[Heterogeneity of natural populations of staphylococci].

It was revealed by the replique method that the Staphylococcus aureus populations were (in the primary cultures of material obtained from sick and healthy individuals) heterogeneous by phage type, pathogenicity signs and by the resistance to the antibacterial preparations. The extent of heterogeneity could be assessed by the number of variants and by the percentage of the most numerous variant. It differed in different groups of the patients examined. The extent of heterogeneity decreased in cloning the subcultures; this was in favour of the fact that heterogeneity of the primary cultures was caused chiefly by the entrance into the human organism of staphylococci of different biotypes. The replique method permitted to reveal the changes in the clonic structure of the staphylococcus population in the course of the disease, the effect of antibacterial therapy, the appearance of exogenous staphylococci, and their further fate.


[Development of an IHI test for detection of immunoglobulins of different classes].

The authors elaborated a method of obtaining stable erythrocytic diagnostic agent intended for titration of immunoglobulins A, M and G in the human blood serum by means of the indirect hemagglutination inhibition test (IHI). The suggested microdroplet method of conducting the IHI test permits to reveal (X +/- m): IgG--0.29 +/- 0.15 microng/ml, IgM--1.56 +/- 0.2 microng/ml, and IgA--0.16 +/- 0.07 microng/ml. The test is highly specific, simple and can be used in practical serological laboratories. The result is obtained in 2 1/2--3 hours.


[Serum immunoglobulins in patients with food poisoning, salmonellosis, typical and atypical dysentery].

A study was made of 350 patients suffering from food toxinfections and dysentery; the quantitative variations in the Ig content were determined in the blood serum by Mancicni's method, depending on the period and the severity of the disease. A total of 768 investigations were conducted. Distinct shifts in the IgA and IgM were revealed in the patients with food poisoning and salmonellosis pursuing a moderately severe course; IgG content varied within the normal range during the whole observation period. At the acute period of dysentery the content of all the three immunoglobulin classes (both in the typical and atypical course of the process) displayed no significant differences from that in the healthy individuals; during the convalescence in typical and atypical (gastroenterocolitic) course of dysentery the Ig content constituted, respectively: IgA--292.0 +/- 11.5 and 387 +/- 14.1, IgM--84.8 +/- 3.1 and 104.0 +/- 8.0; Ig G--1500 +/- 38.0 and 1730.0 +/- 62.7.


[Unusual small forms in the growth cycle of halprowia (chlamydia) and their possible relation to manifestations of L-transformation].

The authors carried out a comparative electron-microscopic study of the ultrastructure and the developmental cycle of 15 Halprowiae (chlamydiae) strains isolated in different pathology from man and animals. Halprowiae were cultivated in the yolk sac epithelium of the developing chick embryos and in the L-cell monolayer cultures without any special action of the antibiotics and medicines. Formation of minute round structures ("minute forms"), 50--120 nm in diameter, separating from the protoplast into the periplasmic space and surrounded with cytoplasmic membrane by the vegetative forms of a number of strains (MP, AP-23, 25-SM, LB-1, MyB), is described. Along with minute forms, Halprowiae formed polymorphous giant bodies with long protrusions into the inclusion cavity; there was also a separation of vesicles of the cell wall membrane. This apparently indicated a structural derangement of the cell wall in these vegetative forms of Halprowiae. On the basis of similarity of the mentioned structures detected in Halprowiae reproduction to the known morphological characteristics of the L-form bacteria a possibility of L-transformation in Halprowiae during the normal developmental cycle as a peculiar compensatory adaptation to the action of host cell is supposed.


[Cholera vibrio fractions. I. Isolation of alkaline extracts of cholera vibrios and a study of their biological properties].

The authors suggest a well-reproducible method of preparation of a biologically-active fraction of an alkaline extract of cholera vibrio from the strain 569B of Inaba serological type consisting in a preliminary triple removal of endotoxin (O-antigen) of the causative agent from the microbial cell suspension with trichloracetic acid with the subsequent extraction of the microbial mass and neutralization of the extract obtained capable of effective detection of the state of specific sensitization of the organism to cholera vibrio. Preparations of the alkaline extracts (cholera allergen) obtained were standard by chemical composition, they were characterized by a high protein content (up to 77%) and were practically nontoxic. These preparations can be used as a bacterial allergen for the experimental investigations.


[Bactericidal effect of cationic proteins of cellular origin on staphylococci].

A study was made of the bactericidal action of thymus histones, histone-like substance, from the nuclei of rabbit leukocytes and lysosomal cation proteins from the same leukocyte on different staphylococcus cultures. The majority of the strains of coagulasoneagative staphylococci perished under the effect of the preparations tested; cultures forming this enzyme retained their viability, irrespective of their virulence for mice, their capacity to the lecithinase formation and to mannite fermentation. The preparations studied possessed a different bactericidal activity. It is supposed that there existed an correlation between the sensitivity of staphylococcus strains to the antimicrobial action of the leukocytic cation proteins and the index of phagocytosis completion of hese microbes.


[Immunoglobulins and their specific activity in cholera].

The authors studied the quantitative content of nonspecific immunoglobulins and antibodies of the IgG-, IgA-, and IgM-classes to the O-antigen of the cholera vibrio. There proved to be no marked dynamics of the quantitative immunoglobulins indices of various classes established at periods from the 3rd and the 18th day from the beginning of the disease in persons who sustained cholera. In persons who sustained cholera in the nonendemic focus of the disease serum antibodies were represented chiefly by the IgM-antibodies. The formation of IgA-antibodies in the persons examined differed from the regularities detected for the IgG- and IgM-classes and were characterized by rapidity and short duration. No correlation was found between the immunoglobulin levels of various classes and the serum antibody levels in case of cholera affection.


[Group-specific antibodies to meningococcus of serogroup A in different forms of meningococcal infection].

The authors present analysis of the data obtained in titration in the passive hemagglutination test of the sera obtained from 2498 persons with erythrocytes sensitized with specific polysaccharide of group A meningococcus. It appeared that in children aged under one year, even in those suffering from a generalized form of meningococcus infection, antibodies almost failed to be produced, whereas in older children the mean geometrical of the titre on the 5th-14th days of the disease constituted 1:343. The mean titres in the localized forms (nasopharyngitis and carriership) constituted 1:29.5 and 1:15.1, respectively; in the case of detection in the nasopharynx of meningococcus of group A the mean titre was 1:61. One to two months after sustaining any form of the infection the antibodies disappeared almost completely. Thus, the detected antibodies served as the indices of a recent meningococcus infection, including the asymptomatic one. From 12 to 49% of the persons with antibodies to meningococcus A in titres of 1:20 and over were found in the collective bodies in which meningitis patients were present. No antibodies were revealed in the donor sera collected in the localities with complete absence of meningitis, but in the localities with the recorded meningitis morbidity the sera contained antibodies to meningococcus of group A, the percentage varying from 1.5 to 40 depending on the epidemic curve level. A conclusion was drawn that detection in the collective bodies of over 10% of the persons reacting positively in the passive hemagglutination test with polysaccharide of group A meningococcus pointed to the threatening epidemic situation, despite the seeming welfare.


[Comparative analysis of the clinico-constitutional and premorbid features of epilepsy in inbred and outbred families].

By means of clinico-catamnestical and anthropological methods the author examined 162 epileptic patients in the initial period (up to 5 years) and 473--in the florid period of the disease (5--24 years). The author demonstrates distinct clinical (the traits of the onset, development of the process, personality changes, invalidization), morphological (dysgenesia) and premorbid characterological and intellectual traits in patients of consanguineous and nonconsanguineous families. The results demonstrate a correlation between the fenotypical traits of epilepsy and the constitutional morphological and premorbid features. The achieved data point to the necessity of a differentiated approach to therapeutical measures and sociolabour rehabilitation in patients of consanguineous and nonconsanguineous families.


[Thomsen's myotonia (clinico-morphologic study)].

The report deals with the results of a clinico-morphological study of 14 patients with Thomsen's myotonia. The muscles obtained during biopsy were studied by electron microscopy. It was established that in patients with a mild and moderate degree of the disease the muscle fibres did not differ from normal ones. Only in patients with severe forms of the disease was it possible to detect focal changes of the myofebrillar apparatus, a moderate hypertrophy of the sacrotubular system and an enlargement in the size of the mitochondria. These changes as it is assumed, are morphological expression of the myotonic phenomenon and reflect the changed functional relationships in the link Ca-troponin-actomyosine complex.


[Role of genotypic and environmental factors in the origin of cerebral circulatory disorders in young persons].

The paper is concerned with the results of a comparative analysis of clinical signs in cerebral crises, strokes and other symptoms seen in 2 groups of patients younger than 45 years of age, and differing only in the presence (104 cases) or absence (108 cases) of hereditary-familial aggravation by a cardio-vascular pathology. Although in the first group of patients there was a certain tendency towards a more severe disorder of cerebral circulation, it was not possible to mark any statistically significant differences in the clinico-biochemical indices. At the same time different negative environmental influences (alcohol abuse, brain injuries, severe acute and chronic mental traumatization, frequent exacerbations of focal chronic infections of the ENT and the lungs, etc.) and a combination of 2 or 3 of them were significantly more frequently seen in patients without hereditary aggravation (34.8%) rather then with it (10.7%). A conclusion is being made that genotypical factors do not play a decisive role in the etiology of cerebral vascular disorders in young people. They only condition a lesser stability of the organism to unfavourable environmental factors and their different combinations.


[Rheoencephalographic findings in migrainous cephalalgia and their dynamics during treatment with stugeron].

A REG study of 90 patients with migraine headaches demonstrated that a significant role in their genesis is played by regional hypertonia of cerebral vessels and phenomena of cerebral angiodystonia with a tendency towards spastic reactions rather than hypotonic. The use of stugeron for preventive treatment of migrain cephalgia was effective in 85 of the 100 treated patients and especially in those cases where there was an increased tone of the cerebral vessels according to the REG data. The most constant changes demonstrated by the REG were normalization of the vascular tone, more expressed in initial hypertone and to a less extent its influence on the cerebral blood flux (more frequently towards its increase and a decrease of hemispheric asymmetry). The authors consider it expedient to use REG methods when prescribing stugeron.


[State of iodine metabolism in patients with temporal lobe epilepsy].

Using a radioisotope concurrent analysis the authors studied the concentration of general thyroxine (T4), the coefficient of effective thyroxine, the equivalent content of free thyroxine in the blood serum and the fixating capabilities of plasma protein in relation to T3 in patients with temporal epilepsy. The study depicted complex changes of the hormonal activity of the thyroid gland. Considering the amount of the index of free thyroxine and coefficient of effective thyroxine, the state of the thyroid gland in cases of dissociated indices was qualified as hypo-, hyper- and euthyroid (respectively in 3, 8 and 10 patients). The authors discuss the possible pathogenetical significance of changes in the hormonal activity of the thyroid gland.


[Serotonin metabolism in children with different forms of oligophrenia].

The authors examined the serotonin and 5-oxyindolacetic acid content in the blood plasma and diurnal urine excretion of 5 OIAA of 37 children from 7--12 years of age with sthenic and asthenic forms of mental retardation. It was possible to show an increase of the initial serotonin and 5-OIAA level in the blood plasma of patients with the asthenic variant. In a prolonged loading with reserpine there was a disturbance of the corresponding adaptive mechanisms. It is assumed that the serotoninergic brain structures may be involved in the pathogenesis and formation of the clinical forms of oligophrenia.


[Characteristics of tyrosine balance and oxidation in oligophrenia of different origin].

The author conducted a study of the tyrosine balance and the urine excretion of its metabolites: paraoxyphenylpyruvic and homogentistic acid in 39 oligophrenic patients of a nontypical and of 90 with an exogenous genesis. In exogenic forms of oligophrenia the oxidation of tyrosine was characterized by hypertyrosinemia, hypertyrosinuria, a drop of paraoxyphenylpyruvic acid excretion. In genotypical oligophrenia the most typical were high indices of tyrosinemia, tyrosinuria, excretion of paraphenylpyruvic acid and homogentistic acid.


[Importance of scintigraphy in the treatment of hepatic echinococcus].

Report of 105 cases operated upon for hydatid disease of the liver. In all cases scintigraphy was performed preoperatively. The authors came to the following conclusions: 1) Scintigraphy of the liver shows in a great percentage (73%) of cases accurate localisation, dimension and number of cysts. 2) This examination is of great importance to the surageon as it enables him to choose the most appropriate approach to the cyst, reducing at the same time of spilling its content. 3) In one third of the cases in which the cyst was located under the diaphgragme the x-ray finding was negative. Particularly in that cases scintigraphy was of great help.


[Surgical treatment of complications of liver echinococcosis (analysis of 20-year materials].

Analysing our twenty years' materials--394 cases, we found a high percentage of complications--79 percent. Cases of infections suppurations and calcifications due to parasites were most numerous 41 percent. Next, but surgically more interesting were cases of perforations in the abdominal cavity, then penetrations into the bile ducts, the diaphragm and the thorax, and finally cases of the gall bladder affected by the perycyst due to parasites. Solutions of several characteristic cases form every group, are presented in the paper. The conclusion drawn on the basis of our materials is that each case, while respecting the basic principles, requires its own solution.


[Anatomo-functional basis of the liver resection technique in the treatment of hepatic echinococcosis].

Hepatic resection of segments or lobes in same cases the hydatid desease of liver is necessary surgical therapy. The articl presents anatomy's bases for major hepatic resection. It's also present preoperativne care, technic of surgical therapy and postoperativ therapy. The standard liver functional testes should always be performed, in case functional insuffitiency we recomended different metods of temporary support.


[Some interesting cases of pulmonary echinococcosis].

The authors had the opportunity in the interim of the past fifteen years to treat at the hospital in Zadar 277 patients suffering from hydatid disease of different body organs. The most frequently affected was the liver--56.3%, followed by the lungs--24.9% and 18.8% were other organs. Out of the 69 cases of affected lungs, the authors chose several which they considered to be most interesting. These consisted of: 1. A fistula between the cyst in the liver and the right lung. 2. A syndrome of the middle lung lobe caused by the hydatid cyst. 3. The Cumbo's symptom following a perforated lung cyst as a definite sign of hydatid cyst. 4. A hydatid cyst in a two years old child complicated with pneumothorax, peripnemocyst and perforation of the cyst itself in the bronchus. And finally 6. The case of a primary liver cyst which perforated in the vena cava caudalis with secondary dissemination in both lungs.


[Echinococcosis of the bone system].

In the above exposition the basic characteristics of bone localization of echinococcus have been shown specially stressing its specific shape of exogen growth, its malign course, bad prognosis, long asymptomatic course, then diagnostic and differential diagnostic difficulties. We specially stress surgical problems, the value of radical surgery whin possible. Our three cases of echinococcus of the ribs prove the validity of radical surgery. Although we are most often forced to have steady palliative interventions we wished to stress their importance. From the above mentioned cases it is clear that they rarely lead to complete cure or to long remissionss which prolong and make easier patient's life. As far as the psyche of the patient is concerned it gives the patient hope for recovery, and the surgeon the power for endurance and patience.


[Renal echinococcus].

Incidence of renal hydatid cyst is rare and its diagnosis should be made with the utmost care and after subjecting the patient to intensive investigations to exclude other pathologies. Because of the rarity of the disease and because of the clinical similarity with other surgical lesions affecting the kidney, mainly renal tumours and simple renal cysts, the authors are encouraged to record thirty-nine cases of renal hydatid cysts. The value of investigations as aids in the diagnosis has been discussed. The direct consequence of uncertain diagnosis is the risk of performing unwarranted ablative surgery, whereas conservative treatment is currently advocated by the majority of investigators. We followed the policy of saving as much renal tissue in each case, and we obtained results that encourage us to believe that nephrectomy for renal hydatidosis can be avoided in a great many cases with complete therapeutic success. With the exception of cystectomy and marsupialisation--which is recommended as a lifesaving procedure, the method of our choice consisted of a partial pericystectomy, i.e. resection of the pericystium exteriorized until it was flush with the renal parenchyma.


[Dumping syndrome after selective vagotomy and pyloroplasty].

We have analysed the late complications (3--6 years after the operation) in 48 patients we treated by selective vagotomy and pyloroplasty because of duodenal ulcer. Authors have encountered six patients with so severe postoperative dumping syndrome that revison surgery has been performed. By reoperation there was no evidence of peptic disease but gastroduodenitis. After additional antrectomy dumping symptoms disappeared in all but one patient and radiologically the rate of test meal emptying of the stomach was reduced.


[Mediastinal pancreatic pseudocyst].

This article presents a case of pseudocyst of the pancreas, clinically manifested as a benign tumor of the mediastinum. The cyst had spread from the retroperitoneum into the posterior lower mediastinum behind the oesophagus. The diagnosis was proved by the histological examination of the Wall and by analysis of amylase of the cyst contents, for the intraoperatively discovered cyst of the pancreas, the wide drainage into the pleural cavity has been an effective procedure. According to the data of the literature the mediastinal location of the pseudocyst of the pancreas is very rare.


[Pancreatic pseudocysts and cysts treated during the last 10 years].

In the period from 1965 to 1975, in our department were treated ten pseudocysts and cysts of the pancreas. All of them, except two, were operated. Operation was performed in eight patients (external drainage 2 cases, internal drainage 5 cases and excision in 1 selected case), and in two patients occured spontaneous regression. Diagnostic problems, review of treatment and postoperative results were taken into consideration. The most satisfactory results of treatment of uncomplicated pseudocysts have been obtained by internal drainage.


[Unusual diseases which may create the picture of acute appendicitis].

Five specialy interesting cases operated under the clinical picture of acute appendicitis have been described by authors. Another completely different disease have been found during the operation, which required spread surgical treatment combined with blood transfusion even if we didn't identified the blood group. For this reason you have to pay attention while making a final diagnosis because the mistakes are very common, about 25% in out patient department while 1--3% in clinical conditions.


[Is an early diagnosis of neoplastic processes of the rectum possible?].

The better operative results and lasting cure of malignant tumors can be ascribed to early detection rather than to the improvement of surgical techniques. In the cancer of the breast and gynecological carcinoma the importance of early detection has been more emphasized than in cancers of other location. On a total of 5210 rectoscopies performed the authors detected 285 malignant tumors of the rectum. On the average the diagnosis was made 9 months after the appearance of the first symptoms. In 74% of cases the tumors were detected already by the digital examination, while in 46.9% of the rest of the patients inoperable carcinoma was involved. By obligatory digital examination in all cases of "hemorrhoidal" complaints and additional rectoscopy neoplasms of the rectum can be detected at an early time and more patients can be afforded lasting cure.


[Surgical problems of acute cholangio-pancreatitis in man and in experiment].

The article tried to find a relationship between billiary tract disease and pancreatitis. Reflux of duodenal contents into the pancreatic duct is the mechanism responsible for activation of pancreatic enzymes. They cause a varying degree of vascular damage and leading to changes from oedema to frank infraction. If this view of pathogenesis is correct it should also explain the relationship between pancreatitis and known aetiological factors.


[Hurthle's tumor of the thyroid gland].

Refering to last five years experiance in treatment 12 cases of the Hürthle--cell adenomas and one case of Hürthle--cell carcinoma, the author describes characteristics, diagnosis, treatment and aspecialy pathohystological picture of Hürthle--cell toumors of thyroid gland. This material from Surgical clinec Rebro in Zagreb is interesting because of distinction of this toumors, theirs hormonal and metabolic activity, especialy a difference between benign adenoma and malignant carcinoma, in regard of clinical and patohystological aspect of Hürthle--cell toumors. On base of this resaults the operative treatment was performed. Preoperative diagnosis was made with rely hight rate of security, using punction, scintigraphy and clinical observation. At the adenomas subtotal resection, but at the carcinoma total thyreoidectomy was performed.


[Fracture and pseudoarthrosis of the scafoid bone].

Individuality, which is so expressed in medicine has found as well its application in fractures and pseudoarthroses of scaphoid bone. In the treatment of fracture and pseudoarthrosis of scaphoid bone in each case, patient's occupation, age, body constitution, intensity of pains, functional status of fist and extent of osteonecrotic changes should be considered. In our work we have obtained the best results in "early" pseudoarthrosis by surgical treatment according to Matti-u and Russe-u and in the "late" ones by the method of complete extirpation of necrotic scaphoid. As fist and wrist-joint are very mobile, the slightest fist injury can provoke difficult functional disturbances. Therefore, during the treatment of fracture and pseudoarthrosis of scaphoid bone, a special attention should be paid to the consequences, which in these cases should be minimal.


[Indication and surgical treatment of elbow fractures].

The authors give a report of own cases and operative indication they have applied. There are pointed up the fractures in children where minimal operative surgery has advantage comparing to exact and rigid fixation. By adolescent the main attention is payed to save the articulation surface and to restore function of the joint trying to connect that all to rigid fixation. Abundant alenthesis with large devastation of soft tissue is not desirable because it is in collision with the later joint function.--The problem of early rehabilitation is discussed giving advantage to autorehabilitation.


[Surgical treatment of forearm fractures].

Ten years of experience and the results of therapy in fractures of forearm bones are presented. Conservative therapy as the majority of surgical methods requires immobilization that results in lately started rehabilitation and because of that in bad functional result too. The development of pseudoarthrosis after these treatments is not rare. By the application of compressive osteosynthesis, negative aspects of other methods are decline, immobilization is not necessary and early rehabilitation enables quicker and complete efficiency of the injured extremity.


[Surgical procedure in the treatment of pertrochanteric fractures].

The authors discuss the problem of treatment of pretrochanteric fractures and emphasize that this type of fracture generally heals well and that it is characterized by fast callus formation. Conservative therapy in coxofemoral plaster often leads to serious complications and has a high mortality rate. Lasting extension according to Russel demands a long hospitalization period and significantly diminishes the number of surgical beds available. Surgical therapy has several advantages: it has far fewer complications and a mortality rate which is only about half as great as in conservative therapy. The authors evaluate their results obtained in 120 cases of pertrochanteric fractures treated surgically as satisfactory. In 106 cases osteosynthesis according to the AO technique and in the remaining 16 cases osteosynthesis using 3 to 4 Kirschner wires percutaneously were performed.


[Our experiences with total hip prosthesis model "St. George"].

The advantages of the total prosthesis of the hip in the treatment of some degenerative diseases and single traumatic impairments of the hip are described, and the main characteristics of the St. Georg model total prosthesis of the hip are discussed. The results obtained in 92 cases of total prosthesis of the hip have been satisfactory. Special attention has been paid to measures for the prevention of infections. Among the patients treated only one developed infection. The author points to the fact that it is possible to replace an infected prosthesis and achieve complete cure by using bone cement mixed with an antibiotic. The functional results obtained are good: pain is either completely relived, or significantly diminished on walking and movement. During the author's five-year experience signs of wear of the prosthesis have not been recorded in any case.


[Use of Küntscher's distractor].

Kuntscher's distractor is very simply constructed apparatus with a great power of traction, by which remarkable dislocations of shortening of extremity bone fragments can be gradually corrected. It is applied in acute and especially in not correctly grown fractures with shortening and in pseudoarthrosis. By that, closed osteosynthesis according to Küntscher is enabled, and side dislocation of hyperdistended fragments is slightly corrected during the treatment. We have distractor successfully applied in 12 patients with not correctly grown bone fractures, in pseudoarthrosis, and we did a stable osteosynthesis too. It has been usefully applied in contusions of extremities, draining according to Willeneger.


[Use of palacos in osteosynthesis for the connection of fragments (combined internal fixation)].

Internal fixations have become a frequent approach in surgery due to the profound studies dealing with biomechanical details of fractures and quality of metal devices. In the beginning, it seemed practically possible to manage easily, almost all the fractures by using various internal fixation devices excluding, naturally, those which have retained or shall retain probably some indications of further cure by closed methods. Moreover, certain doubts remain still open, particularly for the reason whether all internal fixations have been sufficiently rigid and if so, shall it be indispensable to count on the introduction of additional materials in order to strenghten these fractures. The outcome of the daily practice 1rd traumatho to approach the use of the bone cement, initially to help the fixation of new joints. Later the use of the bone cement was applied for the shaft and pathological fractures in combination with autogenous cancellous bone. Thus, the new notion was borne in traumathology which in the form of combined internal fixation has become a familiar term throughout the professional literature. Cases of the experience gained and this particular approache in surgery will be a subject of the report.


[Metabolic disorders and current treatment of the surgical patient with pancreatitis].

Very frequently in acute and chronic pancreatitis, the surgical treatment is indispensable. The disease itself is accompanied by metabolic disturbances, protein deficiency, hepatic lesion, by diabetes and malabsorption syndrome. Following the laboratory parameters we were able to perform partial or total hyperalimentation, correction of acid-base dis-equilibrium and to obtain the positive nitrogen balance, and in this way keep the patients in optimal conditions pre- and postoperatively.


Surgical treatment of aorto-iliac atherosclerosis.

216 limbs in 180 patients were operated upon for aorto-iliac atherosclerosis during the period of 1967 to 1974. 45% were operated on for rest-pain or gangrene, while 55% had intermittent claudication. Four year patency following semi-closed end-arterectomy was 85% whereas 83% and 74% 4 year patencies were observed after open endarterectomy and synthetic by-pass grafting. However, synthetic by-pass grafts were used in patients with the most extensive atherosclerosis. Femoro-femoral and axillo-femoral subcutaneous by-pass grafts may be useful alternatives when contraindication exists against direct reconstruction of the aorta or the iliac arteries. The operative mortality was 6.7%. Eleven patients were reoperated for bleeding and 10 for early reocclusion. A good result was obtained in 14 of these cases. The indications for the different operative techniques are discussed. It is concluded that both prosthetic by-pass grafting and endarterectomy have a definite place in the treatment of aorto-iliac atherosclerosis.


Endarterectomy for femoro-popliteal atherosclerosis.

303 limbs in 270 patients were operated by endarterectomy for femoro-popliteal atherosclerosis from January 1967 to April 1975. 236 reconstructions were carried out as semi-closed endarterectomy. Sixty-seven open endarterectomies were performed during the same period. In the 2 groups 37% and 33% respectively of the patients were treated for rest-pain and distal gangrene. The remaining patients had intermittent claudication as the main symptom. The operative mortality of the two groups were 2.5% and 4.5% respectively. Although the early results were encouraging, the long-term patency following semi-closed endarterectomy was significantly lower than after saphenous vein by-pass. Open endarterectomies had the same 5-year patency as vein by-pass grafts. This may at least partly be due to case selection, since open endarterectomy was mainly used for short obstructions in limbs with good run-off. Even if fair results may be obtained when semi-closed endarterectomy is performed between 2 arteriotomies above the knee in limbs with good run off, we recommend this method only to be used in cases with insufficient vein for by-pass grafting and sometimes for the treatment of short obstructions of the superficial femoral artery. Since the choice of operative method often has to be done during operation, familiarity with both methods is necessary.


Local complications following surgical treatment of lower limb atherosclerosis.

654 arterial reconstructions for lower limb atherosclerosis were performed during the period January 1967-April 1975. Ten significant infections were seen in the material. Necrosis of the wound edges was observed in 20 limbs. Marked oedema was noticed in 148 limbs, most after femoro-popliteal repair. Forty-two early reocclusions (6.4%) and 39 haemorrhagic complications (5.9%) were observed. About 2/3 of these cases were successfully reoperated with reestablished circulation. Immediate exploration of the reconstructed arterial segment is therefore justified when such complications occur in the early postoperative period. Most early reocclusions were due to insufficient endarterectomy, mostly performed by ringstripping. Ringstripping between two arteriotomies and a better intraoperative control of the endarterectomized arterial segment might have prevented some of these reocclusions. When bleeding occurred in the early postoperative phase local repair was usually successful. Haemorrhage occurring later in the postoperative period had a poorer outcome. As they are often related to infection, such cases should be treated by ligation of the artery and a by-pass through an uninvolved area if the limb is threatened.


Trauma to the liver: twelve years experience.

54 patients operated upon for liver injuries are reported. Hemoperitoneum, estimated blood loss and transfusions given in volumes more than 4 000 ml, and four or more associated injuries, worsened the prognosis markedly. It is also important to make a careful search for possible associated injuries at the operation for liver trauma, in order to decrease mortality and morbidity.


Endoscopic papillotomy (EPT) with removal of common bile duct stones.

Endoscopic papillotomy with removal of common bile duct stones was successfully performed in 14 patients. In 11 patients stones were found after cholecystectomy. In the remaining 3 patients there was a high operative risk. No serious complications occurred. Consequently the removal of choledocholithiasis by endoscopic papillotomy is an alternative to traditional treatment.


Acute effects of truncal vagotomy on gastric wall tissue gases in the dog.

Acute effects of truncal vagotomy on gastric wall tissue gases were studied in the dog by means of implanted Silastic tonometers. It was concluded that vagal denervation produces a significant fall of tissue PO2 in both corpus and antrum. Simultaneously, corpus PCO2 markedly decreases whereas antral PCO2 remains unchanged. The findings may be explained by a dual mechanism: reduced gastric blood flow and decreased metabolic activity in the parietal cell area. It is possible that reduction in CO2 accumulation decreases the supply of carbonic acid to the anhydrase system, thereby reducing the formation of hydrogen ions for acid production.


Enkephalins inhibit intestinal motility: mode of action.

In the guinea pig isolated terminal ileum the opioid pentapeptides, methionine-enkephalin and leucine-enkephalin, dose-dependently inhibit contractile responses induced by electrical field stimulation releasing endogenous acetylcholine, and by specific noncholinergic compounds including histamine, barium chloride, and beta-acetyl-digoxin. Tissue levels of cAMP and cGMP remain unchanged. We conclude that enkephalins exert their effects by a direct action at or within the muscle cell and may play a physiological role in the local control of the gut smooth muscle motility.


Significance of endotoxaemia in experimental "galactosamine-hepatitis" in the rat.

The course of galactosamine hepatitis induced by 1.0 g/kg i.p. injected galactosamine (Ga1N) was investigated a sequential study in normal rats, in colectomized rats, and in rats being endotoxin resistent against both exogenous and endogenous endotoxin. Clinical symptoms of Ga1N-hepatitis such as pyrogen reaction, disseminated intravascular coagulation, arterial hypotension, and hypoglycaemia correlated significantly with the development of endotoxaemia, which was detected by means of the limulus gelation test (L.G.T.) Ga1N refractoriness was found after colectomy, a situation, in which gram negative bacterias and their endotoxins were eliminated. Ga1N refractoriness was also observed in case of endotoxin resistence. It is concluded that endotoxins contribute significantly to the pathogenesis of "Ga1N-hepatitis" and its clinical symptoms.


Wound healing and complications of the liver after percutaneous transhepatic cholangiography.

A total of 10 autopsy cases who had received percutaneous transhepatic cholangiography (PTC) were examed and analysed from the view point of chronological changes of hepatic damage caused by the puncture. The conclusion obtained on the process of simple healing can be summarized as follows: (1) Hemocoagulation or hematoma formation on the hepatic surface and intra-peritoneal hemorrhage were seen until the 7th day after PTC but not in cases of the 13th day or later, while the scar of puncture was recognizable on the hepatic capsule in cases of up to the 16th day but was not remaining in ones of the 41st day and later. (2) Damage of the hepatic parenchyma was existing until the 7th day, which, however, was repaired by the 13th day. (3) Intra-hepatic hematoma was seen until the 13th day but faded away thereafter. Namely, intrahepatic trauma caused by PTC seems to be completely cured without leaving any scar in about a half month. However, the puncture trace on the diaphragm was seen in one case of the 42nd day after PTC examination, therefore the nature of diaphragmatic trauma seems to be somewhat different from that of the liver, including its capsule. Besides, discussions are also made on some hepatic complications caused by PTC, as well as on clinical significance of this kind of pathomorphological study.


The role of bone remodelling in the healing of extraction socket in rats.

Bone remodelling of post-extraction socket was studied in the past by various methods. In the present work, the process was studied with the scanning electron microscope (SEM). The SEM is essential for a three-dimensional description, particularly when hard tissues are involved. Initiation of healing on the first week was characterized by formation of delicate spongy bone. The trabeculae were distributed in a centrifugal pattern around the interradicular bone. Socket healing on the second week consisted of thickened, regularly distributed trabeculae. This was accompanied by resorption and flattening of the peri-socket sharp ridges. The third and fourth weeks were characterized by small bone marrow spaces and a gradual transformation of the trabecular bone to one of cortical-compact nature. The typical characteristics of resorbing, resting and forming surfaces were detected in all phases of socket healing. Two major patterns of ossification could be shown: Firstly, calcification of collagen bundles in osteoblastic lacunae. Concentrations of such lacunae were related to periosteal activity and were also found in areas most probably occupied previously by blood vessels. Another pattern of mineralization was in the form of globular calcospherites and is reminiscent of calcification of ground substance.


Fine structure of the retinal epithelium of the spectacled caiman (Caiman sclerops).

The fine structure of the retinal epithelium, Bruch's membrane and choriocapillaries has been studied by electron microscopy in the spectacled caiman (Caiman sclerops). The retinal epithelium throughout most of the retina is morphologically very typical of that described for other vertebrates. This typical appearance involves a single layer of pigmented cuboidal cells with extensive basal (scleral) infoldings and numerous apical (vitreal) processes enclosing photoreceptor outer segments. A semicircular area of the retinal epithelium in the superior fundus is, however, further specialized as a tapetum lucidum. The reflecting material consists of a large array of guanine, diffusely scattered within the epithelial cells. Centrally in the tapetal area, no melanosomes are found, indicating a non-occlusible tapetum. At the edge of the tapetum, however, both guanine crystals and melanosomes are found within the epithelial cells. In most other respects, the morphology of the epithelial layer in the tapetal region is not strikingly different from that in the non-tapetal area. Bruch's membrane everywhere displays the typical pentalaminate structure described for most vertebrates. The choriocapillaris is also typical in that numerous fenestrations are present in the endothelium bordering Bruch's membrane.


Intra-acinar nerve terminals in four rodent parotid glands.

The distribution of autonomic nerves was studied at the ultrastructural level in guinea pig, hamster, mouse and rat parotid glands employing potassium permanganate fixation/staining technique. In the periacinar connective tissue numerous unmyelinated nerves were observed in all the glands examined. Two types of axonal enlargements were encountered, one contained small, dense-cored vesicles (500-600 A in diameter) as well as a few large (approximately 1,000 A in diameter), the other exhibited numerous agranular vesicles (500-600 A in diameter). In all glands, axons devoid of Schwann cell investment were visualized at the base of the acinar cells, inside the basement membrane and in intimate contact with gland cells. In addition, axonal enlargements of both types were encountered in the intervening space between neighbouring acinar cells. Whereas nerve terminals within the gland epithelium were extremely common in the rat, mouse and hamster, their frequency was much lower in the guinea pig. In addition, only parenchymal varicosities of the adrenergic (dense-cored vesicles) type were encountered in the latter species. No intraepithelial nerves were observed in the striated ducts. However, axonal enlargements were present in the subepithelial connective tissue and were most numerous in the hamster parotid gland. The above findings confirm the dual innervation of the serous acinar cells of the guinea pig, hamster, mouse and rat parotid glands by both parasympathetic and sympathetic nerves. Furthermore, there exists a close membrane-to-membrane contact between autonomic nerves and salivary gland cells.


Chronically denervated rat carotid bodies.

The ninth nerve was severed and the rat carotid body studied in the light and electron microscopes and after formaldehyde-induced fluorescence for its catecholamine content from 3 weeks to 13 months after operation. Minimal changes in the carotid body were observed. Hyperthrophy of the capsule cell was noticed up to about 2 months, after which time these cells appeared normal. Lysosomes in the capsule cells occurred more frequently and were larger than in normal carotid bodies. Discernible pathological alterations did not occur in the glomus cells, despite the absence of afferent terminals upon them. Atrophy of the carotid body was not noticed. The catecholamine content of the denervated carotid body was comparable to its innervated control and no nerve terminals were found on the glomus cells. Autonomic ganglion cells intrinsic to the carotid body varied in number from 1 to 8 and in location. The glomus cells do not receive any significant autonomic innervation, and the ganglion cells in the carotid body, perhaps sympathetic, probably innervate blood vessels. It is concluded that deafferentation has minimal morphological effects on the carotid body. The reactions of other receptor cells to deafferentation are compared with those of the glomus cells.


A functional analysis of fusion of the tibia and fibula in the rat and mouse.

The distal diaphyseal shafts of the rat tibia and fibula fuse postnatally, a process initiated by the seventh day with the formation of secondary cartilage that is subsequently replaced by endochondral ossification. The histological appearance of this fusion process is described. A homologous process occurs postnatally in the mouse. An analysis of some of the pertinent recent developmental, comparative and paleontological data indicated that extrinsic, biomechanical factors probably played a significant causal role in tibia-fibula fusions. The production of secondary cartilage is evoked by extrinsic forces, and these fusions were analyzed within the present concepts of intrinsic and extrinisic factors in skeletogenesis. It was concluded that the fusions currently reported fit well within the hypothesis of the functional matrix and that, such fusions between skeletal tissues are secondary, compensatory and mechanically obligatory responses to the prior demands of functionally related nonskeletal tissues and organs.


The appearance of the otter brain.

On ten otter brains the appearance of the exterior and interior brain structures was studied. Viewed from above there are two forms of brain, a triangular and a longitudinal one. In the triangular form the gyri are sufficiently developed with a considerable number of transient gyri and in the longitudinal form the gyri are wider and separated by considerably deep sulci. The olfactory bulbs, the olfactory tract, the gyrus olfactorius medialis and the gyrus olfactorius lateralis are less pronounced in the triangular form than in the longitudinal one. In the triangular form of the brain all gyri, except for the gyrus sylvius, are vertically positioned. The brain stem is wider in the triangular form and narrower in the longitudinal one. On the medial aspect of the brain, the cingulate gyrus, on which transient gyri are apparent, is well marked. The cingulate gyrus is slightly wider than in the longitudinal form. Below the splenium corporis  callosi there is the tuberculum gyri dentati to be found by a shallow sulcus which is separated from the gyrus corporis callosi. By scaling the brain matter from outside, the pes hippocampi is exhibited. In the longitudinal form it is more sloping and separated from the base of the brain by a thin layer of brain substance. In the triangular form of the brain the cerebellum is covered by the posterior portions of the hemisphere and in the longitudinal form projects rather backward. On the frontal sections of the cerebrum the subcortical grey masses are sufficiently developed.


[The fine structure of baroreceptor's nerve endings in the wall of carotid sinus in cats].

The baroreceptor endings of the sinus nerve extend into the region of the external media, to the media-adventitia border, and into the adventitia of the wall of the carotid sinus. The size of the receptors, tightly filled with mitochondria, varies between 600 and 5,700 nm in diameter. The endings are accompanied by densely structured Schwann's cells, come into contact with the muscular-elastic system or are surrounded by the collagenous material of the vessel wall. This functional junction makes the reception of the tension in the vessel wall possible. Glycogen granules could be demonstrated in some axon endings. In kittens and older cats, numerous receptors were regularly found with various degrees of structural change: homogeneous and lamellar transformation of mitochondria, lamellar aggregates, lysis of axoplasm matrix, irregularities of tubules and vesicles. These modifications may be evaluated as the morphological expression of degeneration and regeneration processes. Physiological detrition is considered to be the cause for this.


Induction of mitosis in the differentiating Purkinje cells of the cerebellum.

The neonate rats of 5 days postnatal age were exposed to low-level X-ray irradiation or were administered microquantities of N-ethyl-N-nitrosourea directly into the cerebellum. Following the initial phase of cell degeneration and phagocytosis of the debris, the surviving Purkinje cells showed recovery of their differentiation. During this stage some Purkinje cells were observed to undergo mitosis, and they were identified in light- and electron-microscopic preparations. The relationship between tetraploidy in the Purkinje cells during their postnatal differentiation and induction of mitosis in them by experimental means is discussed.


[Light and electron microscopic study on the morphological changes in muscle fibers appearing after autologous muscle transplantation].

The extensor digitorum longus muscle of the rat was denervated and transplanted onto the vastus lateralis muscle of the same limb 1 or 2 weeks after denervation. The morphological changes appearing after transplantation were examined by light and electron microscopy. Only three to four superficial layers of muscle fibers remained unchanged after transplantation. The other parts of the transplanted muscle degenerated nearly entirely during the first 10 days. The myofibrils were removed by macrophages, thus within the tubes of basal lamina no contractile material could be observed. In a second period, regeneration of myofilaments took place. 6 weeks after transplantation, newly formed muscle could be observed, capable of normal function. The diameter of the fibres, however, was smaller and the connective tissue between the fibres markedly increased as compared to the normal muscle of the other side. The importance of the findings for muscle transplantation, especially the relationship between satellite cells and myoblasts, is discussed.


Age-related changes in the cellular population of the growth plate of normal mouse.

Age-related changes in the number of cartilage cells within the proximal growth plate of the humerus were determined in normal ICR male mice. The rates of reduction in the number of proliferative and hypertrophic chondrocytes were calculated and compared during the animals' first 6 months of life. It was found that during the period of highest growth activity, between weanling and sexual maturation, the rate of cell production is hardly decreased, thus maintaining the thickness of the cartilaginous growth plate and thereby enabling an extensive bone growth. A close correlation was found between the following skeletal activities: decrease in longitudinal bone growth, narrowing of the epiphyseal growth plate and a decrease in the proliferative activity of young chondrocytes.


The syndrome of continuous muscle fiber activity. Evidence to suggest proximal neurogenic causation.

Four patients with the syndrome of continuous muscle fiber activity were seen in a period of 6 years. Young females predominated. Remarkable improvement followed phenytoin sodium and carbamazepine administration in three patients, one of whom was "cured" within 4 years. In the remaining patient the response was inconstant. Electromyography showed abnormal spontaneous activity with diphasic and triphasic potentials appearing as doublets and multiplets. Waxing and waning was observed. D-tubocurarine and succinylcholine abolished the spontaneous activity excluding the muscle and the myoneural junction as its source. Spinal anesthesia, thiopental sodium, sleep and baclofen had no effect on it, ruling out a central source. In three patients, nerve blocks at the knee and elbow or wrist abolished this activity pointing to a proximal site of origin in the nerve somewhere between the spinal cord and the nerve block. In the remaining patient such a block significantly reduced but did not abolished the activity suggesting a dual source above and below the block. Finally successive examinations in one of our patients led us to believe that this activity may arise from different sites at varying times. It appears that regardless of the site of origin of the activity in the motor axon the counter part clinical syndrome remains the same.


The benign form of multiple sclerosis. Anatomo-clinical aspects.

The present paper is a study of three cases presenting the pathological aspect of chronic, non-evolutive multiple sclerosis, corresponding to a clinical picture of benign multiple sclerosis. The first case was discovered at autopsy, the second patient had two subclinical attacks of multiple sclerosis, with a twenty-year evolution (forme fruste), and in the third case the course of the chronic multiple sclerosis ran parallel to that of a cerebral and visceral arteriopathy. Anatomic study of the demyelinating lesions revealed their non-evolutive aspect and the presence within the plaques of lesions of the walls of small vessels with the perivascular adventitial fibrosis. The vascular changes appear to play a primordial role in the lack of evolution of the demyelinating areas, manifested clinically by a stationary, benign picture.


The effects of caloric stimulation of the labyrinth on the soleus motor pool in man.

The effects of caloric stimulation of the labyrinth on the soleus motor pool have been investigated using the Achilles tendon reflex, the H reflex, and the vibratory inhibition of the H reflex. The excitability of the myotatic reflex are is augmented from the beginning of irrigation and remains so until the end of nystagmus. The effects are bilateral and roughly symmetrical. The observed effects are due to simultaneous activation of non-specific, probably reticular, and specific, doubtless vestibular, , mechanisms. The Achilles tendon reflex is more facilitated than the H reflex, and the vibratory inhibition of the H reflex is not modified following irrigation of the ear canal. These results indicate a simultaneous facilitation of alpha and gamma extensor motoneurones but gamma effects clearly predominate. This interpretation is in good agreement with the findings of the animal neurophysiology. The vibratory inhibition argues against a modification of presynaptic inhibition. Before interpreting this fact as different from animal mechanisms, one must take into account the particular experimental conditions realized in man: the stimulus is complex and interactions between various nervous structures are possible.


Cervical cord atrophy--a pattern of presentation.

This paper introduces the concept of veno-occlusive disease of the upper cervical cord by way of clinical report on 7 patients in whom a remarkable sequence of clinical events was encountered, commencing with weakness of an upper limb, followed by similar symptoms in the ipsilateral lower limb, the contralateral lower limb and finally the contralateral upper limb. In each patient there was wasting of the small muscles of both hands due to a lower motor neuron lesion at a level of the eighth cervical segment. In each case a tumour in the region of the foramen magnum was excluded.


Ultrastructure of muscle biopsies in recent, short-term and long-term juvenile diabetes.

Muscle biopsies from juvenile diabetics were studied by electron microscopy and the results correlated to earlier published light microscopical abnormalities of the same biopsies. A total of 32 striated muscle biopsies from 29 juvenile recent, short-term and long-term diabetes were examined. The ages ranged from 16 to 43 years with a diabetes duration from 1 week to 32 years. The material was compared with biopsies from healthy persons of the same ages. The electron microscopy revealed degenerative changes of the striated muscle fibres which signify a neurogenic atrophy. No myopathic alterations were found. The capillaries in both the recent and long-term diabetics showed an extremely pronounced pinocytosis indicating an increased metabolic activity. In the long-term group the intramuscular capillaries both from upper and lower extremities displayed a definitely thickened basement membrane. In the recent and short-term group the capillary wall alterations were debatable. The motor end plate in the recent diabetics revealed minimal alterations. Contrary to this the long-term group showed severe alterations with occasional disappearance of the nerve fibres.


Social aspects in myasthenia gravis.

The myasthenics in Finland (n = 240) have been registered and treated in one center for more than 10 years. Of this material, an investigation was performed of their medico-social state as of 1 January, 1975. The study comprised 88 per cent (210) of the patients. In the working age (16-64 years) were 181 patients. Compared to the total Finnish population, the myasthenic patients lived more often in urban districts, had had more intermediate-school and university--but less vocational-school education, and belong as a whole to "higher" social classes. The severity and the variability of the disease naturally influenced the disability. A change from severe to slight symptoms occurred in 38 per cent, and 12 per cent of the myasthenics were in complete remission (2/3 of whom had had severe symptoms). One third (72) got a full pension because of myasthenia, and about one tenth (25) because of some other reason. Of these who got a full pension for myasthenia, 7 per cent were in complete remission without any myasthenic symptoms. The influence of thymectomy on the degree of disability was impressive, since more than 50 per cent of disabled myasthenic patients returned to work thereafter. Thus, because of the unpredictable, but on the long term quite favourable course, a full pension should not be prescribed early (during the first 5 years) of the disease. An active treatment may also change the outlook for even the most severely disabled patients.


Fibroblast cultures in Duchenne muscular dystrophy. Alterations in synthesis and secretion of collagen and noncollagen proteins.

Primary skin fibroblast cultures were grown from forearm pinch skin biopsies obtained from 24 patients with Duchenne muscular dystrophy (DMD) and ten normal controls matched for sex and age. The first subcultures were grown for 7 days and incubated with L-(3H)-proline for 24 hours. Intracellular collagen incorporation was significantly decreased (2.2 X) and extracellular collagen incorporation significantly increased (1.8 X) in fibroblast cultures from patients with DMD by both collagenase assay and polyacrylamide gel electrophoresis. The synthesis of noncollagen proteins showed low values from the DMD fibroblast cultures. The alterations in synthesis and secretion of collagen and noncollagen proteins were characteristic only for the log phase of DMD fibroblasts.


Lysozyme activity in cerebrospinal fluid. Studies in inflammatory and non-inflammatory CNS disorders.

Lysozyme activity was measured in cerebrospinal fluid (CSF) from 114 patients with inflammatory (bacterial and serous meningitis, polyradiculitis, encephalitis) and non-inflammatory (multiple sclerosis, CNS tumors, cerebral vascular diseases) CNS diseases. Highly elevated values were found consistently in patients with bacterial meningitis. Elevated values were found also in patients with encephalitis, polyradiculitis, multiple sclerosis and CNS tumors, but a considerable overlapping between these groups and normal controls precludes the use of CSF lysozyme measurements as a diagnostic aid in the latter disease groups. Simultaneous measurements of lysozyme, albumin and IgG in CSF and serum suggested that the mechanism for increased CSF lysozyme values in bacterial meningitis is mainly a breakdown of the blood/brain barrier, whereas the increased CSF lysozyme values in the remaining groups of patients are more likely caused by production of lysozyme by cells within the meninges (neutrophilic granulocytes, monocytes?).


Meningoencephalitis due to Acanthamoeba SP. Pathogenesis and clinico-pathological study.

Amebic Meningoencephalitis (AM) and Primary Amebic Meningoencephalitis (PAM) are infectious diseases essentially confined to the Central Nervous System (CNS) and caused by free-living amebas of the genus Acanthamoeba (A.) and Naegleria (N.) respectively. AM due to A. sp. (Acanthamoeba castellanii and Acanthamoeba culbertsoni) have been reported in chronically ill debilitated individuals, some of them under immunosuppressive therapy, or in immunologically impaired patients without a history of recent swimming in contrast to cases due to N. sp. which usually occurs in healthy, young individuals with a recent history of swimming in man-made lakes or heated swimming pools. AM due to A.sp. is characterized by a subacute or chronic granulomatous meningoencephalitis involving mainly the midbrain, basal areas of the temporal and occipital lobes and posterior fossa structures. CNS lesions in AM are perhaps secondary and the portal of entry in humans is probably from the lower respiratory tract, genitourinary system or skin reaching the CNS by hematogenous spread. The predominant host reaction is usually composed of lymphocytes, plasma cells, monocytes and multinucleated foreign body giant cells. Necrosis is moderate and hemorrhage scant or absent. Cysts as well as trophozoites may be seen within the CNS lesions. PAM is due to Naegleria fowleri and is characterized by an hemorrhagic necrotizing meningoencephalities with an acute inflammatory response. Only trophozoites are found in lesions. The portal of entry is through the olfactory neuroepithelium. CNS tissues fixed in formalin may be used for further identification and taxonomical classification of the causative protoza using immunofluorescent antibody techniques (IFAT) and electron microscopic methods.


Neuraxonal dystrophy of the brain in patients receiving antineoplastic chemotherapy.

The present report describes the neuropathological change found in the brainstem of four patients who were treated with combined chemotherapy for various types of malignant disease. The change consists of localized axonal swellings, the so-called "axonal spheroids" located predominantly in the medial lemniscus, the fibers from the olivary nuclei and around some of the cranial nerve nuclei. In addition to the brain change, all four patients had shown histological evidence of hepatic injury, although none of the patients exhibited overt clinical or chemical evidence of hepatic insufficiency. Neither did these patients show any clinical neurological deficit that could be related to the pathological findings. The neuroaxonal changes are most likely the result of altered metabolism as a consequence of the chemotherapy.


CS2 binding to rat spinal neurofilaments.

The binding of CS2 sulphur to rat spinal cord neurofilaments was studied 3 and 6 h after the intraperitoneal injection of 1.3 mmol of CS2 in control and phenobarbitone pretreated rats. The binding of CS2 carbon was studied similarly 3 h after the injection. The binding of CS2 sulphur was 31% higher in the control neurofilaments than that in the phenobarbitone pretreated group. Half of the neurofilament associated CS2 sulphur was bound to protein in both groups as studied by electrophoresis. Approximately 30% of the neurofilament associated CS2 sulphur was detected 6 h after the injection of that at 3 h in both groups. All of the neurofilament associated CS2 carbon was bound to protein in control group 3 h after the injection. The  binding of CS2 carbon was 4.7 times less than that of sulphur at the same time. The present data may indicate that the high binding of CS2 to the neurofilament protein contributes to the increase in neurofilaments in chronic CS2 intoxication.


Autoradiographic investigation of cell proliferation in the brain of spontaneously hypertensive rats.

Cell proliferation in the brain of spontaneously hypertensive rats (SHR) and control Wistar rats of various ages was autoradiographically investigated using [3H]thymidine. The brain of SHR showed an increase in labeled cells. The increase of labeled cells was seen in the early stage of the development of hypertension when there were still no definite morphological changes in the cerebral vessel walls or brain parenchyma. The labeled cells tended to increase in number with the age of the animals. The distribution of these cells corresponded with areas of increased vascular permeability and cerebrovascular lesions, that is, water-shed regions. The labeled cells consisted of endothelial and adventitial cells of the intracerebral arterioles and pial arteries as well as glial cells. Arachnoid cells, subarachnoid cells, medial smooth muscle cells of the pial arteries were also labeled, though less intensely. The significance of labeled endothelial cells in the development of cerebrovascular changes and sequential parenchymal changes is discussed.


Ultrastructure of striated muscle of the rat after temporary ischemia.

Twenty-six anterior tibial muscle specimens were analyzed with the electron microscope 2 h, 1, 4, 18, 45, 90 and 226 days after temporary ischaemia of the rat hind leg produced by pneumatic tourniquet for 1, 2, 3, 4 and 6 h. No ultrastructural alterations were seen after 1 h ischaemia, but reversible disappearance of muscle glycogen and swelling of muscle and nerve mitochondria occurred after 2 h ischaemia. Irreversible alterations such as disappearance of the Z-line, disruption of cell membrane and vacuolation of muscle mitochondria were observed after ischaemia of 3 h and longer in a part of the muscle fibres. Ischaemia for 6 h was followed by autolysis of all the muscle fibres within the specimens. Autolysis and phagocytosis of the remnants of the affected fibres was present on the 4th day. On that day regenerative phenomena were also observed, such as satellite cells and young myotubes. The fine structure of the muscle fibres was normal on the 18th day after the temporary ishcaemia, although some size variation of the muscle fibres was still observed. Degeneration of a part of the presynaptic nerve endings of motor end-plates with or without simultaneous degeneration of the postsynaptic muscle fibre was seen after ischaemia lasting 3 h or longer. Motor end-plates were first seen on the 45th day in the muscle subjected to 6 h ischaemia and were most likely regenerated ones.


Microvasculature of rat striated muscle after temporary ischemia.

The structure and distribution of the capillaries of the rat anterior tibial muscle were analyzed by electronmicroscopy and microangiography 2 h and 1, 4, 18, 45 and 90 days after temporary ischaemia for 1, 2, 3, 4 and 6 h. Degeneration of some capillaries was seen first after ischaemia for 3 h, more extensive degeneration after ischaemia for 4 h, and after ischaemia for 6 h all the capillaries were undergoing degeneration when analyzed 1 day after the ischemia. Capillaries with normal ultrastructure were seen 45 days after the ischaemia. When examined 18 and 45 days after 3-6 h of ischaemia the capillary density was increased by about twofold but it decreased thereafter. At 18th and 45th days after 3-6 h of ischaemia the endothelial fraction of the capillary area was increased and the luminal fraction decreased. Microangiography of the anterior tibial muscles demonstrate the increase in the capillarization 18 and 45 days after 3-6 h of ischaemia.


Membrane structures of human oligodendroglioma.

Plasma membrane particles of four human oligodendrogliomas were distributed at random, and their average number per micronm2 plasma membrane was 1090+/-233 on face A and 230+/-46 on face B. Gap junction was occasionally visible, usually small in size and composed of a polygonal aggregate of several subunits: isodiametric particles, about 70-80 A in diameter, on face A and pits, about 30-40 A in diameter, on face B. Tight junction in two oligodendrogliomas was characterized by a meshwork of circular or ramifying crests on face A and complementary furrows on face B. It was often continuous in distribution, consisting of 5 or more strands. In addition, many particulate structures, occasionally fibrillar ones, of ridge materials were often visible in the bottoms of furrows, and a few particles were scatteredly found on the tops of crests. The ridge materials, if added together on crests and furrows, were linearly continuous in some case and discontinuous in other.


[Ringed fibres in skeletal muscles--a contribution to the statement of these structures in unselected obductions (author's transl)].

26 muscles with one or more ringed fibres, corresponding to 2,83%, have been found in 939 muscles out of 313 unselected obductions. Taking into consideration that in the M. rectus femoris alone. 21 ringed fibres were found, raises the quota to 6.7%. After desintegration into primary diseases, the cardiovascular illnesses have been accompanied with ringed fibres in 20.6%, in comparison to the other disease groups which have been rarely or not at all affected. Apart from one case probably traumatic ringed fibres formation, individuals above 49 years old are exclusively striken, at which by far the male sex prevails. The number of ringed fibres continually increases with the age, and all cases with 20 or more ringed fibres have exceeded the 60th year. Besides there is also a relation between the ringed fibres frequency and the atrophy degree of the muscle. The fact that this relation is not reversible the presence of an additional dispositional factor must be concluded. The distribution pattern of the ringed fibres is non-uniform, they occur partly disseminated or also partly flock formed, heaped up ringed fibres. They are mostly simple closed circular fibres. Compound forms are sporadically observed. A coincidence of sarcoplasmic masses was in all cases not traceable. The information at hand will be discussed. The frequent appearance in cardiovascular illnesses leads back to stress factors like hypoxidosis, acidosis etc. by reduced cardiac output, the frequency in age to multifactor reasons. The preponderance of catabolic metabolism, electrolyte shifting and disturbances of transmineralisation is particularly made responsible. Etiological traumas play an additional role particularly in younger individuals. The frequent occurrence in the male sex is referred to the different gender-dependent gauge conditions of the two fibre types.


[Hypertrophy of the transversal tubular system in target fibres. An electron microscopic study (author's transl)].

In a muscle biopsy from a patient suffering about 2 years from an amyotrophic lateral sclerosis groups of atrophic fibres and target fibres were observed. By electron microscopic examination, amongst numerous parallel or spinal cisternae near the plasma membrane, single-membrane bound smooth tubular elements with a constant diameter of 200-300 A occur in the central and intermediary zone of some target fibres. The connexion between these tubules and the terminal cisternae (triads) of the sarcoplasmic reticulum, suggest that this phenomenon seems to be a proliferation of the transversal-tubular system due to the partial denervation. Only a mechanical displacement of the T-tubules as a result of the destruction of the muscle fibres is not plausible, because the T-system volumetrically amounts only 0.3-0.5% of the muscle fibre.


Presence of zinc, aluminum, magnesium in striopalledodentate (SPD) calcifications (Fahr's disease): electron probe study.

SPD calcifications from four cases of Fahr's disease were studied with an electron microprobe of Castaing, and found to contain different elements, among them Zn, Al, Mg. The presence of the elements is underlined not because of presumption as to their importance on the pathogenesis of this disease, but because of their rare identification in cerebral calcifications. A1 and Mg have been localized previously in cerebral calcification, but this is the first report of morphological localization of a high concentration of zinc in the brain. Two of these cases had hypoparathyroidism.


Simple hysterectomy in the presence of invasive cervical cancer.

During the years 1956-69, 74 cases of invasive cervical carcinoma treated by simple hysterectomy were referred to the Norwegian Radium Hospital. The 5 year survival for those with free operative borders was 77.1% as compared with 30.7% for those cases in which the tumour was transected during operation. Before operation for a supposed benign condition, cancer should always be ruled out. If simple hysterectomy is performed and cervical cancer found in the specimen, immediate postoperative megavoltage radiotherapy affords the best chance of cure.


Ultrasonic diagnosis of placenta praevia.

741 women suspected of placenta praevia were submitted to ultrasonic scanning during the second and/or third trimesterr of pregnancy. In 61 an abnormal placental site was diagnosed. During Caesarean section, carried out in 46 of these cases, the location was compared with the ultrasound findings. The scanning diagnosis during the last trimester correlated with the findings at delivery. At scanning after the 35th week the diagnosis differed in only 4 cases. In all 4 there was a question of a low-lying placenta versus partial placenta praevia. During the second trimester diagnosis of low-lying placenta were revised in several cases at later scans. It is discussed whether these early diagnoses of an abnormal placental site, which later becomes normal, indicate a migrating placenta and/or an uncertainty of the scanning method. Early diagnosis of low-lying placentae should be checked by repeat scans.


Ultrastructure of the human placenta at term. Observations on placentas from newborn children of smoking and non-smoking mothers.

The placenta was chosen as a possible model for evaluating the vascular injury and tissue injury provoked by tobacco smoking in the human body. Full term placentas from 4 smokers and 3 non-smokers were studied in the transmission electron microscope. Pronounced changes were found in the group of smokers. The characteristic findings were broadening of the basement membrane of the placental villus, increase in collagen content of the villus, decrease in vascularisation and intimal changes in the villous capillaries and arterioles, with pronounced intimal oedema. Since similar changes have been reported previously from human umbilical arteries, and since these changes also can be induced in animal arteries by exposure to carbon monoxide or perfusion with nicotine, this study supports the concept that tobacco smoking is harmful to the human vascular system and tissues.


Abnormal ureteral peristaltic activity during pregnancy.

Ureteral peristalsis in five pregnant patients with signs of acute renal outflow obstruction was studied with the aid of a new technique for recording intraureteral pressure (ureterometry). With this technique it is possible to record the intraureteral pressure at three different levels in the ureter simultaneously. The rate of propagation and direction of the peristaltic waves can thus be determined. Retrograd peristalsis was found in three of the five patients and in one patient and in one patient no peristaltic activity was present at all. The fifth patient demonstrated normal antegrade peristalsis. The findings at renography in the acute stage were in accordance with the ureterometric data.


Spontaneous rupture of the uterus in the third trimester with  a living fetus expelled into the abdominal cavity.

A case of rupture of the uterus during pregnancy with the living fetus expelled intra-abdominally is reported. The main symptoms were slowly increasing abdominal colicky pains. During the first five days of the hospital stay the woman's condition deteriorated and a paralytic ileus developed. The fetal lie changed between the second and third day from longitudinal to transverse and the fetus became situated at the umbilical level. At the same time the fetal heart sounds could no longer be detected and the tense uterine wall grew soft. The changed fetal lie and the paralytic ileus were radiologically substantiated. In spite of a delayed diagnosis the child and the mother were both saved. The etiology was possibly damage to the fundal wall at an earlier curettage carried out because of a spontaneous abortion. The differential diagnosis is discussed from the obstetrical as well as from the radiological and other methodological points of view.


A case of massive, unilateral oedema of the ovary simulating tumour.

This paper describes the first reported Scandinavian case of massive unilateral oedema of the ovary. It represents the tenth such case in the literature. The probable pathogenesis is partial torsion of the mes-ovarium. If suspected clinically, such ovaries might be conserved.


Histamine metabolism in normal pregnancy and in toxaemia of pregnancy.

The urinary excretion of histamine and its metabolites, methylhistamine, methylimidazoleacetic acid and imidazoleacetic acid, was measured under standardized dietary conditions in 24 women with normal pregnancies and in eleven patients with toxaemia of pregnancy. In addition, histamine metabolism was studied in five healthy women at delivery and in four other healthy pregnant women during treatment with aminoguanidine, which is an inhibitor of diamino oxidase (histaminase). A slight increase in the urinary excretion of methylimidazoleacetic acid was observed in normal pregnancy as well as in toxaemia of pregnancy compared to non-pregnant women. In two toxaemic patients and in one of the healthy subjects the urinary excretion of unmetabolized histamine was moderately increased. Despite the very high diamino oxidase activity in the plasma and in the uterus during pregnancy, there were no signs of altered catabolism of endogenous histamine in the pregnant women. Smoking increased the urinary excretion of the quantitatively dominant histamine metabolite, methylimidazolacetic acid, in pregnant subjects as it also does in nonpregnant subjects. The necessity of standardized dietary conditions in the study of histamine metabolism in man was again emphasized.


A comparative study of uterine activity in labour induced with prostaglandin F2alpha or oxytocin and in spontaneous labour.  II. Characteristics of uterine activity and their effect on the progress of labour.

In 76 women with spontaneous labour or labour induced with oxytocin or PGF2alpha, intra-uterine pressure was recorded during the first stage of labour. A statistical analysis was performed of the intensity and frequency of contractions, the total uterine activity and the variability of peak-to-peak intervals and amplitudes of contractions. The duration of the latent phase was shortened by 50% in induced labour compared with spontaneous, while the active phase was less affected. However, the intensity and frequency of contractions and the uterine activity in Montevideo Units were of the same magnitude in spontaneous as in induced labour, apart from two cases of hyperactivity found in the induction groups. The variability of intervals between contractions and amplitudes of contractions were also of the same degree in all groups and no overall tendency towards greater regularity was seen during progress of labour. If irregular intervals between contractions were noted, when active cervical dilatation had begun, the progress of labour was slower and more uterine work was needed for dilatation than when the uterine activity was more regular.


Effects of calorizations and repeated unidirectional angular accelerations on the nystagmus of unilaterally labyrinthectomized cats.

Right unilateral labyrinthectomy of cats resulted in a left-beating, spontaneous nystagmus that was still weakly present in most animals when recorded in darkness 2 months after surgery. Cats given cold calorizations of the non-operated ear during the month following surgery showed no differences in behavior, optokinetic nystagmus, spontaneous nystagmus, or rotation-induced nystagmus when compared with operated cats which received no caloric stimulation. All operated cats showed a reduction in optokinetic responses that was more marked to CCW stimulus and that persisted through the second month after surgery. Most nystagmic responses to angular accelerations were bidirectionally diminished by more than 50%, 1 month after surgery. A series of 15 unidirectional habituation trials was ineffective in producing a directional imbalance in the nystagmic responses of operated cats, but the series was effective with non-operated Control animals. It appears that an intact vestibular system may be necessary for directionally specific habituation effects to evidence themselves. One month after the habituation series, all operated cats showed improved nystagmic output while Control cats showed a trend toward equalization of responses for the two directions.


Electron probe determination of relative ion distribution in the inner ear.

The relative amounts of potassium and chlorine present in various parts of the inner ear were studied by using an energy dispersive X-ray spectrometer in conjunction with a scanning electron microscope. Whereas the amount of chlorine was high in all compartments investigated, potassium was high in endolymphatic spaces and low in perilymphatic spaces. High contents of potassium and chlorine were also found in the tectorial membrane, in the inner sulcus and in the cupula of the semicircular canal. It is concluded that the tectorial membrane and the cupula do not present a barrier to ions and that therefore the sensory hairs in the inner ear are exposed to the ionic environment provided by the endolymph.


A comparison of the furosemide and glycerol tests for Meniere's disease. With special reference to the bilateral lesion.

The feasibility of furosemide test for the detection of endolymphatic hydrops has previously been discussed (Authors, 1973, 1975). The glycerol test also has been reported as being effective for the same purpose but only in Meniere patients with fluctuating hearing loss (Klockhoff & Lindblom, 1966). In 48 patients with Meniere's disease, both the furosemide test (F-test) and the glycerol test (G-test) were performed on 51 ears including 3 cases of bilateral involvement. The average value of urine volume in the F-test was significantly greater than that for the G-test. The decrease in tinnitus was 40% in the former, 45% in the latter. The F-test yielded a positive rate of 73%, and the G-test, 45%. The results were thus: positive in the both tests, i.e., F+: G+ were 17 (33%); F+: G-, 20 (39%); F-: G+, 6 (12%), and both negative, F-: G-, only (16%). The side effects of the F-test were nil, but those of the G-test were as follows: headache (29%), nausea (4%), and increase in tinnitus (9%). The response increase of the hydropic labyrinth caused by the two kinds of systemic dehydration over-lapped in part and differed in part, as a result of the differing diuretic mechanisms and their respective affinities to the cochlea and the vestibulum. The furosemide test may be based on the action of the vestibular response type, which is caused by natriuretic dehydration accompanying the more sensitive response increase in caloric-induced nystagmus, while the glycerol test may be based on the action of the cochlear response type, owing to osmotic diuresis manifested as hearing shift. The correlation between labyrinthine hydrops and dehydration was discussed and it was concluded that these double test were quite adequate methods for choice of treatment of not only unilateral Meniere's disease in its various stages but also in bilateral involvements.


Ultrastructural changes of the nerve elements following disruption of the organ of Corti. I. Nerve elements in the organ of Corti.

3-137 days after disruption of the guinea pig organ of Corti by perilymphatic perfusion with 20% streptomycin (SM), ultrastructural changes of the nerve fibers in the organ were observed. Most of nerve fibers began to degenerate after a latent period of 4 days. On the other hand, a number of fibers survived reactively enlarged and later developed into myelinated and unmyelinated fibers by becoming enclosed in Schwann cells which entered the organ of Corti through the habenula perforata. Regeneration and sprouting of the surviving nerve fibers also occurred. The fibers became mature, but atrophied after 60 days and then gradually disappeared. The regenerating fibers were mainly of the myelinated and unmyelinated efferent type. Retrograde degeneration occurred in both afferent and efferent fibers. In the less damaged organ of Corti perfused with 2% SM or Ringer's solution, Schwann cell invasion was not found.


The catabolism of glucose, glutamate pyruvate and acetate in Neisseria elongata subsp. glycolytica.

Activities corresponding to the enzymes glucokinase, glucose 6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase, malate dehydrogenase, pyridine nucleotide independent malate dehydrogenase, and glutamate dehydrogenase were found in cell free extracts from Neisseria elongata subsp. gkcolytica. Activities corresponding to 6-phosphogluconate dehydrase and 2-keto-3-deoxy-6-phosphogluconate aldolase were not found. Glucose was catabolized only vira the pentose phosphate pathway. The radiorespirometric findings suggest an extensive recycling of the triose and fructose phosphates. There was no evidence for formation of pyruvate from glucose. Glutamate was oxidized via the tricarboxylic acid cycle. Pyruvate and acetate were obviously catabolized by the glyoxylic and tricarboxylic acid cycles, as in N. elongata.


Yersinia enterocolitica and Yersinia like microbes isolated from mammals and water in Norway and Denmark.

Data pertaining to 149 strains belonging to genus Yersinia are summarized in this paper. Yersinia enterocolitica (Y.e.) was isolated from the faeces of 31 of 305 small rodents and from 5 of 31 shrews (Soricidae) trapped at five localities in Norway and one locality in Denmark. Isolations were obtained from 9 of 29 water samples collected within the trapping areas. Three of 25 red foxes (Vulpes vulpes) from one locality in Norway harbored Y.e. in their faeces. Y.e. serotype 16 was isolated from one zoologist suffering from diarrhoea. A total of 85 strains from small rodents, shrews, water and foxes showed biochemical properties intermediate to Y.e. and Y. pseudotuberculosis. Another three strains were classified as Y. pseudotuberculosis on biochemical basis. They were obtained from small rodents in Denmark. Serological examination of 59 small rodents naturally infected with Y.e. and related microbes, revealed two cases of low antibody titres (80) against homologous isolates. Pathological examination of 44 of these animals gave a negative result. Strains antigenically related to the same serotypes were frequently isolated from both terrestrial ecosystems and adjacent freshwater. Strains related to serotype 6 dominated both in red fox and in their small rodent prey. No evidence was found for a dynamical significance of Y.e. in populations of small rodents. The results indicate that Y.e. and Yersinia like microbes have a broad occurrence in terrestial ecosystems.


The compliance curve for the flow limiting segments of the airway. I. Model studies.

By means of a pilot-static tube airway compliance curves describing the cross-sectional area (A) as a function of transmural pressure (Ptm) were constructed for several locations in the elastic airway of a mechanical model of the lung. From these curves local relations between elastic recoil pressure of the lung (Pel) and maximal expiratory flow (Vmax) were calculated and compared with the experimentally determined Pel-Vmax curve for the entire airway, i.e. all parts in series. Theory and experiments showed that the latter was the lower borderline of all the local Pel-Vmax curves. This means that the maximal flow through the entire airway at a given Pel is determined by the segment of the airway, having the smallest Vmax, just as the maximal strength of a chain is determined by its weakest link. The relation between the critical transmural pressure (Ptm-) and the corresponding cross-sectional area (A-) was derived from the experimental Pel-Vmax curve. This Ptm--A- curve had a composed appearance, which was found to reflect parts of the different local Ptm-A curves and transitions between them because of movement of the flow limiting site within the airway. The Ptm--A- curve depends on the elastic properties of the flow limiting segment, and the slope of this curve (dA-/dPtm-) is the compliance of the flow limiting segment. Significant frictional pressure losses upstream from the site of flow limitation caused underestimation of both A- and dA-/dPtm-, but downstream pressure losses had no influence on the Ptm--A- curve.


Scanning electron microscopic study on the distribution of epithelial cells in the Eustachian tube.

Canine Eustachian tube epithelium was examined by means of the scanning electron microscope. The part of the tube at the bone-cartilage junction was found to be the most active. It is here that goblet cells and large numbers of ciliated cells were found. Cilia were dense and covered by a mucus blanket. Near the tympanic end of the Eustachian tube, goblet cells were more numerous and ciliated cells less so. Near the pharyngeal end, goblet cells were numerous, while cilia were scanty and not uniform in length. Our findings support the concept that middle ear clearance is carried out by an active mucociliary mechanism as in other parts of the upper respiratory system.


Evidence for a rate-sensitive regulatory mechanism in myogenic microvascular control.

To reveal a possible rate-sensitive component in the myogenic control, changes of total and segmental vascular resistances in sympathectomized skeletal muscle in response to alteration of vascular transmural pressure (extravascular pressure) by 40 mmHg were compared when the pressure change was applied at two distinctly different rates (15 and 120 s). The papaverine-dilated vascular bed showed an entirely passive behaviour, whereas the normal, myogenically reactive vascular bed responded with active constriction upon transmural pressure increase and active dilation upon pressure decrease. These responses were especially pronounced in the microvessels where a clearcut two-component effector response was observed. The magnitude of the initial component was distinctly correlated to the rate at which the transmural pressure stimulus was applied, whereas the later steady state component during the static pressure change was rate-independent. At the high rate of pressure increase, the initial rate-dependent microvascular constrictor response was some ten times larger than the steady state response. These observations indicate the existence of a rate-sensitive as well as a static component in the myogenic response to changed transmural pressure, an interpretation strongly supported by a previous analogous study on isolated single-unit vascular smooth muscle (Johansson and Mellander 1975). It is concluded that the microvessels in skeletal muscle are highly responsive to myogenic stimuli and that emphasis should be placed on the dynamic rather than the static characteristics of the stimulus. Such rate-sensitivity in myogenic control would seem to facilitate prompt and proper vascular adjustments, for instance in myogenic autoregulation.


Middle ear pressure during and after prolonged nasotracheal and/or nasogastric intubation.

Changes in middle ear pressure during and after prolonged nasotracheal and/or nasogastric intubation were studied in 47 patients who had been intubated, for various reasons, during 1-24 days. All the patients had a negative middle ear pressure; in 84% of the ears the pressure was -200 mm of water or less. In most ears the pressure fell rapidly after the intubation, being most negative before extubation and during the first 2 days after. In all patients who could be followed the pressure returned to normal. The normalization was slow, depending upon the duration in intubation. Possible causes, such as abolished ventilation of the rhinopharynx, insufficient swallowing, mechanical occlusion of the tubal orifice, and the influence of anaesthetic gases are discussed. During the period after extubation the most probable cause is irritative and inflammatory reaction of the mucosa, leading to internal tubal occlusion.


Hemifacial spasm. Nerve block with phenol under electromyographic control.

Seven cases of hemifacial spasm are described. Six were operated upon with intra-osseal exposure of the facial nerve. In all 6 cases transient peripheral facial paresis developed. When the paresis disappeared the patients had a recurrence of the spasms. As an alternative to surgical procedures a method for selective nerve block under E. M. G. control with 3% phenol is described and 5 cases have been treated with this method. Ambulatory treatment with deposition of 3% phenol in the main branch of the facial nerve appears to have an equally good effect to the surgical methods hitherto used. Examination with E. M. G. suggested that the hemifacial spasm is of central origin.


Discrimination of frequency ramps in subjects with cochlear hearing loss.

The auditory sensitivity for detecting linear frequency sweeps of a continuous pure tone has been studied in ten young subjects with cochlear hearing loss. The mean thresholds were elevated by a factor of 2.8 as compared with a normal group over the whole range of ramp durations studied (10-500 msec). The results show that this elevation is most likely caused mainly by the cochlear lesion per se, other possible factors having only a minor effect. No clear correlations could be found between thresholds for frequency change and results of other pure tone audiometric tests. Such tests thus cannot predict a subject's frequency discrimination.


Effect of hypoxia on mitochondrial mass and cytochrome concentrations in rat heart and liver during postnatal development.

Cytochrome concentrations of rat heart and liver mitochondria were measured postnatally from newborn animals to young adults. Mitochondrial cytochrome aa3 concentration increased shortly after birth in both tissues, this concentration being in a newborn animal 0.149 +/- 0.027 nmol/mg protein in liver and 0.333 +/- 0.082 nmol/mg protein in heart. The respective values from a two week old animal were 0.216 +/- 0.031 and 0.583 +/- 0.100. Postnatally cytochromes c+c1 and b increased markedly in the heart, but in the liver of newborn animals the cytochrome content was more close to the adult values. The amount of mitochondrial protein increased after birth, too. In a newborn animal the mitochondrial protein values were 39.7 +/- 3.6 mg/g wet weight in liver and 26.6 +/- 6.5 mg/g wet weight in heart. In adult animals the respective values were 71.5 +/- 4.8 and 80.7 +/- 13.1. The effect of postnatal hypoxia (10% O2, 24 h and 48 h) on liver and heart mitochondrial cytochrome concentration and protein values of newborn animals were investigated. During hypoxia the amount of mitochondrial protein remained about at the level of a newborn animal. The postnatal increase in the mitochondrial cytochrome concentration, which was smaller in the liver than in the heart, was also inhibited by hypoxia.


Contractility, muscle mass and agonist sensitivity of isolated portal veins from normo- and hypertensive rats.

Properties of the longitudinal smooth muscle of portal veins from normotensive Wistar rats, adult (NCR) and young (NCRy); spontaneously hypertensive Okamoto rats, adult (SHR) and young (SHRy); and adult Wistar rats with renal hypertension (RHR) were studied in vitro and histologically. Some aortic strips from SHR and SHRy were compared with controls. In response to noradrenaline (NA) and acetylcholine (ACh) greater maximum force was developed by veins from all hypertensive groups than by those from control rats. Cross-sectional area of the longitudinal muscle of veins from SHR but nor SHRy nor RHR was greater than control. Maximum stress in response to agonists was greater in both SHR and RHR than NCR. ED50-values for NA and ACh were lower in portal veins from SHR than NCR but not from RHR nor SHRy compared to controls. Denervation did not abolish any of the differences between SHR and NCR. Aortic strips from SHR developed less maximum force to NA and ED50 was greater than those from NCR, i.e. opposite to the findings in portal veins. Low levels of external Ca2+ reveal altered calcium handling in veins from SHR compared to controls. It is concluded that portal veins from hypertensive rats are functionally different from those of normotensive rats and differ in SHR compared to RHR. It is suggested that the altered functional properties of portal vein, but not of aorta, in several respects resemble those of arterial resistance vessels. The implications of these findings are discussed in terms of mechanisms of hypertension in these animal models.


Thresholds for linear frequency ramps of a continuous pure tone.

The human auditory sensitivity in detecting linear frequency ramps of a continuous pure tone has been studied. It is shown that for short ramp durations (less than 200 msec) discrimination depends on the difference between base and plateau frequencies, the mean threshold being about 3 Hz at 1 kHz. For longer ramp durations (greater than 200 msec), discrimination was found to be based on detection of the actual frequency sweep. No significant difference was found between thresholds for upward and downward sweeps. Expressed in Hz, the threshold for frequency change was approximately constant for base frequencies up to 1 kHz, above which it increased, reaching approximately 14 Hz at 4 kHz. There was no significant difference in the threshold for frequency change from 40 to 80 dB HL but at 20 dB HL the threshold was significantly higher than at 40 dB HL. Intra-individual variation in thresholds was found to be smaller than inter-individual variation. The results are discussed in relation to previous frequency discrimination data, where either tone pulse pairs, continuous frequency modulation or frequency ramps were used as stimuli.