a short time.


Measurement of frequency of ciliary beats of human respiratory epithelium.

A method for accurate measurement of beats on ciliated respiratory epithelial cells in vitro is described. The technique allows the frequency of ciliary beats to be recorded directly on minute specimens of human respiratory epithelium obtained by bronchoscopic brushing. A "hanging-drop" preparation of the scraped material is placed on a thin, flat welled slide and is viewed with a phase-contrast microscope at a magnification of x450. Light transmitted through the specimen is deflected in varying intensities due to the beating action of the cilia and is detected by a photomultiplier cell, amplified and transduced as peaks on an oscilloscope. Due to the relatively high magnification, a small group of cilia may be focused upon and their activity measured. Specimens from two groups totaling 53 patients were measured; in the first group the frequency of ciliary beats was measured at 23 degrees C and ranged from 9.1 to 12.9 beats per second with a mean and standard deviation of 11.0 +/- 1.3 beats per second. The second group was measured at 37 degrees C, and values ranged from 10.3 to 16.8 beats per second, with a mean and standard deviation of 13.8 +/- 1.8 beats per second. These values are interpreted to reflect the autonomous frequency of ciliary beats of the isolated respiratory cells. This simple method may be applied to screen for abnormalities of ciliary beating in patients with altered respiratory mucous clearance, as well as to examine the specific effects in vitro of chemicals, drugs, or pollutants on human ciliary activity.


Dissociation of the atrioventricular node in acute inferior wall myocardial infarction. 1. Transverse dissociation (alternate Wenckebach periods).

Two cases of alternate Wenckebach periods developing during the acute phase of inferior wall myocardial infarction are presented. In both cases, syncope occurred and severe bradyarrhythmia was recorded on the day of admission. Electrophysiologic study performed in one patient and a narrow QRS complex in the other patient during the alternate Wenckebach periods confirmed the atrioventricular node as the level of block. Transverse dissociation of the atrioventricular node with two (or more) levels of block is the most acceptable explanation for this phenomenon. We suggest that alternate Wenckebach periods occurring during the acute phase of inferior wall myocardial infarction is a severe bradyarrhythmia, and prophylactic temporary pacing is recommended.


Dissociation of the atrioventricular node in acute inferior wall myocardial infarction. 2. Longitudinal dissociation (dual atrioventricular nodal pathways).

Four cases of longitudinal dissociation of the atrioventricular node, with dual pathways developing during the acute phase of an inferior wall myocardial infarction (three cases) or during acute ischemia (one case), are presented. In all four cases, two grossly different P-R intervals were recorded, and in two cases, studies of the His bundle confirmed the location of the dissociation within the atrioventrcular node. In one case, premature atrial depolarization caused a bidirectional shifting of P-R intervals, while in the remaining three cases, premature ventricular depolarization (spontaneous or pacemaker-induced) was responsible for this phenomenon. In all cases, evidence of longitudinal dissociation of the atrioventricular node appeared during the acute phase of the infarction or ischemia, and in all of them the phenomenon was transient. This favors the assumption that this phenomenon is of a functional nature, most probably related to the ischemic lesion of the atrioventricular node.


Etiology of right bundle branch block pattern following surgical repair of atrioventricular cushion defects.

Electrocardiograms and surgical data from 12 patients with complete atrioventricular canal defects and 24 patients with ostium primum defects were evaluated before and after open heart surgery in order to document the incidence of postoperative right bundle branch block. The use and precise location of septal sutures utilized for repair were specifically noted in order to assess their possible role in the genesis of the postoperative right bundle branch block pattern. Septal sutures were placed in all patients with atrioventricular canal defects, and ten (83 percent) of these 12 patients developed right bundle branch block. Seven (29 percent) of the 24 patients with ostium primum defects developed a postoperative right bundle branch block, and in all seven patients, septal sutures were utilized. None of the patients with an ostium primum defect without septal sutures developed a right bundle branch block, and none of the patients in this series developed complete heart block.


The treatment of pleuropulmonary amebiasis with metronidazole.

One hundred forty patients with pleuropulmonary amebiasis were classified radiographically in order to rationalize therapy based on the use of metronidazole. Amebic testing with gel diffusion, serial chest x-ray films, and observation of the patient's response to treatment have dominated management of the patients, 135 of whom made a successful recovery. Five patients died. Sixty percent of the surviving patients have been reviewed at a follow-up clinic, and there has been no instance of recurrence of amebiasis.


d-Transposition of the great arteries and atresia of the mitral and pulmonary valves: association with a normal anatomic left ventricle.

The clinical, angiographic, and pathologic features are presented for a case of d-transposition of the great arteries with atresia of the mitral and pulmonary valves and two well-developed ventricles. The morphologic left ventricle appeared to be functioning as a systemic ventricular aneurysm, and this may have led to the patient's death. A possible explanation for this anomaly is given.


Impaired response to hypoxia after bilateral carotid body resection for treatment of bronchial asthma.

Decreased ventilatory responsiveness to isocapnic hypoxia and increased breath-holding times were measured in a 12-year-old asthmatic boy who had undergone bilateral resection of the carotid bodies. The patient had episodes of cyanosis in which he became disoriented, but he had no subjective feelings of discomfort or dyspnea.


Chylothorax as a manifestation of rheumatic mitral stenosis: its postoperative management with a diet of medium-chain triglycerides.

Chylothorax occurred as a manifestation of severe congestive heart failure resulting from rheumatic mitral stenosis. Following replacement of the mitral valve, chylothorax recurred and was treated by thoracocentesis initially and then resolved during six months of therapy with a diet of medium-chain triglycerides. Ultimately, the patient resumed a regular diet with no further accumulation of pleural fluid.


Deep venous thrombosis of the upper extremity associated with use of the Swan-Ganz catheter.

Two patients who developed unilateral neck vein distention following insertion of a Swan-Ganz catheter are described. One patient developed unilateral swelling of the arm used for catheter insertion. Following removal of the Swan-Ganz catheter in this patient, venograms of both upper extremities revealed internal jugular vein thrombosis and subclavian vein thrombosis of the involved extremity. The other patient had thrombosis of the internal jugular veins and subclavian veins bilaterally, as well as superior vena cava thrombosis.


Echocardiography and perfusion scintigraphy in the diagnosis of pulmonary arteriovenous fistula.

The echocardiographic and perfusion scintigraphic evaluation of an adolescent boy with a pulmonary arteriovenous fistula is reported. Contrast echocardiography following the rapid intravenous injection of indocyanine green dye was utilized to document extracardiac right-to-left shunting. Perfusion lung scintigraphy demonstrated the presence of a single large pulmonary arteriovenous fistula. Contrast echocardiography and perfusion scintigraphy are minimally invasive, safe and easily performed techniques for the rapid diagnosis of pulmonary arteriovenous fistula.


Coronary arterial dissection: an unrecognized cause of myocardial infarction, with subsequent coronary arterial patency.

A 55-year-old man survived an acute myocardial infarction. Coronary angiographic studies at two months after infarction demonstrated a primary dissection with stenosis of the right coronary artery. Repeat angiographic studies 19 months later showed resolution of the dissection, with the return of coronary luminal patency. This is the first angiographic description of primary coronary arterial dissection. This mechanism can cause the phenomenon of myocardial infarction without significant coronary arterial stenosis seen at subsequent coronary angiographic studies.


Venous aneurysm of the facial vein.

We present a case of venous aneurysm of the facial vein at its proximal end on the left side, which might be the first case reported in the medical literature of the world. The anatomy of the vein, venographic studies of the facial vein (with demonstration of the aneurysm), and the type of surgical management are discussed. The possible etiology for the venous aneurysm is indicated.


Antimalarial activity of saccharidic polymers of dapsone and sulfadimethoxine.

With the purpose of obtaining pro-drugs of dapsone and sulfadimethoxine, those chemotherapeutic agents were attached through covalent bonding to starch polymeric dialdehyde (Sumstar-190). The antimalarial activity of the two resulting compounds - the dapsone saccharidic polymer (PS6) and the sulfadimethoxine saccharidic polymer (PS7) - in mice experimentally inoculated with Plasmodium berghei was significantly increased with this molecular modification. Mice infected with malaria and kept without treatment together with others which received different doses of PS6 and PS7 were also partially or totally cured, possibly due to the ingestion of excrements containing the parent chemotherapeutic agents.


In vitro activity of sisomicin and netilmicin alone and in combination with nafcillin, oxacillin and methicillin against enterococci.

The in vitro activity of sisomicin and netilmicin alone and in combination with nafcillin, oxacillin and methicillin against 30 strains of enterococci was investigated. Sisomicin and netilmicin alone were not very effective against enterococci. There was enhanced killing of some strains of enterococci by the combination of sisomicin or netilmicin with one of the three penicillinase-resistant penicillins. Nafcillin was the most effective penicillinase-resistant penicillin in the combination. Sisomicin appeared to be slightly more effective than netilmicin in combination with one of the penicillinase-resistant penicillins against enterococci.


Therapeutic activity of pretazettine on Rauscher leukemia: combination of antiviral activity and cellular protein inhibition.

Pretazettine hydrochloride (PTZ) has been found to inhibit protein synthesis, without being inhibitory to DNA and RNA, in Rauscher leukemic blood cells in mice for at least 6 h after its administration. With comparison to Virazole and cycloheximide, the specific anti-Rauscher virus activity of PTZ has been demonstrated only in acutely-infected NIH/3T3 cells but not in chronically-infected cells. It is not certain that the inhibitory action of PTZ on reverse transcriptase is contributory to its therapeutic activity in leukemic mice.


Ototoxicity of gentamicin: clinical experience in a children's hospital.

In a effort to estimate the incidence of clinical ototoxicity in children we reviewed the charts of 374 patients who had serum gentamicin concentration determined 30 min before ('trough value') and at the pharmacologic peak after parenteral administration. 37 of these patients, between 9 and 17 years of age, had two or more audiograms; of these, 9 developed objective evidence of hearing loss; in 2 the impairment was severe and permanent. Risk factors associated with ototoxicity were renal failure, concomitant administration of diuretics and peak serum concentrations greater than 12 microgram/ml (all significant at p less than 0.01). The minimum incidence of overt hearing loss secondary to gentamicin therapy is approximately 2.4%.


5-hydroxyindoleacetic acid (5-HIAA) levels in the cerebrospinal fluid of hydrocephalic children before and after ventricular shunting procedure.

21 cases of hypertensive hydrocephalus were investigated for lumbar 5-HIAA before and after operation. Seven groups (posterior fossa tumors) of patients aged between 2 and 12 years were tested after tumor removal; the others (nontumorous hydrocephalus) after ventricular shunting. This last group included 8 patients with noncommunicating hydrocephalus aged between 15 days and 12 years and 6 with communicating hydrocephalus aged between 6 months and 9 years. At the time of the second determination all patients presented an improvement of clinical signs of intracranial hypertension. A correlative analysis of 5-HIAA values before and after operation is made. In tumor cases, preoperative levels were higher than controls, and a significant decrease was found after operation in comparison with preoperative levels. In nontumor cases, a significant decrease was also observed in noncommunicating hydrocephalus, confirming clinical usefulness of the results for controlling the degree of the intracranial hypertension and, in consequence, shunt performance. In communicating cases the results were disappointing, because almost always postoperative levels did not differ from the preoperative ones. Possible interpretations of the data are analyzed.


The central (spinal) canal in congenital murine hydrocephalus: morphological and physiological aspects.

Obstruction of cerebrospinal fluid pathways produces changes in the parenchyma of the brain and spinal cord. A murine model of hydrocephalus (hy-3) used to study changes in the central canal of the spinal cord and these changes are correlated with events occurring in the intracranial compartment. The central canal is enlarged and subependymal interstitial edema is produced by cerebrospinal fluid at the same time as the intracranial ventricular system is expanding. Plugging of the obex results in collapse of the central canal. Ferritin tracer studies demonstrate transependymal flow of cerebrospinal fluid throughout the central canal.


Head bobbing in a patient with a cyst of the third ventricle.

The case of a 7 year-old boy with 'bobble head doll syndrome' associated with a cyst in the third ventricle is reported. This movement disorder appears in early childhood and consists mostly in a rhythmic to-and-fro bobbing of the head and eventually of the trunk. As in three previously described cases, this case showed only slight decrease of the 'tic' after partial removal of the cyst by transcortical exploration of the third ventricle. In an inquiry and a survey of the literature, 17 cases with bobble head doll syndrome were collected. The average age of the described cases was 7 years at time of diagnosis. In 13 cases a slow-growing cyst or mass in the anterior part of the third ventricle of close to this region was found. There was no case observed with an acute lesion, in 3 cases it was thought an aqueduct stenosis should be the cause, and in 1 case the cause was unknown.


Cerebral arteriovenous malformations in children.

A series of 36 children under the age of 13 with cerebral arteriovenous malformations (AVM) was retrospectively reviewed. It is shown that haemorrhage is by far the commonest initial manifestation of the lesion, followed by seizures. Of the 14 children who have seizures, 10 suffered from haemorrhage within an observation period of 3 months to 7 years. Analysis of the results of the various forms of treatment indicates that total surgical extirpation provides the best safeguard against future haemorrhage. It is suggested that all cerebral AVM in children should be excised whenever possible.


Unusual subarachnoid metastasis of an intracranial chordoma in infancy.

The authors report a case of large clivus chordoma in a 61/2-year-old child with multiple subarachnoid metastatic dissemination over the cerebellar hemispheres and spinal cord.


[Histomorphology of the bone-cement contact. Experimental phenomenology of the osseous reconstruction processes. I].

In animal experiments the femurs of 25 rabbits were filled with bone cement. In cross sections of the diaphysis even after only one week, small gaps were found filled by lamellar formation of new bone. Osteoblast layers directly on the cement surface were also observed. After 4 to 6 weeks there was a circularly closed contact of inner lamellae and after 9 months a secondary medullary cavity was formed. At this time there was formed a trabcular contact with the implant, interrupted by medullary spaces full of cells. Sometimes woven-bone formations were found in the bone-cement interface.


[Management of traumatic pelvic bleedings using embolization].

Massive retroperitoneal bleeding in pelvic trauma is a difficult problem in surgery, and surgical treatment is rarely attempted due to the risk involved. Angiographic embolization in this region is an uncomplicated and effective measure that may be performed without general anesthesia and simultaneous with shock treatment. Four patients with massive traumatic hemorrhage in the pelvic region were successfully treated with embolization.


[Evaluation of venous hemodynamics as the decisive diagnostic criterion for venous surgery].

The different physical screening tests (ultrasound Doppler technique, plethysmography, phlebodynamometry) are easy documented and make possible a less dangerous, less expensive, and extensive statement about the venous hemodynamics of the lower extremity. The quota of diagnostic error can be minimized and the indication for operation is secure.


[Reconstructive surgery on the venous system].

1. The progress of reconstructive venous surgery in recent years has been mainly based on the use of changed operative techniques (atraumatic preparation and suture technique; intraoperative vascular endoscopy or venography; temporary arteriovenous fistula). As a result, the clinical indications could be remarkably increased (acute phlebothrombosis; some types of post-thrombotic syndrome; venous substitution in tumor surgery; vascular lesions). 2. A peripheral temporary arteriovenous-fistula proves the most effective protective method both in venous thrombectomy and in graft reconstruction (full lumen restoration also in cases with incomplete disobliteration due to increase of flow velocity and flow volume; improvement of graft patency). 3. In long-standing axillar or subclavian venous thrombosis, a distal arteriovenous fistula (similar to a Cimino shunt) has a curative effect (without venous thrombectomy) via stimulation of rapid recanalisation and formation of collateral pathways. 4. Persisting central venous blocks may be corrected by a bypass procedure (great saphenous vein graft for the shoulder region; expanded PTFE grafts (Gore-Tex) for the ilio-caval segment).


[Hyperkinetic portal hypertension. Arterioportal fistula: problems--case reports--review of the literature].

Hyperkinetic portal hypertension is caused by pathological arterioportal shunts. Clinical differentiation is necessary between extrahepatic fistulas, splenoportal hypertension (arteriovenous anastomoses at the level of the pre-penicilary arteries) and intrahepatic fistulas in "active" cirrhosis and malignant tumors. This paper reports the clinical and angiographic features of eight patients with this type of fistula. A review of the literature is also presented (144 cases). Because of the severity of this disease, surgical intervention is necessary. The surgical technique depends on the organ-related necessity of vascular preservation.


[Surgical management of anus incontinence using free-transplanted autologous, endogenous intestinal musculature].

A new treatment for anal incontinence is presented. Smooth muscle from the large intestine is transplanted to form a new sphincter. The advantage of using smooth muscle as a sphincter plastic id discussed.


[Ileostomy function in the early postoperative stage].

If the serosa of the protruding ileum segment is covered by mucosa [2, 3] and exclusion or resection of terminal ileum is avoided, ileostomy dysfunction or water and sodium depletion cannot be observed. Therefore, temporary loop ileostomy may be practiced in patients who have undergone ileorectostomy to prevent leakage of the anastomosis.


Mitotic asynchrony of multinucleate cells in tissue culture.

A high degree of mitotic asynchrony is reported for spontaneously arising multinucleate cells of HeLa and Pt-K1, tissue culture cell lines. Neither nuclear number, nor nuclear size nor the presence or absence of nucleoli, could be directly related to the asynchronous behaviour of the cells. Suboptimal levels of nutrients led to a higher frequency of asynchrony. A partial compartmentation of the cytoplasm could be detected in some of the multinucleate cells. The compartmentation of the cytoplasm may lead to an uneven distribution of inducer and non-inducer metabolites. All these factors together may be responsible for the high degree of mitotic asynchrony.


Studies in heterochromatin DNA: characterization of transcripts synthesized in situ from C-banded preparations.

The transcript of in situ RNA synthesis using Peromyscus eremicus cells, which had been treated with HCl followed by NaOH, proved to be rich in heterochromatin specifying sequences. Such transcript, referred to as heterochromatin RNA, can be characterized biochemically to probe the organization of heterochromatin DNA. It was found that the heterochromatin RNA of P. eremicus contained non-repetitive sequences covalently linked to repetitive sequences.


Selective digestion of mouse metaphase chromosomes.

Metaphase chromosomes prepared from colcemid-treated mouse L929 cells by non-ionic detergent lysis exhibit distinct heterochromatic centromere regions and associated kinetochores when viewed by whole mount electron microscopy. Deoxyribonuclease I treatment of these chromosomes results in the preferential digestion of the chromosomal arms leaving the centromeric heterochromatin and kinetochores apparently intact. Enrichment in centromere material after DNase I digestion was quantitated by examining the increase in 10,000 X g pellets of the 1.691 g/cc satellite DNA relative to main band DNA. This satellite species has been localized at the centromeres of mouse chromosomes by in situ hybridization. From our analysis it was determined that DNase I digestion results in a five to six-fold increase in centromeric material. In contrast to the effect of DNase I, micrococcal nuclease was found to be less selective in its action. Digestion with this enzyme solubilized both chromosome arms and centromeres leaving only a small amount of chromatin and intact kinetochores.


Mitotic chiasmata and other quadriradials in mitomycin C-treated Bloom's syndrome lymphocytes.

Mitotic chiasmata and other quadriradials (QRs) were studied by Q-banding in mitomycin C-treated and untreated lymphocytes from two sibs with Bloom's syndrome. The frequency of chiasmata was very significantly increased by the mitomycin treatment in cells from both sibs. Chiasmata occurred throughout the chromosomes, but were favored in Q-dark regions, particularly at borders between dark and light regions (Kuhn, 1976). No significant difference was found in the distribution of chiasmata among chromosome regions in treated and untreated material. This differs from the reported action of mitomycin C on cultured lymphocytes of normal persons, where chiasmata are concentrated at secondary constrictions and centromeres. Adjacent counterparts to mitotic chiasmata, and chromatid translocations between non-homologous chromosomes, also occurred in the treated material, but with a much lower frequency than mitotic chiasmata. This again differs  from the effects of mitomycin C on lymphocytes of normal persons, where chiasmata account for 20% or less of total QRs.


Hedrocele: report of a case and review of the literature.

Hedrocele represents an unusual variant of the rare posterior perineal hernia and results from a defect in the rectogenital septum. In the male, because of the prostate gland and the resistance of the perineal body, a hernia through this defect is directed posteriorly through the anterior wall of the rectum. Diagnosis is based upon an awareness of the entity combined with the finding of an anterior intraluminal rectal mass. Correction requires celiotomy and closure of the anatomic defect.


Giant sigmoidal diverticulum: report of a case and review of the literature.

A case report of giant sigmoidal diverticulum and a review of the relevant medical literature are presented. Only 20 cases have previously been reported. Diagnosis is dependent on a gradually enlarging mass, usually found on physicial examination. Radiologic study usually confirms the diagnosis and differentiates this condition from others, such as intestinal duplication, emphysematous cholecystitis, cholecysto-enteric fistulas, etc. The treatment is prophylactic. It is important to undertake early surgical intervention before the condition progresses to perforation or other complications.


Villous adenoma with hyponatremia and syncope: report of a case.

A case of villous adenoma of the colon with hyponatremia, hypovolemia, and syncope is presented. The correct diagnosis was delayed because of the prevailing idea that villous adenomas are associated with hypokalemia. The patient recovered fully after surgical removal of one of the largest villous adenomas reported in the literature. Sodium loss may be the dominant feature of this syndrome. Villous adenoma has to be included among the causes of hyponatremia.


Anorectal verrucose squamous carcinoma: report of two cases.

Two cases of anorectal verrucose squamous-cell carcinoma are presented. The clinical course and pathology of these tumors are reviewed. Surgical treatment based on the depth of histologic invasion is recommended.


Synchronous leiomyosarcoma and ameboma of the rectum: report of a case.

A case of leiomyosarcoma of the rectum associated with rectal amebiasis is presented. This is the first case to be reported. Initially, amebiasis obscured the histologic diagnosis of leiomyosarcoma, but incomplete regression following a course of treatment with metronidazole aroused the suspicion of malignancy, which was confirmed on repeat biopsy. A brief review of the features of leiomyosarcoma was also undertaken.


Intussusception following jejunoileal bypass for morbid obesity: report of a case.

A man who had undergone jejunoileal bypass for morbid obesity had cramping abdominal pains for which no cause could be found, despite repeated clinical examinations and numerous investigations. Only during anesthesia could the large mass formed by the intussusception be palpated. Following reduction of the intussusception and refixing to the anterior abdominal wall, all symptoms abated.


Perineal wound healing after proctectomy for inflammatory bowel disease.

One hundred fifty-one cases of patients who underwent proctectomy for inflammatory bowel disease at the Lahey Clinic were analyzed with respect to the factors that predispose to delay in perineal wound healing. Significantly poorer healing took place in patients with Crohn's colitis, in men with ulcerative colitis, and in patients with ulcerative colitis who underwent one-stage operations. Factors that were not statistically significant but that appeared to contribute to delay in healing were younger age of patients and presence of anal fistula. A comparison is made with the results of other series, and recommendations for treatment and prevention are presented.


Hepatic resection for metastasis from colorectal cancer.

Twenty-five patients who had hepatic metastases from carcinomas of the colon and rectum had resection for cure at Memorial Hospital, with a determinate five-year survival rate of 40 per cent, and 10-year survival rate of 28 per cent. Most of the hepatic metastatic lesions were solitary, small, and peripheral, and were treated with simple wedge resection. These favorable results justify an aggressive approach to solitary metastatic lesions in the liver.


Colostomies--indications and contraindications: Lahey Clinic experience, 1963--1974.

Over a 12-year period, 276 temporary colostomies were performed on 271 patients. During this interval 118 colostomies were closed. The morbidity rate of colostomy construction was 21 per cent, and for closure it was 49.1 per cent. No definite factor could be indentified as contributing to this high rate of complications for colostomy construction. With respect to colostomy closure, predisposing factors that seemed to increase morbidity were shorter interval between creation and closure of the stoma and resection of colostomy (as opposed to closure without resection). Intra-abdominal drains were associated with a prohibitively high rate of wound infection, although subcutaneous drainage was not successful in reducing the incidence of infection significantly.


Hidden-loop colostomy.

Records of 15 patients having hidden-loop colostomies were reviewed. All patients had metastatic colonic cancers with impending obstructions. Six colostomies were subsequently opened because of obstructions due to cancer. All colostomy openings were done using local anesthesia in the emergency room. This technique prevented six major celiotomies and provided additional time of living without a stoma. There were two postoperative stomal prolapses, one of which necessitated reoperation. A hidden-loop colostomy is easily constructed and readily opened. It should be considered at celiotomy for selected patients who have metastatic colonic cancer with impending obstruction.


Adenoacanthoma of the colon.

The clinical and pathologic features of five cases of adenoacanthoma of the colon are presented. Although the lesion is rare, both the pathologist and the surgeon should be aware of this unusual neoplasm in order to avoid error in diagnosis, especially when metastatic lesions are being evaluated. In our experience, these rare colonic lesions are more aggressive than ordinary carcinomas of the colon.


Benign neurilemmoma manifesting as a presacral (retrorectal) mass: report of a case.

We recently had the opportunity to treat a patient who had a large presacral mass. The mass, a 13-cm neurilemmoma, was removed through a combined abdominosacral approach. Mostly benign, these presacral masses cause symptoms by compression of adjacent pelvic structures. Digital rectal examination generally provides the diagnosis. Although most such lesions may be removed by a Kraske procedure, large lesions may be best treated using a combined abdominosacral approach.


Adenocarcinoma of the appendix: report of an unusual case.

An unusual case of adenocarcinoma of the appendix is presented. Abnormal growth of the tumor toward the abdominal wall resulted in a cutaneous mass, which was the first manifestation of the neoplasm.


[Surgical treatment of carcinoma of the oesophagus (author's transl)].

Cervical oesolphagogastrostomy (Kirschner's operation) was performed on 16 patients with carcinoma of the oesophagus. There were five hospital deaths (two due to myocardial infarction). The average hospital stay of the survivals was 22 days. This operation is preferred to colon interpolation because it requires only one anastomosis, which is extrathoracic.


[Intragastric bile acids and lysolecithin in clinical stress ulcer risk (author's transl)].

In 10 intensive care patients with a risk of stress ulcer intragastric concentrations of lecithin, lysolecithin and bile acids were determined and compared to values in seven normal persons. All results were increased to multiple normal values. In particular lysolecithin and bile acids showed highly abnormal concentrations. These substances have a pathogenic importance for the occurrence of stress ulcers.


[Selective transfemoral embolization of the internal iliac artery in carcinoma of the bladder (author's transl)].

Inoperable bladder cancer and massive bleeding is an indication for selective bilateral transfemoral embolization of the internal iliac arteries. The method is preferred to the open ligation of these arteries. Histoacryl is the optimal material for longterm vascular embolization. In five patients with bleeding inoperable bladder cancer (stage T4N2) immediate and permanent haemostasis and a regression of pain was achieved.


[Value and reason for routine rectosigmoidoscopy (author's transl)].

Routine rectosigmoidoscopy was undertaken in 700 patients under surgical treatment for disease in other parts of the body. Pathological changes were found in 39 patients (5.6%): 24 with adenomatous polyps, 5 with adenopapillary polyps, 7 with infiltrating growing "carcinomatous" polyps without involvement of the muscularis mucosae, and three with carcinoma. The polyps were removed with an electric loop or haemoclip in 28, by transanal submucous excision in eight. One of the carcinoma cases was treated by resection, the other two by abdominoperineal rectal resection. The results indicate that routine rectosigmoidoscopy is of value.


[Diagnostic and therapeutic aspects of early (superficial) gastric carcinoma: a retrospective analysis of 60 cases (author's transl)].

Among 947 patients operated on for gastric carcinoma between 1961 and 1976 there were 60 with early (superficial) gastric carcinoma. All but two patients consulted their doctor for diverse complaints. In one third of them treatment was delayed for a year or longer. In 26 of the 64 cancer foci it was limited to the mucosa. The correct diagnosis was made radiologically in 60%, gastroscopically in 70%. Selective endoscopic biopsy increased accuracy to 90%. The remaining false-negative findings occurred in the ulcerative form, which was the most frequent one. Improved radiological techniques (double-contrast) and obligatory gastroscopy with biopsy increased the relative proportion of early (superficial) carcinoma from under 4% in 1961 to 15%. The diagnosis of this type of carcinoma can be made only by careful histological study of the surgical specimens. Here as elsewhere in the surgery of carcinoma, multicentricity (in 5%) and possible lymph node metastases (10-20%) must be taken consideration in the surgical management.


[Diagnosis and treatment of trauma to blood vessels around the knee joint (author's transl)].

Eighteen arterial reconstructions after trauma in the region of the knee joint were performed between 1970 and 1976. In seven cases there had been fracture of the distal femur, in five of the head of the tibia, in three dislocation of the knee joint or severe contusion of the popliteal artery. In 12 cases referral had been eight hours or later after injury. The concomitant vessel injury was not recognised in six. Vascular reconstruction by direct suture with a venous patch was performed in eight, interposition of a venous autograft in five, and saphenous vein bypass in four. Results depended upon length of ischaemia time and the level of the vascular injuries. Complete restitution to normal was achieved in only two cases, while in the remaining 12 there were defects of motor and sensory function as seen in the post-ischaemia syndrome. In four cases above-knee amputation was necessary despite successful reconstruction of the artery because there was irreversible ischaemic damage with tissue necrosis. To improve these results careful examination of blood vessels and, in questionable cases, angiography is recommended for every trauma victim.


[Screening for neonatal hypothyroidism? Results of an international questionnaire study (author's transl)].

Questionnaires were sent to 23 centres in ten countries. Results indicate that, for ethical, scientific, clinical and socio-economic reasons, screening for neonatal hypothyroidism should be undertaken. Pilot studies are no longer required. Distribution of the birth-rate in the various lands of the German Federal Republic suggest that, assuming appropriate technical and staffing provision, ten centres with a sample rate of 200/day would be sufficient for full screening. Because of special features in quality control of radioimmunochemical methods, a uniform manner of setting up the necessary laboratories is essential.


[False-positive exercise ECG in women without organic heart disease (author's transl)].

Exercise ECGs (bicycle ergometry in recumbency) were obtained in 252 women (aged 20-49 years) without evidence of organic heart disease. In 51 (20%) there was a false-positive change in the ECG with horizontal or descending S-T depression greater than or equal to 1 mm. The frequency of this change increased with increasing age. In group I (20-29 years) it was 5%, in group II (30-39 years) 20%, in group III (40-49 years) 38%. In 34 of the 51 women abnormal repolarisation changes were present even at rest. The S-T depression during exercise in most cases amounted to less than 2 mm and often occurred only on maximum exercise during the first or second minute of the recovery phase. These "ischaemia" changes disappeared in 29 of 41 women after administration of 100 mmol potassium chloride. Nine of 12 women in whom the positive ECG signs persisted after KCl, coronary angiography failed to demonstrate any abnormalities.


[Minocycline in the treatment of respiratory tract infections (author's transl)].

Minocycline concentrations in serum, saliva, sputum, pleural exudate and lung extracts after a single dose of 0.2 g (orally or intravenously) were measured on 32 patients with bronchial or lung disease. On the first day of treatment, concentrations in purulent sputum were five to ten times higher than in mucous sputum and saliva, after two hours they were one third, after three hours half the serum concentration (0.7 and 1.0 microgram/ml, respectively). After six hours the concentration was the same (1.6 microgram/ml). On the third day of treatment (after 0.2 g every 24 hours) concentrations in purulent sputum were higher than on the first day by 0.8 microgram/ml (after two hours) and by 0.95 microgram/ml (after three hours). After one-hour i.v. infusion of 0.2 g minocycline concentrations in mucous sputum and saliva rose more quickly on the first day than after oral administration. On the third day of treatment (after 0.1 g orally every 12 hours) pleural exudate level was almost as high as serum level. Minocycline concentration in lung extract on the third day of treatment--four, five and ten hours after the last dose--was 0.4 and 0.8 microgram/g, respectively (while serum concentration at the same time was 1.0-1.5 microgram/ml).


[Binding of antacids to bile acids (author's transl)].

The bile acid binding capacity of various liquid antacids and of colestyramin were compared. Aluminium hydroxide containing antacids showed the highest binding capacity. This seems to be of importance also in therapeutic doses for treatment of chologenic diarrhoea, vagotomy diarrhoea and gastric ulcer.


[Action of molsidomine on haemodynamics at rest and on exercise in patients who have coronary heart disease (author's transl)].

In ten patients with coronary heart disease molsidomine achieved a clear-cut decrease in pre- and after-load of the heart at rest. Due to decreased venous return at rest there was a fall in stroke volume resulting in a fall of systolic and diastolic aortic pressure. But at the same level of standardised exercise, systolic and diastolic arterial pressure and cardiac output were similar with or without molsidomine. Without changing after-load, there was a fall in pulmonary artery mean pressure (P less than 0.005), probably due to an increase in left-ventricular compliance and (or) a fall in pulmonary vascular resistance. A rise in venous capacity or a decrease in venous return during exercise was excluded as a possible mechanism of molsidomine action.


[Dose reduction in xeromammography (author's transl)].

The use of a total filter of 3 mm of aluminium permits a considerable reduction of the radiation dose in xeromammography using the senographe. In comparison with conventional xeroradiography radiation is reduced by a factor of 2 to 3, in comparison with foilless film by a factor of 10 to 12. The applied tissue dose is between 0.14 and 0.30 rad per exposure. The presently still hypothetic radiogenic risk of carcinoma due to mammography is thus lower for this system than with other systems. The quality of the radiograph and the diagnostic validity are not reduced by this technique.


[Epithelioid-cell granulomatous lymphadenitis in a case of parasitic infection in the cervical region (case report) (author's transl)].

A case is reported of epithelioid-cell granulomatous inflammation in the neck with fustula formation and cervical lymph-adenitis, resembling tuberculosis. After neck dissection, histological examination of the removed tissue revealed parasitic infection (organism not identified) as the cause.


[Metastases of carcinoma of the breast to the choroid in the female (author's transl)].

Combined hormonal and cytostatic treatment was undertaken in eight women with choroid metastases from a breast carcinoma, in all cases only part of a more generalised - in most cases visceral - metastasization. If there are additional metastases those to the choroid do not require primary radiotherapy, as the treatment resulted with the remission in six of eight of the patients (mean duration of 12 months) and a rise in visual acuity in five of the six indicated. If remission is not achieved with combined hormonal and cytostatic treatment, radiotherapy to the choroid metastases in combination with polychemotherapy can be undertaken as second best.


[Immunosuppressive treatment of HBs-antigen positive and negative chronic-active hepatitis (author's transl)].

The effect of prednisone (15 mg/day) or azathioprine (2 mg/kg daily) or a combination of prednisone (10 mg/day) and azathioprine (2 mg/kg daily) was assessed in a controlled multi-centre trial of chronic-active hepatitis. Since 1st January, 1972, a total of 162 patients were registered, 81 previously untreated. Fifty-two of them (30 HBs-antigen negative and 22 positive) fulfilled the criteria for admission to the treatment trial. 27 of 29 patients not fulfilling the criteria had HBs-antigen positive chronic-active hepatitis. All 29 untreated patients had slight active non-progressive chronic-active hepatitis over an observation period of one to four years by clinical, biochemical and histological criteria. Taking into account clinical, biochemical and histological findings, a treatment effect independent of treatment form was noted in 23 of 30 of the HBs-antigen negative patients. In 18 of the 23 successfully treated patients auto-antibodies were demonstrable. In contrast, in 18 of 22 patients with HBs-antigen positive chronic-active hepatitis no objective improvement or influence on the clinical course was observed, independent of form of treatment, and three died. It is concluded that HBs-antigen negative, auto-antibody positive chronic-active hepatitis is an indication for immunosuppressive treatment with prednisone or azathioprine or the two combined.


[Interruption of pregnancy in alcoholic women (author's transl)].

Basing on previous experience, with alcohol embryopathy the authors recommended interruption of pregnancy in three chronic alcoholics, two of whom were in the chronic phase and one in the critical phase of alcohol addiction. All the three fetuses were hypertrophic, two severely malformed. In the authors' opinion there is eugenically speaking an absolute indication of interruption of pregnancy in alcoholics in the chronic phase of addiction. In women who are in the critical phase of addiction, each case requires close scrutiny, whereas interruption is not indicated from the eugenic aspect in women in the prodromal stage.


[Percutaneous punch biopsy of vertebral bodies with Jamshidi's needle (author's transl)].

In 24 patients with vertebral body changes which could not be clarified either by x-ray examination or scintigraphy, percutaneous vertebral body punch biopsies were performed between the twelfth thoracic vertebral body and the first sacral vertebral body, using Jamshidi's needle. Findings were malignant in six cases and benign in twelve cases, NAD in six cases. Jamshidi's biopsy needle, which is easy to manipulate, has proved very successful, with a good yield of material. Biopsies were conducted on an outpatient basis. No complications were seen.


[Ultrasonic diagnosis in infiltrative gastrointestinal diseases (author's transl)].

The cockade phenomenon in the ultrasound picture is a sign of an infiltration of the gastrointestinal wall caused by tumour or inflammation. In 27 out of 40 patients with known infiltrations of the wall the cockade phenomenon could be demonstrated. In 16 out of 21 patients in whom this ultrasound phenomenon had primarily led to a suspected wall infiltration further diagnostic investigations proved organic wall thickening. Even if the cockade phenomenon is thus neither a specific nor a sensitive sign of gastrointestinal wall infiltrations the observation of this phenomenon is particularly important in patients in whom wall infiltrations of the gastrointestinal tract are not suspected.


[Short-term localized myocardial ischaemia and its consequences in Prinzmetal angina pectoris (author's transl)].

In a 45-year-old female patient with Prinzmetal angina pectoris coronary angiograms and a 201thallium scintigram were performed during an ergotamine-induced episode of angina. The spontaneous and the ergotamine-induced attacks were characterized by transient ST elevation in the posterior wall ECG leads. The coronary angiogram during the attack showed spasm of the circumflex branch of the left coronary artery. In the 201thallium scintigram a large defect in myocardial thallium uptake was noticed in the posterior wall of the left ventricle. Angina and ECG abnormalities disappeared within 4 minutes. However, the scintigraphic defect disappeared only after 6 hours. The slow recovery of myocardial thallium uptake is thought to represent an alteration of the myocardium after a brief 4 minute interruption of regional coronary arterial blood flow. The diagnostic approach in patients with Prinzmetal angina is discussed.


[Malignant melanoma in husband and wife (author's transl)].

There have been three previous reports of malignant melanoma of the skin in husband and wife. The authors add an observation of their own and compare it with the previously reported ones. In their own case, the couple had been married for 27 years. The husband's tumour was noted eight years before that of his wife. The tumours were histologically very similar. None had HL-A-5 antigen.