Visual evoked responses, EEG's and reaction time during a normoxic saturation dive, NISAT I.

Three Navy divers were exposed to a normoxic breathing mixture at 7.0 ATA for seven consecutive days. Visual evoked responses (VER's), electroencephalograms (EEG's) and simple reaction time (RT) were measured. Previously reported amplitude decreases in a VER to a flash rate of 1 Hz (VER 1) and to a flash rate of 16 Hz (VER 16) were again found during this dive. The variability of the VER 16 and the latency of the VER 1 also increased during the saturation period. In the EEG analysis, changes in the amplitude of both alpha and theta were found, as were decreases in alpha frequency. The RT task showed a marked elevation of response time at the beginning of the dive period which gradually returned to predive levels. Latency of the VER 160-180 ms component was highly correlated with the changes in RT. The results are discussed in terms of information processing and cerebral dysfunction.


Dive-induced modifications in platelet kinetics in rats.

The effect of a simulated dive to 8 ATA on platelet kinetics was studied in normal and splenectomized male and normal female rats. Platelet production and consumption was measured in vivo 1 h and 1 day postdive using 35S and 3H isotopes. An increased release of new platelets from the bone marrow and the spleen into the circulation was found 1 h postdive. Data from splenectomized males show that the consumption of new platelets was also increased, resulting in normal platelet counts. The delayed decrease in platelet levels one day postdive has been shown to be caused by a return of new platelet production to normal and an increase in old platelet consumption and/or splenic resorption. No evidence of lung trapping of platelets was found. It appears that decompression stimulates platelet production in the bone marrow and may serve as an adaptive, protective mechanism against severe thrombocytopenia that would otherwise develop in professional divers.


Dyspnea in divers at 49.5 ATA: mechanical, not chemical in origin.

Pulmonary function was studied in six divers living in a hyperbaric chamber at a pressure nearly fifty times normal (49.5 atmospheres absolute (ATA), equivalent to 488 m or 1600 ft seawater (fsw)). As expected, ventilatory function was reduced. At 49.5 ATA, maximum voluntary ventilation (MVV) was 45% less than the control value. Instantaneous rates of gas flow during forced expiration were similarly reduced, especially those flow rates measured high in the lung volume. These reductions occurred despite an apparent increase in functional residual capacity (FRC) and the use of transpulmonary pressures considerably greater than those exerted during the same maneuvers at normal (sea-level) pressure. During underwater work at 49.5 ATA, the divers rapidly became exhausted at moderate levels of oxygen consumption (1.9 liters/min), showing severe dyspnea and impending syncope. These symptoms were not due to retention of carbon dioxide, nor to hemodynamic or metabolic causes. Thus, dense gas breathing, like asthma, exemplifies a state in which severe dyspnea may occur with normal or low arterial carbon dioxide and normal oxygen transport. The physiological adjustments the divers employed were similar to those seen in acute asthma, imposing an elastic load in addition to the flow-resistive work of breathing a gas mixture eight times as dense as air. Although men can do moderate work under conditions similar to those of this experiment, they will have only a limited physiological reserve available to meet the possibilities of emergencies or respiratory infections.


Voice fundamental frequency levels of divers in helium-oxygen speaking environments.

Divers under hyperbaric conditions experience a marked deterioration in speech intelligibility. Included among the possible features that contribute to speech degradation is change/distrotion of speaking fundamental frequency (SFF). Based on the physics of the environment and the physiology of the diver, it would not be expected that SFF would change as a function of varying helium-oxygen pressure conditions. However, in an earlier pilot study, a rise in SFF was found with increases in depth. To test this hypothesis, and to expand the previous limited findings, a large number of U. S. Navy divers were studied. The diver/subjects produced speech samples at the surface and at depths of 200, 450, and 600 fsw in helium-rich environments. The resulting data revealed increases in fundamental frequency to the 450-fsw depth and a subsequent decrease at 600 fsw; further analysis, however, based on data transforms, showed a more linear increase in SFF. From other observations, it was judged that behavioral rather than physical conditions were the primary cause of these SFF shifts; specifically, they appear to have resulted from divers' attempts to speak more intelligibly.


A method for measurement of the bubble formation threshold in biological liquids.

Liquid under pressure is saturated with a given gas, such as argon, nitrogen, or air, by circulation through a column of gas exchangers. A sample of the gas-saturated liquid is isolated in a test chamber, the volume of which can be increased by means of a moving piston. The piston motion is cyclical with a variable frequency. Pressure in the test chamber is measured by means of a capacitive pressure pick-up. When the volume increase of the gas-saturated liquid in the test chamber is compensated for by the development of gas phase bubbles, the pressure decrease will stop; the recording device will show a pressure plateau, or a dip in the pressure-time course, depending on the velocity of the growth of the bubbles. Bubble formation threshold was independent of the frequency of the piston movement within frequency limits from 1 Hz down to 10(-3) Hz. Most experiements were carried out at a single frequency of 0.5 Hz. This new method appears to have advantages over previous ones.


Intrarenal reflux: anatomical, dynamic and radiological studies-part I.

The radiographic appearances and dynamics of intrarenal reflux have been defined in an experimental study of the pig's kidney. Intrarenal reflux occurs only with "refluxing" papillae and is an "all-or-none" phenomenon when the threshold figure of 10-15 mm Hg is exceeded. Increasing intrapelvic pressure leads to increasing density of the radiographic shadow but new areas of intrarenal reflux are not produced.


Urinary clearance of 113m In-DTPA and 99mTc-(Sn)DTPA measured by external arm counting.

Single shot glomerular filtration rate measurements involving chelates (113mIn-DTPA, 99mTc-DTPA etc) assume direct loss from the plasma to urine via glomerular filtration and excretion. Inherent errors, due to considerable uptake of activity in tissue and uncertainty of complete bladder emptying are ignored and taking of half-hourly blood and urine samples involves patient discomfort. This paper describes a simple method of measuring urinary clearance of chelates using serial external arm counting which entails only an initial injection and takes into account tissue loss from plasma. The resultant plotted curve exhibits three phases, the first two depicting input and equilibration between plasma and tissue and the third and exponential part, which is a measure of the biological half-life of the chelate, being representative of the efficiency of renal glomerular filtration, the parameter to be measured. Results obtained, compared with single shot glomerular filtration rate measurements performed simultaneously, gave better correlation with clinical data including renography.


Urinary sodium and calcium in various dog models and relationship to endogenous plasma glucagon.

Clearance studies were performed in 23 dogs undergoing extracellular volume (ECV) expansion by saline in order to evaluate relationship between endogenous glucagon and renal excretion of sodium and calcium. In control animals plasma glucagon (pG1) rose following 120 minutes of ECV expansion and was further increased by additional infusion of arginine. In pancreatectomised dogs ECV expansion failed to increase pG1. Both fractional and absolute urinary excretion of sodium in pancreatectomised dogs were markedly lower compared to control dogs. The difference in renal sodium excretion between control and pancreatectomised animals cannot be explained by the sum of nonhormonal factors influencing sodium excretion. In thyro-parathyroidectomised dogs renal sodium excretion was lower than in control dogs, but significantly higher than in pancreatectomised dogs. The arginine-induced increase of glucagon was associated with an increase of renal sodium and calcium excretion in each group under study without any change in glomerular filtration rate. In control dogs all parameters of renal sodium and calcium excretion investigated in this study were linearly correlated. Thyro-parathyroidectomy did not influence the relationship between renal sodium and calcium excretion. Hyperglucagonaemia therefore might be one factor contributing to the hypercalciuria associated with renal stone formation. In pancreatectomised dogs undergoing ECV expansion there was no significant correlation between renal sodium and calcium excretion. Pancreatic hormones might be involved in the coupling of renal sodium and calcium excretion.


[The physiopathology of vesicoureteral reflux (author's transl)].

The tightness of the ureterovesical junction depends on all the structures composing the terminal and intra-mural ureter. The muscular, collagenic, and elastic fibers of the ureter constitute a mesh net which is stretched during bladder distention and closes the ureteric orifice as a valve. Congenital vesico-ureteric reflux results from a primary structural insufficiency of the terminal ureter or insufficiency of the bladder wall backing. As embryology shows primary reflux can be caused by a high ectopic implantation of the ureter. It results from the development of an ureteric bud appearing in a lower than normal position on the Wolffian duct. This results in a higher and more lateral opening of the ureteric orifice in the bladder which leads to a shorter intra-mural tunnel predisposing it to reflux. Secondary or acquired refluxes are associated with chronic obstructions (i.e. neurogenic bladder--lower urinary tract obstruction), and inflammatory lesions. Their pathogeneses are described and discussed. The maturation of the ureterovesical junction is considered a mechanism involving a reduced likelihood of secondary reflux. It may also, during the first years of life, palliate some minimal structural deficiencies of the intra-mural ureter, but growth and development are unlikely to normalize an ureter presenting at birth with a severe constitutional anomaly.


[Experiences with various antireflux operations (author's transl)].

One hundred and thirty-eight antireflux operations in 94 patients are reported from 1964 to 1974. Bischoff's method was used 44 times with 63% successful results; Lich/Grégoir's method 38 times with 77% success; and Politano/Leadbetter's method 50 times with 92% success. Indications are briefly investigated.


[Vesicorenal reflux (author's transl)].

Antireflux procedures show high efficiency and relatively few technical complications. A tabulated comparison between the intravesical procedure (Politano-Leadbetter) and the extravesical procedure (Lich-Grégoir) reveals an overall success rate of 80%. To simplify the nomenclature, the term primary refluxing ureter is suggested for cases with a freely draining IVP and primary obstructive ureter for a dye collumnating dilated ureter. The indication for antirefluxplasty is divided into urgent cases and those with secondary priority, with immunologic tests providing helpful criteria.


[Improvement of excretory urography with the routine use of tomography (author's transl)].

The additional use of routine tomography during excretory urography in our experience has led to a significant improvement in urographic diagnosis. Tomography has provided more diagnostic studies, it also has demonstrated tumors which would have remained undetected with the use of conventional urography alone. This applies particularly to small hypernephromas of stage A, which should be considered as curable.


[Varicocele: spermiogram, testicular biopsy, plasma testosterone. Results of therapy (author's transl)].

In 73 patients with unilateral (70 patients) and bilateral (3 patients) varicocele and subfertility as a clinical finding, spermiograms, testicular biopsies, and plasma testosterone levels were examined for their prognostic evaluation, and therapeutic conclusions were drawn. The high ligature of the internal spermatic vein in the presence of a normal plasma testosterone level resulted, without accompanying therapy, in an improvement of normalization of the spermiogram in 23.3% of cases, and only in 7% did a pregnancy occur. A significant improvement of these results could be achieved through additional combined therapy with Mesterolone and Clomiphene. In primary testosterone deficiency, a combination of surgical correction and chemotheraphy (Mesterolone and Clomiphene) gave relatively satisfactory results. Primary sperm counts below 10(6)/ml, a motility index under 30%, and histologically proven desquamation of the germ epithelium in the testicular biopsy are to be regarded as extremely grave prognostic criteria.


[Indication and clinical value of vesiculodeferentography concerning urologic-andrologic diseases (author's transl)].

There are 29 cases of vesiculodeferentography (VDG) (1962-1975) presented. The very indication of VDG was the evaluation of azoospermia due to occlusion of the vas deferens, in addition to other urologic diseases. Especially from the andrologic point of view the various forms of occlusion-azoospermia are classified and analyzed. It is pointed out, that the rete testis region is not to be elucidated by VDG.


[The significance of the characteristics of lubricating jellies in use during transurethral prostate resections with metallic sheaths (author's transl)].

If a metallic sheath is used during a transurethral resection of the prostate with high-frequency currents, the lubricating jelly has to exceed a prescribed conductivity, in order to prevent dangerous current-density spots within the urethra. Furthermore, the mechanical behaviour of the lubricating jelly and the mode of its application have to be considered carefully.


[A meatotome for dorsal incision in meatal stenosis (author's transl)].

A meatotomy described which is performed with a cut at 12 o'clock using a new meatotome. In contradistinction to the incision at 6 o'clock there is no so-called watering/car effect. With the new instrument the depth of the cut of the meatotome can be varied.


[Carcinoma of the bladder. Clinical stage classification and therapy (author's transl)].

The therapeutic management of bladder tumors at the Zurich University Hospital is pointed out. It is to emphasize the important rank of the TNM-classification, which is introduced in the European Association of Urology, for comparing the results of therapy.


[Transurethral resection of bladder tumors--indication, technique and results (author's transl)].

In the period 1965 to 1975 treatment of bladder tumors was carried out in 730 patients. A transurethral tumor resection was performed in 86% of which 722 patients were reviewed. The results have been analyzed with respect to the grade and the stage of the tumor. There is a 55% survival with papilloma and transitional cell carcinoma grade 1 and 15% with grades 2, 3, squamous cell carcinoma and adenocarcinoma. The morbidity rate was low, 1.1%. Indication and technique for transurethral bladder tumor resection are reported in detail. From several points of view the transurethral resection is better than the total cystectomy.


[Differential therapy of advanced bladder carcinoma and of postoperative adjuvant chemotherapy (author's transl)].

Advanced bladder carcinoma still has a poor prognosis. While the five-year-survival in stage T1N0M0 is about 80%, less than 50% of the patients in stage T2N0M0 survive 5 years. This prognosis could not be altered by a more radical operation or by radiation therapy. Therefore we started postoperative adjuvant chemotherapy in 1972. First we tested the effect of three different cytostatic drug therapy schedules. Although successful treatment was achieved in several cases, there were other patients who did not respond to one of the three therapy schedules. We then started applying all three schedules, one after the other, in intervals of 4 weeks. Therapeutic procedure now is: After diagnosis by cystoscopy and histology and TNM-classification, urologic therapy is performed (electroresection, cystectomy, etc.). Then in stage T2-4N0-1M0-1 postoperative adjuvant chemotherapy follows. Thus far, we have achieved complete remission in all patients except one (after radiation therapy). No definite comments as to survival can be made at this time.


Renal adenocarcinoma: prognostics and treatment reflected by survival.

A retrospective study of 164 patients with renal adenocarcinoma has reconfirmed the highly malignant potential of this neoplasm. Stage and size of the tumor appear to be the best prognostic parameters. Radical surgery appears to have improved survival statistics. Follow-up must be indefinite since late metastases are not uncommon.


Experience with adrenal cortical carcinoma.

Eight cases of histologically proved cortical carcinoma are reviewed and compared with several series from the literature. Emphasis is given to defining endocrinologic function in these tumors and to the role of nonoperative treatments. Whereas surgical therapy offered significant demonstrated in any of the patients.


Ureteral reimplantation: Lich method.

In utilizing the ureteral reimplantation procedure we have performed 76 reimplantations and have a 96 per cent success rate on our first operation. We review our clinical indications, material, and complications as well as our over-all results. We believe that this operation as outlined is as good or better than other previously reported types of ureteral reimplantation and has avoided some of the major hazards, including no postoperative obstruction.


Voiding pattern abnormalities in children.

Forty-two children with voiding pattern abnormalities (wetting, incontinence, inappropriate voiding) were evaluated by urodynamic techniques. All patients were urologically evaluated and carefully appraised of the mechanics of the urodynamic testing procedure. All patients demonstrated good cooperation in an anxiety-free atmosphere. Twenty-three abnormal bladder types were identified and characterized. Specific pharmacologic and urologic modalities were applied to achieve improved or normal micturition.


Prolaction and prostate cancer.

The efficacy of treating carcinoma of the prostate with levodopa (L-dopa), a known inhibitor of prolactin secretion, has been tested in 11 Stage D patients who were refractory to conventional modalities. Relief of bone pain and recovery of mobility was excellent in 6, fair in 2, questionable in 1, and nonexistent in 2. Acid phosphatase, where initially found to be elevated, was reduced to normal limits.


Hydroxyurea in stage D carcinoma of prostate.

Thirty patients with histologically proved metastatic prostatic adenocarcinoma Stage D were treated with a single oral dose of 80 mg. per Kg. hydroxyurea every third day (based on ideal or actual weight, whichever is less) and 12 mg. chlorotrianisene per day. Toxicity was mild. The most common manifestations were nausea, occasional vomiting, and leukopenia. A definite attempt was made to depress the white blood count to approximately 2,000 cells per cu. mm. Hydroxyurea was not discontinued unless the white blood count decreased to less than 2,000 cells per cu. mm., after which a single dose was usually omitted. Omission of a single dose would allow the white blood count to return promptly to more than 2,000 cells per cu. mm. Objective tumor regression was demonstrated in 15 of the 30 patients, and most patients had a definite improvement in the quality of life.


Transurethral resection of prostate via perineal urethrostomy: follow-up report.

A controlled, prospective clinical study was undertaken to determine the incidence and cause of urethral strictures after transurethral resection. Patients were assigned to one of three groups. Group A consisted of patients in whom it was considered preferable to perform prostatic resection through perineal urethrostomy; therefore, these were excluded from randomization. All other patients were randomized using a sealed envelope method into Group B who underwent resection via perineal urethrostomy and Group C who underwent resection via the entire urethra. Strictures occurred in 16.4 per cent of 85 patients in Group C and in 2.27 per cent of 88 patients in Group B; a statistically significant difference (p less than 0.01). It was concluded that strictures result from the trauma of the urethroscope via the entire urethra and not from the use of indwelling catheters. Perineal urethrostomy is the preferred route for prostatic resection and is mandatory whenever there is any question about the acceptability of the urethra to the resectoscope.


Renal, vesical, and prostatic calculi associated with ochronosis.

A case report of a patient with ochronosis and simultaneously occurring renal, vesical, and prostatic calculi is presented. Literature review suggests an increased incidence of urinary calculi in this syndrome, yet stone composition in such cases is not remarkable.


Mesonephric adenocarcinoma of bladder.

Mesonephric adenocarcinoma of the bladder is an unusual tumor, with its origin unclear. Metaplasia of urothelium and anaplasia of embryonic cell rests appear to be the cause of this tumor. A patient is described with mesonephric adenocarcinoma, who is now apparently free of disease two years after a radical cystectomy and ileal conduit. This represents the second such report in the literature.


Pseudotumor of kidney.

Pyelocancerous backflow during retrograde pyelography is a roentgen sign indicating renal tumors. An example of a pseudotumor (renal hematoma caused by anticoagulation) is presented which displayed this type of backlfow, demonstrating the nonspecificity of the sign. The diagnostic, especially radiographic, findings of intrarenal hematoma are discussed.


Postprostatectomy urinary infection: cystourethrographic study.

Postoperative cystourethrography can be valuable in the diagnosis and management of urinary tract infection and other postprostatectomy complications. The authors have studied 50 patients and recommend voiding cystourethrography prior to endoscopic assessment of bladder outlet resistance. In addition, urinary infection may complicate a clear-cut obstructive lesion and present as a mixture of irritative and obstructive symptoms. The correlation between symptoms and the obstructive lesion is only 40 per cent. There is obviously a need for a more objective evaluation by means of cystourethrography.


Paraganglioma of urinary bladder wall.

A classic case of pheochromocytoma of the urinary bladder is presented. The history of headaches and palpitations during micturition is the result of sudden release of catecholamines into the general circulation. The diagnosis using selective arteriography as well as the medical and surgical management are described.


Prevention of endothelial damage from intraocular lens insertion.

Previous studies have indicated that approximately half the corneal endothelial cells can be lost at the time of IOL insertion. Momentary contact between the methacrylate surface and the endothelial cell appears to cause an adhesion between these surfaces which damages the cells even without prolonged contact. Although other factors may also damage the endothelium, this endothelial damage which seems clinically important can be prevented by simply dipping IOL in simple solutions of PVP.


Phacoemulsification--why?

When a new operation replaces an old, it must be better, not just equally good. The Kelman method of cataract extraction has given impressive results in patients under the age of 30 years. However, for senile cataracts it is not better, the hospital stay is not shortened, and the recovery time is directly proportional to the age of the patient and to the preoperative condition of the eye, not to the type of extraction. Phacoemulsification is a cataract extraction and, therefore, should receive exactly the same monetary reward. No comparative series of cases done by the same surgeon or surgeons of equal skill has demonstrated that the Kelman phacoemulsification procedure is accompanied by fewer retinal detachments, Irvine-Gass syndromes, or other postoperative complications. The Kelman phacoemulsification method should be an adjunct to, and not a replacement for, the current intracapsular cataract extraction.


Ophthalmia neonatorum associated with maternal chlamydial infections.

An unselected sample of 142 pregnant women had a single cervical culture for C trachomatis at 36 to 40 weeks' gestation. Of these women, 18 (12.7%) had positive cultures, and their infants were followed in postoperative fashion. Of these 18 infants, eight (44%) developed ophthalmia neonatorum. A combination of cultures and conjunctival smears for Giemsa staining and fluorescent-antibody examination for infected cells confirmed the diagnosis in 70% of the infants with conjunctivitis. However, 12 of 18 infants has serum antibodies against genital strain chlamydial antigens at 1 year of age, indicating that a majority of the infants were infected. Four of the infants had superior micropannus at 1 year of age; however, none of the infants had active conjunctivitis nor corneal or conjunctival scars.


Keratoprosthesis: a 12-year follow-up.

A retrospective study of our total experience with implantation of four types of keratoprosthesis in 125 cases was reviewed. Diagnoses in the cases treated included chemical burns, derangement of the anterior segment from disease or injury, aphakic bullous keratopathy, ocular pemphigoid, Stevens-Johnson syndrome, anterior cleavage syndrome, Mooren ulcer, and blast injuries. The visual results in some cases have been gratifying and in others heartrending. Thirty percent of the patients attained 20/15 to 20/40 visual acuity, but at the end of 12 years, only 13% still had this visual acuity. Twenty-four percent attained 20/50 to 20/200 visual acuity, but this figure fell to 17% at the end of 12 years. Loss of initial good visual acuity was due to the numerous complications which required close observation and repeated surgery to control. The number of complications has been reduced by the use of a keratoprosthesis with a Dacron skirt and of the addition the Cardona nut and bolt to the shaft. The surgical technique has been improved by the use of a scleral expander, elimination of a scleral graft, and the use of the Tenon graft. The indications for the keratoprosthesis have changed over the years. Many alkali burns and practically all aphakic bullous keratopathy have been eliminated from the indications. Keratoprosthesis should be reserved for desperate cases. The technique of implantation is not complicated and initial results are usually good. The multiple complications, however, make it necessary for these cases to be followed by a surgeon who is familiar with the management of complications.


[Acute destructive cholecystitis in children].

Under observation were 6 children, aged from 1 to 14 years, with destructive cholecystitis complicated with biliary peritonitis. All patients were subjected to surgery with favourable issues.


[Natural resistance of the body in appendicular peritonitis in children].

It is found that in appendicular peritonitis, as the inflammatory process progresses, the protective functions of the organism are lowered, and the intensity of inflammatory changes is increased. The determination of the natural resistance status of the body in peritonitis in children may be used for an objective estimation of the process course, the efficacy of therapeutic measures and prognostication.


[Treatment of rectal atresia with rectal and urinary fistulas in newborn infants].

It is the authors' opinion that one-moment proctoplasty with careful disjunction of fistulas is the best method of treatment of newborn infants with recto-anal atresia and urinary tract fistulas. The results of the treatment in 43 cases are described.


[Plastic surgery of the arteries of the lower limbs with autologous vein and its association with lumbar sympathectomy].

In surgical treatment of patients with arterial occulsion of the lower limbs an autovein was employed as a transplant in 66 patients. In 22 patients reconstructive operation was performed after preliminary lumbar sympathectomy. Restored patency of the operated segment with restoration of foot artery pulsation was noted in 53 patients. Late results were followed up for 1--6 years in 32 patients. Major blood flow was maintained in 24 patients (75%). Other conditions being equal, reconstructive operations yield better results, if lumbar sympathectomy was preliminary performed.


[Early diagnosis of osteochondropathy of the hip joint].

The authors describe early signs of the disease: osteoporosis of the femoral head and neck, the enlargement of the articular fissure, loss of the head sphericity. Later, induration of the epiphysis and enlargement of the femoral neck become a manifest.


[Method of increasing the effectiveness of veno-arterial perfusion].

Under study was the efficacy of heart unloading in different variants of asynchronous peripheral veno-arterial perfusion (VAP). In 12 experiments VAP was accomplished in association with the left ventricle decompression. Due to the latter, complete or nearly complete exsanguination of the left ventricle was gained in 11 experiments. In fibrillation of caridac ventricles no lung edema was noted in these cases. The elaborated technic was successfully employed twice in animals being in the state of "cardiogenic shock", induced by myocardiac infarction lasting for a day.


[Activity of the heart and blood volume in patients with rectal cancer operated on after gamma therapy].

It is found that in irradiated patients subjected to abdomino-perineal extirpation of the rectum, a decrease of arterial pressure, blood volume, minute heart volume is more pronounced than in control patients.


[Various indicators of water-electrolyte metabolism in ulcer and cancer of the stomach].

101 patients suffering ulcerous disease and cancer of the stomach were examined. Disorders in water-electrolyte metabolism were revealed, these being aggravated in the postoperative period, especially at the 3d--5th day following the operation. The aimed correction of the disorders concerned was made. The best results were obtained under the correction, made on the basis of absolute indices of water-electrolyte metabolism disorders.


[Results of arterial shunting with autologous vein below the knee joint].

Good results of femoro-tibial shunting were obtained by the authors im 79.4% of patients in the early and in 60% in the late period. Surgery was performed in 72 patients.


[Certain problems of pathogenesis and clinical course of chronic venous insufficiency in the lower limbs after deep burns].

Based on the examination of 66 patients with chronic venous insufficiency of the lower limbs following deep burns, the authors found that its occurrence mainly results from thromboses of profound veins of the lower extremities during the period of existence of burn wounds and mechnic obstruction of venous outflow, produced by extensive scars. In associated lesions of venous and lymph systems secondary postburn elephantiasis may develop.


[Effectiveness of using gelatin sponge for hemostasis during treatment of acute iliofemoral venous thrombosis].

Patients with acute thrombosis of profound large veins of the lower limbs and pelvis (83) were administered anticoagulants of indirect action, heparin and thrombolytic drugs (fibrinolysin or thrombolytin), as a result of it all patients showed marked hypocoagulemia, contributing to increased blood loss during the operation and the development of hemorrhagic complications postoperatively. With the purpose of hemostasis gelatin sponge was employed in 47 operative interventions. The number of hemorrhagic complications, while using the sponge, was reliably decreased as compared with the group of patients (57) in whom the sponge was not employed.


[Prognosis of postoperative hepatic insufficiency in patients with mechanical jaundice].

The experience with surgical treatment of 389 patients having mechanic jaundice underlie this work. It was found that the level of bilirubinemia and patient's age are of great importance for prognostication of postoperative mechanic jaundice. The greater quantitative characteristics of the former the higher is the incidence of this complication. The duration of jaundice before the operation and the etiology of biliary obstruction are not always of a decisive importance. A combination of most prognostically unfavourable factors does not lead to obligatory development of hepatic insufficiency and, therefore, it does not warrant a cancellation of the operation for a patient with mechanic jaundice.


[Method of simultaneous transaortic endarterectomy in lesions of the visceral branches of the abdominal aorta].

A new method of transaortic endarterectomy is suggested, enabling a specialist to gain the correction of blood flow in visceral and renal branches of the abdominal aorta simultaneously. The technic described was employed during operations in 19 patients. The clinical effect was noted in 17 patients, 2 patients died due to acute cardiovascular insufficiency.


[Laparocentesis in emergency abdominal surgery].

The results of 180 diagnostic punctures of the abdomen after the A. N. Berkutov technic are reported (120--for abdominal trauma and 60-- for acute diseases). Indications to laparocentesis in urgent surgery of the abdomen are presented.


[Secretion of free hydrochloric acid after organ-saving surgery for duodenal ulcer].

Secretory function of the operated stomach was studied in 188 patients after trunk and selective vagotomy with distal resection and pyloroplasty of various extent. Under conditions of vagotomy the preservation of the whole stomach essentially fails to increase residual secretion of free hydrochloric acid.


[Surgical wound dehiscence after esophageal anastomosis in radical surgery of cancer of the cardia].

The authors have analysed 64 observations of suture incompetency of esophageal anastomosis after resection for cancer of the gastric cardiac portion. Three pathogenic phases and three variants of the clinical course are distinguished in the development of the complication. The successful treatment of the complication largely depends on its recognition and properly selected method of treatment with relation to a variant of the course, a phase of the process and terms of its diagnosis.


[Polyps of the major duodenal papilla].

Systematic performance of fibroduodenoscopy in patients with diseases of bile tracts and the pancreas made it possible in 90 cases to reveal polyps of papilla duodeni major, which were the cause of chronic recurrent pancreatitis. An experience with 50 operations evidences that transduodenal polypectomy is a radical method of treatment obviating recurrences of pancreatitis.


[Various problems of surgical treatment of volvulus of the sigmoid].

Some aspects of surgical tactics in 57 patients with sigmoid ileus are discussed. In 42 patients palliative operations were performed, 7 patients (16.7%) died. In 15 cases radical operations were performed. Palliative operations are recommended only for aged patients, but in most cases sigmoidectomy seems to be warranted.


[Age aspects in etiology and pathogenesis of postoperative adhesive intestinal obstruction].

Based on the clinical observations and experiments on animals, the authors consider that in young growing organisms peritoneal adhesions are formed more rapidly and intensively than in adults. Moreover, children show a more rapid reverse development of postoperative adhesions.


[Basic technical aspects of removal of colonic polyps with the use of fibrocolonoscopes].

The authors describe the technical aspects, which observation makes it possible to safely remove polyps from any portion of the colon. Complications necessitating operative interventions were 3: one hemorrhage and two perforations of the colon.


[Importance of morphological studies for precise determination of the limits of local spread of rectal cancer].

115 samples of the rectum were investigated after radical operation for its cancer. In 61 samples its intramural distribution was studied by means of transverse section of the rectum distally to tumor as well as the involvement of regional lymph nodes, cellular tissue and sphincter muscles. The preferential direction of tumor invasion in different stages of cancer growth is a "perpendicular" tumor growth. In 6 samples the spread of distal intramural growth exceeds 2 cm and in 1 sample -- 6cm. No sphincter involvement was noted. Regional metastases were found in 37 per cent of observations. Retrograde metastases were detected in 3 samples. In 7 of 15 samples with total proliferation of the rectal wall tumor elements were detected in peripheral cellular tissue "perpendicularly" above the tumor. The problem of the adequate extent of the operation should be solved taking into account the tumor site, histological structure, limits of intramural and extramural growth and tumor size.


[Surgical treatment of tuberculous spondylitis complicated by bronchial fistula].

The results of surgical treatment of 39 patients with tuberculous spondylitis, complicated with bronchial fistula, are analysed. The fistula was liquidated in 35 patients. Late results followed up from 3 to 18 years were studied in 26 patients. Bronchial fistula is yet present in 4 patients, who were discharged with its presence.


[Use of proteolytic enzymes and ectericide in surgical treatment of suppuration].

The use of proteolytic enzymes and ectericide in treatment of patients with suppurative processes yielded positive results. The duration of the treatment and terms of patients incapacity are shortened.


[Clinical course, diagnosis and surgical treatment of Raynaud's disease].

The work is based on the experience with treatment of 86 patients with Raynaud's disease. 41 patients were treated conservatively, in 45 patients thoracic sympathectomy was performed. All 45 patients subjected to thoracic sympathectomy showed excellent and good immediate results. Late results were favourable in 20 out of 23 operated patients, examined within the terms from 5 to 15 years postoperatively. Thus, thoracic sympathectomy is an effective method of treatment for Raynaud's disease.


Immunotherapy of bovine ocular squamous cell carcinomas.

Squamous cell carcinomas were collected from the eyes of cattle and saline phenol extracts of the tumours were prepared. The aqueous phase of the extract was used in studies on the immunotherapy of ocular squamous cell carcinomas in cattle. After a single intramuscular injection of the extract, regression and sometimes complete disappearance of eye tumours were observed in 39 of 46 carcinomas. Tumours as large as 4 X 5 cm regressed completely. Enhanced growth of tumours was noted in two of three cattle given multiple injections. Regressing tumours were examined histologically and regression appeared to be associated with a cell-mediated immune reaction. Spontaneous regression of a confirmed squamous cell carcinoma was observed in one animal. This spontaneous tumour in one of the larger domestic animals provides a useful experimental model for the study of tumour antigens.


Observations on the reproductive performance of ewe lambs synchronised for oestrus.

Oestrus induction and synchronisation achieved by means of progesterone implants (Silestrus; Abbott) and one or two injections of 500 in FSH (Gestyl; Organon) at 15-day intervals was followed by natural service in 194 10-month-old ewe lambs, fed on pasture (Group A, of 101 animals) or pasture and concentrates (Group B, of 93 animals) used to study the influence of nutrition and of induction of a second synchronised oestrus on the percentage of oestrus manifestations, conception rate, number of lambings and of lambs born among the above animals.


Successful transfer of a bovine embryo through a cannulated fallopian tube.

The fallopian tubes of a recipient cow were surgically cannulated and the cannulae brought out through the flank. Two fertilised eggs, recovered surgically from a donor cow, were transferred to the uterus of the recipient cow through the cannulae. The recipient became pregnant and gave birth to a live normal female calf 289 days after the transfer. After the birth of the calf one cannula was found to be patent.


Fertility of norgestomet treated dairy heifers.

Four studies are described involving 2573 Friesian heifers treated with norgestomet and oestradiol valerate to control the ovarian cycle. All treated animals were inseminated at fixed times following treatment. In study 1 insemination 48 and/or 60 hours after treatment resulted in a non-significant greater proportion of heifers becoming pregnant than at 48 X 72 hours. Large variations in fertility among farms were recorded in field trials of norgestomet (Searle) and oestradiol valerate. In study III the effect on fertility of nutrition, weight and body condition was studied. In section IV a pregnancy rate to fixed time insemination of 66-8 per cent of 500 heifers inseminated at 48 and 60 or at 48 and 72 hours after norgestomet/oestradiol valerate treatment was obtained. Heifers in study IV were fed a balanced ration designed to provide a predicted daily liveweight gain of 0-7 kg for a 12-week period starting six weeks prior to the date of insemination. The range of fertility was from 59-0 per cent to 85-7 per cent.


Ascariasis: the development of eggs of Ascaris suum under the conditions prevailing in a pig house.

Eggs were collected from gravid female Ascaris suum in the abattoir. Cultures were prepared with the eggs in 2 to 3 mm depth of 1 per cent sulphuric acid or on the surface of 2% aqueous agar. They were allowed to develop in a piggery, fresh cultures being started at intervals from January to September. Eggs on the surface of agar developed failry uniformly and a high proportion eventually reached L2. In contrast those under 1% sulphuric acid were less uniform, slower in development and generally less successful. Cultures started on agar between January and May, or from September became infective at approximately the same time in July while those started during June and July contained infective eggs in August and September respectively. No recognisable development occurred between October and April. The significance of these findings for the epidemiology of ascariasis is discussed.


Dystocia in a snake.

Herpetology is a rapidly growing interest in this country, reptiles being kept both for research purposes and as pets. However, there is a lack of literature on reptilian medicine and surgery; the authors know of only one available text (Frye 1973). Furthermore, there are only two published case histories of dystocia in the snake (Huff 1976, Hime 1976) and thus this case was considered to be of particular interest.


A study of a strategic dosing programme against ovine fascioliasis on a hill farm.

In a farm-scale veterinary preventive programme run from 1973 to 1976 the use of rafoxanide (Flukanide; Merck Sharp & Dohme) in the prophylaxis of ovine fascioliasis resulted in a marked reduction in the percentage of ewes passing fluke eggs in the faeces and an absence of clinical cases of fascioliasis throughout these years. Three separate flocks of hill sheep were used in this study in which the aim of the dosing programme followed was to kill the majority of liver flukes (Fasciola hepatica) before they reached adult egg laying stage, thereby eliminating, or considerably reducing, the number of eggs passed on to the pasture.


The urinary excretion of synthetic corticosteroids by the horse.

A radioimmunoassay method has been developed that enables the administration of therapeutic doses of synthetic corticosteroids to be detected in horse urine. Fourteen proprietary preparations of these steroids have been given by intramuscular injection to ponies and thoroughbreds. The administration of some preperations could still be detected six days after a single intramuscular injection of a therapeutic dose. The route of injection of dexamethasone-21-sodium phosphate, whether intramuscular, intravenous or intra-articular, did not appear to alter the length of time over which the steroid or its metabolites were detected. However, the chemical and physical form of the steroid markedly affected the excretion in the urine and this parallelled the duration of its action.


The serological relationship between Theileria parva (Muguga) and Theileria lawrence from Rhodesia.

Thirty-eight sera from cattle from a herd in Rhodesia naturally infected with Theileria lawrencei were titrated with the indirect immunofluorescent test against schizont antigens of T parva (Muguga) and T lawrencei from Rhodesia. T lawrencei was found to be indistinguishable from T parva with the test.


Congenital nuclear cataracts in cattle.

A description is given of the investigation into two outbreaks of congenital cataract in dairy herds. There is a description of the clinical signs, the incidence, the period of time over which the cases occurred and of the seasonal distribution of the births. The type of herd management is descirbed and a hereditary factor is not considered to occur. The possibility of the involvement of other toxic and environmental agents is discussed. The macroscopic and microscopical findings are described; the relation to the early period of lens development of the bovine fetus suggested.


The effect of shearing pregnant ewes on lamb birth weights.

Shearing housed pregnant ewes at about the 11th week of pregnancy resulted in increased ewe liveweight gain (P greater than 0-01) and heavier twin litter weights (P greater than 0-01). The lambs from the shorn ewes also grew faster when put out to pasture. Unshorn pregnant ewes had a faster and more variable respiration rate, probably due to their being too hot in the prevailing conditions. The effect of this apparent heat stress on fetal nutrition is discussed.


[Quantitative changes in produced and destroyed erythrocytes in hemopathy].

Ten healthy volunteers and 38 patients with iron deficiency anemia, aplastic anemia, chronic lymphadenosis, myelofibrosis were examined. On the base of the results from the kinetics of iron-59 and the marked with chromium-51 erythrocytes and from the corrected per cent reticulocytes, the authors set up the task to evaluate the etythropoetic potentialities of bone marrow and the severity of erythrocyte balance disorder, studying the quantity of produced and destroyed erythrocytes daily and comparing the data obtained with those from aspiration biopsy and treparobiopsy. The results, obtained by the authors, reveal the high potentialities indicated by the isotope investigation with iron-59 and chromium-51 as well as the corrected per cent of reticulocytes, for the evaluation of the erythropoetic potentialities of bone marrow and the high correlation between the results obtained and the clinical picture.


[Medical geographical map of Balkan endemic nephropathy in Vratsa District].

The author has studied the spread of the Balkan endemic nephropathy (BEN) according to the dispensary, clinical and post mortem data in the district of Vartza and established that the disease is met in 41 settlements of the district with a total population of 47,589. The average morbidity rate in the endemic villages is 35.9% of the population. In three villages it is over 200% in five--over 100--200% and four from 50--100%, in 25--from 2--50% and only in four villages under 2%. The author has elaborated a medico-geographical map on the base of the number of the settlements where patients with BEN are to be found. As seen from the map, the disease is met in settlements situated at the foot of the Balkan and its foothills: Vratza region of the Balkan and Veslez. It is interesting to be pointed out that certain settlements free of the disease are to be found among the endemic villages. The disease affects the village population. In the towns of Vratza and Mesdra, though situated in the center of the endemic region, no BEN patients have been found among the local population.


[Deviations in the level of serum lipids and higher fatty acids in liver cirrhosis and chronic hepatitis].

Serum lipids and higher fatty acids were investigated in 141 patients with portal liver cirrhosis, 51 patients with chronic hepatitis and 40 clinically healthy subjects--controls. Lower contents of cholesterin in blood was found in the patients with liver cirrhosis as compared with the healthy as well as of total lipids, phospholipids, beta-LP, palmitic, palmitoleic, oleic linoleic and linolenic acids and considerably higher contents, of NEFA endogene heparin, LPL and blood sugar. The deviations described are more manifested in decompensated liver cirrhosis. In the patients with chronic hepatitis, as compared with the controls higher contents of cholesterin, total lipids, phospholipids, triglyceride, beta-LP, NEFA, LPL, endogene heparin, stearinic, palmitic, palmitoleic and oleic acids and blood sugar were found. In the patients with liver cirrhosis, as compared with the patients with chronic hepatitis, a lower contents of cholesterin was found as well as of total lipids, phospholipids, triglycerides, beta-LP, palmitic, palmitoleic and oleic acids and a higher contents of and blood sugar. The described deviations in the contents of serum lipid indices are with a definite regular character and can be used in the diagnosis of liver diseases.


[Functional state of the genital system in men with obesity].

The results from the carried out investigations on fertility indices of ejaculate are reported as well as on the spermatogenic activity test with radioactive phosphorus and on the determination of total gonadotropic excretion in urine of males with high degree of obesity. A statistically significant decrease of all investigated in dices of ejaculate and the test of spermatogenic activity was found. The decreased gonadotropic activity in over half of the patients investigated with obesity, as well as the manifestations of diencephalic alterations in them made the authors admit the secondary character of the gonad disorders.


[Long-term follow-up of mitral commissurotomy patients from Razgrad District].

The authors observed 51 patients after mitral commisurotomy was performed for 1 to 12 years. After the operation the number of the decompensations and the rhythm disturbances had decreased. Twenty six subjects are back at the same work place, 23 retired on pension or changed their work, two died. The mitral commisurotomy appears the only ailing method in advanced cases of mitral stenosis. The active dispensary treatment is an important stage prior to the operation as well as after it.


Carcinoma of the colon and rectum. A perspective for practicing physicians, with recommendations for screening.

Carcinoma of the colon and rectum is the most common serious type of cancer found in the United States and is second only to lung cancer among causes of death from cancer. Its cause is unknown but several environmental factors-especially low bulk, high fat diets-seem to predispose to its development. The disease is readily treatable by surgical operation if it is diagnosed early. Radiation and chemotherapy may offer some additional benefit in treating advanced disease but the response to all forms of therapy is disappointing in patients in whom disease has spread beyond the bowel wall. Colorectal cancer appears to be a very slowly progressive disease with a long asymptomatic period providing an ideal opportunity for diagnosis at an early treatable stage. Both proctosigmoidoscopy and screening specimens of stool for occult blood have been shown to be effective methods for identifying it before symptoms develop. These procedures should be done routinely in all patients over 40 years old and especially in those patients who have other risk factors such as positive family histories or hereditary conditions known to predispose to colorectal cancer.


Selective use of radiography of the skull and cervical spine.

Based on the findings of a five-month study, the authors suggest that physicians should be more discriminating in using radiography of the skull, especially when dealing with patients who are minimally injured. The low incidence of fractures disclosed by radiography in patients with insignificant head injuries is a primary factor in arriving at this recommendation. A lack of correlation between skull fractures, and cerebral injury, and subsequent therapy is another factor. Finally, the prohibitive cost of medical care generally (and radiographs in particular) makes greater selectiveness imperative. Although the number of cervical spine fractures in this study was small, the findings indicate that based on history and physical examination there can and should be increasing selectivity in ordering routine cervical spine series, without increasing the risk of missed fractures.


Familial Mediterranean fever. Recent advances in pathogenesis and management.

The success of colchicine therapy in the management of familial Mediterranean fever has provided new direction to investigations into the pathogenesis of this disease. Examination of HLA antigen frequencies in 53 patients with familial Mediterranean fever and appropriate controls, as well as various immunologic studies have yielded no significant differences. However, B lymphocyte typing and assays for immune complexes, lymphokines and prostaglandins may be of potential interest. Preliminary studies indicate that leukocytes of patients with familial Mediterranean fever release increased amounts of lysozyme (P<0.01), when subjected to high temperatures, and of both lysozyme and myeloperoxidase at low osmotic concentrations. The known and potential effects of colchicine on leukocyte and cellular metabolism, and the current status of colchicine prophylaxis are reviewed. In patients receiving an optimum colchicine dose of 1.5 to 1.8 mg per day, side effects have been minimal and the frequency of attacks has been decreased significantly.


Maternity and perinatal services in an urban-suburban area.

The need for community-wide planning of maternity and newborn services is illustrated by a survey of services in Alameda County, California. The decline in birthrate, coupled with the persistence of a number of low volume obstetrical and newborn units, is reflected in generally underutilized and unevenly distributed services. Primary, intermediate and tertiary levels of care are represented, but not always in a logical relationship to community needs. Postgraduate training in obstetrics and gynecology and in pediatrics continues to produce increasing numbers of specialists despite declining fertility and a decline (represented by children and youth) in the total population.


[A simple procedure to forecast the course of diseases (author's transl)].

A procedure is presented which enables the physician to forecast the course a disease will take by looking through a list of items with attached numbers, i.e. weights, and simply adding the weights of those items which hold true for a specific patient. The application of this procedure to three different diseases, namely schizophrenia, facial paresis, and aphasia is presented and proves its accuracy. Furthermore, a Monte Carlo Analysis of the procedure underlying this method--multiple linear regression of dichotomous items--leads to recommendations concerning the optimum definitions of items and the structuring of data. The procedure is compared with other methods used in computer diagnosis and its main advantage, apart from its high reliability, i.e. independence of computers in its application, is stressed. Its application to other diseases is encouraged and the presentation of data for processing by this Department is invited.


Nononcologic disease in patients with cancer.

Nononcologic medical problems are common in patients with cancer. Failure to evaluate and treat these problems leads to considerable morbidity and mortality in people who often have potential for both comfortable and productive lives. While a physician is sometimes powerless to prevent the progression of underlying cancer, he must not allow a diagnostic category to color his approach. By seeing only an end point which is inevitable for all people, one could be inclined not to treat what is treatable. With clinical judgment, information and the eternal question of diagnosticians, "What else could this be?", a physician can focus not on the inevitability of death but on the quality of life.


[The familial incidence of various types of hyperlipoproteinaemia (author's transl)].

Serum lipid values were determined in the first degree relatives of 31 children within the framework of a screening programme for cardiovascular-disease risk factors in schoolchildren of either sex (11 to 12 years old). Familial hyperlipoproteinaemia was not present in 5 families. The investigations revealed 12 families with hypercholesterolaemia and 2 with hypertriglyceridaemia. 12 families showed that form of hyperlipoproteinaemia which has been described in the literature as "familial combined" or "multiple type" hyperlipoproteinaemia. Spontaneous variation in serum lipids was observed in 4 out of the 12 above-mentioned children when determinations were repeated. The variability in expression of hyperlipoproteinaemia in the individual case, as well as in families, is one of the reasons for the controversy over the classification of hyperlipoproteinaemias. It is well known that hyperlipoproteinaemia, especially of the familial type, represents a significant risk factor for cardiovascular disease. Thus, it is essential to treat persons with elevated serum cholesterol or triglyceride values and to examine their relatives for hyperlipoproteinaemia.


[Lipoprotein analysis by means of the fluorescence probe 8-anilino-1-naphthalene sulphonic acid (author's transl)].

Single and mixed lipoprotein fractions were successfully analyzed by utilizing the fluorescent propertby of the applied reagent, 8-anilino-naphthalene sulphonic acid. The described method is especially useful for determination of lipoproteins present in high dilution, as found in chromatographic column effluents. The concentration dependence of the developed fluorescence was determined and this served as basis for quantitation. Furthermore, the measured activation spectra show two peaks for each lipoprotein class, the relative intesities being different for each class. The intensity quotient shows a tendency towards linear concentration dependence. Investigation of binary and ternary mixtures showed that the ratio of the two maximum intensities is additive, in contrast to the intensities themselves.


[Separation and stability of australia antigen in human plasma fractions (author's transl)].

Commercially-produced human plasma protein fractions were investigated by a radio-immunological method for their content of Australia antigen (HBsAg). Albumin and gamma globulin solutions in which this antigen was present, were fractionated by isoelectric focussing and gel filtration on Sepharose 4 B. Characterization as to size and electrical charge of the HBsAs was carried out on these preparations. Inactivation studies were performed at different temperatures and concentrations to clarify the question of heat stability of HBsAg in plasma derivates. The importance of additional test methods is discussed.


[Comparison of the efficacy of parenteral and enteral pertussis immunization in the rabbit (author's transl)].

The effects of immunization with inactivated B. pertussis were studied in the rabbit using enteral (oral and via suppositories) and parenteral immunization routes. The rise in agglutinating and complement-binding immunoglobulins in the rabbit serum was about equal following immunization by suppository and parenteral administration, but the demonstration of local immunity (immunoglobulins reacting with B. pertussis in salive) by immunofluorescence methods was observed only in the group immunized with enterally-administered B. pertussis.


[Maximum exercise testing during hypobaria and normoxia (author's transl)].

The effects of high altitude (3000 m, low-pressure chamber) on maximum exercise and maximum oxygen uptake were studied in four normal subjects. In order to separate the effects of hypobaria and of hypoxia, exercise testing was performed under normoxic, hypobaric conditions and compared with the results under normoxic, normobaric conditions. There was no significant difference in performance, nor in the effects of exercise on the measured cardiovascular parameters.


[Acute solitary gastric erosion (Dieulafoy) (author's transl)].

Acute solitary gastric erosion (Dieulafoy) is one rare cause of fulminant, fatal acute gastric haemorrhage. Conservative treatment is usually lethal and elimination of the source of haemorrhage by active surgical intervention is the only possible form of therapy. The key to successful surgical treatment is early preoperative diagnosis by means of emergency gastroscopy.


[Long-term results after isolated aortic and mitral valve replacement with a prosthesis (author's transl)].

111 patients with aortic valve replacement (AVR) and 159 patients with mitral valve replacement (MVR) were studied after hospital discharge. The late mortality was 20% after AVR and 32% after MVR. Of the survivors, 93% were greatly improved after AVR and 83% after MVR (functional class I or II). The calculated 5-year survival rate of the patients with AVR is 76% and with MVR 64%. The general state of health of the survivors, the thromboembolic rate and the fatal complications are discussed. Further improvement in the results can only be expected if valve replacement is performed before irreversible myocardial damage has occurred.


[Pial vessel reactions in acute hypertension--an intravital microscopic study and its clinical relevance to traumatic brain oedema (author's transl)].

A fluorescence-angiographic investigation is presented of pital vessel reactions to acute drug-induced hypertension in cats. Observations and documentation were carried out by an intravital-microscopic technique. Acute hypertension, where pressure values of 220 to 260 mm Hg were reached within 10 to 20 sec, was followed by marked vasodilatation: Arterioles under 50 mu in diameter and capillaries were dilated to between 200 to 300% of the resting diameter, whilst arterioles of 50 to 100 mu showed an increase of 50 to 60%. Reddening of veins and acceleration of the blood flow occurred. Vasodilatation persisted after the blood pressure values had returned to normal. In connexion with investigations of the blood pressure immediately after a head injury, the role of acute hypertension in the development of hydrostatic brain oedema is discussed.


[Problems of hip arthrodesis (author's transl)].

A follow-up study of 84 hip arthrodesis is reported. Four methods of arthrodesis were applied: nailblock arthrodesis, double-nail, cross-plate and screw arthrodesis. Double-nail arthroplasty was abandoned in favour of total hip arthroplasty. Moreover application of the screw was given up on account of relatively bad results. Nail-block and cross-plate arthrodesis, when indicated, are still very valuable therapeutic methods, especially in the case of patients who are too young for a total hip arthroplasty and who are still actively working. The influence of an arthrodesized hip on the knee joint and lumbar spine are examined and discussed.


[The value of tracing amyloid in the gingiva in the diagnosis of general amyloidosis (author's transl)].

50% of patients with periodontopathy, exhibited the presence of amyloid in the clinically-altered gums. The biopsy specimen of the gums was examined microscopically by means of the crossed polar method. Seemingly-normal gum biopsies were, in all cases, amyloid positive. Amyloid was detected in two out of ten cases of healthy mucosa libera of the cheek. It was assumed that this deposition of amyloid was the consequence of a locally-limited pathological process. These results cast doubt on the possibility of tracing the pericollagenic form of general amyloidosis through gingival biopsy. An alternative procedure would be to biopsy the mucosa libera of the cheek.


[Prospects and limitations of the treatment of senile maculopathies with phosphatides (author's transl)].

All kinds of treatment attempted so far in cases of senile maculopathies were unsatisfactory. Intramuscular injections of retinal phosphatides were introduced six years ago. In this follow-up study 216 eyes of patients with senile maculopathy treated by Etaretin have been checked. The former experience was confirmed that an improvement in visual acuity can be obtained only in early cases of the dry type. In such cases i.m. injections of Etaretin are actually the treatment of choice. In fairly advanced cases eventually some stabilization of the process may be obtained. In terminal stages no effect can be expected. Experimental observations revealed that the therapeutic effect of a phosphatide compound depends on the content of the polyunsaturated fatty acid C 22:6, but not on the animal organ which serves as the source of the extract. From an economic point of view these findings are of importance for further experimental work, as well as for broad clinical application.


[Differential diagnosis of liver disease by means of sonography: correlation with scintigraphy and angiography (author's transl)].

The value of sonography of the liver is assessed and compared with angiography and scintigraphy on the basis of case material from 102 patients, representing localized and diffuse liver processes. The diagnostic accuracy depends on the characteristic acoustic impedance differences in the examined tissue. Diffuse liver disease and processes without clearly defined acoustic borderlines may cause diagnostic difficulties and differentiation can only be attempted by additional clinical information. Defined tumours represent the main field of application. The combined use of ultrasound, scintigraphy and angiography permits a correct diagnosis to be made in nearly 90% of cases. Differential diagnosis between cystic and solid processes is possible only by ultrasound.


[Exocrine pancreatic function in chronic alcoholics in Austria (author's transl)].

97 chronic alcoholic patients were investigated with regard to exocrine pancreatic function. Chronic calcifying pancreatitis was radiologically established in 7.2% of the cases. Secretin-pancreozymin tests were performed in 30 patients. Pancreatic insufficiency was found in 8 patients, while 8 patients showed marked hypersection. The daily faecal fat excretion in 10 other patients with partial gastrectomy and Billroth II operation was 5.3 g. Pancreatic disorders were, thus, detected in 53.2% cases of chronic alcoholism. This is higher than expected for Austria.


[Allergy diagnosis in childhood (author's transl)].

The determination of total IgE with the PRIST as well as its relevance to paediatric diseases is discussed. An allergic basis to bronchial asthma is detected by RAST in 80% of affected children, which contrasts with only 50% positive results found in adults. The most important allergens are grass pollens, house dust, house dust mite, cat hair, guinea-pig hair and moulds. The existence of pscyhosomatic factors as the sole cause of asthma is questioned. Furthermore, hyposensitization treatment is discussed and emphasis laid on the importance of suppressor-T-cells.


[The differential diagnosis of facial paralysis in the newborn: congenital hypoplasia of the depressor anguli oris and depressor labii inferioris muscles (author's transl)].

Six cases of congenital hypoplasia of the depressor anguli muscle and the depressor labii inferioris muscle are described. Hypoplasia of these muscles causes facial asymmetry in the newborn on crying and smiling, since the affected side of the lower lip cannot be drawn down and outwards. This frequently leads to the false diagnosis of partial facial palsy. Electromyography is helpful in the differential diagnosis by detection of the hypoplasia. In contrast to current opinion in the relevant literature, the authors believe that it is hypoplasia of the depressor labii inferioris muscle which is particularly responsible for the clinical picture, rather than merely hypoplasia of the depressor anguli oris muscle.


Hodgkin's disease. International mortality patterns and time trends.

Mortality rates for Hodgkin's disease calculated by WHO since 1957 are analyzed. In spite of a rather limited variability of the age-adjusted rates, important differences are found in age-specific rates. The mortality curve has 3 main peaks: one in childhood, one in young adults and one in older adults. Only the latter is observed uniformly in all populations. The international variability in the first 2 peaks suggests the effect of host factors in determining the age of onset and the clinical and pathological characteristics of the disease. The last peak is more in line with the usual shape of mortality curves of neoplastic diseases. A slight drop in mortality rates in recent years is reported from some countries.


[Lambdamycin, an antibiotic from strain IMET 31118 of Streptomyces glaucoachromogenes Prauser. II. Physiochemical properties and comparison with chartreusin].

The isolation and purification of the antibiotic lambdamycin are described. The physicochemical properties of the chromoglysoide lambdamycin resemble those of chartreusin. In this paper we compare the physicochemical properties of chartreusin and antibiotic X 465 with lambdamycin (alpha D, UV, IR). Lambdamycin is identified with chartreusin.


[Interdisciplinary cooperation in the diagnosis and therapy of diseases of the adrenal glands and the parathyroid glands].

It is reported on the interdisciplinary cooperation between internists, radiologists and surgeons in the diagnostics and therapy of endocrinological diseases (suprarenal gland, parathyroid gland). On the basis of instances diagnostic step programmes are represented and first experiences of the cooperation are reported.


[Iatrogenic thyroid diseases].

The authors investigated the patients of an ambulant dispensary for patients with diseases of the thyroid gland in the endemic district Dresden for cause, kind and frequency of iatrogenic diseases of the thyroid gland and in 13.1% of the patients they found such lesions which above all are conditioned by wrong use of thyroid hormones and thyreostatics. The foundation of special dispensaries is demanded.


[Results of 10 years hepatitis follow-up].

It is reported on the dispensary care of 789 patients suffering from infectious hepatitis. Of these patients 92.86% healed completely of hepatitis during observation. 2.91% developed sequels after hepatitis, among them 1.03% a posthepatitic hyperbilirubinaemia, 1.03% a chronic persistent hepatitis, 0.17% a chronic aggressive hepatitis, 0.34% a liver cirrhosis, 4.25% had concomitant diseases, such as fatty degeneration of the liver, diseases of the bile duct, pancreatitis, and ventricular ulcer. The probable associations of these diseases with infectious hepatitis are discussed. Three patients suffered from diabetes mellitus. One of these patients developed a chronic aggressive hepatitis and finally an incipient cirrhosis.


[Diagnosis of rare paraproteins in plasmacytoma].

With a casuistics (multiple myoma with IgD-paraproteinaemia in a 64-year-old woman) some problems in the diagnostics of the rare paraproteins in plasmocytoma are described summarizing. In the case demonstrated with much accelerated BSR, dysproteinaemia and clear M-gradient in the pherogram as well as a deminution of IgG, IgA and IgM in the serum the IgD-paraprotein with multivalent antisera could not be proved; this was possible only with monospecific anti-IgD-serum.


[Kidney changes in experimental obesity].

In a survey renal changes in human obesity as well as in experimental obesity of laboratory animals are discussed. Own results are described about a comparison of biochemical and morphological studies on an experimental model of dietary-induced obesity after long-time feeding of a high-fat diet. Obese rats show normal concentrations of plasma proteins after feeding of a high-fat diet of some weeks. Urea-nitrogen levels are not modified as compared to control animals. Despite the mean levels of creatinine concentration in the dynamic and static phase of obesity are not different, some obese rats show increased creatinine values in the dynamic phase. Our histological studies reveal no pathological abnormalities of renal structures and blood vessels.


[Casuistic contribution to the clinical picture of idiopathic hypertrophic osteoarthropathy].

On the basis of a casuistic contribution is referred to the rare, hitherto not clarified clinical picture of the idiopathic hypertrophic osteoarthropathy (pachydermo-periostosis, Touraine-Solente-Golé syndrome). In pronounced cases the diagnosis can easily be made, when pachydermia, drumstick-fingers with watch-glass nails and hyperostotic changes of the skeleton are present. Differential-diagnostic difficulties concerning the osteoarthropathie hypertrophiante pneumonique (P. Marie-Bamberger) are the result as in the present case in abortive forms of the syndrome.


[ECG studies during esophagogastroduodenoscopy].

Esophago-gastro-duodenoscopy combined with ECG-monitoring was carried out on a total of 300 patients. In the group of patients with pulmonary, cardiac and vascular damage (102 patients) there was a high incidence of irregularities in the rhythm and repolarization (21.2% and 36.2% resp.) The deviations observed were of a transitory nature and no permanent damage or deaths occurred.


[Intestinal pseudo-obstruction].

The report is the first on intestinal pseudoobstruction in german literature. The most impressive clinical signs and symptoms in our case were uncharacteristic abdominal discomfort, flatulence, and relapsing diarrhoe over a period of two decades. Finally we observed periods of inappetence, occasional vomiting a few hours after food intake and kachexia developing in 8 months. A localized dilatation of the duodenum and upper jejunum associated with complete atonia was found by laparatomy. The dilated segment of the intestine was largely resected. An impressive decrease in the thickness of the muscularis propria with splitting of muscle fibres and intact neural plexus was found by histology. After treatment with antibiotics it came to a satisfying restitution of the patient. The hitherto very rare clinical syndrome of localized dilatation of intestine with severe disturbance of motility and the published cases of the world literature are discussed.


[Calcium palmitate and cholesterol gallstones].

Ca-palmitate is an abundant secondary constituent of cholesterol gallstones, especially of "multiple facet" and "barrel" stones. 60% of the 146 stones obtained by operation or autopsy contained crystalline Ca-palmitate. From these 70% were multiple and 11% solitary stones. The average percentage of Ca-palmitate calculated from 30 quantitative analyses amount to 1,75% with regard to the dry weight of stones. The occurrence of Ca-palmitate in gallbladder stones mainly depends on concrements which undergo structural alterations (formation of fissures for example) during their stay in the gallbladder and which are impregnated by bile. Ca-palmitate crystallizes within the fissures of these stones after concentration of included bile. There is no important hint that Ca-palmitate plays a role in stone nucleation. The occurence of Ca-palmitate in bile may be favoured by decreased micellar solubilization of palmitinic acid and by increased concentration of Ca as a result of inflammation.


[Possibilities and limitations of obstetric intensive medicine: a cost-savings analysis (author's transl)].

With the increasing use of obstetrics intensive supervision methods, perinatal mortality could be decreased from greater than 2.5% to less than 1.0% between 1965-1975. Cases of clinically relevant acidosis in the umbilical artery (pH less than 7.10) declined from 2.41% to 0.51% between 1973-1975. On the basis of these results and the statistical data from Hagberg (14), it can be concluded that 1 child out of every 1.000 births can be preserved from a severe infantile cerebral paresis and 1 child from severe mental retardation via obstetric intensive supervision. The cost for obstetric intensive medicine per 1.000 births was 370.000 Swiss francs in 1975. As a result of the decline in cerebrally damaged and mentally retarded children, expenditures of between 1.3 to 1.9 million Swiss francs were avoided. This means a savings of 1 to 1.5 million Swiss francs.


[Birth analgesia: late effects on newborn infants? (author's transl)].

Based upon scanty literature we discuss, whether unexpected fatal apneic spells of two full-term, apparently vigorous newborn infants at an age of 3 and 37 hours, respectively, may be related to Pethidine (+ Levallorphane) given to their mothers shortly before birth.


[Concerning the administration of pethidine (Dolantin during delivery: discussion to "Analgesia during delivery--delayed effects for the child? by Riegel, Messow and Pielsticker (author's transl)].

The obstetrical problematic of intrapartal infant death following administration of Dolantin were discussed with the help of both of the cases described in the article by Riegel et al. At the same time, the question of analgesia during delivery with pethidine in combination with a respiratory depressant antidote was examined. Lorfalgyl, according to current opinion, cannot compensate the antidepressive effect of pethidine. Instead, the application of pure pethidine is recommended for obstetric analgesia in the first stage of labor. Today, naloxone used as antidote is particularly suitable before delivery or can be injected into the umbilical vein of the child after delivery. A plan of treatment for pathidine therapy during the first stage of labor in combination with the antidepressant was suggested.


[Placental transfer of carticaine (Ultracain) a new local anesthetic agent (author's transl)].

Serum levels of carticaine were measured in 9 parturient women after peridural anesthesia as well as in the newborns. The neonatal serum level of carticaine amounted to 32 +/- 7% of the maternal (ratio = 0,32). This proportion is compared to those given in the literature for the local anesthetics Lidocaine (0,52-0,58), Mepivacaine (0,64) and Bupivacaine (0,23-0,26).


[A new needle for low risk amniocentesis in early pregnancy (author's transl)].

A new needle will be described, which has been especially useful for amniocentesis in early pregnancy. Construction is based on the principle of the Verres-needle. After passing through the abdominal wall and entering the amniotic sac, a blunt stylet prevents the needle from contacting the fetus. The depth of the puncture is controlled by a device attached to the side of the needle. The needle is easily observed using ultrasound because of good sound waves reflections of specially constructed surface.


[Anhidrotic ectodermal dysplasia--Identification of heterocygote (carrier) females (author's transl)].

We report on a newborn male infant suffering from anhidrotic ectodermal dysplasia. This x-linked recesive disorder has a high letality during the first year of life. Survivors are psychologically grossly impaired. This necessitates identification of carrier females. Characteristics of heterocygotes (e.g. palmar ridge flattening, paucety of pores, dermoglyphic pattern) are described. In pregnancy amniocentesis and chromosome analysis for sex determination are to be recommended.


[Prenatal diagnosis in early pregnancy].

The scope of prenatal diagnostics of hereditary diseases in early pregnancy and the cooperation of gynaecologists and human geneticists in this field are discussed.


[Bilirubin level and estrogen elimination in newborns (author's transl)].

Free estradiol and estriol was determined radioimmunologically in cord blood and in peripheral venous blood during the third, fifth and seventh day of life. The steroid level of a group of children with icterus neonatorum simplex were compared with an anicteric control group. In spite of the higher level of estriol in cord blood during the first week of life, estriol was eliminated much more rapidly than estradiol and independent of the bilirubin level. Given the same initial values for estradiol in cord blood of both control groups, the estradiol elimination rate was significantly slower in icteric newborns. The level of estradiol in cord blood was significantly higher in newborn males than in newborn females. A higher level in cord blood, however, does not increase the risk of a later newborn hyperbilirubinemia. Our findings tend to indicate that no etiologic importance should be attached to the amount of estradiol and estradiol to be eliminated, for the development of icterus neonatorum  simplex. At the same time, icteric newborns have a relative insufficiency in estradiol elimination but not, however, in estriol elimination.


[Relationship between clinical parameters and labor (author's transl)].

In 200 cases of childbirth supervised by intra-amniotic tocometry the relations between various clinical parameters such as age, parity, gestosis, rise of temperature, birth weight, small circumference of the head, duration of the cervical dilatation and the expulsion period, and the exactly defined motility of the uterus were investigated during different phases. The results confirmed the very limited influence of selected clinical phenomena upon the multifactiorially regulated total complex of labour.


[Reduction of myocardial ischemia by betablocker (Pindolol) in patients with acute infarction (author's transl)].

Seven patients with acute anterior myocardial infarction were treated with a betablocker (Pindolol 0.1-0.2 mg i.v.). The goal of the study was to determine the course of the ischemic ST elevation by means of precordial Ecg mapping (sigma-ST). Within 20 min a reduction of of sigma-ST of 23% p less than 0.05 and of the heart rate of 10% p less than 0.05 was noticed. The mean arterial pressure remained constant. In one case the heart rate rose, so did the sigma-ST. -Beside heart rate reduction a competitive effect of the betablocker against myocardial catecholamines in the ischemic area may lead to these results.


[The serum triglycerides and their role as a coronary risk factor (author's transl)].

291 patients with various types of hyperlipoproteinemia and 216 persons with normal serum lipid levels were examined for the frequency of angina pectoris and myocardial infarction. As a risk factor of myocardial infarction, Fredrickson's Type IIb was ranking on top, followed by simultaneous elevation of serum cholesterol and serum triglycerides regardless of the lipid-electrophoretic tappern, followed by Fredrickson's Type IV and finally by isolated hypercholesterolemia and Fredrickson's Type IIa. For angina pectoris, the order was slightly different: the highest risk factor was the simultaneous elevation of serum cholesterol and serum triglycerides, followed by hyperlipoproteinemia Type IV, hyperlipoproteinemia Type IIb, and finally by isolated hypercholesterolemia. The risk of both myocardial infarction and angina pectoris caused by isolated hypertriglycerolemia was not statistically significant, the same observation was made for the risk of angina pectoris in hyperlipoproteinemia Tye IIa. The present results confirm that an elevation of the serum triglycerides plays a minor role as a coronary risk factor in comparison to hypercholesterolemia.


[Studies on the differential diagnosis of carotid sinus syndrome and sick sinus syndrome (author's transl)].

55 patients suffering from syncopes or dizziness were investigated by atrial pacing and carotid sinus reflex. In 17 pts. the only pathologic finding was a prolonged sinus node recovery time, in 8 pts. a pathologic carotid sinus reflex. In 7 pts. both pathologic findings were present, a prolonged sinus node recovery time and a pathologic carotid sinus reflex. In 3 pts. suffering from atrial fibrillation in addition a pathologic carotid sinus reflex was found. In 20 pts. the findings were normal. It is concluded that sick sinus syndrome and carotid sinus syndrome are different diseases, which can be separated clearly.


[The effect of ouabain on sinus node function and intracardiac conduction (author's transl)].

The effect of 0.5 mg Ouabain (O) i.v. on sinus node function and on intracardiac conduction was studied by His bundle electrography and atrial stimulation. 7 patients with normal sinus node function and av conduction (group I), 5 patients with sick sinus syndrome (group II), and 5 patients with av block of changing degree (group III) were examined. 2 additional patients had simultaneous sinus node dysfunction and av block (group II/III). The sinus node recovery time was prolonged in 6 patients, the av block was located proximal to the His bundle in 4 patients and distal to the His bundle in 3 patients. The spontaneous sinus rate decreased in group I and remained unchanged in group II and III after O. The PA interval increased slightly after O in groups II and III, the AH interval during sinus rhythm was prolonged after O in groups II and III and in the whole group together. During atrial pacing, the stimulus-His-time was increased in each group when compared at identical stimulation rates. In 4 of 7 patients av block type Wenckebach appeared at a lower stilmulation rate after O. The HV interval remained unaltered after O, the sinus node recovery time varied after O. Phenytoin had no positive effect on the changes observed after O. Unwanted actions of O such as increased bradycardia or increased av conduction disturbances were not observed. O appears to be reasonably safe in most patients with sick-sinus syndrome and changing av block.


[Heart rate and refractoriness of accessory A-V- pathways (author's transl)].

In 20 patients with WPW-syndrome, the effective refractory periods of accessory A-V conduction were measured by programmed atrial stimulation during His-bundle electrography. The effects of basic heart rate on this parameter were evaluated. Three groups of patients were distinguished: A) The effective refractory periods of accessory A-V conduction were clearly longer than the effective refractory periods of the right atrium in 12 patients. In these patients, acceleration of heart rate shortened the effective refractory period of accessory A-V conduction. Refractoriness of accessory A-V conduction was a linear function of cycle length. B) Block of accessory A-V conduction occured at a rather long basic cycle length in three patients. No rate dependency of refractoriness could be evaluated. Methodical problems regarding the determination of effective refractory period of accessory A-V conduction were discussed. The significance of the parameter in question in respect to the trigger mechanism of paroxysmal supraventricular tachycardias (echozone) and the ventricular rate during atrial tachycardias were demonstrated.


[The effect of Ro 11-1781, a calciumantagonist, on atrioventricular conduction (author's transl)].

The effect of an intravenous bolus of 1 mg/kg Ro 11-1781, a new calciumantagonist, on sinus node automaticity and intracardiac conduction was studied by His-bundle electrography and atrial stimulation. During sinus rhythm, no significant action of Ro 11-1781 on rate, P-A-interval, A-H interval, and H-V-interval was observed. The sinus node recovery time remained unaltered. On atrial stimulation, the St-H-interval was significantly (p less than 0.001) prolonged after Ro 11-1781. Wenckebach Periods occurred at lower stimulation rates in all patients after Ro 11-1781. It is concluded that Ro 11-1781 prolongs av nodal conduction and may be of  therapeutic value in the treatment of supraventricular arrhythmias.


[Hemodynamics after mitral valve replacement with Starr-Edwards, Björk-Shiley and Lillehei-Kaster protheses (author's transl)].

After mitral valve replacement hemodynamic abnormalities persist. These abnormalities were studied 1 year postoperatively. In 50 randomized patients; 15 with Starr-Edwards (SEM), 15 with Lillehei-Kaster (LKM) and 20 with Björk-Shiley (BSM) prostheses at rest and during exercise. Simultaneously were determined: pulmonary arterial pressure, left atrial pressure, left ventricular enddiastolic pressure, mean diastolic pressure gradient across the prostheses, cardiac index, stroke volume index, valve orifice area, and ejection fraction. The results show an important stenosis by the prostheses leading to high pressure increase in pulmonary artery and left atrium during excercise. This stenosis depends on valve size and type. Björk-Shiley tilting disc valves show the best hemodynamic results. This may be due to the most favourable ratio between internal and external diameter. Starr-Edwards prostheses with identical sizes show the most identical results if compared to each other. Therfore we suggest that Starr-Edwards prostheses open completely in every case. However, there is an important pressure gradient caused by the small internal diameter. Lillehei-Kaster pivoting disc valves reach surprisingly small functional valve areas. This may be caused by an incomplete opening of the disc.


[Coronary artery fistula between the left anterior descending branch and the left ventricle; a case report (author's transl)].

The rare case of a coronary fistula from the left anterior descending branch to the left ventricle is presented. The 38 year old woman was admitted with homonymous quadrantanopsia and hyperacusis. An abnormal Ecg and a systolic and diastolic murmur of unknown origin were discovered. Cardiac catheterization yielded normal findings. Coronary angiography demonstrated an aneurysma of the dilated left anterior descending coronary artery with a fistulous communication into the left ventricle. This congenital left to left shunt produced a typical mid-diastolic murmur clearly separated from the systolic murmur.


[Evaluation of social status and hemodynamic results four to six years after prosthetic valve replacement (author's transl)].

In 72 patients the professional and social status before and after prosthetic valve replacement was examined. In 60 of these patients the hemodynamic data (cardiac index, stroke volume index, pulmonary arterial pressure at rest and during exercise) were measured. The patients were classified according to their professional training, their last occupation, and their social status before operation. Postoperative changes in professional life and the daily work load were correlated to the hemodynamic results. The study shows that the social status plays a more important role in regaining the professional position postoperatively than the hemodynamic parameter.


The hypnotherapeutic treatment of impotence.

Fifty cases of primary and secondary impotency are presented. A breakdown of the patients as to age shows that the problem is wide-spread from youth to middle-age; in this study there was a mean age of 29.40 years. All patients who remained in therapy were able to perform sexually at the time of their discharge. In followup of 66% of the patients, all stated they were doing well except for two. Hypnosis used as an uncovering modality is shown to be markedly effective. This, incorporated with ego-strengthening and new self-image suggestions, seems to be the treatment of choice for psychogenic impotence.


The stable bubble test.

Idiopathic Respiratory Distress Syndrome (I.R.D.S.) occurs mainly in preterm babies (Halliday and McClure, 1976). The cause of the condition is a deficiency of surfactant in the fetal lung. (Avery and Mead, 1959). The condition, if untreated, is associated with high fetal mortality. A simple test, The Bubble Stability Test, which can predict the possibility of I.R.D.S. occuring is now in use in the University Teaching Hospital, Lusaka. An analysis of the use of the Bubble Stability Test in fifty cases is presented. In our series a positive Bubble Stability Test accurately predicted fetal lung maturity.


[The assignment of wines to location by determination of trace element patterns (author's transl)].

The concentrations of trace elements were determined in 70 wines by activation analysis and investigated as a function of location, grape variety and vintage year. It is possible using numerical taxonomy to cluster all the wines of one region by their greater similarity in trace element patterns. It is too early for a definative evaluation of the limits of this method.


[Determination of OFF-SHOOT-T in vegetable substrates (author's transl)].

An analytical method has been developed to determine OFF-SHOOT-T in plant substrates. By this method the OFF-SHOOT-T content is calculated via the octanol-(1)-resp. decanol-(1)-concentrations determined via gas chromatography. The limit for determination of octanol-(1) resp. decanol-(1) in the substrates investigated is at around 0.1 mg/kg. This analytical method can be used for the examination of potato, onion, tabacco and other vegetable substrates.


Radiation induced lipid oxidation in fish.

Oxidative rancidity in herring and redfish was studied as a function of the applied irradiation dose, the storage time and storage temperature and the packaging conditions.--Measurements of the TBA (thiobarbituric acid) value and the peroxide value were used to evaluate the degree of oxidation of lipids, and were related with sensory scores.--Especially for the fatty fish species (herring) irradiation accelerated lipid oxidation and induced oxidative rancidity. Irradiation of vacuum-packed herring fillets and subsequent storage at +2 degrees C seems to be an interesting process. For the experiments conducted on a semi-fatty fish (redfish), oxidative rancidity was never the limiting factor for organoleptic acceptability.


Road traffic accidents in Lusaka and blood alcohol.

The present analysis highlights the 37% of deaths due to road traffic accidents 172(79.2%) males and 45(20.8%) females. About 50% deaths involved pedestrians and 15% drivers. Half of the total deaths involved the person below 34 years of age. 26.7% cases showed high blood alcohol more than the statutory limit of 80mg%. 50% of the drinking drivers were below the age of 30 years. The blood alcohol was found in 35 (31.1%) pedestrians out of 109 involved, 9 (17.7%) passengers out of 61, 10 (30.3%) drivers out of 33 and 4 (33.3%) cyclists out of 12 involved in accidents. A steep increase in the incidence of accidents during past years has been tabulated in Table (V) and discussed. One of the major causes for the accident appears to be high blood alcohol levels in the road users.


[Studies on coffee and coffee substitutes. XIX. Dependence of the quantity of a highly polymeric galactomannan on the degree of extraction coffee-extracts (author's transl)].

In extracts of Columbia Arabica Coffee the content of galactomannan precipitable with alcaline copper solution decreases slowly up to an extraction yield of 43.6%; it decreases somewhat more rapidly with higher extraction yields. An extract of Angola Robusta Coffee showed opposite behaviour. In this case the content of galactomannan increased with the extraction yield, although not evenly. Calculated on the basis of roasted coffee solids the extract of the Arabica coffee had a rather limited range precipitable polysaccharide, the Robusta coffee in contrast with rated increased amounts of galactomannan. The different behaviour of the two coffee varieties may be due to mote or less strong binding of this high-polymer carbohydrate to the cell wall.


Syndrome of ankylosis, facial anomalies and pulmonary hypoplasia.

A newly recognized syndrome, with a pattern of malformations (fixation of joints, facial anomalies, and pulmonary hypoplasia) is reported from Zambia Central Africa in an African child. Additional features of deafness and cataract are included in the congenital abnormalities and it is suggested that a form of gentic abnormality is responsible for this condition.


[Prevention of behavior disturbances in small children within the scope of public health care].

Four approaches in secondary prevention are described: the personal initiative of the parents, a risk strategy based on social indicators, crisis intervention, and systematic screening. With the exception of the risk strategy, which--at least in a Swiss urban setting--appears to be rather ineffective, these approaches could make a significant contribution, but cannot be considered as sufficient by themselves. Primary prevention in the form of structured group work stimulating the parents to display own activity is an important part in a combined strategy. Some conditions for such a strategy to be successful are mentioned. The necessity of team work and of personal continuity is stressed. Well baby clinics provide the optimal organisational base on which to build the necessary cooperation between professionals of different fields and appropriate lay organisations.