[Investigations of the bioavailability of iron from bi- and trivalent iron salts (author's transl)].

In a clinical pilot study, performed as an intraindividual comparison, 3 oral iron preparations, one bivalent iron sulfate (quick release stick capsule preparation) and two trivalent iron citrate complex preparations with different additives, were investigated on 9 healthy young male test persons by the iron absorption test (postabsorption serum iron concentration curves) in order to study the bioavailability of these drugs and their compatibility. Whereas both iron drugs proved equally compatible when administered in therapeutical doses, it was again confirmed that the enteral bioavailability of the ferrous iron sulfate is superior to that of the ferric iron complex preparation. According to these results the medication of ferric iron preparations seems once again to be proved unsuitable, trivalent iron having first to be reduced to bivalent absorbable iron, there however being usually not enough "reducing capacity" in the gastrointestinal tract to do this.


[Syndrom of hypercalcemia in a case of hyperthyroidism, primary hyperparathyroidism and cancer of the gall-bladder (author's transl)].

A hypercalcemia syndrom in the case of a 63 year old female patient is reported on, who simultaneously suffered from hyperthyroidism and suspected primary hyperparathyroidism. During autopsy an ectopic (ventral mediastinum) parathyroid adenoma and a gall bladder carcinoma were discovered. Each of these three diseases can induce hypercalcemia by themselves.


[Operations of the gall-system (papillectomy) (author's transl)].

The last 14 years around 4000 operations of the gall-bladder and the gall-system were performed at the surgical hospital in Braunschweig. All cases were benign. A papillectomy was performed in more than 500 cases. Because of better intraoperative diagnostic and routine radiomanometry of nearly all the patients the contingent of papillotomy, which was usually 25% to 30%, decreased to 10% to 12%. Our statistic shows that there was no increase of complications or of the postoperative lethality due to the papillotomy. On the other hand we had to performe a second operation in 82 cases, who had no papillotomy at the first surgical approach. 14 of these patients had a biliodigestive anastomosis and later a bad polycystectomy syndrom. On the other side we had a group of patients who got ailments years after the cholecystectomy. These patients had a stenosis of the papilla as a real second disease and needed to undergo a second operation.


Studies of mitochondria and mitochondrial DNA extracted from organelles harboring an intramitochondrial virus.

(1) Two viper cells lines were investigated, one which harbors IMV in the mitochondria (VSW cells) and one without detectable IMV (VH3 cells). (2) The size of closed circular mtDNA molecules from both VSW and VH3 cells was found to be significantly greater (5.4 to 5.6 micron) than the contour lengths of typical mammalian cells (4.8 to 5.2 micron). (3) A small percentage of mini-circles ranging in size from 0.1 to 0.6 micron was observed to band with closed circular mtDNA from both cell lines. Minicircles were especially abundant in VH3 cells. (4) MtDNA from VSW cells contained 34.1% dimers plus oligomers (10.2% oligomers), whereas VH3 cells had only 14.8% dimeric and oligomeric forms (5.4% oligomers). (5) Treatment of VSW cells with 1 microng/ml ethidium bromide for 48 hours resulted in an increased incidence of IMV (IMV in 15% of mitochondrial sections) as compared with untreated VSW cells (IMV in 3% of mitochondrial sections).


On the cell-free system of protein synthesis from mammalian mitochondria.

Some properties of a submitochondrial cell-free system for protein synthesis are described. The system was prepared from rat liver mitochondria lysed with Triton X-100, and the lysate was characterized by a linear rate of [14C]amino acid incorporation for 15-20 min with subsequent decline in activity. The incorporation reaction was inhibited by chloramphenicol and was insensitive to cycloheximide. Poly(U) addition stimulated [14CA1phenylalanine incorporation by the preincubated submitochondrial system. Upon the addition of 7.5S mRNA that was isolated from mitochondria the major translation product was identified as a hydrophobic poly-peptide which in some properties (solubility in chloroform-methanol mixture) was similar to one of polypeptides synthesized by the sub-mitochondrial system on endogeneous  mRNAs.


Molecular and genetic approaches to the analysis of the informational content of the mitochondrial genome in mammalian cells.

Our laboratory has been involved in the last few years in investigations aiming at analysing by molecular approaches the informational content of the mitochondrial genome in mammalian cells and the mechanisms and control of its expression, H eLa cells and other mammalian cell lines have been utilized for these studies. These investigations, as well as work carried out in other laboratories, have yielded a considerable amount of information concerning the mechanism, products and regulation of transcription of mitochondrial DNA (mit-DNA), the apparatus and products of mitochondria-specific protein synthesis in animal cells, and the number and topology of the sites on mit-DNA which code for the primary gene products identified so far. It is the purpose of the present report to summarize the latest observations in this area, as well as some recent results on the isolation and characterization of chloramphenicol-resistant variants of a human cell line. Reference is made to previous review articles 1,2,3 for the earlier work.


[Changing of clinical symptoms in glomerulonephritis (author's transl)].

76 children with glomerulonephritis (biopsy diagnosed) were studied for evidence of preceeding streptococcal infection, morphological and clinical symptoms. Glomerulonephritis often shows minimal symptoms; only 11% had acute, but 80% subclinical symptoms. Heading symptom was hematuria (95%), in 55% there was additional proteinuria. No correlation could be found between the clinical symptoms and glomerular lesions. Antistreptolysin 0 titers were elevated in only 39% of the children, but in all with acute clinical symptoms. The aetiology of glomerulonephritis in the remainder is uncertain, probably virus infections. The reason for decreased nephritis and increased subclinical nephritis is due to penicillin therapy and the improved renal diagnosis (renal biopsy).


[Propranolol in Fallot's tetralogy: hemodynamic investigations and their clinical use (author's transl)].

During heart catheization in 32 non-selected patients with Fallot's Tetralogy the reaction of O2-saturation, right-to-left-shunt and of cineangiocardiography to 0.2 mg/kg propranolol i.v. was tested. Nine of 32 patients reacted favourably to propranolol. Of these 6 were put on a long term-medication of 2 to 3 mg/kg propranolol orally. Only 1 patient did not respond satisfatorily. The effect of propranolol and hemodynamic results are compared with the literature and discussed. In Fallot's Tetralogy propranolol medication without previous testing ist not recommended: without previously established exact diagnosis it can be dangerous even.


[Autonomous thyroid adenoma in an 11 years old girl with childhood hyperthyroidism (author's transl)].

The thyroid gland of an eleven year old girl developed a 3 x6 cm nodule with endocrine activity and storage ability. Szintigraphic examination with TSH simulation identified it as an autonomous decompensating adenoma. Within a few months a clinically mild hyperthyreotic state developed. After surgical removal histology showed a follicular adenoma with papillary characteristics. Postoperatively thyroid hormon therapy was started.


[To the concentration of delivery and paediatric wards in Rheinland-Pfalz. Contribution to the reduction of mother and infant mortality rate (author's transl)].

Delivery wards and paediatric wards or hospitals must be large enough to be able to afford the necessary technical equipment and personal. They must also be large enough to provide the doctors with the chance to experience deliveries which are complicated as well as rare in their nature or, in paediatric wards, serious as well as rare diseases. In rural areas delivery wards should have a minimum of 600 deliveries per year, and better still 1000 to 2000. Paediatric wards should have at least 80 beds, better still 100 to 120. There are still to many small delivery and paediatric wards in the Federal Republic of Germany as well as in the Bundesland Rheinland-Pfalz. Especially hospital births are scattered over too many tiny wards with less than mininmal equipment. 89% of the wards in Rheinland-Pfalz have less than 600 deliveries, 52%even less than 300 per year. In all probability the mother and infant mortality rate will decline markedly, through the concentration of delivery and paediatric wards.


[Electron microscopic study of alcoholic liver damage, with special reference to changes in the mesenchymal liver cells].

Needle-hepatic biopsy of 48 chronic alcoholic patients was investigated by the aid of electron microscopy. On the base of clinical and histological features five stages of the hepatic lesion could be distinguished: 1. fatty liver, 2. fatty liver with increasing activity of the mesenchymal cells, 3. acute alcoholic hepatitis ,4. chronic alcoholic hepatitis, 5. alcoholic cirrhosis. Changes of the liver cell organella and mesenchymal cells in different stages were compared. It was observed, that the damage to the hepatocytes--exept acute alcoholic hepatitis--was not parallel to the severity of the clinical picture. On the other hand proliferation of mesenchymal cells their secretory activity and fibrogenesis seem to go parallely with the progression of the hepatic lesion. Authors assume, that between alcoholic hepatitis and alcoholic cirrhosis there exists an intermedier form of the disease i.e. the chronic agressive alcoholic hepatitis ,which morphologically is similar to the chronic agressive hepatitis. This form of the hepatic lesion can be characterized not by the severity of the lesion of hepatocytes, but the by enormous proliferation of mesenchymal cells and by lymphocytic infiltration.


[Myocardial necrosis in acute carbon monoxide poisoning].

Two cases of carbonmonoxid poisoning--of young males--are described. In the absence of any coronary disorders--after a long CO exposition--necrosis of the papillary muscles have been revealed. Correlations of CO poisoning and myocardial ischaemia are discussed.


[Scanning electron microscopy of heat-damaged bone tissue].

Parts of diaphyses of bones were exposed to high temperature of 200-1300 degrees C. Damage to the bone tissue caused by the heat was investigated. The scanning electron microscopic picture seems to be characteristic of the temperature applied. When the bones heated to the high temperature of 700 degrees C characteristic changes appear on the periostal surface, higher temperatura on the other hand causes damage to the compact bone tissue and can be observed on the fracture-surface. Author stresses the importance of this technique in the legal medicine and anthropology.


[Occurrence of nuclear bodies in acute viral hepatitis].

Needle-hepatic-biopsy of 10 patients with acute viral hepatitis was investigated by the aid of electron microscope. In the hepatocytes striking nucleolar alterations were observed, i.e. breakage and dispersion of the nucleolonema in the karyoplasma. Not infrequently nuclear bodies were seen. According to the present knowledge it can not be decided whether nuclear bodies are normal constituents of the hepatocytes or product of the impaired function. Complex nuclear bodies--in acute viral hepatitis--might indicate the presence of viral infection, on the other hand they might be the sign of the disturbance of the nuclear RNS-synthesis.


[Light microscopic determination of hepatitis B surface antigen (HBsAg) in liver biopsy material from adults and children].

Occurrence of the hepatitis B surface antigen in the paraffin-embedded sections of needle-hepatic-biopsy taken for diagnostic purpose from 138 patients (108 adults and 30 children) and from 52 simptomless hepatitis B antigen positive donors was investigated (modified orcein dye, "ground glass" hepatocytes). The following was established: I. this technique is simple, reliable and useful; 2. antigen can be detected first of all in hepatocytes of simptomless carriers; 3. it seems, that the antigen-positivity in tissue is in inverse ratio to the activity of hepatic lesion; 4. in the material taken from the children ground-glass hepatoyctes could not be revealed. Only in one case could be revealed a minimal orcein-positivity. 5. By technical reasons in needle-biopsy material a false-negative result can not be regarded as a rarity.


The frequency of recessive lethal heterozygotes among inidividuals obtained from inbred strains. A random-number simulation study.

In small and moderate sized inbred strains the variation with regard to the frequency of lethal heterozygotes is of such a magnitude that it is almost impossible to predict the degree of heterogeneity from one generation to another. This was shown from computer simulations of the generational variation in inbred strains maintained by full-sib matings at different breeding regimes. The results are discussed in relation to Haldane's theoretical derivations and to the practical implications with regard to strain keeping and to design and evaluation of experiments.


Chromosome aberrations in the leukocytes of pigs after half-body or whole-body irradiation.

Chromosome aberrations were scored in 48-h leukocyte cultures from pigs subjected to whole-body or half-body gamma irradiation with 100, 150, 200, 300, or 400 R. Half-body irradiation resulted in the recovery of approximately half as many aberrations as did equivalent whole-body exposures at levels of 200 R or less. Higher exposures yielded proportionally fewer anomalies in half-body irradiated subjects. These lower levels apparently resulted from the selective disadvantage of irradiated cells in coming to mitosis but did not seem to be related to the amount of chromosome damage sustained by the cell. When adjustments were made for effective dose to the in vivo cells, the dose-response pattern showed good agreement with published values for mixtures of normal and in vitro-irradiated human lymphocytes.


Semi-conservative deoxyribonucleic acid synthesis in unirradiated and ultraviolet-irradiated xeroderma pigmentosum and normal human skin fibroblasts.

Rates of semiconservative DNA synthesis have been investigated in asynchronous xeroderma pigmentosum (XP), XP variant, and normal human skin fibroblasts using the technique of cellular autoradiography. In unirradiated cells, no differences in DNA synthesis rates were detected among the three cell strains. Exposure to UV radiation caused the rate of DNA synthesis to decrease for at least three hours in all three cell strains. In the normal cell strain, recovery of the DNA synthetic rate occurred at later times following a UV fluence of 5 J/m2. At this same UV fluence, recovery was absent in classical XP cells during a 24 h post-irradiation period while it was slower than normal in XP variant cells. When the UV fluence to classical XP and XP variant cells was reduced so that survival in all three cell strains was approximately the same (25%), recovery of the DNA synthetic rate was similar in all three cell strains. These results are discussed in terms of current models of DNA replication in UV-irradiated cells and indicate: (1) that pyrimidine dimers are very effective blocks to DNA synthesis and (2) that there is no inherent defect in semi-conservative DNA synthesis in either classical XP or XP variant cells which is independent of a defect in DNA repair capacity.


Nonoliguric acute renal failure.

To delineate the clinical spectrum of nonliguric renal failure, we studied prospectively 90 patients with acute renal failure 54 of whom were nonoliguric throughout their periods of azotemia. Although the causes of nonoliguric renal failure varied, nephrotoxic failure occurred more frequently in nonoliguric than in oliguric subjects (P is less than 0.01). As com pared to oliguric patients, those without oliguria had significantly lower urinary sodium concentrations (P is less than 0.05) and fractional excretions of sodium (P is less than 0.02), had shorter hospital stay (P is less than 0.01), had fewer septic episodes, neurologic abnormalities, gastrointestinal bleeding and acidemia, required dialysis less frequently (P is less than 0.001) and had lower mortality rate (26 per cent in nonoliguric vs. 50 per cent in oliguric patients -- P is less than 0.05). Nonoliguric renal failure occurs more often than is generally recognized and causes less morbidity and mortality than oliguric acute renal failure.


Alcohol consumption and blood pressure. Kaiser-Permanente Multiphasic Health Examination data.

We studied blood pressure in relation to known drinking habits of 83,947 men and women of three races (83.5 per cent white). Using health-check-up questionnaire responses, we classified persons as nondrinkers or according to usual daily number of drinks: two or fewer per day, three to five per day, or six or more per day. As compared to nondrinkers blood pressures of men taking two or fewer drinks per day were similar. Women who took two or fewer drinks per day had slightly lower pressures. Men and women who took three or more drinks per day had higher systolic pressures (P less than 10(-24) in white men, and less than 10(-12) in white women), higher diastolic pressures (P less than 10(-24) in white men, and less than 10(-6) in white women), and substantially higher prevalence of pressures greater than or equal to 160/95 mm Hg. The associations of blood pressure and drinking were independent of age, sex, race, smoking, coffee use, former "heavy" drinking, educational attainment and adiposity. The findings strongly suggest that regular use of three or more drinks of alcohol per day is a risk factor for hypertension.


[Fatty acid composition of free and bound fat in milk powers].

The results obtained from 6 milk powders (produced by different procdures) show that the proportion of unsaturated components is considerably greater in the fatty acids of the free fat. It was found that the proportion of polar lipids in the bound fat is greater. It is presumed that the greater content of polar lipids in the bound fat plays also a rôle in the interaction between fat and protein.


[Determination of nitrate in raw spinach and commercially-prepared baby food].

During the years 1972--1975, the author performed nitrate determinations, using the xylenol method according to E. Bohm, to verify if the standard or maximum permissible values established by the Ministry for Health of the GDR in 1972-1973 for spinach and spinach preserves for babies had been respected. The relative standard deviation of the method is +/- 5%. The values found in spinach samples of the same harvest and from the same area varied considerably (up to +/- 40% of the mean). Taken altogether, the nitrate content, especially in autumn spinach, exceeded by far the maximum permissible values for baby food as well as for general consumption in spite of contractual agreement with the farmers on the use of nitrogenous fertilizers. It is recommended to study systematically all the factors of nitrate accumulation in order to secure safe spinach products.


[Determination and occurence of aflatoxin M1 and B1 in milk and dairy products].

The described method enables a simultaneous identification and determination of aflatoxin M1 and B1 in milk and dairy products by means of a self-registering fluorescence spectrophotometer with a thin-layer chromatographic accessory, directly from the plate. The semiquantitative estimation on the thin-layer chromatographic plate enables also routine analyses in the hygienic practice. The recovery rates for aflatoxin M1 and B1 in milk are about 83 and 82%, respectively -- the detection limit is about 0.1 microng per kg. The recovery rates for aflatoxin M1 and B1 in milk powder are about 89 and 94%, respectively -- the detection limit is bout 0.5 microng per kg. The reproducibility is given with a standard deviation between +/- 1.1 and 6,3% and a variation coeffecient of 1.3 and 6.7, respectively. 4 of 24 analized samples of commercial winter milk were aflatoxin M1-positive, whereas aflatoxin B1 could not be found. One of the milk powder products, a sample of the infant food, "Ki-Na", made in the GDR, contained, however aflatoxin B1. Aflatoxin M1 could not be found. Food-hygienic-toxicological conclusions are discussed.


[Thin layer chromatographic detection of aflatoxins on ready-made silica gel plates].

Silica gel instant plates with an aluminium reflection foil as the carrier material (Silufol) were tested for their suitability for the thin-layer chromatographic separation of aflatoxins in comparison with conventiol silica gel G coated glass plates. Besides the well-knwon merits of instant plates, the Silufol plates offer remarkable analytical advantages; increased sensibility and shorter time of development. For this reason, the Silufol plates may be recommended for routine examinations of foods for aflatoxins.


Stephanofilaria okinawaensis n. sp. from cutaneous lesions on the teats of cows in Japan.

This is the first report on the occurrence of stephanofilarial sore on the teats of cows in the Nansei (South western) Islands, Japan, and on the taxonomical position of etiological parasites. Stephanofilaria worms were collected from cutaneous lesions of affected teats of cows in such proportion that the sex ratio of worms might be one male to three females. Morphological and anatomical observation was made on parasites suspended in lactophenol and by the scanning electron microscope. As a result, these parasites belonged to the same species as Stephanofilaria sp. Kono, 1965, which was previously reported to cause a strange type of dermatitis on the muzzle of cattle in the Nansei Islands. The description of Stephanofilaria sp. by Kono was reviewed. Subsequently, detailed comparison was made between those parasites and the other known species of the genus Stephanofilaria. It led to the establishment of a new species called S. okinawaensis Ueno and Chibana, 1977 after the name of the enzootic area.


N-acetyltransferase activity in pineal gland of rats treated with pargyline.

After injection of 20 mg/kg of the monoamine oxidase inhibitor pargyline every other day up to 9 days, the activity of N-acetyltransferase (NAT) in the pineal gland of rats remained unchanged during the light-period. At the darkness, however, an increase above controls was observed. The latter effect was not affected by subchronic administration. The monoamine oxidase inhibitor activated not only the NAT but a second enzyme with different kinetic parameters. The drug levelled the circadian changes in the content of serotonin whereas noradrenaline and 5-hydroxyindole acetic acid were hardly influenced. These findings may be explained in such a way that pargyline activates the enzyme not via beta-receptors as supposed by Deguchi and Axelrod (1972a) but by an intracellular mechanism. The increased serotonin concentration might be responsible for the additional activation of the enzyme.


Effects of the local anesthetics brufacain and lidocaine on transmembrane action potentials, refractory period, and reactivation of the sodium system in guinea pig heart muscle.

Lidocaine (3-10(-5) and 10(-4) M) and equimolar concentrations of brufacain dose-dependently reduced the depolarization velocity (dV/dtmax) and the force of contraction of guinea pig atria and papillary muscles. Repolarization time was increased in atria but reduced in papillary muscles. The maximum effects on action potential parameters were identical but developed with brufacain more slowly than with lidocaine. In papillary muscles lidocaine (3-10(-5) M) prolonged the functional refractory period. No such effect but even a shortening was observed with brufacain. As brufacain reduced the duration of the action potential (AP) more than the functional refractory period, the "relative refractory period" (in percent of AP duration) was slightly prolonged. The half-time of the recovery of the Na+ system was increased three to five times the control value after lidocaine but only doubled after brufacain.


Transfer of sodium and water through isolated rat colonic mucosa under the influence of deoxycholate and oxyphenisatin.

1. The influence of oxyphenisatin (OP), a diphenolic laxative, and deoxycholate (DC) on the transfer of sodium and water in an everted sac preparation of stripped rat colon was investigated. 2. OP (10(-5) M, mucosal side) and DC (3 X 10(-4) M, mucosal side) completely blocked net water and sodium absorption. Net movements from the serosal to the mucosal side could not be induced by  higher concentrations of the drugs. 3. Unidirectional sodium movements in both directions were increased by OP and DC. 4. The effect of DC on the sodium flux from the serosal to the mucosal side was reversible. 5. The potassium content of the mucosal epithelium was not changed by DC and OP. 6. The integrity of the epithelium, as judged by light microscopy, was not disturbed by either drug under the experimental conditions. 7. It is concluded that DC and OP do not interfere with active transport mechanisms but increase the permeability of the epithelium to sodium.


The risk of anticoagulation in hemodialysis patients.

The risks of intermittent anticoagulation with heparin for hemodialysis and longterm anticoagulation with warfarin to prevent clotting of arteriovenous shunts were assessed in a group of 125 home dialysis patients. Over a 7-year period, there were nine bleeding complications attributable to heparin anticoagulation for an incidence of one complication for every 40 patient year on dialysis. In contrast, 20 of 48 patients anticoagulated with warfarin for an average of 2 years each, had a total of 50 hemorrhagic complications requiring 542 days in the hospital and 15 operative procedures. Concersion to an alternative form of vascular access, the internal arteriovenous fistula, obviated the need for warfarin therapy and its unacceptably high complication rate in this population of patients.


Distribution of calcium in the rat due to chronic renal failure.

During the 12 weeks following 5/6 nephrectomy in rats with moderate uremia (creatinine 0.7-1.2 mg/100 ml, BUN 53-89 mg/100 ml), no significant increases in total soft tissue calcification were observed. The calcium concentration of skeletal muscle remained unchanged at 4, 8, and 12 weeks after surgery. A slight but not significant increase in skin calcium was found. However, a significant decrease in cardiac calcium was found for the uremic animals. Total body calcium as determined by neutron activation analysis was significantly lower in the uremic rat when compared with the age-matched animal. However, when normalized for body weight, the total calcium content in uremic rats did not differ from the controls. Similar findings were observed for the absolute calcium content of the tibia and when normalized for weight. Furthermore, a highly significant linear relationship (r = 0.92, p less than 0.001) was established between absolute levels of total body calcium and tibia calcium which was identical for control and uremic groups.


Effect of acute experimental uremia on the stability of liver lysosomal membranes.

Acute uremia was induced in male Swiss albino mice by complete urethral ligation and the animals were sacrificed 2, 4-6, 24, and 48 h after operation. Sham-opeated animals (without the urethral ligation) were similarly treated. The blood urea levels of animals with total urinary tract obstruction went up to 175 mg/100 ml at 4-6 h of urethral ligation and reached an average level of 827 mg/100 ml at 48 h, while the control group exhibited and average blood urea level of 37 mg/100 ml. Lysosomes obtained from livers of uremic mice sacrificed at different time intervals demonstrated a lability of the lysosomal membranes (as determined by the acid phosphatase activity in mU/mg) which was maximal at 4-6 h of urethral ligation, declining towards normal at 24 and 48 h, despite an increase in the animal's blood urea. In vitro studies exposing liver lysosomes to progressively higher urea concentrations (differences of as much as 100,000 times) did not reveal any effect of urea upon the stability of lysosomal membranes. The reason for the lability of lysosomal membranes in the uremic group was not apparent in the present study.


Effect of hemodialysis on methylprednisolone plasma levels.

The effect of hemodialysis on methylprednisolone levels in uremia was investigated. Methylprednisolone 15 mg/kg was given intravenously over a period of 20 min to five patients undergoing routine maintenance hemodialysis. Dialysis began 5 min after the infusion ended and continued for 5 h. Pre- and post-coil plasma levels and the dialysate level of methylprednisolone were measured at intervals. Dialysance averaged 18.4 +/- 6.1 ml/min, and mean half-life 149 +/- 26 min. The volume of distribution was 0.80 of body weight. The significant dialysance of methylprednisolone may require adjustment of dosage in certain clinical situations when hemodialysis is necessary for patients receiving the steroid.


Familial hypouricemia due to isolated renal tubular defect. Attenuated response of uric acid clearance to probenecid and pyrazinamide.

A 37-year-old female was found to have hypouricemia (1.1-1.9 mg%) with markedly increased uric acid clearance (24.7039.5 ml/min). Uric acid excretion was only slightly affected by pyrazinamide, a drug which suppresses renal tubular uric acid secretion, and by probenecid, a drug which inhibits tubular uric acid reabsorption. The attenuated response in this subject to both drugs suggest a renal tubular defect in the proximal high capacity-high affinity uric acid reabsorption mechanism. No other renal tubular or metabolic abnormalities were detected. A survey of the family-three sisters and two brothers, revealed two similarly affected sisters. The abnormality described in this family is defined as familial renal hypouricemia due to an isolated renal tubular defect with attenuated response of uric acid clearance to probenecid and pyrazinamide.


The palm tree cervical spine--a normal anatomical variant.

A case of "palm tree" cervical spine with cervical spondylitic myelopathy is described. It is shown that this upward course of the nerve roots over the pedicle is a variant of normal anatomy, not described in standard textbooks and that this variation may be seen on myelograms. The futility of attempting to correct the variation is described.


Intradural spinal echinococcus simulating lumbar disc protrusion.

A case of intradural hydatid cyst, simulating disc protrusion is described. It is emphasized, that in countries like Greece, the possibility of hydatid cyst compressing the spinal cord, should always be considered.


[Insomnia and anxiety].

The paper reports a trial of finding correlations between the level of anxiety, regarded as a consistant personality trait measured by means of the so-called personality scale, and difficulties in falling asleep. It was found that the greatest difficulties in falling asleep were observed in individuals with medium level of anxiety. The interpretation of this observation is discussed.


[Serum content of alpha-amino nitrogen in patients with stroke].

The concentration of alpha-amino nitrogen in the serum of 18 healthy subjects, 17 patients with cerebral haemorrhage, and 23 patients with encephalomalacia due to thrombosis was determined by the colorimetric ninhydrin method of Moore and Stein modified by Slavik. The determinations were done on the 1st, 3rd and 10th days of the disease. The mean concentration of alpha-amino nitrogen in the serum of patients with cerebral haemorrhage was lower than in controls on the 1st and 3rd days of the disease but the difference was not significant statistically. The mean level of alpha-amino nitrogen in the serum of patients with encephalomalacia was lower on the 1st day than in controls while on the 3rd and 10th day it was slightly higher as compared with controls, however, statistically the differences were not significant. The mean values of alpha-amino nitrogen in the serum of patients with cerebral haemorrhage and those with encephalomalacia gradually approached the control values.


[Periodic EEG discharges of stereotyped morphology].

Clinical course of disease and results of EEG examinations of 6 patients with severe brain disturbances of various aetiology provided grounds for discussion on the phenomenon of periodic stereotyped EEG discharges (PSD) which is of considerable diagnostic value in some cases. The variability in appearance of these discharges, in their form and duration of intervals between them are stressed--the last parameter varied in own material from 0.5 to 8 sec. The appearance of PSD may indicate increased convulsive excitability of the cortical and subcortical structures of the gray matter. The prognostic value of PSD was not always the same and it could be established only basing upon a comparison of EEG findings during successive examinations.


[Effect of tensilon on the behavior of optokinetic nystagmus in myasthenia].

In 14 myasthenics tensilon test was performed together with electronystagmographic recording of optokinetic nystagmus. The mean amplitude of deflections and the mean frequency of nystagmus were calculated before and after intravenous administration of tensilon 10 mg. The results were compared with those obtained in a control group. The test was positive in 11 myasthenics: the amplitude and frequency of nystagmus beats increased and extinction at the end of the test was absent or diminished. In the control group the test was negative, with the exception of 3 cases in which a slight increase in amplitude and frequency was observed. The authors stress the advantages and disadvantages of tensilon test and state that it is diagnostically valuable in myasthenia and myasthenic syndromes in subjects sensitive to the drug.


[Olivopontocerebellar atrophy].

A sporadic case of olivo-ponto-cerebellar atrophy in a woman aged 52 years is described. The diagnosis was based on a history of progressing cerebello-extrapyramidal syndrome lasting 10 years. Neuropathological investigations demonstrated much advanced changes typical of the condition in the brain stem and cerebellum. Moreover lesions of the lenticular nuclei and substantia nigra were revealed. The authors discuss the results of ultramicroscopic investigations reported as yet which suggest a possible role of infectious factors in the pathogenesis of the disease.


[Aneurysm situated within the optic nerve].

A case of carotid-ophthalmic aneurysm of unusual location in the optic nerve is reported. The development of the disease was sudden: pain in the eye was followed by unilaternal blindness and manifestations of subarachnoid haemorrhage. The optic nerve was dilated balloon-like, cyanotic and vigorously pulsating. It was divided longitudinally and the aneurysmatic sac was exposed from the nerve. A vascular clip was put on its peduncle communicating with the cervico-ophthalmic portion of internal carotid artery. Despite preserved patency of the ophthalmic artery and partial continuity of the optic nerve, the vision of the eye didn't improve.


[Physical rehabilitation in mastectomized women].

The paper highlights the importance of rehabilitation programmes for women subjected to radical mastectomy. Within the Milan National Tumour Institute, the activity promoted by the antalgic and Rehabilitation Department concerning some 700 patients per annum takes in 3 phases: information; prevention; treatment of the disease. After thorough psychological and medical observation of the patient, all available treatment methods are deployed on conditions which present in the form of hypomobility of the homolateral extremity, lymphangitis, lymphoedema and possibly neurological damage to the brachial plexus. The results of this rehabilitation programme have meant a notable reduction in the forms and have led to rapid return to society.


[Diffuse entero-mesenteric lipomatosis].

Successful surgical management of an unusual case of diffuse lipomatosis is reported. The clinical and radiological pictures are described and the essential points to be taken into consideration in differential diagnosis are illustrated.


[Thyroiditic reactions during a course of thyroid cancer].

The clinical, immunological, and immunoistochemical features of 10 thyroid cancers associated with intra and extra tumoral thyroiditis are described. These cases have been obtained from a review of 806 thyroidectomies. A proper distinction of the described pathology from the immunological and histological point of view, is emphasized, especially if compared with the prognosis of other thyroid cancers.


[Y-shaped uretero-ureteral anastomosis. Notes on surgical anatomy in humans].

Anatomosurgical investigation shows that Y-shaped ureteroureteral anastomoses can be performed even when the whole of the pelvic segment and part of the abdominal segment of the ureter have been lost. The very high level at which a crossover between the two ureters can be obtained is indicative of the area of application that this operation offers in the reconstruction of unilateral damage to the distal ureter.


[An unusual crystallographic aspect of a cholesterol biliary calculus. Optic and x-ray diffractometric study].

The unusual crystallographic appearance of a pure cholesterol calculus is described. Optical and X-ray diffraction data are presented in an initial note. A thorough physical and chemical investigation of the mechanism that led to the formation of this calculus and its particular appearance and shape will be reported in a subsequent paper.


[Endothoracic goiter with retro-tracheo-esophageal migration].

A case of endothoracic goitre with crossed, left-right, retrovascular, retro-tracheo-oesophageal migration is used as the basis for pathogenetic and diagnostic discussion and for stressing the surgical importance of correct topographic and migratory classification of each form.


[Intraoperative cholangiomanometry. Critical review and proposed original method].

A review of the techniques and presentation of a new method.--Cholangiomanometric techniques and methods described in the literature are reviewed, with particular reference to their associated anaesthesiological and pharmacological problems. Original physiological concepts are relied on in a proposal for the adoption of a new intraoperative method with pharmacological tests and specifically direct to functional evaluation of Oddi's sphincter as a means of determining indications for surgery.


[Plasma and erythrocyte magnesium concentration in the postoperative period. Relations between calcium and magnesium].

Transient hypomagnesiaemia was noted postoperatively, particularly on the 1st day in patients submitted to intestinal procedures. Slight hypocalcaemia was also observed; this was often related to a low plasma Mg value. A hormonal mechanism is presumed to be the cause of this stress-linked fall in blood magnesium.


[Intestinal occlusion caused by jejunal leiomyosarcoma].

A case of intestinal occlusion due to jejunal leiomyosarcoma is reported. Attention is drawn to the unusualness of the picture and the absence of an indicative symptomatology. Early diagnosis is desirable if surgery is to be successful.


[Echinococcosis of the pancreas. Description of a case].

After a brief survey of the world literature on echinococcus cysts in the pancreas, a case is described. The peculiar clinical picture as well as treatment are underlined.


[Emergency in psychiatry].

Any form of intervention carried out with various means that cannot be put off may be described as urgent. The differences between urgency in psychiatry and in general medicine are recalled. A distinction is drawn between real psychiatric, real pseudopsychiatric, and psychiatric pseudourgency due to pathomimesis. The first category includes cases of anxiety crisis, suicidal tendency, widespread pathological depression, and mental confusion, the second those in which the main psychotic symptom masks a somatic disease, and the third cases brought into being by the patient because his ambient, family or precarious economic position offer no other solution to his problem than the mimicking of a disease and its dramatisation to the point of an emergency. General hospital should deal with psychiatric urgency in cooperation with psychiatric divisions or clinic, since resort may have to be made to resuscitation centres, toxicological laboratories, intensive cares departments, cardiology departments, etc. Emergency patients can be handled at the out-patient level, or by means of a short period of hospitalisation.


[Unequal ventilation: phenomenon of trapped helium].

The results of preliminary research designed to prepare a method for using mouth measurements to identify alveolar air trapping phenomena which cannot be detected by normal techniques are reported. With a present rapid thermoconductivity CO2/He analyser, it was shown that even after the completion of a standard He wash-out process, it is possible to reveal the persistence in the expiratory air of bronchiolostenotic patients of residual traces of inert gases alongside CO2 originating from normally ventilating sectors. The information obtained from the mouths of patients corresponds with the results of measurements taken inside the lung. Finally it is shown that with adequate therapy the trapping phenomenon may be reversed.


[Chronic extemporal aregenerative anemia as a possible transition form between primary global bone-marrow aplasia and chronic idiopathic erythroblastopenia not associated with thymoma. Clinical contribution].

After briefly recalling present-day clinical and experimental knowledge regarding chronic idiopathic erythroblastopenia, a case of chronic anaemia with definite aregenerative character is reported. The case was followed up for years; it was refractory to ordinary therapy, slightly and temporarily sensitive to immunosuppression, and nosographically classifiable as a transition form between primary global marrow aplasia and pure chronic erythroblastopenia not associated with thymoma.


[Closed-heart mitral valve surgery].

Good results and an absence of complications were obtained in 100 cases of closed-heart mitral commissurotomy. The present importance of digital divulsion of the beating heart is emphasised. Widening of the ostium was not hampered by the presence of calcifications or tendinous chords. Intracavitary thrombosis proved to be closely related to age, the seriousness of the symptoms, and the state of the ostium surface.


[Prevention of arrhythmias during heart catheterization].

The utility of using beta blocking drugs, specifically Pindolol, as a prophylaxis for arrhythmia during cardiac microcatheterism according to Grandjean's technique has been observed. The drug is even more useful when it is considered that it does not affect dp/dt value.


[Complete polygraphic examination using the Diamont and Killip calculations in the functional evaluation of the heart patient].

Recently discharged infarct patients were examined to assess their ability to rehabilitate. This led to the elaboration of a classification based on polygraphic parameters, rather than the history and clinical record, coupled with comparison with the ideal values given for such subjects by the formula of Diamont and Killip.


[Study on the rapid effects of SAMe in primary and secondary triglyceridemias].

A single dose of 30 mg of S-adenosylmethionine was administered to 15 fasting subjects, scrupolously typified, eight of which were affected with primary hypertriglyceridemia, either of type II B or IV according to Fredrickson's classification, and seven with secondary hypertriglyceridemia. Triglyceride and phosphatide concentrations determined 1, 2, 3 and 4 hours after SAMe administration have shown a decrease in blood triglycerides and an increase in phosphatide levels, with significant values for the subjects with the primary form.


[Importance of the thyroid gland in calcemic homeostasis during intestinal calcium absorption in man].

The importance of calcitonin (CT) in calcaemic homeostasis has been studied in control subjects and in thyroidectomized patients. After administration per os of a calcium load together with a radioactive tracer, calcaemia increases more markedly in thyroidectomized cases while the radioactivity curve shows no difference between the two groups. Unlike the controls, in patients the absorption-induced calcaemic increment curve coincided with the cumulative intestinal calcium absorption curve evaluated by the biradioisotopic method. Thus absorption-induced hypercalcaemia in athyroid subjects would not seem to be controlled by homeostatic factors. Through CT, the thyroid exerts an evident, though limited, braking action on calcaemic increase due to absorption. Considering that absorption of calcium is prolonged for a number of hours, CT secretion will last at least as long as will its action on the skeleton. The saving of skeletal mineral that follows may be considered to be physiologically more important than the effect of the hormone on calcaemic homeostasis.


[Not the beta-thalassemia syndrome but hemoglobinopathy H. Studies of 3 clinical cases].

Clinical and laboratory data for three patients are presented. Electrophoretic separation of the freshly obtained haemolysate showed a fast beta-chain fraction on each occasion. This is typical of Hb H disease. The test for erythrocyte inclusion bodies was also positive. The main clinical and haematological features of the disease are illustrated.


Endometrial stromatosis of the uterus.

This study details the clinicopathologic features of 9 patients with endometrial stromatosis of the uterus, including 1 with the circumscribed variant. The potential of stromatosis for local invasion, intravascular penetration, and pulmonary metastasis is documented. Recurrent lesions often develop late, are amenable to surgical therapy, and do not necessarily portend a fatal outcome. Our findings and those of others indicate that the histopathologic appearance and relatively indolent behavior of stromatosis are sufficiently characteristic to justify its separation from the more aggressive homologous endometrial stromal sarcomas.


Primary vulvar neoplasia: a review of in situ and invasive carcinoma, 1935-1972.

This survey reports the past 38 years of experience with 192 cases of carcinoma of the vulva seen and treated at the Johns Hopkins Hospital. The review stresses the increased incidence of in situ neoplasia and the importance of individualization of therapy. Also the changing concepts in terminology (eg, the leukoplakic vulvitis of the past is the dystrophy of the present) suggest that the precursory alterations of previous discussions must be reviewed in the light of such an altered nomenclature. Features of epidemiologic and histologic importance are discussed.


The pathogenesis of ovarian inclusion cysts and cystomas.

Sections from 1000 ovaries were examined in order to elucidate the pathogenesis of germinal inclusion cysts and ovarian cystomas. Reconstructions and dynamic interpretations of the morphology examined led to the conclusion that these lesions are almost always initiated by the mechanisms of ovulation, both normal and abnormal, and the consequent alterations of the ovarian surface. These mechanisms are described.


Elective appendectomy at salpingectomy for ectopic pregnancy: is it desirable?

Controversy persists regarding the desirability--indeed, the permissibility--of elective incidental appendectomy at salpingectomy for ectopic pregnancy. A study of 7500 surgical specimens submitted to a central laboratory by physicians working among the Igbos of Nigeria indicates that elective appendectomy is carried out more frequently with elective salpingectomy than with emergency salpingectomy for ectopic pregnancy. However, an extensive review of the literature reveals that the latter procedure is relatively safe, and one that can be recommended provided certain requirements are met.


Steroid and prostaglandin relations during the menstrual cycle.

Estrone, estradiol (E2), progesterone, prostaglandin E (PGE), and prostaglandin F (PGF) were measured simultaneously in uterine and peripheral venous plasma. PGE and PGF were determined in endometrial curettage samples. Prostaglandin levels decreased in the absence of an intact blood supply; therefore, tissue samples were all taken before hysterectomy. The levels of ovarian steroids were found to be higher in uterine venous, compared with peripheral venous plasma. PGF levels were significantly higher (P less than 0.01) in secretory endometrium compared with proliferative endometrium and throughout the cycle PGF levels in the endometrium were linearly related to the log10 concentration of E2 in uterine venous blood (P less than 0.001). PGE levels remained constant throughout the menstrual cycle.


Observations on the variability of plasma estriol.

Total plasma estriol and unconjugated plasma estriol were measured daily for 8 days in 9 women during the 38th week of pregnancy. The average coefficient of variation of total estriol concentration was 15.0%; that of unconjugated estriol was 16.5 per cent.


Amniotic fluid cortisol in high-risk human pregnancies.

Amniotic fluid cortisol (AFC) levels were measured in 76 normal and 67 high-risk human pregnancies. When compared to normal gestations, diabetic pregnancies were found to be associated with lower AFC levels, while toxemic, early Rh-sensitized, and other stressed pregnancies had higher mean cortisol values. Serially followed normal and high-risk pregnancies showed a progressive rise in AFC with increasing gestational age. Significant correlation between AFC concentrations and lecithin/sphingomyelin (L/S) ratios was noted in normal, diabetic, and toxemic gestations. These results are concordant with the hypothesis that cortisol may be involved in fetal lung development.


Accuracy of real-time sonography in the determination of fetal viability.

After 8 weeks of fetal age, real-time ultrasonography is a simple, rapid, and highly reliable technic for differentiating a viable from a dead fetus. Fetal movements are invariably detected after 8 weeks of fetal life, and a discrete, fluid-filled, intrathoracic pulsating heart can be seen after 11-12 weeks of fetal life. Absence of these findings, as observed by two independent examiners each viewing the fetus for 3 minutes with real-time sonography, provides reliable evidence of fetal demise. A prospective evaluation of 390 consecutive fetuses yielded only one false positive diagnosis of fetal viability. No living fetus was diagnosed as being dead.


Mucinous cystadenocarcinoma of the retroperitoneum.

A case of a primary retroperitoneal mucinous cystadenocarcinoma of ovarian type found at laparotomy in the presence of two normal ovaries is described. Careful examination of the tumor showed no evidence of ovarian tissue in the wall. The appearance of this tumor could be traced from areas of benign mucinous cystadenoma, through a mucinous tumor of borderline malignancy to a highly malignant anaplastic tumor containing only occasional mucicarmine positive cells. In areas, the connective tissue of the neoplasm, resembled ovarian stroma in appearance. At autopsy, the retroperitoneum was free of neoplasm, but widespread metastases, consisting of poorly differentiated adenocarcinoma were observed. This neoplasm may have arisen from displaced coelomic epithelium or from a supernumerary ovary.


Proliferating Brenner tumor.

Proliferating Brenner tumor is rare as there are only 17 previously reported cases. A case of proliferating Brenner tumor is presented with special emphasis on the pathologic and histologic findings. This variant of Brenner tumor is considered to be benign, as no recurrences have developed in any reported patients.


Failed prostaglandin F2alpha-induced abortion: a case report.

A case of an attempted prostaglandin- and oxytocin-induced abortion which failed when the pregnancy continued to term is presented.


A computerized obstetric medical record.

Duke University has utilized computerized obstetric medical records since 1971. System evolution is described. Deficiencies in the current system appear to evolve from the computer/human interface rather than from basic system design. Critical elements in system success are physician acceptance of the appearance of data collection sheets and printed notes and continual rapid response in programing modification to allow for physician individuality and changes in medical practice. The limiting factor in the potential usefulness of such a system is the rate of incomplete data collection. It is suggested that if the physician were to enter data directly into the computer through a terminal, data collection would be more accurate and complete.


Is the occurrence of a temporal pterygium really so rare?

The author, in keeping with the data quoted in literature, confirms that a temporal pterygium is rare. Out of 1,388 Arab patients with pterygia, only 33 (2.4%) had temporal pterygia. The other statement, i.e. that temporal pterygium rarely occurs without a nasal one, is also confirmed. This was found only in one case (0.08%) out of the total number of people afflicted by pterygium.


Patchy iris atrophy in a case of chronic simple glaucoma.

A case of chronic simple glaucoma associated with 'moth-eaten-like' iris atrophy is presented. In spite of bilateral glaucoma the iris atrophy is only in one eye and is associated with uncontrolled intraocular pressure.


Some observations concerning expulsive hemorrhage.

The authors describe the occurrence of expulsive hemorrhage in 12 patients out of a total of 23,985 intraocular surgical operations (0.05%). As principal etiological factors they regard increased intraocular pressure in combination with coexisting hypertension and vascular sclerosis. Attention is drawn to the manifestation of the complication during the last years under the mild form of subchoroidal hemorrhage as a result of the use of osmotically acting drugs. In 9 cases the eyeball was salvaged.


The histogenesis of retinoblastoma. An electron-microscopic analysis of rosette.

The histogenesis of retinoblastoma has long been a constantly debatable problem since the last century. Rosettes of retinoblastoma have been studied by electron microscopy using 15 eyes as speciments. The evidences suggest that the rosette is at least composed of visual cells and glial (possibly Müller) cells, providing characteristics of the primitive retina. Therefore, it has been concluded that retinoblastoma does not arise from either of the developing neuronal or glial cells, but from the multipotential embryonic retinal cell which is capable of being differentiated into either of these two cellular systems.


Peripheral cone disease.

Peripheral cone disease is characterized by an absent cone function as measured by the ERG but a normal or slightly affected colour vision. The authors examined 20 cases. The most striking fact was the high incidence of myopia and the presence of nystagmus; on the basis of this finding the authors suggest that at least some cases of peripheral cone disease are due to myopic choroido-retinal degeneration (in French: "choroïdose myopique").


Mucoepidermoid carcinomas of the lid. A clinico-pathologic report of two cases.

Two cases of mucoepidermoid carcinoma of the lids are reported in view of the clinical history and histopathology. These tumors were originally described as originating from the excretory ducts of major and minor salivary glands. Such glands not being present in the lids, it is assumed that they developed in the ducts of the glands of Moll. While in case 1 epidermoid cells predominate, mucoid cells are encountered in greater number in case 2. One patient was treated by radical surgery and is free of symptoms for 2 1/2 years; the other had a recurrence 2 years after radiotherapy.


Muscle force analysis of the lumbar spine.

A mathematical analysis of the complex musculature controlling the lumbar spine was performed, using computer analysis of muscle areas seen on serial cross sections through two fresh human cadaver trunks. Physiologic cross sectional areas were used to approximate maximal potential forces generated, and three dimensional centroid lines of muscles were used to approximate their direction of action. Results indicate that the total extensor moment exceeds the total flexor moment only slightly; the rectus abdominis, internal oblique, and external oblique muscles contribute approximately one third to total flexor moment; the erector spinae group of muscles contributes approximately one half of the total extensor moment; and in rotation (twisting) the large abdominal oblique muscles dominate over small "rotator" muscles of the spine. The maximal calculated total extensor moment was 2860 kg.-cm. The magnitude of flexor and extensor moments suggests that the rise in intra-abdominal pressure during lifting is produced by the transverse and posterior oblique abdominal muscles, and not by the rectus abdominis.


Water soluble myelography.

Our experience with 451 water soluble myelograms has been presented. We feel that the advantages exceed the disadvantages and that a water soluble medium is essential for a truly diagnostic myelographic study.


Sinoscopy and sinus disease in children.

Sinus disease in children is usually ethmoidal in location. Acute illness is common and responds well to antibiotics. Sometimes the infection causes ipsilateral orbital cellulitis or rarely an orbital abscess. Systemic administration of antibiotics is usually effective in bringing about resolution. Surgery is not often needed. Acute maxillary sinus disease occurs more often in the older child in the second decade of life. It is manifested by pain in the cheek and teeth, nasal obstruction, and discharge. Treatment with antibiotics is usually effective. For chronic illness, irrigations in most cases bring about resolution. However, occasionally Caldwell-Luc surgery may be necessary.


The effect of 50 grams of glucose orally on a number of biochemical variables.

The values of a number of biochemical variables have been studied before and after a 50-gram load of glucose orally. Reductions which were statistically significant were found for sodium, potassium, urea, total protein, albumin, calcium, phosphorus, urate, bilirubin, alkaline phosphatase, but not for bicarbonate, creatinine, creatine kinase, lactate dehydrogenase, aspartate aminotransferase, cholesterol, triglyceride or chloride. The magnitude of the changes was generally not great, but could be clinically appreciable. The differences may need to be taken into account in comparing population studies.


Diagnosis of Batten disease from urinary sediment: a brief report.

Urinary sediment from a patient with the juvenile form of Batten disease was examined by electron microscopy. Membrane bound fingerprint profiles were found which were similar to those previously described in a biopsy from this patient's thyroid gland. These findings might represent a useful diagnostic tool.


Lymphangiosarcoma arising in a congenitally lymphoedematous arm: case report.

A malignant endothelial tumour arising in a congenitally lymphoedematous extremity is a sufficiently rare tumour to deserve the reporting of a new case. This tumour presented as small nodules on the back of the hand and in spite of midhumeral amputation widely scattered pulmonary metastases were present at the autopsy 28 months after the original presentation.


Metabolic liver disease of childhood.

The broad topic of metabolic liver disease may be divided into three pathophysiologic groups -- storage diseases, cholestatic syndromes, and metabolic defects contributing to hepatocellular necrosis. The important disease entities in each group have been discussed in terms of incidence, clinical course, inheritance, diagnostic criteria, pathogenesis, hepatic pathology, and therapy. An approach to the evaluation of metabolic liver disease has been proposed. It is hoped that this review will be helpful to the clinician who is engaged in the primary care of children.


Hepatic encephalopathy and Reye's syndrome.

The encephalopathy of Reye's syndrome is a potentially reversible, treatable problem in many cases. Treatment requires (1) accurate, early diagnosis; (2) the prevention of anoxia; (3) the restitution of body glycogen stores through the administration of glucose; (4) the control of the complicating cerebral edema; (5) the avoidance of counterproductive treatment measures, such as the unwarranted infusion of sodium bicarbonate and the inappropriate use of respiratory depressing anticonvulsants; and (6) the early and aggressive use of exchange transfusion.


Pulmonary function abnormalities in symptom-free children after bronchiolitis.

Twenty-three children less than 18 months old who had clinical and radiological evidence of bronchiolitis and remained symptom-free thereafter were studied to determine pulmonary function ten years later. Abnormal Pao2, Viso V and RV/TLC ratio were found in the majority of subjects, and 31.3% had abnormalities in all three tests; four and one-half percent had exercise-induced bronchospasm. These changes indicate a residual parenchymal or airways lesion following bronchiolitis.


Physiological-behavioral coupling research in the Soviet science of higher nervous activity: a visitation report.

Behavioral research paradigms presently used by Soviet scientists to explore relations between behavioral and physiological activities are discussed. Each laboratory represented was physically visited by the author during a six month exhange visit to the Soviet Union. Research ranging from central concommitants of language and meaning to biofeedback and peripheral autonomic functions are described.


Intractable diarrhea in a boy with vasoactive intestinal peptide-producing ganglioneuroblastoma.

A 1-year-old boy had intractable diarrhea and symptoms of the watery-diarrhea-hypokalemia-achlorhydria (WDHA) syndrome, a well-known entity in adults. Resection of a ganglioneuroblastoma situated in the neck caused prompt relief of symptoms. The ganglioneuroblastoma in this instance contained the enterohormone vasoactive intestinal peptide (VIP); blood levels of this peptide were elevated preoperatively. After tumor resection, the VIP level returned to normal, and the diarrhea ceased on the day of the operation. The genesis of the diarrhea in relation to the production of polypeptides from neuroendocrine origin is discussed (APUD-cell concept). VIP may be the mediator of the WHDA syndrome in ganglioneuroblastoma.


Folic acid nonresponsive homocystinuria due to methylenetetrahydrofolate reductase deficiency.

Four siblings from a family with 11 children of Irish ancestry were observed to suffer from an essentially identical clinical illness, consisting of delayed psychomotor development in infancy and childhood, severe mental retardation, and upper motor neuron dysfunction. Death occurred at an early age in three siblings. In cases in which detailed physical examinations were performed, ectopia lentis, marfanoid features, and severe bony deformities were absent. Homocystinuria, homocystinemia, relatively normal concentrations of methionine and cystine in tissue fluids, and absence of methylmalonic aciduria were found. A deficiency of methylenetetrahydrofolate reductase was demonstrated in cultured skin fibroblasts from two siblings. Postmortem examination of two of the three patients who died showed extensive vascular thrombosis. No biochemical improvement was observed in the surviving child following treatment with large doses of folic acid.


Insecticide residues in human milk from Arkansas and Mississippi, 1973-74.

Between September 1973 and February 1974, 57 samples of human milk were collected from women residing in selected areas of Arkansas and Mississippi. Residues of p.p'-DDT, p.p'-DDE, p.p'-TDE, beta-BHC, dieldrin, heptachlor epoxide, oxychlordane, and trans-nonachlor were measured by electroncapture gas chromatography; trace amounts of o,p'-DDT and polychlorinated biphenyls were also detected. Additional analytical procedures were employed to confirm the presence of specific residues.


Monitoring agricultural insecticides in the cooperative cotton pest management program in Arizona, 1971--first-year study.

A county-wide pest management program was initiated in Pinal County, Ariz, in 1971 to improve ecologically, economically, and socially the system for protecting cotton from insect pests. In cluded in this program was a plan to determine the environmental impact of any resulting pesticide load in the environment. Monitoring studies were developed for the assay of insecticide residues in soil, sediment, water, and biological materials. This report presents results of the first year's study and analytical methodology used to achieve those results.


[Abdominal tomometry. 1st results in exploration of the liver and pancreas].

Over a two month period, 120 patients were explored using an Acta Scanner tomometer for various hepatic disorders. In parallel, comparison was made of anatomical slices and computed tomography findings in cadavers and isolated livers. This made it possible to recognise normal structures seen at computed tompgraphy and to identify certain hepatic images which might be sources of error. Serial transverse axial sections were used to reconstruct the whole liver in space, thereby making it possible to eliminate certain cases of pseudotumoral hepatomegaly. Systematic densitometry was carried out using hepatic radio-anatomical and pathological studies. This new type of analysis led to a quantified diagnosis in certain diffuse hepatic disorders and a histological approach to tumour lesions. Hepatography using special contrast agents in very low dosage was used in liver computed tomography after animal experiments. This method, free of untoward effects, makes possible the diagnosis of hepatosplenic tumour lesions less than one centimetre in diameter.


The effect of a low-protein diet on some pharmacokinetic parameters of hexobarbital in the rat.

Hexobarbital, given at a dose of 100 mg/kg iv crosses the tissue barriers more rapidly, and is more quickly eliminated from the body of rats kept for a long period of time on a low-protein diet, D-III, than from the control rats.


Unusual presentations of multiple myeloma.

Multiple myeloma has many unusual manifestations, which may obscure the true cause and delay proper treatment. Physicians in all specialties should be alert to this possibility, since myeloma may be at the root of such diverse disorders as carpal tunnel syndrome, peripheral neuropathy, solitary lytic bone lesions, hypercalcemia, and hyperviscosity syndrome.


Electrocution: an ever-present hazard.

Hospitals have become safer from electric shock accidents, but physicians who delegate to the electronics experts full responsibility in this regard will be shirking an obligation. Every physician should be involved both in programs to prevent these accidents in medical settings and in efforts to educate the public concerning the risk of electrocution in and around the home.


Biosynthesis of catecholamines, uptake of 3H-noradrenaline, and reactivity of cardiovascular system of the rat after chronic and acute treatment with a new antidepressant agent, IPF C-45.

The effect of acute and chronic treatment of rats with IPF C-45 on the following biochemical and pharmacological parameters was tested: catecholamine concentration in brain, heart and adrenals, 3H-noradrenaline uptake by cardiac muscle, the action on catecholamine synthesis following treatment with alpha-methyl-p-tyrosine, reactivity of cardiovascular system to catecholamines and isoproterenol-induced tachycardia. Given chronically, IPF C-45 does not affect noradrenaline uptake by the cardiac muscle. Both chronic and acute administration of the drug decelerates catecholamine biosynthesis by inhibition of tyrosine hydroxylase activity. It seems that the action of IPF C-45, a benzonaphthyridone derivative, affects catecholamine metabolism in a manner distinctly different from that of tricyclic antidepressant drugs.


Effect of flavonoids on the platelet adhesiveness in repeatedly bred rats.

Decrease of the platelet adhesiveness in rats by some flavonoids has been stated using the method of glass wool filter. The antiadhesive activity of investigated flavonoids may be ordered as follows: nobiletin greater than isorhamnetin 5,7,4'-trimethylether 3-glucoside greater than isorhamnetin 3-glucoside. Methylation of hydroxyl groups of isorhamnetin-3-glucoside markedly increases its antiadhesive activity.


Neurologic problems prevalent in alcoholics.

The chronic alcoholic who is fortunate enough to escape the cardiovascular, gastrointestinal, hepatic, hematologic, and other systemic effects of alcohol still has little to look forward to. Once neurologic damage has been sustained, abstinence may not result in a return of normal function.


Alcohol and liver disease.

It has recently been shown that alcohol may produce liver damage even in the presence of adequate nutrition. Absolute intake, regardless of the type of alcoholic beverage consumed, appears to be the important determinant of whether liver damage will occur. The spectrum of liver injury produced by alcohol includes fatty liver, hepatitis, and cirrhosis. Liver biopsy is necessary for confirmation and to determine prognosis. Therapy includes abstinence, supportive care and nutritional replacement.


Office treatment of craniocerebral trauma.

The first physician to see a victim of craniocerebral trauma must provide necessary first aid and then rapidly assess the type and extent of injury. The level of consciousness is the most important guide to severity of injury, and frequent appraisal is essential until the critical period is determined to have passed.


Gastroenterology: a hypothetical case of ascites incorporating a management self-test.

When ascites is the presenting symptom and the underlying disease is not apparent, the physician must be aware of the various diseases that may be associated with the accumulation of serous fluid in the abdominal cavity and the various approaches that are available to aid in the differential diagnosis.


Management of asthma. 1. Approach.

Management of asthma requires confirmation of the diagnosis; characterization of the severity, chronicity, and precipitating factors; and development of an appropriate treatment plan based on the established efficacy of the various pharmacologic and nonpharmacologic modes of therapy.


Failure to elicit conditioned taste aversion by severe poisoning.

In an attempt to assess the universal validity of the conditioned taste aversion (CTA) paradigm, various types of poisoning (UC) were associated with the gustatory CS. Water deprived rats were habituated for two days to the drinking box, where water was available for 15 min. On Day 3, access to the CS (0.1% saccharin 15 min) was followed after 30 min by a sublethal dose of the poison (0.15 M LiCl, 4% body weight; 0.1 M sodium malonate, 1% body weight; pyrrolopyrimidine drug BW 58-271, 15 mg/kg; sodium cyanide 4 mg/kg; sodium iodoacetate 40 mg/kg; sodium fluoride 30 mg/kg; gallamine triethiodide 40 mg/kg). Rats injected with the last drug were maintained under artificial respiration until muscular paralysis disappeared. After 4 days of recovery, water deprivation schedule was resumed on Days 8 and 9. During the retention test on Day 10 saccharin consumption dropped by 60% in the LiCl poisoned rats, but not CTA developed in animals poisoned by pyrrolopyrimidine, gallamine, malonate and cyanide. CTA of intermediate intensity was evoked by iodoacetate and fluoride. The absence of CTA was not due to the amnesic effect of poisoning, since LiCl administration to NaCN poisoned rats produced CTA of usual intensity. It is concluded that CTA is not related to the overall severity of poisoning but rather to the effect of the poison on specific interoceptors.


Effects of cholinomimetic drugs and their antagonists injected into vertebral artery of unanaesthetized dogs.

In unanaesthetized dogs, cholinomimetic drugs and their antagonists, catecholamines and 5HT were injected into vertebral artery placed in a skin loop. Acetylcholine (1 mg), pilocarpine (1-2 mg), nicotine (250-500 microng), eserine (100 microng) and neostigmine (250 microng) produced sleep apart from a few other peripheral effects. Sleep for longer periods followed injections of tubocurarine (1 mg), atropine (50 microng) and hexamethonium (500 microng). Adrenaline (50 microng) and noradrenaline (50-250 microng) did not produce significant effects on behaviour and sleep. 5HT (250-500 microng) also caused sleep.


Changes in the coronary vascular system following prolonged exposure to stress.

Hearts of stressed rats showed marked changes in the coronary vasculature. It was suggested that such morphological changes could be explained on the basis of an increased coronary vascular permeability. Endogenous inflammatory substances could induce swelling of the endothelial cells and cause separation of the neighbouring cells from one another, thus allowing the passage of lipid molecules through the endothelial lining. In order to gain supportive evidence for the above hypotheses an electron microscope study was undertaken. The presence of junctional gaps in the endothelial lining of the coronary vascular system was observed following prolonged stress, as well as platelet aggregation. The use of lipid staining of frozen sections indicated the presence of large lipid deposits in the arteriole walls, corresponding to vacuoles seen previously. It would appear therefore, that prolonged exposure to stress may result in pathological changes in the myocardium associated with changes in the vascular endothelial permeability, and platelet aggregation. Pathological changes induced in this way, however, should be inhibitd by high glucocorticoid levels and should not be manifested until adaptation of the steroid response to stress has occurred. Measurement of plasma glucocorticoid levels over the period of prolonged stress shows a good correlation between the adaptation of the steroid response and the onset of a progressive degeneration of the coronary vascular system.


Effect of cortical spreading depression on audiogenic seizure priming of C57BL/6 mice.

At 19 days of age, C57BL/6Bg mice received KCl-induced cortical spreading depression during which they were acoustically primed by exposure to an initial auditory stimulus. At 28 days of age, the mice were tested for susceptibility to audiogenic seizures. Cortical spreading depression had no effect on acoustic priming of C57BL/6Bg mice and it had been previously reported to have no effect on acoustic priming of SJL/J mice. These findings are discussed in the context of pharmacogenetic differences for the effects of aminooxyacetic acid on acoustic priming of C57BL/6 and SJL/J mice.


Some experimental results on W values for heavy particles.

The total ionization produced by ions stopped in argon and tissue-equivalent (TE) gas has been measured in the energy range 25-500 keV. A large ionization chamber was used for this study. The chamber was alternately operated as a proportional counter and as a ionization chamber to measure particle rate and the total ionization produced by them, respectively. The average energy loss per ion pair (W value) was found to be dependent on both the energy and mass of the incident ions. For argon gas the accelerated ions were H+, He+, Ar+; the W value ranges from 23.72eV for 25 keV H+ to 63.12 eV for 50 keV Ar+; Irregularities in the W value were found for He+ in the region 70-130 keV. For TE gas the accelerated ions were H+, He+, C+, N+, O+; the W value ranges from 29.13 eV for 25 keV H+ to 51.45 eV for 50 keV O+. Comparisions with existing data show a good agreement in the absolute values for TE gas and in the relative variations in argon gas. Differences between absolute values in argon might be due to impurities in composition.


Compton scatter imaging of transverse sections: corrections for multiple scatter and attenuation.

The electron density (e cm-3) of a tissue sample can be determined by measuring the fluence of photons which it Compton scatters from a narrow incident beam of X- or gamma-radiation. This technique has been applied successfully to diagnostic denistometry (bone, lung), and less successfully to whole body tomography. In this work, the physics of Compton scatter tomography is examined with emphasis on transverse section scanning. The two major limitations of the scatter technique, attenuation of the single scatter photon fluence (of interest), and contamination of this fluence by multiply-scattered photons, are studied and corrective procedures are proposed. The methods described are applied to a simple test phantom; it is concluded that transverse images with an electron density precision of approximately 5% are possible.


[Comparison of the measurement of absorbed doses by ferrous sulfate dosimetry and by ionization chambers].

A comparison has been carried out among six radiotherapy centres in Canada to determine the absorbed dose by means of ferrous sulphate dosemeters and ionization chambers. Previous to these measurements, epsilon was found to be 2196+/-7 dm3 mol-1 cm-1. The results show that: for 60Co at four centres, two are better than 1% and the other two differ by 2 to 5%; for high energy electrons at four centres, one is better than 1%, another differs by 1 to 3% and the last two differ by more than 3% (the maximum discrepancies are +7% and -6%); for high energy photons at five centres, two are equal to 1%, two others differ by 2 to 4% and the last one differs by + 12%. The chemical dosemeter with irradiation cells made of quartz appeared to be an excellent dosemeter for this type of comparison. The standard error of the means was about 0.3%.


A new method for the accurate localization of 239Pu in bone.

A new method for the localization of 239Pu in bone is described. The method, which is based on semi-automatic digitization of neutron induced autoradiographs, allows the 239Pu to be localized with respect to bone surfaces with an accuracy of +/- 2 micron. Results are presented for the distribution of 239Pu in the central lumbar vertebrae of female CBA mice at 24 h post-injection.


Clinical significance of arthrography of the humeroscapular joint.

This paper discusses the possibility of using arthrography of the humeroscapular joint for further differentiation of the syndrome of humeroscapular periarthritis. A description of the normal arthrogram is followed by a discussion of the arthrographic features of rupture of the rotator cuff, rupture of the long biceps tendon, and anomalies of the joint capsule.


Angiography in the diagnosis of renal scleroderma.

Three patients with different stages of renal scleroderma are presented, and the angiographic diagnosis of this disease is dicussed. No one pattern is specific, but the combination of findings is considered diagnostic of this disease. Pharmacoangiography is proposed for differential of renal scleroderma, and selective renal artery infusion of vasodilators is suggested as a potential means of therapy.


Prostaglandin biosynthesis and catabolism in the developing fetal sheep kidney.

The enzymatic capacity to form and degrade prostaglandins was studied in kindeys from fetal sheep (gestational ages 40,44,49,77,79,116 and 140 days). The prostaglandin system was detectable at all ages. Only prostaglandin F2alpha was formed by renal homogenates at 40 and 44 days gestation; prostaglandin E2 was first formed by the 77 day kidney and became the major prostaglandin by 116 days (3 fold relative to prostaglandin F2alpha). Prostaglandin catabolism took place via the PG 15-hydroxy dehydrogenase and PG 13-reductase pathways. Catabolism was first detected at 40 days gestation and rose with age to an activity (15-PGDH) approximately 80 ng/min/mg protein in the term kidney. Only PG 15-hydroxydehydrogenase activity was detected at 40 days gestation, but PG 13-reducatse activity became evident by 116 days and persisted until term. As with fetal sheep lungs (see preceding publication) PG 13-reductase activity was saturated quickly. These results confirm our observations with other tissues that prostaglandin catabolism is variable during ontogeny.


Prostaglandin E in the secretions of allergic rhinitis.

Prostaglandin (PG) was extracted from nasal secretions of individuals with hay fever and from nasal washings of normal subjects. The extract was chromatographed in a silicic acid column and the purified PGE fraction was converted to PGB by alkaline dehydration. The PGB was then measured by a competitive radioimmunoassay with tritiated PGB1 and anti-PGB1 antibody, employing the double antibody technique. PGE was detected in the secretions of 6 of 12 hay fever patients and in the pooled normal nasal washings.


Pulmonary inactivation of prostaglandin by hypertensive rats.

Lungs of normotensive and genetically hypertensive (GH) albino rats were perfused in stiu with 5 ml/min Krebs solutuion containing 100 ng/ml PGE2 or F2alpha. Inactivation rates of 76,0 ng PGF2 alpha and 146,3 ng PGE2/g dry wt. lung/min were recorded for GH rats. Values for normotensive controls were 191,2 and 226,1 ng/g/min.


Effect of prostaglandin PGE2alpha on the synthesis of placental proteins and human placental lactogen (HPL).

The biosynthesis of placental proteins and placental lactogen (HPL) was studied in vitro in 10-12 week, 16-18 week and term human placenta in the presence and absence of PGF2alpha. The highest 14C-leucine incorporation was detected in 10 to 12 weeks old placentas of PGF2alpha to the incubation medium depressed the rate of incorporation of 14C-leucine into placental proteins in a dose dependent manner. Placentas most sensitive to this action of PGF2alpha were those obtained at 18 weeks of gestation followed by placentas at term. In vivo application of PGF2alpha for therapeutic induction of abortions resulted in the marked inhibition of placental protein synthesis in vitro.


Reproductive performance after prostaglandin-induced labor.

The data of this follow-up study fail to prove that elective induction of labor at term by amniotomy and intravenously or orally administered PGF2alpha or PGE2 has an untoward effect on reproductive performance. If, however, the procedure is complicated by a serious degree of sustained uterine hyperstimulation, permanent damage to the internal cervical os may ensue, as illustrated by one of our patients.


Prostaglandins in the isolated testicular capsule of immature and young adult rats.

The presence of prostaglandins (PGs) E1, E2, F1alpha, F2alpha and the metabolite 13,14-Dihydro-15-keto PG Falpha (1+2) has been studied in the isolated testicular capsule of Wistar rats (22 to 90 days of age). Handling and homogenization of tissues were controlled and the in vitro synthesis and degradation were prevented by immediate freezing of samples and homogenization in a solution containing a PG synthetase inhibitor. The PGs were measured by specific and sensitive radioimmunoassay. The isolated rat testicular capsule was found to contain mainly PG E2 and PG F2alpha at concentrations about 100 times higher than those in decapsulated testes (ng/g of tissue).


Effect of estradiol on prostaglandin metabolism in rat uterus.

The purpose of this work was to investigate the effect of a single injection of estradiol (10 microng/rat) on prostaglandin(PG) metabolism in rat uterus. The PG content of uterus was increased within 6 hr after estradiol injection but the incorporation of 3H-arachidonic acid into PG in uterus was not changed within same period. The uptake of 3H-PG was increased within 6 hr after estradiol injection. In these results, it is discussed that PG from other tissue are also involved in the metabolism of PG in uterus.


Angiotensin II effects on plasmatic renin activity.

Intravenous infusion of angiotensin II into the cat (4.13 microng/45 min) produces a decrease of plasmatic renin activity. This reduction was not modified after the bilateral denervation of the kidneys or section of both carotid and aortic nerves. The reserpinization of the cats does not modify the angiotensin effects on the renin plasmatic concentration. These observations suggest that the sympathetic nervous system and the catecholamines do not alter significantly the effects of angiotensin II on the renin secretion.


[Osmolar and free water clearance as renal function test during extracorporeal circulation with parcial and total hemodilution (author's transl)].

Four groups of dogs are subjected to extracorporeal circulation. Total hemodilution is used in groups I and II, either in normothermia or moderate hypothermia at 30 degrees C. Partial hemodilution is used in groups III and IV with identical temperature variations. The animals are kept under extracorporeal circulation for 120 min. Osmolar and free water clearance are measured at basal conditions after 40, 80 and 120 min. The present results show that total hemodilution should be used in those patients subjected to extracorporeal circulation where renal function has been previously disturbed.


[Inhibition of urease by hypoglycaemic drugs (author's transl)].

The effect of oral hypoglycaemic drugs (derived from sulphonylurea) on urease activity in the quantitative determination of urea has been studied. These compounds have been found to produce a competitive inhibition of enzyme activity with respect to substrate. Possible interference of these antidiabetic agents upon urea analysis is discussed.


Ultrasonic diagnosis and aspiration of loculated pleural effusion.

A method of localizing and evacuating pleural effusions under visual control is described which in the author's opinion is an improvement and enhancement over current procedures. This method is easy, rapid, safe and causes no distress to the patient. On many occasions, failures at puncture of loculated fluid by conventional methods can successfully be accomplished under ultrasonic guidance.


The different flow pattern in tracheal stenosis, bronchospasm and emphysema.

We can conclude that the combination of high FEV2/1 index and a "peak-flow-less" flow-volume loop is characteristic for the presence of proximal airway stenosis and is a reliable means for differentiation against bronchospasm and emphysema. In comparison, the measurement of airway resistance, FEV1 alone, inspiratory shift of mid-breathing level etc., indicate only the presence of airway obstruction, but fail to give specific information for functional differentiation of bronchial obstruction and morphological evidence of proximal airway stenosis.


[Psychodynamic observations on a group of patients treated with lithium carbonate (author's transl)].

The authors consider some psychodynamic aspects which may have influences Lithium Carbonate therapy in 45 patients. Transfer and contra-transfer situations are considered emphasizing how Lithium therapy with its characteristic features may promote a peculiar relationship with the therapist answering some of the needs of cyclothymic patients. The physical needs of dependence from the therapist who controls both ingestion and expulsion of Lithium can be accepted without feeling of guilt by the patient as it usually happens in cyclothymic pre-genital personalities. Lithium allows the therapist to appear as if he had great power on the patient and makes it possible for the therapist to avoid the anxiety of losing the patient at the end of the episode and to accept the pre-genital relationship as a necessity in order to continue his therapy.


[Foix-Chavany's syndrome: clinical and electrophysiological study of 1 atypical case (author's transl)].

An atypical case of "Foix-Chavany syndrome", is described. A definite diagnosis could be achieved through an electromyographic and reflessological investigation (jaw reflex, blink reflex, perioral reflex), when a poor clinical history was not helping towards a definite diagnostic conclusion. It is proposed that the diagnosis of "Foix-Chavany syndrome" should not be limited only to classical "facial diplegia of cortical origin" or to "facio-linguo-pharyngo-laryngo-masseter paralysis of cortico-subcortical origin". Considering the great clinical variability of a syndrome with a common anatomical substrate, it is proposed to use the eponym for all syndromes characterized by: 1) a motor deficit in the cephalic district with relative integrity of motor function of the limbs; 2) a dissociation between loss of voluntary motility and preservation of reflex and automatic motility.


[Neurosurgical emergencies: cranio-cerebral injuries and their diagnosis and therapy (author's transl)].

The neurotraumatological case material of the Neurosurgical Clinic of the University of Pavia, from the August 1st 1972 to July 31st 1975, includes N. 122 patients, submitted to neurological surgery. All data are examined and discussed in relation to age, to the coma level, to the type of endocranial lesion and the results obtained are compared with the data of literature. The incidence of associated lesions, both endocranial and in other regions, is made standing out more clearly. The importance of an early diagnosis, by neuroradiological tests, is made cospicuous in order to get a correct surgical therapy. The survival is discussed in relation to the type of surgical act and of pathology.


[Encephalitis during mycotic dissemination in a patient (clinical and post mortem findings) (author's transl)].

A case of disseminated mycosis with encephalitis unobserved in life is reported. A mycosis infection ought always be taken into consideration every time that a clinical impression of encephalitis, meningitis or cerebral abcess is reached. Criptococcosis, Histoplasmosis and Candidiasis may present as a meningitis, which the Nocardiasis and the Cladosporosis may appear as an intracranial abscess in the absence of significant lesions of other organs. Many deep mycosis prove to have characteristic lesions in other organs before affecting the Central Nervous System. Development therefore of neurological symptoms ought to make one think of a dissemination at CNS level. Finally Candidosis and Aspergillosis ought to be suspected in all cases of progressive general weakeness after an illness especially when treated with antibiotics, citotoxis drugs, or hormonal steroids. In many cases the neurological lesions represant a manifestation of terminal type in a subject with many more lesions than one would suspect at first.


[Experience with percutaneous embolization of renal tumours (author's transl)].

We have repeated first observations of various authors of blocking angiography in 8 patients with renal tumours. Comparing angiographic findings and the surgical specimens, the success of embolization could be assessed. Control angiography 2 months following an inoperable renal tumor showed shrinking of the tumour by about one half and improvement of the general condition of the patient.


[Multiple gastric carcinoid, its diagnosis in gastric polyposis (author's transl)].

Carcinoid of the stomach, hormonally inactive, is diagnosed with MDP, gastroscopy and biopsy. Solitary carcinoids are treated with excision in toto with immediate histology of the edges. Multiple gastric carcinoids require gastrectomy.


[New perspectives in the treatment of occult, non invasive breast cancers by means of non-notilating surgical therapies (author's transl)].

Six cases of occult, non-invasive cancer or cancer lobular "in situ" of the breast are presented which were treated by means of non-mutilating surgical therapies (such as subcutaneous mastectomy or tumorectomy). Control between 1 and 4 years.


[Extrarenal excretion of urographic contrast media in renal failure (author's transl)].

Communications about extrarenal excretion (ERE) of urographic contrast media are not frequent. The contrast medium is secreted via the liver. It can be observed in the gallbladder and the colon. A case of ERE in a 28 years old patient with renal failure is described.


[Percutaneous aspiration biopsy aided by computertomography (author's transl)].

Computer tomography (CT) permits recognition of normal and pathologic structures and renders percutaneous biopsy easy, giving a high degree of diagnostic accuracy with few complications. It is an ideal technique for the biopsy of foci which cannot be reached otherwise.


[Paget-von Schroetter-syndrome (awthor's transl)].

Report on 3 cases of thrombosis of the axillary vein (Paget-von Schroetter-syndrome). In this relatively rare condition phlebography and early thrombolytic treatment are required.


[Myelopathies cervical arthroses. Apropos of 14 personal cases, 12 of which were operated on].

Reviewing fourteen cases, the authors show that cervical myelopathies present by spastic quadriplegia associated in half of the cases with sensory impairment and in a third of cases with radicular signs in the upper limbs. Tomography always shows posterior discal osteophytosis, sometimes gross, which reduces the lumen of the canal more particularly since it is associated (eleven times out of fourteen) with constitutional stenosis, of variable severity. Opaque or gaseous myelography makes it possible to exclude malformation or new formation and will demonstrate cord constriction within the canal. Surgical treatment (eleven laminectomies, 1 discectomy-artrodesis) resulted in 7 improvements, no change in 3 cases and 2 exacerbations. The myelopathies appeared to be due to repeated contusions of the cord and its arteries against the wall of the canal, caused by neck movements.


Function of neutrophils in preleukaemia.

The function of blood neutrophil granulocytes was studied in vitro in 17 patients with preleukaemia. 3 patients had a cellular defect of chemotaxis. 2 of them had monosomy-7 in bone marrow karyotype, in 1 associated with the deletion of the long arm of a chromosome 20. The third patient had trisomy-8. In the patient with trisomy-8, the high percentage of band neutrophils was possibly associated with the chemotactic defect. In another patient with trisomy-8 chemotaxis was normal. There was a statisically significant tendency to reduced phagocytosis and impaired ability to kill Staphylococcus aureus. 1 patient with a chemotactic defect and monosomy-7 suffered from repeated infections. The other 2 patients with defective chemotaxis had several febrile episodes most probably of infectious origin, and 1 of them died in sepsis. All of these 3 patients had cutaneous abscesses. It is concluded that defects in neutrophil granulocyte function are not uncommon in preleukaemia and may result in reduced resistance to infection.


The relationship between Normotest and Thrombotest in patients on oral anticoagulant therapy.

Normotest (sample volume: 25 micronl) and Thrombotest were performed in parallel on 150 consecutive capillary blood samples from patients on long term oral anticoagulant therapy. The ratio of Normotest to Thrombotest decreased from 2.50 at a Thrombotest level of 5-5.5% to 1.95 at a Thrombotest level of 13-13.5%, indicating that the effects of PIVKA were more pronounced at lower levels of coagulation activity. The influence of varying sensitivity of the thromboplastin reagents to PIVKA is discussed. The therapeutic range of Thrombotest (5-10%) corresponded to a Normotest level of 12-20%.


Evidence of local synthesis of smooth-muscle antibodies in the central nervous system in isolated cases of multiple sclerosis and chronic lymphocytic meningoencephalitis.

Paired samples of serum and concentrated cerebrospinal fluid (CSF) from 53 patients with multiple sclerosis (MS) and from 36 patients with other neurological diseases were adjusted to an equal concentration of IgG and examined for occurrence of auto-antibodies. Anti-nuclear antibodies, anti-mitochondrial antibodies, and rheumatoid factor were not detected with increased frequency in the materials studied. Smooth-muscle antibody (SMA) was, however, detected in CSF and serum from three patients with MS and one patient with chronic lymphocytic meningoencephalitis, and in the CSF only from one additional patient with MS. The SMA activities of the CSF were 4 to 16 times higher than in the matching sera, suggesting a local SMA synthesis within the central nervous system. The SMA was associated with electrophoretically restricted fractions of IgG, but an association between SMA and oligoclonal IgG of the CSF could not be demonstrated in the SMA-positive patients by the methods used.


IGE in human urine and milk.

IgE was found in urine from healthy adult volunteers at very low levels (approximately 0.003-0.010 IU/ml), corresponding to a 24-h excrection rate of 3-16 IU. IgE was not detected in 36 out of 47 samples of milk and colostrum. In samples from six women the protein was present at low concentration 1-2 days postpartum but was not detected in later samples (usually day 5 or 6). Mammary secretions from four allergic donors were studied, and IgE was detected at low concentrations in samples from the two most severely affected individuals. The levels of IgE observed in both urine and milk suggest that there is no significant synthesis of the protein in either the urinary tract or in mammary tissue.