Food sensitivity reported by patients with asthma and hay fever. A relationship between food sensitivity and birch pollen-allergy and between food sensitivity and acetylsalicylic acid intolerance.

Among adult patients with bronchial asthma and/or allergic rhinitis undergoing allergological investigation with skin test, nasal provocation test and RAST, 1129 answered a questionaire regarding food sensitivity (FS). 276 (24%) of the patients reported some kind of allergic symptoms on eating or handling various foods, of which hazel nut, apple and shell fish were the most often named. Females reported FS more often than males. A correlation was found between birch pollen allergy and FS with nuts, apple, peach, cherry, pear, plum, carrot and new potato. The higher the degree of birch pollen allergy, according to skin test, RAST or provocation test, the higher the frequency of FS. A correlation was found too between acetylsalicylic acid intolerance and FS with some foods, e.g. nuts, strawberry, almond, green pepper, hip, chocolate, egg, cabbage, milk and wine. The connection between birch pollen allergy and FS is probably explained by the structural relationship between birch pollen allergen and some allergens of the foodstuffs, whereas the high incidence of FS in acetylsalicylic acid-intolerant patients is probably explained by additives in foods as well as salicylates or benzoates naturally occurring in some food.


Use of RAST technique in wasp sting hypersensitivity. Cross-reactions between various insect antigens are specially considered.

Clinical hypersensitivity to wasp stings was found to be fairly well correlated with the presence of serum IgE-antibodies against yellow jacket venom as detected by the RAST technique. Such antibodies were never found in a control group of non-allergic blood donors, but they were detected in a surprisingly large proportion of patients with bee sting allergy without known allergic reactions to wasps. Studies using RAST inhibition technique failed to prove cross-reactions between bee and wasp venoms. Considerably better results were obtained when venom antigens instead of whole body antigens were used in the RAST. RAST inhibition studies suggested that IgE-antibodies detected with RAST using whole body antigen are directed against bee venom constituents in the whole body extract.


Absolute determination of IgE antibodies to grass pollen allergens.

Knowledge of specific IgE bound on immunosorbent as assayed by RAST is useful but cannot give a complete description of the biological states of patients concerning IgE antibodies. Using a computer program based on a least squares error method and knowing the amount of bound specific IgE antibodies to grass pollen antigens in a serum at each of the four tested dilutions it is possible to calculate the absolute value of specific IgE antibody level, the relative value of affinity constant and the relative proportion of IgE antibodies to the total amount of specific (IgE plus non-IgE) antibodies. It is found that specific IgE antibodies account for high percentages of the total IgE protein (mean of 20%). High differences in affinity constant and in the proportion of IgE antibodies to the total amount of antibodies could be found between sera. Severity of grass pollen allergy could be related to the absolute level of IgE antibody, but no definite conclusion could be made on the importance of affinity constant and the proportion of IgE antibodies to the total amount of antibodies.


Variations of blood eosinophils and eosinophil cationic protein in serum in patients with bronchial asthma. Studies during inhalation challenge test.

Inhalation challenge test was performed in 12 patients with bronchial asthma. The subsequent variation in blood cosinophils and serum-eosinophil cationic protein was followed up. Uniform patterns in both parameters were seen suggesting active participation of the eosinophil leucocyte in allergic inflammation.


Hepatic function and fibrinolysis in patients with hereditary angioedema undergoing long-term treatment with tranexamic acid.

Prophylactic treatment with antifibrinolytic agents, epsilon-aminocaproic and tranexamic acid, reduces the incidence and severity of attacks in patients with hereditary angioedema. Long-term effectiveness or risk of antifibrinolytic agents has not been established. Sixteen patients needing continuous prophylaxis because of frequency and severity of attacks were treated with tranexamic acid. In four patients this treatment was ineffective and the drug was withdrawn after 2 months. A remission or reduction in the frequency or severity of attacks was observed in 12 patients treated for a period ranging from 8 to 34 months. Hepatic tests and blood fibrinolytic activity were not influenced by long-term oral treatment with tranexamic acid.


Extraction and degradation of timothy pollen allergen during simulated in vivo conditions.

Extraction and degradation of timothy pollen in saline has been compared with extraction in nasal secretion and gastric fluid. By measuring the absolute amount of one important allergenic substance by quantitative immunoelectrophoresis and the total allergenic activity by RAST as a function of time it was shown  that the allergens were extracted extremely fast and that both the total allergenic activity and the concentration of one allergen reached maximum after about 20 min. Compared with saline, extraction under the simulated in vivo conditions gave a lower maximum level and a faster degradation of allergens.


Quantitative immunoelectrophoretic analysis of extract from cow hair and dander. Characterization of the antigens and identification of the allergens.

Quantiative immunoelectrophoresis used for the analysis of a dialysed, centrifuged and freeze-dried extract from cow hair and dander revealed 17 antigens. Five of these were identified as serum proteins. Partial identity to antigens of serum and extract from hair and dander of goat, sheep, swine, horse, dog, cat and guinea pig, and to antigens of house dust was demonstrated. Sera from 36 patients with manifest allergy to cow hair and dander selected on the basis of case history, RAST, skin and provocation test, were examined in crossed radioimmunoelectrophoresis (CRIE); sera from five persons with high serum IgE, but without allergy to cow hair and dander, and sera from five normal individuals were controls. 31/36 of the sera contained IgE with specific affinity for two of the antigens of the extract. Further, two major and six minor allergens were identified. The control sera showed no specific IgE binding. A significant positive correlation was found between RAST and CRIE for the first group of patients. The approximate molecular weights of the four major allergens obtained by means of gel chromatography were: 2.4 x 10(4), 2 x 10(4), 2 x 10(5) dalton, respectively. Using Con-A  and Con-A Sepharose in crossed immunoaffinoelectrophoresis, eight of the antigens were revealed to contain groups with affinity for Con-A.


Total serum IgE levels in normals and patients with chronic non-specific lung diseases.

Total serum IgE was measured, using a sensitive sandwich method, in a healthy control population, in healthy persons with a familial history of chronic non-specific lung disease and in patients with chronic non-specific lung disease (CNSLD). In the control population a median total serum IgE of 39 I.U./ml was found. Total serum IgE levels were significantly lower in women that in men. Healthy persons with a familial history of CNSLD had significantly increased total IgE levels compared with the control population. The IgE level was even higher in the group of patients with CNSLD. The presence of specific IgE antibodies and/or an early onset of the symptoms of CNSLD was accompanied by higher total serum IgE levels compared with the IgE values in the other CNSLD patients. But the total IgE levels were increased in all subgroups of CNSLD patients. A significant decrease of the IgE level with age was observed in CNSLD patients.


Excessive airway pressure during anaesthesia. Hazards, effects and prevention.

The modern continuous flow anaesthetic machine supplies gases under high pressure directly to the patient's trachea. Accidental obstruction to the outflow of expired gases is not uncommon, and may lead to the application of excessive pressure to the patient's airways with potentially disastrous results. The ways in which obstruction to outflow may occur, and the factors which affect the subsequent rise in intrapulmonary pressure are enumerated. The effects of a substained elevation of airway pressure on cardiac output are discussed and an outline is given of the sequence of events which lead from alveolar rupture to the development of mediastinal emphysema and tension pneumothorax. Finally, suggestions are made for ways in which the patient can be protected from excessive airway pressure, by routine use of a pressure-limiting reservoir bag in conjunction with a suitable pressure-limiting valve on all anaesthetic breathing attachments.


An unusual complication of passing a narrow bore nasogastric tube.

A care of oesophageal perforation and aspiration of a pleural effusion by a narrow bore nasogastric tube is reported. The presence of cardiac enlargement was thought to be a precipitating cause. It is suggested that insufflation of air with auscultation over the epigastrium and aspiration of narrow bore tubes, as well as chest X-ray, should be carried out routinely to establish the position of such tubes prior to commencing feeding.


Unilateral pulmonary oedema and "Mandrax" poisoning.

A case of unilateral pulmonary oedema following "Mandrax" overdose is presented. The pulmonary oedema is believed to result from hypoxia and increased pulmonary vascular permeability. A multi-factorial pathophysiology including patient posture, may have been responsible for the unusual unilateral distribution of the oedema. This report should serve to increase awareness of this interesting clinical entity.


Paraplegia and epidural analgesia.

A patient who developed paraplegia subsequent to epidural analgesia is presented. The patient was further investigated and it was proved that there was spinal canal stenosis L2-4 level and epidural analgesia had precipitated the paraplegia.


Monitoring low blood pressure. A non-invasive technique.

Surgical procedures frequently warrant the use of hypotensive anaesthesia, yet the nature of the surgical procedure may not require intra-arterial monitoring of blood-pressure which is associated with a significant incidence of hazards. An ultrasonic technique is described which is convenient and without complication and which may be employed when intra-arterial cannulation is difficult or undesirable as, for example, in the neonatal case.


The Treonic Haemoheater: a new blood warming device.

A new blood warming apparatus, the Treonic Haemoheater, is described. The blood circulates through a disposable warming bag situated between two electrically heated panels containing two types of thermostat. The apparatus appears to be electrically safe and exhibits a high capacity for the transference of heat. Haemolysis is not caused and the device is simple to use.


Clinical considerations in anaesthesia for hip arthroplasty.

Experiences with the anaesthetic management of 248 patients undergoing total hip replacement are presented. Blood loss does not appear to be influenced by hypertension, the method of venting or the type of anaesthetic, with the exception of neurolept-analgesia. The importance of oxygen therapy in the treatment of the pulmonary embolic syndrome is stressed and the prevention of deep venous thrombosis is discussed. Mortality and morbidity figures are given.


Estimation of nitrous oxide in blood. Gas chromatographic analysis of trace or analgesic levels.

The estimation of nitrous oxide (N20) at trace and analgesic levels in whole blood is described. A micro-ionisation cross section (MICS) detector was used to measure trace levels of N2O (0.69 to 17.88 mumol N20/litre of blood); whilst a thermal conductivity (TC) detector was used to determine levels from 0.17 to 13.34 mmol N20/litre of blood. The coefficient of variation was 1.3% and 3.2% for the TC and MICS detectors respectively. The technique equals the precision of previously described methods but is considerably quicker. It appears to be suitable for use in the measurement of blood levels of N20 in both theatre personnel and patients undergoing anaesthesia.


Blood levels of nitrous oxide during bronchoscopy.

Arterial blood levels of nitrous oxide have been measured during bronchoscopy using two types of ventilating bronchoscope. It seems unlikely that the blood levels of nitrous oxide achieved using these devices would contribute to a reduction in the incidence of awareness during this procedure.


Osmolar output in the peri-operative period.

The hourly urine volume and urine concentration of seven patients undergoing major abdominal surgery were measured during the operative and postoperative periods. From these, the hourly osmolar output was calculated. The results show that the osmolar output, 700 mOsm/day, in the peri-operative period is less than that of a 70 kg man consuming a normal 2000 calorie diet. Calculation of the osmolar output might help in the differentiation of postoperative oliguria and renal dysfunction.


Osmometry. 1. Terminology and principles of measurement.

The measurement of the osmolality of body fluids is used increasingly in clinical practice. This paper discusses the terminology and describes the methods available for its measurement.


Osmometry. 2. Osmoregulation.

The maintenance of osmolar constancy of the body fluids is dependent upon the recognition of osmolar disequilibrium and its correction by modifying the ingestion and excretion of fluid and solute. Osmolar changes are sensed by the hypothalamus which regulates the secretion of antidiuretic hormone to modify the renal excretion of water. The integrity of the system depends upon the renal ability to vary the solute concentration of urine.


Osmometry. 3. Clinical applications.

Measurement of plasma and urine osmolality is quick, easy and accurate. The recognition of the interdependence of urine volume and osmolality on the excretion of the daily obligatory solute load assists in the diagnosis and management of fluid balance and renal excretory problems in the acutely ill. In addition, syndromes of osmotic disequilibrium present a challenge in metabolic care.


Removal of anaesthetic waste gases. An inexpensive antipollution system for use with pipeline suction.

A simple, safe, and extremely inexpensive system is described for removing anaesthetic waste gases from the operating theatre, by utilising such equipment and facilities as already exist in most modern operating departments.


Throwing light on blind intubation.

A method of tracheal intubation is described which uses transillumination of the tissues to identify entry into the trachea. The method is suggested as an alternative to blind intubation in cases where difficulty occurs using conventional laryngoscopy.


From the other end of the needle. The patient's experience of routine anaesthesia.

During a single 5 day working week a series of adult National Health patients undergoing general anaesthesia for routine surgery at a District General Hospital were interviewed on the day following the anaesthetic. The experiences of anaesthesia, and their opinions of their anaesthetists are discussed.


Do they do as they are instructed? A review of out-patient anaesthesia.

Sixty patients who underwent out-patient anaesthesia were assessed by interview the day following surgery to determine the extent to which they remembered and complied with instructions given preoperatively concerning their post-anaesthetic activities such as, drinking, driving, cooking and operating machinery. The first group of thirty patients received verbal instructions only, except for a written instruction not to drive after anaesthesia. The following group of thirty patients received clear, concise printed instructions in addition to their pre-operative verbal instructions. There was a significant improvement between the two groups of patients in the ability to remember their instructions from a range of 77--99% failure rate to 4--12.5% depending on the sphere of activity. However, a certain proportion of patients deliberately ignored the instructions in both groups. It would appear from this study that verbal pre-operative instructions were easily forgotten unless re-inforced with written directives. Patients from ethnic minorities may need printed instructions in their native language and the services of an interpreter.


[The anaesthesia outpatient clinic. A new concept of preanaesthetic preparation and treatment after two years experiences (author's transl)].

The anaesthesia outpatient clinic can be a new concept of preanaesthetic preparation and treatment. Related to the figures of 1977, a report is given about our 2-years experience. Patients from the usual outpatient clinics, like gynecology, urology, ENT, who are expected to be operated upon are immediately sent to the anaesthesia outpatient clinic for preanaesthetic check up. After the overall state of the patient has been examined, the original outpatient clinic and/or the family doctor are given information about the patients condition, and probably proposals for a preanaesthetic treatment are made. In 1977, 15% of all anaesthetized patients were checked as outpatients, another 40% were only examined after entering the hospital, whereas as few as 17% were not checked in the anaesthesic outpatient clinic. In patients, checked as outpatients, the period between the first day of hospitalisation and operation was evidently shorter than in patients, having been hospitalized at the time of preanaesthetic examination. This gives the opportunity to save money and beds. Furthermore, the anaesthesia outpatient clinic improves the organisation and efficiency of surgery, urology, gynecology etc., improves the relationship between patients and anaesthetists, decreases the risk of anaesthesia and operation, saves personnel and gives a qualified additional background for the purposes of graduation and student training.


[Effects of isovolaemic haemodilution on pulmonary gas exchange and haemodynamics (author's transl)].

In experiments on 11 closed chest dogs the behaviour of pulmonary gas exchange and haemodynamics during isovolaemic haemodilution with 6% dextran was studied. The dogs were ventilated artificially (IPPB, PEEP = 0) with room air. After haemodilution a slight increase of arterial PO2 from 86 to 92 mm Hg was found. In another series of experiments an inspiratory O2-concentration of 25% was applied resulting in an increase of arterial PO2 from 106 to 113 mm Hg. In both series a decrease of alveolararterial PO2 gradients was observed. Effective pulmonary capillary blood flow varied in accordance with changes of cardiac output. Thus intrapulmonary shunt is supposed to have remained constant. The changes of pulmonary O2 diffusing capacity could be explained by the effect of haemodilution per se. At the end of the experiments ventilation was changed by adding a positive endexpiratory pressure of 8 cm H2O resulting in a decrease of arterial PO2 and a steep fall of cardiac output. In conclusion, isovolaemic haemodilution leads to only negligible variations of pulmonary gas exchange which should not be of any clinical importance.


[Hormonal changes during electrocoagulation of the Gasserian ganglion under neuroleptanalgesia and the effects of administration of a beta blocking agent (author's transl)].

Hormonal changes, occurring during electrocoagulation of the Gasserian ganglion under neuroleptanalgesia, and the effects of intravenous administration of pindolol 0.4 mg on these changes were investigated in two groups of 10 and 12 patients of advanced age. At the end of the operation there were marked increases of the concentrations of catecholamines, a rise of the plasma cortisol and a fall of the serum insulin. The administration of the beta-adrenergic blocking agent did not induce any statistically significant changes of the determined hormones compared to the control group.


[The influence of enflurane on intraocular pressure (author's transl)].

Various forms of inhalation anaesthesia with enflurane were carried out in 30 patients. An attempt was made to eliminate all the factors influencing the intraocular pressure (IOP), and to record the behaviour of blood pressure, pulse rate and IOP with the gradual increase of concentration of enflurane. Results are discussed and the use of the inhalation anaesthetic enflurane is recommended for intra-ocular operations.


[Hyperamylasaemia in patients in shock (author's transl)].

In 69 patients, treated in the intensive care unit of the department of traumatology we have examined the blood amylase activity. We found, that traumatic shock produced an increase in serum-amylase. Hyperamylasaemia is strongly related to the duration of shock and is due to an increase in S-type amylase. The increase is probably caused by an increased production and not by decreased renal excretion. The mechanism of hyperamylasaemia and the source of it are discussed.


[Pulmonary hypertension and pulmonary edema caused by intravenous ketamine (author's transl)].

Induction of anaesthesia with ketamine 1.5 mg/kg i.v. in a patient with coronary artery disease caused an increase in mean pulmonary artery pressure from 27 to 65 mmHg, a threefold rise in pulmonary vascular resistance and an increase of the left ventricular filling pressure from 18 to 48 mmHg which was associated with arterial hypoxaemia due to pulmonary edema. Fentanyl (0.01 mg/kg i.v.) promptly reversed the systemic and pulmonary vascular effects of ketamine.


[Malignant hyperthermia during the 13th general anaesthesia (author's transl)].

We report a case of malignant hyperthermia in a man of 41 years during his 13th general anaesthesia. All previous anaesthetics were quite normal. Musculoskeletal abnormalities and increased CPK-levels are to be found in some members of the patient's family. The combined use of suxamethonium and halothane might have caused the development of malignant hyperthermia. As a concept of the aetiology of the syndrome the case history indicates that it may be stress-related.


Embolization of detached fragments of intravenous plastic catheter.

Three cases of embolization by detached fragments of "Intracath" intravenous catheters are described. In two, successful surgical removal was performed, whilst in the third, due to the poor general condition of the patient, no attempt at removal was made and after long-term observation, there were no untoward side effects.


[A new safe system for the prevention of peroperative hypothermia (author's transl)].

On the basis of our experiences and data from the literature concerning thermal injury by warming blankets in anaesthetized patients, a new and safe system for the maintenance of body temperature during the operation is described. The following advantages are emphasized: 1. Adjustable double-thermostat with audible alarm. 2. Easy-to-read control thermometer of water bath. 3. Thermal blanket water temperature cannot rise above 43 degrees C.


[Experiences with hyperbaric bupivacaine solutions in spinal analgesia (author's transl)].

Spinalanaesthesia with hyperbaric bupivacaine (0.4%, 1.0%, 0.5%) was used in 713 patients having general surgical and urological operations. On average 19.30 +/- 1.55 mg bupivacaine was given and a spread of anaesthesia up to Th 7.21 +/- 1.55 achieved. Detailed evaluation of the 3rd group (0.5%) showed a latency period of 2.21 +/- 0.82 min and mean effective time of 4.33 +/- 0.75 h. The motor blockade was in 87% complete. The problem of the 0.5% solution with a specific gravity of 1.037 g/ml, which is in our opinion too high, was pointed out and a recommendation for a specific gravity of about 1.020 g/ml was given. Assuming proper positioning, spinal anesthesia with hyperbaric bupivacaine is a safe and simple anaesthetic method.


Bupivacaine in caudal anaesthesia for anal surgery.

A study is described of 100 consecutive patients given a caudal block for anal surgery using either 0.25% or 0.5% bupivacaine with adrenaline. The initial success rate was 91%, and a further 8% achieved only a unilateral block. Satisfactory anaesthesia in these cases could be achieved with either a second caudal block or unilateral infiltration of the un-anaesthetized half of the surgical field with lignocaine. Optimal anaesthesia took up to 15 minutes to develop in 90% of the patients, and 20 minutes for all patients. No serious complications were observed. Post-operative analgesia lasted between 10 and 12 h after the block and this compared favourably with the results from two small control groups given either a general anaesthetic or a lignocaine caudal block in which the patients required analgesics 2,5 and 4,5 h respectively from the start of the anaesthetic procedure. In the bupivacaine treated patients there was a significant reduction in the need for post-operative analgesics throughout the whole postoperative period.


[The continuous perivascular axillary plexus block in hand replantation surgery (author's transl)].

A modified techniques of axillary plexus block is described which enables prolonged analgesia. The main principle of this techniques is to insert an indwelling canula into the perivascular tissue of the plexus brachialis. A cold local anaesthetic (4 degrees) is injected for controlling the canula site. The indications for this technique are all corrective and reconstructive operations of the upper extremity and the postoperative alleviation of pain. Twenty cases with different indications are discussed in this paper. No allergic, toxic or inflammatory reactions were seen in our patients. They were satisfied with this method of analgesia. The easy application, absence of time limiting factors and suitable intraoperative monitoring are the advantages of the method.


[Methaemoglobin-behaviour due to carticaine (= Ultracain) (author's transl)].

The influence of carticaine on the formation of methaemoglobin was investigated in 22 patients undergoind spinal (n = 10) or epidural (n = 12) anaesthesia. Carticaine in a dose of 1,35 mg/kg, as used for spinal anaesthesia, did not influence the concentration of methaemoglobin. Carticaine in a dose of 5 mg/kg however, as used for epidural anaesthesia, increased the formation of methaemoglobin slightly at 30 min after injection. This increase is of little clinical importance since the upper limits of the normal range were not reached.


[Anaesthesia in the extremely obese patient (author's transl)].

This paper reviews the literature on anaesthetic problems in extremely obese patients. The main concerns of the anaesthetist in these patients is pulmonary function, especially hypoxaemia. The pathogenesis of hypoxia is explained by an increased tendency to airway closure by the weight of fat, which compresses the thorax. The significance of the patient's position during and after operation is stressed. The Pickwick-Syndrome is extremely rare, even in large series of obese patients, but its diagnosis is important for therapeutic consequences. For anaesthesia in these patients neuroleptanaesthesia as well as classical inhalational procedures can be used.


[Metabolism and distribution of bupivacaine-experiments in rats. II. Distribution and elimination (author's transl)].

To avoid the influence of general anaesthetics on the functions of most organ systems, the present experiments were carried out in unanaesthetized rats. Blood concentrations in the aorta, V. portae and Vv. hepaticae as well as urinary and biliary excretions of bupivacaine were studied after either intravenous or enteral administration. From the course of the aortic bupivacaine concentrations after i.v. injection the following pharmacokinetic data were derived: t1/2 = 24,7 min; k2 = 1,467 h; V = 1,492 1. Absorption of bupivacaine from the jejunum is rapid. The hepatic clearance of bupivacaine in the rat is 12 ml/kg b.w..min-1. The biliary excretion of bupivacaine in the rat is very small; therefore the enterohepatic circulation of this substance may be considered neglible.


[Suprapubic bladder drainage in the surgical patient (author's transl)].

Suprapubic bladder drainage is today a safe method of urine deviation. Outflow obstruction after lesions or operations in the uro-genitary system is the main indication for suprapubic drainage. The best indications therefore exist in urological and gynaecological patients. We used suprapubic bladder drainage in 20 patients after general surgery, applying a catheter set (Cystofix) with removable split cannula. There were no serious complications. Urine cultures in 6 patients controlled 6 days after insertion of the catheter were negative. Suprapubic bladder drainage using suitable catheter sets, can be recommended in patients without outflow obstruction, especially in intensive care.


Gas identity hazards and major contamination of the medical gas system of a new hospital.

During commissioning of the medical gas system of a new hospital, fourteen connection defects were found; six of these were potentially lethal cross-connections. A major contaminant was also detected throughout the medical gas system. The methods of testing a new medical gas system described in this report highlight the need for up-grading of existing standards.


Altered drug metabolism in anaesthetists exposed to volatile anaesthetic agents.

Antipyrine kinetics were measured on saliva in eight anaesthetists during a period when they were giving general anaesthetics and a period when they were working exclusively in intensive care. During the anaesthesia period there was a reduction in antipyrine half-life and the clearance of antipyrine increased. Analysis of the data in groups failed to detect these changes because of the wide variation in metabolism between subjects. Exposure to anaesthetic agents under non-scavenging operating theatre conditions appears to enhance hepatic metabolism.


Intravenous ketamine anaesthesia for major abdominal surgery--an assessment of a technique and the influence of ataractic drugs on the psychomimetic effects of ketamine.

Eighty-two patients presenting for major abdominal surgery were divided into five groups, and received intravenous ketamine, muscle relaxation and controlled ventilation with oxygen-enriched air. For maintenance of anaesthesia patients were given a single intravenous dose of either droperidol 5 mg, diazepam 5 mg, promethazine 25 mg, flunitrazepam 0.5 mg or lorazepam 2 mg, followed by incremental doses of ketamine. Flunitrazepam and lorazepam were the adjuvants associated with the lowest incidence of dreaming and emergence phenomena; postanaesthetic sequelae occurred most frequently with both ketamine/diazepam and ketamine/droperidol anaesthesia. However, the differences between the five groups failed to reach statistical significance.


The contrasting effects of enflurane on transplacental exchange after methohexitone and ketamine induction of anaesthesia for caesarean section.

Supplementation of general anaesthesia with enflurane 0.6% before delivery of the foetus by elective Caesarean section, produced contrasting effects after methohexitone and ketamine administration. Enflurane, an inhalational agent causing vasodilation and uterine relaxation, enhanced maternal to foetal transplacental exchange following methohexitone induction of narcosis. This beneficial effect of the volatile agent was not seen after ketamine, a vasoconstrictor drug which stimulates myometrial contraction.


Local anaesthetic plasma levels in children.

Blood levels of lignocaine and bupivacaine were measured in children following caudal, subcutaneous and tracheal administration. The highest peak levels were in children under 3 years following tracheal spray but all blood levels were below accepted toxic adult levels for anaesthetised patients. No toxic manifestations were seen.


Continuous lumbar plexus block--analgesia for femoral neck fractures.

In a series of 21 patients with fractures of the neck of the femur, continuous lumbar plexus block provided effective pain relief in 17 cases. The technique for continuous lumbar plexus block is described. The technique has advantages over conventional methods of analgesia.


A new polyvinyl chloride coil with improved performance for blood warming.

A new polyvinyl chloride (PVC) coil has been tested. The thinner walls give a better heat transfer so that an output temperature of 32.7 degrees occurs at 150 ml/min under test. This is higher than any PVC coil previously tested. Suggestions are made about methods of further improving the performance.


An epidural anaesthetic with unusual complications.

Respiratory paralysis and prolonged duration of anaesthesia followed lumbar epidural block with bupivacaine. Subdural, extra arachnoid block is postulated.


[Vascularization and glial structures of the area postrema in sheep (Ovis aries) (author's transl)].

The area postrema of the sheep (Ovis aries) reveals the typical position and structure as seen in the domestic animals. The fetal development of the organ concerning especially the vascularization does not give any reference to a phylogenetic connection with the area postrema of birds. The glial border of the organ ist strikingly marked by the funiculus separans, which seems to be lacking in other domestic animals.


[On the reaction of the sense cells in the cristae ampullares to experimental loads in guinea pigs (author's transl)].

The different experimental tests brought the explanation about the ampullae sensory epithelium. It was shown that the transmission of impulses by the peripheral sensory cells can lead to swelling as well as to shrinkage of their nuclei. The spicific stimulus for the semicircular canals is the angular acceleration as well as lateral pendular movement. We managed, however, to proove by single semicircular canal, also by linear acceleration a certain transmission of stimuli. The higher the movement frequency, the larger is the volume variations of the sensory nuclei. The cells of the upper and the lateral semicircular canals response to a lateral right-left-deviations with a considerable increase of their nuclear volume. Excluse of a left rotation the sensory cells of all ampullae of the right side react with an increase of their nuclear volume. On the contrary those of the left side react with a decrease of their nuclear volume. Only the upper ampulla respond to a forwards-backwards-movement, also to a vertical dropmovement with a slight swelling of their sensory nuclei. All ampullae of both petrous bones reactet to alternating right-left rotation with a shrinkage of their nuclei. Further more we succeded in recording certain structure and form variation in the claimed sensory cells. More experiments on the cells give rise to nuclear pyknosis. The cytoplasme of the cell body participates also in the process of recharging and decharging of the action potential.


Discovery of a variant in the region of the adductor magnus and the short head of the biceps femoris.

As a variant between the adductor magnus and the short head of the biceps femoris a small, triangular, flat muscle is described. Its fasciculi originate from both muscles and its long, thin tendon lying between the popliteal vessels and the sciatic nerve runs into the tendon of the adductor magnus inserting into the adductor tubercle.


Formation of apical pseudopods by canine thyroid follicular cells: induction by thyrotropin and 5-hydroxytryptamine; antagonism by reserpine.

The role of biogenic amines in the activation of thyroid follicular cells by thyrotropin (TSH) was studied. 5-hydroxytryptamine (5-HT) was chosen as the amine to study and apical pseudopod formation, assessed by scanning electron microscopy, was used as the index of follicular cell activation. All experiments were done on dogs. TSH and 5-HT were both potent inducers of pseudopod formation. The action of TSH but not that of 5-HT was antagonized by the amine depleting drug reserpine. Reserpine depleted the thyroid of 5-HT in newborn, adolescent, and adult dogs. It is concluded that one or more biogenic amines, such as 5-HT, are probably involved in follicular cell activation by TSH.


Site of iodination in rat mammary gland.

The ability of the mammary gland to take up and organically bind radioiodide was studied in non-pregnant, pregnant, and lactating rats. Autoradiography was used to determine whether duct cells or alveolar cells are responsible for iodination in the rat mammary gland. Iodination was not detected in mammary glands from non-pregnant rats, but occurred late in the twelfth day of gestation and continued throughout pregnancy and lactation. Protein-containing vacuoles in alveolar cells and casein-like proteins in milk were the major sites where iodination occurred within the gland. Milk proteins in the lumens of ductules adjacent to alveoli were also iodinated. In contrast, ducts, myoepithelial cells, fat cells, blood vessels and other histological components of the gland did not show iodinating capability. Cytochemistry was also used to identify endogenous mammary peroxidase activity in the same glands, and it was found that the presence and location of this enzyme was correlated with the ability to iodinate.


Filtration of circulating particles by splenic autotransplants.

To determine whether filtration in reconstituted perifollicular marginal zones underlies particle sequestration in regenerating spleen transplants, the distribution of IV injected particles of tantalum was examined in autografts freely transplanted into subcutaneous pouches in rats. In two to six weeks old autografts removed one to three hours after particle injection, the reconstituted marginal zones contained practically all of the sequestered tantalum. At 48 hours to 20 weeks following injection, marginal zones were largely free of particles which were distributed extracellularly throughout the red pulp. This sequential pattern of distribution conformed closely to that observed in the intact spleen. The findings indicate that a reconstituted marginal zone allows splenic autotransplants to function as simple mechanical filters. Increased demand for this activity rather than for phagocytosis may be the predominant factor regulating spleen growth.


Rod-shaped particles in the plasma membrane of the mitochondria-rich cell of amphibian epidermis.

A freeze-fracture study has revealed rod-shaped intramembranous particles on the plasma membrane P-face (cytoplasmic leaflet) of the mitochondria-rich cell (or flask cell) of Xenopus laevis and Rana ridibunda epidermis. Such particles have previously been found in all other mitochondria rich cells examined by this technique, namely, the MR-cell of toad bladder epithelium, the dark cell of rat kidney collecting tubule, and the flask cell of Xenopus kidney collecting tubule. These particles are assumed, therefore, to be closely connected with the function of this cell type.


A quantitative analysis of hepatic ultrastructure in rats during enhanced bile secretion.

The ultrastructural changes in hepatocytes of rats subjected to selective biliary obstruction (SBO), wherein the biliary system draining approximately two-thirds of the liver is obstructed, were evaluated by quantitative electron microscopy or stereology. The remaining unobstructed portion of the organ compensates for this loss of bile secretion by functioning in a hypersecretory mode. This animal model permits the comparison of hepatocellular fine structure associated with the conditions of nonsecretion and hypersecretion of bile with that found in normal secreting sham-operated rats. Since recent evidence suggests the presence of lobular gradients in hepatic structure and function, both centrolobular and periportal hepatocytes were examined. The low incidence of Golgi membrane profiles in high magnification electron micrographs results in a low confidence level of sampling and, thus, necessitates the application of a novel parameter for estimating the amount of Golgi complex, i.e., the Golgi-rich area. For the most part, the lobular variation in hepatic fine structure in the sham-operated animals was similar to that described by Loud ('68). However, the periportal parenchyma contained approximately twice the volume of Golgi-rich area as the centrolobular tissue. The amount of cytoplasmic lipid increased significantly in the SBO unobstructed lobes, although there were few or no changes in the other intracellular organelles or inclusions except those related to the Golgi complex. The volume of Golgi-rich area increased significantly in the centrolobular tissue of the SBO unobstructed (hypersecretory) lobes to the extent that both intralobular zones contained similar amounts of this component. These data suggest that the Golgi complex is a dynamic unit which responds to changes in hepatocellular activity and may be involved in bile secretion.


Orthogonal arrays of particles in plasma membranes of the gastric parietal cell.

Freeze-fracture of rat gastric mucosa revealed a specific set of intramembranous particles in the plasma membrane of the parietal cells. The particles were small and of square shape and formed orthogonal arrays in the P-face with corresponding orthogonal arrays of pits in the E-face. Arrays, scattered among usual globular particles, were particularly numerous at the basal pole of the cell and less concentrated on the lateral side. They were not present in the apical microvillar membrane nor in the membranes of intracellular tubulovesicles. As in other cell types in which similar arrays were described previously (e.g., astrocytes, "light" cells of the kidney collecting tubule), their presence in parietal cell membranes suggest some specialized function of these membranes not shared by plasma membranes showing only a population of globular particles. This function has yet to be identified.


The site of collagen resorption in the periodontal ligament of the rodent molar.

In an attempt to determine the pattern of collagen phagocytosis by fibroblasts in the periodontal ligament, a stereologic investigation of the mesial root of the maxillary first molar of the rat was undertaken. The distribution of fibroblasts containing intracellular collagen fibrils was studied at the electron microscope level in the periodontal ligament along resorbing and non-resorbing surfaces of the alveolar wall. It appeared that fibroblasts with collagen-containing vacuoles were more or less randomly distributed across the width of the periodontal ligament. No major differences were observed among the alveolar, cemental and intermediate zones of the ligament. However, local variations in the occurrence of cells containing intracellular collagen fibrils may occur. A relatively high concentration of ingested collagen fibrils was seen in fibroblasts located in the direct vicinity of osteoclasts, but not in the vicinity of osteoblasts. These observations suggest that remodelling of collagen is evenly distributed throughout the ligament, but may be influenced by local circumstances, such as the occurrence of bone resorption.


Identity of a population of progenitor cells in gingival connective tissue of the mouse incisor.

In the gingiva of the mouse incisor, connective tissue cells were observed which were undergoing mitosis and contained collagen fibrils enclosed in vacuoles in their cytoplasm. The presence of intracellular collagen was noted in the majority of the dividing cells. On the basis of this observation it is suggested that renewal of the fibroblast population in the gingiva occurs preferentially by division of differentiated fibroblasts rather than by division of cells with a lower degree of differentiation.


Monosaccharide transport across membranes of human spermatozoa. II. Basic properties of D-fructose and D-glucose uptake.

D-glucose uptake by human spermatozoa shows like D-fructose uptake a hyperbolic kinetic. The affinities to the transport system are similar, but the maximal capacity of D-glucose transport is greater than the D-fructose transport. Both transport processes are inhibited by monoiodoacetate. Therefore these transports can be regarded as carrier-mediated active transports. The D-glucose transport moreover is inhibitable by ouabain and is influenced by extracellular Na+. These differences could be the expression that for both monosaccharides different transport systems exist. But the dependence of D-glucose and D-fructose uptake on the extracellular D-fructose-D-glucose-relation permits the conclusion that both systems interact with another.


[Isolation and analysis of glycolipids from human semen].

Glycolipids from human semen of two different diagnoses were separated from a total lipid extract by silicic acid column chromatography. Fatty acids and carbohydrates were determined by gas-liquid chromatography. Quantitative differences in the fatty acid and carbohydrate contents were found between the two diagnose groups.


Effect of testosterone on development of the lumen in seminiferous tubules of the rat.

Although systemically administered testosterone can effect the postnatal maturation of elements in the seminiferous tubule in hypophysectomized rats and mice, it does not elicit the same degree of development which occurs in normal control animals. In view of reports of precocious spermatogenesis in androgen secreting Leydig cell tumors, the present study was designed to determine if high local levels of testosterone accelerate development of the seminiferous tubules. Testosterone pellets were inserted under the tunica albuginea of the right testis of 7 day old rats. At 17, 23 and 28 days of age development of the seminiferous tubules, as judged by the formation of tubule lumens, was more extensive in the treated testes than in contralateral and sham operated controls. Tubule diameters were not necessarily correlated with lumen formation. This study demonstrates that high local levels of testosterone accelerate seminiferous tubule development in the rat and indicates that tubule diameter may not be a valid basis for estimating development of the testis. It is suggested that testosterone exerts this effect through its actions on the Sertoli cells.


The effects of mesterolone on the male accessory sex organs, on spermiogram, plasma testosterone and FSH.

42 subfertile male ambulatory patients were treated with Proviron. Moderate oligoastheno-teratozoospermia was the most common injury in sperm analysis. The treatment did not change the amount of plasma FSH, testosterone or prostate phosphatase. Acid phosphatase and citric acid of semen showed an increased activity with mesterolone treatment. The amount of fructose decreased, it is probably due to the increased number of spermatozoa, which need more fructose for their metabolism respectively. The sperm of 93% of the patients improved or stayed unchanged. 30% of the patients developed normozoospermia. 6 pregnancies were achieved.


[Light and electron microscope studies of the morphology of A spermatogonia in men with normal spermatogenesis and in patients treated with antiandrogens].

Based on cytological criteria, three types of A-Spermatogonia may be distinguished in the germinal epithelium of normal men. Cells belonging to Type I conform to A pale spermatogonia and those classified as Type II conform to A dark-spermatogonia according to Clermont ()963). Type III-spermatogonia do not meet the criteria set up by Clermont. Quantitative analysis of the germinal epithelium of two normal men indicates that 50% of the A-spermatogonia may be classified as Type I, 20% as Type II and 30% as Type III-spermatogonia. Type II-spermatogonia appear preferentially reduced in men treated with antiandrogens. In one of the two cases, Type I-spermatogonia were found to have increased to as much as 88%. At the same time, Type III-spermatogonia appeared to have decreased to 12%. Thus, Type II-cells were eliminated from the germinal epithelium. Long-term treatment with antiandrogens also altered the morphology of organelles in the spermatogonia. Based on these findings, a new concept concerning the sequence of events in the spermatogoniogenesis is advanced.


Seminal vesicles and its importance in the regulation of male fertility.

During experimental studies on the physiological significance of accessory sex glands, it was documented that excision of prostate in rats did not affect fecundity; conversely, surgical removal of seminal vesicles or its plasma consistently made the animals infertile. However, fertility of the plasma-removed animals was found to return to normalcy after 3 weeks following the surgical manipulation. Human chorionic gonadotropin or testosterone treatment starting immediately after surgical manipulation of the vesicular plasma retained fertility throughout the test period. The importance of seminal vesicular plasma in terms of male fertility has been discussed.


Reifenstein's syndrome--a target cell failure.

The features of Reifenstein's Syndrome comprise hypospadias, microtestes, gynecomastia, azoospermia and elevated gonadotropins. The disease is inherited as either a male limited autosomal dominant or as a X-linked recessive trait and affects only genetic males. A case is reported suffering from this condition. Pituitary function was evaluated using the GnRH-test and appeared to be normal. Prolactin and testosterone values were in the normal range. The patient was a phenotype male and sexual function was satisfactory. Primary tubular failure resulting in hypergonadotropic hypogonadism was diagnosed. No other relatives were found to be affected. The syndrome seems to be due to relative insensitivity of Leydig cells to androgens.


Effects of FSH and LH administration on the testes and seminal vesicles.

Weight increases in the testes of pre-pubertal rodents when FSH was administered were revealed by histological observations to be a result of seminiferous tubule lengthening. LH administration effected a sex accessory gland weight increase (seminal vesicles) but there were no apparent testicular effects. The serum androgen level, in response to increased LH administration, showed a continuous decrease in concentration although there was a significant seminal vesicle weight increase. The evidence presented in this paper leads us to postulate that LH has a sensitizing effect on androgen dependent tissues in the pre-pubertal rodent.


[Andrologic study in immunosuppressive treatment of chronic aggressive hepatitis].

By andrological and internal investigations in men with chronic aggressive hepatitis the problem is discussed, whether the therapy with Azathioprin can cause damage of the exogenous function of the testes. It would be demonstrated that within an observation time of 1720 days there have not been determined alterations of consistency and volume of the testes, sperm density and motility of spermatozoa, when the maximum of the daily dose was not more than 150 mg. Depending on the individual dose the morphology shows more pathological spermatozoa, but a direct and regular dependence could not be found. The density of spermatozoa did never decrease below values of 40 mill./ml. These results do not allow the suggestion that this cytostaticum is absolutely harmless. The main duty will always be to observe each patient currently and during a long period.


Evaluation of sperm counts and total sperm counts in 2543 men requesting vasectomy.

Semen analyses were performed on semen specimens from 2543 men requesting vasectomy at Planned Parenthood of Houston and the results were compared to earlier reports of semen analyses in allegedly fertile men. The comparisons suggest that mean sperm counts and mean total sperm counts are significantly lower than those reported in 1951. Furthermore, a shifting pattern of frequency distribution of sperm counts and total sperm counts was noted. Greater percentages of men with sperm counts 20 million/ml and total sperm counts below 100 million/ejaculate were found in the present report and other recent reports than had been noted in 1951. These data suggest that standards of male infertility proposed in 1951 are no longer applicable.


Clinical report about some cases with retrograde ejaculation.

The incidence of retrograde ejaculation may be expected to increase by factors as a higher incidence of vascular- and colon-surgery, the increase of road accidents with as a result transversal lesions as well as the increased use of medicines particularly hypotensive drugs. After some remarks about the mechanism of ejaculation and the closing mechanism of the sphincter internus, some cases-histories are dealt with. After these case-histories, a survey is given about the etiology of the retrograde ejaculation. Finally some possibilities in treating this disorder are given, such as intravaginal deposit of urine after intercourse and the administration of a drug, called phenylpropanolamine, a so-called a-sympathicomimetic.


The occurrence of simple and mixed fungal infections in patients at the department of andrology/Hamburg (1972--1976).

Skin scales from 228 patients, referred to the Department of Andrology at the University of Hamburg during 1972--76, were examined mycologically, because of being suspect of mycotic infections. In 54 cases dermatophytes were isolated, and yeasts were found in 13 cases. Nocardia minutissima and Malassezia furfur were present in 138 and 25 cases, respectively. In 12 patients, mixed infections were diagnosed; the infective organisms were yeasts in 46.2% of the cases, dermatophytes in 11.1%, and Malassezia furfur was represented in 8%. The infections were localized in the inguinal region in 208 patients.


The diagnostic and prognostic significance of the testicular biopsy.

The authors present the histological features of the testes in 1,609 cases of male sterility. In 485 cases (30.1%), histological changes were found, which did not warrant treatment. The histologic pattern of the testes was normal in only 39% of the cases of azoospermia; and only these patients were qualified for surgery, consisting of vasoepididymoanastomosis. Degenerative changes in the seminiferous tubules were observed in the patients with azoospermia, oligozoospermia and varicocele in 39.9%, 25.8% and 17.2% of cases, respectively.


[Fatty acid composition of neutral lipids of human semen].

The fatty acid composition of neutral lipids of human semen was determined by gas liquid chromatography. Qualitative and quantitative differences in the fatty acid contents were not found between pooled semen from oligozoospermic and astheno- or teratozoospermic patients. The neutral lipids contained relatively high proportions of unsaturated acids.


Screening for infertility in Indonesia. Results of examination of 863 infertile couples.

During a five-year study, 863 infertile couples were examined by a quite simple screening procedure, adapted to the facilities or a rural hospital. Tubal obstruction, with an incidence of 45.4% appeared to be the most prominent cause of infertility. The second most important factor was poor semen quality, which accounted for 32.4%. Azoospermia was found in 12% of all semen samples, and a sperm count below 5 million/ml in 8.7%. Disturbances in ovulation were responsible for 13% of the infertility. Comparison of the causes of primary and secondary infertility demonstrated the greater role played by the semen factor in primary infertility and of the tubal factor in secondary infertility. Accordingly, the female-male ratio in secondary infertility was much higher than in primary infertility.


[Value of determining trace elements in septicemia. Clinical correlations, prognostic value].

Among 17 septicemic patients, a statistically decrease of seric oligo-elements is demonstrated. The longitudinal study shows the rapid correction of these perturbations in the surviving group and the lack of correction among the non survivors. The level of phosphorus is the most interesting one. The importance of S.R.E. activity is probably the physiopathologic support of seric oligo-element modifications in sepsis.


Calf blood flow and ankle systolic blood pressure in intermittent claudication monitored over five years.

The response of calf blood flow and ankle blood pressure to 2 minutes of ischemic exercise were recorded every 6 months over a 5-year period in 9 patients with intermittent claudication who were treated conservatively on a regime including alpha tocopherol. No statistically significant change was noted in the pattern of the calf blood flow response over this period. Statistically significant (P less than 0.05) increases in resting and minimal postexercise ankle systolic pressures were partially attributable to a concomitant increase in central arterial pressure as indicated by brachial systolic pressure. Results from 18 patients over 1 year and from 14 patients over 2 years are consistent with these findings. The evidence presented suggests that the arterial disease process was stable over this period.


[Treatment of facial neuralgias: retrogasserian thermocoagulation under iterative discontinuous narcosis with propanidid].

Coagulation of the Gasserian ganglian is currently recommended in the treatment of trigeminal neuralgia due to the slight risks that it presents. It is accompanied by brief but intense periods of pain which necessitate the need of an Anaesthetist. As well as we have been able to verify in the course of sixty-two of these procedures, a discontinuous narcosis obtained by reiterated injections of propanidid presents a satisfying solution. It permits the neurological examinations, which need absolute cooperation of the patient, before each new coagulation to be accomplished in good conditions.


Complete heart block complicating acute myocardial infarction.

Complete heart block (CHB) developed in 10.3% of patients with acute myocardial infarction (MI). It was more frequent among patients with inferior myocardial infarction compared to anterior myocardial infarction, but the mortality was significantly high among patients with anterior MI who developed CHB. A new classification into primary (P) and secondary (S) CHB is suggested by the sequence of events. The incidence and mortality of SCHB was significantly high when compared to the incidence and mortality of PCHB. Wide QRS complexes, a heart rate of less than 60/min, and syncopal attacks were the grave prognostic signs. Progression from a lesser degree of AV block and regression of CHB to a lesser degree of AV Block were both observed in 25.8% cases. Circulatory failure in the form of shock, hypotension, congestive heart failure, and left ventricular failure, alone or in combination was a factor in 17 of the 22 patients who died. Four of 5 patients who underwent transvenous pacing also died.


Effect of manual lymph drainage massage on urinary excretion of neurohormones and minerals in chronic lymphedema.

Treatment of 29 cases of chronic lymphedema of various origins, mostly of the lower limbs, by manual lymph drainage massage resulted in significant changes of neurohormone excretion in the urine, whereas the secretion of 17-KS, thyroxine, minerals, and creatinine was not significantly changed. Comparison of the values of urinalysis before and after manual lymph drainage of the patients showed the following changes: 17-KS; -3.5% (non significant); 17-OH: -31% (significant); adrenaline: +50% (significant); noradrenaline: +19% (significant); serotonin: -22% (significant); 5-HIAA: +21% (significant); histamine: +129% (highly significant); thyroxine: -17% (nonsignificant); creatinine: -17% (nonsignificant); sodium: -1% (nonsignificant); potassium: -14% (nonsignificant). The corresponding values for ten controls were all non significant. These findings underline the importance of adrenaline and noradrenaline release by manual lymph drainage, which improves circulation. On the other hand, our results indicate the involvement of histamine and perhaps of serotonin in lymphedema formation, and suggest a combination of manual lymph drainage massage with antihistamine and antiserotonin treatment.


Ischemia of toes as a presenting symptom in primary thrombosis: a case report.

Although thrombotic occlusion of small vessels in thrombocytosis is allegedly well recognized, it has been reported only rarely. We treated 4 patients with primary thrombocytosis in whom ischemic toe lesions with normal peripheral pulses were the presenting and only symptoms. The symptoms preceded diagnosis by 5 years, 3 years, 1 year, and 1 month respectively. Treatment of the hematologic disorder resulted in disappearance of the toe lesions. Thrombocytosis should be routinely searched for in patients with ischemic toes and normal peripheral pulses.


Polymorphic post-albumin of cattle and horse plasma identified as vitamin D binding protein (Gc protein).

Cattle and horse plasma samples of known post-albumin types were radiolabelled with 14C-vitamin D3. These samples were then analysed by polyacrylamide gel electrophoresis, followed by autoradiography. The patterns observed were identical to those of post-albumin variants. The polymorphic post-albumin protein of cattle and horse was thus identified as the vitamin D binding protein and homologous to the Gc protein of human plasma.


Presence of horse blood group antigens in the major glycoprotein fraction of the erythrocyte membrane.

The aqueous phase of the chloroform/methanol extract of the horse erythrocyte membrane contained the blood group activities Ad, Dc or Dd. The factors Ad and Dc could be separated by gel filtration.


Polymorphism of vitamin B12[57Co] binding proteins in rabbit serum.

When rabbit serum labelled with vitamin B12[57Co] was subjected to starch gel electrophoresis and autoradiography, three phenotypes of proteins capable of binding vitamin B12 were observed. Family data revealed that these phenotypes (called TC-A, TC-AB and TC-B) are controlled by two codominant alleles (TCA and TCB), at an autosomic locus.


Albumin polymorphism in the feral donkey of Death Valley National Monument, California.

Evidence is presented for the occurrence of a second allele in the albumin system of the donkey (Equus asinus). Samples were collected from 127 feral donkeys in four locations within the Panamint Mountains of Death Valley National Monument, California. A common phenotype, electrophoretically characterized by a single band, was recorded from all four locations. A rare, double-band phenotype was recorded from two locations.


Near-fatal and fatal anaphylactic reactions to insect sting.

Two patients experienced anaphylactic reaction to insect stings, with residual encephalopathy. One patient had anaphylaxis despite hyposensitization with whole-body extracts, thus supporting recent reports that reliable protection cannot be achieved unless pure venom is used. The other patient had pathologic confirmation of anoxic encephalopathy, thus supporting the concept that encephalopathy with anaphylaxis is secondary to associated circulatory collapse rather than a primary allergic response of brain disease.


Honey bee venom allergy immunological studies of systemic and large local reactions.

The IgE and IgG antibody responses to four allergen fractions of honey bee venom were studied in 13 sera from patients who experienced systemic reactions from bee stings and eight from those who experienced large locals. Both groups were similar in allergen response. IgE and IgG levels and ratios. A significant number of patients were found to have experienced both types of reactions from bee stings. It is proposed that IgE antibody positive systemic and large local reactions are both IgE mediated allergic reactions. The determining factors for reaction type include venom dose and sting site.


Dermatophagoides farinae antigen skin test sensitivity in Wisconsin.

Fifty consecutive patients with allergic asthma and/or rhinitis in Madison. Wisconsin, were tested intradermally with a house dust extract (1:100) and with a Dermatophagoides farinae antigen (1:2000). The close relationship between the two skin test results (mite and house dust) suggests that both contain the same cross-reacting antigens and that mites make a major contribution to the antigens in house dust in Wisconsin.


Pharmacokinetics of delayed (DR) versus sustained release (SR) theophylline formulations following single (SD) and repetitive dosing (RD).

The present study compares the pharmacokinetic characteristics of equivalent theophylline doses of a delayed release formulation of oxtriphylline and a sustained release formulation given as single or six hourly repetitive dosings in six adult asthmatics. Both formulations maintained serum theophylline levels within therapeutic range for eight hours following six hourly repetitive dosings. The same dose of theophylline given as a single dose or after reaching steady states does not produce comparable serum levels. Effective and safe theophylline therapy in the management of chronic asthma not only requires frequent monitoring of serum theophylline levels but also requires clear understanding of the formulation used, the time and the clinical condition under which sampling is done.


Three-year evaluation of biofeedback techniques in the treatment of children with chronic asthma in a summer camp environment.

Systematic biofeedback techniques were applied and evaluated in the treatment of chronic bronchial asthma in a summer camp environment during three consecutive summers--1974, 1975 and 1976. From this three-year study the investigators have concluded that biofeedback mediated muscle relaxation training can be a valuable adjunct in the treatment of bronchial asthma.


Ultrastructural morphogenesis of acute viral pneumonia produced by feline calicivirus.

The ultrastructural morphogenesis of acute viral pneumonia was studied in pathogen-free cats exposed to aerosols of a virulent strain of feline calicivirus. Electron microscopy and fluorescence microscopy indicated that the virus had a marked tropism for alveolar pneumocytes. Viral-induced necrosis of pneumocytes was observed as early as 12 hours after exposure and was associated with acute serofibrinous and neutrophilic inflammation in the distal air exchange tissue. The acute exudative phase abated by 168 hours after exposure. The regenerative phase that followed was characterized by hyperplasia of type II pneumocytes; influx of monocytes, lymphocytes, and plasma cells; and interalveolar and intraalveolar proliferation of fibroblasts. The decrease in pneumocyte injury coincided with the increase in alveolar macrophages and immunocytes. With minor exceptions, feline calicivirus-induced alveolar damage and the subsequent repair resembled toxic alveolar injury produced by oxidant gases. Feline caliciviral pneumonia, therefore, is a naturally occurring example of viral-induced diffuse alveolar damage.


Midline myelotomy of the clinically normal canine spinal cord.

Clinically normal dogs underwent dorsal laminectomy, durotomy, and full-thickness midline myelotomy between either the 1st and 2nd lumbar vertebrae or the 3rd and 4th lumbar vertebrae. The myelotomy was 1 1/2 vertebral bodies long and was performed with a microbalance spatula. Neurologic and histopathologic changes were recorded. Full-thickness midline myelotomy done by this technique was found to cause severe necrosis of spinal gray matter.


Echocardiographic assessment of normal and abnormal valvular function in Beagle dogs.

Echocardiograms were obtained from 5 young Beagles (4 to 5 years of age) and from 4 old Beagles (12 to 14 years of age). Ultrasound surface transducers and esophageal transducers were used on all animals during anesthesia. Triplicate studies were performed on the 5 young Beagles over a 2-week period. The left atrioventricular valve and aortic root were identified by both procedures, whereas the right atrioventricular valve dynamics could be viewed with difficulty by the transcutaneous approach. Suitable recordings of the pulmonary valve were not obtainable with either technique. Abnormal left atrioventricular valve dynamics, characterized by a decreased closing velocity of the left atrioventricular septal cusp and increased valve thickness, were observed in 2 of the 4 aged dogs, using echocardiography. Excellent correlation between the 2 methods was evident, and minimal variation in results from one recording session to another occurred.


Cell-mediated immune responses in swine from a herd infected with Brucella suis.

Cell-mediated immune (CMI) responses in swine naturally infected with Brucella suis biotype 3, swine suckling an infected sow and Brucella-noninfected swine were studied by an in vitro lymphocyte transformation procedure. The antigen used was a soluble antigen prepared from killed cells of B suis biotype 3. Lymphocytes were prepared from peripheral swine blood by the Ficoll-Hypaque technique, suspended in RPMI-1640 medium (1.5 X 10(6) lymphocytes/ml), cultured with B suis-soluble antigen or concanconcanavalin A, and incubated for 6 days. Sixteen hours prior to termination of incubation, cultures were labeled with 1 muCi of [3H]thymidine and, after harvesting, were assayed for [3H]thymidine incorporation into DNA by liquid scintillation spectrometry. Agglutination tests were conducted on sera collected simultaneously with samples for lymphocyte-stimulation tests. The B suis-soluble antigen elicited specific stimulation in lymphocytes from infected pigs. On a group basis, there was high correlation between the amount of serum antibodies and specific lymphocyte stimulation, but on an individual animal basis, there was little correlation of the results of both systems in infected swine. There was high correlation between recovery of Brucella from the tissues of animals and the degree of CMI response. Suckling pigs from an infected sow did not develop CMI responses, as measured by our system.


A technique for pinealectomy in deer, with notes on the neuroanatomy.

A technique for removing the pineal gland in adult and young male deer is described. A unilateral craniotomy or craniectomy was performed and the pineal gland was approached by parting the 2 hemispheres of the brain. The blood vessels supplying the pineal gland were coagulated and the gland was removed with forceps. Magnification, microtechniques, fiberoptic illumination, and bipolar coagulation rendered the surgical procedure safe and precise.


Inhibition of calcium absorption in ponies fed diets containing oxalic acid.

The effects of dietary oxalic acid on absorption, excretion, and retention of calcium was determined in Shetland ponies in 2 experiments. In each experiment, the results of feeding a control diet consisting of oats, molasses, and a complete pelleted horse ration were compared with those of feeding the control diet plus 1% oxalic acid. The diets contained 0.6% calcium in the 1st experiment and 0.45% calcium in the 2nd experiment. Oxalic acid increased the fecal excretion of calcium and decreased calcium absorption. The endogenous fecal excretion of calcium determined in the 1st experiment, using 47Ca, was not affected by dietary oxalic acid, indicating that the increase in fecal calcium was due to unabsorbed dietary calcium. Ponies fed 1% oxalic acid in diets containing 0.45% calcium were in negative calcium balance. The ponies did not conserve calcium by reducing the urinary calcium excretion if they were fed oxalic acid. Magnesium balance was measured in the 3 ponies in the 1st experiment. Urinary magnesium excretion increased and magnesium retention decreased in response to oxalic acid intake.


Increased plasma bromide concentration in the horse after halothane anesthesia.

A long-lasting increase of the plasma bromide concentration was found in 25 horses after clinical halothane anesthesia. The plasma bromide concentration was significantly (P less than 0.005) increased at the end of anesthesia. In 18 horses, peak values were reached between 48 and 72 hours after anesthesia. Eighteen days after horses had been anesthetized, the plasma bromide concentration remained significantly (P less than 0.005) increased. Significant correlation was not found between the total dose of halothane and the plasma bromide concentration. In 1 horse reanesthetized with halothane 4 days after initial halothane anesthesia, the plasma bromide concentration increased to high concentrations.


Venezuelan equine encephalomyelitis vaccine (strain TC-83): a field study.

In 1971, more than 370 horses in south Texas were studied with respect to their clinical, virologic, and neutralizing antibody responses to vaccination with Venezuelan equine encephalomyelitis (VEE) strain TC-83. This study confirms reported findings that the vaccine used in the 1971 epizootic in the lower Rio Grande Valley of Texas was safe and efficacious. Vaccinal virus viremia titers were generally below the postulated infection threshold of epizootic vectors. In general, reactions to the vaccine were minimal and transient, with no observed abortions or deaths attributable to use of the vaccine. Eleven months after vaccination, VEE antibody titers were demonstrable in most horses that had VEE antibodies within 30 days after vaccination. Presence of western equine encephalomyelitis antibody titers of greater than or equal to 1:50 at time of VEE vaccination appears to modify or to interfere with VEE antibody production.


Cardiopulmonary effects of narcotic agonists and a partial agonist in horses.

The cardiopulmonary effects of the narcotic agonists morphine, meperidine, oxymorphone, and methadone and of the partial agonist pentazocine were examined in the pain-free adult horse. The drugs produced dysphoric followed by euphoric effects. Increases in heart rate, arterial blood pressure, and cardiac output were observed in all horses with all drugs. Arterial blood pressure remained increased even after heart rate and cardiac output had returned to base-line values. Respiratory rate generally remained unchanged or increased shortly after drug administration and then decreased insignificantly (P less than 0.05) below base-line values at later times. Arterial pH and blood gas values (Paco2, Pao2) did not change.


Anthelmintic activities of fenbendazole against Nematodirus helvetianus in cattle: effect on egg production, embryogeny, and development of larval stages.

Calves experimentally infected with Nematodirus helvetianus were treated with a single dose of fenbendazole at the rate of 5 mg/kg of body weight. Fenbendazole was found to have an efficacy of 97.4% against adult N helvetianus. Additionally, eggs recovered 12 hours after calves were given the anthelmintic had fewer and frequently abnormal blastomeres. Fewer eggs were evident at 36 hours after treatment, and none was found at 72 hours or later. On the culturing of eggs from manure passed at 12 hours and later, almost no larval stages developed.


Lidocaine concentrations associated with intravenous regional anesthesia of the distal limb of cattle.

Cannulation for injection of lidocaine HCl was done in 3 distal veins in the hindlimb of 5 young Friesian cattle maintained in a light plane of general anesthesia. The local and systemic plasma and tibiotarsal joint synovial fluid concentrations of lidocaine (British lignocaine) were estimated for 60 minutes after the drug (10 ml, 2% (w/v)) was injected into the veins distal to a tourniquet. The lidocaine concentration in the distal veins was high but variable initially, and fell markedly over the 60 minutes. The systemic circulation always had a low but measurable concentration of lidocaine that became slightly higher in the 5 minutes after tourniquet release. According to the concentrations found, the risk of toxicity of lidocaine by using this technique in clinical practice would appear negligible.


Effects of furosemide on plasma volume and extracellular fluid volume in horses.

The effects of IV administered furosemide upon plasma volume (PV) and extracellular fluid volume were determined in horses at rest and after exercise. Serum sodium, potassium, chloride, and osmolality determinations were made. Furosemide caused a significant (P less than 0.05) decrease in PV and serum potassium concentrations in resting horses only. Furosemide's effects upon PV and electrolytes were evident longer than its hemodynamic effects.


Effect of luteinizing hormone on ovarian release of steroids: ovarian vein-sampling technique in conscious gilt.

After ventral midline laparotomy was done, silastic tubing was inserted into the ovarian vein through a cranial branch of the uterine vein. The free end of the silastic tubing was exteriorized through a perforation of the dorsal wall of the vagina and then passed to the outside of the vulva. The free end of the tubing was sutured to the skin approximately 3 cm lateral to the ventral aspect of the vulva. In the ovarian vein of the sow, the plasma concentration of ovarian steroids was 1.5 to 4.0 times greater than that in peripheral blood, thus making possible the detection of changes not found in peripheral plasma samples. Blood samples were taken immediately after surgical placement of the sample collection tube for a 4-month period from unstressed gilts. Surgical stress seems to increase significantly the release of steroids into the ovarian vein. After the luteinizing hormone injection, progestin but not estrogen was consistently released into the ovarian vein.


A specific ureaplasmal serotype associated with ovine uterine infections.

Nine major serologic groups were identified in 19 ureaplasmal isolates obtained from the genitourinary tract of sheep. One specific serotype was associated with uterine infections resulting in infertility.


Delayed cutaneous hypersensitivity in the dog: reaction to tuberculin purified protein derivative and coccidioidin.

A quantitative skin test for delayed-type hypersensitivity was developed in the dog. The test procedure involved testing animals in the pinna of the ear and quantitating the reaction by measuring the change in ear thickness. Skin test reactions to tuberculin-purified protein derivative and coccidioidin were found to be specific and to correlate with the immunization histories of the 27 dogs tested. Kinetic studies on the tuberculin reaction indicated that ear thickness increased slowly following antigen injection, reaching a peak at about 48 hours. Cellular infiltrates at reaction sites were primarily responsible for the increase in ear thickness. They consisted predominantly of mononuclear cells, although a marked number of neutrophils were also present. Multiple skin tests with tuberculin-purified protein derivative and coccidioidin on 8 nonimmunized (normal) dogs indicated that a skin test was capable of actively sensitizing a portion of the animals tested.


Electronic cell volume analysis of growth and rejection of EL-4 ascites tumor cells.

The in vivo growth of EL-4 ascites tumor cells in peritoneal cavities of syngeneic (C57BL/6) and allogeneic (DBA/2) mice was monitored by electronic volume analysis. In the growth of EL-4 cells in the C57BL/6 mice, daily decrease in electronic modal cell volume and labeling indices was observed. After day 7, the rejection of EL-4 cells in DBA/2 mice was indicated by increase in the percentage of small cytotoxic lymphocytes and decrease in the labeling indices of tumor cells.


Preoperative aortography before abdominal aortic aneurysmectomy?

A review of 100 consecutive patients undergoing abdominal aortic aneurysmectomy was made to assess the value and necessity of preoperative aortography. Comparison of arteriography with physical examination, plain roentgenograms and ultrasonography suggests that angiography is required only for evaluation of specific problems. Indications for the selective use of preoperative aortography are proposed.


Hypertension secondary to complete occlusion of the renal artery.

In summary, we feel the results of this study support an aggressive approach toward the diagnostic evaluation and operative management of patients with renovascular hypertension secondary to complete occlusion of the renal artery. Further, the frequent presence of contralateral disease and the progressive nature of renal artery occlusions represent a significant threat to renal function. Since renal function is frequently compromised but potentially retrievable by revascularization, nephrectomy should be employed only when hypertension is difficult to control, revascularization is impossible, and excretory function in the affected kidney is minimal.


Complications of peripheral arteriography.

This paper offers an analysis of possible complications of peripheral arteriography. Complications are considered in terms of the most common fundamental problems: 1) reactions to contrast media; 2) vasovagal response to arterial puncture; 3) local hemorrhage; 4) vein and nerve injuries in vicinity of arterial puncture site; 5) subintimal injection of contrast material; 6) arterial thromboembolism; 7) special problems related to catheters and guide wires; and 8) intravascular injection of foreign substances. The paper also provides ten examples of specific clinical conditions caused by arteriographic procedures. Finally, various safeguards in the prevention of complications are discussed.


Carotid endarterectomy.

In conclusion, an extensive study comparing routinely shunted carotid endarterectomies with routinely non-shunted carotid endarterectomies, supports the findings of others that there is a higher morbidity and mortality rate in the non-shunted population when shunting is performed non-selectively and supports the hypothesis that this morbidity and mortality may be reduced to more acceptable levels if selective shunting is employed.


Local anesthesia for mediastinoscopy: experience with 450 consecutive cases.

Mediastinoscopy has been widely applied in the evaluation of patients with suspected bronchogenic carcinoma over the past decade. Though there remain those who feel that such findings should not play a significant role in determining resectability, we have found a number of patients who have been saved from exploratory thoracotomy in obviously incurable situations. We have had a relatively high degree of success in the diagnosis of benign diseases. Wtih no mortality and a morbidity of 1.1%, we feel that mediastinoscopy under local anesthesia is applicable in many clinical circumstances in which the requirement for general anesthesia would preclude such evaluation. Though it is not necessary that local anesthesia be exclusively applied, we feel that our experience with over 450 cases in the last six years has demonstrated safety and efficacy in universal application of local anesthesia for cervical mediastinal exploration.


Pulmonary artery aneurysm.

Less than 200 cases of main pulmonary artery aneurysms have been reported and most came from autopsy series. The aneurysms may be associated with congenital cardiovascular lesions, syphilis, degenerative changes in the arterial wall and possibly trauma. Pulmonary artery aneurysm is a true entity which can occur with or without typical clinical findings. Physicians should pay more attention to the so-called "aneurysmal dilatation" or "idiopathic dilatation" of the pulmonary artery and obtain a correct diagnosis by angiography. Since pulmonary artery aneurysm carries a risk of rupturing, the operation should be considered as soon as the lesion is recognized. Few surgical interventions have been reported.


Cancer of the large bowel with special reference to incidence and etiology.

1. Cancer of the large bowel is second in cancer incidence to lung cancer in Kentucky and in the United States. It is second only to breast cancer in women. 2. It is far more common in the United States and countries with people in the higher socio-economic levels. 3. In addition to the well known associated or premalignant disease, diets high in fats and proteins are thought to increase the risk of the disease. 4. Much research is being carried on to determine other factors in the etiology of this condition. 5. The treatment of choice is still surgical removal of the lesion and all node-bearing and neighboring tissue, including the no-touch isolation technique with early ligation of the section of bowel to be removed. 6. Chemotherapy and radiation therapy are of proven value in more advanced disease. 7. Carcinoembryonic antigen is of value in the prognosis of colorectal cancer.


Role of antibiotics in penetrating abdominal trauma.

The effectiveness of antibiotics in the management of penetrating abdominal injuries was studied retrospectively in two non-controlled, non-randomized groups of patients. The uncontrolled group (107 patients) received a variety of antibiotic(s) mainly intra- and postoperatively. The protocol group (121 patients) received a combination of clindamycin and gentamicin preoperatively in the Emergency Room. The protocol group had a statistically significant reduction in the incidence of intraabdominal sepsis, 1.7% as compared to 8.3% in the uncontrolled group. Although the improved results cannot be attributed solely to the antibiotic regimen, the trend seems apparent. Therefore, to minimize septic complications in penetrating abdominal injuries, we advocate: 1. prompt resuscitation, 2. early and appropriate surgical intervention and 3. preoperative antibiotics that are effective against both the aerobic and anerobic resident flora of the gastrointestinal tract.


Objective assessment of femoral artery profundaplasty.

The physiologic results after profundaplasty in a group of patients with uncorrected complete occlusion of superficial femoral artery are presented. The limbs were evaluated by ankle B.P. index and muscle pH, and pulse volume plethysmograph showed that the deep femoral artery, in occlusion of superficial femoral artery, can provide pulsatile flow and adequate perfusion to calf muscles in most cases.


Blood coagulation profile in patients with acute diffuse peritonitis.

Coagulation studies conducted on 42 patients with acute peritonitis of varying etiology revealed statistically significant prolongation of kaolin cephalin clotting time, decrease of platelets and elevation of plasma fibrinogen and serum fibrinogen degradation products. The relationship of the coagulopathy to bacterial invasion of peritoneal cavity was indicated by the absence of significant change in KCCT, prothrombin time, and bleeding time in patients with sterile peritoneal fluid. The results suggest a process of insidious defibrination intricately superimposed on the hypercoagulable state in these patients.


Mammary augmentation in a community hospital by a general surgeon: results and treatment of encapsulation.

One hundred females underwent mammary augmentation for cosmetic reasons. All operations were performed under general anesthesia through a para-areolar incision. All of the patients were pleased with the results, although 7% developed excessive scar contracture or encapsulation. Two patients were operated upon again, and both re-encapsulated. A closed compression technique for rupturing the capsule was then applied to all seven, with rupture of the capsule and return to a normal breast consistency. Even the group with encapsulation stated that they were generally pleased with the augmentation.


Diagnosis and treatment of pericarditis by the subxiphoid approach.

The subxiphoid approach for the diagnosis and treatment of pericarditis was used in 49 patients. Various diagnoses were established in 43 cases, and drainage was accomplished in 46. One patient died as a direct consequence of the procedure. Accidental right pneumothorax occurred in three cases. Total evacuation of the pericardial contents, direct inspection and palpation of structures, correction of unsuspected pathology and simultaneous biopsy of the pericardium and other tissues can be achieved, while avoiding the need for repeated pericardiocentesis. The procedure can be done safely under local anesthesia, providing prompt relief of abnormal hemodynamics and a sample for tissue diagnosis.


[Hypoglycorrhachia in mumps meningitis (author's transl)].

Eighty cases of mumps meningitis are studied in children between the ages of one to seven years. The parotids were affected before, after and during the meningitis in all cases. In fifteen cases, when admitted to the hospital, levels of glucose were found in the C.S.F. equal or lower than 40 mg/100 ml. In three of them the hypoglycorrhachia persisted for a long time, as reported by other authors. The possible causes of low C.S.F. glucose values in meningitis are analized, not explanation for this phenomenon in viral meningitis is found.


[Neurological alterations due to metoclopramide in children (author's transl)].

Some clinicals and epidemiological considerations are made on the base of eleven children affected by ingestion on this drug.


[Study of digestive atresia mortality. Its relation with weight and malformation. Part II (author's transl)].

Authors study digestive atresia mortality in relation to different parameters such as type of atresia, weight at birth and associated malformations. Mortality increases depending on whether the atresia be single or multiple, this increase being quite obvious when single or multiple atresia is associated with trisomy.


[Preduodenal portal vein (author's transl)].

Three cases of preduodenal portal vein (PDPV) observed in newborns and young infants are reported. In two patients the diagnosis was made during operations for duodenal stenosis and in the remaining one while operating for midgut volvulus and necrosis. In no case was the PDPV responsible for the clinical picture but in all three patients it was accompanied by other causes of obstruction: annular pancreas, extrinsic adhesive bands and malrotation. In one case there was also an asplenia, and polisplenia was present in another one. Both had malrotation and some degree of abnormal visceral asimmetry. The incidence of associated malformations in 52 previously reported cases is analyzed, and the more convincing embriological explanation for this anomaly is commented upon.


[Pathology of the neutrophil motility in childhood (author's transl)].

Polymorphonuclear motility has been recently recognised as a major step of host defense mechanisms, and its' impairment associated with recurrent infections. The deficiency could be essential or secondary to systemic illnesses, etc. The aim of this paper is to review briefly the different kinds of motility: chemotaxis, random and chemoquinesis, its' physiology and current laboratory techniques of evaluation. Finally, clinical findings and most relevant syndromes in clinical pediatrics are reviewed in the context of author's experience.


[Advances in the rational therapy of epilepsy in children (author's transl)].

Advances in the rational therapy epilepsy require: 1) an accurate diagnosis and classification, based upon the clinical manifestations of the attacks electroencephalographic pattern, 2) a selective pharmacotherapy adjusted to the particular type of epilepsy, 3) a correct mode of administration based on the pharmacokinetic characteristics of the drugs, and 4) to follow the guide-lines for a safe therapy control. The international classification of epileptic seizures is presented. The practical consequences of the pharmacokinetics of the antiepileptic drugs and their interactions between them as well as with other drugs are discussed. The need of administering single, pure drugs, as much as possible is emphasized. Special recommendations are given to attain a good blood level control of antiepileptic therapy. On the basis of such drug blood monitoring, a particular consideration is given to the interpretation of therapeutic concentrations and to the discussion of the many variables that account of achieving either subtherapeutic or toxic blood levels.


Renal damage with intestinal bypass.

Renal function and biopsies were studied in 18 patients, 7 to 108 months after intestinal bypass. Enteropathy was found in 12 and hyperoxaluria in 16. Every biopsy showed a type of focal interstitial nephritis, tubular atrophy, fibrosis, and glomerular hyalinization. Damage ranged from minimal to extensive and renal function from normal to end-stage failure. Tubular injury had resulted partly from oxalate deposits. However, in 10 patients no oxalate crystals were seen. In eight others, most of the damaged areas were remote from crystal deposits. Immunoglobulin M and C3 deposits, found in glomerular capillaries and the messangium in six of 11 specimens, and the presence of circulating immune complexes in five of 10 patients, in addition to the extraintestinal organ involvement, suggested immune complex mesangial injury as one factor in bypass nephropathy. With progressive impairment of renal function, a biopsy appears justified. If damage is significant, the bypass should be dismantled.


[Heterocygous beta thalassaemia (author's transl)].

Two girls with an heterocigotic beta-thalassemy are presented in this study. Case 1 has an hypochromic and microtic anaemia with an enormous splenomegaly, increased osmotic resistence of red blood cells in salted solution and increase of A2 hemoglobin. This situation is associated with an increase of the glucolitic intraerythrocitic enzimes. Case 2 showed increase of A2 hemoglobine, but this anomaly was associated with decrease of intraerythrocitic enzimatic rate. First clinical signs of erythrocitic disturbances was an acute hemolytic crisis developed by the supply of the sulphometoxipiridacine. The erythroquinetic study showed a decrease of the average life of the red blood cells in both patients.


[Chronic continuous bleeding in a girl with lack of F. XIII (author's transl)].

A case with chronic continuous bleeding on an eleven year old girl with lack of F. XIII with positive family antecedents and without declarate consanguinity is presented. Analytic data are widely clear as well as parent's research which shows the heterocygosity but with doubts exposed.


A familial visceral myopathy.

A kindred contained at least 18 members with visceral myopathy. Sixteen had symptoms of chronic obstruction of the gastrointestinal or urinary tracts. Of six patients with megaduodenum on contrast roentgenograms, two were asymptomatic. Four patients had redundant colon on barium enema, and four had megacystis. Specimens from duodenum, jejunum, ileum, colon, or urinary bladder from five patients showed thinning and extensive collagen replacement of the longitudinal muscle layer; ganglion cells were normal by light and electron microscopy. Esophageal manometry in three patients showed decreased gastroesophageal sphincter pressures and no contractions in the smooth muscle segment of the esophagus; duodenal manometry showed a low frequency and amplitude of contractions. Three patients developed fever and signs of peritonitis after operations to bypass dilated segments. This seems to be a generalized smooth muscle disease with variable clinical manifestations and with an autosomal dominant or sex-linked dominant mode of inheritance.


[Nephrotic syndrome and hereditary spherocytosis (author's transl)].

A case of nephrotic syndrome associated with hereditary spherocytosis in a 22 month old girl is reported. In an attempt to explain the relationships between these two entities and alteration of lipidic metabolism, red cells count and serum cholesterol during relapses of nephrotic syndrome were compared. Until now only two cases involving this association have been published.


Subacute fluorosis: a consequence of abuse of an organofluoride anesthetic.

A young woman presented with a novel multisystem disease: painful periostitis, osteosclerosis, hypertension, and renal dysfunction. The similarity of some of this clinical picture to fluoride intoxication led to the discovery of massively elevated fluoride levels in serum, urine, and bone. Although initially an enigma, the source of fluoride was later found to be the illicit use of an anesthetic agent, methoxyflurane. This agents is one of a class of organofluorides that, by virtue of biotransformation, is a known cause of inorganic fluoride exposure. Though the drug is potentially nephrotoxic as generally used, exposure to it is transient and has not previously led to discernible bone disease.


[Leopard syndrom. Four observations (author's transl)].

Four cases of Leopard syndrom in a mother and in three children of hers are reported. The main clinical and electrocardiographic features characterizing the syndrome are exposed and analyzed in relation with phacomatosis and pathoetiologic mechanism.


Amikacin serum concentrations: prediction of levels and dosage guidelines.

Amikacin is a new aminoglycoside antibiotic that behaves pharmacokinetically similar to kanamycin, gentamicin, and tobramycin. Our study was designed to test whether a digital computer program could correctly predict amikacin serum concentrations in the clinical setting. A significant relation (P less than 0.0001) was found between 153 measured (bioassayed) and computer-predicted levels from 26 patients. The computer program reliably estimated amikacin serum levels after either intravenous or intramuscular doses. Prediction accuracy was not significantly affected by patient sex, hematocrit, or periods of unstable renal function. Predicted levels were most accurate when based on creatinine clearance corrected to 70 kg body weight or corrected to body surface area. The pharmacokinetic parameters in the computer program were used to generate a new aminoglycoside dosing chart. Ten patients were given amikacin according to this guideline, and the mean peak serum level for the group was 25.6 microgram/ml.


The myocarditis of systemic lupus erythematosus: association with myositis.

Five patients with clinically overt myocarditis in the setting of systemic lupus erythematosus were analyzed in terms of associated clinical and serologic features. Myositis and antibodies to nuclear ribonucleoprotein (RNP) were present in all. A retrospective review in 140 consecutive patients with systemic lupus erythematosus, including three of these five, showed a highly significant association of myocarditis with myositis (P less than 0.0005). The presence of antibodies to RNP in this small group did not attain statistical significance (P less than or equal to 0.10). The pathologic findings in the one patient who died showed similar patterns of inflammation in both cardiac and skeletal muscle, suggesting the possibility of a generalized inflammatory process directed against striated muscle. Furthermore, although anti-RNP antibodies were found uniformly in these patients, their significance remains to be defined.