Pneumoencephalographic and clinical findings of the XYY syndrome.

In order to approach the hitherto unknown brain involvement in the XYY syndrome five adult patients with this syndrome were studied clinically and pneumoencephalographically. Clinical manifestations included delayed difficulties of speech and learning, clumsiness, mild intention tremor, muscular hypotonia, convulsions, hyperactivity, distractibility, impulsiveness, weak mental control, psychosexual disturbances and a slight defect of intelligence. All five had committed crimes. Pneumoencephalograms showed general ventricular enlargement of mild or moderate degree. The enlargement of lateral ventricles was unilateral or asymmetrically bilateral. The suprapineal recess of the third ventricle was uniformly enlarged. Small cerebellum and enlarged fourth ventricle were the abnormal findings in the posterior fossa. No cortical abnormalities were found. The clinical and pneumoencephalographic findings suggest a slight non-progressive developmental disorder of the brain resembling the so-called minimal brain dysfunction syndrome. The XYY syndrome appears to be one cause of the male preponderance in minimal brain dysfunction syndrome and criminal psychopathy.


Prevalence of psychological impairment in city and country samples.

A study was conducted of the psychological health of 125 married French women aged between 35 and 39 years, divided into five professional groups of 25 subjects. Two of these groups were taken from a rural area, three from Paris. The criteria of health have been psychiatric symptomatology, psychological impairment, and the frequency of the periods of impairment. A significant difference was found between the farmers and all the other groups. Differential data are also given regarding the medical assistance received by the groups.


Analysis of mood change during and following sleep deprivation therapy.

Recent work suggests that depriving endogenous depressives of sleep for 1 night may be followed by an alleviation of their illness. In order to facilitate further study of the mechanisms underlying this effect, hourly self-rated measurements of mood were obtained throughout the sleepless night and the time of onset of any response noted. Of the patients who improved, some did so during the day following sleep deprivation; in others the response did not occur until after the next night's sleep. The two groups of responders differed in terms of self-reported emotional arousal during the course of the sleepless night. The implications of these findings are discussed in relation to further studies of sleep deprivation therapy.


A multi-aspects classification of mental disorders. Experiences from clinical routine work and preliminary studies of inter-rater reliability.

A multi-aspects classification model--MACM--is presented. Several studies concerning reliability between diagnosticians, both trained and untrained psychiatrists from the department, trained psychiatrists from other departments, students, psychologists and social workers are presented and comparisons are made with diagnosis according to ICD-8. The MACM seems to be a step forward and seems to have many advantages over a multi-category system.


Survey of psychiatric morbidity in a semi-urban population in Sri Lanka.

This paper reports a survey of psychiatric morbidity in a semi-urban community (population 7,653) in Sri Lanka. The entire population was first screened by social workers using a standardized interview. Probable cases were then examined by psychiatrists. Each psychiatric disorder identified was rated on four different parameters of severity, and only those rating moderate or severe were labelled as cases. The socio-demographic characteristics of the cases and the population at risk, and the frequency and nature of psychiatric disorders are presented in Tables. The 6-month period prevalence for all psychiatric disorders was 45.5 per 1,000, with psychoses amounting to 6.9 (males 5.5; females 8.4) per 1,000, and neuroses to 25.2 (males 9.9; females 40.6) per 1,000. The large majority of disorders were chronic and had not received psychiatric treatment. The relevance of these surveys in the provision of psychiatric services in developing countries is discussed.


Sensitive delusion of reference, "sensitiver Beziehungswahn". Some reflections on diagnostic practice.

Ten patients discharged with the diagnosis of "sensitiver Beziehungswahn" were followed up 22--28 years after their discharge. In one case, the course of the illness indicates that the patient suffered from a manic-depressive psychosis, and in two cases, this diagnosis was likely. In two cases the disorder seemed definitely to be schizophrenia. One case was presumably a transient paranoid reaction. One patient was likely to have suffered from hysteria or epilepsy, three cases remained uncertain. The study did not prove suitable in the evaluation of the validity of "sensitiver Beziehungswahn" as a nosological entity, since at the time of diagnosis the patients only incompletely fulfilled the criteria set up the Kretschmer, but it throws light on the diagnostic practice and the tendency to a change between the classification into many independent disease entities and the subsequent inclusion into larger and fewer forms.


Contrast enhancement of cranial lesions in computed tomography.

The time course of enhancement in apparently normal brain tissue, edema and focal lesions during 30 to 60 min after intravenous injection of vascular contrast medium was evaluated in a series of 41 patients with different intracranial lesions. The attenuation of apparently normal unenhanced brain tissue varied with the level of the scan, mainly an effect of beam hardening. Different types of enhancement response are discussed in terms of a 3-compartment model. The differential diagnostic potential of contrast enhancement in the early phase needs further evaluation using instruments with short scanning time, while the late phase of enhancement must be recorded with the use of a reliable head fixation to provide reproducibility of repeat measurements.


Recurrent cavernous branches of the ophthalmic artery.

Two arteries arising from the orbit, coursing through the superior orbital fissure to supply the cavernous region and the tentorium, may be identified at angiography. The radiologic and anatomic appearances of these arteries are discussed on the basis of the embryologic development.


Patella alta and gonarthrosis.

The frequency of patella alta as defined by the method of Insall & Salvati in knees with femoro-patellar osteoarthrosis was determined. Patella alta was six times as frequent in knees with osteoarthrosis than in those with a normal femoro-patellar joint. Patella alta is more common in women and is often bilateral.


Arthrography of the ankle. Value in diagnosis of rupture of the lateral ligaments.

Arthrography was performed in 105 cases with freshly sprained ankles and signs of rupture of the anterior talofibular ligament. They were subsequently operated upon. The arthrographic films were examined retrospectively to assess the value of different criteria for the differential diagnosis between rupture of the anterior talofibular ligament and combined rupture of this and the calcaneofibular ligament. The diagnostic value of arthrography was found to be high in isolated rupture of the anterior talofibular ligament, and is acceptable in the combined ruptures.


Radiologic determination of rotational instability of the knee joint.

A method for measuring rotational instability of the knee joint at radiography is described. Together with determination of sagittal instability the method might well serve as a simple guide in choosing the appropriate technique for surgery. It also enables an assessement of the operative results, since the method is simple and reproducible.


Gastrocnemio-semimembranosus bursa and its relation to the knee joint. IV. Clinical considerations.

The frequency of communication between the gastrocnemio-semimembranosus bursa and the knee joint was investigated in a clinical material and in autopsy cases. The frequency was higher in the older age groups. No increase in this frequency or in the size of the bursa was found in patients with knee joint lesions at arthrography. By cineradiography, and in the majority of cases by conventional arthrography alone, a good idea of the flow between the joint and the bursa was obtained. A valvular mechanism between the joint and bursa was demonstrated in 5 cases.


Malignant features of breast tumours at radiography.

A consecutive series of 302 cases of microscopically confirmed mammary carcinoma was reviewed mainly with regard to abnormalities indicating malignancy at mammary radiography. Most important was the demonstration of a tumour mass and distortion of adjacent tissues. Calcifications of malignant type were present in 31 per cent of all cases, but led alone to a preclinical diagnosis of malignancy in only 2 per cent of the cases. Carcinomas detectable by both clinical examination and mammary radiography seemed to be as advanced irrespective of whether they were detected at a referral clinic or at screening of asymptomatic women.


Percutaneous transhepatic portography.

The technique, indications, contraindications and complications of percutaneous transhepatic portography and selective catheterization of the major and minor veins draining the splanchnic organs based on the experience of 200 cases are described. The advantage of this method is discussed and compared with transjugular and transumbilical portography.


Microarteriography of the cadaveric human lumbar spine. Evaluation of a new technique of injection in the anastomotic arterial system.

The theory and practice of a new technique of microarteriographic injection, which depends on the development of a resistance to outflow in anastomoses, are described, using 18 human cadaver lumbar spines. Histology demonstrated that this technique injected 90 per cent (SD 6%) of arterial vessels, which was significantly better than another technique. Possible reasons for not achieving 100 per cent injection are discussed. This technique may form a basis for the radiographic evaluation of the vertebral microcirculation.


Topography of ovarian veins in pregnancy.

The course of the ovarian vessels and the ureters in pregnancy was evaluated by a topographic coordinate system presented previously. The vein was found to be displaced with the artery, whereas the displacement of the ureters was distinct from that of the vessels. The vessels thus reflected both the pressure and traction transmitted from the uterus to the abdomen whereas the ureters reflected only the pressure applied to the posterior abdominal wall.


Effect of ionic and non-ionic contrast media on morphology of human erythrocytes.

The effects of solutions of the ionic contrast media diatrizoate, iocarmate and metrizoate and the non-ionic metrizamide on red cell morphology were compared by interference contrast optics in vitro. All the media produced changes, in solutions both isotonic and hypertonic to blood. The changes increased with increasing volume ratio (contrast medium/blood). At low volume ratio the cells were transformed into crenated cells (echinocytes) in ionic solutions both hypertonic and isotonic to blood. At high volume ratio the hypertonic ionic media caused the red cells to become shrunken (desiccocytes), corresponding to the shrinkage caused by hypertonic saline. The low osmotic non-ionic metrizamide never produced desiccocytes but echinocytes also in high volume ratio. In solutions isotonic with blood metrizoate and metrizamide transformed more cells into echinocytes than the diatrizoate and iocarmate solutions.


Lecithine as an adjuvant in resorption of contrast medium in oral cholecystography.

No or poor filling of the gallbladder was obtained in 21 patients at cholecystography. They were re-examined after 10 days of later with the addition of lecithine to the contrast medium. The filling of the gallbladder, which was without abnormality, was improved in all cases. The mechanism of this effect is discussed.


Computer tomography of the brain and spectrophotometry of the CSF in cerebral concussion and contusion.

Computer tomography (CT) and spectrophotometry of CSF were performed in 30 patients with the clinical diagnosis of cerebral concussion or contusion. The patients with concussion all had normal CT-findings. Spectrophotometry of CSF was sometimes positive for cerebral contusion with normal CT-findings, but the two methods were complementary so that the extent of the lesion was determined by CT and spectrophotometry of CSF indicated the cause.


Therapeutic embolization in the external carotid artery region.

Therapeutic transcatheter embolization with spongostan in the region of the external carotid artery has been employed in 17 patients, in some of them on several occasions. The technique is presented and different means of avoiding complications are discussed in detail. Embolization has been used preoperatively and as the single mode of treatment of ENT tumours or meningeomas, and also as the only treatment in arteriovenous malformations. The technique has proven particularly useful in preoperative de-arterialization of ENT tumours when surgery follows in 1 to 2 days. In cases with arteriovenous shunts, a subjective improvement has been achieved.


Physical correlates of radiologic heart volume.

Radiologic heart volume was calculated on a 10 per cent random sample of subjects examined in the London Civil Service Health Survey. Data were available for 1188 men over the age of 40, and the importance of correcting radiologic heart volume for body size, age and heart rate was demonstrated. After these variables were taken into account, the most important association found was with blood pressure. Radiologic heart volume has potential value in cardiovascular screening programmes.


Left ventricular function evaluated by videodensitometry in patients with coronary heart disease.

The ejection fraction of the left ventricle was determined by videodensitometry in 121 patients with angina pectoris. The mean value was 31 per cent. This estimation, which is easily performed by the method described, gives important and accurate information on the left ventricular function which, added to other parameters, should increase the reliability of the clinical evaluation of the patient.


Roentgenologic examination of tracheal stenosis.

Conventional roentgenography, tomography and tracheography were compared for evaluation of tracheal stenosis in phantom experiments and in 55 patients. It was found that the stenosis, as well as the relative position of a tube inserted for dilatation, is best evaluated by tracheography. If this method cannot be used, conventional roentenography with a high tube potential gives a better result than tomography.


Effect of ionic and non-ionic contrast media on red cell aggregation in vitro.

The effect of solutions of the ionic contrast media diatrizoate, iocarmate, and metrizoate and the non-ionic metrizamide on red cell aggregation in vitro was examined. The aggregation was recorded by both microphotography and photometry in a counter-rotating rheoscope chamber. All the contrast media decreased the formation of red cell aggregates. This desaggregating ability increased with both increasing volume ratio (contrast media/blood) and with increasing osmolality of the contrast media. The desaggregating effect was also obtained with the contrast media solutions isotonic with blood. The iocarmate and diatrizoate solutions induced less reduction in red cell aggregation than the metrizoate and metrizamide solutions.


Spasm of cortical arteries as a complication to selective nephroangiography.

Six cases of spasm of the cortical arteries with redistribution of blood flow to the corticomedullary glomeruli as a complication to nephroangiography are reported. The etiology and the underlying anatomy and physiology are reviewed. Advice is given to avoid the complication.


Intraarterial tolazoline in angiography of the foot.

Foot angiography was performed in 32 diabetic patients with and without intraarterial injection of tolazoline (Priscoline). The angiographic quality was improved with tolazoline, manifested as an increased flow rate with acceleration of the arteriovenous transit time, a higher incidence of complete arterial filling with contrast medium in clinically important regions, and considerably longer arterial segments demonstrated within defined regions of measurement.


Experimental colonic tumours in the rat. III. Induction time, distribution and appearance of induced tumours.

In 189 rats N-methyl-N'-nitro-N-nitrosoguanidine or 1,2-dimethylhydrazine (DMH) was given in order to induce colonic tumours. The tumour induction was followed by double contrast examination. At 894 examinations 196 adenomatous tumours were revealed. Autopsy and microscopy revealed 214 macroscopic and 53 microscopic benign or malignant adenomatous tumours. Metastases were found in 17 per cent in the DMH group. The relationship between adenomas and carcinomas is also evaluated.


Blood inflow into intra-arterial catheters following injection of contrast medium.

Inflow of blood into intra-arterial catheters following injection of contrast medium into the common carotid artery in patients and into the aorta in dogs is investigated. Influence of form and orientation of the catheter in the vessel and the effect of constant flushing are determined as well.


Morphologic sequelae to contrast medium deposits in the kidney. An experimental investigation in the rabbit.

Various doses of Pantopaque and Vascoray were injected percutaneously into the kidneys in 17 rabbits. Histologic examination of the kidneys at different time intervals following the injection demonstrated only slight injury to the renal parenchyma which could be related to the contrast media. Therefore, it seems reasonable to assume that the risk of causing renal damage by using Pantopaque in connection with renal cyst puncture is small.


Movements in the sacroiliac joints demonstrated with roentgen stereophotogrammetry.

Using a roentgen stereophotogrammetric method, the three-dimensional movements in the sacroiliac joints were quantified in 4 patients. To provoke motion of the sacrum, changes between body positions and a test with manual pressure were used. In tests with symmetric forces on the sacrum, it in most cases rotated mainly about a transverse axis and at most approximately 2 degrees. The axis of rotation passed through the iliac bones mainly in the lower part of the iliac tuberosity. The rotations between the iliac bones and the sacrum about any of the three main axes were determined with a precision in the mean of 0.2 degrees. The distance between the two superior posterior iliac spines varied at most 0.4 mm between seven different body positions.


Talofibular compartment of the ankle joint after recent ankle sprain.

The validity of predicting the condition of the anterior talofibular ligament from the shape of the lateral compartment of the ankle joint was investigated in patients with recent ankle sprain. The diagnostic value of the method was found to be restricted.


Lymphatics filled at knee arthrography.

A review of 587 knee arthrographies revealed filling of lymph vessels in 12 cases. They occurred in connection with arthritis (4 rheumatoid), osteoarthritis, ruptured meniscus, ruptured popliteal cyst and after operation. Lymphatic filling was not related to the leakage of contrast through a ruptured popliteal cyst or to inadvertent extra-articular injection. Filling of lymphatics is more likely to occur in examinations with a positive contrast medium when a larger amount of medium is used.


Facial bone scintigraphy. I. Metastatic lesions in the mandible.

Five cases of metastases in the mandible are reported. Conventional radiography and bone scintigraphy by 99Tcm-DP recorded by gamma camera were performed. Invariably the lesions were clearly demonstrated by scintigraphy when radiography revealed only minor structural changes of the bone tissue.


Aspiration biopsy of intrapelvic metastases of cervical carcinoma.

The findings at aspiration biopsy of palpable intrapelvic lesions were reviewed in 316 patients who had previously received radiation therapy for carcinoma of the uterine cervix. A cytologic diagnosis of malignant spread had been made in 55 cases. The crude five-year survival rate in these patients was 4 per cent, as compared with 51 per cent among the patients who received a negative cytologic report. Aspiration biopsy was positive in only about 48 per cent of the patients in whom follow-up observations suggested intrapelvic spread of carcinoma. The factors that may have influenced the diagnostic accuracy are discussed. Use of a screw (0.5 mm thick) technique instead of the 22-gauge needle may enhance the diagnostic accuracy.


Increased serum calcitonin in patients with mammary carcinoma.

Serum calcitonin war within normal range in 11 patients with benign breast tumour. In cases with local malignant breast tumour increased calcitonin was found in 25 per cent (4/16), in cases with regional metastases in 40 per cent (2/5), and in cases with osteolytic bone metastases in 77 per cent (10/13). Two patients with osteosclerotic bone metastases had low calcitonin concentration. It is suggested that increased calcitonin in mammary carcinoma is a physiologic response to osteolytic bone metastases.


Parathyroid hormone and calcitonin in serum of patients with mammary carcinoma.

Immunoreactive parathyroid hormone and calcitonin in serum were measured in 34 normocalcemic patients with mammary carcinoma. The mean value of parathyroid hormone was significantly higher in 26 patients with bone metastases than in 8 patients without (p less than 0.025). One patient with bone metastases had slightly raised calcitonin in serum. No difference as to parathyroid hormone values between the groups of previously irradiated and non-irradiated patients was found. A possible explanation of the normocalcemic hyperparathyroidism is presented.


HLA antigens in Hodgkin's disease of very long survival.

Determination of 32 different HLA types in the A, B, and C series was performed in 40 patients with Hodgkin's disease, 10 of whom had a very long survival. A group of 1 263 healthy subjects was used as reference. HLA-B18 was seen significantly more often in all 40 patients and also in the subgroup of patients with nodular sclerosing Hodgkin's disease. An increased frequency of HLA-A28 was observed among the 10 long survivors, but only with weak significance.


Hodgkin's disease treated by chemotherapy and large field irradiation. Hematologic effects.

The hematologic effects of combined chemotherapy and irradiation were analyzed in 70 patients with Hodgkin's disease stage I and II. The schedule used was as follows: one cycle of 15--21 days of chemotherapy immediately followed by irradiation, including mantle and lumboaortic fields. After a rest of one month, another cycle of the same chemotherapy was applied. The erythrocytes varied slightly; the leukocytes decreased during chemotherapy and were stable or increased slightly during irradiation. Platelets decreased slightly during chemotherapy and more markedly during irradiation. No major side effects were observed, and the regimen appeared well tolerated.


67Ga-subtraction scanning in Hodgkin's disease and lymphomas.

Recently a new method was described, the 67Ga subtraction scanning method. 67Ga accumulates in neoplastic and inflammatory tissue. The subtraction method was applied for evaluating 38 patients with Hodgkin's disease and non-Hodgkin's lymphoma. The preliminary experiences are described. It was found that the diagnostic accuracy is comparable to that of 67Ga scanning. The subtraction method offers potential improvement of the accuracy for equivocal scans, but further technological refinement is needed before the method can be widely applicable.


Bile salt malabsorption in the radiation syndrome.

The fraction of faecal activity (FBS) excreted after intravenous administration of 14C-labelled cholic acid was measured in 20 patients with gastrointestinal symptoms (diarrhoea, abdominal pains, malabsorption and rectal haemorrhage) after pelvic irradiation. An FBS excretion of 52 +/- 16 per cent (mean +/- SD) was found in 13 patients with diarrhoea and 18 +/- 12 per cent in 7 patients without diarrhoea. In normals the excretion is not above 18 per cent. Bile salt malabsorption appears to be an important factor in the pathogenesis of diarrhoea in these patients.


Radiation dose related to collimator geometry in the first generation EMI scanner.

The radiation dose from the first generation EMI scanner has been analysed, including the variation of the dose perpendicular to the section, the dose dependence of the size and collimation of the beam, and the fraction of radiation passing the patient and utilized for information. The possible dose in case of malfunctions of the scanner was also measured.


Thyroid gland volume estimated by use of ultrasound in addition to scintigraphy.

The method of estimating the mass of the thyroid gland from the area of the scintigraphic image has been compared with a method combining ultrasonic with scintigraphic images. The results for both methods were compared with surgical findings, and the scintiscan method alone was found to produce estimates which were on an average 79.5% of the surgical results. The corresponding estimates for the combined method were, on average, 100.4%.


Compact bone mineral density of the normal human radius.

Compact bone mineral density was determined by roentgen ray photodensitometry in the proximal radius of 292 normal men and 302 normal women in the 20 to 90 years age range. Between 20 and 49 years, the bone mineral density did not change significantly. The normal bone mineral density was found to be slightly higher in women than in men. After age 50, bone mineral density decreased proportionately more in women than in men.


The preferential role of triiodothyronine in the regulation of basal metabolic rate in hyper- and hypothyroidism.

The free triiodothyronine index (FT3I) was significantly correlated to basal metabolic rate (BMR) in hyperthyroid (r=+0.63, p less than 0.01) and hypothyroid patients (r=+0.61, p less than 0.05). Elimination of the effect of the free thyroxine index (FT4I) on the total correlation between BMR and FT3I by partial correlation analysis gave partial r=+0.60, p less than 0.01 in hyperthyroid patients and partial r=+0.43, p less than 0.1 in hypothyroid patients. The FT4I did not correlate to BMR in either hyper- or hypothyroid patients. These results point to triiodothyronine as the major regulator of BMR in hyper- and hypothyroidism.


Myxoedema and thyrotoxicosis: relations between clinical state and concentrations of thyroxine and triiodothyronine in blood.

The clinical manifestations in thyrotoxic and myxoedematous subjects were assessed by clinical diagnostic score indices and related to the free thyroxine index (FT4I) and the free triiodothyronine index (FT3I), basal metabolic rate (BMR) and in the hypothyroid patients to serum thyrotropin (TSH) level. The clinical score index was significantly correlated to both FT4I and FT3I in both groups of patients. No difference existed in degree of correlation between the clinical score index, on the one hand, and FT3I and FT4I, on the other, in either thyrotoxic or myxoedematous subjects. The degree of correlation between clinical score index and FT3I and FT4I was higher than that between the thyroid hormones and BMR. The clinical score index thus appears to be a better indicator of severity of hyper- and hypothyroidism than BMR. Serum TSH concentration was not correlated to the clinical state.


Cardiovascular risk factor changes in a three-year follow-up of a cohort in connection with a community programme (the North Karelia Project).

A re-examination after 3 years was done in 1975 in a 20% random subsample (n = 1683) of the representative population sample (males and females, 25-59 years) that was examined in 1972 in North Karelia (NK), and a matched reference county as the baseline survey for the community programme in NK. The changes in smoking habits, serum cholesterol, dietary fat consumption and systolic BP were more favourable among the subjects in the NK sample than among the reference sample, although the differences were generally small. Results from multivariable analyses are presented to show the variables that predict a favourable risk factor change in the individual. Living in NK is associated in the analysis with a favourable change in each of the three risk factors. The limitation of this method in the evaluation of a community programme is discussed.


Coronary arteriographic findings in patients with previous acute myocardial infarction.

In a consecutive series of 234 patients admitted for selective coronary arteriography, 49 had had definite acute myocardial infarction (AMI) three months to ten years previously. More than 75% stenosis in at least one of the major coronary arteries was found in 80% of the patients. Two and three-vessel disease was demonstrated in 31% of the patients, which differs significantly from the 75-80% reported in autopsy studies in patients dying from AMI. At ventriculography all 22 patients with pathological Q waves had dyssynergy of the left ventricle.


Cerebral attacks due to excessive vagal tone in heavily trained persons. A clinical and electrophysiologic study.

Cardiac syncopes appeared in four heavily trained male patients without a history of cerebral or heart disease. Three were young athletes participating in competitive sport, one had trained intensively for years after poliomyelitis complicated by paraplegia. On admission all patients had sinus bradycardia; one had second degree atrioventricular (AV) block at rest, and one had transient sinoatrial (SA) block. His bundle studies demonstrated prolonged recovery time of the SA node (SAN) in two, prolonged atrio-His interval in three, and appearance of second degree AV block at abnormally low pacing rates in two. Refractory periods of the AV node (AVN), determined in three, tended to reach the upper limit of the normal range. The dysfunction of SAN and AVN was temporarily abolished in all patients by 1 mg of atropine i.v., and disappeared during exercise test, which was done by the three young athletes. The patient with paraplegia and one of the young athletes, who had second degree AV block at rest, were given atropine, 0.5 mg six times a day, and all three active sportsmen reduced training activity considerably. After 6--12 months all patients were re-examined. None had cerebral symptoms or other complaints. They were in regular sinus rhythm and in excellent physical condition.


Neutrophil kinetics in acute bacterial infection. A clinical study.

Neutrophil kinetics in peripheral blood were studied with DF32P-labeled cells in eight patients during severe acute bacterial infection. Contrary to previous studies in man, the blood transit time of labeled neutrophils was short and the neutrophil turnover rate increased, up to ten times the normal, during the early phases of infection. This early phase was followed by a period in which the specific neutrophil radioactivity in the blood remained constant for up to 50 hours, probably indicating that in early convalescence neutrophil egress from the bone marrow to the blood is almost stopped. The demonstration of increased neutrophil turnover may seem to illustrate what might be considered an obvious fact, but is in contrast to previous findings and seems to obviate the prevailing theory of quantitatively unchanged but redistributed neutrophil kinetics during bacterial infection in man. The mechanism which apparently abruptly stops neutrophil egress from the bone marrow to the blood during early convalescence is unknown.


The shock liver. Clinical and biochemical findings in patients with centrilobular liver necrosis following cardiogenic shock.

Five patients with severe heart disease developed cardiogenic shock of more than 24 hours' duration. As a sequela to the shock, severe liver affection was demonstrated. Serum aspartate aminotransferases and serum lactate dehydrogenases showed very high activities. The prothrombin-proconvertin index was reduced to less than 25% of the normal. Four of the patients were jaundiced. The condition gave rise to some differential diagnostic problems. Liver biopsies were available from four of the patients, and histological examination of an autopsy specimen of the liver was performed in each case. The liver histology showed centrilobular necrosis and haemorrhage in all patients. It seems that centrilobular fibrosis develops later in the condition. The pathogenesis of this liver affection is probably hypoxic injury to the centrilobular areas of the liver lobule due to reduced liver blood flow.


Thallium intoxication treated with long-term hemodialysis, forced diuresis and Prussian blue.

A 56-year-old woman, who ingested 2 g of thallium sulfate, was successfully treated with long-term hemodialysis for 200 hours during ten days, combined with forced diuresis and Prussian blue. The effect of the artificial kidney dialysis was determined by repeated analysis of the thallium concentration in the dialysis bath and in blood samples. During the first 120 hours of hemodialysis, 143 mg of thallium was eliminated via the artificial kidney and 110 mg via the urinary tract. The present case of acute thallium intoxication is the first in which long-term hemodialysis has been used in the acute phase together with forced diuresis and Prussian blue. The data obtained are compared to those obtained from cases treated with hemodialysis in the past. It is concluded that treatment with hemodialysis should be considered as an important supplement to treatment with forced diuresis and Prussian blue in cases of thallium intoxication.


Benign lesions of the cervical spine.

Benign tumours of the spine are infrequent. Among the bony lesions occurring in children and adolescents are osteochondroma, benign osteoblastoma, and aneurysmal bone cyst. Although more than 50% of the osteochondromas are found in patients below 20 years of age, their incidence in the vertebrae is very low. In contrast, benign osteoblastoma and aneurysmal bone cyst are rare lesions, but occur relatively commonly in the spine. A case report of each of these bony lesions is presented. The symptomatology, the characteristic radiological and pathological appearance, and the appropriate treatment of these benign lesions of the spine are described.


Results of laminectomy in spinal cord compression due to tumours.

In the neurosurgical clinic of the University of Groningen 67 patients were admitted during 8 years with a diagnosis of spinal cord compression by a tumour. Fifthy-three patients had an epidural tumour mass and 14 an intradural tumour. Of the epidural tumour patients became ambulatory, 20 (37.7%) while in the intradural group 78.5% of the patients were improved. The possible pathogenesis of the transverse lesions is discussed, and the necessity for further clinical research is stressed.


Prolapsed lumbar intervertebral disc with partial or total occlusion of the spinal canal. A study of 30 patients with and 28 patients without cauda equina symptoms.

The clinical findings and operation results in two series of patients with medial prolapse of an intervertebral disc with total or partial occlusion of the spinal canal are reported. In one of the series (30 patients) symptoms of cauda equina compression, with bladder and rectal disturbances, were present, and in the other series (28 patients) these symptoms were absent. The observation period was five years (median value). The late results are evaluated in relation to the time interval between the onset of symptoms and operation. In the series with caudal compression syndrome, sphincter disturbances persisted in 10 patients, six of whom underwent operation during the first week after the onset of symptoms. The prognosis was most favourale when the symptoms developed slowly. Seventeen patients have returned to work. The importance of early operation in patients with classical compression syndrome of the cauda equina is emphasized. In the series without caudal compression syndrome, the symptomatalogy varied. The duration of symptoms was strikingly long. Only 19 patients are able to work. The others are prevented from working by persistent backache and leg pains, and in four cases by pareses of the extremities. In these cases also the importance of early operation is stressed.


Congenital stenosis of lumbar spinal canal: comparison of results of surgical treatment for this and other causes of lumbar syndrome.

The operative results in 37 consecutive patients suffering from developmental stenosis of the lumbar spinal canal, compared with those in spondylosis and disc herniations, are discussed. The diagnostic certainty of stenosis, suspected on the bases of clinical and radiographic data, is reached only at the operating table. To judge the usefulness of the operation we have considered not only the patients' verdicts, but also the improvements in neurological signs and the appearance of new deficits. Satisfactory results are around 80%, slightly less good with stenosis than with the other causes of lumbar syndrome. Radiographic study with contrast medium is mandatory. Dimer-X has been used with very clear radiographic findings and very few complications. Operating technique is also described: a wide laminectomy with facetectomy is advised. The great importance of early physiotherapy is emphasized.


Redundant nerve roots of the cauda equina.

Two cases of redundant nerve roots syndrome are presented. Both cases displayed coiled and elongated nerve roots of cauda equina, associated with proliferated fibrous tissue on the ligamentum flavum or with spondylosis and disc protrusion compressing the caudal dural sac. The pathogenesis of the syndrome of redundant nerve roots is briefly discussed.


Meningiomas of the third ventricle.

Intraventricular third ventricle meningiomas are very rare. Fourteen cases have been previously reported. We present a case of third ventricle meningioma, and discuss aetiology, pathology, symptoms, signs, position in the ventricle, and surgical approaches.


Cytological alterations in alumina cream experimental epilepsy.

The cellular changes in the neighbourhood of an alumina cream epileptogenic focus and in the mirror focus in chronic experiments in cats have been studied. According to the neuroglial morphology, four layers are described around the alumina cream lesion. At an ultrastructural level, and increase in gap junctions with a great amount of gliofilaments in astroglial processes are observed. There is a decrease in the number of neurons in the vicinity of the alumina cream. Some are coated by glial processes filled with gliofilaments. The dendrites of the pyramidal neurons in the mirror focus show long mitochondria. The possible significance of these data, in relation with the current theories about epileptogenicity, are discussed.


Has vitamin D a direct renal effect on the tubular reabsorption of phosphate? A study in parathyroidectomized (PTX) and non-PTX man.

The effect of 1-alpha-hydroxycholecalciferol (1alpha-OH-D3) on the renal handling of phosphate and the immunoreactive parathyroid hormone in serum (i-PTH) has been studied in 10 patients with a wide range of glomerular filtration rate (GFR), maximal tubular reabsorption of phosphate (TmP) and i-PTH. The patients were treated with 2 microgram 1alpha-OH-D3 per day for approximately 80 days. Before and after this period of treatment, the TmP, i-PTH, 51Cr EDTA clearance, extracellular volume, standard bicarbonate, and serum calcium were measured in each patient. The TmP/GFR ratio was used as an index of the renal handling of phosphate. The index increased significantly (mean 26.5%, p less than 0.01) during the treatment, while i-PTH decreased significantly (mean 37.0%, p less than 0.01). A significant inverse correlation was demonstrated between the TmP/GFR index and i-PTH both before (r = -0.87; p less than 0.001) and after (r = -0.79; p less than 0.01) the administration of 1alpha-OH-D3, while none of the other factors investigated were correlated to the index. This may suggest that the stimulating effect of biologically active vitamin D on the tubular reabsorption of phosphate is mediated via the parallel suppression of PTH, but does not exclude that biologically active vitamin D exerts a direct effect on the human renal tubule. Therefore, the effect of 1alpha-OH-D3 was studied in 5 totally parathyroidectomized patients, in whom concomitant suppression of PTH would not occur. Estimation of TmP/GFR was performed 1) when the patients were vitamin D depleted and hypocalcemic, and 2) after 14-27 days of treatment with 1alpha-OH-D3 to obtain stable normocalcemia. In patients with absent parathyroid function, no increasing effect of 1alpha-OH-D3 on TmP/GFR could be demonstrated. It is therefore concluded 1) that 1alpha-OH-D3 exhibits no antiphosphaturic effect in the absence of PTH and 2) that the previously demonstrated antiphosphaturic effect of 1alpha-OH-D3 in man is mediated via a concomitant suppression of PTH.


Visceral calcification and the CaXP product.

The authors studied the presence of visceral calcification as evidenced by the visceral uptake of bone-seeking radionuclides during the course of a bone scan among 22 patients with terminal renal failure maintained on dialysis, nine patients with hypercalcemia secondary to malignancy, and nine patients with primary hyperparathyroidism. Uptake by the lungs or stomach was observed in 11 renal failure patients (50%) and in four of those with malignancy and hypercalcemia (44%). None of the patients with primary hyperparathyroidism had evidence of visceral calcification. The serum CaXP product was significantly higher among those with visceral calcification than those without. The results of this study indicate that a CaXP product of 60 represents the saturation product of calcium phosphate in serum above which spontaneous precipitation of this salt may occur in such viscera as stomach and lungs.


Renal handling of phosphate in very low birthweight (VLBW) infants (less than 1.3 kg): effects of calcium and sodium intake.

Five patient groups of VLBW infants with the same P-intake but varying Ca and Na intake were examined as to their urinary excretion of P and Na and on their renal clearance of P. The effect of increasing the Na intake from 1.5 to 3 mEq/kg/24 h on C(P) was also examined. In the control group of infants with an intake of 210 mg Ca and 80 mg P/kg/24 h, the C(P) was significantly correlated with postnatal, but not postconceptional age. A relatively low Ca intake of 100 mg/kg/24 h led to age-related values two to three times as high, whereas Ca supplementation to a total intake of 250 mg/kg/24 h decreased the C(P) significantly. A Ca intake of 175 mg/kg/24 h led to C(P) similar to those seen with one of 100 mg/kg/24 h. Changing the Na intake from 1,5 to 3 mEq/kg/24 h did not influence the C(P). There was no correlation between UP and UNa in any of the patient groups examined.


The effects of phosphate depletion on bone.

Phosphate depletion causes significant changes in the composition of the cell population in bone and the metabolic activities of these cells. The data presented indicate that a vitamin D metabolite has a significant role in producing the increase in osteoclast number associated with phosphate depletion. The increased resorptive activity and number of osteoclasts leads to a marked increase in the rate of bone resorption resulting in the liberation of calcium phosphate, while the decrease in the rates of the processes involved in bone formation (matrix production, osteoid maturation, and mineralization) reduces the amount of phosphate which is removed from the circulation. Thus, all of the effects of phosphate depletion on bone are consistent with the interpretation that bone acts as a reservoir of phosphate and is used to maintain soft tissue and serum phosphate levels at the expense of bone.


Effect of PTH on osteocyte ultrastructure.

Osteocyte ultrastructure was studied in the cortical bone of the tibia of rats after acute or chronic administration of supraphysiological doses of PTH. Confirming previous reports, an increase in the width of the cytoplasm with the appearance of numerous thin cytoplasmic processes, an increase in rough ergastoplasmic reticulum and Golgi apparatus, an increase in lacunar width and lysis of the lacunar wall ("brush border" after Bonucci) were observed. Particularly striking was the appearance of numerous microfilaments and microtubules in the cytoplasm of activated osteocytes. The appearance of microfilaments, often densely packed in cytoplasmic processes or running parallel to the plasma membrane, points to a role of the cytoskeleton in mediating the effects of PTH on conformational changes of the plasma membrane (and possible on cell motility); microtubules were particularly prominent in the Golgi field and are presumably involved in the exocytosis of lysosomes. Another striking feature was the non-random distribution of periosteocytic osteolysis along the lacunar perimeter. Osteolysis was particularly pronounced at the cell pole opposite to the cell nucleus. After chronic administration of PTH, autolysis of osteocytes, associated with signs of excessive periosteocytic osteolysis, was frequently encountered.


Regulation of the tubular transport of phosphate in the rat: role of parathyroid hormone and 1,25-dihydroxyvitamin D3.

The reduced capability of the tubular Pi transport to adapt to a high Pi diet in TPTX rats can be normalized by physiological doses of 1,25-(OH)2D3. This suggests that the chronic consequence of a lack of PTH could be due, at least in part, to the reduced production of 1,25-(OH)2D3. The mechanism of Pi adaptation appears to be the most important regulator of Pi excretion in the growing rats, since it can markedly alter the acute phosphaturic response to parathyroid hormone.


Pilot epidemiological studies in thrombosis.

Some differences in the blood of farmers in Nurmijarvi, Finland, Canino, Italy, and Beltsville, Maryland in the United States apparently were associated with differences, among the areas, in the farmers' diets. Those associations suggested that diets that are high in saturated fats (Nurmijarvi) could predispose humans to develop intravascular disease. Such predisposition has been observed in experimental animals. Low levels of the parameters that are considered active in such predisposition apparently were associated with diets that were low in saturated fats (Canino) or with diets that were low in saturated and high in unsaturated fats (Beltsville). Within the limits of the experimental design, the data from the three population groups indicated that a more comprehensive study might establish a relation between diet and intravascular disease in humans.


A model implicating altered macrophage function in H-2 linked nonresponsiveness to hen lysozyme.

Studies on the basis of differential responsiveness of H-2b mice to gallinaceous lysozymes suggest T cell involvement and active T cell suppression with those lysozymes not responded to. Results from other laboratories suggesting a directive role for macrophages through limited presentation are summarized. A model is presented proposing that suppressors (recognizing a determinant only on lysozymes not responded to) are present in all strains; that suppression requires antigen bridging between suppressor determinant and positive T determinant; that this bridge is disrupted in all strains but H-2b; and that this failure to disrupt the antigen bridge is a result of a genetically (Ia) controlled loss of a normal macrophage processing step.


Immune responses of inbred guinea pigs and mice to helical sequential polymers of amino acids.

The immune responses against the sequential polypeptides; (T-G-A-Gly)n, (T-A-G-Gly)n, (Phe-G-A-Gly)n and (Phe-A-G-Gly)n were studied in inbred guinea pigs and mice. Strain 13 guinea pigs responded to (Phe-G-A-Gly)n and (T-G-A-Gly)n whereas strain 2 guinea pigs responded to (T-A-G-GLY)n and (Phe-A-G-Gly)n. These responses which are linked to MHC, are only against the helical form of the polymers which have conformational determinants. Significant cross reactions at the humoral and T cell levels (PELS) are exhibited with the following reciprocal combinations: (Phe-G-A-Gly)n and (T-G-A-Gly)n; (T-A-G-Gly)n and (Phe-A-G-Gly)n. With mice, the polymers were shown to be T dependent with the following response patterns: mice of H-2b haplotype respond against (T-G-A-Gly)n; those of H-2b, f and r haplotypes respond against (T-A-G-Gly)n. There are no responders against (Phe-G-A-Gly)n and only mice of H-2f respond against (Phe-A-G-Gly)n. "Nonresponders" respond against the MBSA aggregates of all of these polymers. The Ir gene(s) controlling these T cell dependent H-linked responses mapped to the IA subregion. Antibody responses against (T-G-A-Gly) and (T-A-G-Gly) were quite variable, and were most marked in, F1 mice of (responder and nonresponder) and in backcross populations of (F1 x R) and (F1 x NR). However, the T cell proliferative responses performed with nylon wool purified T cells gave clear cut and predictable distinctions between "responders" and nonresponders and linkage with responding haplotype. Hypotheses advanced to explain these findings relate to the poor immunogenicity (antibody) of these polymers, which have a restricted number of repeating determinants, the B cell mitogenic properties of these polymers and the possible involvement of suppressor cells. The specificities of the humoral responses, i.e. cross reactions, were similar to those found in guinea pigs. However, in contrast to the guinea pig studies cross stimulation with structurally related polymers occurred only in those situations where the immunizing and "crossreacting" polymers were both immunogenic in mice of the same haplotype, i.e., (T-A-G-Gly)n and (Phe-A-G-Gly)n in mice of H-2f haplotypes.


Effect of dimaprit on gastric acid secretion in conscious cats.

Gastric acid secretion was studied in conscious cats with gastric fistulas. Dimaprit and Nalpha,5-dimethylhistamine produced higher maximal responses than histamine. In the presence of pyrilamine, the maximal response to histamine was equal to that of dimaprit. Pyrilamine increased submaximal but not maximal responses to pentagastrin. Cimetidine decreased the potency of dimaprit but did not alter the maximal response. Gastric acid secretion continued for 90 min after infusion of dimaprit was stopped. Possible mechanisms for the enhancement of acid secretion by pyrilamine include: (a) blocking of an inhibitory histamine H1-receptor and (b) inhibition of histamine methyltransferase.


Active bronchial anaphylaxis in the rat: inhibition by tiaramide.

Intravenous administration of the benzothiazoline derivative tiaramide hydrochloride, to rats actively sensitized to ovalbumin, inhibited immunologic lung reactions in a dose-related manner. Methysergide also inhibited anaphylactic lung reactions. Serotonin, but not other chemical mediators, produced changes in pulmonary mechanics qualitatively similar to those produced by the sensitizing antigen. The bronchoconstrictive action of serotonin was blocked by methysergide and tiaramide. The latter drug also inhibited bronchoconstriction induced by methacholine. The results implicate serotonin as the primary mediator of the respiratory component of systemic anaphylaxis in the rat: however, the mechanism by which tiaramide inhibits anaphylactic bronchoconstriction remains to be elucidated.


Regional levels of histamine in rat brain after microwave irradiation: evidence for artifacts in the enzymatic--isotopic assay.

Histamine levels in the brain, measured fluorimetrically, were similar for rats killed by decapitation and microwave irradiation. However, enzymatic--isotopic assay yields 5--20 times higher value for microwave irradiation versus decapitation. Thin layer chromatography of the methylated products in the enzymatic--isotopic assay indicated the formation of artifacts following microwave irradiation. The results strongly suggest that a combination of microwave irradiation and enzymatic--isotopic assay is not suitable for histamine analysis in the rat brain.


Induction of cytokines by tilorone hydrochloride.

Tilorone hydrochloride, an interferon inducer in small laboratory animals, was demonstrated to elicit formation of macrophage migration affecting and microbial growth inhibitory cytokines after peroral drug administration to mice. Serum kinetics of the migration inhibitory cytokine resembled those of interferon, exhibiting a peak after about 24 h, whereas the bactericidal cytokine showed a steady increase up to 48 h after drug treatment. Both the factors were found to have molecular weights of 10,000--30,000 daltons as determined by Sephadex G-200 chromatography, to be stable at pH 2 and at 56 degrees C for 30 min, sensitive to chymotrypsin and resistant to RNase digestion. The migration enhancing serum activity could not finally be characterized so far. The physicochemical data are discussed in comparison to those of lymphocyte-derived cytokines. It is suggested that cytokine production may be, at least partially, responsible for the immunological effects of tilorone and possibly contribute to its antiviral action.


Inhibition of adjuvant-induced arthritis in the hyperuricemic rat.

In man, there is a strong negative correlation between gout and rheumatoid arthritis. To investigate this apparent mutual exclusion, we studied the influence of oxonate-induced hyperuricemia on the development of adjuvant arthritis in male Wistar rats. The results indicate that in the primary reaction (inflammation of the injected paw) the differences are weak (0.10 greater than p greater than 0.05) between normouricemic and hyperuricemic rats. In hyperuricemic rats the secondary reaction (induced polyarthritis) is delayed and significantly reduced (p less than 0.005). Non-immunologic carrageenin paw edema is not statistically different between the two groups (p greater than 0.25). Experimental hyperuricemia in rats seems to influence essentially the secondary, cell mediated, reaction without affecting the acute inflammatory phases.


Anti-inflammatory effect of sialic acid.

Sialic acid was shown to possess anti-inflammatory properties as measured by carrageenan-induced rat paw oedema and pleurisy tests. As the number of leukocytes mobilized was significantly reduced it was concluded that the inhibitory effect of sialic acid on leukocyte accumulation is responsible for the inhibition of exudate/oedema formation.


Growth retardation in children with chronic asthma in the absence of prolonged steroid therapy.

Height and weight measurements were made on 380 boys and 219 girls age 4 to 20 with chronic asthma and compared with normal values from National Center for Health Statistics Growth Charts. These patients were not on prolonged steroid therapy. Heights and weights were both significantly lower than normal (P less than 0.005 for height and P less than 0.01 for weight) for the total sample and for some individual age groups for boys, but reached normal values by age 19 and 20. Average height percentiles for boys with early onset (age 0 to 2 years) were at the 25 percentile level but improved with later ages of onset. Height and weight of girls were not affected significantly by chronic asthma. Growth retardation in asthmatic boys appears to be linked with delayed sexual maturation.


Allergy and experimental chronic broncho-pneumopathy.

House dust is a mixture of specific and non-specific stimulating factors. More particularly it contains a wide range of irritating factors, antigens, responsible for the production of immediate and delayed allergic reactions, moulds, microbes, etc. It may therefore be understood that inhalation of house dust induces in the respiratory tract of treated rats various reactive pictures. These pictures are, however, dominated by immuno-allergic reactions. Immuno-allergic reactions are manifested by the dominant increase in plasma cells and lymphocytes. This increase generally occurs in the vicinity of connective tissue macrophages containing numerous dust granules, as if macrophagic digestion formed more active antigens from the dust. Sometimes in the proximity of these plasma cell aggregates, mast cells in the degranulation phase are observed. The release of histamine, serotonin, etc. which occurs with mast cell degranulation produces the intense tissue edema which is observed in these areas. An infiltration with eosinophils is also observed here probably drawn to the site on account of their protective, enzymatic, antihistaminic action. The morphological picture thus indicates the co-existence of two allergic reactive movements: one of the immediate type, the other of the delayed type linked to specific allergens of the mixture of antigens present in house dust. The stimulus of the inhalation of house dust also includes the possible action of microbes, irritants, etc. which produce regressive changes in the tissue, attract polymorphs and stimulate the proliferation of fibroblasts so that more or less wide area of tissue undergo a fibrous transformation. Such changes may be found in the pulmonary parenchyma as well as in the bronchial mucosa. The concordance of these findings with those of chronic bronchitis in man appear sufficiently important to attribute, a predominantly allergic pathogenesis to both pathological conditions. This concept obviously does not exclude other etiopathogenetic factors which under certain environmental or constitutional conditions, may in various degrees be also included in the overall picture of respiratory tissue reactivity.


[Inhibition of expontaneous cytotoxicity and antibody dependency by rheumatoid synovial fluid].

A number of authors have pointed out a diminution of ADCC (Antibody dependent cellular cytotoxicity) in lymphocytes from peripheral blood of patients with rheumatoid arthritis (RA). It has also been found that the addition of rheumatoid serum inhibits ADCC and also spontaneous cellular cytotoxicity (SCC). This effect could be the result of blocking of effector cell receptors for the Fc fragment of IgG by anti-immunoglobulins and/or immune complexes, present in great quantities in rheumatoid serum. We investigated the effect of synovial fluid on the ADCC and SCC shown by purified suspensions of lymphocytes from healthy donors and RA patients towards chicken erythrocytes tagged with 51 Cr. The samples of synovial fluid from patients with RA or arthrosis did not influence per se the spontaneous release of 51 Cr, once their complement had been removed. Seven-eight of the rheumatoid synovial fluid (RSF) produced a significant decline (p less than 0.01) of SCC. Lymphocytes from the peripheral blood of RA patients showed a greater decline in SCC after the addition of RSF than those from healthy subjects (p less than 0.02). In 14/16 RSF and 5/7 samples of arthrosis synovial fluid (ASF) the ability to diminish ADCC significantly (P less than 0.01) was shown. RSF maintained this inhibitory effect in 1:40 and 1:80 dilutions, whereas in these conditions ASF had no effect on ADCC. RSF and ASF, before their complement was removed, showed an opposite effect, provoking an increase in cytotoxic activity, both SCC and ADCC, though in different proportions. These experiments show that RSF, like rheumatoid serum, inhibits ADCC and SCC, possibly by the same mechanism which blocks the Fc receptors by means of immune complexes, and coincides in its general lines with the recent findings of Díaz Jouanen et al. The pathogenetic implications of this phenomenon are difficult to clarify at present. Its occurrence in vivo would represent the establishment of a local block of cytotoxic effector cells (protector effect), which, on the other hand, would no longer be able to exercise their destructive action against cells responsible for the initiation and/or maintenance of articular damage (pathogenic effect). The non-participation of T cells, in these types of cytotoxicity, previously shown by other authors, accentuates the importance of thymus-independent regulatory systems in the mechanisms which maintain articular damage in RA.


Recognizing, confronting and helping the alcoholic.

Vomiting, amnesia, a history of falls and other injuries, and depression and anxiety may all be clues to a drinking problem. Decreased work performance, absenteeism and difficulty in getting along with others may be present. Coming to grips with the problem is essential. Once the patient accepts the need for abstinence, the use of disulfiram (Antabuse) and the support of Alcoholics Anonymous are both therapeutically valuable.


Electromyoneurography.

Electromyoneurography is the combined use of electromyography and electroneurography. Electromyography is useful in defining the cause and site of different myopathies, such as muscular dystrophy, myotonia and myasthenia, and lesions involving the motor neuron in the anterior horn of the spinal cord. Electroneurography helps to localize the site of peripheral nerve disorders, such as radiculopathy and axonopathy. Use of the two procedures together enhances diagnostic capacity and, in some situations, may obviate the need for myelography.


Gynecologic cytology.

Cervical Pap smears should be initiated at the time a woman becomes sexually active or by 21 years of age. Additional sites for obtaining specimens include the vulva, vaginal wall, vaginal pool, cervix and endometrium, each serving a specific purpose. The primary use of vaginal pool cytology is to detect an abnormal endometrium or an extrauterine malignancy. Meticulous technique and knowledge of the types of yield from specific sites are required in order to obtain accurate cytologic information.


Diagnosing the common alopecias.

Ample scalp biopsies, including subcutaneous fat, are easily obtained by excision or punch biopsy. Using a knowledge of normal hair patterns and histologic features, the physician can identify common baldness, trichotillomania, alopecia areata, discoid lupus erythematosus, lichen planopilaris, tinea capitis and follicular mucinosis. While hair loss is usually of more psychologic than physiologic significance, accurate diagnosis can be of great importance.


Counseling sexual abuse victims.

Rape can cause tremendous physical, social and psychologic disruption which affects the victims, their families and friends, and the community. In the past, society has been quite remiss in its response to rape victims. Major attitudinal changes based on factual information must take place, because the attitudes and biases of those helping the victim can further victimize the sexually assaulted woman.


Electrophysiological studies in four patients with atrial flutter with 1:1 atrioventricular conduction.

Electrophysiological studies of atrioventricular conduction during rapid atrial overdrive pacing and during programmed premature atrial stimulation are reported in four patients with an unusually rapid 1:1 ventricular response to atrial flutter (ventricular rates 240 to 310 per minute). Second-degree AV block development during atrial overdrive pacing at rates well below those during spontaneous atrial flutter. Although none of the four patients showed evidence of pre-excitation on the standard 12-lead electrocardiogram, evidence suggesting a partial AV nodal bypass was demonstrated at electrophysiological study in one case. It is postulated that the profile of the atrial wavefront presented to the normal AV node by atrial flutter differs from that during high right atrial pacing and may account for the lower ventricular rates achieved during high right atrial overdrive pacing than during spontaneous atrial flutter in the remaining three cases.


Significance of P wave terminal force in presumably healthy middle-aged men.

In  a material comprising 695 males aged 40 to 60 years without cardiovascular disease, the prevalence of abnormal P wave terminal force in V1 (V1Ptf) (less than or equal to - 0.03 mm. second) at rest was 7.1 per cent, whereas the prevalence five minutes after a near-maximal exercise test was 25.4 per cent. Abnormal V1Ptf was associated with a slightly higher systolic and diagstolic blood pressure, maximal rise of systolic blood pressure, and maximal rate-pressure product during the exercise test. The prevalence of abnormal V1Ptf was not significantly higher in another group of 95 individuals who were angiographied because of strong suspicion of latent coronary heart disease (CHD) according to exercise electrocardiogram. An abnormal V1Ptf may be considered as a possibly clinically unimportant anomaly in otherwise healthy middle-aged men. V1Ptf is not suitable as a tool for the diagnosis of latent CHD.


Clinicopathologic study of the conduction systems in 10 patients with Kawasaki's disease (mucocutaneous lymph node syndrome).

Clinicopathologic study of the conduction systems was done on ten hearts obtained at autopsy from patients with Kawasaki's disease. The pathologic lesions were discovered in the atrioventricular (AV) conduction system in nine out of 10 cases and in five of eight cases in the sinoatrial (SA) conduction system. The lesions of the AV conduction system were classified according to duration of illness at death. Eearly acute state (0 to 9 days) was characterized by inflammation with cellinfiltration and edema without coronary stenosis. The most severe acute stage (21 to 31 days) was characterized by severe compression of conduction cells without the diffuse necrosis due to severe perivascular edema and cell infiltration. In the end stage (48 days to 7 months), old changes with perivascular fibrosis and fatty infiltration without considerable loss of the conduction cells were noted. Coagulation necrosis of the conduction cells was not evident despite the severe coronary stenosis. Lesions in the conduction system are therefore acute and inflammatory. Pathology and electrocardiogram showed a good correlation in seven of eight cases. PQ prolongation was a sensitive indicator of acute inflammation of the AV conduction system in the present study.


Protection of ischemic myocardium by whole-body hypothermia after coronary artery occlusion in dogs.

Anesthetized dogs were cooled to a core body temperature of 26 degree C. or maintained at a body temperature of 37 degree C. during periods of 5 and 10 hours of LAD coronary artery occlusion. Subsequent macroscopic dehydrogenase enzyme mapping showed that ischemic injury was 25 per cent less after 5 hours of coronary occlusion and 20 per cent less after 10 hours of occlusion in hypothermic dogs than in normothermic controls. The heart rate and left ventricular minute work in hypothermic dogs decreased to roughly half the levels measured in normothermic animals, while left ventricular contractility was 10 to 40 per cent lower in hypothermic dogs than in normothermic dogs. However, cardiac index and left ventricular end-diastolic pressure were unchanged by whole-body cooling. Thus, hypothermia appeared to diminish the oxygen requirements of the ischemic myocardium without reducing the performance of the heart as a pump. Hypothermia may be useful as a therapeutic adjunct to myocardial revascularization or pharmacologic interventions.


Endocardial fibroelastosis: myocardial and vascular alterations associated with viral-like nuclear particles.

Although clinical, immunologic, and experimental evidence exists implicating in utero viral infection of the myocardium in the development of primary endocardial fibroelastosis, the infectious etiology of this condition remains somewhat controversial. To date, specific features of viral myocarditis and morphological demonstration of viral particles have not been described in EFE. The present case is the first in which extensive light microscopic and ultrastructural analysis of the myocardium revealed abnormalities consistent with a primary viral myocarditis associated with typical EFE. These alterations consisted of chronic myocardial inflammation, extensive interstitial fibrosis, severe degenerative changes in myocardial cells, and a marked proliferation of endothelial cells in large nad small intramyocardial vessels leading to vascular occlusions. In support of the infectious etiology of this disease, similar features were noted in skeletal muscle. Most interestingly, viral-like particles were observed in many myocardial and endothelial nuclei. Although we are not absolutely certain of the viral nature of these particles, their appearance suggests viral assoicated material. We propose that the presence of these particles in this case in association with the other morphological alterations in support for the viral etiology of EFE. The prominent vascular occlusion observed in the myocardium may be an important clue to the pathogenesis of fibroelastosis as either a primary or secondary disease.


Teflon felt embolism of coronary arteries after cardiac surgery: a case report.

A case is presented of fatal coronary embolism of Teflon felt used to buttress sutures in the placement of a Björk-Shiley aortic valve prosthesis. The embolism occurred on the tenth postoperative day, lodging in the left anterior descending branch of the left coronary artery 5.5 cm. from the ostium, causing a large anterior myocardial infarct. The patient died in less than 24 hours following the infarct. A review of the literature indicates that this is the first reported case of clinically significant embolism of Teflon felt used in the placement of a Björk-Shiley aortic valve.


The effect of chain length on glucose absorption and the related metabolic response.

The relative absorption of saccharides on different chain length has been reexamined. Whether glucose is administered as a monosaccharide, a disaccharide (maltose), an intermediate polysaccharide mixture with a mean chain length of five glucose units (Caloreen), or a polysaccharide (starch), the rate of rise and fall in blood glucose concentration is similar in healthy subjects. In a maturity onset diabetic, peak blood glucose is similar whether monosaccharide or Caloreen is ingested. Plasma insulin and plasma free fatty acid responses to glucose saccharide ingestion do not appear to be affected by chain length. The dietary form in which starch is administered, rather than chain length, is probably important.


Absorption of mono- and polyglutamyl folates in zinc-depleted man.

The effect of experimental zinc depletion on the intestinal absorption of mono- and polyglutamyl folates was assessed in six healthy male subjects by measuring the increase in serum folate after an oral dose of pteroylmonoglutamate and pteroylheptaglutamate before and after initiation of a zinc-deficient diet. At the beginning of the study, no differences were detected in the absorption of pteroylmono- and heptaglutamate. After zinc depletion, the rise in serum folate after an oral dose of pteroylheptaglutamate was reduced by an average of 53% while pteroylmonoglutamate absorption appeared to be unchanged. These data suggest that zinc depletion results in a decreased intestinal hydrolysis of pteroylpolyglutamate and that intestinal conjugase in man is a zinc-dependent enzyme.


Elevated serum levels of unsaturated folate binding protein: clinical correlates in a general hospital population.

We measured the capactiy of unsaturated folate binding protein to bind 3H-pteroylglutamic acid (UFBC) in serums from 489 general hospital patients. Of the patients 20% had mild-to-moderate elevations in UFBC (250 to 500 pg/ml), but only 6% had marked elevations (greater than 650 pg/ml), which correlated with metastatic cancer, active granulomatous disease, and especially with liver disease. The poor correlation of serum UFBC with folate status of the patient suggests that in many instances the elevated serum UFBC is neither the consequence nor the cause of folate deficiency. Although the role of folate binding protein remains unknown, it may be primarily an intracellular protein that is released into the serum as an index of activity of liver cells, granulocytes, and perhaps certain cancer cells.


Granulomatous hepatitis and pleuritis after ileal bypass for obesity.

A patient is presented who developed a granulomatous hepatitis and pleuritis approximately 7 months after an ileal bypass procedure for morbid obesity. Although the etiological agent was presumed to be Mycobacterium tuberculosis no pathogenic organism was grown from the liver, pleura, bone marrow, sputum, or gastric aspirate. The possibly increased susceptibility of these patients to mycobacterial infections is discussed. The value of obtaining serum levels of ethambutol, isoniazid, and rifampin, in patients with malabsorption is stressed. Although this patient seemed to respond to antituberculous therapy, other possible causes for the granulomatous process are explored.


Prevalence of hyperostosis frontalis interna in relation to body weight.

In a prospective study, hyperostosis frontalis interna (HFI) was found to be present in 49% of the subjects. The group included 259 nuns between the ages of 60 and 80. A prevalence of 84% of HFI was found in the obese subjects (greater than 40% over ideal body weight) whereas in the thin subjects HFI was found to be present in only 16%. The possible relationship between adipose tissue mass and HFI is discussed.


Talc-coated rice as a risk factor for stomach cancer.

Analysis of data from Japan and Hawaii offers no support for the hypothesis that the use of talc-coated rice increases the risk of developing stomach cancer. This conclusion is based on the observation that Japanese in Japan have very high rates of stomach cancer but consume no talc-coated rice, that Japanese in Hawaii have intermediate rates of stomach cancer but consume considerable amounts of talc-coated rice, and that Filipinos in Hawaii have very low rates of gastric cancer but consume the highest amounts of talc-coated rice of these three groups. Furthermore, secular trends in gastric cancer incidence show a much greater decrease in the incidence of this tumor among the exposed Japanese in Hawaii than among the unexposed Japanese in Japan.


Breast cancer and diet among the Japanese in Hawaii.

Eighty-six Japanese men out of 6860 male participants in a prospective study of cancer were married to women who had breast cancer. These 86 men were compared with the remaining men by dietary factors that were identified during two different time periods. Based on the assumption that there is a similarity between husbands and wives in their dietary patterns, it was noted that the spouses of women with breast cancer consumed more beef or meat, butter/margarine/cheese, corn, and wieners than the other men. Furthermore, the breast cancer spouses also consumed less Japanese foods than controls, even though there were minimal differences between the two groups in other Oriental practices. These results suggest that certain American foods are important in the search for possible dietary factors related to the occurrence of breast cancer in women.


An assay for terminal deoxynucleotidyl transferase in leukocytes and bone marrow.

A modified technic for the assay of terminal transferase activity in leukocytes and bone marrow is presented. 3H-deoxyadenosine-5' -triphosphate serves as nucleotide donor and (dA)10 as primer. The reaction product is collected as a trichloroacetic acid precipitate, which is dissolved for radioactive quantitation. All reagents are commercially available, and the procedure has been designed to minimize cost and to provide low blank values. Excellent linearity between enzymatic concentration and activity and between time and activity is observed. Because the assay is carried out at conditions approaching the optimum for the enzyme, the measured activities are more than ten times those observed with previous methods.


Predictive values of erythrocyte indices for tests of iron, folic acid, and vitamin B12 deficiency.

The probabilities of low transferrin saturation, folic acid, or vitamin B12 levels in association with various erythrocyte indices was determined from the prevalences of these abnormalities and the distributions of the indices among 206 hospitalized and 1,000 ambulatory anemic patients. At mean corpuscular hemoglobin (MCH) greater than 30 pg, the probability of low transferrin saturation was 0.04 for hospitalized patients and 0.14 for ambulatory anemic patients. For MCH less than 27 pg, the corresponding probabilities were 0.52 and 0.67. The probabilities of low vitamin B12 or folic acid levels among hospitalized anemic patients were 0.0011 for mean corpuscular volume (MCV) less than 95 cu micron and 0.18 for MCV greater than or equal to 95 cu micron, indicating that measurements of these vitamins are of very limited value in most cases of anemia. These findings indicate that in some patients, the erythrocyte indices are sufficiently predictive for or against deficiency states to facilitate decisions regarding further diagnostic tests, as opposed to the increasing tendency to order such tests regardless of the indices.


Endometrial lesions in uteri resected for atypical endometrial hyperplasia.

Resected uteri from a series of 48 consecutive patients with atypical endometrial hyperplasia ("carcinoma in situ") identified in curettings were studied to determine the frequency of associated adenocarcinoma. Thirty-nine of the women had received estrogen or oral contraceptives. Twelve uteri (25%) contained small superficial foci interpreted as well differentiated adenocarcinoma. Consideration of this observation together with the absence of adenocarcinoma in the extensive experience reported in other studies of women with atypical hyperplasia treated with progestogens alone shows a deficit of patients with progression to invasive carcinoma. We reconcile this apparent conflict with the hypothesis that lesions classified as focal well-differentiated endometrial adenocarcinoma occurring with atypical hyperplasia in perimenopausal women exposed to estrogen are common and are consistently reversed by progestogen therapy.


Increased incidence of positive tests for estrogen binding in mammary carcinoma specimens transported in liquid nitrogen.

Use of a liquid nitrogen container for convenient transport of frozen mammary carcinoma tissue for hormone-receptor assays is described. The container can be used in dry or wet mode and is appropriate for all types of transport, including air. Experience shows a significantly higher incidence of positive tests on specimens transported by this means than on specimens transported in dry ice.


Age dependence of serum enzymatic activities (alkaline phosphatase, aspartate aminotransferase, and creatine kinase) in healthy children and adolescents.

The activities of alkaline phosphatase, aspartate aminotransferase and creatine kinase in sera of 1,033 children and adolescents aged 5 to 20 years were measured. The results showed significant deviation from the gaussian distribution. Because of differences between sexes and nonlinear relationship to age, sex- and age-related values for the 95th, 90th, and 5th percentiles are presented. Alkaline phosphatase activity increased markedly between 5 and 14 years of age in male subjects and 5 and 12 years of age in female subjects. The peak at puberty was more pronounced in boys than in girls. After puberty, activities decreased toward adult values. Aspartate aminotransferase activity showed a gradual significant decrease between 5 and 17 years of age in male subjects and 5 and 16 years of age in female subjects; then it remained steady until 20 years of age. Creatine kinase activity remained constant in male subjects between 5 and 12 years old, then rose to a maximum at 15 to 16 years of age before declining rapidly toward adult values. In female subjects, creatine kinase activity remained stable from 5 to 12 years of age, then decreased gradually in early adulthood.


Elevations in serum copper, erythrocytic copper, and ceruloplasmin concentrations in smokers.

Previous investigators have reported significant elevations of serum copper and ceruloplasmin levels in lymphoma patients and subjects using estrogen, but have not taken into account the smoking habits of these populations. In order to determine whether smoking had any effect on these variables, the authors examined five groups for serum and erythrocytic copper and ceruloplasmin levels: 40 healthy subjects, 14 users of oral contraceptives, 25 smokers, 14 nonsmoking pretreatment lymphoma patients, and eight treated lymphoma patients. Significant elevations of serum copper and ceruloplasmin in pretreatment lymphoma patients, treated patients, and estrogen users were found, confirming previous reports. In addition, all groups had elevations of erythrocytic copper compared with the healthy subjects. Also, significant elevations of serum copper (P less than .0053) and ceruloplasmin (P less than .0001) were found in smoking relative to nonsmoking subjects. No correlation between duration of smoking and these elevations was found.


A modified sensitive spectrofluorometric method for the determination of propranolol in serum.

A modification of the spectrofluorometric propranolol procedure of Shand and associates and Ambler and colleagues is presented. A 3-ml volume of propranolol in serum is made basic with sodium hydroxide and extracted with 1.5% isoamyl alcohol in n-heptane. The drug is back-extracted into a mixture of 0.01 M citric acid in 50% ethylene glycol and measured spectrofluorometrically with the use of 299 nm for excitation and 352 nm for emission. Excellent linearity is observed in the 25--200 ng/ml range. The effects of sodium hydroxide, citric acid, and ethylene glycol concentration on the procedure were investigated. Ethylene glycol--citric acid in water is a better back-extracting mixture from the organic phase than hydrochloric acid. Using pentyl acetate as the extracting solvent instead of isoamyl alcohol in n-heptane did not change significantly the amount of the drug extracted. Other extracting solvents investigated did not increase sensitivity. At high citric acid concentrations a decrease in fluorescence intensity was observed at 350 nm. Interferences from other drugs using this procedure were investigated. Quinidine, methaqualone, and procainamide interfere at therapeutic levels.


Standardization of a rapid microbiologic assay for aminoglycosides using Enterobacter cloacae.

The standardization of a rapid serum aminoglycoside assay using Enterobacter cloacae is described. This includes the sensitivity testing of the organism and its performance on various media, with Mueller-Hinton agar being the medium of choice. The precision and reproducibility of the assay, as measured by the within-run and between-run coefficients of variation, were 5.0 and 5.9, respectively. A significant positive correlation was obtained between the microbiologic assay for gentamicin and a 125I-labeled gentamicin radioimmunoassay with the use of both normal and uremic sera. When known amounts of gentamicin, tobramycin, and amikacin were added to antibiotic-free sera from normal persons, recovery rates of 80.0% to 97.9% were found. In the case of gentamicin, recovery rates of 85.0% to 97.9% were found with the use of sera from patients undergoing either hemodialysis or peritoneal dialysis. There were no effects on the recovery rates of the aminoglycosides from normal serum if high concentrations of clindamycin, methicillin, ampicillin, penicillin G, cephalothin, cefamandole or cefoxitin were also present in the sera. The newer cephalosporins, cefamandole and cefoxitin, had no in-vitro effect on the Kirby-Bauer sensitivity patterns of gentamicin, tobramycin, or amikacin, when tested against the assay organism.


Combined vs. single-drug studies of susceptibilities of Mycobacterium kansasii to isoniazid, streptomycin, and ethambutol.

The effects of combined drugs were compared uith the effects of single drugs in vitro against Mycobacterium kansasii. The single drugs isoniazid 1.0 microgram/ml, streptomycin 2.0 microgram/ml, and ethambutol 5.0 microgram/ml and the combinations of 1.0 microgram/ml isoniazid and 2.0 microgram/ml streptomycin, 1.0 microgram/ml isoniazid and 5.0 ethambutal and 1.0 microgram/ml isoniazid, 2.0 microgram/ml streptomycin and 5.0 microgram/ml ethambutol were evaluated as to their effects on M. kansasii organisms from 22 patients with pulmonary mycobacterial disease. These drugs were incorporated into Middlebrook 7H11 medium. Colonial growth was then observed and assigned numerical values for statistical analysis. The results showed that isoniazid was not significantly better than ethambutol. Streptomycin, however, was significantly better than both isoniazid and ethambutol alone. The double combinations were better than the single drugs, with isoniazid--streptomycin being better than isoniazid--ethambutol. The combination isoniazid--ethambutol was not significantly better than streptomycin alone. However, the triple combination of isoniazid--streptomycin--ethambutol was markedly better than all single drugs, better than isoniazid--ethambutol, but not better than isoniazid--streptomycin. Combined-drug testing thus showed a pattern of susceptibility not demonstrated by single-drug testing.


Aerobic and anaerobic susceptibility tests with three tetracyclines. Reassessment of the "class concept" of disk testing.

Both aerobic and anaerobic susceptibility tests were performed with tetracycline, doxycycline, and minocycline, using disk diffusion and agar dilution technics. The data were examined in order to reassess the concept of testing a single disk, representative of the tetracycline class of antimicrobics. All strains that were susceptible to a tetracycline disk were predictably susceptible to the tetracycline analogs. Some strains that gave zones in the resistant or intermediate range were susceptible or moderately susceptible to doxycycline and minocycline by agar dilution methods. However, disk tests with the more active analogs were often unproductive, since most tetracycline-resistant strains gave indeterminate results with doxycycline or minocycline disks. It was concluded that the "class concept" of disk testing is still appropriate and that tests with tetracycline disks predict susceptibility to the other tetracycline analogs reasonably well.


Serum bile acid levels in protracted diarrhea of infancy.

Significant elevations in two glycine-conjugated serum bile acid levels (cholic and chenodeoxycholic) were detected in a majority of infants with intractable diarrhea of infancy. In contrast, children with chronic inflammatory bowel disease had values of serum bile acids within the normal range. Although intravenous alimentation and constant-infusion elemental diet may alter hepatic function, serum bile acid levels were also elevated in other infants with intractable diarrhea not treated by these methods. We hypothesize that endotoxemia or other unknown mechanisms together with therapy are exerting a detrimental effect on hepatic function.


Cerebellar medulloblastoma. An analysis of four cases of extraneural metastasis.

In four of 28 patients (14%) with medulloblastoma who were treated at the University of Wisconsin, Madison, over a 20-year period, extraneural metastases developed. In an effort to delineate the causal factors involved in extraneural metastases, salient features of patients with metastases and without metastases were compared. Suboccipital craniectomy, radiation therapy, and patient longevity were not well correlated with metastases. However, subarachnoid tumor spread was a consistent precursor. A ventriculoatrial shunt may have been a factor in one patient and a serious infection that preceded diffuse metastasis may have been a factor in another patient. Half of the patients with metastases were found to have the desmoplastic variety of medulloblastoma while only one of 24 patients without metastases had this tumor type.


Ring chromosome 13 in a child with minor dysmorphic features. Irregular phenotypic expression of ring 13 syndrome.

A patient with ring chromosome 13 had some physical and stigmata that to our knowledge have not been reported in previous articles. These include alopecia, scattered pigmentation, trigonocephaly, and telecanthic fold. This case reemphasizes how mitotic instability can produce clinical features during the critical period of organogenesis.


Failure to thrive. The role of clinical and laboratory evaluation.

One hundred eighty-five patients hospitalized for evaluation to thrive were reviewed retrospectively. Eighteen percent had proven organic etiologies. The specific organic diagnosis was strongly suggested by the history and physical examination in all of these patients. Fifty percent of the patients were failing to thrive on the basis of environmental deprivation. Only 1.4% of the laboratory studies performed were of positive diagnostic assistance. No study was of positive value without a specific indication from the clinical evaluation. The history and physical examination are the most valuable tools in the evaluation of failure to thrive. Laboratory investigations are rarely helpful without a specific indication from the clinical evaluation.


Sex liability to single structural defects.

Forty-two of 52 single, localized defects of morphogenesis showed a nonrandom predeliction to one sex. For some of these malformations, the sex liability may be explained on the basis of normal anatomic or hormonal differences between the sexes. For example, the male excess of "prune belly" or triad syndrome is considered due to the fact that most cases are secondary to obstruction in the penile urethra, and the male excess of pyloric stenosis is hypothesized as being secondary to the muscle hypertrophying effect of testosterone in the male neonate. The sex differences for most of the defects suggest that genes on the X and/or Y chromosome exert a role in morphogenesis that extends well beyond the development of sex-related structures.


25-Hydroxycholecalciferol for early neonatal hypocalcemia. Occurrence in premature newborns.

Oral 25-hydroxycholecalciferol (25OHD3) has been used to prevent early neonatal hypocalcemia. Thirty premature neonates were studied prospectively from birth: 22 premature infants constituted a control group, and eight were treated orally with 25OHD3 (2 microgram/kg/day) for five days beginning within the first 12 hours of life. Eleven of the 22 premature infants in the control group became hypocalcemic, with serum ionized calcium (Ca++) level less than 3.0 mg/dl and total calcium (CaT) level less than 7.0 mg/dl on day 2 of life. Only one of the eight premature infants treated with 25OHD3 became hypocalcemic. In treated neonates, serum 25-hydroxyvitamin D, as well as serum Ca++ and CaT levels, increased during the first five days of life and were considerably greater than levels in control neonates. No untoward effects of this treatment were observed.


Fetal hydantoin syndrome in triplets. A unique experiment of nature.

Birth defects associated with phenytoin and phenobarbital taken during pregnancy include craniofacial and limb deformities. These anomalies were found in various degrees of severity in triplets born to a mother taking phenobarbital and phenytoin for an epileptic disorder, giving us a unique opportunity to recognize different manifestations of the hydantoin syndrome in infants that presumably were exposed to the same level of the drugs. These infants were trizygotic and their clinical manifestations varied widely, suggesting the possibility that genetic background may play a significant role in the susceptibility of the fetus to phenytoin and phenobarbital during pregnancy.


Do we support parents of high-risk infants? A survey.

The establishment of regional neonatal intensive care units has reduced physical and mental handicaps in premature infants, but has caused emotional and psychological strain on parents because of frequently lengthy separation of mother and child. The study was undertaken to learn what is currently being done to support parents of high-risk infants. A questionnaire survey showed that prenatal screening was performed by only a few institutions. Not all nurseries employed full-time social workers. Such full-time status was no guarantee that all parents were interviewed and given support. Furthermore, requests for public health nurses to make predischarge and postdischarge home visits were not universally made.


Prolonged nitroprusside and intermittent hemodialysis as therapy for intractable hypertension.

Nitroprusside was used with intermittent hemodialysis over a 26-day period in a 6-year-old boy with intractable hypertension. Hemodialysis effectively removed thiocyanate from the blood, thus preventing its accumulation and subsequent toxic manifestations. Prolonged nitroprusside infusion maintained arterial blood pressure at acceptable levels until the patient became responsive to other antihypertensive therapy.


Recurrent acute suppurative thyroiditis.

Two patients had two recurrent episodes each of acute suppurative thyroiditis. Circulating concentrations of plasma thyrotrophin, thyroxine, and triiodothyronine were within the range of normal. Antibodies to thyroid microsome or thyroglobulin were not found. Anaerobic bacteria such as Bacteroides, Peptostreptococcus, and Peptococcus were identified as causative agents, indicating that anaerobic organisms may play an important role in the pathologic process. The present cases are the third and fourth reported cases of recurrent acute suppurative thyroiditis in the literature.


Pneumococcal pneumonia with pneumatocele formation.

Two infants had pneumococcal pneumonia and bacteremia, complicated by pneumatocele formation. The pneumatoceles appeared during the recovery phase and were indistinguishable from those associated with staphylococcal pneumonia. Complete resolution occurred in both patients. Pneumatoceles occur in pneumonias caused by varied agents; therefore, determination of the cause is imperative for appropriate therapy.


Pneumococcal empyema in childhood.

Two serotypes, uncommon in pediatric infections, accounted for a disproportionately large number of cases of pneumococcal empyema at the Children's Hospital of Pittsburgh. Eight of ten empyemas were caused by types 1 or 3, and two additional cases of mixed infection involved the type 3 pneumococcus. The type 3 pneumococcal empyemas tended to be more severe than those due to other serotypes. Counterimmunoelectrophoresis (CIE) appeared to be more useful than culture in establishing the cause of this condition; in seven of ten cases, the pleural fluid was CIE positive while cultures of blood and pleural fluid were negative. In each of the seven culture-negative cases, antibiotics had been given prior to hospitalization. One case of type 7 pneumococcal empyema illustrated the potential value of the Ouchterlony test for the etiologic diagnosis of this condition.


Recurrent Reye's syndrome.

The clinical diagnosis of recurrent Reye's syndrome can be made only after a systemic exclusion of other diagnostic possibilities. We report such a case, providing guidelines for a complete clinical and biochenical evaluation of this entity. If a comprehensive study of patients experiencing recurrent Reye's syndrome is to be made, each patient must be subjected to thorough examination.


Dominant inheritance of Scheuermann's juvenile kyphosis.

Familial occurrence of Scheuermann's juvenile kyphosis is well known, but no specific mode of inheritance has been recognized. We describe five families in which the disease seems to follow and autosomal dominant pattern of inheritance.


Problem acuteness and medical record utility.

We studied the usefulness of having the patient's medical record available to the pediatrician at the time of the patient's visit. For most acute problems, the medical record had no effect on the management of the patient, whereas the record frequently affected the handling of chronic or recurrent problems. These results suggest a means of improving the effectiveness of pediatric emergency room management and also a means for defining empirically criteria for evaluation of care by record audit.


Basilar skull fractures in children. The incidence of CNS infection and the use of antibiotics.

Forty-six cases of basilar skull fractures in children were reviewed to determine the incidence of CNS infection following injury and the possible value of antimicrobial chemoprophylaxis. The clinical course of the children who were treated with antibiotics was compared with that of patients who received no antimicrobial therapy. Included in the study were patients with hemotympanum alone or with hemotympanum plus additional clinical or roentgenographic signs of basilar skull fracture; patients with tympanic membrane perforation without otorrhea but with blood in the auditory canal; and children with either otorrhea or rhinorrhea. Acute, delayed, or recurrent infection of the CNS did not develop in any of the patients. This study is the first of its kind presented in children. It would seem on the basis of the present series that the systematic use of antibiotic prophylaxis in children with hemotympanum following basilar skull fractures is unwarranted and that children with other signs of basilar skull fractures may have an equally small risk of meningitis following injury.


Infant tracheostomy. A new look with a solution to the difficult cannulation problem.

Although most infant airway and ventilatory problems will be best solved by the use of endotracheal tubes, clear-cut indications for tracheostomy exist. Past reticence to use tracheostomy for infants has been due mainly to the fear of decannulation problems. Recognition of obstructive airway lesions, particularly the lumen-narrowing tracheal stomal granuloma, has been facilitated by the routine use of the newer infant bronchoscopes with optical telescopes. Successful decannulation begins with proper tracheostomy technique, and continues through tracheostomy management and a well-conceived decannulation program. Decannulation should include evaluation of the structure and function of the airway endoscopically and it may include translaryngeal endoscopic resection or formal surgical removal of any obstructing lesions. Experienced nursing personnel are essential to the entire program.