Total colectomy and mucosal proctectomy with preservation of continence in ulcerative colitis.

Since ulcerative colitis is a mucosal disease, it would appear possible to remove the diseased rectal mucosa and preserve all anorectal musculature. When performed in conjunction with total colectomy, the terminal ileum could then be placed inside the retained muscular wall of the rectum and anastomosed to the anus. This would remove all of the disease and yet preserve anorectal continence. Seventeen patients with chronic ulcerative colitis have undergone this operation with satisfactory results in 15 and no deaths. Many details of preoperative, operative and postoperative management are presented which are imperative for a successful result. Sufficient experience has been gained that the operation can now be recommended.


A rational approach to the surgical management of melanoma.

Our experience with 294 regional lymph node dissections in 250 patients are reviewed. The relationship between the Clark's level of invasion and the thickness of the primary is related to regional lymph node metastases. Patients with Clark's Level III melanoma had a 29% incidence of regional lymph node metastases, Clark's Level IV had a 42% incidence of regional lymph node metastases and Clark's Level V a 58% incidence of regional lymph node metastases. Primary melanomas greater than 1.5 mm in thickness had a 38% incidence of positive regional lymph nodes. We therefore recommend a regional lymphadenectomy in patients with Clark's Levels III, IV and V and all melanomas that are greater than 1.5 mm in thickness. A new technique is described which is helpful in localizing the direction of ambiguous lymphatic drainage in patients with truncal melanoma. The use of radioactive colloidal gold scanning has been useful in predicting lymphatic shed in these ambiguous truncal melanomas. Certain technical aspects of inguinal lymph node dissection are emphasized in an attempt to reduce the morbidity of these dissections. It is emphasized that iliac-obturator lymph node dissections are not performed unless the inguinal lymph nodes are found to be involved by frozen section examination at the time of surgery.


Permanent transvenous balloon occlusion of the inferior vena cava: experience with 60 patients.

Traditional operations to obstruct the IVC are often unsatisfactory because the morbidity and mortality is appreciable: poor risk patients do not tolerate surgical and anesthetic trauma. Furthermore, if the patient is anticoagulated, an operation requires that such desirable treatment be stopped. Ten years ago a study was begun to develop a transvenous method of IVC occlusion in the awake anticoagulated patient. Animal studies were done prior to patient application. A technique was evolved wherein IVC interruption could be accomplished with a balloon bearing catheter inserted through the jugular vein. The balloon was positioned with venography and after inflation held in place by lateral pressure in the distensible IVC. The catheter was then removed, leaving the balloon in position. Balloon occlusion has been used in the management of 60 selected patients since 1970. Twenty-nine patients were simultaneously anticoagulated without complication. Very sick patients tolerated the procedure well. No patient experienced further pulmonary emboli. Nine hospital deaths occurred from a variety of causes, none related to the balloon catheter. Late follow-up shows that the occluding balloon gradually deflates in about 12 months. The remnant has remained stable in all patients, contained in a scar that permanently interrupts the IVC.


A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity.

A randomized prospective evaluation of the gastric and jejunoileal bypass procedures for morbid obesity was performed. The gastric bypass was performed predominantly as a 90% gastric exclusion with a Roux-en-Y reconstitution. The jejunoileal bypass was an end-to-end anastomosis between 30 cm of jejunum and 25 cm of terminal ileum, the bypassed segment of small bowel being decompressed by an end-to-side ileocolostomy. There were 32 patients in the gastric group and 27 in the jejunoileal group. The two groups were comparable in age, preoperative weight and height. There were no postoperative deaths, but the gastric bypass operation was associated with a slightly higher early complication rate indicating it is a more technically demanding procedure. Late sequellae were more prominent in the jejunoileal bypass group and included significant diarrhea in 56% and need for medication in 74%. Kidney stones and cholelithiasis also complicated the jejunoileal group and were not seen after gastric bypass. All patients showed fatty metamorphosis on the original liver biopsy. This had worsened in 75% of the jejunoileal group at one year whereas it had improved or was stable in all of the patients in the gastric group.


Proximal gastric vagotomy compared with vagotomy and antrectomy and selective gastric vagotomy and pyloroplasty.

A prospective, randomized study of proximal gastric vagotomy without drainage (PGV) was done in 174 adult men with chronic duodenal ulcer intractable to medical therapy. PGV was randomized against truncal vagotomy with antrectomy (TV + A) and against selective gastric vagotomy with Finney pyloroplasty (SGV + P). Postgastrectomy sequelae (dumping, diarrhea and reflux gastritis) were less after PGV. One patient after PGV developed a recurrent ulcer as did one patient after SGV + P. Two patients developed gastric ulcers after PGV. Good to excellent results (Visick I and II) were obtained in 96% of patients with PGV, 94% with TV + A and 86% with SGV + P. Follow-up studies were from six months to four years.


Acid and endocrine responses to meals varying in pH in normal and duodenal ulcer subjects.

Recent studies suggest that duodenal ulcers may develop because of increased drive to secrete acid and decreased effectiveness of feedback mechanisms that inhibit acid output. This study was designed to compare gastric acid, gastrin, gastric inhibitory peptide (GIP) and secretin responses to meals (varying in pH) in 12 normal subjects and nine duodenal ulcer patients. Acid secretion was measured by an intragastric titration method which allows actual measurement of acid response to food within the stomach (ten per cent amino acid meal (AAM) adjusted to various pH levels, 7-1.5). Blood samples were collected at each pH level for radioimmunoassay of gastrin, secretin and GIP. Gastric acid and gastrin responses to AAM were found to be significantly greater in duodenal ulcer patients than in normal subjects. In duodenal ulcer patients, acid response to AAM at pH 7 or 5.5 reached 82% of Histalog maximum. Decreasing the pH of the meal resulted in a stepwise reduction in both acid secretion and gastrin in normal subjects and duodenal ulcer patients. At pH 1.5, acid inhibition was complete, but gastrin inhibition was partial. Secretin increased significantly at pH 1.5; there was no difference in secretin release between the groups. Plasma GIP was highest at pH 7 in all individuals. Use of a marker substance showed 80% recovery of AAM at pH 7-4; below pH 4, recovery rose to about 90%. We conclude that gastric acid and gastrin release are pH-dependent in normal and duodenal ulcer subjects. Inhibition of gastric secretion by acidified meals is associated with a pH-dependent suppession of gastrin and GIP levels and elevation of plasma secretin. This study confirms increased acid and gastrin responses in duodenal ulcer patients but shows no evidence of defective feedback inhibition of gastric secretion and gastrin release.


Pharmacological preservation of the ischemic heart.

This study was based on the concept that intracellular accumulation of calcium plays a role in mediating ischemic myocardial injury and that inhibition of entry of calcium into cells may have a salutary effect on the ischemic heart. Nifedipine, a potent vasodilator and inhibitor of transmembrane calcium flux, was infused into the aortic root of 6 dogs (5 microgram/kg/hr) during 2 hours of myocardial ischemia while on cardiopulmonary bypass. Seven control animals received normal saline at the same flow rate and temperature (20 degrees C). The results showed that none of the 7 control animals were able to maintain adequate aortic pressure or cardiac output after 30 to 60 minutes of normothermic reperfusion. All had marked left ventricular failure and were unresponsive to large doses of inotropic agents. In contrast, the 6 dogs treated with nifedipine were weaned from bypass either without difficulty or requiring small doses of calcium chloride and norepinephrine. Light microscopy demonstrated more marked ischemic damage in the control group than in the group of drug-treated dogs. We conclude that the concept of inhibition of transmembrane calcium flux offers a new and potent method for myocardial preservation during ischemia.


Does local cardiac hypothermia during cardiopulmonary bypass protect the myocardium from long-term morphological and functional injury?

Twenty-eight dogs were subjected to 90 minutes of hypothermic (30 degrees C) cardiopulmonary bypass with moderate hemodilution. In 6 dogs the heart was vented and beating for 60 minutes. Eight dogs underwent ventricular fibrillation with coronary perfusion (VF + CP). In 14 dogs the aorta was cross-clamped for 60 minutes while the myocardium was protected by local cardiac hypothermia (ICA + LCH). Eighteen animals survived. Hemodynamic studies at seven weeks revealed no major differences among the three groups. At postmortem examination, no gross scarring was noted in any heart. Microscopical examination of 14 hearts was completely-normal. In the VF + CP group, 2 hearts had isolated microscopical scars. Similar linear subendocardial scars (less than or equal to 1.5 X 0.5 mm) were noted in 2 hearts subjected to ICA + LCH. Survival after 60 minutes of VF + CP or ICA + LCH did not result in long-term morphological injury to or functional impairment of the myocardium.


Rehabilitation after aortic valve replacement with autologous fascia lata: a sociomedical study.

In a series of 50 patients who underwent aortic valve replacement with frame-supported fascia lata, 32 were seen for a combined medical and psychosocial examination 10 to 33 months postoperatively. The investigation included a psychometric test battery and an interview concerning the patient's social and psychological situation at the time of the operation and at follow-up. Twenty-seven patients had improved in their New York Heart Association Functional Classification at the time of follow-up. In most instances NYHA classification correlated well with the patients' subjective opinion on their recovery. Those who for various reasons were not able to return to work did not consider themselves recovered. The employment rate after operation was 66%. There is a great need for more information and support to families as well as for more intensive rehabilitation efforts, especially vocational, for the postoperative patient.


Removal of infected epicardial electrodes by traction.

Five patients who had infected cardiac pacemakers with epicardial electrodes have been managed by exteriorization of the pulse generator and placement of an endocardial unit. In each case the remaining electrode leads where detached from the myocardium and removed by simple traction, avoiding a surgical procedure. In 4 patients, sets of cables had been sutured to the myocardium through an anterior thoracotomy, in some instances using Teflon pledgets as buttresses. In one of these procedures a pericostal suture had been used to secure the leads from the thoracic cavity against the ribs. The remaining patient had received a subxiphoid pacemaker also implanted with sutures. This is a consecutive series, and we have had no failures so far. All pulse generator units were bipolar and located beneath either the pectoral or the rectus muscle. All of them were functioning properly when infection was diagnosed. This procedure constitutes an alternative method of management when more conservative techniques, such as closed irrigation and debridement, cannot be utilized.


Midesophageal web in adults.

Stenotic webs in the midesophagus of adults are rare. Including the present patient, only 6 have been described in the literature in English. Clinical presentation is characterized by dysphagia and insidious weight loss in a patient usually over 40 years old. The cause of the lesion is unknown. Based on knowledge of the embryological development of the esophagus and the absence of microscopical inflammatory changes in true webs, a congenital rather than inflammatory basis seems likely. Treatment of midesophageal webs can be accomplished by dilation, divulsion through an esophagoscope, or transthoracic excision.


The surgical management of multiple lung metastases.

From 1970 to June, 1976, 56 patients who had multiple metastatic tumors of the lung were treated by lung resection. Most of the bilateral lung lesions were removed through a median sternotomy so as to avoid staged bilateral thoracotomy. The surgical mortality was 1.8%. A total of 26 patients are alive at 7 to 69 months (estimated median survival, 20.7 months). Patients with tumor doubling time of less than 40 days had lower survival results (median, 9.5 months), compared to patients with tumor doubling time of more than 40 days (median not yet reached). The type of primary tumor, tumor-free interval, number of lesions removed, and presence of unilateral as opposed to bilateral lung metastases did not seem to affect the therapeutic results.


Aortic origin of the right pulmonary artery.

A seven-week-old infant with aortic origin of the right pulmonary artery and patent ductus arteriosus is reported. During preoperative studies, a balloon catheter was used to occlude the ductus arteriosus in order to define the status of the pulmonary vascular bed. Corrective operation was performed by anastomosis of the anomalous right pulmonary artery to the main pulmonary trunk and ligation of the ductus arteriosus. Preoperative assessment of the presence of pulmonary vascular obstructive disease is discussed.


Left ventricular subendocardial necrosis.

The hearts of as many as 90% of patients who die after open-heart operations have left ventricular subendocardial necrosis. This form of myocardial infarction depresses myocardial performance postoperatively and may result in late myocardial fibrosis. It occurs without anatomical obstruction of the coronary arteries and is caused by a discrepancy between subendocardial oxygen supply and demand during the perioperative period. This review of subendocardial necrosis summarizes the author's current understanding of: (1) why the subendocardium is especially vulnerable to this injury; (2) how to predict which patients are most susceptible to it; (3) how interventions before, during, and after extracorporeal circulation can either contribute to it, minimize its severity, or prevent it; and (4) where future study of this problem should be directed.


Influence of acetylcholine, isoproterenol, quinidine and ouabain on effective refractory periods of atrial and ventricular myocardium in the dog.

Acetylcholine-, isoproterenol-, quinidine- and ouabain-induced variations of the effective refractory periods (E.R.P.) of the non-specialized atrial and ventricular tissue have been explored in the dog by the extra-stimulus method during total cardiopulmonary by-pass. Acetylcholine significantly shortens the E.R.P. of atrial fibers, but does not provoke any change in the ventricular tissue, whereas a parallel decrease of atrial and ventricular E.R.P. is noted with isoproterenol. Quinidine induces a larger increase of the E.R.P. in the atrium than in the ventricle. The ouabain-induced shortening of the E.R.P. in the atrium is more marked than in the ventricle but is followed by a secondary increase which depends on both time after injection and dose. Hypotheses about the mechanisms of these effects, their importance in fibrillation and their relation to clinical uses are discussed.


Comparison of the cardiac effects of ASI-222 HCl, an aminosugar cardiac glycoside, and digoxin.

The effects of ASI-222 HCl and digoxin on cardiac contractile force, dP/dt, heart rate and mean blood pressure in the dog were evaluated following i.v. administration. Additional studies were performed on isolated, electrically driven rabbit atria with both ASI-222  and digoxin. Our data show that ASI-222 (40 microgram/kg) in non-vagotomized dogs produced a two-fold greater increase in cardiac contractile force and dP/dt than did an equimolar dose of digoxin. ASI-222 caused a peak increase in contractile force and dP/dt 10 min after administration, whereas the peak to digoxin occurred at 30 min. ASI-222 was more effective in non-vagotomized dogs in increasing contractile force and dP/dt than in vagatonized dogs. The inotropic responses to digoxin were not reduced by vagotomy. Studies on isolated electrically driven rabbit atria indicate ASI-222 to be 7-8 times more potent than digoxin in increasing contractile force. These data demonstrate that ASI-222 produces an earlier and greater increase in contractile force and dP/dt than digoxin in equimolar doses.


Inhibitory effects of sexual steroidal hormones on the responses of the isolated guinea-pig lleum to acetylcholine and histamine.

Six sexual steroidal hormones (progesterone, pregnenolone, testosterone, ethinyl-oestradiol, oestriol and oestrone) inhibit acetylcholine- and histamine-induced contractions of the isolated guinea-pig ileum. Different degrees of inhibitory capacity were found. High concentrations of PGE1 and F2alpha reverse some of these inhibitions. This reversal seems to be non-specific and probably related to sensitization of the ileal smooth muscle by prostaglandins. The inhibitory action of sexual steroids might be non-specific as well. But a "corticoid-like" effect cannot be excluded.


Absorption, fate and excretion of glaziovine-14C in the dog.

The pharmacokinetic parameters of glaziovine, a proaporphine alkaloid with neuropharmacological properties, were investigated in dogs. At alkaline pH, glaziovine-14C showed a very high partition coefficient value from a buffered water solution and both benzene and chloroform. When administered i.v. to both conscious and anaesthetized dogs, levels of glaziovine-14C were higher in the heart, liver, kidneys and brain, and lower in skeletal muscle, skin and plasma. The high amount of radioactivity found in the small intestine as well as that found in bile obtained from a biliary fistula demonstrates that glaziovine is excreted both via the bile and via urine in not dissimilar amounts at least in dogs. When administered orally, peak plasma levels were encountered in 1 hr. Cumulative urinary excretion of glaziovine over a 24 hr period was 49% after the i.v. route and 39% after the oral route. By comparing the percentage of urinary excretion or the area under the plasma level time curve (AUC) obtained in the first 24 hr after i.v. and oral administration, percentages of bioavailability were obtained ranging from 80 to 98%. Glaziovine thus seems to possess a very high enteral absorption.


Measurement of drug displacement of protein-bound bilirubin using gel filtration.

Gel filtration was used to measure drug interaction with protein-bound bilirubin in 0.5 ml samples of Gunn rat serum, human serum and fraction V human serum albumin. Using sulfadimethoxine as a prototype differences in displacement were found in all 3 sera. The differences between human and rat serum were related to the binding characteristics of sulfadimethoxine whereas the differences between human serum and fraction V human serum albumin were attributed to displacement of bilirubin from albumin to other proteins in serum. Gel filtration permitted the use of small samples with bilirubin-albumin ratios less than 1.0 and provided data that were used for analysis of drug displacement of bilirubin using principles of drug-receptor theory. Ten of 14 drugs found to alter serum bilirubin concentrations in icteric Gunn rats had measurable effects on protein binding of bilirubin.


The relative sensitivity of pyridoxal phosphate-dependent enzymes to inhibition in vitro.

The effect of carbonyl and non-carbonyl reagents on five pyridoxal phosphate-dependent enzymes in vitro is described. Specific histidine decarboxylase of rat stomach and non-specific histidine decarboxylase (aromatic L-amino acid decarboxylase) of guinea-pig kidney are more susceptible to inhibition than are aspartate aminotransferase of pig heart, glutamic acid decarboxylase of mouse brain and kynurenine aminotransferase of rat kidney. This greater effect of inhibitors on the histidine decarboxylases is particularly marked in the case of carbonyl reagents, and it should limit the number of untoward side effects which might result from the inhibition of other pyridoxal phosphate-dependent enzymes when these compounds are used in vivo.


Studies on drug metabolism and liver ultrastructure after conjoint treatment with pregnenolone-16alpha-carbonitrile and dl-ethionine.

Zoxazolamine paralysis, hexobarbital anesthesia and digitoxin convulsions were diminished in rats by 3 days of pretreatment with pregnenolone-16alpha-carbonitrile (PCN). Simultaneous injection of dl-ethionine did not block this effect of PCN. Dl-Ethionine decreased, while PCN or PCN + ethionene increased, zoxazolamine metabolism by the 9,000g supernatant fraction of the liver. Dl-ethionine neutralized the influence of PCN and phenobarbital on zoxazolamine metabolism in rats that were pretreated with PCN or phenobarbital for 1 day, and it inhibited the action of phenobarbital on hexobarbital anesthesia. PCN augmented the liver weight of animals given dl-ehtionine whereas dl-ethionine in itself did not. PCN produced SER proliferation in hepatocytes and dl-ethionine caused lipid accumulation, SER proliferation and myelin-figure formation. When administered conjointly, these compounds had an additive effect on the liver cell ultrastructure.


Studies of excretion in rabbit milk after administration of carbon-14 labelled amitriptyline and nortriptyline.

The excretion with rabbit milk has been investigated after subcutaneous administration of carbon-14 labelled amitriptyline and nortriptyline. The amounts of drug material in suckling neonates from nursing rabbits dosed repeatedly with the two drugs were also measured. It was found that the concentrations of radioactivity in milk were of the same size as the concentration in serum. The concentrations of radioactivity in the organs of neonates, which had received milk from rabbits dosed for five days with either amitriptyline or nortriptyline were considerably below those found in the corresponding organs of the dam. Amitriptyline administration to the dams seems to lead to higher concentrations in the organs of the offspring than does nortriptyline administration.


Blockade of delta9-thc induced hypothermia in rats.

Pretreatment of rats with 6-hydroxydopamine over a narrow dose range (100 mg/kg i.p.), attenuated the hypothermic response elicited by administration of delta9-tetrahydrocannabinol (delta9-THC) (10 mg/kg i.p.). Pretreatment with hexamethonium (10 mg/kg i.p.) also attenuated the response. These findings suggest that the hypothermic response produced by delta9-THC administration in the rat is related to alteration of autonomic outflow.


[Treatment of Parkinson's syndrome with a combination of levodopa and carbidopa].

It is widely known that administration of L-Dopa benefits patients with Parkinson's syndrome and combination of this drug with decarboxilase does it to a greater extent. In the present study 20 patients with Parkinson's syndrome received MK 486, a combination of L-Dopa and Carbidopa 10:1 (250 mg of the fomer and 25 mg of the latter). The aim of this study was to evaluate therapeutic activity of this drug combination. It was found that MK 486 is effective for controlling clinical manifestation in Parkinson's syndrome. Although side effects were seen frequently, they diminished or disappeared after time of drug administration.


[Reiter's syndrome in children. Ultramicroscopic study of the synovial membrane].

The clinical picture of a 12 year-old boy with Reiter's syndrome, manifested by conjunctivitis, keratitis, polyarthritis and urethritis, is presented and compared with the other 26 boys and girls with this syndrome that have been reported elsewhere. Light microscopy and inmunofluorescence studies of synovial membrane showed nonspecific changes. However, with the electron-microscope two types of cellular inclusions were seen in both, synovial cells and macrophages. Such changes were similar to those described in adults with Reiter's syndrome.


[Effect of non-radioactive thymidine on mitosis in bone marrow].

Intraperitoneal administration of thymidine into albino mouse (strains CD-1) at dose of 4.8 mg (180 mg/kg) increases mitotic rate in bone marrow at 6, 9 and 12 hours; this effect begins at 3 hours and disappears at 24 hours. It is suggested that thymidine increases mitotic rate by an indirect mechanism, stimulating DNA synthesis during S phase through activation of thymidoquinase. Control group (saline solution without thymidine) showed reduction in mitotic rate; such a finding has no explanation as yet.


Surface fixation as a rapid test for detection of penicillin antibodies.

Surface fixation has been used to detect antigen antibody-reactions with bacteria, protozooa and in some instances with drugs considered responsible of adverse reactions attributed to allergy. The application of this method to penicillin is reported. The test has been positive with serum from well-proven cases of hypersensitivity but also in subjects that had undergone penicillin treatment. So far, no comparative observations with conventional tests have been made; however, if the presence of circulating antibody is considered the cause of adverse reactions to penicillin, this simple test may have clinical usefulness.


Pathological changes associated with dietary protein deficiency in guinea pigs.

Feeding a protein deficient diet containing corn and beans as the protein source for 100 days produced marked malnutrition in guinea pigs. The organs most affected were the liver, pancreas, and testis. Some of the clinical and histological manifestations included growth retardation, atrophy of the liver, decreased number and size of islets of Langerhans, and sterility in male animals. The animals showed clinical signs of protein-calorie malnutrition. This could be the consequence of malabsorption, poor nutrient utilization, and reduced food intake which led to inadequate dietary protein and, secondarily, to inadequate levels of other essential nutrients, especially calories. The low protein level and low biological value of plant proteins used in this study were especially effective in producing the severe pathological changes associated with chronic protein-calorie malnutrition. Some of the changes were marked and incompatible with normal function.


[Evaluation of the quality of tomato paste existing in the Mexican market].

Quality evaluation of tomato paste offered in the mexican market: In Latin America there are not enough studies about the nutritive value of processed foods or over nutrient alterations before reaching the consumer. A global quality evaluation was made to five different commercial brands of tomato purée with two can size of each brand. This purée is one of the food products with the highest consumption in Mexico. Packaging analysis was also carried out on the canned samples. The solid content and cost of each can showed wide variations. Defects were observed in colour and level of fungal counts. The results obtained in this work allowed to select the best tomato purée, based on the relation cost-nutrient supply.


[Protein quality and hemagglutin content in tender and dried bean seeds (Phaseolus vulgaris) coscorrón variety].

Protein quality and hemagglutinating content in tender and dry seed beans: The chemical composition, hemagglutinating activity, protein queality (NPU10) and true digestibility of samples at three certified bean seeds (Phaseolus vulgaris) var coscorrón, tender and dry (recollected 90-95 days and 120-125 days after seeding respectively), were determined. The tender and dry seeds were submitted to usual cooking (tender equals 30' boiling and dry equals 90' boiling previously soaked for +/- 14 hours in water). The hemagglutinating activity in raw tender and dry seeds was similar. The hemagglutinating activity was completely destroyed by these treatments. The protein quality and digestibility of cooked tender and dry samples were similar (NPU10) equals 48,4 and 47,5; true digestibility 79,9 and 80,1 respectively). It is concluded that heat treatments used are adquate to eliminate the hemagglutinating activity and toxicity of the seeds. In relation to protein quality there is no nutritional advantage of consuming tender or dry beans.


Bacterial metabolism of substituted phenols. Oxidation of 4-(methylmercapto)-and 4-(methylsulfinyl)-phenol by Nocardia spec. DSM 43251.

4-(Methylmercapto)-phenol (MMP) and 4-(methylsulfinyl)-phenol (MSP) are oxidized by the soil isolate Nocardia spec. DSM 43251, which is closely related to Nocardia calcarea. The rate of degradation depends on the capability of a substrate to support growth and is strongly enhanced in the presence of a second carbon source under the conditions of cooxidation. MMP and MSP are cometabolized by hydroxylation of the benzene ring with the formation of the substituted catechol following by ring cleavage between carbon atoms 2 and 3 ("meta" fission) to give 2-hydroxy-5-methylmercapto-or-2-hydroxy-5-methylsulfinylmuconic semialdehyde. Oxidation of MMP to MSP represents a bypath of MMP-oxidation. The intermediates were identified on the basis of their physical properties. The enzymes responsible for the metabolism of MMP and MSP are induced by growth with MMP or MSP, but not with glucose. MMP-and MSP-induced cells catalyze the oxidation of a variety of substituted phenols. This indicates a rather low substrate specificity of the enzymes induced by MMP and MSP.


Decomposition of 14C-labelled lignin and phenols by a Nocardia sp.

A Gram-positive bacterium which was isolated from a Finnish soil and identified as a Nocardia sp., was able to decompose lignin and to assimilate lignin degradation products as a carbon source. It could release 14CO2 from 14C-labelled methoxyl groups, side chains or ring carbons of coniferyl alcohol dehydropolymers (DHP) and from specifically 14C-labelled lignin of plant material. Furthermore, it could release 14CO2 from phenolcarboxylic and cinnamic acids and alcohols labelled in the OCH3, COOH groups, side chain or aromatic ring carbons.


Reversion by Fe(III) of the inhibition by hydroxamic acids of the cyanide-insensitive respiration in the yeast Saccharomycopsis lipolytica.

The specific inhibitory effect of benzhydroxamic acid on the cyanide-insensitive respiration could be reversed in whole cells of the yeast Saccharomycopsis lipolytica, by addition of Fe(III), in a way suggesting a competition between the added iron and an enzyme-bound metallic ion, both central atoms for the ligand benzhydroxamic acid. The possibility that added metal ions modify the penetration of BHAM into the cells was ruled out. Co(II), Cu(II) and Al(III) could substitute for Fe(III). A linear relation between the concentration in added Fe(III) and the reversed respiration rate was observed. At a given cell concentration, the reversion by added Fe(III) of the inhibitory effect of benzhydroxamic acid on the alternative respiration appeared more related to the degree of inhibition rather than to the concentration in added inhibitor. Increasing cell concentrations required increasing amounts of Fe(III) to reach the same level of reversion. No reversal occurred at concentrations in added Fe(III) lower than 0.1 mM, whatever the benzhydroxamic concentration, the cell concentration or the yeast batch.


Glucose metabolism in Acetobacter aceti.

Acetobacter aceti NCIB 8554 grows on a minimal medium with ethanol but not with glucose as carbon and energy source. Addition of glucose to a wild type culture on ethanol has no influence on growth of the organism. Growth of a glucose sensitive mutant A5 is inhibited by the addition of glucose until all glucose has disappeared from the medium. In order to determine the routes by which glucose is metabolised in wild type and mutant, radiorespirometric, enzymatic, and uptake experiments have been performed. For the radiorespirometric experiments of the "continuous substrate feeding" type as apparatus has been constructed. Of the glucose entering the cells about 30% is excreted as gluconate and 6% metabolised with liberation of C-1 as CO2. The rest is accumulated intracellularly. No differences were found between wild type and mutant. Under different growth conditions and with different enzymatic assay methods no pyruvate kinase activity (EC 2.7.1.40) could be detected. This might explain the inability of A. aceti to grow on glucose.


Induction of microcycle sporulation in Bacillus brevis spp. AG4 by amethopterin.

Addition of amethopterin to medium before inoculation inhibited DNA synthesis and induced microcycle sporogenesis in Bacillus brevis spp. AG4. Synthesis of RNA and proteins occurred at a considerably reduced rate.


[Intraventricular hemorrhages in hyaline membrane disease].

Twenty prematures children with hyaline membrane disease treated by artificial ventilation under continuous alveolar distension pressure, died after intra-ventricular hemorrhage (group I). These cases have been compared to 20 surviving children, with respiratory diseases of similar severity, and supposed to be uninjured with regard to such cerebral lesions (group II). During the first two days of life, the frequency of important hypothermia, hemodynamic instability with tendency to collapse, metabolic or mixed recurring acidosis were significantly more frequent in group I than in group II. These abnormalities probably promote bleeding; their practical consequences are discussed. On the other hand, perinatal suffering and distrubances in blood coagulation do not take a determinant part. The further aggravation of the neurological status, after an lay phase, unexplained and important hematocrit drop, presence of blood at lumber puncture and, overall, at the electro-encephalogram rolandic sharp spikeswaves constitute the major arguments for the diagnosis of hemorrhage.


The value of clinical question for the cytological judgement upon effusions.

Cytological investigation of the cell sedimentation of body cavity effusions is neither screening nor method of earlier cancer detection. Cytology rather means in these cases etiological enlightment of a manifest morbid state. You unwarrantedly compress the possibility of information if you restrict the examination of seeking only for cancer cells. The reason for it is the fact that exfoliation of tumour cells or of tumour cell-clusters does not occur in all cases of malignancy and that on the other side 50 p.c. and more of all fluids are of benign etiology. Certainly the specific morphological signs permit per se the diagnosis of malignancy. But the question is in all other cases whether reactions of the hematopoietic system or of the serosa or of both you will recognize, evoked by different impulses. The kind of clinical question will then be the key for a correct cytological judgment. The cytologist acts as a counsellor of the clinician. In such a position he urgently needs informations on anamnesis, development of the disease and reports concerning to the direction of the provisional clinical diagnosis.


[Comparing electron microscopical investigation of cells from mesotheliomas (author's transl)].

The difficulties of diagnosing cells originating in mesotheliomas by light microscopic methods are well known. Therefore we tried to find some additional criterions for the cytologic diagnosis using electron microscopy. Only the microvilli seemed to be a distinct criterion as seen by electron microscopy. By this we were able to differentiate mesothelioma cells from macrophages which exhibited large appendices of their cell borders.


[Placental anomalies and neonatal development of hypotrophic infants].

The study of 181 hypotrophic children led to the following conclusions: 1. In pregnancies preceding the birth of hypotrophic children, placenta is significantly more frequently altered than in all other cases. 2. Among all the changes observed in the structure of placenta, ischemic necrosis of placental villi seems to be the worst, in terms of immediate neonatal evolution. Hypoglycemia, especially, is most often observed in such instances. Consequently, examination of the structure of placenta allows a prognosis at the time of birth of a child with intra-uterine growth retardation; its practice should become generalized.


[Primary nonspecific chronic pleurisy (author's transl)].

Cytologic examinations of pleural exudate and cyto-histological examination of biopsies taken from the pleura give useful contributions in the differential diagnosis of primary chronic nonspecific pleurisy. In the early stage of disease the cellular findings are characteristic and enable easy differentiation of mesothelioma. Later on in primary chronic nonspecific pleurisy alterations of mesothelial cells can be seen which mimic tumorous cells and may be erroneously taken for mesothelioma cells. Quantity and quality of these alterations of nucleus and cytoplasma of mesothelial cells in primary chronic nonspecific pleurisy can be distinguished from tumor cells of mesothelioma by critical evaluation in the majority of cases.


[Morphological and cytochemical investigation of Ehrlich ascites tumor cells of the solid form as compared with peritoneal exudate in mice (author's transl)].

Ehrlich ascites tumor cells in peritoneal exudate of mice show a more regular round shape, greater and multiple nucleoli and more abundant and dark cytoplasma in comparison with cells of  the same tumor transplanted in the limb. In solid tumor cells activity of naphthol-AS-acetate esterase is significantly higher than in exudate cells which demonstrate higher activity of PAS reaction. Other cytochemical reactions show no significant differences between the two cell forms. It seems that exudate cells are biologically more active than cells from the solid tumor.


[Halasz syndrome revealed in the newborn infant by pulmonary arterial hypertension. Study of 4 cases].

In the 4 studied patients presenting with an Halasz's syndrome, the disease was complicated since the neonatal period by pulmonary arterial hypertension and heart failure. Three out of the 4 infants rapidly died, one after pneumonectomy. The fourth is surviving and benefitted solely from medical cardiotonic treatment. The pathogenesis of early pulmonary arterial hypertension in Halasz's syndrome is complex. The possibly associated cardiac malformations, the persistance of fetal obstructive hypertension due to the increase of the flow in the left pulmonary artery, the left to right shunt induced by the abnormal venous return and predominantly by the systemic blood supply to the right lung, are responsible, at various degrees, for pulmonary hypertension. Among surgical procedures to be proposed, the simple ligation of abnormal arteries which take their origin from the aorta seems to be preferable to pneumonectomy.


[A scala of malignancy of the histomorphological forms of p.rimary pulmonary sarcomas (author's transl)].

By means of 435 case reports of the corresponding world literature from 1957 to 1972, among them 41 personally observed cases from 1957-1974, a scala of malignancy of the histomorphological forms of primary pulmonary sarcomas is stated. The prognostic chance of survival of the sarcoma patient is rising after active therapy parallel to the maturation of the tumor.


[Choleriform diarrhea in a case of ganglioneuroblastoma. Demonstration of a high blood level of vasoactive intestinal peptide (VIP)].

The case of a 6-month old infant presenting with profuse diarrhea associated with increased plasma V.I.P. (600 pg/ml) is reported. The increased excretion of V.I.P., most probably of tumoral origin may be considered as responsible for the diarrhea. The discovery of an increased plasma level of V.I.P., occuring during a choleriform diarrhea, leads to evoke and search for a tumoral process of the APUD system.


Muscle fiber number in immobilization atrophy.

Eight Sprague-Dawley rats 10 to 12 weeks of age had one limb immobilized by plaster in knee flexion and ankle plantar flexion for four weeks. The soleus muscles from the control and immobilized limbs were excised and frozen. The technique used insured that cross sections subsequently cut and stained would contain all the fibers extending from the origin to the insertion aponeuroses. The total number of muscle fibers per muscle was counted from 25 to 50 photomicrographs made for each muscle cross section. Paired comparisons of total muscle fibers in control and immobilized muscles revealed no significant differences. The total number of fibers in control and immobilized soleus muscles was 2812 +/- 521 and 2930 +/- 403, respectively. Therefore, muscle fiber loss does not occur in disuse atrophy produced by external immobilization as has been reported.


Bacteriuria in patients with spinal cord lesions: its relationship to urinary drainage appliances.

Urine cultures from spinal cord injuried patients demonstrate a high incidence of bacteriuria, with patterns of bacteriuria varying with the mode of drainage. The highest incidence of positive cultures occurs in patients with indwelling or suprapubic catheters, and the lowest in patients who are appliance-free. The organisms occurring most frequently differ from those of the general hospital population as reported by Needham, Smith and Matsen. There is an increase in the incidence of Pseudomonas, Proteus and Serratia and a decrease in the occurrence of E coli and Klebsiella. Sixty-four percent of the organisms occurred in concentrations of 100,000 col/ml or greater, and 65% of all positive cultures contained multiple species of organisms. Cultures taken from urinary collecting appliances and hands demonstrate possible sources of bacteriuria and the need for careful training and education of patients and their attendants and constant monitoring of urinary tract appliance care.


Lactate dehydrogenase isoenzyme levels in collagen disease.

Serum lactate dehydrogenase (LDH) isoenzymes were determined in 27 patients with collagen disease and 88 normal subjects. The mean value for LDH-3 isoenzyme was 20.4 +/- 3% in normal controls, 31.47 +/- 8.9% in patients with collagen disease who showed activity of the disease, and 20 +/- 3.74% in patients in complete remission. Six patients who had positive rheumatoid factor showed higher LDH-3 levels. There was also some correlation between the activity of the disease and serum LDH-3 level in patients with connective tissue disorders.


Histologic studies in animals after intramuscular neurolysis with phenol.

The histologic effects of the intramuscular injection of phenol concentrations ranging from 1% ot 7% were studied in rats and dogs at from one day to ten months after injection. The sites within the muscle localized by a standardized technique for electrical stimulation proved to be intramucular nerves, either near the terminal innervation band, or more proximally, mixed nerves running in the neurovascular bundle in the interfascicular regions of the muscle. The latter was by far the more frequent site of localization. The procedure is therefore identified as "intramuscular neurolysis" rather than motor end-plate or motor point block. Phenol causes nerve destruction with secondary denervation and atrophy, and muscle necrosis, Both nerve and muscle show regeneration which is well established by two months, and almost complete in three months.


Cardiorespiratory variables in middle-aged men.

The purpose of this investigation was to assess the relationship among selected physican and cardiorespiratory variables in active men, aged 40-59 years. Thirty-one subjects who had been running for only an average of five years volunteered for treadmill testing, running to volitional exhaustion. For the total group (40-59 yrs), significant negative correlations were found between age and maximal heart rate (HR max) and age and maximal oxygen uptake (VO2 max), suggesting an inverse relationship between these variables. In both the 40-49 and the 50-59 yr groups, significant positive correlation coefficients were obtained between VO2 max (liters/min) and VO2 max (ml/kg/min), between VO2 max (ml/kg/min) and O2 pulse (ml/kg/min), and between VO2 max (liters/min) and V E max (maximal pulmonary ventilation) liters/min), In both these groups, resting heart rate (HR rest) was significantly positively related to HR max and also to HR 1 min after recovery (1 min rec). Overall, however, the correlation coefficients between selected variables were low, implying that the evaluation of cardiorespiratory variables in these age groups should be based upon several variables.


Durability of monopolar Teflon-coated electromyographic needles.

The results of a two-year study on durability and cause of failure of electromyographic monopolar electrodes are reported. The electrodes were obtained from the regular stock of three different manufacturing sources. Durability is defined on the basis of the number of patients that could be examined before failure. The range was 3 to 110 with the averages 19.7, 33.8, and 62.5 for the three different manufacturers. Common causes of electrode failure included: Teflon retraction, 40.6%; tip dullness or burrs, 34.8%; structural failure of wire or pin, 13.1%; electrical artifacts, 9.7%; and bending of needle shank, 5.7%. Variations in manufactures' tip contour and bevel correlated with tip durability.


Experience with an all-plastic patellar tendon-bearing orthosis.

Forty-three patients were fitted with a new all-plastic PTB orthosis over a period of 42 months. The diagnostic categories were primarily musculoskeletal impairments of the tibia and the ankle, with some instances of injury or disease of the plantar surface of the foot. Improvement in cosmesis, orthotic weight-reduction, ease of donning, marked relief of pain, and functional gains in ambulation were reported. No product failures occurred except for minor cracks in the distal plantar surface; replacements were provided to children within 11 to 14 months, and to adults within 19 to 24 months. Of the entire study population, only four preferred their previous long-leg braces that felt more secure after many years of use.


Eaton-Lambert syndrome: reflex improvement with guanidine.

A 46-year-old man with typical clinical and electrophysiologic findings of the Eaton-Lambert syndrome did not have muscle stretch or H reflexes. With guanidine treatment (42.0 mg/kg/day), all of the tested muscle stretch reflexes except the right knee and the ankle jerks were improved and the H reflex on the left calf muscle was obtained. Latency of this response was normal but amplitude was decreased. The patient's clinical status was also improved. We suggest the basic defect at the neuromuscular junction in this syndrome as the most likely explanation for hypo- and a-reflexia.


Carpal tunnel syndrome: contribution of flexor tendons.

Tension in flexor tendons during wrist flexion may play a role in otherwise unexplained instances of the carpal tunnel syndrome. As the wrist is flexed, the median nerve in the tunnel bends around the taut flexor retinaculum. At the same time, the nerve is subject to compression against this ligament by tensed overlying flexor tendons that also bend around the ligament. Experimental data to support this possibility have been collected from cadaver hands. A pressure transducer has been substituted for the median nerve in the tunnel and registered sizable pressures when tension was applied to the flexor digitorum profundus tendons of the second and third digits during varying degrees of wrist flexion. If the profundus tendons are not tensed, pressure in the tunnel remains negligible until wrist flexion reaches its extreme. Thus, repetitive hand activities involving pinch or grasp during wrist flexion may be a contributing factor in some instances of the carpal tunnel syndrome.


Mechanically provoked insertional activity before and after nerve section in rats.

Mechanically provoked insertional activity was recorded at intervals prior to and through the development of positive sharp waves and fibrillation potentials in the gastrocnemius and soleus muscle group of eight male Wistar rats in the normal state, and after the sciatic nerve was cut at the sciatic notch. The wave form and duration of injury potentials were analyzed. Positive sharp waves were found to occur prior to the development of fibrillation potentials. No significant increase in the duration of injury potentials was noted prior to the development of positive sharp waves and fibrillation potentials. The frequent clinical use of the term "prolonged" or "increased" insertional activity as an abnormal finding in a continuum to positive sharp waves is questioned.


Stroke and brachial plexus injury: a difficult problem.

Five patients are presented, all of whom had middle cerebral artery syndrome with hemiplegia on the contralateral side. All five had electromyographic evidence consistent with neuropathy involving the upper trunk of the brachial plexus on the side affected by the stroke. All patients were exposed to intensive rehabilitation team effort involving range of motion, strengthening exercises, positioning, splinting, coordination exercises and exercises designed to increase ability at arm placement. Three patients regained EMG evidence of innervation of the shoulder girdle muscles after more than eight months, during which time a rehabilitative effort was made. The other two patients have not yet regained control over the muscles of the shoulder girdle by EMG or clinical criteria. The EMG evidence of brachial plexus injury in those patients who eventually showed reinnervation took 8 to 12 months to resolve. The rehabilitation of the patients with stroke involving the upper extremity may have been set back significantly as a result of the neuropathy. It is suggested that patients with stroke and brachial plexus injury probably will have a more arduous and prolonged course in rehabilitation of the upper extremity as a result.


Cardiac output and pulmonary wedge pressure. Use for evaluation of fluid replacement in trauma patients.

Cardiac output and pulmonary wedge pressure (PWP) were used to evaluate the end point of fluid resuscitation in 20 patients suffering from multiple trauma and shock. Eleven patients received crystalloid resuscitation and nine patients received colloid resuscitation. Fifteen of 20 patients had an adequate cardiac output at the termination of resuscitation, but but only six of these patients had a PWP above 10 mm Hg. There was no significant correlation between left ventricular stroke work index and PWP in these patients, either at the completion of resuscitation or during the following three days. Five patients did not achieve adequate cardiac output and four of these patients died, suggesting that cardiac output was the most important criterion for adequate resuscitation. If the goal of fluid resuscitation is to achieve an adequate cardiac output, then PWP was not a reliable guide. Furthermore, using both cardiac output and PWP as a guide to fluid resuscitation of our patients, we found that the type of fluid (crystalloid or colloid) for resuscitation did not influence the course of respiratory distress in these patients up to three days following resuscitation.


Neoplasms of the large bowel following ureterosigmoidostomy.

A poorly differentiated adenocarcinoma of the rectum developed in a 43-year-old man 37 years after ureterosigmoidostomy for epispadias with urinary incontinence. The review of literature indicates that patients who have undergone ureterosigmoidostomy have an increased risk for the development of large bowel neoplasia. The median time interval between the procedure and the diagnosis of the neoplasm is 21 years, and the median age at diagnosis is 33 years. The majority of the lesions are malignant and seem to occur at the site of ureteric anastamosis. The suggested etiologic mechanisms and the clinical aspects of colonic neoplasia following ureterosigmoidostomy are discussed.


Small paraduodenal hernias.

During an 18-month period, five patients ranging in age from 3 1/2 to 79 years old were treated for small paraduodenal hernia. Three had acute strangulated obstruction, while in the other two patients the hernia was found incidentally, during surgery for other causes. As the mortality of obstructing internal hernias exceeds 50%, all paraduodenal hernias, even small and asymptomatic ones, should be considered an operable condition. The operating surgeon must be aware of the various types and locations of paraduodenal hernias and look for them whenever operating for unexplained abdominal pain or obstruction. Contrary to the common assumptioh that paraduodenal hernias are rare congenital anomalies, we believe the rarity of this condition to be due to insufficient attention to the clinical picture and inadequate exploration of the paraduodenal hernia during laparotomy.


Pancreaticoduodenal artery aneurysm simulating carcinoma of the head of the pancreas.

Aneurysms of the pancreaticoduodenal arcades, although uncommon, may rupture and produce symptoms similar to those of pancreatic carcinoma. We describe one patient with a ruptured interior pancreaticoduodenal artery aneurysm and a large hematoma in the pancreatic head. He had a three-week history of painless jaundice. Angiography was essential in establishing the diagnosis and defining a vascular road map preoperatively. The surgical management involved resection of the aneurysm and vascular reconstruction.


Large branchiogenic cyst in a neonate producing upper airway obstruction.

We report on a large branchiogenic cyst in a neonate. The etiology of these cysts is assumed to be of branchial origin because of their communication with the pharynx and their intimate association with the thyroid and thymus glands. This report documents an additional occurrence of this rare lesion. Physicians are alerted to the fact that, should massive enlargements and compromise of the respiration be present, external decompression of these cysts is feasible.


Tension pneumomediastinum.

Tension pneumomediastinum is an infrequently diagnosed but potentially fatal condition. The collection of air under pressure in the mediastinum compromises venous return to the heart and compresses major bronchi, leading to sudden and profound cardiovascular collapse. Although its mechanism was elucidated in the 1940's, when tension pneumomediastinum was most commonly a complication of tuberculosis, the same mechanism explains its formation in neonates with respiratory distress and in patients ventilated with volume respirators. Awareness of this condition will lead to more frequent diagnosis, but, more important, will also lead to prompt mediastinotomy and relief of this rapidly fatal condition.


Stenosis of the small intestine due to nonocclusive ischemic disease.

Intestinal stenosis following nonocclusive disturbances of mesenteric circulation will probably be encountered with increasing frequency as patients with low blood flow states resulting in transiently ischemic but viable bowel are treated early and successfully. The case reported here clearly documents the temporal sequence of dated cardiogenic shock and the subsequent onset of abdominal pain, culminating in intestinal stenosis and obstruction and necessitating later bowel resection. The pertinent literature has been reviewed. It is suggested that the likelihood of this complication be entertained in high-risk patients and supportive therapy be employed promptly and judiciously.


Mesenteric vascular occlusion associated with oral contraceptive use.

We report a case of mesenteric venous occlusion in a young woman receiving oral contraceptive medication. Review of the literature revealed this to be a rarely reported association. Discussion of the pathophysiology, diagnosis, and treatment of this entity is presented. A brief review of the literature is included.


Onset of tuberculosis after intestinal bypass surgery for obesity. Guidelines for evaluation, drug prophylaxis, and treatment.

The association of tuberculosis after gastrectomy is well documented. Two case reports of tuberculosis developing after jejunoileal bypass for massive obesity are presented, with a review of five previously reported cases. Four of the seven reported patients had tuberculosis infection at extrapulmonary sites. Initial symptoms included fever and acceleration of weight loss. The mean time elapsed from the time of the operation to the diagnosis of tuberculosis was 16 months. Guidelines are given for monitoring patients undergoing jejunoileal bypass with tuberculin skin tests. Indications for isoniazid prophylaxis and multiple drug chemotherapy are given. Serum concentrations of oral antituberculosis drugs must be monitored to ensure adequate absorption.


Disarticulation of the knee. A modified technique.

Knee disarticulation provides an excellent level of amputation in the lower extremity, particularly of the younger, active male amputee. Many surgeons, particularly in England, still prefer knee disarticulation when major amputation is required for peripheral vascular disease. Its use has been restricted over the years, largely because of certain prosthetic problems associated with fitting the standard prosthesis. Modification in surgical techniques to allow the incorporation of modern prosthetic design and materials will enlarge the range of usefulness of through-knee amputation. This is particularly true as it relates to the knee control mechanism of the prosthesis. The surgical modifications presented in this report allow modern prosthetic application to the amputation, with maximum functional benefit and retention of the basic functional advantages of amputation at this level.


Rubber band ligation of hemorrhoids.

While rubber band ligation has found increasing acceptance as a method of dealing with internal hemorrhoids, there is a paucity of literature on the subject. This report gives a detailed, step-by-step approach to this technique.


Diamond-shaped anastomosis for congenital duodenal obstruction.

A retrocolic side-to-side duodenojejunostomy has been a generally accepted standard operative procedure for the correction of congenital duodenal atresia and stenosis. However, this operation has the complication of delayed anastomotic function that often requires a use of transanastomotic feeding tube or intravenous hyperalimentation. A diamond-shaped side-to-side duodenoduodenal anastomosis has been performed in nine consecutive cases of congenital duodenal obstruction, with satisfactory results. A transverse incision is made in the dilated proximal duodenum, and a longitudinal incision in the duodenum distal to the obstruction. The stoma is fashioned by approximating the end of each incision to the appropriate midportion of the other incision. Transanastomotic feeding tubes were not used and oral feedings were easily tolerated. This technique offers the theoretical advantage of providing a more physiological gastrointestinal pathway.


Falciform ligament. A possible twist?

Abdominal pain radiating to the right upper quadrant, producing peritoneal signs, developed in a 30-year-old pregnant woman. At  surgery, she was found to have an infarction of the falciform ligament that was excised.


Recurrent aortoduodenal fistula.

We describe the second successful repair of a recurrent aortoduodenal fistula (ADF) occurring two years following insertion of the original prosthetic and 18 months following the repair of the first ADF. The recurrent ADF developed at the site of the previous repair, fistulizing between the sutured aorta and the duodenum closed by staples. Despite the admitted technical challenges of reoperation for a third or fourth time, as in the current case, these patients can be salvaged.


Experimental infection of adult axenic rats with Parker's rat coronavirus.

The pathogenesis of Parker's Rat Coronavirus (PRCV) was studied in axenic CD rats. Three to four 9 to 10 week old rats were euthanized daily for eight days after intranasal inoculation. Rats remained free of clinical disease. Virus was recovered from the nasopharynx and trachea after twenty-four hours and from the lung by day three but was not detected in respiratory tract after seven days. Viral antigen was detected by indirect immunofluorescence in the mucosal epithelium of upper respiratory tract and in pulmonary alveolar septae from day two to six postinoculation. Acute rhinitis developed by day two and was associated with mild focal necrosis of respiratory mucosal epithelium. Mild nonsuppurative tracheitis and multifocal interstitial pneumonia appeared by day five and persisted through day eight. Dacryoadenitis did not occur, sialoadenitis was detected in only three rats and virus was recovered from only one submaxillary salivary gland. This experiment indicates that PRCV can be a primary pathogen for the respiratory system of adult rats. In contrast to sialodacryoadenitis (SDA) virus the tropism of PRCV for salivary and lacrimal glands is low.


Cytoplasmic and nuclear inclusions in epidermal cells of pigs inoculated with vaccinia viruses.

The morphology of cytoplasmic and nuclear inclusions in the epidermal cells of pigs inoculated with vaccinia viruses was studied. Cytoplasmic inclusions observed were those corresponding to type B described by KAMAHORA et al. (11). They were subdivided into three morphologic types and were tentatively designated type B-1, B-2 and B-3, respectively. Type B-1 was eosinophilic, granular in structure, relatively large in size, and round or ovoid in shape. Type B-2 was poorly stained with hematoxylin and eosin, granular in structure, small in size, and was a relatively elongated mass along the nuclear membrane. Type B-3 was basophilic, and was a uniformly stained small body. Electron microscopically, various aberrant findings were seen in most of the cytoplasmic inclusions and they differed depending on their types. Nuclear inclusions could also be classified microscopically into three morphologic types. Type 1 was eosinophilic or neutrophilic and had a homogeneous structure. Type 2 was eosinophilic and fibrillar in structure. Type 3 appeared as small eosinophilic bodies. Electron microscopically type 1 was found to be composed of fine fibro-granular structures, type 2 was found to be composed of relatively long filaments which resembled tonofilaments, and type 3 consisted of unique fibrillar structures.


[Development of intramural ganglia of the gastrointestinal tract in embryo rabbits under conditions of thyroidin loading of the mother's body].

Ganglia of myenteric plexus in 13-, 15.5-, 16.5-, 19.5-, 25-, 27- and 29-day-old rabbit embryos, as well as in newborn rabbits delivered under experimentally induced thyrotoxicosis in the maternal organism during gestation were studied and compared with those of control animals at the same age. Different methods of silver impregnation, hematoxylin--eosin staining and Nissl's method were used. Total amount of nervous cells and differentiated neurons were counted; numerical data were statistically treated. At early stages of embryogenesis, there were no differences in migration processes, in laying and differentiation of nervous elements in the intramural ganglia of the intestinal tubes of the test and control embryos, that is in accordance with literature data on the placental barrier nonpermeability for the thyroid hormones at that time. Thyroidin stimulates the intramural ganglia development, growth of their neurons, stipulated by cytoplasmic protein synthesis. The experimental results were seen in increasing amount of highly differentiated multipolar neurons in the embryos before birth and in the newborn animals in comparison with the control. In lower vertebrates, thyroxine was stated by Coujard (1950) to influence the earliest stages of the intramural ganglia laying as a result of stimulation effect on the migrational movements of neuroblasts.


[Use of disulfiram in a histochemical study of the influence of different stimuli on the concentration of noradrenaline in brain structures].

With the help of the histochemical fluorescence method the changes in noradrenaline fluorescence of nuc. septi lateralis, nuc. interstitialis striae terminalis and nuc. preoticus medialis during conditioning and unconditioned stimulation were studied. In 135 disulfiram pretreated rats the depletion of noradrenaline fluorescence in the investigated structures was found after electro-stimulation of feet during 5 min., 1 and 2 hours, open-field behavior and reproduction of a conditioned avoidance response. Twelve hours after disulphiram administration the suppression of the open-field behavior and reproduction of the conditioned avoidance response as well as the depletion of noradrenaline fluorescence in the investigated structures were detected.


[Structural characteristics of the mediodorsal nucleus of the cat thalamus].

By means of the light and electron microscopy, construction and architectonics of neurons in the cat thalamus medio-dorsal nucleus are described. Differences in the neuronal body dimentions, their form, number of deferent dendrites and character of axonal branching made it possible to define 3 types of neurons. Applying the method based on retrograde axonal transport of exogenous horse-radish peroxidase, it was demonstrated that neurons of type II, contrary to the existing opinion, send their axons into the prefrontal cortex and, hence, are associative-projective. Ultrastructural difference of axonal terminals, differences in the form and size of synaptic vesicles made it possible to reveal 5 types of presynapses.


[Characteristics of the structure and functional potentials of the metaepiphysis of tubular bones].

During early postnatal ontogenesis in the metaepiphyseal plate of the developing rat tibial bone, the borderline zone, the columnar cartilage zone and the zone of macrovesiculous cells differ in their cell composition, structure of basic substance and in functional and reactive potencies, which manifest themselves most distinctly after injection of growth-promoting hormones to the animals. The organic specificity of the metaepiphyseal borderline zone depends, first of all, on its intermediate position between the cartilage, fulfilling further bone growth lengthwise as an organ, and a developing endochondral bone substituting cartilage in the epiphysis. The borderline zone retains these features under hormonal effect. In the zone of columnar cells, it is reasonable to distinguish a layer of cuboidal cells--mature chondrocytes posessing great reactive and reparative possibilities, which become especially distincitive after prednisolon and TCT injection.


[Morphofunctional characteristics of the thyroid gland under conditions of decreased adrenergic mediation].

Histophysiology of follicular thyreocytes of the thyroid gland of mice (line Bal) was studied under depressed function of the sympathetic nerve system (antibodies were introduced to the growth factor of the nerves). The data of electron microscopic analysis, quantitative cytochemical investigation and biochemical estimation of iodine binding with blood plasma proteins, demonstrated changes during secretory process in the follicular thyreocytes and in functional intensity of the whole gland. Stimulating effect of the sympathetic nervous system on the releasing process of the thyroid hormones is suggested.


[Histostructure of the venous bed of the hemorrhoidal zone of the human rectum].

In 90 preparations of the human rectum, venous vessels were studied. In all age groups, newborns and children including, trabecular veins with cone-shaped protrusions, intimal "cushons" and microvalves were revealed. In the columnar zone, on the lateral walls of the anal canal, they form cavernous bodies in arterio-venous anastomoses. In elderly and old-aged persons, as a result of myoelastofibrosis, thinning of the cavernous vein walls and partial hollowing of their lacunae take place.


[Routes of blood flow away from human spinal ganglia].

Blood outflow from the spinal ganglia is accomplished along the deferent veins of the lateral part of the ganglia into the intravertebral veins (for most of cervical ganglia--into the veins surrounding the spinal cord artery), from the medial part of the ganglia--along the deferent veins into the longitudinal veins of the interal spinal plexus. Analysing total cross section area of the deferent veins of the spinal ganglia, we were able to reveal a gradual increases in cross section area from the cervical towards the lumbar veins, and a decrease towards the sacral veins. A ratio of total cross section area of the deferent veins to the volume unit of the ganglia substance characterizes capacitance density of the deferent venous bed of the spinal ganglia and is 0.01--0.014 mm2 per 1 mm3.


[Hepatic microcirculatory bed of dogs under normal conditions and after radical resection of the liver].

In 43 dogs two left and two right hepatic lobes were resected simultaneously. Microcirculatory bed was studied by vessel injection and morphometrically. The lobe area and the diameter of the central veins were stated to have a different morphometric index, that demonstrates the presence, in the dog liver, of certain lobar complexes arranged like druses in a rock crystal. Under extensive liver resection, in 15--20 days, a regenerative lobular hypertrophy with a further new formation of the hepatic lobes on the upper part of the liver complex was noted. The ways of extrasinusal blood outflow were examined.


[Method of stereometric study of the intramural arterial bed of the walls of the human heart ventricles].

Principles and technique for selecting material from the human heart ventricular walls to study stereometrically their intramural arterial bed are described. The left ventricular wall was investigated as an example. Stereometric investigation of the intramural arterial bed of the myocardium is carried out under an ocular grid by the method of dots counting on histological sections, obtained from pieces of three-plane orientation (horizontal, vertical and frontal). To obtain the most informative data on average volume density of the intramural arterial bed along the whole left ventricular wall, it is enough to confine our examination to its six areas (superior, medial, inferior thirds of the anteior and posterior-lateral parts of the left ventricular wall). From each area, at least, one piece with horizontal and vertical and two pieces with frontal orientation should be taken. In order to obtain reliable data on volume density of the intramural bed in a certain myocardial part (a zone of infarction, cardiosclerosis, etc.), it is necessary to take more pieces excised, no less than two both with horizontal and vertical orientation and four with frontal orientation.


[Device for determining the elastic properties of the internal organs and vessels].

Apparatuses to study elastic properties of organs and vessels in small laboratory animals, human fetuses and infants were suggested in the work. Their advantage in comparison with the existing ones is a combination of a highly sensitive intensity measuring device with quickly detachable clamps of a peculiar construction, which make it possible to examine small samples (less than 1 cm) of low solidity (no more than 300 g) and of large stratching capacity. One apparatus has a hand-operated drive, the other--an electric motor and a device for graphic registration of loading and stratching capacity. The intensity-measuring device in both apparatuses has a mobile disk attached to a motionless axis by a spiral spring; the clamps have fixing screws in the butts of a spong. Some data obtained with the apparatuses are presented.


[Method of silver impregnation of adrenal noradrenocytes].

Cell containing catecholamine noradrenaline were reveled in the adrenals of albino rats and mice after fixation in the formalin-calcium mixture by the method of impregnation in the solution of silver ammonium. The specificity of the method was checked up by blocking the noradrenaline synthesis by reserpine as well as by a comparison of results of the method of impregnation of noradrenocytes with the fluorescent Erönkö's method in serial sections of those organs. The proposed method may be used for the estimation of the functional state of adrenals.


[Morphology of immune destruction of the erythrocytes in fetuses and newborn infants].

In the second half of pregnancy destruction of erythrocytes as a result of immunological aggresion in the fetus may occur in different manners: hemolysis in the vessel bed, fragmentation of erythrocytes, phagocytosis of intact erythrocytes and their fragments. Intravascular hemolysis occurs in immature fetuses. At that, the products of erythrocyte decomposition (hemosiderin and lipofuscin) are accumulated in the epithelial cells of the liver and the kidneys, the pancreas, the thyroid and the thymus. Fragmentation of erythrocytes (anuclear forms alone) occurs in the red splenic pulp and less in the vessels of the other organs. This process has been observed in fetuses after 7 months of gestation. Phagocytosis of erythrocytes and their fragments is done mainly by macrophages of the red splenic pulp as well as macrophages of the bone marrow, lymph nodes, and the Kupffer cells of the liver. Massive and long-term effect of iso (rhesus) antibody results in inhibition of the phagocytary activity of macrophages. In such cases, destruction of erythrocytes occurs in the vessel bed by lysis.


[Spontaneous regression of malignant melanoma].

Malignant melanomas are known to be prone to undergo spontaneous regression (spontaneous resorption). The morphological picture of this process similar to that in spontaneous regressions of nevuses (halo-nevus), pigmentous spots (Dubreille melanosis) and superficially spreading melanoma is described. Six observations of spontaneously regressing melanomas are presented. Resorption of pigmented malignant tumors is similar to radiation resorption of malignant melanomas. It is noted that spontaneous resorption of malignant melanomas does not improve their prognosis.


[Ultrastructure of malignant fibrosarcoma].

Electron microscopic examinations of two malignant fibroxanthomas revealed some ultrastructural features characteristic of this tumor. The tumor elements were represented by histiocyte-like, fibroblast-like and little differentiated cells. In some of the latter the signs of macrophage differentiation could be seen and therefore a possibility of their transformation into histiocytes is assumed.


[Ultrastructural changes in the liver in experimental diffuse peritonitis].

Ultrastructural changes in the liver were studied on the 1st, 2nd, 4th and 8th days of the disease in random-bred dogs with induced diffuse microbial peritonitis. As early as on the 1st day of the disease considerable changes of hepatocytes, hepatic stroma, microcirculatory and bile tracts were detected. Dystrophic and necrobiotic changes in hepatic cells were most marked at 4-8 days of the disease. By the end of the 2nd day the edema of the hepatic stroma subsided, but subsequently it increased markedly. In microcirculatory tracts of the liver and greatest changes were found at 4-8 days in lymphatic capillaries, up to their complete blocking.


[Niemann-Pick disease (Crocker type B)].

A severe visceral form of Niemann-Pick disease from the first days of life was manifested in the progressive retardation of psychomotor development and hepatosplenomegaly. The disease was complicated by anemia and cachexia which led to a fatal outcome in a girl of 7 months.


[Case of Goodpasture's syndrome].

A case of Goodpasture's syndrome in a patient of 26 is described. The disease mainly involved the lungs and the kidneys. The development of the pneumo-renal syndrome in the patient was favoured by the occurrence of chronic focal diseases (rhinitis, otitis, sinusitis) which created opportunities for long-term microbial sensitization of the organs.


[Lipoma in the region of corpus callosum and vascular plexus of the brain].

An observation of lipoma of the region of corpus callosum and plexus vasculosus in combination with underdevelopment of corpus callosum in a 58-year-old man (an accidental anatomic discovery; death was due to mechanical asphyxia) is described.


[Morphogenesis of atypical myocardial infarct].

Morphology of atypical myocardial infarctions and their morphogenesis were studied in 120 cases. The importance of atherosclerosis as the background process, the secondary development of coronary thrombosis and the leading role of metabolic factors (hypoxy, acidosis, etc) in the origin of atypical myocardial infarctions were established.


[Ultrastructure of heart vessels in rheumatism].

Blood and lymphatic vessels in patients with rheumatic heart lesions in active and inactive phases of rheumatism were studied electron-microscopically and electron-histochemically. In the active phase of the disease there were revealed dystrophic changes in endothelial and smooth-muscle cells, fragmentation of the inner elastic membrane, the splitting of collagenic fibrils of media and adventita. In the invactive phase dystrophic changes in cells were not observed in media and adventitia, an increase in the amount of collagenic structures was noted, and in hyalinized walls of arteries there were considerable aggregations of material identical to the substance of the basal membranes of the endothelium and smooth-muscle cells. These changes were combined with evidences of elevated permeability (extravasates) and vulnability to injuries (micro-hemorrhages) in the micro-blood vessels of the myocardium.


[Morphological indicators of the peripheral blood leukocytes at different periods of development of myocardial infarct (experimental study)].

The morpho-functional features of peripheral blood leukocytes were studied in 50 rabbits with experimental myocardial infarction at various intervals after ligation of the anterior interventricle artery. Changes in the leukocytes were compared with the morphological picture of myocardial infarction. In the acute period of experimental myocardial infarction not only quantitative changes were found to occur but also functional values of leukocytes changes: the content of glycogen and the activities of peroxidase and phagocytic activity of granulocytes were reduced, while the activity of alkaline phosphatase increased. Electron microscopic examinations of lymphocytes revealed ultrastructural changes in mitochondria. In the subacute period of the disease some of the values showed a trend for normalization. In the period of recuperation when the zone of infarction in rabbits is replaced by crude fiber connective tissue all the values under study in the peripheral blood became normal. The exceptions were the animals with extensive as well as complicated myocardial infarctions.


[Pathological anatomy and pathogenesis of influenza].

The analysis of most important publications and the authors' own data on the pathological anatomy and pathogenesis of influenza are presented. Severe complicated forms of influenza are characterized by the development of acute bacterial tracheobronchites which are the source of staphylococcal aspirations into the lungs. The degree of severity of developing pneumonias is determined to a large extent by destructive changes in the lungs. The destruction of osmiophilic bodies in the alveolar epithelium and the disturbance of the surfactant system is conducive to pulmonary edema. An important role in the involvement of the lungs and other organs is played by viralstaphylococcal toxicity. Lymphoid-macrophage and leukocyte reactions responsible for the production of antibody, interferon, and other factors of resistance are very important for protection against influenza. During epidemics, particular attention should be paid to combinations of influenza with cardio-vascular diseases.


[Angiographic and anatomical study of the coronary vessels in ischemic heart disease].

Collations were made of the results of angioroentgenological and standard anatomic studies of the coronary vessels in 40 elderly and old persons who had died of ischemic heart disease. The post mortem coronarography showed that the indices of the incidence of stenoses and occlusions of the major coronary arteries were more elevated.


[Pathological anatomy of splenic lymphogranulomatosis (according to the materials of diagnostic laparotomy)].

The study of 48 cases of spleen lymphogranulomatosis showed lymphogranulomatous growths to be localized only in the periphery of lymphoid follicles. In the early stages of the disease (before the appearance of Berezovsky-Sternberg cells) of the spleen the occurrence of Hodgkin cells is specific when the diagnosis is confirmed histologically before the operation by examinations of the lymph node bioptate. Lymphogranulomatous growths in the spleen appear against the background of hyperplasia of lymphoid follicles which is most likely to be of reactive nature. Lymphogranulomatous growths in the spleen may correspond to any of 4 morphological variants of the disease (according to the classification of Lukes et al., 1966) which are its successive stages: lymphohistiocytic variant--mixed cell--lymphoid exhaustion. Similar changes of the cell composition in the granulomatous tissue occur in cases of lymphogranulomatosis with nodular sclerosis.


[Immunomorphological study of melatonin synthesis in the enterochromaffin cells].

A specific immunomorphological method was used to localize melatonin. It is emphasized that the detection of melatonin production in enterochromaffin cells extends considerably the concepts on the role and importance of these cells in the vital activity of the body and formation of pathological reactions.


[Ultrastructural changes in the rabbit aorta in early stages of experimental atherosclerosis].

First morphological (ultrastructural) signs of atherosclerotic changes in arteries have been shown to appear in the second week of keeping of rabbits on an atherogenic diet. They are manifested in the changes of "glycocalix" on the endothelium, disorders in the vessel wall permeability, distention and mucoid swelling of the subendothelial space, vacuolation of endothelial and smooth-muscle cells, and fragmentation of elastic fibers. The foamy cells appearing by 4 weeks of the experiment from the smooth-muscle cells migrating into the intima through fenestrations of the inner elastic membrane. As lipids accumulate, myointimal foamy cells undergo some ultrastructural changes such as swelling and loss of mitochondria, distention and vacuolation of the endoplasmic reticulum. Dystrophic changes are found not only in the intima of forming plaques but also in smooth-muscle cells of the adjacent parts of tunica media.


[Formation of microliths in the kidneys of rats on a diet with high RNA content].

When 25% RNA to the protein mass was introduced in the ration given to rats, deposition of urates occurred in the kidneys of the animals in the form of microlites of different sizes. These microlites were found in lumina of distal parts of the convoluted tubules and collective tubules at 21 days of the experiment. In addition to RNA, microlites included RNA, neutral and acid mucopolysaccharides, as well as calcium salts. The epithelium of the tubules at sites of microlite localization underwent necrobiotic changes, sometimes it was desquamated, and the walls of the tubules were represented only by a markedly thickened basal membrane. As a rule, no interstitial tissue reaction was observed at sites of microlites localization.


[Cancer developing in the adenoma of the parathyroid gland].

A description of a very rare malignant tumor, cancer of the parathyroid gland which developed in adenoma of this gland is presented. The histological study of the tumor revealed an adenoma of the trabecular structure consisting mostly of dark oxyphilic cells. In its turn, an area of trabecular cancer was found in the adenoma. Complexes of cancer cells infiltrated the adenomal tissue in some sites, but never grew through its capsule. The tumor was hormonally active like most cancers of the parathyroid gland. A particular feature of this case is the development of cancer in adenoma of the parathyroid gland which did not grow beyond the adenoma and produced no metastases.


[Chondrosarcoma of the base of the tongue].

A case of chondrosarcoma of the root of the tongue diagnosed as cylindroma in a woman of 51 is described. The tumor was 4 cm in diameter. It is noted that such neoplasia occurs rarely, the localization of the tumor is unusual and metastases into the lungs developed rapidly.


Conduction in myelinated, unmyelinated, and demyelinated fibers.

Conduction in demyelinated axons is characterized by decreased conduction velocity, temporal dispersion of impulses, and conduction failure. It is not possible to infer the electrical properties of the bared internodal axon membrane in demyelinated fibers from observations of decreased conduction velocity or conduction failure. Cytochemical evidence indicates that there are, in fact, distinct structural differences between nodal and internodal regions of the normal axon membrane. This conclusion is confirmed by freeze-fracture and pharmacological studies. A number of approaches to the development of effective symptomatic therapy in the demyelinating diseases are suggested by recent experimental findings: determination of the membrane properties necessary for conduction across focally demyelinated regions and the identification of agents that would encourage the development of these properties; alterations in the external milieu of demyelinated fibers; and the development of agents that might promote remyelination.


Isotope localization of infarcts in aphasia.

Radionucleide localization of infarcts producing aphasia was undertaken in 65 patients with a scan-test and onset-test interval of one months or less. The scans were traced on anatomical templates without knowledge of the aphasias. A phasics were classified by their test scores according to taxonomic criteria, independently from localization. Scans belonging to each clinically distinct group were overlapped "blindly". The results showed distinct areas for Broca's conduction and Wernicke's aphasics along the parasylvian axis of the lateral templates. Lesions of global aphasics covered all these areas, while transcorticals were outside of them. Lesion size and severity of aphasia showed significant correlation. It is concluded that a brief systematic survey of aphasia like ours is useful in predicting the anteroposterior location and often the depth and extent of lesions.


Cranial computerized tomography. A radiologic-pathologic correlation.

One hundred twenty-three patients having cranial computerized tomography (CT) within two months of death were reviewed to determine the accuracy of CT. Those patients having scans within two weeks of death on the 160-matrix EMI head scanner had a false-negative rate of 11%. Approximately one third of all lesions 1 cm or more were not demonstrated. Computerized tomography appears to be the most sensitive neuroradiologic diagnostic tool, but certainly is not infallible.


Herpes simplex encephalitis treated with vidarabine (adenine arabinoside).

Vidarabine, an antiviral chemotherapeutic agent shown to have in vitro activity against the herpes group of viruses, was administered to five patients with brain biopsy-proved herpes simplex virus encephalitis. The mortality in this small number of patients (one of five or 20%) was less than that in most published reports of patients receiving other treatment modalities or no treatment other than supportive measures. No apparent toxicity was found that was attributable to vidarabine. Neuropsychological impairment of varying degree was noted in four surviving patients tested at two months after treatment and again 12 to 21 months later. Progressive improvement had occurred in three.


Adult-onset hereditary ataxia in Scotland.

A systematic search for cases of adult-onset hereditary ataxia was conducted on location in Scotland. The investigation resulted in the discovery of eight pedigrees with 42 patients of whom 16 were alive in 1975. Nine patients were examined by the authors and recent hospital records were available on the remaining seven. The clinical features were quite variable. In declining order of frequency, findings were gait and limb ataxia, dysarthria, hyperreflexia, extrapyramidal motor disturbances, impaired vibratory sense, spasticity, defects of extraocular movements and nystagmus, reflex depression, Babinski signs, impaired joint position sense, muscle weakness, optic atrophy, and mental abnormalities. Foot deformity occurred only once. Inheritance was compatible with autosomal dominant transmission, but complicated by consanguinity in two families. The minimum prevalence was calculated as 0.31/100,000. Autopsy in two members in one family revealed olivopontocerebellar degeneration.


Gustatory phenomena after upper dorsal sympathectomy.

In a series of 100 bilateral upper dorsal sympathectomies performed for palmar hyperhidrosis, gustatory sweating and other gustatory phenomena were reported by 68 of 93 patients (73%), followed up for an average of 1 1/2 years. These gustatory phenomena were quite different from physiologic gustatory sweating: a wide range of gustatory stimuli caused a variety of phenomena in varied locations. There was a negative correlation between the incidence of these phenomena and the occurrence of Horner's syndrome after sympathectomy. Analysis of our observations, and of clinical and experimental work of others, leads to the conclusion that gustatory phenomena after upper dorsal sympathectomy are the result of preganglionic sympathetic regeneration or collateral sprouting with aberrant synapses in the superior cervical ganglion.


Giant cell arteritis with normal sedimentation rate.

We report two elderly patients with normal erythrocyte sedimentation rate (ESR) and biopsy-confirmed giant cell arteritis. Because of the potentially disastrous consequences of undiagnosed giant cell arteritis, early treatment based on clinical diagnostic criteria is urged despite a normal ESR.


Brain dopamine turnover and the relief of parkinsonism.

The relationship between dopamine receptor activation and the relief of parkinsonian clinical features was studied in 40 patients with Parkinson's disease. Treatment with dopamine receptor agonists, piribedil or bromocriptine, decreased significantly both the basal level and probenecid-induced accumulations of homovanillic acid (HVA) in the CSF. But there were no changes in the concentrations of 5-hydroxyindole acetic acid (5-HIAA). Correlation analyses showed that patients who improved with both the dopamine agonists used had significantly lower probenecid response of HVA in the CSF and a less severe disease condition than those without beneficial effect. This relationship between dopamine receptor activation and improvement of parkinsonian disability suggests that the therapeutic efficacy of dopamine receptor agonists depends on the functional capacity of brain dopaminergic mechanisms.


Brain stem toxoplasmosis complicating Hodgkin's disease.

We describe a unique case of CNS toxoplasmosis in a patient with stage IV B Hodgkin's disease. The initial neurological manifestation was Weber's syndrome. The only laboratory abnormality was moderate elevation of CSF protein level. Postmortem examination showed parenchymal toxoplasma infiltration throughout the intramedullary course of the right oculomotor nerve in the midbrain, without meningeal involvement.


CNS lesions in cystinuria.

A man with cystinuria developed, at the age of 23, a neurological disorder with relapses and remissions similar to multiple sclerosis. This is the third documented case of cystinuria with central neuraxis lesions, and it is suggested that neurological complications may occur in cystinuria more frequently than is generally recognized.


Reversible corticospinal tract disease due to hyperthyroidism.

Corticospinal tract malfunction was seen in a patient with Graves' disease. The absence of intracranial and intraspinal lesions likely to cause the neurologic manifestations and their regression after control of thyroid dysfunction favors a cause-effect relationship. We review and compare similar cases previously reported and discuss the mechanisms.


[Overgrowth (of the femoral shaft) and rotational deformities following femoral shaft fractures in childhood (author's transl)].

A follow-up study of 149 pediatric fractures of the femoral shaft (146 patients had a radiographic control) demonstrated a significant influence of multiple reductions and residual axial deviations on the incidence and extent of post-traumatic overgrowth. The presented group of patients did not show a positive correlation between therapeutic shortening at the time of the initial reduction and reduced incidence of long term overgrowth. Neither extent nor incidence of overgrowth could be prevented by this method. We therefore recommend to reduce fractures of the femoral shaft without forshortening, because it stimulates repair mechanisms at the growth plate and enhances overgrowth. In contradiction to the current concept of therapeutic recommendations it could be shown that post-traumatic rotational deformities will correct themselves in the course of physiologic detorsion of the femoral neck. In 67% of the studied group of patients initial errors of rotation corrected themselves by this mechanism. According to our results the therapeutic concept of pediatric femoral shaft fractures is revised and a new concept of initial and long term treatment is proposed.


[Experiences with arthroplasty for tumors and metastases of the proximal femur and humerus (author's transl)].

This report describes the results of 17 arthroplasties of the hip joint for tumors or metastases in the proximal part of the femur and 3 arthroplasties of the shoulder joint because of tumors in the proximal humerus. Based on case reports the paper discusses the indication in the case of malignant, potentially malignant and benign primary bone tumors and in the case of metastases. In addition principles for the construction of suitable hip and shoulder prostheses are cited, whereby the partial joint replacement continues to retain its justification beside total replacement. While the results of the hip arthroplasty proved satisfactory, the results of the corresponding operation on the shoulder are less satisfactory and urge to exercise more restraint in the operative indication.


A new method of achieving accuracy in osteotomy of any long bone.

The use of basic trigonometrical principles enables the translation of theoretical pre-operative estimations for the correction of bony deformities in long bones into accurate wedge resections at surgery without the need for templates or the use of goniometer in a restricted operative field. The method described has been shown both to be accurate and simple, obviating the need for extra instrumentation and undue manipulation during surgery.


[Mechanical properties of carbon as implant material in orthopedic surgery (author's transl)].

Among others material problems are come to the fore in endoprothetic with growing biochemical knowledge, also because of the realisation that in different parts of the same prothesis functionally different mechanical demands must be set. Technological progress in carbon production has lead to the development of a spectrum of different carbon specialities with various mechanical properties. In orthopaedic surgery of endoprothetic high strengh isotropic carbon, impregnated carbon and fibrereinforced carbon-carbon-composites are of particular interest, because of their physical properties and unchanged favourable chemical and biological properties of carbon. Thereby it is on one side a question of carbon material with extraordinary tribological qualities, on the other side of carbons with nearly isoelastic behaviour towards the bone, respectively with equal quotient of breaking strength and young's modulus. Therefore in future the manufacture of components with functional approbiate material using the same basic material carbon seems to be possible for the production of endoprothesis with different working parts.


[Contribution to the osteolysis in distal end of the clavicle (author's transl)].

A case of rare osteolysis of the distal clavicle end is reported. Our 36-years old male patients also suffered from a well-discernible Hyperlipoproteinemia, type II/a after Fredrickson. A short view of the various forms of clavicle osteolysis is given. Their differentialdiagnostical and ethiological relations are discussed.


[Tissue compatibility of bone cement with and without barium sulfate (author's transl)].

Cylindrical plugs of polymerized Simplex-P bone cement with and without barium sulfate were implanted in the rabbit tibial metaphysis. Titanium was used as control material. The animals were observed for 4--4.5 months. Histological analysis showed that all titanium implants were healed into the bone with a direct bone-implant contact, which was also true for about 60% of the cement implants. The remaining cement implants were encapsulated by connective tissue, probably due to biomechanical factors. It was not possible in this study to show a difference in the tissue reaction to bone cement containing barium sulfate and bone cement free from barium sulfate.


[Has the duration of cast fixation after shoulder dislocations an influence on the frequency of recurrent dislocation? (author's transl)].

102 primary shoulder dislocations have been evaluated. Some were retained in a Velpeau bandage reinforced with plaster immediately after reposition for three weeks, others were treated with a sling or tube gauze only. The frequency of recurrent dislocation in both groups was compared. It could be demonstrated that the results were equal for both groups. We conclude that fixation with Velpeau Sling and cast reinforcement does not significantly influence the occurrence of recurrent dislocations.