[Septic phlebitis. Its consequences and its treatment].

Septic phlebitis is characterized clinically by a local syndrome in an arm, the chest or a leg, by an irregular temperature (toothsaw curve), by blood cultures that are simultaneously or successively positive for one or several pathogenic microorganisms, by repeated, multiple infected embolism and by the possibility of endocarditis as a complication. Septic phlebitis occurs either spontaneously (staphylococcosis, syndrome of angina pectoris and infarction), or through secondary infection by secondary microbial colonization of a thrombosis of gynecological or obstetrical origin or, thirdly, as the consequence of venous catheterization (perfusion, pacemaker, explorations). Prevention is based on the selection of the material (silastic piercing catheters), the choice of the site of injection, the observation of strict surgical asepsis and of choice of the fluid injected (no corticoids, nor heparin which inactivates the oligosaccharides). As regards the curative treatment, no use should be made either of heparin or of anti-inflammatory agents (especially no corticoids); first of all, the material that has caused the thrombophlebitis should be withdrawn immediately; secondly, 24 to 36 hours later, a specific antibiotic treatment should be instituted and after two weeks, if still necessary, surgical ligation may be carried out of the inferior vena cava, the subclavian vein or the brachiocephalic venous trunk, depending on the localization of the phlebitis.


[Serum phenytoin determination, its value in the treatment of epilepsy].

The concentration of phenytoin in serum was determined by gas chromatography for a total of 101 patients treated on an outpatient basis. In contrast to data reported in the literature, six patients (6 percent) showed therapeutically effective serum concentrations which were far below 7.0 microng/ml. In the majority of cases, however, the therapeutically effective range was from 7.0 to 20.0 microng/ml. A considerable reduction in the frequency of fits was obtained for 23 out of 32 patients who were treated in this manner. Examinations made on patients treated on an inpatient basis showed a definite correlation of daily dose, body weight, and serum concentration. However, interindividual differences were so high that the serum concentration cannot, in general, be safely concluded from the daily dose and body weight. Four percent of the patients showed toxic serum concentrations when normal doses of phenytoin were used. About 50 percent of the patients treated on an outpatient basis showed values indicating very irregular use of the drugs.


[Spinal cord tumor in childhood--case report on an extradural cyst in the spinal cord].

The present paper is concerned with special aspects of the incidence, type-specificity, age distribution, and symptomatology of spinal tumors in childhood. Differences from similar processes observed in adults agre discussed. Difficulties of diagnosis are reported, and the advantages and disadvantages of various diagnostic methods are described. The case of an eleven-year-old child who was diagnosed as having developed an extradural spinal cyst has been restored to for a discussion of this rare phenomenon. The usually unfavorable prognosis in the case of childhood spinal tumors underscores the need for early recognition and immediate surgical therapy.


[Postoperative paralysis of the bronchial plexus due to positioning].

A survey of the literature on problems of postoperative Duchenne-Erb paralyses caused by particular forms of arm positioning is followed by a report on observations made by the authors on a total of eleven patients. The paralyses observed were above all those of muscles of the Duchenne-Erb group. In four cases there were observed musculocutaneous paralyses. The tendency for reinnervation was good to excellent. Responsible for the development of paralysis was, in eight cases, the unphysiologic positioning of the arm during anesthesia and, as an additional straining moment, either the pressing down of the shoulders for Trendelenburg's position of the retroflection of the head in operations for struma. In three cases there was observed an involvement of that arm which had to be subjected to hyperabduction for the purpose of insuring free access to the site of operation. The careful analysis of causes requires important prophylactic considerations to be made. Also, consideration should be given to consequences in connection with insurance law, since the development of paralyses is in direct contradistinction to the risk involved in a surgical operation.


[Tuberous sclerosis--early diagnosis and its significance in juvenile epilepsy].

Twenty-three cases of tuberous sclerosis, found in the ten years' material of the authors among 2900 epileptics between o-16 years of age, are presented. 11 patients were treated before the age of 3 years, all showing infantile spasms. The earliest, in most cases congenital extraneural signs were depigmented areas on the skin. They were absent only in one case. They allowed, together with the Westsyndrome to establish the diagnosis if tuberous sclerosis before the appearance of other characteristic symptoms. Sebaceous adenoma, generally accepted as pathognostic for tuberous sclerosis, presented itself in all 12 early cases later then the leukoderma and the epileptic fits. Tuberous sclerosis is one of the important causes of epilepsy in childhood, primarily in early childhood. In this period of life the West-syndrome is the most frequent type of epileptic manifestations of tuberous sclerosis


[Current aspects of neurocysticercosis. Clinical and pathological report on 3 cases].

This is a clinical and pathological report on three cases (one 48-year-old male, one 57-year-old female, and one 59-year-old male) of neurocysticercosis where postmortem examinations were made between 1972 and 1974. In all of these three cases invasion of the body by the larva of Taenia solium and, more specifically, of the interpeduncular cisterns had led to chronic lymphocytic and granulomatous leptomeningitis and severe hydrocephalus. Complicating the disease picture in one case each were an occlusive granular ependymitis in the aqueduct and a nonspecific endangiitis. The great importance of liquor eosinophilia to the clinical diagnosis of neurocysticercosis is again demonstrated by reference to these cases. The complement fixation reaction is recommended as the most reliable method of diagnosing. This should be should in all ases of etiologically uncertain chronic leptomeningitis


[Electroencephalographic curves in diseases of the basomedian cerebral structures].

In twenty-two patients bilaterosymmetric, slow frequencies occurring in groups frontoprecentrally and frontoparietally, respectively, were found for a total of thirty-four spaceoccupying processes of basomedian structures. Such alterations should not be considered to be characteristic of tumors located adjacent to the median line, but may be regarded as an important indication. The changes themselves are due to the diffuse thalamocortical system as well as the reticular activating system. The overlapping of functions of these systems and the different responses of equal structures to different intensities of stimulation make it impossible for clinicians to assign them to individual basomedian structural levels even if necropsy records and reports on surgical operations are taken into consideration.


Human contact and cardiac arrhythmia in a coronary care unit.

In a sample of 225 coronary care patients it was observed that a significant reduction in ventricular arrhythmias occurred following pulse palpation. These data suggest that significant changes in ventricular arrhythmia can occur as a result of even minimally arousing psychosocial interactions.


Prolactin levels in mild depression.

To determine if serum prolactin levels were correlated with the level of depression in an ambulatory medical clinic population, prolactin was measured by immunoassay in all new medical patients completing the Langer Scale and the Popoff Index of Depression. Thirty-four of 71 patients (48%) were found to be depressed with a positive Popoff Scale. There was no difference in the prolactin levels in the depressed and nondepressed patients, who were matched for age and sex. Thus, depression, as seen in an ambulatory medical population, is not associated with increased prolactin release.


Urinary cortisol excretion rates and anxiety in normal 1-year-old infants.

Urinary cortisol excretion rates were determined for each voiding during 8 hours on 3 days for 20 infants. The first day served as the control. On the second day stress was imposed by having the mother leave the infant for an hour. On a third day the child was stimulated by novel toys and socialization for an hour in the mother's presence. There was no significant difference between mean cortisol excretion rates on control and stress days. Variability in cortisol levels was significantly greater on the day of stress than on the other 2 days. Ratings of separation anxiety and levels of cortisol excreted 40 to 160 min after the imposed stress were positively correlated (r = 0.46, P less than 0.01). Cortisol levels also differentiated between anxious infants who were agitated from those who were withdrawn. No altered levels of cortisol were associated with excitement.


Cortisol and growth hormone responses to psychological stress during the menstrual cycle.

Twenty-one healthy women were studied during one menstrual cycle in order to determine whether cortisol and growth hormone responsivity to psychological stress was related to estrogen levels. Blood was drawn approximately three times per week for analysis of estradiol, progesterone, cortisol, and human growth hormone. During either the menstrual or intermenstrual phase, each subject participated in an interview that was designed to be mildly stressful. State and trait anxiety were assessed using the Spielberger State-Trait Anxiety Inventory. Anxiety state was measured prior to and immediately following exposure to the psychological stress; trait anxiety was assessed at the end of the study. Cortisol and growth hormone responses to the psychological stress were not related to menstrual cycle phase. Anxiety levels were also independent of menstrual cycle phase. Subjects who displayed significant cortisol and/or growth hormone responsivity to the interview had significantly higher anxiety levels post stress than did nonresponders, although anxiety level prior to the interview was not different for the two groups.


Control of a measles outbreak in an elementary school. Baltimore County, Md. 1975.

Between April 18 and May 20, 1975, 16 cases of measles occurred in pupils in an elementary school in Baltimore County, Md., and 1 case occurred in a sibling at a junior high school. Measles was serologically confirmed in 16 of these pupils. Attack rates were determined by grade and by vaccine status. The measles attack rate was 2.1 percent for the 377 children who had been given measles vaccine at 1 year of age or later. The rates were 27.8 percent (13 times higher) for those vaccinated at less than 10 months of age and 20.0 percent (10 times higher) for those with no definite history of vaccine. The higher attack rates for children who were vaccinated only before 10 months of age supports the 1972 recommendation of the Public Health Service Advisory Committee on Immunization Practices that children vaccinated before this age need to be revaccinated with live measles virus vaccine to assure full protection. The finding that 2 of 10 children with a history of measles became ill during the outbreak suggests that such histories are not a totally reliable indicator of immunity. Containment of the outbreak was attributed to the high level of immunity in the community and prompt initiation of control measures.


Suicide: who's counting?

A study of suicide certifications explored their accuracy in the light of the difficulties inherent in the certification of death. The primary question addressed was whether the variation in reported suicide rates was significantly related to the structure, function, and procedures of coroners' offices, in comparison with traditional social aspects of the community, such as demographic factors, socioeconomic status, and residential mobility. A stratified sample of 202 counties in the 11 continental western States was selected, and data on coroners' offices were obtained from 191 of these counties. These data were analyzed by means of weighted least squares, which separately related coroner's office variables and community variables to indirectly age-standardized suicide rates. Data for counties with populations of 30,000 or more and those with less than 30,000 were also separately analyzed. Assessment of the multiple regression analyses suggests that the coroner's office variables compare favorably with the community variables in predicting suicide rates, provided a distinction is made between large and small counties. The coroner's office variables in counties with 30,000 or more population explained 37 percent of the variation in reported suicide rates, whereas the community characteristics explained 41 percent. In the counties with less than 30,000 coroner's office variables explained 24 percent of the variation, while community variables explained 13 percent. In the more populous counties, the characteristics of the coroners most predictive of the suicide rates were a nonrejecting attitude toward suicide, an interest in the personal aspects of the deceased, and concern with the physical circumstances of the death. In the less populous counties, the variables most predictive of the suicide rates were related to the physical aspects of the death.


Systemic lupus erythematosus. A review of 110 cases with reference to nephritis, the nervous system, infections, aseptic necrosis and prognosis.

Observations made on 110 patients with SLE over a four and a half year period have been reviewed. The patients were seen at intervals of two months when, both clinical and serological findings were recorded, according to a set protocol. The results have been presented with particular reference to nephritis, neurological manifestations, infections, aseptic necrosis, mortality and predicted survival. Such studies have led to the identification of various prognosis factors in SLE, and assisted in providing better directed therapy. The results indicate a milder from of SLE in the patients of this series when compared with previously published studies, and is more representative of the wide spectrum of disease severity seen in the general population.


The treatment of Cushing's disease by trans-sphenoidal hypophysectomy.

Thirteen patients aged 24 to 65 with Cushing's disease have been treated by transphenoidal hypophysectomy. There was one incident of meningitis and one late death from myocarditis. No radiotherapy was given. In 12 patients pituitary histology showed Crooke's changes and an adenoma was present in seven. On review of the 12 survivors two to 11 years later, 11 are in complete remission. One patient still showed some clinical features of Cushing's syndrome but steroid levels were normal. In five of the seven premenopausal women normal menstruation has returned and pregnancy has occurred in three. In four patients replacement hormone therapy is no longer required and a further four take only partial treatment. We conclude that transphenoidal hypophysectomy is an effective treatment for Cushing's disease.


Waterborne gastrointestinal illness at a ski resort. --Isolation of Yersinia enterocolitica from drinking water--.

Approximately 41 percent of the visitors and employees who were at a ski resort in Montana between December 23, 1974, and January 17, 1975, became ill with diarrhea and other gastrointestinal symptoms. The association between illness and water consumption proved to be significant, and the previously noncontaminated water supply was found to contain coliforms. No pathogens except Yersinia enterocolitica were isolated, and it was isolated from two wells serving the area. The role of Y. enterocolitica in this outbreak is not clear, but it was the only organism isolated that is known to be pathogenic.


Acceptance of auxiliary health worker in rural Iran.

A pilot project to train and deploy low-level rural health auxiliaries is being carried out in southern Iran. This first group of 16 village health workers (VHW) went to work in the initial 16 project villages early in 1974. The group consisted of 11 men and 5 women ranging in age from 15 to 45. These workers are taught to treat simple medical conditions, to practice preventive health measures, and to conduct health education and visit programs. Six months after initial deployment to the villages, a sample survey of 226 villagers was carried out to determine what characteristics of the VHW and of the consumers were associated with greater acceptance of the VHW's work and his or her role in the village. The results indicated that both male and female health workers are accepted in an equivalent role, and that workers returning to their own villages are no more or no less likely to have difficulties in gaining acceptance than are those returning to a different village. It was found that experience with a VHW of a particular sex could significantly alter attitudes toward the preferred for the VHW. The age of the worker was the only variable closely associated with the villagers' confidence in the worker--the older the VHW, the higher the villagers tended to rate his or her knowledge. In Iran, as in many developing countries, the rural village tends to be a closed, male-dominated group. The experience of the VHWs in Iran makes it apparent that the health worker, regardless of sex, age, or village of origin, can gain the confidence and respect of the villagers.


Practolol peritonitis. A study of 16 cases and a survey of small bowel function in patients taking beta adrenergic blockers.

Sixteen patients with practolol peritonitis are described. Dense peritoneal thickening and adhesions caused small bowel stasis and obstruction with characteristic radiology and histology. The disease was best treated by surgery though complications were frequent and three of 16 patients died. Ocular and skin involvement were common. Fifty four asymptomatic patients who had taken a beta adrenoceptor blocking drug for more than 12 months were studied. Seven were found to have radiological abnormalities of the small bowel. These changes were associated with propranolol, oxprenolol and practolol therapy. It is not known whether they are related to practolol peritonitis.


Poisoning by bites of the saw-scaled or carpet viper (Echis carinatus) in Nigeria.

The Saw-scaled or Carpet Viper (Echis carinatus) whose range extends from Senegal to Bengal probably bites and kills more people than any other species of snake. One hundred and fifteen patients with poisoning caused by its bite were studied in the savanna region of Nigeria, where victims of this snake may occupy 10 per cent of hospital beds. Patients showing no signs of envenoming were excluded. All patients had local swelling at the site of the bite. Other features included local blistering (13 per cent), local necrosis (11 per cent), incoagulable blood (93 per cent), and spontaneous systemic bleeding (57 per cent). There was evidence of disseminated intravascular coagulation in all cases; fibrinogen was severely depleted, fibrin degradation products were increased (mean 1711 +/- 904 micron per ml), but significant thrombocytopenia (less than 103 000 per mm3) was seen in only ten severe cases. Clotting factors V, VIII, II and XIII were depleted, while X and VII were usually normal. Fibrinolytic activity was rarely increased, so it seems likely that a procoagulant action (direct activation of prothrombin) is principal effect of E. carinatus venom on blood coagulation in man. Development of the haemostatic defect was observed as early as 75 minutes and as late as 27 hours after the bite. Spontaneous haemorrhage is clinically the most important effect of E. carinatus venom, causing the five deaths in this series. The relative importance of procoagulant and haemorrhagic components of the venom in causing haemorrhage is discussed. Complement activation via the classical and alternative pathways may have contributed to vascular damage. Mortality was reduced from the untreated level of between 10 and 20 per cent to 2.8 per cent in a group of 107 patients treated with 10 to 110 ml of specific antivenom. The dose was controlled using a simple clotting test. Blood coagulability was restored in two to 39 (mean 12) hours after the first dose of antivenom. Immediate-type serum reactions were observed in 21 per cent of cases. Additional treatment included blood transfusion for patients in haemorrhagic shock and ealry surgical débridement of necrotic tissue at the site of the bite.


Pregnancy in Wilson's disease.

The effect of pregnancy has been studied in 10 mothers with Wilson's disease. Three were presymptomatic but had the typical biochemical lesion, two of these were receiving penicillamine treatment at the time of conception, the third had yet to be diagnosed. The remaining seven mothers had had symptoms of Wilson's disease and had been receiving treatment for periods ranging from two and a half to 19 years. These mothers had 15 pregnancies between them, 13 went to full term but two ended prematurely at 26 and 30 weeks. In only one did pregnancy have an unfavourable effect on the Wilson's disease; this mother had been on penicillamine for only two and a half years in a suboptimal dose because of drug induced thrombocytopoenia. In addition she had extensive oesophageal varices and pregnancy was complicated by toxaemia. The other nine patients remained well and two had three pregnancies each. On six occasions penicillamine was taken throughout pregnancy, but in seven it was discontinued from the sixth to the twelfth week. All 15 babies were normal but one died of extreme prematurity (26 weeks gestation). Pregnancy does not appear to be contraindicated in well treated Wilson's disease and penicillamine does not seem to pose an undue risk to the foetus.


The clinical and surgical feature in 40 patients with primary cerebellar ectopia (adult Chiari malformation).

This paper reports 40 patients with primary cerebellar ectopia investigated in the University of Manchester departments of neurology and neurosurgery over the five years, 1968-1973. A review of the clinical and surgical findings showed that (a) pain of varying type was the most common symptom, (b) four main clinical groups could be recognized--syringomyelia, paraparesis, cerebellar syndrome and 'raised pressure' syndrome and (c) surgical decompression of the posterior fossa and upper cervical spine resulted in improvement in over 70 per cent of patients with a small incidence of post-operative complications. It should be emphasised that primary cerebellar ectopia is not uncommon and is an important syndrome in its own right. It is often not accompanied by syringomyelia and in these patients the diagnosis can be difficult without supine myelography.


Jaundice associated with lobar pneumonia. A clinical, laboratory and histological study.

Twenty-eight patients with jaundice associated with lobar pneumonia have been studied. The epidemiological and clinical features were compared with 70 patients with lobar pneumonia without jaundice. Jaundice was associated with a predominance of males, a high incidence of right lower lobe consolidation and hepatic tenderness. Although the jaundiced patients remained pyrexial for longer it was not associated with a poor prognosis. There was no evidence of immunological deficiency although pneumococcal polysaccharide antigenaemia was commoner in jaundiced patients. Laboratory investigations showed evidence of haemolysis in the majority of jaundiced patients and the cause of this was found to be G6PD deficiency. Starch-yel electrophoresis demonstrated that the phenotype was A- in deficient patients. Hepatic function tests were unhelpful. Light and electron microscopical changes consistent with haemolysis were present in liver biopsies from G6PD deficient patients although hepatocellular damage and cholestasis were also present.


Addison's disease with renal microangiopathy and renal failure (a new syndrome).

A syndrome comprising Addison's disease, renal microangiopathy and renal failure is described in two patients. The renal lesions manifested despite corticosteroid replacement therapy and were characterized by glomerular damage and thrombo-microangiopathic changes in afferent arterioles and intralobular arteries. Both patients died as a result of their renal disease.


Idiopathic membranous nephropathy.

The clinical and histopathological features of 37 patients with idiopathic membranous nephropathy are presented. Males were four times as commonly affected as females and the age at presentation ranged from nine to 70 years. The period of observation varied from three months to 23 years. Twenty-eight patients (76 percent) presented with the nephrotic syndrome and nine patients (24 per cent) presented with non-nephrotic proteinuria. At the end of the study, of the patients presenting with the nephrotic syndrome, seven (25 per cent) were in remission, seven (25 per cent) remained nephrotic, nine (32 per cent) showed only proteinuria and five (18 per cent) were dead or on dialysis. Altogether eight patients (28 per cent) developed renal failure. The nine patients who presented with non-nephrotic proteinuria appeared to do better, and none developed renal failure. The occurrence of spontaneous remission makes assessment of benefit from immunosuppressive therapy difficult. However, analysis of our data and a review of the literature suggest that in this condition oral prednisone, cyclophosphamide and azathioprine have no significant therapeutic properties. Histological assessment confirmed the occurrence of mild (Grade 1) changes in patients biopsied soon after presentation, and tubular atrophy increased with the duration of illness. Immunofluorescence confirmed deposition of mainly IgG and complement. Repeat biopsies in 14 patients showed no histological improvement and remission was not accompanied by resolution of histological abnormalities.


The relationship between central carbon dioxide sensitivity and clinical features in patients with chronic airways obstruction.

A technique has been developed which enables respiratory motor output to be measured independently of lung mechanics. The maximum rate of change of pressure at the mouth during initial transient occlusion of the airway, (d P/dt) max., represents the rate of isometric force development by the inspiratory muscles. This technique was used to study central CO2 sensitivity in 40 patients with chronic airways obstruction. Subnormal CO2 sensitivity was associated with chronic cough and sputum production, relatively mild dyspnoea, raised arterial CO2 tension, hypoxaemia, polycythaemia and cor pulmonale. Normal CO2 sensitivity was associated with severe dyspnoea, normal blood gas tensions, and allergic features.


Sarcoidosis of bone.

Sarcoidosis of bone has been observed in 29 patients for up to 43 years. It was present in the hands and/or feet in 26 patients, in the nasal bone in three and once each in the hard palate and temporal bones. There were three types of bone lesion: (a) lytic in 25 patients; rounded cortical or medullary lesions ranging in size from 1 mm to 1 cm in diameter, which on healing left a residual punched-out 'cyst'; (b) permeative in nine patients; these showed progressive cortical 'tunnelling' with remodelling of trabecular and cortical architecture; (c) destructive in three patients: rapidly progressive with pathological fractures and secondary joint surface involvement. Soft tissue swelling preceded the radiological abnormality for up to four yearts in 10 patients, accompanied it twice, followed it once and was absent on 16 (55 percent) occasions. Bone involvement was usually an incidental finding when sarcoidosis presented elsewhere. Other features included intrathoracic sarcoid (86 per cent), lupus pernio (48 per cent), skin plaques (41 per cent), ocular inflammation (48 per cent), nasal mucosal disease (24 per cent), lymphadenopathy (24 per cent), hepatomegaly (13 per cent), splenomegaly (10 per cent), and parotid enlargement (10 per cent). Pulmonary infiltration with or without lymphadenopathy was observed in three fifths and hilar adenopathy alone in one third of patients. Abnormalities in chest radiographs of patients with bone sarcoid resolved in only 20 per cent. Hypercalciuria was noted in one and hypercalcaemia in the other two patients with bone distruction.


Hereditary coproporphyria. Demonstration of the abnormalities in haem biosynthesis in peripheral blood.

Hereditary coproporphyria is biochemically distinct from the other porphyrias and is characterized by excessive excretion of coproporphyrin in faeces and usually in urine. The laboratory findings in 28 patients with this disease are presented and the clinical details of eight patients who have been in attack summarised. The remaining 20 patients were latent for the disease. In all patients studied the activity of delta-aminolaevulinic acid synthase was raised and coproporphyrinogen oxidase depressed in the leucocyte. This indicates the partial enzyme block in the haem biosynthetic pathway in this disease. The activities of the other enzymes in the pathway, leucocyte ferrochelatase and erythrocyte delta-aminolaevulinic acid dehydratase, porphobilinogen deaminase and uroporphyrinogen decarboxylase showed no consistent change. On review of 111 cases, 35 per cent presented in acute attack: 80 per cent had abdominal pain, 34 per cent vomiting, 29 per cent solar sensitivity, 23 per cent neurological involvement, 23 per cent psychiatric symptoms and 20 per cent severe constipation. Only two fatalities have been published, both from respiratory failure. There was a female preponderance of cases in attack of 2-5:1 and in the latent cases of 1-5:1 suggesting hormonal provocation in the uncovering of the disease. Drugs were implicated as precipitating 54 per cent of acute attacks and in 34 per cent of cases, these were barbiturates. This study demonstrates the reduction in activity of coproporphyrinogen oxidase in the haem biosynthetic pathway and the elevation of delta-aminolaevulinic acid synthase in the peripheral blood. These features, together with the typical abnormal porphyrin excretion pattern, appear to be diagnostic of hereditary coproporphyria whether in attack, remission, or in the latent form.


Renal vein thrombosis as the major cause of renal failure in familial Mediterranean fever.

Eighteen out of 57 patients (31-6 per cent) suffering from Familial Mediterranean Fever (FMF) were found to have the nephrotic syndrome, histologically proven amyloidosis and progressive renal failure. In 14 cases renal function deteriorated rapidly after the first appearance of significant proteinuria, and 12 cases (66-7 per cent) required regular haemodialysis. Seven of these patients, seen in the early stages of renal impairment, were subsequently diagnosed clinically as probably having developed renal vein thrombosis. There was radiological proof of intrarenal or major renal vein occlusion in five which in one patient progressed to inferior vena cave obstruction. Treatment with heparin, plasminogen activators and fibrinogenolytic agents was disappointing although renal function has stabilized in one patient on long term oral anticoagulant therapy. It is suggested that renal vein thrombosis is common in FMF with renal amyloidosis and usually causes rapid deterioration of function and irreversible renal failure requiring dialysis. Renal phlebography may delineate clot in the main renal veins or indicate areas of reduced blood flow due to thromboses in intrarenal venules. Treatment is only partially satisfactory but there is some evidence to suggest that renal phlebography should be undertaken promptly when renal function begins to fall followed by anticoagulant therapy to prevent further thromboembolic complications.


Long-term haematological complications of thorotrast.

Six cases representing the spectrum of haematological complications due to systemic administration of Thorotrast are reposted. Two patients suffered from acute leukaemia, one patient had marrow failure and three patients presented with haematological features of hyposplenism; two of these also had solid tumours. The literature is reviewed.


Clinical and biochemical studies in Engelmann's disease (progressive diaphyseal dysplasia).

The clinical and biochemical features of four adults with Engelmann's disease (Camurati-Engelmann disease; progressive diaphyseal dysplasia) are presented. One young patient, with a particularly severe form of the disease, is discussed in detail. Biochemical abnormalities were found in three of the patients. In two of them, one with localized hyperostosis and one with generalized bone disease, the only changes were an increase in the plasma alkaline phosphatase and urinary total hydroxyproline excretion. The most severely affected patients, who had had progressive and generalized bone disease from age two and a half years, also had persistent hypocalcaemia and hyperphosphataemia, a positive calcium balance, and a very low urine calcium excretion. It is suggested that some patients with Engelmann's disease may have a previously unrecognized metabolic disorder associated with increased retention of calcium and excessive bone formation. The possible role of abnormal phosphate metabolism in this increased formation of bone, and the relationship of Engelmann's disease to other hyperostoses, are discussed.


A comparative kinetic study on the conversion of fluoresceindiacetate to fluorescein in living cells and in vitro.

The kinetics of fluoresceindiacetate (FDA)-hydrolysis in erythrocytes, CHO-cells and homogenized cells was investigated by means of fluorescence spectroscopy. At a 10(-6)m FDA concentration the enzymatic conversion in the homogenized cells can be described by first order reactions. When studying intact cells, total kinetics requires the addition of a first order transport term. Consequently, the total hydrolytic process can be described by three exponentials. The following model was set up on the basis of the data obtained: FDA, which exists in two sterically differing conformations, reaches the cell via an "active transport mechanism", where the two conformations are converted at different rates into fluorescein by an enzymatic reaction. Intracellular FDA-enrichment factors of 100-6-- were derived. In addition, the action of chemical inhibitors and of elevated temperatures on the individual reaction steps was investigated.


Changes of fluoresceindiacetate-hydrolysis and transport in mammalian cells after ultra-violet- and gamma irradiation.

Changes in the permeability of cell membranes and in the enzymatic activity of intact cells and their homogenates after irradiation were studied. CHO-cells, erythrocytes and their homogenates were irradiated with cobalt-gamma radiation and UV-light. It was found that the esterases are more radio-sensitive in intact cells than in the corresponding homogenates. The decrease of the enzymatic activity after irradiation can be described by a one-hit curve, whereas the loss of transport activity can be resolved into two one-hit curves. The slope associated with the more sensitive target mainly determines the course of the composed transport curve. Mechanisms for the decreases in the rate constants are discussed.


[The effect of roentgen rays on the transmembrane potential and on the electrophoretic mobility of polymorphonuclear granulocytes and FL-cells (author's transl)].

Two hours after X-irradiation at 37 degrees C in vitro at doses ranging from 50 rad to 20 krad the transmembrane potential and the surface charge of polymorphonuclear granulocytes and FL-cells showed a dose-dependent decrease. However, between two and four days after irradiation at 10 krad FL-cells revealed an increase in both transmembrane potential and surface charge. Small doses of ionizing radiation (e.g. 10 rad) resulted in aperiodically damped oszillations of membrane polarisation in leucocytes.


Immediate X-radiation induced contractions of the isolated guinea pig terminal ileum: the localization of the effect by drugs.

Tone and motility of the isolated guinea pig ileum were increased by irradiation with a dose of 10 krd. The maximal effect corresponds to that induced by 0.001 microng/ml acetylcholine or 0.3 microng/ml nicotine. The pharmacological analysis of this effect performed with acetylcholine and nicotine and several blocking agents including hexamethonium, atropine, tetrodotoxin, diphenhydramine, and verapamil suggests that radiation acts on the postganglionic parasympathetic neuron and the neuromuscular synapse. The mechanism of radiation is likely to consist of both an increased release of acetylcholine from the postganglionic neuron and a sensibilization of the cholinergic receptor site at the smooth muscle cell. The latter effect is thought to result from an increased contractile action induced by acetylcholine or nicotine in the irradiated ileal smooth muscle.


Factors modifying radiation induced stimulation in plants: pre-irradiation seed moisture content.

The effect of moisture content of seeds at the time of irradiation in relation to radiation-induced stimulation was investigated on rice (Oryza sativa c.v. D-6-2-2). The optimum moisture content was 8% for stimulation measured as seedling height. It is concluded that seed moisture at the time of irradiation plays an important role in the expression of stimulation and its reproducibility.


Absorption of different amino acids by an intestinal preparation from normal rats and from rats exposed to supralethal X-irradiation.

Absorption of different amino acids [lysine, alpha-amino isobutyrate (AIB), methionine, alanine, glycine] was studied in an intestinal in vivo preparation from normal and X-irradiated rats (1 and 3 days after 2000 R). Absorption of amino acids under loading and in presence of other amino acids was also followed. Lysine and AIB absorption follow a saturation kinetics with a maximal velocity of 35 and 85.6 micronmoles/min and a Kt of 10 and 67 micronmoles for lysine and AIB respectively. Interference in  absorption exists not only between amino acids of the same class, but also by lysine on neutral amino acids. One day after irradiation, absorption is normal or even enhanced, although active transport appears impaired as indicated by the increase in Kt. Three days after exposure absorption, particularly the active one, is severely depressed. This is indicated by the low Vm and high Kt as well as by the fact that loading has little influence on absorption.


Localisation of the site of action of tube growth stimulation by micro UV-irradiation of pine pollen.

Micro-irradiation of pine pollen grains was carried out with different doses at four different dose rates and the tube growth was observed. The irradiation of the whole pollen grains in the dehydrated state and dorsal position and of those in the hydrated state and ventral position induced stimulated tube growth after receiving low doses of UV light. The effect of stimulation depended on the ratio between dose and dose rate. After partial irradiation of pollen grains at low doses, carried out with the technique of "blind shot", a stimulation effect could also be observed. It was calculated that the irradiation of the cytoplasm had a strong, the irradiation of the active nucleus (vegetative) had a moderate and the irradiation of the dormant nucleus (generative) had little or no dose rate dependance. The dose effect of the nuclei showed a reverse tendency to the dose effect of the cytoplasm. Experiments with different light filters suggested that the dose rate dependence of the cytoplasm is probably not caused by a repair mechanism. The vegetative nucleus showed an effect of photoreactivation and probably also of a dark repair. The generative nucleus exhibited only an effect of photoreactivation.


Influence of neutron collimation on the energy deposition in a tissue equivalent sphere.

The influence of neutron collimation on the shape of energy deposition spectra was investigated using a spherical walled proportional counter. Experimental dose averaged lineal energies were obtained and compared with theoretical values. The fractions of total absorbed dose corresponding to various intervals of lineal energies were also deduced from the measured distributions.


133 Xenon air contamination: a radiation safety aspect of pulmonary ventilation imaging.

Potential leakage of 133 xenon is a covert, insidious facet of ventilation imaging procedures. Airborne xenon is often unrecognized and, consequently, unmanaged. The presence of xenon in air is usually unrecognized because it is not sought! Ventilation imaging procedures should incorporate safeguards for the protection of people against the internal exposure of radiation due to the inadvertent release of xenon gas in the air. Protective measures include surveillance by area survey and air monitoring, maintenance of equipment, establishment and preservation of safety procedures, and management of airborne contamination. The need to follow the accepted health physics objective to reduce radiation exposure of humans to the lowest practicable level is reaffirmed!


Risk versus benefit in mammography.

Controversy surrounds the use of mammography in asymptomatic women 35-49 years of age. There is agreement that routine mammography is useful beyond 50 years. By extrapolating data from relatively high radiation exposures, a radiation carcinogenic risk at diagnostic levels has been calculated by some workers. Benefit for asymptomatic women in the 35-49 year age group has been questioned. This paper presents evidence that significant numbers of breast cancers are found in this age period on the basis of x-ray examination alone. Data also indicate absorbed dose from modern-day mammography is half to one quarter of that previously assumed. Based on these data, mammography is recommended as a tool for diagnosis of nonpalpable carcinomas of the breast.


Computed tomography of the lower lumbar vertebral column. Normal anatomy and the stenotic canal.

Computed tomography (CT) was used to obtain images of the vertebrae and spinal canal. The normal CT anatomy of the lower spinal canal is demonstrated. Examples of spinal stenosis caused by degenerative spondylosis, post-fusion hypertrophy, and pseudospondylolisthesis are presented.


Computed tomography of systemic lupus erythematosus.

Computed tomographic (CT) findings in 14 patients with systemic lupus erythematosus are correlated with clinical symptomatology. Microinfarction (manifested by perisuical atrophy) large infarcts, and hematomas are the major abnormalities demonstrated by CT. The neuropathology of these changes is discussed.


Students or employees: a federal threat to radiologic technology education.

The Fair Labor Standards Act, also known as the "Wage and Hour Law," has been expanded to include health professionals in radiologic technology programs as interpreted by functionaries of the Department of Labor. This interpretation is diametrically opposed to that of hospital administrators and program directors. It remains for federal courts to decide whether technology students are indeed students or hospital employees, deserving of minimum wages by their "employers." Program directors are advised to litigate any claims by field representatives of the Department of Labor who claim that technology students are hospital employees and not legitimate students in a bona fide school. The federal loan program recognized technology students as true students rather than employees, thereby exempting them from qualification for the minimum wage rules. If students in programs of radiologic technology are viewed as employees, the additional cost to most hospitals could destroy the system of training as we now know it.


Demonstration of the superior ophthalmic vein by high resolution computed tomography.

Computed tomography has revolutionized the diagnosis of ophthalmologic and neuro-ophthalmologic disease. High resolution CT with thin-section techniques has made available the depiction of finer anatomic orbital detail and permits radiologic detection of more subtle lesions than was previously available. The display of normal-sized superior ophthalmic veins by CT is further evidence of the resolving power of the currently available machines. A segment of the superior ophthalmic vein was identified in 18 of 64 orbits examined by CT. Virtually the entire superior ophthalmic vein was identified in three orbits.


Pulmonary sequestration associated with a gastric duplication cyst.

A case of right subdiaphragmatic extralobar pulmonary sequestration (PS) associated with a gastric duplication cyst is reported. To the authors' knowledge such a case has not been reported previously in the English literature. PS was first noted as a defect on a nuclear liver image. The duplication cyst was defined by ultrasonography. A review of the English literature is included.


The mysterious wall around exposure.

The quantity, exposure, and its associated unit, the roentgen, have been employed for approximately 50 years for the practical measurement of x- and gamma-ray source "output." Practical exposure-measuring devices must be provided with a wall of critical thickness and composition. Confusion arises since the wall is not mentioned in the definition of "exposure." This mystery can be dispelled by the fact that exposure never is measured in the manner in which it is defined.


Collective bargaining challenge to college and university allied health educators.

Within the scope of teachers' collective negotiations and the futuristic trends, an attempt has been made in this paper to alert college-based, allied health educators to one of the most important activities on the college/university scene today. The purpose has been to arouse our curiosity and to get us to consider the possible implications and ramifications such an activity will have on programs in allied health. Various health disciplines entering the world of academia must constantly be aware of the many forces at play, one of which is collective negotiations. The objective has been to initiate this process of awareness.


Cranial chondrosarcomas. Report of four cases and review of the literature.

Four cases of chondrosarcoma of the skull are presented. The clinical and radiographic features and differential diagnosis are discussed. The previous literature is reviewed and all cases tabulated. Computed tomography and angiography are important radiologic tools in suggesting the correct diagnosis prior to operation. Stippled, finely speckled, or amorphous calcification or bony erosion on radiographic studies and an avascular mass angiographically may suggest the diagnosis.


Evaluation of bronchospasm during excretory urography.

Mean pulmonary function was significantly decreased in 57 patients during excretory urography. Patients with a history of allergy had significantly greater mean decreases in flow rates than those without. Twelve did not have significant decreases in pulmonary function after needle puncture and intravenous injection of 5% dextrose in water. Eight healthy subjects did not have significant mean decreases after intravenous injection of 5% saline. Most patients undergoing excretory urography have bronchospasm that is greater in magnitude in those with a history of allergy.


Hepatic emboli following inferior vena caval ligation. Brief report.

Radionuclide venography performed by foot vein injection of 99mTc MAA and 99mTc DTPA in a 34-year-old man approximately one year after inferior vena caval ligation demonstrated an unusual collateral pathway between the veins of the lower extremities and the portal vein, and also evidence for multiple hepatic emboli. This is a newly recognized sequela of inferior vena caval ligation.


Asymptomatic bacteriuria in schoolgirls. VII. A follow-up study of the urinary tract in treated and untreated schoolgirls with asymptomatic bacteriuria.

The urinary tracts of 116 schoolgirls with asymptomatic bacteriuria detected at screening were investigated by excretory urography and micturition cystourethrography. Three years later the studies were repeated in 11 patients with scarred kidneys, 11 patients with unscarred kidneys plus reflux, and 14 untreated patients with radiologically normal urinary tracts. Exceptionally small scarred kidneys showed little growth. Unscarred kidneys with vesico-ureteral reflux exhibited normal growth, as did unscarred kidneys in untreated patients. The risk of kidney damage developing as a result of asymptomatic bacteriuria in a schoolgirl with a radiologically normal urinary tract seems to be small.


Capillary hemangioma of the lung. Radiological quiz.

Capillary hemangiomas of the lung are very rare, usually presenting solitary circumscribed lesions on chest radiographs. Hemoptysis is frequently present. All 7 known patients with isolated pulmonary capillary hemangiomas have been females. The authors describe a girl followed up from 2 months to 3 1/2 years of age with a large lesion which at times appeared as a mass of water density and at other times as air-filled cysts. This changing radiological pattern correlated well with the pathological evidence of repeated hemorrhage, scarring, air trapping, and cyst formation.


Absence of vesico-ureteral reflux in children with ureteral jets.

The jet phenomenon is a normal finding in excretory urography. The presence of such a jet is a good sign that vesico-ureteral reflux is not present. Of 19 ureters with a jet sign, only one had minimal transient ureteral reflux, while in 39 ureters without a jet sign 15 had reflux.


Radiographic findings in Wolman's disease.

A case of Wolman's disease or primary familial xanthomatosis with calcification of the adrenals is presented. The bilaterally enlarged, calcified adrenals are virtually pathognomonic of this condition.


Patent ductus arteriosus in preterm infants with idiopathic respiratory distress syndrome. Radiographic and echocardiographic evaluation.

Clinical, radiographic, echocardiographic and operative findings were evaluated in 55 preterm infants with idiopathic respiratory distress syndrome (IRDS) complicated by patent ductus arteriosus (PDA). Pulmonary plethora was detected prior to age seven days in 52 infants, and prior to murmur detection in 42 infants. In those with large shunts, only 35% had cardiomegaly while 78% had a significant increase in cardiothoracic ratio (C/T) on sequential radiographs. Moreover, within 48 hours after ligation, 91% of infants had a significant decrease in C/T. Echocardiographic left atrial to aortic ratio (LA/Ao) was elevated in 71% with large shunts. In one patient with a large shunt there was neither a sequential increase in C/T nor an increased LA/Ao. Severity of left-to-right shunting across a PDA in the newborn was reliably gauged by combined radiographic and echocardiographic evaluation. Either modality alone failed to reflect the presence of a large volume shunt in a number of infants.


Techniques for improved delineation of normal anatomy of the upper abdomen and high retroperitoneum with gray-scale ultrasound.

Improved scanning techniques, positioning, and adjustments in instrumentation have been developed on the basis of more than 1,500 ultrasound examinations of the upper abdomen and high retroperitoneum. The latest instrumentation was employed, including gray-scale signal processing and focused transducers. These methods have resulted in improved visualization of normal anatomical structures, including the aorta, inferior vena cava, portal venous system, and major branches of these vessels as well as the common bile duct. Aspects of these techniques are illustrated and their applications and limitations in the differential diagnosis of upper abdominal disease are discussed.


Gray scale ultrasound evaluation of hepatic neoplasms: patterns and correlations.

Ninety malignant hepatic neoplasms were studied by gray scale ultrasound. Four different ultrasonic patterns were observed: (a) discrete, relatively echo-free masses; (b) discrete, relatively echogenic masses; (c) totally echo-free masses; and (d) a diffuse alteration of echo architecture without discrete masses. There has been no apparent association of ultrasonic pattern with either the histologic type of neoplasm or the angiographic vascularity. Corresponding isotopic data is discussed.


Immunologic competence in adults following thymic irradiation in infancy.

Removal of, or irradiation to, the thymus during the neonatal period in man has resulted in no reported adverse effects on cellular immunity, although thymectomy in neonatal experimental animals is known to produce profound immunological disturbances. Adverse effects in humans may not be recognized until several decades have passed. The immunological capabilities of 7 adults with histories of thymic irradiation as infants were evaluated; normal tests results indicated intact immune systems in all cases. The 3 women tested, however, had abnormal clinical histories, including 2 with multiple tumors and 1 with chronic mucocutaneous candidiasis.


Five years' experience with the gold button technique for intraoral interstitial implants with iridium-192 seeds.

To simulate crossing of the ends in standard removable interstitial implants, we used the loop technique for intraoral tumors when treating them with afterloading interstitial removable implants. Because of technical problems, we changed to a straight tube method with heavy end-loading to compensate for the uncrossed ends. High doses to the normal mucosa close to heavy end-loading is reduced 2.5 times by the use of gold buttons in place of standard stainless steel buttons, thus decreasing unnecessary mucosal reactions and morbidity.


Perforated duodenal ulcer and pneumomediastinum.

Two cases of anterior wall perforation of a duodenal ulcer, resulting in pneumomediastinum and pneumoperitoneum, are presented. The literature regarding perforation of the gastrointestinal tract with associated mediastinal emphysema is reviewed.


A comparison of fluoroscopically controlled patient positioning and conventional positioning, including comparative dosimetry.

The size of the area of exposure on the skin during excretory urography was determined by either technician-controlled fluoroscopy or conventional assessment in 2 comparable groups of patients. The mean skin exposure to radiation per patient was the same in each group. The time required for a urogram was 10% less when fluoroscopy was employed. Since accurate, tightly shuttered exposure areas improve radiographic quality, fluoroscopically controlled determination of patient positioning is justified.


Computed tomography of the mediastinum. Normal anatomy and indications for the use of CT.

Correlative CT studies of a cadaver and a statistical analysis of all thoracic scans performed in the first year of operation of a delta-Scan 50 were undertaken in order to better understand normal mediastinal anatomy as displayed by computed tomography. Several levels are illustrated, and the results of the analysis are reported. The authors propose a list of indications for which CT of the mediastinum seems to be helpful.


The role of computed tomography in the management of cancer of the larynx.

Computed tomography (CT) offers a unique method of displaying the anatomy of laryngeal cancer. Asymmetrical contours of the thyroid cartilages have been found as a normal variant. Marked asymmetry may indicate buckling of the cartilage which could contribute to acute airway obstruction following radiation therapy. A low-density, soft-tissue plane medial to the thyroid cartilages may prove valuable in evaluating cartilaginous involvement with tumor. Computed tomography should make a significant contribution to more accurate planning of radiation therapy portals by showing the relationship of lymphatic spread to the primary tumors.


The double contrast shoulder arthrogram: evaluation of rotary cuff tears.

Double contrast shoulder arthrograms revealed rotator cuff abnormalities in 14 of 31 cases. Although both the single and double contrast methods provide a means of diagnosing complete tears of the cuff, or partial tears of its inferior surface, the double contrast study provides additional information regarding the width of the tear, the presence of degenerative changes in the cuff, and the condition of the articular cartilages.


Radiosensitization of normal tissue by chloroquine.

Severe radiation reaction with chest wall necrosis occurred following 5,000 rads of 60Co irradiation. The patient was arthritic and on chloroquine therapy. This delayed reaction was due to chloroquine radiosensitization. Rats treated with combined chloroquine and chest wall irradiation were compared to rats receiving irradiation alone. The acute radiation reaction was greater in the drug treated animals.


Thin-section computed tomography in the evaluation of third ventricular colloid cysts.

The computed tomographic (CT) scan findings in 4 cases of third ventricular colloid cyst are presented, and the importance of thin-section CT in the evaluation of this lesion is discussed. Overlapping 8-mm sections are helpful in differentiating normal vasculature adjacent to the foramen of Monro from a third ventricular colloid cyst.


Clostridium-produced gas gangrene of the colon.

A case of radiologically demonstrable gas gangrene of the colon was proved pathologically to be caused by C. perfringens. The case was radiologically indistinguishable from that of bowel infarction. When intramural gas is seen in patients with the symptoms of toxemia but without the bloody diarrhea associated with bowel infarction, infectious gas gangrene should be considered.


Evaluation of the atretic distal esophageal segment.

In infants with congenital esophageal atresia with a gasless abdomen, we have determined the length of the distal esophageal segment by injecting air into the stomach through a gastrostomy tube and causing the infant to burp. It is a safe and accurate method and can be done with or without fluoroscopic control.


Evaluation of benefits and risks of breast cancer screening.

Benefit/risk ratios derived by another study group for a population screened at a breast cancer detection center during the first year of operation are analyzed. The authors of the present paper look at the problem in a somewhat different manner. Benefit/risk ratios derived using this approach are significantly lower than those reported in the previous study. The results of the present study indicate that annual mass screening of women under the age of 50 is of questionable value.


Long-term effects of urinary tract infections. The need for a controlled trial.

Two series of children with urinary tract infections are compared: in one the infections were primarily covert, while in the other they were predominantly overt. Grade III reflux occurred only in the overt infection group, and the development or progression of renal clubbing and scarring was much more common in these patients. Now that effective, long-term prophylactic therapy for infection is available, the author urges that controlled trials be established to determine whether or not sterile reflux is harmful and whether or not ureteral reimplantation for reflux is of value.


Cholecystographic diagnosis of duodenal ulcer: the incomplete ring sign.

Three patients are described with unusual collections of cholecystographic contrast material in the right upper abdomen medial and posterior to the gallbladder, in a characteristic "incomplete ring" configuration. Subsequent barium examinations of the upper gastrointestinal tract proved each of these collections to represent contrast material trapped in active duodenal ulcer craters. This cholecystographic sign, though uncommon, is believed to be fairly specific for duodenal ulcer. Recognition of the "incomplete ring" sign should prompt the radiologist to obtain barium studies necessary to confirm the presence of ulcer.


Intra-arterial lidocaine: an effective analgesic for peripheral angiography.

Intra-arterial lidocaine was found to be an effective and safe method for reducing pain associated with peripheral angiography. A convenient method for delivery is to directly mix 2% lidocaine and contrast material in a ratio of 1:10 by volume. In a comparative evaluation, 25 of 29 patients experienced significantly less discomfort when the lidocaine-contrast mixture was used as compared to contrast material alone. There were no apparent complications from the use of intra-arterial lidocaine.


The angiographic appearance of thymic tumors.

Angiography of the internal mammary artery was performed in 30 patients with suspected tumors in the anterior mediastinum. In 3 patients, thymic venography was also performed. In 13 lymphoepithelial thymomas, a smooth outline with the arteries penetrating the periphery of the tumor was demonstrated. Frequently, neovascularity but never encasement of large arteries or arteriovenous (AV) shunting was exhibited. In the lymphoepithelial thymomas of the cell-rich type, the accumulation of contrast medium and neovascularity were pronounced. This type of thymoma may possibly be locally more invasive than others. In carcinomas, the arteries penetrated the tumor and AV shunting was common. Arteriography was superior to venography in the few patients in whom both examinations were performed. Angiographically, it should be possible to differentiate thymomas from carcinomas.


Angiography of nonfunctioning pheochromocytomas of the adrenal gland.

Two patients with clinically nonfunctioning pheochromocytomas of the adrenal gland were studied angiographically. The radiological characteristics were indistinguishable from those of functioning pheochromocytomas. In patients with hypervascular adrenal masses, the diagnosis of pheochromocytoma should be considered even in the absence of customary signs and symptoms.


Angiographic features of fibromas and fibrosarcomas.

Angiography was done in 38 cases of pathologically-confirmed fibrous-tissue tumor. All benign fibromatous tumors and one case of desmoid fibroma were angiographically normal. A great spectrum of angioarchitecture exists in fibrosarcomas, whether they are of bone or soft-tissue origin. Heterogeneous vascularity was seen in 55% of these cases, and was related to the cell composition of the tumor. There exists a close relationship between the number of vessels in a tumor and its degree of clinical and histopathological malignancy. The most vascular part of a tumor is the least differentiated and should be used for biopsies. Angiography can be used for the grading of fibrosarcomas, and probably for assessing clinical prognosis.


Differences in the velocity-displacement relationship of systolic contraction of normal and ischemic canine myocardium.

In the canine model there exist major differences in the velocity-displacement relationships of systolic contraction between normal and ischemic myocardium. These differences are noninvasively measurable in vivo from video recordings of the fluoroscopic image of the heart, and can be detected within the time period of one cardiac cycle. Velocity data is plotted against the corresponding wall displacement on orthogonal axes (phase-space), producing characteristic loops which give an immediate visual indication of myocardial dysfunction.


Sodium nitroprusside in the treatment of ergotism.

Severe peripheral vasoconstriction of the legs due to hypersensitivity to small doses of ergotamine tartrate developed in a patient with migraine headaches. The vasospasm was successfully treated with continuous intra-arterial and intravenous infusion of sodium nitroprusside. The contribution of angiography in the diagnosis and treatment of ergotism is stressed.


Computed tomography of acoustic neuroma.

Review of computed tomographic (CT) scans of 49 consecutive patients with surgically excised acoustic neuromas revealed positive scans in 80% following contrast enhancement, with 20% false negative scans. All tumors over 2 cm in diameter were shown by optimal scans with contrast enhancement. The positive scans were evaluated to determine the accuracy of the size of the lesions as predicted by the scan. A radiological approach to the evaluation of suspected acoustic neuromas is suggested.


An inaccuracy in computed tomography: the energy dependence of CT values.

The CT values of a variety of materials were studied in an EMI and a Syntex head scanner. The presence of bone-simulating rings changed the CT values despite the use of constant length water paths and software corrections. Errors due to beam hardening in CT scanning are discussed. These errors could be of significance, particularly in quantitative studies. The changes in CT values with KV setting of the scanner are used to illustrate their energy dependence and the peculiarities of the scaling system introduced by EMI. The difficulty in specifying a standard scale or unit for CT scanners is discussed.


Factors affecting the use of quantitative information from a CT scanner.

Computed tomography can be used quantitatively in a variety of ways in both diagnosis and therapy. However, the successful use of CT numbers depends on the appreciation of several features of CT scanning, including the diagnostic viewer. It is also possible to employ the quantitative output of a CT scanner to improve the accuracy of isodase curve computations for photon (or electron) beam radiotherapy. A quality-control program is mandatory for anyone wishing to use CT numbers for this purpose.


Long-term results in surgical treatment of cleft lips and palates.

Of a total of 3681 operations for hare lip and cleft palate, 139 patients operated between 1951 and 1975 were compared with the aid of exact measurements of the impressions to ascertain whether early orthodontic treatment had an influence on the growing maxilla. 49% of 200 patients who were followed up had normal speach, 39% had minimal disturbances of articulation, in 12% of the patients the speach was poor. In 13 out of 16 of these patients pharyngoplasty improved the speach.


Hirschsprung's disease--long-term results in non-operated cases.

1. In cases of Hirschsprung's disease with aganglionic segment confined to the rectum, even severe symptoms can subside considerably at some time or other usually before the age of 20. 2. Very slight symptoms may occur in spite of considerable radiological dilatation of the colon. 3. A period--even of several years--with only slight symptoms is no assurance against later aggravation. Severe and even fatal symptoms can suddenly appear.


Imperforate Anus: a five to thirty year follow-up perspective.

A twenty-five year experience with 284 patients with imperforate anus has been reviewed, with a 5 to 30 year assessment after surgical intervention. The following conclusions seem to be suggested by the study: 1. There was a 20% mortality overall, with the greatest number of these occurring in the Type III high lesions. Eighty per cent of the deaths were unrelated to imperforate anus and resulted from associated anomalies. 2. Eighty-eight per cent of the overall series achieved socially acceptable continence. Four out of five poor results occurred in the Type III high lesions. 3. Functional results achieved in imperforate anus surgery seem more closely related to the anatomy presented to the surgeon than by his choice of operative procedure. 4. Continence is more slowly achieved in an imperforate anus patient than in a normal child. It is an evolutionary process which seems to improve with age, being especially influenced by the social motivation that comes with puberty. 5. An appreciable number of patients with poor musculature for continence remain clean by promptly heeding the defection signals, by avoiding laxative foods, and by enforced constipation. 6. Secondary surgery when the levator sling muscles have been missed or partially bypassed seems to improve continence in a high percentage of patients.


Long-term results of simple removal of pigment gallstones in childhood.

Twelve patients with gallstones were operated at Our Lady's Hospital for Sick Children in Dublin from 1960 to 1973. Seven patients were dealt with by cholecystolithotomy and followed up for periods ranging from 18 months to 13 years. All cases were in good health without any evidence of recurrences of calculi. Three cases 11 to 13 years after cholecystolithotomy showed normally functioning gall bladder on cholecystography.


Megacolon: long-term results of surgical treatment.

The 10-year follow-up results for operations for Hirschsprung's disease from 24 pediatric surgical clinics are reviewed. Some of the bad results achieved are probably due mainly to operative technical errors. Many of the problems occured rather early during the follow-up period.


Long-term results in treatment of biliary atresia.

The 10-year follow-up results of operation for biliary atresia from 11 pediatric surgical clinics are evaluated; 638 cases were analyzed. The results for non-correctable biliary atresia before Kasaï's operation were uniformly bad, and even now only a very small percentage of the cases is cured.


The upper urinary tract in neurogenic bladders without diversion---a ten-year follow-up.

Within the first 5 years of life, 50% of children with neurogenic bladders developed subvesical obstruction. Children with neurogenic bladders who did not developed subvesical obstruction (according to group I) up to the age of 5 years are not likely to develop obstruction unit they reach the age of 10 years. Children who do develop such an obstruction before the age of 5 years are possible candidates for urinary diversion.


Late results of chemical oesophageal burns in childhood.

1. Systematic conservative treatment leads to the complete recovery of 75 to 76% of patients with chemical oesophageal burns. The surgeon should be skilled in the techniques and methods of treatment. 2. Recurrences after a sufficiently long treatment by bouginage were observed in 0.6% of all cases. In 22% of cases (the patients came late), a continous control was required. 3. The criteria for operation (not more than 1% of the cases) are as follows: Atresia of the oesophagus, ineffectiveness of skilled conservative treatment, too frequent exacerbations after bouginage. 4. The preferred method of operation is retorsternal prefascial operation employing the right or left sides of the colon. 5. The danger of scarring of the oesophagus and subsequent malignancy is not higher than the risk of completely resecting the damaged oesophagus.


Long-term results in surgical treatment of posterior urethral valves.

In a series of 44 boys operated on for urethral valves more than 10 years ago two died. In the surviving patients, hydronephrosis and hydroureters improved markedly in 4/5, infection disappeared in 3/4, renal function seemed to normalize in more than 1/2. All valves arose from the anterior wall of the prostatic urethra. Consequently, transurethral resections were done anteriorly. Preoperative treatment was restricted to temporary correction of dehydration and acidosis for some hours or a few days. Otherwise, uremia is no contraindication.


Long-term results of ureterosigmoidostomy for ectopia vesicae.

Ureterosigmoidostomy was performed on 31 children with ectopia vesicae between 1941 and 1964. Two of the children died as a result of the operation and 25 of the remaining 29 were followed up in detail. Contrary to what is sometimes believed, the long-term results leave much to be desired, whether a Coffey or a Mathisen technique is used. Only four of the patients are perfectly normal, but here the end result is very good indeed. The remaining patients suffer from moderate to severe complications or are incontinent or both. It is essential that after ureterosigmoidostomy the patients are carefully followed up for the rest of their lives.


Birth fractures of the femur.

Even though we dealt with only a few cases, we can conclude that: 1. The elongation, which is sometimes feared, does not occur. 2. Due to the lack of adequate X-ray techniques, the question of rotary failures in newborn infants cannot be discussed in a satisfactory way. Based on these cases, even though there might be some undetected rotary failures, there is no reason to stop conservative therapy. 3. Even large axial displacements are corrected. The fact that in two cases an antecurvature persisted is interesting, especially if we see that in our cases only axial displacements of more than 30 degrees were not totally corrected. Perhaps one should keep an eye on this form of dislocation in the future.


Fundoplication in hiatal hernia--results after 10 years.

Of the 194 fundoplications for hiatus hernia published by the authors at an earlier date, 66 were done before 1965 and 61 were available for an evaluation of the results after 10 years. Clinical results are good, 58 patients being free of symptoms. Only 3 complained of diarrhea or slight dysphagia. The radiological check up was ideal in 59 cases. 2 patients showed an "en bloc" herniation, but the fundoplication worked still very well as a reflux-preventive mechanism. 40 patients were no'longer able to vomit, a fact that has been suspected by other authors. Only 14 of them resented this as an inconvenience.


Cause of funnel chest recurrences---operative treatment and long-term results.

We found that 2-3 years after operation the result is final. If a partial or total recurrence develops, this will take place within the first 2 to 3 years after operation. Local deformities of the cut ribs or the cartilages will enlarge and bulge the skin during the first 24 months. There is no overgrowth after that time. There is no reason to leave the metal strut in place longer than 1 year. All the cut and resutured ribs have grown together after that time, and there is no interference with the growth of the ribs or the further development of the chest wall. Our recurrences are due to local infections, removing the metal strut too early, i.e. within the first 4 to 5 months after operation, using a metal strut too small, and not resuturing the cut ribs themselves.


Long-term results of pulmonary resections in childhood.

We have found that following lung resection in childhood, one-third of the patients followed-up at least 10 years postoperatively presented mainly minor complaints. Compared with follow-up examinations about 8 years age [4], findings had changed only in two bronchiectasis patients. In both cases a moderate exertion dyspnea had occured. Although pulmonary function tests still showed normal values, the radiologic findings according to residual bronchiectasis had increased. Altogether, pulmonary function tests, however, sometimes show a considerable interference with lung ventilation, which seems to be astonishingly well compensated in childhood. They should not be neglected, however, with regard to strains and physiological changes in later life. Therefore, the indications for pulmonary resection in childhood have to be evaluated very carefully and the extent of the resection should be kept as small as possible.


Long-term results of the surgical treatment for pulmonary malformations and disorders.

Of the 1029 thoracic surgeries carried out since 1950 at the Second and later at the Third Surgical, University Clinic in Budapest on infants, children, and adolescents 215 were cases to correct some developmental anomaly. Pulmonary cysts--both single and multiple--represent the largest number, followed by lung-sequestration, lobar emphysema, and bronchial arterioma. To assess the late results, 106 ex-patients were invited to the clinic for check-up. They had beed operated at least 10 years before; the longest follow-up time was 23 years. Eighty-nine (83.9%) of the 106 patients appeared at the clinic. One pulmonectomized for a polycystic lung (0.9%) died in the meantime; 16 were not available. The 89 patients were submitted to a clinical examination, including radiological examination, spirometry, and ECG. With one exception (Kartagener syndrome), they were found in good condition and free of complaints. They carried on some studies or worked in different jobs. There were no relapses. They developed very satisfactorily no matter whether their operations took place in infancy, childhood or adolescence. The surgical intervention did not affect growth and development. Congenital pulmonary malformations and disorders should be treated by surgery, and the long-term results are better if the operation is performed at the proper time.


Congenital lobar emphysema.

The aetiology of congenital lobar emphysema is not always evident. In the group with demonstrable check-valve mechanism, which allows the air to enter but not to leave the lung, there is either internal stenosis or external compression of the bronchus. When no cause can be found, the condition is called idiopathic, although in some cases alveolar fibrosis has been demonstrated, the check-valve mechanism being in these cases at an alveolar level. In the small group of rare cases of bronchial atresia, air which enters through a collateral ventilation cannot be removed by the same route; in these case too, the check-valve mechanism exists at the alveolar level. Five cases of "congenital lobar emphysema" are presented. One case showed no bronchial anomaly; another case showed an increase in interstitial connective tissue in the lung; tow cases showed hypoplasia or absence of bronchial cartilage; in one case, bronchial atresia was found at operation. Infants show a typical symptomatology of dyspnoea and cyanosis, and a typical chest X-ray with unilateral radiolucency and a delicate lung pattern, collapse of surrounding lung tissue, and mediastinal hernia. In older children, the diagnosis is made either incidently or following a complication. The condition is usually found in the left upper and the right middle lobe. Treatment is surgical and consists of resection of the emphysematous segments.


Posterolateral diaphragmatic hernia--long-term results.

During the years 1965--1974, 125 cases of posterolateral diaphragmatic hernia have been operated at five departments of pediatric surgery in Sweden. The overall operative mortality was 50%. A follow-up investigation included 19 cases, where in 12 cases spirometry and in 11 cases studies of the mobility of the diaphragm were included. Physical examination revealed excellent results in most cases. Lung function studies, however, show a moderate (20--30%) reduction, which is not surprising with regard to lung hypoplasia and impaired movement of the diaphragm on the operated side. In adolescence and younger age, these patients are mostly in excellent condition; but later, when lung function is also reduced by the age factor, their neonatal condition may be of importance.


Oesophageal atresia with distal tracheo-oesophageal fistula--a long-term follow-up.

At the Royal Children's Hospital, Melbourne, 375 patients with oesophageal atresia and/or tracheo-oesophageal fistula have been admitted under the care of one surgical unit and, as with other reported series, there has been a predominance of the type with proximal atresia and distal tracheo-oesophageal fistula. With the object of evaluating the long-term follow-up, a review of the patients seen before 1963 has been made. During the period 1948 - 1962, 132 babies with oesophageal atresia and distal tracheo-oesophageal fistula were treated surgically with 72 survivals. A complete follow-up has been possible in 58 of these patients for periods varying from 13 to 26 years. This follow-up has shown that although oesophageal function is not normal, dysphagia is an early problem, the children are subject to recurrent respiratory infections in the early years of life, there are demonstrable radiological changes and there are demonstrable manometric abnormalities, the end result is, by and large, very satisfactory.


Duodenal atresia--60 years of follow-up (case report).

The first surviving patient with duodenal atresia operated upon by Dr. Ernst Copenhagen has been followed up for 60 years and is perfectly well.


Intestinal anastomosis.

The long-term results of 370 cases of intestinal anastomosis are described. 121 cases were studied in detail. There were 61 duodenal, 43 small intestinal, and 17 colon anastomoses. The follow-up examinations permitted the following conclusions: 1. The long-term results of duodenoduodenostomy and duodenojejunostomy are similar. 2. Resection of a duodenal membrane was often followed by stenosis. 3. End-to-end anastomosis of small intestine and colon give good long-term results, but after side-to-side anastomoses, 24% of the cases will develop a closed loop syndrome.


Late results following to side-to-side anastomosis of the small intestine in infancy and childhood.

1. Malabsorptions and anemia can be used by ulceration or stenosis of the anastomosis, also well known in other anastomotic techniques. 2. Long-term problems are seldom seen in children secondary to side-to-side anastomosis if the technique is satifactory. Blind pouches may result from unsatisfactory technique, or may develop just as in the adult. They may or may not be symptomatic. We surely have to ask whether the blind loop will really grow with the growing child. Nevertheless this study only has historical character because since 1965 we only use end-to-end anastomosis and its modifications with the well known good results.


Long-term results of Swenson's operation for Hirschsprung's disease.

84 of 89 cases were traced 18 to 27 years after Swenson's operation. Seven had long segments. All were alive and in good general health except one who had renal transplant for hypertension due to pyelonephritis in a residual solitary kidney. 61 are married of whom 34 have children. None of the children have Hirshsprung's disease. 48 were fully normal within one year of operation. 29 had constipation enough to require treatment. Seven had diarrhoea which in three required hospitalisation for electrolyte disturbances and dehydration. 39 had some degree of soiling, but in only nine was this troublesome. Recovery of normal bowel control was more rapid in those with a good social background. Eight had postoperative strictures, but treatment has remained successful in the long-term in seven of these. Five patients had inadequate resections and are well after further surgery. Nine had urinary incontinence of which seven had only nocturnal enuresis. All are fully recovered. Two male patients have absence of ejaculation and two females are infertile with scarred Fallopian tubes. 83 of the 84 now have normal bowel control and good health. One has a permanent ileostomy.


13--25 Years follow-up after Swenson's operation for Hirschsprung's Disease.

77 patients with Hirschsprung's disease, operated according to the Swenson procedure in the period from 1949--1960 have been followed up in 1961 and 1975. 6 were dead, all from operative complications (a mortality of 8%). The results in the survivors were assessessed with regard to their bowel function and genito-urinary symptoms. The results in 1961 were 37 good (48%), 25 satisfactory (32%) and 9 poor (11%). In 1975, 8 patients were untraceable (10%), of the remainder 34 were good (44%), 22 satisfactory (29%) and 4 poor (5%), while 3 had been reoperated (4%). Two of the patients in the "poor" group had permanent enterostomy. The detailed assessment seems to indicate that diarrhoea and especially soiling in the first postoperative years are symptoms with a tendency to subside spontaneously. A residual constipation did subside in a few cases, but on a whole was much less likely to do so. In some instances, patients who for a long period had had normal stool passage again developed slight constipation, but only in one case a real recurrence with severe constipation was seen. tthere were no sexual complaints among the patients, and their fertility seemed normal. Only 5 patients had very moderate urinary symptoms, although a somewhat larger proportion of urinary anomalies might have been expected. (At the time of admission, a complete urological survey was not routine in these patients).


The treatment of the hepatorenal syndrome with intra-renal administration of prostaglandin E1.

Three patients with the hepatorenal syndrome were treated with prostaglandin E1 administered through a selective renal arterial catheter. Prostaglandin E1 was given in progressively increasing doses (2 to 100 ng/kg/min) over a 60-minute period. Control plasma prostaglandin E levels were elevated in all three patients, 0.98, 0.91, and 0.83 ng/ml, respectively. At the end of the infusion, plasma prostaglandin E levels had risen to 10.4, 2.63, and 10.3 ng/ml in the three patients respectively. Plasma renin activity increased during the course of the infusion in two of the patients. The plasma aldosterone concentration did not change during the prostaglandin E1 infusion. Intrarenal prostaglandin E1 failed to increase urine volume or urinary sodium concentration in three patients with the hepatorenal syndrome.


The effect of prostaglandins of cultured lapine articular chondrocytes.

The effect of B protaglandins (PG) on growth and sulfate incorportation by monolayer and spinner-cultured rabbit articular chondrocytes has been measured. PGA1, PGB1, PGE1 and PGE2 reduced synthesis of sulfated glycosaminoglycans (GAG) but the PGF series did not. PGA1 was the most potent, being effective at a concentration of 2.5 microng/ml [6.8 micronM] while the others required 25 microng/ml. These compounds had no effect on degradation of GAG. All 8 PGs augmented growth slightly but significantly at 2.5 microng/ml. At the higher concentration, PGA1 was highly cytotoxic, and PGB1 as well as PGE2 reduced cell growth. The cytotoxicity of PGA1 was also observed in two additional types of cultured connective tissue cells, but the inhibition of sulfated-GAG synthesis by PGA1 and PGB1 was confined to the chondrocytes. The response of cultured chondrocytes to exogenous PGs, albeit at apparently unphysiologically high concentrations, together with other evidence, suggests that these compounds may conceivably play a direct role in cartilage metabolism in vivo.


Neurological and electroencephalographic changes in newborns treated with prostaglandins E1 and E2.

Six newborns with obstructive right heart lesions were examined neurologically and electroencephalographically during treatment with prostaglandin (PG) E1 or E2 given to maintain patency of the ductus arteriosus and to increase pulmonary blood flow. PG was administered intravenously or intraarterially in the aortic isthmus proximal to the ductus arteriosus. Besides a rise in arterial oxygen saturation, all patients had some sign of central nervous system involvement. The electroencephalogram showed minor changes suggestive of sedation. In addition, three patients in whom PG  was given intravenously presented various combinations of neurological abnormalities ("myoclonic jerks", apnoeic spells, hiccup) of subcortical origin. Side-effects subsided after stopping the treatment and posed no problem in the management of the patients. These findings confirm the usefulness and safety of the PG therapy and indicate that the intraaortic route of administration is preferable.


Effects of prostaglandin endoperoxide analogs on contractile elements in lung and gastrointestinal tract.

Prostaglandin endoperoxides are formed in the lung as intermediate compounds in the biosynthesis of prostaglandins and thromboxanes. The effects of different doses of two analogs of prostaglandin endoperoxide PGH2 were compared with those of PGF2alpha and PGE2 on superfused preparations of isolated trachea, bronchiole, peripheral lung, pulmonary artery and gastrointestinal smooth-muscle tissues. Endoperoxide analogs induced contraction of all smooth-muscle structures in the lung and airway. Compared to PGF2alpha, analog I was approximately 71 times as potent on guinea-pig trachea, 214 times as potent on guinea-pig lung, and 57 times as potent on guinea-pig pulmonary artery. Analog II was moderately less potent on all tissues than analog I. On gastrointestinal smooth-muscle organs, the PGH2 analogs were generally closer in activity to PGF2alpha and PGE2, or even weaker. The findings show that PG endoperoxide analogs are potent constrictors of airways, lung and pulmonary vessels, and suggest that the naturally occurring compounds may participate in the mediation of bronchoconstriction and pulmonary vasoconstriction in disease states.


The role of prostaglandins in the excitatory innervation of the rat urinary bladder.

The possible role of PGs in hyoscine-resistant nerve mediated responses of the rat urinary bladder was investigated. Responses to electrical stimulation were inhibited by cinchocaine (30 micronmol/1) but were only partially inhibited by a high concentration of hyoscine (25 micronmol/1) or by the choline uptake inhibitors, hemicholinium-3 (500 micronmol/1) and troxypyrrolidinium (500 micronmol/1). Indomethacin (50 micronmol/1) produced partial blockade (30%) of responses to electrical stimulation without markedly affecting responses to acetylcholine and the degree of blockade was of a similar order in the presence of hyoscine or troxypyrrolidinium. PGE2 (0.028 -2.8 micronmol/1) or F2alpha (0.029 -2.9 micronmol/1) produced a slowly developing increase in tone and spontaneous activity. Responses to electrical stimulation were at most only slightly increased in the presence of either PG. However, the PGs always increased the responses to electrical stimulation after indomethacin, indomethacin plus hyoscine or indomethacin plus troxypyrrolidinium. Responses to acetylcholine in the presence of indomethacin were not increased by PGE2. It is concluded that PGE2 and F2alpha do not function is transmitters responsible for resistance to anti-muscarinic drugs in the bladder but may exert a modulating effect on nervous transmission.


The pharmacology of prostaglandin-like substances released from guinea-pig lungs during anaphylaxis.

The pharmacology of the prostaglandins (PGs) and thromboxanes (Txs) released from immunologically challenged guinea-pig lungs is related to their roles in the anaphylactic response. 6-oxo-PGF1alpha probably contibutes substantially to bronchoconstriction during anaphylaxis. TxB2 may contribute to the anaphylactic response by increasing SRA-A release and by stimulating leucotaxis. The 15-oxo metabolites of PGE2 and PGF2alpha are rather weak spasmogens, but might modify respiratory muscle contractions and pulmonary vascular resistance. The 15-oxo 13,14 dihydro metabolites of PGE2 PGF2alpha and TxB2 were inactive in the systems studied, suggesting an important inactivating role for the 13:14 reductase enzyme.


The effects of prostaglandin F2alpha on sperm output in boars.

The effect of prostaglandin F2alpha (PGF2alpha) on the sperm output of six boars was investigated in two studies. Although PGF2alpha did not significantly affect sperm numbers in the ejaculate, a significantly longer (P less than 0.05) ejaculation of the sperm rich fraction occurred following injection of PGF2alpha. In the second study it was found that PGF2alpha produced a 49% increase (P less than 0.05) in the number of sperm in the sperm rich fraction of the ejaculate. The implications of these results on artificial breeding are discussed.


Prostaglandin E2 (PGE2)-induced growth hormone (GH) release: effect of intrahypothalamic and intrapituitary implants.

Ovariectomized rats were unilaterally implanted with a 23-gauge stainless steel cannula in different hypothalamic areas or in the pituitary gland and subsequently were treated with estrogen (sc, 10 micron g estradiol benzoate, Eb). Two days after the estrogen injection, an inner cannula containing PGE2 or PGF2alpha at its tip was inserted into the cannula. Other animals were implanted with an empty inner cannula. Plasma GH concentrations were measured by RIA in blood samples drawn from the jugular vein while the animals were lightly etherized before (-2) and at 20, 40, 60 and 120 min following the implantation. Plasma GH levels in control animals bearing an empty cannula in the body of the arcuate nucleus-median eminence region (BARH-ME) were significantly depressed by the ether stress. The implantation of PGF2alpha in this area was completely ineffective in preventing ether stress-induced decline in plasma GH. By contrast, PGE2 implanted in BARH-ME or the post-chiasmatic region of the hypothalamus (HARH-ME) elevated plasma GH 20 min following its implantation and partially prevented the subsequent decrease in GH levels induced by ether stress. PGE2 implants located in several other hypothalamic areas failed to induce GH release or to prevent the decline in GH levels induced by ether stress. However, PGE2 implanted in the pituitary gland elicited a marked increase in plasma GH at 20 min and completely prevented the subsequent ether stress-induced decline in GH levels. The results suggest that PGE2 can act at both hypothalamic (ARH-ME) and pituitary levels to stimulate GH release. At the hypothalamus, PGE2 may inhibit GH-inhibiting factor (GIF) release or induce release of GH releasing factor (GHRF).


Effect of indomethacin on estrogen-induced luteolysis in the ewe.

Three groups of 6 ewes were laparotomized on day 9 of an estrous cycle (estrus = day 0) and the corporà lutea (CL) were marked with India ink. Indwelling cannulae were inserted into the uterine horn adjacent to the CL in groups 2 and 3. Group 1 was injected intramuscularly (i.m.) with corn oil twice daily on day 9. Group 2 received 750 microng 17beta-estradiol (E2) i.m. twice daily on day 9 plus intrauterine injections of indomethacin (INDO) vehicle on days 9 through 13. Group 3 received in the same estrogen treatment plus the injection of 20 mg INDO twice daily on days 9 through 13. Jugular venous samples were taken once daily on days 9 through 14 for progesterone analysis. At re-laparotmy on day 14, the ovaries were examined for new ovulations, and the ovary bearing the marked CL was removed. Results showed that E2 induced premature luteal regression as indicated by decreased CL weights and plasma progesterone levels. INDO when given in conjunction with E2 effectively blocked the luteolytic action of E2. These results suggest that the luteolytic action of E2 is mediated via increased prostaglandin secretion and release from the uterus.


The effects of ovariectomy and stretch on the regulatory profile and activity of the uterus.

Following ovariectomy of five New Zealand white rabbits at day 25 of pregnancy, the intrauterine pressure (IUP) and uterine progesterone (P) and prostaglandin (PG) levels were measured sequentially at days 25, 26 and 27. At day 25, when the uterine P and PGE and PGF were high, massive intrauterine treatment with 500 microng PGF2alpha provoked only a sustained contracture on which only low level oscillation in IUP was superimposed. At day 26, when the P levels had decreased significantly (P less than 0.001) and the PG levels had not changed significantly, 50 microng PGF2alpha significantly increased cyclic IUP as compared with the day 25 value (P less than 0.001). At day 27, when the P levels decreased further, as little as 5 microng PGF2alpha provoked still higher cyclic IUP, in spite of a significant reduction in PG levels (P less than o.05). Stretching the uterus of six post partum and six 26 days pregnant rabbits (after removing the uterine contents) significantly increased the uterine PGF levels (P less than o.001). However, stretch increased only cyclic IUP of the post partum uterus and was without effect on the pregnant uterus, which still had high P levels. These results indicate that the myometrium is activated by exogenous PG or stretch, regardless of whether the uterine PG levels increase, remain unchanged or even moderately decrease, provided that the uterine P levels are reduced to a critical value.


The kinetics of extraamniotically injected prostaglandins to induce midtrimester abortion.

In an attempt to improve the extraamniotic administration of prostaglandins in effecting abortion, the movement of injected prostaglandins in a high or low viscosity medium has been observed by radiological studies and radioimmunoassy of PGE and PGFalpha in amniotic fluid and maternal plasma in association with intrauterine tocographic responses. Results obtained suggest that the immediate response by the uterus is a reflection of the speed of absorption of prostaglandins from the chorio-decidual space and that this influences the outcome in inducing abortion within 24 hours. By giving the prostaglandins in a viscous medium a slower release of prostaglandins was produced in most cases, which probably accounts for the greater efficacy obtained using single injections of prostaglandins in this vehicle compared with normal saline.


Second trimester abortion: single dose intra-amniotic injection of prostaglandin F2alpha with intravenous oxytocin augmentation.

One hundred-sixty mid-trimester pregnancies were terminated by intra-amniotic injection of Prostaglandin F2alpha with concomitant intravenous oxytocin. Only four of 77 nulliparas and one of 83 multiparas required a second prostaglandin injection. Mean injection-abortion interval was 22.8 hours, and 17.0 hours respectively. This difference between groups was statistically significant. Four nulliparas sustained uterine trauma, a high incidence suggesting that this method may be ill-advised in these women. Because of the predictable short injection-abortion interval in the multipara, this method can be combined conveniently with surgical sterilization.


Arachidonate-induced thrombosis in mice: effects of gender or testosterone and estradiol administration.

Sodium arachidonate (i.v.) has previously been shown to induce pulmonary emboli formation and a dose dependent cyanosis and respiratory depression in mice. Subsequently, we found that male mice are significantly more sensitive to arachidonate than females. Aspirin given orally 2 hours prior to arachidonate administration inhibits the responses of both males and females. Pretreatment with depo-testosterone markedly increases the effect of arachidonate in both males and females and depo-estradiol pretreatment reduces the responses in all mice. This exacerbation by testosterone of the arachidonate response and the attenuating effects of estradiol is consistent with data reported using other thrombogenic techniques.