Host responses to hepatitis B infection in patients in a chronic hemodialysis unit.

Host responses to hepatitis B infection were studied in 222 patients in a chronic hemodialysis unit. From 1970 to 1976, patients were monitored monthly for development of hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), and serum transaminase (SGPT) elevations. Five categories of patients were identified as: 1) chronic carriers of HBsAg; 2) transiently HBsAg(+), who developed anti-HBs; 3) HBsAg(-) on admission, who developed anti-HBs without becoming HBsAg(+); 4) anti-HBs(+) on admission; 5) uninfected who remained HBsAg(-) and anti-HBs(-). For a patient who became HBsAg(+) in this clinic, the probability of becoming a chronic carrier was 62-8% and rose to 88.5% if he or she had been HBsAg(+) for five consecutive months. Males were more likely to become chronic carriers, and females were more likely to develop anti-HBs. Neither age, race, nor type of underlying kidney disease was associated with particular host responses to hepatitis B virus. No effect of hepatitis B infection on mortality was detected. Variation in host response to hepatitis B infection among renal dialysis patients may affect the usefulness of hepatitis B hyperimmune globulin and hepatitis B vaccine and be related to the outcome of kidney transplantation.


[Cyclocryotherapy of haemorrhagic glaucoma: clinical long time and histopathologic results (author's transl)].

67 eyes with a haemorrhagic glaucoma have been treated with different methods of cyclocryotherapy. 54 of the 67 patients were painless after a follow-up from 6 to 53 months. In 49 eyes the intraocular tension was under 25 mm Hg regardless of the applicationmethod used. 9 of the 67 eyes were found to be phthistic most of them in the series with the longest follow-up. The histopathologic findings of 8 eyes which had been excised after different postoperative periods show severe necrosis and chronic tissue reaction following cyclocryotherapy.


[A new operative method for the treatment of malignant glaucoma (author's transl)].

Since 1971 the University Eye Clinic Graz has used the cryocoagulation of the ciliary body as a method of therapy in cases of malignant glaucoma. In all 7 eyes treated once by coagulation the malignant course was interrupted and the tension permanently regulated. It is believed that the cyclotherapy directly interferes with the pathomechanism of the malignant glaucoma.


[The diagnostic and prognostic significance of increase intra-ocular pressure (author's transl)].

A single tonometry observation is not very relevant due to considerable interobserver variations which are also found in applanation tonometry. Furthermore, the intraocular decreases by repeated applanation tonometry and intra-ocular pressure that change for as much as 8 mm Hg in 1 minute has been found in continous pressure recordings. There are in addition diurnal pressure variations and pressure alterations with the position of the body. Therefore, the diurnal pressure curve is much more important than the single tonometric value. The prognosis and also the decision to start medical treatment depends upon the height of the pressure, the family history diabetes, vasoclerosis, low blood pressure, heart insufficiency, age, disease of the carotid artery, anemia, the size of the excavation, the condition of the visual field, the reliability of the patient and the pressure lowering effects of pilocarpine, which can be very different individually. Rarely pressures of 26 mm Hg or more can be left untreated. If unfavourable factors are combined, even in pressures of 20 mm Hg it should be tested if pilocarpin lowers the intra-ocular pressure considerably. There is no magic number of pressure where treatment has to be started.


[On the clinical picture of Handmann's anomaly of the optic nerve Morning glory syndrome? (author's transl)].

The author reports on the case of a 20-year-old patient who shows the characteristic changes of the central vessels, described by Handmann in 1929 to be a "herditary degeneration - ppresumably congenital and glial - of the optic nerve in which the central vessels are particularly involved". The optic papilla of about normal size is surrounded here by a slightly protruding ridge, which shows separate pigmentary sediments on its edge. The retinal vessels arise out of the depth in increased number on the edge of the papilla. An excavation of the papilla cannot be seen. In its place a whitish-yellow mass surrounded by grayish-pink colored tissue is evident, which obstructs the view into the deeper layers. Kinkler described very similar cases in 1970 and named the characteristic changes "morning glory syndrome". However, in the cases he described, the papillas were apparently greatley enlarged. In addition to the changes in the papillary area and the vessel structure in our case, there are definite changes in the macula (on both sides). Due to the conspicuous distribution of vessels within the papillary region in the father of the patient, similar to those found in Handmann's anomaly of the nerve, the author believes that he can safely assume a developmental disturbance of the origin of the retinal vessels of the papillary area in this case also and that therefore a hereditary component of this developmental disturbance could be described for the first time since Handmann in 1929. In the kin which the author examined, a further apparently familial renal hypoplasia was noted.


[Binocular fusion of anamorphotic distorted images (author's trnasl)].

A astigmatic eye corrected with a spectacle lens results in an anamorphotic optical system which gives a distorted image of the environment on the retina. Fusion disturbances were ppresent especially in oblique astigmatism. The explanation for this can come either from a displacement of the image points on the retina or from the prismatic side effects of the spectacle lenses.


[Valuation aetiology of venous retinal anastomotic vessels (author's transl)].

Description of an aspect of a disease characterized by marked retinal venous anastomotic vessels in a 69-year-old man. There is no recognition of blindness of patients left eye and a declared trauma of war.


[Experiences with drug therapy in association with ischaemic vascular disease of the fundus oculi (author's transl)].

The action of Thilocombin was tested on various eye conditions classified in groups. Common to all six groups was the presence of ischaemic vascular disease with reduciton of central visual acuity. The results of long term treatment with Thilocombin were significant: in almost 60% of cases a lasting improvement of function could be achieved. In the remainder of cases worsening of the loss of vision could usually be arrested.


[Chorioidal detachment following lasercoagulation for diabetic retinopathy (author's transl)].

A case is presented of unilateral chorioidal detachment following bilateral retinal ablation for diabetic retinopathy by argon laser photocoagulation.


[The action of stabilised pilocarpine drops on the human eye (author's transl)].

The use of certain additional substances enables preparation of pilocarpin solutions which remainstable for at least 4 years, while the usual pilocarpin solutions were subject to a relatively early decomposition. A double-blind study with 30 patients demonstrates that there is no difference between the pharmacologic effect at the pure and the modified pilocarpin solution, which justifies the use of solutions with added substances to stablize the effective component.


[Contact lens-fitting, a hepatitis risk? (author's transl)].

Hepatitis-B-antigen has been demonstrated by the radioimmunologic method in 5 out of 40 patients with acute or chronic HBs-antigen-positive hepatic disease. The importance of this finding as to the transferral of hepatitis by the fitting of contact lenses and its consequences are discussed.


[Improved method of lens photograpy using retroillumination (author's transl].

Lens photography with a fundus camera using retroillumination is suited for long term follow-ups of senile cataract development. An improved method using a 9 grade colour standard is presented, which makes a comparative evaluation of the colour of the fundus reflex possible. A colour filter effect of the lens nucleus in nuclear sclerosis can thus be evaluated.


[A fixation lamp for panoramic fundus pictures (author's transl].

A fixation lamp is described that enables a rational generation of panoramic fundus pictures with the Zeiss, Oberkochen, or other fundus camera of similar field, provided the patients collaborate. An illuminated marker at infinity is perceived centrally on the one hand, and on the other hand the marker is guided along a circle of 22 degrees eccentricity by a rotatable mirror system with click stops at every clock position 1 to 12 hours. If the camera is provided with angle scales, and use is made of its horizontal and vertical excursions, another circle of pictures at 38 degrees eccentricity can be obtained. With a total of 19 pictures a field of 96 degrees diameter is thus completely covered in a regular manner (see Fig. 6). Resolution wide-angle composite pictures of this kind is as good as resolution obtained by other means.


[The mirror as a fixation aid for the fundus camera (author's transl)].

A supplementary mirror is described for the fundus camera easily permitting correct adjusting of the central and temporal regions of the ocular fundus.


[A new procedure for keratometry (author's transl)].

The principle of construction of a keratometer is explained which shows digitally the radii of curvature of the cornea obtained by automatic optical measurement and processed by an inbuilt computer.


[A variable pressure and distance impression funnel for fundus examination (author's transl)].

We describe a variable pressure and variable distance impression funnel for the Goldmann-3-mirror contact glass. The advantage of this apparatus lies in the possibility of denting the bulbus up to the equator for the diagnosis of holes while the retina is still attached. This funnel has proved itself especially in light coagulation through the contact glass with the slitlamp.


[The slit-lamp as operating microscope a personal device (author's transl)].

Instead of the operating doublemicroscope described by Harms the Zeiss slit-lamp was suspended on the microscope stand by means of two special couplings in form of two stairs, so that the biomicroscopy in the optic section can be performed also when operating, especially in surgery of the retina when using contact glasses. This improvisation is a cost saving alternative against the newly commercially available operating slit-lamp.


[Assessment of eye lesions in private accident insurance. IV. (Supplement). Decision of the German Federal Supreme Court dated Apr 24, 1974 (IVVZR 54/73, celle)].

Blindness of one eye, caused by accident, has to be judged as a degree of invalidity between 30 and 70 per cent if the other eye had partial or complete loss of function before the accident. Some statements leading to that sentence of the federal german supreme court are shown. (See also Klin. Mbl. Augenheilk. 169 [1976] 647, 774; 170 [1977] 131).


[Investigations on retinopathia pigmentosa. Statistical analysis of perimetry results (author's transl)].

Kinetic perimetry was carried out using the Goldmann perimeter in 201 patients with primary pigmentary retinal dystrophy, 156 autosomal recessive and 45 autosomal dominant cases. "The advanced stage" of the isopter deterioration was defined as the isopter area with the test object I-4 being 1 cm2 or less on the chart of Goldmann. The frequency of "the advanced stage" cases in creased with age in both hereditary forms, but it was higher in the recessive than in the dominant form throughout all age groups. The frequency-age relationship was exponential as is found in various aging phenomena. Fifty per cent of the patients were in "the advanced stage" at the age of 30 years in the recessive and at the age of 56 years in the dominent form.


[Light injury to the retina. Manifestation of acute posterior multifocal placoid pigmentepitheliopathy (author's transl)].

Light injury to the human eye has been correlated exclusively with wellknown thermal effects (e.g., solar maculopathy; photocoagulation). One may speculate whether clinical conditions exist in which the light impact from strong conventional light sources--otherwise innocuous--may become harmful to the retina. A case history is presented of a patient suffering from acute posterior multifocal placoid pigment epitheliopathy in which a possible relationship is discussed between the appearance of the fundus changes and the damage due to direct viewing of a halogen head light.


[From perceptive flicker to macular ERG by sinusoidal stimulation (author's transl)].

A short presentation is given of the instrument used for perceptive flicker and for macular ERG. A modified de Lange's curve is obtained (the trimodal curve) and a macular ERG response is obtained from stimulation within a theoretical angle of 46 minutes of are.


[Topical oxpernolol in the treatment of various forms of glaucoma (author's transl)].

Oxprenolol is a new beta-adrenergic blocking drug, whose effectiveness in the treatment of various forms of glaucoma has been evaluated. The drug was administered topically as 0.5% -1%-2% solution. The results of the investigation may be summarized as follows: The instillation of the drug produces a transient and slight conjunctival hyperaemia and a not significant miosis. A significnat ocular hypotensive action has been observed in the treatment of chronic open-angle, hemorrhagic and congenital glaumiosis. A significnat ocular hypotensive action has been observed in the treatment of chronic open-angle, hemorrhagic and congenital glaucoma. The concentration of 0.5% Oxprenolol seems to be as effective as topical 1% Propranolol. At the same concentration (0.5%), Oxprenolol produces no significnat change of the systemic blood pressure or of the heart rate. Topical pre-treatment with 1% Oxprenolol inhibits the systemic side-effects (tachycardia) produced by topical Isoproterenol, a wellknown ocular hypotensive drug. The authors conclude the investigation affirming that Oxprenolol may represent a new effective means for the medical treatment of glaucoma.


[Indications and contraindications of the combined operation (fistulation and cataract extraction) in open- and closed-angle glaucoma (author's transl)].

The respective indications are briefly described for: a) trabeculectomy through a scleral flap, b) simple cataract extraction, c) combined operation of lens extraction and fistulation in open-angle glaucoma on the one hand and close-angle glaucoma on the other. The choice of operation is dictated by many considerations. The main considerations are as follows. A Lens extraction alone has no lasting effect on the pressure in open-angle glaucoma, but is a good operation against early closed-angle glaucoma. B. Any fistulising operation predisposes to cataract when performed on old patients whose lenses suffer from senile changes already before the operation. A fistulising operation predisposes more to cataract in close-angle as in open-angle glaucoma. C. Lens extraction removes the risk of post-operative "athalamia" and hence of post-operative malignant glaucoma. D. The combined operation avoids a second surgical intervention and reduces the risks of oedematous dystrophy of the cornea in elderly patients who already have before the operation definite signs of endothelial dystrophy. E. Combining the glaucoma and cataract operations although, having certain peculiar risks, gives in a high percentages of cases efficient and long-lasting fistulation and a satisfactory intracapsular lens extraction.


[Photography of the optic disc in the management of glaucoma (author's transl)].

Repeated photography of the optic disc is helpful in the management of 1. patients with glaucoma, especially those who do not give reliable results on visual field testing, and 2. patients with ocular hypertension. The changes to be looked for are; a) any increase in the size of the cup, b) any decrease in the width of the rim of tissue between the edge of the cup and the edge of the disc, c) the occurrence of small haemorrhages on the disc, d) changes in the course of vessels on the disc.


[A choroidal tuberculoma simulating a melanoma (author's transl)].

The clinical picture, the angiogram, the echogram, and especially the positive P 32 test led in a 30-year-old man to the diagnosis of a choroidal melanoma. Histologic examination revealed a tuberculoma.


[Neuroleptanalgesia in ophthalamic surgery (author's transl)].

After listing the bibliography, the author sugests cases in which neuroleptanalgesia is specially advisable in ophthalmic surgery, mainly in delicate and not too long operations (cataract, glaucoma a.s.o.). In cases of ocular hypertension "Diamox" is previously injected. In the premedication "Valium", and in some patients "Fentanest" and "Droperidol". During surgery the patient breathes spontaneously; oxygen is provided by means of a nasopharyngeal sound. In cataract operations akinesia is recommended. Neuroleptanalgesia  has been employed in 140 eyes, mainly in cataracts (80 cases) and chronic simple glaucoma (40 cases).


[Indications, technique and results of anterior vitrectomy (author's transl)].

The indications for anterior vitrectomy are presented and the surgical technique is described. An analysis is made of the results of anterior vitrectomy in 93 eyes followed for 4 years and compared with the results of a previous study in which vitreous loss was treated more conservatively. The results of anterior vitrectomy are significantly better particularly in regard to prevention of complications in the anterior chamber and the final visual result.


[Vitrectomy after intracapsular cataract extraction (author's transl)].

A report is given on transpupillar vitrectomy with the suction wedge for prolapse of the vitreous after intracapsular cataract extraction. From the results obtained this method can be recommended. In aphakic eyes with drawn up pupil the pupil should be cut out underneath after opening the anterior chamber. Also in this case vitrectomy must be performed before closure of the anterior chamber.


[Intercellular bridges in intraocular melanoblastomas (author's transl)].

Scanning electron microscopic investigations were carried out in three cases of epitheloid melanoblastomas. Intercellular junctions were described which overbridged even broad intercellular spaces.


[Mykosis of soft contact lenses (author's transl)].

A 63-year-old patient suffering from old sclerokeratitis was fitted with a therapeutic soft contact lens one and a half years after corneal transplantation and half a year after cataract surgery. The patient was on oral and local cortisone treatment. The first three months were uneventful with an aphakic high water content lens worn continuously. This lens was lost and she was given a B-L plano T. One month later the patient was admitted to the hospital with a red eye and a large corneal ulcer. Two white spots were noted on the contact lens. In a frozen section yeast-like structures were seen on the lens that partly invaded the lens material. Fungal culture from the other deposit revealed candida tropicalis and fusarium. The corneal ulcer healed with antimycotic therapy. The possible relationship between cortisone treatment, corneal ulcer and fungal contamination of the lens is discussed.


[The influence of artefacts on visual evoked respnses (author's transl)].

In 38 healthy persons ranging in age from 23 to 30 years the visual evoked potential over both hemispheres were taken and the latencies and amplitudes of waves I-V registered, first undisturbed, then following defined eye and arm movements, and acustic irritation. The results of 30 persons could be evaluated. It is shown that under these experimental conditions the form of visual evoked potentials is practically undisturbed.


[Vitelline macular degeneration and Best's macular degeneration are the same disease (author's transl)].

In 1905 F. Best had discovered infantile macular degeneration with dominant transmission, later named after him. From Best's pedigree 19 members could be examined by us. Besides the usual examination-methods, EOG, ERG, Fluorescein-Angiography and Chromato-Ophthalmoscopy were applied. In this way the characteristic findings of vitelline macular degeneration could be demonstrated. 7 family-members were typically affected according to their ages. 2 of them were found to be carriers with normal macula; they had however a pathological EOG. The question, if the diagnosis of Best's macular degeneration should be used further in the system of the hereditary macular degenerations or whether it is indeed the same disease as vitelline macular degeneration, is discussed. Best's macular degeneration and vitelline macular degeneration are synonymous. We recommend, that the term vitelline macular degeneration ought to be used intead of Best's macular degeneration. It remains F. Best's merit, that this disease has been recognised and des


[Adapto-electroretinography: a new criterion of scotopic reaction (author's transl)].

The b2-waves in the human electroretinogram provoked by blue- and orange-light stimulation can be united to a single scotopic wave. By this procedure a continuous demonstration of the adaptation process can be achieved beginning with the final point of the light adaptation.


[Genetic aspects of keratoconus (author's transl)].

The diverging views expressed in the literature on the inheritance of keratoconus gave us cause to examine the genetic relationships in 304 cases of keratoconus from our own clinic material. In the 22 cases (19 families) where two or more family members were affected, the genetic relationships generally indicated a multifactorial mode of inheritance, although isolated dominant or recessive variants could not be excluded. The assumption of a multifactorial inheritance is further supported by the occurrence of keratoconus in connection with various syndromes, as well as the fact that keratoconus does not only express itself in sharply defined stages, but also occurs in all possible degrees, from almost normal to the extreme.


[Thygeson's superficial punctate keratitis (author's transl)].

Ten cases of Thygeson's bilateral punctate epithelial keratitis were observed during a two year period. The diagnosis, therapy and prognosis are discussed. The common erroneous diagnosis of herpetic keratitis may lead to corneal damage as a result of too intensive therapy. Highly hydrophilic contact lenses have proven to be a valuable aternative to steroid therapy. The etiology remains obscure. Viruses were not detected with either tissue culture technique or with electron microscopy.


[Traumatic cyclodialysis and its treatment (author's transl)].

A summary of the literature concerning traumatic cyclodialysis is given. Among 5 cases reports 4 hypotension-syndromes occurred. Traumatic cyclodialysis with persistent hypotension as well as postoperative hypotension resulting from planned cyclodialysis require the same surgical treatment. 3 out of 4 cases with hypotony-syndrome were treated succesfully by surgical closing of the cleft. Another case who had panophthalmitis prior to surgery became phthisic. The surgical procedure used is similar to that described in the literature.


[Controlled hypotension by sodium-nitroprusside in general anaesthesia for difficult intraocular surgery (preliminary report) (author's transl)].

General anaesthesia was performed in 75 patients with difficult intraocular procedures in which the standard relaxation and hyperventilation was supplemented by controlled short-term hypotension by sodium-nitroprusside. This resulted in a significant decrease of the "vis a tergo"--e.g. the threatening prolaps of intraocular tissue. Preliminary experience revealed that intraoperative complications in these difficult situations are reduced. As this facilitates also the task of the anaesthesist this broadens our indications for complex intraocular surgery particularly in younger patients.


[Malformation of the tear ducts associated with clefts in the face (author's transl)].

A case of malformation of the tear duct associated with clefts in the face is described. To our knowledge this combination has not been described before. The whole symptoms complex consisted of: bilateral cleft lip upper jaw and gum, choanalatresia, mucocele of the left nasal cavity from adhesions of the lower concha with the nasal septum, cystic dilatation of the tear sac at the connection to a bony naso-lacrimal duct. Right inguinal hernia, syndactyly of the first and second left toes, iris-chroid coloboma right with congenital cataract and unilateral right convergent squint. Because of the advanced dacryocystitis on the basis of the congenital dacryostenosis, and external dacryostorhinostomy (modified after Kaleff 1937) was performed after pre-treatment by instillation of antibiotic solutions in the tear ducts. At the same time the nasal cavity mucocele was opened by partial excision of the lower concha and opening the choanal atresia. After a post-operative course free of complications and with clear patency of the tear ducts the oral surgical operation was done--closure of the face clefts. The chromosome analysis was normal the only abnormal result here was an unexplained slow rate of multiplication of lymphocytes in four cultures inoculated at various points of time. Because we could not find any hereditary factors, this symptom complex is probably due to exogenous embryo damage during the early development phase.


[Isomerisation and bioavailability of beta- and alpha-acetyldigoxin (author's transl)].

Bioavailability of acetylated derivatives of digoxin tablets have been studied in healthy subjects after a single oral and intravenous dose as well as during maintenance therapy. alpha-acetyldigoxin shows a lower bioavailability than beta-acetyldigoxin even if the alpha-acetylated derivative is incorporated in a matrix of aerosil (SiO2). Moreover, beta-acetyldigoxin can be transferred to alpha-acetyldigoxin in alkaline solutions. This isomerisation leads to a decrease of the bioavailability of such fixed preparations which contain beta-acetyldigoxin and the hygroscopic salts of potassium-magnesium-aspartate. A prevention of the isomerisation is attained by isolating beta-acetyldigoxin from potassium-magnesium-aspartate. The bioavailability of a such new formulation is comparable to that of beta-acetyldigoxin alone. The experiments show the bioavailability of acetylated derivatives of digoxin to be influenced by the physico-chemical properties of a drug and its preparation.


[Critical analysis of the saralasintest in the diagnosis of hypertension (author's transl)].

The reliability of the angiotensin II (AT II)-antagonist Saralasin in the diagnosis of AT II-dependent forms of hypertension was investigated in 61 cases of hypertension of different etiology. In 14 patients, lowering of blood pressure by Saralasin suggested an AT II-dependent hypertension which could be ascertained in 8 patients (5 had undergone successful surgery) by increased levels of plasma-renin-activity (PRA), AT II, PRA-ratio in renal vein blood and by angiography. Besides, depressor reactions by Saralasin yielded additional information in three patients with renovascular hypertension but normal levels of PRA and AT II, in two patients with high renin essential hypertension and one patient with pheochromocytoma. This test seems to be valuable in the diagnosis of renin-dependent hypertension.


[Values of hemisoagglutinins and immunoglobulins among patients with surgical diseases and blood donors. Preliminary communication (author's transl)].

Our investigations show distinctly higher values of hemagglutinins and immunoglobulins in patients with severe consuming and tumor diseases than in blood donors or subjects with slighter illness. Therefore, those are often able to form much more antibodies than supposed till now, inspite of their severe or cancer diseases. The stimulation of their immune system by intestinal mucosa is discussed, containing compounds identical to blood group substances A and B. They are resorbed from ulcers or during operations. More than 3/4 of our patients with severe or cancer diseases suffered from gastro- or intestinal illness. Cancer patients having often a good antibody forming system do not need automatically stimulating means such as BCG-vaccine in the cancer diseases.


[Importance of inheritance in cardiomyopathies (author's transl)].

Inheritance plays an important role in the cardiomyopathies (i.e. dysfunction of the cardiac muscle of unknown origin). This especially has become obvious for the entity asymmetric septal hypertrophy of autosomal dominant inheritance (ASH), a cardiomyopaty with and without obstruction. But this is not the only type of cardiomyopathy of dominant transmittance as was shown by the demonstration of a kindred, in which echocardiographically no hypertrophy of the septum could be found. For it was not possible to find a uniformity for all the affected members of the kindred, for example a congestive course of the disease. Therefore it is suggested to name the disease without any prejudice "cardiomyopathy without asymmetric septal hypertrophy of dominant inheritance" to distinguish it from the "cardiomyopathy with asymetric septal hypertrophy of dominant inheritance". There also may occur a cardiomyopathy of autosomal recessive inheritance. This form could represent a large part of the "sporadic" cardiomyopathies and should challenge to search intensively for enzyme defects as a cause of the disease.


[Relations between complement and blood coagulation (author's transl)].

The complement system as well as the blood coagulation system are involved in several disease processes so that it seems to be of interest to search for direct or indirect functional relations. Both systems can be activated in vitro as well as in vivo by the same substances, as e.g. endotoxin or antigen antibody complexes. In spite of these common characteristics a direct functional relationship between complement and plasmatic blood coagulation could not be established. Complement and blood coagulation do not interact with each other. Activated complement components, however, can induce platelet aggregation and release reaction both of which may accelerate but not trigger intravascular coagulation. Therefore, indirect relations between complement and blood coagulation can be found in patients or in animal experiments, especially after activation of intravascular coagulation. These interactions depend on further mediator sugstances of both systems.


[Clinical pharmacology of two new oral antidiabetics of the sulfonamide type (author's transl)].

Pharmacodynamic studies were performed with two new blood glucose lowering sulfonamides of high potency: gliquidone and gliflumide. The aim was to obtain equipotent doses on the basis of a maximum 30% blood glucose decrease in healthy normals (Ed 30) in order to compare the new compounds with the well known effects of tolbutamide and glibenclamide. Our investigations demonstrated a dose dependent blood glucose decrease with each sulfonylurea corresponding with the insulin levels after intravenous application. Gliquidone revealed a "tolbutamide-typed" dynamic both on insulin secretion and on blood glucose decrease whereas gliflumide showed a "glibenclamide-typed" reaction. The delayed and more prolonged insulin decrease, well known for glibenclamide, was even more distinct following gliflumide. Differences of insulin secretion after sulfonulureas can be observed only under intravenous conditions. Following oral application an only small increase of insulin can be noted when measured in peripheral blood.


Interrelations between age and plasma renin, aldosterone and cortisol, urinary catecholamines, and the body sodium/volume state in normal man.

Interrelations between age and plasma renin, aldosterone and cortisol levels, urinary catecholamiens, plasma and blood volumes, exchangeable body sodium and blood pressure wwere studied in 28 young (19 to 29 years), 16 middle-aged (32 to 58 years) and 15 elderly (60 to 74 years) healthy subjects. Supine and upright plasma renin and supine aldosterone levels decreased while urinary noradrenaline excretion rate increased progressively with aging (r= greater than 0.34; p less than 0.05), with significant differences in mean values between young and elderly subjects (p less than 0.02). There was also an age-related decrease in upright plasma aldosterone concentration, although this was no statistically significant. Furthermore, mean plasma cortisol concentrations increased in response to upright posture in elderly ( + 50%; p less than 0.02), but not in young ( --10%) or middle-aged ( --8%) subjects. Blood pressure correlated with age ( r =0.35; p less than 0.05) or noradrenaline excretion rate ( r= 0.34) in the entire study population and with blood volume in the elderly ( r = 0.68), but not in the young or middle-aged study. Groups. There were no significant age-related differences in the body sodium/volume state, basal plasma cortisol levels or urinary adrenaline excretion rate, and plasma renin or aldosterone levels did not correlate with these parameters or with blood pressure. It is concluded that the influence of age on plasma renin or aldosterone levels, plasma cortisol responsiveness to upright posture, and urinary noradrenaline excretion should be taken into consideration, whenever these factors have to be interpreted in patients with arterial hypertension or other clinical disorders. Further more, these data are conssitent with the possiblity that in normal man increases in supine blood pressure with aging may be related at least partly to concomitant changes in free peripheral noradrenaline.


Phagocyte dysfunction in common variable immune deficiency.

The history of a 13-year old boy is reported who suffered from frequent bacterial, enteroviral, and protozoal infections since late infancy. A decrease in the serum levels of IgG2, IgG3, IgA, a neutrophil dysfunction, and a partial cellular immune deficiency could be demonstrated. A deficiency of folic acid produced a pancytopenia which enhanced the patient's susceptibility to infections. The combined substitution of gammaglobulins and folic acid only was able to break this vicious cycle.


Interaction of allopurinol with phenprocoumon in man.

Conditions in two patients on long-term phenprocoumon (Marcumar) treatment are reported who had signs of phenprocoumon overdosage when given simultaneously allopurinol. The determination of phenprocoumon plasma concentrations in one patient showed that phenprocoumon accumulates for several weeks during treatment with allopurinol. Signs of phenprocoumon overdisage thus can appear long time after starting allopurinol treatment.


Tubular aggregates induced by anoxia in isolated rat skeletal muscle.

The fast-twitch extensor digitorum longus and the slow-twitch soleus muscles of the rat were incubated for 1 to 6 hours in vitro in oxygen-free medium or a medium containing potassium cyanide. Within 3 hours of incubation, characteristic structural alterations of the sarcoplasmic reticulum were observed in extensor digitorum longus muscle fibers. Concomitant with the disruption of the normal sarcotubular organization there was a selective clustering of sarcoplasmic reticulum elements with formation of tubular aggregates similar to those observed in human muscle under various pathologic conditions. The aggregates increased in size by apposition of new tubules at the periphery and acquired a regular hexagonal arrangement. Double-walled tubules, apparently derived from folding of sarcoplasmic reticulum tubules, were also contained in the aggregates. Electron-opaque material was seen connecting adjacent tubules. It is proposed that this material derives from the Z-bands which appeared largely extracted since early stages of anoxic injury. Tubular aggregates were not seen in the soleum muscle fibers incubated under the same conditions in vitro. The results indicate that tubular aggregates can be formed by simple rearrangement of the sarcoplasmic reticulum without proliferation of new sarcotubular elements.


Mumps virus-induced hydrocephalus in hamsters. Ultrastructure of the chronic infection.

Newborn hamsters were inoculated intraperitoneally with neuroadapted mumps virus and sacrificed at intervals from days 3 through 50. Intracytoplasmic collections of nucleocapsids were found in ependymal cells and neurons on days 3 and 5 and virus formed at the plasma membrane of such cells by building. At closely apposed ventricular surfaces, mature particles appeared to form "bridges" between cilia of adjacent cells. Intracytoplasmic collections of nucelocapsids without evidence of maturation from cell surfaces could be found in ependyma for as long as 33 days. At the sites of apparent aqueductal occlusion, located in several animals, were found enlarged and distorted ependymal cells that did not define a lumen. The ependyma lining hydrocephalic lateral ventricles showed markedly attenuated cytoplasmic processes. Ependymal lined channels frequently coursed below the ventricular surface. Interstitial edema separated parenchymal elements of the underlying white matter. Conversion from an acute productive phase of infection to a chronic, nonproductive phase of infection in this model has ultrastructural correlates that appear to typify persistent paramyxoviral infections of brain.


Perturbation of the adipose cell plasma membrane in obese (ob/ob) mice.

The plasma membrane organization of adipocytes of genetically obese (ob/ob) mice has been studied by freeze-fracture and compared to that of control (lean) mice and of small and large adipocytes in rats of different age. The large size increase of ob/ob adipocytes is accompanied by a decrease in the concentration of surface invaginations and of intramembrane particles in the plasma membrane as compareed to control, nonobese mice. By contrast, the membrane of large adipocytes of normal old rats has a concentration of invaginations and particles similar to that present in the membrane of small adipocytes of young rats. Thus, the changes of the plasma membrane organization in ob/ob adipocytes seems not to be due to size increase only but may reflect a more general perturbation of the membrane, such as evidenced by the reduced insulin and lectin binding capacity demonstrated in these cells.


Analysis of the cores of ferruginous (asbestos) bodies from the general population. I. Patients with and without lung cancer.

Ferruginous (asbestos) bodies may be found in the lungs of almost everyone in the population, but little information is available as to whether such bodies are nucleated on asbestos or on some other fibrous dust. In this study morphologically "typical" ferruginous bodies were isolated from the lungs of 23 autopsy and surgical patients, none of whom had primary asbestos exposure. Eleven patients had carcinoma of the lung. To determine the nature of the core, 328 bodies were examined by electron diffraction. Of these, 264 (80%) showed the diffraction patterns of amphibole asbestos, whereas six showed the pattern of chrysotile asbestos. No amorphous cores or crystalline nonasbestos cores were identified. Fifty-eight (18%) bodies could not be diffracted because of the thickness of the iron-protein coat. No differences were seen between patients with and without lung cancer. We conclude that typical ferruginous bodies have asbestos cores, which are usually amphibole type. The findings suggest widespread exposure to asbestos dust; occupational histories appeared to indicate the source of exposure in some but not all patients.


Characterization of lipid-laden aortic cells from cholesterol-fed rabbits. I. Resolution of aortic cell populations by metrizamide density gradient centrifugation.

Enzymatically isolated aortic cells from control and cholesterol-fed rabbits were subjected to isopycnic density gradient centrifugation in Metrizamide. Control cells formed a single band equilibrating at a median density of 1.13 to 1.14, while cells isolated from atheromatous aortas formed two distinct bands, one equilibrating in the density range of 1.12 to 1.14 and the other occurring at a lower density of 1.03 to 1.07. Morphologically, the low density cells exhibited typical features of aortic foam cells. They were found to be greatly enriched in free and esterified cholesterol and in four lysosomal hydrolases. Further studies showed these cells to contain lipid-laden lysosomes. The high density cells from cholesterol-fed rabbits were also enriched in cholesterol and lysosomal enzymes compared to control aortic cells but not to the extent showen by the low density foam cells. While exhibiting the ultrastructural characteristics of smooth muscle cells, the cells in this fraction showed a considerable degree of morphologic and biochemical heterogeneity, suggesting the occurrence of many transition forms between normal smooth muscle cells and fully transformed foam cells.


Tuberculoid leprosy and tuberculosis skin: a comparative histopathological study.

Since it has been found hard to differentiate histopathologically tuberculoid leprosy from tuberculosis of the skin, a study of 20 biopsies from each of those conditions was undertaken to identify if possible some of their characteristic features. In tuberculoid leprosy along with tuberculoid granulomata there is always selective involvement and destruction of nerves, lack of fibrosis, absence of caseous necrosis and often epidermal atrophy. In cutaneous tuberculosis, on the other hand, in addition to tuberculous granuloma, there is often a proliferation reaction of the epidermis, areas of ulceration, absence of nerve destruction, marked increase in the reticulin, significant fibrosis and occasionally caseous necrosis.


Isolation of a mycoplasma from three patients with lepromatous leprosy.

Using a modified cell-free culture medium and modern microscopic equipment, a mycoplasma was isolated from scrapings of skin lesions of three patients with lepromatous leprosy. Three specimens were taken from the first patients. All five isolates were arginine-positive and their antibiotic sensitivity was identical with only one slight exception.


Fundamental frequency-sound pressure level profiles of adult male and female voices.

Fundamental frequency-sound pressure level (fo-SPL) profiles were determined for 12 female and 10 male subjects. Profiles were obtained by having each subject produce the maximum and minimum sound pressure level of which he was capable, at 10% intervals of his fo range. Comparison of male and female profiles showed similar values for frequency range in semitones, maximum and minimum SPL output, and total SPL range. A minimum SPL of 50 dB was necessary to produce a steady-state frequency for all subjects, and the maximum level ofr an acceptable fo was 126 dB SPL. The fo-SPL profiles obtained with the amateur subjects used in this study had a somewhat wider dynamic range than those obtained in earlier studies which utilized trained singers producing musically acceptable tones.


Validity of the Peabody Picture Vocabulary Test as a measure of hearing vocabulary in mentally retarded and normal children.

The Peabody Picture Vocabulary Test (PPVT) and the auditory and visual subtests of the Illinois Test of Psycholinguistic Abilities (ITPA) were administered to 48 normal and 48 retarded subjects. Results suggested that the PPVT is not an adequate measure of hearing vocabulary for mentally retarded subjects. Half of each group was given the visual reception subtest of the ITPA in a form which had been modified to control the visual memory variable. No differences were found as a function of that variable. It was concluded that caution should be exercised when using the PPVT as a clinical diagnostic procedure in the assessment of receptive auditory vocabulary.


Language and memory disorders following closed head trauma.

Patients who suffer closed head trauma may demonstrate communication disorders which have been variously described as aplasia, severe memory impairments, traumatic aphasia, or confusion. The memory and language skills of 14 patients who had suffered closed head trauma were documented after they regained ocnsciousness and at one-month intervals for four monts utilizing the Porch Index of Communicative Ability and the Wechsler Memory Scale. Results indicated that patients initially suffered both reduced memory and language skills. After four months, expressive and receptive language skills were grossly functional for conversational purposes, and all memory taskd with the exception of orientation skills were within normal limits. Significant improvement in both language and memory functioning most often occurred during the first month after regaining consciousness, although gradual improvement in both language and memory skills was noted beyond the one-month period. No significant correlations existed between the length of unconsciousness and the initial and final language and memory scores.


Discrimination of linguistic stress in early infancy.

The high-amplitude sucking (HAS) paradigm was used to evaluate the ability of one- to four-month-old infants to discriminate two artificially synthesized disyllables (/ba bá and bá ba/) which differed solely in the location of perceived stress. One hundred and twenty infants were tested in two experiments. A modification of the HAS paradigm was developed, in which both stimuli are alternated postshift. The results of the first experiment demonstrate that young infants are able to discriminate the acoustic correlates of stress location (fundamental frequency, intensity, and duration) and that the modified HAS paradigm produces significantly stronger evidence for this discrimination than does the standard paradigm. The second experiment determined that infants can discriminate durational differences alone, without concomitant variations in the naturally correlated parameters of fundamental frequency and intensity.


Effects of noise and increased vocal intensity on stuttering.

The present study was designed to assess the effects of increased vocal level on stuttering in the presence and absence of noise, and to assess the effects of noise on stuttering with and without a concomitant increase in vocal level. Accordingly, eight adult stutterers spoke in quiet with normal vocal level, in quiet with increased vocal level, in noise with normal level, and in noise with increased level. All subjects reduced stuttering in noise compared with quiet conditions. However, there was no difference in stuttering when subjects spoke with normal compared with increased vocal level. In the present study, reductions in stuttering under noise could not be explained by increases in vocal level. It appears, instead, that reductions in stuttering were related to a decrease in auditory feedback. The condition which resulted in the largest decrease in auditory feedback, speaking in noise with a normal level, also resulted in the largest decrease in stuttering.


A comparison of three methods for predicting hearing loss from acoustic reflex thresholds.

Previously reported acoustic reflex threshold data from normal and hearing-impaired subjects indicate that the effect of stimulus bandwidth on reflex thresholds is altered by sensorineural hearing loss. It is this change in the "bandwidth effect" that forms the basis for predicting hearing loss from reflex threshold data. Three predictive procedures were compared for 17 normal and 60 hearing-impaired ears. All methods correctly identified most hearing losses but none of the methods accurately estimated magnitude of hearing loss. Two methods were characterized by a high rate of false positives. The third was tailored to minimize false positives (6%) and maintain a high rate (93%) of predicting hearing losses greater than 32 dB while making no attempt to make finer discriminations. This more conservative approach minimizes serious predictive errors while identifying a high proportion of clinically significant hearing losses.


Approximations of selected standard English sentences by speakers of black English.

The purpose of this study was to investigate the changes in six selected linguistic features as a function of age among children from the North Texas area who utilized features of black English in their oral language. A total of 48 children were tested, with eight selected from each chronological age group from four through nine years. Each subject's sole task was to imitate a series of Standard English sentences. The results indicated that, while a gradual decrease in black English characteristics occurred as a function of age, there was a tendency for the most pronounced dialectal decline in the language of the subjects to occur between six and seven years of age for most of the linguistic features. However, it was observed that black English caracteristics did not completely disappear from the surface structure of even the oldest subjects in the study.


Identification and description of homogeneous subgroups within a sample of misarticulating children.

A multivariate, hierarchical clustering procedure was used to identify homogeneous subgroups among 98 misarticulating children age eight years through nine years, six months. Clustering was based on 40 tests or measures of language, auditory processing, school achievement, oral structure, oral form recognition, and other phenomena. Clusters were described and then compared for performance on measures of articulation status and articulation improvement with training. Clusters were also derived from subsets of children who misarticulated only one sound, either /s/or/r/. Also, the subset of children who misarticulated /s/ was compared with children who misarticulated /r/ for performance on the measures classified above. Few of the clusters identified differed in articulation status or improvement with training.


Listener judgement of differences in stutterers' nonstuttered speech during chorus- and nonchorus-reading conditions.

The hypothesis that a stutterer's usual manner of speaking changes during chorus reading was tested. Nine stutterers orally read a passage under chorus- and nonchorus-reading conditions. Stutter-free speech samples of similar prose content were obtained from oral readings made between and within both conditions. Observers were asked to identify pairs of samples made under different (chorus/nonchorus) or similar (chorus/chorus or nonchorus/nonchorus) oral reading conditions. The results provided only partial support for the hypothesis. Observers were unable to distinguish confidently the speech sample group that was made under similar conditions from the sample group made under different conditions. However, judges were able to identify correctly samples from four of the nine stutterers that were made under different speaking conditions.


Revision behaviors in the speech of normal children developing language.

Revision behaviors in the speech of normal children were investigated. The subjects were 18 children, six at Brown's Language Stages I, II, and III. During the collection of a one-hour spontaneous language sample from each child the experimenter pretended 20 times not to understand and asked, "What?" The results indicate a significnatly greater use of revisions than repetitions or no responses at each stage and significant differences among the types of revisions observed across stages. These findings are related to current language models.


Factor analysis of measures of articulation, language, auditory processing, reading-spelling, and maxillofacial structure.

This study was concerned with the correspondence between the classification of measures by clinical judgement and by factor analysis. Forty-six measures were selected to assess language, auditory processing, reading-spelling, maxillofacial structure, articulation, and other processes. These were applied to 98 misarticulating eight- and nine-year-old children. Factors derived from the analysis corresponded well with categories the measures were selected to represent.


Using circumaural enclosures with children.

Pure-tone thresholds were obtained from 24 children between the ages of eight and 13 years using a standard, supraaural cushion (MX-41/AR), and one of four circumaural cushions. Testing was performed in quiet and in the presence of wideband noise presented at 60 dB SPL fro three conditions: Condition 1 (test) used a TDH 39 driver mounted in the MX-41/AR cushion; Condition 2 (experimental) used the same TDH 39 driver mounted in one of the circumaural cushions under investigation; and Condition 3 (retest) which was the same as Condition 1. Statistically significant differences were found between thresholds with the MX-41/AR cushion and thresholds with one of the circumaural enclosures in quiet. In noise, thresholds with three of the circumaural enclosures were significantly lower than those with the MX-41/AR cushion. A significant test/retest difference was observed for the MX-41/AR cushion at 6000 Hz in quiet only.


Effects of selected linguistic variables on apraxia of speech.

Ten adults with apraxia of speech responded to sentences of an article (pronoun) + noun + verb + article (pronoun) + noun design. Each sentence was presented and then re-presented with the noun in Noun Phrase 1 (NP1) or Noun Phrase 2 (NP2) omitted. The subjects' task was to orally produce the omitted word. Sentences were either active or passive and the omitted noun was a concrete, abstract, or nonsense word. Results revealed significantly more errors in NP1 than NP2, more errors on nonsense and abstract nouns than on concrete nouns, and more errors on passive than on active voice sentences. Linguistic bases for these findings are discussed.


Short-term memory factors in oral retention.

Study or exploration time and retention interval duration between orignal-form exploration and test-form exploration were varied to assess the effect of these two variables on performance accuracy on an oral stereognostic memory task. Irregularly shaped, four-sided plastic forms were used as stimuli. Retention performance improved significantly with an increase in exploration time of up to 15 seconds, but was not effected by delays in testing of up to 60 seconds. Clinical and theoretical implication for oral stereognosis are discussed.


Evaluation of syntax in three-year-old Spanish-speaking Puerto Rican children.

The performance of 30 normal and 30 language-deviant three-year-ols Spanish-speaking Puerto Rican children was compared on two measures of linguistic proficiency. They are mean length of utterance, following a scoring procedure adapted for Spanish speakers by the primary investigator, and Lees' Developmental Sentence Scoring procedure adapted for Spanish by Toronto. Results indicated that both methods of language assessment were sensitive to age and language status differences within the three-year age range. Accordingly, they can be usefully employed in research investigations to equate subjects on a linguistic basis, and in the clinical evaluation of small differences in the language maturity of preschool Spanish-speaking Puerto Rican children.


Respiratory kinematics in profoundly hearing-impaired speakers.

Anteroposterior diameters of the rib cage and abdomen were measured in profoundly hearing-impaired individuals in a standing position during respiratory maneuvers and utterance tasks. Data were charted in relative motion diagrams (rib cage vs abdomen) which enabled graphic solution for lung volume change, relative volume displacements of the rib cage and abdomen, and chest wall configuration. Function during resting tidal breathing was within normal limits. Function during utterance was frequently deviant in one or more of the following regards: (1) linguistic programming, (2) mechanical adjustments of respiratory origin, and (3) mechanical adjustments of the larynx and upper airway. Deviancies in mechanical adjustments of respiratory origin were confined mainly to lung volume events. Overall function is discussed with respect to the potential muscular mechanisms governing different respiratory behaviors. We conclude that both a lack of normal auditory sensation and inappropriate early speech skill instruction are responsible for the respiratory behaviors observed. Implications for clinical endeavors are detailed and data are presented to illustrate the power of biofeedback in managing speech disorders in the profoundly hearing impaired, when those disorders are partially respiratory based.


Methods for measuring the temporal characteristics and filter response of electroacoustic impedance instruments.

Methods for determining the temporal response of electroacoustic impedance instruments are presented along with sample measurements from one instrument. The conditions under which reflex artifacts may occur are discussed in light of electrical measurements of filter response characteristics and measurements of the "threshold" of the artifact measured from two subjects with no acoustic reflex.


Alcohol consumption and cognitive functioning in social drinkers.

Performance by social drinkers on tests of abstracting and adaptive abilities was negatively associated with the amount of alcohol consumed per drinking occasion. The pattern was strongest in heavy drinkers but was also evident in light and moderate drinkers.


Intellectual functioning in alcoholics during six months' abstinence.

Data from five measures of intellectual functioning indicated a recovery of functioning during the first 3 weeks of abstinence in 51 alcoholics; but there is no evidence that recovery continued over the course of continued abstinence.


Alcohol and opiate dependence; a review.

The literature pertaining to alcohol use among opiate addicts is reviewed. Among the issues presented are the medical hazards, history and prevalence, etiology and treatment responsiveness of excessive drinkers in the opiate-dependent population. The possible biological relationship of alcohol and narcotic use to affective disorder is discussed.


A psychosocial comparison of drunken drivers and alcoholics.

A self-administered questionnaire was used to compare selected demographic, drinking and psychosocial variables of 306 convicted drunken drivers with those of 289 alcoholics and 269 controls. The drunken-driver group fell between the other groups on many parameters but resembled the control group on as many others.


Effects of reducing the legal alcohol-purchasing age on drinking and drinking problems. A review of empirical studies.

A review of studies of the effects of reducing the legal age for drinking and purchasing alcoholic beverages suggests that there are public health reasons for not introducting such changes in jurisdictions which have not already done so.


Acculturation and drinking in an Italian American community.

The hypothesis that drinking practices among Italian Americans become more Americanized with successive generations was tested. In general, it was found that aspects of drinking behavior from both Italy and America were selected to form a third distinct drinking pattern.


Development of comprehensive language on alcoholism in collective bargaining agreements.

The processes by which language on alcoholism is incorporated into labor-management contracts are surveyed. Provisions for disciplining and treating alcoholic employees are found to vary widely.


The association of smoking and drinking habits in a community sample.

A general population survey showed a significant though modest correlation between smoking and drinking habits. Heavy drinkers who are also smokers appear to be at high risk of developing drinking problems.


Failure of MMPI scales to predict treatment completion.

Four previously reported scales of the Minnesota Multiphasic Personality Inventory (Admission, Control, Denial and Dependence) which distinguished between alcoholics who completed or withdrew from hospital treatment were reassessed. None of the measures differentiated completers from drop-outs.


A surgical technique for resecting malignancies invading the facial nerve and petrous pyramid.

Certain head and neck malignancies tend to invade branches of the cranial nerves and progress centripetally. The maxillary and mandibular divisions of the V (trigeminal) nerve are the most commonly invaded, but the VII (facial) nerve may harbor extensions of primary parotid malignancies and/or skin cancers originating in or near the ear. Paresis of the VII nerve signifies a serious but not entirely hopeless situation if countered with an appropriate surgical procedure. The optimal treatment of malignancies invading cranial nerves is surgical excision, which may necessitate removal of substantial portions of the cranium. Surgical pursuit of a malignancy in the facial nerve leads to a direct confrontation with the petrous pyramid of the temporal bone. Resection of the petrous pyramide is surgically feasible, but, if performed en bloc, extracts a high morbidity and mortality. An alternate technique in which the soft tissue and bones are removed disjunct is advocated. In this technique, the soft tissues are excised flush with the surface of the temporal bone. After making perforator and burr openings in the squamous temporal bone, a subtotal temporal craniectomy is completed with rongeurs. A prerequisite for success with this technique is the rotation of a large scalp flap and other local flaps to cover the exposed meninges and carotid arteries. A resume of four cases using this technique is presented. The age of the patients, the type, stage, and duration of the malignancies, and other factors which might influence the end stage results are given.


Chemoimmunotherapy of a murine fibrosarcoma: critical factors for success of combined modality therapy.

Thiabendazole (TBZ), a new nonspecific immunopotentiator, was evaluated in combination with Cytoxan in the therapy of a syngeneic murine fibrosarcoma. The reduction of tumor burden by chemotherapy was critical in achieving an optimal response from immunotherapy. Eighty-eight percent of the mice that responded to Cytoxan had sustained regression of tumor with TBZ treatment. The response to TBZ was markedly diminished, both in duration and magnitude, in the mice considered to be Cytoxan nonresponders. Timing of immunotherapy was also important. If Cytoxan and TBZ were given simultaneously, growth kinetics similar to those observed with Cytoxan alone were observed. However, if TBZ was given 4 days after Cytozan administration, prolonged regression of tumor was seen. Alone, TBZ was most effective at a dose of 20 mg/kg. However, in combination with Cytoxan the most effective dose was 0.2 mg/kg. The implications of this finding are discussed.


Influence of initial neck node biopsy on the incidence of recurrence in the neck and survival in patients who subsequently undergo curative resectional surgery.

During a period of 23 years, 57 patients who had an initial neck node biopsy elsewhere, with the diagnosis of metastatic squamous cell carcinoma established, underwent curative resection by our department after the site of head and neck primary was found. Ten patients free of disease died of other causes, leaving 47 patients who were eligible for at least 3 years of follow-up. Ninteen patients are alive after 3 or more years. The incidence of recurrence in the neck was 57% (27/47). The 3-year survival in this group of Stage III was 40% (19/47) and 5-year survival was 34% (16/47). Compared with historical data, it appears from the present study that a previous biopsy of a neck node did not adversely affect the incidence either of neck recurrence or survival when appropriate surgery is performed.


Effects of immunosuppression on the rejection of methylcholanthrene tumor isografts.

The effect of immunosuppression with azathioprine, methylprednisolone, or both, on primary and secondary immune responses to a transplanted tumor was studied. The ability to reject a methylcholanthrene-induced squamous cell carcinoma of the prostate in Lewis rats was determined by rechallenge with tumor cells after amputation of the primary transplant. Oral azathioprine (20 mg/kg/day) increased the incidence of tumors in a primary challenge, but did not affect the ability of immunized rats to reject subsequent tumor isografts. Similar results were obtained with 2 mg/kg day intraperitoneal (IP) azathioprine, 2 mg/kg IP methylprednisolone, and the combination of 2 mg/kg/day IP methylprednisolone and 10 mg/kg/day IP azathioprine. It appears that immunosuppression by azathioprine affects the proliferation of sensitized cells during the immunological response to antigens of this specific tumor. Immunosuppression does not appear to alter substantially the processing of tumor-specific antigens or the cytotoxic effectiveness of the immune system. This data is reassuring to the concern of whether transplantation in patients previously cured of cancer is safe.


X-ray exposure and premature aging.

An hypothesis of an aging effect of exposure to ionizing radiation in humans is proposed and given precise mathematical expression. The assumption is made that the biological changes which occur when humans are exposed to ionizing radiation from medical x ray are comparable to those occuring through the natural aging process, since both factors are known to increase the relative risk of nonlymphatic leukemia. This assumption focuses on this one aspect of aging only. The hypothesis that aging and exposure to ionizing radiation are comparable for increasing the relative risk of non-lymphatic leukemia is tested against the data from the Tri-State Leukemia Survey. It is shown to explain the data in a statistically acceptable way, giving an estimate of 1 rad skin dose exposure to the trunk as comparable to 1 year natural aging. This research raises further questions concerning the effects of exposure to ionizing radiation, and presents a new methodology by which these questions may be researched.


Ameloblastoma of the anterior maxillae.

Few generalizations may be made about the ameloblastoma. Its many varied characteristics may mimic those of many other lesions. The case presented, against all odds and expectations, proved to be highly infiltrative. The use of all available information for accurate diagnosis and sound treatment is stressed. Block resection was found to be the best treatment assuring no recurrence and minimal deformity.


Surgical management of pulmonary stenosis in tetralogy of Fallot.

Fifty-five consecutive patients with the tetralogy of Fallot underwent intracardiac repair in a 12 month period. A standardized protocol for outflow tract enlargement was used. When the measured diameter of the pulmonary valve ring was at least the "minimum acceptable pulmonary valve ring diameter," primary patch-graft enlargement across the valve ring was not done (Group I, 34 patients); when it was less, primary patch-graft enlargement was done (Group II, 21 patients). The right ventricular-left ventricular systolic pressure ratio (PRV/LV) after repair without patch-graft enlargement across the ring was related to the size of the ring. Sixteen (94 percent) of 17 such patients with normal-sized or large pulmonary valve rings (according to the criteria of Rowlatt, Rimoldi, and Lev) had PRV/LV equal to or less than 0.65; four (80 percent) of five patients with smaller rings but within the 50 percent confidence limits had PRV/LV equal to or less than 0.65; five (56 percent) of nine with still smaller rings but within the 72.5 percent confidence limits had PRV/LV equal to or less than 0.65. In Group II, 15 patients had abnormally small rings, but after patch-graft enlargement the mean PRV/LV was 0.44 +/- 0.140. A surgical protocol based on these data has been developed.


Regional pulmonary function during experimental unilateral pneumothorax in the awake state.

This study examines changes in regional pulmonary function during unilateral pneumothorax, immediately after, and 2 hours following re-expansion in awake dogs. Respiratory rate, tidal volume, physiologic dead space, arterial blood gases, and pulmonary shunt fraction were determined at each stage. Cardiac output (thermodilution), vascular pressures, and regional ventilation and perfusion (133Xe scans) were also measured. Chest roentgenogram confirmed the presence of UP. Respiratory rate increased 124 percent (p less than 0.01) during UP while alveolar ventilation remained unchanged. Pulmonary shunt fraction rose 93 percent (p less than 0.01) during UP, causing PaO2 to fall from 86 to 51 mm. Hg (p less than 0.01). PaCO2, pH, and cardiac output were not altered by UP. UP caused a relative underventilation of the collapsed lung (V/Q = 0.73 (p less than 0.01)) and an overventilation of the contralateral lung (V/Q = 1.74) (p less than 0.01). Immediately after re-expansion of the collapsed lung, all the above changes reverted to the control values. All variables remained unchanged 2 hours following complete re-expansion.


Pulmonary dirofilariasis in man. A case report and review of the literature.

Pulmonary dirofilariasis in man is becoming a well-recongnized entity. Its pathogenesis and histopathologenical picture have been well characterized but the preoperative diagnosis still remains a challenge. The roentgenographic picture, usually described as a "coin lesion," is nonspecific and easily mistaken for other inflammatory and neoplastic nodules. Forty-seven clinical instances of pulmonary dirofilariais have been reported in the literature, with most of them in the last two decades. Considering the entire clinical picture, a strong suspicion can be based on serological studies, thus improving the possibilities of a correct preoperative diagnosis.


Avulsion of a tricuspid valve leaflet during traction on an infected, entrapped endocardial pacemaker electrode. The role of electrode design.

Endocardial pacemaker electrodes rely in part upon endocardial fixation proximal to the electrode tip to prevent ejection of the tip from the ventricular apex. Fixation of these electrodes to the superior vena cava and tricuspid valve, in particular, has been reported. Infection of endocardial electrodes necessitates their removal. This report concerns avulsion of a tricuspid valve leaflet during traction on an infected electrode. With the availability of new methods of apical fixation, the utilization of electrode sheathing materials which discourage endocardial fixation would increase the safety of their removal under the circumstances reported herein.


Experimental bypass of the left ventricle.

Bypass of the left ventricle was accomplished in dogs and the entire circulation was supported temporarily by only the right ventricle. The atrial septum was excised, and the atrium was repartitioned so that the pulmonary veins were in continuity with the right ventricle and the venae cavae were connected through the atrium. Anastomosis of the superior vena cava to the right pulmonary artery brought systemic venous return directly to the lungs. The main pulmonary artery was ligated proximal to the bifurcation, preserving distal confluence of right and left pulmonary arteries. A tubular prosthesis between the proximal pulmonary artery and the aorta connected the right ventricle to the systemic circuit. This procedure, or some modification of the principle, may have clinical feasibility in the treatment of patients with hypoplastic left heart syndrome.


Surgical treatment of coronary artery aneurysm with rupture into the right atrium.

Considering the increasing number of patients with chest pain who undergo routine coronary artery arteriography, coronary artery aneurysm may be found more frequently. To know how to manage these aneurysms, we must understand their possible complications. The aneurysms can produce symptoms of angina or acute myocardial infarction by total thrombosis of the aneurysm and vessel, embolism to the distal vessel, or progressive enlargement and encroachment upon the distal vessel until it is occluded. Moreover, the aneurysm may enlarge and rupture into the free pericardium or produce a fistula by eroding into a chamber of the heart. The case described herein may represent the first reported case of a coronary artery aneurysm eroding into a cardiac chamber and causing an arteriovenous fistula. The treatment of choice is resection of the aneurysm, closure of the fistula, and re-establishment of continuity of the distal coronary artery with a saphenous vein bypass graft.


Subtotal cor triatriatum with left partial anomalous pulmonary venous return. Successful surgical repair in an infant.

A 10-week-old infant underwent successful repair of subtotal cor triatriatum associated with left-sided partial anomalous pulmonary venous return to the innominate vein. This unusual type of cor triatriatum represents an intermediate embryologic form between pure cor triatriatum and total anomalous pulmonary venous return. Important hemodynamic differences exist between this defect and pure cor triatriatum. Exact anatomic diagnosis prior to operation is highly desirable. To our knowledge, this case represents the first successful repair of this very rare congenital cardiac defect.


Tetralogy of Fallot with aorticopulmonary window. Report of two surgical cases.

The association of aorticopulmonary window and tetralogy of Fallot is rare. In this report, we describe two cases in which this combination of anomalies was repaired successfully. Both patients made uneventful recoveries.


Strut fracture in De Bakey valve. Successful reoperation and valve replacement.

Strut fracture in a De Bakey aortic valve is reported. The theoretical disadvantage of a Pyrolite carbon--coated ball and titanium struts is mentioned. Periodic cinefluoroscopy is recommended in all patients with a De Bakey aortic valve to avoid the complications associated with strut wear or fracture.


Clinical features and management of cystinuria.

Cystinuria is a complex hereditary disorder that affects both sexes with equal frequency and severity. Symptoms usually begin early (children and young adults) but may develop at any age. Stature is normal and there are no clinical nutritional abnormalities. The morbidity of cystine urolithiasis is considerable. Hyperuricemia is a frequent associated finding and is probably the result of multiple factors. No other abnormalities are consistently related to this disease. Treatment with adequate oral fluids to ensure a copious urine volume and with oral alkali to keep the urine alkaline is most successful when used prophylactically in the stone-free patient. However, dissolution of existing calculi is unlikely with this regimen alone. The addition of D-penicillamine often results in dissolution of stones and prevention of recurrent calculi in patients who have continued stone growth despite the use of oral fluids and alkali. Because toxic reactions with D-penicillamine are frequent and sometimes severe, this drug should be used only when necessary and then as an adjunct to rather than a substitute for increased oral fluids and alkali. Failure of treatment in spite of adequate therapy should alert the physician to the possibility of coexisting complicating problem.


Alimentary tract manifestations of multiple endocrine neoplasia, type 2b.

Alimentary tract manifestations were found in all of 17 patients with multiple endocrine neoplasia, type 2b. The manifestations are important because (1) they were chronic, (2) they were severe and led to abdominal operation in 5 patients, (3) they antedated detection of the endocrine neoplasms in the syndrome in 16 patients (94%), and (4) they provided clinical clues that stimulated search for thyroidal C-cell and adrenal medullary disease in 6 patients. The alimentary tract manifestations were diverse: symptoms included constipation, diarrhea, difficulty with feeding, projectile vomiting, crampy abdominal pain, and loud borborygmi; findings included thickened lips, nodules on the anterior third of the tongue, abdominal distention, visible peristaltic waves, and roentgenographic evidence of megacolon or diverticulosis of the colon or of dilatation of the small intestine and stomach. Initial misinterpretation or failure to realize the significance of one or more of these alimentary tract manifestations led to suspicion of aganglionic megacolon (three patients), malabsorption syndrome (two patients), and tracheal ring (one patient).


Frequency of surgical treatment for hypertension in adults at the Mayo Clinic from 1973 through 1975.

We reviewed the records at the Mayo Clinic for the years 1973, 1974, and 1975 to determine the number of patients with hypertension who had had operations for repair of renal artery stenosis, excision of pheochromocytoma, or resection of aldosterone-producing adenoma. During the years studied, the average numbers of procedures per year were, respectively, 46.7, 10.3, and 2.7. For the purpose of estimating the frequency of each one of these three conditions among the population of hypertensive patients examined at the Mayo Clinic, we applied age- and sex-specific incidence figures from the US National Health Survey to the 162-273 patients examined who were more than 15 years old in 1974. We estimate that there were 26,589 patients who had diastolic blood pressures equal to or greater than 95 mm Hg. The indices generated estimated that renal artery stenosis repair was done in 18/10,000 (0.18%) hypertensive patients, pheochromocytoma excision in 4/10,000 (0.04%), and aldosterone-producing adenoma resection in 1/108000 (0.01%). These indices are strikingly lower than those frequently reported elsewhere, suggesting that these conditions are truly rare among hypertensive patients seen in clinical practice.


Straddling right atrioventricular valve in criss-cross atrioventricular relationship.

Two cases of complex congenital heart disease are described in which systemic and pulmonary bloodstreams crossed at the atrioventricular level. Both patients were examined clinically, echocardiographically, and by cardiac catheterization, including angiography, and both underwent cardiac surgery and had intraoperative mapping of their conduction systems. Both patients were found to have levocardia and situs solitus of viscera and atria, large ventricular septal defect, and straddling right atrioventricular valve. One patient had atrioventricular discordance but with the left ventricle anterior and alightly on the right and with pulmonary atresia and dextromalposition of the aorta. The other patient had atrioventricular concordance but with the left ventricle inferior and slightly on the left and with ventricular-arterial concordance to normally related great arteries and banded pulmonary trunk. To our knowledge, this combination including straddling right atrioventricular valve has not been reported in the literature before. In both patients the straddling atrioventricular valve was thought to preclude corrective operation at that time. A unique palliative procedure--left ventricle-to-pulmonary trunk shunt--was successful in the first case and partial debanding of the pulmonary trunk in the second.


A criss-cross heart. Detailed anatomic description and discussion of morphogenesis.

Hearts with criss-cross atrioventricular connections are rare. Reports in the literature describe great anatomic variations with regard to the atrioventricular connections, spatial relationships of the ventricles, and connections and spatial relationships of the great arteries. In the example described in this report, the basic anatomic picture was that of transposition of the great arteries, but the criss-cross atrioventricular valves had resulted in atrioventricular discordance; hemodynamically, therefore, the situation resembled congenitally corrected transposition. One hypothesis for this anatomic configuration is that pronounced counterclockwise rotation (as viewed from below) brought the ventricular septum into a frontal plane and altered the respective positions of the pulmonary and aortic valves from those usually seen in congenitally corrected transposition and thereby resulted in crossed atrioventricular connections. An alternative hypothesis is that in this case one of the atrioventricular valves (the anteriorly positioned valve) may represent an anomalous communication that developed early in embryogenesis and connected the left atrial appendage to the right ventricular infundibulum.


Transesophageal atrial pacing in the Wolff-Parkinson-White syndrome.

In a patient with Wolff-Parkinson-White syndrome, protracted, disabling tachycardia occurred because of low left lateral accessory pathway refractoriness and rapid retrograde conduction, most likely by a septal pathway. Conventional medications, including intravenously administered lidocaine and procainamide, were ineffective in terminating the tachycardia. Transesophageal atrial pacing easily terminated the recurrent supraventricular tachycardia.


Interaction of vibrio cholerae El Tor and gut mucosa in ligated rabbit ileal loop experiment.

Light and electron microscope studies in ligated rabbit gut loops showed that cholera vibrios El Tor attached themselves to the enterocytes and multiplied, most probably on the intestinal epithelium surface. But they did not penetrate deeper and were unable to cause destruction of the epithelium or marked inflammation. Ultrastructural manifestations of both apocrine and merocrine secretion of the enterocytes were observed. In addition, the enterocytes showed signs of generally enhanced activity. Some other changes and alterations in the lamina propria, presumably induced by excessive transport of water, are also described. The enterotoxin-induced epithelial hypersecretion with fluid accumulation in the gut loops resulted in the attached vibrios being cleared off the epithelium lining into the gut lumen. NAG vibrios were mostly incapable of inducing the above changes. We discuss the importance of cholera vibrio attachment to and its multiplication on the intestinal epithelium in the pathogenesis of cholera.


Change of the hepatic cells in parabiosis between old and young rats.

The hepatic cells of the parabiotic unions 3 to 9 months after uniting between old and young rats were micrometrically examined. In the older parabiotic partners, it cannot be denied that the character of the findings tended in part towards that of the young controls. In the younger parabiotic partners, the estimated number of hepatic cells was apparently decreased, size of the hepatic cells and their nuclei was significantly increased, and number of binucleate hepatic cells was markedly increased. The findings of the hepatic cells in the younger partners were similar to those in the old controls. From the results, it is inferred that the proliferation of the hepatic cells of the younger parabiotic partners is inhibited by the inhibitory factors for cell division secreted from the hepatic cells of the older partners.


Age related alterations in purified fructose-1,6-diphosphate aldolase from the nematode Turbatrix aceti.

Fructose-1,6-diphosphate aldolase has been purified to homogeneity 62.0 and 58.3 fold from young and old nematodes respectively. The aldolase preparations from young (7 days) and old (35 days) animals are indistinguishable in their electrophoretic mobility, molecular weight of the tetramer (158,000) and monomer (40,000), and Km, although the "old" enzyme is more heat stable than the "young" enzyme. Enzyme from old animals has only about 55% specific activity per mg purified protein of the "young" enzyme and its catalytic activity per unit of enzyme antigen is about 50% of that of the enzyme from young animals. Immunological identity of purified enzyme from old and young animals was established by the Ouchterlony technique by antiserum produced against purified "young" enzyme and antiserum against purified "old" enzyme. Thus, this work shows for the first time that the altered form of an enzyme which appears in senescent animals apparently does not possess extra antigenic sites which are acquired as a function of age.


Qualitative changes in immunocompetent cells with age: reduced sensitivity to cortisone acetate.

Recent studies suggest that immunocompetent cells that respond to primary antigenic stimulus in old mice are different cell types from those that respond in young mice. This hypothesis was tested by determining the cortisone acetate sensitivity of antigen-sensitive lymphocytes from young and old donors. It was found that antigen-reactive lymph node lymphocytes from young donors are cortisone-acetate sensitive whereas the antigen-reactive lymph node lymphocytes from old donors are cortisone-acetate resistant.


Low platelet monoamine oxidase activity in human alcoholics.

Platelet monoamine oxidase (MAO) activity was found to be significantly reduced in human alcoholics as compared to matched controls. A probable transitory increase in activity was observed during the abstinence phase. The low platelet MAO activity was not due to iron deficiency or to the presence of acetaldehyde. Since we have previously found a lowered MAO activity in the brains of suicide victims, especially in those with a previous history of alcohol abuse, we suggest that low platelet MAO activity reflects a primarily "weak" monoaminergic system in the CNS which causes an increased vulnerability to alcohol abuse and suicidal behaviour.


Comparison by autoradiography of macromolecular biosynthesis in "young" and "old" human diploid fibroblast cultures. A brief note.

The biosynthetic abilities of WI-38 fibroblasts from early and late population-doubling-level cultures were compared by autoradiography of cells grown with labeled precursors of DNA, RNA, protein and lipids. Incorporation of radioactive thymidine, uridine, protein-hydrolysate, acetate, oleic acid and cholesterol, as measured by the number of grains per cell surface, decreased with the progressive aging of the culture. However, the decrease in the incorporation of acetate, oleic acid and cholesterol was much smaller than that of the other precursors, indicating that lipid synthesis is affected to a lesser degree than protein and nucleic acid synthesis on aging. This result is in accord with the higher lipid content and proliferation of intracellular membranes in cells of "old" WI-38 cultures reported by others.


Purification of bovine milk lipoprotein lipase with the aid of detergent.

The present study describes a simple method for the purification of bovine milk lipoprotein lipase based on affinity chromatography on agarose containing covalently linked heparin and the use of a non-ionic detergent, Triton X-100. By this procedure miligram amounts of detergent-free lipoprotein-ionic lipase with a specific activity of 28.9 mmoles free fatty acid/mg protein/mg protein/hour can be obtained. The apparent molecular weight of the polypeptide as determined by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulphate is 55,000. The purified triacylglycerol lipase also hydrolyzes monoacylglycerol, but the activity against this lipid is 40 times lower than that against triacylglycerol.


Diminished axonal transport of glycoproteins in the senescent rat brain.

At various time intervals (10, 15, 20, 25, 30 min) after injection of 3H-fucose into the medial septal nucleus of young adult (3 months old) and senescent (25 months old) Fischer-344 rats, the specific activities of trichloroacetic acid-phosphotungstic acid (TCA-PTA) soluble and insoluble fractions were determined in the medial area of the septum and in three successive rostro-caudal sections of the hippocampal formation containing mainly the dentate gyrus, but also its hilus with fields CA4 and CA3c of the hippocampus. The rate of 3H-fucose incorporation into glycoproteins of the septum did not differ in young adult and senescent rats. Part of the TCA-PTA soluble and insoluble radioactive material was transported through the septo-hippocampal pathway to the dentate gyrus. This transport was inhibited by the injection of colchicine into the septum prior to 3H-fucose injection and was completely blocked by electrolytic lesion of the medial septal nucleus. The arrival time and the amount of the TCA-PTA soluble radioactive material transported to the dentate gyrus did not differ in young adult and senescent rats. However, the TCA-PTA insoluble labelled glycoprotein was transported to the dentate gyrus in a significantly smaller amount and during a longer period of time in the senescent animals. This age-related change may reflect a reduction in amount and/or in rate of axonal transport of glycoproteins in the septo-hippocampal pathway of senescent rats.


Estimating demand for emergency transportation.

Current and future demands for emergency transportation services are estimated relative to actual and potential use by the population at risk. Correct and incorrect utilization are defined by matching levels of responses (MICU, BEA, Transfer Vehicle, Nonemergency Vehicle, Transport/Private Vehicle) to the level to severity (Life-threat, Urgent, Routine, Transfer, Dry Run). From these definitions and data available from emergency facilities, demand and need are calcualted. Multiple regression models are developed for estimating future demand. Data from a rural county is then used with the models to develop the predictive equations. In both cases, five significant variables explain over 90 per cent of the variation in number of calls for emergency transportation services.


Supply, need, and distribution of anesthesiologists and nurse anesthetists in the U.S., 1972 and 1980.

This paper examines the relationship between problems in anesthesia care delivery and the availability and utilization of trained anesthesia manpower. The 1972 and 1980 projected supply and mix of anesthesiologists and nurse anesthestists is described and compared to the current and projected need for their services. The need estimates developed for anesthesia manpower are based upon published data on operations, productivity and theoretical team configurations. Utilization data are used since they are quantifiable and the need for anesthesia services is, indeed, supply-induced. Two estimates of need are developed based upon differing degrees to which anesthesia teams can be effectively employed, this being contingent upon the size of the hospital operative workload. While the need estimates developed for anesthesiologists for 1972 and 1980 were fairly close in aggregate number to the actual and projected supply; the need estimates for nurse anesthetists fell far short of their 1972 and 1980 projected supply. The 1972 need estimates are then compared on a statewide basis to the actual supply and mix of anesthesia personnel to reveal a severe maldistribution which is quantified in terms of shortage and execesses of anesthesiologists and nurse anesthetists for each state.


Refining physician manpower data.

Many conclusions about trends in physician manpower are based on the physician data set of the American Medical Association. Comparisons of specialty and activity status of physicians over time are hampered by changes in the AMA classification procedure in 1968 and growth in the "not classified" category since 1970. A method of adjusting data on physician manpower, taking into account these changes, is presented. The adjustments suggest that movements in the total physician supply away from patient care and primary care practice are overstated by use of unadjusted AMA data, and the percentage of physicians engaged in patient care has increased rather than decreased over the past decade.


Patients' attitudes toward gynecologic examination and to gynecologists.

A self-administered questionnaire exploring attitudes to gynecologic examination and gynecologists was completed by 409 female patients. Contrary to public statements of some consumer groups, overall results revealed predominantly favorable attitudes to both examination and gynecologists. However, a number of specific criticisms were found. Subjects reported problems with component parts of the gynecologic examination. The traditional lithotomy position and breast examination were the most difficult aspects of the examination emotionally. Speculum insertion was the most uncomfortable part physically. Of the respondents, 10.8 per cent never had had a rectal examination. Many subjects were dissatisfied with gynecologists' understanding of women's psychological and sexual problems. The importance of physicians becoming better informed about female psychology and sexuality, and adapting to women's changing needs is discussed.


[Contribution to biliobronchial fistula (author's transl)].

A case report has been made on a bronchobiliary fistula which was caused from an unspecific liver abscess. The causal therapy was the drainage of the liver abscess. The fistula then healed spontaneously. A primary thoracic sanitation of the fistula is in such cases not indicated.


[Experiments in animals in connexion with truncal and selective gastric vagotomy in rats (author's transl)].

The effects of truncal and selective gastric vagotomy after 9 h ligation of the pylorus were studied on Shay rats. No statistically significant difference was found with regard to gastric tonicity, volume of gastric juice, its pH value, nor with regard to the acidity. However, the size of the stress ulcers showed evident differences; vagotomy of the trunk protects the rat better from developing ulcers than selective vagotomy. By means of additional experiments e.g. ligature of the left gastric artery, truncal and selective gastric vagotomy performed simultaneously, we could demonstrate that this statistically significant difference is due to devascularisation of the lesser curvature of the stomach.


[Surgical management of liver trauma (author's transl)].

Surgical management and follow up of 85 patients with liver trauma are reported. 20 patients had only liver trauma, all others were polytraumatised. Letality was 20% in patients with sole liver trauma, the overall letality was 43%. In most cases death resulted from prolonged circulatory shock. Most of the other casualities resulted from septical complications of biliary peritonitis. Prognosis was mainly correlated with the interval between trauma and surgical treatment as well as with the amount of blood lost. The main features of the operative technic were access to the liver through a subcostal and sometimes transdiaphragmal incision, temporary tamponade of the bleeding source, compression of the hepatoduodenal ligament, of the vena cava (intrapericardial) to minimize blood loss. Instead of hemihepatectomy, resection of liver tissue was limited to the smallest amount possible, and followed by extensive drainage.


[An analysis of factors which can be influenced in geriatric surgery (author's transl)].

A retrospective study has been made of 1457 surgical patients over 70 years of age in three one-year periods (1960/61, 1969, 1973). While the average age remained 77, there has been changes in the frequency of diseases leading to hospitalisation. Degenerative lesions and casualties have increased. There are more elderly patients undergoing major surgery. On the contrary the mortality has reduced to 7.8%. The results of geriatric surgery are influenced by previous and concomitant diseases, the surgical lesion and the type of therapy. Suggestions for reducing the number of emergency operations are discussed. When necessary smaller palliative operation which improve the quality of life should be considered instead of major curative surgery. Surgery in the aged is a speciality and requires simultaneous consideration of various factors.


Motivation in hearing aid acceptance.

Patient case histories are presented in an attempt to pinpoint possible motivational factors affecting the acceptance of a hearing aid. Personality profiles were constructed on three representative patients through the use of an in-depth interview as well as three personality scales: the 16PF Multiphasic Personality Scale; the Crowne-Marlowe Social Desirability Scale; and the Attitude Toward Disabled Persons Scale. The very preliminary results indicate at least some face validity to the assertion that unsuccessful hearing aid wearers are measurably different from successful wearers and that these differences may be used to predict success of failure for future patients.


Gastro-esophago-pharyngeal reflux.

Reflux of gastric contents into the esophagus, pharynx, and larynx does occur. This phenomenon can produce hoarseness, globus, dysphagia, otalgia and laryngospasm. It may be responsible for the appearance of contact granulomata, esophageal webs, and pachyderma. The key to reflux is the lower esophageal sphincter and the nature of the stomach contents. Multiple factors may be influential including those conditions causing aerophagia. The diagnosis of reflux depends on a high index of suspicion. Physical findings may reveal only subtle changes of arytenoid erythema. Thyrohyoid tenderness is not an infrequent sign. Treatment is usually simple, involving first elimination of those factors which increase intragastric pressure or lower the lower esophageal sphincter pressure. Elevation of the head of the bed and antacids will often prevent further gastric insult to the pharynx and larynx and thus eliminate the patient's discomfort.


The effect of tracheostomy on the laryngeal closure reflex.

The clinical observation of aspiration following prolonged tracheostomy prompted a neurophysiologic investigation of the glottic closure reflex in dogs longitudinally evaluated after permanent tracheostomy. The data support significant alterations in the central organization of the protective closure reflex heretofore considered phylogenetically primitive and therefore physiologically stable over wide ranges of functional demand. The data indicate that chronic upper airway bypass results in: 1. increased threshold of the evoked adductor response; 2. random shifts in its latency; 3. rapid attenuation of the primary evoked response to repetitive SLN stimulation; and 4. reduced after-discharge activity, all of which contribute to a weakened, ill-coordinated closure respons.