Efficacy of preoperative and postoperative bone scanning in the management of breast carcinoma.

With use of 99mtechnetium-labeled phosphates, we performed preoperative bone scans on 122 women with biopsy-proved breast carcinoma. Only two of the 110 patients with Stage I or II disease had scan abnormalities interpreted as bone metastases. Of 55 patients with normal preoperative scans, 20 later had changes suggesting bone metastases on the subsequent scans, most within 24 months of operation. In women with Stage I and II tumors, 13 of 48 (27 per cent) had scan evidence of bone metastasis of postoperative follow-up examination. Five of 23 with potential surgical cures (negative lymph nodes at operation) had bone metastasis within two years of operation. In Stage I and II patients, postoperative discovery of evolving metastases was most often (11 to 13) made by bone scan. Although the initial yield from preoperative bone scans is low, preoperative scanning combined with sequential postoperative scans constitutes one of the most sensitive indicators of evolving metastatic disease.


Autonomy for burned patients when survival is unprecedented.

Altered states of consciousness often exclude the seriously burned patient from decision making in his own case. During the first few hours of hospitalization, however, even the most severely burned patient is usually alert and mentally competent. When burns are so severe that survival is unprecedented, we use an aggressive approach to decision making to preserve patient autonomy. While still lucid, and with sufficient information, the patient is asked if he wishes to choose between a full therapeutic regimen or ordinary care, reassured that with either choice, the burn team will provide the constant presence of human caring and full use of its professional skills. This approach has not changed the mortality rate of such patients, but has increased both the self-determination that they exercise and the empathy that they receive.


Healing of duodenal ulcer with an antacid regimen.

To determine whether a large-dose antacid regimen is effective in promoting healing of duodenal ulcer, 74 patients with endoscopically proved duodenal ulcer completed a 28-day double-blind clinical trial comparing such a regimen with an inert placebo. The ulcer healed completely in 28 of the 36 antacid-treated as compared to 17 of the 38 placebo-treated patients (P less than 0.005). The antacid regimen was not more effective than placebo in relieving ulcer symptoms. Presence or absence of symptoms during the fourth treatment week was a poor predictor of presence or absence of an ulcer crater. Ulcers of placebo-treated patients who smoked cigarettes were less likely to heal than those of nonsmokers (P = 0.03). Except for mild diarrhea, no side effects of the antacid regimen were observed. We conclude that a large-dose antacid regimen hastens the healing of duodenal ulcer.


Questionable relation of aryl hydrocarbon hydroxylase to lung-cancer risk.

To test whether the genetically determined trait, aryl hydrocarbon hydroxylase inducibility, affects susceptibility to lung cancer, we measured this trait in cultured lymphocytes from a normal population, patients with lung cancer and progeny of such patients. We found very low aryl hydrocarbon hydroxylase activity (19 per cent of normal) in about half the patients with lung cancer. Only part of this activity can be accounted for by reduced cell growth and by reduced protein synthesis. In an indirect assessment of inducibility, both 57 progeny and 27 matched controls had a mean inducibility of 2.95 and a similar distribution into low, intermediate and high groups (chi-square = 0.3 P = 0.9). No differences in basal or induced activity were observed. Thus, if patients with lung cancer possess altered aryl hydrocarbon hydroxylase inducibility or activity these characteristics are not transmitted to their progeny.


Partial androgen insensitivity: the Reifenstein syndrome revisited.

We investigated eight patients with the Reifenstein syndrome to define the hormonal basis for this condition. The patients had normal or elevated concentrations of plasma androgens, normal production rates of testosterone and dihydrotestosterone, elevated serum levels of luteinizing hormone and normal 5alpha-reductase activity in skin fibroblasts. These findings indicate that the syndrome results from defective androgen action rather than from decreased androgen synthesis. The term "partial androgen insensitivity syndrome" describes this condition more accurately than a term based on clinical phenotype. Dihydrotestosterone binding studies in skin fibroblasts demonstrated two genetic variants similar to those reported in complete androgen insensitivity syndrome. One patient had a partial deficiency of cytoplasmic dihydrotestosterone binding, and four others had normal binding activity. The cause of the androgen insensitivity in the last four cases is unknown. Treatment with testosterone suppressed serum luteinizing hormone levels and promoted mild virilizing effects.


An evaluation of early or delayed adjuvant chemotherapy in premenopausal patients with advanced breast cancer undergoing oophorectomy.

We treated randomly 75 premenopausal patients with advanced breast cancer with combination chemotherapy (5-fluorouracil, cyclophosphamide and prednisone), either as an early adjunct to oophorectomy or as a delayed treatment upon appearance of progressive metastatic disease after operation. The group receiving early systemic chemotherapy enjoyed an improved response rate, an improved survival rate and, most importantly, an improved progression-free interval (median of 53 versus 17 weeks). With the exclusion of the group with early (within three weeks after oophorectomy) progression, the progression-free intervals had a median duration of 77 weeks in the early-treatment group versus 33 weeks in the control group. The early-progression group did exceedingly poorly, although systemic chemotherapy was employed at that juncture, having a median survival of 22 weeks as compared to 144 weeks in the immediate-treatment group and 105 weeks in the control group.


Elective surgical rates--do high rates mean lower standards? Tonsillectomy and adenoidectomy in Manitoba.

We used claims data from the Canadian province of Manitoba to test alternative explanations for regional differences in tonsillectomy and adenoidectomy rates. Respiratory morbidity, standards of selection for operation, and surgical resources were compared with elective surgical rates across geographic areas. Statistically significant correlations were not found. Individual practice patterns were then examined. In some regions, a few physicians accounted for the great majority of tonsil/adenoid operations. In other regions, the work was much more widely distributed. Despite great variation among individual physicians in the frequency of performing tonsil/adenoid operations and the standards of selection for operation, use of these procedures and standards applied were only weakly related to such variables as physician age, place of training and specialty.


Biochemical studies on Egyptian buffalo meat Part 1. Determination of phosphorus, calcium and magnesium.

The effect of age, sex, season and cut on the phosphorus, calcium and magnesium contents of buffalo meat was studied in 128 samples. Statistical analysis for the data showed significant difference to 0.01 level for phosphorus in relation to sex and in dry season in relation to sex. There is also significant difference for both calcium and magnesium in relation to season and also in case of both male and female in relation to season. At 0.05 level, phosphorus shows a significant difference in green season in relation to sex and at 0.1 level in relation to season.


Biochemical studied on Egyptian buffalo meat. Part 2. Determination of iron, zinc and copper.

A total of 128 samples of Egyptian buffalo meat were collected from animals differing in age, sex, season and cuts. Their samples were analysed for iron, zinc and copper contents. Statistical analysis of the data obtained shows, that zinc and copper differ significantly at 0.01 level in relation to cut variation. In case of female, they differ also at the same level in relation to season. Zinc differes significantly at 0.01 level seasonally and in male in relation to season. On the other hand copper differs significantly at 0.05 level for green season in relation to sex. Iron and copper show significant differences at 0.1 level due to sex and in dry season in  relation to sex, respectively.


Biochemical studies on Egyptian buffalo meat. Part 3. Determination of sodium, potassium and chloride.

Sodium, potassium and chloride contents fo buffalo meat were studied in 128 samples. Statistical analysis for the data obtained show significant difference at 0.01 level for sodium, potassium, and chloride in relation to season, and in female in relation to season. Sodium and potassium differs significantly at 0.01 level in male animals in relation to season, and chloride differs at this level due to green season in relation to sex. At 0.05 level sodium shows a significant difference in cut while chloride shows a variation at this level due to dry season in relation to sex.


Gamma-irradiation and storage effects on some chemical aspects of carrots.

Studies on chemical changes induced by gamma-irradiation at optimum dose of 75 krad in carrots were undertaken. Sugars, nitrogen, free amino acids, amino acids of alcohol insoluble solids, and pectin fractions were determined. The results indicate that the postharvest irradiation of carrots does not dramatically affect their chemical composition during storage. However, it was observed that storage time affected significantly the biochemical changes occurring in the constituents of carrots exposed to gamma-irradiation.


[Thin-layer chromatographic determination of chlordimeform in cucumbers and apples].

The author describes two methods for the thin-layer chromatographic determination of chlordimeform residues in cucumbers and apples. Chlordimeform is determined alone or together with its relevant metabolites after conversion into 4-chloro-o-toluidine. The limit of detection is 0.1 and 0.05 p.p.m., respectively. The rate of recovery is 76-85 and 90-105%, respectively. Studies on the stability of the residues and on the metabolism and distribution of chlordimeform in cucumbers are discussed.


[Gas-chromatographic determination of insecticidal chlorinated hydrocarbons using the GCHF 18.3-6 gas chromatograph with an attached electron detector].

The authors describe the gas chromatographic determination of residues of insecticidal chlorinated hydrocarbons in foods by means of the GCHF 18.3-6 gas chromatograph with electron attachment detector of the VEB Chromatron Berlin which is most frequently available in the GDR for routine work. Furthermore, the authors deal with possibilities of identifying and confirming residues of chlorinated hydrocarbons with the aid of chemical reactions.


Studies on sodium ion retention and antidiuretic effects after administration of L-tryptophan to rats.

Under certain conditions the i.p. injection of L-tryptophan leads to a reduction of elimination of Na+. At the same time, the fractional Na+ -reabsorption increases. No increase in the absolute tubular sodium transport rate was observed since the significantly reduced plasma-sodium concentration leads to a decreased sodium load. The most probable cause of a decreased plasma-sodium concentration seems to be a retention of sodium-free water under the chosen conditions of infusion. The water retention is compatible with the antidiuretic effect of 5-hydroxytryptamine.


The effects of an inhibitor of phenylethanolamine N-methyltransferase upon stimulated adrenal catecholamine release and excretion in the rat.

SK&F 64139, an inhibitor of adrenal phenylethanolamine N-methyltransferase (PNMT), was found to significantly decrease 2-deoxy-D-glucose (2-DG) induced epinephrine excretion in the conscious rat under conditions where the former agent was administered chromically at 50 and 200 mg/kg/day over a 12-day period and 2-DG was administered after 3, 7 and 11 days of treatment. The reduced epinephrine output caused by SK&F 64139 in response to 2-DG was accompanied by an increased norepinephrine excretion pattern at 200 mg/kg/day of the compound. The reductions in epinephrine excretion were also associated with significant decreases in adrenal epinephrine and increases in the norepinephrine content.


Effect of atropine and acetylcholine on nerve stimulated output of noradrenaline and dopamine-beta-hydroxylase from isolated rabbit and guinea pig hearts.

The role of a cholinergic muscarinic inhibitory mechanism in sympathetic neurotransmission was investigated in isolated rabbit and guinea pig hearts with intact sympathetic nerves. The effect of varying frequencies of stimulation (2.5, 5 and 10 Hz) on the concentration of noradrenaline (NA) and dopamine-beta-hydroxylase (DBH) released into the perfusate was investigated. Stimulation in the presence of atropine sulfate (3.4 micrometer) resulted in an augmented outflow of NA at all three frequencies while DBH outflow was significantly incrreased only at 5 and 10 Hz. d-Tubocurarine (2.0 micrometer) attenuated the augmenting effect of atropine on NA release at all frequencies of stimulation whereas it negated the significant effect of atropine on DBH release. Nerve stimulation in the presence of acetylcholine (0.55 micrometer) resulted in a significant decrease in the concentrations of NA and DBH in the perfusate. It is suggested that atropine augments NA outflow in part by blocking an "intrinsic" muscarinic inhibitory mechanism. Acetylcholine's inhibitory effect on NA release is reflected in a similar decrease in DBH release and, therefore, may function in vivo via an effect on exocytosis at the adrenergic nerve ending.


Increased incorporation of fatty acids into phospholipids of lungs and livers of rabbits under the influence of bromhexine and ambroxol.

The incorporation of lauric acid, palmitic acid and oleic acid into phospholipids of lung and liver has been studied in tissue slices of control rabbits and of rabbits treated with bromhexine or ambroxol in doses of 10 mg/kg. A marked increase (up to 200% of the controls) of palmitic acid incorporation into phosphatidylcholine (lecithin) and phosphatidylethanolamine of the lung was found whereas the incorporation rate of palmitic acid into lecithin and phosphatidylethanolamine of the liver displayed no significant change. The incorporation of lauric acid and oleic acid into lung phospholipids was not accelerated. The observed effects were more marked in short time experiments (analysis 2 h after drug injection) than after treatements for 7 days. It is concluded that the phospholipid synthesis is stimulated by the drugs especially in the lungs. This seems to be of particular interest with respect to the surfactant system of the lung and might have some therapeutic relevance.


Mechanism of the enrichment of phosphatidylcholine in liver accompanying enzyme induction by phenobarbital.

The mechanism of the increase of phosphatidylcholine in liver, accompanying enzyme induction by phenobarbital, has been studied in rats. Using radioactively labeled precursors, the two main pathways of phosphatidylcholine biosynthesis--the CDP-choline pathway and the methylation of phosphatidylethanolamine--were analyzed after pretreatment with 4 doses of phenobarbital (80 mg/kg) on 3 consecutive days. After i.v. injection of choline [Me-3H], choline [Me-14C] or NaH2[32P]O4 the specific radioactivity (sp. act.) of phosphatidylcholine (dpm/nmol) was decreased by 60%, and after methionine [Me-3H] or ethanolamine [1.2-14C] by 40% compared to control rats. These changes are partly due to the increased concentration of phosphatidylcholine and phosphatidylethanolamine, causing the incorporated precursors to dilute, and partly to a secondary effect which leads to a reduction of the sp. act. of free choline in pretreated animals. The concentration of glycerylphosphorylcholine, one of the metabolites of phosphatidylcholine catabolism, was also diminished by almost 50%. From these results it may be concluded that the increase of phosphatidylcholine is due to a retardation of its breakdown rather than to an increase of its synthesis.


Treatment of urinary-tract infection with a single dose of amoxycillin.

31 patients with a urinary infection were treated with a single oral dose (3 g for adults and 100 mg/kg for children) of amoxycillin; 23 (74%) were cured. 20 women and 26 children were then randomly allocated to either a single dose of amoxycillin of a 5- to 7-day conventional course of the same antibiotic. The results of both treatment regimens were comparable. Single-dose therapy for the treatment of urinary-tract infections was simple, effective and well tolerated. Patients preferred taking their treatment in this manner. Failure of single-dose therapy to eradicate bacteriuria may indicate which patients require subsequent investigations of their urinary tract.


Hyperchloremia associated with membranoproliferative glomerulonephritis.

16 patients with membranoproliferative glomerulonephritis had a mean serum chloride level significantly higher than that in normal subjects or in comparable groups of patients with nephrotic syndrome secondary to either systemic lupus erythematosus or to other primary nephrotic glomerular diseases. Differences in the severity of histologic alterations of the renal interstitium did not correlate with the different levels of serum chloride seen in these groups. The increased chloride concentration may be partially explained as a compensating reaction for a decrease in protein anions. However, a renal tubular acidifying defect demonstrated in one of our patients may also contribute to the hyperchloremia in some cases.


Renal hemodynamics in HgCl2-induced acute renal failure.

Renal blood flow (RBF), outer cortical blood flow (OC-rbf) and inner cortical blood flow were determined by the microsphere method in water-drinking rats and chronic saline-drinking rats at 3, 12 and 24 h after injection of HgCl2, 4.7 mg/kh body weight. RFB and OC-rbf were decreased in both groups at 3 h post HgCl2 injection. Persistent reduction of OC-rbf was noted in water-drinking rats at 12 and 24 h post HgCl2 even though the total RBF returned to normal by 24 h. These parameters were normal in chronic saline-drinking rats. Despite normal RBF in water-drinking and saline-drinking rats, serum creatinines were still signigicantly elevated 24 h post HgCl2. Therefore, alterations in total renal perfusion do not entirely account for the decreased renal function that occurs under these circumstances.


Failure of sodium restriction to abolish exaggerated natriuresis in poststreptococcal glomerulonephritis.

Exaggerated natriuresis in response to hypertonic saline infusion occurs with great regularity in patients with documented previous attacks of poststreptococcal glomerulonephritis. Five patients were studied before and after 1 week of dietary sodium restriction in order to examine the possibility that increased extracellular fluid volume might play a role in the response to acute saline infusion. Plasma renin activity (PRA) and PRA responsiveness to sodium depletion were normal, suggesting that extracellular fluid volume was not increased. In all patients, extracellular fluid volume decreased during sodium restriction, as judged by weight loss, cumulative negative sodium balance, small decreases in measured plasma volume, and appropriate increases of PRA and plasma aldosterone concentration. Hypertonic saline infusion provoked exaggerated natriuresis in all patients equally as well after dietary sodium restriction as before. Exaggerated natriuresis in poststreptococcal glomerulonephritis occurs without evidence of chronic expansion of extracellular fluid volume and is not affected by reduction of extracellular fluid volume.


Sequential clearance and dialysance measurements in chronic peritoneal dialysis patients.

The long-term efficiency of chronic peritoneal dialysis was investigated during a 10-months follow-up period in eight patients with indwelling Tenckhoff catheters by determining sequential urea, creatine and glucose clearances. Dialysis was performed in the hospital with nurses changing commercially prepared 2-liter dialysate bottles. Mean +/- SE urea clearance declined from an initial valua of 23.6 +/- 1.5 ml/min to 17.7 +/- 1.2 at the termination of the study. The mean glucose and creatinine clearance also decreased from 14.1 +/- 0.9 to 10.2 +/- 0.7 and from 17.5 +/- 1.9 to 12.9 +/- 1.0, respectively. All of these decreases were statistically significant (p less than 0.05) by paired t testing analysis. It is concluded that the efficiency of chronic peritoneal dialysis may decline during maintenance therapy and that sequential clearance measurements should be obtained in all chronic peritoneal dialysis patients.


Effect of dialysis on hearing acuity.

In order to determine the effect of dialysis on hearing acuity, 20 patients on chronic maintenance hemodialysis or peritoneal were followed with hearing examinations every 6 months over a follow-up period of 1-4 years. While 70% of the study group had some measureable hearing loss at the beginning of the study, 75% of the patients showed no deterioration of hearing loss during the follow-up period. It is suggested that hearing deficits in chronic renal failure are common and multifactorial in etiology, and that most patients undergoing chronic dialysis show no further deterioration in hearing acuity.


Peritoneal dialysis: a temporizing means for hemodialysis patients with subdural hematomas.

Subdural hematoma has a higher mortality rate with hemodialysis patients than the normal population. One reason for this is the coagulation abnormalities of hemodialyzed patients. One case of a successfully treated subdural hematoma in a chronic peritoneal dialysis patient is presented. Changing the mode of dialysis from hemodialysis to peritoneal dialysis in a patient suspected of having a subdural hematoma may be beneficial in improving overally survival.


[Evaluation of different treatment in minimal brain damage].

In 78 children (5-13 years old) with minimal brain dysfunction, a comparative trial was carried out in order to evaluate three different treatment plans: carbamazepine alone, carbamazepine plus psychotherapy and psychotherapy alone. The improvement obtained in children who received carbamazepine (alone or with psychoterapy) was greater than that of patients treated with psychotherapy only. The difference was highly statistically significant (p=0.01). Carbamazepine was well tolerated. This trial has shown that carbamazepine is a useful aid in the treatment of behavioral and learning disorders occurring in children with minimal brain dysfunction.


[Neurophysiological bases of hypnosis].

A neurophysiological hypothesis for hypnosis is suggested. Frequently, a hypnotic state is considered close to sleep. Experiments show that it closer to wakefulness, that attention is present and, at times, increased. Physiological changes under hypnosis, changes in suggestibility, conditionability, memory, visceral and endocrine changes, are outlined. Four large neuronal groups with diverse functions are described: wakefulness system, sleep system, that of conscious experience and the executive system; these last two, localized in the midbrain, pons and medulla, are considered the structural basis for the hypnotic state which arises from their increased or decreased functions. In the hypnotic state, through functional variations in these groups, modifications are seen in the spinal chord, in afferent fibers such as the optic ribbon and in complicated cortical functions such as memory.


Endocystography in cystic neurilemmoma.

During myelographic evaluation for a suspected herniated disc, a cystic neurilemmoma in the lower lumbar region was inadvertently punctured and a contrast study of the interior of the lesion resulted. The possibility of puncture of a cystic mass should be considered in the differential diagnosis when a complete block is encountered above and below the site of needle puncutre, and particularly when the contrast column demonstrates a relatively smooth biconcave appearance.


Unrecognized atypical tuberous sclerosis diagnosed with CT.

Past experience in this hospital has shown that the neuroradiological diagnosis of tuberous sclerosis is often made before the diagnosis is clinically suspected. We present a child in such a circumstance in whom axial and coronal CT demonstrated significant neoplastic progression of this disease. The presenting symptom was merely that of increased intracranial pressure.


Spinal epidural angiomatous malformations draining into intrathecal veins.

Nine angiomatous malformations situated on the outer surface of the dura and one situated in the pelvis, from which draining veins pierced the dura and joined the coronal venous plexus are described. The clinical manifestations and myelographic appearances are similar to those of the majority of intradural angiomatous malformations. This suggests that neurological deficiences with both types of malformation are usually due to raised venous pressure with secondary ischaemic hypoxia.


Constancy of convexity air block on pneumoencephalography.

Twenty-two patients with dementia were examined by pneumoencephalography using special technic with the aim of filling the subarachnoid convexity space. Seven had no obvious hydrocephalus. All patients had convexity blocks which were more or less extensive. Ten had bilateral air block in the frontal, parietal and occipital regions. It was concluded that convexity air block is not a technical artifact and consequently seems to have an organic background.


Cardiovascular reactions to myelography with watersoluble contrast media.

Arterial blood pressure and heart rate were recorded for 5 to 7 h during myelography with iothalamate meglumine and metrizamide in 23 rabbits. After 0.6 ml iothalamate meglumine containing 280 mg I/ml a significant decrease in blood pressure and signs of circulatory failure were found. After identical doses of metrizamide and after reduction of the dose of iothalamate meglumine to 0.4 ml containing 140 mg I/ml no significant fall in blood pressure was recorded. A decrease of blood pressure was always accompanied by a decrease of heart rate. Arterial blood pressure and heart rate during experimental myelography are suggested as useful variables in the evaluation and comparison of new contrast media for myelography.


Arterial and venous signs of tumors within the fourth ventricle.

A positive diagnosis of tumors located within the fourth ventricle should be based on specific signs therby excluding other space occupying lesions in the posterior fossa. These are a typical omega form of the hemispheric cerebellar branches on the lateral projection, and an also typical inverted 3 form of the PICA in the semiaxial projection. Alteration of the veins of the lateral recess of the fourth ventricle and of the precentral cerebellar vein are important venous signs. Indirect signs are found in the absence of tonsillar herniation with arterial and venous signs of AP stretching of the cerebellar tonsils.


The anatomy of the inferolateral trunk (ILT) of the internal carotid artery.

The authors of the paper present the results of 20 anatomical dissections of the cavernous sinus area, correlated to 90 angiographies and to basic embryological knowledge; they emphasize the role played by the inferolateral trunk in the arterial blood supply of the cavernous area and its complex and the value of the internal maxillary angiogram for its visualization.


Angiography before and after radiotherapy for a thalamic tumor.

A patient with a thalamic tumor received radiotherapy. A right cerebral angiogram seven days after the irradiation was finished revealed increased vascularity, early filled deep cerebral veins and signs of increased mass. A subsequent angiogram showed gradual regression of these features. There is no literature on angiographic progression with early venous filling following radiotherapy.


The malpractice controversy and the quality of patient care.

The widespread doctor strikes of 1975 stimulated belated attention to a crisis in malpractice insurance. Most state legislatures responded only to a shadow crisis in insurance as they rallied to the defense of health care providers. The smouldering substantive crisis--the reality of malpractice--is now galvanizing institutions and professions into aggressive activities for quality assurance and renewal of trust between patient and doctor. New procedural experiments offer prospects for preserving economy and equity by containing the causes of malpractice suits within the health care system itself.


[Current acquisitions on the treatment of pseudocysts of the pancreas].

Modern views concerning the surgical treatment of pseudocysts of the pancreas are presented. The patient's general condition, the presence of complications, the features and site of the pseudocysts, and the state of "maturation of the wall" will determine the steps to be taken in any given case. The different of operation employed are described, together with their indications and contraindications, possible complications and results.


[Proximal selective vagotomy. Statistical review approximately 200 cases of selective vagotomy. Preventive note].

Gastric resection for the correction of duodenal hyperacidity in patients suffering from duodenal ulcer has always seemed out of proportion to the objective which is simply that of the clinical and anatomopathological cure of a small lesion. Vagotomy, particularly proximal selective v. offers the surgeon a rational approach to duodenal ulcer. This is also seen in the series of the F. Ponti Surgery Division of the Ca' Granda General Hospital of Milan.


[Case reports of emergency exeresis for intractable pulmonary hemorrhages].

Five cases of surgically treated unrestrainable pulmonary haemorrhage are described. The satisfactory results obtained show that pulmonary exeresis, in some cases of haemorrhages, is the only effective method for saving the patient's life and removing the anatomic cause of the haemorrhage.


[Stenosis of the left angle of the colon caused by chronic pancreatitis].

Case of stenosis of the left flexure of the colon caused by pancreatitis is reported. The relevant literature is surveyed and an account is given of the pathogenesis of this forms, and the examinations required in its diagnosis, particularly coloscopy. A preference is expressed for an internal colic derivation (colon-colon anastomosis) rather than resection, on account of the smaller degree of risk involved.


[Hepatorenal syndrome].

The term "hepatorenal syndrome" is used to bring together a variety of syndromes whose common feature is liver and kidney parenchymal distress. For this reason, its use has been questioned by many workers. A subdivision into acute and chronic forms is proposed and emphasis is placed on the common physiopathogenetic processes, together with the notable importance of DIC. This approach is supported by reference to a series of 36 chronic and 6 acute cases.


[Anatomo-surgical assumptions in typical hepatic resections].

The synthetic resin moulds of the human normal livers permit the schematization of the distribution and the disposition of the vascular elements of the hepatic tree. The authors have described all the segments and sectors of the ilus in their modal disposition that are important from the point of view of the operation. Beside that, they have pointed out the presence of anastomosis, at the level of the ilaris plate and the existence of anastomotical ramifications between the right and left sectors, and the close dependence of each sector from his own vascular ilus. The authors emphasize the importance of this observation from the surgical point of view.


[Jaundice caused by estro-progestinic agents. Description of a case].

A case of oestroprogestinic icterus is reported. The potential toxicity of these drugs, which have now been in use for twenty years in medical and non-medical practice, on liver parenchyma is discussed. Such treatment should be carried out only under the attentive, constant control of a physician who should not neglect liver function in his examination.


[Indications for permanent cardiac pacemaking].

Technical improvements have considerably extended the indications for the implantation of pacemakers. Nearly all forms of bradyarrhythmia and some forms of tachycardia, including sinus node disease, have gradually been added alongside stable A-V blocks, while preventive implantation is now commonly indicated in asymptomatic forms and bradycardia due to drugs. The recent appearance of rapid-pulse and scanning pacemakers has further extended their indication to cover other forms of ectopic and reciprocating tachycardia.


[Permanent endocardiac electrostimulation. Considerations on 511 implantations and reimplantations in 7 years of practice].

Permanent pacemakers were implanted and reimplanted in a total of 511 patients (mostly men) during a period of about 7 yr. Mean age was 67.9 yr. The cephalic route was used in nearly every case, with subclavicular implantation of the generator. Mean hospital stay was 7.6 days. Ventricular inhibition pacemakers were used in over 84% and fixed-frequency models in 7%. Mean pacemaker life was 24.1 months, with longer periods in the last months of the period of observation. The evaluation of battery run-down and recent and long-term complications is discussed, together with a particular type of decubitus of electrolytic origin. Hospital mortality was 2%. Survival was 91% at 1 yr and 54% at 6 yr. Emphasis is placed on the fact that subjects continue to be heart patients. Their well-being depends on psychological and general medical care, together with help from their, families and society, quite apart from cardiological attention.


[Phonomechanocardiographic evaluation of hypertensive cardiopathy].

The result of a study of 100 cases of arterial hypertension with various aetiology is presented from a phonomechanocardiographic viewpoint. Findings suggest that irregularities in the apicocardiographic curve recorded in Pachon position, and particularly the "a" wave and the "a" index, are highly sensitive and provide an early warning of contractile deficiency of the left ventricle. The mechanism leading to the pathological appearance of the "a" wave is discussed.


Amniotic fluid neutrophils prior to Cesarean section and intrauterine infection.

Amniotic fluid from 35 patients delivered by cesarean section was examined by Wright's stain. Of the patients in labor and with rupture of the membranes, 32% had more than 1 polymorphonuclear neutrophil per oil field (PMN/OF) while 68% had less than 1 PMN/OF. In both groups, endometritis occurred frequently, and fever indexes were similar. With ruptured membranes prior to cesarean section, observing greater than 1 PMN/OF of amniotic fluid did not discriminate groups at high and low risk for intrauterine infection.


Adriamycin-methotrexate combination chemotherapy of advanced carcinoma of the cervix.

Sixteen women with advanced carcinoma of the cervix were treated with adriamycin and methotrexate. Median age on entry into the study was 51 years. Seven subjects were premenopausal, 7 postmenopausal, and 2 were within 2 years of their last menstrual period at the time of diagnosis. Median time of inclusion in the study was 3.3 months. Median survival from initial diagnosis thus far has been 39.0 months. Median survival from the institution of therapy has been 5.8 months. Of 16 evaluable patients the following results were obtained: no complete remissions (0%), 2 partial remissions (12.5%), 1 patient with stable disease (6.2%). When used in dosages which do not precipitate dangerous toxicity this therapy is not effective and in the opinion of the authors should be abandoned.


Foley catheter for salpingography, pneumonography, tubal insufflation, and hydrotubation.

Using a pediatric Foley catheter, salpingography, CO2 insufflation, hydrotubation, pelvic pneumography, pelvic pneumoperitoneum for laparoscopy, and pneumohysterosalpingography were performed in more than 1000 cases. The Foley catheter technic was fully described and the advantages outlined. In general, the Foley catheter proved to be a simple and atraumatic technic, eliminating some of the difficulties associated with the use of the metal cannula.


Team nursing coverage of prenatal-intrapartum patients at a university hospital. An innovation in obstetric nursing.

A unique approach in utilization of nursing personnel was instituted at the University of Colorado Medical Center to alleviate the following patient care problems: 1) lack of continuity of care of obstetric patients, 2) inadequate prenatal instruction, and 3) the unpredictability of patient census in the labor and delivery area. Half the nurses from the labor and delivery area were organized into four teams of two nurses each who acquired a case load of patients for antepartum care. When a patient was admitted to the hostpial in labor, the nurse from her team who was on call came in and provided all nursing care during the intrapartum period. The problems and benefits of this new approach to nursing care are discussed.


Ovarian dysgenesis and chromosome abnormalities.

The association of ovarian hypoplasia with trisomy 18 in 6 infants and trisomy 13 in 5 infants and 1 fetus is reported. Three infants also had thymic hypoplasia. The possible etiology of ovarian dysgenesis is discussed in relation to a variety of clinical and experimental associations.


Carcinoma of the cervix in the young patient.

Two thousand and two cases of cervical carcinoma were studied, and the patients were divided into 3 age groups specifically to study the prognosis of the young patient. The distribution of histologic tumor types was the same in all age groups. The young patients had a more favorable stage distribution and as a group a better prognosis than the older ones, but within each stage the same 5-year survival was found for all age groups. The period studied was relatively short (6 years), and modern therapy was available to all patients.


Erosions and ulcers of the vulva: diagnosis, incidence, and management.

In a study of 877 patients with disorders of the vulva seen at a vulva clinic, 375 (43%) presented with an erosion or ulceration or a condition in which an erosion or ulceration developed as a complicating feature. One hundred sixty-one of these patients had a sexually transmitted disease. This report identifies the conditions associated with erosions and ulcerations of the vulva by incidence and provides a simple clinical classification of them as an aid in diagnosis. Methods of study of this group of diseases and their management are discussed.


Initiation of human parturition. VIII. Metabolism of progesterone by fetal membranes of early and late human gestation.

A decreased rate of progesterone metabolism is detected in human fetal membranes several weeks preceding normal parturition at term. A 10- to 20-fold decrease in 20alpha-hydroxysteroid oxidoreductase activity and a 2- to 6-fold decrease in 5alpha-reductase activity are observed in human amnion and chorion laeve after 33 weeks' gestation.


Fetal movements in utero: nature, assessment, prognostic value, timing of delivery.

Fetal movements in utero are an expression of fetal well-being. However, a sudden increase of fetal movements is a sign of acute fetal distress, such as in cases of cord complications or abruptio placentae. Decreased fetal movements are seen in cases of chronic fetal distress such as preeclampsia, hypertension in pregnancy, etc. It was shown that in these cases a pronounced decrease up to cessation of fetal movements occurred before fetal death in utero while fetal heart beats were still audible for at least 12 hours. This situation was called "movements alarm signal" (MAS). This sign points to a severely disturbed fetus and indicates impending intrauterine fetal death. Such a development is an indication for immediate delivery of the fetus, provided it is viable. High-risk pregnant women are instructed to assess and record fetal movements daily as a monitor of fetal condition. A special device which records fetal movements is used to confirm the women's assessment of fetal movement. It was shown that fetal movement monitoring was found to be more reliable than the urinary estriol determination in predicting impending fetal death in utero. It was also shown that in cases of MAS, fetal heart rate (FHR) changes will appear 1 to 4 days after the MAS has appeared. Meconium was found in only 50% of these cases. Increased fetal movements are manifested as a response to various stimuli such as sound, light, touch, and ultrasound. Classification of high-risk pregnancies into 3 groups according to the hormone assays, enzyme assays, ultrasonic cephalometry, fetal movements, and FHR is suggested.


Effects of terbutaline on the pregnant baboon and fetus.

The effects of terbutaline on the mother and fetus were evaluated in 8 near-term pregnant baboons. Significant suppression of postoperative spontaneous and oxytocin-augmented uterine activity was achieved with infusion rates of 0.36 and 0.56 microgram/kg/min, respectively. Maternal and fetal blood pressure and acid-base states as well as fetal heart rate were unaffected by the administration of terbutaline to the mother, but a mild maternal tachycardia was observed. Both maternal and fetal blood glucose increased during terbutaline infusion. Direct administration of terbutaline to the fetus did not alter the fetal cardiovascular or acid-base state. It is concluded that in the baboon, terbutaline is an effective tocolytic agent with minimal untoward effects on either mother or fetus.


The preventability of "bloody taps" in second trimester amniocentesis by ultrasound scanning.

In 856 patients over a 6-year period, amniocentesis was performed in the midtrimester for prenatal genetic counseling. The use of ultrasound scanning of the gravid uterus prior to the procedure reduced the incidence of bloody taps threefold and the withdrawal of grossly bloody amniotic fluid by fourfold. The best results (7.6% overall and 2.0% grossly bloody taps) were obtained when the procedure was performed by an operator not only experienced and adept at intrauterine manipulation but who had training and experience in ultrasonography as well. These results contrast favorably with that of operators utilizing but not trained in ultrasound scanning (36% overall, 8% grossly bloody taps) and of those who had the uterus "mapped out" by a sonographist but performed the amniocentesis later in their offices (18% overall, 12.1% grossly bloody taps). Other advantages of prior sonography are also discussed.


Ultrasonography preceding diagnostic amniocentesis and its effect on amniotic fluid cell growth.

Experience with 107 consecutive patients with and without ultrasonography preceding diagnostic amniocentesis is presented. Cell cultures and alpha-fetoprotein levels were obtained on all specimens. Adequate cell growth was found in both groups. The frequency of bloody taps was reduced from 15 to 6.9% and of repeat taps from 6.3 to 0%. Possible complications of amniocentesis which might be avoided by prior ultrasonography are discussed. The use of gray scale or real time ultrasonography prior to diagnostic amniocentesis is stressed.


Amniotic fluid L/S ratio in twin gestation.

Transabdominal amniocenteses were performed on both sacs of 14 sets of twins. In each instance one sac was marked with methylene blue to correctly identify the fluids. The lecithin/sphingomyelin ratio was determined on each fluid, and the correlation coefficient between the two sets of fluids was 0.86. There was no significant difference in the fluids' L/S ratios. The importance of this in terms of understanding the variables affecting fetal lung maturation and in clinically managing twin pregnancies is stressed.


Is cerebral palsy a preventable disease?

The causes of cerebral palsy in 96 young patients were analyzed. Potentially avoidable situations including inappropriate obstetric management and inappropriate neonatal care occurred in 38%. There should be a shift in emphasis from the rehabilitation of cerebral palsy to its prevention by improving services for reproductive care. Prevention can be undertaken by 1) identification and referral of the mother with a high-risk pregnancy to a perinatal center for her confinement; 2) fetal monitoring and appropriate resuscitation at delivery; and 3) early transfer of compromised infants to a neonatal care unit under good supervision.


Hepatitis Bs antigen (HBsAg) during pregnancy.

Three patients with serum hepatitis during pregnancy are described. The first patient was delivered of an infant in whom hepatitis B surface antigen (HBsAg) was detected at 3 months of age; the second patient had a child who became HBsAg positive at 6 weeks of age; and the third patient's child (recently delivered) was negative for HBsAg at birth. Suggestions for the management of this unusual complication of pregnancy are made.


The rape victim: a review of 117 consecutive cases.

The case records of 117 women examined at University Hospital for the complaint of alleged rape have been reviewed. The usual victim was white, single, under the age of 25 years, and attacked by a single assailant. Fifteen patients sustained serious physical injury, and 60 received minor injuries. Six children required hospitalization for reparative surgery. One patient required hospitalization for 9 days secondary to severe emotional stress. The number of attacks was lowest in the daytime and highest from midnight to 6:00 AM. Cultures from the endocervix were positive for gonorrhea in 12% of rape victims. Unfortunately, it would appear from public records that there is little hope of the attackers being convicted.


Cloacal dysgenesis.

Cloacal dysgenesis is a rare anomaly. Fifty cases have been reported in the literature. This condition differs from the usual imperforate anus. The diagnosis, evaluation, and therapeutic management require an understanding of the embryogenesis of the cloaca. The presence at birth of a single interlabial orifice or an abnormality sited anus is a surgical emergency. Early salvage of the kidneys and relieving intestinal obstruction are emphasized. There is a high incidence of multiple system congenital abnormalities.


Combination chemotherapy of advanced endometrial adenocarcinoma with adriamycin, cyclophosphamide, 5-fluorouracil, and medroxyprogesterone acetate.

Seven patients with advanced endometrial adenocarcinoma achieved objective tumor regression following chemotherapy with cyclophosphamide, Adriamycin, 5-fluorouracil, and medroxyprogesterone acetate. Combination chemotherapy has a favorable risk/benefit ratio for patients with advanced endometrial adenocarcinoma, including patients with severe debilitation, if supportive care such as hospitalization, parenteral antibiotics, and platelet transfusions are available. New Adriamycin-based drug combinations have sufficient antitumor activity to warrant major prospective evaluation by oncology cooperative groups.


Adriamycin treatment of advanced vulvar carcinoma.

Four consecutive patients with measurable recurrent squamous cell carcinoma of the vulva were treated with Adriamycin, in small doses approximately 45 mg/square meter of body surface area every 3 weeks. Three patients achieved objective regression of nodal metastases and residual tumor with clinical subjective benefit. Tumor control was maintained for 32, 31+, and 28+ weeks.


Peutz-Jeghers syndrome: case presentation.

The different aspects of the Peutz-Jeghers syndrome are discussed following a case presentation of a 36-year-old woman with Peutz-Jeghers syndrome, sex cord tumor with annular tubules of Scully, mucinous metaplasia of tubal epithelium, and adenocarcinoma of the endocervix. The latter two findings have not been described with the syndrome and an attempt is made to correlate them with Peutz-Jeghers syndrome.


Verrucous carcinoma arising from an artificial vagina.

Verrucous carcinoma is a well known and extensively reported entity in the English literature. It can occur in many tissues including vaginal mucosa. The first report of this entity occuring in an artificial vagina, including typical gross and histologic features, is presented with a discussion of the literature. The best mode of therapy remains primary excision of the lesion, and prognosis is excellent if early surgical intervention is accomplished.


Giant uterine tumors: case report and review of the literature.

This is a case report of the management and surgical removal of a 65-lb uterine leiomyoma. This is the 56th reported case of a giant uterine tumor (25 lb or over) and the eighth such case reported in the last 35 years. The literature concerning these large tumors is reviewed, and a discussion of some of the important aspects of surgical management is presented.


Functional lutein cyst in a postmenopausal woman.

A postmenopausal woman presented with enlarged breasts, increased vaginal mucus, and elevated serum estrogen and normal progesterone levels. A laparotomy was performed and revealed a cystic right ovary. Histologic examination of the ovary demonstrated a cyst lined by stratified lutein cells with abundant eosinophilic cytoplasm. The endometrium showed cystic and adenomatous hyperplasia. The diagnosis was functional lutein cyst. Removal of the cystic ovary reduced the estrogen levels, and the clinical picture reverted to that of a normal postmenopausal state.


A case of bilateral gonadoblastoma in streak gonads.

A report of a patient with bilateral gonadoblastomas who sought consultation for primary amenorrhea and infertility is presented. Thelarche and adrenarche occurred spontaneously at age 13. Clitoromegaly and a hypoplastic uterus were noted on physical examination. Flat plate X-ray of the abdomen demonstrated radiopaque material in both adnexa. Urinary 17-ketosteroid levels were normal, but the serum testosterone concentration was elevated. Serum gonadotropin values were markedly elevated, and total serum estrogens levels were very low. The karyotype was XY. The gonads were extirpated, and typical histology is demonstrated. A postulate was made to explain the clinical findings.


Bilateral gonadoblastoma with chromosomal aberration.

A case is presented of a patient with bilateral gonadoblastoma characterized by primary amenorrhea and intense, generalized hirsutism. The physical examination showed somatic stigmas compatible with gonadal dysgenesis. Pneumopelvigraphy showed a uterus and hypoplastic gonads; no microcalcification was seen. Negative sex chromatin in buccal mucosal cells and a 46, XXr/46,XXp-q-45,X karyotypic constitution was found.


Progesterone production by an ovarian granulosa cell carcinoma.

A patient with a progesterone-producing granulosa cell carcinoma is the basis of this report. Seven years after initial surgical therapy pelvic masses were palpated. At laparotomy the recurrence of tumor was confirmed, and many nonresectable metastases were discovered on the surface of the liver and on the mesentery of the bowel. An exceedingly high plasma progesterone level of 6270 pg/ml was obtained in the postoperative period. During 12 months of single agent chemotherapy with melphalan, serial plasma progesterone assays declined to 310 pg/ml. Complete tumor regression was subsequently confirmed by laparoscopy. Evaluation of progesterone levels in patients with granulosa cell tumors is recommended to determine the incidence of this finding and to further assess its value in following response to therapy.


Subclinical spontaneous abortion.

Blood samples were obtained from 5 women during the menstrual cycle in which they had conceived. Although neither the women nor their physicians were clinically aware that conception had occurred, one or more of the blood specimens from each woman contained human chorionic gonadotropin (hCG), as measured by a specific radioimmunoassay. Each patient underwent a spontaneous abortion with 4 of the 5 women describing a delayed, but otherwise normal, menses. The fifth noted an unusually abundant amount of vaginal bleeding. Immunologic urinary pregnancy slide tests were negative in the 4 women on whom the tests were performed. The levels of hCG in the serum of these women were abnormally low for the estimated length of gestation, suggesting that defective trophoblastic function may be important in the pathogenesis of this phenomenon. These examples illustrate that some women may conceive and abort so early that the pregnancy and the abortion may remain subclinical. Therefore, it is likely that the true incidence of spontaneous abortions during the first trimester is greater than the presently accepted incidence of 15%.


Hypokalemia and cardiac arrhythmia associated with prostaglandin-induced abortion.

Experience with 1 patient undergoing second trimester therapeutic abortion induced by prostaglandin F2alpha administration is described. Serious hypokalemia in association with cardiac arrhythmia followed intraamniotic administration of the drug. Further observations on a group of normal subjects receiving prostaglandin injections for induction of abortion showed a small but significant serum hypokalemia after treatment.


Meconium staining of amniotic fluid at midtrimester amniocentesis.

Meconium-stained fluid was found in six of the first 234 amniocenteses performed at the University of Washington Prenatal Diagnosis Center. The taps were done between 16 and 20 weeks from the last menstrual period. Although in each case there was a factor that could have produced fetal distress, in no instance did intrauterine demise occur. All the pregnancies have terminated in the births of healthy children. Therefore, we believe that meconium staining of midtrimester amniotic fluid may in fact reflect a transient episode of fetal compromise but that the finding cannot be used to prognosticate either impending fetal death or the presence of congenital malformations in the newborn.


Fetal bradycardia without fetal distress: case presentation and review of the literature.

A case of a term pregnancy with a persistent fetal heart rate of 65 to 80 beats/min is presented. Initially this was presumed to be due to congenital heart block. Subsequent fetal ECG revealed blocked atrial extrasystoles. Review of the literature showed 31 previously reported cases of heart block diagnosed in utero. A review of this literature is discussed and the importance of differentiating bradycardia due to heart block from bradycardia due to fetal distress is emphasized.


Intrauterine fetal demise after negative oxytocin challenge tests.

The oxytocin challenge test was used to evaluate the fetoplacental unit in 572 patients over a 5-year period. Four fetuses died in utero within 7 days of a negative test. None had periodic fetal heart rate decelerations of any type. All 4 showed periodic accelerations of the fetal heart rate (FHR) in association with fetal movement. Two had baseline changes in the fetal heart rate during the oxytocin challenge test.


Fetal trigeminal rhythm.

A case of fetal trigeminal cardiac arrhythmia in labor is presented. The literature on fetal cardiac arrhythmias is reviewed. The significance and management of abnormal fetal rhythms in labor is discussed. The majority of fetal arrhythmias in labor do not require therapy.


Diagnostic studies and fetal assessment in advanced extrauterine pregnancy.

Advanced extrauterine pregnancy occurs rarely and may present diagnostic difficulty. Failure to induce uterine contractions during oxytocin infusion is a well-established diagnostic technic. The present case suggests that additional newer technics for fetal assessment, including sonography, unstressed monitoring of the fetal heart rate, uterine contractions, fetal movements, and serial urinary estriol determinations may also be useful in diagnosing and managing such complex cas-s.


Villous adenoma of the rectum diagnosed during labor.

A villous adenoma of the rectum was first discovered when it was forced through the anal canal during the second stage of labor. This is the first case of its kind reported. The management of this case is presented along with a discussion of the characteristics and possibly premalignant behavior of the villous adenoma.


Tricuspid atresia and pregnancy.

Tricuspid atresia is one of the rarest heart defects, and it is rarely associated with prolonged survival. This paper describes the third known case of pregnancy associated with tricuspid atresia. This is the first detailed report of the clinical course of a patient with this disorder. Complications included heart failure, multiple pulmonary emboli, cerebral embolization, and premature labor. Recommendations are made regarding patient care.


Infant survival following uterine rupture and complete abruptio placentae.

This report concerns a case of spontaneous rupture of the uterus through a previous cesarean scar with resulting complete abruptio placentae and extrusion of the fetus inside the intact membranes and the placenta into the peritoneal cavity. That the infant survived this dual insult is worthy of reporting.


Maternal death in a patient with Eisenmenger's syndrome.

A pregnant patient with Eisenmenger's syndrome is reported. The hemodynamic data gathered during this pregnancy suggest that decreased peripheral vascular resistance and reflex bradycardia secondary to postural changes could be of extreme importance in contributing to the extremely high maternal mortality. Suggestions are made with respect to the management of these patients which could be of value in preventing maternal death.


Severe sarcoidosis in pregnancy.

A case of pulmonary sarcoidosis in a pregnant woman with severe constitutional symptoms and markedly restricted pulmonary function is presented. Serial pulmonary function testing before and during steroid therapy documented significant improvement. Although the severity of this patient's disease is apparently rare, more studies are required to define the prevalence of significant pulmonary function impairment in pregnant women with sarcoidosis.


Endometrial response to estrogen and progesterone therapy in patients with gonadal dysgenesis.

A study was made of the endometria of 16 patients with gonadal dysgenesis who had been give cyclic replacement treatment with conjugated estrogens for 2 to 10 years, and of 9 other patients who had received medroxyprogesterone in addition to the conjugated estrogens for 2 to 5 years. Seven of the former group showed varying degrees of endometrial hyperplasia, and in all of these cases the duration of estrogen therapy had exceeded 5 years. At the time of the study no cases had developed frank adenocarcinoma. Only 1 of the 9 patients who had been given medroxyprogesterone in addition to the conjugated estrogens demonstrated evidence of hyperplastic change. Progesterone may afford some protection against the development of endometrial hyperplastic activity, but its potential role in protecting against neoplasia remains to be determined. This study supports the view that estrogen replacement therapy in gonadal dysgenesis carries the risk of endometrial hyperplasia and neoplasia. Possible methods of decreasing this hazard are discussed.


Chorionic gonadotropin and progesterone levels in ectopic pregnancy.

It is assumed that one function of hCG is to preserve the developing corpus luteum and maintain pregnancy by producing progesterone and thus preventing menstrual shedding. In 8 of 17 cases of ectopic pregnancy, progesterone values were in the range of the proliferative phase of a normal cycle (0.1-1ng/ml), whereas the levels of hCG were 299-1600 mIU/ml. In 8 cases the progesterone levels were in the range of the secretory phase (2.3-6.9 ng/ml), and the hCG level was 182-5500 mIU/ml. In 1 case only was the progesterone level 15.0 ng/ml with an hCG level of 325 mIU/ml. In normal pregnancies of the same gestational age, the values of progesterone were 3.8-18.7 ng/ml, and the levels of hCG were 260-1300 mIU/ml. It seems that in addition to the level of hCG, a normal fetoplacental unit is needed for the preservation of the function of the corpus luteum.


Effect of preoperative scrub on the bacterial flora of the endocervix and vagina.

A study was designed to evaluate the effectiveness of a preoperative vaginal and perineal scrub in reducing bacteria. An iodophore soap followed by an iodophore solution was used for the scrub. Cultures were taken from the vagina and endocervix of 50 patients before and after the scrub, and cultured for aerobes, anaerobes, and mycoplasma. An average of 5.62 bacterial species per patient was cultured from the vagina before the scrub and 3.9 from the endocervix. The corresponding numbers after the scrub were 0.08 species per patient from the vagina and 1.84 from the endocervix. The reduction of organisms from the vagina was unrelated to the reduction in the endocervix. The scrub was by far more effective in the vagina than in the endocervix. The vagina was bacteria free in 92% of cases while the endocervix was bacteria free in only 8% of cases. No organisms could be recovered from the cervix of 8 patients who had removal of the endocervix by hot conization followed by the iodophore scrub. There was an average of 4.25 species per patient from the 8 cultures of the endocervix prior to the cone and scrub.


A formula for selective lymphadenectomy. Its application to cancer of the vulva.

A statistical formula can be applied to aid clinical judgment in decisions regarding the advisability of lymphadenectomy in gynecologic cancer. If benefit (B) factors in a given case do not exceed debit (D) factors, the procedure is ill-advised. In unilateral vulvar cancer, for example, if the ipsilateral inguinal nodes are negative, the risks from routine contralateral or deep pelvic node dissection appear to exceed the benefits.


Myometrial invasion and hysterography in endometrial carcinoma.

One hundred and seventy-nine patients with endometrial carcinoma underwent hysterography as part of their pretreatment evaluation. One hundred and twenty-six women received preoperative irradiation followed by hysterectomy; 30 had surgery alone; while 23 received radical radiotherapy. We have classified hysterograms by the degree of tumor invasion suggested radiographically and have compared these, in the operated cases, with postoperative pathologic examination. Characteristically, lesions confined to the endometrium, or with superficial myometrial penetration, demonstrate either no radiologic abnormality or a small, shallow defect by hysterogram. In those patients with deep myometrial invasion of cancer, hysterograms usually demonstrate a large defect in the endometrial cavity. We believe that hysterography helps assure optimum treatment of each individualized case by helping to determine the volume of tumor and extension into the myometirum.


Management of the pelvic floor after pelvic exenteration.

At the Mayo Clinic, 198 exenterative operations were performed from 1950 through 1971. Although the 5-year survival rate of all patients was 33%, bowel obstruction occurred in 11.6% of patients and intestinal fistula formation in 12.6%. The majority of patients with these complications had had previous pelvic irradiation. The difficulty in dealing with the large raw area in the pelvis is discussed with a review of the various methods that have been tried to date to reperitonealize the pelvis and thereby, it is hoped, prevent adhesions or fistula formation.


Diagnosis of hydatidiform mole with and without coexistent fetus by nonstored image echography.

One hundred ten patients suspected of having hydatidiform mole or partial mole were examined during a 21/2-year period, utilizing nonstored image echography. All echograms were performed and interpreted by an obstetrician-gynecologist. Hydatidiform mole was confirmed in 23 patients, 4 of whom presented with a coexistent fetus and 3 with blighted ovum. No false diagnoses of hydatidiform mole were made. Reasons for the superiority of a nonstored image technique are discussed, particularly with regard to elimination of primary and secondary problems inherent in echographic diagnosis.


Fetal immune response following congenital toxoplasmosis.

Serum concentrations of IgA, its subgroups IgA1 and IgA2, IgM, IgG, and IgD were determined in a group of 14 mothers who contracted toxoplasmosis during pregnancy and their 14 offspring. Four newborns developed toxoplasmosis, 10 did not. The 4 infants with congenital toxoplasmosis had evidence of increased immunoglobulin synthesis in utero in sharp contrast to the 10 offspring of toxoplasmosis-infected mothers who failed to develop the disease. Three of these 4 affected children had elevated IgM levels; all 4 had significantly increased IgA values. The use of IgA subclass IgA1 and IgA2 was not helpful in distinguishing infants with congenital toxoplasmosis from unaffected infants. The present series is consistent with other studies from this laboratory, indicating that the fetal immune response to intrauterine infection may include IgA as well as IgM.


Abnormal fetal growth patterns. Ultrasonic diagnosis and management.

Diagnostic ultrasound is a useful tool in the management of high-risk pregnancies and provides valuable information about abnormal fetal growth patterns including excessive fetal size and intrauterine growth retardation. Two patterns of growth retardation can be distinguished ultrasonically. Fetuses exhibiting "reduced growth potential" type patterns have little risk of fetal distress and are readily recognized as small for gestational age at birth. Fetuses suffering from uteroplacental insufficiency frequently exhibit a pattern of biparietal growth arrest in the third trimester. These fetuses have a high risk of fetal distress and should be closely monitored with other parameters of fetal-placental function including serial estriols and oxytocin challenge tests. Utilizing conventional pediatric growth criteria, the existence of intrauterine growth retardation is often unrecognized in this latter group.


Experience with an adolescent pregnancy program. A preliminary report.

A program has been designed to give comprehensive health care services to pregnant adolescents. The program components include community liason, patient education, counseling and social services, a nurse "on call" program for labor and delivery, and pediatric nurse-practitioner followup. In addition, a drug use identification component screens the patients by interview and urinalysis. Hypertensive disorders of pregnancy occurred in 10% of the first 202 patients. Forty-three percent had anemia (hematocrit less than 35%), and screening cervical cultures for gonorrhea were positive in 3.5%. Cigarettes, alcohol, and marijuana constituted the most common nonmedical drugs used, and aspirin the most common medical drug. Eighty-one percent of the patients attended 7 or more antenatal visits, one-half did not miss a single clinic appointment, and 95% completed a post-partum visit, indicating that the program was well accepted by the adolescents.


Catamenial pneumothorax. Bilateral occurrence while on suppressive therapy.

A case of recurrent bilateral catamenial pneumothorax is presented with pathologic, cytologic, and radiologic documentation. Unlike previously reported cases where the pneumothorax is unilateral and the symptoms relieved while ovulation is suppressed with cyclic oral contraceptives, in the present case the pneumothorax occurred despite oral contraceptive therapy concurrent with anovulatory withdrawal or breakthrough bleeding.


An automated clinic management system for a family planning network.

The medical information, financial, and logistic aspects of a comprehensive computer-based Appointment, Registration, Information System, and Evaluation (ARISE) are analyzed for the management of a family planning program serving 30,000 patients annually. An overview of the existing computer system network is presented with descriptions of the interactive master patient index, the batch appointment process, the management statistics package, and Department of Health, Education, and Welfare (HEW) reporting. Emphasis is placed on the financial management control system which includes 1) procedures for third-party submission of claims for payment, in particular Titles IVA, XX, and XIX (Social Security Act), together with discussion of related administrative requirements; 2) technics of auditing data integrity including systematic sampling of collected data; and 3) the process of billing and receipts collection. Methodology and implementation aspects of ARISE may have wide applicability to other family planning and similarly structured clinical programs.


Endometrial cancer after menopausal use of estrogens.

The incidence of endometrial cancer has increased rapidly during recent years, paralleling the increased postmenopausal use of estrogens. The relation of endometrial cancer to disease conditions in which estrogens are elevated and three case-control epidemiologic studies suggest the likelihood of a cause-and-effect relation between estrogen use and endometrial cancer. These studies and New York State Cancer Registry data further suggest that the incidence will continue to rise in coming years. A thorough reevaluation of the medical indications for estrogen replacement therapy is urgently needed. Women with long-term exposure to estrogens should have periodic cancer screening examinations.


[Comparison of the isoacceptor makeup of transfer RNA for 2 early stages in the development of loach embryos].

The chromatographic profiles of isoacceptor tRNA's for 9 amino acids from the loach embryos at two early developmental stages were compared by the method of chromatography on sepharose column in the decreasing gradient of ammonium sulphate concentration to elucidate the possible role of tRNA in the control of early embryogenesis processes. Certain differences both in the proportions of some isoacceptor peaks and their relative positions on the chromatographic profile were found for 8 aminoacyl tRNA. Methionyl-tRNA was represented by one constant peak.


[Switching on sequence of lactate dehydrogenase loci in the early embryonic development of the mouse].

The dynamics of changes in the spectrum of lactate dehydrogenase was studied in the early pre- and postimplantation development in the CBA mice by the method of ultramicrophoresis. In the preimplantation embryos only LDH-1 was found during the first 5 days of development. The LDH-5 first appears by the 5th day of development and is preserved at all subsequent stages. The LDH spectrum of 5--7 days old embryos is represented by LDH-1 and LDH-5 and a very small amount of hybrid forms. The distribution of isozymes in the spectrum does not correspond to the binomial one. The LDH-1 is completely absent from 8--11 days old embryos and reappears in some tissues beginning from the 13th day of development. The distribution of isozymes in the LDH spectra from the 8th day of development is close to the binomial one.


[Study of the stability of morphogenetic substances in Acetabularia].

It was shown by means of interspecific transplantation that the morphogenetic substances in the A. crenulata cytoplasm kept their ability to determine the species specific morphogenesis in the A. mediterranea fragments during not less than 30 days. The isolation of the A. crenulata cytoplasm from the cell resulted in the complete inactivation of morphogenetic substances within 2--3 hrs. The removal of chloroplasts from the injected cytoplasm did not change its morphogenetic activity. The cytoplasm treatment by exogenous ribonuclease accelerated the inactivation of morphogenetic substances; this suggests its ribonucleic nature.


[Study of the destruction of the sympathetic ganglia by the administration of guanethidine to newborn rats and mice].

Following the injection of guanethidine (25 mg/kg) to rats from the first day of life during 2 weeks, over 70% of sympathic neurons in the stellate ganglion die. If the injections are carried out during 4 weeks, over 99% of neurons die. The injection of guanethidine to mice during 5 weeks did not result in the destruction of nerve elements in the ganglion, as compared with the control.


Cicatricial entropion.

One hundred thirty-five cases of cicatricial entropion operated by the Oculo-Plastic Service of the Manhattan Eye, Ear & Throat Hospital were reviewed. Results of 114 of these were available for study. There was an overall success rate in primary surgery of 57 percent. Of those cases reoperated, only nine percent had a subsequent successful result. The most common procedure done was the transverse blepharotomy and marginal rotation. There was no statistical correlation between the success rate and the age or sex of the patient. Results on the fellow eye correlated well with results of the first eye in bilateral cases.


Normal lid margin after eyelid reconstruction.

To prevent corneal damage, the central lid margin must have a normal skin-conjunctiva interface following the lid reconstruction. A two-step procedure may be employed: In the lower lid an initial Hughes reconstruction should be tried. If this is unacceptable, a subsequent block excision of the segment is performed. The important step in both phases is a thorough lateral cantholysis. In the upper lid, the central defect is immediately reconstructed by sliding the lateral lid remnant to the medial remnant. The resulting lateral defect is reconstructed with a Hughes procedure. In both cases, a physiologic lid margin is insured, because normal lid is sutured to normal lid.


Delayed hypotony, shallow anterior chamber, and choroidal detachment in the postoperative cataract eye. A comparative study of closure with 7-0 silk, 9-0 silk, and 9-0 nylon.

To determine the time relationships between hypotony, choroidal detachment, and shallowing of the anterior chamber, an initial 64 eyes closed with 7-0 black silk were studied with applanation tensions, indirect ophthalmoscopy, and slit lamp examinations before surgery and for six weeks after cataract extraction. Applanation tension less than 6 mm Hg was detected in 72% of eyes, choroidal detachment in 44%, and shallowing of the anterior chamber in 28%. Low intraocular pressure was always detected at the same time or before either choroidal detachment or shallow anterior chamber. The peak period when pressure dropped to less than 6 mm Hg was shortly before 12 to 14 day suture removal or the day after. Suture tract leakage appears to be the predominant mechanism triggering this hypotony. Hypotony is prolonged past the leakage period, probably by ciliary body detachment. This 7-0 silk closure group is compared with 53 eyes closed with 9-0 virgin silk and 45 eyes closed with 9-0 nylon. Both of these latter groups showed substantially lower incidences of hypotony, choroidal detachment, and shallowing of the anterior chamber.


Dacryocystectomy for tumors of the lacrimal sac.

A high index of suspicion is very important in the early diagnosis and treatment of potentially lethal tumors of the lacrimal sac. The triad of a mass above the medial canthal tendon, chronic dacryocystitis which irrigates freely and bloody reflux on irrigation should alert the ophthalmologist of this potentially fatal situation. Complete surgical excision and postoperative irradiation are important in the treatment of malignant tumors.


Reversal of morphine and stimulus-produced analgesia by subtotal spinal cord lesions.

This study examined the hypothesis that descending inhibitory pathways from brain stem to spinal cord mediate the analgesic effect of both electrical brain stimulation and morphine. In the first set of experiments, the effect of subtotal midthoracic spinal cord lesions on the analgesic effect of electrical stimulation in the periaqueductal gray matter of the rat was examined. In the second, the effect of similar cord lesions on the analgesic effect of intraperitoneal morphine was studied. In both cases, a lesion of the dorsal part of the lateral funiculus (DLF) reduced or abolished the analgesia of the hindlimbs. Analgesia of the forelimbs was unaffected. Lesions of the dorsal columns, which include the corticospinal tract, or lesions of the ventral part of the lateral funiculus had no effect on analgesia. It is concluded that an inhibitory pathway, which descends in the dorsal part of the lateral funiculus and which probably originates in the nucleus raphe magnus of the medulla, mediates the descending control found in both morphine and stimulus-produced analgesia.


Peripheral suppression of first pain and central summation of second pain evoked by noxious heat pulses.

Psychophysical experiments were carried out on 6 huma subjects to determine how first and second pain are influenced by peripheral receptor mechanisms and by central nervous system inhibitory and facilitatory mechanisms. For these experiments, brief natural painful stimuli delivered to the hand were a train of 4-8 constant waveform heat pulses generated by a contact thermode (peak temp. = 51-5% C). The magnitude of first and second pain sensations was estimated using cross-modality matching procedures and reaction times were determined. The latter confirmed the relationship between first and second pain and impulse conduction in Adelta and C noxious heat afferents, respectively. The intensity of first pain decreased with each successive heat pulse when the interpulse interval was 80 sec or less. This decrease was most likely the result of heat induced suppression of Adelta heat nociceptors since it did not occur if the probe location changed between successive heat pulses. In contrast, second pain increased in intensity with each successive heat pulse if the interval was 3 sec or less. This summation was most likely due to central nervous system summation mechanisms since it also occurred after blockage of first pain by ulnar nerve compression and when the location of the thermode changed between heat pulses. These observations and their interpretations are supported by our recording of responses of singlt Adelta heat nociceptive afferents, C polymodal nociceptive afferents, and "warm" afferents of rhsus monkeys to similar trains of noxious heat pulses. Their responses to these heat pulses show a progressive suppression. Furthermore, previous studies have shown that wide dynamic range dorsal horn neurons show summated responses to repeated volleys in C fibers (greater than 1/3 sec). These spinal cord summation mechanisms could account for the summation of second pain.


Comparative study of perceived pain and nociceptive flexion reflex in man.

The purpose of this study was to compare the amplitude of the flexion reflex of the biceps femoris muscle (BF) with the intensity of the painful sensation elicited by a nociceptive stimulation resulting from application of constant-current either on the sural nerve or on the skin in its distal receptive field. Experiments were carried out on 15 normal volunteers. It was observed that: (1) Stimulation of the sural nerve (either on or through the skin) elicits two different reflex responses in the BF: the first (RII) is of short latency, low threshold and corresponds to a tactile reflex. The second (RIII) is of longer latency and higher threshold, and corresponds to a nociceptive reflex. The threshold of RIII was found to be the threshold of a pain sensation. (2) Stimulation of the skin elicits only a late nociceptive (RIII) response in the BF. The threshold of this response was also found to be that of pain. (3) The threshold of both pain and RIII were found to be higher for sural nerve stimulation (10 mA) than for cutaneous stimulation (5 mA). It was suggested that the large diameter cutaneous fibers could have an inhibitory effect of both pain and the nociceptive reflex. This was supported by the results obtained during a selective ischemic block of the largest diameter fibers in the sural nerve, when a 10 mA stimulation was applied to the nerve. In this case, a decrease of the RII reflex was observed in BF, together with an increase of both RIII and pain sensation. Functional implications of these results are discussed.


On the sensitivity of the tourniquet pain test.

Twenty-four chronic pain patients were given, on each of 4 successive days, oral doses of 60 mg morphine, 60 mg codeine, 600 mg aspirin and placebo, using a double-blind counterbalanced design. Two hours after ingestion, subjective pain estimates and tourniquet pain scores were obtained. Variability of the tourniquet pain scores was too great for differences in response to the analgesics to be significant. However, differences in pain estimates were also too small to discriminate among the drugs, and the lack of sensitivity may be a function of pain chronicity. The tourniquet techniques will continue to be useful until there is a purely objective measure of the severity of clinical pain.


Pharmacological modulations on the nociceptive flexion reflex in man.

Pharmacological actions on the nociceptive flexion flexes of the hindlimb were investigated in 14 normal subjects. These reflexes were used as an index of pain and were recorded in the biceps femoris muscle, elicited by electrical stimulation of the ipsilateral sural nerve (RIII,su) and of the skin in the distal receptive field of this nerve (RIII,Cu). The ratio of the threshold of RIII,Cu/RIII,Su was calculated since it gives an indication on the mechanism and the efficacy of the drug. During control periods, the mean values of RIII,Su threshold (10 mA) and of RIII,Cu threshold (5 mA) remained stable, as RIII,Cu/RIII,Su threshold (50%). Cutaneous application of naphthalene provoked a decrease in the RIII,Cu threshold and relative pain threshold, whereas lignocaine increased them. No changes in the RIII,Su, threshold and relative pain were observed. The ratio RIII,Cu/RIII,Su threshold and relative pain were observed. The ratio RIII,Cu/RIII,Su was lowered to 10% with naphthalene and increased to 110% with lignocaine. Intravenous injection of acetylsalicylic acid increased only the RIII,Cu threshold and relative pain threshold. The ratio RIII,Cu/RIII,Su was 90% at the maximal effect of the drug. In contrast, pethidine provoked a decrease in the RIII,Su threshold and an increase in RIII,Cu threshold, parallel with an increase in pain threshold sensation. The ratio was found to be 190% at the maximal effect. Practical implications of these results, concerning a method for testing the efficacy and mechamisms of an analgesic, are then discussed.


Perceived control over pain: individual differences and situational determinants.

Determinants of perceived control over pain were varied to assess their impact on pain tolerance to electric shock in an experimental setting where variably tolerant models were used to influence pain reports and behaviour. On the basis of locus of control scores, subjects were assigned to internal and external groups. Instructions were presented emphasizing personal or environmental determinants of pain. Fifty subjects were assigned randomly to 5 groups based on these instructions and whether they were paired with a model who was tolerant, intolerant or inactive. Findings indicated internals manifested greater pain tolerance, but that the instructions on situational as contrasted with personal sources of control over pain did not influence pain behaviour. As expected, the models promoted or inhibited exposure to the shocks consistent with the model's role. Subsequent disclosure of the model's roles, followed by further pain tolerance assessment, did not lead to changes in pain behaviour, indicating that the training effect was persistent. The discussion examines relative contributions of individual differences and situational factors to pain behaviour.


A neurophysiological theory for the pain mechanism of tic douloureux.

In attempting to understand the mechanism of pain production in tic douloureux, one must account for the myelination pathology seen in the primary afferent fibers, the cases where trigger is in a different division than the pain, the frequent lack of a fixed neurologic deficit, the effective trigger stimuli corresponding to large caliber axons which would not seem to involve the small axons usually associated with pain production, and similar puzzling features of the disease. We present a theory which satisfactorily predicts, or is consistent with, most known features of tic; it is based upon two mechanistic assumptions, both of which have strong experimental foundations in the literature. The first is the trigeminal dorsal root reflex, and the second is the creation of extra action potentials at sites of altered myelination.


Effects of intrasegmental electrical acupuncture on dental pain: evaluation by threshold estimation and sensory decision theory.

The effect of 80 min of low frequency (2 Hz) electric acupunctural stimulation at facial sites on the perception of induced dental pain was evaluated using both pain threshold and sensory decision theory (SDT) procedures. The demonstration of a 187% increase in threshold over a 20 min period of acupunctural stimulation replicated earlier work by Swedish investigators. SDT analyses indicated that the threshold increase reflected a relatively pure sensory change with no significant modification of response bias. However, subjects were able to perceive some of the stimuli presented below threshold level following acupuncture, thus indicating that the threshold concept has been an inadequate description of the phenomenon. This study demonstrated that intrasegmental analgesic stimulation is more efficacious than the extrasegmental meridian point stimulation used in our earlier studies. Possible mechanisms for the observed effect were discussed.


Effects of root or nerve destruction on vibrotactile sensitivity in trigeminal neuralgia.

Vibrotactile thresholds were determined at 7 frequencies between 25 and 300 Hz at the medial edge of the cheek in 11 patients who had been or were currently being treated for major trigeminal neuralgia, tic douloureux. A control group, comparable in age but without neural pathology, was also tested. Results indicate essentially no difference between normal and affected sides of the face prior to surgery. The drug carbamazepine (Tegretol), commonly used to control pain of trigeminal neuralgia, did not affect vibrotactile thresholds. Infraorbital neurectomy resulted in an initial loss of sensitivity at all frequencies, followed by a gradual return of sensation which reached preoperative levels at approximately one year. The return of sensitivity was followed by the return of neuralgia. Following alcoholic gasserian rhizolysis, low-frequency thresholds were elevated considerably as after neurectomy, but sensation above 100 Hz was lost completely. A return of high-frequency sensitivity accompanied the recurrence of pain in some patients who had been injected up to 13 years prior to testing. The results are discussed in terms of recent anatomical, electrophysiological, and clinical findings.


A comparison of primary dysmenorrhoea and intrauterine device related pain.

A pain questionnaire designed to measure sensory, affective, evaluative and temporal components of pain was administered to 119 patients with primary dysmenorrhoea and 75 patients with intrauterine device (IUD) related pain. In addition "self-report" information was obtained on the behavioural effects of pain, global ratings and biographical details of these patients. It was found that dysmenorrhoea and IUD related pain were generally similar in nature. This led to the conclusion that IUD insertion does not in general lead to an exacerbation of presenting dysmenorrhoea, nor does it radically alter the type of sensations experienced by the patient. While no differences between patient groups emerged, the implications of the different pain components did vary. Thus, pain intensity scores were reflected in a larger sensory component with IUD users, whereas with dysmenorrhoea the affective component predominated. The results show sufficient consensus in the two patient groups of word adjectives used to describe their pain, to allow the development and evaluation of a rapid card sort system for pain assessment.


The pain ward follow-up analyses.

Two-year and 3-year follow-up analyses show that those who did not receive surgery for pain relief did as well as those who did receive such surgery during their stay, both groups showing consistently lower pain levels and analgesic intake than on admission, while activity levels progressively increased. The surgical patients were more likely to be readmitted for their pain problem than were the others, whereas the others were more likely to be readmitted for other medical problems.


Transfer of immunity to Trichinella spiralis in the mouse with mesenteric lymph node cells: time of appearance of effective cells in donors and expression of immunity in recipients.

Cells capable of transferring immunity to Trichinella spiralis, i.e. of accelerating adult worm expulsion, were present in the mesenteric lymph nodes of mice infected for 4, 6 or 8 days, but not in mice infected for only 2 days. The time-course of worm expulsion in mice infected on the day of transfer was similar in recipients of day 4 or day 8 cells, expulsion becoming marked only when the recipients had been infected for at least 6 days. Transfer of cells 4 or 6 days after infection did not result in an accelerated worm expulsion; transfer 1 or 2 weeks before infection did not enhance the level of immunity in recipient mice. In contrast to the results obtained with mesenteric lymph node cells (MLNC) on immunity was transferred when recipients were given spleen cells taken from donors infected for 8 days. It is suggested that MLNC do not cause worm expulsion directly, but cooperate with another component of the host's defence mechanism. Accelerated expulsion in recipients of cells was accompanied by a premature decline in fecundity of female worms. Evidence is presented to show that worm expulsion and impaired reproduction may represent independent aspects of the immune response to T. spiralis.


Evidence for the involvement of a bone marrow-derived cell population in the immune expulsion of Trichinella spiralis.

When mice were irradiated immediately before infection with Trichinella spiralis there was a profound and long-lasting interference with their ability to expel adult worms from the intestine. Irradiation given after the fifth day of infection was progressively less effective in this respect. The ability to expel worms was not restored when mesenteric lymph node cells (MLNC) were transferred (a) on the day of infection in mice irradiated one day previously, or (b) on day 7 of an infection in mice irradiated on day 6, even though the MLNC transferred immunity to intact recipients. Transfer of bone marrow (BM) alone was also without effect. However, worm expulsion was restored if, following irradiation and injection of BM, 10 days were allowed for BM differentiation before transfer of MLNC. This restoration was effective even after lethal levels of irradiation and was clearly dependent upon a donor-derived BM component cooperating with, or responding to, the activity of the transferred MLNC. The possibility that the BM component is non-lymphoid in nature is discussed.


The development of Haemonchus contortus, a nematode parasite of the ovine abomasum, in the laboratory rabbit.

The development and growth of Haemonchus contortus was studied in the stomach of the laboratory rabbit. Less than 1% of the ensheathed infective larvae given to rabbits became established, whereas after exsheathment in vitro under physiological conditions, 20-30% of the larvae administered developed to the 4th stage. Following doses of up to 10000 larvae, nearly all worms were lost from the 16th to the 21st day after infection, but after doses of 50000 larvae considerable numbers of 4th-stage larvae were recovered 25 days after infection. No adult worms were recovered and no eggs were found in the faeces. Infection was accompanied by inflammation, haemorrhage, disruption and flattening of the mucus secreting cells and by mononuclear infiltration. No cellular reactions in the immediate vicinity of the nematodes in the mucosa or changes in the pH of the stomach contents were observed.


Pholeter anterouterus Fischthal & Nasir, 1974 (Digenea: Opisthorchiidae) redescribed, together with remarks on the genera Pholeter Odhner, 1914 and Phocitrema Goto & Ozaki, 1930 and their relationship to the centrocestine heterophyids.

Photoleter anterouterus Fischthal & Nasir, 1974, from Pelecanus occidentalis Linnaeus and Pelecanus erythrorhynchos Gmelin from Florida, USA and the ventro-genital complexes of Photeleter gastrophilus (Kossack, 1910) from Delphinus delphis Linnaeus from Queensland, Australia and of Phocitrema fusiforme Goto & Ozaki, 1930 from Alopex lagopus (Linnaeus) and Phoca vitulina Linnaeus from Alaska are redescribed. The genus Photoleter Odhner, 1914 is emended and compared with Phocitrema Goto & Ozaki, 1930 and both genera are compared with members of, and as a result transferred from the family Opisthorchiidae Looss, 1899 to, the subfamily Centrocestinae Looss, 1899, family Heterophyidae Odhner, 1914.


Interference with Fasciola hepatica snail finding by various aquatic organisms.

Previous studies using radioactive miracidia have shown that a number of non-host snails and bivalves, interposed as 'decoys' in linear test channels, may interfere with the capacity of Fasciola hepatica miracidia to infect Lymnaea truncatula. Applying similar experimental principles, the role of several other potential interferents have been analysed in the present study. Daphnia pulex (Cladocera) and larvae of Corethra sp. (Diptera) exercised significant interfering effects by protecting 'target' snails from infection. Evidence suggested that this effect was a result of their normal predatory behaviour. Other organisms including Herpobdella testacea and Helobdella stagnalis (Hirudinea), Acellus aquaticus (Isopoda), Planaria lugubris (Turbellaria) and L. truncatula egg clusters failed to interfere with miracidial host-finding. Nor did P. lugubris and L. truncatula 'conditioned water' interfere with the capacity of the miracidia to infect their host snail.


Babesia bigemina in Kenya: experimental transmission by Boophilus decoloratus and the production of tick-derived stabilates.

A Babesia-free batch of laboratory reared Boophilus decoloratus ticks was infected with a Kenyan strain of Babesia bigemina by feeding them on a steer infected by inoculation of a blood stabilate. The engorged female ticks showed developing stages of B. bigemina in their haemolymph and subsequently their progeny transmitted the parasite to a susceptible splenectomized steer. Attempts were made to produce stabilates from pre-fed larvae and nymphs derived from infected batches of B. decoloratus. Only the stabilates derived from the nymphs pre-fed either on cattle or rabbits produced B. bigemina infection when inoculated intravenously into susceptible cattle.


Malignant melanoma with adjacent Hutchinson's melanotic freckle in Black Africans.

Hutchinson's melanotic freckle (lentigo maligna) is a well-known pigmented lesion, usually seen on the face of white patients. It may be associated with invasive malignant melanoma. This paper reports the incidence of this lesion in association with invasive malignant melanomas of the feet and hands of Black Africans. In Blacks, as in Whites, malignant melanoma with adjacent Hutchinson's melanotic freckle carries a considerably better prognosis than other histogenetic patterns of malignant melanoma.


Bacteria in neonatal omphalitis.

A 6-year study of bacteria isolated from swabs taken from clinically apparent infections of the stump of the umbilical cord showed an overall infection rate of 0.7% (200/27,107), with a preponderance of Gram-negative organisms as compared with Gram-positive organisms (171/118), an excess which was statistically significant. When the data were broken down into premature and non-premature nurseries, the incidence of infection in the former was 2.08% (84/4028) and in the later 0.5% (116/23,079), a highly significant statistical difference. Most of the organisms isolated from the premature nurseries were Gram negative (83/120) and this finding too was statistically highly significant.


Histiocytoid cardiomyopathy of infancy: an unexplained myofibre degeneration.

An unusual multifocal degeneration of the myofibres of all chambers and the conducting system of the heart was found in a 4-month-old female in whom ventricular pre-excitation (Wolff-Parkinson-White syndrome) had been demonstrated. There was a complex malformation of the brain with hydrocephalus and bilateral corneal opacities and microphthalmos. The affected myofibres had a swollen vacuolated or granular cytoplasm and rounded nuclei giving a histiocytoid appearance. Disruption of myofibrils and gross dilation and disorganization of mitochondria were the major fine structural features. Reports of similar lesions in 8 other young female children are reviewed. 'Histiocytoid cardiomyopathy' is the term preferred over others which refer to an increased lipid content. The aetiology is unknown.


The distribution of dextran macromolecules in the glomeruli of normal and nephrotoxic rats.

The incorporation of intravenously injected dextran molecules (molecular weight 500,000 & 2,000,000) by the glomeruli of laboratory rats was studied by electron microscopy. In normal rats some dextran molecules were observed 12 minutes after injection in vesicles and invaginations of both endothelial and mesangial cells. Rats with nephrotoxic serum nephritis showed extensive separation of endothelial cells from the glomerular basement membrane. These subendothelial spaces contained irregular granular material, cytoplasmic extensions of mesangial cells and, in animals injected with dextran, dense accumulations of dextran molecules. There was no apparent difference in distribution of the two test samples of dextran. These findings demonstrated the involvement of both endothelial and mesangial cells in the glomerular localization of circulating material and indicated that immunologically inactive macromolecules can be incorporated into subendothelial deposits following immunological injury to the glomerulus.