[Increased frequency of CRD in the broiler production in northern Jutland. I. Possible connexion between increased frequency of CRD and recently started vaccination with live infectious bronchitis vaccine (Massachusetts type) in egg producing flocks (author's transl)].

An increased condemnation rate due to CRD (chronic respiratory disease) is documented by means of condemnation lists collected in collaboration with directions and veterinarians at 6 poultry slaughterhouses. The geographic distribution of the 41 affected farms appears from Fig 1. The first outbreaks occurred around the turn of the year 1975/1976 and reached its climax in the 12th period (Table I). The increase in percent CRD of slaughtered chickens culminated in week 23/1976 amounting 0.64% (Fig 2). The increased total condemnation rate closely corresponds to an increase in CRD (Fig 3). These facts are intimately connected with the high number af consultations about respiratory diseases. Although not provable it seems possible and not unlikely that the broiler production has been exposed -- to increased directly or indirectly -- risk of infection from a raised number of IB vaccinated egg producing flocks.


[Increased frequency of CRD in the broiler production in northern Jutland. II. Influence on production and economy (author's transl)].

The consequences for production and economy caused by an increase in CRD outbreaks in broilers in northern Jutland are estimated by comparing production results from book-keeping farms to the average results of the whole country, where an improvement of 19 gram was found, while a similar increase did not occur in northern Jutland (Table I). The condemnation rate has risen 0.4% in northern Jutland. For the whole country 0.1% rise has been registered. Production results from 6 book-keeping farms with CRD have been compared to the results from all book-keeping farms in the region. It appears from Table III that the 6 farms were lacking 60 gram weight increase and 0.03 in feed conversion. Gross margins for production without problems have been calculated to 0.70 kr. per chicken against 0.42 kr. per chicken in the 71 CRD attacked flocks (Tables IV and V). If in addition also slaughterhouse expenses are added the total loss due to CRD in the 71 flocks sum up to 510.144 kr.


The influence of dietary pectin on the cholesterol content of egg-yolk and muscle and on various haematological indices in laying-hens.

Studies were undertaken to see if a commerical poultry diet, supplemented with 0, 2, 4 or 6% pectin would influence the cholesterol content of egg-yolk and muscle, the total lipid, cholesterol and protein contents of blood serum, and the erythrocyte count, packed cell volume and haemoglobin content of whole blood, in laying hens. The cholesterol content of the egg-yolk and muscle from birds given pectin was not significantly different from that of control hens. However, the birds which received the pectin weighed somewhat less than the controls at the end of the experiment, and produced fewer eggs, despite the same intake of digestible energy. Pectin treatment also resulted in higher erythrocyte counts, higher packed cell volumes and higher haemoglobin contents in the blood. The variation in the cholesterol content of egg-yolk was significantly lower within layers than between layers. This suggests that it should be possible to select for hens which produce eggs of lower cholesterol content, provided that other aspects of egg-production are not thereby negatively influenced.


[Myocardial infarction following administration of oral contraceptive agents. 3 cases].

The authors report the cases of three women aged 23, 24 and 28 years, receiving oestro-progestational agents and suffering a myocardial infarction. 25 cases in the literature are reviewed. Infarction is in most cases the first symptom. The clinical picture has no special features other than the frequency of anterior localisations. Coronary arteriography carried out in 15 cases showed a lesion of one vessel in 10 patients. The most common finding was a thrombosis of the left anterior descending. The coronaries were almost of completely normal in 3 cases, diffuse lesions being found only in 2 patients. The long term prognosis, at first sight favourable since the problem is one of localised lesions, is worsened by the frequency of ventricular contraction abnomalities. Myocardial infarction in patients taking oestro-progestational agents remains rare. A logical hypothesis to explain it would be a synergistic effect between the hypercoagulability induced by the drug and the risk factors in the individual patient. They are present with a frequency similar to that seen in other series of young patients with coronary disease.


[Rupture of the papillary muscles of the mitrale valve during myocardial infarction].

Between 1967 and 1976, 13 cases of papillary muscle rupture during the acute phase of myocardial infraction were collected. Six patients have been treated surgically during the past three years. Three could undergo surgery by virtue of the use of an intra-aortic counterpulsion balloon. There were no operative deaths. One patient died ten days after surgery as a result of a neurological complication; while a second died 4 months after a successful operation of an undetermined cause. For very satisfactory results were obtained with a follow-up of 7, 16, 18 and 18 months.


[Scintigraphic discordances between technetium 99m and iodine 131 in the study of thyroid nodules].

Eighty thyroid nodules found to be hyperfixating, isofixating or heterogeneous after an initial scintigraphy with Technetium 99m were studied comparatively using iodine 131. Differences in the apparent activity of the nodule and the extra-nodular parenchyma were found in one third of cases. A "cold nodule" appearance, not seen with techneitum was found in 8 cases at the time of the examination using iodine. Five of these patients underwent operation, the diagnosis being a carcinoma in one.


[Prenatal detection of crying cat syndrome due to balanced translocation in one parent].

Prenatal detection of "Cri du chat" syndrome, as the consequence of balanced translocation 46,XY,t (5, 15) (p 13, p11) of the father, is described. A phenotipically normal child, with the same type of translocation possesed by his father was born in this family, as well as a child with "Cri du chat" syndrome. Four pregnancies were termed by spontaneous abortion. In the seventh pregnancy amniocenthesis was performed. On the basis of cell culture of amniotic fluid the diagnosis of "Cri du chat" syndrome was established. The diagnosis was confirmed by culture of peripheral blood of prematurely born foetus. Tissue cultures of some fetal organs were performed in order to find the origin of amniotic cells whose culture served for screening cytogenetic analysis.


[Role of the intracavitary irridiation in the curative treatment of cancer of the rectum. 170 cases].

In carcinoma of the rectum occurring in patients in whom surgery represents a high risk, the problem of local treatment is worthy of discussion in certain precisely defined cases. Intracavitary radiotherapy (contact radiotherapy, interstitial curietherapy) proved to be effective in a series of 170 patients, observed over a period of five years. The death rate due to carcinoma was less than 11 per cent. This simple, ambulatory method may be used in fragile and very elderly patients and is without danger. Surgery is still possible in the case of failure but irradiation can be used only in selected patients, in whom very close follow-up is possible.


[Incidence of metabolic acidosis during status asthmaticus in adults. Physiopathological consideration].

In the course of 28 cases of status asthmaticus in adults, the authors noted the frequency of metabolic acidosis, assessed as a base deficit. This disorder, already noted by other authors, remains poorly explained. It may nevertheless be conceived that its onset is favourised by the special haemodynamic consequences of this particular form of acute respiratory insufficiency.


[Necrosis in acute pancreatitis. Surgical and anatomopathological comparisons. 7 cases].

The surgeon should take pains to section and study himself the operative specimen after excision for acute pancreatitis, in order to understand the true nature of the lesions, which the most attentive and competent pathological examination cannot describe as vividly as direct examination by the operator. Often he will be surprised to find that the lesions, predominant in the capsule, are less profound and less severe than he had thought at first sight. Findings of this sort, if they were to be confirmed, would put into doubt the principle itself of routine pancreatectomy for acute pancreatitis.


[Mitral replacement using a ball-valve prosthesis under hypothermic protection of the myocardium. 230 cases].

A series of 230 mitral valve replacements using exclusively the Starr-Edwards ball valve prosthesis is presented. These 230 patients underwent surgery over a 4 year period, a uniform operative technique being used. Its essential feature was the use of a standardised technique for protection of the myocardium based upon continous clamping of the aorta and deep hypothermia at around 15 degrees. The technique of myocardial hypothermia, already reported, is briefly reviewed. The results are analysed, in the short and long term. Overall hospital mortality was 6.9 per cent, including multiple valve replacements and combined coronary surgery. The total number of thrombo-embolic complications was 8, including 1 early thrombosis out of 230 patients - i.e. 0.4 per cent and 7 late thrombo-embolic episodes out of 180 patients followed up for 1 month to 4 years - i.e. 3.8 per cent. Secondary and late mortality was 11 cases out of 180 patients. The survival rate at 4 years was 78 per cent by actuarial calculation, including operative mortality. These results justify the continued use of ball prosthesis, the long term thrombo-embolic risks of which are equal to or less than those of disc prosthesis, and the resistance of which to wear and tear is shown by the long postoperative survivals.


[Diagnosis of juvenile diabetic retinopathy using fluorescein angiography. Description of initial lesions].

In order to ascertain the first vascular lesions responsible for infantile diabetic retinopathy, 300 angiofluorographies were performed in 87 children and adolescents whose diabetes became clinically apparent before the age of 14. Compared with normal ophtalmoscopy, the angiofluorography enabled to double the frequency of the diagnosis of incipient retinopathy. In addition to the classical diabetic lesions, the authors describe modifications of vascular permeability noted by leakage of fluorescein and observed in 75% of initial retinopathies. These leakages must be considered to be the first lesions of infantile diabetic retinopathy. They appear before microaneurysms: they seem to be reversible. Highly significant correlation between degree of control, duration of diabetes and frequency of retinopathy were demonstrated.


CNS manifestations of diabetes mellitus.

The neurologic manifestations most frequently described in association with diabetes are caused by involvement of the peripheral nerves and nerve roots. Whether there is also a specific central nervous system involvement has not been well documented. Pseudotabes diabetica and diabetic amyotrophy probably can be explained on the basis of severe neuropathy or radiculopathy. According to fairly recent studies, however, both myelopathy and encephalopathy may be part of the diabetic process. In the cases of myelopathy, there are degeneration of the long tracts and areas of demyelination with gliosis, as well as microinfarcts. In the cases of encephalopathy, there are degeneration of ganglion cells and nerve fibers in the cerebrum, brain stem, and cerebellum; cell loss, demyelination and gliosis; and infarction secondary to severe angiopathy.


Propranolol and lidocaine. Clinical use as antiarrhythmic agents.

Using propranolol or lidocaine as an antiarrhythmic agent takes keen clinical judgment if optimal efficacy is to be obtained or minimal risk. Serious adverse effects of propranolol are cardiac, while those of lidocaine are usually dose-related and most often involve the central nervous system.


Ankylosing spondylitis.

Ankylosing spondylitis occurs chiefly in young men and affects principally the sacroiliac, apophyseal, and costovertebral joints. Physical findings may be minimal, and special tests may be necessary to find objective evidence of the disease. HLA-B27 histocompatibility antigen is present in 90% to 95% of patients. The feature of highest diagnostic significance is the roentgenographic finding of syndesmophytes. The natural course of the disease is characterized by spontaneous remissions and exacerbations and by possible arrest at any stage. In general, the prognosis is good for maintenance of functional ability despite the development of severe back deformities. In management, emphasis must be given to maintaining normal posture and body habitus and to encouraging the patient to cope with individual needs and problems. If basic measures, including salicylate therapy, do not control the disease, additional drug therapy must be initiated. Surgical intervention is a last resort.


Psoriatic arthritis.

Despite having several modes of presentation, psoriatic arthritis usually can be readily distinguished from other forms of polyarthritis. Prominent features in all forms are a predilection for digital joints and occurrence of osteolysis and ankylosis. Rheumatoid factor is usually absent, and the prognosis appears to be better than that for rheumatoid arthritis. The relationship of HLA-B27 histocompatibility antigen to psoriatic arthritis is indefinite; presence of the antigen predisposes to spondylitis. For most patients, treatment directed at the psoriasis is adequate, especially if it is combined with the administration of nonsteroidal anti-inflammatory drugs.


Hypertension--the fledgling of modern medical practice.

The treatment of hypertension was discovered long before the mechanisms of the disease became known. Only recently has it been appreciated that blood pressure is controlled physiologically in many ways. Hypertension has suddenly achieved celebrity status. It is now recognized as the second leading cause of death in the United States. New programs have made the public aware of it and have prompted many individuals to have their blood pressure checked. Office diagnostic measures usually suffice to determine the presence of the disease. Treatment should generally be initiated with a slow-acting diuretic or with propranolol; other drugs may be added later. Treatment is a lifelong undertaking, and engaging the patient as a partner in the venture by means of home blood pressure measurements and an educational program contributes to its success. Treatment of hypertension is the first step in the prophylaxis of atherosclerosis.


Diet and athletic performance.

There are no dietary tricks or special diets that will give athletes a competitive advantage. Appetite and satiety are sensitive regulators of food intake to meet the caloric requirements of physical conditioning, training, and athletic competition.


Read to weight and consider. Method of continuing education.

Physicians seeking to add to their knowledge of medicine are advised to consider reading as a means of individual continuing education. The printed word, which has been extolled for centuries, can be read and reread at any pace and often leads down mind-broadening avenues of investigation.


Dealing with dental injuries.

Any physician who sees patients on an emergency basis will be confronted with dental or oral injuries. Certain patients, eg, those with pulp exposure or with any apparent tooth displacement, should be referred immediately to a dentist. Patients with lesser dental injury, eg, with chipped teeth, can wait until the next day to see a dentist. Patients with dental or oral injury should be examined for jaw fractures and for lacerations inside and outside the mouth. Following emergency management, they should be instructed in proper mouth care to be used until they can see a dentist or return to that physician for follow-up examination.


Therapy for essential cutaneous telangiectasia.

A method of treatment of essential cutaneous telangiectasia is described which has been used successfully in more than 150 cases. Small amounts of a weak solution of sodium chloride are injected slowly into the dilated vessels. The injections are repeated, and stronger solution used, if necessary. Before any physician attempts to treat telangiectasia by this method, he or she should observe its performanace by an experienced operator.


Surgical treatment of reflux esophagitis and stricture.

Surgical intervention is usually indicated in reflux esophagitis when medical therapy fails to control symptoms. Since most patients with peptic esophagitis also have a sliding hiatal hernia, early procedures focused on hernia repair. Weakness of the lower esophageal sphincter is now known to be the pathogenetic mechanism, and Belsey, Nissen, and Hill have developed operations to restore sphincteric function. The Hill repair is used most often because of its low incidence of side effects, but the other procedures are recommended in specific situations. Stricture, the most common complication of reflux esophagitis, presents a special problem in treatment because interference with swallowing is added to the characteristic symptoms of reflux. Because of its high long-term success rate, the combined Thal-Nissen procedure is preferred to forceful dilation plus an antireflux operation.


The shaking patient. Diagnosis and management of tremor.

Tremor can be categorized into three general types: resting, action, and intention, Each requires different therapy. Resting tremor is present when the hands are at rest; it disappears with movement. It is characteristic of Parkinson's disease and responds to treatment with L-dopa either alone or in combination with a decarboxylase inhibitor. Action tremor is maximal when the hands are outstretched to the front; it may persist during movement. It is not rare and is often misread as a sign of Parkinson's disease. Propranolol is beneficial. Intention tremor occurs with movement and is characteristic of cerebellar disease. Pharmacologic agents are not helpful. The only known effective treatment is stereotaxic surgery.


Cardiology. Reassessment of left bundle-branch block.

In a population of patients who seek medical attention because of possible cardiac symptoms and are found to have left bundle-branch block, the vast majority have obvious cardiac disease, usually atherosclerotic or hypertensive. The prognosis in this group is poor and is a function of the underlying heart disease and not the conduction defect per se. The situation is distinctly different in a population of asymptomatic subjects whose conduction defect is discovered during routine electrocardiographic screening. In some of these individuals the conduction defect reflects previously unrecognized cardiac disease, but the majority have no other evidence of cardiovascular abnormality and approximately two thirds continue to do well over a relatively long follow-up period. It seems reasonable to reassure such patients regarding their prognosis, while at the same time maintaining careful follow-up. In situations where there is an important need to know for certain whether an individual has underlying cardiac disease, cardiac catheterization is indicated and should include coronary arteriography and hemodynamic measurements during exercise.


Pneumonia in children.

Pneumonia in children tests the clinician's diagnostic and therapeutic acumen. Bacterial infection can occur at any age, while aspiration pneumonia is most common in the newborn, viral pneumonia is most prevalent in infants and preschoolers, and mycoplasmal pneumonia is most often encountered in school-aged children and young adults. Careful follow-up of outpatients will indicate whether the choice of therapy is adequate and should detect progressive disease requiring more specific diagnostic and therapeutic measures.


Oral complications of cancer radiotherapy.

Injury to surrounding tissues during radiotherapy for oral cancer can have devastating physical and psychologic consequences for the patient. Oral complications include xerostomia, dental decay, mucositis, taste loss, osteoradionecrosis, infection, and trismus. In many instances, these problems can be eradicated or controlled with appropriate treatment.


Abdominal aortic aneurysm. Recognition and management.

Elective resection and prosthetic graft replacement of asymptomatic abdominal aortic aneurysms 5 cm or more in diameter are dependable measures to counter the formidable threat of rupture. Operative mortality should be less than 5% among patients without severe associated disease. Those patients who have large aneurysms but who represent marginal risks for major vascular repair may be guided through such an operation with reasonable safety by meticulous preoperative and postoperative care. Particular attention should be devoted to assessment and support of pulmonary and renal function and to detection of associated arteriosclerosis of the coronary and carotid arteries.


Fibreoptic bronchoscopy. Part I: TECHNIQUE AND APPRAISAL.

Fibreoptic bronchoscopy is a simple, useful examination suitable for the investigation of outpatients without general anaesthesia. It considerably extends the range of vision and diagnostic ability that is achieved with a rigid bronchoscope. Further, it lends itself to the diagnosis and management of many medical lung diseases in addition to carcinoma. The applications of fibreoptic bronchoscopy will be discussed in more detail in Part II.


Urinary glucose testing by diabetic patients.

One hundred diabetic patients were watched while testing urine with "Clinitest" tablets. Only 20 made no mistakes. The main errors were in the use of the dropper and timing. We consider that more time should be spent on the initial instruction of patients.


Chest physical therapy: a survey and a challenge.

Physical therapists have been criticized for ignoring patients with acute or chronic chest diseases, or chest surgery, at a time when increasing numbers of patients having chest diseases are challenging the health professions. A questionnaire survey of 63 physical therapy schools was made to explore this problem. Results of the survey showed that a majority of schools did not offer a course in chest physical therapy. A number failed to teach the treatment of each chest disease or allowed too little time for adequate preparation of the student. Suggestions are offered for more adequate preparation of the student. Suggestions are offered for more adequate treatment of these patients and greater involvement of the physical therapist on the chest team.


Positioning for knee strengthening exercises.

Fifty normal subjects (20 men, 30 women) were tested for maximal isometric contraction of the right knee extensor muscles while their hips were at angles of 100, 110, 120, and 130 degrees to the horizontal. The tested knee was positioned in 60 degrees of flexion. Knee-extensor force attained with the hip at 110, 120, and 130 degrees differed significantly greater than the knee force attained with the hip at 100 degrees. No significant difference in knee-extensor force was found when the hip angles varied between 110, 120, and 130 degrees. The findings were similar for both men and women. The results indicate a need for changes in the design of exercise units. Exercise units should provide for back stabilization with the hip positioned at varying angles and should be narrow enough to permit short subjects to grasp the sides of the unit.


Attitudes of physical therapists toward cancer: a pilot study.

Two instruments developed to measure attitudes of physical therapists toward cancer patients are described: the Attitude Toward Cancer Scale which provides an overall index of a person's attitude toward cancer patients, and the Story Completion Form for Cancer Care which measures more distinct and subtle attitudes. Results of a pilot study using both instruments suggest that students have strong emotional reactions to cancer and demonstrate needs for information and guidance in the treatment of cancer patients.


Diabetic peripheral neuropathy: review of literature and case study.

Diabetic peripheral neuropathy is a secondary manifestation of diabetes mellitus. The purpose of this review of literature and case study is to increase the clinical physical therapist's understanding of diabetic peripheral neuropathy.


Anion selectivity in biological systems.

As background for appreciating the still-unsolved problems of monovalent anion selectivity, we summarize the facts and intepretations that seem reasonably well established. In section II we saw that specific effects of monovalent anions on biological and physical systems define qualitative patterns, in that only certain sequences of anion effects are observed. For example, the 4 halides can be permitted on paper as 4! = 24 sequences, yet only 5 of these sequences have been observed in nature as potency sequences. In addition, there are quantitative regularities in anion potency that permit the construction of so-called empirical selectivity isotherms (Figs. 4 and 13). That is, a given potency sequence is found to be associated with only a certain modest range of selectivity ratios. The sequences and isotherms apply to effects with a nonequilibrium component (e.g., permeability and conductance sequences) as well as to purely equilibrium effects. Since students of cation selectivity have had difficulty accepting this conclusion, we discuss the reasons why it is not as paradoxical as it at first seems. In sections III and IV we develop four theoretical models to account for the observed anion potency sequences as sequences of equilibrium binding energies. Two of these models involve calculation of electrostatic binding energies between anions and monopolar or dipolar cationic sites, assuming anions as well as sites to be rigid and nonpolarizable. The other two models use thermochemically measured binding energies between anions and thealkali cations or occasionally alkaline-earth cations, which in fact approximate rigid, nonpolarizable spheres. All four models consider the anion selectivity pattern of a given cationic site to be determined by anion differences in the balance between hydration energies and ion-site binding energies. Site differences in anion selectivity pattern are attributed to site differences in radius, charge, coordination number, or dipole length. These models succeed in predicting all five observed selectivity sequences of the halides. The models predict in addition the possible existence of two further halide sequences that arise from very strong sites and that have not yet been observed in nature. For polyatomic anions the predictions agree approximately but not completely with observations. Thyroidlike systems, which greatly prefer iodide over other halides,re interpreted as having the weakest sites. Site hydration is predicted to affect the magnitude but not the sequence of potency ratios. For the thyroidlike systems, observed potency ratios are smaller than would be expected if anions were completely dehydrated at biological sites.


Subcutaneous mastectomy in the large ptotic breast.

A procedure is described for doing a subcutaneous mastectomy on large ptotic breasts. The method employs a reduction of the skin brassiere, free transplantation of the areola-nipple, and a double layer closure technique.


Clinical treatment of partial tendon lacerations without suturing and with early motion.

Partial lacerations of flexor tendons in chickens come out the strongest and glide best if they are not sutured and not immobilized. We treated 17 patients with 20 partial flexor tendon lacerations by not suturing the tendon and by early mobilization of the digit. These partial tendon lacerations varied from 25 to 95 percent of the cross-sectional area. Sixteen  of obtained excellent function of the digit, and one obtained good to excellent function. This technique should be used only in cooperative patients.


Deltopectoral flap with a segmental dermal pedicle in head and neck reconstruction.

Eight cases of extensive oromandibular resections have been reconstructed by the use of deltopectoral shoulder flaps with a segment denuded for deep placement. The operative technique is described, and the various uses of this flap are outlined. This technique has allowed us to extend the versatility of the deltopectoral flap, and to avoid the occurrence of the often annoying and occasionally dangerous orocutaneous fistula.


Ring avulsion injury.

Dependent upon the age, the occupation, and the requisites of an individual patient, the less important ulnar fingers may be of great value; in these the philosophy of discriminate preservation should be  given considerable weight in the choice of treatment. Revascularization of fingers injured by a ring avulsion, and restoration of tactile gnosis with esthetic coverage make salvage of the valued ulnar fingers feasible. Three illustrative cases are described.


Calcification of the fibrous capsule about mammary implants.

The possibility of fibrous capsule calcification should be kept in mind when evaluating mammograms in patients who have had an augmentation mammaplasty. One of our 4 cases was examined radiologically and the calcifications were not characteristic of those associated with malignancy, but the appearance might be different in the next case. The etiology is undetermined.


Pentazocine ulcers.

Four cases of skin ulceration in pentazocine addicts are presented. Appearing in broad areas of a peculiar wood induration and often massive in size, these ulcers can be clinically distinguished from comparable skin manifestations in other types of drug abuse. The histological finding of an obliterative vasculitis of the small vessels helps to explain the non-healing nature of these lesions. It also offers a rationale for the surgical therapy of wide excision, prior to skin grafting.


The lymphatics in experimental flaps.

The lymphatics dilate greatly after a  flap delay procedure. After they return to normal in two weeks, they do not undergo further dilatation after a second delay; this suggests that alternate pathways are opened, possibly lymphaticovenous communications, for the egress of lymph. When hexamethonium is given before a primary delay, the delay is not followed by lymphatic dilatation in, or gross edema of,the flap.


Spider bite on an augmented breast.

A patient who had had an augmentation mammaplasty two years previously sustained a spider bite on one breast. The treatment and the course of the recovery are described, and the latter is illustrated.


Research variables in psychology and the logic of their creation.

In their book The Language of Psychology, Mandler and Kessen (1964) have concluded that research psychologists should limit themselves to studying variables that are defined in "response invariant" terms. The present author agrees with this general conclusion. The first part of this article will be a review of Mandler and Kessen's concept of "response invariance" and a probe of the reasoning that suggests such a conclusion. This analysis will prepare the way for outlining three kinds of methodological problems in psychology and corresponding solutions for each. This methodological analysis will be used also to relate two traditions in psychological research: the objective operational tradition that has been concerned, primarily, with the rigor of psychological research, and the phenomenological tradition that has been concerned with elucidating subtle, psychological profundities that are mysteriously entangled in human values and perspective, delicate dimensions of human experience that do not yield easily to rigorous and effective research designs.


Psychotherapy and the new psychiatry.

It seems appropriate from time to time to pause and reflect on our field of psychiatry. Particularly during a period of rapid growth it is incumbent upon us to draw up some sort of a map that will permit us to maintain a conceptual scheme holding together all facets of our perpetually evolving specialty. While we do construct an evolving body of fact and theory derived from a data base, psychiatry, like other medical specialties, is not a science in and of itself but a congeries of sciences and methodologies within the physician's role. We bring together scientists as well as sciences. Sometimes they speak the same language; many times they are incomprehensible to one another. It is my belief that academic psychiatrists have the particular task of achieving whatever integration of science and practice is possible and teaching it, and this is being done well in many teaching centers.


The influences of race on the psychotherapeutic relationship.

The influences on the therapeutic relationship of racial differences between client and therapist are receiving renewed attention in the psychological literature. The subject has been examined in several reviews (Banks, 1971; Gardner, 1971; Sattler, 1970) and a growing number of research studies in the past few years. The reviews reveal that most of this literature consists of anecdotal accounts, uncontrolled observations, limited research findings, and a rather one-sided emphasis upon the white therapist-black client relationship, to the neglect of other racial combinations. This review will examine the psychotherapeutic relationship under varying racial matches of white and black clients and therapists. It seeks to sharpen the sensibilities of therapists to some of the racial factors contributing to premature termination of treatment.


The dying role: its relevance to improved patient care.

Society is failing to meet the obligation it has to its dying members. Persons with terminal illnesses suffer isolation and neglect in hospitals, receive overzealous treatment by physicians, and are kept in ignorance of their situation by families and medical personnel. Evidence for these statements has come from observers of the medical care system and from dying patients themselves (Kübler-Ross, 1969; Reynolds and Kalish, 1974; Sudnow, 1967); In the nineteenth century it was common for persons to die in the familiar environs of their homes, surrounded by grieving families from whom they parted in a meaningful manner (Blauner, 1966). Dying persons of today no longer fill a well-defined social role. Instead, the distinction between the roles of sick and dying persons has been lost and, in the resulting confusion, the care of dying people has suffered. The purpose of this article is to clarify the distinction between the dying and sick roles, identify the signs of existing role confusion, suggest ways in which this confusion may be corrected, and show how reestablishment of the dying role can result in improved care of dying people. The important part physicians play in defining sick and dying roles will be emphasized.


Children's understanding of their emotionally disturbed peers. II. Etiological factors.

In a previous study, we (Marsden and Kalter, 1976) found that fourth- and sixth-grade children not only made distinctions between normal and emotionally disturbed behavior, but also were able to discriminate degrees of childhood psychopathology in a manner strikingly congruent with clinician-judges. Having assessed children's perceptions of emotional disturbance, we turned our attention to how the children might account for the development of such childhood disorders. We are aware of no previous study which has examined children's views of the etiology of emotionally disturbed behavior of their peers. Such information could shed further light on children's understanding of childhood psychopathology and might implicitly indicate what children believe are the necessary ingredients for healthy emotional development. This knowledge would be useful to mental health professionals, teachers, and parents seeking both to understand the emotionally disturbed child's place in his peer group and to convey an understanding of emotional illness to normal children.


Sealing-over in a therapeutic community.

Integrating and sealing-over are terms that are frequently used to describe a patient's general style of coping with stress, especially the stress of an acute psychotic break. Work to date (McGlashan et al., 1975, 1976, in press; Levy et al., 1975) has defined these terms both clinically and dynamically within the context of a patient's relationship to his own psychosis. Integration and sealing-over as concepts have also proved useful in understanding and describing interpersonal and group behavior on an inpatient psychiatric unit. A patient's ultimate style of recovery from an acute psychotic episode results from many forces-internal and environmental. The tendency to either review and assimilate (integrate) or deny and repudiate (seal-over) the often painful affects and ideas prominent during psychosis mobilizes various forces within the patient's social environment. The way in which the therapeutic milieu and patient interact with one another reflects and, in part, determines the manner and degree to which each party comes to master the patient's psychotic experience. This report explores this interaction as observed in an inpatient therapeutic community established to treat acutely schizophrenic patients.


The mental health center and the women's liberation group: an intergroup encounter.

When two separate and independent organizations must work together to accomplish a mutual task, difficulties often arise which remain poorly understood. The analysis of intergroup phenomena involves an exploration of interaction within and between groups; such relationships include problems arising from differences in tasks, structure, and culture of the two groups, definition of the intergroup task, choice of group representatives, and the possibilities and problems of dual group membership for the negotiators. While the literatures on group process and organization development contain some work on intergroup phenomena (e.g., Aldrich, 1971; Baker and O'Brien, 1971; Klein et al., 1971; Mills, 1975; Walton, 1972), much conceptual work remains to be done. We will focus upon one type of intergroup relationship--that between a traditional human service organization and a social movement group--in which dual membership is a particular problem, and in which conflict may be neutralized by the form of the negotiations. A case example of an interaction between a mental health center and a women's liberation group will provide one example of such negotiations. The analysis is presented within the framework of the open system model of Miller and Rice (1967) and Rice's general model of intergroup relations (1965, 1969).


Linking young and old institutionalized people.

A proprietary nursing home for the elderly in the State of North Carolina succeeded in pairing itself for joint activities of residents with an institution for the young mentally retarded. The young and old residents of the two homes were thus enabled to help each other, and thereby to help themselves as well. For the nursing home residents, this program provided an opportunity to engage in respected volunteer work and to regain a meaningful role in the community. It is believed that indications drawn from this demonstration of interaction between a nursing home and a home for the mentally retarded can aid in farther planning of such arrangements and in identifying research needs and potentials. Although only relatively few of the mildly impaired elderly in the nursing home volunteered for the joint activity, the ripple effect of the project extended beyond the direct participants. Since residents of the two institutions alternated visits, nonparticipants had a chance to observe and even participate in the activities for short periods. Even those who chose not to participate at all shared in the enriched conversation that resulted from this experience. The project was obviously a source of satisfaction and pride to residents of the nursing home, and the activity was eagerly received by the mentally retarded youngsters. The program demonstrates that aged persons in nursing homes can be tapped as a resource for providing service to institutionalized mentally retarded children and that a mutually beneficial relationship between the two institutions can accompany such service. Many leads for worthwhile research emerge from this pilot project.


Relationship of wives' preventive health orientation to their beliefs about heart disease in husbands.

Selected by area probability sampling, 199 wives residing in the city and county of Lebanon, Pennsylvania, were interviewed about their attitudes, opinions, beliefs, and behavior in respect to the role that wives can play in helping to prevent heart disease in husbands. After the "Don't know" respondents were eliminated, the remaining respondents were categorized into a continuum of low, medium, and high levels of preventive health orientation, according to how much of a role they believed wives could play in the prevention of heart disease in husbands. The orientations were then cross-tabulated with several variables in a health belief model (initially formulated by G. M. Hochbaum and associates and discussed in a monograph edited by M. H. Becker) and also with several sociodemographic variables. A substantial majority of the 187 wives expressed beliefs that wives could play some or very much of a role in preventing heart disease in husbands, that treatment for heart disease was effective, and that the disease was preventable. The majority indicated that they had not worried about their husbands getting heart disease. Magazines and television had been their main sources of information about the condition. Emphasis was placed on the wives who ranked low on the preventive health orientation continuum, since it is people like these who are of most concern to health educators and health care providers. Compared with the medium-ranked and high-ranked respondents, fewer of the low-ranked group (a) had ever suggested any health-related behavior to their husbands, (b) felt that their husbands were very susceptible to heart disease, or (c) believed that treatment was very effective. The majority of wives in the low group nevertheless considered heart disease to be a serious condition that would reduce a person's chances of living a normal life. With chi-square as a measure of statistical significance and Cramer's V as a measure of the strength of relationships, statistically significant support was found for the relationships between the wives' preventive health orientation and their perceptions of (a) the seriousness of heart disease, (b) their husband's susceptibility to it, (c) the effectiveness of treatment, and (d) the disease's preventability (all variables in the health belief model), as well as between the orientation and place of residence, years of education, and both the respondent's and husband's age. The relationships, however, were not very strong.


Evaluation of a televised stop-smoking clinic.

A stop-smoking clinic was designed to fit into the format of a local television news program in New York City. A step-by-step quitting plan consisting of twenty 30- to 90-second segments was broadcast each weekday evening for 4 weeks in August 1975. Almost 4,800 smokers "registered" for the clinic by postcard, and a sample of 310 was followed up at the end of the clinic and 1 month later. The majority of the respondents were women. The average age was 47 for men and 49 for women. They had been smoking for more than 30 years, and when they registered for the clinic, they were averaging more than 30 cigarettes a day. Almost half had never been off cigarettes for as long as 24 hours. In general, the respondents were similar to the hardcore smokers that usually attend smoking clinics. Almost 10 percent reported that they had stopped smoking by the end of the broadcasts. The rate of quitting among men was twice that among women. A major factor differentiating those who quit from those who did not was the number of programs they had seen. The lower rate of quitting among women was due mostly to the women smokers over age 50 in the sample. The study indicated that use of the mass media may be an effective way to reach the large number of smokers who would not attend organized clinics but who may be able to stop smoking on their own with minimal support and guidance.


The right paratracheal stripe.

The right paratracheal stripe (RPS) is seen on postero-anterior chest radiographs as a thin, water-density stripe between the air column of the trachea and the adjacent right lung. The range of width of the RPS in 1,259 normal subjects was 1 to 4 mm. An RPS width of 5 mm or more is reliable evidence of disease. The differential diagnosis of this finding is lengthy, and best divided into those diseases affecting the (a) trachea; (b) mediastinum; and (c) pleura.


Multiple fistulas between the coronary arteries and the left ventricle.

The authors report a case of fistulas connecting the anterior descending, circumflex, and dominant right coronary arteries with the left ventricle. Although fistulous connections between a coronary artery and a cardiac chamber have been described before, this is only the third known case in which all of the coronary arteries communicated with the left ventricle.


Pulmonary alveolar proteinosis: its association with hematologic malignancy and lymphoma.

Pulmonary alveolar proteinosis (PAP) developed in 5 patients with hematologic malignancy or lymphoma. Possible pathogenetic mechanisms which might predispose the patient to this association include the unavailability of competent alveolar phagocytes secondary to profound leukopenia, or inhibition of alveolar phagocytosis by elevated globulins. The spectrum of pulmonary abnormalities produced by PAP includes classical butterfly perihilar alveolar consolidation, lobar consolidation, parenchymal nodules, and hilar adenopathy. Four of the 5 cases had complicating infections, making the exact radiological correlation with PAP difficult.


Lung entrapment and infarction by chest tube suction.

Focal pulmonary infarction resulting from entrapment of lung within a chest tube represents one of the complications of thoracentesis. The radiographic demonstration of a pulmonary density in the region of the side or end hole of a chest tube should alert one to this possibility.


The suprasternal fossa.

A well-demarcated U or V-shaped gas density superimposed over the trachea on posteroanterior chest radiographs is due to air in the suprasternal fossa. This is the depression on the skin surface of the neck between the sternal heads of the sternocleidomastoid muscles. The fossa is frequently visualized radiographically in cachectic or very thin people, and in patients with prior laryngectomies. It is also seen in patients with chronic obstructive lung disease and in patients in acute respiratory distress. Because of its typical location and configuration, it should not be confused with an air-fluid level in the esophagus or an upper airway diverticulum.


Esophageal perforation following the use of esophageal obturator airway.

Two cases of distal esophageal perforation following the use of the esophageal obturator airway are reported. Plain radiograph findings of pneumomediastinum, subcutaneous emphysema, mediastinal widening, or pleural effusion suggest this entity; esophagography should be performed in the appropriate clinical setting. The recognition of this uncommon but serious complication is important because medical and/or surgical management is urgent.


Linear and rod-shaped peptic ulcers.

Experience with the routine use of the pharmacologically aided, double-contrast examination to demonstrate various primary and healing ulcers over a six month period is assessed. Thirteen linear or rod-shaped ulcerations were diagnosed. It appears that gastric relaxation and the demonstration of fine mucosal relief are necessary to detect ulcers of linear or rod form.


Localized giant pseudopolyposis complicating granulomatous ilecolitis.

A case of localized giant pseudopolyposis complicating granulomatous ileocolitis is reported. The authors discuss the etiology of the lesion and its potention relationship to a similar lesion seen in some patients with ulcerative colitis.


Partial small bowel obstruction secondary to ileal diverticulitis.

A case of distal ileal diverticulosis complicated by diverticulitis causing partial small bowel obstruction is presented. To the author's knowledge, this is the first reported case of such obstruction, and the third reported case of preoperatively diagnosed ileal diverticulitis. This diagnosis should be considered in patients with acute abdominal symptoms and/or small bowel obstruction.


Benign ulceration of the cecum.

Three proved cases of benign ulceration of the cecum are presented, 2 with acute onset of abdominal pain, the third with acute hemorrhage. The clinical, pathological, and variable radiographic features are described.


Splenic flexure carcinoma as a source of hepatic portal venous gas.

Most patients with hepatic portal venous gas are seriously ill with some combination of bowel ischemia, distension, and/or necrosis. The authors report a case in which a necrotic splenic flexure carcinoma seeded gas and septic thrombi to the liver.


Arterial-portal venous shunting in cavernous hemangioma of the liver.

Arterial-portal venous shunting was found to occur in a focal cavernous hemangioma of the liver. This occurrence stresses the lack of specificity of this finding in differentiating benign from malignant lesions.


The cortical rim sign in renal infarction.

The authors describe a case of unilateral renal artery occlusion in which a thin, dense rim was seen on infusion pyelography with subsequent marked atrophy of the kidney. This "cortical rim sign" appears to be due to collateral blood supply from the renal capsule, preserving a thin rim of viable cortex.


Retroperitoneal fibrosis and inapparent obstructive uropathy.

Emphasis is placed on the minor degree of caliectasis often observed in the presence of severe renal failure in patients with retroperitoneal fibrosis. This finding should suggest the diagnosis in individuals presenting with obscure causes of renal failure. A possible explanation for this is based upon an interference with ureteral dynamics and subsequent interference with normal ureteral peristatic activity rather than mechanical obstruction of the ureter per se. Twenty-one patients with retroperitoneal fibrosis are reported with the usual sex and age distribution (mostly male, aged 40-55 years). Two of the patients are interesting because of associated cardiac disease and 31 had been on prolonged methysergide therapy for migraine headaches. Eighteen patients appeared to be improved or cured and 3 died.


Redistribution of renal blood flow caused by contrast media.

Rerouting of blood from the renal cortex to the renal medulla (Trueta shunting), observed in 5 cases, may occur in normal kidneys during renal angiography. The temporary nature of this artifact may be proved by performing an abdominal aortogram with the catheter tip inserted farther away from the renal arteries. The exact mechanism of this phenomenon is unknown; it may also occur with various renovascular disorders.


Horizontal fracture of the anterior arch of the atlas.

Horizontal fracture of the anterior arch of the atlas can be easily overlooked on lateral radiographs. The fracture is not associated with neurological deficit but may be the cause of severe pain. A review of the literature reveals only 3 previously reported cases. Seven new cases, including 2 without other cervical spine fractures, indicate a much higher incidence than was previously thought. Hypotheses about the mechanism of injury are discussed.


Radiographic anatomical landmarks of the metacarpo-phalangeal joints.

The location of cortical bone changes in the metacarpo-phalangeal joints has been variously described as periarticular, juxta-articular, articular, or subarticular. Suitable radiographic landmarks on anatomical specimens were sought to assess the cartilage-covered articular surfaces of these joints. Precise landmarks for the limits of the joint space are not available, but unequivocal intra-articular regions were identified.


Dysplasia of the lymphatic system.

A case of diffuse lymphangiectasis without lymphedema of the limbs is reported in a woman. Translucent vulvar vegetations with edema were noted. Lymphatic vessels enveloping the iliac veins were resected over a length of 10 cm above the termination of the inferior vena cava, followed by complete remission. Abundant leucorrhea was probably due to chylous discharge by reflux at the ectatic vessels of the vulvar region.


A Monte Carlo computer model to investigate patient scheduling.

A Monte Carlo computer model was developed to investigate various types of patient appointment schedules for a single channel queue. Input parameters included the incidence of no-shows, the rate of unscheduled walk-ins, the frequency distribution of physician examination times, and the string of appointment times. The results included the frequency distributions of physician utilization rates and the total waiting time of all patients. Five hospital clinics were simulated. Even increment schedules yielded the best trade-off between physician utilization and patient waiting.


Evaluation of brain and epidural abscesses by computed tomography.

Most brain abscesses have a characteristic but nonspecific appearance on computed tomography (CT), consisting of a ring configuration of the abscess capsule which shows marked enhancement after injection of contrast material. CT scanning is invaluable in both the initial investigation of a brain abscess and assessment of its response to therapy. The CT scan showed a peripheral low-density crescent in one case of epidural abscess.


Computed tomographic appearance of methotrexate-induced necrotizing leukoencephalopathy.

A case of methotrexate-induced brain damage is presented. Computed tomography (CT) demonstrated a high-density mass lesion with a low-density area in the white matter which pathologically represented a large area of acute necrotizing cerebritis. CT appearance was indistinguishable from brain abscess.


Acquired spontaneous, nontraumatic normal-pressure cerebrospinal fluid fistulas originating from the middle fossa.

Five cases of spontaneous cerebrospinal fluid (CSF) fistulas originating from the middle fossa are described, including one patient with an "empty" sella. It is suggested that acquired meningocele and meningoencephalocele progress to become CSF fistulas. The normal anatomical and physiological factors which give rise to acquired bone/dural/arachnoid dehiscences are discussed and illustrated.


Physiological and radiographic assessment during the development of pulmonary radiation fibrosis.

Repeated regional measurements of pulmonary blood flow and ventilation were performed in 25 patients irradiated for breast cancer. Patients were studied before and at varying times after (16 to 47 days) the start of radiotherapy. At the same time, chest radiographs were taken and symptoms recorded. Of all the parameters measured, blood flow showed the earliest and greatest decrease. Since changed in blood flow at 60 days are predictive of the changes at 300 days, we believe that earlier studies during the course of irradiation could be useful in predicting long-term effects.


Visualization of the spleen with a bone-seeking radionuclide in a child with sickle-cell anemia.

99mTc-methylene diphosphonate, a bone-seeking radionuclide, accumulated in the spleen of a 16-year-old boy with sickle-cell anemia even though no splenic calcification was visible. This may be explained by the presence of microscopic calcium deposits in the spleen, which form at an early age in this disease. Bone-seeking radionuclides may accumulate in regions of recent splenic infarction, as has been demonstrated in cerebral and myocardial infarction. Such radionuclides may be the only means of demonstrating the spleen in such patients.


Applications of ventilation lung imaging with 81mKrypton.

A method for the evaluation of regional lung ventilation using 81mKr eluted from a rubidium generator is described. The tracer distribution at equilibrium is a function of regional ventilation, not of volumes. The study can be performed on a wide range of patients, including unconscious and mechanically ventilated patients, and can be performed immediately following or concurrently with a perfusion study. Thus, precisely comparable ventilation and perfusion images can be obtained.


Localization of the renal cortical imaging agent 99mTc-Sn-DMSA in the bowel.

Renal imaging in 2 patients with severe renal disease (serum creatinine greater than 10 mg/dl) showed deposition of 99mTc-Sn-DMSA in the bowel. Like 203 Hg-chlormerodrin, this radionuclide may be associated with a hepatobiliary excretory mechanism in patients with renal impairment.


Concentration of 99mTechnetium polyphosphate in fibrothorax following pneumonectomy.

Following the injection of 99mTechnetium-polyphosphate for bone scanning, a diffuse accumulation of radioactivity in post-pneumonectomy fibrothorax was demonstrated in 3 patients. This substantiates the nonspecificity of the localization of 99mTc-phosphorus compounds, and underlines the need for close clinical correlation in the accurate interpretation of such scans.


Scintigraphic findings in hyperostosis frontalis interna.

Transient diminution of activity was seen on early radionuclide images of the brain in 5 patients with hyperostosis frontalis interna and filled in on subsequent studies. Radiographs confirmed the diagnosis. In 3 patients the changes corresponded extremely well with both modalities. This entity should be considered when diminished activity is seen in the frontal area.


Use of a generalized modular data handling system in nuclear medicine.

Addition of a CAMAC modular data handling system to a small computer used for gamma-camera work has allowed the acquisition and processing of a broad variety of nuclear medicine data. Significant contributions have been made ranging from clinical renal evaluation to radiopharmaceutical development. Digital rectilinear scanning and computer acquisition of physiological signals such as the electrocardiogram are other applications. The system provides an inexpensive means of matching present-day nuclear computers to the diversity of data.


Bubbles in hyaline membrane disease. Differentiation of three types.

Three types of bubbles can be radiographically identified in hyaline membrane disease (HMD). The first type, seen in the early acute phase, represents overdistended terminal bronchioles and alveolar ducts. Type II represents pulmonary interstitial emphysema, and is related to positive pressure assisted ventilation. Type III represents focally distended alveolar groups in a scarred, immature lung, and occurs in the chronic stages of HMD. An understanding of the three types of bubbles aids in the management of HMD.


Anomalies of the intrahepatic portal venous system in congenital hepatic fibrosis.

Duplication of intrahepatic venous channels was observed in 9 of 13 children with congenital hepatic fibrosis and portal hypertension. Portal hypertension due to other causes was not associated with venous duplication. This anomaly may be a distinctive feature of congenital hepatic fibrosis with portal hypertension.


Asymmetric renal enlargement in acute glomerulonephritis.

Three children presented with unilateral and asymmetric renal enlargement and clinical and laboratory evidence of acute poststreptococcal glomerulonephritis. This asymmetry resolved at the same time as the nephritis. Angiographic evidence of absence of renal artery stenosis was available in one case. Angiography was not performed in the other 2 cases. The authors suggest that the differential diagnosis of unilateral acute renal inflammation (swelling of the kidney, prolonged nephrogram, calyceal distortion, poor concentration of contrast medium) should include acute glomerulonephritis. Extensive radiological evaluation is probably not necessary unless asymmetry persists.


Volvulus of the colon in a child with congenital asplenia (Ivemark's syndrome).

Volvulus of the colon occurred in a child with congenital asplenia (Ivemark's syndrome). This type of volvulus does not appear to have been reported previously and was found to be due to an underlying abnormality of mesenteric attachment.


Short rib-polydactyly syndrome type 3.

Three infants died perinatally of asphyxia due to thoracic narrowing. Their uniform radiographic findings are different from previously described and recognized chondrodysplasias and possibly represent a distinct syndrome. Three identical or very similar cases are found in the literature.


Performance survey of ultrasound instrumentation and feasibility of routine monitoring.

Short quality control tests for ultrasound instruments were developed based on the AIUM standard 100mm test object and procedures recommended for its use. While demonstrating the tests of technologists on their instruments, the authors obtained performance data on instruments in 22 hospitals. Subsequent quality control testing on the same instruments demonstrated that manufacturer's servicemen usually had improved performance significantly in the rather large number of cases in which adjustments were indicated by initial tests. Technologists in several hospitals, as well as the authors, performed the tests routinely for extended periods of time, with a moderately high yield for detection or demonstration of malfunctions.


Echocardiography of premature infants with pulmonary disease: a noninvasive method for detecting large ductal left-to-right shunts.

Echocardiography was used to evaluate premature infants with large patent ductus arteriosus (PDA) shunts and proved lung disease. A PDA producing large left-to-right shunting also causes left atrial enlargement. Since the left atrial diameter (LAD), measured by ultrasound, normally varies with body size, its value was compared to that of the aortic root diameter (AO) to adjust for body size variations. In those infants with pulmonary disease but no significant PDA, the range of LAD/AO ratios was similar to that of the control group. In patients with a proved large PDA the ratios were significantly higher. The ultrasound ratio returned to normal in all cases following surgical ligation of the PDA.


Thromboembolic complications of angiography for peripheral arterial disease: prospective assessment by Doppler ultrasound.

The incidence of thromboembolic arterial complications related to percutaneous angiography done for patients with arterial disease was assessed in 101 cases (105 procedures). There were 2 instances of anterior tibial artery obstruction and 3 of a decline in ankle pressure greater than 20 mmHg in patients with preexisting leg arterial disease. No patient evidenced symptoms of the complications. This incidence of thromboembolic accident, detected by Doppler ultrasound, is significantly less than those incidence rates noted previously, although the reasons for this difference have not yet been established.


Stage III ovarian carcinoma: treatment and results. Comparison of multiple drugs, a single drug, and irradiation.

Multiple drugs, a single drug, and irradiation were compared in patients with Stage III ovarian carcinoma. The results were categorized as "favorable" [pelvic mass less than 8 cm and/or upper abdominal tumor nodule(s) less than 2 cm] or "unfavorable" (more massive disease). A total of 62 patients are reviewed of whom 25 had irradiation and 37 had chemotherapy. It was found that patients with slight residual disease after celiotomy did equally well with either irradiation or chemotherapy, but survival was improved using a combination of both. Use of 5 drugs did not significantly improve survival beyond that obtained with a single drug.


Therapeutic embolization for intractable chronic bleeding.

Intractable, chronic vaginal and/or vesicle bleeding complicating pelvic cancers in five women was treated by transcatheter embolization of the hypogastric artery or its branches. Bleeding was presumed to be from hypervascular granulation tissue formed in response to irradiation in two patients and from tumor tissue in three. The embolic materials were Gelfoam and Oxycel reinforced autologous clots. Bleeding was stopped or reduced in volume by at least 90% in each patient. This form of therapy was useful even though bleeding site was not demonstrated angiographically.


Noise reduction by radiographic magnification.

Effective noise in the rare-earth system can be substantially reduced by use of radiographic magnification technique. The basic imaging properties of the rare-earth system (Alpha 8-XM) and the medium-speed system (Par-RP) were evaluated by the Wiener spectra, modulation transfer functions, and H&D curves. The visibility of radiographic details was determined with simple test objects. Results indicate that, as the magnification increases, the effective noise in the rare-earth system is reduced, and that the visibility of small structures can be improved.


Linearity of exposure with indicated time and current for diagnostic radiography units.

Quality control in diagnostic radiography begins with production of predictable exposures. The authors describe a technique which permits determination of the variation of mR/mAs for the entire diagnostic range of times and currents in only about 1 hour. The mR/mAs in newly installed units has been shown to vary by as much as +/- 50% compared to institutional acceptance levels of +/- 10%. Records of annual surveys and acceptance tests from 31 medical facilities, including 293 radiographic and fluoroscopic units, are reviewed, and effects of small variations in mAs on radiographic quality are shown.


Field separation in radiation therapy with opposing fields.

Dose distribution at the junction of two pairs of opposing fields with 60Co radiation was investigated. In order to obtain a uniform dose distribution, the field separation at the depth of interest was found to be the most important parameter. Values of this parameter to be used in every specific situation are reported. A simple formula is derived, which should be of practical help to the radiotherapist. This formula enables one to compute the field separation at the skin level in order to obtain the best dose distribution in the junction area at the tumor depth.


Radiation exposure in radiographic examinations of the newborn.

Radiation exposure of the newborn during routine chest and abdominal radiographic examinations has been determined. The exposure has been measured at sites representing the entrance and exit chest, entrance, midline, and exit abdomen, the gonads, and the thyroid. Results of these measurements are reported as a function of kVp and in terms of mR received at the anatomical site per mR output of the generator at 24 in. (61 cm). This reporting procedure facilitates application of the results to exposure estimates under similar conditions at other institutions.


Radiation tolerance of the rat spinal cord: time-dose relationships.

The cervical or lumbosacral region of the rat spinal cord was irradiated with 300-kV x rays. Syndromes of radiation myelopathy similar to those in man were observed in rats. Iso-effect curves for tolerance in relation to the number of fractions at daily intervals have a slope of 0.44 and 0.42 on a log-log scale for the cervical and lumbosacral regions, respectively. With intervals of up to 7 days, no significant further increase in tolerance was observed. Low dose rate treatments indicate a half-time of 1.5 hr. for repair of subeffective damage. These results suggest that tolerance of the spinal cord depends very strongly on the number of fractions given and only to a small extent on the overall time of treatment.


Computed tomography: in vitro evaluation of myocardial infarction.

An in vitro study of computed tomographic (CT) scanning of experimental myocardial infarction (MI) was performed by studying isolated canine hearts 18 to 48 yrs. post-infarction. CT scanning does not detect histologically present calcification in the area of an MI, but can be used to identify wall thickness changes in these areas. Decreased attenuation coefficients are found infarcted myocardium where thinning is present. The potential CT scanning to detect areas of MI is confirmed.


Neck and mediastinal angiography by computed tomography scan.

CT scanning of the neck and upper mediastinum is a valuable tool in the differential diagnosis of soft-tissue tumors. Visualization of the major vessels in the neck, which aids in the study, can be accomplished by a rapid intravenous drip infusion technique during the actual scanning, a new approach to contrast enhancement.


A radiographic and histologic study of fracture healing in osteopetrotic rats.

Repair of tibial fractures in osteopetrotic rats was delayed in comparison to that of normal littermates, due to reduced remodeling. Reduced bone resorption, known to be the cause of the disease in this mutation, is expressed in both skeletal development and fracture repair. The possible implications for human juvenile osteopetrosis are discussed.


Pulsed Doppler studies in B-mode ultrasound scanning.

In B-mode ultrasound abdominal studies, vascular structures may be confused with other tissues. A pulsed Doppler unit was coupled to a B-mode scanner by attaching the Doppler transducer to the B-mode transducer. A standardization procedure was designed to assure that the ultrasound beams from the 2 transducers were properly aligned, and that the Doppler focusing was accurate. The Doppler signal may be obtained from any point in the B-mode image in order to differentiate vascular structure from other tissue types.


Initial performance of the Stanford Medical pion generator.

A novel, cylindrical geometry, superconducting pion channel has been constructed at Stanford. It can simultaneously deliver up to 60 radially converging pion beams of the same mean momentum but with individually variable momentum spread (0.0-4.3%). Virtually no tuning of the pion beam is required Preliminary tests have demonstrated many of the performance characteristics which facilitate the treatment of selected human tumors.


The standard biphasic-contrast gastric series.

Biphasic gastric studies combining the advantages of both single- (positive) and double-contrast techniques performed under hypotony can now be accomplished as a routine procedure. In a series of 5,000 studies, the standardized method averaged only 15 minutes per patient.


A new radiological technique in evaluation of prosthetic fitting.

Xeroradiography is an excellent technique in evaluating the fit of extremity prostheses. Because of its inherent characteristics, xeroradiography can clearly demonstrate the stump-socket relationship. Consequently, the degree of contact achieved and attendant pressure problems, if any, can be precisely determined.


The 105mm camera as a supplement to nuclear venography.

Nuclear venograms were supplemented by contrast venograms with use of a 105mm spot film camera under direct visualization. This technique is a simple effective way of resolving questionable areas observed on nuclear venograms.


A cassette holder for therpay portal radiographs.

A rotational cassette holder was designed for obtaining port films. It is suited to multidirectional views and different source-to-skin distances.


Radiological manifestations of neonatal renal vein thrombosis on follow-up examinations.

Renal atrophy involving all or part of one or both kidneys was found in 10 children with renal vein thrombosis who had been given conservative treatment. This appearance is nonspecific and can be found in any condition which disturbs the renal parenchyma. However, in a significant number of patients calcification produced a pathognomonic radiological pattern. Awareness of these late radiological manifestations may help in recognizing those cases in which renal vein thrombosis went unnoticed in the neonatal period and the patient is now found to have a perplexing radiological appearance.


[Blood uric acid in myeloma].

A study was made of the mean blood uric acid level in a group of patients with myeloma, assessed before treatment and in cases where renal insufficiency had been formally excluded. This mean uric acid level of the blood was 63.3 +/- 15 mg. per liter in a groupe of 16 men, and 59.5 +/- 16.5 mg. per liter in a group of 18 women. Comparison of these findings with those obtained in a number of control groups suggests that in myeloma without renal failure, mild hyperuricemia exists. No clear mention of this fact is found in previous publications. The moderate extent of this hyperuricemia is probably due to the fairly slow growth of the myelomatous tumor mass. It is suggested that accurate determinations of the variations of the uricemia and uraturia might yield exact data concerning the sensitivity of the myelomatous cells to the cytolytic agents used to combat them.


[Discopathies after fractures and destructive vertebral lesions during rheumatismal pelvispondylitis].

In three cases of rheumatic spondylitis, fracture across the disc of an ankylosed spinal segment (C5-C6, D7-D8, and D12-L1 respectively) resulted in rapid development of a discopathy with destruction of the adjacent vertebral bodies. In one of these cases, surgical exposure of the focus permitted anatomical study of the lesion; the changes that had developed after the fracture were inflammatory in appearance, which at first suggested infection by non-specific micro-organisms, an assumption that was rapidly abandoned. This misleading histological appearance largely explains why these destructive discopathies in spondylitis have long been regarded as a consequence of the rheumatic process itself. A review is presented of the arguments which suggest that they have, in fact, a mechanical pathogenesis, often determined by a fracture. From this it may be concluded that the treatment of choice is temporary immobilization in moderate cases and surgery with transplantation in complicated or unstable cases.


[Surgical opening of the carpal tunnel. Long-term results].

The authors present the results of surgery of a short series cases of compression of the median nerve. All cases involved idiopathic acroparesthesia. The surgical technique was the same in all cases: opening and resection of the large annular ligament, and opening of "loge de Guyon". All the patients were seen again by the same observer 1 to 6 years later (average time after surgery 2 1/2 years). The results were excellent as regards pain and subjective sensory disorders. In contrast, the muscular atrophy was little improved. The results of comparative electric examinations (19 cases) were improved, except where there were pre-operative signs of considerable denervation. In conclusion, the authors think that surgical opening should be restricted to patients presenting signs of serious denervation and to those who no longer benefit from medical infiltration treatment.


[Synoviorthesis with radioactive gold in hemophilia].

Intra-articular haemorrhage in haemophiliacs often provokes chronic synovitis which leads to further repeated haemorrhages. This conditions has been treated by means of intra-articular injection of 198Au in colloidal solution and this treatment has cured the synovitis in 50 per cent of cases and given a notable improvement in about another 40 percent. Because of this, in this group of patients it was possible to reduce replacement therapy to less than 1/4 and the effect persisted over at least 3 years. This treatment even means that surgical synovectomy may be avoided in many cases. No unfavourable effects were seen on joint mobility or on bone growth but an undesirable effect of the radioactivity has been described in the form of chromosome changes in the circulating lymphocytes, and the importance of these pathological transformations is the subject of new experiments.


Transcutaneous pO2 electrode.

Measurements of pO2 on the skin surface (tc-pO2) by means of a conventional Clark electrode have under normal conditions (i.e., without producing hyperaemia) shown low tc-pO2 values and thereby indicated only a small exchange of oxygen through the skin. By using a heated Clark electrode specially designed for application on the surface of the skin it is, however, possible to perform continuous, non-invasive monitoring of tc-pO2 which is highly correlated to the arterial pO2 (pO2 (aB)) and which responds rapidly to changes in the inspired oxygen concentration (pO2 (I)). The tc-pO2 electrode developed by Radiometer and based on the above mentioned principles, viz.: --the use of a Clark oxygen electrode --the application of hyperthermia to produce local hyperaemia is described together with the Radiometer TCM1 TC OXYGEN MONITOR. The in vitro calibration of the electrode is performed at 43 degrees C using water saturated with atmospheric air as high calibrating standard, and a sulphite solution as zero standard. The response time of the electrode lies within the range 12-18 sec for 95% response when using a 25 mu Teflon (FEP) membrane. If the calibration is performed as described, the electrode will respond almost linearly to pO2 values up to 700 mmHg.


Transcutaneous measurement of arterial blood oxygen tension with a new electrode.

A new electrode for measuring the transcutaneous oxygen tension (tc-PO2) is described. The electrode has been tried out on newborn infants suffering from idiopathic respiratory distress syndrome (IRDS), and the results obtained have been compared with the arterial oxygen tension (PaO2). A fairly close agreement was found, and the least deviations were seen in the range below 250 mmHg.


Experiences with a new direct-reading oxygen saturation photometer using ultrasound for hemolyzing the blood.

The new oxygen saturation meter (OSM2, Radiometer A/S, Copenhagen) is fully automatic and measures the oxygen saturation and the hemoglobin concentration of whole blood or packed red cells. Volume requirement 20 mul, time 40 s. The blood is hemolyzed directly in the capillary cuvette by means of ultrasound generated piezo-electrically. The instrument measures the absorbance at wave lengths of 505 nm and 600 nm. Absorbance range 0-3. The results are calculated electronically and appear in digital display. Other applications are (1) determination of the oxygen affinity of the hemoglobin (P50) after equilibrating the blood with a known pO2 or after measuring the pO2 in the blood sample, (2) determination of carboxyhemoglobin after complete reduction of the hemoglobin by means of dithionite, (3) determination of methemoglobin after complete oxygenation of the blood.


Effect of amiloride on electrical activity and electrolyte transport in human colon.

It is not known whether factors other than Na transport are involved in generating the electrical potential difference (PD) across the human colonic wall. Therefore, experiments were performed in which the effect of amiloride on PD and ion transport was evaluated in the in vitro short-circuited human colon. In control periods the short-circuit current (Isc) was 2.9 +/- 0.3 (mean +/- S.E.M.) muEq per hr per cem2, while the corresponding net transfer of Na and Cl was 4.6 +/- 0.4 and 1.4 +/- 0.1 respectively. The residual flux was insignificantly different from zero. Amiloride caused a prompt, but reversible, decrease in Isc, PD, and conductance when added to the mucosal sie,dbut only a relatively small reduction of the mucosa to serosa fluxes of Na occurred. Bidirectional Cl fluxes were unchanged while the residual flux increased significantly. It is proposed, therefore, that some ions other than Cl (presumably mucosa to serosa fluxes of H and/or serosa to mucosa fluxes of HCO3) are the main counter ions for actively transported Na in the large bowel. Experiments performed in vivo showed that the rectal PD decreased exponentially from -46 mV +/- 0.8 TO -27 MV +/- 0.3 (mean +/- S.E.M.) following rectal instillation of 10-3 M amiloride. The half-time required for this effect was less than 13 seconds.


The effect of sucrose malabsorption on the growth pattern in children.

The clinical significance of sucrose malabsorption in 7 children (5 danish, 2 greenlandic)is discussed. the principal symptom was chronic, watery diarrhea, but meteorismand crying spells were frequent symptoms. the attacks of diarrhea started at thetime sucrose was  introduced into the diet. treatment with a diet poor in sucroseled to immediate relief of all symptoms. charts of the growth pattern were drawnup in 5 cases, and they showed a relative increase in weight and length as a result of dietetic treatment, although the values for both length and weight were within the normal range when treatment was commenced.


Pancreatic extract and the intestinal uptake of vitamin B12. I. Effect on the intestinal epithelium and the vitamin B12-intrinsic factor complex.

Pancreatic extract (PE) reduced the uptake of rat intrinsic factor (IF)-bound 57CoB12 by perfused rat intestinal segments (p is less than 0.02) as well as by isolated rat intestinal brush borders (p is less than 0.01). The inhibition was concentration-dependent. Preincubation of the brush borders with PE recular weight of the 57CoB12-IF complex, as well as the uptake of the complex by isolated intestinal brush borders, was unchanged after prolonged preincubation with PE. PE also inhibited the uptake of glucose by perfused intestinal segments (p is less than 0.01), but the morphology and idsaccharidase activity (p is greater than 0.5) of the intestinaleptihelium was unaltered. The results indicate that the inhibition may be due to interaction between the intestinal epithelium and PE.


Duodenal bile acid concentrations in fat malabsorption syndromes.

Meal-stimulated duodenal bile acid concentrations were measured in 38 control subjects and in 138 patients with various gastrointestinal diseases with or without fat malabsorption. In controls, the duodenal bile acid concentrations were normally distributed after Iogarithmic transformation, with a mean of 10.8 mM/1 (range: 5.4-21.5 mM/1). In general, the lower normal limit, 5.4 mM/1, discriminated well between patients with or without steatorrhea in whom other causes of fat malabsorption had been ruled out. The combination of intraluminal bile acid deficiency and steatorrhea was most often encountered in patientswit h hepatic disease, ileal disorders, and in the stagnant loop syndrome. Measurements of duodenal bile acid concentrations may serve to detect disorders of bile acid metabolism and thereby elucidate the pathogenesis of fat malabsorption syndromes.


Plasma pyridoxal phosphate levels in fulminant hepatic failure and the effects of parenteral supplementation.

Plasma concentrations of pyridoxal-5'-phosphate (PLP), the active coenzyme form of vitamin B6, were found to be markedly raised in patients with fulminant hepatic failure, when estimated within one week of the onset of symptoms. In parallel with the rise in plasma PLP, there was an increase in serum aminotransferase activity, suggesting that as a result of the severe hepatocyte injury, vitamin is released from theliver in the form of transaminase holoenzymes. There was no correlation between plasma levels of PLP and the urinary excretion of 4-pyridoxic acid, its main metabolite, either in the patients or normal control subjects. There was a progressive decline in plasma PLP levels after the initial period, which was not prevented by administration of high doses of pyridoxine hydrochloride (100 mg intravenously daily), suggesting that thseepatients are either unable to convert pyridoxine to PLP, or that degradation of PLP occurs at a pathologically incrased rate in this condition.


Serum calcitonin in acute pancreatitis in man.

Serum calcitonin (Ct) levels, serum calcium, and urine amylast were analyzed in 29 patients with an acute pancreatitis collected at random. In two of the patients the acute pancreatitis complicated a primary hyperparathyroidism. It was found that the calcitonin levels in serum were usually elevated during the acute phase of the pancreatitis. During this phase of the disease 22 of 27 examined patients had Ct-values above the upper normal limit of 1 mug/ml. The patients with normal Ct-values also had moderately elevated amylast values and a less pronounced pancreatitis. Normal Ct-values were usually found in patients more than 10 days after the onset of symptoms. Serum calcium was mostly within normal limits. However, a slight fall in serum calcium or low values was recorded in six patients with a pronounced disese. One patient with hyperparathyroidism normalized a previously elevated serum calcium during the calcitonin release.


Effect of endogenous and exogenous glucagon on pentagastrin-stimulated lower esophageal sphincter pressure in man.

The effect of endogenously released pancreatic glucagon on pentagastrin-stimulated lower esophageal sphincter pressure (LES-P) was studied in 10 healthy subjects. Glucagon was released by continuous intravenous infusion of 1-arginine in a dose of 0.6 g/kg-h, which resulted in plasma concentrations of pancreatic glucagon comparable to those seen after a protein meal. Infusion of arginine resulted in a significant inhibition of pentagastrin (0.5 mug/kg-h) stimulated LES-P. Five of the subjects furthermore had a study of the effect of exogenous glucagon in a dose of 1.6 mjg/kg-h on pentagastrin-stimulated LES-P. This dose of glucagon also reduced LES-P, but in spite of higher plasma glucagon concentrations, to a lesser degree than arginine.


Double contrast X-ray examination of stomach.

A comparison was made between three double contrast methods and the conventional method of X-ray examination of the stomach. 106 patets received ordinary barium sulphate together with effervescent granules. 119 patients were examined with a special barium sulphate preparation containing dissolved carbon dioxide (Baritop). The third group, 100 patients, received Baritop and effervescent granules, and 100 patients a conventional barium meal. The films were analyzed as to the quality of mucosal pattern demonstration, mucosal affinity of the contrast medium, and the degree of dilatation of the stomach and duo8num. In addition, the degree of interference by gas bubbles was estimated. The best results were obtained with the contrast medium containing carbon dioxide (Baritop).


Isoamylases in pancreatic carcinoma and chronic relapsing pancreatitis.

Pancreatic isoamylases were determined in serum and in duodenal aspirate in 7 patients with pancreatitis. The serum activities were abnormally low in 3 cases with cancer and in 7 cases with pancreatitis. In 2 cases with normal pancreatic isoamylase activities in serum, pancreatic disease was reflected by an abnormal isoamylast pattern. Thus the serum amylast determination was abnormal in 12 of the 20 patients.


Protectomy in ulcerative colitis. Results in 143 patients.

Secondary protectomy caused only one death in 59 patients while 10 deaths in the other 84 patients could be ascribed to simultaneous procedures such as colectomy. The perineal would was closed round a drainage tube. Healing was unrelated to age, primary or later protectomy, and corticosteroid medication. Mean healing time was significantly shorter in females (5.5 months) than in males (6.7 months). Only 50% of the patients reported healing in 6 months, and 20% still had an open wound at follow-up. These facts suggest that the present method should be altered. Healing seemed to follow an exponential curve, a trend which could be broken by revision, which was successful in 14 of 25 cases. Non-absorbable material, probably originating from ligatures on the superior hemorrhoidal vessels, was the apparent cause of sinus in 5 cases at least. Low as opposed to high ligation gives a long vascular pedicle, which may descend with its ligatures. This may explain the slower healing after protectomy for ulcerative colitis than for cancer.


Hexosamine-containing macromolecules in human colon carcinomas.

Normal, transitional, and carcinoma areas of five colons resected for carcinoma were examined morphologically, histochemically, and biochemically. The transitional area contained a larger amount of non-sulphated acid mucin than the normal mucosa as verified histochemically. Normal mucosa contained mainly sulphated mucin. The hexosamine-containing macromolecules present in different areas were isolated and characterized. They were divided into the following groups: 1) acid glycosaminoglycans, 2) high-molecular-weight glycopeptides, and 3) low-molecular weight glycopeptides. The concentration of the total hexosamine-containing material was in the carcinoma area twice as high as in normal areas. Acid glycosaminoglycans were identified as hyaluronate, heparan sulphate, dermatan sulphate, and chondroitin 4-(6)-sulphate. Their concentraitons were found to increase from normal to transitional and from transitional to carcinoma areas. The high-molecular-weight glycopeptide was composed of fucose, galactose, glucosamine, galactosamine, sialic acid, and variable amounts of sulphate. The sulphation degree of the glycopeptide was higher in normal mucosa than in transitional or carcinoma areas: The low-molecular-weight glycopeptides consisted of about a half of the total hexosamine-containing substances. The concentration of saline-insoluble fraction of the low-molecular-weight glycopeptides was in transitional areas about two times, and in carcinoma areas about four times, higher than in normal mucosa.


Effect of pentagastrin on blood flow distribution in the stomach of cats with gastric ulcer.

Ulcer was induced in the anterior wall of the antrum by injection of acetic acid solution. Carbonized microspheres 15 +/- 5 mj in diameter and labelled with 85Sr and 141Ce were used to measure blood flow in different regions and layers of the stomach. The radioactivity of the blood and tissue samples was determined, and the blood flow was calculated for each tissue sample. Three groups of anaesthetized animals were used: 1) animals, with normal stomachs, 2) animals with normal stomachs given pentagastrin, 3)animals with a one-week ulcer given pentagastrin. In animals with normal stomachs given pentagastrin during 20 minutes, the mucosal blood flow increased in all areas of the stomach apart from the antrum. In animals with a gastric ulcer pentagastrin was not found to influence the mucosal blood flow significantly. Pentagastrin was not found to change the muscularis flow in animals with normal stomachs, or in animals with a gastric ulcer.


The effect of insulin on food-stimulated secretion of gastrin after parietal cell vagotomy and selective gastric vagotomy.

Serum gastrin concentration was measured in 11 patients with Parietal Cell Vagotomy and Drainage (PCV + D) and in 11 patients with Selective Gastric Vagotomy and Drainage (SGV + D) in the basal state, after a meal, and after a meal in combination with insulin-hypoglycaemia. Insulin had an early and transitory, but significant, inhibitory effect on the food-induced rise in serum gastrin concentrations. This inhibition was the same whether the patients had a PCV + D or SGV + D, indicating that it has no relation to the vagal innervation of the antrum. In the second hour after the meal the integrated gastrin output was significantly higher when insulin was added to a meal in patients with PCV + D but not in patients with SGV + D. This may indicate a certain, possibility sensitizing, effect of the vagal antral nerves.


Hepatic copper content, urinary copper excretion, and serum ceruloplasmin in liver disease.

Increased liver copper concentration and raised serum ceruloplasmin were demonstrated in primary biliary cirrhosis and disorders of the biliary tract, and occasionally in chronic active hepatitis and cirrhosis of the liver. Eight of 13 patients with primary biliary cirrhosis had liver copper content as high as seen in patients with hepatolenticular degeneration (is greater than 250 mjg/g dry weight). Normal liver content was found in patients with acute hepatitis, steatosis of the liver, hepatic amuloidosis, haemochromatosis, and Gilbert's syndrome. The urinary copper excretion was increased (is greater than 75 mjg/24 h) in half the patients with primary biliary cirrhosis and occasionally in the other patient groups. Serum ceruloplasmin was raised in more than half of all patients, and none had levels below the reference range. Raised heaptic copper content did not always coincide with enhanced urinary copper excretion, but was significantly correlated with this parameter and also with ceruloplasmin, alkaline phosphatases, and vitamin-K-dependent clotting factors, but not with ALAT. Combination of laboratory data, as found in typical cases of hepatolenticular degeneration, was not observed in this study, including 66 patients.


Assessment of the therapeutic value of an elemental diet in chronic inflammatory bowel disease.

Thirty-four patients with chronic inflammatory bowel disease, 23 with ulcerative colitis, and 11 with  crohn's disease, weretreated with elemental diet. thirty-one patients had been on high dose prednisonetherapy one to four weeks prior to the diet with no or insufficient response. Fifteen patients (44%) went into remission when elemental diet was introduced as the only change of treatment. Furthermore six patients (18%) went into remission when the dietary treatment was supplemented with high dose prednisone treatment (2 cases) or an increase of prednisone dose (4 cases). Remission occurred in 16 of 21 patients with disease of moderate activity, but in only 5 of 13 cases with severe disease. Remission rate was higher in patients with a limited extent of the lesion, but 8 patients with extensive colitis responded to treatment. There was no significant change of haemoglobin  serum iron, transferrin, albumin, orosomucoid, or renal excretion of creatinine. However, significant decreases were observed of sedimentation rate, renal urea excretion, faecal volume and daily number of bowel movements. Colectomy was performed in 8 patients whose condition remained unchanged or aggravated during treatment. Follow-up studies of non-operated patients who went into remission showed that 6 of 13 patients with ulcerative colitis were perfectly well 7-28 months after the study, 3 patients suffered a mild recurrence after 4-24 months, and 4 patients were colectomized 5-10 months later due to severe attack. Of 8 patients with Crohn's disease 4 remained unoperated and free of symptoms 22-35 months after the study.


Criteria for selection of patients for medical treatment (chenodeoxycholic acid therapy) of gallstones.

With the introduction of medical treatment (chenodeoxycholic acid therapy) of cholesterol gallstones, the prediction of the gallstone type, cholesterol--non-cholesterol stones, (i.e. cholesterol predominating or not), has become important. In 24 consecutive patients admitted for surgery because of gallstones, the value of various criteria for differentiation between the two types of stones was assessed. It is concluded that the combined requirements of radiolucency of the stones and a cholesterol saturation index in duodenal bile above 1.00 constitutes a fairly reliable method for selection of patients for dissolution therapy with chenodeoxycholic acid.


[The intestines: an endocrine gland with multiple secretions].

The endocrinology of the digestive system has been a stimulating area of research for 15 years. Studies have shown that the intestine, with the many hormones it secretes, is to be considered an endocrine gland per se. The questions surrounding the nature, origin and functions of these hormones, and their role in human clinical medicine, are discussed. The answers, although incomplete and provisional, open highly interesting perspectives for the gastroenterologist.


[Yersinia enterocolitica infections in the Zurich area. Bacteriologic-serological diagnosis and case reports].

It has been investigated whether in the region of Zurich there are infections caused by Yersinia enterocolitica, and, if so, whether these could readily be diagnosed by us. Both questions can be answered in the affirmative. Yersinia enterocolitica type 3 was identified in 5 of the 837 stool specimens sent to our Salmonella diagnosis unit. In 19 of the 1125 blood serum specimens the titer of agglutinin against Yersinia enterocolitica type 3 was higher than 1 : 160. Our methods of isolation and identification of Yersinia enterocolitica are described. The clinical findings were in accordance with previously published observations by different authors. In none of the cases could any other causal agent have been responsible for the symptoms.


[A personal pollen trap. Preliminary report].

A device is briefly described by which the personal exposure of hay-fever patients to pollen and fungal spores can be ascertained. Pollen and fungal spores are caught on an adhesive surface, after which they are mounted in the Gelvatol and determined qualitatively and quantitatively under the microscope.


[Depressions with a surprising ending].

Periodicity of depressive episodes over many years, onset of depression entirely unconnected with external circumstances, or spontaneous end without a change in the patient's life situation strongly suggest and endogenous cause. The actual symptomatology alone does not provide direct evidence. The second criterion, the independent onset of an episode, may be difficult to reconstruct. However, a spontaneous and unexpected end is an impressive event and an argument for endogenicity even in cases of apparently reactive or neurotic origin.