Fine structure of the human sweat ducts of eccrine and apocrine types.

The sweat ducts of human eccrine and apocrine (ceruminous) glands were observed with the transmission electron microscope. Both the dermal and epidermal segment of the eccrine as well as apocrine ducts consist of two epithelial layers: luminal cells and peripheral cells. Well-developed microvilli, occurrence of cored vesicles, dense granules, multivesicular bodies and phagosomes in the adluminal filamentous zone, and a strong accumulation of mitochondria in the basal part of the duct epithelium at the dermal segment, as well as an accumulation of small clear vesicles beneath the surface of the luminal cells of the epidermal segment are all prominent in the eccrine duct and concomitant with the special function of the human eccrine duct, i.e., absorption of ions to make the sweat hyotonic and an active endocytosis of some material from the sweat. All of the above enumerated characteristics of the eccrine duct are only rarely or never seen in the apocrine duct. On the other hand, lipid droplets appear in the peripheral cells in a certain level of the apocrine duct near its orifice into the hair follicle, suggesting a kind of metaplasia towards the sebaceous gland. Epidermal duct cells of both eccrine and apocrine sweat glands may keratinize. In the eccrine duct the process in the duct cells precedes the surrounding keratinocytes, while in the apocrine duct the relationship is reversed.


Morphological and morphometric studies on the ultrastructural changes during the active release of neurosecretory substance from the neurohypophyseal nerve terminals in dehydrated rats.

Secretory nerve terminals in the posterior pituitaries of normal rats and animals dehydrated for 1, 3, 5, 7, and 9 days were observed with the transmission electron microscope. Neurosecretory granules were markedly decreased after dehydration and received the minimum number at 5 days. Small vesicles in the terminals may be classified into two types: one in aggregated vesicles about 53 nm in diameter and the other is dispersed vesicles 66 nm in diameter. The former vesicles are seen in the normal terminals and slightly decreased in number after dehydration, while the latter are hardly seen in normal pituitaries, but increase enormously due to dehydration at 3 days and thereafter. It may be conjectured that the former are the real synaptic vesicles probably containing acetylcholine, while the latter are the fragments of limiting membranes of the neurosecretory granules. Inversely to the slight decrease of dispersed vesicles at 7 and 9 days of dehydration, reticular tubules in the nerve terminals were strikingly increased in volume. Such a terminal reticulum may be formed by fusion of vesicles derived from fragmentation of the envelopes of neurosecretory granules. Finally the reticulum as well as dispersed vesicles may be destroyed by lysosomes.


Two populations of microvesicles in the SGC (small granule chromaffin) cells of the mouse adrenal medulla.

A second population of cytoplasmic microvesicles was constantly recognized in the SGC (small granule chromaffin) cells of the mouse adrenyl medulla by means of transmission electron microscopy in glutaldehyde/osmium tetroxide-fixed material. The microvesicles were rendered in shape and of mean profile diameter of between 30, 40 nm: some contained several dense precipitates. The vesicles were usually dispersed throughout the cytoplasm among the typical secretory granules of 100-230 nm in profile diameter, though they occasionally formed aggregations. The SGC cells were also characterized by a high nucleus to cytoplasm ratio, rich innervation, and long cytoplasmic processes which were traced up to 30 micrometer. Co-existence of the synaptic-like vesicles and secretory granules in the SGC cells suggests that they may represent an intermediate position between the chromaffin and sympathetic nerve cells.


Suicide in Norwegian, Finnish, and Swedish psychiatric hospitals.

The numbers of suicides in Norwegian, Swedish, and Finnish psychiatric hospitals during the period 1930 to 1974 are analyzed. The suicide rate in the psychiatric hospitals of all three countries has arisen markedly. The author's methods and results are compared with those of other authors. Explanations for the rise in suicide rate are discussed. According to the author: (1) With the expansion of psychiatric treatment facilities, an increasing number of all who commit suicide in a country have been admitted to psychiatric hospitals. (2) To be admitted to a psychiatric hospital represents more of a defeat and entails greater social pressure today than before. It is more difficult to readjust to work and family now than 20 years ago. (3) To some extent, the rise may be regarded as a side-effect of modern therapeutic methods, with the introduction of the open-door policy, milieu therapy, ataractic drugs, rehabilitation pressure, and democracy processes. That a greater number of all who commit suicide are now treated in psychiatric hospitals increases our possibilities of preventing suicide, particularly if we stake more on after-care measures. Priority should be given to suicide research, especially to the better prediction of high risk of suicide from demographic and clinical variables and to the improvement of prophylactic treatment, including network therapy and long-term psychotherapy.


Biochemical investigations into the alcoholic delirium: alterations of biogenic amines.

In eight male patients with alcoholic delirium concentrations of 3-methoxy-4-hydroxyphenylglycol (MHPG) and homovannilic acid (HVA) in CSF, activity of dopamine-beta-hydroxylase (DBH) and urinary excretion of noradrenaline (NA), adrenaline (A), and dopamine (DA) were measured during the delirium and a drug-free control period. MHPG concentration in CSF, excretion of NA and A as well as activity of serum DBH were significantly elevated during the delirium phase as compared to the control period. Urinary DA excretion and HVA in CSF did not show any constant changes. There was a positive correlation (r = 0.64) between DBH activity and the intensity of the delirium (as measured on the delirium rating scale). It is hypothesized that there is a relationship between alcoholic delirium and increased central noradrenergic activity.


Further developments of the 'present state examination' and CATEGO system.

Some further developments of the PSE and CATEGO system are reported. The shorter ninth revision of the PSE, together with its glossary of definitions of symptoms, has proved useful in skilled hands and certain sources of error in the eighth edition have been reduced. The Syndrome Check List and Aetiology Schedule have proved useful in decreasing the number of coding errors.


[Premorbid personality of monopolar and bipolar depressives. A comparison based on personality inventories (author's transl)].

Premorbid personalities are studied in 65 monopolar endogennous depressives (ICD-Nos. 296.0, 296.2) and in 45 bipolar depressives (ICD-No. 296.3) by a retrospective self-rating evaluation after recovery. The instruments used are two questionnaires of v. Zerssen, especially constructed for that purpose, along with the AUPI questionnaire, which is based on Eysenck's system of personality description. The two groups are compared according to each test scale. Significant differences result in two of the scales. Monopolar depressives score higher than bipolars in the scale representing Tellenbach's "melancholic type". This can be described with terms such as orderly, strenous, and conscientious. Bipolars show more extroversion than monopolars. None of the patients' groups can be distinguished fr-m the normal population in any of the AUPI scales (extroversion, neuroticism, and psychoticism).


[Alcohol consumption, alcohol abuse, and subjective feeling: a representative inquiry in the Federal Republic of Germany].

The investigation was carried out in a representative sample of subjects of the Federal Republic of Germany, including West Berlin (n = 1952). The subjects were 20--64 years old. The following were investigated: 1. Social and abusive drinking patterns 2. Relations between drinking behavior and sociodemographic data 3. Relations between drinking behavior and subjective feeling. Of the subjects, 47% consumed alcohol daily or several times a week, 6% called themselves teetotallers. Beer was the preferred beverage. The drinking behavior varied among income classes and vocational groups. Of the whole sample, 8% drank regularly whilst working; 25% of the skilled workers did so. Comparing alcohol consumption and subjective feeling, there was a slight association between elevated mood and frequent alcohol consumption. Of the subjects, 4% were identified as alcohol misusers (7% of the males, 1% of the females). Persons at high risk were men living alone (especially widowed and divorced subjects) and persons of medium income. Regular consumers of hard liquor were at higher risk than consumers of beer or wine. The highest percentage of misuse was found among unskilled and skilled workers and among inhabitants of large cities. There was a slight association between high alcohol misuse index and depressive states, subjective complaints, and paranoid attitudes.


Sociosexual behavior in male and female homosexuals: a study in sex differences.

The results of a post hoc comparison of two West German studies on male and female homosexuals are reported. The lesbian sample consisted of 151 subjects, 18-35 years of age. The male homosexual sample included 581 males of the same age range. The data of both studies are compared with regard to "coming out," heterosexual experiences, homosexual activity, partner mobility, and partner relations. The results indicate that being a woman tends to influence the sexual behavior of lesbians more than being a homosexual.


Gender identity change in a transsexual: an exorcism.

Gender identity change in a conservatively diagnosed 21-year-old transexual after faith healing was fortuitously observed, was objectively and independently measured, and is reported. This case, and other recent developments, suggests a reexamination of the possibilities of psychosocial intervention to modify atypical gender identity.


The clinical syndromes of femmiphilic transvestism.

Thirty-four members of a club established for heterosexual transvestites were interviewed. They were categorized into two groups. Subjects in group I were satisfied with cross-dressing and did not desire additional feminization. Subjects in group II desired to alter their bodily appearance toward female by taking female hormones or by having surgical intervention. Group II transvestites cross-dressed more frequently and had a more intense feminine gender identity and stronger homosexual interests than did group I transvestites. A feminine gender identity appeared to be present from childhood in both groups but to be stronger in group II. Cross-dressing in subjects of both groups often occurred first during childhood and almost always prior to age 15. All subjects showed a period of fetishistic arousal to women's clothes during adolescence. With increasing age, fetishistic arousal diminished or disappeared and the frequency of cross-dressing increased. Terms in the literature used to describe the type of transvestism reported in this study are discussed. It was suggested that the term "femmiphilic transvestism" be used to describe the condition of the subjects of both groups. The term has fewer disadvantages than terms previously suggested.


The Clarke SHQ: a clinical sex history questionnaire for males.

The development of a 225-item sexual history questionnaire is reported. The frequency, desire for, and disgust for a wide range of sexual behaviors, including anomalous behavior, were examined. Twenty-four scales were derived from factor analysis of the items. The scales were represented by modest unitary factors but were relatively free of bias from age, education, intelligence, social desirability, and defensiveness. The scales generally discriminated clinically relevant groups from control subjects and therefore meet a clinical need in the assessment of anomalous sexual behavior. The instrument also appears to be useful in examining hypotheses for research. Among these observations was the continuity between exhibitionism and heterosexual pedophilia and the apparent bisexuality of some homosexual males. The scale allows for the assessment of the preferences of sexually inexperienced males as well.


Anorgasmia and cataplexy.

Ten married women with cataplexy were found to be rarely orgasmic. Cataplexy is characterized by recurrent episodes of short-lived generalized muscle paralysis. It is precipitated by arousing emotional precipitants such as laughter, fear, and anger. Patients learn to avoid situations exposing them to these precipitants. It is suggested that anorgasmia is a consequence of this general tendency to avoid arousal.


Surgical treatment of renovascular hypertension.

Two hundred sixty-four patients exhibiting renal artery occlusive disease underwent operation for renovascular hypertension between 1961 and 1977. Included were 27 pediatric patients. Fibrodysplastic disease affected 132 adults. Atherosclerotic lesions affected 51 patients with and 54 patients without clinically overt extrarenal arteriosclerotic cardiovascular disease. Ischemic kidney renin hypersecretion (renal: systemic index greater than 0.48), associated with suppressed contralateral kidney renin secretion (renal: systemic index approaching 0.0) predicted curability most reliably. Three hundred forty-eight operations were performed, of which 297 were primary and 51 were secondary procedures. Nephrectomy was initial therapy in 15 cases. Three operative deaths occurred among 51 patients manifesting overt extrarenal arteriosclerotic disease. No operative mortality was encountered among the other 213 patients. Surgical benefits were afforded 96% of pediatric patients and adults with fibrodysplastic disease, 91% of patients with focal renal arteriosclerosis, and 73% of those exhibiting overt extrarenal arteriosclerosis.


Assessment of myocardial performance and optimal volume loading during elective abdominal aortic aneurysm resection.

Myocardial depression has been suggested as a cause of declamping hypotension. To investigate and manage this problem, thermal dilution catheters were placed in 22 elderly, high-risk patients (mean age 71 years) who underwent elective abdominal aortic aneurysm resection. There were no deaths. Myocardial performance curves (MPC) were determined preoperatively, following induction of anesthesia, during aortic clamping, following declamping, and 12 to 48 hours postoperatively. The slope of this curve was taken as an index of myocardial performance. Preoperative cardiac index at a pulmonary artery wedge pressure of 10 mm Hg (CI10) decreased significantly following induction of anesthesia (P less than .002) and persisted during aortic cross-clamping. Following declamping, CI10 rose to preoperative levels. The slope of the MPC followed this same pattern. There was no significant change in blood pressure with the aorta clamped or following declamping. Myocardial performance is depressed following induction of anesthesia but declamping hypotension can be minimized or prevented by optimum volume loading as guided by Starling's myocardial performance curves.


Value of concomitant sympathectomy in aortoiliac reconstruction. Results of a prospective, randomized study.

The efficacy of concomitant lumbar sympathectomy in improving results of aortoiliac reconstruction was assessed by a prospective, randomized study of 51 patients undergoing operation for occlusive or aneurysmal disease. Sympathectomy was performed on 50 limbs, while 52 extremities served as controls. Sympathectomy resulted in a significant reduction in foot vascular resistance determined by plethysmography. However, the procedure had no effect on leg circulation, assessed by ankle/arm pressure indices determined by Doppler ultrasound. In the sympathectomy group, there were three early postoperative amputations for ischemia, despite patent grafts. In the control group, there was one late graft occlusion, caused by progressive atherosclerotic disease. Although sympathectomy may improve pedal circulation, the procedure does not appear to improve the results of aortoiliac reconstruction.


Coagulation abnormalities in patients with arterial, venous, and combined arterial and venous thromboses.

Thrombotic disorders are much more common than hemorrhagic disorders. Nonetheless, most knowledge of coagulation relates to the hemorrhagic disorders. We have done extensive coagulation evaluations in patients with arterial thromboses only, venous thromboses only, and in patients with combined arterial and venous thromboses. Prominent abnormalities in platelet aggregation, factors VIII, IX, and XI levels, and fibrinogen were noted in all groups. These types of studies should eventually lead to a fuller understanding of thrombotic disorders.


Transmetatarsal amputation.

We have reviewed the records of 25 patients who underwent a transmetatarsal amputation at San Francisco General Hospital. The average patient age was 63 years old. Twelve of the patients were diabetic, while transmetatarsal amputations were performed in eleven with simple arteriosclerosis. Two patients underwent amputations for either trauma or nonhealing ulcer. Thirteen of the patients healed their amputation, and twelve of these became ambulatory. Eleven required higher amputation, because of nonhealing due to infection in seven and progressive ischemia in four. One patient died on the first postoperative day of pneumonia. The failure group was younger, contained more diabetics, and had a higher incidence of infection. The operative procedure of transmetatarsal amputation is described. We believe that patients with distal gangrene without spreading infection should be considered for transmetatarsal amputation, reserving initial below-knee amputation for those with greater involvement of the foot.


The asymptomatic carotid bruit and the ocular pneumoplethysmography.

Patients with asymptomatic carotid bruits require some noninvasive method for detecting which would benefit from angiography and possible prophylactic operative repair of the suspected atherosclerotic lesion. This report describes the use of the ocular pneumoplethysmograph (OPG) in this regard. Data for establishing OPG criteria of significant carotid stenosis were derived from studies in symptomatic patients who had also undergone angiography. In this review, the OPG demonstrated an accuracy of 91.6% in detecting at least a 75% diameter stenosis. The OPG criteria were applied to 116 patients with asymptomatic carotid bruits. Forty two of the 116 patients fulfilled at least one of the four criteria for angiography. In 38 of the 40 patients who underwent angiography, the OPG findings were confirmed, for an accuracy of 95%. Twenty-two patients underwent 27 operations, without morbidity or mortality.


Ultramicroscopic ulcerations and thrombi of the carotid bifurcation.

It is widely accepted that transient cerebral ischemia and permanent stroke frequently are caused by platelet and thrombotic cerebral emboli that originate from lesions at the carotid bifurcation. Microembolization from ulcerated atheroma during carotid dissection also offers a logical explanation for the incidence of intraoperative neurologic deficits during carotid endarterectomy. The risk of intraoperative embolization is obvious when ulcers are macroscopic; but focal cerebral ischemia associated with atheroma that appear smooth and nonulcerated usually has been attributed to decreased regional cerebral blood flow. Several endarterectomy specimens were submitted for scanning electron microscopic evaluation using X20 through X4,000 malignification. Results indicate that carotid atheroma may contain superficial ulcerations and thrombi that are not appreciated by direct inspection or conventional microscopic techniques. Electron microscopic ulcerations and intraluminal thrombi may be responsible for embolic transient ischemic attacks, spontaneous strokes, and intraoperative neurologic deficits in patients in whom gross ulcerations are absent.


[Studies on the methionine-threonine imbalance in chicks].

Experimental lots of 12 chicks each received, in addition to their standard diets, supplements of 1, 2 or 3% DL-threonine, in each threonine treatment 1, 2 or 3% methionine being added. After an 8-day feeding period the chicks were injected 35S-methionine and were killed after 6, 12 and 24 hours, respectively. The increasing methionine supplementation was found to markedly deteriorate chick growth. It was not possible to correct this effect by any of the threonine doses. The 35S-activity of the blood decreased very strongly from the 6th to the 12th hours following injection. The 35S-activity of the liver also declined clearly at low threonine supply, but less markedly at high threonine rates. In the breast muscle, the 35S-activity also proved three times higher 24 hours after the injection at equal methionine supplementation to the diet (1 or 2%) and at triplicated threonine level (3% against 1%). This finding is related with the fact that threonine supplements to not attenuate the negative imbalance symptoms after methionine overdosing, but that they are likely to aggrevate due to transport competition. The possibility of threonine degradation into glycine does not seem to be of importance for methionine detoxication in chicks.


[The secretion of radioactively labeled amino acids into the digestive tract. 3. 14C-labeling of the intestinal wall after subcutaneous injection of 14C-L-leucine in rats].

Experimental rats allotted in 4 different groups received 14C leucine injections at 4 different levels of specific 14C activity. Groups A and B were injected a leucine dosis corresponding to the daily requirement, the specific 14C activity being high (A) and low (B). Groups C and D were injected a leucine dosis of one ninth the amount applied to groups A and B, the level of 14C labelling being again high (C) and low (D). The 14C labelling of the TCE-soluble fraction of the 1st third section of the small intestinal wall in all 4 groups proved identical with the course of the curve representing the TCE-soluble fraction of the small intestine contents. The specific 14C leucine activity of the intestinal wall of the 1st third section of the small intestine was found to be 5 to 8 times lower than in the TCE-soluble fraction of the pancreatic gland. Thus a dilution effect has been produced from absorption. Two minutes after injection, the 14C labelling of the intestinal wall proteins had half the level of labelling of the pancreatic proteins. This finding applied to both the 1st and the 3rd sections of the small intestine. The results obtained allow to conclude that 14C labelling of intestinal wall proteins is relatively independent of 14C leucine absorption and is conditioned by the level of labelling of the plasma leucine.


[The effect of physical shape of dried green feed and of various sources of starch on the site of digestion of carbohydrates and proteins and on the protein synthesis in the cow rumen].

The experiments were performed on cows with duodenal bridge fistulae to study the influence of the physical form of roughage (forage rye, chopped or pelleted) and of the starch source (barley or maize) on the place of carbohydrate digestion and on microbial protein synthesis. The organic matter digested in the stomachs contained more than 90% carbohydrates. Their digestibility was not found to be influenced by the physical form of the roughage and by the kind of starch source. Feeding pelleted roughage (30% crude fibre) as against chopped roughage increased the share of intestinal digestion of crude cellulose from 5 to 13%, whilst it remained relatively constant with starch (alpha-polymer bound glucose). Under high-starch feeding (some 2100 g/day) 710 g (maize) and 400 g (barley) of alpha-polmer bound glucose entered the duodenum. This corresponds to 29.6 and 17.6% of the starch consumed with maize and barley, respectively. When feeding the pelleted roughage (as compared to chopped roughage) a large amount of the non-bacterial N derived from feed protein and endogenous N (69.6 and 52.8 g/day) was available in the duodenum. Against this, the synthesis of bacterial N decreased (82.7 and 109.0 g/day). In the intestine, 107.1 and gN were absorbed daily from pelleted and chopped forage rye, respectively. In comparison with maize, barley was found to promote N availibility in the intestine (108.9 and 115.3 g N/day). Out of every 100 g of organic matter digested in the stomachs 28 and 21 g of bacterial protein were synthesized under chop and pellet feeding, respectively. Referred to the same amount, 6.6 g and 6.2 g N were found to enter the duodenum for chopped and pelleted roughage, respectively.


[Relationships between the apparent digestibility of crude protein and the amino acid balance of the swine digestive tract].

A diet of equal composition (88% barley, 5% extracted sunflower meal, 3% fishmeal and 3% yeast) was subjected to 9 different forms of thermal treatment and fed to experimental pigs. The biological value of the proteins was found to decline from 65.9 below 50. The amino acid balance of the digestive tract ("true digestibility of amino acids" according to other authors) proved to deteriorate due to the thermal treatment. The individual amino acids always revealed highly significant positive correlations with the apparent digestibility of crude protein. This finding is related with the often demonstrated fact that the fecal protein always has a constant amino acid composition, irrespective of feed protein and, consequently, only influences the quantitative fecal protein secretion, i. e. the amino acid balance of the digestive tract which is suggested to be the cause of the mathematical relations shown.


Enchancement of leukemogenesis in mice after prolonged administration of anti-interferon or normal rabbit globulin.

The prolonged adminstration of rabbit anti-mouse L cell interferon globulin had a marked potentiating effect on Rauscher Murine Leukemia Virus (MuLV-R) infection in BALB/c mice, as shown by spleen size. Normal rabbit globulin had a lesser, but still significant, augmenting effect on splenic enlargement. It was possible to discriminate quantitatively between the non-specific enhancement of splenomegaly in MuLV-R infected mice due to antigenic stimulation with normal rabbit globulin and the effects due to elimination of endogenous interferon by specific antibodies. The difference in the spleen-enlarging activity between the anti-interferon IgG and normal rabbit IgG was found to be maximal 3-4 weeks after infection when potent, diluted anti-interferon IgG (58 microgram protein per dose) was used. It would appear that the endogenous interferon, even prodcued in undetectable amounts, plays an essential role in controlling infection with an oncogenic virus.


[Methodical possibilities and tasks of current clinical morphology].

The analysis of methodic potentials of the current clinical morphology leads to a conclusion that this new discipline may serve for the solution of the problems of both clinical diagnosis and scientific research. The pathoanatomist (clinical pathologist) is the central figure in the solutin of these tasks. A trend of the current medicine to comperehend pathological phenomena in the unity of structure and function suggests that in particular pathology the clinical medicine will seek regularities of the general pathological nature and that this search will be conducted in cooperation with specialist of "interested" fields.


[Morphological changes in the lungs in myocardial infarct].

Morphologica lesions in the lungs were studied in 48 rabbits with experimental myocardial infarction and in 17 fatal cases where death occurred at various intervals after the onset of myocardial infarction. The study revealed 4 interrelated stages of morphological lesions in the lungs due to the development of myocardial infarction: (1) hypoatelectasis, (2) classical atelectasis, (3) the stage of alveolitis, (4) the stage of bronchopneumonia. A certain regularity was established in the dynamics of the oxidative-reductive enzymes in alveolar cells: early in the disease the activity of succinate-, malate- and lactatedehydrogenase decreased but by the end of the 1st week began to recover. In cases where atelectasis was complicated by bronchopneumonia the activity of succinatedehydrogenase again decreased.


[Functional morphology of the hypothalamo-hypophyseal neurosecretory system and adrenal cortex in myocardial infarct].

The hypothalamo-hypophyseal neurosecretory system (HHNS) was studied in patients dying at various intervals after the onset of the first clinical manifestations of myocardial infarction. All the 75 cases were divided into two groups depending on the presence or absence of decompensation with disorders of the water-salt metabolism. Despite the duration and pattern of its course, myocardial infarction was shown to be always accompanied by a high activity of the HHNS and adrenal cortex, although different variants of its intensity could be distinguished by the studies of the secretory cycle in neurosecretory nuclei. When infarction was complicated by cardiac decompensation, there developed the state of hypervasopressinism constantly accompanied by hyperthrophy of the glomerular zone of the adrenal cortex producing aldosteron and by an increased concentration of intracellular sodium.


[Perspectives of the development of current pathological anatomy].

The author presents a general picture of the progress of morphological methods of investigations and gives a historical evaluation of the role of autopsy and examinations of biopsy specimens in the clinical practice. On this basis the author outlines the three main directions in the development of pathological anatomy: (1) continuous increase of the accuracy of the structural analysis of vital activity processes; (2) increasingly complete and diverse functional evaluation of morphological lesions, and (3) maximum extention of contacts, particularly "vital", with the clinic. Further development of these directions will determine the prostpects of development of pathological anatomy.


[Changes in the activity of succinate dehydrogenase and lactate dehydrogenase in the muscles of patients with progressive muscular dystrophy].

Histochemical investigation of 32 biopsy specimens of the muscular tissue taken in patients with Erb's myopathy and 15 bioptic materials from patients with Charcot--Marie--Tooth's amyotrophy was carried out. Characteristics of distribution of enzymes (succinate dehydrogenase, lactate dehydrogenase) in the muscular tissue of the patients referred to above are presented. A quantitative evaluation of the activity of enzymes was made by the method of count of granules of diphormazan with subsequent treatment of data by the statistical variation method.


[Morphogenesis of emphysema in occupational lung diseases (clinico-anatomical comparisons)].

The distinction of pneumoconiosis and occupational (dust) bronchites in the clinic of occupational lung pathology required morphological justification of such divisions. Examinations of 37 fatal cases with dust pathology of the lungs showed that in two thirds of the cases predominantly obstructive bronchitis forms of emphysema and compensatory perinodular forms of emphysema in silicosis could be diagnosed morphologically. A less marked diffuse character of emphysema in focal forms of pneumoconiosis is conducive to the inclusion of compensatory mechanisms preventing the development of pneumonial and cardial insufficiency.


[Histopathological characteristics of the inguinal lymph nodes and skin in onchocerciasis].

The study of 46 inguinal lymph nodes and in 3 cases of skin of subjects affected with African onchocerciasis established the development of parasitic-toxic lymphadenitis and dermatitis. Lymphogenic sclerosis of lymph nodes is due to mechanical regional insufficiency of lymph circulation in them. Fibrous changes begin and progress in the medullary substance, and severe involvements lead to the development of a "fibrous lymph node". Such nodes become poor filters for lymph and blood as a reduction of the lymphatic and circulatory network occurs. Arteriolization of small vessels, the appearance of vessels of the locking type, hyalinosis of their walls and congestive phenomena are indications of regional hypertension.


[Acute untreated idiopathic polymyositis with cardiac lesions].

An autopsy observation of acute idiopathic polymyositis with the involvement of the sceletal musculature and the heart in a man of 23 who had not been treated with corticosteroids is presented. The main morphological lesions were found in the cross-striated muscles and myocardium. They were characterized by deep degeneration, necrosis, and atrophy of muscle fibers, multiplication of sarcolemma nuclei, massive lymphoplasmo-histiocytis infiltration of the interstitial tissue, active resorbtion by macrophages of the dead muscle cells, the occurrence of giant cells. No disorganization of the connective tissue of the muscles, derma, and the vessels was observed.


Fluorescein angiographic defects of the optic disc in glaucoma.

An improved technique for high-contast, high-resolution fluorescein angiography of the optic disc has been developed that almost eliminates pseudofluorescence. Fluorescein angiography of the optic disc was performed on normal, ocular hypertensive, and glaucomatous patients. Rapid-sequence angiograms in the early arterial phases have demonstrated localized areas of hypofluorescence or filling defects of the optic disc. Two types of fluorescein filling defects were observed-absolute and relative. The number of absolute filling defects, which increased with degree of visual field loss, was greater in glaucomatous than in ocular hypertensive or normal eyes. Similarly, ocular hypertensive eyes showed a larger number of discs with filling defects than normal eyes. It is postulated that relative defects progress to absolute filling defects, which may be an indication of impending loss of visual field.


Optic disc in glaucoma: Topography and extent of fluorescein filling defects.

The topography and extent of localized areas of hypofluorescence or absolute filling defects of the optic discs of glaucomatous patients correlated positively with the loss of visual field. Filling defects tended to cluster at the inferior and superior poles of the optic disc and were closer to the disc margin than to the center. The location of the defects corresponded with the expected site of visual field loss. There was a positive correlation between the percent area of the filling defects and the degree of visual field loss. These observations support the concept that fluorescein filling defects of the optic disc in glaucoma represent areas of ischemia that are highly correlated with loss of visual field.


Fluorescein angiographic defects of the optic disc in ocular hypertension.

Fluorescein angiograms of the optic disc were studied in 23 normal and 29 ocular hypertensive eyes. Significant differences in the frequency distributions of areas of defects were obtained between normal and ocular hypertensive eyes. Increased areas of filling defects were noted in ocular hypertensive eyes as compared to normals. There were also significant correlations of the areas of filling defects with age and systolic blood pressure in the ocular hypertensive eyes that were not present in the normals. These observations support the concept that fluorescein angiography of the optic disc demonstrates localized areas of impaired circulation that increase with ocular pressure, age, and systolic blood pressure. This technique may be useful in separating normal from the ocular hypertensive patient who shows changes in the circulation of the optic disc with increased ocular pressure.


Open-angle glaucoma following surgery for congenital cataracts.

Eighteen patients who, years earlier, had undergone operations for congenital cataracts were discovered to have high intraocular pressures. Several had profound glaucomatous loss of vision. All had deep anterior chambers with flat iris planes and wide open angles. The uveal meshwork was unusually coarse and pigmented in some cases. Nystagmus, aftercataracts, and small pupils made visual field testing and observation of optic discs difficult. Most cases were bilateral, which suggested a hereditary origin; some had a family history of glaucoma. In none did we observe signs of congenital glaucoma or rubella syndrome. The incidence of this disease is not yet known, but it is common enough in our clinic to indicate lifetime surveillance for glaucoma in all patients who undergo congenital cataract surgery.


Malignant glaucoma induced by miotics postoperatively in open-angle glaucoma.

A case of malignant glaucoma that developed in a patient with primary open-angle glaucoma is described. The malignant course was induced during the immediate postoperative period by the inadvertent use of miotics. The malignant course was successfully managed by osmotic agents, acetazolamide, cycloplegics, mydriatics, and topical steroids.


Foveal lesions seen in retinitis pigmentosa.

A total of 110 patients with retinitis pigmentosa were prospectively and consecutively evaluated for the presence of foveal lesions. Of these 69 (63 percent) patients showed one of two types of separate and distinct bilateral foveal lesions. Forty-seven (43 percent) patients had atrophic-appearing lesions of the retinal pigment epithelium within the fovea of both eyes, and an additional 22 (20 percent) patients showed bitalteral foveal cysts or partial-thickness holes. Of the 22 patients in this last group, 16 showed cystoid macular edema evident on fluorescein angiography.


Orbital extension of Choroidal and ciliary body melanomas.

In a review of 432 choroidal and ciliary body melanomas, histopathologic evidence of orbital extension was found in 45 cases (10.4 percent). The occurrence of orbital extension was influenced mainly by the cell type (P less than .05) and by the size of the choroidal mass (P less than .001). Local orbital recurrence occurred in 23 percent of cases with evidence of extrascleral extension. Survival rates were independent of cell type, pigmentation, and size and shape of the extension. Patients treated by exenteration had significantly better prognosis than nontreated patients or patients treated by chemotherapy, radiotherapy, or local excision (P equals .0002). Early exentration is the best treatment for choroidal melanomas with orbital extension.


Orbital involvement in 'sinus' histiocytosis. A report of four cases.

Sinus histiocytosis is a newly recognized benign disease affecting mainly children and young adults and usually having a protracted clinical course that is relatively unaffected by therapy. This paper describes four additional patients who had orbital involvement initially and reviews the salient clinical and histopathologic features of this entity. The outstanding clinical feature is cervical lymphadenopathy. Associated findings include low-grade fever, anemia, leukocytosis, and elevated IgG levels. A small percentage of patients develop proptosis with palpable orbital tumors. Such patients may not have appreciable lymphadenopathy. Progressive proptosis may lead to exposure keratitis, corneal ulceration, endophthalmitis, and loss of the eye. Histopathologically, the lymph nodes and orbital mass show a proliferation of large histiocytes intermixed with a variable proportion of lymphocytes and plasma cells. Lymphocytes and occasionally other cells derived from the hematopoietic system are commonly seen within the cytoplasm of the histiocytes.


Conjunctival flora in patients receiving immunosuppressive drugs.

The bacterial, fungal, and viral flora of the conjunctiva were compared in patients receiving immunosuppressive drugs and in a control group of patients seen for routine eye examinations. The lysozyme concentration of the patients' tears was also measured. No significant difference was found in the number of positive cultures nor in tear lysozyme content in the two groups. A positive correlation was noted between increasing doses of prednisone and the number of bacterial organisms found in the patients' conjunctiva.


Histopathologic findings in human eyes after pars plana vitrectomy and lensectomy.

Six eyes, four obtained at autopsy and two enucleated for neovascular glaucoma, were studied histopathologically between one week and 3 1/2 years after pars plana vitrectomy (some combined with lensectomy) for proliferative diabetic retinopathy. Fibrovascular proliferation at the sclerotomy site was minimal. Lensectomy through the pars plana proved to be quite complete. A cyclitic membrane was found in eyes with postoperative rubeosis irides. Excision of the vitreous from the posterior part of the vitreous cavity was quite complete except for remnants of stalks and membranes on the retinal surface.


Surgical management of necrotizing scleritis.

We successfully used autogenous periosteum to reinforce the weakened sclera of two patients with necrotizing scleritis. One of these patients previously had an onlay scleral graft made from homologous banked sclera, which had subsequently melted. Autogenous periosteum is suggested as an alternative to banked sclera for scleral reinforcement.


Medial canthal tendon branches out.

A previously undescribed, superior supporting branch of the medial canthal tendon has been found by careful cadaver dissection. This branch unites the common tendon to the frontal bone; thus, it provides a superior support to the medial canthus. The posterior portion of the medial canthal tendon is a thin and weak structure, as  compared with its anterior companion. It inserts on the posterior lacrimal crest. While most surgeons contend that the posterior limb of the medial canthal tendon maintains the position of the medial canthus after either accidental or surgical disinsertion of the anterior tendon, it is likely that this superior supporting branch maintains the canthal position in these clinical conditions.


Lactate dehydrogenase levels and isoenzyme patterns in the serum and aqueous humor of adult cataract patients.

Serum and aqueous humor lactate dehydrogenase (LDH) levels were assayed in 46 patients with senile cataracts at the time of cataract extraction. The mean aqueous level was 37 IU/liter and the mean serum level 152 IU/liter. In each case, the serum LDH level was higher than the corresponding aqueous LDH. The LDH isoenzyme levels were also determined; LDH 4 and LDH 5 were elevated in cataract aqueous samples, while the serum isoenzymes were normal. The LDH studies of normal and diseased globes must be rigorously standardized to avoid artificially high or low levels.


New foot switch panel for microsurgery.

The purpose of this panel is to provide an assistant a space for a relaxed position in microsurgery. Fifteen apparatuses can be controlled easily.


[Kinking deformities in collagen (author's transl)].

The affect of stretch on collagen was investigated. Alterations of mechanical dimensions and thermostability of fibrils were measured and changes in fine structure determined by x-ray diffraction and electronmicroscopy. Collagen underwent changes both in tensile strength and fine structure following stretch beyond the physiological range. The severity of these changes depended both on the degree of stretch and the cross-link density of the collagen Fibrils either became split into bundles consisting of subfibrillar units or showed circumscribed kinking deformities. The mechanism producing kinking was investigated. It is possible that a connection exists between fibrillar kinking and tendon rupture.


[The action of high-concentrated fibria on bone healing (author's transl)].

The influence of a biological tissue glue--based on fibrinogen clotting--on bone healing has been investigated in animal experiments. Standardized cortical defects in the tibiae of rabbits were closed with a plug of homologous or heterologous fibrin. The course of restoration has been studied using histological techniques, x-ray examinations and isotopes (Ci 99 TC). Heterologous fibrin delays bone formation, due to a local immune response. Homologous fibrin on the other hand cubances and accelerates sprouting of capillary vessels and connective tissue cells which results in rapid new formation of bone.


[Dynamic force resistance of different osteosynthetic procedures in pertrochanteric femoral fractures (author's transl)].

In a comparative experimental study stability of different extra- and intramedullar methods of osteosynthesis for stable and unstable pertrochanteric fractures has been examined under dynamical stress. For the treatment of stable pertrochanteric fractures in old patients the intramedullar methods of osteosynthesis (nailing by Ender of Küntscher) were shown to be biomechanically superior. Extramedullar osteosyntheses (130 degrees and 95 degrees angled plate) also guaranteed very high stability; under permanent stress however angled plates showed metal fatigue. In case of unstable pertrochanteric fractures the osteosyntheses with additional application of bone cement produced sufficient stability under permanent stress. The importance of reconstructing a stable medial support for the biomechanics of osteosynthetic materials was emphasized. According to our results especially the combination of 95 degrees angle-plates with bone cement permits immediate mobilisation of old patients in case of unstable pertrochanteric fractures.


[The role of glomi (arteriovenous anastomoses) in the pathomechanisms of solitary enchondromas (author's transl)].

The author performed the histlologic examination of 62 solitary enchondromas located in the short tubular bones of the hand and the feet. In 25 cases the thinned cortical bone and its periosteum covering the lesion could be examined, too. Comparison with the controls revealed that the glomi (arteriovenous anastomoses) in the periosteum, or close to it were open in 1 case, strongly contracted in 9 cases, and closed in 15 cases. It is shown throughout the whole material that the pathologic tissue of the enchondromas has a poor vascular supply. In 14 out of 62 cases the septa amoung the cartilaginous lobes were filled with blood. In the vicinity of these, however, a regular osteoblastic ossification sets in. The above results lead to the conclusion that in the pathomechanism of the enchondromas the local hypoxaemia induced by functional disturbance of the glomi plays an important role in the proliferation of the bradytrophic cartilaginous tissue.


[A ceramic total hip endoprosthesis for implantation without bone cement. Preliminary report (author's transl)].

A new total hip endoprosthesis for implantation without bone cement is reported. This prosthesis consists of a ceramic socket and a titanium femoral component which is covered with a ceramic layer (Al2O3). The proximal end of the femoral component is shaped to a conus on which a ceramic ball for articulation with the socket is placed. Beside the construction principles the implantation technique and first clinical experiences are described.


Management of epistaxis in hereditary hemorrhagic telangiectasia. Review of 80 cases.

Intranasal dermoplasty and estrogen therapy have been shown to be the most effective means of managing epistaxis in patients with hereditary hemorrhagic telangiectasia. In a series of 80 patients studied, the most effective treatment was by intranasal dermoplasty; of 22 patients so treated, 14 had improvement for more than six months after surgery and six had improvement for one to six months. Regrafting for recurrent epistaxis was successful in four of five patients (improvement for more than six months). Estrogen was administered for systemic effect to 16 patients and produced improvement of more than six months' duration in eight and of one to six months' duration in three. Other forms of management were less effective for the prolonged control of epistaxis.


Versatile Karapandzic lip reconstruction.

The Karapandzic reconstruction of lip defects is a versatile, anatomically sound, physiologically and cosmetically acceptable method that should be known to all surgeons who excise lip cancers. Because these myocutaneous advancement flaps have intact nerve and vascular supply, the physiologic functions for speech and managing food are quickly restored, in stark contrast to many other major lip reconstruction techniques.


Intraoral open reduction.

The indications for intraoral open reduction of mandibular fractures are essentially the same as those for extraoral procedures. Advantages and disadvantages inherent in this technique are discussed. Intraoral open reduction offers a simple, direct approach to the treatment of certain mandibular fractures and offers advantages over the standard extraoral open reduction method. A review of the technical aspects of this approach is presented, and some potential problem areas are discussed.


Management of brachial plexus tumors.

Brachial plexus neoplasms are uncommon. When this diagnosis is suspected, the functional and anatomical integrity of the brachial plexus and cervical spinal cord must be carefully assessed. A thorough search for other signs of neurofibromatosis (von Recklinghausen's disease) must also be completed. The distinction between neurilemoma and neurofibroma is an important and useful one to know. Evaluation by a pathologist who is well versed in neural tumors is mandatory for appropriate treatment of these usually benign lesions. Surgical intervention, adequately prepared on the basis of the patient's age, the amount of neural impairment, and the extent and histology of the tumor requires a surgeon who is experienced in peripheral nerve surgery and in microdissection techniques. Long-term follow-up is necessary to monitor the growth of known tumors, the detection of malignant change, and the appearance of other stigmata of von Recklinghausen's disease.


Hearing aid dispensing in the otolaryngological-audiological clinic.

Many professionals in the hearing health care field recognize the need for change in the hearing aid delivery system. Reported herein are the results of 30 months of direct dispensing experience within a private otolaryngological-audiological clinic. A review of the dispensing of 520 aids shows numerous advantages and minimal disadvantages of this approach. Equipment requirements, patient cost, fitting procedures, and problems incurred are described. Direct dispensing, along with professional management of the rehabilitative process by the otolaryngological-audiological team is advocated on the basis of the positive results to date.


Genetic hearing loss with preauricular sinus and branchiogenic fistula.

A mother and her two children had hearing loss associated with bilateral preauricular sinus and branchiogenic fistula. All six cochleas studied showed two turns rather than 2 1/2 turns. Complete studies including audiometry, tympanotomy findings, and temporal bone polytomography of these anomalies are reported. Similar cases reported in the English literature are reviewed. It seems that all previous cases may have had an abnormal cochlea as was seen in these cases.


Retropharyngeal abscess caused by atypical mycobacterium.

Mycobacterial retropharyngeal abscesses are usually secondary to cervical tuberculous osteomyelitis. A case is presented of a retropharyngeal abscess that was caused by the atypical mycobacteria with no mucous membrane or cervical spine involvement. The operative and medical management is discussed.


Increased fatigue of cochlear potentials after injection of KCl solution in the perilymph.

Cochlear microphonics (CM), action potentials (AP) and endochochlear potential (EP) were recorded on guinea pigs. The introduction of a small quantity of KCl solution (0.1 N) in the perilymph provoked a moderate decrease of CM and AP. During the period of depressed but stable amplitude, the presentation of intense sounds provoked an exaggerated susceptibility to fatigue and a delayed recovery. Similar changes were observed in the evolution of EP. However, the recovery was slower for EP than for CM. The results, as a whole, suggest that the fatigue which is manifested in the depression of cochlear potentials is related to a leakage of potassium ions from endolymph to fluids spaces within the organ of Corti.


Comparison of earlobe and promontorium recording sites in electrocochleography.

A compound cochlear action potential can be recorded in man from the promontorium, after perforation of the tympanic membrane. This same cochlear action potential (along with the responses of the brain stem auditory nuclei) can also be recorded by means of earlobe-vertex electrodes. Recordings were made in patients with chronic perforations of the tympanic membrane from the promontorium and simultaneously from the earlobe (-vertex) in order to see if there is a difference in response threshold. As click intensity was decreased, the responses disappeared in both recordings at about the same stimulus intensity (threshold). At near-threshold click intensities, the response seen in the promontorium recording was the compound cochlear action potential while in the earlobe vertex recording, the response often seen was seen was that from the inferior colliculus. Thus, in most cases, there is no real advantage to be gained by perforating the tympanic membrane in order to record from the promontorium since an identical response threshold can be obtained using surface electrodes.


Brain stem response audiometry at speech frequencies.

Auditory-evoked brain stem response (BSR; wave V) was studied, using tone pips at three speech frequencies (500, 1 000 and 2 000 Hz) as stimuli. The tone pips consisted of 5-ms rise-decay times without a plateau. BSR recordings were made in 10 normal subjects and in 16 subjects with impaired hearing. In the normal subjects, BSR thresholds ranged from 10 to 20 dB SL at these three frequencies. In the subjects with impaired hearing, BSR thresholds corresponded well to conventional pure-tone thresholds at each frequency in cases of low- as well as high-frequency hearing loss. In all subjects with impaired hearing, the BSR thresholds were higher by as much as 25 dB than the pure-tone thresholds. The mean differences between these two thresholds at 500, 1 000 and 2 000 Hz were 11.3 +/- 8.0, 10.9 +/- 6.2 and 10.9 +/- 7.3 dB, respectively. Thus, we conclude that the BSR is useful for objective assessment of hearing thresholds at each of these speech frequencies.


Auditory processing of frequency ramps.

Linear frequency ramps of a continuous pure tone have been used as stimuli, and behavioral thresholds for frequency change (DLF) as well as the slow cortical potentials evoked by such ramps have been studied on listeners with normal hearing and with various types of hearing losses. A group with cochlear hearing losses showed elevated DLFs as compared to the normal group by an average factor of 3, independent of ramp duration (10-500 ms). Corresponding to this finding, the slow evoked cortical potentials of the cochlear group had longer N1 latencies at small frequency ramps than those of the normal group. However, at larger ramps, this difference disappeared and turned into the opposite relation at the largest ramps. This result has been verified by a psychoacoustical method, indicating the existence of 'recruitment of pitch change'. In a number of subjects with retrocochlear lesions, the evoked cortical responses to frequency ramps were significantly different from those of the normal group as well as of the group with cochlear lesions.


Methodological problems in the determination of homolateral stapedius reflex threshold.

Generally, a bilateral symmetry of the acoustic stapedius reflex is assumed. But a homolaterally higher sensitivity has been described. We examined 71 patients with complete unilateral deafness. With a TDH 39 headphone, stimuli of intensities up to 133 dB were conveyed to the deaf ear. A fairly accurate estimate of the normal homolateral threshold is obtained by correcting for the cross-hearing loss and by mathematical consideration of the relative probabilities of the positive and negative cases. Methodology-specific influences are discussed and a correction made for them. The homolateral reflex threshold is 9-14 dB lower than the contralateral reflex threshold.


The treatment of dyspepsia.

Dyspepsia may result from over-indulgence in alcohol and food, or from anxiety and emotional problems. It may also indicate a peptic ulcer, oesophagitis or less commonly, gallstones or gastric cancer. Investigation by endoscopy or barium studies is always indicated when an organic lesion is suspected. Reassurance, tranquillizers and antispasmodics help patients with functional dyspepsia. Antacids given hourly between meals are important in the treatment of all symptomatic peptic ulcers. Cimetidine causes  rapid symptomatic relief of duodenal ulcer symptoms, and most ulcers will heal with six weeks' therapy. Gastric ulcer can be treated with carbenoxolone, but this drug is avoided in the elderly and in patients with cardiac failure or hypertension. Anticholinergic drugs are of value in duodenal ulcer, especially for night pain, but they should not be used in patients over the age of 50. Special diets are of no value. For the heartburn of oesophagitis, weight reduction and a regime of regular antacid therapy remain the important measures.


An improved model for loudness coding during auditory adaptation.

A comparison of loudness adaptation measured at four baseline intensities and at test values 10 and 20 dB above the baseline intensities revealed an orderly decline. The magnitude of the decline in loudness adaptation with the increasing difference between the test values and the baseline was shown to agree with earlier theories. A method for closely estimating the change in loudness adaptation is presented in convenient graphic form and in algebraic equations.


Occlusion effect: bone conduction speech audiometry using forehead and mastoid placement.

The occlusion effect (OE) was determined for bone conduction speech reception thresholds (SRTs) in 24 normally hearing subjects using forehead and mastoid placement. Results indicated that the OE was about 3 dB greater using forehead as opposed to mastoid placement. The intersubject variability of the OE is similar for the forehead and mastoid positions. The formula for effective masking for bone conduction speech should be equal to the minimum masking level for bone conduction speech plus the air-bone gap of the nontest ear plus 18 dB to account for the OE when using mastoid placement.


Remote masking generated by high-frequency two-tone complexes.

Auditory masking generated by two-tone complexes centered around 7 000 Hz was measured in 10 young adults with normal hearing sensitivity as a function of the frequency separation (deltaf) and SPL of the masker's components. Remote masking (1) was evident for test signals in the frequency region corresponding to the masker's deltaf; (2) increased with masker SPL, but at a rate less than that usually observed when lower frequency bands of noise are used as maskers, and (3) was relatively constant in magnitude for a given SPL as a function of the masker's deltaf. The masking produced in low-frequency regions by high-frequency two-tone complexes adds support to the hypothesis that remote masking is primarily a result of aural distortion.


Problems in general anaesthesia. Obstetrics.

An understanding of the physiological changes seen in late pregnancy, avoidance of the supine posture, together with routine administration of alkali during labour and a careful anaesthetic technique will enable the anaesthetist to avoid many of the potential problems of obstetric anaesthesia.


Regional blocks and their difficulties. Epidural.

The epidural must be regarded as a technique which requires a high level of understanding, and it should be used only by people who have received adequate training. When a spinal technique is thought to be preferable to general anaesthesia for surgical operations, the majority of cases would be managed more certainly and in greater safety by the subarachnoid technique. In obstetrics, the use of the epidural for relieving the pain of first stage labour, though excellent in experienced hands, is the situation above all others requiring great understanding on the part of doctors and nurses alike. The epidural (usually caudal) technique is the ideal method of analgesia for forceps delivery, but in view of the possibility of its associated side effects and complications arising while the operator is occupied with the obstetrical problem, the analgesia and the obstetrics should be managed by separate individuals.


Regional blocks and their difficulties. Brachial plexus.

The effective and safe use of brachial plexus block anaesthesia requires the careful practice of a simple technique, a healthy regard for its potential general and local complications, and due consideration for the patient's psychological comfort. Providing combined anaesthesia and motor block and a variable period of postoperative analgesia, it is the preferred anaesthetic for many forms of hand surgery. Further, it is a valuable alternative for most of the surgery of the upper limb in patients in whom general anaesthesia is particularly hazardous.


Regional blocks and their difficulties. Spinal.

Low spinal analgesia remains a safe, reliable, simple and economical method for perineal surgery. If strict rules are followed during injection, and hypotension is sensibly managed, the technique is devoid of serious complications.


Anaesthetic machine hazards.

The anaesthetist is ultimately responsible for ensuring that the machine used for a particular anaesthetic is in a safe condition before the procedure is commenced. He can only do this if he understands how the machine operates, and has established for himself a checking procedure which will uncover potentially lethal faults in the apparatus. The importance of a systematic and thorough check cannot be overemphasized. Continuing monitoring of the machine and the patient during the anaesthetic is mandatory.


Computerized instant drug information.

Challenges facing doctors when prescribing are listed. Immediate access to all known contraindications, side effects and interactions about a drug, or combination of drugs, would be advantageous to all doctors and pharmacists. A proposal for a rapid, readily accessible computerized system on adverse drug information is outlined. Benefits, such as the possible discovery of contraindications of interactions, hitherto unknown, are considered.


What drug information does the general practitioner need?

There is a great need for imporved drug information services within the Australian medical community. The need has been only partly assessed and should be more objectively surveyed as part of any development of drug information services. Whatever service is established, it should be easily accessible, pay particular attention to the language used in communication, and have a significant ongoing educational component.


Effect of lipid solvents on cutaneous moisture loss.

Application of various lipid solvents and dimethyl sulphoxide to the skin of cattle, sheep, eland and African buffalo exposed to an air temperature of 20 degrees C caused an increase in cutaneous moisture loss. The effect did not occur after exposure to an air temperature of 40 degrees C or after adrenaline administration. Blockage of sweating by either bethanidine or phenoxybenzamine did not affect the response. Camel, donkey, dog and man showed no increase in cutaneous moisture loss after lipid solvent application to the skin. It is concluded that lipid solvents directly stimulate the secretory cells of the sweat glands of members of the family Bovidae and that this is not due to the release of transmitter substance nor to stimulation of adrenergic receptors, but is due to direct stimulation of the sweat glands themselves.


Fate of cyst(e)ine synthesized by microbial activity in the ruminant caecum.

Cyst(e)ine synthesized by microorganisms in the caecum of sheep was labelled following the infusion of Na2 35SO4 into the terminal ileum. [35S]Cyst(e)ine activity was detected in the faeces, but not in plasma or wool. Appreciable absorption of 35S, presumably in the form of sulphide, into the circulation occurred, and its presence in saliva was demonstrated. It was concluded that nutritionally negligible quantities of cyst(e)ine are likely to be absorbed from the ovine large intestine.


Responses of thyroid activity to feed restriction in the goat.

A study of the effect of restriction of feed intake on the deiodination, faecal excretion, distribution and secretion of thyroid hormones was carried out in a group of eight young male goats. In the control goats fed ad libitum no changes in the concentration of circulating thyroxine were observed with increasing age or body weight during the experimental period; however, an increase in thyroxine secretion rate per animal was apparent with increasing age or body weight of the goats. In feed-restricted goats, no changes in the peripheral deiodination of [125I]thyroxine were observed, though significantly reduced faecal excretion of [125I]thyroxine was seen in goats restricted to 50 or 20% of their ad libitum feed intake. Both thyroxine turnover rate and thyroxine distribution volume were reduced by feed restriction. The secretion rate of thyroxine was reduced to 45% of the rate in ad libitum fed animals when feed intake was restricted to 20%. Calculation of thyroxine secretion rate per kilogram 0-75 body weight showed a highly significant correlation with feed intake. It was concluded that the marked reduction in thyroid activity occurring when feed restriction was imposed would be expected to cause a physiologically significant reduction in metabolic activity.


Effect of ingestion of oestrogenic clover on luteinizing hormone release in the ovariectomized ewe.

Luteinizing hormone (LH) concentration was measured in the jugular plasma of six groups of ovariectomized ewes which were fed oestrogenic clover (Trifolium subterranean L. Gray cv. Yarloop) for 3 days. Ewes in groups B, D and F received an injection of oestradiol-17beta (E2) 24 h after first being offered clover, whilst ewes in groups A, C and E received no oestrogen treatment. Following the initial ingestion of clover, plasma LH concentrations for all groups fell within 3 h and then increased significantly. Each subsequent feeding of clover usually resulted in a temporary decrease and then an elevation of the LH concentrations. When ewes in groups B, D and F were injected with E2, LH concentrations fell and remained low for approximately 9 h, then increased to a peak of 72-3 +/- 10-4 ng/ml within 5 h. The LH concentrations remained elevated for a period of about 12 h. The present paper indicates that the ingestion of oestrogenic clover by ovariectomized ewes results in a depression and then a release of LH, and that this release does not appear to deplete the pituitary of LH or cause refractoriness to an oestrogenic stimulus.


Association of a parvovirus with an outbreak of foetal death and mummification in pigs.

A parvovirus was isolated during an outbreak of mummifications and abortions in a commercial piggery. Stillborn piglets from which virus was isolated or in which parvovirus antibody was detected had widespread inflammatory lesions. Lesions were also seen in apparently healthy piglets from affected litters.


Plasma constituents of "downer" sheep slaughtered at an abattoir.

Haematocrit values and plasma glucose, calcium and magnesium concentrations were determined in blood samples collected at slaughter from 105 sheep that were prostrate, comatose, and unable to stand (downer sheep) on arrival at a Queensland meatworks. These values were compared to published normal concentration ranges of these plasma constituents and to values from blood samples taken from 107 apparently normal animals at slaughter. Eleven per cent of the "downer" sheep were considered hypocalcaemic, 13% showed varying degrees of hypoglycaemia and 22% were considered hyperglycaemic.


Percutaneous cardiac puncture in domestic pigs.

Blood sampling by percutaneous cardiac puncture was carried out in 69 domestic pigs. The procedure was shown to be safe and to produce reproducible data. The technique can be carried out without anaesthesia. Repeated sampling is possible over minutes, hours or days, and a wide range of sample volumes can be achieved by this technique.


Trichomas infection in a bull--an apparent change in serotype of the infecting organism.

Routine serotyping of T. foetus isolates from a bull and infected cows showed that the strain in the bull had apparently changed from var. brisbane to var. belfast over a period of 4 months between tests. The significance of this change in the predominance of one serotype over another in mixed infections in vitro and in herds was discussed. The report indicates that the phenomenon should be considered in studies on the epidemiology of trichomoniasis.


Modifications of the McMaster worm egg counting method.

Modifications of the McMaster egg counting technique are presented and discussed including the breaking up of hard faecal pellets, removal of air bubbles prior to counting, avoidance of salt spillage on the counting microscope and the use of sodium azide for preventing development of nematode eggs in field samples.


Joint Committee on Aviation Pathology: I. Fatal aircraft accidents.

The Department of Aviation Pathology was established at RAF Halton in 1955, and is now 21 years old; the early history of aviation pathology and the establishment of the department following the Comet disaster in 1954 are briefly recounted. The past work of the department and possible future trends are discussed, including the importance of helicopter accidents, the value of periodical medical examination, the problems in large passenger aircraft crashes and the subsequent medico-legal difficulties.


Joint Committee on Aviation Pathology: II. Epidemiology of military air display accidents.

The paper examines fatal Canadian military air display accidents occurring between March 1, 1956, and March 1, 1974. They are discussed in detail from a human factors point of view. It was found that single and separated pilots tended to be at high risk compared with their married counterparts and most of the fatally injured pilots had less than 2,000 h total flying time. Time on type was shown to be less important than total flight time, and age in itself was unrelated to the incidence of fatal accidents. Spontaneity and deviation from prearranged plans was featured in many of the accidents. Human failure in the cockpit appears to be less frequent in air display fatalities than in fatal accidents occurring in routine operations; however, human failure in supervision accounted for 30% of the display accident cause factors, a figure much higher than in nonaerobatic fatal accidents. Finally, evidence indicates that it is possible to select and operate an aerobatic team in which the risk of a fatality is low, provided a few simple guidelines are observed by the team selectors and the team members.


Joint Committee on Aviation Pathology: III. Some influences of restraint harness design on accident pathology.

Careful investigation of restraint harness function can reveal the mechanism of failure and, by rectification, prevent repetition of such failures. The investigation can also lead to alteration in the specification for restraint harnesses, and so eliminate weaknesses in future design. The aviation pathologist can play an important part in the assessment of the efficiency of a restraint system in use. His assessment can sometimes be more revealing than laboratory tests, as the unforeseen event often reveals unknown weaknesses.


Joint Committee on Aviation Pathology: IV. Crew behavior in accident causation.

The behavioral intercrew dynamics were investigated in three fatal air carrier accidents. This is apparently the original research done on this vital safety area and certain important factors have been identified for use in the prevention of future accidents. It is seen that a pilot in a flying situation is, in reality, a processor of information encompassing a system of behavior patterns. A failure in the information processing modes may be contributory to accident causation. The processing system contains four interrelated phases: 1) sensing the incoming information (Perception); 2) analyzing and understanding the processed information (Comprehension); 3) making a decision based on the understanding (Decision); and 4) performing or not performing some physical act based on the decision (Action). The dynamic factors of selective inattention, ego function, and level of awareness are present in all crew behavior. If any one of these dynamic factors affects the performance of the flight task, the behavior may lead to inappropriate performance. This may result in a fatal accident. Conclusions concerning accident prevention are drawn from this study.


Joint Committee on Aviation Pathology: V. The psychologist and flying accidents.

Flying accidents which are caused by human factors short-comings are an area of legitimate concern to the psychologist. This paper briefly reviews and assesses some of the ways in which psychologists have attempted to tackle the problems in terms of personality, skill, and environmental and domestic stress. It is suggested that the evidence is such as to suggest that it is not any single one, but the various possible combinations of these factors which are important.


Joint Committee on Aviation Pathology: VI. Cause of death in aircraft accidents: drowning vs. traumatic injuries.

Sometimes it is difficult to differentiate between injuries and drowning as a cause of death in aircraft-accident fatalities. There are certain anatomic and chemical changes that are compatible with drowning, but there is no single change that is diagnostic of drowning. Drowning is a diagnosis that can be made only after all other causes of death have been excluded. Only after a complete review of the circumstances surrounding the accident and the performance of a thorough autopsy can a correct diagnosis be made when there is a possibility of drowning.


Joint Committee on Aviation Pathology: VII. Aviation pathology in relation to aviation safety.

The mainstay of accident-prevention programs--and accident prevention programs, after all is said and done, are the ultimate objective--has been to educate populations exposed to certain hazards with respect to the nature of the risks involved. While human engineering can frequently limit or diminish the hazard potential in a given situation, it is unlikely that mechanical contrivances alone will offer a pragmatic solution to the human-factor accident. I would invite this group to expend its talent in further developing the application of clinical pathology as well as pathologic anatomy to the still-unanswered problems in aviation safety and join with us at the Naval Safety Center in an effort to make our air operation as safe as possible.


Joint Committee on Aviation Pathology: VIII. Medical investigator preparedness for aircraft accident investigation.

The statutory authority and responsibility of the National Transportation Safety Board in the investigation and determination of the probable cause of aviation accidents is described. The Independent Safety Board Act of 1974 acknowledges the importance of obtaining data regarding trauma sustained in an accident by survivors, as well as those persons injured fatally. Information regarding occupant injuries, coupled with extensive examination of the aircraft wreckage, is necessary in order to identify hazards which inflicted the injuries. The human factors investigator is responsible for reporting the facts, conditions, and circumstances relating to first, the accident causation and, second, the injury causation. These two areas, of necessity, rely quite heavily upon the postmortem examination and laboratory analyses of the cras victims. The Safety Board's investigation must determine if a crewmember suffered from a preexisting disease, whether the crew had ingested drugs contraindicated with their flying duties, as well as a description of all injuries and all toxicological and histological findings for crew and passengers. During Safety Board investigations conducted in densely populated cites, over oceans, and in remote areas, both in the United States and overseas, many situations have developed which have caused musch investigative effort due to less than complete postmortem examinations. These situations, in most instances, could have been averted by advance planning by local authorities.


Joint Committee of Aviation Pathology: X. Previous disease in aircrew killed in flying accidents.

This review article discusses the role of previous disease in military, private, and commercial pilots under the headings of occurrence, accident causation, and accident prevention. The importance of minor disease in military flying is stressed as are psychiatric disorders and alcoholism in general aviation. Disease of the coronary arteries is considered with special reference to commercial operations, where the importance of double crewing is emphasized. While symptomatic disease must always be significant, some of the problems associated with increasingly severe selection on the basis of asymptomatic disease are discussed.


Joint Committee on Aviation Pathology: XI. Evaluation and disposition of Army helicopter aviators with finger amputations.

During the period 1969-1975, 12 disqualified U.S. Army helicopter aviators with various finger amputations were evaluated by the U.S. Army Aeromedical Consultation Service for return to flying duties. The evaluations included both medical examinations and in-flight performance observed by aviation medicine specialists and standardization instructor pilots. The criteria for aeromedical disposition are presented with a discussion of the hand and finger requirements to fly U.S. Army UH-1 rotary wing aircraft. All evaluated aviators were presented to a board of senior U.S. Army flight surgeons, who recommended return to flying. Ten of the disqualified aviators were returned to unrestricted flying. Two required limitations to fly with another qualified aviator. At this time, 1 to 7 years after evaluation, 11 are current Army aviators. None have had to be reevaluated or suspended as a result of problems with their amputations. Not one of these aviators has had a fatal accident. The comprehensive medical and in-flight evaluations of well-motivated, disqualified aviator finger amputees has proven to be of benefit in retaining valued assets for U.S. Army aviation.


Joint Committee on Aviation Pathology: XII. Sarcoidosis: a review of some features of importance in aviation medicine.

Sarcoidosis is defined in terms of its histology and natural history. Emphasis is placed upon its insidious nature and potentially pronounced pathophysiological effects. The use of lung function studies as an index of disability in the three described phases is discussed. Though we have only found the disease coincidentally in aircraft accidents, stress is placed upon the need for careful monitoring of affected aircrew and the necessity for respiratory function tests.


Joint Committee on Aviation Pathology: XIII. Sarcoid and the heart--an aeromedical risk.

Sarcoid lesions of the heart are reported in 13% to 20% of sarcoidosis patients. Sudden death and ventricular arrhythmias occur in 40% to 50%. In view of this frequency and life-threatening significance, review of military aircrew with documented sarcoidosis for myocardial involvement was undertaken. Case records were available for 11 US Army, 19 US Air Force, and 6 US Navy patients. Four patients (11%) had significant cardiac abnormalities to include sustained ventricular arrhythmias, and acquired anteroseptal infarction pattern by ECG with nomal coronary angiography. ECG abnormalities were found in eight additional patients. Suspected involvement of the heart in 33% of this series warrants complete cardiovascular evaluation of the sarcoid patient prior to return to flying duties. A case report demonstrates the difficulty in evaluating ECG abnormalities in the antemortem diagnosis of sarcoid heart disease.


Joint Committee on Aviation Pathology: XIV. Ischaemic heart disease: a problem in aircraft accident reconstruction.

A twin-engine light aircraft crashed at night on the third ILS approach. Runway Visual Range was 300 m. All four occupants were killed. The owner, aged 61, one of the two crew members, occupied the left-hand seat and was found to have an old, extensive antero-lateral infarct and severe coronary artery disease. There was no evidence of recent pathological change. A large number of drugs was found in the personal effects of the owner, including Allopurinol, Indomethacin, and Flurazepam. Subsequent investigation revealed that the owner had his PPL withdrawn 12 months prior to the accident on account of myocardial infarction. The problem of pilot control and the significance of cardiovascular disease as a possible cause for the accident are discussed.


Joint Committee on Aviation Pathology: XV. Medical investigation of fatalities from aircraft-accident burns.

Burn deaths of medicolegal importance are of two main types: those in which the circumstances suggest that the fire was used to commit or conceal a homicide or suicide, and those that involve the public interest or safety, such as an aircraft accident fire. The great majority of fire deaths are accidental, but it would be foolish for anyone, particularly an aircraft accident investigator, to assume anything about a death associated with an aircraft fire. This paper will discuss the medical investigation of fatalities from aircraft-accident burns.


Joint Committee on Aviation Pathology: XVI. Studies on the relation between carboxyhemoglobin concentration and toxicity.

A study was made on the effect of I.P. injection of 100% CO in dogs. Although elevated concentrations of COHb were obtained, no Co toxicity occurred. Inasmuch as the combination of CO and erythrocytes after I.P. injection of CO should be similar to that after inhaling CO, The lack of toxicity cannot be explained by Drabkin's "Haldane effect." It is suggested that the lack of CO toxicity after I.P. injection was due to removal of dissolved CO from the blood by passage through the lungs. On the contrary, when Co is inhaled there is significant dissolved CO in the blood leaving the lungs and when it reaches the organs, especially the heart and brain. To cause toxicity, dissolved CO must be present in the blood to cross into the tissues and interfere with the combination of O2 and cytochrome a3. It is concluded that random COHb values may not be related to those obtained in studies of the relationship of human responses to COHb concentrations.


Joint Committee on Aviation Pathology: XVIII. Correlation of occurrence of aircraft accidents with biorhythmic criticality and cycle phase in U.S. Air Force, U.S. Army, and civil aviation pilots.

The correlation of occurrence of aircraft accidents to critical and negative phases of the biorhythm cycles was investigated. Data from 880 U.S. Air Force pilot-involved accident cases were studied and added to 4,279 previously reported cases. The data were tested by chi-square analysis under the null hypothesis that there is no effect of biorhythm on aviation accidents. Under this hypothesis, the expected number of accidents occurring on critical days should be 179.13 for the U.S. Air Force; there were 179. In analyzing the effect of biorhythmic criticality for pilot-involved cases from all sources, there were were 300 individual chi-square values computed. The frequency of these values by their percentile distribution so closely matched the theoretical distribution that there was no evidence whatsoever to indicate an effect of biorhythmic criticality. There no correlation between multiply negative or individually negative phases of the biorhythm cycles and aircraft accidents in the U.S. Air Force or in the combined pilot-involved accident group.


Physiological analysis of repetitive lifting.

It was hypothesized that physical factors associated with the act of lifting, and also known to adversely affect cardiovascular functions (e.g., increased intrathoracic and intraabdominal pressures), would disturb the linear relationships normally noted among measures of cardiopulmonary variation during exercise. Data collected during repetitive lifting, performed on a unique ergometer (described in the paper), did not support the hypothesis. It was concluded that relationships among energy expenditure rate, pulmonary ventilation, heart rate, and workload were essentially linear through the range of lifting workloads from 1 to 50 W for 18 male Caucasians ranging in age from 21 to 55 years.


Metabolic responses to exercise in three thermal environments.

Male and female "physically active" but untrained subjects walked on a treadmill grade approximating 58% vo2 max as determined in 25 degrees C under three environmental conditions. The environments represented thermal neutrality (Ta = 25 degrees C), a "warm" environment (Ta = 32 degrees C), and a "hot" environment (Ta = 40 degrees C). Relative humidity was 50 to 55%. Exercise vo2 values were significantly influenced by increased environmental temperature. In 40 degrees C, male and female vo2 increased 12% above values in 25 C. VE increase 25% for the female and 32% for the male subjects during exercise in 40 degrees C. In both male and female subjects, true O2 increased slightly in 32 degrees C. but decreased in 40 degrees C from values obtained in 25 degrees C. It was postulated that as Ta increased, blood flow was diverted from metabolically active muscle to nonmetabolically active tissue to enhance heat dissipation via conduction and convection. As a result, oxygen extraction declined, and an increased respiratory drive was incurred.


Shallow habitat air dives I and II: human hematologic responses to compressed air saturation diving.

Two subjects each were exposed to pressure equivalents of 50 (SHAD I) and 60 (SHAD II) feet of sea water gauge (FSWG) for 30 and 28 d, respectively. Red blood cell (RBC) count, hemoglobin (Hb) content, and reticulocyte count of venous blood from divers were measured before, during, and after these exposures. RBC count of the divers decreased a maximum of 7.1% in the 50-ft dive and 10.7% in the 60-ft dive compared to surface control values. Hb content fell 7.7% and 11.1% in the 50- and 60-ft dives, respectively, when compared to nondiving subjects. Reticulocyte counts tended to increase late in the pressurization phase and during the recovery. The total month-long responses of Hgb in SHAD I, and RBC, Hgb, and reticulocyte count in SHAD II were significantly altered when compared to those of the surface control subjects. The changes in these factors were directly attributable to the month-long exposure to the total hyperbaric environment. The threshold for hematological effects of chronic exposure to compressed air would seem to lie between 50 and 60 FSWG.


Prediction of airbone target detection.

The visibility of a uniformly luminous object depends on the apparent contrast between the object and its background, the angular subtense of the object, the contrast threshold of the observer at the level of luminance to which the eyes are adapted, the conditions and technique of observing, and the shape of the object. Techniques for combining the influence of the various factors have been applied to the problem of predicting airborne target detectability. Recommendations for achieving the desired detectability are made.


Femur-bending properties as influenced by gravity: III. Sex-related weakness after 4-G mouse growth.

Optimum gravitational intensity for growth stimulation depends upon the type of growth measurement. Although the 4-G field resulted in relatively weaker male bones, relative bone size increased. The more moderate 3-G field is known to stimulate relative bone-strength as well. Femurs from 36 male white mice demonstrated no growth of load-supporting ability Fu after 1 to 8 weeks of chronic centrifugation at 4-G from the fifth week of age. Although measurable with 35 female mice, this growth intended to fall below the control rate. When compared to 82 younger control femurs of the same cross-sectional geometry, experimental female femurs could sustain comparable moments Mu while experimental male femurs could not.


Transfer functions for eye-level blood pressure during +Gz stress.

A description of the eye-level blood-pressure response to +Gz stress in relaxed humans was obtained as an empirical, ensemble-average, G-to-blood-pressure transfer function based on three subjects' responses to a total of 23 simulated aerial combat maneuvering runs on the USAFSAM human centrifuge. Three different analytic transfer functions were fitted to the empirical function for frequencies from 5 to 200 mHz, and predictive performance of the empirical and three analytic functions was examined. The double-zero, double-pole mathematical model most closely fit the empirical transfer function and displayed reasonable predictive ability.


Effect of increased oxygen on kidney function in the rat during and after 21 ATA He-O2 exposure.

Two groups of four adult male rats each were exposed continuously for 12 d to 1.2 or 21 ATA He-O2 at 400 mm Hg 02. A third group was maintained under room-air conditions. Urine samples were collected every 12 h for the first 60 h of exposure and for the first 48 h post-decompression. Parameters measured included urine volume, urea, creatinine, calcium, and phosphate. In the 21-ATA group at pressure, urine volume and urea/creatinine increased, and total creatinine decreased; during recovery, total calcium, calcium/creatinine, and urea/creatinine increased and total phosphate decreased. In the 1.2-ATA group, during exposure, urea/creatinine and phosphate/creatinine increased. Diuresis in the 21-ATA group required 48 h to fully develop; however, recovery to normal occurred within 12 h post-decompression. The results reveal a moderate water diuresis and no serious alterations in kidney function during or after 21-ATA exposure at 400 mm Hg O2. There was a mild stress response at pressure and an undefined effect on calcium homeostasis post-decompression.


Effect of sojourn at 3200-m altitude on spinal reflexes in young adult males.

Studies of the H reflex and the Achilles tendon reflex (ATR) were performed in 12 healthy males under six conditions: 1) sea level control, 2) during the first 1-3 h at altitude while normoxic conditions were maintained, 3-5) at 6, 24 and 72 h of hypoxia, and 6) after Ve acclimatization at altitude in 5-14 d. After altitude acclimatization, the peak-to-peak amplitude of the H reflex and the ATR response was significantly elevated over control. A trend toward decreased amplitudes of both the ATR and the H reflex was observed at 6 h after the onset of hypoxia. There was no significant alteration in latency of the H reflex under any test condition. These findings suggest that sojourn at altitude by sea level residents induces changes in spinal motor reflexes. These changes are most probably mediated by altered high central modulation of the cord.


Influence of systemic factors on hyperbaric oxygen toxicity in the rat visual system.

The electroretinogram (ERG) was measured in lightly anaesthetised rats exposed to 4-7 atm O2 until death. An initial increase and later decrease in amplitude with increase in latency was seen which, although not consistently related to the appearance of seizures characteristically seen above 4.5 atm 02, appeared closely linked to systemic factors. A fall in respiration rate always preceded the fall of the ERG, and apnoea preceded ERG extinction. When blood pressure and ERG were measured in two comparable groups of rats exposed to 5.76 atm O2, both records showed similar time courses. The cerebral visual evoked response (VER) was measured at 5.76 atm O2 simultaneously with the ERG. The later VER waves showed a degree of enhancement at the time of seizures, but otherwise amplitude and waveform were maintained until late in toxicity. EEG spiking gave the earliest indication of toxicity, and it is concluded that the primary projection to the rat visual cortex is comparatively resistant to high-pressure oxygen.


Motion sickness and otolith sensitivity: a pilot study of habituation to linear acceleration.

Astronauts, particularly in Skylab flights, experienced varying degrees of motion sickness lasting 3-5 d. One possible mechanism for this motion sickness adaptation is believed to be a reduction in otolith sensitivity with an attendant reduction in sensory conflict. In an attempt to determine if this hypothesis is valid, a ground-based pilot study was conducted on a vertical linear accelerator. The extent of habituation to accelerations which initially produced motion sickness was evaluated, along with the possible value of habituation training to minimize the space motion sickness problem. Results showed that habituation occurred for 6 of the 8 subjects tested. However, in tests designed to measure dynamic and static otolith function, no significant differences between pre- and post-habituation tests were observed. Cross habituation effects to a standard Coriolis acceleration test were not significant. It is unlikely that ground-based pre-habituation to linear accelerations of the type examined would alter susceptibility to space motion sickness.


Prediction of carboxyhemoglobin concentration from transient carbon monoxide exposure.

The mathematical model of Coburn, Forster, and Kane (2) was investigated for use in estimating carboxyhemoglobin concentrations resulting from transient carbon monoxide exposures. The model proved useful in estimating the probable pattern of carbon monoxide exposures in two fatal cases. In each circumstance, using the predictive capabilities of the model in the reconstruction of events, the obvious source of exposure could be absolved.


Comment on Munsinger's adoption study.

The recent adoption study reported in this journal by Munsinger appears to provide clear and powerful evidence for a large genetic determination of IQ. The study has been cited as methodologically superior to all other adoption studies. With the repudiation of Burt's data, the Munsinger study has taken on particular importance. Perusal of the raw data published by Munsinger clearly establishes that serious errors have been made in the determination of socioeconomic status. The entire study depends on these erroneous data and must therefore be dismissed.


Effect of endotoxin-induced shock on the reticuloendothelial system. Phagocytic activity and DNA-synthesis of reticuloendothelial cells following endotoxin treatment.

There was a marked decrease in the RES phagocytic activity during the first 12 hours after injection of high concentrations of endotoxin in rats. Phagocytic activity then increased considerably, reaching maximum values on days 3 to 5 and it was still higher than in control animals 20 days later. Parallel studies on 3H thymidine incorporation showed a significant increase in the rate of DNA-synthesis of reticulum cells of the liver during the 5 days period following endotoxin injection. Peak values were obtained on day 2 when the number of labelled cell were 50 times higher than in the controls. A likely reason for the increased DNA-synthesis is a repair of RES following endotoxin induced damage but it may also represent an endotoxin induced proliferation of reticulum cells that may at least partly account for the enhanced phagocytic activity.


The exfoliating epithelial surface of the uterine cervix. IV: Scanning electron microscopical study in invasive squamous carcinoma of human subjects.

The exfoliating epithelial surface of 15 invasive squamous carcinomas of the uterine cervix was investigated with the aid of the scanning electron microscope (SEM). At low magnification (less than or equal to 5,000 X) thirteen tumors presented irregular cobblestone-like structures and the remaining two, irregular intermediate formations (i.e. between cobblestones and mosaics). Cellular overlapping was found in three tumors. At higher magnifications (up to 25,000 X) all 15 tumors showed irregular disorganized structures such as bizarre microvilli with or without fragmented microrugae. Seven tumors had in addition tall finger-shaped protrusions and two rumors crater-like formations covered by irregular microvilli. The SEM structure found in invasive squamous carcinoma differed from the SEM structures earlier reported for the normal squamous or glandular epithelium, squamous metaplasia, dysplasia or carcinoma in situ of the uterine cervix.


[Pathogenesis of endocarditis verrucosa simplex in the newborn (author's transl)].

Verrucous endocarditis in the newborn is not only a rare but also a problematic disease as concerns its etiology and pathogenesis. In the older literature septic infections of mother and child were said to be the causative factors. Recent experiences with the pathophysiology and pathomorphology of shock have also shown new aspects of the origin of this kind of endocarditis. Two cases from our own experience are compared with 7 cases from the literature. In the maternal history of gestation there was no infectious disease which could explain the endocarditis of the newborn. A short time after delivery the children showed a respiratory distress syndrome and died between 1.5 hours and 3 days after birth. At autopsy verrucous vegetations up to 8 X 5 X 4 mm in diameter were found on the tricuspid valve in 8 cases, once on the mitral valve and twice on both mitral and tricuspid valve. Malformations of the hearts were not noted. Histologically the fresh vegetations consist of clotted platelets and a fibrin network. At the base of the verruca the valvular leaflets show an edema, occasional fibroblastic changes and tiny lympho-histiocytic infiltrates in the subendothelial layer. Extracardial findings are hyaline membranes of the lungs and microthrombi in small vessels of lung, heart, liver and kidney due to shock and consumption-coagulopathy. According to Mittermayer et al. (1971a, b) who studied endocarditis verrucosa simplex in adults and animal-experiments endocarditis verrucosa simplex of the newborn is probably caused by intrauterine or perinatal shock.