[Problems in prevention of mental disorders in preschool children].

In primary prevention, we meet many methodological difficulties: the promotion of mental health requires the transmission of specialized knowledge: this is in fact very difficult to realise. Validation of such programs is impossible. Moreover, primary prevention remains generally unspecific, often helpless--as in the case of psychosis. Problems of prediction are so important that we are not even able to predict--and then to prevent--the development of depression, one of the most common forms of psychiatric disturbance. Early diagnosis (secondary prevention) is also still inadequate: in most cases, we do not know how symptoms detected in early childhood will develop. In view of the poor state of etiopathogenic theories, 2 concepts are being used preferentially in prevention: high risk groups, and the notion of crisis. Large segments of population can be evaluated from these points of view and provided with preventive interventions. Prevention programs can address themselves to either the child himself, his family, or his larger environment. Most successful prevention programs organised by psychiatrists have addressed themselves to the early mother-child interaction. This is one of the most valuable targets for high risk or crisis interventions. Now that various preventive programs have been active for years, one can start evaluating the first results of primary prevention: while difficulties are enormous, one should not regress to comfortable isolationism of clinical work only. On the other hand, utopian dreams of eradication of psychic troubles through environmental manipulation are not valid any longer.


[Preventive training of parents].

General conditions, the theoretical frame, the contents and purposes of our preventive training of parents are discussed. The attention is drawn to the fact that our preventive training of parents is--at the time being--examined in a pilot study with regard to acceptability and understanding. First results let suppose that our preventive training supports the parents in their educational behavior. An extensive study with two control groups and an accompanying study basing on psycho-pedagogical and social-medical criteria are planned.


[Epidemiological factors and personality structure].

The relation between sociodemographic characteristics and structure of personality (MMPI) was analyzed using the results of the "Basle Adolescence Study". Type of housing, family structure, employment of the mother and number of working hours of the father produced statistically significant differences, which, however, were small in respect to the general variability of the structure of personality.


[Personality, school-achievement and behavior disorders].

In the framework of the Basle Adolescence-Study, students with indications of behaviour disorders were the subject of a special analysis. The greater part of them belonged to the lower social class and frequented the intellectually less demanding branches of the school system. Even where this was not the case their personality profile showed the characteristics of the lower class populations. The theoretical base of the "labelling approach" could be verified. School and Counselling Service proved to be efficacious parts of the system of social control.


[Epidemiological study on mental morbidity of the child at the age of latency].

A random sample of 300 9-year-old children in the canton of Vand were given a psychiatric examination. Boys showed psychopathology more often than girls, lower class children more than higher class children, children of foreign origin more than children of Swiss parents, children who had been separated from their families during their first three years of life more than children who had not been separated. On the other hand, the child psychiatric services were less well known by persons from those population groups, in which children showed psychopathologic findings more often. Questions concerning the intervention strategies that follow from these observations are discussed.


[Prevention of mental disorders after the loss of a sibling in childhood].

Reaction to the loss of somebody close is determined, not only by cultural, historical, social and family factors, but above all by the stage of individual development that has been reached. Children behave differently from adults following "object loss". Their ego and object relations are developing rapidly. The classical phenomena of mourning are usually manifested only after adolescence. When their psychological balance has been upset by bereavement children try to restore it through reparative and adaptive measures. If they are not given adequate support from the parents and paediatrician, or psychotherapeutic help when this is called for, then the loss of a significant person frequently disturbs children's further development. There is an important field for preventive psychohygienic measures open in relation to fatal illness in childhood.


[Self-damaging mechanisms. Motivation of drug- and luxury-abuse, drug consumption, tendency for suicide].

Abuse of legal and illegal drugs, alcohol and cigarettes, and suicide tend to be studied separately from each other, and different organizations concern themselves with their respective treatments. A study of self-damaging behavior patterns conducted at the University of Zurich has shown that one and the same motivational structure is expressed through these different manifestations: Processes of self-devaluation explain a large part of those behaviors that reduce the chances of survival. Since inhibition of self-actualization can be explained by social structures, it follows that preventive medicine has to open a social political dimension. The conference on which this article is based presents numerous unpublished data on alcoholism, cigarette consumption, abuse of legal and illegal drugs, and suicide fantasy. The Zurich project is expected to be terminated in 1977.


[Preventive aspect of behavioral disorders with emphasis on school and upbringing].

Prevention in the field of pre-school and school education is a permanent process, which has to be reflected in concrete measures. Based on practical experience, several such measures are proposed. These are discussed before the background of child development.


[Prevention of mental anesthesia caused by child-care pedagogics].

The phenomenon of the incapability to take initiative and decisions which is apparent in comparatively high proportions amongst welfare cases leaving educational institutions has led to concern in the practical activities of the Department of Social Welfare of the Canton of Tessin regarding the future of these cases. Various authors have observed the same phenomenon. It has been described as a syndrome which conveys the impression of a psychic anaesthesia. It has the characteristics of a masked depression. In spite of the absence of exact figures it is already obvious that apart from the deplorable state of mind of these cases, they are likely to in the long run become an increasing financial burden to the social welfare services of the productive part of the community. Effective prevention would require a structure of social services as well as educational institutions which correspond to the natural phases of development, and where the necessary satisfaction of psychic needs typical of each phase of development is achieved in a natural community including children of various ages.


[Naive objectivism in the assessment of behavioral disorders].

Naive objectivism is a widespread attitude in human and social science research, although it disregards important principles of the theory of cognition. In the history of philosophy two naive approaches to the understanding of the world were continually disputed; 1. rationalism which purports unlimited cognitive power of the human mind, 2. a kind of empiricism which denies subjective elements in the process of cognition. Today the overestimation of human understanding is reflected in a dogmatic adherence to specific professional or idealogically biased doctrines and in the dubious ideal of a purely empirical science with its limited applicability to mankind. The exaggerated expectations regarding the inherent lawfulness of the empirical research field is demonstrated by excessive data collection and by the useless attempt to define behavioral disorders as deviation from the statistical norm. However, behavior disorders can only be understood, if the totality of being human is considered. They are to be seen as failing attempts to give and to maintain a meaning to life.


[Behavior disorders and epidemiological, classificatory and terminological aspects from the psychological viewpoint].

Natural language describing children with unusual forms of behavior may have different meanings, depending on context and situation. Labelling does not do justice to these subleties, and it tends to harm the child, as in the undertone of presently used terms, there tends to be an element of moral condemnation, predisposing for its part to poor prognosis. A necessary means of prevention would be by protecting our children from professional language, as it blocks the avenue to the art of a socially integrated, "good" life.


[Diagnosis and nosographic classification in the child-psychiatric epidemiology].

Psychiatric epidemiology is founded on clinical experience and scientific research; these two spheres are not contradictory but complementary. Different aspects need to be examined thoroughly; for instance, diagnosis, considered as the result of a rather complicated process has hardly ever been studied. This should not lead us to give up or to act in a pseudo-scientific way as if we could control all the problems. The existing results show us that diagnosis is getting significant only with complementary and specific items. From the methodological point of view, video-tape and discussions about case histories allow us to study the diagnosis process. Field researches, comparative studies about systematic case data of different services, clinical and longitudinal investigations contribute ot epidemiological knowledge and facilitate interdisciplinary and international cooperation. Any linear and causal explanations on epidemiological phenomena appear unreliable.


[Burdens due to noise and air pollution in residents of areas near streets with heavy traffic].

The residents of different streets with varying traffic density and building density were questioned about annoyance due to traffic noise and air pollution. Frequency and extent of annoyance felt, effects of immissions on such living aspects as recreation, or communication, and also the reactions to the disturbance felt (such as closing windows and taking sleeping pills) were investigated. Noise levels as well as particulate matter and gaseous air pollutant concentrations were measured along the streets under investigation. The evaluation of 1300 questionaires showed that reactions to noise were different in different quarters although noise levels were the same. In general, about 40% of residents were heavily disturbed during daytime when the noise level Leq was around 65 dB(A); while for the same noise level at night about 55% reported to be heavily disturbed. Strong correlations were also obtained between annoyance due to noise and that due to air pollution. The results show that annoyance felt is dependent not only on the measured noise levels and/or air pollution concentrations, but that there do exist interactions between the residential quarters and annoyance. These interactions should be considered while fixing the limits and standards.


[The problem of noise adaptation during sleep].

Within experimental series carried out till now habituation to noise during sleep was, as a rule, statistically insignificant, though most of the papers are reporting a decrease of awakening-reaction during the experiment. This discrepancy rises from the small number of experimental trials, so that statistical test fail. Summarizing the published data the decrease of reaction during test series is significant. Based on these data a function of habituation has been calculated demonstrating an increase of O-reactions (all reactions less than a change of one sleep stage) and a decrease of awakening-reactions caused by acoustical stimuli. The ascent of the curve of habituation becomes flatter and is about 0 within the 9th test night. As indicated by the calculated curve, it seems that a second process of habituation takes place but this further decrease of reactions could not be proven. The increase of 0-reactions as well as the decrease of awakening reactions is dependent on the content of information of the acoustical stimuli which decreases with the number of stimuli.


[Measure of lead exposure in a group of young girls].

In January--February 1976 blood analyses were performed for two groups (rural and urban) of young girls aged 11--16 years. The following parameters were measured: PbB, ALAD, FEP, haemoglobin and hematocrit. Results indicate only low blood lead levels (PbB less than or equal to 20 microgram/100 ml: ALAD by European method greater than or equal to 33 U/1. A small but statistically significant difference was observed in case of rural/urban ALAD values.


[Suspense-dust-, lead- and benzpyrene emissions in the city of Zurich].

Levels of particulate matter, lead and benzo(a)pyrene were measured during 1971--1976 at different monitoring stations in Zurich. Annual averages in city proper ranged between 90 and 180 microgram/m3 for particulate matter, 2 and 3 microgram/m3 for lead and between 6 and 7 ng/m3 for benzo(a)pyrene. Corresponding values for the suburbs as well as for the village of Netstal were about 1/3 to 1/2. Winter levels were higher than the summer ones at all the sites. These differences were more obvious in case of calms. Ambient concentrations of particulate matter and lead measured in the city center were similar to those measured in german cities and were in the same range as air quality standards. Primary attention should be paid to the reduction of emissions, as surveillance of space heating and incineration equipment, and the reduction of lead in fossil fuels.


[Endotoxins: a neglected environmental factor].

The effects of bacterial endotoxins are well known form an experimental and clinical point of view. Their presence in the environment in general and their possible role for the development of clinical symptoms at low exposure levels has been less studied. Experimental and epidemiological evidence for such effects are reviewed with reference to particular environments where this exposure might be present.


The feasibility of demonstration of GM- and InV-systems in decaying organs.

Gamma-globulin factors (Gm and InV-systems) were determined in 12 cadavers in blood and various organ exprimates (kidney, liver, spleen and muscle). Also checked was the time interval up to which these factors could still be demonstrated in decaying organs. For this purpose blood and portions of the organs were left to decay in plastic containers at an average temperature of 19.1 degree C. Examinations were done with the agglutination-inhibition-test. The exprimates were employed in dilutions 1:10 and 1:20. The serum factors Gm (1), (2), (4), (10) and InV (1) could be demonstrated for varying periods of time. In organs they could be demonstrated for between one and eight weeks. Only factors Gm(1) and Gm(2) could be demonstrated beyond this time. As a rule these serum factors were demonstrable in blood for a longer period of time than in organs; Factor Gm(4) proved to be the most stable one, as it could be demonstrated up to 11 weeks in decaying serum. In 2200 individuals tests with a dilution 1:20 no false positive results were obtained, with the dilution 1:10, however, 5 false positive tests were found. No explanation can be given for the different periods of time for which these factors can be demonstrated under conditions of decay.


The medicolegal usefulness of the Kidd system in exclusion of parentage.

The blood samples of 2741 people from Germany were examined. The gene frequencies of Jka was found  to be 0.49345 and of Jkb 0.50655. The theoretical probability of exclusion lies at 18,57%, the practical one only at 7.09%, because in many cases, the presumptive father is also the biological father. It is a system of dependable information. The Kidd system can be used as a classical system for exclusion of parentage.


[Experience in a group of overweight persons].

The experience with group therapy of five obese persons over a ten-week period is being reported. The purpose was to effect changes in abnormal eating habits by means of behavioural methods toward self-control. The mean weight of the group was reduced from 79,4 kg to 72,2 kg during the period of the course; mean weight reduction was 7,2 kg while mean overweight was lowered from 22% to 10%. In order to prevent rebounds, it is recommended that participants remain under continued care. Despite the small number of probands, it is though that the study provides useful information about the effectiveness and problems of group-dynamic obesity treatment in population.


[The estimation of the time of death of corpses recovered from water (author's transl)].

Putrefaction, autolysis and maceration of water corpses follow a regular sequence depending on the water temperature and the interval in the water, the socalled water period. We have determined the beginning of characteristic exterior and interior changes in 395 water corpses of adult persons with known immersion intervals and water temperatures at the place of discovery at the time of recovery. The corpses had been kept in a cooling-rrom at 4 degrees C for 2 to 3 days until they were studied. Altogether 10 parameters have been considered and plotted (Fig. 1-3): intensive dyscoloration of the skin, gasformation, loosening of hair, loss of hair, putridity transsudate of more than 500 ml into the pleural cavitiesn, bloodlessness of heart, softening and liquefaction of the brain, loosening of fingernails, loss of washer-woman's skin from the hands and loss of fingernails. Several parameters are synchronous (Fig. 1,2). The studied intervals of exposure to water were from 2 to 47 days at water temperatures between 22 and 3 degrees C. - By means of the three diagrams it can be found out how many days at the minimum a corpse had been submerged, if the water temperature at the place of discovery is known and storage in a cooling-room has taken place for 2 to 3 days. Also statements are possible about the maximal period of time. - Corpses found in the Rhine will develop washer-woman's skin on hands and feet after no less than 5 hours, even at summer temperatures, and adipocere after no less than 2.5 to 3 months. There is no difference between running and stagnant water in the chronological developments of the parameters investigated. Also the degree of water pollution does not affect the estimation of the time of death.


[Medicamentous sterility as a subterfuge in disputed paternity cases (author's transl)].

During forensic examination of male fertility in disputed paternity cases cheating is possible. There are substances with effects on spermatogenesis; on transport of spermatozoa and on hormonic regulation. Bis-dichloroacetyl-octamethylendiamine seems the most suitable. It has no side-effects, exept for an antabuse-effect. By daily treatment with 200 mg sterility starts after 2--3 months. After stopping the treatment fertility becomes normal after 2 months.


[The new center for environmental research at the Institute for Social and Preventive Medicine, University of Lausanne].

The organisation and the services of the new Research Center for Occupational Environment and Chemical Pollutants are described and commented. The advantages of this original structure for the monitoring and the prevention of health hazards on a community level are emphasized.


The effect of hypovolemia on the weights of human organs.

A significant hypovolemia causes a statistically significant decrease in the weights of the liver, spleen and kidneys. This decrease can be on an average of 17% of the theoretical normal weight. Postmortem weights and estimated theoretical values are compared and with respect to the organs mentioned above the difference was marked. The weight of thyroid gland increases significantly. The material consisted of data from of 3468 male and 1422 female corpses.


[Relevant research gaps in the field of air pollution].

The Swiss Association for Environmental Research is regularly evaluating environmental research activities in Switzerland and has also tried to set priorities in this field which is important especially in a small country like Switzerland. More attention should be paid to the sectors of social and human sciences, energy, recycling and waste management, agriculture and cultivation in mountains, as well as to limits of maximum load of emissions and immissions within the field of environmental research. Dealing with immissions, one should differentiate between compounds which are already monitored and new compounds which are growing fast. In both cases occurrence, accumulation and effects have to be analyzed. In the sector of air hygiene probably the following areas are therefore the most critical: Immissions of nitrogen oxides, of specific hydrocarbons, of specific aerosols, of radioactive products and synergistic effects of several of these compounds and their interaction with natural processes.


[Measurements of rigor mortis on human skeletal muscles in situ (author's transl)].

The torque, necessary to break the rigor mortis of arms and legs at 17 female and 35 male cadavers stored at a temperature of 4 degrees C was determined. The values show differences between male and female cadavers to an extent, that both groups have to be treated separately. Relating the torque to the diameter or the cross section of the limb does not eliminate the differences: Frequently considerable differences between left and right limbs were obtained, however, without preference of one side over the other. There is no direct functional relationship between post mortem time and the intensity of r.m., but the values occasionally allow estimates on the maximum time post mortem.


Problems in determing A2B group specific properties in blood stains.

Blood stains belonging to various sub-group A combinations were examined by the absorption-elution method (in comparison with Holzer method and mixed agglutination). No difficulties were encountered in the identification of A1, A2, and A1B blood stains, while identification of A antigen in A2B stains was dubious (always negative with the others methods). This seems to be due to low anti-sera titer in relation to A antigen in this subgroup combination.


Determination of phenotypes of phosphoglucomutase (PGM1) in bloodstains by cellulose acetate electrophoresis.

A good separation of PGM1 isoenzymes from bloodstains has been obtained with an adapted Sonneborn method of electrophoresis on cellulose acetate. This method requires very small quantities of the examined material, a short time of electrophoresis, and is cheaper and simpler than hitherto described. A correct determination of PGM1 phenotypes from bloodstains was easy up to 24 weeks. Occasionally it was possible to determine phenotypes in bloodstains as old as 47 weeks, and in one case even in bloodstains 126 weeks old. This method may be useful in the forensic serology for determination of PGM1 phenotypes from bloodstains.


Fractography of human intact long bone by bending.

Human intact tibiae were tested using the static bending method to learn about the relationship between the fracture surface and the failure mode. The bending test was applied to test pieces and to whole bones. The fracture surface was observed by scanning electron microscopy. The bone fracture is closely related to the architecture of the bone substance, especially to the direction of the Haversian canals and the lamellae. The failure mode and the sequence of the break line of the bone can be found out by the observation on the fracture surface. Hardly any crushing effects caused by the compressive force is seen. The mechanical properties of the fractured bone can be estimated to some extend by considering the direction of the break line and the failure mode. The strength calculated by the simple beam formula for elastic materials can not be obtained directly because of the plastic deformation of the bone. The results of the tensile test may be applied to the fracture using the static bending moment.


[Coronary embolism in the medico-legal autopsy material (author's transl)].

The author discusses the problem of diagnosis and evaluation of coronary embolism (CL). He presents four cases of his own observation, including histological examinations and a review of the pertinent literature. The following facts are necessary to make the diagnosis of CE: 1. An embolus consisting of foreign elements like tumor-cells, suture material or similar things. 2. Dilatation of the arterial lumen where the embolus is found. 3. No adherence between the embolus and the arterial wall. 4. Normal consistence of the arterial wall. 5. Knowledge of the source of the embolus. 6. Histomorphological conformity of the source of the embolus and the embolus itself. The mechanisms of flow and the interrelation between trauma and CE which are often difficult to judge in forensic medicine are discussed.


An extraordinary case: suicide with insulin in a grave dug by the victim himself.

The undressed body of a young man was discovered in a pit in a forest. The victim was a 27 year old depressed man, suffering from a severe diabetes. Besides personal objects, three empty insulin vials (400 I.U./vial) and empty ampules of distilled water, injection-needles and a syringe were also found in the pit. The investigation carried out at the scene, the questioning of his family and physicians, and the autopsy clarified this unusual case. In conclusion the hypothesis of "suicide" was maintained: the man administered himself a large dose of insulin; in hypoglycaemic coma he died from a bronchopneumonia in a "grave" dug by himself.


[Transrectal prostate puncture biopsy in ambulatory care].

The transrectal puncture biopsy is an effective method in the histological clarification of suspicious palpation findings of the prostate. The puncture is technically simple, is to be performed in an outpatient department, can be repeated if necessary and is only of little stress for the patient. Preparation of the intestine or anaesthesia are not necessary. No severe complications were observed. The only little traumatized tissue cylinders obtained by means of the TRU-cut-needle allow the pathologist as a rule an evident assertion.


[Enzyme-histochemical examinations of prostatic adenofibromatosis. I. Enzyme activities of glucose metabolism].

In the present paper is reported on the histochemical demonstration of reference enzymes of the glucose metabolism in adenofibromyomatosis prostatae. Here non-glycolitic metabolic processes were particularly taken into consideration. The results do not show any restriction of the glucose metabolism in the benign growth process.


[Recurrence and "pseudorecurrence" after enucleation of adenomas of the vesical cervix].

With the help of observations the author adopts a definite attitude to the problem of recidivations, the residual adenomas, the calculi and the carcinomatous development ("pseudorecidivations") after the enucleation of adenomas of the vesical cervix. The cases in question are often carcinomas or parts of adenomas left in the primary operation. But real recidivations are also possible -- examples are alleged and theoretically proved, too.


[Surgical removal of cast calculi using extensive longitudinal nephrotomy].

The results of the operative treatment of 21 large longitudinal nephrotomies on account of the existence of cast calculi of the renal calyx are reported and discussed. In complete cast calculi with participation of the whole renal pelvis and all renal calyces this operation method leads to satisfactory results. Of the 12 cases (57-1%) with ideal postoperative morphological findings 83-3% became bacteriologically sterile; according to our opinion the lesion of the parenchyma due to operation is to be accounted for. In stone formations which do not fill all the calyces and yet in many cases in literature are called cast calculi, a pyelotomy or resection of the renal pole may by all means be the therapy of choice.


[Our experiences in the treatment of recurrent calculi of the upper urinary pathways in patients with single kidneys].

In the dispensary consulting hours we are relatively often confronted with the relapsing lithiasis and the presence of only one kidney. The number of relapsing calculi repeatedly operated in residual kidneys is, however, not large and arises special problems. It is reported on 29 patients in whom we had to perform altogether 64 operations on the residual kidney--among them up to 8 operations on one kidney. Indication to operation, metaphylaxis and prognosis are explained on own cases.


[Topographic phase analysis of urinary concrements using crystal-optic methods].

In the present paper was reported on the results of the topographic crystal-optic analysis of urinary calculi of 560 concrements. 59% of all urinary calculi had a different phase content in the nucleus and in the calyx. All frequent minerals of the urinary calculi could be proved in the nucleus of the calculus. It could be shown that nucleus and calyx may have a monomineral as well as a polymineral structure. It is referred to the importance of the topographic analysis of the urinary calculi for the metaphylaxis of the urolithiasis.


[Spontaneous hosts of broad bean wilt virus. Communication].

Of 110 plant species, grown from seeds in the vicinity of sources of broad bean wilt virus (BBWV) in 1974, exactly 50% proved to be infected by the mentioned virus within one vegetation period. Obviously 54 of the species are previously unknown hosts of BBWV. They belong to the following 21 families: Amaranthaceae, Boraginaceae, Campanulaceae, Caryophyllaceae, Chenopodiaceae, Commelinaceae, Compositae, Cruciferae, Euphorbiaceae, Hydrophyllaceae, Labiatae, Leguminosae, Loasaceae, Papaveraceae, Polemoniaceae, Portulacaceae, Ranunculaceae, Resedaceae, Scrophulariaceae, Solanaceae, and Umbelliferae. Within 6 families, marked by, no spontaneous hosts of BBWV were ascertained before. Only a few of the plant species found to be infected did not show disease symptoms. However, a considerable part of the BBWV hosts were additionally infected by cucumber mosaic virus. BBWV seems to possess a natural host range not very much less than alfalfa mosaic virus. Among monocotyls BBWV seems to have even a larger host range than alfalaf mosaic virus has.


Studies on the formation of alpha-amylase by Thermomonospora vulgaris.

Conditions affecting the formation of alpha-amylase by static cultures of the thermophilic actinomycete Thermomonospora vulgaris were studied. The organism failed to grow under submerged culture conditions or when the culture medium was devoid of CaCO3-alpha-Amylase was produced during the logarithmic phase of growth and maximum yield was obtained after 3 to 9 days of incubation. Growth and amylase formation took place only in a range from 45 degrees to 55 degrees C; optimum temperature was 55 degrees C. Of the tested carbon sources only starch induced enzyme formation. Maximum enzyme yield was obtained when starch concentration of the medium was 2% and when ammonium citrate served as a nitrogen source. Crushed clay pots could substitute for CaCO3 of the medium, but growth and amylase yield were less.


[The effect of biocides on the microflora of soils and their degradation. 3. Interactions between modified populations of micro-organisms and the decomposition of plants for green-manure in comparison to the decomposition of straw (author's transl)].

The possibilities to influence the decomposition of straw and lucerne by fungicidal, bactericida and total acting microbiocides, respectively, were tested comparatively. Total or fungicidal acting substances caused the heaviest inhibition of decomposition at both the organic matters. The efficiency of active ingredients was greater at straw than at lucerne. The reason of the different inhibiting effects is that the lucerne which is easy to decompose and rich in protein can be decomposed alone by the physiologically active bacteria, which are resistant to active ingredients. That means the decomposition of lucerne takes place without the help of fungi. However, the fungi sensible to the active ingredients play a more important role in the straw decomposition. Therefore substances with permanent fungicidal effects are sufficient for the inhibition of straw decomposition. Inhibiting the decomposition of greenmanure presumes permanent acting fungicidal and bactericidal substances. Such substances are not available at present. Systemic fungicides did not influence the decomposition of plants for green-manure due to their limited scope of activity.


[The effect of biocides on the microflora of soils and their degradation. 4. The influence of substances inhibiting the straw decomposition on the nitrogen transformation (author's transl)].

1. Active ingredients retarding the carbon-transformation of straw (TCP, Thiuram, TBTO) also retard the nitrification. Their active period depends on the concentration and on the presence of organic matter. High doses of urea can inhibit the nitrification as well. 2. The activity of urease and the ammonification could not be influenced by adequate doses of the tested active ingredients. 3. The species of bacterium Azotobacter fixing the nitrogen from the air were inhibited by TCP, urea and D-chloramphenicol and promoted by Thiuram and WTZ II 277 after a short period of inhibition. 4. The fungi are very important in the biological nitrogen fixation after manuring straw and in prevention of nitrogen leaching in the autumn. 5. The sufficient concentration of the active ingredients to inhibit the nitrification are lower than the fungicidal concentrations. The soil bacteria could even not be restrained by doses of 5000 ppm. The bacilli were more retarded in presence of organic matters than in a not manured soil.


Survey of some Fusarium moniliforme strains from different host plants for compounds possessing gibberellin-like activity.

Fifty cultures of Fusarium moniliforme were isolated from different hosts and were studied morphologically and physiologically for gibberellin production. Gibberellin production is not limited to rice isolates, since isolates from other host plants revealed also production. These isolates were highly utilizing sucrose, fructose, glucose, sorbose, maltose, mannose, xylose, and arabinose, more than lactose; also ammonium nitrate, ammonium sulphate, and ammonium tartrate were better utilized as nitrogen source than soybean, dry yeast, and corn steep liquor.


Fusarium solani (Mart.) Sacc. was found to be the causal pathogen of Fusarium wilt of Prunus armeniaca seedlings. The fungus pathogenicity could be correlated with the increase in its mycelial growth and conidial germination under the influence of the host root exudates, volatile and gaseous exudates of either germinating seeds or roots, and the content of the host seedlings. Chromatographic and biological detection for indol derivatives in host root exudates indicated the presence of beta-indolacetic acid and indol-3-carbonic acid. Benzaldehyde, acetaldehyde, ethanol, ethylene, in addition to carbon dioxide, were among the volatile and gaseous exudates of either germinating seeds or roots of the host.


[Surgical treatment in deep venous thrombosis of the legs and pelvis (author's transl)].

The only effective causal therapy in thromboses of the deep pelvic and femoral veins is fibrinolysis or operative thrombectomy. Concerning the contraindications, fibrinolysis is successful only up to the 5th day. After that time patients with deep vein thrombosis were submitted to thrombectomy and at the same time, to prevent renewed thrombosis secondary to a slowing down of the flow, a peripheral arteriovenous fistula was temporarily positioned. Between 1974 and 1976, 14 patients were treated operatively this way. In 6 cases of pulmonary embolism a vena cava umbrella filter was inserted.


[Phlebography before and after surgery of the deep femoral and pelvic veins (author's transl)].

This paper deals with indications and results of phlebographic diagnostics in acute and chronic occlusive processes of the deep veins of the leg and the pelvis. While in former times phlebography was mostly with regard to surgical treatment of varicose veins, today the reconstruction of obliterated deep veins of the lower extremity by by-pass procedures or thrombectomy come to the fore. In the postoperative period is only phlebography that will prove the therapeutical effect exactly.


[Operation and maintenance of a.v. fistula for chronic hemodialysis; a preliminary report].

42 patients underwent chronic hemodialysis at the Medical City Teaching Hospital in Baghdad. The ages ranged from 11 to 64 years. 30 patients had AVF constructed above the wrist, in 9 patients the fistula was established at the anticubital fossa and 3 patients had saphenofemoral grafts. A satsifactory technique has been developed for vascular access in chronic hemodialysis with the so called tennis racket fistula constructed at the wrist joint together with distal ligation of the artery and vein. The use of Bovin graft and autogenous mandrils have been discussed.


[Traumatic aorto-caval fistula (author's transl)].

A 33-year-old man sustained a thoracoabdominal bullet injury discovered on exploration to have tears in the liver and perforation in the stomach. Two months later admitted for bilateral serosanguinous pleural effusion, hypertension, heart failure and continuous murmur heard at the right hypochondrium. Aortogram showed aorto-caval fistula at the site of the injured right renal artery and a non-functioning right kidney. Successful external obliteration technique of the fistula had to be performed because of the heavy adhesions encountered, together with right sided nephrectomy. Two other alternative methods of treatment were suggested namely the application of profound hypothermia and circulatory arrest or the use of the aortic compressors and open fistulectomy.


[Problems of vascular injuries at a large industrial-accident hospital (19 year experiences at the industrial-accident hospital Vienna XII)].

This report covers 213 vessel injuries out of 840 000 injuries through accident. Even considering that these are mostly cases of polytrauma, the results could be improved significantly. This however, only under the condition that all traumatologists and surgeons active in traumatology receive practical training in vessel surgery.


[Incomplete aortic ring (arcus aortae circumflexus); compression of oesophagus and trachea (author's transl)].

A baby of 5 months had an incomplete aortic ring (arcus aortae circumflexus) in combination with a ligamentum arteriosum. Even in infancy specific symptoms may occur. Carefull angiographic investigation can avoid misjudging the symptoms (stridor, dysphagia) and can contribute to an exact diagnosis thus preventing unnecessary operation.


[Amputation after traumatic lesion of the popliteal artery-avoidable or inevitable? (author's transl)].

Each serious injury of the joint of the knee involves the possibility of an additional lesion of the popliteal artery. Among the arterial injuries the traumatic lesions of the popliteal artery with a frequency of up to 20% are of great importance. Failure to recognize or estimate them correctly may result in a high rate of amputations. In addition, three own cases were critically analysed.


[Normal standards for birth weight and birth length of newborns in the DDR].

Normal anthropometric standards of birth weight and birth length are presented for newborn boys and girls in the GDR between 28 and 44 weeks' gestational age. Newborns with uncertain duration of gestation, multiple births, malformations and stillbirths have been excluded. It is directed to necessity of regional standards.


[Estimation of the fetal head-trunk proportion by ultrasound (author's transl)].

Using ultrasonic A- and B-scan equipment, cross-sections of the fetal head and abdomen were recorded in 219 pregnancies of the last trimester. Normal values of the body composition were established by several diameters, the circumferences and the areas. The diagnostic reliability of the different methods is demonstrated in a case report.


[Effect of drug therapy during pregnancy on the clotting potential of the newborn].

Drug therapy in mothers may lead to various disturbances of the hemostasis of the newborn. Some authors reported on severe hemorrhages in newborn after coumarin treatment of the mothers, others had not or only seldom observed such events. Our examination did not reveal any significant clotting disorders in 4 newborns whose mothers had received Athrombom. Perhaps the indandion derivative does not significantly penetrate the placental barrier. However, therapy with anticoagulants of the vitamin K antagonist type may be instituted during pregnancy only in cases where it is strictly indicated. Streptokinase and heparin will certainly not enter the fetal circulation, therefore they may be used without risk for the child. Furthermore the clinican must known severe bleeding conditions of the vitamin K deficiency type in newborns of mothers with anticonvulsive therapy. Preventive administration of vitamin K to pregnant women and newborns or, in the presence of bleedings, instantaneous and exact substitution may bring under control the critical situation. Acetylsalicylic acid given during the last weeks of pregnancy causes an inhibition of the aggregation of thrombocytes of the newborn. Bleedings occur only seldom. Other drugs administered during pregnancy may induce neonatal thrombocytopenia through immunological or toxic mechanisms, such for instance quinine, quinidine, tolbutamide and thiazides.


[Sex chromatin and cytohormone smear in premature and dystrophic newborn during the first week of life].

In newborn females parallel investigations on: a) oestrogenisation symptoms, b) vaginal epithelium smears stained modo Shorr, c) sex chromatin positive nuclei in buccal epithelium smears, have been performed. Low frequency of sex chromatin in the day after birth suggested a relationship between hormone level and Barr bodies' appearance.


[Mechanical action of obstetrical forceps on the fetal skull].

By means of schematic illustrations we demonstrate the working point of the power of labour, obstetrical forceps and vacuum extractor, The bones of the fetal skull are by sutures movable fastened together. Every extraction so will rise the intracranial pressure of the fetus, because the resistance of the birth canal tissues must be overcome. This for the extraction needed power and rising of the intracranial pressure is independent from the instrument with which the extraction is carried out. It is impossible to make a "cage" around the fetal head with the Shute forceps during extraction, to protect the fetal head from the extraction power. Another question is, that some instruments (included vacuum extractor) can limit the used power. By using forcipes with crossed lock without fixation the forces for extraction are not limited and there is a need of better operative technic. By the comparison of the forcipes from Shute, Naegele and Zweifel we can summarize, that for success is decided the indication and good operative technic and not the instrument. Every instrument for vaginal extraction has advantages and disadvantages in different obstetrical situations.


[Intrauterine fetal skull injuries from an accident during pregnancy].

To 22 intrauterine fetal skull-injuries known in literature is hereby an additional case, in which the pregnant woman died from haemorrhage from ruptured uterus after a motor traffic accident. The fetus delivered through abdominal section strongly prove the occasionally doubted possibility of intrauterine skull-fractures, which causal mode is still bone of contention. The pregnancy stadium, the cause of accident resulting in maternal injuries as well as the location of the child's skull-fractures are discussed. Such skull-fractures are indeed seldom, but 7 children of the mentioned cases survived.


[Simultaneous extra- and intrauterine pregnancy with the birth of a healthy child].

Report on the occurrence of a simultaneous intra- and extrauterine pregnancy. A live, mature infant was born at term. At the time of the operation of the ectopic pregnancy there was diagnosed the intrauterine pregnancy. The possible cause of a simultaneous intra- and extrauterine pregnancy are analysed and the clinic and diagnosis emphasized. In case of not having a child-wish the authors take into consideration a routine curettage of the uterus at the time of the operation of the ectopic pregnancy.


Sarcoplasmic reticulum vesicles and glycogen-protein particles in microsomal fraction of skeletal muscle.

1. Heavy microsomal fraction (HM) of rabbit skeletal muscle obtained by differential centrifugation between 8 000-30 000 g and consisting of sarcoplasmic reticulum (SR) vesicles contains variable amounts of glycogen and reveals some activity of phosphorylase b. The monomer of this enzyme of mol. wt. about 100 000 co-migrates in SDS-polyacrylamide gel electrophoresis with the main SR protein--Ca2+,Mg2+--dependent ATPase. 2. The highest specific activity of phosphorylase and the highest content of glycogen is present in the light microsomal (LM) fraction (30 000-100 000 g). 3. Contrary to the ATPase, phosphorylase b is released from the microsomal fraction by treatment with EDTA and is resistant to trypsin. 4. Both HM and LM fractions can be further fractionated on continuous sucrose density gradient at high speed. Main fraction of HM consists of highly purified SR vesicles. The second, small fraction of HM is identical with the main fraction of LM and consists of two populations: vesicles of structure and properties different from those of SR vesicles, and the particles of a complex of glycogen with some glycolytic enzymes.


A modified procedure for determination of metallothionein-like proteins in animal tissues.

1. The effect of low-molecular-weight substances interfering with determination of metallothionein is eliminated by precipitation of 203Hg-thionein by tannic acid. 2. In animals not exposed to metals, the mean values for metallothionein content in liver and kidney are, respectively, 0.10 and 0.18 mg/g in rats, 0.06 and 0.07 in mice and 0.12 and 0.29 in guinea-pigs, i.e. are 2-3 times lower as compared with the values obtained by the procedure not involving treatment with tannic acid.


Sensitive radioimmunoassay for thyrotropin by use of commercially available tracer and antibody.

The time course of the association and dissociation of radiolabeled thyrotropin with its antibody was studied. The binding is maximal after five days of incubation. The dissociation is much slower. Highest sensitivity is obtained by a total incubation time of five days with addition of the labeled ligand after three days of preincubation with the unlabeled thyrotropin. An improvement in the sensitivity from 0.4 mU/l to 0.08 mU/l is obtained by that method compared with equilibrium technique thus significantly diminishing the percentage of undetectable serum levels of euthyroid and hyperthyroid subjects. Average sensitivity is 0.14 mU/l, intraassay variance is 2%, interassay variance is about 13% in the normal range. Normal values for euthyroid subjects averaged 1.53 mU/l, for hyperthyroid subjects 0.19 mU/l.


[Isolation and characterization of mistletoe extracts (Viscum album L.). I. Affinity chromatography of mistletoe extracts on immobilized plasma proteins].

The agglutinating effect of lectin from mistletoe (Viscum album L.) relative to erythrocytes and tumor cells is destroyed or reduced by plasma proteins. There is a competition between lectin receptors of plasma proteins, especially immunoglobulins and erythrocytes, as well as tumor cells. The preparation of insolubilized immunoglobin fractions allows one to separate lectin from the mistletoe extract. There exist chemical connections between the lectin fixed to the adsorbent and part of the toxic components.


[Responses of single cells of the rat lateral geniculate body to light stimuli differing in wavelength and intensity].

Single unit responses of the rat's lateral geniculate body to red and green stimuli of light emission diods and to daylight spectrum flashes were recorded. The primary response consisted either in an increase or in a decrease of the discharging rate. Each unit was responsive to all light stimuli either with excitation or inhibition, i.e. the direction of the change in the discharging rate was always the same for one cell. When applying the stimuli in the above mentioned sequence we found a shortening of the latency period and a shorter duration of the primary response, more afterdischarges, and a more marked postexcitatory inhibition.


An improved method for the preparation of the DNA-dependent RNA polymerase B from calf thymus.

A simplified method is described for the large-scale preparation of a highly purified DNA-dependent RNA polymerase B from calf thymus. The method includes homogenization and lysis of the tissue, chromatography on DEAE-cellulose, phosphocellulose, hydroxylapatite-Sephadex G-10 and, once again, phosphocellulose. The procedure avoids the preparation of nuclei, the use of sonication, ammonium sulphate precipitations and dialysis steps and needs no ultracentrifugation.


[The effect of Mn++ on the electrotropic and inotropic vagal effect].

An isolated rabbit atrium, innervated by vagal nerve, was tested. Increased Mn++ concentrations decrease the areas of the action potentials and the amplitudes of contractions. At 2 mM Mn++ the contraction disappears and an extremely sharp action potential is recorded. By variation of both Ca++ and Mn++ concentrations one can observe parallely shifted concentration-response curves for the amplitudes of the contractions. This result is described by the model of a competitive-antagonistic Mn++-Ca++ action. At 1 mM Mn++ the inotropic and electrotropic effects disappear. Small concentrations of Mn++ (0.15 mM) increase the electrotropic vagal effects. At 0.5 mM Mn++ both vagal effects are diminished. The discussion of the results is based on the action of acetylcholine on the slow inward current of calcium and sodium ions.


[Quantitative relationship between the monosaccharide induced change in ion transport and the monosaccharide accumulation in the rat jejunum].

1. In the rat's jejunum, the changes induced by Na+-dependently transported monosaccharides (10 mM) of the unidirectional Na+- and K+-influx across the microvilli membrane were studied under varying metabolic conditions. 2. The monosaccharide induced change of Na+- and K+-influx is a function of the ion gradients active across the microvilli membrane. 3. In the in vitro preparation during the process of energy-dependent accumulation the monosaccharide induced change of permeability in the microvilli membrane decreases the K+ concentration, while the Na+ concentration increases. 4. The monosaccharide concentration in the tissue reaches a final value which is proportional to the change of Na+- and K+-influx and to the change in ion concentrations, and which is retained even upon compensation of the gradient and at low intracellular K+ concentrations. 5. The correlation between the breakdown of the ion gradient and the rise of monosaccharide accumulation is explained by the monosaccharide induced restriction of the active ion transport and the ensuing change of energy dissipation in favour of the monosaccharide transport. The (Na+ + K+)-ATPase in the microvilli membrane is discussed as being transmitter of the energy from the ion gradients.


Chemical sterilization: effects of danazol administration on the testes and epididymides of male rabbit.

1. Danazol, a synthetic (2,3-isoxazole) derivative of 17 alpha-ethinyl testosterone has been studied in rabbits to support our earlier findings in dog, whether Danazol can be developed as an effective means for male contraception. 2. Chronic administration of Danazol resulted in a mass atrophy of the spermatogenic elements. Seminiferous tubule and Leydig cell nuclear dimensions were reduced. The lumen of epididymides and vas deferens were devoid of spermatozoa. These effects were reversible following a period of 60 days of recovery. 3. Hepatic function was followed with determination of SGOT, SGPT, alkaline phosphatase, cholesterol and blood sugar. Serum-amino-transferases were elevated during the period of administration but returned to normal after cessation of drug administration. 4. In conclusion, Danazol can be used as an effective means for male contraception in rabbit. The effects are reversible. Normal spermatogenesis occurs following a period of sixty days of recovery.


[Regulation of the IgM immune response. I. Changes in the affinity of carp anti-DNP-antibodies during immunization depending on the antigen dose].

The affinities of anti-DNP-antibodies (IgM) of carp, immunized with different doses of dinitrophenylated human serum albumin in complete Freund's adjuvant, were determined by a modified Farr-technique using the hapten epsilon-DNP-L-Lysine. Very low affinity antibodies were formed in the early immune response (Ko = 0.2 - 1.0-10(5) M-1). A progressive increase in IgM antibody affinity occurred during the immune reaction. After immunization with low doses of antigen (0.01 and 0.1 mg) the affinity increased up to four weeks (Ko = 3.2 and 9.1-10(5) M-1) and decreased in the subsequent three weeks (K = 0.8 and 1.2-10(5) M-1). Following immunization with a higher dose of antigen (1 and 10 mg), the affinity increased up to seven weeks (Ko = 4.9 and 11.9-10(5) M-1). The highest antibody concentration in all groups were observed at the maximum of affinity.


[Reconstructive surgery in diseases of the blood vessels of the neck].

The authors describe their experience with 40 patients operated upon during the last five years because of pathological processes of the large blood vessels of the neck. In seven cases pathological conditions unrelated to the systematic diseases of the arteries (birth defects, the results of injuries and tumours) existed, while the remaining 33 patients suffered from arteriosclerotic lesions most commonly located on the carotid artery. The localization of the pathological process and the number and extent of the neurological lesions are described. The authors particularly stress the importance of the period which elapses from the first signs of ischemic lesions to the moment of surgical intervention. The aim of surgical intervention is primarily to prevent ischemia and simultaneous cerebral apoplexy, and only after this to prevent the progressions of the existing ischemic changes. Patients with temporary attacks of ischemia without neurological attacks are ideal cases for surgical intervention. Good results can be achieved on patients with apoplexy within the first six hours from the moment at which the attack occurs. Intervention after a longer period gives uncertain results. Good results can be expected only when the diagnosis and localization of the vascular changes are exact and the neurological and general condition of the patient is precisely evaluated. This demands team work by the roentgenologist, the neurologist and the vascular surgeon.


[Liver abscesses of biliary origin].

Liver abscesses represent a rare complication of inflammatory and calculous disease of the biliary system and are enhanced by tardy or delayed removal of the primary cause. Being the result of liver necrosis and depending on its extension they appear in polymorphous pattern and have the tendency to spread through the diaphragm into the chest. The differential diagnosis is not easy: from common cholangitis to sporadic necrosis of liver malignancy, suppurated hydatid cyst and other diseases. The best prophylaxis and the highest recovery rate is achieved by taking up an active surgical approach at the first signs of severe infection, especially in cases of relapse and of prolonged septic evolution in spite of the use of antibiotics and/or the (first) operative procedure. The choice of surgical procedure depends on local findings. An exceptional diagnostic difficulty represent the cases of suppurated intraheptic lithiasis.


[Scanographic picture of development of spontaneous intracerebral hematoma (report of a case)].

The authors present a case of a  25 old male with spontaneous left temporal intracerebral haematoma. The first brain scan (In-113) performed on the 8th day after the onset of symptoms was normal. The second one, on the 12th day showed an abnormal accumulation of Tc-99m in the left temporal lobe. The clinical findings completed with such scanographic evolution suggested a preoperative diagnosis of intracerebral haematoma. The real diagnosis was confirmed during the surgery with the removal of a haematoma consisting of 100 ccm partly fluid, partly coagulated blood.


[Secreting tumors of the testis (author's transl)].

We have observed a secreting tumor of the testis classified as an intermediate malignant teratoma type A. This hormone secreting tumor was associated to bilateral gynecomasty. Surgery with radiotherapy were followed by disappearance of all symptoms for two years. Hormone levels, that were abnormal, returned to normal. Next to seminomas, testis teratomas are grouped in different types according to their differentiation, from well organized tissues to totally anaplastic cells. Clinical manifestations of these lesions are essentially dependent on their secretory capacity. Gynecomasty secondary to oestrogenic production of chorionic gonadotrophins or pituitary hormones, is the usual symptom; one may encounter hyperthyroidism or hypercortisolism. Generally, resection of the tumor is followed by a return to normal hormone values; recurrence of pathological values is often a sign of metastatic evolution. The treatment is orchidectomy with radiotherapy or eventually with chemotherapy.


[Comparison of the results of surgical and conservative treatment of fractures of the diaphysis of the tibia].

In this paper is treated the fundamental problematic of the fracture of the diaphysis of the tibia and the therapeutic results after the conservative and operative treatment are confronted. Among 518 patients with 433 open fractures and 35 with closed fractures of the diaphysis of the tibia, successful treatment of more 2/3 was obtained in the period from 1968 to 1972. Following our casuistics and literature, whose results are similar, we find out that the average total treatment of the osteosynthesis of the fracture of the diaphysis was shortened for 2,5 months depending upon the type and the localisation of the fracture. Apolied methods of the operative and conservative and conservative treatment in relation to the velocity of the medical cure as well as to the extreme anatomical-functional results are analised. We noticed that osteosynthesis, made by the intermedullary nail and the extension of the canals or by a small AO table, by the achieved stability makes conditions of immediate motions and an early rehabilitation. Because of that it gives the best functional results.


[Activity of some enzymes of the cerebrospinal fluid in lumbar disk hernia].

Enzyme activity of Acetylcholinesterase (E.C.3.1.1.7.), Glutamicoxalacetic-transminase (E.C.2.6.1.1.), Glutamic-piruvic-transaminase (E.C.2.6.1.2.), and Creatine-phosphokinase (E.C.2.7.3.2.) are significantly elevated in cerebrospinal fluid of patients with prolapsed lumbar discs lesions. Origin of elevated enzyme activities is from radiculitis which arosed because of root compression by prolapsed disk. There is also wide communication between spinal subarachnoidal space and lymphatic path of spinal roots, and because of that it is possible to note elevated enzyme activities in cerebrospinal fluid of the lubar sac. Elevation of enzyme activity is different of every investigated enzyme. This different elevations point to reversible and mild damage of cells and do not point to the cell necrosis in cases of prolapsed discs lesions. Determination of enzyme activities in cerebrospinal fluid could be clinically valid test.


Primary reconstruction of the mandible after resection for oral cancer.

Forty-seven patients with cancer of the lower half of the oral cavity underwent primary restoration of mandibular continuity with a threaded wire after "en bloc" resection. The overall 3 years tolerance rate of the wire calculated according to the actuarial method is 0.29. Preoperative radiotherapy and inclusion of the wire into silastic reduced tolerance of the prosthesis. The occurrence of an oral fistula required removal of the wire.


[Anesthesia in surgery of the veins].

Patients with varicose complex of low extremities do not present any special problem in anaesthesiology. Method recommended is inhalational anaesthetic, eadly mobilisation of patient and infusion of low molecular dextran, during and immediately after operative procedure. During thrombectomy from deep venous system there is real danger of pulmonary embolism. This group of patients has higher risk than former, too. Authors recommended their own method for prevention of preoperative centripetal mobilization of thrombus, using a standard Recklinhausen's cuff inflated against abdominal wall under a plexiglass plate.


[Osteosynthesis of the subtrochanteral fractures of the femur by using Küntscher's pin].

The method of intramedullary introduction of the Küntscher pin in order to penetrate, immobilize and stabilize a subtrochanteral fracture of the femur in children and adults has given excellent anatomical and functional results. This method is effective because it synthesizes the positive elements of a mechanical, vascular and biomechanical nature. The results published in our own and foreign literature and our own results indicate that this method is effective; it is a simple, quick technique which saves the tissue of the affected area from injury and maintains optimal functioning of the extremity.


[Comparative evaluation of x-ray pictures in septorhinosurgery].

The present trend to objectify the changes resulting from modern surgical procedures on the nasal pyramid, which are primarily functional, the aesthetic aspects being only secondary, has encouraged us to attempt to define these changes by means of measurements of specific angles and distances on the roentgenograms. It has been confirmed that it is possible to do this from antero-posterior radiographs of the sinus as well radiographs of the profile of the nasal bones. The study covers 126 patients and the tabulation reflects the type and method of the operation undertaken. We consider our results to be interesting, particularly as we have added a further objective method, which is available to all, needs no expensive apparatus and makes possible a comparison of the evaluations both before and after the operation, to the small number of existing objective methods. At the end of the study we stress that this method is ideal and a welcome supplement to the existing methods, although it is not sufficient on its own.


[Early cancer of the stomach as a gastroenterological problem].

The article analyzed the problem of early gastric cancer; definition, endoscopic and surgical intraoperative diagnosis and kind of surgical treatment, and also results. It's emphasize importance of the diagnosis early gastric cancer. In that treated cases of early gastric cancer prognosis is excellent (85 -- 92%). The result of 6032 endoscopic examinations are: 360 cases of gastric cancer, and 14 was early gastric cancer. Surgical treated was eleven cases, and they are all have been lived. In the article is extensive discussion the problem of histopathological diagnosis and classification. Extensive is described operative proceed for which we think that is best in treated of early gastric cancer.


[Most frequent errors in the treatment of articular and periarticular fractures of the elbow joint in childhood (report of own cases)].

The importance of the initial diagnosis in the treatment of the intra and periarticular fractures of the elbow joint in the childhood was discussed in the article. Good results in pathoanatomic as well as in functional view were obtained in this series, according to the carefully made terapeutic program and prolonged physiotherapy.


[Osteotomy of the tibia in the prevention and therapy of post-traumatic knee arthrosis].

In this article it has been argued that: (1) factors leading to the post-traumatic osteoarthritis of the knee are (a) abnormal mechanical axis of the knee resulting from post-traumatic varus or valgus deformity, (b) damage to the articular surface of the tibial condyles and (c) excessive venous congestion in the subchondral zone of the upper tibial epiphysis. (2) high tibial osteotomy corrects all above mentioned factors and is therefore supposed to be the method of choice in the therapy and prevention of post-traumatic osteoarthritis of the knee. (3) in the years 1970-75 we performed 14 such operations and achieved 8 good and 6 fair results.


[Blood vessels injuries in intra-articular and para-articular fractures].

The authors reviewed the problems of vascular injuries with fractures in the nearness of joints. They have pointed out the period from injuries to the operations. Particularly they accentuated importance of team work between bone and vascular surgeons. The paper emphasied the evaluation of the possibility and develop to the good and complete functional restitution of the extremity.


[Carcinoma of the stomach in the Gorensjka region].

With the review of his patients author in the discussion brings in consideration some points of interest to him: 1. The gastroscopic control with histologic biopsies of the mucosa. 2. Agressive surgical approach with subtotal resection of the stomach and total omentectomy, also when the resection is only palliative. 3. The total resection of the stomach gives long terms bad results. 4. The best type of resection is Billtorh I, because it is physiologic. 5. The citostatic therapy must follow operation.


[Perforation of idiopathic ulcer in the small intestine].

The authors present the case of 51 year old woman admitted to surgical unit from dermatology because of symptoms of diffuse peritonitis urgent laparotomy revealed perforated ulcer of terminal ileum. Segmental resection of small bowel with end to end anastomosis was septic coli peritonitis performed, histologically with non-specific appearance. On 7th postoperative day the patient died. The cause of death was septic coli peritonitis with dehiscence of anastomosis.


[Portacaval anastomosis in experimental surgery as an educational method for the young surgeon].

Portacaval anastomosis in experimental surgery, authors used as one kind of education of young surgeons. Over portacaval anastomosis we learned vascular technic and vital anatomy porte hepatis. We recommend this method of education to other young surgeons.


[Compression of the ulnar nerve near the elbow].

The ulnar nerve is subject to an entrapment neuropathy at the elbow. The groove behind the medial epicondyle is by the adjacent structures transformed to a tunnel. This passage is the most significant entrapment point of nerve. Duurgery we treated 18 patients with the entrapment ulnar neuropathy at the elbow. Operative decompression had been performed and when necessary, anterior transposition and neurolysis under the microscope control. After the operation some of the patients had complete relief of symptoms. Lifelong cases had partly ameliorated. Three patients are described in details. In our paper we appeared the mechanism and diagnosis of cubital tunnel compression, It is pointed that early diagnosis and operative treatment are only preferable in healing the ulnar entrapment neuropathy at the elbow.


[Review of patients with carcinoma of the cardia treated in the hospital of Celje during 1966-1975].

At the department of visceral surgery of the hospital in Celje has been during past ten years surgically treated 41 patients with cancer of cardia. This number of patients represents 11,48% of all patients suffering from cancer of stomach treated in the some period of time. In this short survey we present our methods, complications and results of treatment. Mortality rate of our surgically treated patients with cancer of cardia represents nearly 10% all cases.


[Choice of surgical technic in cancer of the stomach. Results in 999 cases].

Authors analyze 999 of stomach cancer, as well as 865 operated patients (86,58%). Choice of operative method depends concert tumor localisation, its growth, methastasis, general condition and age of patient.


[Current aspects of success in the surgical treatment of gastric carcinoma].

The various operative methods in surgical therapy for gastric carcinoma are presented. In his conclusion the author suggests systematic use of endoscopy together with other methods of examination, as well as the rigorous radicalness in operative procedure. Durable results may be expected from better functional reconstruction after resection and from deeper comprehension of chemo -- and immunotherapy of carcinoma.


[Surgico-technical pecularities of transabdominal gastrectomy in cancer of the stomach].

The review of basal surgical details in act of the transabdominal gastrectomy at the cases of stomach cancer. These details accelerate operation, and made it more reliable, and what is very important more radical. In the article is discussed indication for volume and kind of the resection, a new position about choice of a digestive anastomosis.


[Is basal hypersecretion an indication of the presence of Zollinger-Ellison syndrome?].

Twenty patients with gastric basal hipersecretion over 15 mEq/hr and a suspicion on a Z-E syndrome or gastrinoma were studied by means of histamin gastric analisis, calcium test and measurement of lower esophageal sphincter pressures. In none of them a pancreatic tumour was found at operation, being their post-operative course normal up to a 60 months follow-up. The use of these everyday techniques is proposed for medical centers which have no facilities for gastrin radioimmunoassay techniques.


[Angiographic study of the vascularization of primary malignant tumors of the liver: histological correlation].

During the last seven years 118 patients with histologic diagnosis of malign tumor in the liver were examinated by selective angiography, amongst other diagnostic recourses: 14 patients had primitive tumors: 12 hepatoma, 1 cholangiocarcinoma and 1 hepatocholangiocarcinoma. In 12 patients resection was contraindicated preoperative by the angiographic demonstration of the extension of the tumor to both lobes. In 1 patient with cholangiocarcinoma, the tumor was resected with an outlive of 4 years. In 1 patient with hepatoma very vascular a hard league of the right hepatic artery was done. Two months later angiography demonstrated a rich revascularisation of the tumor with development of the colateral circulation. In our experience the hiper or hipovascularization is related with the degree of fibrosis which accompanies the tumor and no so much with the histologic type, the degrees of differentiation or the existence of intratumoral necrosis. Emphasis is been done to show the diagnostical difficulties of hipovascularized tumors and the importance of angiography in the preoperative evaluation of hepatic tumors.


[Study of gastric secretion in rats with ligation of the pylorus according to the Shay and Dai methods].

A comparative study of gastric secretion in rats with pyloric ligature according to either Shays' or Dais' methods was carried on, studying in both groups gastic acid and peptic secretions, mucous pepsinogen, and Na+, K+, and Cl-. The acid-peptic output as well as gastric Pu/g were greater in Dais' method. There were no changes regarding mucous pepsinogen when comparing both methods. Cl- and Na+ determinations showed minimal changes, whereas K+ showed no difference in both methods. We explain these modifications based on the difference in the secreted volume, since the acid concentration and Pu/ml are practically the same when comparing both methods.


[Ultrastructural study of chronic gastritis].

A study of gastric biopsies with optical and electronical microscope from patients with gastritis in different stages of evolution was realized. The ultraestructural results consist in phenomenal alterations at the epitelium level, apparition of bodies of mielinic aspects in the inside of the Oxintcs cells, reduction of the number of this and the peptic cells and even the disappearance of the last. There is an increase of the mucous cells with mitotic changes, notable hyperplasia of the arget cells and intestinal metaplasia in the advanced cases. In the stroma is demonstrative the infiltration of plasmatic cells having a endoplasmatic reticule in different stages of activity, linphocytes and macrophagous full of primary and secondary lysosomas. A very important fact is the increase of the argentofilous cells and its probably relation with the appearing of the gastritis. The presence of the plasma cells and lynphocyts mark the role that takes the immunitary reaction in this process.


Prostaglandin F2alpha as a mediator of pulmonary changes during platelet aggregation.

Increases in pulmonary arterial pressure, tracheal insufflation pressure, and blood levels of the prostaglandin F2alpha metabolite, 15-keto-13, 14-dihydro F2alpha, were observed after protamine chloride or thrombin-induced platelet aggregation and release reaction in dogs. These effects were largely eliminated after administration of acetylsalicylic acid, an inhibitor of prostaglandin synthesis. The platelet aggregation was not noticeably affected. It is suggested that release of prostaglandin F2alpha from platelets is an important factor for the pulmonary changes during induced platelet aggregation. The necessity of measuring metabolite levels, rather than prostaglandin F2alpha levels, in blood during in vivo conditions is demonstrated.


Selective lumbar epidural block in labour. A clinical analysis.

Segmental epidural analgesia (T10-T12) was performed in 418 parturients, using a 4-6 ml dose of 0.5% bupivacaine, with or without adrenaline. Seventy per cent of parturients were primiparas and 30% had histories, or signs, of possible uteroplacental insufficiency. Our aim was to relieve pain during the long passive opening phase, so that mothers would be rested and active at the beginning of the second phase, but also to avoid abolishing the bearing-down reflex, the absence of which causes an increased frequency of instrumental delivery. The analgesia during the opening phase was of good quality in 89% of primiparas, and 84% of multiparas. The onset of analgesia was rapid (3-5 min) and the duration was on average 2 1/2 h. The incidence of foetal heart rate changes, during the 30 min after epidural, was 5%. The second phase was less than 30 min in about 90% of cases. About 90% of parturients delivered spontaneously, and the frequency of instrument delivery was only 7.4%. Caesarean section was required in 3.7%. Slight, but rapidly correctable, hypotension occurred in 16.5%, and in two cases the hypotension led to more serious complications. This stresses the importance of the availability and competence of both the anaesthetic and obstetric teams. There were no maternal or neonatal mortalities, and the Apgar scores compared well with the figures for the normal material in our obstetric unit.


Peripheral nerve injury due to injection needles used for regional anesthesia. An experimental study of the acute effects of needle point trauma.

Nerve injury can arise as a complication peripheral nerve block anesthesia. Of the various factors involved, the trauma caused by the injection needle may be of significance. In this experimental study the frequency of fascicular injury was investigated immediately after needling isolated rabbit sciatic nerve preparations, and after intraneural injection with the nerve in situ. Two different injection needles were used, one with a bevel angle of 14 degrees and the other with a 45 degrees bevel angle. Fascicular injury was indicated by a fluorescence microscopy technique, tracing locally applied Evans Blue Albumin, The results show that a 45 degrees-beveled needle less frequently produces fascicular damage and should therefore be recommended for use in clinical anesthesia. It is also concluded that paresthesiae, when necessary, should be elicited gently, and that intraneural injections should be avoided.


Human hepatic blood flow and its relation to systemic circulation during intravenous infusion of bupivacaine or etidocaine.

Fifteen healthy young volunteers were studied before and during an intravenous infusion of a local anaesthetic agent. Seven received bupivacaine and eight etidocaine in a dose rate of 2 mg/min over a period of 150 min. Variables of the central systemic circulation and also the hepatic blood flow were measured repeatedly. The circulatory alterations during administration of the two drugs were compared. Comparisons with previous results concerning lidocaine and a placebo were also made. It was found that bupivacaine increased the heart rate, mean arterial blood pressure and cardiac output significantly more than did etidocaine in an equal plasma concentration. Lidocaine was intermediate between bupivacaine and etidocaine. In contrast, these three drugs had the same decreasing effect upon the splanchnic vascular resistance, which caused an almost identical increase in the estimated hepatic blood flow. The calculated vascular resistance in the systemic circulation, excluding the splanchnic, was unchanged during the infusion of etidocaine, while it decreased during the infusion of bupivacaine. Most of this discrepancy was due to the different plasma concentrations of the drugs.


Arrhythmias during halothane anaesthesia II: the influence of atropine.

The effect of i.v. atropine premedication on cardiac rhythm was studied in healthy adult patients during thiopental-N2O/O2-halothane anesthesia without intubation. A higher incidnece of arrhythmias was seen in younger patients in close relation to administration of atropine, but the overall incidence during anesthesia was identical in atropine groups and the control groups. The most common arrhythmias were supraventricular ectopies. None of the ECG irregularities led to serious arrhythmias. No consistent changes in blood pressure were observed as the result of arrhythmias or changes in heart rate. It is concluded that atropine should be reserved for situations where severe bradycardia and hypotension occur, or can be expected to occur, and not given automatically, since cardioacceleration which is inherent in its action may be injurious to patients with limited cardiac reserve.


Glial cell reactions in rats with hyperammoniemia induced by urease or porto-caval anastomosis.

The density and size of astrocyte, oligodendrocyte and neurone nuclei were determined in the corpus striatum of rats with urease-induced hyperammoniemia (plasma NH4+-concentration about 800 micronmol/1). No changes in the number of neurone nuclei were found. After 4 days the density of astrocyte nuclei increased from 13 to 23 per cent of the glial nuclei. However, the number of oligodendroxyte nuclei decreased correspondingly and the total glial nuclear number remained constant. The number of astrocyte nuclei was normalized 1 week after the 4-day period of hyperammoniemia. Moreover, intracerebral injections of colchicine at different times of the experimental period revealed no mitoses, indicating that no astrocyte divisions took place in pure hyperammoniemia. The astrocyte nuclei were of normal size in the urease animals in contrast to the animals with porto-caval anastomosis (PCA) which showed enlarged astrocyte nuclei. Thus, hyperammoniemia caused a reversible transformation of glial nuclei, but no real proliferation. A comparison of the glial reactions 4 days after a brain lesion showed the same frequency of astrocyte mitoses in control and urease animlas but a higher incidence of mitoses in the PCA animals. The number of Alzheimer type I astrocytes was the same in control and PCA animals, whereas no such cells were found in the urease animals, indicating that this form of hyperammoniemia did not lead to arrest of astrocyte metaphases with subsequent formation of Alzheimer type 1 cells.


Spontaneous and PHA stimulated lymphocyte transformation in multiple sclerosis patients during and after acute exacerbations with special reference to steroid therapy.

Spontaneous (SLT) and phytochemagglutinin (PHA) stimulated lymphocyte transformation was studied in multiple sclerosis (MS) patients suffering from acute exacerbations or from the chronic progressive type of MS. The changes in cell-mediated immunity were also observed before, during and after immunosuppressive (prednisone) treatment. A total of 85 venous blood samples from 23 MS patients (11 males, 12 females) were included in the material. The controls consisted of 25 measurements from 17 healthy volunteers who served as normal controls. The pathological controls consisted of 13 patients with neurological diseases other than MS. All these and MS patients were hospitalized. The IUFdR uptake of the cells of MS patients was more rapid than that of the controls at 1-hr incorporation time in SLT. The difference decreased and was eliminated by longer incubation times (2-4 hrs). MS patients also differed from pathological controls in this sense. The reaction to PHA stimulation was lower both in the MS groups (64 per cent from the normal controls) and in the pathological controls. Within the different MS groups, significantly lower values were seen only in the samples of the patients receiving immunosuppressive therapy. Under prednisone (80-100 mg initial dosis) PHA stimulation values rapidly dropped within the first week and slowly returned within 2-4 weeks after the stopping of the corticosteroid treatment. In some cases, however, PHA values remained at a low level for several months. The significance of this finding for the understanding of the underlying pathogenetic mechanisms has to be studied in more detail.


Plasma protein binding of phenytoin after cholecystectomy and neurosurgical operations.

The purpose of the present study was to investigate whether changes in the protein binding of phenytoin occur postoperatively. Fourteen patients were studied after cholecystectomy and six patients after operations for intracranial aneurysm or meningeoma. It was found that the fraction of phenytoin not bound to plasma proteins rose significantly after operation. The total concentration, on the other hand, decreased, so the concentration of free phenytoin did not change much. Possible explanations to the changes observed are discussed, as well as the clinical usefulness of determination of the protein binding of phenytoin.


Hypokalemic myopathy during treatment with diuretics.

Two male patients with severe reversible muscle weakness and excessive potassium deficiency associated with alkalosis during treatment with diuretics are presented. The case reports are further illustrated by the morphologic changes as seen in light and electron microscopic examination of muscle biopsies. Hypokalemia and muscle dysfunction are discussed in relation to other investigations of altered potassium metabolism and myopathy during treatment with certain diuretics.


A psychometric stury of 34 patients afflicted with spasmodic torticollis.

The clinical and psychometric comparison of two group of patients, one with spasmodic torticollis, the other with operated herniated disc, showed closely related psychological profiles. The most important perturbations are found in spasmodic torticollis and seem related to the disease's chronicity. In no case was a predominant hysteric structure found. The results of these investigations on the disorder's etiology are discussed.


Strain differences in the response to morphine on incorporation of 3H-lysine into rat brain protein.

The effect of morphine on the specific activity (SA) of lysine in the plasma free amino acid (FAA) fraction and in the cerebral cortical FAA and protein fractions, as well as on the specific accumulation and incorporation, was determined in male Sprague-Dawley and Wistar rats at various time intervals after intravenous injection of drug and amino acid into unanesthetized animals. The lysine SA was higher in Sprague-Dawley than in Wistar rats in the plasma and brain FAA fraction and in the protein fraction. In the SD strain, morphine decreased the SA of plasma FAA significantly, but had only slight effects in the Wistar strain. In the cortical gray matter, morphine elevated the SA of lysine significantly in both strains, although the rate of decrease of SA with increasing time after injection was different in the two strains. SA of the lysine in cerebral cortical protein increased in both strains with time, but did so more rapidly in the Sprague-Dawley strain. When the data for the free amino acids were expressed in terms of specific accumulation, the observed rates were higher in the Sprague-Dawley animals and reached a point of maximal concentration, which was not observed in animals of the Wistar strain. Morphine elevated the levels of specific accumulation of lysine into the cortical free amino acid pool in both strains of rat. However, specific incorporation of lysine into the cerebral gray cortical protein in control animlas was essentially similar in both strains. Despite the similarity in specific incorporation of lysine into brain protein in both strains of control rat, morphine treatment caused a much more marked inhibition of incorporation of lysine in the Wistar rats. Thus, it is concluded that Sprague-Dawley and Wistar rats are not equivalent in relation to the accumulation of an amino acid in the brain FAA pool from the plasma and that the effect of morphine on specific incorporation of lysine into brain protein is greater in Wistar rats.


Lack of effect of clonazepam on serum levels of diphenylhydantoin, phenobarbital and carbamazepine.

The influence of clonazepam on steady-state serum levels of diphenylhydantoin, phenobarbital and carbamazepine was studied in 22 patients with epilepsy receiving one or two of these drugs. Clonazepam was given in slowly increasing doses for 2 weeks until a maximum dose of 4-6 mg per day was reached; thereafter the dose was kept constant. The serum levels of diphenylhydantoin, phenobarbital and carbamazepine were determined once a week for at least 6 weeks. During clonazepam medication in ordinary doses the serum levels of the drugs in question were unaltered. Thus, it is unlikely that the antiepileptic effect of clonazepam in these patients even partly may be due to increased serum levels of these other drugs mentioned.


The effect of anticonvulsant drugs which induce liver microsomal enzymes on derived and ingested phenobarbitone levels.

A comparison was made between the levels of derived Phenobarbitone in three groups of patients who were taking Primidone as a single drug, Primidone with Phenytoin and Primidone in combination with Phenytoin and Carbamazepine. The levels of ingested Phenobarbitone when this drug was taken as a single drug were compared with the levels when Phenobarbitone was taken in combination with Phenytoin in two other groups of patients. A significant increase in derived Phenobarbitone levels occurred when Primidone was used in combination with Phenytoin alone or with Phenytoin and Carbamazepine. The highest level occurred in a group of patients taking the three drug combination. There was no significant difference between the levels of ingested Phenobarbitone when this drug was used as single therapy or in combination with Phenytoin. We suggest that the increase in derived Phenobarbitone levels relates to the effect of Phenytoin on liver enzyme systems, and that the greater increase with triple therapy was related to the combined effect of Carbamazepine and Phenytoin on microsomal enzymes. As there was no increase in ingested Phenobarbitone levels when this drug was taken in combination with Phenytoin, we were unable to confirm previous suggestions that Phenytoin either inhibits the hydroxylation of Phenobarbitone or impairs its renal excretion.


Theophyllamine and the antiparkinsonian response to levodopa treatment.

In an open preliminary study theophyllamine (theophylline-ethylenediamine) was administered to eight patients with idiopathic parkinsonism showing residual signs of parkinsonism though already in treatment with levodopa. Although theophyllamine in preclinical studies was found effective in potentiating the response to central dopamine stimulation, the drug in the present clinical study was without effect on idiopathic parkinsonism. After a loading dose of aminophylline, 5.6 mg per kilogram given intravenously, a maintenance dose of 0.9 mg per kilogram per hour infused during 2 h resulted in serum levels of theophylline of 23.5 +/- 3.9 mg per liter. 3-methyl-xanthine, a pharmacodynamic active metabolite of theophylline was analyzed in the serum samples. Less than 0.5 mg per liter was found.


Aphasia and epilepsy in childhood.

The syndrome of progressive aphasia and epilepsy in childhood is delineated. Four cases are presented, three of which show the typical gradual onset, fluctuating course and EEG changes with bilateral foci of spike and spike-wave activity, and, finally, normalization after some years of the EEG. Also the aphasia tends to subside, but often with considerable delay in relation to the other features. Neuropsychological assessment showed varying residual defects mainly on language functions. The aetiology is unknown. No pathoanatomical data on this disorder has hitherto been published. In one of the present cases a cortical biopsy was performed on suspicion of a left temporal tumour. The biopsy showed changes indicative of a slow virus infection. It is therefore suggested that the newly established language function in children particularly is vulnerable to a subchronic viral encephalitis affecting both hemispheres.


Diagnostic value of visual evoked response, clinical eye examination and CSF analysis in chronic myelopathy.

The results of neuro-ophthalmological examination, visual evoked responses (VER) to pattern reversal stimulation and cerebrospinal fluid (CSF) analysis were compared in 25 patients with myelopathy of unknown etiology and without subjective symptoms of involvement of CNS outside the spinal cord. Delayed latencies of VER indicating a disseminated disease were found in 76 per cent of the patients. In 64 per cent of the patients, CSF showed abnormalities similar to those found in MS. Pathological findings at the clinical eye examination consistent with such an etiology was found in 36 per cent of the cases. It is suggested that a large proportion of patients with myelopathy of unknown etiology suffer from a disseminated demyelinating disorder similar to MS. By a combination of neuro-ophthalmological, VER and CSF examinations such as etiology can be established with reasonable certainty, and more troublesome investigations such as myelographies and spinal angiographies may be restricted to patients in whom the etiology still remains unclear.


Neurological and motor functioning of 10--12-year-old children who showed mild transient neurological symptoms in the first five days of life.

This study concerns itself with the neurological functioning of 11-year-old children who neonatally presented a variety of shortlived or transient symptoms. These symptoms, while shortlived, are similar in nature to symptoms which other authors have shown to be correlated with later increased rate of neurological deviance. By using the data from a birth cohort of 9,006 consecutive deliveries, we attempted to discover whether such symptoms, when only transiently present in the newborn, are correlated with later neurological functioning. Results indicate that the subjects with transient neonatal symptoms presented more neurological deviance at age 10--12 than did matched controls.


Does O-methyl-dopa play a role in levodopa-induced dyskinesias?

Clinically scored levodopa-induced dyskinesias were correlated with plasma dopa and O-methyl-dopa levels determined every hour during one day in 30 Parkinsonian-treated patients. In patients treated with a combination of L-dopa and a peripheral decarboxylase inhibitor (PDI), those with dyskinesias have very high plasma O-methyl-dopa levels compared with those who have no dyskinesias. In contrast, no significantly different plasma dopa levels are found in these two subgroups of patients, leaving open the question of the possible involvement of such elevated plasma O-methyl-dopa levels in favouring dyskinesias.


Lysosomal enzymes in the lymphocytes and granulocytes of patients with multiple sclerosis.

The activities of three lysosomal enzymes were measured from the lymphocytes and granulocytes of patients with multiple sclerosis and of controls. The activity of acid phosphatase was increased in the granulocytes and that of beta-glucuronidase in the lymphocytes of MS patients in remission, as compared to those in relapse. No marked increases were observed in the activity of acid proteinase. These findings suggest that a number of lysosomal enzymes in both lymphocytes and granulocytes can be activated during demyelinating processes for reasons unknown at the moment.


Subclinical myopathic findings in patients affected by malignant tumours. An autopsy study.

Histoenzymologic studies on representative muscles and the peripheral microcirculation from selected autopsies of non cachectic patients dying of neoplasms, without signs of neuromuscular involvement, demonstrate a high incidence of neuromuscular and microcirculatory changes. A correlation between neuromuscular changes and the peripheral microcirculation particularly evident in myopathic cases is discussed.


Nervous lesions in a case of local gigantism.

A case of local gigantism of the thumb was studied by light and electron microscopy. In the lesion, proliferation of fibroadipose tissue and typical alterations of the nerves were found. The alterations in the nerve were isolated hypertrophy of the perineural cells. The relation of the changes to other peripheral nerve tumours especially in neurofibromatosis, is discussed.


Early stages of status marmoratus.

Basal ganglionic lesions in three young infants were found in a prospective search for early stages of status marmoratus. The lesions had formed and had passed into glial scars well before myelination of the basal ganglia commenced. The myelinating fibers crossing the scarred tissue were disoriented; however, fiber structure was normal, and the numbers of myelin lamellae did not differ significantly between scars and non-scarred tissue. There was no indication of a derangement of the process of myelin formation or of the formation of anomalous myelin sheaths around non-neuronal processes.


The pathophysiology of the blood-brain barrier dysfunction induced by severe hypercapnia and by epileptic brain activity.

The cerebrovascular permeability to protein was studied in hypercapnic rats and in rats with epileptic seizures induced by bicuculline and homocysteine. Despite the differences of the basic pathophysiological mechanisms involved in these models, the blood-brain barrier (BBB) dysfunction was clearly related to the combined effects of high blood pressure and cerebral vasodilatation, thus indicating mechanical factors to be predominantly involved. The BBB changes were most frequent in central and basal regions in contrast to those induced by acute hypertension, which are most common in cortical areas.


[Neuropathological study of incontinentia pigmenti. Anatomical case report (author's transl)].

Report of a case of Incontinentia pigmenti (IP) of the Bloch-Sulzberger type, with neurological features, in a 3 month-old deceased infant. The neuropathological examination revealed signs of a destructive process which had occurred in the perinatal period: ulegyria, cavities of white matter and patchy scar softening of the cerebellar cortex. In addition, there was a diffuse inflammatory process involving the pia-arachnoid and brain tissue: perivascular cuffs of lymphocytes, histiocytes and eosinophilic polymorphs, and mononuclear nodules. No prenatal malformations or vascular lesions were found. These findings are discussed in the light of both the relevant literature on neurological abnormalities in IP and the only already reported neuropathological examination by O'Doherty and Norman (1968). Two main hypotheses might account for the frequency of neurological disturbances in IP, 1. a peculiar sensitivity of the brain to anoxia and/or ischemia: 2. its involvement by the specific inflammatory process which occurs both in the skin as other tissues in this genetically determined disease (Perié et al., 1976).


[Progressive multifocal leucoencephalopathy. Observation with predominant pontocerebellar lesions and association with congenital immune deficiency].

A young woman presented a mixed congenital and familial immunodeficiency syndrome consisting in an absence of IgA and lowered levels of IgG and IgM, with a defect in cellular immunity. She had a mild malabsorption syndrome with slight alterations of the jejunal mucosa. Non-caseating tuberculoid granulomata were found in skin lesions, in lymph nodes and in the spleen. At age 27 the patient died of a neurological disease of 4 months duration. Autopsy revealed a very widespread demyelinating process involving mainly the right cerebellar hemisphere but also most of the pons and left cerebellum, with the typical morphologic characters of PML. In the hemispheres lesions were limited to microscopical "microglial nodules" with discrete demyelination. A review of 86 published cases of PML revealed 9 other cases in which lesions showed a strong predilection for the subtentorial territories. This sampling allows for tha assumption that some 11% of the cases of PML have this particular lesion distribution. Other pertinent features of this case are briefly discussed.