Lyme arthritis in Wisconsin.

Rash, severe constitutional symptoms, and arthritis developed in three persons who were bitten by ticks in Wisconsin. On comparison with other reports of arthritis related to tick bites, we found that the illness of our patients had clinical features consistent with Lyme arthritis. Lyme arthritis appears not to be restricted to New England as has been previously reported.


[Improved interpretation of renal-vein-renin-ratio by simultaneous determination of renal 131I-hippuric-acid-clearance-ratio in patients with renovascular hypertension (author's transl)].

In patients with unilateral vascular kidney disease and hypertension, ratio of renal-vein-renin was compared with 131I-Hippuric-acid clearance and change in blood pressure during Saralasininfusion. The ratio of renal-vein-renin was positively correlated with the ratio in renal plasma flow between the kidneys in all patients studied. The ratio of renins therefore is a result of two factors: The difference in renin secretion and the difference in blood flow in the two kidneys. In patients with angiotensin independent hypertension renin-ratios up to 2.0 were found without relevance to elevated blood pressure. When the difference in renal blood flow between both kidneys was small, even a slight difference in renal vein renin indicated hypertension related to increased renin secretion. Renin-ratios in the critical range between 1.5 and 2.5 should only be interpreted in respect to a similar ratio in renal blood flow.


[A prospective study on course and prognostic criteria in "preleukemia" (author's transl)].

The natural course of disease was followed in 33 patients with so-called preleukemia by a prospective multicentric protocol. Patients with the following criteria were included: Anaemia with granulocytopenia and/or thrombocytopenia, normal or increased cellularity of the bone marrow and exclusion of a known diagnosis of underlying disease. Follow up after assumption of "preleukemia" was 3 years or more. Median survival was 26 months after diagnosis of preleukemia and 36 months after the first unequivocal symptoms of the blood dyscrasia. 40% of the patients changed to the picture of leukemia within 2 years. The most important parameters suggesting subsequent transition to overt leukemia where chromosomal abberations and an increased blast count of the bone marrow.


The vulnerability of the right atrium. III. Electrophysiologic correlates of atrial vulnerability.

70 patients were investigated by means of the atrial extrastimulus method at three different driving rates: 80, 100 and 120/min. At each rate the effective, the relative, the total and the functional refractory periods were measured. 30 patients who showed signs of atrial vulnerability at least one of the tested rates were included in the so called vulnerability group. The remaining 40 patients, who did not fulfill the criteria for atrial vulnerability, were included in the nonvulnerability group. When the two groups were compared to each other there were significant larger P waves (p less than 0.005), shorter effective refractory periods (p less than 0.001) and longer relative refractory periods (p less than 0.001) in the vulnerability group. With increasing driving rate there was an increased tendency to repletitive firing in the vulnerability group. The phenomenon of vulnerability correlated well with the rate-induced shortening of the effective and the lengthening of the relative refractory period. The above described phenomena are compatible with the concept of re-entry as the electrophysiologic mechanism of atrial vulnerability in man.


Prenatal diagnosis of beta-thalassemia.

Prenatal diagnosis was attempted in 14 fetuses at risk for homozygous beta-thalassemia, gestational age 18-22 weeks. In 4 cases the placenta was entirely anterior, placental aspiration under ultrasonic control only had to be used for fetal blood sampling. In 10 fetuses fetoscopy was used for puncture of a chorionic blood vessel. Diagnoses were based on the rate of in vitro synthesis of beta-globin related to total non-alphaglobin synthesis. With the aid of fetoscopy, nearly pure fetal blood was obtained in general. Placental aspiration resulted in samples which contained a low percentage of fetal and a high percentage of maternal cells. The attempt of fetal blood sampling resulted in fetal loss in two cases. In 2 aspiration cases no diagnosis could be made because the samples were inadequate. In 2 cases the diagnosis was established in spite of low fetal cell content through determination of the specific radioactivity in the placental and pure maternal blood. Until now 6 children have been born in whom prenatal diagnosis had been attempted, none of them has homozygous thalassemia. Present efforts are directed toward improving the safety of fetal blood sampling and the biochemical methods for the diagnosis in placental samples with low fetal cell content. Although the prenatal diagnosis of beta-thalassemia is possible, the procedure has still to be considered experimental.


Alterations of peripheral testosterone matabolism after induced hypoprolactinemia in patients with prostatic carcinoma.

In 12 patients with advanced prostatic carcinoma the effect of bromocriptine-induced hypoprolactinemia on the peripheral androgen metabolism was investigated after 3H-testosterone injection under conditions that each individual served as his own control. After a 5-day significant prolactin suppression, the elimination of 3H-label 1 h after testosterone injection was about 45% and equal to pre-bromocriptine values. The recovery of dihydrotestosterone separated by silica gel T.L.C., however, was significantly augmented, resulting in a marked decrease of the testosterone/dihydrotestosterone ratio from 12.2 to 6.3. This induced 5alpha-reductase activity after prolactin suppression is in accordance with our earlier findings on prostatic carcinoma tissue, matches well with observations of Magrini et al. on induced hyperprolactinemia and may be a new approach to the understanding of androgen dependent disorders.


Clinicopathologic studies of primary cerebral amyloid angiopathy.

Primary cerebrovascular amyloidosis resulting in significant cerebral parenchymal damage was encountered in 23 autopsied cases at the Mayo Clinic over the past 10 years. Patients were 60 to 97 years old and both sexes were equally represented. Large- and medium-sized leptomeningeal and cortical arteries showed the characteristic pattern of medial and intimal involvement, with luminal stenosis. The walls of smaller arteries were often diffusely infiltrated, with fibrinoid degeneration and miliary aneurysm formation. The amyloid nature of the infiltrate was confirmed by electron microscopic examination in all cases. All cases showed varying numbers of perivascular or independent senile plaques in the cerebral cortex. Alzheimer's neurofibrillary tangles were absent or were limited to the hippocampal region in all but two cases. Multiple, small cortical infarcts and hemorrhages were regularly present. Larger hemorrhage was present in nine cases. Of nine patients with terminal massive cerebral hemorrhage, only two were hypertensive. Six patients had had progressive dementia; four had had single episodes of vascular events and seven, multiple episodes; and four had had both dementia and vascular episodes. Primary cerebral amyloid angiopathy should be regarded as an important cause of mental deterioration and fatal cerebrovascular accidents in the elderly.


The ocular aspects of bypass surgery of the carotid artery.

A new neurosurgical procedure, anastomosis of the superficial temporal artery to the middle cerebral artery, is being performed with increasing frequency. Over a 7-year period (1971 through 1977), 121 patients have undergone this operation in our institution. Ophthalmodynamometry may be of great help in identifying occlusion of an internal carotid artery. Progressing venous stasis retinopathy and ischemic orbital pain are believed to be indications for bypass surgery of the carotid artery.


Colonoscopic polypectomies.

One hundred ninety-three consecutive colonoscopic procedures were carried out over a recent 1-year period. An overall success rate of 92.7% was achieved for 178 attempted polypectomies. Bleeding was a complication in two patients. No colonic perforations resulted from the procedures. The results represent experience gained with 1,450 colonoscopic polypectomies.


Clinical spectrum of Wilson's disease (hepatolenticular degeneration).

Fifty-eight patients with Wilson's disease are reviewed, of whom 25 symptomatic patients experienced liver disease first and 28, brain disease. Ten of these patients presented with liver disease alone, 19 with brain disease alone, and 24 with evidence of both liver and brain disease. The remaining five were discovered as asymptomatic siblings of known patients. Three of the patients with hepatic presentation and one with neurologic presentation later experienced the other type of symptomatology, bringing the total number of patients with mixed disease to 28. Of the 44 patients with brain disease, 12 presented primarily with extrapyramidal findings, 6 with cerebellar findings, and 17 with both; pseudobulbar findings were noted in 9 patients, all of whom had other symptoms of severe nervous system disease. In addition to these presentations, in an appreciable number of patients the first symptoms were of a mental or emotional disorder. Disease of other organ systems, such as the joints and kidneys, also occurred but infrequently. Where adequate family information was available, 13 of 65 siblings (20%) were known to have had or were suspected of having had Wilson's disease. This is consistent with the autosomal-recessive pattern of inheritance.


Roentgenographic findings in thoracic aortic dissection.

Review of 91 confirmed cases of thoracic aortic dissection revealed that the findings on the plain films of the chest often were suggestive of the diagnosis, with abnormalities in the aortic countour, especially when comparison was made with previous roentgenograms. The diagnosis was definitively made in 52 cases by retrograde transfemoral or transaxillary catheterization accomplished without complication. The most common angiographic findings were opacification of the false lumen, visualization of an intimal flap, and deformity of the true lumen. Early diagnosis and institution of appropriate therapy can improve survival in this disease.


Systemic mastocytosis with review of gastrointestinal manifestations.

A 63-year-old man presented with fever, splenomegaly, steatorrhea, diarrhea, and weight loss. A tissue diagnosis of systemic mastocytosis was made. This case is unusual in that diarrhea and steatorrhea were present in the absence of skin lesions and because fever was a prominent symptom. Thus, systemic mastocytosis should be included in the differential diagnosis of intestinal malabsorption even when the skin shows no abnormalities. The gastrointestinal manifestations of systemic mastocytosis are reviewed.


Rates of surgical care in prepaid group practices and the independent setting: what are the reasons for the differences?

The Seattle Prepaid Health Care Evaluation Project is a comparative study designed to assess the care received by persons enrolled in either a large prepaid group practice (PGP) or in a prepaid, independent practice setting in which physicians are reimbursed on a fee-for-service basis (IPP). As part of the study we assessed the patterns of surgical care for hysterectomy, cholecystectomy, appendectomy, and tonsillectomy/adenoidectomy. Overall, there were 215 such procedures with an exposure adjusted rate being five times higher in the IPP than in the PGP. After eliminating 43 per cent of procedures in the IPP and 22 per cent in the PGP which did not meet specified criteria for either necessary, appropriate or justifiable surgery, the exposure-adjusted rate differential was 3.9 times higher in the IPP with the difference in the rates being mainly attributable to hysterectomy and tonsillectomy/adenoidectomy. We conclude there were more unnecessary procedures in the IPP, but the fact that a significant difference in the incidence of surgery persisted even after elimination of such cases suggests that the differences in rates of surgery between the IPP and PGP cannot be solely attributed to a higher rate of inappropriate surgery in the IPP.


Determinants of three stages of delay in seeking care at a medical clinic.

Factors affecting delay were studied in patients seeking treatment for the first time for a particular symptom at clinics in a major, innercity hospital. On the basis of the patients' retrospective report, the total time from first noticing a symptom to the seeking of treatment was divided into three sequential stages: 1) appraisal delay--the time the patient takes to appraise a symptom as a sign of illness; 2) illness delay--the time taken from deciding one is ill until deciding to seek professional medical care; and 3) utilization delay--the time from the decision to seek care until the patient goes to the clinic and uses its services. The variables used to predict the length of delay for each of the three stages and for total delay included reports on concrete, sensory perceptions and abstract, conceptual beliefs about one's symptoms, behavioral factors such as strategies for self-appraisal and techniques for coping with illness, emotional reactions, negative imagery elicited by the illness threat, situational barriers, and socio-demographic factors. Patients experiencing a very painful symptom and patients who did not read about their symptom had a short appraisal delay. Patients with old symptoms and those who imagined possible, severe consequences of their illness had long illness delays. Utilization delay was shortest for persons who were not concerned about the cost of treatment, who had a painful symptom, and who were certain that their symptom could be cured. Patients who had short total delays were persons who did not have a competing personal problem and who had a painful symptom. All of these predictors were significantly correlated with the measure of delay at or beyond the p = .01 level. It was concluded that different factors mediate delay in each of the three stages and that studies which use only a single measure of total delay are likely to be of limited value in understanding delay.


Measures and methods in evaluating patient education programs for chronic illness.

Patient education provides a vehicle for increasing the self-management of chronic illness and promoting modifications of life styles, which are considered important strategies for prevention. Evaluating the impact of such programs is complex and poses a number of methodologic and technical problems. Outcome measures of patient education programs are defined and reviewed in terms of the existing evaluation literature and our own studies utilizing diabetes as a prototype condition. Important dimensions of adaptation are outlined and indices to measure it discussed in an effort to examine aspects of educational programs directed at facilitating coping and maintaining quality of life. Factors which influence outcome variables are identified and include: patient factors (e.g., age, ethnic, socioeconomic, cultural, personality, and emotional), disease factors (e.g., severity of illness, age of onset, length of illness, mode of therapy), system factors (e.g., patient's location in the health care system, relation of teaching program to other health care providers). The effects of these factors are described including their implications for research design.


Provider attitudes toward STARPAHC: a telemedicine project on the Papago reservation.

Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC), is a large-scale telemedicine project, sponsored jointly by the Indian Health Service (IHS), NASA, and the Papago tribe, and in operation on the Papago Indian Reservation outside Tucson Arizona, for the past two years. STARPAHC uses a mobile health unit (MHU), staffed by non-M.D. providers and linked by two-way television, radio, and remote telemetry to an IHS hospital up to 100 miles away, to make medical care available in remote areas of the reservation. Over a two-year-period beginning in January, 1975, 47 individual providers, including 21 physicians, were interviewed, at five intervals, to determine their receptivity to and acceptance of telemedicine; because of staff turnover, not all providers were interviewed at each different interval. Data suggests that television equipment was considered costly and in some cases inconvenient to M.D. providers; it was not considered always essential for providers to be able to diagnose and treat patients. The major problems providers cited were the unreliability of equipment and the time required for television consultations. The major benefit cited was improved access to health care for a population not previously receiving such care near their homes. Non-M.D. providers considered the link they were provided to physicians via television and voice communications from remote areas to be a major benefit.


Primary care in Durham County: who gives care to whom?

The purpose of this study is to describe quantitatively the primary health care system of a defined population. The ambulatory care services of private practices and institutions in Durham County, North Carolina were sampled four times during 1975-1976 to determine the relative contributions to primary care made by specified types of practice and sources of care. All the institutions and 96 per cent of practicing physicians participated. Utilization of primary care services was analyzed by race, sex, age and health insurance status. One striking finding is the predominant role in the delivery of primary care played by the private specialists practicing in the community in contrast to the relatively small role of the university teaching hospital. Another important finding is the low proportion of blacks and Medicaid patients served by these community physicians. Thirdly, removal of legal and financial barriers has made little impact as yet on the patterns of health care delivery established before the institution of mandatory integration of health services. Since these findings have broad implications for health care delivery, this study warrants replication in other settings.


Physicians' changing attitudes about striking.

Both interns and residents and practicing physicians express substantial support for physicians' organizing for collective bargaining and striking. These findings, from 1146 respondents to a 1976 survey of the alumni of the Albert Einstein College of Medicine, indicate that profound changes have occurred in physicians' views on these issues. Although the greatest support for striking came from interns and residents, with 67 per cent of them indicating they think physicians should be allowed to strike, the survey found an increasing pattern of militancy commencing with 1964 graduates. Physicians in private practice and those who spent two-thirds or more of their time in direct patient care were the most likely to support strikes by physicians (60 per cent), while the least support came from those fulltime on medical school faculties (39 per cent). No differences in support for striking were found in relation to sex, religion or size of community in which physicians practice. A longitudinal examination of the medical school Class of 1975 at matriculation, at graduation and during internship training reveals that a major growth of support for striking occurred between matriculation and graduation.


Patient satisfaction questionnaire.

A Patient Satisfaction Questionnaire was developed using factor analytic techniques. The 19-item questionnaire uses a five-point Likert scale, has a coefficient alpha of .972, and consists of three factors. Validity was assessed using correlations with specific criterion items.


Delivering ambulatory health care: the successful experience of an urban neighborhood health center.

During the past few years, the effectiveness of neighborhood health centers (NHCs) has been questioned, and curtailment of funding has indicated a lack of confidence in this organizational model. This article, however, reports on an urban NHC which has achieved considerable success in delivering health care to its target population at a moderate cost. Fifty-two per cent of all community residents and three-quarters of the children and adolescents were active users of the center. The majority of the patients were from low-income families and had established long-term relationships with center providers. Average visits per patient varied with age, sex, diagnosis and insurance coverage. Center physicians, trained as specialists, functioned primarily as general practitioners delivering preventive services, treating minor injuries and self-limiting diseases, and palliating chronic illness. Preventive care was planned as a focal point of the center's program, but third-party reimbursement policies and the lower priority that many patients placed on nonillness care were two major obstacles to the achievement of this goal. The average cost of health care other than mental health services was approximately $20 per visit and $74 per patient per year. Mental health treatment was more expensive. The findings suggest that reconsideration of the NHC as a viable model for delivering health care to the poor might be worthwhile.


Threats to the validity of emergency medical services evaluation: a case study of mobile intensive care units.

Much of the literature concerning emergency medical services evaluation has been criticized as unconvincing. Several sources of invalidity have comprised the interpretability of these studies. When true randomized experiments cannot be accomplished, quasi-experimental research designs offer greater interpretability than the more often used pre-experimental designs. In using quasi-experimental research designs, special attention must be given to threats to internal validity. A case study describes an evaluation of mobile intensive care units. The paper describes eighteen threats to the validity of the evaluation, as well as the methods used for their control. Whether or not evaluators can control all of the threats to the validity of their studies, these threats should be identified and their potential effects assessed wherever possible.


Mental health services: utilization by low income enrollees in a prepaid group practice plan and in an independent practice plan.

Mental health services were included in a comprehensive package of benefits available to low income enrollees in a prepaid group practice plan (PGP) and in an independent practice plan (IPP) under the Seattle Prepaid Health Care Project. There were no out-of-pocket costs for enrollees. Utilization of services was studied for four years under conditions that might simulate universal entitlement. The analyses indicated that females used substantially more mental health services than males and that enrollees aged 20-44 used more services than those in other age groups. The prepaid group practice generally experienced higher utilization than the prepaid independent plan. Significant racial differences were evident with whites using more services than blacks and black males using strikingly few services. The prepaid independent plan was oriented toward physician providers and emphasized individual psychotherapy while the prepaid group practice employed a diversity of practitioners and therapeutic modalities. The data indicated that the per cent of enrollees using any mental health services was twice as great in the PGP as in the IPP. However, once access to the provider system was achieved, the number of services utilized was greater in the PGP. Inpatient services were also examined. A significantly higher proportion of IPP enrollees were admitted for inpatient care as compared to PGP enrollees. Finally, the cost of mental health services was less than ten per cent of total health service costs in both plans.


Some considerations in selecting interactive and analytical decision approaches for EMS councils.

The application of analytical and interactive decision models to decisions, in EMS councils, with various levels of uncertainty is described. Uncertainty is defined as having temporal, procedural, quantifiability, and environmental attributes. Highly uncertain decisions are unique, with unknown decision procedures. Decision premises, like available funds or demands for services, are constantly shifting in uncertain environments. Low uncertainty occurs when decisions are repeatable and follow known procedures. Past practice can be used as templates when uncertainty is "low" because funding levels and use rates are predictable. The results (e.g., validity, risk of omission, etc.) of applying interactive and analytical decision models under varying levels of uncertainty are discussed.


Evaluation and conflict in measures of performance for blood banking.

The policy statements regarding national blood banking goals as established by the American Blood Commission do not identify precise measures of performance. A survey was conducted to identify the most important measures of performance used in blood banking. Three groups: physicians, blood bank administrators and nurses were used. Results indicate that about twenty measures are currently being used in the industry. With respect to the relative importance of the measures of performance, there is strong agreement between physicians and nurses but little agreement between nurses/physicians and administrators. The survey also established that the value of outdating various types of blood is negatively correlated with the relative frequency distribution of blood in the general population.


Development of rural health services: problems illustrated by a nonprofit, privately-based approach.

The historic development of a nonprofit organization designed to improve rural health services in Colorado is described and some of the major problems of rural health are discussed. This corporation, originally derived from four different kinds of provider organizations, has developed a comprehensive approach to improving the utilization of existing rural health resources and to the recruitment and deployment of new resources. Emphasis has been placed on community involvement, decreasing the isolation of rural physicians by linking rural practices with urban resources, centralizing supportive services and development of quality control methods. The peculiarities of the target area and the evolution of the goals and methods of the organization are described in order to facilitate the adaptation of these concepts to other areas.


Attitudes toward self-care among practicing physicians.

Self-care, although growing as a concept and a movement among providers and consumers, has not been studied systematically in any dimension. Because of the potential role of physicians in establishing the credibility and acceptability of self-care interventions and practices, an exploratory investigation was launched to develop an attitude instrument, to describe the degree to which practicing physicians in a community favor self-care, and to explore some of the correlates of the attitudes expressed. A 13-item attitude scale was developed. Physicians with the most favorable attitudes were most likely to have come from a Jewish religious background, to be under 46 years old, to have health beliefs which reflect an internal locus of control, and to be in a group practice or clinic. Physicians with the least favorable attitudes came from Protestant backgrounds, were 46 to 63 years old, had externally controlled health beliefs, and practiced medicine alone.


Measuring need for health services: a proposed model.

Despite the emphasis of the National Health Planning and Resources Development Act of 1974 on need assessment as the basis of health planning, no valid measures of need for health services are currently available. In this paper a need measurement model is presented for the use of health services planners and researchers following a brief critique of two existing models. Data requirements for the model and in hypothesis-testing situations are described.


Brain deviations in adult obese-hyperglycemic mice (ob/ob).

In the brain of adult obese-hyperglycemic mice (ob/ob) deviations, such as reduced brain weight, diminished myelination, and reduced amount of DNA were found. These findings cannot be explained by hypothyroidism in adults since above mentioned deviations could only have been caused by a reduced thyroidal activity in the first weeks of postnatal life. Therefore, our data are in support of the earlier hypothesis of congenital hypothyroidism.


The effect of alcohol ingestion on hepatic aromatase activity and plasma steroid hormones in the rat.

Chronic alcohol ingestion in the rat resulted in increased hepatic aromatase activity, elevation of plasma estradiol, and a decrease in plasma testosterone levels. Testicular incubation studies indicated that the source of the estrogen was not of gonadal origin but was, most likely, due to increased peripheral conversion. The failure of HCG in vitro to restore testicular secretion of testosterone to normal levels suggested a direct action of alcohol, or a metabolic product, on gonadal secretory processes, as distinct from trophic hormone effects. This study demonstrates that many of the hormonal alterations seen in cirrhosis of the liver in man may be produced directly by alcohol feeding without cirrhotic changes in the rat.


Metabolic interactions of xylitol and ethanol in healthy males.

The effects of oral administration of xylitol on the rate of ethanol elimination and on the ethanol-induced changes in blood concentrations of lactate and pyruvate were studied in seven healthy male subjects. Xylitol (1.0 g/kg body weight) was administered orally and ethanol (0.8 g/kg body weight) intravenously. In the control experiments glucose was given instead of xylitol. Xylitol had no significant effect on the rate of ethanol elimination or on the ethanol-induced increase in the blood lactate concentration. The ethanol-induced changes in the lactate/pyruvate ratio were not affected by xylitol. It is suggested that the ineffectiveness of xylitol is due to its low concentration in the liver after oral administration. Ethanol induced a 5--10 fold increase in the blood concentration of xylitol. This is most probably due to inhibition of xylitol oxidation in the liver by the ethanol-induced reduction in the hepatic redox state. The clinical significance of this finding is unknown.


The effects of streptozotocin diabetes on hepatic triglyceride lipase activity in the rat.

The function of the hepatic triglyceride lipase (H-TGL) is not yet clear. The purpose of the present study was to investigate the possible hormonal regulation of H-TGL. Postheparin plasma was obtained 3 min after the intravenous injection of 50 U/250 g body weight of heparin into male Wistar rats. The lipase activities were measured using substrate containing [14C] triolein emulsified with gum arabic and were expressed in mumoles of free fatty acid released/ml/hour (mean +/- SD). H-TGL was the lipase activity remaining after inhibition of lipoprotein lipase (LPL) by 1.0 M NaCl. Diabetic rats were prepared by intravenous injection of streptozotocin (STZ), 65 mg/kg body weight. The contributions of H-TGL and LPL to the total plasma triacylglycerol hydrolase (TGH) activity depend on the amount of heparin injected and the time of blood withdrawal after heparin injection. H-TGL was maximally released at higher heparin (50 U/250 g body weight) concentrations, compared to LPL which was maximally released at lower heparin (5 U/250 g body weight) concentrations. H-TGL was significantly higher at 3 min after the injection of 50 U of heparin/250 g body weight than at 20 min. Twenty-four-hour fasting produced a significant fall in H-TGL compared to H-TGL in fed rats. Total TGH was significantly lower in diabetic rats 3 days after STZ injection. In diabetic rats 3, 5, and 7 days after STZ injection, H-TGL were significantly lower than those in control rats. H-TGL and H-TGL/total TGH were 9.49 +/- 0.99 and 0.551 +/- 0.071, respectively, in rats 3 days after STZ injection, compared to H-TGL (13.46 +/- 0.69) and H-TGL/total TGH (0.739 +/- 0.052) in control nondiabetic rats. When diabetic rats were treated with insulin, total TGH (14.37 +/- 3.01) and H-TGL (6.77 +/- 4.12) rose to 25.16 +/- 1.02 (total TGH) and 16.49 +/- 1.13 (H-TGL), that were comparable to activities in control nondiabetic rats. Separation of H-TGL and LPL was performed using heparin-Sepharose affinity chromatography of postheparin plasma. The enzyme activity of peak I from STZ rats, which is eluted by 0.72 M NaCl-Veronal buffer, pH 7.4 and corresponds to H-TGL, was approximately half the activity from control rats. TGH released by heparin from isolated rat liver parenchymal cells was investigated. The enzyme activites released from isolated liver parenchymal cells prepared from STZ rats was approximately half that from control rats. The role of insulin in the regulation of LPL has been well documented. Our findings suggest that H-TGL also is under hormonal regulation by insulin in rats.


Kinetics of ketone body metabolism in fasting humans.

The rates of production of total ketone bodies (acetoacetate + beta-hydroxybutyrate) were determined using an isotope tracer technique in 23 obese subjects submitted to a fast of variable duration (15 hr--23 days). Constant infusions of 14C-acetoacetate were used in most studies, but similar results were obtained with pulse injections of this tracer or with constant infusions of 14C-D(-)-beta-hydroxybutyrate. Blood concentration, production rate, and urinary elimination of total ketones rose during approximately the first 3 days of fast and plateaued thereafter at values amounting, respectively, to 7.09 +/- 0.32 mumole/ml, 1908 +/- 80 mumole/min and 167 +/- 14 mumole/min. The rates of ketogenesis are significantly higher than those usually reported in the literature. Ketonemia was an exponential function of production rate suggesting that tissue uptake becomes progressively saturated as inflow rate rises. The same type of relationship between concentration and inflow rate was observed in nine control overnight fasted obese subjects rendered hyperketonemic with infusions of variable amounts of unlabeled acetoacetate. The comparison between the fasted and the control subjects at ketone concentrations of 3--10 mumole/ml showed that on an average, starvation is associated with a 35% decrease in the metabolic clearance rate of ketones. These data suggest that fasting is associated with an impairment of mechanisms for utilizing ketones, this defect contributing to the hyperketonemia of food deprivation.


Homocysteic acid: an examination of its possible growth hormone-like activity.

Hypophysectomized rats were injected intraperitoneally for 4 days with various doses of homocysteic acid or growth hormone. The effects of these compounds on epiphyseal cartilage thickness and circulating somatomedin activity levels were evaluated in an attempt to repeat the results of Clopath, Smith, and McCully, who reported that this compound had growth hormone-like activity. DNA polymerase activity in livers of animals treated with growth hormone or with 10 mg/day of homocysteic acid was also measured. Using larger number of animals and including higher doses of homocysteic acid than those previously employed, we did not observe an increase of epiphyseal cartilage thickness in homocysteic acid treated hypophysectomized rats. Growth hormone significantly increased cartilage thickness. DNA polymerase levels in homocysteic acid treated hypophysectomized rats were not substantially increased although a larger, dose-dependent increase was observed with pGH and hGH. Neither homocysteic acid nor GH increased circulating somatomedin activity under the conditions used in this investigation. These observations demonstrate that homocysteic acid was not a substance with growth hormone-like activity in our hands and cast doubt on its possible future usefullness as a substitute for GH in clinical situations.


[Mezlocillin: tissue concentration and efficacy (author's transl)].

Studies on serum and tissue (cutis, muscle and liver) concentrations were carried out with mezlocillin (Baypen), a semi-synthetic new acyl ureidopenicillin, in 51 patients. Serum half life was 59 minutes. The highest concentrations were measured in the cutis, the lowest in the muscles. Concentrations in the liver were found to be relatively constant and persistent.--The efficacy and tolerance of mezlocillin were examined in 48 patients affected by 56 mostly severe infections, which were treated with a dose of 5 g twice or three times daily. The indications for antibiotic treatment were bronchopulmonary infections, peritonitis, soft tissue infections, biliary and urinary tract infections and postoperative febrile conditions of unknown origin. Clinical cure was achieved in 78.5% and an improvement of symptoms in 5.4% of infections. 76% of the causative microorganisms were eliminated. Mezlocillin was locally and systemically well tolerated.


[Intensive care for newborns. Evaluation of questionaires (author's transl)].

This report contains three sections: A general definition of aims and tasks of neonatal intensive care is followed by the description of four regions and four neonatal units of different structure with some relevant statistics. According to this inquiry about 1.5 cots for maximum neonatal care and 4 cots for intermediate care per 1000 live births are needed. Considering efficiency and effectivity the smallest independent intensive care unit should "cover an area" of 4000 deliveries per year; it should be closely connected to a least one obstetrical unit. Where and how this neonatal unit may be integrated into a childrens hospital can be derived from the four examples given. It should be recognized that 1) high quality intensive care depends on the availability of additional pediatric services, 2) comprehensive care of newborn infants necessitates regional organization including a newborn ambulance system. Thus, close contacts with obstetrical, but also with pediatric units offering better facilities should be established. In yearly intervals results are to be self-controlled by statistical means. The following incidences of normal survival of infants referred to childrens hospitals can be gained currently [2]: Birth weights below 1000 g: above 20%; 1000--1499 g: above 85%; above 1500 g: better than 95%. Less favorable figures call for analyses of reasons and measures to abolish them.


[Neurological complications following measles virus vaccination. Evaluation of the cases seen between 1971--1977 (author's transl)].

Within 11 days following vaccination with live virus vaccine in Hamburg 18 cases of neurological complications have been observed between 1971--1977, including 2 cases of abortive encephalitis. A causal connection was assumed only when the onset of symptoms was later than on the 7th day after the vaccination. The following parameters were evaluated; clinical symptoms, laboratory data, seasonal distribution of the neurological complications and their relationship to the total number of vaccinations, and the different results of studies from various countries using the same vaccine strain (Schwarz). The age disposition to convulsions following measles vaccination is comparable to convulsive reactions after smallpox vaccination.


[Bile acids in duodenal juice of infants and children. Normal values, lognormal distribution, and age-dependence of the total quantity and the distribution of bile acids (author's transl)].

43 gastroenterologically healthy infants and children were investigated during the basic secretion period and after the injection of secretin/pankreozymin in order to establish the total quantity and also the distribution of the secreted bile acids. The total concentration and quantity were enzymatically determined while column and thin-layer chromatography were utilized to separate the bile into 34 different bile acids. Quantified results for bile salts were read directly from the thin-layer sheet with the help of a Chromatogram-Spectrophotometer Zeiss KM 3. While the total quantity of bile acids was found to be independent of age, the composition of bile changed during the first years of life. The percentage of cholic acids decreased from 50% in infants to 35% in older children. At the same time, deoxycholic acids went up from 3% to 13%, and chenodeoxycholic acids increased by 5%. The percentage of glycine and taurine conjugated bile salts, however, remained constant after to the second month of life, the former at 58% and the latter at 35%. In comparison, rather small amounts of unconjugated acids and sulfates were secreted, 0,5% and 6% respectively. The latter were distributed in the same sequence as the nonsulfated bile acids. Lithocholic acids (2,6%) and ursodeoxycholic acids (4,3%) were regularly present in the intestinal secretion.


[Primary hypomagnesemia. Clinical, diagnostic and therapeutic studies in three children (author's transl)].

Three children with primary hypomagnesemia are described. First symptoms of the disease were observed, when the children were 35, 19, and 20 days old, resp. The hypomagnesemia was accompanied by a severe hypocalcemia. Therapeutic trials with high doses of calcium given intravenously and vitamin D were without effect on the symptoms. The whole body retention and intestinal resorption of orally administered 28-Mg was greatly reduced in all three patients compared to healthy adults. Symptoms of tetany and seizures ceased immediately after intravenous application of magnesium. An oral Mg substitution with 42--85 mmol per day was necessary to maintain subnormal to normal serum magnesium levels. The patients are now 5, 4 3/12 and 1 5/12 years old, resp. Psychomotor development in all three children is normal. Height and weight are in the lower normal range around the 3rd percentile, while the oral Mg substitution sometimes caused frequent fluid stools. By family studies from these patients and from the literature an autosomal-recessive inheritance for primary hypomagnesemia is proposed.


[Congenital toxoplasmosis mimicking a cerebral tumor. Special aspects in serodiagnostics of connatal toxoplasmosis (author's transl)].

The authors present the first case of congenital toxoplasmosis mimicking a cerebral tumor. Serological reactions and special features of congenital toxoplasmosis relevant to diagnosing in this disease are discussed. Trials to prevent congenital toxoplasmosis as quoted from the literature are reviewed.


Mortality in middle-aged smokers and nonsmokers.

We assessed the relation of cigarette smoking to mortality in an 11-year follow-up study of 4004 men and women, 35 to 54 years of age, who responded to urging to have multiphasic health checkups. Accounting for 48 other characteristics, both individually and in combination, failed to eliminate the association of smoking with mortality from all causes or with mortality from coronary heart disease. The smoker-to-nonsmoker mortality ratios, crude and adjusted respectively, were 2.6 and 2.1 for all causes and 4.7 and 3.6 for coronary heart disease. This analysis did not support the counterhypothesis that the association of cigarette smoking with mortality is secondary to some underlying characteristic.


Replacement estrogens and endometrial cancer.

We examined the incidence of endometrial cancer in a large prepaid group practice in the Seattle area. From July, 1975, to July, 1977, there was a sharp downward trend in the incidence of endometrial cancer that paralleled a substantial reduction in prescriptions for replacement estrogens. Incidence rates were estimated for estrogen users and nonusers among women 50 to 64 years of age with intact uteri; current long-term users had an annual risk for endometrial cancer between 1 and 3 per cent, whereas nonusers had a risk less than 1/10th as great. These incidence rates remained fairly constant over time among users and nonusers; the drop in overall incidence soon after estrogen use declined suggests that the increased risk associated with estrogens falls quickly after discontinuation. The reduction in incidence of endometrial cancer in this group practice was part of a general decline in the United States after 1975.


Androgen insensitivity as a cause of infertility in otherwise normal men.

To ascertain if androgen insensitivity causes severe oligospermia or azoospermia we studied three unrelated, phenotypically normal men with long histories of infertility. The mean plasma concentrations and production rates of testosterone were 14.3 ng per milliliter and 10.1 mg per day, respectively, values approximately twice the average found in normal men. Serum luteinizing hormone concentrations were elevated in two of the three subjects. The specific high-affinity dihydrotestosterone binding capacity of cultured genital-skin fibroblasts was 8, 0 and 10 fmol per milligram of cellular protein, values half (or less) of those from normal men and women but similar to values in subjects with partial androgen insensitivity manifested by incomplete testicular feminization or Reifenstein syndrome. The low amount of androgen receptor and the combination of high serum gonadotropins and plasma testosterone production rates suggest that the defective spermatogenesis in these infertile men was the consequence of androgen insensitivity.


Gerontology and geriatrics in medical education.

The elderly are receiving more attention because of their increasing numbers and because of the substantial public funding for their health and welfare. This article summarizes the findings of an Institute of Medicine committee, whose recently completed report concludes that gerontology (study of aging) and geriatrics (care of the aged) are not covered adequately in medical education. Suggested remedies include increased attention to these subjects in existing medical-school courses, establishment of a complementary required course integrating information from diverse disciplines and emphasis in house-staff training programs on continuous care of the aged in settings other than acute-care facilities. Although an academic discipline of geriatrics is necessary to enhance teaching, research, and specialized patient care, development of a practice specialty would be unwise. More funds for training and research in gerontology and geriatrics are essential to increase the science base and to encourage the development of knowledgeable faculty.


Reduction of immune complexes and immunoglobulins induced by D-penicillamine in primary biliary cirrhosis.

Penicillamine has an effect on immune complexes and immunoglobulins both in vivo and in vitro. We therefore studied the effect of penicillamine on immune complexes and immunoglobulins in primary biliary cirrhosis. Twenty-eight patients were randomly allocated into a treatment group receiving 600 to 900 mg of penicillamine, or a control group, and followed for a maximum of 24 months. After 12 and 24 months, serum immune complexes had fallen significantly in treated patients as compared to controls (P less than 0.05, P less than 0.01). Treatment reduced IgA, IgG and IgM concentrations, with IgM being significantly different from controls at six, 12 and 24 months (P less than 0.01). Over 24 months, serum aspartate transaminase levels fell in treated patients but rose in controls (P less than 0.01). Bilirubin concentrations increased at a slower rate in treated patients. Penicillamine may favorably influence the course of primary biliary cirrhosis by its immunologic action in addition to its copper-chelating action.


Serial assessment of doxorubicin cardiotoxicity with quantitative radionuclide angiocardiography.

We measured cardiac performance sequentially, using quantitative radionuclide angiocardiography to estimate left ventricular ejection fraction in 55 patients receiving doxorubicin for treatment of cancer. With final doxorubicin dosages greater than 350 mg per square meter, the lowest ejection fraction measured was significantly less than the initial determination. Five patients had severe cardiotoxicity (congestive heart failure). All had an ejection fraction of less than 30 per cent at the time of heart failure, and demonstrated moderate cardiotoxicity (a decline in ejection fraction by at least 15 per cent to a final value of less than 45 per cent) before clinical manifestations. Six patients with moderate toxicity in whom doxorubicin was discontinued did not have heart failure or a further decline in ejection fraction during the follow-up period. Moderate toxicity was continued, but mild toxicity (decline of ejection fraction by greater than 10 per cent, noted in 11 patients) was not well predicted. The assessment of radionuclide left ventricular ejection fraction during doxorubicin therapy may make it possible to avoid congestive heart failure.


Familial idiopathic hypercalciuria.

The frequency of hypercalciuria was determined in the families of nine hypercalciuric patients with idiopathic hypercaliuria who formed recurrent calcium oxalate renal stones. Idiopathic hypercalciuria occurred in 26 of 73 relatives, in three consecutive generations of two families and in two successive generations of four other families. Multiple siblings or children of the probands were affected in three families. Nineteen of 44 first-degree relatives (43 per cent) had idiopathic hypercalciuria, as compared to seven of 29 (29 per cent) other relatives; there was no relation to age or sex. Renal stones were formed by 19 of the 44 first-degree relatives but by none of the others; nine of the 19 were women. We conclude that there is a familial form of hypercalciuria, which appears to be transmitted as an autosomal dominant trait. Stone disease is frequent in first-degree relatives, and affects both sexes equally.


Renal-stone dissolution via percutaneous nephrostomy.

Recurrent renal stones associated with urinary infection were treated in eight kidneys in six patients by percutaneous nephrostomy and irrigation with hemiacidrin, a commercially available solution of organic acids and magnesium. The stones, presumably composed of triple phosphates (magnesium, ammonium and calcium phosphate), were completely dissolved in six kidneys; in two they were partially dissolved and subsequently recovered by other methods. No serious complications were encountered. The technic requires special precautions against perinephric and intravascular dissemination of infection, but it offers potentially effective therapy for certain kidney stones without the use of general anesthesia or operation.


Changes in bronchial epithelium in relation to cigarette smoking, 1955-1960 vs. 1970-1977.

To test the hypothesis that the reduction in tar and nicotine content of cigarette smoke that began in the 1950s should be reflected by the histologic changes in the bronchial epithelium of cigarette smokers, 20, 424 sections taken at autopsy from the bronchial tubes of 445 men (non-lung-cancer deaths) were examined microscopically in random order. There were 211 men who died in 1955-1960, of whom 154 smoked regularly, and 234 men who died in 1970-1977, of whom 181 were regular smokers. Changes studied included basal-cell hyperplasia, loss of cilia and occurrence of cells with atypical nuclei. In both periods studied these histologic changes occurred far less frequently in nonsmokers than in cigarette smokers and increased in frequency with amount of smoking, adjusted for age. Sections with advanced histologic changes in those dying in 1955-1960 occurred in 0 per cent of nonsmokers, in 2.6 per cent of those smoking one to 19 cigarettes a day, in 13.2 per cent of those smoking 20 to 39 and in 22.5 per cent of those smoking 40+ cigarettes a day. In those who died in 1970-1977 the percentages were 0, 0.1, 0.8, and 2.2, respectively.


Neonatal respiratory syncytial virus infection.

Respiratory syncytial virus infections are thought to be uncommon in the first month of life. During a community outbreak, we prospectively studied such infection in our neonatal units. Of 82 neonates studied, 66 were hospitalized for six days or longer, and 23 (35 per cent) acquired this virus. Four infants died, two unexpectedly. Infected infants had a significantly shorter gestation and birth weight. Illness was often atypical, with nonspecific signs, especially in infants under three weeks of age, who had significantly less lower-respiratory-tract involvement and lower quantities of virus in their nasal washes. The titer of virus shed correlated with the infants' postnatal, but not gestational, age. Infection was also acquired by 34 per cent of the staff, who appeared to be important in the spread of the virus. These findings suggest that respiratory syncytial virus may readily infect neonates, but the disease may be atypical and may be overlooked.


Childhood leukemias associated with fallout from nuclear testing.

Continuing concern over the possible carcinogenic effects of low-level radiation prompted us to study the population of Utah because of its exposure to fallout from 26 nuclear tests between 1951 and 1958. Certain rural counties (high-fallout counties) received most of the fallout during that period. We reviewed all deaths from childhood (under 15 years of age) cancers occurring in the entire state between 1944 and 1975 and assigned them to a cohort of either high or low exposure, depending on whether 15 between 1951 and 1958. For reasons unknown, leukemia mortality among the low-exposure cohort in the high-fallout counties was about half that of the United States and the remainder of the state. Mortality increased by 2.44 times (95 per cent confidence, 1.18 to 5.02) to just slightly above that of the United States in the high-exposure cohort residing in the high-fallout counties, and was greatest in 10- to 14-year-old children. For other childhood cancers, no consistent pattern was found in relation to fallout exposure. The increase in leukemia deaths could be due to fallout or to some other unexplained factor.


The declining incidence of stroke.

A major decline in the incidence of stroke occurred in the population of Rochester, Minnesota, during the period 1945 to 1974. For every 100 first episodes of stroke that occurred per unit of population during the period 1945--49, only 55 occurred in the period 1970--74. Although the decline was present in both sexes and in all age groups, the reduction in rates was more pronounced in the elderly. There was no major change in age at onset. Analysis of cohorts born during successive five-year periods from 1865 to 1915 confirmed the decreasing incidence rate in all age groups.


[Carcinomas and malignant papillomas of choroid plexus (author's transl)].

Carcinomas and malignant papillomas of choroid plexus occur more frequently in children and are mostly localized in lateral ventricles. Their clinical picture corresponds to that of plexus papillomas. The histological diagnosis is based upon unmistakeable criteria of malignancy in a tumour deriving from choroid plexus. Five such cases have been studied; in three of them the increase of malignancy was proved by the investigation of recurrences. One case was investigated electronmicroscopically.


[A rare orbito-cerebral penetrating knife-wound (author's transl)].

The authors describe a case of open brain injury caused by a 30 cm long knife, which penetrated the right orbit, the point of which reached as far as the right posterior fossa. The patient survived with minor neurologic deficit in relation to the extensive lesion.


Chronic and acute transtentorial herniation with tumours of the posterior cranial fossa.

In patients with expanding lesions of the posterior fossa general hyper-reflexia (and bilateral latency shifts of auditory evoked brain stem potentials) have been noted as possible symptoms of chronic ascending transtentorial herniation. After ventricular tap, this chronic herniation may evolve into acute herniation with progressive reduction of consciousness which in our experience can only be survived by decompression of the compressed brain stem. The chronic transtentorial herniation is related morphologically to demyelination of the pyramidal tracts and the auditory pathways, whereas the acute transtentorial herniation is related to microcirculatory disturbances in the reticular formation of the mesencephalo-pontine junction.


Nutritional evaluation of low-glucosinolate rapeseed meals obtained by various processes.

Defatted meals were prepared from two new varieties of rapeseed, the 'high-glucosinolate' variety, Brassica napus, Lesira, and the 'low-glucosinolate' variety, Brassica napus, Erglu, by each of the following processes: (1) defatting of the ground seed with hexane; (2) extraction of the myrosinase-deactivated ground seed with 70% aqueous acetone for the removal of glucosinolates followed by defatting with pure acetone, and (3) autolysis of the ground seed for the decomposition of glucosinolates followed by defatting and simultaneous removal of the decomposition products with hexane. The defatted meals obtained after extraction with aqueous acetone of autolysis contain very little glucosinolates and their degradation products as compared to those obtained by defatting with hexane only. The contents of available lysine and of phytates in the meals are, to some extent, affected by the treatment for the removal of glucosinolates. The rapeseed meals were fed at different levels to protein-depleted chicks and weanling rats. The animals fed low-glucosinolate meals prepared both from high-glucosinolate and low-glucosinolate varieties of rapeseed gave superior performance with regard to the feed conversion and protein efficiency ratio as compared to the animals fed the corresponding meals which were obtained simply by defatting the seeds with hexane. The levels of thyroxine (T4) and triiodothyronine (T3) in the serum of rats fed low-glucosinolate meals indicated normal function of the thyroid, whereas those in rats fed high-glucosinolate meals revealed hypothyroidism of the animals.


Short-term effect of zinc sulphate on plasma and hepatic concentrations of vitamins A and E in normal weanling rats.

In normal weanling male rats, the intraperitoneal administration of zinc sulphate (ZnSO4) resulted in a decreased hepatic and an increased plasa concentration of vitamin A after 2 h. In an in vitro study, the vitamin A concentrations of liver homogenates were markedly increased when homogenized livers were treated with ZnSO4, ZnSO4, however, did not show any effect on plasma and liver concentrations of vitamin E. These results indicate that zinc may be specifically involved in mobilizing vitamin A from liver to the circulation of normal animals within a short period. The trace element, therefore, could be used only to treat cases of depressed vitamin A in plasma but also to treat hepatic toxicity from hypervitaminosis A.


Iron absorption from hemiglobin (stable oxidation product of hemoglobin) in relation to the dose in subjects with normal and depleted iron stores.

The dose relationship of hemiglobin iron absorption has been investigated in subjects with normal and depleted iron stores and was found to fit a linear regression in a bilogarithmic presentation of hemiglobin iron dose and iron absorption. Identical regression coefficients but different intercepts of regression were estimated for subjects with normal and depleted iron stores indicating a constant proportional increase of hemiglobin iron absorption in subjects with depleted iron stores in the full dose range of 0.10-50 mg hemiglobin iron.


An improved method for the determination of endogenous thiamine and its phosphate esters in biological material.

Nonphosphorylated thiamine was extracted from tissue homogenates in saline or sucrose into ethylbutylketone-acetonitrile using counter-ion extraction and reextracted into hydrochloric acid. The dried samples were then analyzed by the fluorimetric thiochrome method. Phosphorylated thiamine was treated with Takadiastase to split off the phosphate groups and was thereafter extracted and measured. No column chromatography was needed for the separation of thiamine before the thiochrome assay. A higher accuracy and sensitivity for the thiamine assay was thus achieved.


Plasma cholesterol esterifying activity in guinea pigs.

Plasma cholesterol esterifying activity has been measured in guinea pigs fed either a control diet or the same diet supplemented with 1% cholesterol. The extent of esterification was found to be similar in the cholesterol-fed and control guinea pigs and somewhat lower than in rats. The initial rate of esterification was also of the same magnitude as that found in rats and humans, and unaffected by dietary cholesterol if autologous plasma was used as substrate. However, LCAT activity from cholesterol-fed guinea pigs was significantly higher than that of control plasma when acting on either control or cholesterol-fed substrate. This suggests that dietary cholesterol increases the amount (or activity) of LCAT but that the substrate is unsuitable or that a necessary cofactor is present in limiting amounts. Heat treatment of guinea pig plasma seems to alter substrate availability to varying degrees. The implications of these findings in relation to substrate specificity and cofactor requirements of guinea pig LCAT are discussed.


Uptake and distribution of orally applied N-acetyl-(14C)neuraminosyl-lactose and N-acetyl-(14C)neuraminic acid in the organs of newborn rats.

N-acetyl-(14C)neuraminosyl-(alpha,2 leads to 3)lactose enzymatically prepared of CMP-NeuNAc and lactose by a particulate enzyme fraction from lactating rat mammary gland was applied orally to newborn rats and examined for uptake and distribution in relation to those of free N-acetyl-(14C)neuraminic acid. The neonates were allowed to stay with their mother before and during the incubation time up to 6 h. Within this time 70% of the given dose was excreted while 30% was retained in the body. (14C)NeuNAc-lactose activity appeared 1.5 h after application in blood, urine, and tissues and attained maximum values after 3 and 6 h, respectively. The highest uptake occurred in liver, spleen, and brain. The absorption of the trisaccharide was delayed by 30 min compared with free (14C)NeuNAc. The time courses of the curves show a slower but higher accumulation in the tissues suggesting a better utilization of the (14C)NeuNAc from (14C)NeuNAc-lactose or pecularities in the absorption of the trisaccharide by the organs.


[Plasma glucose, insulin and increased serum levels during continuous infusion of glucose in low dosages].

Metabolic reactions during long-time intravenous infusion of glucose in dosages according to basal energy requirements of man were investigated. Infusion of 0.2-0.4 g glucose/kg body weight/h led to the typical behaviour of blood glucose with an initial peak and a subsequent steady state. The steady state was dose-dependent and always higher than the starting value. Insulin always rose significantly with increasing scattering of the individual values with higher glucose loads. With 0.1 g glucose/kg/h, the steady state of blood glucose, after a minimal initial peak, was lower than the starting value, and no change of insulin in the peripheral venous blood could be observed. Free fatty acid levels initially always decreased, but rose again under low glucose loads (0.1 and 0.2g/kg/h). In all experiments, with an increase of insulin, a decrease of serum potassium was found. Sodium, calcium, bilirubin, creatinine and urea-N did not show any typical changes.


Diagnostic scope and certainty: an analysis of FNP practice.

The health problems of 2,136 patients randomly selected from 8,905 patients seen by 356 family nurse practitioners around the U.S.A. were analyzed. Primary diagnoses were reported on all patients using an adapted H-ICDA/ICHPPC classification. This system allowed for 18 diagnostic categories and 115 diagnoses relevant to primary care. The ten most frequent diagnostic categories were reported and analyzed as to certainty and status (old or new diagnosis). Analysis of diagnostic certainty revealed areas where FNPs felt most accurate. Reporting both diagnoses and diagnostic categories allowed greater understanding of the health problems presented to family nurse practitioners in primary care. This comprehensive data bank of patient care problems adds another dimension to the study of primary care and is a useful tool in further family nurse practitioner research and in curriculum development.


A clinical approach to urinary incontinence in the female.

Five hundred and twenty-eight female patients with urinary incontinence were studied and treated over a 10-year period. Details of management are given, including a description of a vaginal method of reconstruction of the anatomically incompetent bladder neck. The results of treatment of each group are discussed, and the importance of initial clinical recognition of the urinary outflow obstruction syndrome is stressed in order to institute correct treatment.


Transrectal ultrasonography in the evaluation of cervical carcinoma.

Transrectal ultrasonography has proved useful in the evaluation of genitourinary disease. Experience with prostate scans has shown that such conditions as prostate carcinoma and benign prostatic hyperplasia can be diagnosed and assessed with a high degree of accuracy. In patients with carcinoma of the bladder this method is useful in determining the degree of tumor invasion within the bladder wall. Our experience with scans of the uterus is in its early stages. We have studied 30 patients with documented cervical carcinoma and are studying 1) the presence and extent of parametrial involvement, 2) the ability to distinguish benign from malignant lesions, and 3) the identification of bladder invasion.


Capillary and venous blood estrogen in pregnancy.

Total estrogens in the third trimester of pregnancy were measured in matched samples of venous and capillary blood serum. A close correlation was observed between capillary blood estrogens (CBE) and venous blood estrogens (VBE). After establishing norms for CBE during the third trimester of normal pregnancy, the parameter was assessed for its use in high-risk pregnancy in comparison with VBE. In 96.6% of the 59 high-risk pregnancy cases studied, the conclusions drawn about the fetoplacental unit on the basis of CBE and VBE were similar.


Primary squamous cell carcinoma of the endometrium.

A case meeting Fluhmann's criteria of epidermoid carcinoma of the endometrium is presented. The patient has been free of tumor for 14 months.


Severe polycystic kidney disease in pregnancy. Report of fetal survival.

Advanced polycystic renal disease associated with pregnancy is very rare. A severely uremic pregnant patient with Landesman's Group C disease was delivered by cesarean section at 33 weeks' gestation, after dexamethasone treatment for fetal lung maturation. This is the first surviving infant in a case of Group C polycystic kidney disease.


Listeria monocytogenes. Macroabscesses of placenta.

Macroabscesses of placenta caused by Listeria monocytogenes were observed in a 37-year-old febrile primigravida. She was prematurely delivered of a depressed 2310-g infant, who was resuscitated and promptly treated with antibiotics. Mother and child are well at 10-year followup. Although perinatal listeriosis with placentitis is not rare, its presentation as macroabscesses of the placenta has until now gone unreported in the English language literature.


Intravascular spill of hyperosmolar urea during induced midtrimester abortion.

Intravascular spill of hypertonic sodium chloride and the resultant serious and occasionally fatal consquences have been reported in association with induced midtrimester abortion. This report details 3 cases of intravascular spill of hyperosmolar urea. Although urea may pose less concern, because of its ability to readily cross cell membranes and its action as an osmotic diuretic, inadvertent intravascular spill can produce symptoms that include nausea, headache, sensations of warmth, and intense uterine cramping. In addition, abnormal blood pigments may occasionally be noted in the urine. Treatment includes intravenous hydration, careful monitoring of fluid/electrolyte balance and renal function, and avoiding the use of oxytocic agents.


Nephrotic syndrome due to preeclamptic nephropathy in a hydatidiform mole and coexistent fetus.

A case study and review of the literature of 2 uncommon obstetric events associated with each other is presented. The diagnosis, treatment, and evaluation of a case of nephrotic syndrome due to preeclamptic nephropathy in a hydatidiform mole and coexistent fetus is presented. Cytogenic studies and appropriate follow-up therapy are discussed. The complete remission of renal and hypertensive complications with evacuation of the pregnancy and lack of malignant transformation is stressed and is found to be characteristic of "partial" mole.


Dysmenorrhea in unicornis with rudimentary uterine cavity.

Two adolescents with a rare müllerian anomaly, uterus unicornis with a noncommunicating rudimentary uterine cavity, are presented because of clinical manifestations characterized by dysmenorrhea and pelvic pain requiring multiple hospitalizations and surgical procedures prior to the correct diagnosis. A high index of suspicion and proper diagnostic evaluation are essential for all adolescent patients presenting with dysmenorrhea associated with menarche and subsequent menstruation. The details of 2 cases and their diagnostic and therapeutic emphasis are presented.


Carbamazepine levels in pregnancy and lactation.

An epileptic patient whose seizures were controlled with carbamazepine and primidone was followed throughout pregnancy and lactation. Blood levels of primidone decreased during pregnancy and rose postpartum requiring dosage adjustments. Pharmacologically insignificant amounts of the drug were detected in breast milk. A review of the literature revealed 94 infants exposed to carbamazepine in utero and no evidence to date that this drug carries a teratogenic risk.


Chlamydiae, cervicitis, and abnormal Papanicolaou smears.

Cervical abnormalities accompanied by Papanicolaou Class II or Class III cytologic results are commonly encountered in gynecologic office practice. Chlamydiae are a common cause of genital tract infection, with or without manifest symptoms or signs. An immunofluorescence method was used to determine the presence of antichlamydial antibodies in cervical secretions. Eleven of 15 patients in whom such antibodies were found (73.3%) had Papanicolaou Class II or Class III smears, in contrast to only 3 of 18 patients (16.7%) without antichlamydial antibodies. The determination of antichlamydial antibodies in cervical mucus was highly reproducible, and specimens were readily collected in the office, without the need of prompt laboratory procedures. In selected patients, tetracycline treatment of early chlamydial infection resulted both in the disappearance of the antibody from cervical secretions and in the reversion of the Papanicolaou smear from Class II or Class III to Class I.


Effect of single and multidose cephradine prophylaxis on infectious morbidity of vaginal hysterectomy.

The administration of cephradine prophylactically to patients who were undergoing vaginal hysterectomies resulted in a marked and significant reduction in the incidence of postoperative infections when compared to a placebo group. Cephradine was the cephalosporin studied because of its unique pharmacodynamic properties, which result in high uterine tissue levels. The protective effect was similar whether 1 g was given preoperatively followed by 500 mg IV q. 6 hours for 4 doses, or a single dose of 2 g IV given approximately 1 hour before surgery. Uterine tissue and serum levels of antibiotic were high and correlated with the degree of protection noted.


Estrogen and progestin binding in cytosols of ovarian adenocarcinomas.

Because a few ovarian adenocarcinomas respond favorably to endocrine therapy, we tested the hypothesis that some ovarian adenocarcinomas have functional similarity with sex-hormone-sensitive endometrial and breast tumors. Cytosols from 23 ovarian adenocarcinomas and 27 control tissues were examined for receptorlike estrogen and/or progestin binding. Eight of 16 primary ovarian adenocarcinomas had estrogen and/or progestin receptorlike components; among the metastases tested, one third retained estrogen binding. No correlations were found between binding characteristics and histopathologic grade. The presence of estrogen binding in a lung lesion helped confirm recurrent ovarian disease. Estrogen binding occurred in specimens from women with no histories of exposure to exogenous estrogen. Because tamoxifen and nafoxidine could inhibit estradiol binding, it is likely that antiestrogens will prove beneficial against some ovarian cancers.


Trophoblastic proteins in ovarian carcinoma.

Trophoblast-"specific" proteins in the plasma of 37 patients with primary epithelial carcinoma of the ovary were measured. Circulating pregnancy-specific beta1-glycoprotein (SP1) was detected in 5 subjects, human chorionic gonadotrophin (hCG) was found in 2 subjects, and human placental lactogen (hPL) was detected in 8 subjects.


Relaxin secretion in early pregnancy.

Relaxin is a peptide hormone produced solely by the corpus luteum of pregnant women. Extracts of human pregnancy corpora lutea have relaxin activity in bioassay systems. This activity can be measured in a heterologous porcine radioimmunoassay (RIA). Immunoreactive relaxin was undetectable in the RIA in 51 nonpregnant women. In conception cycles, relaxin immunoactivity is detectable in peripheral blood by the time of the missed menses. Relaxin detection may be used as a pregnancy test. Relaxin may be an important luteal factor, together with progesterone, in early pregnancy maintenance.


Subarachnoid hemorrhage secondary to ruptured cerebral aneurysm in pregnancy.

Eight patients suffering ruptured cerebral aneurysms during pregnancy were managed at the University of Western Ontario hospitals between 1967 and 1977. Seven aneurysms were managed surgically. All of these patients survived, 1 with permanent neurologic deficit. Seven living infants were delivered, 6 by vaginal delivery and 1 by cesarean section. One pregnancy was terminated surgically. One maternal death occurred in a patient whose aneurysm was inoperable. Fetal heart rates (FHR) were monitored by Doptone monitor during the aneurysm surgery. Clipping of the aneurysms was performed under induced hypotension. The prognosis for ruptured cerebral aneurysms during pregnancy is good for both mother and fetus. A short course of conservative therapy followed by surgical management of the aneurysm is advocated. Delivery may be managed according to obstetrical indications following surgical correction of the aneurysm.


The significance of eradication of bacteriuria during pregnancy.

Over a 20-year period at WHMC the annual incidence of acute antepartum pyelonephritis decreased from 4.0% to 0.8%. This decrease is correlated with the eradication of asymptomatic bacteriuria. Since urinary tract infections frequently recur, these antepartum patients must be monitored after therapy.


Maternal-perinatal calcium relationships.

Serum concentrations of total and ionic calcium, magnesium, phosphorus, and albumin were measureed in maternal and cord blood of 115 near-term deliveries. The same measurements (except for ionic calcium) were made in blood obtained from corresponding newborns at 24 hours of age. Cord levels of all components exceeded maternal values, and maternal and cord levels correlated significantly with each other. In the case of calcium, the cord-maternal difference involved both ionic and protein-bound forms. Significant umbilical arterio-venous differences were found only in the case of total calcium, and this difference reflected variation in the protein-bound form only. During the first 24 hours postpartum, total calcium concentration fell (by an average of 0.75 mEq/liter), phosphorus levels rose (by an average of 0.63 mg/dl), and magnesium and albumin did not change significantly. Cord levels of all agents correlated significantly with corresponding neonatal values. In view of the significant positive relationships demonstrated between maternal and cord levels and between cord and neonatal levels, these results substantiate the importance of the maternal serum ionic calcium concentration in normal perinatal calcium homeostasis.


Fetal injury with midtrimester diagnostic amniocentesis.

One hundred seven infants born after midtrimester amniocentesis were examined. The frequency of fetal injury was 9%, and was directly related to the number of attempts at amniocentesis. All were minor cutaneous injuries except for 1 case of disruption of a patellar tendon. Suggestions are made regarding ways to reduce the incidence of fetal puncture.


The premature breech: trial of labor or cesarean section?

Sixty-six premature breech deliveries were studied retrospectively. Forty-eight patients were permitted a trial of labor, 47 of whom ultimately delivered vaginally. Eighteen patients underwent cesarean section as soon as possible after their arrival at the delivery suite. When Apgar scores, perinatal mortality rates, cord prolapse, and entrapment of the aftercoming head are considered, cesarean section is probably the safer course of management for the patient with a footling breech infant, especially when the infant weighs 1500 g or less. However, the data indicate that a trial of labor can be safely undertaken in the presence of a premature frank or complete breech presentation.


Antithrombotic therapy. Rationale and application.

Arterial thrombosis and venous thrombosis differ in pathogenesis, morphology, and response to antithrombotic therapy. Antiplatelet therapy usually is aimed at arterial thrombi, in whose formation platelet-mediated reactions predominate, while anticoagulant therapy is effective against venous thrombi, in whose formation coagulation predominates.


Adenocarcinoma of unknown origin. A rational approach to a diagnostic puzzle.

Determination of the tissue of origin of disseminated adenocarcinoma is often difficult. Careful clinical evaluation of the patient in light of known characteristics of certain primary tumors, followed by appropriate screening tests, may yield decisive information. If not, a decision for or against more specific tests must be made.


Differential diagnosis of chest pain. Use of isoenzyme LDH1 level as a criterion.

Changes in level of isoenzyme LDH1 seem to be a valuable criterion in differentiating acute myocardial infarction from active coronary insufficiency without infarction. LDH1 level increases noticeably within 48 hours after onset of pain from acute myocardial infarction but tends to decrease if the pain is due to active coronary insufficiency.


A death of one's own.

Recent interest in the subject of dying arises from fear of medical technology that can now prolong physiologic processes long after cognitive life has fled. The setting and type of terminal care influence the quality of death and the attitudes of those left behind. There are several alternatives to hospital care for the dying, and patients should be able to decide the terms and conditions of their death. Consideration of a "living will" may precipitate a valuable spontaneous dialogue among patient, family, and physician.


Syndrome delineation. 1. Malformations and dysplasias.

A practical classification of genetic disorders and birth defects divides them into five categories: malformations, dysplasias, inborn errors of metabolism, deformities, and variant familial developmental patterns. The first two categories are discussed here. The last three will be discussed next month in part 2.


Diarrhea after gastrectomy and vagotomy.

Development of diarrhea in a patient following gastric surgery can be a confusing problem. The clinician is forced to consider and exclude causes that may be independent of the surgery as well as those that are unique to the postgastrectomy state. An orderly approach is mandatory for appropriate workup and management.


Investigation of microcytic anemia.

This article on microcytic anemia is the first of several on laboratory investigation of anemia. Microcytic anemia, characterized by a mean corpuscular volume of less than 80 cu mu, is usually due to iron deficiency or chronic disease but may signify thalassemia minor. Exact identification of the cause is important, since inappropriate iron therapy may be useless or even dangerous.


Anaerobic pleuro-pulmonary infections.

Anaerobic pleuropulmonary infections usually arise from aspiration of oral bacteria. The degree of virulence depends on host factors, especially state of tissue oxygenation, and on size of inoculum. Fetid sputum, if present, frequently is diagnostic. Use of penicillin G is preferred therapy for all forms of anaerobic pleuropulmonary infection.


[Pulmonary scar cancer and tumourlet (author's transl)].

Many investigations stress the importance of dysplastic changes of bronchial epithelium, chronic bronchitis, and chronic scar producing inflammatory processes of the lung in the development of bronchopulmonary carcinoma.--At the Institute for Lung Diseases and Tuberculosis Golnik in the period from 1964--1973 we found among 185 surgically resected lungs 20 cases (10,8%) of pulmonary scar cancer. In six patients (30,0%) we proved the tuberculous origin of the scar. Scar cancer was established in 18 patients (90,0%) in the upper parts of the lung. In half of all cases adenocarcinoma was found, squamous cell carcinoma was present in two cases and small cell anaplastic carcinoma in one case. --In the same period we found in surgically resected material two cases of tumourlets. In the first case in a 49-year old woman, the tumourlet was located in the scar surrounding an aspergillus mycetoma in the right upper pulmonary lobe. In the second case a tumourlet was found in a 42-year old woman in the region of focal fibrosis of the right upper pulmonary lobe. An 8 respectively 12 years postoperative follow-up shows no recurrence in both patients. This corresponds to the data from literature describing the tumourlet as benign process, recently reported as a minute peripheral carcinoid tumour.


[Chemotherapy of inoperable endothoracic tumours (results of the Karrer and aco polycytostatic therapy) (author's transl)].

The success of chemotherapy of inoperable endothoracic cancer largely depends on interdisciplinary cooperation. 30 years of research have succeeded in developing some promising combinations of cytostatic agents. Administered sequentially they are better tolerated and this has made outpatient treatment possible. 87 persons had polycytostatic therapy according to the Karrer/Sighart formula. It was followed by a difinite improvement in the general condition of the patients, but without any substantial lengthening of the average survival time. The ACO scheme (Seeber/Schmidt) has been used since April 1977 in 42 persons. Preliminary results indicate a definite prologation of survival time, especially in cases of small-cell bronchogenic carcinoma.


[Normal values of respiratory resistance in childhood (oscillation method) (author's transl)].

Normal values for respiratory resistance were determined by means of the oscillation method in 257 children and adolescents of both sexes aged 3--17 years. Respiratory resistance, measured by both the oscillatory and plethysmographic method, increased in inverse proportion to body height, body weight, body surface and age. Normal values can be estimated by means of the equation: y = 14.51--0.064X (X = hight in centimetres).


[Absorption of anti-tuberculous drugs after gastric surgery (author's transl)].

Although partial gastrectomy does not, as a rule, greatly impair the absorption of ethambutol by tuberculous patients, subtotal or total gastrectomy may reduce it by 40--60 per cent. Rifampicin and isoniazid are almost completely absorbed; but postprandial administration of rifampicin may be preferable in these cases. In the presence of anacidity absorption of isoniazid is slowed down but not reduced quantitatively. To estimate the degree to which absorption is impaired the drug levels in the blood after oral and intravenous administration should be determined over two consecutive days.


[Isoprodiane therapy for previously untreated cavitating pulmonary tuberculosis (author's transl)].

Isoprodiane (a combination of isoniazid, prothionamide and dapsone) was given to 22 persons with open cavitating pulmonary tuberculosis. None of them had been treated before. Microscopic and cultural sputum conversion occurred within an average of 5 and 11 weeks respectively. Treatment was discontinued in five patients: as a safety measure, despite sputum conversion, on account of the extent of the process and the general condition of the patient (one case); because of side-effects (two cases, one of whom was hypersensitive to isoniazid); because the patients failed to continue with the treatment (two cases). The early results were very promising; the long-term results cannot yet be assessed. The therapy did not materially affect the haemoglobin levels.


Orthopedic manual therapy--an overview. Part I: the extremities.

Part 1 of an introductory overview of orthopedic manual therapy is presented, covering evaluation and treatment of the extremities. The first section defines introductory concepts about passive movement, including types of movement, limitations of movement, and types of treatment movements. The remaining four sections cover general concepts, evaluation schemes, and treatment procedures of four practitioners belonging to different schools of thought in orthopedic manual therapy: James Cyriax, MD, MRCP; Freddy Kaltenborn, DO, RPT; Geoffrey Maitland, MAPA, FCSP; and John McM Mennell, MD. The conclusion stresses the importance of developing skills in evaluation, as well as treatment, prior to practicing orthopedic manual therapy.


Learning style preferences: physical therapy students in the United States.

The purpose of this study was to describe the learning style preferences of students enrolled in their first year of basic professional programs in physical therapy in the United States in the academic year 1975 to 1976. The testing instrument used was the Learning Styles inventory developed by Canfield and Lafferty. A sample of 1,099 (40.8% of the total population) was collected. The results have been tabulated using descriptive statistics of means and standard deviations for: 1) total sample, 2) men, and 3) women. The "typical" or "average" physical therapy student is described. These results have important implications for physical therapy educators in terms of arranging their instructional activities to optimize learning.


Intrinsic shoulder pain syndrome: rationale for heating and cooling in treatment.

This article reviews the literature on pathology and symptoms of the major intrinsic shoulder pain syndromes. Treatment rationale for heating and cooling agents is suggested, based on the pathology of the syndromes and the physiological effects of the agents.


Regression in organizational leadership.

The choice of good leaders is a major task for all organizations. Inforamtion regarding the prospective administrator's personality should complement questions regarding his previous experience, his general conceptual skills, his technical knowledge, and the specific skills in the area for which he is being selected. The growing psychoanalytic knowledge about the crucial importance of internal, in contrast to external, object relations, and about the mutual relationships of regression in individuals and in groups, constitutes an important practical tool for the selection of leaders.


Explorations in the uses of language in psychotherapy: complex empathic statements.

I have suggested (1978) that the language occurring to us in personal and psychotherapeutic speech reflects our distance from one another, and that the empathic position in particular evokes emotional reverberations and spontaneous verbal accompaniments which serve to identify that position. I have also suggested some prototypic forms of this spontaneous empathic speech. A clinical anecdote and two observations will illustrate these points and prepare for the discussion of more complex empathic forms.


Verbal response modes and psychotherapeutic technique.

This paper presents a taxonomy of verbal response modes and applies that taxonomy to the verbal behavior of psychotherapists of three contrasting schools: client-centered, gestalt, and psychoanalytic. The taxonomy consists of a theoretically based set of classificatory principles that define a mutually exclusive and exhaustive set of modes. Its purpose is to describe dyadic verbal interaction comprehensively and quantitatively. Such description is a necessary first step in investigating the therapeutic effectiveness of different interaction styles.


The natural history of a psychotherapy group for battered women.

This paper presents the authors' experience with evaluation and treatment of battered women and assesses the implications of the work. Assuming that battered women have special problems requiring modifications of psychiatric treatment methods currently available, we chose to work with them in a consciousness-raising, problem-oriented group designed to address those special problems. Assessment includes a description of changes in the women and modifications in the treatment during the course of therapy, an indication of persistent problems in the treatment of battered women, particularly the high drop-out rate, and suggestions for further treatment modifications that might help therapists to avoid the common pitfalls of work with these patients.


The compulsive gambler's spiral of options and involvement.

The material presented in this report is not intended as an explanation of compulsive gambling. I do not pretend to be refuting the psychoanalytic or the personality theorists. Rather, I describe the changes that take place in the career of the person turned compulsive gambler. Some of what is described here adds to the already existing knowledge of the compulsion.


Angiography of angiomatous lymphoid hamartoma (Castleman tumor) and a suggested pathogenesis.

The histological nature and angiographic characteristics of two cases of Castleman tumor support the concept that these tumors are hamartomatous. On angiography, both tumors exhibited a dense and homogeneous blush in the later phase. In one, in the mediastinum, hypertrophied branches of the bronchial artery gave rise to multiple irregular vascular spaces within the tumor; in the other, in the retroperitoneum, hypertrophied branches of the lumbar artery gave rise to irregular vascular channels spaced throughout the tumor. Histologically, both lesions contained numerous lymphoid follicles which, in the central portion, contained capillary vessels with thick hyalinized walls and prominent endothelial cells. A pathogenesis of hamartoma formation is suggested based on a disturbance of the normal orderly replacement of somatic cells and tissues.


Gas formation after renal tumor embolization without abscess: a benign occurrence.

Gas formation was observed in the infarcted tissues of 2 patients after renal tumor embolization. There was no clinical evidence of abscess, which would have required special treatment, at the site of infarction. This is postulated to be part of the post-infarction syndrome, analogous to the appearance of gas in the fetal tissues after intra-uterine death.


Early medullary cystic disease: a urographic diagnosis?

Excretory urography of a patient with an early stage of medullary cystic disease demonstrated an inhomogeneous, streaky nephrogram confined to the medulla, presumably due to accumulation of contrast material in dilated tubules. This was seen best one to two hours after contrast injection and may represent a specific urographic finding which does not appear to have been described previously in this condition.


Angiography in giant-cell bone tumors.

Angiography was performed on 48 patients with giant-cell bone tumors. Sixty-four per cent were hypervascular; 25% were hypo- or moderately vascular; and 10% were avascular. Findings were similar in the 45 benign and 3 malignant tumors. There was no correlation between the findings and degree of histological aggressiveness. There was a high (60%) incidence of aneurysmal bone cyst component in the hypovascular group. Hyperemic synovium, occasionally simulating tumor, was seen in 80% of surgically proved lesions. Angiography was useful in assessing tumor extent, particularly when an extraosseous component was present.


Dorsal defect of the patella (DDP): a characteristic radiographic lesion.

The dorsal defect of the patella (DDP) is a benign lesion with specific radiographic features. Seven cases of DDP are reviewed; all 7 lesions were identical in location and radiographic appearance. The characteristic lesion is round and lytic, with well-defined margins; it is located in the superolateral aspect of the patella adjacent to the subchondral bone. Arthrography reveals intact cartilage. DDP may occur in both sexes and may be bilateral. It is often found incidentally on radiographs ordered for acute trauma. Its etiology is not known. Differential diagnosis is also discussed.


Calcification in augmentation mammoplasty.

Twenty-five cases of augmentation mammoplasty from among 1,600 routine mammograms were divided into paraffin and silicon compound groups. Calcification occurred in 11 cases and was seen in 75% of the paraffin group and 29% of the silicone group. The calcifications in the paraffin group were small, annular, and too numerous to be counted. They were diffusely distributed and tended to involve the lymph nodes. The calcifications in the silicone group were large, egg-shaped, localized, and fewer in number. Lymphadenopathy was rare. The two groups also differed in time elapsed between mammoplasty and mammography.


Malignant seeding of the tract after thin-needle aspiration biopsy.

Fine-needle aspiration biopsy is an established technique for cytodiagnosis of malignant neoplasms, yielding a high rate of positive tissue with negligible local sequelae. The authors report the first instance known to them of needle tract seeding following this biopsy technique in a patient with an unresectable pancreatic carcinoma. Because of the rarity of this occurrence, the procedural indications remain unaltered.


Controlled single-blind clinical evaluation of low-dose mammographic screen--film systems.

The ability of five low-dose mammographic screen--film systems to portray normal and abnormal breast structures was evaluated in parallel with a study of physical image properties. Single-blind evaluations of the visibility of normal breast architecture, mass lesions, and calcifications were made on the mammograms of 100 patients radiographed with each of the systems. There was increased noise and slightly poorer resolution for the faster recording systems, but there was no difference in final diagnostic impressions among the five systems. These results suggest that the faster systems will result in substantial dose reduction without sacrificing diagnostic accuracy.


Tracheal bronchus.

Congenital tracheal bronchus is an uncommon condition that may occur together with other, sometimes clinically significant anomalies of the tracheobronchial tree. Two such patients are reported. Both presented with respiratory distress, and one was initially diagnosed as having a pulmonary cyst. Radiographic demonstration of an upper-lobe cyst, particularly on the right, should suggest a tracheal bronchus.


Radiologic features of inferior pulmonary ligament air collections in neonates with respiratory distress.

Radiologically characteristic extra-alveolar air collections in one or both inferior pulmonary ligaments developed in 14 neonates with respiratory distress on assisted ventilation. Eleven infants had radiographically visible pulmonary interstitial emphysema prior to or concurrent with the air collections. All infants subsequently exhibited pneumothorax. This variant of extra-alveolar air must be recognized because it has essentially the same pathogenesis and significance as the more commonly seen anterior pneumomediastinum.


Necrotizing enterocolitis of infancy. Early roentgen patterns as a guide to prompt diagnosis.

Necrotizing enterocolitis of infancy most commonly affects premature infants during the first several weeks of life. In most cases it is a devastating condition that often progresses to severe complications of death. The classic abnormalities, such as gas in the bowel wall and/or portal vein, are generally late manifestations. The author has consistently observed several distinct radiographic findings in early stages of the disease: (a) ileus and elongation of bowel loops; (b) loss of bowel wall definition; and (c) a disorganized, atonic pattern of intestinal gas. These findings are helpful in early diagnosis, particularly when the clinical features are nondiagnostic.


Computed tomography in white-matter disease.

CT scans of 11 patients with proved white-matter disease were reviewed and divided into three categories. The demyelinating (secondary) and diffuse sclerosis groups frequently exhibited abnormal intravenous enhancement and mass shift. This made differentiation from inflammatory and neoplastic processes difficult. In the dysmyelinating disorders, pathologically noted diffuse loss of white matter and absence of inflammatory response appeared on the scans as areas of diffuse and decreased density in the centrum semiovale. There was no evidence of abnormal contrast enhancement.


Computed tomography in cerebellar atrophic processes.

Forty-six patients with cerebellar atrophy were identified by review of CT scans of 7,500 patients. Independent examination of a separate file of the same group disclosed 49 patients whose history indicated cerebellar degeneration. Forty-three patients were in both groups indicating excellent correlation between CT abnormality and clinical cerebellar signs. Three patients with CT cerebellar atrophy failed to show clinical cerebellar signs, and 6 had clinical signs without evidence of changes on CT. Specific anatomic correlation was suggested in 10 of 13 patients with predominantly midline cerebellar CT abnormalities, and in 3 with olivopontocerebellar degeneration clinically who showed brainstem and cerebellar atrophy.