Induction of fetal rat enterokinase (enteropeptidase EC. 3.4.21.9) in utero by hydrocortisone and actinomycin D.

Enterokinase activity is first detected in the small intestine of the rat at the 20th day of gestation, whereas sucrase activity first appears in the 14th day of postnatal life. Intraperitoneal injection of hydrocortisone to pregnant rats before the normal appearance of enterokinase in fetuses causes the premature appearance of enterokinase (58 +/- 8 units), but not of sucrase activity. The addition of actinomycin D in the pregnant rat results in supermaximal stimulation of enterokinase activity (229 +/- 25 units). Sucrase activity is stimulated by hydrocortisone when given in the first 3 days of life (118 +/- 0.04 units). The maximal induction occurs 2 days before the normal appearance of the enzyme in untreated animals (7.3 +/- 12 units). The addition of actinomycin D diminished the effect of hydrocortisone on sucrase activity in the neonatal rat (1.4 +/- 2 units versus 1.8 +/- 0.4 units in 3-day-old rats). Thus, enterokinase and sucrase of the small intestine of the fetal and infant rat respond differently to combined hydrocortisone and actinomycin D. The response to hydrocortisone is age dependent and the maximal induction occurs before the time of the natural appearance of the enzymes. No effect is elicited after the normal appearance of enterokinase or sucrase. Glucocoticoids stimulate an early appearance of small intestinal enzymes only before the expected time of the natural development burst of activity. In both, sucrase and enterokinase, glucocorticoids have no effect after the enzymes are fully developed. New enzymes develop in clusters during the late fetal, neonatal, and late sucking periods. The effect of glucocorticoids on the "maturation" of the small intestine is limited to the induction of one phase only; i.e., only before the late fetal period is the precocious appearance of enterokinase possible. The induction of enterokinase activity can serve as an indicator for the early phase of maturation. Whereas the induction of sucrase activity can serve as a marker for late phase of maturation of the small intestine in the rat. The superinduction of enterokinase, but not of sucrase activity, by the addition of actinomycin D to glucocorticoids might be related to the different stability of the mRNA's of these enzymes.


Alternative pathway of complement in sickle cell disease.

Thirty-one patients, 10 months to 20 years of age, were studied. A complement abnormality was not identified in sera from patients with sickle cell disease (SCD) by the methods employed in the present study. Concentrations of C3, factor B, total hemolytic activity (CH50), properdin, and C3b inactivator were similar in sera from patients and control subjects (Table 1 and Fig. 2). Although concentrations of C3b inactivator protein were below normal in a few patients, there was no evidence that these levels were low enough to alter the functions mediated by this protein. Initiation of the complement sequence via the alternative pathway by reaction with inulin was equal in patient and control sera when assessed by the activation of factor B, cleavage of C3 and the comsumption of hemolytic complement components (Table 1). Lysis of erythrocytes treated with reduced glutathione was similar in patient and control sera during alternative pathway activation (Fig. 3), indicating comparable formation of lytic complexes via this pathway. An abnormality of the alternative pathway was not detected when the serum from patients with sickle cell disease was reacted with inulin. Thus, this polysaccharide, although commonly empolyed to assess alternative pathway function, is not satisfactory for studying serum from these patients. In addition, activation of the alternative pathway by cobra venom factor was comparable with controls when assessed by the lysis of glutathione-treated erythrocytes.


Pyrimidine metabolism during restorative brain growth after neonatal undernutrition in the rat.

Three litters of 20 Wistar rat pups each were maintained until age 6 days at which time only the 4 lightest and 4 heaviest pups from each litter were left with the mother until age 13 days. Three control litters of eight pups each were also maintained for 13 days. At that time, the undernourished light pups showed body weight, cerebellar weight, and cerebellar DNA, respectively, of 79.2%, 86.6%, and 90.4% compared with a "combined control" group consisting of control pups plus undernourished heavy pups which were statistically indistinguishable with regard to these three measurements. After the week of "catch-up" or restorative body and brain growth, activities of enzymes from metabolic pathways leading to pyrimidine and nucleic acid biosynthesis were measured in cerebella from all three groups (control, undernourished heavy, and undernourished light). The salvage pathway enzyme thymidine kinase (TK) and the inter-conversion pathway enzyme thymidylate synthetase (TS) in the undernourished light group showed significant elevations of 32% and 11%, respectively, above activity in the combined control group. The salvage pathway enzyme uridine kinase (UK) and the de novo pathway enzyme aspartate transcarbamylase were not significantly different in cerebella from these two groups. The significant elevation in TK and TS in undernourished pups suggest that these enzymes are critical for restorative brain growth. The significant elevation of TS indicates that the inter-conversion pathway converting available uridylate, a ribonucleotide, to thymidylate, a deoxyribonucleotide, is activated in order to augment DNA biosynthesis.


Effect of 4-pentenoate on rat liver ornithine transcarbamylase.

The effect of 4-pentenoate on rat liver ornithine transcarbamylase was studied. No effect was found. It is concluded that the effect of 4-pentenoic acid on ornithine transcarbamylase reported by others was probably due to technical errors. Available evidence indicates that 4-pentenoate inhibits ureagenesis by interfering with mitochondrial energy metabolism, which in turn impairs mitochondrial ornithine transport or depletes mitochondrial ATP, impairing carbamyl phosphate synthesis, or both.


Studies on cystic fibrosis using isoelectric focusing. IV. Distinction between ciliary dyskinesia activity in cystic fibrosis and asthmatic sera and association of cystic fibrosis protein with the activity in cystic fibrosis serum.

The cystic fibrosis protein (CFP) and ciliary dyskinesia activities (CDA) in sera from CF homozygotes, heterozygote carriers, and individuals with bronchial asthma have been partially purified. Concurrently, the CDA's in sera from patients with cystic fibrosis (CF) or bronchial asthma were shown to be different substances by ion-exchange or gel permeation chromatographic procedures. Sephadex G-200 chromatography indicated that the CF-CDA eluted with a protein fraction of molecular weight (MW) 68,000-150,000 and that the asthma CDA was found in a protein fraction of MV greater than 150,000. The two activities could also be separated by DEAE-cellulose chromatography. Prior acidification of whole normal, CF homozygote, obligate heterozygote, or asthmatic sera to pH 3.7 using EDTA, followed by fractionation of Sephadex G-200 removed all the CDA's from fractions of highermolecular  weight and shifted the activities to a protein fraction of MW 1,100-13,700. This procedure afforded a 200-fold purification of the CDA's in sera from patients with asthma or CF. EDTA treatment, however, also generated a CDA in previously nonreactive normal sera. Subsequent fractionation of the various active G-200 fractions on Bio-Gel P10 allowed for the separation of three separate activities (Bio-Gel Fractions I, II-IV, and V). Fraction I was shown to represent the activity in sera from patients with asthma and was determined to be C3a (MW 9,000). Fraction I was also found in normal, CF, and carrier sera and therefore is not a specific CDA. Fraction II-IV is thought to represent a CF-specific CDA (MW 5,000) since it could not be demonstrated in either normal or asthmatic sera but was found in sera of obligate heterozygotes. Fraction III-IV also did not react with antisera to human C3a. Fraction V was generated from all serum types upon acidification of the serum with EDTA and is thought to be a nonspecific CDA. Bio-Gel P10 filtration of Sephadex G-200 fractions provided 823-fold and 650-fold purification of the asthmatic and CF CDA's, respectively. Concurrent analysis of column fractions for CDA's by bioassay and for CFP by electrofocusing showed CFP only in fractions that contained the CF-CDA. Combined analyses employing acid disc gel electrophoresis, isoelectric focusing, and EDTA treatment of active CF-immunoglobulin (Ig) G and Sephadex G-200 column fractions, followed by Bio-Gel P10 chromatography, provided evidence that CFP was associated with the CF-CDA. It is unknown as yet whether CFP itself is responsible for the CF-CDA activity.


[Lateral transparietal cholangiography. Okuda's technic. Remarks apropos of 111 examinations].

The diagnosis of proctated jaundice is done in 50% of all cases by clinical examination; in 30% of all cases by peritoneoscopy; in the other 20% instrumental opacification of the biliary tract is required (before the laparotomy) in order to determine the site and the nature of the cholestasis. Among these instrumental devices, a transhepatic cholangiography with the Okuda needle allows biliary tract opacification in 98% of all cases if the obstacle is extra-hepatic and in 69% of all cases if the obstacle is intra-hepatic. This technique is easy to perform, without danger, and readily available to any physician. It should be performed after the peritoneoscopy and before the retrograde cholangiography.


[Fine-needle percutaneous transhepatic cholangiography. 84 cases].

The authors report the results of 84 percutaneous transhepatic cholangiographies using a fine needle, describing the technique. Beyond the context of jaundice, failure of or inadequate opravenous cholangiography requires the use of other radiological techniques. By virtue of its simplicity, its usually good tolerance and its results, percutaneous transhepatic cholangiography has a place of choice in these indications. Its value in comparison with other non-surgical methods of direct opacification of the biliary tract is discussed.


[Heat stroke with anuria, muscular disorders and early hypercalcemia].

A case is reported of heat stroke associating dehydration, anuria, muscle disorders and early hypercalcemia. All disorders disappeared within 48 hours with rehydration. Early hypercalcemia differs from late hypercalcemia reported at resumption of diuresis. Early hypercalcemia might result from blood concentration with hyperproteinemia and release of bone calcium under the action of PTH. Its prognosis is good, which is not the case of late hypercalcemia.


[Nephrotoxicity of gentamicin. Conditions for the use of this antibiotic in the elderly and in the patient with renal insufficiency].

Reversible acute renal failure was observed in 13 patients after combined antibiotic therapy using gentamicin. High and prolonged doses were used in 7 patients whose initial renal function was normal, while 6 other patients with preceding chronic renal insufficiency received usual doses of gentamicin. Precipitating factors were: increasing age, previous renal impairment, and combined use of other antibiotics, mainly cefalotin (8 patients). The nephrotoxicity of gentamicin is poor but well established, and may be prevented by checking the initial renal function, adjusting the dosage subsequently, and monitoring the renal function and gentamicin serum levels during therapy.


[Digital necroses of the upper limb. 86 cases].

The authors study 86 cases of ischaemic problems affecting the upper limb associated with digital necrosis. They emphasise the wide range of aetiologies encountered and discuss the relationship between this syndrome and the main forms of arterial disease, principally inflammatory, scleroderma appearing to be the dominant though not sole aetiology. The aetiological results are also studied in relation to the extent of the necrosis and the sex of the patient. These data are compared with those found in the literature.


[Breast cancer in man].

Mortality from carcinoma of the breast in man varied from 0.6 to 0.8 per 100,000 from 1950 to 1970. Over the same period the equivalent figures in women were 22 to 29 per 100,000. From 1955 to 1968, the Enquête Permanente Cancer recorded 537 cases of carcinoma of the breast in men. 293 of which were seen before any treatment. This last group is described with respect to the age of the patient, the topography of the tumour, the histology, the tumor node metastasis and treatment. Survival rates were as follows: 39.2% at 5 years, 23.7% at 10 years and 16% at 20 years. The relative survival was 49% at 5 years, 37.5% at 10 years and 43.8% at 20 years. These results are identical to those published for numerically similar series. In this enquiry, a comparison between the results of carcinoma of the breast in men and women showed no difference.


[Prognosis of visceral and osseous metastases of differentiated thyroid cancers. 24 cases].

Twenty four cases of differentiated thyroid carcinoma with distant metastases are analysed. Prolonged survival periods are possible. The best prognosis in papillary forms is stressed. Metastases fixing I131 progress more slowly, as a result of treatment with radioactive iodine but apparently also by virtue of the higher degree of differentiation of such metastases. One case of apparent cure of pulmonary metastasis after treatment with radioactive iodine is described. Surgery and external radiotherapy retain a place of choice in the treatment of metastases. In our experience, chemotherapy has been disappointing.


[131I therapy in hyperthyroidism. Results of treatment from 1960-1974].

488 PATIENTS WITH Graves' disease were treated by 131Iodine between 1960 and 1974. 427 (87,5%) of these patients were reexamined several times (clinically, 131I-uptake, PB127I, T4 (CPB-A), T3-uptake, and since 1973 TRH-test). The 131I was given as an individually calculated single dose treatment, using 7 000 -- 10 000 rd before 1965 and 6 000 rd thereafter. Two thirds of the patients became euthyroid after a single 131I-dose. In 20% the treatment had to be repeated. These patients show evidently a different biological behaviour of their disease, since multiple treatments revealed a higher rate of failure (33--35%). There is no principal difference between the out-come after 131I-therapy and surgery concerning the rate of failure, respectively relapse (3--4%) and hypothyroidism. Early incidence of hypothyrodism is dose--dependent, as could be shown in patients treated with higher doses before 1965. The reduction of the irradiation dose to 6 000 rd was followed by a drop of hypothyroidism from 18% to 7%. The reasons of late incidence of hypothyroidism are discussed. The incidence of hypothroidism  was calculated by three different methods (over-all incidence, incidence within the observed interval after therapy, life-table method). All three methods revealed different results. This has to be taken into account comparing results after radioiodine as well as after surgery. Radioiodine therapy for hyperthyroidism offers a true alternative to surgery.


The use of 81mKr gas for the measurement of absolute regional lung ventilation.

In this paper a new method of using 81mKr for the measurement of specific absolute regional lung ventilation is described. Experimental data suitable for the  calculation of quantitative regional ventilation are provided using an adequate respiratory system for 81mKr dosage and a scintillation gamma camera interfaced to a digital computer. A simple mathematical lung model for the inhalation of 81mKr is used to determine the specific ventilation and the parameters proportional to the ventilation for the whole lung and different lung regions in patients and in healthy subjects. The lung count rate for a given region correlated well with the ventilation of that region. Clinical examples are given and discussed.


[Relative uptake of 99mTc-diphosphate and its temporal change in bone diseases].

Quantitative regional measurements of the distribution of a bone seeking radiopharmaceutical is performed easily together with a bone scan using a scintillation camera. Comparative measurements of regional radioactivities yield a  ratio of relative uptake. The time change of such a relative uptake ratio is obtained by repeating the regional comparison measurements after a 4--8 weeks interval. The time change of the relative uptake ratio was found to be a clinically useful parameter in the follow-up of skeletal diseases. A decrease in the relative uptake ratio was found with healing fractures, with receding osteomyelitis and during radiation therapy of bone metastases; an  increase was observed with spreading metastases, developing osteomyelitis, developing pseudathrosis, and in the beginning of normal fracture healing.


Basic studies of various 99mTc-labelled renal agents and clinical application of 99mTc-malate.

Various renal imaging agents that were reported in the past and a new agent, 99mTc-malate as well as99mTc-cystein acetazolamide complex were prepared using electrolysis and electrochemical methods. These were studied for their labelling efficiency. After animal experiments with selected 99mTc-compounds, 99mTc-malate proved to be sufficient for renal imaging with adequate concentration. 99mTc-malate differs from other renal imaging agents in the utilization of endogeneous metabolic product. The first half time of 99mTc-malate in humans is 17 minutes, on the average, and the urinary excretion  rate of 99mTc-malate is 36+/-6.05% in 1 hour after  intravenous administration, 44+/-3.41% in 2 hours and 50+/-5.62% in 3 hours. In our 40 clinical experiences of 99m-Tc-malate, most cases demonstrated quite clear renal images in the serial scintiphotos except cases whose serum creatinines were over 4.5 mg/dl.


Purification of UDP-glucose dehydrogenase by hydrophobic and affinity chromatography.

UDP-glucose dehydrogenase was purified from an extract of calf liver acetone powder by sequential chromatography on norleucine-agarose, Type 2, agarose-hexane-AMP, and UDP-hexanolamine-Sepharose. The overall yield of the highly purified enzyme was 80% and the subunit molecular weight was 52,000.


Rapid separation of cells at unit gravity.

An apparatus is described for the rapid separation of cells at unit gravity. The apparatus is filled with a discontinuous density gradient, followed by the sample and then an overlay. The sedimentation chamber is turned from a vertical to a horizontal position before sedimentation takes place in order, (a) to form a continuous gradient out of the discontinuous gradient and, (b) to reduce the time required for the separation. After the sedimentation is completed the chamber is returned to a vertical position and the gradient fractionated by hydrostatic pressure using a newly developed floating device. The usefulness of the method is illustrated by the separation of leukemia cells in different phases of the life cycle.


Affinity purification methods. V1. A novel and rapid isolation procedure for lysozymes.

Lysozymes from animal and plant sources have been purified on agarose derivatives containing a phenylacetyl ligand. While this adsorbent can also bind chymotrypsin, the use of imidazole permits separation of lysozymes from the protease. The phenylacetyl-agarose is a general affinity sorbent bearing a ligand of non-biochemical origin in contrast to those, for example, which use nucleotide cofactors. By careful selection of desorption conditions, different enzymes can be purified with the same sorbent. Results also suggest that binding of lysozymes to an affinity ligand does not require a leash structure between ligand and support matrix.


[Effect of transformed steroid compounds on the adrenal gland function].

A study was made of the effect of steroid compounds of the pregnan series containing delta5-3-oxy- or delta4-3-keto-group in the A ring, oxygen-containing substitutes in the D ring and a built up 20-ketolateral chain on the adrenal gland function and the corticosterone-receptor (type III) interaction. The adrenal gland function was assessed by the rate of the aldosterone and corticosterone secretion into the adrenal vein and by the adrenaline content in the tissue of the rat adrenal gland. Replacement of delta4-3-keto-group by delta5-3-oxy-group in the A ring changed in a number of cases both the direction and the action intensity of the preparations on the adrenal gland function. Among the compounds of the delta4-3-ketone series in which the oxygen-containing substitutes were absent in the lateral chain at CC22 and 16 alpha, 17 alpha-epoxyderivatives there were revealed steroids which stimulated aldosterone secretion. Compounds with the 3-keto-group in the A ring significantly decreased the corticosterone-receptor interaction, whereas introduction into the position 17 of the steroid molecule (with the 3-oxy-group) of the oxy-group, and into the position 16 of the OAc-group increased the corticosterone-receptor interaction significantly.


[Shifts in the electrolyte and energy metabolism of rat myocardium in experimental hypercorticism].

Experiments were conducted on 612 albino male rats; a complex study was made in the myocardium of K+, Na+, Ca2+, Mg2+, Cl-, water, creatinphosphate, inorganic phosphorus, adenylic system components. A study was made of the effect of exogenous hypercorticism created by the administration of prednisolone, hydrocortisone and DOCA on the cardiac metabolism. Potassium-sodium tissue homeostasis in the myocardium proved to be stable under these conditions. Glucocorticoid hypercorticism was characterized by a reduction of creatinphosphate and by the accumulation of inorganic phosphate. DOCA administration failed to be significantly reflected on the balance of the phosphate macroerg balance. Glucocorticosteroids caused an increase in the Mg2+ and a reduction of the Cl- level, whereas DOCA brings about an increase of Ca2+ and Cl- in the myocardium. Dosaged sharp physical load is accompanied by the K+ cumulation in the myocardium. In the case of 2-hour swimming this is combined with a "stable" condition of the energy processes. When swimming is continued up to 5 hours there occurs a distinct disturbance of the balance of disintegration and resynthesis of the phosphate macroergs in the cardiac muscle. Administration of the corticosteroids under study against this background produced no significant influence on the character of the shifts in the electrolyte-energy metabolism, and failed to prevent the normal course of the restorative processes in the myocardium at the immediate period after the exercises.


[Liver circulation under the effect in intestinal hormones in patients with diabetes mellitus].

The following significant disturbances of the blood flow were revealed in the liver of 104 patients suffering from diabetes mellitus as a result of rheographic studies: a reduction of the amplitude-frequency index, of the sphygmometric velocity and of its components--the rate of rapid and slow blood filling. The intestinal hormones--secretion and cholecystokinin-pancreosimin improved these indices. The duration of their effect (1.5 U/kg, intravenously) was not less than 20, and not less than 10 min, respectively.


[Blood serum proteins in bilaterally adrenalectomized rats].

Ten days after bilateral adrenalectomy rats displayed a disturbance of the protein-synthesizing function of the liver expressed in hypo- and dysproteinemia (a reduction of albumin and an increase of globulin level). Twenty days after the operation there was a tendency to normalization of the mentioned function, and in 90 days the protein-forming function of the liver became normal; in all probability this was caused by the transformation of the regulating function of the organism and by the direct regulation of this function of the liver by the hypothalamo-hypophysial system.


[New modification of surgical model of diabetes mellitus].

For the purpose of modelling diabetes mellitus and exclusion of the external secretory function of the pancreas the authors elaborated two variants of pancreato-duodenal resections which were performed in 21 dogs. Advantages of these operations (reduction of postoperative mortality, etc.) in comparison with pancreatectomy after Markovich, performed in 38 dogs, were revealed.


[Study of lipid metabolism in pregnant women with diabetes mellitus and in women with physiological pregnancy].

Blood serum free fatty acid (FFA), triglyceride (TG), cholesterol and phospholipid content was studied during the 3 pregnancy trimeters in 247 pregnant women--139 suffering from diabetes mellitus without adiposity, and 108 healthy ones. As revealed the concentration of all the lipid fractions under study increased with the progress of physiological pregnancy. The FFA, cholesterol, and phospholipid levels failed to differ in the pregnant women suffering from diabetes mellitus at the stage of compensation from the corresponding indices in the group of healthy pregnant women at the same periods of pregnancy; as to the TG content--it remained increased in comparison with control group, although lower than in decompensated diabetes mellitus.


[Blood serum euglobulins in diabetes mellitus and diabetic microangiopathies].

A study of serum euglobulins carried out in 26 patients with diabetes mellitus and in 14 healthy persons permitted to detect definite differences between sick and healthy individuals. In the patients with diabetes mellitus (most distinctly in those with microangiopathies) the level of soluble and insoluble in the phosphate buffer euglobulins was greater than in the healthy persons. The microprecipitation reaction and immunoelectrophoresis with the monospecific immunoglobulins (IgA, IgM and IgG) more frequent and higher titers demonstrated IgA and IgG in diabetic patients. More pronounced heterogeneity (particularly distinct in the subfraction of euglobulins insoluble in the phosphate buffer) than in healthy individuals was revealed in the patients with diabetic microangiopathies by disc electrophoresis in polyacrylamide gel. The data obtained served as the basis for the search in the serum euglobulins of the patients with diabetes of compounds possibly possessing the antigenic properties, capable of producing antibodies and immune complexes, i.e. the immunological factors taking part in the vascular wall injury.


[Microcirculation and blood coagulation in patients with diabetes mellitus undergoing antidiabetic therapy of different types].

A comparative study of the peculiarities of the course of diabetes and metabolic disturbances, and also of the indices of capillary permeability, biomicroscopy of the conjunctival vessels, platelet aggregation, coagulorgam and blood clot retraction was carried out in the group of patients treated with insulin and sacharreducing sulfanilamides. Marked derangements in the microcirculatory system concerning both the vascular wall proper and of the rheological properties of the blood were revealed. These derangements were more distinct in the patients over 45 years of age with prolonged affection and the presence of vascular complications but proved to be independent of the therapy carried out.


[Concentration of protein-bound iodine in blood plasma in thyrotoxicosis at the early postoperative period and the effect of neuroleptoanalgesia].

The concentration of thyroid hormones increased in the blood of patients the first 2 days after the toxic goiter resection; the degree of this elevation proved to depend directly on the severity of thyrotoxicosis. Application of neuroleptanalgesia prevented in mild and moderately severe thyrotoxicosis, and decreased in severe toxicosis an increase in the blood thyroid hormone level undesirable at the early postoperative period.


[Myocardial contractility and hemodynamics in hypothyroidism].

The author determined the phasic structure of the systole of the left ventricle by the method of polycardiography and hemodynamics in 20 patients suffering from hypothyrodism. Blood plasma and erythrocyte electrolytes were examined at the same time. Patients with hypothyroidism displayed a phasic syndrome of hypodynamia and a marked correlation between the phase of the synchronous contraction, the period of ejection, the strength of contraction of the left ventricle and the electrolyte content. Sodium and magnesium produced the greatest influence on the phasic structure of the systole; potassium and calcium had a lesser effect. The heart stroke volume diminished; as to the cardiac index, expenditure of the energy of cardiac contractions directed to the maintenance of movement of 1 litre of the minute blood volume; the external work, and the peripheral vascular resistance displayed no significant change.


[Dynamics of changes in the indicators of electrolyte metabolism after surgical treatment of Cushing's syndrome].

The authors present the results of study of the state of the water-electrolyte metabolism at the early postoperative period in 58 patients suffering from Itsenko-Cushing's disease with consideration of the potassium deficiency correction. Potassium and sodium level was studied in the plasma and the erythrocytes. Besides, in 31 patients potassium and sodium content were examined in the muscular tissue obtained during the operation. Hypoglycemia was revealed in 48.2% of the cases, and hypernatriemia--in 19.0%. A reduction of potassium level in the erythrocytes was revealed in 50%, and a rise of sodium--in 52% of cases. The muscle tissue potassium level fell in parallel to the reduction of this electrolyte level in the erythrocytes. Disturbances of the electrolyte balance proved to be most pronounced at the early postoperative period in the patients given no potassium preparations. Separate use of potassium preparations, or (particularly) together with veroshpiron, prevented potassium deficiency at the early postoperative period.


[Changes in the mammary glands, adrenal glands and thyroid gland in young female rats after castration and administration of sex hormones and hydrocortisone].

Experiments were conducted on young female rats with the aid of morphological, morphometric and histochemical methods; a study was made of the adrenal glands, mammary and the thyroid glands under conditions of castration and administration of synestrol, progesterone, both sex hormones, hydrocortisone. Sex hormones proved to produce a fulminant growth of the glandular tree against the background of reduction of the functional activity of the thyroid gland and relatively high indices of the hormonal activity of the fasciculo-reticular zone of the adrenal glands. A harmonious development of the glandular tree of the mammary glands was noted only under the effect of a simultaneous administration of synesterol and progesteron. A shift in the hormonal balance in the direction of synestrol caused the appearance of pathological deviations in the mammary glands by the type of cystic mastopathy. Under conditions of castration hydrocortisone produced a moderate stimulating influence on the mammary glands only in case of a prolonged action.


[Blood plasma content of thyroxine and thyrotropic hormone in Cushing's syndrome and juvenile dyspituitarism syndrome].

The radioimmune method was applied to determination of the thyrotropic hormone (TTH) and thyroxin (T4) in the plasma of 20 patients with Itsenko-Cushing's disease and 12 patients with the syndrome of pubertal-juvenile dyspituitrism. The plasma thyroxin level proved to be lowered in the patients with Itsenko-Cushing's disease (3.1 +/- 0.9 gamma%); it was normal in the patients with the syndrome of pubertal-juvenile dyspituitrism (7.8 +/- 0.9 gamma%). The plasma TTH content gradually decreased in Itsenko-Cushing's disease with the increased duration of the malady. The TTH test demonstrated that the plasma T4 level was much less elevated in 24 hours in Itsenko-Cushing's disease than in the patients with the syndrome of pubertal-juvenile dyspituitrism (by 28 and 86% of the initial level, respectively). The differences in the functional condition of the hypothalamus-hypophysis-thyroid gland system in Itsenko-Cushing's disease and in the pubertal-juvenile dyspituitrism pointed to the different pathogenesis of these diseases.


[Sensitivity to insulin in children and adolescents with susceptibility to diabetes].

In examining insulin sensitivity in 109 children and adolescents with heredity aggravated by diabetes there was noted a high incidence of various changes up to insulin resistance. Determination of insulin sensitivity should be referred to the methods of the earliest detection of disturbances in the general system of carbohydrate metabolism regulation in persons with heredity aggravated by diabetes.


[Seasonal changes of corticosteroid content in practically healthy young persons under condition of monsoon climate of Khabarovsk].

In 195 apparently healthy young men, residents of Khabarovsk, a study was made of the contents of the sum total 11-OCS, corticosteroids--free and protein-bound, cortizol and corticosterone in the blood plasma, and 17-OCS in the urine, depending on the season of the year, climatic and weather factors. Seasonal changes of glucocorticoid function of the adrenal cortex with the maximal plasma hormone level during winter and their greatest urinary excretion during summer were found. An increase of free (biologically-active) corticosteroid fraction was recorded during bad weather at all the seasons.


[Effect of large doses of progesterone on pregnancy, lactation and morphology of the corpora lutea].

Cells of the corpora lutea of albino rats were examined histochemically after the administration of high perogesteron doses at various periods of pregnancy and lactation. Before the prepartum exogenous progesteron failed to influence the fetal development, during the prepartum--led to prolongation of the periods of pregnancy, and by the 25th day--to the intrauterine death of the fetuses in 100% of cases. Progesteron administration during the lactation increased the lactic acid function. Saturation of the organism with exogenous progesteron was accompanied by depression of the secretory activity of the lutein cells without any functional changes in the interstitial cells. Metabolic processes were disturbed in the lutein cells, this being expressed in the interruption of formation of the secretory vacuoles, reduction of the plate complex of Golgi function and a sharp depression of the lipid synthesis. Mitochondria are subject to disintegration. A comparative morphofunctional analysis of the corpus luteum cells under conditions of directed changed hormonal balance confirmed the concept on the separate production of progestins and estrogens by two types of the secretory cells.


[Utilization of cortisol and corticosterone by the tissue in thermal burns].

Clinico-experimental studies were made of the level of cortizol and corticosterone in the tissue fluid of burn vesicles and the blood plasma flowing from the burned and intact body areas; the character and the extent of entrance into the tissues and utilization by them of these hormones was assessed. Along with the increase in the blood cortizol and corticosterone concentrations, and, particularly, in the exudate of the burn vesicles the burned humans and rabbits displayed a different dynamics of the changes in the hormone level in the biological media under study. In the patients and the experimental animals cortizol content in the burn exudate was several times greater than corticosterone concentration. Cortizol level in the edema fluid directly correlated with the degree of edema. It appeared that the burned tissues had a different capacity to the uptake and utilization of cortizol and corticosterone. Features of similarity and differences were noted in the dynamics of the hormonal shifts in the sick and experimental animals. In difference from the intact animals, in the burned rabbits the corticosterone type of the adrenal secretion changed to preponderantly cortizol one.


[Multiple forms of 3-beta-hydroxy-steroid dehydrogenase of the adrenal glands of rats].

Experiments were conducted on Wistar rats. A study was made of the heterogeneity of 3beta-oxysteroiddehydrogenase (3beta-olDH) of the adrenal glands, the intracellular distribution of its multiple forms and the change of their activity in prolonged (for 3 months) keeping of the animals on a diet devoid of vitamin A. Four 3 beta-olDH fractions were revealed by the method of electrophoresis in polyacrylamide gel in the rat adrenal glands. The principal activity of 3 beta-olDH (68%) was revealed in the endoplasmic reticulum, and only 14%--in the mitochondrial-lysosomal fraction. Hypovitamonsis A caused a reduction of the 3 beta-olDH activity of the adrenal glands, chiefly on account of the 3 beta-olDH-2 fraction.


[Various physiological mechanisms of regulation of incorporation of H3-noradrenaline into the adrenal glands of rats].

It was revealed on the isolated adrenal glands of rats that an increase of noradrenaline-3H concentration in the incubation medium was accompanied by the elevation of the KM (Machaelis' constant) and Vmakc (V maximum) amine uptake parameters. A simultaneous elevation of the KM and Vmakc leads that the efficacy (E) of the uptake altered much less than the main parameters. The revealed dependency between the substrate concentration in the medium and the rate of noradrenaline uptake was apparently caused by the heterogeneity of the system reserving catecholamines in the medullary layer of the adrenal glands. It was shown that under the effect of phentholamine (2-5.10(-7) M) the alpha-adrenoceptor blockers, and propranolol (2-5.10(-7) M) the uptake of noradrenaline-3H by rat adrenal glands became activated. However, with the action of urea (5.10(-3)--1.10(-2) M) an activator of alpha-receptors, and of isopropylnoradrenaline (5.10(-7)--5.10(-6) M), and activator of beta-adrenocereceptors, the rate of noradrenaline-3H uptake was decreased. It is supposed that one of the ways of regulation of noradrenaline accumulation in the adrenal glands was connected with the heterogeneity of the reserving catecholamine system, and another one--with the changes in the functional condition of the adrenal gland cell adrenoceptors.


Histamine receptors in the isolated rat stomach fundus and rabbit aortic strips.

The effects of histamine and 4-methylhistamine (a selective H2-agonist) were studied on the isolated rat stomach fundus and rabbit aortic strips superfused with Krebs' solution. The contraction induced by histamine was found to be mediated via mepyramine-sensitive H1, while the relaxation induced by the amine through metiamide-sensitive H2-receptors in both smooth muscles. Prior addition of metiamide to the superfusion medium caused an apparent dose-related potentiation in the response to histamine on the aortic strip but not on the stomach fundus strip. The relaxation produced by histamine on the aortic strip demonstrated when the muscle was pretreated with mepyramine and contracted by angiotensin II or serotonin. Metiamide competitively inhibited the relaxation induced by histamine but not by papaverine in both smooth muscles. 4-Methylhistamine produced only a relaxation in the rat stomach fundus which could be competitively inhibited by metiamide. This analog had no agonistic property in the aortic strip. From these results it was concluded that histamine H1-and H2-receptors are present in both smooth muscles. The predominant contractile effect of histamine is mediated through H1-receptors and the relaxing effect of the amine through H2-receptors.


Harmine action in rats with lymphostatic encephalopathy.

In rats with lymphostatic encephalopathy the duration of harmine tremor was lengthened, and the brain concentrations of harmine decreased more slowly than in sham-operated controls. The tremor began simultaneously in both rat groups at coinciding brain concentrations of harmine. In rats with lymphostatic encephalopathy harmine concentrations in brain at the termination of tremor lay in the same range as in sham-operated controls. The plasma concentrations of harmine were not changed by the disease. It is concluded that during lymphostatic encephalopathy the lymphatic drug elimination from brain is impaired whereas--at least for harmine--the blood-brain barrier functions as normal.


The effect of prostaglandin E1 on central cholinergic mechanisms.

The influence of PGE1 and its precursor dihomo-gamma-linolenic acid on the central action of acetylcholine was studied. PGE, and dikomo-gamma-linolenic acid increased the depressive action of acetylcholine as evaluated with Lat's and thiopental sleeping time tests. PGE1 and its precursor diminished or eliminated the influence of acetylcholine on pentetrazol convulsions. Endogenous acetylcholine in excess inhibited hyperthermic effect of PGE1. The results show that PGE1 and its precursor may change the action of acetylcholine in the central nervous system.


Effects of adrenergic stimulation on the choledochoduodenal sphincter mechanism.

The object of this study was to access the effects of systemic bolus injections of epinephrine and of norepinephrine upon the sphincter at the choledochoduodenal junction in the cat and the dog. The bile duct was transected and the downstream segment was cannulated. Two methods were used to assess sphincteric activity. In method I the bile duct was perfused with Ringer's solution at a constant pressure and the flow rate of the solution was recorded. In method II the bile duct was perfused at a constant rate of flow and the terminal intraductal pressure was recorded. Intraduodenal pressure and respiratory movements were also recorded. There was a significant decrease in sphincteric activity following both epinephrine and norepinephrine administration in both cats and dogs, using both constant pressure and constant flow methods.


Extraordinary cardiac effects of 16-epi-gitoxin in comparison to ouabain in cats and dogs.

The contractility and arrhythmogenic effects of 16-epi-gitoxin and ouabain were studied in dogs. ECG alteration-producing and lethal doses of both glycosides were determined in cats. 16-Epi-gitoxin was found to be a glycoside with rapid onset and short duration of action. In case of equal contractile increment ouabain caused a higher percentage of rhythm disturbances in dogs than 16-epi-gitoxin. This finding corresponds to that in cats, in which ECG changes (QRS complex prolongation) occurred after ouabain at a lower percentage of the lethal dose than after 16-epi-gitoxin. Apart from its slight arrhythmogenic effects, 16-epi-gitoxin may be compared with acetylstrophanthidin.


Anti-inflammatory and antiproteolytic properties of substituted guanidines.

Ten N-(4-propoxyphenyl)-N'-(4-chlorophenethyl)-N"-substituted guanidines were synthesized from the corresponding 1-(4-propoxyphenyl)-3-substituted thiocarbamides and evaluated for anti-inflammatory and antiproteolytic properties. All substituted guanidines (50 mg/kg) provided 1-31% protection against carrageenin-induced edema in rats. Hydrocortisone (10 mg/kg) and oxyphenbutazone (40 mg/kg), used as reference drugs, exhibited greater anti-inflammatory activity. All substituted guanidines (1 mM) possessed antiproteolytic activity. The degree of protection observed by these compounds against trypsin-induced hydrolysis of bovine serum albumin ranged from 12.9 to 52.0% while such a protection with sodium salicylate (1 mM), used as a reference drug, was 52%. In the present study, the antiproteolytic activity possessed by these compounds was found to bear no relationship with their anti-inflammatory property.


Developing strategies for biofeedback. Applications in neurologically handicapped patients.

Strategies involving muscle biofeedback applications in the rehabilitation of neurologically handicapped patients are discussed. These include positioning of the limbs, initiating contractions, and controlling spasticity. Guidelines in the proper application of electrodes and biofeedback equipment are presented along with methods of documentation. The authors offer their training strategies as an initial guide and stress that uses of biofeedback need to be explored and documented.


Orbital expansion for anophthalmia and micro-orbitism.

In severe cases of microphthalmos or anophthalmos, the bony orbital cavity is often too small to allow one to create a satisfactory socket for a prosthesis. An omnidirectional expansion of the orbit, by osteotomies done in a step-like fashion, allows the creation of a larger bony cavity and improves the symmetry of the face. The risks of the craniotomy and of the mobilization of the free bone pieces are discussed.


Reduction mammaplasty by the inferior pedicle technique. An alternative to free nipple and areola grafting for severe macromastia or extreme ptosis.

Patients with massive macromastia, or severe ptosis, should be candidates for a reduction mammaplasty by the inferior pedicle transposition technique, instead of by free nipple and areola grafting. With the inferior pedicle technique the blood supply to the nipple and areola remains generous, coming from the entire width of the inframammary fold. By using a keyhole skin flap pattern, a conical breast shape is achieved when the medial and lateral skin flaps are brought together as a skin brassiere. The methods seems safe and simple, and the results have been satisfactory. An unexpected benefit has been the excellent postoperative sensation of the nipple, areola, and the skin of the breasts.


Abdominoplasty assessed by survey, with emphasis on complications.

Some 958 surgeons replied to a survey designed to determine the complications of abdominoplasties. The results appear in this paper. We believe that the patient contemplating an abdominoplasty and the surgeon planning it should be aware of the unpleasant reality of these complications, which range from the annoying to the lethal. It is of some solace, however, that despite the inevitability of readily visible scars, nearly all of these patients are quite satisfied with their results.


The sphincter pharyngoplasty as a secondary procedure in cleft palates.

A method of pharyngoplasty based on the orticochea principle of using lateral pharyngeal flaps which contain the palaptopharyngeus muscle, is described. The results of this procedure, and its advantages over other methods, are presented.


A review of 324 rhytidectomies, emphasizing complications and patient dissatisfaction.

The results and complications after 324 rhytidectomies, done between 1962 and the middle of 1973, were reviewed. The major complications were hematoma, skin slough, and facial nerve damage. In addition, respch as numbness of portions of the face, loss of hair, bothersome scarring, and general dissatisfaction with the operation. In general, these latter were of more concern to them than the major complications.


The psychic consequences of a reduction mammaplasty.

We studied 8 consecutive patients who had reduction mammaplasties to determine their psychological reactions. All 8 experienced pleasure with the operative results and the improvement or disappearance of their physical symptoms. Most described a general increase in self-esteem. In 5 of the 8 patients, however, there were postoperative emotional disturbances directly related to the operation, lasting from 3 weeks to 8 months. None of these would have been noted by the plastic surgeon (JMG)hand this study not been in progress.


When is there nipple involvement in carcinoma of the breast?

Two hundred cases of carcinoma of the breast were examined to determine the extent of nipple involvement. Carcinoma was present in 8 percent of the specimens. Fourteen of the 16 nipples which contained tumor were macroscopically abnormal in reappearance--being either ulcerated, retracted, or attached to an underlying indurated mass. Clinically normal niples are not likely to contain carcinoma. A frozen section across the nipple base should also be used as a safeguard if the nipple is to be used in reconstruction.


Silicone implants for contour deformities of the trunk.

A follow-up study of 12 patients who had preformed silicone implants inserted for correction of body contour deformities (8 for pectus excavatum and 4 for soft-tissue deformities of the shoulder and pectoral region) has demonstrated the safety of this technique and its lack of significant early or late complications. No implants have been removed, and 10 of the 12 patients regarded the overall results as good or excellent.


Pterygoid dissections for extensive cancer. An old concept revisited.

We present a series of 14 consecutive patients who received radical en bloc resections of the pterygoid and subtemporal fossa. After a median follow-up of 20 months it appears that local control has been achieved in 10 of them (71 percent), certainly an encouraging result. The addition of postoperative radiation therapy has probably contributed to this local control, and immediate reconstruction with a deltopectoral flap has improved the postoperative appearance.


Conservative management of the ulcerated diabetic foot.

Four cases are presented of the conservative treatment of the diabetic foot. Using the known principles of wound healing and of management of soft tissue infection, the obviously necrotic or infected tissue was debrided and the wounds were managed conservatively. The use of such debriding adjuncts as a pulsating jet lavage, topical antibacterials, and biological dressings, has controlled infections--so that the foot wounds could be closed then with sking grafts or local flaps. This resulted in the salvage of these feet, with maintenance of biped ambulation.


Congenital claw-like fingers and toes. Case report of two siblings.

A report is given of two siblings with a congenital claw-like deformity of the fingers and toes, which is extremely rare. The deformity is similar to the claw of lower animals, and perhaps its cause is atavistic. The long-suppressed characteristic might have come to expression by interactions among the genes, perhaps influenced by some unknown environmental factors.


Subcutaneous mastectomy for gigantomastia in an adolescent girl. Case report.

A 12-year-old patient with macromastia had 8,000 gm of breast tissue removed in a reduction mammaplasty. After a recurrence 14 months later, she had a subcutaneous mastectomy in which 2,000 gm more of breast tissue was removed from the breast and silicone prostheses were inserted. She has a good result, and we think this last operation should be used more often in these cases.


Replantation of a completely amputated distal segment of a thumb. Case report.

An unusual case of replantation of a completely amputated distal segment of a thumb is presented. Although only one digital artery and one nerve were reanastomosed, but no vein was, the digit survived and it acquired good sensation and motor power.


Modification of the Dott-Dingman mouth gag.

In cleft palate patients with a protrucing premaxilla, retrusion or collapse, the abnormal alveolar arches require a mouth gag which can be fitted to the individual. This modification of the Dott-Dingman mouth gag allows maximum adjustability and exposure.


[Schizophrenic and paranoid - bi- or trisection of endogenous psychoses].

The fundamental differences between the syndromes united under the term of schizophrenia are demonstrated. Attempts to reduce these syndromes to a common denominator of a nosological unit bearing the same designation have failed. Important arguments are advanced against the identification, widespread in practice, of the terms "paranoid" and "schizophrenic". It is pointed out that these two terms are incompatible to some extent. There is a fundamental difference between the nature of paranoia and the symptoms characteristic of schizophrenia (Dementia praecox). Paranoia is far more dependent on the personality than on the pathological process. A division into three aspects - schizophrenia, paranoid psychoses and MDP instead of the dichotomy schizophrenia/MDP, is proposed for a better theoretical and practical understanding in the field of endogeny. Further semantic arguments are advanced against the term "schizophrenia" indicating its iatrogenic effect.


[Epidemiology and clinic for manic-depressive psychosis in People's Republic of Bulgaria].

The term Cyclophrenia substitute better for the term Manic-depressive Psychosis than the term Cyklothymia. Registered prevalence of Cyclophrenia in Bulgaria increase from 0,30% for 1960 to 0,74% for 1975, but there are some unregistered patients. The percentage of Cyclophrenia by resident patient rate in psychiatric hospitals increase from 5,54% for 1960 to 11,16% for 1975. Among 1741 cyclophrenic patients 55% have unipolar depression, 16% unipolar mania and 29% bipolar course. Mortality by Cyclophrenia is 1.5 more as in the general population. Cancer-diseases among our patients and their geneology occure more frequently than in control groups.


[Group therapy in gerontopsychiatry, limits and possibilities].

The still insufficient accommodation given gerontopsychiatric patients and the resignation as regards therapy in most hospitals gave rise to systematic experiments over several years. This aimed at creating a therapeutic community by means of a psychagogic therapy for maintaining the mental and emotional alertness of patients in order to prevent loneliness. A description is given of problems which arose not only with patients but above all with the reeducation of nursing staff. Therapeutic activity in wards which have the character of a home reduces their "para-position" and makes work more attractive for all those involved.


[Young suicide patients and emotional climate in family].

The examination deals with the emotional climate in the family and looks into the reasons for disturbances thereof, with special emphasis on the significant role of alcoholism and the relations between the parents. Reference is made to the frequency of disturbed familial relations in suicide attempts among young people, 109 children and adolescents under 16, and possible prophylaxis is dealt with.


[Symptomatology of schizophrenia in Libya].

The most frequent symptoms of schizophrenia in Lybia are described and compared with symptoms of schizophrenia in Great Britain. The phenomenon of pseudoneologisms is explained. It was found that symptoms of primary importance after K. Schneider are applicable only to a small part of schizophrenias and then almost only to schizophrenics of the Chado-Hamitic Negroid tribes.


[Usefulness of shortened questionnaires for detection of accentuated personalities].

A survey is given of literature on the experience gained with the shortened questionnaire developed by Schmieschek for the registration of accentuated features of the personality acc. to Leonhard, information is given on the results of statistical tests of this procedure leading to a decrease in the numberof items. Factorial analysis confirmed the homogeneity of some hypothetic scales of features along the lines  of factorial validity, but the homogeneity of others appeared questionable. The shortened questionnaire therefore would not, at first sight, seem to be a reliable and valid measuring instrument for diagnosis in an individual case. Reference is made to further implications of possible diagnosis of accentuated features by means of questionnaires.


[Etiology and classification of mental disorders from viewpoint of "Universal genesis of psychoses"].

The concept of a "Universal genesis of psychoses" has been worked on by the author for about 12 years. It is mostly biologically orientated and deals with the development, classification and therapy of psychotic syndromes in an unconventional manner. Prejudices which would only interfere with research have been avoided as far as possible, and new results e.g. of biochemistry have been included. A more purposeful treatment with psycho-pharmacological agents is aimed at. Special emphasis is laid on the negation of real demarcations between manic-depressive, cycloid and schizophrenic syndromes which are assumed to be caused by many factors, and on the fact that psychopathological basic symptoms are "fundamental conditions" principally characteristic of all psychotic syndromes in different constellations.


Urethral Syndrome in the female ("irritable bladder"): the expression of fantasies about the urogenital area.

The urethral syndrome is a frequently encountered psychosomatic disorder; it constitutes the main complaint of some 20% of all women who consult a urologist. After a brief survey of the history of this syndrome, the authors examine 55 case reports of women with the urethral syndrome. The authors particularly emphasize the significance of the manner in which patients describe their perceptions of the pain, which is a valuable diagnostic sign. A follow-up study of patients for 3 to 21 years after the first interview demonstrated the releative efficiency of the various forms of treatment. A discussion of the therapeutic possibilities and their limitations follows.


Operant control of alpha EEG and the effects of illumination and eye closure.

The effects of eyelid position (open or closed) and three levels of room illumination on operant control of alpha EEG were investigated utilizing a factorial design. After base-line levels were determined, subjects were given alpha-contingent feedback and instructed to increase and decrease alpha production during six successive 4-min intervals. In addition, a comparison was made between percent time and average amplitude as dependent measures. The percent time data indicated that eyes-open training facilitated alpha enhancement and suppression. However, this was not supported by the average amplitude data. Ambient illumination, regardless of the measure utilized, facilitated alpha training, particularly when the eyes were open. These results are related to previous research and theoretical issues.


Effects of abstinence from tobacco smoking on physiological and psychological arousal levels in habitual smokers.

Effects of abstaining temporarily from tobacco smoking were studied in a group of habitual smokers during a 15-day period, during which they smoked normally for the forst 5 days, refrained from smoking the next 5 days, and smoked again during the last 5 days. Results were evaluated against values obtained in a nonabstaining group of smokers. Adrenaline and noradrenaline excretion decreased, skin temperature increased, and hand steadiness was improved when the subjects stopped smoking. Submaximal, physical work tests were performed once each period. No changes occurred in perceived exertion for abstainers during work, in spite of a reduced heart rate. There were only minor differences between abstaining and smoking subjects with regard to performance in the cognitive tests. Irritation, depression, lack of concentration, sleep disturbances, anxiety, tension, and restlessness were frequently reported as abstinence symptoms. The results indicate a decrease in arousal level during abstinence.


Panic-fear: a personality dimension related to intractability in asthma.

A 15-item MMPI scale has been developed that relates to the reported frequency of panic-fear symptoms on the Asthma Symptom Checklist (ASC). High scale scores describe fearful, emotionally labile individuals who profess to be more sensitive than others and unable or disinclined to persist in the face of difficulty. The relationship between the MMPI panic-fear scale and the ASC panic-fear symptoms is highly replicable and related to a crucial aspect of chronicity in asthma. High scoring asthmatic patients were prescribed more intensive discharge steroid regimens upon completion of residential treatment. This relationship was not mediated by available objective pulmonary function measurements used to index medical condition. Development of the MMPI panic-fear scale should enable further investigation of personality and behavioral aspects related to the perceived severity and intractability of other medical conditions and disabilities.


E.E.G. alpha feedback--a comparison of two control groups.

It is controversial whether or not veridical feedback is necessary to bring about increases in alpha activity in the feedback situation and has been suggested that the instructional variable may be a crucial determinant of outcome. In this experiment two groups of subjects were both given false feedback. One group was misled into believing that the feedback was contingent. Increases in alpha index occurred only in those subjects who believed that they were receiving contingent feedback, indicating that subjects knowledge and belief concerning the experiment were important in determining the outcome.


Locus of control and vasomotor response to sensory processing.

Heart rate and forearm blood flow responses were measured during experimental tasks requiring sensory intake, sensory rejection, and a mixture of the two behaviors. Subjects were 29 college students who had been categorized using Rotter's locus of control scale. Significant increases in both cardiovascular indices were seen in all three tasks; the responses were smaller, however, during sensory intake. Internals showed a differential response of forearm blood flow. In contrast, externals showed a similar vasodiatation across all tasks. The findings indicate that some of the variability in cariovascular response to sensory processing may be explained by individual differences in personality charcteristics related to subjects' perferred level of involvement in differing sensory processing behaviors.


Depression and hypertension.

The study consisted of 1101 Caucasian, male outpatients, who were screened for depression and hypertension in order to test the hypothesis that there is a unique relationship between these two illnesses. Depression was assessed by the Zung Self-Rating Depression Scale (SDS) while diastolic blood pressure (BP) was accepted as the index of hypertension. Medical records were reviewed to determine whether the patient's clinical diagnoses would have an effect on any relationship between depression and hypertension. It was found that there was no correlation between elevated scores on the Zung SDS and diastolic BP. The diagnosis of anxiety, however, was significantly associated both with depression and hypertension.


Stomach symptoms and up-down metaphors and gradients.

Previous work demonstrated a relationship in an ulcer patient between stomach pain during psychotherapy sessions and preoccupation with up-down themes. The generality of this phenomenon was investigated by determining in normal males the relationship of number of stomach symptoms to various up-down parameters. A significant positive correlation was found between stomach symptoms and the shifting of horizontal upward. Stomach positive correlation was found between stomach symptoms and the shifting of horizontal upward. Stomach symptoms were also significantly positively correlated with an up-down physiology index (hand minus foot temperature). Finally, a borderline positive correlation was found between stomach symptoms and relative awareness of the upper as compared to lower sectors of one's body. The data suggest that the occurrence of stomach symptoms is linked to up-down sets or gradients at perceptual, physiological, and perhaps body image levels.


Sudden death in the laboratory rat: cardiac function, sensory, and experiental factors in swimming deaths.

Three reported charateristics of sudden death in the wild rat, (1) bradycardia, (2) decreased survival without whiskers, and (3) increased suvival with preexposure to the stressor, are demonstrated in the domestic rat. Differences in sudden death between wild and domestic rats are discussed as well as possible interpretations of the phenomenon.


Plasma noradrenaline and dopamine-beta-hydroxylase during sexual activity.

Plasma noradrenaline (NA) concentrations and the activity of its synthetic enzyme, dopamine-beta-hydroxylase (DBH), were determined during sexual activity in one male subject on three occasions. Blood was obtained through an intravenous catheter by means of a peristaltic pump and an automatic fraction collector. NA was significantly (P less than 0.001) related to stages of sexual arousal and erection quality. Maximal arousal and erection was accompanied by plasma NA concentration 100% to 1200% higher than basal levels. NA levels also increased significantly with upright posture and with emotional stress. DBH activity did not correlate closely with sexual arousal and erection.


Chief complaints in a free walk-in clinic: a study of 3,009 consecutive patient visits.

Men under 20 and over 50 years of age used a free walk-in clinic of the Navy more than women of the same age. Women 20-50 years old used it more than men in this age group. This appears to be a result of the distribution of Navy health care facilities in the study area. Teenagers used the clinic as much as patients over 50. Sore throat, skin rash, abdominal pain, earache, and backache were the five most common complaints (302 per 1,000 patients.) These complaints and 19 other problems were responsible for 822 patient visits per 1,000 in a study of 2,272 consecutive new patient visits. Eighteen percent of all visits were return visits for a specific complaint. An analysis of complaints by body system showed that 21.9 percent were otolaryngological, 18.8 percent musculoskeletal, 12.5 per cent gastrointestinal, 9.7 percent dermatological, 8.7 percent cardiopulmonary, 7.8 percent genitourinary, 9.0 percent general (fatigue, nervousness, malaise, or weakness), and 11.6 percent other system (neurological, hematological, and miscellaneous). These data indicate that a physician's time might be used more efficiently in a walk-in setting and that training for such a clinic must be different from traditional training for such fields as internal medicine.


Nuclear medicine technology.

Combined liver-lung scanning has proven to be an extremely rapid and useful tool in the diagnosis and localisation of sub-phrenic abscess and differentiation of basal defects of the right lung. There is little discomfort to the patient who may be experiencing considerable chest pain. The patient spends less than 20 minutes in the nuclear medicine department. The results are quickly obtained, no complex mathematical analyses are needed, and the images are easily interpreted.


Renal growth.

Application of the renal growth chart may yield considerable information on longitudinal growth of normal and diseased kidneys. Its systematic use in following patients with urinary tract infection and vesicoureteral reflux is established, and application to other forms of renal disease in childhood may increase current knowledge of the natural history of these diseases.


Pelviureteric obstruction in childhood.

Pelviureteric junction obstruction is a common cause of intra-abdominal mass in childhood. The diagnosis is usually apparent when the characteristic signs of obstruction are seen at intravenous urography. A voiding cystourethrogram should be performed to exclude vesicoureteral reflux as the underlying condition. Obstruction may be further assessed by a diuretic load or by pressure-flow studies.


Evaluation and management of infants and children with neurogenic bladders.

The clinical management of infants and children with neurogenic bladder dysfunction relies heavily on radiologic studies to follow the status of the upper tracts. Radiology also plays a vital role in the evaluation of patients who are candidates for insertion of an artificial urinary sphincter, or reconstruction of their previously diverted urinary tracts.


Exstrophy of the bladder.

Exstrophy of the bladder is the most common of a spectrum of related anomalies. The pelvic skeletal changes in all of these disorders vary in degree but are similar in type. The kidneys are urinary collecting systems are usually normal in patients with untreated exstrophy, and the "hurley" appearance of the lower ureters should be regarded as a physiologically normal variant.


[Morphology of interstitial pneumonia (author's transl)].

The roentgenographic appearance of acute interstitialproliferative disease of the lung is described. This is based upon different single or combinated microscopic features: 1) Alveolitis -- 2) interstitial mesenchymal proliferation -- 3) tuberculous granulomas -- 4) lymphatic infiltrations. -- In the acute stage of the disease (in most cases with unknown etiology) steroid therapy shown rapid success. Early lung biopsy should be performed to establish the diagnosis and to avoid pulmonary fibrosis.


Caution: speed ahead--rare earth imaging systems.

New faster imaging systems present intensified control problems in image quality. The rare eath imaging system can provide adequate resolution at a great reduction in patient dosage. Analysis of all factors involved in screen imaging is necessary to assure correct implementation of the rare earth system.


[Roentgenographic pattern of interstitial pneumonia and allergic alveolitis (author's transl)].

Roentgenographic examination of the lungs permits diagnosis of inflammatory and allergic pulmonary disease with predominantly interstitial and less alveolar involvement in which pulmonary fibrosis may develop. Reaction of the sensitised lung to allergic exposure causes typical roentgenological patterns. Development of pulmonary fibrosis in interstitial lung disease can be prevented be early cortison therapy.


A systematic approach to continuing education for radiologic technologists.

As continuing education programs for radiologic technologists expand, it is important that needs be properly assessed and well-designed programs be developed. This reports on the step-by-step process of a regional medical education center to provide continuing education for technologists that would be most beneficial to them and indirectly to the patients they serve.


[Basic differentiation of granulomatosis and fibrosis in sarcoidosis (author's transl)].

Active pulmonary granulomatosis due to sarcoidosis in stage I is characterized on chest films by well-defined enlarged hilar and mediastinal lymph nodes. In stage II a involved lymph nodes decrease in size. Interstitial infiltration causes ill-defined broadening of vessels and bronchi. Focal infiltrates correspond to just detectable or nodular lung shadows of up to several centimeters in size. Active granulomatosis is demonstrated by Gallium-67-scans in lymph nodes as well as in areas of interstitial and focal pulmonary infiltrates. Following spontaneous or therapeutically induced regression of granulomatosis the abnormal uptake is not seen anymore. X-ray findings of fibrosis include partial shrinkage of pulmonary lobes or segments along with displacement of vessels and bronchi and (fibrous) adhesions of interlobar, parietal and mediastinal pleura. Honeycombed, occasionally bullous emphysema are the most reliable findings suggesting fibrosis. In addition to the fibrosis demonstrated on chest films, the Gallium-67-scan often shows progressive granulomatosis. So stage III disease is often (almost regularly) associated with stage II disease. Such cases still need further treatment.


Predicting registry results.

A statistical procedure is demonstrated that allows the instructor to predict registry grades with the use of a practice registry examination. The procedure is regression analysis and it is presented in statistical notation. By using the charts and equations presented, other instructors can predict registry grades from their own practice examinations.


[Lung and pleural involvement in collagen disease (author's transl)].

Frequency and type of pulmonary and pleural involvement in collagen disease (rheumatoid arthritis, progressive systemic scleroderma, polymyositis-dermatomyositis and lupus erythematodes are analysed on the basis of literature and of own cases with particular regard to the roentgenographic appearance.


Diagnostic x-ray tube failure and prevention.

The radiologic technologist is educated in the composition and function of the x-ray tube. He also has the responsibility of tube protection. This paper describes common causes of tube failures and lists specific preventive measures that should be taken to prolong the life of the x-ray tube.


[Alterations of pulmonary vessels in congenital heart disease. A summarized differential diagnostic table (author's transl)].

Roentgen signs of congenital heart disease are demonstrated by plain p. a. chest films and kymograms. Diagnostic critieria are discussed which cause increased, decreased, or minimal altered pulmonary blood flow. This simple diagnostic method in combination with the clinical symptom of cyanosis allows differentiation of congenital heart disease prior to catheter examination.


A method of instructing in the affective domain.

As we continually strive to teach our students the increasingly sophisticated aspects of our profession, we must also be sure to include planned instruction for the development of their value system. Through the use of values clarification techniques, various strategies may be designed and inserted into the curriculum.


[Idiopathic pulmonary hemosiderosis and Goodpasture's syndrome -- radiological findings (author's transl)].

Description of roentgenographic changes in idiopathic pulmonary hemosiderosis and Goodpasture's syndrome. Diagnostic criteria for differentiation from alveolar edema are shown. Separation of disseminated alveolar infections without clinical information is not possible. The close relation to idiopathic pulmonary hemosiderosis and Goodpasture's syndrome is emphasized.


[Possibilities and limits in roentgenographic documentation of lung lesions particularly in pneumoconiosis (author's transl)].

Roentgenographic appearance of minimal pneumoconiosis has changed with reduction of dust exposure. This urges radiologists to reconsider the evaluation of follow-up chest films. The possibilities of high-kilovoltage technique offer standardized and possibly stabilized conditions. Information about technical exposure data, chest x-ray equipment, and the generator are mandatory for film reading.


[Roentgenologic diagnosis of agenesis of the gallbladder (author's transl)].

A 58-year-old female with a surgically confirmed agenesis of the gallbladder is resported. Infusion-cholegraphy revealed a bud-like bulging of the common hepatic duct with a diameter of 6 mm. Celiac arteriography did not demonstrate cystic arteries supplying the gallbladder. As combined malformations celiac arteriography revealed an accessory spleen and a small hamartoma of the liver.


[Giant multifocal cavernous hemangioma of the liver with phleboliths (author's transl)].

A multifocal giant hemangioma of the liver with phleboliths is described. The value of the roentgen signs and the differential diagnosis are discussed and compared to those of the literature. The most valuable examinations are angiography and ultrasound.


The columnar-lined esophagus--analysis of 26 cases.

A review of 26 cases of columnar-lined (Barrett's) esophagus suggests that this lesion is more common than generally appreciated, usually arising consequent to reflux esophagitis. The radiologically detectable lesions frequently do not support the idea that Barrett's esophagus presents only with high esophageal ulcer and/or stricture. Hiatal hernia, gastroesophageal reflux, stricture, ulcers, and even minor mucosal abnormalities may be present alone or in combination, and may be variably located.


The widened interspinous distance: a useful sign of anterior cervical dislocation in the supine frontal projection.

Anterior dislocation of the cervical spine may be detected reliably in the supine frontal projection by evaluating the cervical spinous processes. A widened interspinous distance (ISD) which measures more than one and one-half times the ISD above and more than one and one-half times the ISD below indicates the presence of an anterior cervical dislocation at the level of abnormal widening. Measurements of the interspinous distances from the C3-C4 interval through the C7-T1 interval in 500 patients with normal cervical spines and in 14 patients with documented anterior cervical dislocations revealed neither false positive nor false negative diagnoses by these criteria.


Positive and negative contrast myelography in spinal trauma.

The myelograms of 60 acutely injured patients were reviewed. Positive contrast material (Pantopaque) was preferred in cervical and thoracic trauma manifesting bony deformity, in cervical trauma without bony deformity (in the prone position), in delineating the thoracic spinal cord in the frontal projection, and in lumbar spinal injuries. Negative contrast material (air) was preferred in cervical trauma without bony deformity, to delineate the thoracic spinal cord in the lateral projection and in chronic trauma to demonstrate cord atrophy. An experimental, water-soluble positive contrast material (Amipaque) may show the spinal cord advantageously in both the anteroposterior and lateral projections and may be more extensively used. A protocol has been devised, based on the analysis of the myelographic findings.


Gallium-67 scanning in the differentiation of maxillary sinus carcinoma from chronic maxillary sinusitis.

Gallium-67 scans of 25 patients in whom the clinical symptoms and radiographic findings were suggestive of either maxillary sinus carcinoma or chronic sinusitis proved to be valuable in the differentiation between the two disease processes. Those patients with carcinoma had positive scans, while those with sinusitis had either negative or only weakly positive scans.


Observations on the sequential use of 99mTc-phosphate complex and 67Ga imaging in osteomyelitis, cellulitis, and septic arthritis.

Sequential studies with 99mTc-methylene diphosphonate (99mTc-MDP) and 67Ga were performed in 40 patients to determine the role of each agent in evaluating osteomyelitis, cellulitis, and spetic arthritis. Apart from the value of 67Ga in distinguishing cellulitis from osteomyelitis, it is a good adjuvant to 99mTc-MDP imaging in chronic osteomyelitis to identify continuing or recurrent sepsis and localize the focus of infection more precisely.


The value of 67Ga scintigraphy in soft-tissue sarcoma and chondrosarcoma.

Forty-one 67Ga images were obtained for 33 patients with a diagnosis of soft-tissue sarcoma or chondrosarcoma. Tumor was detected in 27 cases of soft-tissue sarcoma; 25 (93%) of these were found on the Ga scans. The overall accuracy of scanning was 95.1%. All patients with positive scans had tumor present. In soft-tissue sarcoma patients the scan detected the tumor in 39 out of 45 sites. Ga scintigraphy was found to be useful in the initial evaluation and follow-up of these patients. If the Ga citrate scan is positive at multiple sites, the possibility of tumor being present is 100% with a false negative rate of 16%.


Radioscintigraphy in the diagnosis of upper airway obstruction.

Radiological and scintigraphic patterns in patients with upper airway obstruction are discussed. In contrast to the multiple hot spots of radioaerosol in bronchial asthma, localized spots were demonstrated in the neck and mediastinum. The sites correspond to those of severe obstruction of upper airways confirmed by tomography and bronchography. Aerosol inhalation lung scintigraphy is recommended for the patient with wheezing and a normal chest radiograph when a localized obstruction is suspected.


Increased retroperitoneal fat: a sign of corticosteroid therapy.

Abdominal radiographs of 8 children treated with glucocorticoids showed large accumulations of retroperitoneal fat. Excessive retroperitoneal fat in a child is suggestive of corticosteroid therapy.


Resorption of contrast material from the bladder during cystourethrography causing an excretory urogram.

A small amount of cystographic contrast material is resorbed regularly from the bladder into the blood stream during routine cystourethrography in children. If the agent remains in the bladder for a relatively long period of time, the amount of iodine absorbed may be large enough to produce an excretory urogram.


Radiological findings in Yersinia ileitis.

Bacteriological and clinical studies of patients with acute retional ileitis indicate that numerous patients with this diagnosis have a benign ileitis of short duration, caused by Yersinia enterocolitica, whereas others develop chronic Crohn's disease. Yersinia ileitis has some clinical and radiological features in common with Crohn's disease, but the two conditions are basically separate. In Yersinia ileitis, three stages are apparent: (a) the nodular stage, lasting up to three weeks; (b) the edematous stage (4th-5th week); and (c) resolution, observed during the 5th-8th week. The radiological findings in 25 patients with Yersinia ileitis and their distinction from Crohn's disease are described.


Pilomatrixoma (calcifying epithelioma of Malherbe): radiographic features.

Pilomatrixomas (calcifying epitheliomas of Malherbe) are benign soft-tissue tumors that occur in the dermis or subcutaneous tissues; about 40% are found in children under 10 years of age. More than 80% have microscopic calcification and/or ossification. Although the incidence of radiographically visible calcification is not known, heavily calcified tumors have a distinctive radiographic appearance. The authors describe the radiographic and pathologic findings in 2 children with pilomatrixomas.


Osteodysplastia (Melnick-Needles syndrome). Radiological quiz.

Postmortem examination of a child with osteodysplastia (Melnick-Needles syndrome) showed peculiar fibro-osseous tissue in the marrow cavity, with areas of bone constriction but no abnormality of endochondral ossification. Pectus excavatum and scalloping of the vertebral bodies were also present.


Ultrasonic differentiation of right pleural effusion from subphrenic fluid on longitudinal scans of the right upper quadrant: importance of recognizing the diaphragm.

Care in identifying the diaphragm on longitudinal sonograms through the liver allows differentiation of subpulmonic effusions from subphrenic fluid collections.


Diagnosis of cor triatriatum by echocardiography.

The echocardiographic findings in a case of cor triatriatum are described. The diagnosis was suggested by a normal anterior mitral valve echo and a dense band of echoes posterior to the aortic root and within the body of the left atrium; it was documented at cardiac catheterization and proved surgically. Echocardiography is an important diagnostic aid in assessing pulmonary venous obstruction in children.


Echocardiographic detection of pericardial effusion and pericardial thickening in malignant lymphoma.

Serial echocardiographic examinations of the heart were obtained for 13 patients undergoing irradiation for malignant lymphoma. Eleven of these had been shown to have mediastinal adenopathy; none had clinically detectable pericardial disease. The pericardial effusion which had been echocardiographically evident in 6 patients prior to treatment disappeared during or subsequent to the course of radiotherapy. Small asymptomatic effusions appeared in 5 patients during the follow-up period. Pericardial effusions, detected easily by echocardiography, occur more commonly than hed been previously thought in patients with malignant lymphoma.


The ultrasonic demonstration of inferior vena caval compression: a guide to pancreatic head enlargement with emphasis on neoplasm.

The ultrasonic demonstration of compression of the anterior (ventral) wall of the inferior vena cava by the pancreatic head was proved to be a reliable sign of neoplasm enlarging the pancreatic head in 10 patients. It would appear that this sign is less reliable and probably not as important diagnostically in patients with pancreatic head enlargement secondary to pancreatitis or pseudocyst. This sign must be constant and reproducible on longitudinal scans done with a single transducer pass in suspended inspiration. This sign was not seen in 50 patients who had no evidence of pancreatic disease.


Value of ultrasonography in the detection of retroperitoneal inflammatory masses.

The ultrasonographic and radiologic findings for 7 patients with retroperitoneal inflammatory processes are presented. Ultrasonographic findings were critical to the diagnosis in 6 of the 7 patients and allowed for rapid evaluation and the institution of successful therapy. The relative sensitivity and specificity of ultrasonography is compared with conventional radiologic modalities. The application of diagnostic ultrasound to the problem of retroperitoneal inflammation is advocated.


Echographic demonstration of mobility of the dissecting flap of an aortic aneurysm.

Echographic findings are reported in a patient in whom the anterior dissecting flap shows an undulating movement. Cine angiograms show expansion of the false lumen.


Factors affecting survival in over 500 patients with stage II carcinoma of the cervix.

Charts were reviewed of 519 patients with stage II (League of Nations) carcinoma of the cervix to determine those factors in the history, work-up, and treatment which affected survival. Those factors which correlated with a significant decrease in five-year survival were abnormal admission blood urea nitrogen level or excretory urogram, a history of pelvic pain or weight loss over 10 kg (20 lbs.), or tumor extension to the endocervix or uterus. These factors, as well as the results of lymphangiography, should be included in the staging of carcinoma of the cervix.


Sensitization of mouse skin to X irradiation by moderate heating.

The combined effects of heat and x irradiation have been studied on mouse skin using skin reactions on the feet. The skin was heated for one hour by immersion in a water bath at temperatures ranging from 25.5-43.5 degrees C. When the x irradiation was in the middle of this heating period a thermal sensitization to the x-ray damage was observed. The effect increased with temperature above 39.5 degrees C and doubled the effectiveness of the x rays at 43.5 degrees C. When the heating and irradiation were not concurrent the timing and sequence of treatments were important. Heat before irradiation was more effective than heat after irradiation, particularly if the interval was three hours or greater.


Cytotoxic and radiosensitizing effects of 5-thio-D-glucose on hypoxic cells.

The effect of 5-thio-D-glucose on the viability and radiosensitivity of P815-X2 mouse mastocytoma cells was studied in vitro. By itself, this compound is specifically cytotoxic toward hypoxic cells; moreover, it sensitizes hypoxic cells to irradiation while it protects aerobic cells from radiation damage. These features, together with its low toxicity, suggest that 5- thio-D-glucose may be useful adjuvant to radiotherapy


New dimensions in computed tomography.

Total body CT scanning may be utilized as a means of treatment planning for radiation therapy. Computer reconstruction of coronal and sagittal views from CT cross-sectional slices was accomplished by taking each of the cross-sectional images and placing them together in the specific order in the sequence in which they were scanned to form a cube. Once the cube is built, retrieving in the sagittal and coronal views is readily achieved.


Autoradiographic studies of distribution in the stomach of 99mTc-pertechnetate.

The histological and cytological distribution of 99mTc-pertechnetate in animal stomachs was studied by autoradiography. Unlike halogens, technetium is handled predominantly by the gastric surface mucosal cells. The parietal and chief cells have little or no role in the gastric secretion of Tc-pertechnetate.


Modification of the Phillips Cradle for visualization of the left main coronary artery and proximal left anterior descending branch.

The authors describe a simple, inexpensive modification of the Philips cradle to give improved visualization of the left main coronary artery, the proximal anterior descending artery (LAD), and the origins of proximal lateral ventricular branches of the LAD in the left and right anterior oblique hemiaxial projections.


Use of the air wedge in hemiaxial views of the proximal left coronary artery.

The authors describe a simple, inexpensive method of obtaining hemiaxial views of the proximal left coronary artery, using an inflated air wedge to support the patient at the appropriate angle.


Magnetic removal of foreign bodies from the upper gastrointestinal tract.

The authors describe a simple method of removing objects such as bobby pins and straight pins from the upper gastrointestinal tract. A small but strong magnet such as the one used in a magnetic potholder is inserted in a nasogastric tube and passed through the mouth and nasopharynx under fluoroscopic control until it makes contact with the foreign body. The entire procedure takes only about two minutes and requires no special endoscopic skill.


The lateral view in selective renal angiography.

Use of the lateral view in selective renal angiography is helpful in differentiating cysts from tumors. The position of the cyst is better defined, facilitating aspiration if necessary, while in malignant masses this technique gives a better idea of the dimensions and vascularity of the tumor. Three illustrative cases are presented.


Faster-flow enema equipment.

The author describes a new 127-mm (1/2-inch) bore disposable plastic enema system for administration of the viscous barium used in double-contrast colon examinations. The larger internal diameter permits simple, rapid instillation and drainage of the suspension. Faster flow in and out results in less discomfort to the patient, especially the old and handicapped, and also saves time for the patient, technician, and physician.


A simple method of barium administration for double-contrast enemas.

The authors describe a simple and rapid method of administering the high-density barium used in double-contrast examinations of the colon. The use of 60-ml syringes permits better placement, control of the proper amount, and removal of excess barium from the rectum.


Balloon occlusion of the renal artery using contrast material instead of air.

Occlusion of the ipsilateral renal artery prior to nephrectomy is facilitated by substituting contrast material for air in the balloon of the Swan-Ganz catheter. The higher specific gravity of the contrast medium causes the balloon to settle in the bloodstream instead of floating in it, permitting it to be carried rapidly into the renal artery.


Use of the Seldinger technique in sialography.

The authors describe a modified Seldinger Technique for sialography which is especially helpful in cannulization of the submandibular ducts. This procedure was successful in 2. of 30 patients tested.


Use of a 5 French catheter with multiple side holes in abdominal aortography.

The authors describe a simple technique of abdominal aortography using a 5 French catheter with multiple side holes. Bursting points for catheters of varying lengths and numbers of side holes are given.


Light sources as a means of reproducing patient positioning.

A simple method to insure the reproducibility of patient positioning is described. The system uses an adjustable frame fastened to the camera head and two light sources. The light sources project two circles of light on the patient. These reference points are marked on the patient's skin with a felt pen. If the patient moves or requires a follow-up study, these two reference points can be used to reposition the patient exactly. Comparison of the light-sources method with the persistence-scope method showed a significant improvement in accuracy with the former.


Tomogram degradation due to eye shielding and collimation.

Phantom-image, line-pair resolution and anterior eye exposure have been measured to determine the optimum collimation and eye shielding for petrous temporal tomography. Small round collimation and 0.5-1.0-mm lead equivalent eye shields are recommended. This reduces eye exposure to 10% of the usual dose without changing line-pair resolution.


Kidney cassettes for intraoperative radiography.

A miniature vacuum cassette, contoured to conform to the kidney, has been used successfully in the operating room to visualize intraparenchymal calculi fragments. A low-dose technique using a single-emulsion film and high-definition intensifying screens has been developed. A vacuum system assures good screen-film contact. The vacuum cassette can be sterilized and reused.


Body computed tomography: a clinically important and efficacious radiologic procedure.

In the institutions represented by the authors, more than 7,500 body CT examinations have been performed. Body CT has been found to be particularly useful in solving specific problems, especially when other diagnostic procedures yield confusiing results. Radiologists and their collegues, and not governmental agencies and insurance companies, should define the experimental, research and clinical usefulness of computed tomography.


Loculated pneumoperitoneum simulating gas in the bowel wall.

The radiographic appearance of intramural bowel gas can be simulated by extraserosal gas bubbles loculated within adhesions.


Torsion of the wandering spleen seen as a migratory abdominal mass.

Torsion of the wandering spleen is an unusual cause of an acute abdomen, rarely diagnosed preoperatively. The authors describe a case which was suspected prior to surgery and confirmed by radionuclide imaging. Radiographic findings include an extrinsic mass on barium-enema examination and absence of the splenic shadow in the left upper quadrant.


Pancreatic pseudocyst of the mediastinum.

The mediassinum is a relatively uncommon site for a pancreatic pseudocyst. Two such cases are presented, along with a review of 14 additional cases from the English literature. In most cases the pseudocyst is located in the posterior mediastinum, with entry to the mediastinum via the aortic or esophageal hiatus. The most common presenting symptoms are chest or abdominal pain and dyspnea. Displacement of the esophagus and stomach anteriorly and to the left on the upper gastrointestinal series and an associated mediastinal mass are the most helpful radiographic manifestations.


Paradoxical embolism in morbidly obese persons.

Three cases of paradoxical embolism are reported in patients with morbid obesity. Early consideration of the possibility of paradoxical embolism allows the appropriate therapy to be instituted without delay. It appears that these patients are at increased risk for both pulmonary emboli and paradoxical emboli. The necessity of early diagnosis in the pathophysiology of paradoxical embolism is discussed.


Direct radiographic magnification for skeletal radiology. An assessment of image quality and clinical application.

Recent advances in technology have made radiographic magnification of the skeleton clinically feasible. A new electron gun micro-focal tube combined with new high-resolution recording systems were used to perform magnification radiography which was then compared with conventional contact radiography. Quantitative evaluation included measurements of speed, contrast, resolution, and noise. Qualitative evaluation included an analysis of 215 clinical cases in which both techniques were used. The superior image quality of direct radiographic magnification is confirmed and the clinical areas in which it proved most helpful are defined.


Osteolysis of the clavicular tip associated with repeated minor trauma to the shoulder.

Osteolysis of the acromial end of the clavicle was seen in a 30-year-old man who had played a great deal of handball and softball, apparently as the result of repeated stress to the acromioclavicular articulation. Such osteolysis appears to be self-limited and requires no specific therapy other than rest of the affected area.


The sesamoid bones of the hands and feet: participators in arthritis.

The sesamoids generally appear as small ovoid bones adjacent to articulations or at sites where tendons are angled about osseous surfaces. At either location they participate in joint afflictions, the pattern of abnormality being remarkably constant and predictable. Sesamoids may demonstrate osseous erosion in rheumatoid arthritis, bony proliferation or "whiskering" in rheumatoid variants, joint space narrowing and bony ankylosis in septic arthritis, and eburnation and osteophyte formation in osteoarthritis and diffuse idiopathic skeletal hyperostosis. These changes become particularly important when they occur in the absence of significant adjacent articular disease. In these instances, recognition of sesamoid abnormalities allows accurate radiographic diagnosis.


Single view negative mode xeromammography: an approach to reduce radiation exposure in breast cancer screening.

With the increasing use of xeromammography in mass screening for breast cancer, the potential risk to women from repeated exposure to low energy ionizing radiation must be weighed against the benefit of early detection of breast cancer. Although xeromammography allows detection of 80-90% of breast cancers before metastases occur, the radiation hazard from repeated xeromammographic screening must be considered and attempts made to reduce radiation exposure. The dose from xeromammography can be reduced by greater than one half with the single mediolateral view, negative mode imaging technique. Moreover, no reduction of diagnostic accuracy of xeromammography in early detection of breast cancer was found with this technique.


Computed tomography of porencephaly and other cerebrospinal fluid-containing lesions.

The EMI head scanner was used to review a large number of cases of porencephaly; computed tomographic scanning was found to be the most satisfactory method of evaluating these lesions. The nuclide brain scan has not usually been of significant value for diagnosis, and although angiography and pneumoencephalography were used for correlation in some cases, the CT scan is often the only neuroradiological procedure necessary to achieve the correct diagnosis. Porencephalic areas usually have a well-defined border, have the density of cerebrospinal fluid, and do not change in density following the use of contrast medium enhancement.


Detection of subarachnoid blood clot and other thin, flat structures by computed tomography.

Eight cases of subarachnoid hemorrhages are reported to illustrate the ability of CT to demonstrate thin, flat collections of subarachnoid blood clots and the importance of CT in localization of the bleeding site, especially in cases of multiple aneurysms. The major factors in the detection of these lesions are discussed on the basis of partial volume phenomenon.