[Coronary autoregulation of the isolated rabbit heart].

The autoregulation behaviour of the coronary circulation was studied on an isolated Langendorff-heart of rabbit. Static pressure-flow curves were recorded for the normal and maximally dilated vascular system. For analyzing the dynamics of autoregulation of the flow to pressure jumps within the autoregulation range was measured. Modelling was performed by means of the linear system theory, assuming first-order transfer functions for the contraction and dilatation process co-acting in the regulation. The system parameters were determined in the time-range by adapting a bi-exponential function to the measured data. For the dilatation reaction following pressure fall a mean time constant of 5.4 s was measured, while a time constant of 146.8 s was found for the counterregulation (constriction). These events are discussed with regard to possible further studies on the pharmacology of coronary regulation.


[Contractile properties of the striated muscle fibres of esophageal muscle in comparison with skeletal muscle in rats].

The contractile properties of the striated oesophageal muscle of the rat were studied in vitro at 35 degrees C and 25 degrees C. They were compared with those of the slow-twitch soleus muscle and the fast-twitch extensor digitorum longus (EDL) muscle of the same animals. The contraction time of the oesophageal muscle is 30 msec (+/- 2.5 msec S.E.) at 35 degrees C. It is little but significantly longer than those of the soleus muscle. It is remarkable that the twitch-tetanus ratio of the oesophageal muscle fibres is approximately twice that of the skeletal muscles. Immediately after a tetanic stimulation the amplitude of a single twitch of the fast EDL is increased (posttetanic potentiation); in the slow soleus muscle it is unchanged or decreased, however. Also the muscle fibres of the oesophagus exhibit a post-tetanic-potentiation, but this is smaller than in EDL. A decrease of the temperature of the bathing solution causes in preparations of the fast EDL a higher tension developed by a single twitch (cold potentiation). This is not detectable in preparations of the slow soleus muscle. The oesophageal muscle shows also a remarkable cold potentiation, but it is smaller than in EDL. An increase of the extracellular K+-concentration evokes a short-lasting contracture in the investigated rat muscles. The mechanical thresholds of the oesophageal muscle fibres are clearly higher than those of the soleus muscle but lower than those of the EDL. The striated oesophageal muscle fibres of the rat in spite of their low speed of contraction show some properties of muscle fibres of the fast twitch type.


Actions of O-ethyl-S-(2-dimethylaminoethyl)-methylphosphonothioate and some pyridine aldoximes on isolated guinea-pigs heart atria.

1. The effects of acetylcholine and methylfurmetide on isolated guinea-pigs heart atria in the presence or absence of O-ethyl-S-(2-dimethylaminoethyl)-methylphosphonothioate (EDMM) were investigated. The influence of three cholinesterase reactivators on the heart atria pretreated with EDMM has been studied. 2. In the presence of EDMM, the negative inotropic effect of acetylcholine on the isolated heart atria was not significantly increased. This effect of methylfurmetide on heart atria was significantly decreased in the presence of EDMM. 3. EDMM alone caused negative inotropic and negative chronotropic effects depending on its concentration. These pharmacological effects were accompanied with inhibition of acetylcholinesterase activity in the heart muscle. 4. Addition of cholinesterase reactivators normalized the inotropic response of the isolated guinea-pig heart atria altered by EDMM and also increased the acetylcholinesterase activity in the heart.


[The involvement of thalamic nuclei in the formation of conditional avoidance reflexes in rats. I. Lesions in the anterior part of the nucleus ventralis lateralis].

Hooded rats (Long-Evans-strain) were not able to elaborate conditioned avoidance responses in a simple runway respectively in a jumping test after bilateral lesions of the anterior part of the nucleus ventralis lateralis thalami. When the number of the CS-US-combinations was increased from 10 to 25 per session, then during the last ten combinations the punishing electrical foot shocks were correctly avoided, but the animals showed no retention in their long-term memory.


Equilibria between horseradish peroxidase and aromatic donors.

Equilibria between horseradish peroxidase and aromatic hydrogen donors have been analyzed spectrophotometrically and potentiometrically. The donors alter the peroxidase spectrum slightly but reproducibly with changes of two types. Donors of the two groups compete for the same binding site with no systematic difference in affinity for the enzyme. Donors with one aromatic ring are fairly loosely ligated, Kd3-25 mM, but enlargement, or extension of the pi-electron system, increases the affinity. A negative change in entropy and a large negative change in enthalpy upon binding indicates a specific donor-enzyme interaction, and the retention of the peroxidase by phenyl- but not by octyl-Sepharose points at the involvement of aromatic amino acid(s) in the ligation of an aromatic donor. Substitution of the hematin vinyl groups by ethyl or acetyl groups does not affect Kd of the peroxidase-donor complex. Reduction of the iron atom to Fe(II), or its removal, influences Kd only modestly. The fluorescence of the protoporphyrin-apoprotein HRP C2 associate is not quenched by donors from either group. These observations are in accord with NMR and other data from the literature and point at a ligation of the donor only to the protein moiety. Our results do not support the assumption of an Fe(III) H2O...donor hydrogen bond. The energy balance in the four-membered system free and donor-bound peroxidase Fe(III)/(II) has been analyzed. The model donors used in the present study modulate the redox properties only slightly. Plant peroxidases in situ may be donor-bound to a large extent.


A generalized theoretical treatment of the transient-state kinetics of enzymic reaction systems far from equilibrium.

The transient-state kinetics of enzyme systems far from equilibrium have been analyzed by a theoretical treatment of the generalized King-Altman mechanism for enzyme reactions. Conditions are defined under which the kinetics differential equations for this generalized mechanism can be analytically solved, and the structure of the analytical solution is characterized. The practical implications of the theoretical results are discussed with reference to the planning, evaluation, and interpretation of transient-state kinetic experiments performed by stopped-flow techniques.


Flow and myocardial microcirculation after experimental mammary-coronary bypass.

The functional capacity of mammary-coronary bypass was assessed in acute dog experiments by means of electromagnetic flow measurement and estimation of myocardial flow by hydrogen polarography. 1)In the intact myocardium the central flow of the mammary-coronary bypass and the tissue perfusion provided by its correspondence to the functional capacity of the intact anterior descending coronary; 2) despite an unchanged perfusion pressure the myocardium damaged by infarction is no longer able to take up the available quantity of blood, and both flow and tissue perfusion decrease; 3) the reactive hyperaemia induced by ischaemia considerably reduces the microcirculation of the damaged myocardial tissue.


Sutureless repair of ruptured urethra.

Two cases of complete traumatic rupture of the posterior urethra are described. The ends of the urethra were united without suture by pulling them together with a transurethral balloon catheter. The results were excellent; the patients healed without sticture and remained continent. These observations suggest the applicability of the method to similar injuries.


[Papillary tumors of the renal pelvis: 25-year-old clinical material].

A total of 83 patients with papillary tumour in the renal pelvis have been observed in 25 years. The peak incidence was in the age group between 51 and 70 years. The first symptom was almost always haematuria without any other symptom. The therapy is surgical, complemented with radiotherapy and/or chemotherapy. The problem of the involvement of the bladder is discussed.


[Late results of thoracic sympathectomy in various diseases].

The late results of 171 thoracal sympathectomies performed on 142 patients in the 20-year period 1952 to 1971 are described. Favourable results were achieved in Raynaud's disease, obliterating endarteritis and other occlusive vascular diseases, and also in hyperhidrosis.


[Traumatic subcutaneous ruptures of the cervical trachea (author's transl)].

Traumatic subcutaneous rupture of the cervical trachea is a rare but serious lesion that may cause death of the patient. Few cases come to treatment. This lesion results from a contusion to the anterior neck during hyperextension. It consists in a straight transection between larynx and trachea or between one of the 4 first tracheal rings, and is usually associated to multiple trauma involving the chest and head. Specific symptoms are often blurred by those of the associated lesions making diagnosis complex. This should ideally be confirmed by endoscopy or, if not feasable by cervicotomy. Emergency treatment is directed to restablishment of an adequate ventilation. Direct anastomosis by separate resorbable sutures yields excellent long-term results without stenosis. Creation of a transitory tracheotomy, when commanded by regional atresion, sometimes induces late stenosis; secondary repair is then less favorable. The rate of definitive recurrent nerve paralysis is high. There are also frequent distortions of the vocal cords with modifications of the voice and transitory palsy of the phrenic nerve. The authors draw these conclusions from one personal case and from the literature.


[Traumatic ruptures of the diaphragma. Diagnostic and therapeutic problems (author's transl)].

Between 1970 and 1976, 34 cases of traumatic ruptures of the diaphragma were observed and treated at the Surgical Clinic of the University of Würzburg: 23 acute ruptures and 11 delayed diagnostic ruptures. The etiology and mechanism of the rupture are discussed. A predominency of left over right ruptures occured in 90% of cases. In only one case there was an open rupture of the right side. Among associated abdominal lesions, ruptures of the spleen are the most frequent. Among skeletal associated lesions, one observes most frequently, fractures of the ribs. In 4 acute cases, there were no herniated organs. In the 11 patients were diagnosis was delayed we always found herniated viscera. Symptoms and diagnostic means are discussed. Traumatic rupture of the diaphragm is an absolute surgical indication. In acute cases we attempt the repair through a laparotomy; delayed cases should be treated by thoracotomy. Among 23 cases operated in emergency, 3 died because of associated lesions. Operative mortality was zero in the 11 patients with delayed diagnosis.


[Blunt and open trauma of the heart and thoracic aorta in 26 patients (author's transl)].

Twenty-six patients with blunt or open trauma to the heart and thoracic aorta were admitted and 23 were operated on. Among 19 blunt trauma there were 15 ruptures of the aorta among which 12 were operated and 3 were not, 2 lesions of the ventricular septum, 1 coronary thrombosis and 1 rupture of the right atrium. In 7 open wounds there were 3 ventricular lesions; 3 cases of pericarditis and 1 aortic lesion. Among operated patients 1 died of a rupture of the aortic isthmus and another of a rupture of the aortic arch and left carotid artery. The 3 patients that were not operated died of a rupture of the aortic isthmus. In these cases the diagnosis must be set early and the aortography must be followed by an operation. In cases of an open wound early thoracotomy is recommended.


[Circulatory arrest under deep hypothermia in the correction of the interventricular communication in the newborn (author's transl)].

The technique of circulatory arrest under deep hypothermia has completely changed the therapeutic outlook of some congenital heart malformations in the newborn. The authors have tried this method particularly in neonate cases of the interventricular communication. This experience bears on ten newborn cases aged 3 to 11 months. Surgical indication was mandatory because of global heart failure, unresponsive to conservative treatment. Intracardiac correction is realized under optimal conditions of operative technique by means of the circulatory arrest. In six cases, the interventricular communication is large and isolated; in four cases there were multiple interventricular communications. The immediate postoperative is favourable in all cases. One was reoperated for a residual shunt. Evolution is satisfactory in nine cases. There was one late death. Hemodynamic controls prove the soundness of this method of treatment. Favourable results up to 2 1/2 years after the procedure encouraged the authors to extend the indications for deep hypothermia and circulatory arrest to other congenital anomalies of the newborn.


Our personal experience with intra-aortic balloon pumping.

Intra-aortic counterpulsation (IABP) was used in 64 patients because of: 1. Low output syndrome after open heart surgery. 2. Medical refractory cardiogenic shock. 3. Elective, preoperative in ischemic heart disease. 4. Extending myocardial infarction. 5. Evolving impending infarction. In the first group in 78% hemodynamic stabilization was achieved but the survival percentage was 46%. In cardiogenic shock the results were closely related to the duration of shock, but nevertheless survival rate was low (3 from 13 patients treated). IABP was also applied as elective, preoperative support in high risk patients with ischemic heart disease (unstable angine and poor left ventricular function). In this group the rate of perioperative myocardial infarction was lower than in overall material.


[Left heart by-pass in case of ventricular fibrillation (author's transl)].

The authors have studied in 11 mongrel dogs the hemodynamic conditions created by a transarterial closed chest left by-pass (TaCLVB) in ventricular fibrillation. The attention was focussed on the function of the right atrium. This function is recorded with closed chest by means of a catheter in the external jugular vein. The experiments show a left heart by-pass can function only if there are good contractions in the right atrium. The right atrium insures pulmonary circulation during ventricular fibrillation. This well continue for 30 to 60 minutes by means of the TaCLVB then the right atrium will fail and fibrillate. The animals died of right heart failure.


[Closure of a bronchial fistula after pneumonectomy in a case of carcinoma in a patient in chronic dialysis (author's transl)].

A 53 year old patient in chronic dialysis underwent a left pneumonectomy for bronchial carcinoma. This was followed by a bronchopleural fistula. Despite the very poor condition of the patient closure of the fistula was obtained by means of a flap of the large omentum. This is a simple procedure easily tolerated by the patient and that could also be used in less complicated cases.


[Results and complications of bronchoplastic operations for bronchial cancer (author's transl)].

Among 1548 patients hospitalized from 1964 to 1975 for bronchial carcinoma, 779 underwent a brochopulmonary resection. Seventeen patients underwent bronchoplastic resections. The average hospital stay was 45 days which is explained by the frequency of postoperative complications (n = 8). The mortality during hospitalization was 11.5% and the 5 year survival rate was 18%. The survival curved was comparable to that of the patients who underwent a lobectomy or simple or enlarged radical pneumectomy. Actually, the average survival is 26 months and the comfort in these cases is impressive. We consider that the indication for these plastic resections should be extended to patients who are capable of tolerating a pneumectomy.


Bronchoplastic lobectomies for advanced carcinoma: functional changes and survival.

Twenty-five patients underwent "sleeve" or "wedge" lobectomies for bronchogenic carcinoma: 24 squamous cell type and one adenocarcinoma. In 6, the tumor extended to a segmental bronchus (T1) in 15 to a lobar bronchus (T2) and in 4 to a main brochus (T3): 19 were in the right lung, 6 in the left. Eight patients had no lymph node involvement (N0), 10 tumors had spread to hilar nodes (N1), and 7 to mediastinal nodes (N2). There were 11 "sleeve" and 14 "wedge" bronchoplasties. Two patients developed a bronchopleural fistula: one of them died 2 weeks after pneumonectomy, the only death related to the procedure. A third patient had a local recurrence. Plethysmography, bronchospirography and Xe133 gammagraphy were performed in six patients. Lung volumes usually decreased but dynamics were unchanged or even improved after "sleeve" resection. After "wedge" resection all parameters were impaired. Twelve patients have died of cancer after a mean survival time of 16 months. Four of the 10 eligible patients have survived 5 years and more; seven patients are alive less than 5 years.


[The use of a myocardial screw electrode for continuous stimulation of the heart with a pacemaker (author's transl)].

In 50 patients with serious heart conduction disorders the authors describe the use of a new epicardial screw electrode (Medtronic models 6917 and 6917-A), inserted through a substernal route. The operative technique, the electrode and the authors' experience are described in detail. By comparison with others, the present technique offers many advantages.


[Concerning 50 low colorectal anastomosis by mechanical suture (author's transl)].

The authors report 50 cases of low colorectal anastomosis performed with a Russian circular suture apparatus : the KC-28. They reserved this technique for all tumors situated more than 4 cm above the anorectal function and for which the exeresis required a dissection below the peritoneal reflection. Their study seems to confirm the impression that this technique maintains a sphincteral function while decreasing the operatory difficulties encountered during the production of similar anastomosis and far from compromises the cancerology value of the resection. The postoperative complications seem no more frequent than for the classical techniques. The only minor inconvenience being a anastomotic stricture in 24% of the cases.


[Conservative surgery of the pulmonary parenchyma and bronchial cancer (author's transl)].

In a series of 236 patients operated upon for bronchogenic carcinoma, a limited pulmonary resection with bronchial resection and anastomosis has been performed in 22 cases. There has been no postoperative mortality; the complications have been remarkably rare: anastomotic stenosis (1 case), temporary bronchial leak (2 cases), local recurrence (2 cases) by patients with hilar or mediastinal involvement, chylothorax (1 case). The pulmonary function also has not been much reduced by the operation, leaving the patients a good quality of life. Survival after bronchoplastic procedures as compared with pneumonectomy or lobectomy shows a mean survival of 30% to 12.5% and 21% respectively for the latter procedures.


[Duplication of the colon in the adult (author's transl)].

The authors describe 2 cases of duplication of the colon. One was discovered by accident and not treated. The other occurred in a patient with a long story of abdominal pain and had been operated twice with signs of intestinal obstruction. A partial resection of the duplication with the adjoining bowel segment was performed and the digestive tract was reconstructed bij and end-to-end anastomosis. The different forms of duplication are described with their specific features and the current theories about their mode of formation. Finally a brief description of the symptoms and of the available surgical techniques is given.


[A propos a case of intestinal duplication in an adult (author's transl)].

The authors report the case of a 26 year-old patient presenting with rectal hemorrhage. Roentgenograms showed the origin of this was an intestinal duplication. This congenital malformation is very rare in adults as it usually appears during childhood. Then comes an appraisal of the clinical signs, the histology, the embryology and the differential diagnosis between the isolated diverticulum of the digestive tract and the duplication.


[Hernial contusion : a little known lesion (author's transl)].

A personal case and a review of the literature are presented. The clinical picture consists essentially in a persistant pain in the hernia, following a benign trauma to the abdomen, that simulates a false strangulation and a peritonitis. The best diagnostic procedure is a median laparotomy with or without a herniotomy both allowing treatment of the lesions, of which the most common is a rupture of the small bowel on the side opposite to the mesenteron. This complication of a hernia, usually inguinal, often goes unrecognized because it is rare and has therefore a poor prognosis.


Transthoracic vagotomy for recurrent peptic ulcer after gastrectomy. An appraisal of fifteen years experience.

The case records of 38 patients operated for recurrent ulcer following partial gastrectomy were examined. They all underwent a transthoracic vagotomy. Two patients died during follow-up, one because of a gastro-intestinal bleeding 14 days after operation and one following a psychiatric disorder (vital depression) three months after his second intervention. According to Visick's  grading overall results are very good in 89%, moderate in 5.5% and disappointing in 5.5%. These figures indicate that transthoracic vagotomy is the treatment of choice for recurrent ulceration after partial gastrectomy.


[Accidental papillary disinsertions during gastroduodenectomies. Report of two cases (author's transl)].

This is a report of two accidental papillary disinsertions. The first had a good result up to 23 years after a duodenal reimplantation. The second, referred from elsewhere was reimplanted in a pediculated intestinal segment interposed between the papilla and the afferent loop of the gastrectomy : the result ten years after is favorable. The authors stress the difficulty of recognizing an unexpected disinsertion and insist on the necessity of an early reoperation. Despite the optimism of some statistics there are serious operative complications. The best prevention in the surgical treatment of low situated duodenal ulcers remains a vagotomy associated to a gastric suction.


[Anti-infections prophylaxis of infantile burns (author's transl)].

Analysis of 300 consecutive hospitalized children with burns. To prevent infection, patients are given a bath with chlorhexidine (0.03%) every day and their burns covered by silver sulfadiazine (1%) and occlusive dressings. In 5.3% of the children positive swabs were obtained during hospitalization and in only 2.3% on several occasions. No case of septicemia could be documented.


[Use of absorbable suture material for the correction of prominent ears (author's transl)].

The ester of the polyglycolic acid is very useful to maintain a correction of prominent ears. The good tolerance and longstanding traction force allow a satisfactory healing of the cartilage. Catgut for skin closure behind the ear has the psychological advantage of not having to be removed. This paper deals with the respective advantages of available suture materials.


[Intraoperative identification of parathyroid glands with methylene blue (author's transl)].

Identification of parathyroid glands during surgery for treatment of hyperparathyroidism remains difficult. The staining with methylene blue was first described by Dudley. Twenty-one patients were explored. Thirty to sixty minutes before surgical incision, an intravenous perfusion of methylene blue was started. The dose varied between 5 to 10 mg per kg. Thirty-seven enlarged glands were found of which 33 were obviously stained; 13 showed some color that could not be attributed with certainty to the dye; 1 adenome was not stained at all. In 89.2% of the cases the staining had the favorable effect of shortening the operation. Only 4 normal glands showed the blue stain. The affinity for methylene blue is thus mainly found in pathological parathyroid glands.


The extent of tissue damage in missile wounds one and six hours after the infliction of trauma studied by the current method of debridement.

Spherical missiles with velocities around 1000 m/s were used to inflict simultaneously missile trauma to both thighs of pigs. The determination of the impact and exit velocity enabled the extent of energy transferred to the tissues to be calculated. One thigh of each pig was treated surgically within one hour and the other one after a delay of 6 hours after trauma. The surgical procedure consisted of debriding muscle tissue which showed impaired contractility, consistency, discoloration or lack of capillary bleeding--current criteria of non-viability. The amount of debrided muscle tissue at the first operation showed a linear regression versus the extent of energy transfer, whereas after 6 hours no relation could be found between the amount of debrided tissue and energy transfer. There was no significant difference between the amount of debrided tissue per joule of transferred energy when the results of the two operations on each pig were compared.


Cancer of the oesophagus. I. 1002 cases. Survey and survival.

A total of 1002 patients with cancer of the oesophagus seen at the Finsen Institute, Copenhagen, Radium Centre and/or Department of Surgery, during the 25-year period ending 31.12.1969, were analysed with a view to sex, age, localization of tumour, histology, and survival. The 5-year survival for all seen patients, corresponding to 25% of the cases recorded in the whole of Denmark, was 2.3%, the half-life 5.2 months, and the mean survival 7.5 months. After five years 18 of the 23 5-year survivors succumbed to recurrences. The prognosis is largely independent of sex, age, localization and histological type of tumour. In the present report no regard is paid to treatment, treatment variables being described in part II.


Mesenteric plication in the treatment of adhesive intestinal obstruction.

A material comprising 29 patients operated on by the method introduced by T. B. Noble is presented. The indication was acute obstruction in 17 cases, peritonitis in 6 and chronic obstruction in 6. The period of observation ranged from 1 to 11 years. The postoperative mortality was 3/29 and after follow-up of the remaining patients, the results were judged as satisfactory (good or fair) in 23 patients and poor in 3.


Recurrent small bowel obstruction caused by a benign tumor. A report of two cases.

Two cases of primary small bowel tumors causing an acute intussusception are presented. In one case two polyps were found and in the other case a lipoma in the wall of the jejunum. In both cases there were symptoms of recurrent bowel obstruction for several months before the acute condition. Although intussusception caused by a benign tumor of the small bowel is a rare condition it should be taken into consideration in the differential diagnosis of abdominal pain of doubtful origin.


Left paraduodenal hernia with chronic abdominal symptoms.

A case of left paraduodenal hernia giving chronic abdominal symptoms is presented. For 3 years the patient had had unexplained abdominal pains, the reason for which was not found until a laparotomy was performed. A retrospective review of the x-ray films showed that an internal hernia should have been suspected from the small bowel follow-through and barium enema. The possible existence of an internal hernia in cases of unexplained abdominal pains is emphasized.


Effects of chronic TSH treatment on blood sugar, serum IRI and FFA levels of thyroidectomized dogs. Glucose and insulin tolerance tests.

The effects of TSH treatment (0.1 USPU/kg body weight/die, for 3-4 days) on the blood sugar, serum IRI and circulating FFA responses to glucose and insulin were studied. Blood sugar and serum FFA levels of the dogs, in basal conditions and at any time interval during the test were slightly modified by TSH treatment. The kinetics of insulin disappearance from blood was not affected while the mean serum IRI during the insulin tolerance test was moderately reduced, which suggests that insulin space is moderately raised by TSH. The serum IRI response to glucose (OGTT, IVGTT) was found to be significantly and intensely reduced. The possibility of an inhibitory action of TSH on the insulin response to glucose in dogs, excluding the participation of the thyroid, exerted via insulin space and secretion is discussed.


Attempts to prepare 'insulin-free plasma' from human subjects: effects of serial dilution and insulin recovery studies on immunoreactive insulin activity of partially insulin-free plasma.

The reason for attempts to prepare insulin-free plasma from human plasma is discussed. Binding agent, employed to prepare insulin-free plasma, had a capacity to bind 40% of insulin in the system. Insulin recovery from the filtrate of human standard insulin-binding agent reaction was 60%. Human plasma incubated with binding agent gave a filtrate--partially insulin-free plasma (PIFP)--which contained significantly higher amounts of insulin compared to calculated values. Insulin in PIFP was not augmented by serial dilution. Human standard insulin added to PIFP was recovered in full and the mixture was not dilution augmentable. Incubation of human plasma--human standard insulin (106 microunits/ml) mixture with binding agent gave a PIFP which had 60% of total insulin in the mixture. Dialysis did not alter the immunoreactive insulin activity of plasma. Dialysed samples showed augmentation of insulin activity on serial dilution. These observations strongly suggest the presence of a high molecular-weight, insulin-like inhibitory component in human plasma.


Studies on the morphologic and metabolic changes of human fat cells maintained in culture.

Specimens of human adipose tissue were maintained in vitro for one week and cell size as well as metabolic rates determined before and after the culture period. Large fat cells from obese donors decreased towards 'normal' cell size while this was not the case for cells from non-obese donors. This decrease was probably due to the increased lipolysis found while glucose incorporation was unchanged. Analogous to the findings with obese subjects placed on a weight-reducing regimen, the present data show that when large fat cells are removed from their anabolic, hyperinsulinic environment, 'normalization' in cell size occurs.


Increased intestinal absorption of insulin in a micellar solution: water-in-oil-in-water insulin micelles.

Water-in-oil-in-water (W/O/W) insulin micelles were prepared, and the possibility of insulin absorption in a micellar form was examined. In this preparation, insulin was trapped in oil droplets of oleic acid in glyceryl-alpha-monooleate. (1) W/O/W insulin micelles were absorbed from the ligated jejunal loop of rabbits to the order of 12.3 to 58.5% of the dose given (10 mU/kg body weight) during the 3-h experimental period. (2) Alloxan diabetic rats were treated with intrajejunal administration of W/O/W insulin micelles at a dosage of either 25 or 50 mU/100 g body weight, three times daily for as long as 14 days. During treatment, a significant reduction in the daily excretion of urinary glucose was observed, concomitant with a decrease in fasting blood glucose. Quantitative estimates suggested that the effectiveness of 25 mU/100 g of intrajejunal W/O/W insulin micelles was comparable to that of regular insulin at a dosage of 1 mU/100 g i.m. These results would indicate that W/O/W insulin micelles, when given enterally, are more effective in lowering blood and urinary glucose levels than W/O/W insulin emulsions in which insulin was trapped in oil droplets of triglyceride.


Increased sensitivity to 5-hydroxytryptamine due to intraventricular administration of 5,6-dihydroxytryptamine.

The possibility that intraventricular administration of 5,6-dihydroxytryptamine (5,6-DHT) can cause a development of denervation hypersensitivity to central 5-hydroxytryptamine (5-HT) was examined in rats with special reference to the pituitary-adrenocortical functions. Pretreatment with intraventricular injection of 5,6-DHT itself did not affect the basal concentrations or stress-induced increases of plasma B. The same pre-treatment, however, elicited augmented responses to subcutaneous injection of 5-HTP, i.e. there was a significant rise in the concentrations of plasma B as compared with those in the controls. These results suggest a development of denervation hypersensitivity to 5-HT following intraventricular injection of 5,6-DHT.


Clonidine effect on insulin secretion and lipolysis in man.

Clonidine is a hypotensive drug acting as an alpha-mimetic agent in the central nervous system and causing cardiovascular depression. Clonidine administration in animals and man causes slight hyperglycemia and lipid mobilization, as well as an increase in growth hormone levels. We have studied the effect of a 3-day oral treatment (78 microgram three times daily) upon glucose (5 g i.v.)- and tolbutamide (1 g i.v.)-induced insulin release in subjects without metabolic alterations. Acute insulin response (3 min after IVGTT) and insulin release (area between 0 and 10 min) were significantly reduced after clonidine treatment. Blood glucose levels were not affected by clonidine treatment; the insulinogenic index 3 min after the glucose load was significantly reduced by clonidine administration. There was neither an evident effect on tolbutamide-induced insulin release nor a modification of the hypoglycemic effect of tolbutamide. Clonidine did not affect basal lipolysis, evaluated in vitro as glycerol release from human subcutaneous adipose tissue fragments, while norepinephrine-induced lipolysis was slightly reduced. The results presented are compatible with an alpha-mimetic effect of clonidine on pancreatic and adipose tissue.


Primary empty sella syndrome with panhypopituitarism, diabetes insipidus, and visual field defects.

A 58 year old woman with a history of hypothyroidism was evaluated for marked visual impairment and found to have the primary empty sella syndrome with multiple endocrine abnormalities. Visual field determination revealed preservation of vision only in the left inferior quadrants bilaterally. Failure of growth hormone (hGH), cortisol and prolactin to respond to insulin induced hypoglycaemia (0.1 U/kg), of luteinizing hormone (LH) and follicle stimulating hormone (FSH) to respond to gonadotrophin releasing hormone (GnRH, 100 microgram) and of thyrotrophin (TSH) and prolactin to increase after thyrotrophin releasing hormone (TRH, 500 microgram), confirmed the diagnosis of panhypopituitarism. Following water deprivation with a 9% loss in body weight, her urine osmolality remained at 204 mOsm./kg H2O), indicating that she had posterior pituitary deficiency as well. During surgical exploration, which was performed in an effort to improve her markedly impaired vision, a compromised vascular supply to the left optic nerve and chronic arachnoiditis was demonstrated. This case represents one extreme of functional impairment in a syndrome which is generally considered benign and which rarely requires therapeutic intervention. Our patient is compared to 29 reported cases of the primary empty sella syndrome with visual field defects. The operative findings in eight of these cases are reviewed. The need for a multidisciplinary approach and close follow-up of patients with an empty sella and functional deficits is emphasized. Surgical intervention including lysis of adhesions and chiasmapexy has been effective in selected cases in reversing or stabilizing visual field abnormalities.


Painful myocardial infarction in severe diabetic autonomic neuropathy.

Two cases are reported of painful myocardial infarction in diabetics with severe autonomic neuropathy confirmed by abnormal autonomic function tests. Painless myocardial infarction in diabetics has traditionally been attributed to damage of cardiac pain fibres by autonomic neuropathy but other factors such as microangiopathy in the myocardium may be responsible. It may simply be that diabetics come into hospital more often for other reasons and a silent myocardial infarction diagnosed incidentally.


Urinary hydroxyproline excretion in acromegaly.

The urinary hydroxyproline excretion of 8 acromegalics kept on a collagen free diet has been studied. Urinary hydroxyproline showed a circadian rhythm with maximum excretion rates at night and early morning and minimum excretion rates in the late afternoon and evening. When mean values are compared, there is a significant correlation between fasting GH-levels and 24 h urinary hydroxyproline excretion (Rs = 0.74 and between GH and fasting hydroxyproline:creatinine ratios (Rs = 0.76). No significant correlation could be demonstrated between collagen content of bone biopsies and GH-levels or urinary hydroxyproline excretion. It is suggested that a practical assessment of disease activity in acromegaly can be achieved through a simplified hydroxyproline assay.


Diabetic neuropathic cachexia.

A case of diabetic neuropathic cachexia is presented. This unusual syndrome within the broad group of diabetic neuropathies is characterized by extreme loss of body mass and severe neuropathic pain. The loss of body weight is unassociated with glycosuria or ketoacidosis. Initially, the patient may present a confusing picture suggestive of carcinomatous neuropathy.


Studies on a human chorionic gonadotrophin-like material present in non-pregnant subjects.

The presence of an hCG-like material in urinary and pituitary extracts and plasma obtained from non-pregnant subjects was investigated. Two assay methods were used to detect this material following fractionation of pituitary and urinary extracts by gel filtration (Ultrogel AcA 54) and/or isoelectrofocusing: a) a radioimmunoassay employing an antiserum raised against a specific sequence of the carboxy terminal region (residues 115--145) of the beta-subunit of hCG, and b) an in vitro bioassay method which measures both hLH and hCG activities. The fractionation procedures employed provide a satisfactory separation of highly purified hCG and hLH preparations. In the pituitary and urinary extracts hCG beta-peptide-like immunoactive (PIA) material was found consistently, which co-eluted with iodinated hCG following gel filtration and possessed pI values similar to those of hCG when subjected to isoelectrofocusing. The PIA material also exhibited in vitro biological activity similar to that shown by hLH and hCG. Detectable levels of immunoactive material were also found in plasma; however, the plasma levels of this PIA material were not influenced by classical endocrine measures such as the stimulation or inhibition of gonadotrophin secretion. The low levels of this material in plasma precluded its further characterization by gel filtration or electrofocusing. Whereas the present data and those reported by other investigators seem to suggest the presence of some hCG-like material in urinary and pituitary extracts and possibly in plasma of non-pregnant subjects, it is emphasized that the available evidence is not sufficiently conclusive to exclude other interpretations as to the nature of this material.


Ultrastructural morphometry of sparsely granulated prolactin cell adenomas of the human pituitary.

Fifteen sparsely granulated prolactin-producing adenomas and 10 nontumourous adenohypophyses, removed by surgical hypophysectomy, have been studied using morphometry at the electron microscopic level. Compared to non-tumourous prolactin cells, sparsely granulated adenomatous prolactin cells showed a significant decrease in diameter and volume density of secretory granules and an increased volume density of rough-surfaced endoplasmic reticulum and Golgi apparatus. The volume density of mitochondria remained unchanged. These results indicate that the cells of the adenoma are in a highly active functional state. It appears that the equilibrium between hormone synthesis, storage and release is altered in adenomatous prolactin cells.


On the relative biological and immunoreactive potencies of luteinizing hormone in the oestradiol benzoate-treated male rat.

Mature male Sprague-Dawley rats were treated with 50 microgram oestradiol benzoate (OeB) per day for 7 days and killed 24 h after the last injection. Serum and pituitary luteinzing hormone (LH) levels were measured by RIA using NIAMDD rat hormone for iodination code I4 (rLH-I4) combined with either NIAMDD-anti-rat LH serum 3 (AS3) or serum 1 (AS1). Pituitary LH levels were also measured by an in vitro bioassay procedure in which testosterone production by dispersed rat testicular interstitial cells is related to the concentration of LH. Pituitary LH levels were reduced in OeB-treated rats regardless of which of the three assay systems was used. However, absolute values obtained in all three assays systems were statistically correlated. OeB-treatment did not significantly alter the relative bioassayable and immunoassayable potencies of LH present in pituitaries at autopsy. OeB-treated rats had non-detectable serum LH levels as measured by RIA using either AS1 or AS3 in combination with [125I]rLH-I4. These results confirm that chronic OeB-treatment decreases pituitary LH and suggest a decrease in serum LH as well. Comparison of the present with previous results revealed particular combinations of RIA reagents yield divergent estimates for serum LH in OeB-treated male rats. This situation emphasizes the need to carefully specify all RIA reagents used in any study since the results may very with different lots of RIA regents.


Cytoplasmic oestrogen receptor replenishment: oestrogens versus anti-oestrogens.

The effect of the in vivo administration of various triphenylethylene antioestrogens and physiological (0.05 microgram) versus pharmacological (0.5--5 microgram) doses of oestradiol-17 beta (Oe2) on the uterotrophic process in general and the nuclear accumulation and cytoplasmic depletion and replenishment of uterine oestrogen receptor was determined. Regardless of the dose of Oe2 the changes in uterine wet weight, total protein and incorporation of [3H]thymidine into DNA and [14C]leucine into protein were the same at 24 h. The anti-oestrogen receptor was also studied. The net increase, above control, of cytoplasmic oestrogen receptor at 24 h and 48 h after Oe2 injection was approximately 0.35 and 0.77 pmoles/uterus, respectively. The effect of anti-oestrogens (U-11,100A, CI628, en- and zuclomiphene) on the  increase in cytoplasmic  oestrogen receptor at 24 h and 48 h measured from maximally depleted levels was nearly identical to the Oe2 induced net increase. This suggests that in both cases these particular increases represent newly synthesized receptor and that Oe2 causes some receptor replenishment through a recycling process.


Characterization of the human chorionic gonadotrophin fractions in pregnancy urine.

The human chorionic gonadotrophin (hCG) preparation (ca. 3000 IU/mg) from pooled pregnancy urine has been fractionated using anion-exchange and gel exclusion chromatography. The various fractions, many of which were heterogeneous, were assayed using radioimmunoassay (RIA) and a testicular radio-receptor assay (RRA). Three fractions were obtained with potencies between 9000 and 20 000 IU/mg); five fractions were characterized by potencies between 1000 and 6000 IU/mg; and four fractions exhibited low potencies (less than 500 IU/mg). A linear relationship between RRA and RIA potency (P) was found to exist for the various fractions: In(PRRA) = 1.14 In(PRIA) - 1.67. The major fractions, which exhibited various potencies, were further characterized by amino acid and carbohydrate analysis. Urine was collected from an individual at various times of gestation, and the hCG fraction was concentrated by benzoic acid and ethanol precipitation. Ion-exchange chromatography of the hCG fraction yielded multiple immunoreactive components throughout pregnancy; thus the observed heterogeneity in the commercial preparation does not appear to result from processing pooled urine from numerous donors. Also, heterogeneity was observed in an individual donor whose urine was not treated with the benzoic acid and alcohol fractionation scheme. It seems indisputable that individual urinary hCG is heterogenous, and this does not appear to reflect isolation artefacts.


Malignant hyperthermia.

Malignant hyperthermia is now recognized as a distinct entity in anesthetic practice and can be considered as a pharmacogenetic disease of obscure etiology occuring in man and pigs with a dominant inheritance. A close association with myopathy has been noted. Commonly used muscle relaxants or anesthetic drugs can act as triggering agents in genetically susceptible patients, who develop a real hypermetabolic state, characterized by a rapid rise in body temperature, muscular rigidity, tachycardia and tachypnoea, cyanosis and severe respiratory and metabolic acidosis, the lethality being about 60%. Other clinical, biochemical and histopathological features of this condition are described. The prevention and early diagnosis of this syndrome is very important. Therefore, it is necessary in the preanesthetic evaluation, to obtain information from the patient, with regard to previous anesthetic experiences, and to have a more exact anamnesis in patients with muscular diseases or with other members of the family under suspicion. Some screening methods are described. The prognosis of malignant hyperthermia depends on an early diagnosis. Although the incidence is, fortunately, small, this condition is sufficiently significant and acute in nature to require that anesthesiologist be aware of its clinical pathophysiology and prepared to recognize and treat it promptly. Therefore body temperature should be controlled continuously in all anesthetized patients, particularly in the younger age group and especially in those in which symptoms of muscle rigor have been observed particularly after application of succinylcholine and halothane. A regime of treatment is suggested, based on current concepts of the pathogenesis. It consists in establishing effective and rapid cooling, reversal of tissue hypoxia and correction of respiratory and metabolic acidosis and hyperkalemia. Specific therapy with dantrolene sodium may prove to be an answer to this serious problem.


Anesthetic death.

Death due to anesthesia is a tragic paradox. The numbers about the frequency of anesthesia-related-death published in many reports have a relative value, as it is impossible to compare them one to another. A synoptic table of 20 important studies made on this subject, shows a great variation in figures concerning the incidence of death related to anesthesia. The most common causes of "anesthetic-death" are mentioned and some suggestions are made to decrease the frequency of death due to anesthesia.


The place of the anesthetist in the medical hospital team.

The historical development of surgery and anesthesiology, has made the anesthetist an expert in the following fields: 1. Providing analgesia. 2. Homeostasis of the internal environment or respiratory, circulatory and metabolic resuscitation. 3. Continuous titrated therapy. 4. Applied pharmacology. The question put forward to the anesthetist has been, whether he should limit the application of his skills to the operating theatre, or whether he should take his skills to the whole hospital, by working in the intensive therapy unit and participating actively in the preparation of the patient for surgery, in the care of life threatening emergencies in the hospital and outside of the hospital, in treating pain problems in hospitalized and ambulatory patients. From our experience, we think that the anesthetist cannot and may not limit his activities to the operating theatre. In order however to maintain availability and competence, intensive therapy, emergency care and pain therapy, should be organized on an interdisciplinary basis. A special team, as old as anesthesia itself, is the team surgeon-anesthetist. The rules of conduct within this team are discussed. It is concluded that safety during anesthesia has increased, through the activities of the anesthetist outside of the operating theatre. One anesthetist should however remain available at any moment during anesthesia, for every one patient.


The influence of staff and personnel on the safety of the patient during anesthesia.

The safety of the patient under anesthesia is directly correlated to the quality of the service delivered by the anesthetic department. A good organised work, supposes a staff, which accords to numerical and qualitative requirements. The number of personal required is a function of working conditions. The quality required for the persons who administer anesthesia, depends upon the intrinsic danger of the procedure. As the nature of anesthesia is still linked with the acute control of vital functions of the patient, the qualifications of the person who administer the narcosis should be of the highest level.


The importance of monitoring in anesthesia.

A plea is made for continuous electronic monitoring of every patient undergoing an anesthetic. Such monitoring is far superior to clinical observation by means of the natural sensors. A continuous record of the vital phenomena is indispensable. Routine monitoring of the following is advised: ECG, heart rate, capnogram, plethysmogram, temperature, oxygen percentage and indirect blood pressure. Big operations demand central venous pressure and direct blood pressure monitoring, in addition. In the Institute of Anesthesiology in Utrecht all electronic monitors are built into a single unit which is used during every anesthetic. Capnography it dealt with in some detail and its value as a universal monitor demonstrated. The routine use of electronic monitors improves the quality of anesthesia and increases the safety of the patient.


Safe anesthesia: some general considerations.

Most of the articles on safety in anesthesia take the mortality as the criterion. This is fallacious. The anesthetist's area of responsibility must be clearly defined before his contribution to any given mortality can be assessed. The development of the field of anesthesiology has extended this area enormously. As a result, the techniques employed and the results obtained need to be reviewed and reconsidered. Outdated attitudes must be resolutely abandoned, particularly with regard to monitoring. The use of a coding system for anesthetic complications helps towards an objective assessment of the degree of safety achieved. The results obtained by this means in the Institute of Anesthesiology in Utrecht are reported.


The risks of tracheal intubation.

Various lesions have been described as post-intubation complications: injuries, of usually minor degree, of the pharynx and larynx, oedema of the larynx, ulcerations of the pharynx and larynx with pseudomembranes and bleeding, chondromalacy of the larynx, granulomata, oesophago-tracheal fistula, stenosis of the larynx or trachea, paralysis and synechia of the vocal cords, paralysis of the tongue. Etiologic factors of these complications are mainly chemical, in relation with the material of the tube and with the sterilization agents, or mechanical due to pressure on neighbouring tissues. Post-intubation sore throat seems independent from traumatic laryngoscopy. Although intubation is meant to provide safer ventilation, interference with respiration may occur by compression of the tube or accidental obstruction from various causes. It should not be forgotten that in anesthesia cases, for which intubation is not really required, it may be advantageous to administer the anesthetic by mask.


Are anesthetic accidents unavoidable?

Fatal anesthetic accidents still occur frequently. Origins and causes are being reviewed especially in the light of lawsuits against anesthetists. The importance of utmost continuous supervision and care for both the vital functions: respiration and circulation, is stressed. General recommendations for security during anesthesia are advanced.


The role of the recovery room for the safety of anesthesia.

Three groups of activities taking place in the recovery room are separately analyzed and compared with the same done on the wards. It is concluded that all three of them are preferably done in the recovery room. When these principles are followed, mortality in the direct postoperative period can be reduced to an absolute minimum. Data from 50,000 cases confirmed this statement.


Guillain-Barré syndrome: demonstration of antibodies to peripheral nerve tissue.

Sera from 30 patients with acute Guillain-Barré syndrome were tested for the presence of antibodies to peripheral nerve tissue using the antiglobulin consumption test. An increased binding of IgG was observed in 15 out of 30 sera and in these sera F(ab')2 fragments prepared from IgG retained the capacity to combine with peripheral nerve tissue, suggesting an antigen-antibody interaction. The specificity for peripheral nerve tissue was demonstrated by absorption experiments. F(ab')2 fragments prepared from IgG of normal sera, however, failed to react with the tissue, suggesting a non-specific binding through the Fc part of the molecule. In sera from patients fully recovered from the Guillain-Barré syndrome and from patients with other neuropathies, no increased binding of IgG was observed.


Changes of electrooculogram (EOG) in Parkinson's disease.

Twenty Parkinsonian patients and 20 control subjects were compared with respect to their electrooculographic findings. It was found that Parkinsonian patients are distinguished from controls by their significantly lower mean EOG ratios. L-dopa treatment restored EOG ratios to control values. The findings are interpreted as indicating an association of Parkinson's disease with metabolic changes in the melanin-containing cells of the pigment epithelium.


Linoleic acid in multiple sclerosis: failure to show any therapeutic benefit.

We have studied the effect of a dietary supplement with linoleic acid (LA) in 76 patients with MS. We could detect no effect of this supplement on the progression of neurological findings, the relapse rate, or the severity of relapses. We were also able to show that oral supplementation with a linoleic acid preparation would raise the blood level of LA in these patients. We were unable to show that there was any reduction in the linoleic acid blood levels associated with acute relapses of MS during this study.


Anterior spinal artery syndrome.

Three patients are presented, each showing clinical and electrophysiological findings indicative of the anterior spinal artery syndrome: sudden onset of nonprogressive weakness and spasticity of one or both legs, associated in one patient with pain and in all three patients with selective impairment of temperature sensation, radiological evidence of aortic calcification, normal sensory and motor conduction velocities and normal amplitude of sensory potentials, but diminished amplitude of evoked motor responses. Electromyography showed widespread fibrillation in muscles of the leg in two patients and evidence of marked loss of motor units in all three patients.


Carbamazepine, carbamazepine-10,11-epoxide and phenytoin concentrations in brain tissue of epileptic children.

Carbamazepine (CBZ), carbamazepine-10,11-epoxide (CBZ-epoxide) and phenytoin (DPH) were measured in brain tissue in two epileptic children undergoing temporal lobectomy. The patients had been treated with the anticonvulsants in question for 2 years. The CBZ concentration in brain tissue was higher or equal to the plasma concentration. Brain/plasma ratio for CBZ was 1.0 and 1.4, respectively (grey substance). Brain/plasma ratio of CBZ-epoxide was 1.0. Concomitant treatment with DPH increased the percentage of CBZ-epoxide relative to CBZ in both brain and plasma. In white brain substance the concentration of CBZ, CBZ-epoxide and DPH was higher or equal to the corresponding concentration in grey substance. No major age-related differences in the distribution of anti-epileptic drugs between brain and plasma in these two children compared to adult epileptic patients were noted. A new quantitative thin-layer chromatographic method for the determination of DPH and phenobarbital (PB) in brain tissue and plasma is described.


Epidemiologic survey of multiple sclerosis in the Bucharest city and suburban area.

Epidemiologic survey over a restricted area of Romanian territory, i.e. the city of Bucharest with a population of 1,934,052 and a surface of 605 km2, established the following values for the MS parameters studied. On January 5, 1977 the prevalence rate for "probable" and "possible" cases was 46.4 per 100,000 inhabitants and for "probable" cases alone (with certain clinical diagnosis) 41.3 per 100,000. The specific 20- to 60-year age adjusted prevalence rate was 79.4 per 100,000. The incidence rate over the 1969--1976 period was 1.78 per 100,000. The prevalence and incidence rates in this survey are similar to those reported for two other large urban centers of Romania (population over 100,000 each), Romania being therefore situated in a geographical area of "high risk" for MS. The 0.61 per 100,000 nationwide and the 0.65 per 100,000 Bucharest mortality rates are lower than those reported in other geographical areas of "high risk" for MS.


Thyroiditis in myasthenia gravis.

Three out of 40 patients with myasthenia gravis had chronic thyroiditis. The thyroid disease preceded the neuromuscular disorder in two patients, while the third developed a slowly progessive hypothyreosis during the course of the myasthenia. One patient had an initial thyrotoxicosis with subsequent development of hypothyreosis. Of the remaining 37 patients, two had enlarged thyroid glands, positive family history of thyroid disease and antibodies to thyroid globulin, but were euthyreot.


Diffuse cerebral sclerosis, melanoderma and adrenal insufficiency (adreno-leukodystrophy).

Two cases of adrenoleukodystrophy are described. The pathological picture was consistent with earlier observations about the disease with the difference that the brain tissue revealed material which stained metachromatically with toluidine blue and was insoluble in fat solvents.


Computerized tomography in hereditary ataxias.

Thirty-nine patients with hereditary ataxia (HA), hereditary spastic paraplegia or Charcot-Marie-Tooth disease were investigated with computerized cranial tomography (CT). Infratentorial as well as supratentorial atrophies were registrated and scored. These were compared with the patient's neurological symptoms, which were related to the lesion in the central nervous system, and scored. There was correlation between the distribution of brainstem/cerebellar symptoms and the distribution and degree of infratentorial atrophy. HA cases with cerebral cortical atrophy had significantly higher dementia scores than those without wide sulci. Intravenous injection with contrast medium was of no diagnostic aid, as no focal changes were found. It is concluded that CT is an aid in the diagnosis of hereditary ataxias and hereditary spastic paraplegia.


Abnormal ultrastructural appearances in axons of feline pericruciate cortex after lateral funiculotomy.

Following left lateral funiculotomy, axons of cat pericruciate cortex exhibited neurofilamentous hyperplasia and complex, adaxonal, oligodendrocytic invaginations into electron-lucent or (commonly) electron-dense, degenerating axoplasm. These changes were absent form sham-operated and unoperated animals. Neurofilamentous hyperplasia was exclusively right-sided and appeared in myelinated axons 5--49 days postoperatively and in nonmyelinated axons 14--153 days after surgery. Oligoglial invaginations were present 1--49 days after surgery and were predominantly right-sided. Intramyelinic, axo-dendritic synapses appeared in operated cats 5--10 days postoperatively. Intra-axonal accumulations of ribosomes were found also. These changes also occurred exclusively or predominantly contralateral to spinal surgery. Other ultrastructural abnormalities, e.g., amorphous transformation of axoplasm and accumulations of dense bodies in intra-myelinic, dark cytoplasm, had a less certain relationship to lateral funiculotomy. The axonal alterations that were limited to operated cats possibly represent a true retrograde axonal degeneration occurring at a distance from the site of axonic interruption and unaccompanied by evidence of nerve cell death.


Initial response of silver-impregnated "resting microglia" to stab wounding in rabbit hippocampus.

Adult rabbits received stab wound in the cerebrum and were sacrificed at intervals of 20, 30, and 39 h thereafter. Each animal was injected intracerebrally with 3H-thymidine 2h before fixation. Altered brain tissues of the stratum radiatum of hippocampus were taken for examination. Response of "resting microglia" to stab wounding was investigated by electron microscopic autoradiography and by autoradiography applied on silver-impregnated materials. Following results were obtained: (1) Resting microglia undergo marked swelling shortly after the brain damage. We designate these cells as "swollen microglia". (2) Swollen microglia form the only cell population that proliferate actively in the initial stage of glial response to the brain injury, and (3) astroglia do not proliferate during the same experimental periods, in the rabbit hippocampus.


Maturation of Purkinje cells in mouse cerebellum after neonatal administrations of cytosine arabinoside.

ICR-JCL strain mice were injected subcutaneously with 30 mg/kg body weight of cytosine arabinoside at 2, 3, and 4 days of age. This chemical prevented the production of the basket cells, stellate cells, and granule cells in the external granular layer of the cerebellum. Decrease in number of these microneutrons affected the noraml synaptic connections between the Purkinje cells and the microneurons, thus causing the disarrangement and abnormal arborization of the Purkinje cells. Of the three types of microneurons, the basket and a few stellate cells played a more important role in the disarrangement of the Purkinje cells and abnormal arborization of their primary dendrites than the granule cells did. Abnormal outgrowing directions of other smooth dendrites of the Purkinje cells were caused mainly by the diminution of stellate cells. Although parallel fibers were grossly decreased in number in the treated cerebellums, spines of the spiny dendrites of the Purkinje cells sprouted considerably in the 15-day-old mice, and then their morphological features remained even after 100 days of age.


Mineralized cells: neurons, glia or macrophages? Ultrastructure of cerebellum in chick nutritional encephalopathy.

Mineralized dead cells were found in infarcted areas in the cerebella of three chicks killed in the healing stage of nutritional encephalopathy. The mineral depostis were found in vacuoles and consisted of radially packed threads and spicules, concentric laminated structures and centrally located amorphous masses. The cells in which these deposits were found were positively identified as astrocytes and macrophages. The presence of such deposits in neurons was suspected but not proven.


Ultrastructural studies on blood-brain barrier dysfunction after cerebral air embolism in the rat.

Male albino rats were anaesthetized with diazepam, injected with horseradish peroxidase and Evans blue-labeled albumin and given an embolus of 0.01 ml air in the right common carotid artery after ligation of the external carotid branch. The pial arteries of the right cerebral hemisphere were stained blue, particularly the middle cerebral artery and its main arterial branchlets. Ultrastructurally, some endothelial cells in the right middle cerebral artery, small arteries and arterioles showed a diffuse distribution of horseradish peroxidase in their cytoplasm, although these vessels only occasionally showed peroxidase in their basement membranes. Other endothelial cells in these arterial branchlets showed few if any signs of a diffuse distribution of peroxidase but displayed several pinocytotic vesicles and occasionally trans-endothelial channels filled with peroxidase, sometimes with a slight leakage of peroxidase into adjacent basement membranes and neuropil. Scattered pinocytotic vesicles were observed in capillaries and venules, but there was usually no extravasation of peroxidase around these vessels.


Morphology and origin of arachnoid cysts. Scanning and transmission electron microscopy of three cases.

Three surgically removed primary arachnoidal cysts were studied with scanning electron microscopy (SEM) and two of the cases with transmission electron microscopy (TEM). The cells lining the cyst cavity had microvilli at the surface, true cilia were absent. In the cytoplasm multivesicular bodies, many pinocytotic vesicles, some large vacuoles and strands of tonofilaments were prominent features. The cells were interconnected by desmosome-like junctions and were separated from the surrounding tissue by a distinct but sometimes incomplete basal membrane. Based on these findings it is concluded that arachnoid cysts are derived from the outer arachnoid cells (subdural neurothelium), the formation of the cysts being attributabel to secretory capacity of the subdural neurothelium.


The nature of macrophages (foam cells) in neurinomas. Tissue culture study.

Fourteen cases of neurinomas of variable location are studied by tissue culture technic in an attempt to typify the foam cells as primary or superimposed elements in the tumor population. Our results demonstrate that the "in vitro" behavior of the neurinomas is constant and characteristic and that three cell types are found in them: fusiform, star-shaped cells and macrophages. There appears that the macrophage is an evolutive aspect of the star-shaped cells and probably of the fusiform one. On this basis, macrophage and foam cells of neurinomas must be considered as primary.


Fine structure of an unusual spongy variant of medulloblastoma.

The prominent finding on electron microscopy of an unusual spongy variant of medulloblastoma was the marked distention of a well-developed smooth endoplasmic reticulum of the tumor cells. To the authors' knowledge, this fine structural feature has not been described previously in this tumor.


The influence of the deep femoral artery on wound healing in amputees.

Seventeen patients with arterial occlusive disease, of whom 14 were diabetics, were studied by angiography after amputation of the lower extremity. In one patient the angiography was normal and the stump wound healed well. In two patients the angiographic findings indicated extremely severe impairment of blood supply and wound healing was considerably delayed. Of the remaining 14 patients: in five the superficial femoral artery alone was occluded and wound healing was normal and in nine patients, both the superficial and deep femoral arteries were occluded and wound healing was delayed. Wound healing of the stump after amputation of the lower extremity due to extensive arterial occlusive disease is decided by the patency of the deep femoral artery.


Scattered mitosis in adult joint cartilage after partial chondrectomy. A histological, autoradiographical and biochemical study in rabbits.

Full-grown rabbits were operated on and subjected to total or partial chondrectomy of the cartilage in the patellar groove. In one group, only arthrotomy was performed in the control knee. The animals were killed at various times after the operation. Histologically, proliferation of the synovial cells at the joint margins, as well as osteoblastic activity, could be seen; later, osteophyte formation was observed. There were only minimal signs of degenerative changes in the cartilage. The biochemical investigation did not show any difference in the nucleic acids of the cartilage, either in relation to the time after the operation had taken place or in relation to the size of the trauma. In the knees where the cartilage was excised, thymidine-labelled chondrocytes were seen scattered in the joint. The number of labelled chondrocytes showed a rising tendency up to 14 days postoperatively, but no peak value was seen. In the arthrotomized knee joints, labelled chondrocytes were occassionally seen. It is possible that the scattered mitosis is the result of a reduction in the concentration of normal cell-specific inhibitors of mitosis, so-called chalones.


Torsional strength and geometry of diaphyseal bone. An experimental study on dogs.

A previously presented method for measuring the torsional strength of diaphyseal bones has been used to study the effect of direction of twist upon the torsional strength and stiffness of diaphyseal canine bones. No significant effect of the direction of twist upon the studied properties has been found. The reason for the observed twist direction independence of the torsional strength and stiffness is assumed to be the adaptation of the diaphyseal bone architecture to functional demands.


Evaluation of fracture healing in man by serial 99mTcSn-pyrophosphate scintimetry.

Serial 99mTc-pyrophosphate (99mTcPP) uptake measurements were performed, during the healing period, in 12 patients with fracture of the distal end of the radius without displacement. A peak value in uptake ratio was seen within 4 weeks in all patients. For clinical reasons the patients were divided into a normal healing and a slow healing group. 99mTcPP uptake at 6 weeks after the fracture was significantly higher in the slow healing group. Quantitation of the healing process in forearm fractures is possible using 99mTcPP and a gamma camera, and concentrating on small selected areas of interest.


Structural role of bone apatite in human femoral compacta.

Tensile and compressive strength of human femoral compacta have been shown to be related (P is greater than 0.005) to the average bone apatite crystallite length (D002) as determined by X-ray diffraction line breadth measurement. However, statistical variance of crystallite length was not sufficient to explain observed differences in mechanical properties, these differences being primarily due to variation in mineral density. Average bone apatite crystallite length was not found to change significantly with biological age (P=0.30) over the range 3 1/2 to 87 years. It is concluded that increased bone apatite crystallite length is detrimental to the structural role of the skeleton but that this is not a major factor in determining fracture incidence in the elderly.


Dystrophic calcification in tubercular lesions of bursae.

Four patients with extensive dystrophic calcification, in osteorticular tubercular lesions of relatively short duration, are described. All lesions healed satisfactorily after treatment with antitubercular drugs combined in some cases with en bloc excision.


Atrophy of cortical bone caused by rigid internal fixation plates. An experimental study in the dog.

The cortical atrophy induced by a rigid internal fixation plate on diaphyseal bone was studied on the femora of seven dogs. When the plate, which had been in position for 7 months without previous osteotomy, was removed, a pronounced reduction of the cortical bone was observed in the previously plated section of the diaphyseal bone. The atrophy took the form of loss of cortical bone mainly caused by endosteal resorption with enlargement of the medullary cavity. Neither periosteal resorption nor formation of woven bone under the site of the plate were observed. The process of adaption to the changed stress and strain conditions, caused by the mechanical joint, i.e., implants and bone, was studied by means of a histological technique, and was still in progress after a period of seven months.


Effect of pneumatic tourniquet on muscle oxygen tension.

Recent investigations suggest that circulation in a limb can be reduced with a tourniquet to less than 1 per cent of the control limb, or even completely occluded. The development of tissue oxygen tonometry with implanted silastic tubes has provided new possibilities for assessing muscle tissue oxygen tension. In the present work, this method was employed to register the effect of tourniquet blackade on the lower limb muscle PO2 in rabbits. The duration of the tourniquet blockade was 60, 120 and 180 minutes. The baseline muscle PO2 in the tibialis anterior muscle was 22.6 +/- 0.6 mmHg. During the tourniquet blockade the oxygen tension dropped to minimal values between 9.2 +/- 0.5 and 10.7 +/- 0.6 mmHg in these experimental groups, but the tissue microclimate never reached fully anoxic conditions. The rapid response of muscle PO2 to oxygen breathing after release of the blockade suggests that limb microcirculation tolerates tourniquet occlusion well.


Intracardial arteriographic study on vascular changes in amputated rabbits.

The vascular changes in rabbits after amputation were studied in vivo with arteriography, after intracardial injection of contrast. In the amputated extremity an initial vasoconstriction of the arteries was found. Thereafter changes were observed in arteries and veins, both in the operated and contralateral extremities, depending on the level of amputation and the manner in which the stump was closed. After amputation distally on the extremity and after stump closure without myoplasty arteriovenous shunting was observed in the amputation stump. Arteriovenous shunts were not seen after knee disarticulation and after proximal amputation on crus with myoplasty. Inactivity of the muscles in the amputation stump is supposed to be the cause of the shunt formation. After mid-femur amputation a permanent vasoconstriction of the femoral artery was observed, whereas artery dilation was seen when amputation on the femur was combined with plugging of the medullary cavity.


Radiological studies of the wrist joint among chain saw operating lumberjacks in Japan.

Radiological changes of the wrist joint among 580 chain saw operators and 90 forestry workers (control) who had never used vibratory tools have been studied. In both groups, degeneration in the distal radio-ulnar joint and the lunate bone was recorded as a prominent finding. However, changes peculiar to chain saw operators or a close relation between those changes found and the number of years spent operating a chain saw could not be found in this study.


Prediction of spirometric values in patients with scoliosis.

The prediction of normal spirometric values requires a measure of the non-deformed body height of scoliotic patients. The arm-span method has been used for estimating the non-deformed body  height in spite of the fact that opinions about the normal relationships between body height and arm span differ. In order to minimize the error of estimation of non-deformed body height, the normal relationships between body height and arm span were determined for 91 males and for 118 females of ordinary body stature, varying age (5-78 years), and Swedish origin. The body-height/arm-span relationships were described by linear regression equations taking age into account. The results indicate significant sex and age differences in the arm-span/height ratio. Multiple regression equations including arm span and age as regressors were used to calculate the non-deformed body height in scoliotic patients. The arm-span method was compared with the method using the degree of lateral curvature of the spine for calculation of non-deformed body height of scoliotic subjects. The arm-span method resulted in a correction of body height and predicted spirometric values that agreed closely with those obtained by the method using the degree of curvature of the spine. The two methods may be used alternatively. In accordance with earlier reports, the predicted spirometric values were underestimated when the measured body height was used.


Peripheral vasoconstriction in the rat in response to sound. III. Dependence of pause characteristics in continuous noise.

The peripheral vascular reaction to sound was studied in the non-anaesthetized rat. Arterial pulsations were recorded by a non-invasive technique from the tail of the animal. The offset of a noise was found to be a weak stimulus for vasoconstriction, eliciting responses in only half of the presentations. A vasoconstriction was, however, regularly elicited by onset of sound after the end of the pause. The vasoconstriction was independent of pause duration in the range 10 ms to 100 s. For shorter pauses the reaction was smaller; It was especially noted that a 10 ms pause gave a larger response than a 10 ms burst of noise. The results were discussed in relation to decay of sensation and partial masking effects.


Ion transport in the cochlea of guinea pig. II. Chloride transport.

The -Cl transport of endolymph--perilymph barrier in guinea pigs was studied by perfusing the perilymphatic space with artificial perilymph containing 36Cl and measuring the uptake of 36Cl in the endolymph. In normal animals no marked difference in -Cl concentration was found between the endodlymph and perilymph. The data showed that the uptake of 36Cl in the endodlymph could be represented by a simple exponential function of the perfusion time, the rate constant being 0.01 min-1. The concentration of 36Cl in the endolymph was greater with perfusion of the scala vestibuli than with perfusion of the scala tympani, indicating the Reissner's membrane is more permeable to -Cl than the rest of the endolymph-perilymph barrier. Anoxia and local application of ouabain decreased the -Cl concentration and 36Cl uptake in the endolymph. Our results imply that the endocochlear potential is the principal driving force for unidirectional flux of -Cl from perilymph to endolymph.


Further studies of the effects of continuous white noise of moderate intensity (70--80 dB SPL) on the cochlea in young guinea pigs. Time course and distribution of hair cell degeneration.

Guinea pigs aged one week were exposed to white noise at a maximum of 76 dB SPL for 7 days and were then killed 3, 8 and 16 weeks later for histological examination of the cochlea by the surface preparation method. Appreciable increases in outer hair cell losses were observed in the apical turn 3/3 1/2, chiefly in the outer two rows, between the 3rd and 8th week, but not between the 8th and 16th week. No significant losses were seen in control groups corresponding to 3- and 8-week periods, although in the control group of 16 weeks' survival, small deficits, attributable to natural ageing, were seen in the apical half-turn, 3 1/2.


A physiological and morphological study of the cochlea of the rat following treatment with atoxyl and neomycin.

By means of physiological and morphological techniques the inner ear pathology following exposure to the ototoxic compounds atoxyl and neomycin was analysed in the rat. Primarily a high tone deterioration occurred with a subsequent morphological degeneration pattern among the hair cells in the basal part of the cochlea. The outer hair cells were more frequently affected than the inner hair cells following the administration of both atoxyl and neomycin.


Diagnosis and surgery of acoustic tumours.

In the diagnosis of acoustic neuromata the stapedial reflex test, the forward vs reverse Békésy test, the loudness balance test, and the adaptation test have all been found superior among the special tests used in predicting a tumour diagnosis. Conventional X-ray studies of the internal acoustic meati are always performed, followed by tomograms and in suspected cases by meatocisternography. In the present series translabyrinthine total removal was performed in 21 cases, a planned decompression in 5, while in 2 the removal was subtotal. Only two permanent facial paralyses arose, one corrected by masseteric plasty and the other by facial-hypoglossal lateral perceptive hearing impairment as being caused by a tumour until proven otherwise.


[Vidian nerve: perspectives and realities].

The author presents the history and the actual indications of vidian neurectomy with results out the literature. The endonasal approach of pterygo-palatine fossa is discussed. What is the place of vidian neurectomy in the management and treatment of hypertrophic rhinitis? The question is open but the nasal functional microsurgery is born.


Sialochemical examinations in non-tumorous parotid enlargements.

Secretion rates and the composition of isolated parotid saliva samples were samples were examined in 51 patients suffering from chronic recurrent parotitis, sialosis, or Sjögren's syndrome, and in 17 healthy controls. Evaluation of the results indicated that sialochemical examination may provide a valuable help in the differential diagnosis of parotid diseases characterized by swelling of the gland. Chronic parotitis is characterized by a significantly decreased flow rate, extremely high sodium and protein concentration and lack of secretory response to stimulation. In Sjögren's syndrome the low flow rate was found to be associated with a decreased potassium secretion rate as well as decreased flow rate and decreased sodium concentration after stimulation. In sialosis, where flow rates display a considerable individual variation, a significant increase in potassium secretion rate could be revealed.


Directional specificity for head rotation in the pigeons posterior cerebellum.

Neurons in the posterior cerebellum, including the vestibulocerebellum, which respond to rotation in the plane of the horizontal semicircular canal exhibit considerably greater plane specificity than is known for primary afferents. This is shown by a response amplitude decline with tilt out of the canal plane which exceeds the decline predicted to a cosine function. Of 96 horizontal canal cells, 41 also responded to yaw movements about neck joints with only three of these cells exhibiting responses to roll movements as well. Other neurons responding to head rotation in roll very commonly responded to neck movements about the roll and/or pitch axes. Cells with converging vestibulo-cerevical input were found throughtout lobules VI to X, most of these cells being located in the uvula and only very few in the nodulus.


[Statistical data concerning passive anterior rhinomanometry (PAR)].

The authors measured the values of the passive anterior rhinomanometry (PAR) obtained from 30 normal subjects and studied the influence of the different variables involved in PAR. This influence was calculated by using of statistical analysis (ANOVA). By measuring "p" with successively changing flows, it was possible to determine that the airstream was mainly laminair.


A study of the vibration of the basilar membrane in human temporal bone preparations by the use of the Mössbauer effect.

Using the Mössbauer technique, we have studied the vibration of the human basilar membrane and malleus head in the sound frequency range 0.2--9.0 kHz and at a sound pressure of 100 dB at the tympanic membrane. The displacement frequency response curves for the basilar membrane and the malleus head have similar shapes, with a maximum at about 1 kHz. Below and above 1 kHz the curves have a slope of about 10 dB/octave and--100 dB/octave, respectively. In addition, the basilar membrane has a maximum displacement at a frequency dependent distance from the stapes. A simple hydrodynamic model for the cochlea is used to interpret the experimental data. A possible mechanism for the frequency resolution of sound by the ear and noise-induced hearing loss is discussed.


The mucociliary activity of the upper respiratory tract. II. A method for in vivo studies on maxillary sinus mucosa of animals and human beings.

A method for photoelectric in vivo recordings of the mucociliary activity of the mucosa of the upper respiratory tract is described and tested in model experiments. In vivo recordings from the maxillary sinus mucosa of rabbits were easy to analyse and the method is useful for further experimental research on animals. Examples of in vivo recordings from the human maxillary sinus during Caldwell-Luc operations are also presented. These results are compared with subsequent in vitro recordings of biopsy material.


Aspergillosis of the maxillary sinus. Clinical and histopathological features of 4 cases and a review of the literature.

Four patients with aspergillus maxillary sinusitis are reported and a review of the literature on aspergillus paranasal sinusitis during the last 10 years is presented. The patients had symptoms and X-ray findings similar to a chronic bacterial sinusitis. One patient had been operated upon 6 years previously due to a chronic sinusitis and 3 of the patients had been treated with broad-spectrum antibiotic drugs. Caldwell-Luc operations were performed, also to exclude malignant tumours. The aspergillus etiology of the sinuitis was discovered in routine stained sections by histo-pathological examination of the sinus mucosae. No recurrence of the fungus infection occurred after the Caldwell-Luc operation, which was valuable for the correct diagnosis as well as being the best suited therapy.


[Sudden deafness].

Concerning sudden deafness, the author rather defends viral origin than vascular, based on comparative histo-pathological studies. Possibility of "inner ear baro-trauma" or "labyrinth membrane rupture" is also discussed. Conservative treatment by bed-rest, cortico-steroïds and vasodilators is advised.


Experimental surgery on the nose. I. Airflow and goblet-cell density.

In rabbits the nasal vestibule was surgically occluded on one side. The rabbits were observed for varying periods, maximum 90 days. The mucosa of the septum was removed from both sides, stained by the PAS-alcian blue whole-mount method, and the goblet cells were counted. The difference in goblet-cell density between the occluded and open side of the nose was less than expected according to previous reports. A completely abolished air flow for 3 months caused only some increase in density. During the first 16 days there was an increase in density on the occluded as well as on the open side of the nose. This can hardly have been due to altered airflow, but must be attributed to an irritative action by the operation upon the nasal mucosa.


[Electrophysiology of vestibulo-ocular reflexes].

Electrophysiological and morphological properties of premotor neurones in the vestibulo-ocular system have been studied intracellularly in the unanesthetized  "encéphale isolé" cat. 1. Secondary neurones of the vestibulo-abducens reflex, identified both by their antidromic and orthodromic responses, showed no nystagmic modulation of their activity. 2. Only 12% of the recorded population in the medial vestibular nucleus showed burst firing patterns correlated with the phases of nystagmus. 3. Two classes of neurones which did not respond to stimulation of the abducens nerve were recorded in the abducens nucleus. The first were inhibited by phasic vestibular stimulation and fired 180 degrees out of phase with the ipsalateral motor nerve discharge. The second type of neurones was excited by vestibular stimulation and fired in synchrony with the motor nerve activity.


Styloid process syndrome or stylohyoid syndrome?

The literature on the syndromes related with the stylohyoid apparatus is reviewed and the embryology is discussed. Since the embryological, and symptomatical similarity, a "stylohyoid" syndrome can be defined including symptoms related to the styloid process, stylohyoid ligament, the hyoid bone and even the hyothyroid cartilage junction. Some possible aetiological factors are listed even as appropriate treatment which includes surgery.


Remnants of vitelline duct: analysis of 66 cases.

In twenty years, 66 infants and children with remnants of vitelline duct requiring surgery have been admitted. The patients were classified into three groups:  patient vitelline duct (20 cases); Meckel's diverticulum as the primary surgical diseases (19 patients); and Meckel's diverticulum found incidentally at surgery (27 patients). The male preponderance in the groups of patent vitelline duct and symptomatic Meckel's diverticulum was 9:1. In contrast with other data, Meckel's diverticulum requiring surgery occurred with nearly equal frequency up to fourteen years. The gravest complication in the cases of patent vitelline duct were a T-shaped protrusion of ileum and a small bowel volvulus around the fibrous cord or the patent duct; and in the cases of Meckel's diverticulum causing symptoms, intestinal obstruction, bleeding peptic ulceration or inflammation. Three deaths occurred in newborn age in connection with patent vitelline duct, and one patient died who belonged to the group of asymptomatic Meckel's diverticulum.


Mild variant of maple syrup urine disease.

The case of a three-year-old boy with mental retardation, moderate muscular hypotony and speech delay is presented. The mild form of maple syrup urine disease was suspected at the first blood screening test by means of ion-exchange thin-layer chromatography. The diagnosis was confirmed by quantitative serum amino acid analysis and protein loading. On a low protein (2 g/kg body weight) diet completed with leucine-isoleucine-valine free formula prompt and lasting normalization of the serum amino acid level ensued with steady improvement of the clinical and neurological status.


Enterobiasis and urinary tract infection.

The correlation between enterobiasis and urinary tract infection was studied in girls aged 6-14 years. Enterobius ova were demonstrated in anorectal scrapings, carried out three times in each case. Of the 84 patients suffering from urinary tract infection, 55 were Enterobius positive, as compared to 60 among 100 control girls. The difference was not significant. Enterobiasis was not found to be more frequent even when urinary tract infection reappeared within 6 months. There was no significant difference among patients with monosymptomatic bacteriuria and pyuria either. Enterobiasis thus seems to play no pathogenic role in urinary tract infections of girls.


Interaction and interdependence of somatic organism and psyche in childhood.

In order to clarify the interconnection and interdependence of the human somatic organism and psyche, their nature is discussed. The somatic organism is a specific morphological functional system, developing in every being. The psyche is a functional structure developing individually in the course of ontogeny, under the effect of internal processing influenced by the environment. The function of conditioned and unconditioned reflexes is discussed including the way in which the conditioned reflexes are built up on unconditioned ones. The mechanism is described, by which the psyche develops in the individual and how its functions manifest themselves. A concept is discussed concerning the structure of the human psyche, the system and nature of the conscious and unconscious functions. The personality is the manifestation of the interconnections and the formation into a system of the somatic organism and the psyche. This interconnection brings about the socialized humanization of the vital processes in man living in society. A concept concerning the essence of personality is discussed, emphasizing the "actual personality" and describing its structure. Clinical examples are given concerning the interconnection of somatic organism and psyche and the somatopsychic and psycho-somatic processes, and conclusions are drawn for the purposes of education.


Physical growth of children born small for gestational age.

In a longitudinal study the postnatal physical growth of 188 small for gestational age and 225 appropriate for gestational age children was compared. A significant retardation in weight, stature, head circumference and osseous development of SGA children was observed even at the age of 3 years.


Micronuclei studied in fine needle goitre aspirates.

Small nuclei at the size level of 1--3 mu--micronuclei--were studied in fine needle goitre aspirates. The greatest frequency of such structures was found in carcinomas, toxic goitres, and lymphoid thyroiditis, but even in the cases where they were found in greatest numbers, these structures comprised only a few promille of the nuclei. The possible significance of the micronuclei, especially with regard to carcinogenesis, is discussed.


Lymph node identification in carcinoma of the colon and rectum. Value of tissue specimen radiography.

A method for identifying lymph nodes in tissue specimens from patients with carcinoma of the colon and rectum by soft X-rays is described and assessed. The method seems superior to more time-consuming and possibly tissue-damaging procedures, and it affords a possibility of identifying lymph nodes down to a size 1--2 mm in formalin-fixed as well as in non-fixed tissue specimens.


Metastasis spread from syngeneic murine tumours. Establishment of a test protocol for comparisons between ascites tumours and their progenitors.

We have transformed two new MC-induced tumours, a sarcoma (MCB31-SC), into ascites form. When transplanted s.c. these ascites tumours grow as solid, quite undifferentiated tumours, (AS = ascites solid tumours). We compared the metastasizibility of the AS tumours with that of the parent tumours. In doing so, we used both the tail and the hind leg as transplantation sites. The tumours can be radically removed from both sites by amputation, which prolongs the survival time of the animals and permits metastases to grow into detectable sizes. As registered grossly and by microscopy, the AS tumours have a greater tendency of spread than the parent (SS/SC) tumours. MCB-21 AS grows quicker than 21-SS and gives rise to more lymph node metastases. When transplanted to the tail the AS tumour also gives a higher incidence of lung metastases. We detected no such difference by leg-transplanted tumours. MCB31-SC did not produce any detectable metastases at all, while 31-AS, particularly from the tail, gave rise to numerous lymph node and lung metastases. There were no differences in tumour size or growth rate to account for this difference. Thus ascites conversion has changed the carcinoma MCB31-SC into an undifferentiated, metastasizing tumour, as detected by our procedure. The design of test protocols to detect metastasizibility is discussed.


Heart autopsy in ischemic heart disease. An autopsy protocol.

The commonly performed autopsy of the heart often fails to demonstrate a satisfactory clinicopathological correlation in cases of death due to ischemic heart disease. An autopsy protocol devised specifically for the study of hearts from patients succumbing to ischemic heart disease is presented. This protocol has been employed in a consecutive series of 63 patients with ischemic heart disease dying at the medical department B, Rigshospitalet in the period 1 September 1975 to 1 May 1976. It comprises a meticulous histological examination of the coronary arteries, including quantitation of luminal narrowing. The ventricular myocardium is sliced transversely, and the Nitro-BT test is applied to identify and delineate acute myocardial infarction, the extent of which is quantitated by pointcounting. In a search for histopathological changes responsible for conducting disturbances, the sinoatrial and the atrioventricular nodes are examined histologically.


Renal infection after ileal conduit urinary diversion. An autopsy study.

Autopsy records from cases with urinary bladder carcinoma, consisting of patients operated upon with conduit urinary diversion and controls without diversion, were studied. We found macroscopical evidence of upper urinary tract infection (renal abscesses and/or pus-filled pelves/ureters and/or reddish mucosa in pelves/ureters) in 18 of 21 conduit cases without evidence of cancer at autopsy and in 14 of 50 control cases. The difference is statistically significant (p less than 0.0005). Abscesses were found more often in conduit cases (10/21) than in non-diverted cases (8/50) (p less than 0.01). The known connection between dilated ureters and/or pelves and urinary tract infection was demonstrated in non-diverted cases.


Pleural effusion disease in rabbits. Histopathological observations.

Pleural effusion disease (PED) is a generalized infection of laboratory rabbits caused by an unidentified agent, believed to be a virus. The histopathological response of 17 rabbits infected experimentally with this agent was studied. The light microscopical changes were minimal and the most consistent findings were alterations of the lymphoid tissue. Fatal infections were characterized by a uniform reduction of the splenic white pulp, focal degenerative changes of the thymus and lymph nodes and probably slight proliferative changes of the kidney glomeruli. In surviving animals there were transient myocardial and hepatic lesions and, after clinical recovery, proliferative changes in spleen, lymph nodes, interstitial lung tissue and probably kidney glomeruli. The results do not permit any conclusions to be drawn regarding the aetiology or the pathogenesis of PED infection.


Plasma membrane motility of cultured human glia cells in phase II and III.

A human diploid glia line (U-787 CG) was cultured on haptotactic islands using a miniclone method recently described. The surface morphology and motility pattern of the cells were studied using timelapse cinemicrophotography and scanning electron microscopy. Proliferating cells showed locomotion and ruffling activity with intermittent associated macropinocytosis. Non-dividers, viz, cells which had not divided 10 days after seeding on the haptotactic islands, were immobile, larger than the dividers, rather flat with few microvilli, and showed only very occasional ruffles almost completely without associated macropinocytosis. Our present findings show that phase III cells growing singly on haptotactic islands in serum-containing medium behave like phase II cells starved of growth factors or density growth inhibited. The results corroborate the theory that stationary cells have depressed ruffling activity and associated macropinocytosis as compared with proliferating cells.