A scanning electron microscopic study on the fractured rat parietal cells in resting state and after stimulation with tetragastrin.

Parietal cells in the rat gastric mucosa fractured by freeze cracking methods under resting (control) state and tetragastrin stimulation were studied by field emission scanning electron microscopy. The structures thus revealed were compared with those studied by transmission electron microscopy. In the fractured cytoplasm, intracellular canaliculi lined by numerous microvilli invaginated deeply towards the basal cytoplasm. Tubulovesicles appeared as many small holes about 0.05mu in diameter and were distributed predominantly in the apical or pericanalicular cytoplasm. Some tubulovesicles directly opened into the secretory canaliculi. Occasionally, tiny microvilli appeared in tubulovesicles. After being stimulated for 30 min with tetragastrin, the secretory canaliculi of parietal cells became enlarged and there were a concomitant increase in both the number and size of microvilli. Tubulovesicles also were increased in size and number and the tiny microvilli in them were also increased. The tubulovesicles were enlarged presumably as a result of membrane fusion between contiguous tubulovesicles. It was found that the enlargement of the secretory canaliculi was the result of fusion of the membrane of a single tubulovesicle or a confluence of tubulovesicles to that of the secretory canaliculus and the successive disappearance of the fused membrane.


Scanning electron microscopic observations of tooth germ in tissue culture with special reference to the migration of epithelial cells.

Tooth germ derived from the mandible of newborn mice was used in this study. The enamel organs were dissected and attached directly to coverslips without using the plasma clot. By this method it was possible, for the first time as far as is known, to attain preparations in which the major part of the outgrowth from the explant consisted purely of epithelial-like cells which probably were aneloblasts. Abundant desmosomes and tonofilaments were confirmed by transmission electron microscopy. Under the scanning electron microscope this outgrowth of epithelial cells revealed characteristic intercellular connections which were divided into four types. 1)In the part nearest to the explant, cell boundaries were indicated with a large number of short microvilli. 2)In the zone beyond the first type, the intercellular connection was represented by bridge-like processes firmly combined with each other. 3)In a still further zone, the tips of bridge-like processes were free from the cell connection and extended to the adjacent cells with the advance of cell migration. 4)In the most peripheral part of the explant, the cytoplasmic processes were capable of further expansion. These cells were soon separated from the adjacent cells to migrate as free cells.


Connection of microtubules, caveolae, mitochondria and sarcoplasmic reticulum in the taenia coli of guinea-pigs.

Microtubules were identified in the subsarcolemmal area of smooth muscle cell in the taenia coli of guinea-pigs. They may traverse myofibrils but more frequently they run parallel with the long axis of the cell. The microtubules were often in contact with sarcolemmal caveolae. A caveola appeared to contact with an end of a microtubule or with the outer membrane of a mitochondrion. Occasionally a long mitochondrion was located between two evaginations of sarcolemma. The direct contact of caveolae with a mitochondrion was typical in such long mitochondria. Granular and agranular sarcoplasmic reticulum (SR) were also in the vicinity of mitochondria. The SR was in contact with mitochondria and also with vesicles. Subsarcolemmal mitochondria were often in continuity with agranular SR or invaginations of sarcolemma. Low evaginations of sarcolemma appeared to be a cell contact device but nexas-like interdigitations, protrusions from the dark cell into the light cell, were also evident. These morphological findings may suggest a potential network of transport or conductance in this type of smooth muscle.


Electron microscope studies on the ellipsoid of the cat spleen with special reference to the filaments in the endothelial cell.

The fine structure of the ellipsoid of the cat spleen was studied by electron microscopy. The ellipsoid consists of closely packed reticular cells and fibers, and macrophages around a capillary. The macrophage cytoplasm contains phagocytized red blood cells within cytoplasmic vacuoles. The endothelial cells are specifically high in the lumen surrounded by an incomplete basement membrane. Two types of filaments are revealed within the endothelial cell cytoplasm. Thick filaments, 100A in diameter, are found in almost any part of the cytoplasm and show a tubular structure in cross section. They are thought to be cytoskeletal in function. Thin filaments, 60A diameter, are seen as electron-dense patches in the basal area of the cytoplasm. Their possible contractile function is discussed.


Freeze-etching images of capillary endothelial pores in the liver, thyroid and adrenal of the mouse.

The capillary endothelial pores of perfusion-fixed and immersion-fixed liver, thyroid and adrenal of mice were observed using freeze-etching preparations. In liver sinusoids, endothelial pores are heterogeneous in size and range from 50-100 nm. When the pores are classified into three types according to their size, small pores up to 100 nm in diameter represent 69.8%, intermediate pores measuring 100-500 nm 27.6% and large pores exceeding 500nm 2.6% of all pores in number. The endothelial pores of the thyroid blood capillaries are fairly homogeneous in size (70-90 nm), corresponding to the small type pores in the liver. In both adrenal cortex and medulla, the capillary endothelial pores measure 40-50 nm in diameter, showing small and intermediate types. In the adrenal cortex the former occupy 80.6% of all pores and the latter 19.4%. No larger type pores are recognized in the adrenal gland. These findings are not affected by different fixation methods, either perfusion or immersion.


Scanning electron microscope study on hemostatic reaction. Mural thrombus after the removal of endothelium, with special references to platelet behavior, site of fibrin formation and microhemolysis.

Hemostatic reaction in the mural thrombus formation (up to 2 hrs) was examined by scanning electron microscopy after removal of the endothelium in the rabbit carotid artery by the use of a rough-surfaced needle. The endothelium was almost completely removed leaving a network of subendothelial microfilaments which sometimes appeared half embedded in the basement membrane. Platelet adhesion occurred on this subendothelial tissue in the following steps: attachment of discoid platelets, pseudopod formation and spreading. The subendothelium was thus covered by a layer of platelets in about 10 min. During adhesion they caught the microfilaments by their pseudopods and never produced hemispherical protrusions. Loose aggregates of the rounded platelets were then formed on them but they were frequently reversible, resulting in 1-2 hrs, in coverage by only one or two layers of the adhered platelets. This platelet reaction was weaker than that to collagen in case of bleeding in the previous report. Leukocyte participation in thrombus formation began at around 30 min. Fibrin strands appeared as tiny filaments which were attached exclusively to the activated platelets and later grew into thick and long fibers forming a network. Thus activated platelets seemed to be very important as the base of development of fibrin thrombus. Many erythrocytes were demonstrated to be destroyed at the mural thrombus after attaching to either the subendothelial components or activated platelets or fibrin strands and being deformed by the blood stream. This finding supports the hypothesis of microhemolysis in the hemostatic process by HELLEM (1961). This type of hemostatic reaction was proved to be caused by a slight manipulatory pressure on the arterial wall, suggesting the occurrence of thrombus formation in our daily life.


Some observations on ciliogenesis in the oviduct epithelium of the mouse.

Ciliogenesis in the epithelium of the oviduct ampulla of 5-9 day-old mice has been investigated by electron microscopy. As reported by many investigators, fibrous granules, deuterosomes, and procentrioles are important for ciliogenesis. After injection of colchicine, fibrous granules disappear, while numerous coated vesicles and lysosome-like dense bodies appear in the same region, and the formation of deuterosomes and procentrioles is impeded. In the ciliogenic cell, the Golgi apparatus, consisting of numerous vesicles, is very well developed, and a large number of microtubules are distributed between the supranuclear and apical cytoplasm. In addition to these, many small vesicles, some of which are fused with the plasma membrane, occur in the apical cytoplasm. These vesicles, which may be derived from the Golgi apparatus, are considered to be necessary for the apical plasma membrane, because the protrusion of cilia requires additional plasma-membrane substance during their differentiation and development. The microtubules, some of which are connected with these vesicles, might play some role in the movement of these vesicles from the Golgi field to the apical cytoplasm. When colchicine is administered to suckling mice, formation of microtubules is blocked in the upper part of the ciliated cell, and the apical vesicles disappear. This also indicates that the microtubules bring the vesicles from the Golgi field to the apical region of the cell.


Sarcoplasmic reticulum and intracellular calcium localization at rest and during contraction in Mytilus smooth muscle.

The fine structure of the sarcoplasmic reticulum (SR) in the smooth muscle of Mytilus and the localization of intracellular calcium at rest and during acetylcholine-induced contraction were studied using the pyroantimonate-osmium (PAO) technique. 1. The SR showed vesicular and tubular elements which were alternately interconnected along the axis of the fiber. Transverse components were sometimes observed. The vesicular elements of the SR formed specialized junctions (couplings) with the plasma membrane. 2. The electron opaque precipitate which formed in the SR, mitochondria and on the inner surface of the plasma membrane after treatment with PAO was proven to be mainly Ca-pyroantimonate by both energy-dispersive and wavelength-dispersive X-ray microanalysis. 3. In muscle fibers treated with PAO shortly after the peak of contraction, the SR was the last site of the three Ca-accumulating sites in which the precipitate was relocalized. This finding suggests that the SR plays a principal role in the regulation of the contraction and relaxation cycle. 4. Fused paramyosin filaments were not observed during the catch state.


Histological study on the prenatal development of the cheek-teeth of rabbits (Oryctolagus cuniculus).

The prenatal development of cheek-teeth of rabbits was studied by histological methods. Females from 15 to 30 days of gestation were sacrificed and their fetuses were collected and decapitated. The heads were fixed in buffered neutral formalin and paraffin embedded. Sagittal and frontal sections of 7 mu were obtained and stained with hematoxylin-eosin. The first tooth-germs observed were the m3 and m3, in the animal of 16 days of fetal life. One day after the m4 and m4 are observed in the bud stage. The last teeth to initiate development in the fetal rabbits are the M3 and M3 at 30 days. Only the m3, m4, m3 and m4 start cementogenesis in the prenatal stage.


Disappearance of the difference between adrenal A and NA cells in the level of radioactivity after 3H-dopa injection in the hypophysectomized mouse.

Radioactivity in adrenal medullary chromaffin cells of the mouse was examined by autoradiographic methods 15 min to 1 hr after an intraperitoneal injection of 3H-dopa. In the normal control mice, the concentration of radioactivity was significantly higher in the A cells than in the NA cells, whereas in the hypophysectomized mice (9 days after operation by the transauricular method) the radioactivity was evenly distributed in the two cell types. It was suggested that both A and NA cells possessed a special trapping and concentrating mechanism for extracellular dopa and/or its metabolites and that the activity of this mechanism was made greater in the A cells than in the NA cells by the pituitary gland.


Ultrastructural and cytochemical studies on the matrix vesicle calcification in the teeth of the killifish, Oryzias latipes.

Tooth germs of killifish were examined by both ultrastructural and cytochemical methods. The ultrastructure of the dentin in the early calcification stage of its development resembled that of mammals. Numerous extracellular membrane-bounded vesicles, matrix vesicles, were seen in the predentinal space, especially abundantly in the basal portion of the tooth germ. They were more numerous and more uniform in appearance than in any other higher vertebrates. Where calcification was going to start, slightly identifiable needles of apatite crystals were found in the vesicular structures. Crystals increase in number filling up the vesicles and then ther surroundings, finally to form many calcified spherules. Where calcification was more extensive, the matrix vesicles were no longer visible having been buried calcified among spherules. Contrary, to popular belief, there was no relationship seen between collagen fibrils and the initial deposits of minerals, that is, collagen fibrils did not seem to work as the initial site of calcification. Instead, matrix vesicles and plasma membranes of odontoblasts likely were involved in calcification as they both showed alkaline phosphatase activity. The ultrastructural and cytochemical findings from this study thus indicated that calcification of the killifish tooth germs was initiated not in the enamel, but in their dentin by the matrix vesicles which were liberated into the dentin matrix from odontoblasts mainly by way of fragmentation of cell processes.


Freeze-etching observation on the development of intercellular junctions of the duodenal epithelial cells in the chick embryo.

Development of intercellular junctions in duodenal epithelium in the chick embryo was studied by electron microscopy using the thin-section and freeze-fracture techniques. Incomplete tight junctions are already seen in 6 and 7 day old embryos at the apical portion of the lateral plasma membrance, and consist of 1-7 strands, their mean depth measuring 0.2 micron. This corresponds to a "very leaky type" (CLAUDE and GOODENOUGH) of tight junction. Ridges on the PF are discontinuous and rarely cross or link. The tight junctions extend basally at the place where more than three epithelial cells are in contact. On the lateral plasma membrane, particle-aggregates suggesting primitive gap junctions are already recognized. Some are dense aggregations of 3-5 membrane-particles with a halo free of the particles and others are rather loose aggregations of 5-10 particles with an indistinct halo. In 9 day old embryos, the ridges of the tight junction become more discontinuous, although the frequency of the linkage of the neighboring ridges increases. The compartments bounded by the tight junctional strands are angular. These strands become continuous and the facets surrounded by them are roundish in 12 day old embryos. The presumptive immature gap junctions show a characteristic polygonal pattern in 9 day old embryos and gradually increase in size. Mature tight junctions and typical gap junctions of 0.3-0.4 micron diameter are seen after 18 days of incubation. The strands number 6-8 and the depth of the tight junction measures about 0.4 micron in 18 day old embryos. In the chick embryo duodenal epithelium, the tight and gap junctions develop independently from each other without any direct interaction between them.


Effects of vitamin A administration upon Ito's fat-storing cells of the liver in the carp.

In the normal carp livers, Ito cells (fat-storing cells) could be identified with light and electron microscope within the hepatic sinusoidal wall and actually in the Disse's space, but they were almost lacking lipid droplets in the cytoplasm (empty Ito cells) in contrast to the majority of vertebrate species. After administration of large doses of vitamin A, fat droplets appeared in hypertrophic cytoplasm of enlarged Ito cells, and their size and number increased roughly in proportion to the amounts of vitamin A administered. This evidence was thought to demonstrate that the administration of large doses of vitamin A could convert empty Ito cells into lipid containing ones and further suggested that excess vitamin A administered might be stored in newly prepared lipid droplets of the Ito cells of the liver. In experimentally hypervitaminotic carp, hypertrophic Ito cells showed proliferation of fine filaments in addition to the accumulation of lipid droplets. The correlation between perisinusoidal fibrogenesis in the hepatic lobule and proliferation of cytoplasmic filaments in the Ito cells was discussed.


A fine structure study of the non-ciliated cells in the mouse tracheal epithelium with special reference to the relation of "brush cells" and "endocrine cells".

The non-ciliated epithelial cells in the air way of mice were examined by electron microscopy. They are flask-like or pyramidal cells dispersed singly or occasionally in pairs. The apical portion of the cells reaches the air way lumen with microvillous projections. Their cytoplasm always contains abundant and variable numbers of small granules (60-170 nm in diameter). Close appositions between non-ciliated cells and nerve fibers are frequently observed at their lateral or basal surfaces. Fine structures of the non-ciliated cells are similar to those previously reported in the cells under different designations such as brush cells, basal-granulated cells, cells of neuroepithelial bodies and endocrine cells. The present study proposes that these names express different features of the same cell group collectively called "non-ciliated cells" in this paper. Furthermore images indicating exocytotic granule release are obtained in this study, indicating an endocrine function of these cells.


Transmission electron microscope observation of epithelial cells with single cilia in intrahepatic biliary ductules of bats.

Cells with long single cilia arising from basal bodies in the apical cytoplasm were occasionally revealed in the bile ductular epithelia of bats (Miniopterus schreibersi (Kuhl), Myotis macroductylus (Temminck) and Rhinolophus cornutus (Temminck)). The basal body (distal centriole) was associated witha proximal centriole, so the basal structure was of "two centriole type." In cross sections of the long tapering cilia the arrangement of cilary microtubules was determined. In the most proximal portion of the cilia doublet microtubules were arranged in the 9+0 pattern, while in more distal portions alteration and diminution of the doublet fibers occurred, splitting entirely into single microtubuli which were most frequently rearranged in the 6+1 or 7+1 pattern. The occurrence of the 9+0 fiber pattern and the basal structure of "two centriole type" suggested that the biliary ductular cilia might be sensory or chemoreceptive in nature and not motile. Similar cilia are expected to be found distributed widely in the epithelia  of excretory ductal system of large exocrine glands of vertebrate species.


Occurrence of centrioles in interphasic hepatocytes of bat and chicken.

Occurrence of centrioles in non-dividing hepatocytes was examined by electron microscopy in the bat, Miniopterus schreibersi (Kuhl) and Myotis macrodactylus (Temminck), and the chicken. In both species centrioles were mostly found in the apical hyaloplasmic halo which was distinct in the chicken but rather indistinct in the bat. There was no difficulty in locating centrioles in the hepatocytes of either species. In the chicken centrioles were found in the attenuated apical cytoplasmic areas of 4-6 hepatocytes surrounding the bile canaliculus, giving us the impression that the occurrence of centrioles in non-dividing hepatocytes might be more frequent in the chicken than in the bat. The centrioles found in non-dividing bat and chicken hepatocytes apparently formed diplosomes. Neither multiple centrioles (comprising more than three) nor centriolar replications were found. Single cilium formation from the centrioles was not observed in either species.


Bilateral femoral shortening for overgrowth in young adults.

Through 17 years ten patients were treated for psychologically unacceptable tallness by bilateral femoral shortening. All were young adults between 17 and 28 years; one was acromegalic, one had Marfans syndrome and the other were tall for unknown reasons. The amount of shortening obtained was between 6 and 16 cm. One patient was reoperated bilaterally because of insufficient stability of the pin and plate fixation. All patients healed without significant complications. For exclusive cases, which have been carefully observed over several months, bilateral shortening seems to be a safe procedure either with midshaft shortening and Küntscher nailing or subtrochanteric femoral shortening with pin and plate fixation. At review all patients were satisfied with their decision to be surgically shortened. Similar cases seem not to have been published.


Osteotomy of the patella in chondromalacia. Preliminary report.

There are many factors involved in the aetiology of chondromalacia of the patella. If possible, the appropriate operative procedure should be chosen for each patient, hence attempting to eliminate the cause of softening of the cartilage. Increased pressure over the lateral facet, with or without reduced pressure over the medial facet of the patella, resulting from lateral positioning or tilting of the patella, the Wiberg/Baumgartl-types III and IV, and the "Hunter's Hat" form are important causes. With reduced pressure, the cartilage is inadequately stressed and consequently receives insufficient nourishment. As the medial facet is particularly thick and has little contact with the femoral condyle, nutritional disturbance is almost a normal occurrence. Longitudinal osteotomy of the patella has been found to improve the contact of the medial surface of the patella with the femoral condylar groove. The analgesic effect of this surgical procedure may derive from the resultant reduction in subchondral interstitial pressure, presuming that the pain in chondromalacia patellae, like that of osteoarthritis, is a manifestation of raised intramedullary pressure. To ensure an improvement in patellar tracking the osteotomy is combined with a lateral capsular release.


The influence of oestrogen on bone metabolism.

The literature concerning the effect of oestrogen upon bone metabolism is reviewed. Studies both in man and in laboratory animals have been considered. It is concluded that the most constant effect of oestrogen upon bone in man and most other mammals is reduced bone resorption. However, in man and most mammals the bone accretion rate is also  reduced as a result of oestrogen influence. Previous studies reporting stimulated bone synthesis produced by oestrogen seem to be unreliable in the light of research of recent years. Thus oestrogen seem to produce an overall slow-down of bone metabolism.


Experimental osteotomy fixed with a composite resin.

Some composite resins used in dentistry are claimed to have qualities superior to those of the commercial bone cements. A bis-GMA composite resin was used for the fixation of experimental tibial osteotomies in rats. The osteotomies were fixed with bis-GMA in 84 rats, while intramedullary nailing was used in 28 rats. In 28 rats used as controls the osteotomy was left unfixed. Radiologic, histologic, microradiographic and oxytetracycline (OTC) fluorescence studies were performed after 1,2,3,6, 12, 18 and 24 weeks. The most favorable results as regards the healing of osteotomy were obtained in the intramedullary nailing group, but the results with bis-GMA fixation were more favorable than those obtained in the untreated group. It is concluded that the material employed is suited for the fixation of osteotomies and that the bone tolerated the tested material well.


A composite resin as an implant material in bone. Histologic, radiologic, microradiologic and oxytetracycline fluorescence examination of rats.

The potential of a bis-GMA composite resin as implant material in bone is evaluated. The material is claimed to have mechanical and physical properties superior to those of the bone cements used today. A groove made in the cortex of the tibia in 18 rats was filled with bis-GMA, while a similar groove was left empty in the contralateral tibia. The reaction of the bone to this material was evaluated by histologic, radiologic, microradiographic and OTC-fluorescence methods. The material was well tolerated by the bone; after 1, 3 and 6 weeks no reaction to the material was observed.


Non-metallic fixatives in orthopedic surgery. Some aspects of their present and future properties.

Some materials obviously possess bone fixing properties and may hence be used in anchoring prostheses to the bone, in filling bone defects and even in the fixation of fractures. The commercial bone cements are an example of materials already used today, and their development and basic properties are known. Some newer materials, which seem to possess bone fixing properties of a different kind are also, described. The polycarboxylate cements used in dentistry adhere to bone and metals by complex formation. Some hydrophilic materials, which absorb water while setting, have a self-locking capacity. Very strong composite resins can be obtained by mixture of suitable materials. A firm fixation may result from the growth of bone into some porous materials implanted into bone. Biodegradable products disappear from the tissues after some length of time, thus allowing healing to take place by a normal regenerative process. It is concluded that newer and better cementing materials are needed and that such materials may be expected soon to become available.


External fixation. Classification and indications.

The conclusion from the above clinical and experimental presentation is that stabilization by using external fixation in problematic cases is the method of choice because the risk of infection is better than by using the standard methods of plating and nailing. Using external fixation based on the tubular system of ASIF we can achieve rigid stability. Correct application allows early mobilization ensuring alignment even in bone defects. This method of treatment also facilitates the care of wounds. Our experimental and clinical information provides us with the opportunity to offer a systematic classification of each individual type of external fixation and its merits, as described above in types I, II, and III and its application in different situations. Our clinical experience also shows that external fixation has greatly reduced the risk of amputation in these problematic cases, but it has not solved all the problems associated with the primary injury. The advantage of the three-dimensional external fixation type III can also be seen in the case of arthrodesis of the knee joint. Here there is a better neutralization of the bending moment, than by using type II. Finally we would like to emphasize that the external fixation is not the panacea for every problematic case and each surgeon should be well aware of its methodical and correct application, as abuse of external fixation may lead to secondary complications.


[Comparative experimental investigations with bioglass (L. L. Hench) and Al2O3-ceramic coated with mod. bioglass. II. Results of experiments with loaded implants (author's transl)].

This report is based on 4 comparative experimental series is sheep using a cementfree total hip replacement model. Basically a smooth stem design was compared to a step stem design for biomechanical interlocking anchorage. Both designs were implanted as pure high density Al2O3-ceramic components and as Al2O3-ceramic parts coated with Bioglass or Bioglass-ceramic (post op. follow up 13 months, 17 animals). None of the 4 stem modifications showed a tendency for permanent stabilisation or bonding in bone. Besides insufficient bonding of the glass coatings to the substrate and apparent biodegradability of the bioglass coatings in the body, insufficient biomechanical knowledge of endosteal direct anchorage of prosthetic devices is the main reason for failure in these experiments. An exclusive biochemical way of anchoring prosthetic parts in the marrow cavity is rejected. The results presented are discussed in the light of the recent literature.


[Experimental studies of autograft with cancellous bone in the diaphysis of long bone (author's transl)].

The acceptance of fresh autologous cancellous bone in a wedge-shaped diaphysial cortical defect was examined in 2 groups of 5 dogs microangiographically and histologically 1,2,3,4 and 6 weeks after transplantation. The main recanalisation takes place after one week from the medullary canal, two weeks later periosteal vessels are connected and finally three weeks later the tender vessels of the Haversian canal system within the cortex are being integrated. Histologically, after one week active formation of fibrous bone can be seen adjacent to numerous capillaries originating within the medullary canal. Simultaneously, considerable degradation of transplanted trabeculae by mono- or polynuclear osteoclasts takes place. Formation of new bone occurs according to newly built capillaries. After 4 weeks, transplanted trabeculae can be found only sparsely, the new fibrous bone is being remodelled into lamellar bone. After 6 weeks, the entire fibrous bone has been transformed into lamellar bone and is calcified. A trajectorial orientation of the Haversian system according to that of the host cortical bone can be recognized vaguely.


Traumatic single facet subluxation of cervical spine without neurological damage. A new clinical sign.

The vast majority of injuries to the cervical spine, unaccompanied by neurological deficit, escape diagnosis because of the minimal clinical symptoms associated with such injuries. For the same reason many of those who consult their doctors following such injuries, are not adequately investigated. This article presents a new clinical sign to recognise a certain type of cervical spine injury, and a simple way of documenting the observations. It is proposed that in the presence of this sign, adequate radiological investigations must be deemed mandatory to exclude bony injury to the cervical spine.


Hypercalcemia in children with spinal cord injury.

Eighty-seven children less than 16 years of age with recent spinal cord injury were studied during a 7-year period (1970--1976). Serum calcium concentration was determined at least once in each of 76 of these patients, and in 18 (23.6%) it was above 11 mg%. Fifteen of the 18 patients had quadriplegia and 3 had paraplegia. In 5 patients, the first symptoms of acute hypercalcemia simulated those of an acute abdomen. Two of the 5 patients underwent exploratory laparotomy, with negative findings. The incidence of urinary stones was 55% (10 of the 18), a difference from the control population of only 18%. Hypercalcemia in the acute phase was almost always accompanied by decreased renal function characterized by inability to concentrate the urine and low corrected creatinine clearance. The treatment with saline infusions and furosemide was usually effective.


Calcium balance in paraplegic patients: influence of injury duration and ambulation.

Calcium metabolic balance determinations, which have been done in various clinical and experimental conditions, were applied to the study of 8 spinal cord injured patients receiving a diet with 1600 mg calcium and 85 to 120 gm protein daily. All of the patients had hypercalciuria prior to ambulation. Those with spinal cord injuries of less than 3 months duration (early group) had a calcium balance of -27 mg before ambulation and 235 mg after ambulation. Patients with spinal cord injuries of 6 months or more duration (late group) had calcium balances of 55 mg before ambulation and 175 mg after ambulation. Ambulation significantly decreased the hypercalciuria and modified the calcium balance in a positive direction. Smaller changes were noted in the responses of the late group than in those of the early group. Early ambulation will probably prevent bone loss, calcium stones in the genitourinary tract, and other sequellae of negative calcium balance.


Electromyogram-gas cystometrogram: its use in the management of neurogenic bladder of spinal cord injury.

The electromyogram (emg)-gas cystometrogram was used to study spinal-cord-injured patients with indwelling catheters before trial of voiding (TOV) to remove an indwelling catheter. Twenty-four patients were studied during 27 consecutive admissions. A coaxial needle electrode was placed in the external urethral sphincter. The output of a cystometer was simultaneously recorded on the emg printout so that the relationship of the shpincter response to distention of the bladder could be observed. Of 10 patients without bladder contractions, 7 had active urethral sphincters and 6 of these failed to achieve less than 50 ml residual thereby failing the TOV. The seventh patient succeeded in the trial and on subsequent study was found to have developed bladder contractions with a coordinated bladder-sphincter synergy. The 3 patients without bladder contractions or sphincter activity succeeded in their TOV using Credé's method. Seventeen patients with bladder contractions were divided into synergic, nonsynergic and partially synergic patterns. The 3 patients with synergic patterns succeeded in their TOV. Thirteen of 14 nonsynergic or partially synergic patients failed the TOV. The 1 nonsynergic patient who succeeded had bladder contractions of 70 cm of water compared to a mean of 28 cm of water for all other patients with bladder contraction. The emg-gas cystometrogram was helpful in selecting those patients who were successful in removing the Foley catheter. Important factors governing success in the multiple effort trial of voiding were the amplitude of the detrusor contraction, the presence of detrusor-sphincter synergy and the presence of a flaccid sphincter.


Urinary bladder smooth-muscle electrical activity: response to atropine and bethanechol.

Fourteen patients with spinal cord injuries and lower motor neuron type neurogenic bladders and 12 patients with upper motor neuron type neurogenic bladders and spinal cord injuries, were evaluated before and after bethanechol or atropine, respectively. They were compared with 5 patients with benign prostatic hypertrophy or bladder tumors but without neurologic disease. Both drugs were found to modify partially smooth-muscle response. The implications of these results are consistent with the production of electrical activity by the smooth-muscle cells of the bladder wall.


F wave evaluation of thoracic outlet syndrome: a multiple regression derived F wave latency predicting technique.

To assess the occurrence of a neurologic verus a vascular component of thoracic outlet syndrome (TOS), ulnar nerve function via the F wave was studied in 16 patients with clinically diagnosed TOS and 38 control subjects. To simplify the procedure the following formula was developed, through multiple regression analysis, which can predict the ulnar F wave latency in an individual: [arm length (cm) x 0.31] minus [ulnar nerve forearm velocity (meters/sec) x 0.123] plus [11.05]. The mean plus 2 standard deviations, the maximum acceptable prolongation above the predicted value, is 2.5 msec. This formula can be used for assessment of any ulnar nerve conduction defect. Using this technique, some patients with clinically diagnosed TOS were shown to have slowed conduction of the ulnar nerve through the thoracic outlet.


Gastrocnemius muscle belly and tendon length in stroke patients and able-bodied persons.

Length changes of gastrocnemius muscle belly and tendon at different passive tensions and ranges of motion (ROM) were measured in 31 healthy persons and 15 hemiplegic patients with clinically demonstrated ankle joint plantar flexion (PF) contractures. Preliminary studies were done to obtain accurate determination of gastrocnemius muscle insertion and origin points on x-ray films, to calculate the magnification factor due to x-ray beam divergence and to measure the length changes in muscle belly by the use of a wire hook placed at the muscle-tendon junction. Our results revealed: (1) change in length at different passive tensions is in the muscle belly, not in the tendon, (2) in hemiplegic patients no statistical difference in elongational characteristics of affected gastrocnemius muscle bellies with clinically demonstrated ankle PF contractures and of the contralateral nonaffected muscle bellies, (3) spastic and flaccid gastrocnemius muscle bellies are not statistically different in respect to passive elongations, (4) gastrocnemius muscle bellies of both affected and nonaffected legs of hemiplegic patients were statistically different from the muscle bellies of healthy persons in regard to maximal ROM and maxinum muscle belly length changes, (5) there was approximately .5 mm change in the belly length for each degree of ankle ROM, (6) age is not a factor influencing passive elongation of muscle belly, (7) average muscle belly lengths were consistently shorter in hemiplegic muscles while their tendon lengths did not change.  The enumerated findings suggest that the limitation of ankle ROM in spastic hemiplegic legs obtained by the standard clinical measurements technique represents a change in muscle belly rest length without a structural contracture of the muscle fibers.


Cerebellar electrical stimulation: a critique.

Cerebellar electrical stimulation has been advocated as a beneficial treatment device for improving function in cerebral palsy, but a review of the literature raises questions as to its efficacy and safety. Evaluation of one reported study showed that only 32% of people with implanted cerebellar stimulators had significant improvement in function. This is in contrast to 68% to 92% improvement levels claimed by advocates of the procedure. There is evidence of potential long-term damage to the cerebellum from the device. Further studies are indicated, following the criteria established by the 1976 Medical Device Amendment to the Drug and Cosmetic Act dealing with medical device regulation and control.


Fibrous muscular contractures: treatment with a new direct contact microwave applicator operating at 915 MHz.

A patient having bilateral contractures of the rectus femoris and brachial biceps muscles due to pentazocine injection was treated with a regime of heat and stretch. Heat was provided by a new air cooled direct contact applicator operating at 915 MHz. Stretch was applied by adding weights to a cable which was attached to the arm or leg to be stretched. While the left and right elbows which were limited by the contracted biceps were not stretched sufficiently to achieve a normal range of motion, the rectus femoris muscle on both sides did achieve a normal range of motion.


Background and sexual experience of Israeli medical students.

It is now general professional consensus that to develop a good human sexuality curriculum it is mandatory to first study the future target population, Such a study was done on a national basis at the four medical schools in Israel, concentrating on the senior students. The data on background, sexual experience, knowledge, and attitudes were analyzed and compared to findings of similar studies in other countries. This article reviews the results on background and sexual experience, also trying to analyze logical hypotheses of possible links between variables. Most Israeli senior medical students are unmarried Jewish Ashkenasi males, with a rather small proportion of females, Sephardic-originated Jews, Moslems, and Christians. Their sex education during childhood originated mostly from peers and literature, but was almost completely lacking at school. Masturbation started early, being more frequent for males. The majority of both sexes had dated, had gone steady, and had had sexual intercourse frequently with at least two partners. Only 5.4% of males had never experienced coitus. Intercourse with prostitutes was infrequent. The students' background has direct influence on their early sexual knowledge and experience. This in turn influences self-ratings on sexual matters. This is further correlated with sexual behavior.


Female self-report and autonomic responses to sexually pleasurable and sexually aversive readings.

This study was designed to investigate possible differential autonomic responses to sexually pleasurable and sexually aversive readings. Reading conditions were counterbalanced so that an equal number of subjects received both orders of the two readings. Female subjects' ratings, skin conductance (SC), finger pulse (FP), and heart rate (HR), in response to these readings were compared. The sexually pleasurable as compared to the sexually aversive passage was rated as more sexually stimulating, less anxiety and guilt provoking, and less disgusting, but as equally well portrayed and interesting (extent of boredom). While essentially equal SC increases were noted in response to both readings, HR deceleration and vasodilation were more characteristic of the response to the sexually pleasurable passage. These findings were compared within the context of preexperimental setting conditions and were interpreted in terms of Lacey's intake-rejection hypothesis. These findings are consistent with the idea that pleasurable sexual readings are associated with interest, attention, and heart rate deceleration, whereas aversive material may be related to rejection of the material and to heart rate acceleration.


Marital sexual enjoyment and frustration of professional men.

The psychological maturity, interpersonal, and marital attributes associated with the sexual pleasure and frustration of 59 married professional men, who had also been studied as adolescents, were examined by means of 10--12 hr of psychological tests, questionnaires, and interviews. The men's wives, closest friends, and colleagues also completed questionnaires about them. Masters and Johnson's hypothesis was confirmed that sexual pleasure is enhanced in psychologically mature and healthy men whose interpersonal relations are mature, whose relations with their spouses are marked by mutuality in fulfillment of each other's needs, and whose marriages are happy and satisfying. Increasing sexual frustration was associated, although not so consistently, with psychological unhealthiness, interpersonal immaturity, inadequate marital communication, and marital unhappiness. Degree of adult sexual pleasure and frustration was not reliably predicted by adolescent peraonality traits.


Age differences in attitude change toward premarital coitus.

Research on changes in attitudes toward premarital sexual behavior examine either (1) changes in attitudes of college students over a relatively short period of time or (2) changes in attitudes of adult nonstudent populations over long periods of time using noncomparable data sources. The present research examines changes in attitudes toward premarital coitus over a relatively short period of time utilizing national probability samples of the U.S. population. Rather than treating age as a dichotomous variable of the young and the old, age is considered in 10-year age groups, and changes by age group and sex are examined. The results indicate obvious dangers in employing gross breakdowns of the age variable in that considerable differences within young and old age groups are observed. Further, these difference interact with sex, producing sex- and age-specific change patterns. The exact nature of these patterns strongly suggests that the most rapid change is taking place among females in the 30--39 age group and that this change is such to produce intersex convergence in this age group. Rates of change by age and sex are discussed in terms of the possible differential influences of changes in women's roles.


Pseudohomosexual psychosis in basic military training.

The emergence of homosexual anxieties in heterosexual males following a severe blow to masculine self-esteem has been termed "pseudohomosexual" by Ovesey and has been shown to reflect sexual dependence and power conflicts. This article extends the concept, described largely in neurotic patients, to psychotic reactions occurring in basic trainees following failure to adapt to military life. The military setting is viewed as a culturally specific stress for emergence of pseudohomosexual anxieties in predisposed individuals. Case studies illustrate the power and dependence conflicts, sexual symbolization, projective defenses, and restitutional violence which characterize these patients. The pseudohomosexual psychosis defends the patient against perceiving his inability to effect separation from mother, bear the object loss, and attain cultural manhood.


The anomalous behaviour of dimethyl phosphates in the biochemical test for delayed neurotoxicity.

Several dimethyl phosphate behave anomalously in tests for delayed neurotoxicity. Doses given to hens caused high inhibition of brain neurotoxic esterase (NTE) but no ataxia. Less inhibition of NTE was seen in spinal cord than in brain. Di-isopropyl phosphorofluoridate caused equal inhibition of NTE in brain and cord. When dosing with dimethyl phosphates was repeated NTE  inhibition in cord increased and pair-dosed birds became ataxic. In vitro brain and cord NTE were indistinguishable but the in vivo discrepancy between inhibition of brain and cord NTE was matched by a similar discrepancy in inhibition of AChE. It appears that ataxia arises from inhibition of spinal cord NTE and that only in the present cases (among about 200) was the effect in brain not a perfect biochemical monitor.


Transformation and action of metrifonate.

Chemical formation of dichlorvos (2, 2-dichlorovinyl dimethyl phosphate) was found to occur in mouse brain after i.p. injection of metrifonate (2, 2, 2-trichloro-1-hydroxyethyl dimethyl phosphonate). A mass fragmentographic technique was used. Different isotopic variants were used both as internal standards and to compensate for dichlorvos formed during the workup procedure. The dichlorvos formed in vivo was found to have its maximal concentration a few minutes after the maximum of the metrifonate itself. The effect of metrifonate and dichlorvos on acetylcholine levels, acetylcholinesterase activity and synthesis rate of acetylcholine in mouse brain was also studied. In all three cases the effect of metrifonate was found to be prolonged and delayed as compared to the effect of dichlorvos. It is concluded that metrifonate acts as a slow release formulation in the body giving rise to dichlorvos nonenzymatically. This circumstance at least partly explains its efficacy in the treatment of schistosomiasis.


Regional pre- and postganglionic sympathetic activity during experimental paraoxon poisoning.

The effects of 0.4 or 0.8 mg paraoxon/kg i.v. on circulation and regional pre- and postganglionic sympathetic activity were studied in anaesthetized rabbits. At both doses, the discharges of the preganglionic efferents increased slowly, whereas the changes in activity of postganglionic efferents differed. Concomitantly with a transient initial rise in blood pressure a temporary increase of discharges to the skeletal muscles and to the intestine was observed which is attributed to spontaneous firing of the regional ganglionic cells. After injection of 0.4 mg/kg there occasionally occurred a second pressor reaction conditioned by enhancement of preganglionic activity and facilitated transmission in certain sympathetic ganglia. After injection of the higher dose, postganglionic activity generally decreased except for the discharges of gastrointestinal efferents, which increased. Arterial blood pressure, cardiac output and total peripheral resistance fell markedly. A shock syndrome occurred which could be controlled by atropine injection if timely. From the results it was concluded that the higher dose of paraoxon blocked synaptic transmission in the paravertebral ganglia of the sympathetic trunk, and facilitated impulse transmission in the prevertebral abdominal ganglia.


Distention ulcer as a model for testing of drugs for ulcerogenic side effects.

A modification of the distention ulcer was studied in albino rats and a new possibility of testing ulcerogenic side effects of drugs was described. The distention alone was not sufficient to produce lesions. The severity of ulcer lesions was highly dependent on the volume of the acid solution. Large volumes of 0.1 N HC1 evoked severe ulcers within 1 h. Small amounts of weak acid solution did not cause any ulceration. Anti-inflammatory drugs administered in therapeutic doses, which did not yet produce any ulcers in animals, increased the sensitivity of the gastric mucosa against the aggresive factor, the acid. In animals pretreated by anti-inflammatory drugs in toxic doses an earlier development of ulceration was observed by distention with acid. Stress also accelerated and aggravated the formation of distention ulcers.


[Density of receptor neuron nuclear membrane pores during the early ontogenesis of Gallus domesticus L].

In 10, 14, and 18-day-old embryos, as well as in 3, 14 and 30-day-old chickens, neurons of cerebrospinal ganglia have been studied electron microscopically. A method for quantitative evaluation of pores in nuclear envelope by means of estimating pore density index (PDI) has been suggested. By methods of regressive analysis it has been stated that neuronal development and differentiation in the cerebrospinal ganglion at embryonal and early postnatal ontogenesis of Gallus domesticus are accompanied by a regular increase in density of pores per stipulated unit of the nuclear envelope area. During the studied period of the hen ontogenesis, PDI has a characteristic exponential dependance. A suggestion is made to use the index of the pore density as a criterion for estimating functional state of the receptor neuron.


[Hormones and differentiation of retinal ganglion cells during embryogenesis of mice of the mutant line ocular retardation (karyometric study)].

Hormonal effects on differentiation of neuroblasts forming the ganglionic zone have been studied in hereditary damaged ocular retina of mice from the mutant line "ocular retardation" (or). By the method of karyometry, it has been demonstrated that injection of cortisone, triiodethyronine and somatotropic hormone on the 8--9--10th, as well as on the 11--12--13--14th or on the 9--10--11--13--14th days of gestation produce statistically significant volumetric decrease or increase of the ganglionic cell nuclei in the retina of 15-day-old embryos or/or. The data obtained and those from the literature suggest that the hormones mentioned above, depending on the dose and prenatal stage in the or/or mice, increase or decrease the inhibiting effects of the mutant gene or on the differentiation of ganglionic cells of the ocular retina in embryos.


[Morphologic study of rat adrenals following flight aboard biosatellites "Cosmos-605" and "Cosmos-782"].

Dynamics of morphological changes of the rat adrenals was investigated on the first day and 25--27 days after a prolonged exposure to weightlessness. Analysing the general histological picture of the adrenal cortex during the first hours of the flight (presence of a subglomerular sudanophilic layer and distinct zones in other cortical parts), it is possible to conclude that by the completion of the flight the cortical substance has reached a definite degree of normalization, hence the animals have adopted to the flight conditions. Morphological signs of elevated functional cortical activity 9--11 h after the flight, such as enlarged nuclear volume of the fascicular zone cells and delipoidization of the internal parts of the cortex could be treated as manifestation of an acute stress-reaction developing in the animals after landing. Evaluating morphological manifestation of the acute stress-reaction observed in animals at transition from weightlessness to the earth level of gravitation, it is possible to conclude that there are no signs of depletion in the adrenal cortical function and hence, adaptive possibilities in the organism are preserved after a prolonged exposure to weightlessness.


[Adrenergic and cholinergic innervation of the kidneys in several mammals].

In dogs and some other mammals, the major neuronal sources for plexus renalis, distribution, architectonics and topographic interrelations of intrarenal neuronal plexus were studied. Adrenergic nerve fibres were revealed by the luminiscent histochemical technique; cholinergic--by the cytochemical method for acetylcholinesterase identification. Peculiar patterns of the intrarenal adrenergic and cholinergic neuronal plexus around the preglomerular arterial bed (main periarterial and adventitial plexus), innervation of efferent arterrioles and vasa recta are described. The system of fine varicous fibres forming neuronal plexus in the marginal zones of the connective tissue and at the cortico-medullar border, that of cortical tubes, venous, pelvic and fibrous capsule innervation of the organ are considered. Some species differences are discovered. The data obtained are compared with those from literature and discussed in terms of functional neuromorphology.


[Comparative histochemical characteristics of the secretion of superficial gastric epitheliocytes].

Comparative histological investigation of the gastric pavement epitheliocytes in a number of species (amphibia, reptile, birds, mammals, man including) has demonstrated that in amphibia, protective function of the stomach is connected with the presence of a certain neutral carbohydrate component in its secrete. In reptiles, the barrier function is performed by the neutral carbohydrate component and sialosaccharides, in birds, besides the carbohydrates mentioned, sulphosaccharides, as well. Histochemical properties of the mammal stomach as a barrier are determined by phylogenetically dependent peculiarities of food specialization.


[Histochemistry and choline acetyltransferase in cat spinal cord and spinal ganglia].

Cytochemical activity of choline acetyltransferase has been studied in the pericaryon of motor neurons of the spinal enlargement and sensitive neurocytes of the intervertebral ganglia in the cat by means of Burt's method. It has been demonstrated that cytoplasm of all motor neurons positively reacts with acetyl KoA. According to the activity of choline acetyltransferase, four groups of neurons have been determined. In cerebrospinal ganglia, the enzyme is present in 58% of pseudounipolar cells, which seem to be cholinergic neurocytes. It has been stated that for all nonspecific reactions the presence of massive and dense residue in all the neurons, walls of small blood vessels and sometimes in astrocytes is a characteristic feature.


[Circadian rhythms in the functional activity of rat brain capillaries].

Diurnal density of the capillary network and the activity of butyrilcholinesterase and alkaline phosphatase in the capillary wall of the rat medulla oblongata and mesencephalon have been studied. Maximum activity of butyrilcholinesterase has been stated to be in the day time (12--15 a. m.) and minimum--at night (24 p. m.). In the activity of alkaline phosphatase two peaks are noted: in the morning (9--12 a. m.) and in the evening (21 p. m.). Decrease in the activity of the two substances is observed at 24 p. m. Since these two enzymes participate, to a certain degree, in metabolic and barrier function of brain capillaries, a conclusion is made on diurnal fluctuations in the level of the brain capillary blood circulation. It is recommended to take into account the circadian rhythms of the capillary blood circulation while investigating brain capillary circulation in practice.


[Structural organization of the palatal salivary glands of rats according to the results of stereological analysis].

By means of semi-thin serial sections and by the method of plastic reconstruction, the palatal salivary gland have been structurally analyzed and some objective data have been obtained on spatial organization of identical glandular complexes which make a component part of the lobule and are known as adenomeres. In the adenomere, several interconnected glandular components are distinguished, the terminal sections, acini comprising the most numerous group among them. An individual acinus is integrated in the adenomere not as its autonomic member but as its intrinsic part. The structural-functional unit of small salivary gland, with the palatal gland being their most representative group, are supposed to occupy the highest level in their structural organization.


[Circulatory bed of the small intestinal villi of newborn infants].

By a complex approach, the injection technique, the non-injective method of impregnation after V. V. Kuprianov and some histological methods including, it has been demonstrated that the terminal villous network is formed by vessels of a single type--capillaries. The capillaries constitute the subepithelial network, with the outflow realized along the postcapillary venules taking their origin from the upper third of the villus. The postcapillary venules, merging at the base of the villus, form the collecting venules which are drainage vessels for the mucosal cripts, as well. The venules flow into the submucosal venous collector. In the connective tissue stroma typical arterioles are absent.


[Structure and blood supply of the heart valves of several domestic and wild birds].

By means of a complex technique some structural and blood supply peculiarities of the valve apparatus have been studied in 118 hearts of 8 representatives of domestic (Anser domesticus, Anas domestica) and wild (Cygnus olor, Cygnus sygnus, Chenopsis atrata, Anser anser, Anas platyrhynchos, Anas strepera) waterfowls. The investigations have demonstrated that in all the waterfowl studied the right atrioventricular ostia have only one cusp consisting mainly of transversal-striated muscular fibers. In the muscular valve, a dense vascular network and elements of the conducting system--Purkine's fibers have been determined. The main bulk of blood vessels penetrate the left atrio-ventricular valve, the aortal and pulmonary stem valves having transversal-striated muscular fibers. A part of vessels can be detected in the connective tissue stroma of the valves. In wild birds, the valve cusps possess more powerful bundles of muscular fibers and a much denser capillary network.


[Structure of the elastic framework of the walls of major human arteries].

By the method of raster electron microscopy, the structure of the elastic carcass in the human aortic arc walls and the common carotid arteries were investigated at the age of 30--40 years. Preliminary preparation of vessel samples helped to reveal elastic structures with the preserved interconnections. Peculiar features of the elastic carcass components in the sheaths of the vessel wall were demonstrated. The fenestrated membranes and elastic plexus were found to be interconnected and form a single structural complex of the elastic formations in the middle sheath of the vessels studied.


[Comparative study of mouse teratoids developed from blastocysts and embryos at the three germ layer stage].

Germs of three stages: blasocyst, three layer germ cylinder, as well as head-fold and neural plate were implanted under the testicular capsule of mice, CBAXC57Bl line. Teratoids developed at the place of implantation are represented by the derivatives of all germ layers, as well as by some organic structures. The method for an experimental production of teratoids by means of transplantation of developing embryos is discussed as one of the methods for experimental histology. At the same time, possible tissue determination in embryos which do not undergo normal gastrulation is considered.


[Correlative relationships between the microangioarchitectonics and histomechanics of the human urinary bladder].

The intraorganic blood bed in the human urinary bladder walls is a multilayer vascular plexus with a morphofunctional specificity of microcirculatory construction in every layer. In the formation of architectonic features and structure of the microcirculatory parts of the urinary bladder wall, is phase activity (alternate filling and emptying) plays an important role. A suggestion is made that large arterial and venous plexus with peculiar constraction presenting in the most important urodynamic sections (in the ureteral orifice and in the ureteral segment of the urinary bladder) perform not only trophic function, but also actively participate in urodynamics of these parts.


[Regional features of the architectonics of the dermal fibrous framework of human skin].

Collagenous carcass of human derma is formed by interconnected fibrils, fibrillar fasciculi, fibers and their fasciculi. The latter form a three-dimentional network or spatial carcass (collagenous dermal pattern) subdivided into three main types (layer-forming, rhombic and complex-looped) and several mixed types of pattern. Every pattern has its own definite topographic-anatomical localization in the human body, depends on the functional loading experienced by every part of the body and is historically connected with the erect posture and labour activity.


[Innervation of the urogenital venous plexus].

The neural apparatus of the urogenital venous plexus is represented by intrafascial perivasal, adventitial and intramural plexus, perivasal and adventitial ganglia. Afferent venous innervation is mediated by the sacral cerebrospinal ganglia. Vegetative plexus of the abdominal and pelvic cavities are the ways of venous innervation in the urogenital plexus. Perivasal plexus and ganglia of the veins in the urogenital plexus localized in the distal sections of urogenital organs in both sex are separated as zones concentrating neural elements and must be taken into consideration when intrapelvic operations are performed. A single nerve plexus of the venous wall in the urogenital plexus is subdivided into perivasal (periadventitial), adventitial and intramural plexus. Receptor venous apparatuses of the urogenital plexus are represented by noncapsulated interstitial nerve terminals.


Neuropsychologic correlates of depth spike activity in epileptic patients.

The statistical properties of depth spiking in the interictal EEG were assessed in 12 patients with intractable temporal lobe epilepsy in whom electrodes had been stereotactically implanted for diagnostic purposes. Prior to the implantation surgery each patient was administered a battery of neuropsychologic tests. Correlational analyses showed that the total amount of depth spike activity (TA) negatively correlated with measures of intelligence, while the laterality of the spike activity (LAT) appeared to be positively related to a memory score and the degree of psychologic independence. The results of this study are consistent with previous findings of a significant relationship between surface EEG recordings and performance. In addition, our data suggest a relationship between specific neuropsychologic functions and the patterns of in-depth EEG epileptiform discharges.


Short-latency somatosensory evoked potentials.

Short-latency components of the somatosensory evoked potential (SEP) were studied in 20 subjects who had median nerve stimulation using knee, forehead, and ear reference recordings. Six potentials were identified (P10, P12, P14, N19, P20, P23). Potential P10 seems to originate in the brachial plexus, P12 most likely is generated in dorsal column nuclei and medial lemniscus, P14 is probably thalamic in origin but is frequently bilobed and may have a second generator source, and N19 may originate in sensory radiation or cortex. The origin of P20 is unclear, and P23 appears to be generated in the contralateral somatosensory cortex. Clinically, we recommend using right, left, and bilateral median nerve stimulation at 4 Hz. Intensity of stimulus should produce at least a small thumb twitch, it was only with knee reference recording that all early potentials were seen.


Clinical and anatomic findings in a case of auditory agnosia.

A case is reported of severe agnosia for verbal and nonverbal sounds in a setting of well-preserved intelligence and transient dysphasic symptoms. The lesions responsible for this disorder were bilateral cerebral infarcts, one of which had virtually destroyed the areas of Wernicke and Broca. The relation between lesions and disabilities is discussed and comparisons made with other published cases.


Malignant optic gliomas in adults.

Malignant gliomas of the optic pathways are uncommon in adults and are rarely diagnosed in life. In three cases of such tumors, the diagnosis was not suspected during life. Neuropathological examination showed involvement of the optic nerves, chiasm, and tracts with extensive involvement of contiguous structures in all of the cases. In view of the consistent clinical features, it is stressed that in adults with progressive visual failure, malignant gliomas of the optic pathways be included in the differential diagnosis.


Pineal tumors. A 53-year experience.

Thirty-four patients with pathologically confirmed primary pineal tumors were evaluated at the Mayo Clinic from 1923 through 1976. All tumors were of germ cell or pineal cell origin. Most patients were adolescent boys with subacute increased intracranial pressure and Parinaud's syndrome. Hypothalamic symptoms were surprisingly infrequent. Direct surgical intervention was associated with high mortality, but has been more successful in recent years.


Peripheral neuropathy in myotonic dystrophy. Relation to glucose intolerance.

Motor nerve conduction velocity (MNCV) was measured in three peripheral nerves in each of 24 patients with myotonic dystrophy having various degress of associated glucose intolerance and was compared with results in a control group. Both groups had similar glucose tolerance and were matched for age and adiposity. The mean MNCV in the ulnar, median, and peroneal nerves in the myotonic dystrophy group were all significantly slowed (P less than .01). This peripheral nerve dysfunction, usually subclinical, is yet another manifestation of this multisystem disease and is unrelated to the associated glucose intolerance.


Familial cavernous angiomas.

Cavernous angiomas are rare, surgically remediable vascular malformations of the CNS that may be characterized by hemorrhage, seizures, or focal neurologic deficits. Three families with cavernous angiomas have been described, and we report two more. In the first, the mother died suddenly with headache. A pontine cavernous angioma was found at autopsy in one son. His brother has similar pontine signs and a radiographically proved pontine mass. The brother's son has seizures and a calcified cerebral lesion. In the second family, the father had a cavernous angioma excised from the caudale. One of the daughters had a hemorrhagic mass removed from the spinal cord. Another daughter has seizures and a temporal lobe vascular lesion proved angiographically. Awareness of the possibility of familial involvement may aid in diagnosis of cavernous angioma.


Thermolability in Wernicke's encephalopathy.

A patient with signs of Wernicke's disease had low body temperature and showed thermolability when challenged with cold and heat. This man expressed no feelings of thermal discomfort about his persistently low core temperature or about induced changes in his core temperature. He also showed abnormalities in his febrile response to pyrogen and in his circadian temperature rhythm. Treatment with thiamine hydrochloride resulted in substantial improvement in these thermoregulatory deficits.


Treatment for patients with cerebral metastases.

To establish the effectiveness of treatment of patients with intracranial metastatic neoplasms, a retrospective study of survival of patients who had surgical excision, irradiation, or chemotherapy was compared with survival of patients who received no treatment. Our results indicate that although any form of therapy was superior to no treatment, no modality was clearly better than another. Furthermore, the prognosis for survival of patients with solitary lesions from a known primary was only slightly better than that of patients with numerous metastases. The prognosis was slightly improved when the cerebral lesion was detected before finding the primary site of origin. These observations should be considered when planning treatment for patients with brain metastases.


Traumatic and postoperative lesions of the lumbosacral plexus.

In 53 cases of injury of the lumbosacral plexus, 31 were due to trauma and 22 followed operations on the hip joint. Post-traumatic lesions occur mostly in conjunction with severe bony injuries, especially fractures of the acetabulum and of the pelvic ring. Nearly always, it is the sacral portion of the plexus that is involved, either predominantly or exclusively. Seventeen of the 22 postoperative pareses followed complete hip-joint replacement. In the postoperative lesions the lumbar plexus portion is most frequently involved. Ninety-one percent of all of our cases were misdiagnosed in previous clinical examinations, that is, as a lesion of the femoral or sciatic nerve, or they were unrecognized because of lack of awareness of the possibility of plexus damage or because the signs were obscured by the associated bony injuries or hip-joint disease. In order to make an exact diagnosis, a detailed electromyographic investigation is necessary.


Informed consent in medical practice. With particular reference to neurology.

Informed consent is a significant ethical as well as medicolegal issue. Both aspects are summarized in this article, which focuses on the major unresolved problems raised by legal and moral analyses of informed consent. The discussion stresses the effects of the doctrine of informed consent on medical practice, with particular reference to problems encountered in the neurological health field.


Child neurology: Amino acid concentrations in cerebrospinal fluid.

Cerebrospinal fluid amino acid concentrations were measured in 16 pediatric patients with febrile convulsions, in 9 with bacterial meningitis, and in 8 noninfected newborn infants. Most CSF amino acids are present in greater concentration in patients with bacterial meningitis than in those without CNS infection. Newborn infants have elevated CNS amino acid concentrations similar to those found in older patients with bacterial meningitis. The reason for increased amino acid concentration in the meningitis group may be due to alterations in brain metabolism, changes in the kinetics of CSF formation, alterations in the removal of amino acids by active transport mechanisms, or a combination of factors. Delayed maturation of transport mechanisms may explain the high levels found in newborn infants.


A neurological model for childhood autism.

We analyze the behavioral and motor disturbances in childhood autism. On the basis of analogy to signs and conditions seen in adult neurology, we propose that the syndrome results from dysfunction in a system of bilateral neural structures that includes the ring of mesolimbic cortex located in the mesial frontal and temporal lobes, the neostriatum, and the anterior and medial nuclear groups of the thalamus. The mesolimbic cortex is cytoarchitectonically, angioarchitectonically, and neurochemically distinct and, along with the striatum, forms the entire target area of dopaminergic mesencephalic neurons. This raises the possibility that autism is related to neuromediator imbalance in those structures. Such dysfunction might be the result of macroscopic or microscopic changes in the target area or in structures functionally influencing them, consequent to a variety of causes such as perinatal viral infection, insult to the periventricular watershed area, or genetically determined neurochemical abnormalities.


Human brain. Cytoarchitectonic left-right asymmetries in the temporal speech region.

The auditory regions in four normal brains were mapped and the full extent of the cytoarchitectonic subdivisions was measured for the presence of right-left asymmetries. It was found that asymmetries similar to those found in the planum temporale (left commonly larger than right) are also seen in auditory cytoarchitectonic area Tpt, and area of probable importance for language function. There is a strong positive correlation between the planum asymmetry and the asymmetry of Tpt. It is concluded that the previously described planum asymmetries probably reflect asymmetries in an auditory cytoarchitectonic area  and therefore may represent, at least in part, the anatomic substrate for language lateralization.


Presenile dementia with Lewy bodies and neurofibrillary tangles.

A 55-year-old man showed progressive mental deterioration over a five-year period along with a syndrome of "normal pressure hydrocephalus." At autopsy the main finding was the presence of two age-related neurocellular changes, the neurofibrillary tangle and the Lewy body, in limbic structures and in the pigmented nuclei of the brain stem. Cortical changes were mild, and senile plaques were not present. Electron microscopy occasionally showed an intimate relationship between the paired helical filaments of the neurofibrillary tangle and Lewy bodies in nerve cell processes in the hypothalamus. The findings suggest a closer relationship between Lewy bodies and neurofibrillary tangles than usually suspected. We also speculate that the presence of one type of age change in the brain may accelerate or predispose to other age changes.


Muscle fiber-type disproportion. Report of a family with symptomatic and asymptomatic members.

Two members of a family have slowly progressing proximal muscle weakness starting from ages 2 and 6 years. Muscle biopsy specimens from these patients, as well as two other asymptomatic members of the same family, demonstrate predominance of type I fibers (without fiber-type grouping) and minimally enlarged type II fibers. In all four cases there was an increase in serum creatine phosphokinase levels, but electromyographic studies were normal. To our knowledge, this family represents a previously undescribed syndrome of type I muscle fiber predominance without a history of "floppy" babies and includes asymptomatic members with similar pathologic changes.


Familial and acquired paroxysmal dyskinesias. A proposed classification with delineation of clinical features.

On a clinical basis the paroxysmal dyskinesias can be classified into two distinct categories--familial and acquired. The former begins in childhood and the dyskinesia may or may not be induced by sudden movements (kinesigenic or nonkinesigenic forms). In the familial kinesigenic form, the movements are brief, usually occur daily, and respond readily to anticonvulsants. This form has an autosomal dominant or recessive mode of inheritance. In the familial nonkinesigenic form, the movements are of longer duration, occur less frequently, and rarely respond to anticonvulsants. This form has a clear autosomal dominant mode of inheritance. The etiology is obscure. The acquired form of paroxysmal dyskinesia has a later onset and is an expression of an underlying neurological or metabolic disease. Some cases of acquired paroxysmal dyskinesia are manifestations of unusual forms of epilepsy. In these cases the differential diagnosis may be extremely difficult and must be based on EEG findings during an ictal episode.


Clinical and computerized tomographic study of hypertensive intracerebral hemorrhage.

Historical, neurological, and computerized tomographic findings were correlated in 32 patients with hypertensive intracerebral hemorrhage. The mortality figures given in standard texts appear to be too high; the more acceptable figure would seem to be approximately 40%. Special attention was given to intraventricular rupture, which complicated 62% of the cases. Sudden onset of coma appears to correlate with the presence of intraventricular rupture. The "ring sign," if looked for, will be seen in most cases of resolving intracerebral hematoma.


Electrical correlates of normal binocular vision.

Several characteristics of the visual stimulus determine the waveform of the visually evoked potential (VEP). Many of them must be controlled for the most efficient application of this technique as a clinical diagnostic test. We describe a simple system that demonstrates the effects of the VEP of adding structure to the stimulus, varying the size and clarity of its pattern elements, and presenting an image to the eye opposite the stimulated eye. We identify wave components of the VEP generated by a flashed pattern that reliably reflect each of these changes in stimulus properties.


Meningeal sarcoma of the spinal cord in a newborn.

In a newborn infant, spinal rigidity and signs of cervical cord compression developed. Myelography suggested the presence of a spinal cord neoplasm, and pathologic studies confirmed the diagnosis of a pleomorphic cellular sarcoma originating from the leptomeninges of the thoracic spinal cord. A review of neonatal spinal cord neoplasms disclosed a high incidence of developmental tumors in this age group and, therefore, the need for early diagnosis, since many of these tumors are amenable to radiation therapy and surgical removal.


Morphological appearance of the healing corneal endothelium.

We studied endothelial cell patterns in both the central and the superior regions of the cornea in 43 cases of cataract extraction and intraocular lens implantation. During the early postoperative period, the central endothelial cells maintained their preoperative appearance. The endothelium within 3 to 4 mm of the superior limbus, however, demonstrated large dark areas where no cell outlines were visible, bounded by large cells. During the late postoperative period, there was an increase in the size and a reduction in the density of the central endothelial cells. In the periphery the previously acellular areas were populated with cells of varying diameter. These changes are consistent with postoperative spreading and sliding of existing cells to cover the traumatized cell-free areas. Central endothelial cell density in the early postoperative period does not accurately reflect the actual degree of cell loss.


Endothelial cell population changes of human cornea during life.

A photo slit lamp was used to obtain color, specular reflex, high magnification photographs of the corneal endothelium of subjects ranging in age from 3 to 88 years. Multiple areas of the cornea were examined to determine the endothelial cell population. No appreciable difference in cell density was found between the right and left eyes of the subjects nor between male and female subjects of similar age. Apparent defects in the endothelial cell coverage of Descemets membrane were found in subjects as young as 20 years of age and with increased frequency in older age groups. These defects were at times associated with variations in endothelial cell populations between the central and peripheral cornea. The average corneal cell population fell from nearly 1 million cells in the first years of life to about one third that number by the eight decade of life.


Ocular injuries from exploding beverage bottles.

Exploding glass bottles filled with carbonated beverages cause serious ocular injuries that have not received adequate attention in ophthalmic publications. All three patients described in this article had corneal lacerations and traumatic cataracts developed. One patient was left with an inoperable retinal detachment. Beverage bottles may explode with normal handling and without provocation. Manufacturing standards have just taken effect that may help to eliminate defective bottles. The addition of plastic sleeves to beverage bottles and the use of plastic shatterproof bottles also reduce the hazard of explosions and high velocity fragments. It is advisable to avoid subjecting beverage bottles to undue heat and agitation and to direct the cap away from the face when opening the bottle.


Cavernous hemangioma of the retina.

Cavernous hemangioma of the retina is recognized as a distinct clinical entity. Although neurocutaneous findings are sometimes associated with these retinal tumors, in most of the cases reported to date, systemic features have not been described. This report describes two patients with cavernous hemangioma of the retina. One had neurologic symptoms and signs that were highly suggestive of a hemangioma of the brain stem, and the other had major congenital cardiovascular anomalies. During a five-year interval, the second patient had spontaneous incomplete sclerosis of the retinal hemangioma.


Subretinal neovascularization associated with fundus flavimaculatus.

Hemorrhagic disciform degeneration centered in the fovea with serous detachment of the overlying neuroepithelium developed in two patients with fundus flavimaculatus. Fluorescein angiography disclosed the presence of subretinal neovascular membranes. There was no evidence of other diseases associated with subretinal neovascularization. Fundus flavimaculatus must be added to the growing list of diseases associated with subretinal neovascularization.


Proliferative retinopathy after treatment of carotid-cavernous fistulas.

The carotid-cavernous fistulas of two young patients were treated by multiple carotid artery ligations. The fistulas persisted, supplied by retrograde flow through the ophthalmic artery. In one patient, neovascularization of the optic disc occurred and, in spite of suspected later spontaneous closure of the fistula, progressed to cause nearly total loss of vision. Spontaneous closure of the fistula also occurred in the other patient, but vitreous hemorrhage due to neovascularization of the retina developed four years later.


Postenucleation orbital implant extrusion.

A new idea helps to explain postenucleation orbital implant extrusion. Implant extrusion is related to would dehiscence followed by conjunctival epithelial downgrowth. A prospective clinical study with pathological data are used to support this concept. A procedure for repair of this problem is described.


Quantitative lacrimal scintillography.

In a study of 100 asymptomatic lacrimal systems, we have found that quantitative lacrimal scintillography provided a sensitive and reproduceable test of canalicular function. This technique, at the present time, appears to have no role in the clinical evaluation of tear passage through the nasolacrimal duct to the nose. A revision of the currently accepted theory of lacrimal drainage is proposed. Lacrimal drainage is best approached as a bimodel system. The first part, from conjunctiva to lacrimal sac, is dependent upon the "lacrimal pump." The second part, by which tears drain from the sac to the inferior meatus of the nose at basal tearflow levels, is dependent on gravity and the resistance of the nasolacrimal duct.


Ascorbate therapy in impaired neutrophil and monocyte chemotaxis. With atopy, hyperimmunoglobulinemia E, and recurrent infection.

A Candida albicans corneal ulcer developed in a 24-year-old man with a history of eczema, asthma, and multiple bacterial infections since childhood. The infection responded well to oral flucytosine (12 g/day for 15 days) and topical amphotericin B. Positive laboratory findings included eosinophilla, hyperimmunoglobulinemia E, and impaired neutrophil and monocyte spontaneous migration and chemotactic responses. Ascorbic acid corrected the monocyte defect in vitro and in vivo, but had no effect on neutrophil function.


Iritis in patients with cutaneous melanoma and vitiligo.

Two patients with cutaneous malignant melanoma, vitiligo, and uveitis are described. The occurrence of vitiligo following cutaneous melanoma is not uncommon and has been interpreted to result from cellular and humoral factors directed against melanoma cells that also destroy normal cutaneous melanocytes. The present cases raise the possibility that melanocytes in the eye as well as the skin may be affected.


Corneal histology after epidemic keratoconjunctivitis.

Two years after typical signs and symptoms of epidemic keratoconjunctivitis developed in a 67-year-old woman, in whom locally effective steroids were not used for treatment, a lamellar graft was transplanted because of marked visual disturbances that were due to corneal opacities. Histopathology of the cornea revealed notable changes in the superficial stroma, including Bowman's membrane, with some lymphocytic infiltration of the stroma and the overlying epithelium. Electron microscopy showed no virus-like particles.


Choroidal melanocytic tumor observed for 41 years before enucleation.

A pigmented choroidal lesion was observed 41 years prior to enucleation. The patient, with a clinical diagnosis of malignant melanoma in an eye with good visual function, was followed up for the last 25 years by one of the authors. Sudden growth of the lesion and loss of vision led to enucleation and allowed histologic confirmation of the diagnosis of malignant melanoma. A pigmented iris lesion in the same eye was also present for 25 years and showed no notable growth under observation. The patient died of metastatic disease approximately one year after enucleation.


Orbital teratoma.

An orbital teratoma with extension into the maxillary sinus, pterygopalatine fossa nasal cavity, and middle cranial fossa is presented. Through combined efforts of the services of Ophthalmology, Otolaryngology, and Neurosurgery, a tumor that was 4.5 cm in greatest diameter was removed, leaving the globe and optic nerve within the orbit. Within the 2 1/2-year period since surgery, the condition of the patient has been satisfactory.


Cystoid macular edema with equatorial choroidal melanoma.

Symptoms and signs related to cystoid macular edema were the initial findings in a patient with a choroidal malignant melanoma located in the equatorial region of the globe. Histopathologic findings included retinal perivasculitis and cystoid macular edema. There was no evidence of a serous detachment of the macula. Patients with cystoid macular edema should be carefully examined for tumors or other pathological findings in the peripheral fundus.


Endothelial changes in rabbit corneas. Observation by specular microscopy during storage in McCarey-Kaufman (M-K) medium.

Corneal banks are beginning to screen donor tissue with a specular microscope to detect abnormal endothelium. To determine the appearance of normal corneal endothelium under storage conditions, the endothelium of healthy rabbit corneas was examined with a modified specular microscope while being stored in McCarey-Kaufman (M-K) medium at 4 degrees C. Black areas within endothelial cells and decreased clarity of the endothelial cell borders were observed during storage and were found to be reversible on warming of the M-K medium.


Clonidine.

Clonidine hydrochloride has been demonstrated to produce vasoconstriction in the anterior segment of the cat eye. The mode of this action has been found to be due to direct stimulation of alpha-adrenergic receptors. In the intact, enucleated, arterially perfused eye, clonidine was found to decrease the rate of aqueous humor production. We suggest that clonidine, like hydroxyamphetamine hydrobromide, phenylephrine hydrochloride, and dopamine hydrochloride, decreases aqueous humor formation by constriction of afferent ciliary process blood vessels.


Staphylococcal keratitis. Experimental model in guinea pigs.

An experimental model of staphylococcal keratitis in guinea pigs was devised that is suitable for quantitative evaluation of therapy. The growth curve in the cornea of a virulent strain of Staphylococcus aureus was determined. The organism multiplied rapidly, reached a peak in about 12 hours, and began to decline in numbers after three days. Infections were relatively resistant to therapy begun 24 hours after infection was established. Treatment started earlier when fewer bacteria were present was more effective than treatment begun later. Treatment begun at the time of infection, which might be considered prophylaxis, was highly effective. When treatment was begun eight hours after infection, tobramycin sulfate and gentamicin sulfate solutions administered topically in doses of 20 mg/ml were more effective than topical bacitracin, erythromycin, clindamycin phosphate, or a solution containing polymyxin B sulfate, neomycin sulfate, and gramicidin. Bacitracin and erythromycin ointments were ineffective.


Lack of association of histocompatibility antigens with primary open-angle glaucoma.

Eighty-seven patients (35 with primary open-angle glaucoma, 20 with angle-closure glaucoma, and 32 controls) underwent HLA typing of peripheral lymphocytes. Sixteen specificities were detected at the A locus, 19 at the B locus, and four at the C locus. No significant differences were found between patients with either type of glaucoma and control patients.


Histocompatibility antigens and primary open-angle glaucoma. A reassessment.

Histocompatibility (HLA) antigen typing was performed on 306 patients who had been studied and classified carefully. Black individuals with primary open-angle glaucoma (POAG) had no significant differences in HLA antigen prevalences from black control subjects. In one white population with POAG, a significant decrease in HLA-A1, a significant increase in HLA-Aw31, and a significant increase in the antigen combination HLA-B7 and HLA-Bw22 were noted. However, these differences were not confirmed in a second white population with POAG. We concluded that associations between the A and B loci of the HLA antigen system and POAG were not as impressive as has been previously reported.


Quantitative visual field and optic disc correlates early in glaucoma.

A retrospective study was made of persons with ocular hypertension and normal initial visual fields. Seventy eyes were followed, and glaucomatous visual field defects developed in 25 of these eyes. In eyes with ocular hypertensio, the area enclosed by the central visual field isopter (I2e) was significantly smaller than that previously reported for an age-corrected group of eyes with normal intraocular pressure. In the absence of glaucomatous visual field defects, isopter areas were not releated to cup-disc ratios. Coincident with visual field loss, reductions in both peripheral (I4e) and central (I2e) isopter areas correlated linearly with increases in the cup-disc ratio. Prior to visual field loss, the I4e isopter area wassignificantly smaller among those eyes destined to lose visual field.


Intraocular pressure and glaucoma in the Zuni indians.

A glaucoma-screening examination was performed on 119 full-blooded Zuni Indians and 286 control subjects who were aged 40 years or older. The mean intraocular pressure (IOP) of the Zuni Indians was significantly lower than that of the control group, adjusted for age and sex differences, in both diabetic and nondiabetic subjects. The control group demonstrated an increasing IOP with age, while the Zunis did not. The prevalence of ocular hypertension was significantly greater in the control group than in the Zunis. The majority of the Zuni subjects with ocular hypertension had diabetes mellitus. None of the Zuni Indians who were screened had primary open-angle glaucoma and none had a family history of glaucoma.


A repeated dose-response study of methazolamide in glaucoma.

Twenty-two patients with open-angle glaucoma were given weekly courses of methazolamide at different dosages. Mean intraocular pressure reductions of 3.3, 4.3, and 5.6 mm Hg were achieved at dosages of 25 mg, 50 mg, and 100 mg of methazolamide every eight hours, respectively. Maximal intraocular pressure lowering was still present nine to ten hours after administration. The mean reduction in outflow pressure for all eyes receiving a daily dosage of 300 mg was only 31%, but this included eyes (17% of the total) that demonstrated less than 13% reduction in outflow pressure, despite similar methazolamide serum levels. Eight patients subsequently received acetazolamide, 250 mg four times a day for a week. The effect of this dosage of acetazolamide on pressure was between the effects of 50 and 100 mg of methazolamide three times daily.


Gastrointestinal therapeutic system for acetazolamide. Efficacy and side effects.

Acetazolamide has been formulated in a new gastrointestinal therapeutic system that delivers the drug at an essentially constant rate of 15 mg/hr (GITS 15/125). We compared the therapeutic effect, magnitude of plasma concentration fluctuations, and incidence of side effects produced by the GITS 15/125 with conventional 250-mg acetazolamide tablets on eight glaucomatous patients randomly assigned to a different regimen each week. One or two GITS 15/125 twice a day (bid) were found as effective in reducing intraocular pressure as one 250-mg acetazolamide tablet. Plasma concentration fluctuations with the GITS 15/125 were decreased, compared with acetazolamide tablets, and, as a result, the incidence of drowsiness, tingling feet, tingling hands, and confusion was substantially reduced.


Argon laser iridotomy on primary angle closure or pupillary block glaucoma.

Scanning and transmission electron microscopy were performed on peripheral iridectomy specimens from seven patients with failed pulsed argon laser iridotomies. Four to seven hours after the laser, severe edema, coagulation necrosis, focal vascular occlusion, and hemorrhage were present. Five days after the laser, cell detritus and collapsed cell processes were noted. Forty-two days after the laser, the anterior iris surface appeared considerably thinned and irregular. Eight and one-half months after the laser, the burn site displayed a dense matted appearance. Two years after the laser, the anterior iris showed a depression with pigment dispersion, irregular stroma, and disruption of the dilator muscle. The lack of inflammation could be due to the use of pulsed argon laser heat delivered at very short intervals, with deep penetration and minimal heat dispersion, since the beam is highly collimated.


False-positive 32P uptake tests.

Three patients had suspected choroidal melanoma and positive results for radioactive phosphorus (32P) uptake tests, leading to enuclearion in two of the patients. No malignancy was present on histopathologic examination. This experience reemphasizes the need for the ophthalmologist to evaluate the total clinical picture and not to give inappropriate consideration to a "positive" 32P uptake test in deciding for or against enucleation in a suspected choroidal melanoma. The positive 32P uptake test, even with high values, cannot be equated with malignancy, and a variety of nonmalignant lesions may give false-positive results.


Adenocarcinoma of the retinal pigment epithelium.

A 57-year-old woman complaining of decreased vision for six months had a mass expanding the choroid inferonasally in the right eye. Clinical examination, ultrasonography, and fluorescein angiography were consistent with a malignant melanoma. The eye was enucleated and pathologic studies showed an adenocarcinoma of the retinal pigment epithelium (RPE). Malignant tumors of the RPE may simulate exactly choroidal melanomas clinically, but apparently have a much better prognosis, in that very few cases have been documented to produce metastatic disease. The vast majority of cases studied histopathologically, in which a diagnosis of adenocarcinoma of the RPE has been made, are low-grade malignant neoplasms with the absence of invasion beyond the choroid or lamina cribrosa at the time of enucleation.


Mucogenic glaucoma and goblet cell cyst of the anterior chamber.

A 25-year-old woman had a unilateral open-angle glaucoma that was initially thought to be caused by an anterior uveitis. A deformity of the chamber angle was noted and interpreted as a peripheral anterior synechia or an old scar. A peculiar haze was noted in the anterior chamber. The intraocular pressure was controlled by trabeculectomy. A slowly enlarging cyst was observed at the site of a previous anterior synechia. Excision of the cyst resulted in clearing of  the anterior chamber haze. The second trabeculectomy specimen contained mucous strands. Problems exist, both clinically and histopathologically, in diagnosing and managing this rare form of secondary glaucoma (mucogenic glaucoma).


Experimental Bacteroides fragilis keratitis.

To determine the corneal pathogenicity of certain anaerobic bacteria, Bacteroides fragilis keratitis was induced in rabbits by the intrastromal inoculation of 10' viable organisms. All eyes inoculated developed central abscesses within 24 hours. Abscesses persisted and became vascularized in two of three eyes that were observed for two weeks, as demonstrated both clinically and histologically. Eyes inoculated superficially with live organisms or intrastromally with solutions of dead organisms did not develop inflammatory lesions. Anaerobically incubated blood agar plates and thioglycollate broth were equally efficient in recovering organisms, although longer incubation times were occasionally necessary to recover organisms from broth cultures. Bacteroides fragilis and other anaerobic bacteria should be considered in the differential diagnosis of bacterial keratitis, and specific methods should be used to recover these organisms.


Traumatic retinopathy in primates. The explanation of commotio retinae.

We have produced experimental commotio retinae in 12 owl monkeys by blunt trauma. The ophthalmoscopic and fluorescein angiographic appearance of this contrecoup lesion is identical to the acute traumatic retinal opacity in humans. We examined these eyes by light and electron microscopy from 4 hours to 12 weeks after injury. Immediately after injury, the only abnormality is disruption of the receptor outer segments. From one to six days after trauma, many receptor cells undergo degeneration. The retinal pigment epithelium phagocytoses the degenerating outer segments, occasionally migrating into the retina. There is no extracellular retinal edema. The opacity of commotio retinae seems to represent disrupted receptor cells. Visual loss may result from permanent loss of receptors. The pigment epithelial response to traumatic receptor damage is similar to that observed in experimental retinal detachment and light-induced retinal damage.