Studies of the surgical scrub.

A study comparing the relative efficacy of a five versus a ten minute surgical scrub was carried out using random sampling of personnel scrubbing for routine scheduled hospital surgical procedures. Scrubbing for five minutes was found to be equally as effective as scrubbing for ten minutes. Betadine was compared to pHisoHex as a scrubbing agent and found to be statistically more effective in degerming the skin following a five minute scrub. As a result of this study, a routine preoperative surgical scrub of five minutes' duration, using Betadine as the scrubbing agent, is recommended.


Peritoneovenous shunting for ascites.

The peritoneovenous shunt of LeVeen can be safely performed under local anesthesia in patients with advanced cirrhosis and ascites. The results of the technique described have proved satisfactory in 25 diuretic resistant ascites in selected patients. The rapid, downhill course of the patient with severe hepatic encephalopathy or coma is probably unchanged by the presence of the valve. Eighteen surviving patients discharged with shunts in place are under continuing study.


Technique for intraoperative arteriography after arterial reconstruction of the lower extremity.

A simple technique for performing intraoperative arteriography to assess the adequacy of arterial reconstruction of the lower extremity has been devised. All arterial reconstructive procedures are readily visualized using undiluted Renografin 60. Unnecessary time delays are avoided with the optimum co-operation between the surgeon and the Radiology Department. Excellent quality arteriograms are obtained using basic materials without the need for more sophisticated arteriographic equipment.


Bilateral optic canal meningioma.

A case of bilateral optic canal meningiomas which presented with progressive visual deterioration and optic atrophy is described. Complete neurologic investigation was negative, only surgical exploration disclosed the tumors.


Automatic cycling bipolar coagulator.

Bipolar coagulation may be more effective if the currents is delivered in short bursts. This technique is described, along with a bipolar coagulator which automatically dispenses the current in short regularly cycled bursts.


Bilateral temporal-middle cerebral artery anastomosis for Moyamoya syndrome.

Moyamoya syndrome has been recognized for approximately 15 years. Medical and surgical treatment by sympathectomy and ganglionectomy has proved futile. This report presents a case treated by bilateral superficial temporal artery, middle cerebral artery anastomosis in a black American male.


Cerebral hydatid cysts in central India.

Four cases of hydatid cysts of the brain are reported. All of the patients were under 18 years of age. One presented with a localized erosion of the skull and a characteristic cracked-pot sign. Angiographic findings were most useful in their diagnosis.


Tuberculous abscesses of the cervical spine with quadriparesis.

Four cases of tuberculosis of the cervical spine with quadriparesis either from subluxation, and/or compression of the spinal cord are described. Our surgical approach has been laminectomy with excision of abscess and cervical fusion. Pre and post operative cervical traction with Crutchfield tongs on Stryker beds was employed in three of the four cases. Excision of these abscesses and cervical fusion, following improvement of the nutritional status and adjunctive chemotherapy, can reverse paralysis in these patients. Three of our four patients recovered.


Intracranial subarachnoid pressure recording: experience with 650 patients.

One hundred and forty-seven patients had intracranial pressure monitoring by means of a subarachnoid screw as part of their routine neurosurgical care. Average length of monitoring was five days. Successful recordings were obtained in 92% of the patients. Improper technical placement caused the majority of failures. The overall infection rate associated with the monitor was 2.1%, with 0.7% CNS infection (one patient developed a brain abscess). We have since monitored an additional 500 patients and find the subarachnoid screw to be a reliable, low risk means of clinically recording intracranial pressure in neurosurgical patients.


Direct attack on carotid ophthalmic and large internal carotid aneurysms.

Some cases of carotid-ophthalmic and large internal carotid aneurysms successfully excluded from the carotid circulation by direct approach are presented. The principal anatomical and clinical features of the two groups of aneurysms, together with the technique used, are described. It is concluded that direct attack is the treatment of choice because it ensures exclusion of the aneurysm, permits sparing of internal carotid artery and removal of the aneurysmal sac where it compresses adjacent nervous structures.


Computed tomography in intracerebral hemorrhage.

Computed tomography is a practical and simple procedure for diagnosis of acute intracerebral hemorrhage. By this means, operable intracerebral hemorrhage was diagnosed in five patients; four were treated surgically. Computed tomography showed the size and location of the hematomas, making surgical treatment feasible despite occasional large extensions of the lesions.


Computerized axial tomography of the brain in neonates and young infants.

Twenty critically ill infants with abnormal head growth and/or seizures underwent CAT of the brain. Signs of birth asphyxia or respiratory distress were present in all. Six out of ten infants with abnormal size of the head had abnormal CAT scans. Nine out of ten infants with seizures had abnormal scans. Abnormalities included hydrocephalus, intraventricular hemorrhage, cerebral edema, subarachnoid hemorrhage and porencephaly. Six infants required neurosurgical procedures. Development at two to 15 months of age in the 19 surviving infants was normal in nine, suspect in eight, and severely delayed in two patients. Until the prognosis of the various CNS disorders discussed is clearly defined, aggressive management appears indicated.


Experimental decompression of spinal cord.

An artificial, slowly expanding mass which compressed the spinal cord produced histological, electrophysiological, and neurological changes. A comparison was made of the effects of laminectomy in the cat with dorsally and ventrally placed masses. Laminectomy reversed declining cord function and produced prompt recovery of somatosensory evoked potentials in cats with dorsally placed masses. In contrast, a worsening of these functions occurred following laminectomy in animals with ventrally placed masses. In all cases, evoked potential changes were consistent with neurological status and were predictive of the outcome of surgery.


A ventriculo-peritoneal shunt for hemorrhagic or high protein fluid.

A ventriculoperitoneal shunt may be a more satisfactory method of treating hydrocephalus than periodic needle aspiration or external drainage. A shunt that can be used when the ventricular fluid is hemorrhagic or has a high protein content is described. Only two of 12 patients required revision for shunt obstruction in the two months after surgery.


Embolization of an arteriovenous malformation of the brain stem.

A case of complete or nearly complete obliteration of a brain stem arteriovenous malformation by embolization is presented. At the termination of the final angiogram the patient bled into the midbrain and died. The reasons for this complication are unknown.


Membranous occulusion of the aqueduct of Sylvius.

Two cases of membranous occlusion of the aqueduct of Sylvius are presented. The role of Conray ventriculography in the precise diagnosis of this condition is stressed. Both cases have been operated upon, and the membranes perforated by catheterisation. The catheter was left in the aqueduct in one case. One of the patients was cured, the other died. Membranous occlusion of the aqueduct of Sylvius is a rare cause of hydrocephalus. Occurrence of two cases within a four-month period attracted our attention to this disorder.


Vasoactive properties of prostaglandin compounds on the in vitro human basilar artery.

The action of six prostaglandins A1, E1, (A2, E2, F1 alpha, F2 alpha) on in vitro human basilar artery circumferential strips was evaluated to assess relative vasoreactivity. Degree of contraction was compared with 5-hydroxytryptamine (5-HT), hitherto the most active in this laboratory. The three most vasoactive prostaglandins were E1, E2, and F2, alpha. The three PGs giving highest magnitude of response were F1 alpha, F2 alpha, and E2. Most were more active when compared to 5-HT. Vasodilation did not occur. Because of their vasoconstrictive qualities, prostaglandins may participate in arterial vasospasm. It is postulated that prolonged vasoconstriction may lead to vasospasm and that the latter may result from one or more autacoids acting along or synergistically.


Subarachnoid hemorrhage following intranasal procedures.

Two cases of subarachnoid hemorrhage complicating intranasal ethmoidectomy are presented. In both, the bleeding was initally considered coincidental to the rupture of a congenital aneurysm or an arteriovenous malformation. A direct relationship between the surgical procedure and the subarachnoid hemorrhage only became evident after extensive studies or after delayed development of CSF rhinorrhea, pneumocephalus and meningitis.


Aminophylline and isoproterenol in the treatment of cerebral vasopasm.

Eighteen patients with cerebral vasospasm following subarachnoid hemorrhage were treated with 21 trials of intravenous aminophylline and isoproterenol. After angiographic demonstration of spasm, all patients were started on a continuous intravenous infusion of aminophylline 125 mg/hr and isoproterenol 125 micrograms/hr, preferably for a period of at least five days before the medications were tapered. Of the 21 treatment trials, there were 11 definite beneficial responses and ten failures. This study emphasizes the importance of instituting this therapy as rapidly as possible following the confirmation of symptomatic cerebral vasospasm. In addition, if a response occurs it will be noted within 24 hours of institution of the medications. If no response is noted following this time period, the medications should be discontinued. The major complications of this therapy include hypotension, tachycardia and arrythmias. These complications may necessitate diminishing the dosage of the medications. However, if a response has been obtained, every effort should be made to avoid discontinuing therapy prematurely since cerebral vasospasm may recur. The use of isoproterenol and aminophylline is based on their demonstrated ability to increase cyclic adenosine monophosphate (cyclic AMP) levels in vascular smooth muscle, thus producing relaxation of vasospasm.


Dandy-Walker syndrome: clinico-pathological features and re-evaluation of modes of treatment.

Eighteen cases of the Dandy-Walker syndrome are presented. The clinical manifestations are analyzed. Almost half of these children had associated congenital anomalies. Only four had the "characteristic" radiological findings. Direct surgical attack upon the cyst was not a successful form of treatment. Satisfactory treatment consisted of shunting of the ventricular system but the incidence of complications was high. There was a 27% mortality. The etiology and pathology are discussed.


Anomalous lumbosacral nerve roots associated with spondylolisthesis.

Anomalies of the lumbosacral nerve roots, if unrecognized, may lead to injury of that nerve in operations on lumbar disks. Myelography rarely predicts the anomaly before operation. However, the presence of congenital skeletal defects of the lumbosacral joint should alert the surgeon to the possibility of anomalous nerve roots. Two cases of spondylolisthesis of the lumbosacral joint with with associated nerve root abnormalities are presented.


Giant intracranial aneurysms: a review of 13 cases.

Thirteen cases of subarachnoid, extracavernous giant aneurysms are reported. The various types of presentation and treatment are discussed. Of interest is the fact that the paraclinoid carotid artery is the most common location for giant aneurysms. Thirty-one percent have another vascular abnormality associated with them, and 70% presented initially with a subarachnoid hemorrhage.


Intradural extramedullary spinal arterio-venous malformations fed by the anterior spinal artery.

There is a small group of spinal arteriovenous malformations which differ from all of the others. They receive their blood supply from the anterior spinal artery but are located outside of the spinal cord and its pia mater. Six such malformations from our series of 150 spinal arteriovenous malformations 1,4 are reported. They differ in their clinical manifestations from the others. They can be extirpated with improvement in the patient's clinical manifestations.


Intradural rupture of lumbar intervertebral disk: report of two cases with review of the literature.

Two cases of intradural rupture of lumbar intervertebral disks are described, in addition to 22 cases reported in the literature. Our case occurred among 753 herniated disks surgically treated in this department, an incidence similar to that in the literature. Clinically most cases presented as an acute cauda equina syndrome, and a myelographic block was almost always present. Prognosis is not made worse by the perforation. Various factors that might contribute to this relatively rate complication of disk disease are mentioned.


Massive hemorrhage in tumor of tuberous sclerosis.

A massive hemorrhage originating in a giant celled astrocytoma of tuberous sclerosis is reported and pertinent literature is reviewed. No such association has been reported previously.


Chronic pancreatitis: a cause of biliary stricture.

This is a report of our experience with 13 patients who had a distal common duct stricture associated with chronic relapsing pancreatitis. All patients, when first seen, had an elevated alkaline phosphatase level; eight of 13 patients also had an elevated serum bilirubin level. Five of the jaundiced patients had a febrile course; a preoperative diagnosis of acute cholangitis was made in four of these. Eight of the 13 patients have had a choledochoduodenostomy for relief of biliary obstruction; seven of these patients are living and well; one died of continued alcoholism and pancreatitis. One patient had a loop cholecystojejunostomy; decompression was inadequate and death due to septicemia secondary to ascending cholangitis ensued. Four patients have not yet had an operation. Two are symptomatic, but elective operation has been refused. Two have been lost to follow-up. We recommend investigation of the biliary tract in patients known to have chronic relapsing pancreatitis who also have persisting abdominal symptoms and an elevated alkaline phosphatase. If a stricture of the distal common bile duct is identified in the absence of acute pancreatitis, choledochoduodenostomy should be performed.


Abdominoperineal resection in the treatment of devascularizing rectal injuries.

Local debridement, drainage, and diverting colostomy, with or without primary repair of the rectum, have been considered to be the standard treatment for most rectal injuries, but they are not sufficient for those patients sustaining uncontrollable bleeding or extensive rectal devascularization. This report assessed the indications and results of abdominoperineal resection of the rectum in these patients. Ten patients who were victims of explosive trauma presented with massive perineal injuries and extensive rectal devascularization. Six of these were treated with local debridement of necrotic tissue, pararectal drainage, antibiotics, and colostomy. Five of the six patients initially treated by colostomy died after operation from hemorrhage or sepsis. The sixth patients, who survived, had an abdominal resection of the rectum performed 5 days after the colostomy for removal of a gangrenous rectum. All five of those who underwent abdominoperineal resection survived (p less than 0.01). Increasing violence in the life patterns of modern society enhances the possibility of occurrence of this type of lesion, previously limited to military practice. The need for careful investigation of rectal viability is emphasized. Primary abdominoperineal resection of the rectum is advised when extensive devascularization has occurred.


Carotid endarterectomy: is an indwelling shunt necessary?

Three hundred and four consecutive endarterectomies were performed with general anesthesia and without a temporary indwelling shunt. Eight patients (2.6%) awoke from anesthesia with a new neurological deficit. Eight additional patients later developed neurological symptoms, suggesting that the absence of a shunt did not contribute to their complication. Of these 16 patients, two (0.6%) died, nine (3.0%) had a temporary neurological deficit, and five (1.6%) had a permanent neurological deficit. A prolonged occlusion time, a stump pressure of less than 50 mm Hg, or the presence of additional carotid lesions did not show a significant statistical relationship to postoperative neurological deficit.


The diagnosis and surgical treatment of patients with Gardner's syndrome.

Of one hundred and twenty-six patients with Gardner's syndrome, 60% showed soft tissue tumors, 32% showed osteomatosis, 67% polyposis, and 20% the complete triad. Bowel cancer developed in 32% of the patients. The frequency of other diseases in these patients showed fibrous tumors in 8%, and two patients with cancer of the ampulla of Vater; otherwise the diseases seen did not show any major variation from what might be expected for the group at risk. Laboratory evaluation has included the demonstration of increased fecal cholesterol and primary bile acids in these patients. The recommended surgical treatment is colectomy and ileorectal anastomosis at a measured 12 cm level. This level of ileorectal anastomosis may be vital in giving a regression of rectal polyps, which was seen in 15 to 17 patients so treated. The conversion of an ileosigmoid to an ileorectal anastomosis resulted in polyp regression in one patient. The oral administration of ascorbic acid gave polyp regression in seven of 10 patients. There may be a possible relationship of fecal coprostanol and cholesterol levels and polyp regression.


Routine preoperative upper gastrointestinal series (UGIS) in patients with biliary tract disease: a plea for more selectivity.

Preoperative upper gastrointestinal x-ray series (UGIS) in patients with documented biliary tract disease commonly is carried out before cholecystectomy. Of 250 patients who had consecutive cholecystectomies performed in a 400-bed private hospital, 105 patients did not have UGIS prior to operation and no gastroduodenal disease was discovered at operation. Thirty-nine positive x-ray examinations were obtained among the 145 patients who had preoperative UGIS. In only three of these patients was a gastric procedure added at operation; no unexpected cancers were found. In the other 36, "positive" findings consisted of small hiatal hernias, diverticula of the esophagus, stomach, or duodenum not clinically significant or postgastrectomy anatomic abnormalities. This review suggests that routine preoperative UGIS may not be warranted in such patients and urges greater selectivity of patients having this procedure.


Hepatorenal syndrome: reversal by peritoneovenous shunt.

Two patients with hepatorenal syndrome were treated by insertion of a peritoneovenous shunt. The renal deficit was corrected rapidly in both cases. A 62-year-old woman with a slow onset syndrome with urine output of 100 to 150 ml/day and urinary sodium excretion of 1 mEq/day responded with large volume urinary output and sodium excretion. She is alive with minimal ascites 18 months after shunt. A 53-year-old man with severe nutritional cirrhosis, alcoholic hepatitis, and eventual massive necrosis was treated for bleeding esophageal varices by portacaval shunt. Postoperative massive ascites progressed to acute hepatorenal syndrome. Insertion of a peritoneovenous shunt reversed the renal deficit. HE eventually exsanguinated due to a hemorrhagic diathesis caused by massive hepatic necrosis.


Questionable value of furosemide in preventing renal failure.

The effects of furosemide on renal function and hemodynamics were evaluated in 54 critically ill surgical patients. Standard clearance techniques were used to measure glomerular filtration rate (GFR), renal plasma flow (RPF), osmolar clearance (COsm), sodium clearance (CNa), and renal blood flow (RBF). RBF distribution to outer cortex, inner cortex-outer medulla, and inner medulla was measured by the radioactive xenon disappearance technique. Furosemide produced a marked rise in urine output, COsm, and CNa; it produced no change in GFR, RPF, RBF, and RBF distribution. Twelve of the 54 patients received furosemide for therapy not related to the study; six patients developed renal failure and five became hypotensive 2 to 10 hours after administration of furosemide. These data demonstrate that furosemide does not protect against renal failure by altering or increasing RBF but may cause renal failure by producing hypovolemia.


The delayed hypersensitivity response: application in clinical surgery.

Delayed hypersensitivity skin testing was performed on 520 surgical patients. Significantly higher incidences of sepsis and mortality (p less than 0.001) were found in the abnormal patients as compared to normal responders in the preoperative (322 patients), postoperative and post-trauma (115 patients), and nonoperative (83 patients) groups. Sequential testing in individual patients was of even greater prognostic value. Of the 177 patients who either remained normal or whose responses became normal, the sepsis rate was 10.1%, and the mortality rate was 8.4%. However, a sepsis rate of 57.6% and a 78% mortality rate were found in those patients who developed abnormal responses or whose responses did not improve. Cancer and increased age (older than 80 years) did not account for the incidence of anergy and relative anergy. The mortality rate was higher in the cancer group. Anergy and relative anergy were found to be associated with malnutrition, sepsis, shock, and trauma. In the clinical setting, effective treatment of these associated conditions, especially the maintenance of body cell mass by the use of total parenteral nutrition, was associated with reversal of the anergic state and an improved prognosis.


Management of the morbidly obese patient after small bowel bypass failure.

Fourteen patients underwent small bowel bypass (SBB) takedown for complications such as chronic nausea and vomiting, excessive flatus, intractable diarrhea, liver dysfunction, electrolyte imbalance, hyperoxaluria with renal stones, and arthritis. The average weight loss in these 14 patients after SBB was 93 pounds (34% of initial weight), with a mean follow-up of 23 months. Four of the 14 patients had SBB takedown only and gained an average of 36 pounds over the ensuing 14 months. Similarly, three patients had SBB takedown with delayed (asynchronous) gastric bypass (GB) and gained an average of 55 pounds during the 14 months prior to GB. Following GB these three patients lost only an additional 8 pounds over a 12 month period, leaving them 47 pounds heavier than at the time of SBB takedown. In contrast, seven patients treated with SBB takedown and synchronous GB not only maintained the weight reduction obtained with SBB, but, in addition, had further modest weight reductions (average, 18 pounds), for a mean follow-up of 8 months. There were no serious operative or late complications with any of the above operations. In addition, the complications leading to SBB takedown resolved in each case. It is concluded that synchronous GB is an effective means of maintaining the weight reduction in the morbidly obese patient after SBB takedown.


The exteriorized anastomosis: its role in surgery of the colon.

Sixty-one patients (59, trauma; two, nontrauma) have been managed at Detroit General Hospital from 1972 to 1976 utilizing an exteriorized colon anastomosis. Healing of the anastomosis was present in 42 (70%) of the patients, and 37 (62%) avoided colostomy. Our experience with this procedure has demonstrated that it is a safe, reliable adjunct to be used in colon surgery when primary intraperitoneal repair is not desirable, that the added operating time (20 to 30 minutes) will not be deleterious to the patient, that the lesion is at least 18 cm above the peritoneal reflection, and that the likelihood of a prolonged septic postoperative course is not high.


Complications associated with the use of gastrointestinal stapling devices.

Complications arising in the intraoperative and postoperative period were assessed over a 2-year period in 132 patients in whom gastroinestinal operations had been performed using the TA-type or GIA-type stapling devices. Specific complications are described and their relationship to the staple-suture technique is evaluated. Bleeding from the anastomotic line is believed to be a complication directly attributable to the technique. Technical errors in the use of the device, as well as mechanical malfunction, can contribute to morbidity or mortality. Methods for avoding staple-related complications are suggested. The history of stapling instruments is reviewed briefly.


[Results obtained using various types of suture material in laparotomy and the treatment of umbilical hernia in horses (author's transl)].

Comparative studies were done on healing of the wound following laparotomy through the ventral wall of the abdomen (paramedian incision or in the linea alba) in seventy horses and following surgical treatment of umbilical hernia in eighty-five (young) horses, in which perlon, (chromic) catgut, stainless steel wire and polyglycollic acid were used as suture material. Though with some reserve, as the study was concerned with the comparison of findings in clinical cases in which a number of conditions may vary, it is concluded that steel wire and polyglycollic acid are preferable to perlon and (chromic) catgut in suturing the abdominal wall and hernial ring in horses.


[Treatment of a traumatic intestinal prolaps in a lizard (author's transl)].

A serious intestinal prolaps in a lizard (Lacerta pityusensis pityusensis) that was sent by parcel post package, was replaced and the wound sutured. Anaesthesia, surgery and post-operative course are described.


[Social function of pets (author's transl)].

The present paper is an abridged version of one written in 1974. Only one of several functions of small pets, viz. their social function, is discussed, both the positive and the negative aspects being considered. A test developed in Great Britain serves to show how important a pet may be. The reasons for which man regards his animals as important are more within the scope of the psychologist bus are also referred to in the paper. An entirely new social function, especially of dogs, is the role of therapeutic aids in the psychotherapy of children. This method is used specifically by the American psychiatrist B. M. Levinson. Drawbacks to pets are inadequate hygiene, agressiveness and zoonoses, though veterinarians may play an important role in overcoming these disadvantages.


Surgical treatment and adjuvant chemotherapy of gastric cancer on the basis of pathological findings.

Gastrectomy was performed in 626 outo 692 operated cases of gastric cancer. Histologic examination of the resected specimens revealed that the cancer was confined to the mucosal (m) or submucosal layer (sm) in 256 cases, advanced to the muscularis propria (pm) or subserosal layer (ss) in 110, and to the serosa (se) or the surrounding organs (si, sei) in 260. 238 (93%) of m and sm cases were free from lymphnode metastasis. Lymphnode metastasis was noted in 51 (46%) of pm and ss cases, 177 (77%) were positive in lymphnode metastasis and 108 (47%) showed metastasis in n2 and n3 degree. Adjuvant chemotherapy fairly improved the psotoperative survival rate of the advanced cases with lymphnode metastasis, serosal involvement, or lymph and blood vessel involement of gastric cancer.


Effect of starvation on excretion, distribution and metabolism of DDT in mice.

Effect of starvation on tissue radioactivity of 14C-DDT was examined in mice 8 days after its single injection. Animals were completely fasted and given barium sulfate by gastric intubation for the last 3 days. The findings obtained from starved mice were as follows: 1) loss of body weight, 2) decrease in organ weight of epedidymal fat and liver, 3) reduction in lipid content of whole body as well as of epididymal fat, 4) a marked elevation of DDT levels in tissues except muscle, and 5) occasional neurotoxidc signs characterized by tremors and convulsions. Excretion of DDT-related metabolites was not changed by starvation. Analysis of metabolic producets of 14C-DDT using thin-layer radiochromatography revealed that there was little or no significant difference between control and starved mice in the metabolic pattern of DDT-related compounds in the tissues and excreta. It was assumed the DDT-ingested animals with dietary energy restriction had a subsequent risk of toxicity resulted from redistribution of DDT, but not from alteration in excretion or metabolism.


Regional contraction patterns of the left ventricle during ventricular pacing.

Ten mongrel dogs were used to assess regional myocardial function in response to electrical pacing form the inflow (RVI), outflow tracts (RVO), and apex (RVA) of the right ventricle and apex (LVA) and lateral wall (LVL) of the left ventricle. Strainguauge arches were sutured to the epicardial segments of the apical and lateral walls of the left ventricle and their mechanical shortening was measured during right artial (RA) and during ventricular pacing. The onset of shortening of two segment did not differ significantly in RA and RVI pacing, while the stimulation of RVA and LVA caused the initial contraction of the apical segment, and RVO and LVL pacing caused that of the lateral segment; i.e. RVA and RVO pacing resulted in left ventricular asynchrony of contraction similar to LVA and LVL pacing, respectively. Asynchrony of contraction was not accompanied by a uniform change in peak tension of regional myocardial segments, but prejection tension rose and ejection tension fell at the pacing site. The reduction in mean aortic pressure inversely correlated with the prolongation of the time interval between the onset of shortening of two segments during left ventricular pacing. The decrease in cardiac performance observed during ventricular pacing was related to the severity of asynchrony rather than the direction of the ventricular depolarization or change in regional myocardial tension.


Effect of exercise on alimentary lipemia in healthy men.

To investigate the effect of exercise on alimentary lipemia, 6 healthy volunteers were exmained for their plasma parameters successively for 6 hr after ingestion of emulsified butter (1 g/kg body weight) with and without subsequent intermittent loading of exercise (720 kilopound meters per min for 2 min, 6 times at hourly intervals) using a bicycle ergometer. No apparent differences were found between the fat loading test and the fat and exercise loading test in the 6 hr levels of plasma chylimicron-triglyceride, lipoprotein-triglyceride and endogenous lipolytic activity measured by the usual lipoprotein lipase assay method, although the increase in plasma free fatty acids in the fat and exercise loading test was significantly greater than that in the single fat loading test. It is concluded that the intermittent muscle exercise adopted in this study has no significant inffuence on the triglyceride elevation after the fat loading in man.


Clinical evaluation of angiotensin II antagonist in advanced hypertension.

Eighteen patients with advanced or malignant hypertension due to essential hypertension, systemic lupus erythematosus or chronic glomerulonephritis were infused intravenously with 1-Sar-8-Ile-Angiotensin II, a competitive antagonist of aniotensin II. The spectrum of responses was broad from a mild elevation to a marked fall in blood pressure. The changes in mean blood pressure caused by this peptide showed a significant correlation with the level of peripheral plasma renin activity immediately before the infusion (r=0.5652, p less than 0.02). This peptide infusion reduced blood pressre in 12 patients (responders), but not in 6 (non-respnders). There were no differences with age, sex and severity of hypertension except for the level of peripheral plasma renin activity between the two groups. Our retrospective study showed that in 12 responders propranolol reduced blood pressure to near the normal level, while in 6 non-responders furosemide induced similar depressor response. It is concluded that the vasodepressor effect of this peptide correlates with the levels of peripheral plasma renin activity and that the responses to this drug can be used as a guide for the selection of effective antihypertensive drugs.


Dependency representing Markov properties of spike trains recorded from central single neurons.

Neuronal spike trains are regarded as stochastic point processes.  To estimate the order and the vale of Markov properties of the adjacent interspike interval sequences, we have proposed new statistics "dependency" Dm for discrete variable and "simplified dependency" Dm for continuous variable in the stationary point processes, and Dm(t) for discrete variable in the non-stationary point processes. With the use of Dm it was shown that the maintained activity of the neurons of the mesencephalic reticular formation and red nucleus (tonic neuron groups) revealed higher order and larger values of Markov properties than that of the optic tract (OT) fibers and lateral geniculate nucleus neurons (phasic neuron groups) in cats. By employing Dm(t) it was shown that the value of the 1st order Markov properties of OT spike trains induced by the light spot presentation became to increase earlier in Y-fibers than in X-fibers; and that the value for Y-fibers returned to the maintained level in a short time, while the maximum value for X-fibers continued up to the light-off. The differentiation is considered to have a decided functional significance. From these results it is suggested that dependency code represents the stability of neuronal functions.


Studies of the metabolic fate of p-hydroxybenzoic acid in male and female cats.

Metabolic studies conducted on p-hydroxybenzoic acid orally administered at dose levels of 13 and 26 mg/kg to male and female cats have shown that the compound is rapidly excreted in the urine exclusively in the form of the glycine conjugate p-hydroxyhippuric acid. Similar results were obtained following either single administration or 7-day treatment. The metabolite in the urine was characterised by thin-layer chromatography, amino acid analysis and mass spectrometry.


Pathological alterations in Syrian golden hamster lungs after passive exposure to cigarette smoke.

The effects of 2 types of research cigarettes, differing in their total smoke delivery and condensate, were examined as to their histopathological effects of Syrian golden hamster lungs. The animals were passively exposed to the total smoke of the cigarettes once a day, 5 days/week for 1 year. Experimental and control animals were killed one day after termination of exposure. Varying effects on the macrophages of pulmonary alveolar tissue were observed. Infiltration of lung tissue by "Brown cells" was a common pathological alteration. Qualitative and quantitative differences existed between the two cigarette groups with respect to the occurrence of such "Brown cell" clumps. The response of the lung tissue to smoke exposure would appear to be dependent upon the amount of mainstream total particulate matter (TPM), the amount of condensate, the time exposed and the number of cigarettes.


An alternative method for the evaluation of organ weight experiments.

Previous work has suggested that the use of relative organ weights can lead to erroneous conclusions in toxicological experiments. A method of analysis involving very little extra experimentation is suggested and evaluated. Simulated results from rat organ weights indicate that the method is superior to the use of relative organ weights and leads to reliable conclusions being drawn about the treatment effects.


Effect of endosulfan pretreatment on organ weights and on pentobarbital hypnosis in rats.

The effects of endosulfan on the weights of the liver, adrenal and ovary, on pentobarbital blood and brain levels and on sleeping time (ST) have been investigated in female rats after daily oral doses of 0, 1.0, 2.5 and 5.0 mg/kg for a period of 7 or 15 days. No significant change in body weight was observed. With higher doses (2.5--5.0 mg/kg) the liver weight was significantly increased, but ovary and adrenal weights did not increase. Endosulfan treatment shortened sleeping time, while induction time was significantly increased. The concentration of pentobarbital in the blood and brain of rats after 30 min and upon awakening indicated that there was a significant decrease at 30 min. No change at awakening was observed in endosulfan-treated rats as compared to controls. It is suggested tha endosulfan may shorten the duration of pentobarbital-induced sleep, perhaps by induction of hepatic microsomal enzyme activity.


Determination of mercury in fish from rivers and lakes in Hungary by atomic absorption technique.

In 1975, in cooperation with 8 County Hygienic Stations, total mercury content in fish from rivers and lakes in Hungary was measured. The mercury content in fish muscle-tissue from 164 fish samples averaged 0.36 mg/kg. Average levels in different fish species ranged from 0.10 to 0.57 mg/kg. The amount of mercury in fish from rivers and lakes, with the exception of the Danube, was, in general, lower than the tolerance level (0.50 mg/kg) as adopted in many countries. Mercury levels in fish from Lake Balaton did not amount to more than 0.30 mg/kg. The circulating cold vapour atomic absorption method was used to determined the mercury content in the fish samples.


Toxicity of methyl testosterone in the beagle dog.

When methyl testosterone was administered orally to beagle dogs at dosage levels of 2, 4 and 6 mg/kg per day for 27 weeks, hepatotoxicity was induced. The change induced was characterized by enlargement of periportal hepatocytes and the presence of haemosiderin within macrophages. There was some evidence of recovery over a 13-week period.


Metabolism of triphenylmethane colours II. Absorption, excretion and distribution of Benzyl Violet 4B (FD and C Violet No. 1) in rats.

Absorption, excretion and distribution of Benzyl Violet 4B were investigated in rats, deterimining the colour by the 2-wavelength technique. This colour was hardly absorbed when given orally; only 0.89% of the dose was recovered from the bile after 24 h. On the other hand, it was rapidly excreted through the bile when given intravenously; the cumulative recovery of biliary excretion amounted to 88.4% at 4 h and 95.9% at 24 h. The levels of the colour distributed in the liver, kidney abdominal muscle and blood serum were in the range of 1--3 microgram/g  of tissue in rats fed a diet containing 5% Benzyl Violet 4B for 8 weeks, whereas they were slightly lower in rats fed the diet for 18 weeks. When rats were given the colour intravenously, there was no sex-related difference in the distribution of the colour in either Wistar or Sprague--Dawley rats, but the disappearance of the colour from the brain, liver, abdominal muscle, abdominal skin and ear of Sprague--Dawley rats was slower than from those of Wistar rats.


Contraceptive risk taking and abortion: results and implications of a San Francisco Bay Area study.

A study of 500 abortion-seeking women in the San Francisco Bay area, in California, revealed that, although a majority of them had used contraceptives previously, only a minority had consistently used effective contraceptives. This paper presents a theory of contraceptive risk taking and analyzes the decision making process described by 50 of the women during in-depth interviews. The decision not to contracept is shown to be the result of a rational process of "cost accounting." To decrease the need for abortion, it is argued, programs that change attitudes toward sexual behavior and that give women increasing economic opportunities are needed in addition to programs that make contraceptives more available.


Recent trends in contraceptive use in Mexico.

In 1973 the Mexican government changed its official position on family planning from one of neurtality to one of support. Prior to that time, family planning activities had been limited to the commercial sector and two private programs. As a result of the new policy, all major official health programs began organizing family planning activities. While about the same number of couples were served by the private programs in 1976 as in 1973, the commercial sector grew at over 10 percent per year and official coverage expanded around fivefold. It is estimated that the proportion of eligible women protected by contraception doubled and that the birth rate fell from 43-44 in 1973 to 37-40 by the end of 1976.


Communicating through satisfied adopters of female sterilization.

Communication patterns between 127 satisfied adopters of female sterilization (agents) and 257 potential adopters of family planning (recipients) were examined in this study conducted in a rural community in southern India. The influence of satisfied adopters relative to other family planning communication agents was evaluated. Satisfied adopters were identified as the most important source of family planning information by 55 percent of agents and 74 percent of recipients. Communication usually occurred between persons of similar caste, occupation, education, and income.


Breastfeeding and abstinence among the Yoruba.

Contemporary patterns of breastfeeding and postpartum abstinence among the Yoruba of Nigera are examined. Quite extensive periods of postpartum abstinence are still observed by most rural and poorer urban women to prolong breastfeeding and increase child survivorship. Differentials in duration of breastfeeding and abstinence relate to both socioeconomic factors and age, suggesting the likelihood of large future reductions. Implications for family planning prospects and policies are noted.


Mycoses of the Sudan.

Mycoses in the Sudan are still significant and, as well as mycetoma, there are a number of fungal diseases: paranasal aspergillus granuloma, which came into eminence in 1966; actinomycosis; subcutaneous phycomycosis; systemic phycomycosis; post-operative opportunistic infection of the eye with Trichosporon cutaneum and rhinosporidiosis. Mycetoma and paranasal aspergillus granuloma are discussed in detail.


Infection and its effect on the growth of young children: a comparison of The Gambia and Uganda.

Longitudinal studies of 152 children from Keneba, The Gambia, and 45 from Namulonge, Uganda, investigating the relationship between growth and different types of infection in the two areas are reported and their relevance to the patterns of malnutrition seen in Africa are discussed. The relative ineffectiveness of curative medicine in the real health problems of rural Africa and the need for prevention are stressed.


Malnutrition and gastroenteritis in The Gambia.

There is a strong association between failure to thrive and diarrhoeal disease in young Gambian children. The high prevalence of diarrhoeal disease seen is not due to frequent attacks of "acute infantile diarrhoea" of viral orgin. The picture of protracted diarrhoea is almost certainly due to colonization of the upper bowel and the high prevalence demonstrated to be at least partly due to the environment to which the children are exposed, particularly in terms of food and water hygiene. Until this cycle of upper bowel colonization and protracted diarrhoea is broken, a diet-based nutrition programme cannot be expected to function effectively.


Endemic pyoderma in Ghana: a survey in rural villages.

The prevalence and characteristics of pyoderma in a randomly sampled rural population in Ghana has been studied. Findings are compared with studies reported in recent literature which describe pyoderma in other countries. In the present study, conducted in 1975 as part of the Danfa Project's Village Health Survey, pyoderma was diagnosed in 19.4% of villagers examined. Peak rates occurred in the five to nine-year-old age group, and pyoderma was more prevalent among males and unskilled labourers and farmers than among those engaged in more sedentary occupations. Non-bullous impetigo was most common (72% of lesions) and, in contrast to other studies, non-group A-streptococci predominated in these lesions (82% of streptococcal lesions were Group G, 18% Group C). Current knowledge of transmission and control of pyoderma is discussed.


Underweight, stunting and wasting in black and white South African schoolchildren: malnutrition or adaptation?

Prevalences of underweight for age in South African schoolchildren rose from seven years to reach high levels during puberty. In Black children at the height of the pubertal growth spurt, half to three-quarters were underweight for age and hence classifiable as "malnourished". However, percentages fell rapidly to one-fifth or less at 17 years. High prevalences of stunting were common in Blacks. Wasting occurred in similar proportions of urban Black compared with White children, i.e., the large majority of both Blacks and Whites were normally proportioned; younger children were more wasted than older pupils. Factors additional to nutrition appear to share in the regulation of growth. In Whites on adequate diets, there were (i) similar patterns, but smaller rises in underweight prevalences over the growth spurt, also (ii) small but not insignificant prevalences of stunting: (iii) closely similar "normal" patterns of weight for height occurred in Whites as well as Blacks, and (iv) in Blacks the sharp fall in prevalences of underweight and wasting, after the rapid growth phase, occurred without any dietary intervention. A plea is made to use not only weight, but height, particularly relative to weight, at all ages, in assessing nutritional status and "at risk" groups. The stunted and wasted child is likely to be at greater risk than a similarly stunted but normally proportioned or overweight child--both could be underweight for age. Further definitive studies are required.


Malaria eradication in Portugal.

Research on malaria, which was endemic in several parts of Portugal at the beginning of this century, was intensified in the 1940's and led to the development of better control methods, especially in the rice-growing areas of the country. In the 1950's residual DDT spraying was introduced and followed by extensive detection of cases of malaria and their treatment. Plans for eradication of the disease were made, and by 1958 the transmission of the infection was interrupted in nearly all areas of European Portugal. The country was placed in the maintenance phase of malaria eradication and the certification of malaria eradication was confirmed by the WHO in 1973. The political and military events of the past five years greatly increased the number of cases of malaria imported into Portugal from tropical Africa and indicated the need for much vigilance to prevent the resumption of transmission by the local vectors. It appears that the measures put into action have succeeded in this respect. This was due to the high degree of effective surveillance and also to the fact that Anopheles atroparvus does not readily transmit the exotic strains of Plasmodium falciparum and P. vivax. However, further vigilance must be maintained and intensified.


Post-streptococcal glomerulonephritis in African children.

Streptococcal infection remains almost the sole cause of the clinical syndrome of acute glomerulonephritis in African children. Evidence for this is in elevated levels of antistreptolysin "O" (ASO) titre in 93% of 28 patients and growth of Group Abeta haemolytic streptococci from the skin and throat in 32%. Spread of infection from the skin, where lesions were present in all patients, to the throat would account for positive cultures at both sites and the frequent and vigorous antistreptolysin "O" responses. Clinical recovery occurred in most within seven days and in all within 60 days of admission. IgG and IgA, but not IgM, were increased in patients; C4 was normal in the majority and low in seven out of 24 (29%), C3 was diminished in 26 out of 28 (93%) and the mean level of C3 PA was lower than in controls. Total haemolytic complement paralleled C3 values; C3 breakdown products were not detected in any patient. Renal biopsies in seven out of 28 patients showed typical histological changes of diffuse exudative proliferative glomerulonephritis on light microscopy and fibrinogen and C3 on immunofluorescent staining. These findings suggest that events leading to glomerular damage in acute post-streptococcal nephritis in African children involve activation of both classical and alternative pathways of complement proteins and also confirm the well recognized and predictable nature of the disease, irrespective of geographical distribution.


Delayed hypersensitivity to PPD-S following BCG vaccination in African children--an 18-month field study.

BCG vaccine given to young Gambian children produced a conversion rate, measured by delayed hypersensitivity to PPD-S, which increased with improving nutritional status. Retesting when nutrition had improved showed a considerable loss of delayed hypersensitivity in all nutritional groups. This may be the result of enhanced macrophage microbicidal acitvity at the time the BCG was administered. BCG is not likely to be very effective if given to malnourished children or to those who are undergoing repeated antigenic stimulation.


Clonorchiasis in New York City Chinese.

Among 150 Chinese-born residents of New York City a single stool examination showed 26% were infected with C, sinensis. Most of those infected were immigrants from the Kwangtung Province of China. The possibility of clonorchiasis in Oriental-born residents is emphasized.


[Atypical course of Leishmania donovani infections in dogs. Histopathological findings (author's transl)].

Four beagles infected with an Indian strain of Leishmania donovani showed histiocytic granulomas with very few leishmania in liver and skin biopsies. 3 animals died with formation of tumor-like histiocytic infiltrates in several organs (heart, ling, liver, kidney, pancreas, muscle) and with development of anyloidosis; one survived with minimal residual lesions.


[Latex-Chagestest-reactions of immunsera against Bartonella bacilliformis, Haemobartonella muris and Eperythrozoon coccoides (author's transl)].

Sera from 10 patients positive for Carrion's disease were analysed by means of the latex Chagas test. Sera from 40 SPF-rats experimentally infected with Haemobartonella muris and 5 SPF-mice experimentally infected with Eperythrozoon coccoides were similarly tested. Both the human and mice sera were negative whereas positive reaction was observed with rat sera. The nature of this positive reaction has not been clarified.


Studies on the attraction of Simulium damnosum s.l. (Diptera: Simuliidae) to its hosts. III. Experiments with animal-baited traps.

In the forest zone of the United Republic of Cameroon, a live chicken proved far more attractive to hunting S. damnosum s.l. than did a live sheep; but in the Sudan-savanna zone, a sheep was more attractive than a chicken. It is suggested that the populations of flies in the two areas represented different species of the S. damnosum s.l. complex with different host-finding mechanisms, that in the forest (? S. squamosum) hunting mainly by smell, and that in the Sudan savanna (? S. damnosum s.s.) hunting mainly by sight.


Immunological studies in onchocercosis patients.

The immunological profile of onchocercosis patients from an endemic region in Venezuela was studied. The sample was made up of patients suffering from onchocercosis and undergoing treatment, persons previously treated and apparently cured of the disease, and a group of apparently healthy individuals from the same area. The results obtained indicate that during the course of the disease the immunological apparatus suffers only slight modifications since no great variations were found in the immunoglobulin levels, the third component of the complement, the reactivity to DNCB, or the response of peripheral blood lymphocytes to mitogens. When under treatment, the levels of serum IgG and IgM are increased and there is a decrease in C3 levels. The slight modifications found can be attributed to the low severity of the disease as only one patient of those studied presented clinical manifestations ascribable to the disease (onchocercoma).


On the development of onchocerca volvulus in mosquitoes.

In an attmept to find an experimental vector for Onchocerca volvulus which can be easily be bred under laboratory conditions, the susceptibility of Anopheles gambiae and Aedes aegypti to infection with O. volvulus was studied. The mosquitoes were fed on a membrane feeding apparatus containing microfilariae of O. volvulus. Whereas A. gambiae was refractory to infection. 14.9% of A. aegypti females became infected with developing stages, 11,2% showed young and mature third-stage larvae as well as some which had developed abnormally. However, no infective larvae of O. volvulus were found in the abdomen or the head of the mosquitoes.


[Comparative study of the ultrastructure of cells of the zona fasciculata of the adrenal cortex of rats of different lines].

By means of morphometric analysis, some tissue and cellular parameters of the zona fasciculata of the adrenal cortex of three rat inbred strains (Wistar, Sprague-Dawley, August) and of the wild grey rats were calculated. Significant genotypic differences were found in the absolute volume in the number of cells per mm3 of tissue, and in relative volumes of basis cellular compartments (smooth endoplasmic reticulum, liposomes) which take part in corticosteroid biosynthesis. A hypothesis is put forward that these differences determine different potential possibilities of rat adrenals, which are realized when their functional activity is enhanced under extreme conditions.


[Pulmonary capillary ultrastructure during accumulation of a phosphoorganic cholinesterase inhibitor in the lungs].

The ultrastructure of the blood-air barrier in rabbits was investigated during different periods after i. v. injection of high hydrophobic organophosphorus cholinesterase inhibitor GA-95. According to the biochemical data, this inhibitor is accumulated mostly in the lungs. The most pronounced changes observed 20 min after injection involved a significant increase in number of pinocytose vesicles in the cytoplasm of endothelial cells of lung capillaries. The morphological data may serve an indirect evidence for the inhibitor sorption at the surface of lung capillaries.


[Ultrastructure of the mesencephalic visual center of the steppe turtle].

A layer-by-layer study of ultrastructural synaptic organization of mesencephalic optic centre (tectum opticum) of T. horsfieldi Gray was made. The predominating type of synaptic contacts is axo-dendritic, however, there are some axo-axonic synapses which are met most frequently in the regions where polysynaptic complexes and glomeneruli (sublayer Ib, sublayer IIa and the upper zone of layer III) are disposed. Axo-somatic contacts are localized virtually in all the neuronic types. In the external layers of the tectum opticum where the terminals of optic afferents are disposed, a considerable morphological variety of nerve terminals is revealed which are distinguished not only by their ultrastructural parameters but also by the character of organization in synaptic complexes at different levels of the cortical plates of the investigated centre.


[Appearance of nuclear formations of the "drumstick" type in neutrophilic leukocytes under the influence of neonatal thymectomy in male-rats].

The morphology of nuclei of neutrophil luecocytes was studied in neonatally thymectomized Wistar rats. In thymectomized males, the number of neutrophils with "drumsticks" increased up to 5.9 for 500 neutrophils counted, whereas no such changes were observed in females. The contents of "drumsticks" in neutrophils of the intact Wistar rats was shown to be equal in males and females therefore unfitting for sex identification. The neonatal thymectomy did not influence and absolute quantity of neutrophils but led to a greater segmentation index of the nucleus.


[Influence of inhibitors of energy metabolism on the interaction of neutral red with Ehrlich ascitic carcinoma cells].

Effects of energy metabolism inhibitors on the granule formation of neutral red in Ehrlich ascite carcinoma cells have no relation with the action of these agents on the ATP formation. Accumulation of neutral red by cells has no relation with granule formation and does not depend on the energy metabolism of cells. The action of 2,4-dinditrophenol, oligomycin, Tween-20, Tween-80 and sodium deoxycholate on the granule formation may be linked with direct action of these agents on the cell membranes, for example, on the Golgi membranes.


[Morphometric study of the ultrastructure of cells of the zona fasciculata of the adrenals in rats under stress].

A morphometrical study of cell ultrastructures of zona fasciculata of rat adrenal cortex was performed in norm and after immobilization during 4 or 24 hours. A 4 hour's immobilization (alarm reaction) is characterized by adrenocorticocyte activation: relative volumes of mitochondria and reticulum increase by 1.1 and 1.2 times, resp., and lipid volume decrease by 2.6 times. 24 hours after immobilization (the stage of maximal strain), mitochondrion and reticulum volumes decrease by 1.5 and 1.7 times, resp., compared to the initial ones, and autophagosome volumes increase sharply reaching 11% of the cytoplasm volume, i.e. this is the evidence of degeneration clearly registered morphometrically.


[Comparative assessment of quantitative methods of determining proteins in nerve tissue structures].

The determination of the amount and concentration of protein substances in structures of neuron tissue by two most popular methods of quantitative histochemistry (cytophotometry and interferometry) revealed a significant comparability of the data provided by the two methods. These methods were compared using the pattern of early vision deprivation, taking layer V neurons of the rabbit brain visual cortex as example. In addition to merits and demerits of these methods, their interchangeability was determined. A merit of cytophotometry is that it allows to evaluate more in detail the condition of neuron morphochemical differentiation both in normal state and under changes in functional state of neuron system.


[Kinetic analysis of mechanisms of Na+-dependent organic acid transport in the proximal tubules of surviving frog kidney. II. Relationship between Na+ concentration in the medium and changes in the parameters of the Michaelis-Menten equation for fluorescein and uranin transport].

The dependence of active transport rates of fluorescein and uranin into proximal tubules was studied, firstly, on the concentration of these substrates in the incubation medium with constant Na-concentration and, secondly, on Na+-concentration in the medium with constant concentrations of fluorescein or uranin, Km, Vmax, and KmNa, VmaxNa values being determined correspondingly. With the decrease of Na+-concentration in the medium the apparent Km values for fluorescein and uranin increase, while Vmax values remain unchanged and ratios Vmax/Km decrease. The 1/Km value for uranin transport is a linear function of Na+-concentration, while it is a quadratic function of Na+-concentration for fluorescein transport. The KmNa value for fluorescein transport is twice as much as that for uranin transport. The obtained data suggest that one Na+-ion is spent from the medium for translocation of one uranin molecule across the basal membrane, whereas two Na+-ions from the medium are necessary for translocation of one fluorescein molecule. It is assumed that fluorescein and uranin transports are carried out by producing a four-fold transporting complex (a carrier+a substratum+2Na+; in the case of fluorescein 2Na+ appear from the medium, whereas in the case of uranin only one Na+ from the medium is used.


[Mitochondria in a living nerve cell].

The vital staining of the mechanoreceptor neuron of crayfish with Janus green in concentrations from 0.01 to 0.0005% was performed with electrophysiological estimation of functional state and with controlling the staining procedure by the quantitative analysis of densitographs of cell photonegatives. The possibility of the investigation of mitochrondrial space rearrangements in the neuron soma associated with the functional activity has been shown (optimal dye concentration being 0.001%, the time of staining varying from 30 minutes to 2 hours).


[Dynamics of changes in a population of human fibroblasts after long-term cultivation in the stationary phase].

Defined and repeated alterations in human fibroblasts were discovered under continuous cultivation in the stationary phase. In the normal diploid fibroblast population, two cell subpopulations were distinguished by the heterochromatinization degree of the nucleus. While in the stationary phase, the number of cells with a parahaploid number of large chromocenters, regularly arranged in the nucleus, is seen increasing. It is supposed that the death of the normal diploid fibroblast culture occurs primarily at the expence of cells with heterochromatinized nuclei. Examination of strains with trisomy (47, XY, +7) and of a strain taken from a patient with pigmented xeroderma has shown that the process of nucleus heterochromatinization and its dynamics are substrains. A possibility is discussed of gene or chromosome mutation influences on the well-regulated nuclear heterochromatinization process and on the cell population structure alteration.


[Comparative characteristics of the dentritic spines of the 3 chief cortical zones of the steppe turtle forebrain].

A comparative study of the dendritic spines in three principal cortical zones of the turtle forebrain reveals certain patterns of spine distribution, length, shape and other specific morphological characters in every cortical region. The dorsal cortex spines show the highest density, the greatest length, the smallest head diameter, the largest number of mitochondria and invaginated spines. The above features markedly distinguish the dorsal cortex spines from the those of the medial and lateral cortex, which is associated with a more complex morpho-functional organization of this cortical region.


[Proliferative activity and cell differentiation during the period of intensive growth of the iris, ciliary body and pupillary sphincter in rats].

The duration of the cell cycle in the sphincter pupillae and in the inner and outer neuroepithelia of the iris and ciliary body was studied. The four-day old rats were injected H3-thymidine and three-day old animals were administered H3-dopa to be processed for autoradiography. Cells of sphincter and of both neuroepithelia of the iris have the doubling time of 9.2--9.8 days, whereas the doubling time of cells of neuroepithelia of the ciliary body reaches 5.3--5.9 days. All pigmented epithelia of the iris-ciliary body complex synthesize melanin with the same intensity despite their specific differentiation. The most differentiated smooth muscle cells localized at the outer surface of the sphincter have almost half a melanin synthetic activity as compared with that of more deeply laying cells. Mitotic and H3-thymidine labelled cells were observed in all the areas of the sphincter. The data obtained were interpreted in terms of possible compatibility of both processes in smooth muscle cells of the iris; the synthesis of contractile proteins and the mitotic activity. The cell proliferation and differentiation of the structures in question were regarded as processes being regulated independentely at the stage studied.


[Mechanism of potentiation of contractions after muslce loading with glycerin. II. Relationship between incubation conditions and obstructing the inflow of glycerin].

A study was made of the influence of glycerol loading on contraction responses of the m. sartorius upon stimulation in normal and calcium-free Reinger solutions by caffeine, tetanic electrostimulation and single electric impulses. It was determined that in the glycerol medium each type of stimulation caused contractility potentiation. Ca2+-ions proved to block the responses of potentiation. The data suggest that there should be a potentiation mechanism common to each type of stimulation.


[Kinetics of populations of enterocytes of experimental tumors of the large intestine in rats].

With the aid of histoautoradiography, the proliferation of enterocytes in rat intestinal adenocarcinomas induced with subcutaneous treatment by 1,2-dimethylhydrozine has been studied. The experimental adenocarcinomas are characterized by a high proliferative activity being, however, lower than that in the proliferative zone of the normal intestinal crypt. The parameters of adenocarcinoma proliferation are very close to those of a cell population from the bottom part of crypts in the control animals. This population involves several subpupulations and it is here that stem enterocytes occur. The tumour enterocytes are characterized by the enlargement of short mitotic cycle from 11 to 16 hours, due, mainly, to the prolongation of G1 phase as well as to a more pronounced degree of heterogeneity in relation to the mean tS and tG2 and, probably, to the appearnace of subpopulation R2.


[Stabilizing effect of calcium ions on glucose oxidase of Penicillium vitale].

Reconstruction of P. vitale glucose oxidase from apeonzyme and coenzyme (FAD) was studied as affected by iodine acetate as well as mercury and calcium ions. Mercury ions, iodine acetate as well as the labilizing fraction (flavin adenine-containing component) are established to inhibit the reconstruction affecting the sulphydryl groups of the apoenzyme which take part in addition of FAD to it. Calcium ions prevent the effect of the "labilizing" fraction, iodine acetate and mercury ions on the glucose oxidase apoenzyme as well as the effect of mercury ions on the glucose oxidase coenzyme. The effect of Ca2+ consists in "labilizing" fraction-calcium complexing.


[Activity of carbohydratephosphate metabolism enzymes in liver slices after freezing and thawing].

Activity of hexokinase, phosphorylase, glucoso-6-phosphate dehydrogenase lactate-dehydrogenase was studied in liver slices, homogenate and supernatant fraction after freezing at a rate of 1 degree/min down to -30 degrees C. The enzyme activity in homogenate and supernatant fraction does not change after freezing. A significant reduction in the activity of most enzymes that is followed by an increase in their activity in the freezing medium was observed in the experiments. Cryoprotectant polyethylene glycol, mol. wt. 300 and 1,000 (PEG-300 and PEG-1,000), partially prevents the observed changes in the enzyme activity; PEG-1,000 is more effective than PEG-300. Experimental results show that the main reason for the reduction of the enzyme activity observed after freezing the tissue slices is a decrease in the volume of intracellular enzyme proteins due to their leakage from the injured cellular elements into the exocellular medium.


[Monoamine oxidase activity and amount of catecholamines in rat tissues with adrenalectomy and demedullation].

The activity of monoaminoxidase (MAO) and the amount of catecholamines (CA) were studied in the heart, brain and liver of adrenalectomized and demedullated rats. Adrenalectomy increased the MAO activity of the brain and heart homogenates but had no effect on that of the liver mitochondria. The level of liver mitochondria MAO does not change when rats were demedullated, in this case there is some reduction in the content of the so-called PO (substances with the affinities of CA chinoid oxidation product). Neither adrenalectomy nor demedullation affect the amount of CA of all the studied tissues.


[Formation of thymine nucleotides in bone marrow of animals of different species].

The activity of enzymes of thymidine and thymidylic acid phosphorylation up to thymidine triphosphate and dCMP-desaminase was studied in bone marrow of rats, rabbits and dogs. A soluble fraction of hyaloplasm obtained after bone marrow homogenates centrifugation at 105000xg for an hour at 0-4 degrees C used as a source of the enzymes. It is found that the rate of thymidine and TMP phosphorylation up to TTP by the rat and dog bone marrow extracts is approximately the same, in rabbits this process is slower. The formation of TTP from TMP in animals of all three species is 1.4-2 times as active as in thymidine phosphorylation. The highest activity of dCMP-desaminase is found in the bone marrow cells of dogs, in rabbits and rats it is 1.6 and 2 times as low, respectively.


[Ultrasonic effect on synthesis and excretion of porphyrines].

A ten-fold sequential action of supersound on rats results in disturbances in synthesis of protoporphyrine IX and its excretion respectively; the level of protoporphyrine in erythrocytes and feces is reduced. Redistribution of porphyrines in erythrocytes is detected; the control level of coproporphyrines being retained; a higher initial content of protoporphyrine IX drops due to an increase in a relatively low level of porphyrines.


[Effect of corticosteroids on content of amino acids in liver tissue during muscular activity].

Metabolism of amino acids in the liver in connection with the adrenocortical functions of the adrenals was studied in rats as affected by 3-hour swimming. This load causes an increase in the content of corticosterone in blood, in the activity of alanine aminotranspherase as well as the decrease in the amount of free amino acids in the liver tissue. These changes are absent in adrenalectomized rats and appear again when corticosterone is administered to adrenalectomized animals before swimming.


[Effect of muscular activity and administration of amino acid mixture on protein synthesis in rat skeletal muscles].

The mechanisms were studied determining the protein synthesis intensification in the skeletal muscles of albino rats during systematic physical activity only and in combination with enteroadministration of amino acid mixture. It is shown that systematic physical activity induces an increase in the RNA content in the skeletal muscles along with the lack of differences in specific radioactivity of microsomal, ribosomal and poly-A-containing mRNA. Supplementary administration of amino acid mixture in combination with the systematic physical activity induces a further increase in the skeletal muscle RNA content along with a decrease in specific radioactivity of poly-A-containing mRNA, parallel with an increase in its portion in microsomal RNA, as well as results in shifts of the ribosomal spectrum towards polysomal complexes.


[Sensitive method for determination of proteolytic activity].

The method is developed for estimating the proteolytic activity on the basis of photometric determination at 350 nm of the complexes of products of enzymic splitting of proteins with chloranyl. The advantages of the method are as follows: its high sensitivity (possibility to determine the amount of the enzymic proteolysis products formed from 2-4 microgram of protein), stability of the complexes (three days), wide ranges for direct dependence of absorption on the proteolysis products concentration (0.08-1.2 scale units), simplicity and possibility to conduct determination in the presence of nucleic, acids components.


[Activity of enzymes of tricarboxylic and pentose-phosphate cycles in dog brain with myocardial infarction].

Under conditions of experimental myocardium infarction caused in dogs by ligation of the anterior descending branch of the left coronary artery, the activity of alpha-ketoglutarate dehydrogenase and succinate dehydrogenase in mitochondria of the cortex, cerebellum and medulla ablongata lowers most intensively on the first and fifth day after the appearance of acute myocardium infarction. Activation of the most important enzymes of the pentose-phosphate cycle (glucose-6-phosphate dehydrogenase and transketolase) which is clearly pronounced on the fifth day is observed in the mentioned sections. In the authors' opinions the above changes in the activity of the enzymes are due to the brain hypoxia which may be the main reason of disturbance in the function of the central nervous system under this disease.


Is the electron wavelength an observable?

This paper is concerned with a problem often overlooked; it stems from the fact that the electron wave is also influenced by the magnetic vector potential. If one considers this influence, problems arise from the ambiguities in the gauge of the vector potential. They bear on the question of whether the electron wavelength can be considered observable or not. The answer lies, probably, in the definition of measurability.


[Isoenzyme spectra of lactate dehydrogenase in tissues of pigs at different stages of embryonic development].

Dynamics of the activity and correlation of isoenzyme spectra of lactate dehydrogenase in extracts of the liver, hip muscle and blood serum of the 30-60- and 108-day pig embryos was studied by polyacrilamide gel diskelectrophoresis. A high specificity of isoenzymes sets in all the tissues under study is established.


[Energy metabolism in gastrocnemius muscles of frogs after tetanic contractions].

The content of the adenylic system components (ATP, ADP, AMP+IMP), creatine phosphate and inorganic phosphorus (Pin) was determined in the frog gastrochemius muscles in vivo and in vitro at different time after one-second and four-second tetanic contractions. After a one-second contraction the content of ATP in the muscles both in vivo and in vitro increases with respect to the initial level and simultaneously the contents of creative phosphate and Pin decrease. 15 seconds after a four-second contraction the content of ATP in the both cases is below the initial level; in the isolated muscles it restores the initial level during the second minute of rest and subsequently does not change significantly. In vivo the content of ATP continues to increase, accounting for 114% of the initial level during the eighth minute of rest. This rise is accompanied by an essential utilization of Pm, the content of which during the eighth minute of rest is 79.4% relative to control. The content of ADP, AMP+IMP after a one-or four-second contraction does not change significantly.


Prospects of three-dimensional high resolution electron microscopy of non-periodic structures.

In the first part of the paper the general features of three-dimensional electron microscopy of non-periodic structures at high resolution are discussed. Such an analysis requires series of 20 or more exposures of mechanically moved specimens. It is fundamentally important that the integral radiation dose, however, need not be increased--three-dimensional analysis yields extra information without additional radiation loading. It is demonstrated that the constraints characteristic for atomic resolution can in future facilitate many difficulties like restricted tilting range (conical tilting), inaccuracies in the refinement of the origin determination etc. Data collection up to atomic resolution is possible with existing image reconstruction methods if the chromatic spread of the cathodes can be partially corrected. The relatively great radiation induced changes of "stable" specimens will require additional averaging in the experiment (quasi-simultaneous registration). The advantage of a time dependent analysis of radiation sensitive structures--especially the possibility of using redundancies in the analysis (trace structure analysis)--is discussed. The experimental part (studies of radiation damage and three-dimensional work on carbon foils) presents examples of such analyses. The main experimental difficulty consists in the collection of many exposures with no extra load of the specimen in the intervals between exposures.


Optical and digital image processing in high-resolution electron microscopy.

A comparison is made of the deblurring by digital and optical processing of a single conventional bright field electron image of ferritin particles distributed on a carbon supporting film. The deblurring functions include the effects of the partial temporal and partial spatial coherence of the electron beam, the phase contrast transfer function of the objective lens and Weiner signal to noise optimisation. Practical aspects of the similar results achieved by the two methods are discussed. The relative advantages and disadvantages of the batch and interactive computer modes for picture processing are considered in an Appendix.


Computer algebra and the study of unconventional electron lenses.

The calculation of aberration coefficients, and even the derivation of paraxial equations, can involve an immense volume of elementary algebraic manipulation; the use of a computer to lighten this task for some unconventional electron lens types is described.


[Effect of thyroxine on distribution of lactate dehydrogenase isoenzymes and content of pyruvic and lactic acids in tissues of rats of various ages].

Distribution of lactate dehydrogenase (LDH) isoenzymes and content of lactic and pyruvic acids were studied in the heart, kidneys and skeletal muscle of rats at the age of 1, 3, 12 and 24 months at normal state and after thyroxine administration. With age the activity of aerobic isoenzymes of LDH increases and that of hybrid anaerobic isoenzymes of LDH decreases in the heart and kidneys; in the skeletal muscle the activity of LDH5 increases and that of LDH3 and LDH4 decreases, the content of the studied acids in  the heart, kidneys and skeletal muscle changes irregularly. Under the effect of thyroxine the activity of aerobic isoenzymes of LDH increases in the heart of one-month animals and in the kidneys of one- and three-month animals, as well as in the skeletal muscle of 24-month rats; the activity of LDH5 rises in the skeletal muscle of one- and three-month animals. Thyroxine causes an increase in the content of pyruvic acid in the tissues of all the studied rats.


Scherzer's formula and the correction of spiral distortion in the electron microscope.

Scherzer's general expression of 1937 for the spiral distortion coefficient of electron lenses is used to calculate the spiral distortion of the rectangular-field model for the axial flux density distribution in magnetic projector lenses. The results show why it is difficult to correct the spiral distortion produced by conventional lenses. On the other hand, corresponding calculations for single-polepiece projector lenses indicate that the employment of such lenses could lead to a significant improvement of the projector stage of the electron microscope, especially that of the high voltage electron microscope.


[Biologically active low-molecular fragments of fibrinogen molecule].

A peptide fraction with a specific property of interaction with D fragment was found in the fibrinogen tryptic hydrolyzate. This fraction is called a protector. In the protector presence the time of the monomer fibrin polymerization prolonged with D fragment is greatly lowered. The protector was found in the first minutes of fibrinogen degradation. It was shown for low concentration of trypsin (enzyme-substrate ratio being 1:7500). The gel filtration of a tryptic fibrinogen hydrolyzate on Sephadexes G-10, G-15, G-25 showed that the protector has a low molecular weight. It was found that a preincubation of the protector with D fragment should take place before interaction of their mixture with a fibrin monomer. The interaction of the protector with D fragment is reversible.


Partial fraction expansion of electron optical cardinal elements.

Studying the behavior of virtual or asymptotic cardinal elements (position of focal points, focal widths) of electron optical systems during variation of the acceleration voltage U characteristic discontinuities (poles) are encountered. Partial fraction expansion of the quantities in question with regard to U-1/2 for magnetic systems (round lenses and quadrupoles, straight axis) are investigated. Convergence of the series is established by methods of complex analysis, especially by use of the concept of R-functions introduced by E. Wigner. The results can be used also for systems consisting only of electric quadrupoles. The relations with the terminology introduced by Otto Scherzer are worked out. Applications in analytical field models are suggested. Connections with the problem of determination of the lens field from optical data and with inverse eigenvalue problems are discussed.


The bright and shadow images of an atom in the transmission electron microscope.

Scherzer discussed in his paper of 1949 the phase contrast of an atom image which was given in the form i(psi-psi). The second order term psi psi, which gave the bright image of the atom, was neglected. Under the first Born approximation as adopted by him, the phase contrast disappears at the exact focus of the ideal electron microscope. Under the second Born approximation, the phase contrast does appear under the same condition. It can be interpreted as the shadow image because it compensates the bright image.


Factors affecting high resolution fixed-beam transmission electron microscopy.

An experimental and theoretical characterization of a fixed-beam transmission electron microscope with a field emission gun has been made with regard to the factors of electron beam brightness, spatial and temporal coherence of the incident electrons, objective lens current fluctuation, mechanical stability, and specimen contamination. It has been found that mechanical stability and temporal coherence are the primary factors that prevent the contrast transfer function from extending to 2.0 A in our microscope. Different amorphous thin films have also been used in order to compare their suitability for testing the imaging capability of the microscope at atomic resolution.


Motif detection in quantum noise-limited electron micrographs by cross-correlation.

The use of cross-correlation to detect randomly positioned low-dose realizations of a motif in an image field is quantitatively evaluated. For both the bright- and dark-field cases, we derive theoretical expressions for the minimum dose allowing detection in terms of motif size, resolution, and contrast. Model computations on simulated low-dose images of a spherical virus particle give results that agree with our theoretical formulas and demonstrate the feasibility of this approach.


High resolution bright field electron microscopy of biological specimens.

Various parameters which affect the information content in bright field electron micrographs of biological specimens is discussed. Special attention is paid to the resolution of phase contrast imaging, specimen supports and radiation damage.


Improvements in electron microscopy by application of superconductivity.

Resolution tests on amorphous carbon foils were carried out in an electron microscope with a superconducting system containing 4 lenses including a shielding lens at 200 kV beam voltage. Due to the mechanical and electrical stability of the system and the absence of contamination of the specimen the highest space frequencies transferred at vertically incident beam were 6 nm-1 corresponding to a resolution of 0.17 nm, a value which approaches the theoretical resolving power of the electron optical system. It should also be feasible to apply such a lens system for microprobe analysis without strongly reducing the theoretical resolution limit, if the construction of the shielding lens is slightly changed.


Nonstandard imaging methods in electron microscopy.

A rigorous treatment of image formation, taking into account inelastic scattering and partially coherent illumination, is given for the CTEM. The results also hold for a STEM if the momentum vectors of the incident and outgoing waves are interchanged and the flight direction of the electrons is reversed. A generalized optical theorem is found which connects the anti-Friedel part of the elastic scattering amplitude with the squares of the elastic and inelastic scattering amplitudes. This theorem has important consequences for all approximation methods. For example, it shows that inelastic scattering influences the elastic scattering amplitude. It is further shown that the observed wings in optical diffractograms, obtained from micrographs of amorphous material taken using tilted beam illumination, can only be explained if double scattering (elastic and inelastic) is assumed. Hollow-cone illumination strongly suppresses the structural noise in the phase contrast image. The corresponding phase contrast transfer function (PCTF) is calculated for two different cone angles, assuming that no beam-limiting aperture is present. In addition, the PCTFs of a corrected microscope are calculated for two different illumination modes, one yielding negative and the other positive phase contrast. Finally, the contrast transfer has been investigated for a stem operating with a split detector.


A reflection on partial coherence in electron microscopy.

The concept of partial coherence, which originated in light optics, is investigated in the case of dark-field electron microscopy. Two atoms arbitrarily arranged in the object space are considered as sources of the secondary waves. The influence of lens aberrations is taken into account. The real degree of coherence gamma r is calculated for the STEM as well as the CTEM. In the case of atomic resolution, the finite size of the atoms significantly influences the degree of coherence, so that it becomes a function of the image coordinate. Analytical expressions are obtained for gamma r which are valid at present-day resolutions for both the CTEM and STEM. The dark-field intensity distribution in the detector plane of a STEM is calculated for an object consisting of two atoms in different configurations and for different positions of the scanning spot.


Effect of succinimide on hyperoxaluria in the rat estimated value of the different dosing methods of oxaluria.

In the female rat intoxicated with ethylene glycol the oxaluria increases with the degree of intoxication. The increase is less in the animals treated with succinimide. The comparative study of the results of the dosages made with gas-liquid-chromatography and by various colorimetric methods show that this later gives varying results and underestimates high concentrations of oxalic acid. The result is that any study based on results of dosages of urinary oxalic acid made by colorimetry must be taken with some reserve, and this on whether the oxalic lithiasis is experimentally induced or human, or whether its evolution is spontaneous or influenced by a therapeutic.


Surface topography of the healthy and diseased transitional cell epithelium of the human urinary bladder.

51 biopsies from healthy and diseased epithelium from human urinary bladders were examined by scanning electron microscopy. The luminal surface of the cover cells was marked by microvilli and microplicae. The replacement of the cover cells takes place by simple desquamination. This exposes cover cells having numerous microvilli, and these later develop characteristic microplicae. The ability to form cover cells is lost by the transitional epithelium following tumour formation. No tumour-specific surface morphology was observed.


Serum proteins in prostatic cancer. V. Alterations in immunoglobulins and clinical responsiveness following cryoprostatectomy.

Levels of the three major serum immunoglobulins (G, A, M) were quantitated prior to and up to 2 weeks following each of two independent freezing treatments of the primary prostatic tumour in 4 patients undergoing remission or healing of their metastatic lesions. Cyclical alterations in the level of IgG accompanied by moderate alterations in the level of IgA were noted post-operatively. Most striking was an almost twofold increase in the level of IgM in 3 of the 4 patients evaluated. While possibly a non-specific association, observations of increased levels of IgG and IgM following cryotherapy may represent an active immunologic response by the host to prostatic tissue (tumour?)-specific or tumour-associated antigen(s) in the form of 'blocking' factor(s) or cytotoxic antibody.


[Immunoblastic sarcoma with clinically primary manifestation in the testis (author's transl)].

Three own observations of immunoblastic sarcomas with clinically primary manifestation in the testis are reported. In all cases an already generalized tumor stage was evident. In two patients a combined surgical, radiological, and chemotherapeutic treatment was performed with satisfactory success. The essential functional-morphological and clinical criteria of the immunoblastic sarcoma were summarized and discussed.


Fifteen year review of treated cases of retinal angiomatosis.

This study describes the experience of the Wills Eye Hospital Retina Service in the treatment of 125 eyes with retinal angiomatosis, with follow-up ranging from 1 to 15 years. The results of several treatment modalities are compared. In lesions smaller than 2.5 DD, xenon arc photocoagulation, argon laser photocoagulation, and cryotherapy all appear to be effective in eradicating the tumor and salvaging useful visual acuity. For lesions larger than 2.5 DD, cryotherapy appeared to offer the best results. The advantages and disadvantages of the various treatment modalities are discussed.


Diabetic maculopathy.

The incidence, pathogenesis, and treatment of diabetic maculopathy are discussed. A plea is made for earlier, more discrete treatment that may improve the chances of prolonging sharp central vision.


Preoperative factors influencing anatomic success rates following retinal detachment surgery.

The percentages of retinal detachment surgical cure rates determined in this study should not be regarded too literally. At least ten preoperative factors have been described which, acting in isolated fashion, are associated with decreased rates of retinal reattachment. Among these factors are visual acuity of 20/60 or less, myopia, preretinal membrane formation, alphakia, pars plana detachment, reoperation, age over 80 years, vitreous membranes, giant tear, and choroidal detachment. Usually there are several influential factors acting simultaneously. The behavior patterns of combinations of predictive factors have not been determined. In addition, there are undoubtedly some factors which are insignificant when acting alone but which have an adverse influence when arranged in certain combinations. More sophisticated analysis would be required to confirm this hypothesis.


Clarification of foveomacular nomenclature and grid for quantitation of macular disorders.

Standardization of terminology and precise localization of lesions are imperative in the study of the natural course of various retinal vascular and macular disorders. The RAZ localizing system provides an easy and accurate way of documenting and following lesions of the posterior pole in terms of RAZ diameters rather than disc diameters. This type of quantitation is important because consideration regarding prognosis and management is often in terms of involvement of the retinal avascular zone. This type of grid system also permits the clinician to measure and follow the size of some choroidal masses. Based on our preliminary studies, it appears that at this stage of development, this method of studying and recording posterior pole lesions is of useful accuracy. Hopefully, certain guidelines, such as how close one may approach the retinal avascular zone with photocoagulation and still maintain reasonably good vision, can be more accurately determined.


Cystoid macular edema in retinitis pigmentosa.

Cystoid macular edema was commonly observed in retinitis pigmentosa and documented, fluorangiographically, in 70% (41) of 58 consecutive patients. Macular fluorescence representing the intraretinal accumulation of dye from leaking perifoveal capillaries was best seen by simultaneous projection of early- and late-phase angiograms. This facilitated visualization of dim cystoid staining amid mottled and sometimes confusing hyperfluorescence in the posterior pole. Patients of many different ages demonstrated cystoid macular edema and there was no predominant involvement of any particular age group. Although visual acuity was affected in the majority of patients with cystoid macular edema, 25% had 20/25 or better due, perhaps, to sparing of the fovea. Bone corpuscular pigmentation appeared frequently with cystoid macular edema and we were, therefore, unable to corroborate previous opinions that depicted cystoid macular edema as part of a presumed atypical nonpigmented form of retinitis pigmentosa.


Optociliary veins.

Optociliary veins occur in three clinical settings: in chronic central retinal vein obstruction, with retro-orbital tumors, and as congenital anomalies. In the last setting, associated anomalies of the disc and retinal vessels may be present, which makes differentiation from the first two difficult. Fluorescein angiography may be of value in making this differentiation for, in some if not all congenital OC veins, the direction of flow is from the choroid into the central retinal vein. Two cases are presented in which a congenital optociliary vein was present in association with a fundus picture mimicking a central retinal vein obstruction or papilledema. In both cases, fluorescein angiography demonstrated that the vessel was a congenital anomaly, draining from the choroid into the retina.


Diseases of the macula: the diagnosis and management of choroidal neovascularization.

Choroidal neovascularization is the major complication of several macular diseases. Criteria for the selection of patients for consideration of photocoagulation treatment are presented. The distance of the foveal edge of the choroidal new vessel membrane to the center of the fovea is the most important criterion in considering the patient for photocoagulation. Photocoagulation is not considered unless the edge of the new vessel membrane is at least one fourth disc diameter (375micron) from the center of the fovea. Randomized controlled studies are required to document the role of photocoagulation therapy for choroidal neovascularization.


The otologic manifestations of mandibulofacial dysostosis.

Sixteen patients (32 ears) with diagnoses of mandibulofacial dysostosis were reviewed. The characteristic otologic manifestations of the syndrome were delineated, found to be bilateral, and consist of the following: 1. Mild symmetric deformity of the auricle (grade 1 microtia). 2. Agenesis or hypoplastic development of the mastoid and mastoid antrum. 3. Absence of the external auditory canal. 4. Marked narrowing or agenesis of the middle ear cleft. 5. Agenesis or severe malformation of the malleus and incus. When present, the malleus and incus are most often rudimentary, fused to form a conglomerate mass, and ankylosed to either the atretic plate, epitympanum, or both. 6. Stapedial malformations which usually consist of a deformed suprastructure. 7. Frequently the tegmen assumes a more inferior (low lying) position than normal. 8. Occasionally, the facial nerve pursues an abnormal course and is located more anteriorly than would be expected. 9. A normal inner ear. 10. Normal bone conduction with a marked (greater than 50 dB) conductive hearing loss. 11. Marked disparity between the degree of auricular deformity (mild; grade 1 microtia) and the degree of deformity of the remaining first and second branchial arch derivatives that constitute the external and middle ears (severe).


Fiberoptic visualization of motion of the eustachian tube.

The use of fiberoptic endoscopy presents a viable method of examining the nasopharyngeal aspects of the eustachian tube. It involves a nontraumatic procedure and, if introduced transnasally, allows an extended, thorough inspection of the eustachian tube and surrounding structures. The rigis telescope (Storz) is particularly versatile with respect to the areas in the nasopharynx which can be visualized and the angles at which observations may be made. For research and training purposes, phenomena of the eustachian tube and nasopharynx in subjects who do not have openings in the face or hard palate may be studied using fiberoptic endoscopy. Cinematography and videotape recordings of observations provide permanent records, with or without sound, of the dynamic features of the area. The videoendoscopic technique described herein imposed no interference with the structures under observation. Both scopes used for the observations reported herein revealed a variety of movements of the pharyngeal aspects of the eustachian tube and surrounding structures. Endoscopic observations and human cadaver head dissection supported the contention that levator veli palatini acted upon either the torus tubarius or the torus tubarius-salpingopharyngeal fold complex. The mechanism underlying activity at the isthmus of the eustachian tube was not clarified using the methodology described herein.