Gastric relaxatory response to insulin before and after vagotomy.

Experiments were performed on 4 non-anaesthetized dogs with chronic gastric fistulae, Gastric tonus was studied by volume recording at low pressure head. 0.5 IE insulin/kg bodyweight intravenously was followed by an immediate gastric relaxation, obvious before any marked decrease of blood glucose or plasma potassium occurred, and furthermore not affected by administration of glucose or potassium. This initial relaxation was still present after vagotomy and might be due to transmembraneal metabolic changes upon insulin administration or to direct effect of insulin on gastric smooth smooth muscles. During hypoglycaemia, a second relaxatory phase occurred, and glucose given during this phase temporarily increased gastric tonus, indicating this relaxation to be due to hypoglycaemia. The hypoglycaemic relaxation was markedly reduced but not abolished by vagotomy, indicating also extravagal factors in this response.


The acid perfusion test. A study in patients with symptomatic hiatus hernia, and of the effect of a modified Belsey MK IV repair on the test.

Acid perfusion with 0.1 n HC1 (5 ml/min for max. 30 min) and simultaneous intragastric instillation of equimolar amounts of sodium bicarbonate were performed in 55 patients with sliding hiatus hernia and symptoms attributable to gastro-oesophageal reflux. Acid perfusion reproduced the patient's spontaneous symptoms, and was thus positive, in 44 per cent of the cases. A positive acid perfusion test means that the patient's spontaneous symptoms may be of oesophageal origin, whereas a negative test does not allow any conclusions. The acid perfusion test was likewise performed before and three months after a modified Belsey MK IV repair in 37 patients with hiatal hernia and symptoms indicating surgical repair. The operation was followed by a reduction in oesophageal acid sensitivity (p less than 0.01).


Acetylsalicyclic acid and gastrointestinal propulsion in the rat.

The possible influence of moderate amounts of acetylsalicyclic acid (ASA) on gastric emptying, duodeno-gastric reflux and small bowel propulsion was studied in rats with permanent gastric and duodenal tubes. The ASA-containing or the control solution was introduced intra-gastrically half an hour before the simultaneous administration of differently labeled radioactive test meals into the stomach and the duodenum. ASA was given as 7.5 or 15.0 mM solution in 100 mM hydrochloric acid or in 100 mM sodium chloride. After 15 minutes the gastrointestinal propulsion was examined. No effect of the ASA treatment was noted. No increase in duodeno-gastric reflux was found in the ASA-treated animals.


In vitro responsiveness of human gastric carcinoma to pentagastrin.

The influence of pentagastrin on thymidine incorporation of five human gastric carcinomas was studied by an in vitro short-term cell suspension technique. Two of the five tumours reacted with stimulation of incorporation to the treatment. Five tumours of other aetiology did not react to similar treatment. The possibility of gastric carcinoma as a hormone-sensitive tumour is discussed.


Hepatitis, type B in haemophiliacs. Relation to the source of clotting factor concentrates.

36 children aged 3 to 18 years receiving substitution therapy for haemophilia during the period 1970 to 1976 were studied for infection with hepatitis B virus by assays for HBsAg, anti-HBs, and anti-HBc. Clinical hepatitis B occurred in 3 patients (8%) and serological evidence of infection was found in further 13 (36%). The occurrence of infection was associated with age but less so with the total amount of transfusion. Estimates of the risk of infection by clotting factor material of different origin indicated a figure of 1:53,000 I.U. for Danish volunteer donor preparations as well as for commercial products, the risk being apparently increased following the use of pooled blood donor material and non-Scandinavian products respectively.


The effect of phospholipase C on rat blood platelets in vivo.

Rat blood platelets were treated with phospholipase C in vitro or phospholipase C was injected i.v. to rats. In both cases its effect on the functions of the platelets in vivo has been studied. No change was found in primary bleeding time or in platelet survival. Treatment with phospholipase C gave a moderate reduction of ADP-induced platelet aggregation in the pulmonary circulation whereas the aggregation induced by thrombin was unchanged. Iv. injection of phospholipase C caused a rapid, very moderate and transient increase of 51Cr-activity in the lungs without concomitant overt respiratory distress. A moderate increase in 51Cr-activity was noted in liver and kidney 24 and 48 h after injection of phospholipase C. This may be caused by a slightly increased leakage of 51Cr-labelled material from the platelets during exposure to phospholipase C.


Extracorporeal perfusion treatment with immobilized L-asparaginase.

2 female patients with malignant melanoma were treated with L-asparaginase immobilized in an extra-corporeal perfusion chamber constructed by Hydén et al. The patients were treated for 80 h during 26 d and for 99 h during 36 d, respectively. L-asparaginase was immobilized by covalent bonds on the surfaces of the chamber. Perfusion resulted in an effective decrease down to less than 7 mmol/1 serum of the asparagine content. The patients withstood the treatments well without any signs of allergic reactions. Antibodies against L-asparaginase were not found. Analyses were continuously performed during the treatment with respect to electrolytes, enzymes and immunoglobulins. No abnormal variations could be found.


The Hermansky-Pudlak syndrome. Evidence for a lowered 5-hydroxytryptamine content in platelets of heterozygotes.

A Dutch kindred with the Hermansky-Pudlak syndrome (HPS) is described. We show for the first time evidence of a lowered platelet 5-hydroxytryptamine content in obligate heterozygotes. Platelet ATP and ADP levels and ATP/ADP ratio were normal in these patients. Platelet aggregation with ADP, collagen and adrenaline was within the normal range. In contrast to the homozygous HPS patients the heterozygotes are normally pigmented and none has diaphanous irides, nystagmus or a bleeding tendency. All homozygous HPS patients have the typical triad of oculocutaneous albinism, pigmented macrophages in the bone marrow and a bleeding disorder, based on a platelet dysfunction. The platelets showed the typical characteristics of a storage pool deficiency. Their platelet factor 3 availability was decreased and the aggregation patterns showed an absent second wave with ADP, adrenaline and absent collagen aggregation. Platelet ADP levels were strongly decreased in all homozygous HPS patients, whereas ATP was lowered only in 3 out of 6 HPS patients. The 5-hydroxytryptamine content of their platelets was very low (15-20% of normal).


The effect of HLA antibodies on platelet aggregation.

Twelve different HLA antisera, detecting antigens of both A and B series and the superspecificities w4 and w6, were tested for platelet-aggregating activity in 75 antiserum-platelet combinations. The correlation between the HLA specificities of the antisera and the aggregating effect on platelets carrying the corresponding antigens was significant (P = 0.011). Because the platelet aggregation test is being used for screening of circulating immune complexes, falsely positive reactions caused by HLA antibodies must be eliminated by adequate control experiments.


Sequential antibody affinity chromatography of human leukocyte interferon.

Antibodies to crude leukocyte interferon (CIF) were bound to Sepharose 4B, and CIF was chromatographed. A relationship between recovered interferon and percentage binding of the antibodies to Sepharose 4B was observed. Highest recovery was obtained when only 50%-85% of th- antibodies were bound. When CIF was subjected to normal affinity chromatography, specific activity of 1-5 X 10(6) interferon units (IFU) (69/19B-units)/mg protein was obtained. When this purified preparation was further chromatographed on a column mainly directed against normal cellular proteins and then concentrated by normal affinity chromatography, a tenfold increase in 'direct' specific activity was obtained. It is suggested that the 'indirect' specific activity is about 2 X 10(8) IFU/mg protein.


Attenuation of canine nephrotoxic glomerulonephritis with an extracorporeal immunoadsorbent.

A novel immunoadsorbent is described in which soluble canine glomerular basement membrane (GBM) antigen was immobilized in collodion membranes adherent to small charcoal particles. As much as 80% of the added GBM antigen was retained in the collodion-charcoal. The binding of GBM antibody to immobilized GBM antigen in vitro and in vivo was demonstrated. For in vivo studies, an extracorporeal circulation system was established, and mongrel dogs were then injected intravenously with GBM collodion-charcoal for 4 h. Renal tissue was examined by fluorescence and light microscopy for the deposition of heterologous gamma globulin and glomerular inflammation before and after the extracorporeal procedure. Results showed less deposition of heterologous IgG and less inflammation in experimental dog kidneys than in control kidneys. There was no evidence of release of 131I-labeled GBM from the immunoadsorbent at the conclusion of perfusion experiments and no significant  biochemical or hematologic alterations. Finally, extracorporeal immunoadsorbent treatment was capable of attenuating the early heterologous phase of passive canine nephrotoxic nephritis and may have a potential role in the therapy of anti-GBM-mediated nephropathy.


Leukocyte migration agarose test for the assessment of human neutrophil chemotaxis. I. Effects of environmental factors on neutrophil migration under agarose.

To apply the leukocyte migration agarose test (LMAT) to the in vitro assessment of human neutrophil chemotaxis, effects of different culture conditions on neutrophil migration under agarose were studied. Presence of either serum or human serum albumin (HSA) in the culture medium was necessary for detectable neutrophil migration. HSA was preferred since heat-stabile chemotactic agents were found to be generated from fresh serum in the presence of agarose. Additional CO2 in the assay milieu could be replaced by decreasing the NaHCO3 concentration of the culture medium. Both the directed and the spontaneous migration rates of neutrophil leukocytes increased when the concentration of agarose was decreased. Area and distance of migration and cumulative cell count of migrated neutrophil leukocytes were suitable for quantitating the neutrophil migration rate.


Leukocyte migration agarose test for the assessment of human neutrophil chemotaxis. II. Variables in the attraction assay.

Optimal conditions for the attraction assay of human neutrophil leukocytes were studied, using the leukocyte migration agarose test (LMAT). Larger migration areas were obtained toward the attractant wells when they were filled with zymosan-activiated serum (ZAS) in advance than when both the attractant and the cells were added simultaneously. Chemotactic indices (CI; the ratio between the migration rate toward attractant and that toward the control substance) decreased when the number of applied neutrophil leukocytes increased, whereas migration differentials (MD; the difference between the migration rate toward attractant and that toward the control substance) were not markedly affected. Both the spontaneous and the directed migration rates, and CI and MD of neutrophil leukocytes obtained from the same donor on different days varied markedly. When tested repeatedly, however, the neutrophil leukocytes of different donors migrated on the average rather equally toward inactivated serum, as they also did toward ZAS, and the variation of the means of CI and MD was insignificant.


The effect of chlorpromazine pretreatment on renal function and pathology in kidneys damaged by warm ischaemia.

The influence of chlorpromazine pretreatment on kidney function and survival after temporary occlusion of the renal artery was investigated. Three hours of clamping of the renal artery and contralateral nephrectomy was performed in a group of ten rabbits pretreated with 3.5 mg/kg chlorpromazine and compared with a previously published control group of untreated animals. Chlorpromazine pretreatment improved survival. The kidney function, estimated by serum-creatinine, showed an earlier onset of function and the surviving animals regained nearly normal function. Histological examination revealed mild to moderate ischaemic changes, whereas the control group showed more profound damages.


The effect of chlorpromazine pretreatment on the vascular resistance in kidneys following warm ischaemia.

In studies of 45 rabbits pretreated by chlorpromazine, clamping of the renal artery was performed. Chlorpromazine 3.5 mg/kg was given intravenously 15 min before arterial clamping. The duration of the clamping period ranged from 0 to 180 min. After removal of the kidneys the influence of the pretreatment on the vascular resistance was examined in perfusion studies. Resistance patterns were measured during hypothermic perfusion. The results were compared with an identical group without pretreatment. The vascular resistance rose with the duration of clamping but was lower than in the control group. The maximal resistance attained after 60 min of clamping was approximately 50% lower. In another series of chlorpromazine pretreated animals clamping of the renal artery for 180 min was followed by reestablishment of the circulation for 24 and 48 hours. Perfusion studies were performed on kidneys after removal. The results were compared with a group without pretreatment. The vascular resistance was found to return to normal values more rapidly when the animals had been pretreated with chlorpromazine.


Regional hypothermia in renal surgery for severe lithiasis.

An active approach to severe renal lithiasis is advocated, though operative procedures often require interruption of the blood supply. Te evaluate the effect of ischemia on the kidney the literature has been searched and we have reached the following conclusions. A warm ischemic time of more than 20 minutes causes a brief and transitory reduction in renal function. If ischemia exceeds 30-40 minutes many kidneys will not regain their previous function. If the kidney's temperature is lowered to about 15 degrees C, ischemia can be tolerated for up to 12 hours. A priori these time limits applicable to normal kidneys are to broad for use in diseased kidneys. Cooling of the kidney can be achieved by either perfusion-cooling or by external parenchymatous cooling. We describe a method using the latter system for stone removal in 14 patients with staghorn calculi or multiple stones. Preoperatively 9 patients (64%) had persistent urinary tract infection, whereas infection persisted in only 2 patients following the operation (14%). Complete stone removal was achieved in 13 patients (93%). Renal function evaluated by creatinine clearance and renography generally improved following operation. There were no deaths, but in 9 patients severe complications were seen (transient oliguria and septicemia). At follow-up investigation 1.5 years after operation renewed stone formation was found in 1 patient, while the incidence of urinary tract infection had increased to 3 patients (21%). It is concluded that extensive surgery for stone removal with the use of external parenchymatous cooling is worthwhile and promising in patients with staghorn calculi or multiple stones in the kidneys.


Transurethral stone extraction with a vibrating basket catheter.

In a recent in vitro study, mechanical vibration was shown to facilitate, considerably, both the passing of a basket catheter beyond an artificial ureteral stone as well as the extraction of a calculus. Therefore, a device by which vibration can be transmitted to the basket of a modified stone extractor was developed for clinical application. The basket moves to and fro with an amplitude of 2-4 mm and a frequency of 40-60 Hz. An experimental follow-up study was performed in dogs to find out whether the vibration procedure as such induced injuries to the ureters. Modified stone extractors were passed up bilaterally into the ureters of 11 dogs. Vibration was applied in a standardized manner to one side, the other non-vibrated side served as a control. Postoperatively, 5 dogs were followed during 4-5 weeks with repeated urographies. Specimens of the ureters were examined microscopically when the dogs were sacrificed. No complications which could be ascribed to the vibration procedure as such were observed. The vibration technique was tried also in a pilot study comprising 14 patients with distal ureteral stones; in 9 patients, the stones were successfully extracted. Of the remaining 5 patients in whom the stone extraction failed, 3 passed the stone spontaneously and in 2 ureterolithotomies were performed. No complications were encountered.


Clinical experience with therapeutic arteriovenous fistulae.

Brescia-Cimino arterio-venous fistulae have been used as blood access for intermittent hemodialysis in 67 patients between 1972-74. The mean age of 32 men and 35 women was 48. Thirty-five patients were dialyzed through an external arterio-venous shunt for as long as 7 years before they received a fistula. Of 92 operations, 63 (68.5%) were successful. Ten patients (14.9%) never received a functioning fistula. The mean function time of 63 fistulae was 8.3 months. Twenty-two functioning fistulae eventually failed. In 11 cases no precipitating factor could be found. In six patients, septicemia coincided with infection at the fistula puncture site. Cardiac decompensation because of augmented venous return to the heart was not observed. Advantages and disadvantages with the Brescia-Cimino fistula are discussed and compared with the Quinton-Scribner shunt.


Clinical evaluation of bone-densitometry in patients with final renal insufficiency operated for hyperparathyroidism.

Because of difficulties in evaluating bone mineral mass with conventional methods in patients with final renal insufficiency before and after parathyroidectomy, bone densitometry has been tried. During a three year period ten patients have been selected for surgery. The parathyroidectomy performed was total in nine patients and subtotal in one. Bone mineral mass was significantly lower preoperatively in the operated patients than in other patients on regular hemodialysis and also lower than in a normal material. In four of ten patients there was a transient decrease in bone mineral mass after parathyroidectomy. Thereafter there was a significant increase in five of ten patients and in the whole group of patients. Thus bone densitometry was found to be of value in following patients with renal insufficiency selected for parathyroidectomy.


Effects on the urinary bladder and urethra of different pharmacological treatments. An in-vivo study in normal and parasympathetically denervated cats.

The difference in autonomic nerve functions in vivo between the neurologically normal and the long-term parasympathetically denervated feline bladder and urethra was studied. For this purpose the vesical and urethral responses to electrical hypogastric and pelvic nerve stimulations and to various autonomic stimulating agents were investigated into. The nature of these responses was explored by different blocking agents. In the normal feline bladder phenylephrine caused a contraction. Noradrenaline always resulted in a bladder relaxation which was changed into a contraction after beta-adrenergic blockade. In the parasympathetically denervated bladders noradrenaline caused in most cats a bladder contraction without previous beta-adrenergic blockade. In the normal bladders hypogastric nerve stimulation always evoked an initial contraction and a subsequent bladder relaxation. In the parasympathetically denervated bladders, however, a novel response of a sustained bladder contraction was achieved. This contraction was blocked by a ganglionic or an alpha-adrenergic blocking agent, indicating that the reaction was mediated in preganglionic cholinergic fibres via postganglionic adrenergic neurons. The results indicat that parasympathetic denervation induces a change in the adrenergic receptor functions of the urinary bladder. Thus, in the neurologically normal bladder beta-adrenergic receptors mediating relaxation are in predominance while after long-term parasympathetic denervation alpha-adrenergic receptors mediating contraction dominate. No change in adrenergic receptor function was demonstrated in the urethra. alpha-Receptors mediating contraction were found to predominate both before and after parasympathetic denervation.


Urachal lesion associated with calculus formation causing intestinal obstruction. A case report.

This report presents the history of a 40-year-old man with intestinal obstruction due to intraperitoneal rupture of a urachal cyst with stone formation. This very rare disorder deserves attention in order to avoid delay in diagnosing the true cause to the abdominal disaster and furthermore to encourage radical surgical treatment of the urachal lesion.


Multiple urothelial tumours with metastases to uterus and left ovary. A case report.

A female patient is described with multiple papillary transitional cell tumours involving left renal pelvis, left ureter, bladder and urethra with metastases to uterine cervix, uterine cavity and left ovary with cyst formation. The surgical management and possible explanations of the pathogenesis are discussed.


Carcinoma in situ of the renal pelvis. Case report.

A case of carcinoma in situ of the renal pelvis, diagnosed by exfoliative cytology from ureteral specimens and treated by nephroureterectomy, is reported. Urothelial carcinomas in situ are very rare in the renal pelvis, but an increasing number in the bladder have been diagnosed. Urinary cytology plays the most important role in the diagnosis of carcinoma in situ of the renal pelvis and may be used as a screening test of patients exposed to known carcinogens.


Horseshoe kidney and ruptured abdominal aortic aneurysm.

Ruptured aortic abdominal aneurysm associated with horseshoe kidney is seldom encountered. The surgical procedure is complicated by the overlying kidney and the frequent occurrence of multiple aberrant renal arteries, which may arise from the aneurysmic part or from adjacent arteries. One case successfully treated surgically is reported. Renal function declined during the early postoperative period, but returned to preoperative values within three weeks, and remained at pre-rupture levels for the next three months.


Combined aortic and mitral valve replacement with the Björk-Shiley tilting disc valve prosthesis. Early and late results in 75 consecutive patients.

This study evaluates the early and late results of combined aortic and mitral valve replacement with the Björk-Shiley tilting disc valve prosthesis in 75 consecutive patients operated upon during a 6-year-period commencing October 1969. The Delrin disc model Björk-Shiley prosthesis was inserted in the first 20 patients and the pyrolytic carbon disc model in the remainder. The opening angle was increased from 50 degrees to 60 degress and the Teflon sewing ring was designed with two flanges in the pyrolytic carbon disc mitral model. The patient material was characterized by marked cardiomegaly, impaired physical working capacity, hypokinetic central circulation, pulmonary hypertension and a 59% incidence of atrial arrhythmias before operation. Surgery was performed during generalized hypothermia to 30 degrees C and selective coronary perfusion, and the mitral valve was always replaced first. There were no intra-operative deaths, although 7/75 patients (9%) died while in hospital. Twelve patients (16%) died in average 19 (2-59) months postoperatively. Thrombo-embolic complications, which were frequently associated with poor anticoagulation, occurred in 9 patients and were fatal in 4 cases, corresponding to an incidence per patient month of 0.005 and 0.002, respecitvely. This risk was not affected by the type of prosthesis. One patient required operative repair of an aortic paraprosthetic leakage. Clinical improvement was found in 88% of the long-term survivors. The maximal working capacity increased in average 41% over the pre-operative value (p less than 0.001) and cardiac enlargement diminished in average by 22% (p less than 0.001). The incidence of atrial arrhythmias decreased slightly to 48%. Haemolysis was mild and without clinical significance. The actuarial curve indicated a 75% survival rate 3 years after operation.


Cardiac valve replacement with the Björk-Shiley prosthesis in young patients.

Between 1971 and 1974, 26 valve replacements with the Björk-Shiley tilting disc valve prosthesis were performed in 23 children between 4 and 16 years of age. Mitral valve replacement was carried out in 11 patients, aortic valve replacement in 9 and double replacement in the other 3 patients. Several of the patients presented associated lesions which were also corrected at the same intervention, One patient died during the postoperative period; the remaining 22 all showed significant clinical remission. No incidents of thromboembolism or complications of any other nature were observed during follow-up periods of 6 to 26 months. It is our belief that the Björk-Shiley valve represents an improvement over other prostheses currently used for the surgical correction of valve disease in children.


Clinical and haemodynamic results following mitral valve replacement with the new Lillehei-Kaster pivoting disc valve prosthesis.

Thirty-four patients were re-examined 12-24 months after mitral valve replacement with the Lillehei-Kaster pivoting disc valve prosthesis. There was an improvement of the kinetics with a significant decrease in arteriovenous oxygen difference compared with oxygen consumption. Cardiac output and stroke volume remained abnormally low, not differing significantly from pre-operative values. Resting pulmonary wedge pressure, pulmonary arterial pressure and pulmonary vascular resistance decreased significantly after operation. Mean values for these parameters remained slightly above normal. Exercise produced a rise in pulmonary wedge pressure, which could be explained partly by a simultaneous deterioration of the left ventricular function, as indicated by high end-diastolic pressures, and partly by a degree of obstruction to the foreward flow at the mitral valve itself. The rise in pulmonary wedge pressures led in turn to increased pulmonary arterial pressure, the latter being aggravated in some patients by a rise in pulmonary vascular resistance. Cardiac output increased during exercise, but usually to a lesser extent than was anticipated from the increase in oxygen consumption. The changes in cardiac output during exercise were due to an increase in heart rate, while stroke volume remained unchanged. The mean diastolic pressure difference across the prosthesis was 8.6 mmHg at rest and 12.7 mmHg during exercise. Subjective improvement and reduction in heart volume, as noted in the present series, corroborated the benificial effect of the operative procedure. The valve were all competent, as judged by cinéangiography, except in a few patients, in whom a small valvular or paravalvular leakage was seen. No thrombo-embolic episodes were recorded during the follow-up period.


Surgical treatment of aneurysms of the ascending aorta. With special reference to cystic medial necrosis of the aorta.

The clinical series comprised 14 patients with aneurysms of the ascending aorta. In the autopsy series, there were additionally 19 patients, who had died suddenly as a results of free perforation or dissection of the ascending aorta. In the clinical series, the cause of the aneurysmal formation was cystic medial necrosis in 10 patients, 8 of whom had severe aortic valve insufficiency. Twelve patients were operated on using extracorporeal circulation, Both the ascending aorta and aortic valve were replaced with prosthesis in 6 cases. Three patients underwent emergency surgery due to pericardial tamponade. All three died, despite a technically successful operation. One patient out of 9 electively operated upon died. A follow-up examination was carried out on the 5 surviving cystic medial necrosis patients. Aneurysms of the sinuses of Valsalva developed after supracoronary resection in 2 patients. The results showed that elective operations in the event of aneurysms of the ascending aorta can be carried out with an acceptably low mortality rate. However, after supracoronary resection, in cases of cystic medial necrosis, the risk of developing aneurysms of the proximal aortic remnant seems obvious. Therefore, in patients in whom the whole aortic root is involved, total removal of the ascending aorta and re-implantation of the coronary ostia into the prosthetic tube is preferable.


Synthetic arterial grafts. I. General complications.

A retrospective study of 113 patients operated upon with synthetic arterial grafts was made. This report reviews our experience during the past 15 years as a basis for evaluation of complications of abdominal aortic surgery and investigation of methods for preventing some of the major complications of grafting procedures. The early mortality, within the first 10 postoperative days, is also discussed. The most usual complications were graft thrombosis and infection.


Influence of Xantinoli nicotans (Complamin) and papaverine upon internal carotid artery blood flow after arterial reconstruction.

The effect of intravenous administration of 0.3 g of Xantinoli nicotans (Complamin) and 40 mg of papaverine on internal carotid artery (ICA) blood flow in 17 conscious, newly operated patients was studied with the aid of electromagnetic flowmetry. A flow probe was attached to the ICA after carotid reconstruction. Administration of Complamin resulted in a significant decrease in arterial mean pressure and a corresponding decrease in ICA flow. The arterial mean pressure also diminished after administration of papaverine, but the decrease was moderate and did not influence ICA flow. The results indicate that the cerebral vascular autoregulation may be impaired in the early postoperative period. Vasoactive substances, which cause decreased arterial pressure, also influence ICA flow and should be avoided in patients newly operated upon for occlusive disease of the carotid artery.


The adhesiveness of blood platelets before, during and after cardiopulmonary bypass.

The influence of cardiopulmonary bypass on the adhesiveness of blood platelets, using both bubble (Bentley and Rygg-Kyvsgaard) and membrane (Landé-Edwards) oxygenators, was investigated. With both types of oxygenators, there was a considerable fall in platelet adhesiveness during cardiopulmonary bypass, particularly with the Rygg-Kyvsgaard apparatus. The adhesiveness increased 30 minutes after bypass, but it was still not restored to the initial value.


Thymomas and thymic cysts.

During a period of 20 years, 19 patients with thymomas and 5 with thymic cysts were surgically treated at this clinic. Excluding one operative death, none of these patients had died of causes related to the tumour 7.4 years (average) after operation. Two patients had died of unrelated causes, and in one case a recurrent mediastinal tumour was observed 3.5 years postoperatively. Myasthenia gravis, present at the time of operation in 3 cases, had been alleviated in one case, remained unchanged in another and become aggravated in the third case. In addition, one patient had developed myasthenia 7 years after resection of thymoma. In one case, a preoperative tentative diagnosis of lupus erythematosus disseminatus had been confirmed. Infiltrative growth was mascroscopically observed in only 2 cases. One of these patients died of haemorrhage during the operation; the other patient was in good health 1.5 years after partial resection and subsequent irradiation of the tumour. Four patients received radiotherapy. In one of the 15 cases treated solely by operation, the tumour fell to pieces on resection; a recurrent mediastinal tumour (cf. above) was removed 3,5 years later.


The effect of dilatation in the treatment of benign oesophageal strictures.

Twenty-five years experience with dilatation as the only method of treatment of benign oesophageal strictures is presented. The incidence of complications and mortality rate are equal to those involved in extensive surgery, whereas the frequency of cure is substantially lower. We find bouginage indicated in elderly and debilitated patients, but this form of treatment as the sole measure should be avoided in the younger age groups thereby saving them from repeated hospitalization.


Occupational health standards. An international comparison.

The background for establishing standards for toxic agents is reviewed, and the standards of 14 different countries, including Sweden, are compared with special reference to criteria and organizational aspects. The differences among countries in the numerical limit values for toxic substances are largely due to differences in definitions, biomedical criteria, technical feasibility and sociopolitical judgements.


Endurance limit of force in long-term intermittent static contractions.

The relationship between endurance time and the mean force of contraction was investigated in intermittent and sustained static contractions over a long period of time (60 min). For intermittent static contractions the endurance limit of the mean force of contraction was found to be 14.0%, and for sustained static contractions it was 7.9% of the maximal force of contraction. Weak subjects appear to have a higher endurance limit of force than strong subjects.


Evaluation of chromium exposure based on a simplified method for urinary chromium determination.

The urine chromium levels for unexposed and chromium exposed persons were determined by a simplified method which is well suited for routine, large-scale use. A group of welders working on chromium alloyed steel were investigated. For these welders a high degree of correlation was found between the concentration of inhaled chromium and the chromium concentration in the urine immediately after work. At an exposure level of 0.05 mg/m3, measured as chromium, a urinary chromium concentration of approximately 40 microng/l was measured after work. This urinary chromium level is suggested as a guideline indicating the need for a thorough investigation of chromium exposure.


Mercury in human amniotic fluid.

The levels of inorganic and organic mercury in human amniotic fluid were examined in 57 Japanese pregnant women with a gestational age of 4 months to term. Inorganic mercury was detected in all but two samples, while organic mercury was found in only 30 women. The level of inorganic mercury was higher than organic mercury. The highest levels of both inorganic and organic mercury were observed in the seventh month of gestation.


Histochemical and electron microscopic observations on the myoneural junctions of rats with carbon disulfide induced polyneuropathy.

Myoneural junctions in the tibialis anterior muscle of rats with clinical signs of polyneuropathy induced with carbon disulfide were studied by light and electron microscopy. Histochemically demonstrable acetylcholinesterase (AChE; E.C. 3.1.1.7) activity was distributed similarly in the myoneural junctions of both the exposed and the control rats. In both groups intense enzyme activity was localized at the level of the post-synaptic membrane of the myoneural junction. The postsynaptic infoldings of the myoneural junctions of the exposed rats appeared normal. No enzyme activity was seen outside the zone of the myoneural junctions. The ultrastructure of the sub-sarcolemmal space, as well as the postsynaptic membranes of the myoneural junctions of the exposed animals, was normal. In the terminal axons signs of various degrees of degeneration were present, e.g., disappearance of the preterminal axoplasmic neurotubules, partial disappearance of synaptic vesicles, appearance of dense bodies, and even total disappearance or destruction of the terminal axons. Synaptic clefts were often widened with Schwann cell interposition. It thus seems that systemic carbon disulfide poisoning primarily alters the presynaptic structures of the myoneural junctions, while the postsynaptic side remains relatively intact, especially since the histochemical distribution of AChE in myoneural junctions was normal.


A study on the distribution of methylchloroform and n-octane in the mouse during and after inhalation.

The distribution of methylchloroform and n-octane, respectively, in the blood, liver, kidney, and brain of mice was studied at different inspired air concentrations and after different exposure times. The air concentration varied between 10 and 10,000 ppm; and the exposure time, between 0.5 and 24 h. The resulting solvent concentrations in kidney and brain were about the same, but the liver concentrations were usually somewhat higher for both solvents. There was a linear dependence between inspired air concentration and tissue concentrations at fixed exposure times. A correlation between blood and organ concentrations was observed in animals exposed at different inhalation air concentrations but not in animals exposed only at one fixed concentration. The ratios between the concentrations of the solvents in the organs and blood were higher for n-octane than for methylchloroform. The ratios increased as the exposure concentration increased for all organs studied in the case of n-octane but only for the liver in the case of methylchloroform. When the exposure dose, i.e., inspired air concentration X time, was generated in different ways, a high concentration during a short exposure resulted in a ten times higher organ concentration than a low concentration during a long exposure. The liver, kidney, and brain concentrations generally did not differ more than twice between methylchloroform and n-octane after exposure of the same concentration and duration. The blood concentration, however, was much less in n-octane exposed animals than in methylchloroform exposed ones. A pharmacokinetic model with both uptake and elimination of the first order fitted the empirical data better for methylchloroform than a model with zero order uptake and first order elimination. Postexposure concentrations of methylchloroform were linear in a semilog graph. A one-compartment pharmacokinetic model was in accordance with the experimental data for methylchloroform. For n-octane, however, at least a two-compartment model must be assumed.


[Eugenic significance of linkage between the gene loci for dystrophia myotonica (Steiner's disease) and ABH-secretor].

36 relatives of 2 patients with myotonic dystrophy (M.d.) were investigated during a field study. All were neurologically examined at home and their ABO blood groups and ABH-secretor phenotypes in parotid saliva were determined for linkage analyses. Additional investigations such as EMG or slit-lamp examinations were carried out by specialists in doubtful cases. Nine additional patients presenting with varying clinical manifestations of M.d. were found. In most of the secretor-positive individuals the corresponding genotypes could be identified as heterozygotes (Sese) through the segregation pattern of their first-degree relatives. In both families the allele for M.d. was linked to the dominant allele Se, the probability being greater than 99%. A recombination was observed in 1 patient of either family. This is, however, fairly consistent with the expected recombination fraction of 0.08. No further linkage information was obtained from determinations of the Lutheran blood groups carried out in family no. 1 only, since all individuals were of the most frequent type Lu (a-/b+). In 5 out of 8 matings between M.d. patients and healthy spouses the secretor genoypes were potentially informative for the estimation of risk of their children being affected or for prenatal diagnoses. The secretor analyses and special tests for the detection of preclinical cases (e.g. by slit-lamp) and their practical value for genetic counseling are discussed, especially with regard to the limitations, which derive partly from low probabilities in the predictions even in some of the so-called informative matings, and partly also from the recombinations to be expected.


[Criteria of brain death. Spinal reflexes in 45 personal studies].

In 45 patients without spontaneous breathing or cranial reflexes, and in whom blood pressure had to be supported, spinal reflexes were obtained in 60% and polysynaptic spinal reflexes in 33%. In all cases angiography showed cerebral circulatory arrest and/or repeated EEG recording gave an isoelectric line. The presence of spinal reflexes, appearing most frequently 6-36 h after death (which we defined as a sudden fall in blood pressure below 80 mm Hg with absence of spontaneous breathing) is not in contradiction with the assumption of brain death. 9 patients without signs of intoxication showed, in addition, a fall in body temperature below 34 degrees C. Such a fall in body temperature also in agreement with the diagnosis of brain death.


[Rhemuatismus nodosus. Relationship between joint findings and rheumaserology in chronic polyarthritis].

The clinical course and radiologic and serologic findings are reported in 37 subjects who, during the years 1954 to 1974, had rheumatoid nodules removed and examined histologically. The observations were classified into four groups according to a system similar to that of Steinbrocker. The histological findings were the same in all four groups. In 4 subjects the diagnosis of rheumatoid arthritis was established by the biopsy. In 5 additional patients the histologic examination confirmed the clinical diagnosis. Radiologically the joints of 5 adults were unremarkable while those of 14 subjects had developed slight or moderate changes, and in 18 patients advanced destruction or deformities or ankylosis were present. In instances of marked joint destruction the course  of the disease may, spontaneously or after appropriate treatment, become bland. 90% of our patients were seropositive and 10% seronegative. 9 subjects had temporarily low RF serum titers. Serologic data are of value for the differential diagnosis of joint diseases. They are not, however decisive.


[Fatal panmyelophthisis following 8-year-long abuse of appetite depressants].

A case of irreversible panmyelophthisis with fatal outcome in a 28-year-old patient is reported, following 8-year continuous abuse of anorectic drugs.


[Pneumoblastomas. Apropos of 2 cases].

Pulmonary blastomas, also referred to as embryonal carcinosarcomas or, in the past, embryomas, are rare tumors of which thirty cases have been described in English, German, and Italian publications. We present two typical pulmonary blastomas one in a 43-year-old man and the other in an infant of six months, the youngest case yet reported. Several arguments exist in favor of the embryonic origin of these neoplams: their histogenesis, their resemblance to nephroblastomas, their bifocal or multifocal presence in certain cases, and in about one third of all cases their discovery in patients under 20 years of age. Histologically the tumoral tissue contains two components: an epithelial component in which tubes resembiling fetal bronchi are found, and a loose mesenchymal component of an embryonic type containing various areas of differentiation. Although some tumors evolve slowly or have been known for years, most of the time the appearance of symptoms is soon followed by hematogenous dissemination and rapid demise. Our two patients died quickly: the infant from mediastinal compression with cardiorespiratory insufficiency, and the adult form metastatic dissemination.


[Hyperparathyroidism. Quantitative determination of specific skeletal changes in the radiography of the hand].

1. The extent to which skeletal involvement in hyperparathyroidism can be detected by X-ray remains an unsolved issue. The present investigation, aimed at resolving this problem, was carried out in 44 patients with primary (PHPT) and 57 subjects with secondary hyperparathyroidism (SHPT) due to terminal renal insufficiency. For comparison, 49 age-matched controls were included in this series. Subperiostal resorption of the phalanges of the hand was considered pathognomonic and graded according to a semiquantitative system using a magnifying lens. The data were compared with the serum calcium and alkaline phosphatase values. 2. Pathological subperiostal resorption was detected in 38.5% of the PHPT and in 56% of the SHPT patients while the controls showed 4% (false) positive results. A highly significant correlation between the extent of bone resorption and alkaline phosphatase was found (PHPT: r=0.80, SHPT: r=0.71, p less than 0.001). No correlation of the X-ray findings to the serum calcium could be detected. Compared to the degree of skeletal involvement demonstrated by X-ray, the alkaline phosphatase was significantly lower in SHPT than in PHPT. In PHPT on the other hand, subperiostal resorption was prominent among female patients aged over 40 years, while no prevalence for sex and age was found in the SHPT group. 3. These results demonstrate that a clinically relevant degree of bone involvement in hyperparathyroidism may be easily and reliability assessed by evaluating X-rays of the hands by means of a magnifying lens. Increased bone resorption in hyperparathyroidism appears to be paralleled by an increase of osteoblastic activity as assessed by elevation of alkaline phosphatase. In SHPT due to chronic renal failure, however, a relative osteoblastic insufficiency seems to exist. In PHPT, the prevalence of subperiostal bone resorption in women aged over 40 years may be compatible with a skeletal protecting effect of intact ovarian function (estrogens).


[The multiple sclerosis patient as a driver].

From the course and manifestations of multiple sclerosis it can be expected that the persons affected will perform less well as drivers. Evaluation of the statistical material of the Institute for Forensic Medicine of the University of Zurich--35 multiple sclerosis patients compared to a healthy control group--confirms this assumption on the basis of the statistics of traffic offences and accidents. These patients cause significantly more accidents and--to a less significant extent--commit more offences. Special care and restraint is necessary in the issue of driving licences to multiple sclerosis patients. If the patient is allowed to keep his license, regular medical check-ups are required.


[Potassium chloride and non-specific ulcers in the small intestine].

Gut toxicity due to potassium chloride preparations is well known, but there is little information concerning side effects of the newer slow release preparations. Small bowel ulceration due to the new slow release formulation is described. As far as the authors are aware this is the first such case published in Switzerland.


[Malignant double tumor of the lung: endobronchial carcinosarcoma in the left and polypous squamous cell carcinoma in the right upper lobe].

According to MOORE, two types of carcinosarcoma in the lung may be distinguished: one with a peripheral and one with an endobronchial localization. The latter type is characterized by minimal local infiltration, absence of distant metastases and early symptomatology of bronchial obstruction. This report deals with the autopsy findings in a 67-year-old smoker in whom a typical endobronchial carcinosarcoma was found in the left upper lobe. In all the published cases, as well as in our patient, the epithelial part of the tumor was found to be a squamous cell carcinoma with varying grades of differentiation. On the other hand, the mesenchymal part has not been uniformly described. In the present case, it occurred as a spindle-cell shaped sarcoma. Morphologically, carcinosarcomas are to be distinguished from carcinomas associated with pseudosarcoma. Prognosis of successfully operated patients seems to be favourable. Survivals of up to 6 years without recurrence have been reported. In our patient the carcinosarcoma was associated with a polypoid squamous cell carcinoma in the right upper lobe. No other case with such a combination has been reported.


[Drivers license qualification for epileptics].

The question whether a person with epilepsy qualified for a driving licence must be examined from the point of view of the individual as well as that of the community. The general public should be protected against unduly high risks from epileptic drivers, whereas the patient has a right to live as normal a life as possible, which includes driving an automobile. Too rigid criteria for obtaining the license increase the number of persons who evade medical control and drive "illegally". To require physicians to report their epileptic patients to the authorities would be counterproductive; it would also destroy the personal confidence between physician and patient which is so essential for successful treatment. Epileptic persons endanger safety on the road only slightly: 0.1-0.3% of all traffic accidents are due to epileptic seizures. In contrast, abuse of alcohol plays a major role in 6-9% of all accidents, whereas 80-90% are attributable to evident mistakes by the driver. Epileptic patients under regular medical supervision who are licenced on grounds of approved criteria do not cause more accidents than the general population. A dangerous group are, however, those with mental alterations (organic or reactive) and particularly patients with aggressive and expansive-compensatory traits, as well as those driving without permission. Prognostic criteria as to the further course of the disease are paramount for the assessment of qualification for the licence. The following rules have proved their worth: 2 years freedom from seizures (with or without therapy), no abnormalities specific for epilepsy in the EEG, no serious mental changes, regular medical supervision and treatment mus be guaranteed. Departures from these rules should be confined to exceptional cases with the consent of a physician specialized in epileptology. The same holds for admission to higher categories of driving licence, the only practical eventuality being category D (lorries), and even this only in rare cases. It will scarcely ever be possibel to licence a person who has at some time had epilepsy for professional passanger transportation. The attitude of the physician who first sees the seizure patient is often decisive. It is important that he recognizes the problem, objectively informs his patient and from the very outset gives him realistic advice in order to avoid false decisions, particularly regarding his professional career.


[Increased closing volume in asymptomatic respiratory sarcoidosis].

In 21 patients with asymptomatic respiratory sarcoidosis, 11 with hilar lymph node enlargement (stage I) and 10 with both hilar and lung involvement (stage II), pulmonary function tests revealed that the closing volume was increased as compared with control values obtained from healthy individuals of the same age and smoking habits. The difference was statistically significant but more pronounced in stage II patients than in stage I patients. Other function tests were normal (VC, FEV1, MMF, RV, TLC, DLCOSB).


[Feminizing adrenal cortex carcinoma in a 66-year-old man].

Feminizing tumors of the adrenal cortex in man are very rare. The case is reported of a 66-year-old man who had a carcinoma of the right adrenal cortex which produced various steroid fractions. In the primary tumor and in the second reccurrence the estrogens were dominant. In electron microscopy the tumor cells are poorly differentiated. They may be attributed to the fasciculo-reticular layer and show no signs specific for their secretory activity. The patient died 2 1/2 years after onset of the disease. The case is discussed in the light of the pertinent literature.


[Exercise-induced muscular weakness, myalgia and contractures. II. Casuistic contribution].

Two sisters with exercise-induced myalgias, muscular weakness and contractures are reported. Neurologic and psychiatric findings were normal, nor did electromyography, serum enzymes and ischemic forearm exercise test reveal specific findings. Under the light microscope multiple muscle fibers contained small vacuoles which stained positive with Oil Red O. No further information resulted from histochemical examinations. In the more seriously affected patient morphometric analysis of electronmicrographs showed a tenfold increase of fat content in comparison to normal controls. Alterations in the enzymatic activities could be demonstrated in glycogenolysis, glycolysis and in fat metabolism, but there were no previously described enzyme defects such as phosphorylase deficiency, phosphofructokinase deficiency, phosphohexoisomerase inhibitor, carnitine or carnitine-palmityltransferase deficiency. Myopathy with lactic acidosis, prolonged muscular relaxation due to deficient reabsorption of sarcoplasmic calcium in the tubular system and dyskalemic paralysis can be ruled out on the basis of the clinical signs. This myopathy may be due to an as yet unknown metabolic disturbances.


[The measurement of gastric emptying of solid food. Comparison of 2 solid phases by means of double isotope technic].

The suitability of a simple method of measuring the rate of gastric emptying of solids using 99mTc-marked filter paper pieces has been evaluated. In five healthy volunteers emptying of the filter paper pieces and of 198Au-tagged liver was measured simultaneously. In every proband the filter pieces left the stomach at a faster rate than the liver, but showed a linear emptying pattern in each experiment. Based on these observations and on recent results of other authors, a new concept of the gastric emptying of solids is presented. Within the framework of this model the use of the filter pieces in clinical studies to simulate a solid meal appears to be justified.


[Juvenile diabetes, tapeto-retinal degeneration, neurogenic hearing disorder (Alström syndrome), associated with congenital dyserythropoietic type III anemia].

The case is reported of a 32 year old female with diabetes mellitus, tapeto-retinal degeneration and neurogenous deafness combined with congenital dyserythropoietic anemia. The ophthalmological, otological, neurological and hematological findings are discussed and compared with those in the literature. Light microscopic and ultrastructural aspects of erythroblasts in congenital dyserythropoiesis of type III are shown. With the exception of the congenital dyserythropoietic anemia, the clinical findings cn be attributed to Alström syndrome.


[Radioisotope diagnosis of brain death].

In the light of 6 examples the authors emphasize the value and reliability of radionuclide angiography in determining the absence of cerebral perfusion, i.e., brain death.


[Treatment of Parkinson's disease with the combination drug L-carbidopa/L-dopa. Report on a 2 years study].

Forty patients have been treated with Sinemet (L-carbidopa/L-dopa) for a period of up to two years. The results are in agreement with those in the literature. In two-thirds of cases a good to very good improvement was obtained. The principal side effects were dyskinesia, hypotonia, and gastrointestinal and psychotic symptoms, though they seldom necessitated treatment interruption. L-carbidopa/L-dopa affords a real alternative therapy in the modern treatment of Parkinson's disease with L-dopa and a decarboxylase inhibitor. Generally the dosage range was up to a maximum of one tablet three times daily. Sinemet tablets are simple and convenient to handle for both doctor and patient. Dosage titration to therapeutic efficacy can be achieved in one week to ten days without complications, though we recommended a slower titration based on individual patient reaction and requirements.


[Experiences with thrombocytopenia test in specific diagnosis of food hypersensitivity].

100 thrombocytopenia tests (TT) from 73 patients with suspected food allergies were critically examined to establish the value of this method compared with case history, skin tests and, where possible, with the RAST for determination of specific IgE antibodies. 85% of the tests most probably, or definitely, provided the correct result. 10% of the results were either false positives or false negatives, and 5% were inconclusive. A flare-up was observed after 18% of the tests. No positive TT for milk, as the most frequent allergen, was observed in a control group of 20 healthy persons. The thrombocytopenia test is a useful exposure test but should be regarded as a supplement to skin tests and other methods of allergy diagnosis.


[Morbidity and mortality in cystic fibrosis. Results of 20 years of experience].

In this study the clinical data and treatment concept in 197 patients with cystic fibrosis, seen during the past 20 years at the University Children's Hospital of Berne (Switzerland), are presented. The results showed that during recent years the median age of survival, the mean age at death and the cumulative survival rates have improved. Furthermore, this study demonstrates that by forming groups of patients with similar age at diagnosis the cumulative survival rate declined in the group with early diagnosis much more markedly than in the group of patients with later diagnosis. Further evaluation of these data revealed that most patients of the former group had a more severe form of cystic fibrosis than the latter group. Since there are different patterns of severity in this disease, it will be necessary to develop staging for the purpose of statistical comparisons.


[Lipomatosis of the ileocecal valve].

Lipomatosis of the ileocecal valve is a diffuse infiltration of the submucous coat with fat cells. This syndrome is discussed on the basis of a personal observation and a review of the literature. The characteristic endoscopic picture is the overgrown, yellowish lips of Bauhin's valve prolapsing into the cecum, reminiscent of a uterine cervix. Coloscopy with biopsy is therefore the method of choice in assuring proper diagnosis. On the other hand, radiology cannot recognize the disease with certainty. Generally treatment of this benign syndrome is only necessary in the event of disturbances. As a surgical procedure ileocecal resection is suggested.


[Transvenous endomyocardial biopsy in the assessment of congestive cardiomyopathy].

Transvenous endomyocardial biopsy by the technique of CAVES and SHUMWAY was performed in 12 patients with the clinical, hemodynamic and angiographic findings of congestive cardiomyopathy (COCM). Coronary artery disease was ruled out by selective arteriography. Light and electron microscopic findings were correlated with a functional classification based on physical working capacity (PWC) and three left ventricular (LV) angiographic parameters (ejection fraction, end-diastolic volume, mean velocity of circumferential fiber shortening). PWC and the LV volumetric indices (vi) were determined in 52 patients and allowed the following grouping: group 1 with normal PWC and borderline VI (subclinical COCM); group 2 with normal PWC and decreased VI; group 3 with reduced PWC and severely depressed VI. Endomyocardial biopsy was successful in 10 out of the 12 patients. The grade of myocardial damage was assessed by 10 different criteria of typical morphologic abnormality. The myocardial damage score correlated closely with functional impairment as present in the three groups. Immunological fixation tests with the biopsy specimens revealed no antigen-antibody complexes. (1) right ventricular endomyocardial samples adequate for morphologic examination are easily obtained by transvenous biopsy; (2) in COCM, functional impairment parallels the extent of morphologic abnormalities although assessments of cardiac function were essentially confined to the left ventricle, whereas the morphologic specimens were obtained from the right ventricle.


[Side effects of nalidixic acid in a patient with severe renal failure. Clinical study and proposal of a pharmacokinetic model].

Side effects due to ingestion of nalidixic acid in a 46 year old patient with phenacetine-induced interstitial nephritis and severe renal failure are reported. This observation underlines the point that, besides the direct neurotoxic effect of nalidixic acid, disturbance of the acid-basic equilibrium could be seen in patients with renal failure in particular. A hypothetical pharmacokinetic model suggests that two metabolites of nalidixic acid could provide enough hydrogen ion to induce acidosis in cases of renal failure.


[Contribution of cases to the new classification of polyposis syndrome in the gastrointestinal tract].

In Schweizerische Medizinische Wochenschrift 106, 894-897 (1976) an article was published on a kinship with hereditary "minor adenomatous polyposis" of the colon with a higher than expected incidence of carcinoma of the stomach. Evidence for a genetic relationship between this family (Sch.) and another branch with an isolated case (Sch. E.) of familial polyposis of the gastrointestinal tract was found. The patient Sch. E. is presented here. The polyposis of this patient is phenotypically identical with that found in the classical familial polyposis of the colon, but also exhibits features of "minor adenomatous polyposis". A systematic clinical-endoscopic examination of ten members of the patient's family produced no further cases of gastrointestinal polyposis of carcinomata. In the case of Sch. E., therefore, a spontaneous mutation is postulated. A new classification of the various types of colonic polyposis is suggested.


The need for a new medical model: a challenge for biomedicine.

The dominant model of disease today is biomedical, and it leaves no room within tis framework for the social, psychological, and behavioral dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching, and a design for action in the real world of health care.


Charon phages: safer derivatives of bacteriophage lambda for DNA cloning.

The Charon lambda bacteriophages have been developed as vectors for cloning. Their construction incorporates mutations that make them simple to use and also greatly increases their safety for the biological containment of cloned recombinant DNA. Three of the Charon vector phages, 3A, 4A, and 16A, have been certified for use as EK2 vector-host systems, when propagated in bulk in a special bacterial host, DP50SupF. We present here some of the data on which the safety of these systems was evaluated. DNA fragments ranging in size from 0 to 2.2 X 10(4) base pairs can be cloned in these EK2 Charon phages.


Chemical synthesis of restriction enzyme recognition sites useful for cloning.

By a triester chemical synthesis method, three decameric DNA's have been made; these act as substrates for several restriction endonucleases, including Eco RI, Bam I, and Hind III. These homogenous decamers form duplexes that can be efficiently blunt-end ligated to themselves or to other DNA molecules by the action of T4 DNA ligase and thus are useful tools for molecular cloning experiments.


Use of phage immunity in molecular cloning experiments.

Immunity to phage superinfection is a useful selective marker in molecular cloning experiments. Plasmids which have unique sites for several different restriction endonucleases and which specify immunity to bacteriophage are described.


Interspersion of short repetitive sequences studied in cloned sea urchin DNA fragments.

The length and spacing of repetitive sequence elements were studied in several cloned sea urchin DNA fragments. Sequence organization in these fragments was found to be of the short interspersed form expected for sea urchin DNA, and for one clone the evidence shows that nearby repeats do not belong to the same repetitive sequence family.


Nucleotide sequences from a rabbit alpha globin gene inserted in a chimeric plasmid.

Rabbit alpha globin gene copies have been made, using reverse transcriptase and DNA polymerase I, and cloned in bacterial plasmids. Plasmid pHb72 has been shown to contain the alpha gene sequence by restriction enzyme analysis and nucleotide sequencing studies, and therefore has been approved for propagation under P2 plus EK1 conditions by the National REcombinant DNA Committee.


Clones of individual repetitive sequences from sea urchin DNA constructed with synthetic Eco RI sites.

Interspersed repetitive sequences were isolated from sea urchin DNA by renaturing to low Cot followed by treatment with nuclease SI. Synthetic Eco RI sites were ligated onto the repetitive sequence elements, which were then inserted at the Eco RI site of plasmid RSF2124 and cloned. The repetitive sequences can be excised from the plasmid with Eco RI for further study.


Human globin messenger RNA: importance of cloning for structural analysis.

The sequence of most of the human beta globin messenger RNA and large sections of the alpha globin messenger RNA has been determined. Partly because of genetic polymorphism, it was necessary to clone globin complementary DNA in order to extend the analysis. Purified human fetal globin messenger RNA was isolated and used as a template by reverse transcriptase to produce duplex complementary DNA molecules. These molecules were linked in vitro to plasmid DNA by use of T4 ligase in the presence of Escherichia coli Pol 1. Several colonies transformed by these molecules have been shown to hybridize with labeled human globin complementary RNA.


Probability of establishing chimeric plasmids in natural populations of bacteria.

Formulas for estimating the probability that chimeric plasmids carried by disarmed hosts will become established in natural populations of bacteria are presented and their use illustrated with a series of realistic numerical examples. The implications of these a priori probability estimates for the problem of containment for recombinant DNA research is discussed.


Hepatic regeneration and erythropoietin production in the rat.

The regenerating liver produces erythropoietin in response to hypoxia. The amounts of erythropoietin produced in animals subjected to hepatectomy are significantly higher than those observed in sham-operated animals. Hepatic erythropoietin production appears to be dependent upon the stage of regeneration with the highest levels being produced during the period of greatest proliferation and increase in liver mass.


Permeation of manganese, cadmium, zinc, and beryllium through calcium channels of an insect muscle membrane.

Larval muscle fibers of a beetle, Xylotrupes dichotomus, produce calcium spikes that are maintained when the fibers are bathed in saline solutions containing manganese, cadmium, zinc, or beryllium instead of calcium. This indicates that these cations permeate the calcium channels of the muscle fiber. By contrast, cobalt, nickel, and magnesium are nonpermeating and behave as competitive inhibitors of the permeation of the other divalent cations. Some of the permeating cations suppress delayed rectification.


Neoplastic and possibly related skin lesions in neotonic tiger salamanders from a sewage lagoon.

Tiger salamanders (Ambystoma tigrinum) inhabiting a sewage sedimentation lagoon become neotenic, and approximately one-third develop neoplastic skin lesions including cancer. Circumstances suggest a chemical etiology for the neoplasms.


The heart: a target organ for estradiol.

Autoradiographic studies of rat heart reveal that tritiated estradiol concentrates in cell nuclei of the myocardium of the atria and auricles, similar to the myometrium of the uterus. This suggests that estrogen has a direct effect on atrial myocytes through which its "protective" action may be mediated. Cardiac glycosides that are known to exert estrogen-like effects on classical estrogen target tissues, such as uterine muscle, endometrium, vagina, and mammary gland, probably act on atrial muscle through a genomic, steroid hormone-like mechanism of action.


Hypothalamic stimulation facilitates contralateral visual control of a learned response.

Rats that ate during hypothalamic stimulation were trained to press a lever for food only while receiving light signals from head-mounted lights. During stimulation, they pressed if the signal was visible to the eye contralateral to the electrode, but ignored the signal if it was visible only to the ipsilateral eye.


Sea urchin recruitment patterns and implications of commercial fishing.

Coexisting sea urchins Strongylocentrotus purpuratus and S. franciscanus exhibit different recruitment patterns. Juveniles of the former species are found in a variety of habitats, whereas juveniles of the latter occur almost exclusively under the spine canopy of conspecific adults. The commercial harvest of S. franciscanus thus seems to affect nursery grounds as well as the reproductive potential of exploited populations.


Antischizophrenic drugs: chronic treatment elevates dopamine receptor binding in brain.

Chronic treatment of rats with the neuroleptic drugs haloperidol, fluphenazine, and reserpine elicits a 20 to 25% increase in striatal dopamine receptor binding assayed with [3H]haloperidol. This increase in receptor sites may account for behavioral supersensitivity to dopamine receptor stimulants in such animals and for tardive dyskinesia in patients treated with these drugs.


Common bony densities mimicking chest disease.

Images of bony densities on routine chest radiographs may simulate intrathoracic disease processes. Such entities include images produced by normal anatomic structures, anatomic variants, and benign processes. Most commonly, chest disease was simulated by virtue of projection or poor visualization of the bony density in question on the routine chest radiograph. The true nature of the "abnormal" images produced was usually revealed by further roentgenographic evaluation using specialized radiographic technics or additional views.


Asymptomatic space-occupying lesions of the kidney: a programmed sequential approach and its impact on quality and cost of health care.

Sequential roentgenographic investigation of asymptomatic space-occupying lesions of the kidney is credited with establishing the diagnosis in 84.6% of 940 patients using only two examinations. Two thirds of all patients were diagnosed by relatively noninvasive technics such as infusion nephrotomogram, renal scintiscan, and the cyst puncture and aspiration test complex. Only for 2.3% was surgical exploration required to establish a diagnosis. The accuracy and confidence level of the diagnosis obtained by roentgenographic examinations (97%) compared well to that of surgical exploration (98%). Mortality and morbidity, however, were considerably reduced among patients examined according to the sequential roentgenographic protocol, as was the cost for diagnosis both in money and hospitalization time. The predominance of older patients in the group harboring asymptomatic space-occupying lesions of the kidney calls for an approach capable of establishing the diagnosis with acceptable confidence, but at a minimum cost in time, money, and complications. Our program of a systematized roentgenographic investigation of such lesions appears to provide a protocol capable of meeting these demands.


Management of anterior intraocular opacities with the roto-extractor.

The roto-extractor was used in 32 cases of anterior segment membranes or opacities during an 18-month period. Of these, 27 eyes improved and five did not improve or became worse. Significant complications included retinal detachment, massive preretinal retraction, and recurrent hemorrhage which contributed to the visual loss in these patients.


Symptomatic inflammatory fibroid polyp of the small bowel: report of two cases with review of literature.

Two cases of symptomatic inflammatory fibroid polyps (IFP) of the small intestine are presented, and the 17 adequately described symptomatic IFP previously reported are reviewed. IFP of the small bowel are rare. Most patients present with intestinal obstruction and a few with chronic anemia. IFP have characteristic histologic features and are easily recognized if they are considered in differential diagnosis.


Transbronchial lung biopsy using fiberoptic bronchoscope.

Transbronchial lung biopsy through the fiberoptic bronchoscope was done in 15 patients, and adequate pulmonary tissue was obtained in 14 (93.3%). A pathologic diagnosis was made in nine patients (64.3%), and through direct histologic examination of lung tissue in two patients certain disease entities were excluded, thus significantly influencing treatment. There was no significant hemorrhage and only one small pneumothorax occurred.


Carpal tunnel syndrome: report of 430 operations.

Analyzed are data on 430 operations in 326 patients for median nerve compression at the wrist. Follow-up data from a patient self-evaluation questionnaire were available for 71% of patients. Incidence was highest in the fifth and sixth decades of life, and 65% of patients were female. For most patients, symptoms were worse at night or with excessive hand use or both. Self-evaluation questionnaires showed total relief of symptoms after operation in 51% of cases, 75% or greater improvement in 31%, and 50% or greater improvement in 10%. The dominant hand was more severely involved in two thirds of the patients and 78% of patients had occupations involving considerable use of their hands, suggesting that an occupational factor might be involved in the genesis or aggravation of median nerve compression.


Acute febrile illness associated with bilateral pulmonary infiltrates after irradiation in a patient with Hodgkin's disease.

An 18-year-old woman with stage IIIB Hodgkin's disease presented with minimal shortness of breath and progressed to fatal pulmonary insufficiency in five days. Biopsy and necropsy lung tissue specimens established the diagnosis of acute radiation pneumonitis. The diagnosis of radiation pneumonitis should be considered in the presence of a nonproductive cough, dyspnea, mixed interstitial and alveolar infiltrates on chest roentgenogram, negative cultures, and the characteristic findings on lung biopsy of macrophage accumulation and alveolar fibrin deposition in the face of minimal cellular infiltrate. A trial of steroid treatment may be warranted.


Acute corneal injury by mustard gas.

Described is an acute ocular injury caused by mustard gas. The clinical course was similar to what has been established by laboratory research. Some of the histopathologic events have been discussed in theory since no tissue sample from this reported case was available for examination.


Nasal hemangiopericytoma.

Nasal hemangiopericytoma is difficult to diagnose preoperatively or before examining a histologic specimen. It is a locally invasive tumor with an excellent five-year prognosis, but which requires lifetime follow-up. The patient reported was treated by aggressive local surgical treatment of the tumor followed by systemic therapy for multiple myeloma.


Mesenteric venous thrombosis and oral contraceptives.

Reported is a case of mesenteric venous thrombosis occurring in a 46-year-old woman who had taken an oral contraceptive for six years. Seventeen cases of mesenteric venous thrombosis have been reported in young women taking oral contraceptives. An association between oral contraceptive agents and mesenteric venous thrombosis is suggested.


Collision and interlocking of twins.

Breech/transverse presentation of twins is highly uncommon. However, this presentation is very likely to develop into a tru collision syndrome should the mother be allowed to labor. In cases of interlocked twins in which vaginal delivery is attempted, loss of the first twin is common. Our experience, and the experience of others cited in this report, indicates that early cesarean section can prevent such a disastrous outcome. Suspicion of a collision or interlocking syndrome should be aroused in any patient carrying twins in the breech/transverse position. Abdominal delivery should be accomplished before descent of the presenting twin.


Rapid karyotypic diagnosis of a case of trisomy 18 in the neonatal intensive care unit.

Recent modifications in the technic of bone marrow preparation for karyotypic analysis permit confirmation of chromosomal aneuploidy such as trisomy 13, 18, or 21 within two to four hours. The patient reported illustrates how the technic of bone marrow karyotyping may assist the pediatrician in treating an acutely ill newborn, in accurately counseling parents, and in selecting with them an appropriate course of management.


Subacute staphylococcal meningitis secondary to postpartum endometritis.

A woman with Staphylococcus aureus meningitis following postpartum endometritis presented with lumbar backache and fever of several weeks' duration. Thick, green exudate was aspirated at lumbar puncture hours before death. Histologic examination demonstrated subacute inflammation of the meninges and chronic inflammation of the endometrium. Although rare, postpartum endometritis followed by low back pain and fever should alter the physician to the possibility of serious infection involving the central nervous system. Diagnosis and treatment at this early stage would be expected to decrease mortality.


Acinar cell carcinoma of the pancreas in a 9-year-old child: case report with electron microscopic observations.

A case of acinar cell carcinoma of the pancreas in a 9-year-old boy is presented, in which the diagnosis was established by electron microscopy. Treatment was by combination chemotherapy and the survival time was two years.


Right-sided diaphragmatic hernia of delayed onset in the newborn infant.

Postnatal herniation of abdominal contents through a defect in the right leaf of the diaphragm is often difficult to diagnose. Two cases of this condition are presented and the use of pneumoperitoneum in assisting with the diagnosis is discussed.


Hemodialysis in treatment of acute chloral hydrate poisoning.

A young pregnant (32 weeks' gestation) woman with severe chloral hydrate intoxication was treated with hemodialysis. This resulted in dramatic improvement of her profound central nervous system depression, protracted ventricular arrhythmias, fetal distress, and resumption of spontaneous respiration. The blood concentration of trichloroethanol was measured hourly during the dialysis and its dialysance was calculated. This experience suggests that hemodialysis may be a useful adjunct in the treatment of severe chloral hydrate poisoning.


Metastatic melanoma of the stomach: the endoscopic and roentgenographic findings and review of the literature.

A case of metastatic melanoma of the stomach is reported with illustrative endoscopic and radiographic findings. Metastatic melanoma of the stomach may present with vague gastrointestinal symptoms, abdominal pain, or gastrointestinal bleeding. A history of melanoma may not be readily obtainable. When gastrointestinal symptoms occur in a patient with known melanoma, gastric metastases should be considered. Polypoid or target lesions are frequently seen on barium x-ray study. Small bowel roentgenograms should be obtained. Endoscopy, cytologic study, brushing, and biopsy may yield the diagnosis. The prognosis is poor. Surgery should be performed only to relieve significant symptoms.


Multiple leiomyosarcomas.

A 32-year-old woman underwent a conservative total excision of a leiomyosarcoma of the sigmoid mesocolon. During the subsequent six years she developed additional malignant and benign smooth muscle neoplasms in the soft tissues and uterus which were treated only by nonmutilating surgical excisions with an excellent result. Since we know of no proof to the contrary, we submit this case as an example for surgically excising adult soft tissue sarcomas in as conservative a manner as is sufficient to locally eradicate the disease. Adjunctive radiation or chemotherapy or both may prove to be beneficial.


Aspergillus infection in the Western Cape.

The inhalation of spores of Aspergillus may result in allergic, infective or saprophytic clinical reactions, depending on the immunological status of the host. Five cases of bronchopulmonary aspergillosis in asthmatics, 62 asthmatics with evidence of skin hypersensitivity to Aspergillus, but without bronchopulmonary aspergillosis, 3 patients with Aspergillus pneumonia and 7 with aspergillomas diagnosed in the Western Cape during the last 18 months, are described. The characteristic features of each type of reaction to Aspergillus are reviewed. The importance of bronchopulmonary aspergillosis and the permanent damage it can produce when it goes unrecognized and untreated, are emphasized. It is hoped that this report will increase local awareness of this complication in asthmatics and thus favour early diagnosis and treatment.


Deafness in Black children is Southern Africa.

An aetiological survey of 499 deaf Black children in 3 schools in Southern Africa is reported. Specific genetic syndromes were identified in 21 children, of whom 13 had the Waardenburg syndrome. Inherited deafness without associated defects was diagnosed in further 32 children, and an indentifiable acquired cause was evident in 108 children (22%). No cause could be found in the remaining 338 children (68%), of whom 71 had various nonspecific congenital anomalies.


Disseminated histoplasmosis associated with disseminated tuberculosis: a case report.

Disseminated histoplasmosis is reported in a 70-year-old White man. There was also evidence of a previous disseminated tuberculosis infection. This is the 9th reported case of disseminated histoplasmosis in the Republic of South Africa.


A method for caecectomy in rats.

A technique for surgical removal of the caecum in young rats is described. Because the technique does not involve end-to-end ileocolonic anastomosis, it is much easier to perform than others described in the literature. The operation was successfully performed on 160 small rats which were afterwards used in nutritional experiments.


Bacteriuria in Black diabetics.

Urine of 198 diabetics and 147 non-diabetics was examined for bacteriuria by means of the Uricult dip slide method. Prevalence of bacteriuria in diabetics (18,7%) was significantly higher than in the control group (7,6%). This increased prevalence in diabetics was due primarily to an exceedingly high prevalence in diabetic women (27%). There was no relation between bacteriuria and age, duration of diabetes, treatment for diabetes, quality of control of diabetes, symptoms of urinary tract infection or hypertension.


Metabolism of 14C-labelled L-tryptophan, L-kynurenine and hydroxy-L-kynurenine in miners with scleroderma.

Six South African White miners were studied with the 2-g L-tryptophan load test and tracer doses of L-tryptophan-7a-14C, L-kynurenine-keto-14C and hydroxy-L-kynurenine-keto-14C. The breath 14CO2 and 14 urinary metabolities were measured. When they were compared with a previous study of American women with scleroderma, similar 14CO2 and tryptophan metabolite excretion patterns were observed in the data from the miners. The labelled quinolinic acid excretion was more significantly elevated in the South African miners' urine than in the urine of the American women. The data from both studies suggest that some patients with scleroderma have an altered step in the tryptophan metabolic pathway after hydroxy-anthranilic acid. What relationship exists between the induction of pulmonary silicosis and the subsequent development of scleroderma, requires additional human studies.


The treatment of snakebite.

The author's experience in treating the victims of snakebite over the past 8 years, a careful evaluation of the antisera and drugs which can be used and information from the available literature are presented to provide a practical guide for the treatment of snakebite.


The reproductive efficiency of the Xhosa.

Four sociogeographical groups of Xhosa were studied to show differences in their reproductive efficiencies. The rural groups showed increased perinatal, infant and over-all death rates compared with the urban groups. The highest death rate in all groups was during the infant period. The infant mortality was about 25% among the rural groups and 10% among the urban groups.


Vitamin A in the treatment of menorrhagia.

Hypovitaminosis A was found to be an important cause of menorrhagia, and a statistically significant difference between the fasting serum vitamin A values of healthy controls and patients with menorrhagia was noted. Vitamin A is a co-factor of 3 beta-dehydrogenase in steroidogenesis and deficiencies of this vitamin may result in impaired enzyme activity. The level of endogenous 17 beta-oestradiol appears to be elevated with vitamin A therapy, and menorrhagia was alleviated in more than 92% of patients.


A laboratory investigation into bilirubin binding in neonates.

The presence of free bilirubin the serum of 59 Black neonates was studied at the time of exchange transfusion with an electrophoretic technique. It was observed that 32 infants had detectable free bilirubin in their serum and that these infants had a significantly greater bilirubin/albumin ratio that infants without free serum bilirubin.


Necrotizing enterocolitis in Black neonates.

Several years ago neonatal necrotizing enterocolitis (NNE) was commonly seen in an open ward for premature babies at Baragwanath Hospital, which was affected by recurrent outbreaks of gastro-enteritis and Salmonella infections. Since outbreaks of infection have been prevented, NNE has been uncommon, in spite of a high incidence of babies of low birth weight, many of who experience neonatal shock from anoxia and hypothermia, conditions considered as predisposing to NNE. The animal experimental work on the protective function of breast milk against NNE is discussed, and it is suggested that the low incidence of NNE at this hospital is due to the establishment of breast milk banks and the encouragement of breast feeding for all neonates.


Continuing education of health workers in rural areas.

The need for effective continuing educational programmes for all health workers in rural areas is discussed, with particular mention of the role of the doctor as a teacher. Various approaches to continuing education are elaborated.


Treatment of paraquat poisoning with the membrane oxygenator: a case report.

A fatal case of progressive pulmonary fibrosis in a 13-year-old boy, due to poisoning by the weed-killer paraquat, is described. Attempted treatments included extracorporeal circulation. The management is discussed in the light of the histological observations, and the pathophysiology of the condition.


Hepatotoxicity of paracetamol enhanced by ingestion of alcohol: report of two cases.

Two fatal cases of poisoning by paracetamol are described. Both patients were heavy imbibers of alcohol and both had swallowed less paracetamol that that generally regarded as a lethal dose. The biochemistry of paracetamol hepatotoxicity is outlined and the increased susceptibility of alcoholic patients to the hepatotoxic effects of paracetamol is remarked upon. Recent trends in the treatment of acute paracetamol poisoning are mentioned.


Subclavian and axillary artery injuries.

Experience with 36 Black patients with disruption of the subclavian or axillary arteries is reported. The clinical presentation and operative approaches are described. The average time interval between injury and diagnosis of arterial injury was 10 days. Two case reports which illustrate the adverse consequences of delayed treatment are presented. Careful clinical assessment of penetrating injuries in the neck and shoulder region is necessary to exclude major arterial injury. Arch aortography is indicated if arterial injury is suspected.


Surgical treatment of chronic destructive pneumonia.

During an 8-year period 78 patients underwent operation for chronic destructive pneumonia (CDP) at Wentworth Hospital. The indications for operative treatment are described and the results of treatment presented. Of the 78 patients, 12 died during or after operation and 27 developed postoperative complications which required further surgical intervention. This high morbidity and mortality rate is contrasted with results achieved in the operative treatment of bronchiectasis and pulmonary tuberculosis. The complications are caused by haemorrhage and by pleural or pulmonary infection. Control of infective complication depends on the elucidation of the aetiology of CDP.


Graduated internal dilatation in the treatment of fibromuscular dysplasia of the internal carotid artery.

A patient with transient ischaemic attacks due to fibromuscular dysplasia of the internal carotid artery is presented. Standard methods of vascular reconstruction may not be possible as the disease often involves the distal half or two-thirds of the extracranial internal carotid artery. For this reason the technique of graduated internal dilatation first described by Morris et al. was employed and showed satisfactory results on short-term follow-up.


The use of phenothiazines and tricyclic antidepressants in the treatment of intractable pain.

The use of trifluoperazine and amitriptyline in the treatment of pain is described. Of 12 patients who were suffering chronic pain from various causes, 8 obtained a major degree of relief from the use of this combination of drugs.


Tuberculosis of the skull vault: a case report.

We describe a 3-year-old boy who had fluctuating swellings of the head and an infra-orbital sinus which were due to tuberculous osteitis. On radiological examination, the lesions may be found to be multifocal, and usually appear to be circumscribed and lytic. Definitive diagnosis depends, however, on bone biopsy.


Pneumoconiosis in non-mining industries on the Witwatersrand.

Two hundred and eighty-seven patients referred to the National Research Institute for Occupational Diseases with suspected pneumoconiosis are recorded. The patients are classified according to the type of dust to which they were exposed, and by occupation or industry. Radiological evidence of pneumoconiosis according to ILO/UICC classification is the only acceptable basis for compensation at present, and the number of patients so diagnosed is also given. None of these figures show the true distribution and incidence of pneumoconiosis as a form of occupational disease on the Witwatersrand. They only indicate the presence of pneumoconiosis not associated with mining and reflect a wide range of occupations.


Tests for completeness of vagotomy.

A battery of tests was applied to 60 patients at periods varying from 2 to 24 months after they had undergone truncal vagotomy (42 with pyloroplasty, 18 with gastro-enterostomy). The major comparison was between those with endoscopic evidence of recurrent duodenal ulcers, and those in whom endoscopy showed no abnormality. Tests which differentiated between the two groups to a statistically significant extent were those for increased acid concentration in the first hour after insulin and serum gastrin, which was lower in this group. Useful, but statistically not significant tests, in patients with no endoscopic evidence of recurrent ulcers, were a postoperative decrease in basal acid output and maximal acid output after pentagastrin or insulin. Symptoms, the combined pentagastrin-insulin test, the volume of acid secreted after insulin, and the acid concentration in the second hour after insulin stimulation were poor indicators for differentiating between patients with recurrent ulcers and those without ulcers. Almost as much information was obtained by the postoperative basal acid output alone as by the pentagastrin and insulin stimulatory tests.


Amniotic membranes as a biological dressing.

Amniotic membrane dressings were tested in the treatment of 30 patients. Fifteen of them had burns, 5 had chronic varicose ulcers, and 10 had decubitus ulcers or other open infected wounds. No effort was made to separate the chorion from the amnion. Dressings were changed every 48 hours, and treatment was, in some cases, partially ambulatory. Good results were obtained in the treatment of 2nd- and 3rd-degree burns and of other open, infected wounds, both in the preparation of the patients for autografting and in consequent treatment.


Bone cement and antibiotics.

Antibiotics of various kinds were added to the powdered polymer of methylmethacrylate in a concentration of 1 g antibiotic/40 g cement, prior to the addition of the liquid monomer. Specimens were subjected to mechanical testing by loading them in direct compression on a 20-ton Instron Universal Testing Machine, and load deflection curves were recorded. It was found that the addition of antibiotics does have an effect on the mechanical strength of the cement--the loss was small, less than 10% for both the compressive strength and the elastic modulus, provided the antibiotic was in powder form. Liquid antibiotics resulted in a greater loss of the compressive strength of the mixtures, but specimens tended to be less porous. In vitro studies of the antibiotic properties of the mixtures demonstrated potent antibacterial activity in all the antibiotics tested, except chloramphenicol. Possible clinical applications are discussed. Further in vivo studies are needed before widespread clinical use can be advocated.


Rhinosporidiosis: case reports.

Two cases of rhinosporidiosis are reported from Natal. Rhinosporidiosis is a benign fungal disease, usually of the nose and upper respiratory tract and closely resembles the common angiomatous nasal polyp.


Medicine at McMaster; an innovative programme for undergraduates.

An innovative programme in undergraduate medical education, developed at the McMaster Medical School in Hamilton, Canada, is described. A number of features distinguish the McMaster approach from the more traditional system. Among these is a firm commitment to well-defined goals which stress the need for comprehensive patient care and an awareness of changing patterns of health delivery. Emphasis is placed on the student as the focal point in the educational process and a flexible curriculum provides the medium through which all facets of this novel system can best find expression.


OASDI (Old-Age and Survivors Insurance): fiscal basis and long-range cost projections.

A thorough understanding of the financing structure of social security is a prerequisite to serious discussion of the financial condition of the program. In examining this structure, it becomes clear that the most important test of the program's financial soundness is whether expected future income to the funds equals expected future expenditures. Short-range and long-range cost estimates indicate that this condition does not exist and that an actual deficit of 7.96 percent of taxable payroll, equivalent to $4.3 trillion, needs to be eliminated--half of it perhaps by stabilizing benefits at current levels in relation to preretirement earnings. In addition, an unfunded accrued liability of $3.1 trillion exists, although there is no indication that this liability needs to be funded.


Thirteenth valuation of the railroad retirement system.

The most recent valuation of the financial condition of the railroad retirement system reveals that an existing actuarial deficiency will become more pronounced over time unless corrective action is taken. After projecting the progress of the fund under present law and certain assumptions about the future, the Railroad Retirement Board has concluded that the present value of benefits can be maintained only if the tax rate--already considerably higher for employers than under the social security program--is raised. An immediate increase of 4.1 percent of taxable payroll is required to effect an actuarial balance. Alternatively, a rise of 2.6 percent would be sufficient to prolong the fund until the year 2001. If the present tax rate is not changed, the fund is projected to run out in 1986.


State supplementation under SSI, 1975.

This article summarizes State supplementation activities under SSI for 1975. It discusses changes in the State programs that occurred during 1975 and presents some comparisons with data for 1974--the initial year of the SSI program. A slight shift occurred in the distribution of recipients by eligibility category for Federal and State supplementation from 1974 to 1975. During 1975 a few States changed from Federal administration to State administration of their mandatory supplementation programs while a few others initiated or expanded their optional supplementation programs. Several States also increased their supplements during the year.


Private industry health insurance plans: type of administration and insurer in 1974.

This report examines the major forms of administration of private health insurance plans. Plans are classified according to whether they are employer-only or joint worker-employer-operated and according to whether they are negotiated or not. A further focus of examination that often reflects industry patterns is whether the plans cover workers of a single employer or involve multi-employer arrangements. These classifications of administration and the method of insuring benefits are examined in terms of proportions of workers with specified plan characteristics and health benefits.


Private industry health insurance plans: employment requirements for coverage in 1974.

In 1974, approximately 28.4 million active workers participating in almost 52,000 health plans on their jobs were covered by in-hospital health insurance benefits. A survey of these plans, conducted for the Social Security Administration by the Bureau of Labor Statistics, revealed that not all workers are automatically entitled to benefits on the first day they report for work. More than three-fifths had to fulfill at least one job-related requirement before their hospital coverage was effective. The extent and variety of employment requirements in private industry are discussed here along with data that show how plans that have such requirements differ from those that do not.