On the incidence of renal vein thrombosis in the nephrotic syndrome.

Forty-eight patients with nephrotic syndrome were evaluated prospectively; the studies included inferior venacavagrams and ventilation perfusion lung scans. Eleven patients were found to have renal vein thrombosis (RVT). Eight of 21 patients with membranous glomerulonephritis (MGN) or membranoproliferative glomerulonephritis (MPGN) has RVT (38%). Clinical, laboratory, and pathological findings were not different among those patients with MGN and MPGN whether RVT was present or not. Patients with diabetic nephropathy or lupus nephritis did not have RVT. There was a high incidence of other thromboembolic phenomena as well as asymptomatic perfusion defects demonstrated by the lung scan, especially in patients with MGN or MPGN. These data suggest the disease process underlying the nephrotic syndrome may play a paramount role in the genesis of RVT or thromboembolic phenomena.


Splenectomy, chemotherapy, and survival in Hodgkin disease.

The question was raised whether routine splenectomy might, by virtue of its effects on the receipt of subsequent chemotherapy, offer long-term benefits to patients with advanced Hodgkin disease. Therefore, we compared followup data from a group of patients who were receiving mechlorethamine hydrochloride, vincristine sulfate, procarbazine hydrochloride, and prednisone (MOPP regimen) and who had had splenectomies to a group of similarly treated, carefully matched control patients on the MOPP regimen who had not had splenectomies. Our results indicate no important difference in duration of survival or long-term remission status. There was only a suggestion that splenectomy in such patients may be followed by impaired resistance to subsequent infections. Therefore, although early splenectomy can be important in the assessment of splenic disease, it must not be considered to be a therapeutic procedure per se.


Inappropriate antidiuretic hormone secretion. Occurrence in a patient with Rocky Mountain spotted fever.

A 51-year-old man with serologically confirmed Rocky Mountain spotted fever was believed to have inappropriate antidiuretic hormone (ADH) secretion. He was observed for four days in the hospital until the correct diagnosis was made. During this period, he progressively became more hyponatremic, despite a low BUN level and the administration of large amounts of sodium and water. At the time, his serum sodium concentration was 117 mEq/liter, and his urine was hypertonic to that of serum. Thereafter, his serum sodium level rose with fluid restriction. Rickettsia-induced CNS damage may have lead to the inappropriate ADH release that was observed in this patient.


Reversible malignant hypertension and azotemia due to urethral stricture.

A previously normotensive 24-year-old black man developed malignant hypertension and azotemia. The patient was found to have bladder outlet obstruction due to urethral stricture. Transurethral dilation resulted in brisk improvement in renal function and rapid lowering of blood pressure in association with minimal diuresis. On follow-up one year later, while he was not receiving medications, the blood pressure was 120/70 mm Hg and the creatinine clearance was 150 ml/min. A kidney biopsy specimen showed minimal residual pathologic abnormalities in the renal arteries and arterioles. The renin-angiotensin system was probably involved in the maintenance of the hypertension, in view of the elevated peripheral plasma renin activity on admission. This represents a rare case of hypertension due to urethral stricture. Despite rapid progression to azotemic malignant hypertension, urethral dilation restored the blood pressure and renal function to normal.


Effect of splenectomy on teardrop-shaped erythrocytes in agnogenic myeloid metaplasia.

Teardrop-shaped erythrocytes (TD) are frequently observed in the peripheral blood of patients with agnogenic myeloid metaplasia (AMM). These deformed cells may result from the myelofibrosis or the extramedullary hematopoiesis in the spleen. To determine the influence of the spleen on TD formation, we reviewed the presplenectomy (pre-S) and postsplenectomy (post-S) peripheral blood smears from 13 patients with AMM. The splenectomy was performed for a variety of reasons, including symptomatic hypersplenism or splenomegaly. The average number of TDs per 1,000 RBCs in the pre-S smears was 42 (range, 15 to 112 TDs), compared with 11 TDs in the post-S smears (range, 6 to 20 TDs)(P = less than .001). Only one of the 13 patients failed to exhibit this decrease in TDs post-S. There was no definite correlation between the number of TDs and the weight of the spleen removed at surgery, the interval since surgery, or age and sex of the patient. Based on this fourfold decrease in the number of TDs post-S, we conclude that the spleen in AMM play an important role in TD formation.


Doxorubicin hydrochloride-associated renal failure.

Doxorubicin hydrochloride (Adriamycin) therapy was associated with renal failure in a 78-year-old man. The pathophysiologic findings in this patient were similar to those seen following administration of structural analogues of doxorubicin. Daunorubicin hydrochloride, particularly, is known to cause renal failure in experimental animals. Renal function should be monitored in patients receiving doxorubicin.


Colchicine toxicity: a multisystem disease.

A 23-year-old black man survived a life-threatening multisystem disturbance resulting from a large single dose of colchicine administered intraurethrally for condyloma acuminata. Gastroenteritis and probable pancreatitis rapidly evolved into severe respiratory failure, marked neuromuscular problems, alopecia, and complete bone marrow aplasia. Within two months he had completely recovered. This patient demonstrates that colchicine should be used with extreme caution, if at all, for the therapy of condyloma acuminata.


Microbody of n-alkane-grown yeast. Enzyme localization in the isolated microbody.

Microbodies appearing abundantly in n-alkane-grown cells of Candida tropicalis pK 233 were isolated by means of sucrose density gradient centrifugation. Electron microscopical observation showed that the microbodies isolated were intact. Localization of catalase and D-amino acid oxidase in the isolated microbodies was confirmed. Isocitrate lyase, melate synthase and NADP-linked isocitrate dehydrogenase were also located in the microbody, but malate dehydrogenase, citrate synthase, aconitase and NAD-linked isocitrate dehydrogenase were not. Neither cytochrome P-450 not NADPH-cytochrome c reductase, the components involved in the n-alkane hydroxylation system of the yeast, were detected in the microbody fraction.


Selective spore survival during replica-plating of fission yeast.

Vegetative cells of Schizosaccharomyces pombe, upon exposure to acetone vapours, are inactivated at a faster rate than ascospores of this yeast. This observation has been used to develop a simple and fast method by which colonies can be replica-plated and only spores survive in the replicas. The colony patterns are exposed to acetone while still on the velvet used for replica-plating.


Growth of sulfate-reducing bacteria with sulfur as electron acceptor.

In addition to three new isolates, six strains of representative species of sulfate-reducing bacteria were tested for their capacity to use elemental sulfur as an electron acceptor for growth. There was good growth and sulfide production by strain Norway 4 and the three isolates, two of which had been enriched with sulfur flower and one isolated from a culture with green sulfur bacteria. Slow but definite growth was observed with Desulfovibrio gigas. The type of strains of Desulfovibrio desulfuricans, D. vulgaris, and Desulfotomaculum nigrificans as well as Desulfomanoas pigra did not grow with sulfur. The four strains that grew well with sulfur flower were straight, nonsporulating rods and did not contain desulfoviridin.


A new anaerobic, sporing, acetate-oxidizing, sulfate-reducing bacterium, Desulfotomaculum (emend.) acetoxidans.

A new strictly anaerobic, polarly flagellated, sporing, acetate-oxidizing, sulfate-reducing bacterium was isolated from anaerobic fresh or sea water mud samples. The oxidation of acetate to CO2 is stoichiometrically linked to the formation of H2S from sulfate. Ethanol, butanol and butyrate are also used. Hydrogen, lactate or pyruvate are not used as electron donors; organic substances are not fermented. A cytochrome of the b-type and a supposed sulfite reductase, P582, were detected spectrophotometrically. An emended description of the genus Desulfotomaculum is proposed which includes the new bacterium as the species Desulfotomaculum acetoxidans.


Energy conservation during nitrate respiration in Paracoccus denitrificans.

P/2e ratios were calculated from anaerobic chemostat cultures of Paracoccus denitrificans with nitrogenous oxides as electron acceptor. P/2e ratios were calculated, using the YmaxATP values determined for aerobic cultures. When succinate was the carbon and energy source the average P/2e values of the sulphate- and succinate-limited cultures with nitrate as electron acceptor were 0.5 and 0.7, respectively, and of the nitrite-limited culture 0.9. With gluconate as carbon and energy source and average P/2e values of the gluconate-limited with nitrate as electron acceptor and nitrate limited cultures were 0.9 and 1.1, respectively. leads to H+/O ratios measured in cells obtained from sulphate-, succinate, nitrite-, gluconate- and nitrate-limited cultures yielded respective average values of 3.4, 4.5, 3.5, 4.8 and 6.2 for endogenous substrates. From our data we conclude that sulphate- and nitrite- limitation causes the loss of site I phosphorylation. Nitrite has no influence on the maximum growth yield on ATP. We propose that metabolism in heterotrophically grown cells of Paracoccus dentrificans is regulated on the level of phosphorylation in the site I region of the electron transport chain.


Energy conservation during aerobic growth in Paracoccus denitrificans.

Paracoccus denitrificans was aerobically grown in chemostat culture with succinate or gluconate as carbon source. Due to the presence of two phosphorylation sites in the respiratory chain and the absence of branching, theoretical P/O ratios of 1.71 and 1.82 were calculated for cells growing respectively with succinate and gluconate as carbon source. Using these data, 95% confidence intervals for the P/O ratio were determined, via a mathematical model, at 0.91-1.15 and 1.00-1.37 for sulphate-limited cultures, with respectively succinate and gluconate as carbon source. These results and measurements of P/O ratios in membrane particles and of proton translocation in whole cells have led to the conclusion that site I phosphorylation is affected under sulphate-limited conditions. Under conditions of carbon source-limitation the endogenous leads to H+/O ratio is about 7-8. Average values of 3.40 and 4.78 were respectively found for sulphate-limited succinate- and gluconate grown cells. For starved cells, oxidizing succinate as exogenous substrate, the leads to H+/O ratios were determined at about 3-4, independent of the growth limiting factor. It is concluded that the number of protons ejected per pair of electrons per energy-conserving site (leads to H+/site ratio) is about 3-4, instead of 2 as postulated by the chemiosmotic hypothesis.


Isolation and characterization of disc-shaped phycobilisomes from the red alga Rhodella violacea.

Disc-shaped phycobilisomes were purified from Triton X100 treated cell homogenates of the unicellular marine red alga, Rhodella violacea. Their absorption spectrum had principal maxima at 544 and 568 nm (B-phycoerythrin), 624 nm (C-phycocyanin) and a distinct shoulder at 652 nm (allophycocyanin). Intermolecular energy transfer within the phycobilisomes was clearly demonstrated by fluorescence data. Excited at 546 nm intact phycobilisomes showed a main fluorescence emission maximum at 665 nm, a minor one at 577 nm and a shoulder at 730 nm. Dissociated phycobilisomes revealed a composition of 58% B-phycoerythrin, 25% C-phycocyanin and 17% allophycocyanin under the cultural conditions used. Analytical methods resolved no other components than phycobiliproteins. In addition to the defined C-phycocyanin and two isoproteins of B-phycoerythrin a stable heterogeneous aggregate of B-phycoerythrin/C-phycocyanin was separated in considerable amounts. In the electron microscope negatively stained phycobilisomes appeared as elliptical aggregates having dimensions  slightly above the values found in ultrathin sections and a detailed subunit structure. All observations and data suggest a new rhodophytan phycobilisome type in Rhodella violacea.


Autoinduction of bacterial luciferase. Occurrence, mechanism and significance.

The synthesis of the luminous system of the marine luminous bacterium Photobacterium fischeri is subject to a complex, self-regulated control system called autoinduction. The bacteria produce an autoinducer which accumulates in the medium at a constant rate (as a function of cell growth). When autoinducer reaches a critical concentration it stimulates, at the level of transcription, the synthesis of the luminous system. Autoinduction is thus viewed as an environmental sensing mechanism, which curtails the synthesis of the luminous system under dilute conditions. For several isolates of P. fischeri it was found that variations in luminescence intensity could be accounted for by correlated variations in autoinducer production.


Low oxygen is optimal for luciferase synthesis in some bacteria. Ecological implications.

The synthesis of the bioluminescent systems in many strains of two species of the genus Photobacterium which were isolated as symbionts is greater at low oxygen concentrations, where aerobic growth is blocked. In strains of two other species, one Photobacterium of symbiotic orgin, and one (genus Beneckea) whose lent response is observed. At low oxygen concentrations, where there is an inhibition of growth, there is also a similar decrease in the synthesis of the luminescent system. These species-specific differences may indicate important ecological differences along with distinctive differences in the molecular control mechanisms involved in the synthesis of luciferase.


Determination of the isotope distribution in malate-14C with fumarase-negative lactic acid bacteria.

No fumarase activity could be found in whole cells or in cell-free crude extracts from Leuconostoc mesenteroides or Lactobacillus curvatus. The degradation of L-malate-4-14C by these organisms yielded more than 95% of the label as 14CO2. It is therefore recommended that these organisms, rather than Lactobacillus plantarum, should be used in the determination of isotope distribution in L-malate-14C, since L. plantarum exhibits a significant fumarase activity and thus randomizes malate prior to the decarboxylation of this substance by the malolactic enzyme.


Reliability of psychiatric diagnosis. II. The test/retest reliability of diagnostic classification.

In a study of interrater diagnostic reliability, 101 psychiatric inpatients were independently interviewed by physicians using a structured interview. Newly admitted patients were randomly selected and examined by one of three psychiatrists. A second psychiatrist reexamined the same patient about 24 hours later. Interviews from the two examinations were evaluated independently and diagnoses were made on the basis of objective criteria. The degree of diagnostic agreement for the two examinations were calculated using the kappa statistic. Agreement was found to be high as compared to other studies in the psychiatric literature, despite the fact that in most previous investigations diagnoses were not made independently. The results were also compared to studies of reliability of medical judgments. Possible reasons for the high interrater reliability are discussed and include the use of a structured interview and objective diagnostic criteria.


Diagnostic correlates of discharge against medical advice.

The clinical histories of patients discharged against medical advice from a general hospital were studied to discern important diagnostic correlates of this event. Drug addiction occurred in 22% of the 73 test subjects and in none of 175 random controls. Chronic alcoholism was diagnosed in 42% of patients discharged prematurely vs 15% of controls (P less than .01). Discharge against advice should be considered a clue to the presence of one of these conditions if not previously appreciated. Since both are identifiable chronic disorders, early counseling is recommended to prevent such noncompliant behavior and its consequences for effective hospital care.


Prediction of outcome in schizophrenia. III. Five-year outcome and its predictors.

Recent studies of schizophrenia have begun to demonstrate the complex nature of its outcome characteristics and their predictors. However, generalization of findings has been limited by methodological problems such as relatively short-term follow-up the use of retrospective data, or employment of evaluation techniques without demonstrated reliability. This report describes a prospective, five-year follow-up using reliable evaluation techniques to determine whether specific relations between predictors and outcome variables represent behavior patterns persisting over an extended period. Results demonstrate the prognostic importance and specificity of certain predictors over five years. These results support the view that outcome function is comprised of persisting open-linked systems of behavior.


Mexican American and European Americal psychopathology and hospital course.

Demographic information, reason for admission, mental status on admission, hospital course variables, and discharge diagnosis were collected for 99 patients admitted consecutively to the psychiatric inpatient unit of a community mental health center serving a low-income population with a large proportion of Mexican-Americans; Patient ethnic distribution reflected that of the catchment area. Although ethnicity, sex, and social class each showed distinct characteristics, when any two of the factors were held constant, only three variables maintained significance, none of which indicated severe, flamboyant psychopathology. This study does not support earlier reports that hospitalized Mexican Americans are more severely disturbed than other ethnic groups.


Prediction of relapse in schizophrenic outpatients treated by drug and sociotherapy.

Despite the established efficacy of neuroleptics for maintaining schizophrenics in the community, there are data suggesting that those with very good prognostic signs may do as well without drugs. In testing this, we find no evidence that patients with good signs are not in need of drugs; instead they profit most from drug treatment. Patients who benefit little (1) are men whose families were disrupted earlier in their lives, (2) live alone or with extended families whose attitudes toward the study are not positive, and (3) are irregular in taking their medication. The practical implication is that the drug nonresponder can be helped by some means to ensure regularity of medication taking, such as a visiting nurse or long-acting medication. A second research question is whether major role therapy (MRT, a combination of social casework and vocational rehabilitation) can lengthen the time until relapse. Major role therapy affected time to relapse in a disordinal manner; asymptomatic patients benefited from MRT, while in patients with greater symptom severity MRT- suprisingly--hastened relapse. It is hypothesized that symptomatic patients are suffering from an inability to manage an expanded and enriched cognitive field; MRT, a therapy that urges the patient to become more responsible and to expand his horizons, may actually induce a state with which the patient cannot cope. It is recommended that a therapy such as MRT be deferred until the patient is essentially asymptomatic.


Methylphenidate hydrochloride effects on psychological tests in acute schizophrenic and nonpsychotic patients.

Actively psychotic schizophrenic and nonpsychotic psychiatric inpatients received intravenous methylphenidate hydrochlroide (0.5 mg/kg). Each patient was rated for level of psychosis and talkativeness, and each received the Holtzman projective ink blot tests and the Kent-Rosanoff word-association tests before, during, and after methylphenidate infusion. Minnesota Multiphasic Personality Inventory Goldberg Index scores were also obtained as a general measure of psychosis. For the entire patient group, methylphenidate infusion was followed by a significant increase in talkativeness and psychosis ratings and in pathological responses to the Holtzman ink blot test. There was a significant decrease in common word associations. Since neither of the psychological tests allow more than one response per item, it appears that methylphenidate truly effects pathological thought processes and decreases common word associations as such, rather than merely making these processes more evident by increasing verbalization.


Clinical implications of imipramine plasma levels for depressive illness.

Sixty depressed nonschizophrenic patients were admitted to a research unit. Following one drug-free week and one week of placebo, patients received 3.5 mg/kg of imipramine hydrochloride for 28 days. Plasma levels of imipramine and its metabolite desipramine hydrochloride (desmethylimipramine) were measured three times weekly and the relationship between plasma steady-state levels and clinical outcome was examined. Steady-state levels ranged from 50 to 1,050 ng/ml. There was a statistically and clinically significant relationship between plasma levels and response. The relationship existed across the entire sample, and was accentuated when the bipolar and unipolar nondelusional populations were examined. Because a strong relationship between sex and outcome was observed, the unipolar nondelusional patients were stratified by sex and a significant relationship still persisted. Only the unipolar delusional patients failed to demonstrate an association between blood level and clinical response.


Imagery mediation of vocal emphasis in flat affect.

The hypothesis that schizophrenics with flat affect have an interference with imagery mediation of language function was derived from clinical impressions that (1) such patients fail to show appropriate voice emphasis, and (2) that word imagery contributes to normal vocal emphasis patterns. Experiment 1 acoustically measured the emphasis patterns in schizophrenics with and without flat affect as they read text controlled for word imagery. Experiment 2 studied the effect of imagery in a paired-associate learning task in the same patients. The results supported the hypothesis, both for emphasis patterns and learning rates. These findings suggest that flat affect may be the product of factors in the schizophrenic process interacting with cognitive processes that are independent of the disease.


Sequential patterns of multiple-drug use among high school students.

Only recently have multiple-drug use studies involving more than heroin and marijuana begun to be reported in the literature. Four of these studies have found evidence that multiple-drug use is a progressive phenomenon, although the particular pattern of multiple-drug use reported in different  populations varies somewhat. This study examines the patterns of multiple-drug use reported by a random sample of 1,094 high school students living in greater New Haven, Conn in the 1972-1973 academic school year. Scalogram analysis reveals a progressive relationship for nine drugs: alcohol, marijuana, hashish, barbiturates, amphetamines, LSD, mescaline, cocaine, and heroin. Cigarettes and glue were not found to play a part in this pattern. The temporal order in which respondents reported that they had begun using each drug supports the results of scalogram analysis only in part.


A contrast of the three more common illnesses with the ten less common in a study and 18-month follow-up of 314 psychiatric emergency room patients.

The present study combines four factors: an initial research interview, a blind follow-up of the patients seen initially, the use of specified diagnostic criteria, and the application of these techniques to a psychiatric emergency room population of 314 patients. Follow-up studies were done in 299 patients (95%) a mean of 18.2 months after the initial interview. The patients were described diagnostically and demographically. There were three more common diagnoses: affective disorder, alcoholism, and antisocial personality. There were ten additional less common diagnoses, as well as an undiagnosed group and a group without diagnosis. There were single diagnoses in 190 patients and multiple diagnoses in the remaining 124 patients. Three diagnoses or less per patient were not uncommon; more than three diagnoses per patient were uncommon. Diagnoses of affective disorder, alcoholism, and antisocial personality occurred in 64% of the total number of diagnoses. The remainder of the diagnoses occurred in 36%. Prompt hospitalization occurred in 14% of the total sample.


A contrast of the three more common illnesses with the ten less common in a study and 18-month follow-up of 314 psychiatric emergency room patients. II. Characteristics of patients with the three more common illnesses.

The three more common illnesses diagnosed in the sample of 314 emergency room patients were (in order of frequency) affective disorder (N = 135), alcoholism (N = 112), and antisocial personality (N = 57). This study describes the occurrence and frequency of affective disorders and evaluates the relative usefulness of three separate sets of diagnostic criteria for the depressive phase of the illness, which are considered in three self-evident, mutually exclusive groups, the definition of which depends on chronology of onset in relation to other diagnoses. Findings show a 3:2 ratio of primary affective disorder to secondary affective disorder. The 112 diagnoses of alcoholism were based on defined criteria that separated "definite" (N = 102) from probable (N = 10) alcoholism. A high incidence of secondary affective disorder (38%) in patients with a first diagnosis of alcoholism is noted. The third most common diagnosis, antisocial personality, was based on defined criteria requiring a specified number of manifestations both before and after age 15 years. Only 11% of the antisocial personality patients received a single diagnosis of antisocial personality. An additional diagnosis of alcoholism occurred in 61%. Besides antisocial symptoms, the 57 patients reported 74 different nonantisocial symptoms, supporting the conclusion that antisocial personality patients may be as susceptible to neurotic and psychotic symptoms as other patients.


An 18-month follow-up of 314 randomly selected psychiatric emergency room patients showed that, although there were 15 possible diagnostic groups the diagnoses made at initial interviews proved to be largely accurate. Follow-up results showed the prediction based on those initial diagnoses was 84% correct in the 299 patients (95%) that could be followed up. Follow-up results also showed that 88% of the individual diagnoses (as opposed to diagnosed patients) were correct. The kappa coefficients were high, all of them being above 0.60, some between 0.80 and 0.90. In addition to the relatively high diagnostic validity, the results also demonstrated a high item reliability for the more than 400 separate items for which kappa coefficients were calculated. Less than 15% of these items had a kappa coefficient of less than 0.60. This study thus demonstrated a high diagnostic reliability and a high diagnostic validity The basis of these diagnoses in a heterogeneous psychiatric population was the application of precisely defined and applied diagnostic criteria. The diagnostic process was blind in that the follow-up diagnosis was made in the absence of knowledge of the initial diagnosis. The use of precisely defined and systematically applied criteria may prove to be superior to multivariate analysis, cluster analysis, or other statistical techniques.


Short vs long hospitalization: a prospective controlled study. VII. Two-year follow-up results for nonschizophrenics.

A controlled, prospective study examined the relative effectiveness of short-term versus long-term psychiatric hospitalization. Results of a two-year follow-up of a sample of 74 nonschizophrenic subjects are reported here. Two years after admission there were no statistically reliable differences in functioning between short-term and long-term subjects with diagnoses of either affective disorders, or neurosis and personality disorders (including hysterical personality disorder). The findings reported do not support extended hospitalization for patients with these diagnoses. Caution regarding these findings is suggested by an anecdotal impression that short-term hospitalization may not have allowed for proper diagnosis and treatment for some persons in the affective disorder group.


Symptom change and prognosis in clinic psychotherapy.

Applicants for outpatient psychotherapy completed a symptom checklist that permitted evaluation of the duration, intensity, and patterning of presenting symptoms. Random assignment of patients acceptable for psychotherapy to immediate treatment or to the waiting list resulted in two comparable groups who repeated the symptom checklist after an average interval nine months. Patients in psychotherapy showed a greater reduction in average intensity of all symptoms than was observable in the waiting list group. In the waiting list group, improvements tended to be limited to those patients whose conditions were of comparatively brief duration. In the psychotherapy group, improvements of chronic patients were frequent; however, improvements tended to occur among those patients reporting some new symptoms rather than those giving no evidence of exacerbation. A predmoninance of "neurotic" over "behavioral" complaints also appeared to be predictive of a positive response to psychotherapy.


Anorexia nervosa and gonadal dysgenesis. Further evidence of a relationship.

We report the ninth documentated coincidence of anorexia nervosa and XO gonadel dysgenesis (Turner syndrome) and the second confirmed coincidence of anorexia nervosa and XO/XX (mosaic) gonadal dysgenesis. Three other women who had anorexia nervosa and clinical stigmata of gonadal dysgenesis, but who were not karyotyped, are also described. We thus consider the possibility that patients with gonadal dysgenesis are at special risk for anorexia nervosa and discuss hypotheses to explain such a relationship.


Withdrawal from methadone maintenance. Rate of withdrawal and expectation.

One hundred twenty-seven successfully methadone-hydrochloride-maintained patients were randomly assigned to one of the following four groups and studied for 30 weeks: (1) known maintenance-patients were maintained on methadone under open conditions; (2) blind maintenance-patients were maintained on methadone under double blind conditions; (3) rapid withdrawal-patients were withdrawn under double-blind conditions at a rate of 10% of initial dose per week; (4) gradual withdrawal-patients were withdrawn under double-blind conditions at a rate of 3% of initial dose per week. Differences in dropout rates, illicit drug use, symptoms scores, and requests for study interruption indicate that withdrawal from methadone maintenance should be carried out at approximately 3% of initial dose per week. Better patient preparation also is indicated to reduce the effects of expectation.


Cervical orthoses effect on cervical spine motion: roentgenographic and goniometric method of study.

Movement of the cervical spine in the sagittal plane was studied in ten normal subjects from 20 to 30 years of age without and with four different cervical orthoses: (1) polyethylene Camp plastic collar with chin and occiput piece, (2) plastizote Philadelphia collar, (3) four-poster and (4) SOMI (sternal occipital mandibular immobilization). The effect of the orthoses on restricting sagittal motion was measured simultaneously using roentgenographic and bubble goniometric methods. The subject was immobilized in a straight back chair to eliminate trunk motion, and lateral cervical spine films were taken of each subject in neutral, flexion and extension without and with each orthotic device. Distortion forces exerted on the orthotic devices were standardized by measurement of pressures at the chin and occiput. Roentgenographic measurements of flexion and extension and anteroposterior displacement of the cervical spine were compared to the measurements obtained by bubble goniometry. The four-poster and SOMI were found to be most effective in restricting extension and flexion respectively. The polyethylene and plastizote orthoses were significantly less effective in restricting motion. The bubble goniometer is an adequate clinical tool in assessing overall flexion-extension of the cervical spine but is not so precise and does not give information on the degree of motion at an individual vertebral level.


Elderly patients with lower extremity amputations: three-year study in a rehabilitation setting.

Of the 112 mostly elderly patients with lower extremity amputations who were initially evaluated for this study, 86 were discharged as independent prosthetic ambulators after completion of both phases of a two-phase prosthetic rehabilitation program with a team approach. In four years of outpatient follow-up of the 86 patients who completed phase II, 14 died and contact was lost with 6. Sixty-six remain prosthetic ambulators. Six others who had unilateral amputations underwent amputation of the other limb; the initial procedure was above knee in one and below knee in five. All of the patients included in the study were originally referred to the Helen Hayes Hospital with a multitude of problems. The majority had emotional, social and financial difficulties, as well as medical problems. Many of the patients had undergone multiple surgical procedures prior to the first amputation. Psychological problems, particularly depression, were often severe in that group of patients.


Immobilization effect on the tensile properties of striated muscle: an experimental study in the rat.

To investigate the effect of immobilization on the tensile properties of atrophied gastrocnemius muscle, the left hind legs of 40 rats were fixed with padded plaster casts for three weeks. Seven to 42 days after starting the immobilization, load-deformation curves were registered from both gastrocnemius muscles of each rat and several parameters assessed from the curves. The rupture always occurred at the muscle belly. The decrease in breaking strength and energy absorption capacity following immobilization for one week averaged 20% and 34%, respectively, and the values fell further to about 32% and 46% at the end of the immobilization (21 days), when compared to the contralateral control muscles of the same animals. The elastic stiffness of the immobilized muscles was markedly decreased but rose nearly to the level of the controls after removal of the casts. The tensile properties of the previously immobilized muscles had not yet reached the control levels three weeks after removal of the casts.


Sensory threshold measurements for electrical stimulation of the digits.

Repeated impedance measurements of electrical stimulation to the finger using the stimulator of an electromyograph were evaluated in seven normal subjects to determine whether reliable threshold values to perception of pain could be obtained. Stimuli were delivered through ring or disc electrodes separated by 3 cm and interfaced to the skin of the digit with EKG paste. Stimulation through these electrodes produced only relative values of threshold, expressed as a potentiometer dial setting. Such values proved to be meaningful only when repeated during a single session. A possible reason for the apparent unreliability of repeated measurements over time is discussed. When a constant current source was substituted, reliable and consistent threshold measurements were obtained. It is suggested that the clinician wishing to make accurate, repeatable and quantified measurements of patient thresholds to electrical stimulation of the finger employ a nonloading source, namely, a constant current or constant voltage stimulator.


[Sleep EEG alterations in patients suffering from circulatory disturbances. Relation to neurological and psychopathological changes (author's transl)].

In 30 conscious patients (24 men, 6 women) aged 30-74 years suffering from ischemic lesions in the cerebral hemispheres, polygraphic night sleep recordings were performed about 45 days after the beginning of the illness. The alterations in sleep were characterized by a delay in the onset of sleep, prolonged waking periods, and a reduction of deep synchronous sleep. Statistical analysis revealed a relationship between prolonged waking time with higher age as well as with high complex reaction time and euphoric state of mind, which can be considered as a sign of psycho-organic impairment. In contrast thereto, the degree of the neurological symptomatology is of less importance for the kind and extent of the sleep disturbances.


[Testing chronic schizophrenics with the HAWIE test (author's transl)].

The HAWIE test was given to 70 hospitalized chronic schizophrenics with the aim of 1. determining the intelligence level of the patients; 2. finding out to what extent possible changes in intelligence achievement are due to the sickness, the treatment, or the hospitalism. The test results were compared with the norm; they were also evaluated within the sample group, as a function of the amount of time spent in the institution. Compared with the norm, the intelligence level of the patients was low; one contributing factor was the duration of the hospitalization. In connection with the length of hospitalization, a deterioration of the non-verbal IQ was found; this is to be interpreted within the conceptual framework of the deprivation syndrome (hospitalism). Our test results have been compared with those of other studies focusing on the special HAWIE problem.


[Assessment of the premorbid personality in endogenous psychoses. A factor-analytical study of the adjective check list of von Zerssen (author's transl)].

In order to get information about the premorbid personality of patients with endogenous psychosis, we examined the adjective check list of von Zerssen with regard to form and content on a sample of 126 schizophrenic and 31 affective-psychotic patients. The data gathering occured through retrospective evaluation by a close relative of each patient. One aim of the study was the development of a psychometric instrument in order to construct clinically relevant scales, which would allow us to objectify characterizations of the premorbid personality of patients with psychic illness. Another aim was to test the validity of this instrument by investigating the coherence between the obtained test results and the corresponding clinical psychiatric judgments of experts in the form of diagnoses. Finally, we sought to determine if typical premorbid characteristic features give a predisposition for specific aspects of psychotic diseases, in order to be able to differentiate between diverse psychiatric groups of diagnoses. By means of factor analysis (principal component analysis) with Varimax rotation we came to five easily distinguishable clinical-psychological well interpretable factors, from which we derived five scales. These scales seem to be appropriate for the characterization of premorbid personality traits. They represent the following clinical concepts: (1) cyclothymia, (2) sthenia, (3) anancasm, (4) hostility, (5) schizothymia. Formal examination of the factor-analytical proved scales according to criteria of classic test-theory (item-test correlation, reliability, distribution, intercorrelation) showed that we were able to measure rather independent dimensions of premorbid personality by our five scales with sufficient accuracy. To get evidence for the empirical validity of our scales we compared our test results (1) with three groups of different diagnoses concerning premorbid personality and (2) with the two diagnostic groups of schizophrenia and affective psychoses. We also tried to work out differential aspects within the diagnostic group of schizophrenia for four subgroups. As criteria for validity we sued clinical judgments of psychiatrists both for the premorbid personality and for the diagnosis of the present disease. On the whole our adjective check list turned out be as useful instrument to get a discriminating description of premorbid characteristic features which is better than a global evaluation in form of a single diagnosis. First First indications of the practical importance of our scales are discussed.


[The stiff-man syndrome. A case report with regard to clinical, electromyographical and pharmacological signs (author's transl)].

Our electromyographical findings show no evidence for a spinal or neurogenic origin of muscle stiffness in stiff-man syndrome. It is assumed that the tonic muscle rigidity is induced by abnormal impulses from the brainstem. The measured latencies of electrically induced muscle spasm in the legs are in accordance with this hypothetic site of origin. Muscle stiffness and spasm are decreased by the GABA derivative Baclofen as well as by Clonacepam, which is preferable to Diazepam because of less intense sedation. Spasms are increased by Chlorimipramine which may by used as a provocative test in uncertain cases. These pharmacological influences suggest an imbalance between a gabaminergic inhibitory and a noradrenergic and/or serotoninergic excitatory neuronal system.


[Follow-up studies of subtotal carotid artery stenosis (author's transl)].

Angiographic and/or operative follow up studies on 19 patients with angiographically demonstrated subtotal carotid artery stenosis showed the following results: In 3 out of 16 cases where no immediate operation of the stenosis was performed, complete occlusion followed within a week of the angiographic demonstration of the stenosis. Though intramural artifacts did not occur, this could be a consequence of the angiographic procedure (temporary fall of blood pressure?). In 4 out of 7 cases with subtotal stenosis where the diagnosis was known for at least 6 months, no occlusion occurred. The blood flow through a subtotal carotid artery stenosis might not be as small as is usually assumed, as illustrated by 2 out of 3 cases where a definite increase in the symptoms occurred on complete occlusion of the the vessel. The results indicate that cases of subtotal stenosis should be promptly treated by disobliteration.


Colonic neoplasms: tissue estrogen receptor and carcinoembryonic antigen.

Estrogen receptor protein was found in 24% of colonic neoplasms. Presence of estrogen receptor activity was independent of age or sex of the patient, state of differentiation or spread of the tumor, and concentration of carcinoembryonic antigen in the tumor. Estrogen receptor activity in colon tumors probably reflects novel protein synthesis resulting from dedifferentiation. Measurement of tumor estrogen receptor protein and carcinoembryonic antigen may have discriminatory value in the patient with metastatic adenocarcinoma and an unknown primary neoplasm.


Radical resection for periampullary carcinomas: results in 53 patients.

Radical pancreaticoduodenectomy for periampullary cancer was performed in 53 patients over a 22-year period. All tumors were adenocarcinomas: 35 patients had adenocarcinoma involving the head of the pancreas, nine, the Vater ampulla, seven, the distal common bile duct, and two, the duodenum. There were nine hospital deaths (17%). The postoperative course was classified as uneventful in 33 patients (62%). Thirty of the 39 patients who left the hospital died later, with evidence of recurrent carcinoma. The actuarial survival rate for the 53 patients was 51% +/- 6.9% at one year, 12% +/- 4.6% at five years, and 7% +/- 3.9% at ten years. Patients surviving 3.5 or more years appeared to have a decrease in their cancer mortality. We discuss actuarial survival rates, according to the location of the tumor. This experience suggests that radical pancreaticoduodenectomy id indicated to remove small, localized periampullary carcinomas in patients who are otherwise in good health.


Effectiveness of systemic BCG therapy in advanced melanoma.

The effect of systemic BCG therapy on advanced melanoma was studied in 42 patients with stage II and stage III disease. Evaluation of the immune response prior and during therapy revealed that patients who failed to convert a negative purified protein derivative (PPD) reaction and those having a low stimulation ratio of lymphocyte cultures had rapidly progressive disease and short survival. Neither tumor regression nor prolongation of survival could be appreciated in patients with stage III disease. Furthermore, aggravation of symptoms was observed in patients with visceral metastases. Fifty percent of the patients with stage II melanoma treated by operation and adjuvant immunotherapy had recurrent or metastatis disease within two years. No adverse effects were noted in patients with early disease who received adjuvant therapy. Two patients who had a full course of systemic BCG therapy developed severe reactions after intralesional injection of the vaccine. Further experience with various immunotherapeutic regimens and longer follow-up are necessary to evaluate its value in the early stages of melanoma.


Acessory nerve function after surgical procedures in the posterior triangle.

Seventeen patients who had undergone surgical procedures in the posterior triangle of the neck were examined between one day and four years after operation. Eleven patients were studied with electromyography. Clinical and electromyographic evidence of 11th cranial nerve paresis was present in 12 patients. Partial nerve injuries and entrapments, as suggested by delayed symptoms and incomplete denervation on electromyographic studies, were frequent. Physiotherapy was effective in restoring a satisfactory, although in many cases an incomplete, return of function. The spinal accessory nerve appears to be vulnerable to injury despite careful preservation during surgical dissection.


Ultrasonic blood flow assessment in colon esophageal bypass procedures.

Colonic serosal and mesenteric blood flows were assessed by use of the Doppler ultrasound device during three colon bypass procedures for obstructing esophageal carcinoma. The technique allowed confirmation of pulsatile blood flow in large and small vessels after mobilization of the colon and following completion of critical anastomoses. We recommend use of this technique to eliminate serious compromise of colonic blood flow in colon bypass procedures.


Utility of ultrasound in the differential diagnosis of acute cholecystitis.

Three case reports show the usefulness of ultrasound examination in patients with right upper quadrant masses despite clinical or roentgenographic evidence of cholecystitis or cholelithiasis. In one patient an hepatic fungal abscess from Candida albicans was distinguished from the gallbladder; in another, the same was possible for a pyogenic abscess in an old surgical incision; and in a third, extension of a gallbladder carcinoma to the liver was distinguished from the gallbladder itself. Thus, the ultrasound examination allowed assessment of the relationship between the clinically palpable mass and ultrasonically defined anatomy, When needed, increased specificity of diagnosis was obtained by ultrasonically guided fine-needle aspiration biopsy.


An information and discussion program for women after a mastectomy.

We discuss a pilot program of information and group discussion that was presented to a group of women who had had a mastectomy. The program was initiated to determine the nature of the unmet psychosocial needs of this group and to evaluate a means of meeting them. We held three weekly group sessions where information on the medical and psychological aspects of breast cancer were imparted by films, and videotapes, and small group discussions of mutual problems. Self-administered questionnaires completed by participants in the program were used to ascertain the characteristics of those attending and to assess their response to the experience. We found that the need for psychosocial services to be greatest in the year immediately after operation and to persist as long as decades later. We also found that this group method of psychological rehabilitation meets needs not met by other programs held in a more clinical setting and on a one-to-one basis.


Reappraisal of surgery for suppurative cholecystitis.

Ninety-two patients with suppurative cholecystitis operated on as emergency cases were studied in retrospection. Obstructive cholangitis was seen in two, who eventually died. The mortality after cholecystectomy alone was related to the presence of stones in the common bile duct. The mortality after cholecystostomy alone was related to shock and septicemia, but not to the presence of common bile duct stones or obstructive cholangitis. It was concluded that suppurative cholecystitis with accompanying common bile duct stones should be treated with cholecystectomy and choledocholithotomy, because of the lower rate of reoperations and possibly lower mortality than after cholecystectomy alone; an exception should be made in patients with deterioration in clinical condition or patients in whom technical difficulties develop during the operation. These patients should be subjected to a cholecystostomy as the only emergency procedure.


Richter hernia in a sacral foramen: new site for richter hernia.

This is a report of the first case to my knowledge, of a Richter hernia occurring in a sacral foramen. A 60-year-old woman had gradual onset of postsacral pain and swelling. The area was drained and small intestinal contents found. Laparotomy showed that a Richter hernia had occurred in the third right sacral foramen. The bowel had incarcerated and perforated into the posterior sacral area, without leakage into the peritoneal cavity.


Brunner gland adenoma of the duodenum: resection through the fiberoptic endoscope.

We present a case of polypoid adenoma of the Brunner glands of the duodenum. The patient had upper gastrointestinal bleeding. Correct diagnosis of a polypoid mass in the first portion of the duodenum as the cause of bleeding was made, and the lesion was resected endoscopically via an endoscope, using a cautery snare. To our knowledge this is the first reported case of resection of a Brunner gland adenoma with endoscopy, and we hope to encourage the use of this technique for removal of polypoid lesions of the upper gastrointestinal tract.


Endoscopic dilation of a gastric anastomotic stricture.

A stricture developed in a patient two months after undergoind a Billroth I gastroduodenal anastomosis. His mechanical gastric obstruction was relieved by dilation up to 37 F caliber under direct vision using a fiberendoscope. The patient became, and has remained, symptom free. Visualization of the area two months after dilation showed an adequately patent anastomosis.


Effectiveness of elastic stocking decompression.

The compression effectiveness of the five leading brands of antiembolism stockings was compared and related to criteria previously described (pressure gradient diminishing from 18 mm Hg at the ankle to 8 mm Hg at the thigh). Tests were conducted using a standard leg form in common use within the hosiery industry, fitted with specially developed sensors. All of the stockings achieved pressures higher than recommended-some substantially. Elastic stockings from two manufacturers demonstrated tourniquet effects at the calf. Several brands ceased to preserve a continuously diminishing pressure gradient above the knee. Deviation of leg diameter from standard geometry was accompanied by a substantial increase (decrease) in pressure with increasing (decreasing) girth. Reproducibility of pressure effects produced by identical-sized stockings varied among the brands tested.


Operative cholangiography: new cholangiogram catheter clamp and improved technique.

We present 225 cases of routine operative cholangiography, utilizing a new squeeze-locking, split-loop clamp to secure the catheter inside the cystic duct plus an x-ray film technique using two different dye concentrations. No surgical or procedural difficulty was experienced in any of the 225 cases. Additional operating time for the procedure averaged under five minutes, with only one inconclusive x-ray film study. These results suggest that the new catheter clamp and the two-film technique provide a mechanical simplification of the procedure and that many of the causes of inconclusive x-ray film study have been eliminated.


[Nickel--an essential trace element. 1. Influence of the supply of nickel on live weight gains, food consumption and body composition of growing pigs and goats].

Pigs and goats were used in long-term trials to investigate in which way supplements of 100 mug Ni per kg of a semisynthetic diet (control rations: 10 mg Ni per kg of the diet) would influence the rate of weight gains and food consumption and the body composition of the animals. A significant decline in the rate of weight increase was noted in the Ni-deficient animals. Ni-supplements added to the diet (10 mg/kg) increased the weight gains by 21% (goats) and 13% (pigs). In the present trial goats showed a more sensitive response to Ni-deficiency than pigs. Ni-deficiency did not affect the food consumption of neither the growing goats nor the growing pits. It was only during their lactation period that the Ni-deficient goats showed a statistically well-established decrease in food consumption. The level of Ni supply did not affect the crude protein, crude fat and crude ash content of the pigs.


[Attempts at the determination of endogenous and exogenous fecal proportions in monogastric animals].

A trial was made with growing Wistar rats receivine 15N labelled tracers. The animals were fed maize grains (Opaque). Subsequently, the level of urinary and faecal N excretion was measured and the 15N frequency was determined in the urine, faeces and different blood fractions. On the  basis of the model established by Czarnetzki for the nitrogen metabolism in monogastric animals the estimated values were used to calculate the proportion of endogenic faecal N in the total amount of faecal nitrogen. In agreement with previous trails it was found that increase in protein intake produced a significant increase in endogenic faecal N; similarly, a higher value was found for the true digestibility of maize protein (by 9.3 units) compared with that established by the conventional regression technique.


[Studies on the protein and amino acid metabolism of laying hens receiving 15N-labelled casein. 5. 15N incorporation into different blood fractions and into the amino acids lysine, histidine and arginine contained in these fractions].

4 colostomizted laying hens were fed 15N labelled casein as a sole source of protein for a period of 6 days. The birds were slaughtered 2 or 6 days after receiving 15N dose. The blood was separated into corpuscular blood components and blood plasma. Then, the amount and content of nitrogen in the blood, the blood fractions and in the amino acids lysine, histidine and arginine and the excess of 15N atom% (15N') were estimated. The average N concentrationin the blood was 3.8%. The crude protein in the blood corpuscles contained 8.7% lysine, 7.1% histidine and 6.4% arginine; the corresponding values for crude plasma protein were 6.3%,  2.2% and 5.7%. The 15N atom% in blood nitrogen was found to be lower in the hens slaughtered 144 hrs after receiving the last 15N dose than in the birds already slaughtered after 48 hrs. The same trend was found for the plasma proteins. The level of excess 15N atom% in the blood corpuscles increased with the length of time elapsing after the withdrawal of 15N casein (over the period of time investigated); a decrease of excess 15N atom% in plasma lysine was noted, however, for the investigated period of time after the last 15N dose. In the corpuscular blood components a higher level of 15N atom% was usually found in histidine relative to that in lysine and arginine; it was higher in the hens slaughtered 6 days after receiving the final 15N dose than in the hens killed 2 days after administration of the last 15N dose.


[Studies on the use of decanted fat-solids from pig feces in the nutrition of fattening cattle. 2. Comparison of various types of rations].

A 315-day feeding trial (F 3) was carried out with fattening bulls (starting weight: approximately 125 kg per animal) during which 4 groups of 7 bulls each were fed 4 mixtures of pelleted food : (1) concentrates (2) concentrates + 50% straw meal (3) concentrates + 25% straw meal and 25% decanted solids from pig faeces (4) concentrates + 50% decanted solids from pig faeces. The bulls in group 1 and 4 received 1 kg  of meadow hay per day in addition to the pellets. Within the framework of a calf-raising trial the animals had already received pellets containing straw and other solids. The average daily weight increases of the bulls in these 4 groups were 1032 g, 1052 g. 1040 g and 844 g per animal/day. The energy intake per g weight increase was  3.36, 3.07, 3.11 and 3.85 kEFr units; the requirements for food concentrates amounted to 4.60, 3.23 3.23 and 3.47 kg of dry matter per kg of weight increase. The resons presumed to account for the unfavourable results in group 4 are discussed in some detail. A further trial (F 4) was performed with a group of 20 bulls for a period of 252 days to test the results obtained with ration 3. Depending on the liveweights of the animals the bulls were fed rations containing 20%, 25% or 30% of straw meal and solids from pig faeces. For the entire period of the trial the daily weight increases were 1041 g per animal: the energy intake per kg weight gain was 4.05 kEFr units and 4.03 kg of dry matter of concentrate were necessary to produce 1 kg of weight increase. The results obtained in the two trials indicate that solids from pig faeces may be used, in limited quantities, as food component in the feeding of fattening cattle.


[Histogenesis and morphological characteristics of stomach cancer].

Histological and histochemical studies of stomach cancer and comparisons of characteristics of highly differentiated adenocarcinoma (24 observations) and nondifferentiated cancer (51 observations) revealed no differences in the character of the secret and in the activity of alkaline phosphatase in tumoral cells of glandular and nondifferentiated cancer. At the same time different localization of primary cancer was established: nondifferentiated cancer--in the region of glandular necks and basal parts of the mucosa, adenocarcinomas--in the surface regions. Comparison of the data obtained with features of physiological regeneration of the epithelium of the gastric mucosa justifies the assumption that foveate epithelium of nondifferentiated cancer, epithelium of the glandular neck, was the source of origination of adenocarcinoma. A different histogenesis of adenocarcinoma and nondifferentiated cancer accounts for their morphological differences and characteristics of the clinical course.


[Classification of precancerous conditions and cancer of the cervix uteri].

The classification consists of three sections: background processes, precancer states, and cancer of cervix uteri. The background processes depending on the etiological factor and the character of lesion of the epithelium are divided into dyshormonal, inflammatory, and posttraumatic. Groups of the so-called morphological precancer and preclinical forms of cervix uteri cancer are identified.


[Origin of embryonal features of the neoplasm and tumor progression].

It is immature elements of both proliferating and nonproliferating tissues that serve target cells in oncogenesis. Fould's concept of the independant development of tumor characters is supplemented with the idea that one must discriminate between fundamental festures, common for both benign and malignant neoplasms (uncontrolled growth), and secondary ones manifesting malignancy. Some of the latter are thought to be obligatory (invasiveness with destructive growth and the systemic effect) and others--facultative (capacity of metestasizing, cataplasia, etc).


[Proliferative properties of the epithelium of the duodenal mucosa in chronic hepatitis and liver cirrhosis].

The structure of the duodenum mucosa and proliferation of the epithelium were studied in 138 patients with chronic hepatitis and cirrhosis of the liver by count of the number of mitoses and that of cells labeled in the phase of DNA synthesis with 3H-thymidine. The atrophic changes revealed in the mucosa were noted together with the drop in the number of mitoses and the 3H-thymidine-labeled cells. This makes it possible to explain atrophy of the duodenum mucosa by inhibition of proliferative processes in the crypts.


[Regeneration of the myocardium of fetuses and newborn rabbits].

The work is devoted to studies of regeneration of the myocardium in fetuses and newborns of rabbits after a mechanical trauma of the heart. It was established that in fetuses under natural conditions of the alive organism instead of the perished tissue of the myocardium during the period of 5-8 days there developed a wholesome transverse-striated musculature whose fibers contained glycogen and redox enzymes. In newborn rabbits the defect of the myocardium was replaced by a mature fibrous connective tissue, regeneration was accomplished at the expence of hyperplasia of intracellular ultrastructures. The loss by the heart muscular tissue of the capacity for complete regeneration takes place within the 24th day of the intrauterine development and the 1st day of life.


[Cytophotometric method of determination of DNA content of neoplastic cells].

The content of DNA was investigated by the method of pulsed cytophotometry in cells of the following neoplasms: pulmonary cancer, benign lesions and cancer of the stomach, melanomas of the skin, malignant lymphomas and metastases of cancer into the lymphatic node. In the normal tissues and benign tumours the number of proliferating cells (DNA value of 3p, 4p) was not significant--from 2.0 to 5.0%. Polyploid cells were absent. In tumours the number of cells varied broadly--proliferating cells from 5.0 to 27,0%, polyploid cells from 9.0 to 40.0%. The use of the method of pulsed cytophotometry in prophylactic examinations is not effective, since in many cases changes could be detected only in single cells not identifiable on DNA-cytograms. Investigation of DNA content by the method of pulsed cytophotometry in a great number of tumour cells makes it possible to determine more accurately the character of the tumoral process, the level of differentiation of the tumoral tissue.


Clinical problems and levels of psychosomatic dysfunction.

As an introduction, some doctrinary and technical problems dealing with the complexity of the human mind and the possible approaches to investigate and treat the personality are discussed and, among them, the "medical model" is emphasized. A brief description of some cases in the author's experience are presented; they, at first, had been very difficult to diagnose. However, after some time, they were found to be of indisputable neuro-psychogenetic pathogenesis. The psychosomatic aspects of each case are analyzed, with emphasis on the different levels of pathogenic action and the means of elaboration to defend and readapt the affected personality, resulting in its final clinical expression. There are four possible levels where the primary dysfunction may act; (a) physiopathologic neuronal level; (b) cerebral subsystemic level; (c) psychodynamic level; (d) psychosocial level. The primary dysfunction, acting as a new stimulus on each of these levels, may determine in the personality pathologic responses that may assume very complex clinical situations. Many of these responses are quite different from the precipitating primary dysfunction, although there are still many evident links among them.


[Environment, behavior and learning in adult mice].

The effect that being subjected to different environmental situations has in the adult mouse is analysed. Adult mice are placed for that, in groups of twelve mice in cages that contains ramps, catwalks, passages, sleeping boxes and play objects, that were changed in their relative position several times in the week. Other mice were placed in groups of four mice in smaller boxes and without these objects. After 60 days in these conditions mice's exploratory behaviour and their learning ability in a complex maze were studied. A significant difference was observed between these two groups, as much in their exploratory behaviour as in the time spent on resolving maze, and the number of mice that resolved it in every one of ten successive trials.


[Giant cell tumors of the sphenoid bone. Report of 3 cases and review of the literature].

Three cases of giant cell tumor of the sphenoid bone are reported together with a revision of the previously reported cases in the neurosurgical literature. The importance of this tumor in the neurosurgical pathology is stressed, mainly to the impossibility of a correct diagnosis on a clinical and radiological basis. A good prognosis is possible with a least agressive surgery, transphenoidal biopsy and decompression, folowed by radiotherapy.


[Surgical treatment of cerebral hemorrhage. Considerations on 11 cases].

After brief comments about the angiographic findings on 298 consecutive cases of isquemic or hemorrhagic cerebral vascular strokes, cerebral angiography is emphasized as the main diagnostic method, owing to the variety of physiopathogenic and ethiologic factors involved in the genesis of this syndromes. The results of surgical treatment on eleven patients with spontaneous intracerebral hematomata are discussed in detail. Despite the great divergence among the authors about the management of massive intracerebral hemorrhage, the rapid improvement in 54.6% of the patients in this series, in our opinion justifies surgery in the majority of the cases.


[Postural hypotension in tabes dorsalis. Report of a case].

A case of postural hypotension in a patient with tabes dorsalis is reported. A polygraphic study of the arterial pression by intraortic catheterism, laboratory examinations and Minor test were made. As the results were negative for a disorder in the autonomic nervous system, it was concluded that the lesion responsible for the postural hypotension in the reported case was localizated in the aferent system of the baroreceptors.


Cerebral white-matter hypoplasia.

Twelve patients, including three sisters, with lifelong severe intellectual impairment and neurologic defects were found to have generalized hypoplasia of the cerebral white matter, with corresponding enlargement of the ventricular system. Gray-matter structures were remarkably intact. Reactive cellular changes (gliosis, phagocytosis, inflammation) were absent. To our knowledge, this particular syndrome has not previously been delineated in the extensive literature on cerebral palsy. The abnormalities in these cases could result from the effects of a selectively acting tissue-damaging factor, such as has been postulated in perinatal telencephalic leukoencephalopathy, but the factors underlying the disorder are still unknown.


Brain-type creatine kinase isoenzyme. Occurrence in serum in acute cerebral disorders.

Acute brain damage-cerebrovascular or cardiovascular, traumatic or infectious-released brain-type isoenzyme of creatine kinase (BB-CK) into the circulation within a few hours in 16 of 62 patients (26%). Occurrence of BB-CK was transient in the serum. BB-CK activity was found in the peripheral blood in 13 of 23 patients with diffuse brain damage compared to three of 39 patients with a local cerebrovascular accident (P less than .0005). The mortality of patients having BB-CK in their serum was 63% compared to 39% of those without BB-CK activity in their serum (P less than .05).


Doppler ultrasound scanning of the carotid bifurcation.

The results of Doppler scanning of 146 carotid bifurcations in 86 patients were correlated with carotid arteriography. The correlations for normal carotid arteries ranged from 63% to 98%; the correlation for occlusions of carotid arteries was 100%. The Doppler scan correlated in 70% to 85% of stenoses of the internal or external carotid arteries near their origins. The technique may be performed by a well-trained technician or physician.


Symptomatic intracranial steal.

The phenomenon of shunting of blood in association with various intracranial lesions is well known; however, usually clinical symptoms are attributable to the lesion and not to the redistribution of regional cerebral blood flow (rCBF). We report three patients investigated by angiography and rCBF studies in whom symptoms appeared to be due to a hemodynamic steal within one cerebral hemisphere, between hemispheres, and from the brain into a tumor, respectively.


Progressive focal deficit with porencephaly.

The association of porencephalic cysts with hydrocephalus was first cited in 1939. Subsequent descriptions of this combination in terms of fixed, nonprogressive neurological problems have been reported. We describe four patients with hydrocephalus who had progressive focal motor deficits secondary to porencephalic diverticulation of the lateral ventricle. Symptoms of increased intracranial pressure were not a consistent finding in all patients. Enlargement of the porencephalic cyst is related to either a generalized increase in intraventricular pressure or to "hydrostatic" forces that may act independently. Computerized axial tomography has provided a noninvasive technique that allows definition of the abnormality and its progression. Neurosurgical intervention has resulted in clinical improvement in all patients studied.


Phenytoin and cerebellar lesions. Similar effects on cerebral catecholamine metabolism.

Phenytoin has been shown to inhibit catecholamine (CA) metabolism in vitro. The present investigation examined its longer-term in vivo effects in rats. Phenytoin 100 mg/kg/day for two weeks, caused an increase in hindbrain norepinephrine (NE) concentration, a slight decrease in forebrain NE concentration, and little change in dopamine (DA) levels. The turnover rates of forebrain DA and NE estimated by synthesis inhibition, were increased by 70% and 100%, respectively. Surgical lesions of the anterior cerebellar vermis produced similar (but not additive) increases in turnover. It is concluded that long-term phenytoin use stimulates CA metabolism in the forebrain and that this effect may be mediated indirectly by the cerebellar vermis.


Cerebral air embolism. Report of five cases and review of the literature.

We discuss five patients who had cerebral air embolisms. Clinically, these patients had early seizures, focal neurological findings, or failure to awaken from anesthesia. The patients that survived had minimal neurological deficits. We also discuss the pathophysiology of cerebral air embolism and its differentiation from "the bends." The necessity for recognizing this entity early is important in order to administer appropriate therapy.


Duane syndrome and congenital upper-limb anomalies. A familial occurrence.

We report a family in which five members in three generations have been afflicted with Duane syndrome. Four of the five members also have congenital hypoplasia of the thenar eminence. One also was afflicted with Hirschsprung disease and another was born deaf. A sixth member, who does not have Duane syndrome, is afflicted with a more extensive malformation of the upper extremities and unilateral deafness. We present a discussion of Duane syndrome and its association with other congenital anomalies. Although some members of this family presented in this  report show features that are similar to the Holt-Oram syndrome, Wildervanck's syndrome, and others reported in the literature, there are several unique features about this family that we thought were worth reporting.


Familial poliodystrophy, mitochondrial myopathy, and lactate acidemia.

We describe a 16-year-old boy who has a progressive dementia and seizures. On investigation, he was found to have a mitochondrial myopathy and elevated lactate levels in the blood and cerebrospinal fluid. His sister died at 18 years of age of a similar condition.


Slow eye movements, with absent saccades, in a patient with hereditary ataxia.

Saccadic and smooth eye movements are controlled by separate mechanisms within the nervous system. We describe a patient with familial ataxia, considered to be a form of olivopontocerebellar degeneration, who is incapable of generating reflex or voluntary saccades. She can, however, move her eyes smoothly to the normal limits of lateral gaze, even when her head is prevented from moving. Latency before onset of movement is prolonged, and the velocity of movement is abnormally slow. We postulate that the degenerative process may have affected selectively those cells of the ventral paramedian pontine tegmentum responsible for the generation of saccades; and the the prolonged latency from presentation of a visual stimulus to the onset of movement is related to an inability to generate burst discharges needed to overcome the viscoelastic properties of the orbital tissues.


Sudden onset of unilateral third nerve paresis in a patient with Cushing syndrome.

Extraocular muscle pareses in patients with Cushing syndrome are virtually always associated with a greatly enlarged pituitary tumor and with advancement on oculomotor nerves. The present report concerns a patient with a rapidly progressive adrenocorticotropic hormone (ACTH)-dependent hyperadrenocorticism and sudden onset of an unilateral third nerve paresis. The patient had no demonstrable pituitary tumor. After a total adrenalectomy and correction of hyperadrenocortisolism, his third nerve paresis subsided. Ocular paresis may occur in a patient with Cushing syndrome even in the absence of mechanical involvement of ocular nerves by a pituitary tumor.


Amyloidosis with plasma cell dyscrasia. An overlooked caused of adult onset sensorimotor neuropathy.

In ten previously undiagnosed patients, we have found erstwhile-"primary" nonhereditary amyloidosis as an overlooked cause of a predominately sensory, painful, and hyperesthetic distal neuropathy occurring in middle-age and older patients. These symptoms, associated with orthostatic hypotension, diarrhea or constipation, cardiac abnormality, and male impotence are virtually diagnostic (in the absence of diabetes mellitus). Tissue diagnosis is quickly made by crystal-violet metachromasia of amyloid in fresh-frozen sections of a muscle biopsy specimen. Immunoglobulin and bone marrow evidence of plasma cell dyscrasia in eight of the ten patients suggests that the neuropathy in this form of amyloidosis is actually secondary to a plasma-cell-originating dysproteinemia. Therapy with melphalan and prednisone was not of benefit.


Central pontine myelinolysis. A clinical reappraisal.

We discuss three patients with clinical findings of central pontine myelinolysis (CPM). Two patients survived with minimal neurological deficits, and one patient died from medical complications while recovering from his neurological deficit. Postmortem examination showed the typical lesion of CPM. Brain stem auditory evoked potential studies in two of our patients indicate that there was impairment of function in auditory pontine pathways that returned to normal as the patients improved clinically. We conclude that CPM can be diagnosed clinically and that patients may recover if intercurrent illnesses are vigorously treated.


The clinical picture and plasma levodopa metabolite profile of parkinsonian nonresponders. Treatment with levodopa and decarboxylase inhibitor.

Three parkinsonian patients who were nonresponders to levodopa treatment did not improve when shifted to levodopa-decarboxylase inhibitor combination but, instead, experienced involuntary movements. Their plasma levodopa and metabolite profiles showed unusually high baseline 3-0-methyldopa concentrations that further increased significantly during the decarboxylase inhibitor regimen. All patients had 3-0-methyldopa to levodopa ratios greater than 1, even two hours after therapy. Patients who are responders to levodopa-decarboxylase inhibitor combination or to levodopa alone had 3-0-methyldopa to levodopa ratios of less than 1. We discuss the role of 3-0-methyldopa as a metabolite and the significance of the 3-0-methyldopa to levodopa ratio as a predictor of patients' response to levodopa.


Juvenile parkinsonism treated with levodopa.

We describe three patients with early onset of parkinsonism. Two of these were sisters and showed a reduction in homovanillic acid (HVA), 5-hydroxytryptamine (5-HT), and 5-hydroxyindole acetic acid (5-HIAA) levels in the CSF. In the third patient, parkinsonism developed, which was probably related to chickenpox encephalitis. All three patients responed favorably to levodopa therapy.


Electrically elicited blink reflex in normal neonates.

The electrically elicited blink reflex was tested in 30 full-term neonates. Of the two distinctly separate responses, early component R1 and late component R2, R1 was recorded in all but three infants. Its latency, 12.1+/-1.0 msec (mean+/-SD), was significantly greater than that in adults (10.6+/-0.8 msec) despite a considerably shorter length of the reflex arc in infants. Unlike the response in adults, R2 was elicited in only 20 of 30 infants, mostly on the side ipsilateral to the stimulus. The reduction of reflex excitability of R2 in neonates must occur primarily at the level of interneurons since oligosynaptic R1 was elicited with ease whereas polysynaptic R2 was not.


Spontaneous dissecting aneurysm of the internal carotid artery.

A case of a spontaneous dissecting aneurysm of the left internal carotid artery in a 48-year-old woman was treated by endarterctomy. We review the literature and discuss the pathogenesis.


Cranial computerized tomography and the postenhancement abdominal roentgenogram.

Cranial computerized tomography often ultilizes injected iodinated agents for contrast enhacement. Exposure of an abdominal flat plate roentgenogram after such a procedure may uncover silent urinary tract anomalies. We discuss a case in point.


Signs of interhemispheric disconnection in marchiafava-bignami disease.

We report three cases of Marchiafava-Bignami disease. The diagnosis was made on clinical grounds. Evidence of interhemispheric disconnection was found in all three cases. This included left hand anomia, left-sided apraxia, left-hand agraphia, and left-sided pseudoextinction to both visual and tactile stimuli. In two cases, there was a left-ear extinction on a dichotic listening test.


Fenfluramine hydrochloride treatment of parkinsonism.

The oral administration of fenfluramine hydrochloride, which acts centrally to augment serotonin-mediated synaptic function, did not alter extrapyramidal signs in either untreated or levodopa-treated parkinsolian patients. These results support the contention that biochemical indices of serotonergic dysfunction in Parkinson disease do not reflect a critical role for serotonin-containing neural systems in the pathophysiology of parkinsonism and that serotonin-active drugs afford no significant therapeutic benefit to patients with this disorder.


Glaucoma and retinal detachment.

In a survey of 817 patients undergoing primary operations for retinal detachment, glaucoma was present in 9.5%. Ocular hypertension (intraocular pressure [IOP] greater than 21 mm Hg) was present in an additional 6.5%. Primary open-angle glaucoma; the type of glaucoma most frequently encountered, occurred in 4% of the patients. Aphakic eyes and eyes with peripheral anterior synechiae had high prevalences of glaucoma. A high percentage of eyes with posttraumatic angle recessions had either glaucoma or elevated IOPs. Miotics used in the treatment of glaucoma could not be definitely implicated as a cause of retinal detachment. The rate of successful retinal reattachment was the same, whether or not glaucoma was present. However, a good visual result occurred less frequently in patients with glaucoma.


Patterned dystrophies of the retinal pigment epithelium.

Three varieties of patterned dystrophies of the retinal pigment epithelium have been described in the literature: They are reticular dystrophy, macroreticular dystrophy, and butterfly-shaped pigment dystrophy of the fovea (macula). They are all inherited and are bilateral and symmetric. Results of retinal-function tests in all three varieties were essentially normal, except for the electro-oculogram in the butterfly-shaped pigment dystrophy. We have observed within a single family one member manifesting butterfly-shaped pigment dystrophy, one member with macroreticular dystrophy, and one member with probable reticular dystrophy. Electrophysiologic studies of the retina in these patients were in accord with those already reported, except for supernormal scotopic responses in the latter two patients. This family demonstrates the linkage necessary to tie together a number of entities heretofore considered as separate.


Choroidography and photography of the long ciliary nerve and artery.

A noninvasive technique that allows photography of the choroidal vasculature and the long ciliary nerve and artery is described. It does not make use of any injectable contrast material. A simple single lens reflex camera with its close-up lens, mounted on a stand, was used to take illustrative choroidograms.


A case report of a negative 32P test in a histologically proven choroidal hemangioma.

Results from a 32P test in a histologically proven choroidal hemangioma were normal in a case we recently evaluated. It is believed that this case is important because of the infrequent number of confirmations with this test.


Interpretation of tear film breakup.

Tear film breakup time (BUT) was measured in 25 normal subjects on 8 different occasions over a period of one month. Reproducibility of the BUT test and factors involved in interpretation of tear film breakup were studied. It was found that of 50 eyes, the average BUT ranged from five to 100 seconds, and that there were noticeable variations (P less than or equal to .05) in an individual eye from one patient visit to the next. The BUT is not a closely reproducible phenomenon in an individual eye.


Corneal exposure during sleep (nocturnal lagophthalmos).

In our referral practice at the University of Florida, corneal exposure during sleep appears to be a relatively common cause of previously undiagnosed chronic keratitis. The spectrum of the disease ranges from minimal epithelial changes that may heal later in the day to severe exposure ulcers with marked loss of stromal substance. Keratitis sicca and previous lid abnormalities are predisposing factors, but not necessary concomitants of the disease. The diagnosis can usually be made by asking the patient to gently (not forcibly) close his eyes, and usually within a minute or two, a small crack can be seen between the lids by shining light on the intrapalpebral areas-during this time there is usually some fasciculation of the lids. In our experience the most effective treatment, when ointments at bedtime are not adequate, is closing the eye by using a piece of paper tape to pull up the cheek, and then attaching the tape to the forehead, with no pad or pressure on the eye. After the initial healing, ointments at bedtime may be adequate to maintain a symptom-free state in this apparently common cause of treatment-resistant chronic keratitis.


Marginal corneal ulcer due to beta-streptococcus.

A 72-year-old woman with a low-grade nasolacrimal duct obstruction developed a hyperacute conjunctivitis caused by beta-hemolytic streptococci. This condition has been termed "conjunctivitis of Morax". An unusual feature consisting of a large, marginal furrow-like corneal ulcer was noted associated with a plastic iritis. The condition improved with the use of topical erythromycin, irrigation of the lacrimal sac with aqueous penicillin and oral penicillin. We believe that the marginal corneal ulcer was an actual infection of the corneal stroma resulting from the intense conjunctival chemosis trapping the exudate between the conjunctiva and the corneal epithelium, thus causing a breakdown of the corneal epithelium and allowing the organism to gain access to the stroma. Conjunctivitis of Morax can be clinically differentiated from a conjunctivitis associated with pneumococcal dacryocystitis and from the acute and hyperacute purulent conjunctivis due to infection with Neisseria.


Descemet membrane detachment.

Four eyes of three patients had extensive postoperative Descemet membrane (DM) detachment. Blood was present just anterior to the DM in three of the four eyes and later converted to and persisted as pigment. Haziness of the cornea at the level of the DM could be seen with reattachment. Detachments of the DM are classified as planar when there is 1 mm or less separation of the DM from its overlying stroma in all areas. Nonplanar DM detachments exceed 1 mm of separation. Planar detachments have a much better prognosis than nonplanar detachments do, with or without descemetopexy. Repair of DM detachments, when necessary, should include air injection, with the lease possible instrumentation of the DM.


Oncocytic lesions of the caruncle and other ocular adnexa.

This is a clinicopathologic study of 18 oncocytic lesions involving the ocular adnexa. These lesions most commonly occur in elderly patients (median age 73), and there is a striking predilection for women. The broad spectrum of lesions included oncocytic adenomatous hyperplasia, oncocytomas, and oncocytic carcinoma. Ten lesions, all of which were oncocytomas, involved the caruncle, four the conjunctiva, and one the mucocutaneous junction of the eyelid. Two tumors involved the lacrimal sac and one the lacrimal gland. A review of the literature disclosed only 17 previously reported oncocytic lesions of the ocular adnexa. A small yellowish-tan or reddish caruncular mass, especially in an elderly woman, should alert the ophthalmologist to consider the possibility of oncocytoma in his differential diagnosis.


Surgical treatment of eyelid neurofibromas.

The classical surgical treatment of eyelid neurofibromas has been careful dissection of the tumor with preservation of much of the surrounding abnormal lid tissues. The reported outcome has been uniformly unfavorable. These tumors infiltrate extensively and are impossible to dissect out completely. However, the lateral location of lid neurofibromas allows "en bloc" resection of most of the tumor including the adjacent involved lid tissues. Levator function in these cases is potentially good and the lid will elevate well if the levator aponeurosis is joined to the tarsus laterally at the time of surgery. The four cases presented here indicate that this procedure is technically easier and may produce more acceptable results than other forms of treatment.


Intrascleral nerve loop mistakenly identified as a foreign body.

A 5-year-old boy had an excisional biopsy of a pigmented scleral lesion thought clinically to be a foreign body, probably graphite from a pencil. Histological study demonstrated that the pigmented lesion was an intrascleral nerve loop (Axenfeld).


[Hydraulic problems in so-called antibacterial suction-drainage of surgical infections and osteomyelitic cavities (author's transl)].

1. Suction-drainage should only be employed when there is a closed space enabling free flow of the irrigation fluid. 2. The drainage of the irrigation fluid must be ensured. 3. Positioning of the perforated drain is more important than the actual length of the perforated segment of the drain. Enlargment of the holes in the drain may prevent it from clogging and not so much an increase in the number of holes. 4. The irrigation system must be simple and not be complicated by Y-tubes. 5. Wound closure should be water-tight for the construction of a closed drainage system.


[Innominate osteotomy (Chiari) for the treatment of coxa magna--preliminary results of 17 patients (author's transl)].

This is a report on the validity of treatment of coxa magna hips resulting from Legg-Calvé-Perthes-disease or hip dislocation by Chiari's pelvic osteotomy. Only severely deformed, incongruous and subluxated hips were treated by this operation. The aim of treatment is the development of congruency with a well covered femoral head to prevent an early occurence of osteoarthritis of the hip joint. Our results were compared with the results of nonoperative treatment of comparable patient groups.


[Intrathecal herniation of a cervical disc. A case report (author's transl)].

1. The literature concerning intrathecal herniation of intervertebral discs is briefly reviewed. 2. A case of an intrathecal herniation of a cervical disc with transitory paraplegia and a following Brown-Sequard-Syndrome is reported. 3. Laminectomy disclosed a rotation of the cord and a sequestrated disc embedded in the anterior substance of the cord. 4. A trauma of the cervical spine 8 years ago seem to be responsible for the progredient protrusion of the cervical disc. 5. Adhaesions between the dura mater and posterior longitudinal ligament in this case are regarded as origin of intrathecal herniation.


[Late results after homologous nerve grafting (author's transl)].

An account is given about the results of transplantation of homolouges lyophilisated nerves. 48 patients (56 nerves) could be reexamined. The critical clinical and neurological examination shows no positive results. Regarding the taken late results and the experimental findings the use of homolouges lyophilisated nerves for bridging larger defects in human must be rejected, at least at the present.


Evaluation of 350 sciatic blocks in rheumatoid foot surgery.

Sciatic block with Mepivacaine (3-4 mg/kg) revealed successful in 91.9% of 340 rheumatoid patients with Keller/Clayton operation. In unsufficient blocks (8.1%) supplementary anesthesia by femoral nerve block, reblocking the sciatic nerve or local anesthetics secondarily gave good operating conditions. In three cases it was necessary to use additional spinal anesthesia. The concomitant sympathetic block gives an immediate cessation of sweating and a long lasting evaluation of skin temperature.


[The operative treatment of the subtrochanteric pseudarthrosis of the femur in the case of pffd (author's transl)].

The authors discuss 7 cases of congenital subtrochanteric pseudarthroses of the femur which do not fit into the traditional schemes--neither from the histologically nor from the X-ray aspects. A valgus angulation osteotomy was carried out in each case. The procedure depending on the acutness of the angle. The results are positive.


[Surgical interventions on the vertebral bodies of the thoracic spine (author's transl)].

27 operations on the vertebral bodies of the thoracic spine are reported. Indications for operation included markedly progressive infantile and juvenile scoliosis, correction of severe kyphoses in congenital malformation, fractures, Scheuermann's disease and post-laminectomy as well as tuberculous spondylitis and tumors. The two uppermost thoracic vertebrae can be reached by the method of Southwick and Robinson, the two lowest vertebrae from an extraperitoreal-subdiaphragm approach. Thoracotomy was chosen for the remaining thoracic vertebrae. If the staff and material are available, operations on the thoracic vertebrae can be regarded as relatively safe and, in many cases, are the only possibility for obtaining a satisfactory or good result. In spite of this, strict indications must be observed. Severe complications (death, paraplegia etc.) did not occur in any of the patients.


[Fracture of the cervical spine in patients with ankylosing spondylarthritis (author's transl)].

Fracture of the ankylosed cervical spine is a much more serious problem than injury to the normal vertebral collumn. The ankylosed spine may be fractured following relatively mild trauma attributable to loss of flexibility and increased fragility from osteoporosis. The fused spine breaks like a solid long bone, usually completely. Review of the literature shows that the incidence of neurological deficits and the mortality are significantly higher than in comparable patients without ankylosing spondylitis. The fracture often is difficult to reduce and maintain in proper alignment. Neurologic change from spinal cord compression may occur even while the patient is in skeletal traction. Treatment by skull tong traction and anterior fusion is outlined.--Two cases of cervical fracture dislocation causing neurological deficits in patients with ankylosing spondylitis are presented and the relevant literature is cited.


[The intraarticular fracture of the distal end of the tibia as a prognostic criterion (author's transl)].

Ankle fractures with injuries of the distal articular surface of the tibia have particularly unfavourable results. A follow-up of 103 cases shows, that even small marginal fragments of the lip of tibia produce posttraumatic athrosis. Results become statistically worse when the fragment is about 1/5 of the joint surface. Further there is a clear relationship between the number of the single injuries and the incidence of posttraumatic arthrosis. Thus the prognosis of ankle fractures is better described by the genetic classification of Lauge-Hansen than by the classification of Weber,


[Mechanical properties of bonding between cancellous bone and polymethylmetacrylate. IV. Tensile fatigue strength (author's transl)].

In joint replacement the fixation of implants to bone is loaded dynamically. The fatique strength of the bonding of PMMA to cancellous bone was determined for cyclic tensile loading. It was found to be 35% of the static tensile strength and greater than 0.6 Nmm-2 within a 95%-safety-range.


[Multiple fractures of the atlas with delayed fatal thrombosis of vertebral artery following "whiplash" injury of the neck (author's transl)].

Report of the case of a 62 year old male, who died in a car crash on his way home from duty, when he had a frontal collison with annother car at a speed of about 70 km per hour. After the collision, the car had completely turned over to its wheels. As the man had put on the seat belts, he had not been cast against the front window so that there were no head injuries. Following an unconsciousness of about ten minutes the patient recovered quickly and was already fully oriented when arrived at hospital. No neurological symptoms could be substantiated. He only suffered from pain of the neck and had a marked swelling of the left side of the neck. A burstin fracture of the atlas vertebra (Jefferson-fracture) was overlooked in routine X-rays of the craniovertebral region. Eight days after the accident, the hitherto "well improving" patient died suddenly and unexpectedly. The autopsy revealed an obstructing thrombosis of the left vertebral artery, less than 24 hours old. The wall of the artery showed numerous dissecting ruptures with intramural bleedings.


Copper levels in livers of turkeys with naturally occurring aortic rupture.

Lesions of connective tissue in the media of the aorta, including ruptures, were produced with experimental copper deficiency in turkey poults. The copper and molybdenum contents in the livers of 12 turkeys that had succumbed to naturally occuring aortic ruptures were measured to determine if field cases of the disease are etiologically related to copper deficiency. Half of the livers contained less than 10 ppm copper, and the others contained 10--20 ppm copper. Molybdenum levels were less than 1 ppm.


Isolation of Salmonella hessarek from starlings (Sturnus vulgaris).

Salmonella hessarek was isolated from dead starlings which were part of a large population wintering in Israel. Isolation techniques and laboratory inoculation of birds are described.


Aerosol vaccination against Newcastle disease. III. Field experiments in broiler chickens.

Two different aerosol generators were used for aerosol-vaccination of 128,000 broiler-type chickens having moderate to low maternal antibody titers with the B1 and LaSota strains of Newcastle disease virus (NDV). Efficacy of vaccination was evaluated from resistance to challenge with a velogenic strain (Texas GB) of NDV and hemagglutination-inhibition (HI) antibody titers, Both aerosol generators induced adequate immune response at the aperture settings used. There was little detectable benefit from vaccination at 1 day old, but antibody response and resistance to challenge were good from vaccination at 10 and 28 days of age.


Fowl cholera: induction of cross-protection in turkeys with bacterins prepared from host-passaged Pasteurella multocida.

Modified fowl cholera bacterins prepared by inoculating agar medium with infected liver tissue from birds which died of acute fowl cholera induced 70% cross-protection in turkeys, i.e., protection against a different immunologic type of Pasteurella multocida. Standard bacterins prepared from cultures which had been lyophilized and stored showed variable cross-protection (0--40%). Repeated subculturing of the standard inoculum on agar reduced cross-protection. The protection with either the modified or standard bacterins was comparable (80--100%) when immunity was challenged with the homologous strain. With lyophilization of P. multocida and subculturing on agar, it appears that antigens capable of inducing cross-immunity may be lost more readily than antigens capable of inducing homologous immunity.


Antibiotic egg injection to eliminate disease. I. Effect of injection methods on turkey hatchability and Mycoplasma meleagridis infection.

Mycoplasma meleagridis infection in turkey hatching eggs was eliminated by injecting eggs with a combination of tylosin and gentamicin. Hatched F1 and F2 progeny remained free of egg-transmitted infection. Contact exposure was experienced in one negative flock. Of the preincubation injection procedures studied, a drilled hole on the small end of the egg was the inoculation site easiest to administer and best tolerated by the embryo. The embryo can tolerate a dose of gentamicin sulfate injected at 10 days of incubation that would be toxic if administered before incubation. Requirements for maintaining progeny free of infection are discussed.