Thromboxane A2: effects on airway and vascular smooth muscle.

Thromboxane A2, an unstable compound derived from prostaglandin G2, was generated by incubation of arachidonic acid with a suspension of human platelets. The activity of thromboxane A2 relative to that of prostaglandin H2 in causing contractions of a number of smooth muscle organs were as follows: rabbit aorta, 7-20; human umbilical artery, 9-60; and guinea pig trachea, 2-12. Intravenous injection of thromboxane A2 into anaesthetized quinea pigs was followed by a pronounced increase in the tracheal insufflation pressure, potency compared to prostaglandin H2, 31-45.


The effects of prostaglandins on the beating activity of cultured heart cells.

The effects on the beating behavior of cultured rat heart cells of fourteen prostaglandins of the A, B, D, E, and F series were investigated, together with adrenaline and ouabain, at dose levels of 10-7 and 10-5M. Single heart cell beating activity was monitored photo-electrically and five parameters of beating behavior measured. Only PGF2alpha markedly increased rate while PGF2beta reduced it. Maintenance of a stable rate (rate range) was minimally affected by prostaglandins with PGF2beta possibly reducing, and PGF1alpha and 2-decarboxy E1 possibly increasing, rate range. PGF1alpha and F2alpha both statistically reduced the percentage of cells beating while the other prostaglandins had no effect. Most of the prostaglandins either produced no change, or reduced, indices of contractile force (optical density changes with contractions and its first derivative (dOD/dt)). Only the negative chronotropic agent PGF2beta produced a positive density effect. In conclusion, except for PGF2alpha, prostaglandins generally have limited actions on the beating activity of cultured heart cells.


Prostaglandins E1 and E2 stimulate release of intestinal brush border enzymes.

Rat small bowel was perfused in vivo and ex vivo in the absence of biliary and pancreatic secretion. Intraluminal release of sucrase, alkaline phosphatase, aminopeptidase and enterokinase was significantly increased after administration of PG E1 and E2 1 and 5 microgram/kg. This suggests a direct stimulation of the intestinal mucosa, which might be mediated through cyclic AMP; dibutyryl cAMP significantly stimulates intraluminal release of proteins, sucrase and enterokinase.


Intracellular recording of cerebral cortical actions of prostaglandins F2alpha (PGF2alpha).

Our reported data on the cortical inhibitory actions of prostaglandin F2alpha (PGF2alpha) and the diversity of data in the literature on cerebral PG actions are examined here in the light of intracellular recording which provides the requisite membrane data for the first time. Thus, 1) intracellular recording from the cat cerebral cortex is obtained for the actions of PGF2alpha and for norepinephrine (NE) and serotonin (5HT). 2) The parallel changes in firing and polarization and the simultaneous transmembrane conductance changes are qualitatively identical for PGF2alpha, NE and 5HT. 3) The reduction in firing accompanied by hyperpolarization indicates that PGF2alpha, NE and 5HT all inhibit these cells. 4) The ionic species responsible for this inhibition is such that it increased the transmembrane resistance, and this was true for all three. 5) The changes in membrane parameters, identical in direction for PGF2alpha and NE, but stronger for the latter, constitute conditions that can lead to competitive inhibition and therefore connote, presumably, actions at the same or related receptors. Such competition with evoked cortical field potentials is shown in the preceding paper.


Effects of prostaglandin F2alpha on cerebral cortical evoked potentials.

The cerebral cortical action of prostaglandin F2alpha (PGF2alpha) has been determined by recording the effects of intracarotid injections of PGF2alpha on cerebral evoked potentials. PGF2alpha differentially reduced cortical evoked potentials. The cortical action of PGF2alpha appeared to be qualitatively identical with that of norepinephrine (NE) but weaker. A protection of the cortex from the inhibitory action of NE by a preceding dose of PGF2alpha was demonstrated. The actions of both PGF2alpha and NE appear to be on the same or related postsynaptic receptors. The actions described were at doses that did not reduced oxygen availability. PGF2alpha may act as a modulator of adrenergic transmission in the cortex. The intracellular recording in the companion paper supplies the further critical evidence that PGF2alpha has a synaptic inhibitory action.


Effect of furosemide on urinary excretion of prostaglandin E in normal volunteers and patients with essential hypertension.

Urinary excretion of prostaglandin E was measured radioimmunologically in 19 healthy persons (15 men and 4 women) and in 16 patients (10 men and 6 women) with essential hypertension before and after the administration of furosemide. The excretion rates were increased from 26.2 +/- 3.0 to 64.5 +/- 11.3 ng/hr in the former and from 11.9 +/- 2.7 to 26.9 +/- 8.5 ng/hr in the latter. There was a significant difference between them, healthy subjects showing a greater increase than patients with essential hypertension. There was an obvious sexual difference in urinary excretion of prostaglandin. In men, greater increase in the excretion rates was found than in the women. Greater increases were also obtained in healthy men than in hypertensive men and in healthy women than in hypertensive women. The present results suggest that furosemide enhances urinary excretion of prostaglandin E by mechanisms which entails either an increase in prostaglandin synthesis or a decrease in renal metabolism.


Reduced uterine response to PGF2alpha under oral contraceptives.

The effect of prostaglandin F2alpha (PGF2alpha) on the nonpregnant human uterus was evaluated in 35 patients. The compound was administered both by intra-uterine and intravenous routes. Two groups of volunteers were studied;fifteen cases who were under oral contraceptives and twenty women with normal ovulatory cycles. The uterus under the influence of oral contraceptives showed a reduced response to local and systemic administration of PGF2alpha at all phases of the menstrual cycle. The implications of these findings in certain physiological and pathological conditions related to reproduction are discussed.


A study of prostaglandin F2alpha as the luteolysin in swine: II Characterization and comparison of prostaglandin F, estrogens and progestin concentrations in utero-ovarian vein plasma of nonpregnant and pregnant gilts.

Polyvinyl catheters were inserted into the right and left utero-ovarian veins (UOV) and saphenous vein (SV) and artery (SA) of six non-pregnant (O) and five pregnant (P) gilts on day 11 after onset estrus. Beginning on day 12, UOV blood samples were collected at 15-min intervals from 0800 to 1100 hr and 2000 to 2300 hr, and single samples were taken at 1200 and 2400 hrs. Peripheral blood (SA or SV) was sampled at 0800, 1200, 2000 and 2400 hr until gilts returned to estrus (X = 20.6 days) or day 24 of pregnancy. UOV plasma PGF concentrations (ng/ml; n = 1929) were measured by RIA. Status (P vs O) by day interactions were detected (P less than .01) but variances among treatments were heterogenous (P less than .01). Curvilinear day trends were detected for PGF in 0 gilts (P less than  .01) but not P gilts. PGF peaks, defined as concentrations greater than two SD above the mean concentration for each gilt, occurred with greater frequency (chi2 = 16.4; P less than .01) in O than P gilts; and mean peak levels (X +/- SE) were 5.04 +/- .27 and 3.84 +/- .13 ng/ml, respectively. Progesterone concentrations were maintained in pregnant pigs and were indicative of luteal maintenance. Systematic differences in day trends of utero-ovarian venous plasma estradiol were detected between O and P pigs. These differences may be of paramount physiological importance and are discussed.


The metabolism of prostaglandins F2alpha and E2 by non-pregnant porcine endometrial and luteal tissue and early pregnant porcine endometrial tissue, luteal tissue and conceptuses in vitro.

Slices of porcine endometrium and corpus luteum from both early pregnant and non-pregnant sows and conceptuses from early pregnant sows were incubated with radioactive PGF2alpha and PGE2 and the degree of metabolism of the prostaglandins measured. Prostaglandins and a metabolites were separated by TLC, radioactive bands located with a Panax scanner and the radioactivity measured in a scintillation counter. Endometrial and luteal tissue from non-pregnant sows gave no significant metabolism at any stage of the oestrous cycle, and while similar tissue from pregnant sows metabolised both prostaglandins slightly, only the conceptuses gave any significant metabolism. The possible physiological significance of these results is discussed.


Prostaglandin concentrations in intra-uterine tissues from late-pregnant sheep before and after labour.

Prostaglandin E (PGE), prostaglandin F (PGF) and 13,14-dihydro-15-keto-prostaglandin F (PGFM) have been measured in cotyledons and myometrium from sheep before and after labour. Fetal cotyledons contained more PGE than maternal cotyledons which in turn contained more than myometrium. The maternal cotyledon contained the highest concentrations of PGF, but the fetal cotyledon was the only tissue exhibiting a statistically significant rise in the concentration of PGF following labour. Concentrations of PGFM were closely correlated with (although usually lower than) those of PGF.


Management of missed abortion and fetal death in utero.

Termination of pregnancy in missed abortion and intra-uterine fetal death was accomplished using vaginal suppositories of 20 mg PGE2 in 31 cases and the results were compared with oxytocin induction (with or without estrogen pre-treatment) in 17 cases at the doses routinely used in our hospital. The PG suppositories proved much more superior (96.7%) than oxytocin (47.7%), but induced a higher rate of side effects. The latter were not serious and were generally tolerated by the patients. There was a positive correlation between duration of fetal retention in utero and the induction expulsion time. The over all patient acceptance of the method was quite favourable and the approach appears to be a definite advance towards management of these cases.


[Nutritive value of sunflower seeds (Helianthus annus) (author's transl)].

The nutritive value of sunflower seeds (Helianthus annus) was studied and compared to that of casein. Thirty-six male rats, Wistar strain, aged 23 days, were divided into two groups and fed (a) a sunflower cake meal diet, and (b) a casein diet. The results indicate that due to its high protein level (52.06%) and coefficient of digestibility (95 CD) sunflower can be used as a feeding formula although its PER does not recommend its use as a milk substitute.


[Human serum hexosamine. Determination in neoplastic disease (author's transl)].

The serum hexosamine levels of 93 patients with neoplastic disease and of 30 normal individuals chosen among medical students were determined. The mean values obtained in both groups show that in neoplastic disease the levels are higher than in normal persons. The application of Student (/t/) indicates a significant differences in the mean  values (/t/) = 6.93 P less than 0.001). It is concluded that serum hexosamine contents are elevated in neoplastic disease.


Preliminary data on a new method for lithium therapy.

Lithium therapy was assessed using electrosleep on two dogs. Cotton swabs soaked in an aqueous isotonic lithium chloride solution were placed over the eyes and mastoids of the dogs, and connected to the electrosleep apparatus. In two minutes, sleep was induced in both dogs, at point 5 (mA) on the intensity scale (which runs 1 to 9 mA). After two hours, the apparatus was turned off. One of the dogs was put under continuous observation, and the other one was sacrified. Parts of its cortex, subcortex, and cerebellum were processed and fragments were assayed spectrophotometrically for Lithium. Lithium was found in all the material examined. These results suggest a possible technique for Lithium therapy using electrosleep, the ion being carried directly to CNS, avoiding systemic toxicity caused by oral administration.


Influence of the number of questions on the student's achievement in tests of anatomy.

The authors compare student's achievement in tests with low and moderately high number of questions requiring short answers. Five groups of Medical School students underwent their regular Anatomy evaluation tests, which consisted of 13 questions (one group), 15 (two groups) and 25 (two groups). In each group five questions were chosen at random, average scores being calculated from their marks. These scores were statistically compared to the ones calculated from the marks given to the full-length evaluation tests; it became quite evidente that averages go up when the number of questions is increased. Putting the averages in terms of A, B, C and D scores (very good, good, regular and insufficient), it was noted that failure to reach at least the C score is inversely proportional to the number of questions. The results are discussed in terms  of determining the most proper number of questions to be given in a test.


[Career aims of medical students in Brasilia (author's transl)].

Data obtained through a survey questionnaire show that on starting the internship, about half of the University of Brasilia medical graduates expressed a preference for primary care activities and predominant interest in assuming responsibility for patient care. Career aims and choice stability seem to be affected in various ways by personality, academic, and demographic factors. There is no evidence of a prevailing influence of the educational setting on the final pattern of career choice, notwithstanding the indications that the teaching model adopted may influence the development of the choice.


[Cerebral blood flow and metabolism under "diazanalgesia" (author's transl)].

"Diazanalgesia" employs the combination diazepam + fentanyl. Its effects were studied on regional cerebral blood flow and oxygen metabolism in 8 normal subjects, who were examined angiographically. During diazanalgesia, cortical blood flow falls by 56 p. 100. The mean hemispheric flow calculated over 10 min falls by 34 p. 100. Cerebral O2 consumption (VcO2) falls by 34 p. 100. However, large individual variations are found which suggests that the fall in blood flow is not due solely to the decrease in O2 metabolism. The decreases in flow are not proportional to the amount fentanyl, and there is no direct relation between falls in VcO2 and amount of fentanyl. Cerebral vaso-reactivity to CO2 persists but is reduced under diazanalgesia compared with the waking state.


[The classification of hypno-analgesics (author's transl)].

Experience collected by routine E.E.G. studies of narcosis, in volunteers in good health, serves as a basis for a classification of anaesthetic agents. In order to obtain this, we established a correlation between the electroencephalographic effects on the one hand and psychological, motor, sensory and vegetative changes on the other hand. Arguments emerged in favour of the existence of different points of impact for different substances or groups of substances. A distinction was made between holoencephalic hypno-analgesics (affecting the activity of practically all the neurone systems of the brain) and the neuroleptics, tranquilisers and analgesics which have only a limited effect on the telencephalon, neocortex and archicortex, the electroencephalographic actions of which also differ from the classical stages of narcosis. Using this classification based upon the principal points of action of these agents and their possible effects on other systems it is possible to explain the existence of adequate and inadequate associations of medications during so-called balanced anaesthesias.


[Electroencephalographic features during enflurane anaesthesia in older children (author's transl)].

The authors report electroclinical changes observed during Enflurane anaesthesia, at various concentrations, in 25 children aged 4 to 14 years. EEG features are described from induction to surgical anesthesia (concentration 3-3.5%) and during overdoses (4-4.5%) with or without hyperventilation. Groups of spikes, low voltage sequences and electroclinical "seizures" (2 cases) only occur if the concentration of enflurane is not kept below 3.5%. A longitudinal study (24th hour, 3rd and 6th day) shows, by comparison with the pre-anaesthetic EEG, persistence in all cases of EEG slowing 24 hours after the anaesthesia, and in some patients EEG disturbances continue until the 6th day. These results are discussed in relation to data on the biodegradation of enflurane.


[The use of spectral analysis in studying the E.E.G. under enflurane (author's transl)].

Spectral study of E.E.G. activity under enflurane anaesthesia shows a mild and early increase in global power distributed over the whole spectrum up to 20 c/sec, initially without dominant activity. Slow activity at 4-6 c/sec occurs later and gradually becomes slower, although without providing what could be called a specific pattern. These results have been compared with the same spectral analysis approach in anoxia in the normal subject and in epileptic subjects. Our experience so far does not allow the identification of the discharges observed the enflurane as epileptic discharge.


[Electro-clinical features of short-term anaesthesia (author's transl)].

Short-term anaesthesia is defined in terms of duration (allowing brief but what might be painful surgery), rapid recovery, metabolism and mode of administration. After a brief review of barbiturate narcoses, the authors study the electro-clinical features of anaesthesia under Althesin, Epontol and ketamine. For the first two, although there are some clinical differences, the E.E.G. effects are fairly similar with rapid onset of burst suppression. Recovery is rapid and its study (clinically, with psychomotor tests and E.E.G.) indicates that these drugs can safely be used with out-patients. Ketamine causes very specific alterations, both clinical (dissociative anaesthesia) and E.E.G. (diffuse and continuous theta). This drug is used particularly in painful operations; its use with out-patients would seem awkward.


[The E.E.G. during althesin anaesthesia in paediatrics (preliminary study) (author's transl)].

The authors studied 11 children (mean age 5 1/2 years) before and during anaesthesia, and then several times from 1 to 6 hours after the injection of althesin. The anaesthetic agent was either pure althesin or althesin combined with dextromoramide. The electroclinical correlations described for adults are also found in children: slow waves, discontinuous and then isoelectric recording during the operation stage, then rapid recovery after ending drug administration. The special interest of this study was the analysis of E.E.G. recordings during the hours following clinical recovery: only once was the recording like that of full consciousness. Repeated recordings were all of drowsiness and even sleep, despite the clinical state of the subject. A short associated study concerns the E.E.G. of neonates during their first 24 hours, born to mothers anaesthetised with alfathesin.


[An examination of current techniques in anaesthesia (author's transl)].

The techniques of general anaesthesia may be divided into 2 major groups: those used in very brief surgical or diagnostic operations and those used in longer and more pain-producing interventions. The former normally involve a single drug which is very short-acting and allows consciousness to be recovered rapidly and well. The latter are anaesthetics using several drugs together, which allows very precise control of the degree of analgesia, neuro-vegetative protection, muscle relaxation and sleep. The depth of anaesthesia is judged from the patient's sympathetic-adrenergic reactivity to noxious stimuli. It is not possible to direct anaesthesia by reference to the electrical activity of the brain, since there are no electro-clinical correlations. Brain activity depends on a large number of factors related not only to the anaesthetic and nature of its administration, but also the extent of the surgery and the state of the patient. The E.E.G. remains a technique of choice for studying recovery, and any sequels of hypoxia during the operation. This should, of course, be accompanied by a clinical evaluation which is particularly important in assessing the state of ventilation (residual curarisation, depression by central analgesics).


[Analgesia: role of the brainstem (author's transl)].

Potent analgesia results from electrical stimulation of the periaqueductal grey matter in several species including man. Electrophysiological experiments indicate that this electrical analgesia could result from the activation of descending influences which inhibit the activity of dorsal horn interneurons in the transmission of painful messages. Numerous physiological, behavioral and pharmacological studies mention that the descending serotoninergic Bulbo-spinal system plays a major role in electrical analgesia. Several studies suggest that both electrical and morphine analgesia share, at least in part, a common site and mechanism of action. This possibility is mainly supported by the fact that analgesia induced by electrical stimulation is suppressed or reduced by a specific opiate antagonist (Naloxone).


Specific radioimmunoassay for amitriptyline and nortriptyline in plasma.

A specific radioimmunoassay (RIA) for the determination in plasma of the widely used tricyclic antidepressant amitriptyline (AT) and its major metabolite nortriptyline (NT) has been developed employing 3H-AT as the radioligand and a rabbit antiserum to a bovine serum albumin conjugate of N-succinyl-nortriptyline. Although the antiserum cross-reacts almost equally well with AT and NT, specificity is achieved by selective extraction of each compound from plasma at a different pH. A unique aspect of the assay is that at no time during the entire extraction procedure is the AT or NT taken out of solution. Both compounds are back extracted from the organic phase into 0.1 N HC1 and the acid fraction subjected to RIA directly. The method has a limit of sensitivity of about 2 ng/ml using a 0.5 ml sample of plasma. Satisfactory agreement was obtained for plasma levels of AT and NT when determined by the RIA and a specific GC/MS procedure. The correlation coefficients were 0.89 and 0.98 for AT and NT, respectively. THE RIA has been used to measure steady-state levels of AT and NT in man after chronic administration of AT and following a single oral 75 mg dose. The method also lends itself for the specific determination of NT alone in subjects receiving therapeutic doses of NT.


[Monitoring the integrity of saccadic eye movements as a test of post-anaesthetic recovery (author's transl)].

After reviewing various tests of consciousness which can be used during the  post-anaesthetic period, the authors chose to analyse the involvement of the visual receptor during different stages between sleep and complete recovery of consciousness, by an electro-oculographic (EOG) method, providing recordings of the displacement of the optical axis. In states of full consciousness the eye explores a static flat surface in saccades separated by pauses. During sleep caused by anaesthesia or by other types of drugs, the integrity of the eye positioning movements by saccades is impaired, and the EOG shows a sinusoidal recording (smooth movements). In one group of patients, regaining of consciousness was monitored throughout and the EOG reording reflected the clinical state of the patient. In a second group, the state of consciousness was monitored 2 hours after the last injection of the anaesthetic drug, so that correlations could be considered with the type of anaesthesia used. Th conclusion concerns the practical interest of the method (short term hospitalisation after general anaesthetic, medico-legal use due to the existence of a recording) and its basic use in the experimental study of new drugs in man.


Determination of methylprednisolone and hydrocortisone in plasma using high pressure liquid chromatography.

A method for quantitative determination of methylprednisolone and hydrocortisone in plasma using added methylprednisolone acetate as internal standard and high pressure liquid chromatography is presented. The standard curves were evaluated statistically and logarithmic parabolic equation is preferred over the usual standard curve mathematical relationships. The method was applied to samples of one subject's plasma containing methylprednisolone and endogenous hydrocortisone after oral dosing with multiple doses of methylprednisolone.


[Study of recovery and the post-anaesthetic period (author's transl)].

The authors compare recovery and the post-anaesthetic period in 45 patients anaesthetised with a combination of either pentothal, nitrous oxide, fluothane and dolosal (group 1, 24 subjects), or of pentothal, nitrous oxide and phenoperidine (group 2, 21 subjects). The quality of recovery was judged at the end of anaesthesia by determining of occurrence of the first response to 3 types of stimulation (calling the name, noise and pain) and the density of these responses during each minute. During the post-anaesthetic period the respective percentages of wakefulness and sleep were calculated. In this way the authors demonstrate a significant (P less than 0.01) shortening in recovery time for group 2, reactivity to own name occurring first in both groups, and a very significant (P less than 0.001) increase in the percentage of physiological sleep in subjects of group 2 during the post-anaesthetic stage.


Fluorescein-labeled estradiol: a probe for anti-estradiol antibody.

A fluorescent  estradiol derivative binds strongly to antiestradiol antibody. The binding, measured by fluorescence polarization, is inhibited by estradiol and by diethylstilbestrol. Tentatively characterized as N-(estradiol-6-iminooxyacetyl) fluorescein amine, the derivative was prepared from estradiol-6-iminooxyacetic acid, dicyclohexylcarbodiimide, and fluorescein amine, and isolated by TLC. It has a fluorescence emission similar to that of fluorescein and an absorption spectrum consistent with a fluorescein: estradiol molar ratio of 1:1.


[The effect of gamma-OH on cerebral metabolism and blood flow in human patients (author's transl)].

The effects of gamma-OH on cerebral blood flow (CBF) and metabolism were analysed in 10 neurosurgical patients, 15 min after a 60 mg/kg injection, both blood flow and oxygen consumption demonstrates a disconnection between blood flow and metabolism which appears an advantage and hence the interest in using this agent in anaesthesia and neurosurgical intensive care. 1 h40 min later no rebound effect was found; the metabolic reduction persisted whereas the CBF had returned to its resting level. Under gamma-OH CO2 production does not parallel O2 consumption and this could be interpreted as a sign that glucose-6-phosphate is metabolising via pentose.


[Effects of drugs used in anaesthesia and in neurosurgical intensive care on the blood flow and metabolism of the brain (author's transl)].

Changes in cerebral blood flow (CBF) and in O2 consumption caused by anaesthetic agents were studied in 36 subjects in coma after cranial trauma. These changes can be divided into 3 groups: (1) Reduction in CBF and in O2 consumption of about the same percentage, after penthiobarbital, gamma-OH and alfathesin. (2) A reduction in CBF greater than in O2 consumption after diazepam and chlorpromazine. (3) Increase in CBF without significant change in O2 consumption after ketamine. The haemodynamic changes occur in the same direction whatever the initial value of the CBF (normal, hypoperfusion or hyperaemia). The reduction in CBF caused by gamma-OH is associated with a decrease in the arterio-venous difference in O2 (DAVO2). Gamma-OH also prevents the increase in DAVO2 observed in hypocapnia provoked by hyperventilation. These properties are an indication for using gamma-OH, alone or associated with hyperventilation, in reactive cerebral hyperaemia. Comparison of the E.E.G., CBF and cerebral O2 consumption shows that the E.E.G. changes produced by anaesthetic agents, such as fast spindles and burst suppression, are not related to any particular haemodynamic or metabolic state. The E.E.G. changes induced by penthiobarbital or diazepam can be corrected, at the same time as changes in CBF and O2 consumption, by injecting doxapram.


Effect of beta-endorphin on striatal dopamine metabolism.

Acute intraventricular administration of human beta-endorphin increased 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) concentrations in rat striatum at a time when the catatonic effect was also present. This effect of beta-endorphin is compatible with increased striatal dopamine turnover and is similar to the effect noted previously with morphine administration.


[Changes in regional blood flow of the brain during althesin anaesthesia (author's transl)].

The effect of Althesin on local blood flow in the brain was studied using intra-carotid Xenon 133 in 18 subjects: 6 apparently normal, 6 with diffuse cerebro-vascular pathology, and 6 cases of ischaemic cerebral accidents identified by scintigraphy, tomodensitometry and angiography. Blood flow decreased under Althesin in the first 2 groups, although to a lesser extent in the second group, with a concomitant decrease in oxygen metabolism. In the third group a "paradoxical" increase in blood flow was observed in infarcts, and a decrease proportional to the rest of the brain in limited ischaemia which had subsequently regressed. The "Althesin test" proposed by Rasmussen (1975) thus reveals the existence of a disconnection between blood flow and metabolism within cerebral infarcts, and provides a possible means of differentiating the latter from reversible ischaemias.


Pentobarbital distribution in discrete brain areas of tolerant and nontolerant mice.

Uptake and distribution of pentobarbital in tolerant and nontolerant mice were studied. Mice were implanted with pentobarbital or placebo pellets s.c. 3 days prior to the injection of 60 mg/kg sodium pentobarbital i.p. One group of animals was sacrificed when they first awakened. Whole brain, five discrete brain areas, and plasma were assayed for pentobarbital by gas chromatography. In a second group, time studies were performed on brain sections and plasma. In tolerant vs nontolerant animals, sleeping time was markedly decreased (10-20 vs 50-70 min); whole brain, brain sections, and plasma levels on awakening were not significantly different; linear and exponential curves of pentobarbital levels vs time showed an increase in slope (-1.05 vs-0.40) and a decrease in T 1/2 (10.2 VS 35.7 min). These findings suggest that the tolerance development to pentobarbital in the central nervous system is due to functional mechanism rather than brain dispositional mechanism.


Estimation of the systemic availability and other pharmacokinetic parameters of naltrexone in man after acute and chronic oral administration.

First pass metabolism, metabolic clearance, volume of distribution and steady state plasma levels were estimated in man following acute and chronic 100 mg oral doses of naltrexone. Essentially no statistical differences was observed in these values between the acute and chronic physiologic state. The values for the first pass effect were 79.6 +/- 4.6% and 78.0 +/- 3.0% for acute and chronic treatment respectively. From our pharmacokinetic data an apparent chronic release rate (ACRR) for a sustained release preparation of naltrexone was calculated as 11.8 microgram/kg/hr. In practice a release rate of one half the ACRR should be sufficient to provide continuous antagonism of 25 mg i.v. heroin. In conclusion our data clearly indicate that naltrexone is an effective and safe narcotic antagonist in man.


Isoniazid-induced inhibition in the biotransformation of [14C] diphenylhydantoin in rat.

The effect of isoniazid (0,10,20 and 40 mg/kg; i.v.) on the biliary and urinary excretion of [14C] diphenylhydantoin (DPH, 50 mg/kg; i.v.) was investigated in biliary-fistulated rats during the first 5 hours. Isoniazid cause a dose-dependent reduction in the total biliary excretion of 14 C without affecting its output in urine. After 5 h, maximal levels of radioactivity were recorded in the liver, followed by heart and brain. The glucuronides of DPH metabolites accounted for most of the 14C in 5 h pooled bile, less than 1% of the injected dose was excreted as unmetabolized DPH. Isoniazid administration caused the following significant dose-related changes in biliary excretion: (a) increased excretion of the unconjugated principal DPH metabolite, 5-(p-hydroxyphenyl)-5-phenylhydantion (HPPH); (b) decreased excretion of HPPH-glucuronide; and (c) increased excretion of the glucuronide conjugates of the polar metabolites of DPH. The results suggest that the isoniazid-induced elevation of DPH-derived 14C in blood and its marked accumulation in brain, heart and liver is due to inhibition of p-hydroxylation of DPH and the glucuronidation of HPPH.


Effects of propranolol on rat myocardial l-ornithine decarboxylase activity during exercise and hypoxia.

Ornithine decarboxylase activity was higher in the left ventricle than in the right ventricle of the rat. Swimming exercise for 2 hours caused an increase in left ventricular but not right ventricular enzyme activity. This effect was not influenced by the prior injection of propranolol, which also had no influence on the resting level of ornithine decarboxylase activity. After 4 hours' exposure to 400 mm Hg the decarboxylase activity became greater in the right ventricle. This was attributed to the increased work-load on the right ventricle caused by hypoxic pulmonary hypertension. In the left ventricle, ornithine decarboxylase showed an initial increase in activity followed by a transient decrease at 16 hours. Propranolol had no effect on the changes observed in either ventricle. It is concluded that beta-receptor stimulation is not involved in the mechanism of an increased myocardial ornithine decarboxylase activity during increased cardiac work.


Metabolism of 2-nitro-1-phenylpropane to phenylacetone by rabbit liver microsomes.

Phenylacetone was found to be the major metabolite formed when 2-nitro-1-phenylpropane was incubated with rabbit liver microsomes. The enzymatic character of the reaction was demonstrated by the increase of product with microsomal protein and dependency on NADPH and oxygen. Furthermore, phenobarbital induction markedly increased the formation of phenylacetone. Carbon monoxide decreased the reaction indicating the involvement of a metalloenzyme. Experiments with H218O indicated that the carbonyl oxygen originated from water. It is suggested that the microsomal metabolism of 2-nitro-1-phenylpropane involves an enzymatic step followed by chemical hydrolysis of an intermediate, possibly a secondary nitronic acid.


The effects of benfluramate on carbohydrate metabolism in obesity.

Glucose turnover rate, glucose oxidation and lactate production from glucose were investigated in 5 obese subjects using the primed infusion technique, before and four weeks after a course on benfluramate therapy. All subjects lost weight on the drug. Mean glucose turnover rate, but not CO2 and lactate production increased after treatment. The changes in metabolism appear to reflect the combined effects of weight loss and drug action.


A method for recording evoked electrical and mechanical activity of muscle in the intact dog.

A technique is described for investigating the action of muscle relaxant drugs in the intact and anaesthetised dog. The ulnar nerve was stimulated at the elbow and the evoked electrical and mechanical responses were measured and recorded with an electromyograph and pen recorder.


Urinary excretion of protein by adult Yankasa rams.

Total urine was collected from 12 adult Yankasa rams for 13 days. The rams excreted a mean urine volume of 508-0 +/- 201-6 ml each day. The total solids concentration excreted in the urine averaged 9-0 +/- 5-2 g/100g of urine. All the 178 urine samples contained protein. The urinary total protein concentration varied from 0-6 to 2-8 mg/dl. The total protein excreted was 7-0 + 2-6 mg/day of which the globulin content was 3-3 +/- 1-2 mg; mucoprotein, 2-0 +/- 0-7 mg; albumin, 1-7 + 0.6 mg; and A/G ratio, 0-52 +/- 0.06. Electrophoretic analysis of the urinary proteins showed three components which were comparable on a mobility basis with the serum proteins, namely albumin, combined alpha- and beta-globulin, and gamma-globulin. The largest fraction of the urine protein was gamma-globulin. Protein excretion in the urine of adult Yankasa rams was much lower than that reported in sheep bred for temperate climates, a trait that would have survival value in their hot, dry, semi-arid environment.


The protamine sulphate test as a screening test for intravascular coagulation in experimental Babesia bovis infections.

The protamine sulphate test (PST) was studied as a screening test for intravascular coagulation in experimental Babesia bovis infections. The test became positive in 39 of 42 splenectomised calves and two of six intact cattle tested during acute infections. Haematological studies during the course of infection in two splenectomised and six intact cattle indicated that a positive PST was reliable evidence for intravascular coagulation. Of four splenectomised and one intact cattle that were positive to the test and were subsequently autopsied, all had histopathological changes indicative of disseminated intravascular coagulation (DIC). It was concluded that the PST could be used as a screening test for DIC in acute bovine babesiosis.


Experimental Parascaris equorum infection of foals.

Six worm-free pony foals, two to four months old, were infected with parascaris equorum eggs using three different dosage regimes and killed at either 40 or 95-100 days after infection. Coughing and a circulating eosinophilia were features of large infections from which only a small number of worms developed to maturity. In small infections a high percentage of the parasites matured in the small intestine and this was associated with unthriftiness. Pre-patent periods of 80 and 83 days were recorded.


Lactic acid concentration in peritoneal fluid of normal and diseased horses.

Peritoneal fluid from each of 15 clinically healthy horses and five horses with acute abdominal disease was evaluated for lactic acid concentration. The normal range was 2-7--13-4 mg/dl. Simultaneous blood and peritoneal fluid samples from healthy horses revealed consistently lower lactic acid concentrations in the peritoneal fluid than in the blood, whereas peritoneal fluid lactic acid levels were consistently greater than blood levels in the diseased horses. The diseased horses had highly significant (P less than 0-005) increases in both blood and peritoneal fluid lactic acid concentrations compared with those in healthy horses.


Some changes in the composition of maternal and fetal plasma from chronically catheterised sheep during short periods of reduced feed intake in late pregnancy.

Changes in the composition of maternal and fetal plasma from nine sheep were followed during periods of reduced feed intake lasting four to seven days. Feed rations were reduced between 120 and 128 days of gestation and this produced hypoglycaemia in mother and fetus. In each sheep there was a significant negative correlation between the glucose and corticosteroid concentrations in both maternal and fetal plasma, and there were positive correlations between the maternal and fetal plasma concentrations of glucose, and between the glucose and fructose concentrations of fetal plasma. Maternal and fetal packed cell volumes and the plasma concentrations of lactate and thyroxine remained relatively constant.


The effect of praziquantel on Echinococcus granulosus, Taenia hydatigena and Taenia ovis infections in dogs.

The effect of praziquantel on Echinococcus granulosus, Taenia hydatigena and T ovis was investigated in a trial involving 360 dogs. The drug was found to be highly toxic to tapeworms. Few dogs remained infected after a single treatment within the range of dose rates tested (0-31 mg/kg to 10-0 mg/kg body weight). No toxicity to dogs was observed.


Babesia divergens in splenectomised calves: titration of the infective dose.

Two experiments were carried out in which Babesia divergens was titrated in splenectomised calves. In the first experiment, a linear relationship was observed between infective dose (10(5)--10(9)) parasites) and onset of disease. In the second experiment, a similar trend was observed for infective doses of 10(2)--10(6) parasites, but 10(3) parasites appeared to be the minimum dose required to produce overt disease or resistance to homologous challenge in inoculated animals.


The selection of larvae of Boophilus microplus infected with Babesia bovis (syn B argentina).

Observations on the dynamics of the transovarial transmission of Babesia bovis by Boophilus microplus showed that, at 28 degrees C and 90--95 per cent relative humidity, a low proportion of the eggs laid during the first five days' incubation of the engorged female ticks were infected with the Babesia. However, the eggs laid on the sixth and seventh days of incubation were heavily infected. This was the basis of a method for selecting larval cultures of B microplus which contained up to five times the infection rate of B bovis obtained if the entire egg mass of the tick were used. The technique has been used to obtain larval cultures with infection rates exceeding 20 per cent and should facilitate studies on the life cycle and immunology of the invertebrate stages of B bovis.


Fetal umbilical venous-arterial differences of citrate in the chronically catheterised sheep.

Whole blood citrate concentration was measured simultaneously in the umbilical vein, fetal femoral artery and maternal artery in seven chronically catheterised pregnant ewes and their fetuses. The mean citrate concentration was 0-321 mmoles/litre in the umbilical vein, 0-297 mmoles/litre in the fetal femoral artery and 0-095 mmoles/litre in the maternal artery. The mean concentration difference for citrate across the fetal placental circulation was 0-024 mmoles/litre but this was not statistically significant (P less than 0-1).


The pathology and sites of persistence associated with three different strains of feline calicivirus.

The pathology and sites of multiplication associated with three different strains of feline caliciviruses are described. The main pathological lesions were found in the tongue, soft palate and lungs and like the clinical signs were of mild nature. Virus multiplication was associated mainly with the tissues of the mouth and tonsils and in asymptomatic carrier animals the tonsil appeared to be preferred organ of viral persistence.


Pharmacokinetics of sulphadimethoxine in cattle.

Four healthy Angus steers received a single rapid intravenous injection of sulphadimethoxine at a dose of approximately 55 mg/kg. The elimination half-life determined from plasma concentration-time data was approximately 12-5 h, and the volume of distribution was 31-0 per cent of body weight. Animals also received sulphadimethoxine intravenously or orally at a loading dose of approximately 55 mg/kg, followed by sustaining oral doses of approximately 27-5 mg/kg at 24, 48 and 72 h. It was demonstrated that oral maintenance doses served to sustain sulphonamide plasma concentrations achieved with the loading dose.


Age related changes in the motor nerve conduction velocity in dogs.

The motor nerve conduction velocity (NCV) was studied in the ulnar and sciatic-tibial nerves of dogs of various ages. The adult values are reached between six months and one year of age. The NCV remains on a plateau range of approximately 60 +/- 10 m/sec from one to seven years of age. After seven years there is a gradual decline in NCV so that by 10 years the velocity is reduced by 10-15 per cent. In addition to the reduction of velocity there is also an increased dispersion of the evoked muscle action potential.


Experimental toxoplasmosis in calves.

Nine calves were inoculated with tissue cysts of a low virulence strain of Toxoplasma gondii and killed at intervals up to 10 weeks. An immunological response took the form of circulating antibodies and reactive changes in the lymph nodes. The organism could only be recovered from the lymph nodes and this only during the first four weeks after infection. No tissue cysts were demonstrated and only a few inflammatory lesions occurred. Thus, although calves can be infected, the immunological response is prompt with rapid elimination of the organism.


Continued studies on the adjuvancy effect of natural and synthetic double-stranded RNA preparations with inactivated Newcastle disease vaccines in fowls.

The adjuvant effect of the natural ds-RNA, BRL 5907, with inactivated Newcastle disease vaccines was confirmed using different oil-based formulations and could be given either as single injections or separately at adjacent sites. A minimum dose level of 0-04 mg BRL 5907 per bird was required for a significant enhancement of antibody levels following vaccination. While the synthetic ds-RNA Poly IC gave a similar response to that observed with BRL 5907, no significant effects could be detected with two other natural ds-RNA materials.


Comparison of the daily endogenous faecal magnesium excretion from sheep eating grass with high sodium or high potassium concentrations.

Metabolism trials were conducted with two sheep to determine the daily endogenous faecal magnesium excretion and the true magnesium availability of grass which had either a high potassium or a high sodium content. The experiment was conducted as a simple cross-over design and the isotope dilution technique using 28Mg was employed. The sheep ate sodium fertilised grass containing 0-73 per cent Na and 1-55 per cent K and potassium fertilised grass containing 0-15 per cent Na and 3-12 per cent K in the dry matter. The daily endogenous faecal magnesium excretion was not found to be significantly different for each sheep on both grasses; this excretion was approximately 13 per cent of the total faecal magnesium output. The true availability of magnesium was greater in the sodium fertilised grass than in the potassium fertilised grass. It was concluded that the daily endogenous faecal magnesium excretion was not affected by altering the herbage levels of sodium and potassium.


Determination of indole and 3-methylindole in plasma and rumen fluid from cattle with fog fever or after L-tryptophan administration.

A modified gas liquid chromatography method has been developed to analyse the concentrations of indole and 3-methylindole in samples of plasma and rumen fluid from four cows with fog fever together with four control animals and from two cattle given L-tryptophan orally. Satisfactory recoveries of the metabolites were obtained in test samples examined by the gas liquid chromatography procedure and increased levels were found in rumen fluid after tryptophan administration. Absence of abnormal concentrations of the toxic metabolite 3-methylindole in samples from field cases of fog fever was not considered to rule out the metabolite as a possible cause of the disease in view of the rapid restoration of 3-methylindole to normal levels by the second day after loading with L-tryptophan.


Antigenic variation of Babesia bigemina.

The purpose of the study was to determine whether antigenic differences occurred in four stabilates of Babesia bigemina derived from a single purified isolate and propagated as acute and chronic, blood-borne and tick-borne infections in Colombian cattle. Antigens were characterised by means of the complement fixation (CF), gel diffusion (GD), agar gel electrophoresis (AGE) and the indirect haemagglutination tests (IHA). Differences were detected. Acute blood and chronic blood antigens were similar, as were acute tick and chronic tick antigens, when compared by IHA and GD. Similarities were observed between acute blood anc acute tick and between chronic blood and chronic tick when these antigens were compared by AGE and CF.


Intravascular fat globules in the heart of pigs fed rapeseed meals.

Histopathological studies were conducted on growing pigs fed a corn, soybean meal control and two experimental diets supplemented with either a high or a low glucosinolate rapeseed meal. A high incidence of intravascular large fat globules in the heart with mild interstitial oedema was observed in the boars on high glucosinolates in comparison with the boars on low glucosinolates rapeseed meal. Boars and gilts on the corn, soybean meal control diet showed no intravascular fat globules.


Chloramphenicol toxicity in dogs.

Twenty dogs were given chloramphenicol by mouth night and morning for 14 days: six dogs were dosed at 225 mg/kg/day, four each at 175 and 125 mg/kg/day and three each at 275 and 75 mg/kg/day. Six control dogs were given empty gelatin capsules twice daily for the same period. Dogs dosed at 75 mg/kg consumed more food and gained a little more weight than the control dogs, while those in the 175, 225 and 275 mg/kg groups ate less and lost weight. Four dogs dosed at 175 mg/kg or above became dull and depressed and virtually ceased to eat. No changes were observed in erythrocyte and reticulocyte counts, haemoglobin concentration, packed cell volume or total and differential leukocyte counts during the experiment. Bone marrow examination showed suppression of erythropoiesis in four of nine dogs dosed at 225 or 275 mg/kg/day. In addition, there was evidence of decreased mitotic activity and reduced rate of granulocytopoiesis in the 275 mg/kg group. Vacuolation of marrow cells was not observed. The two toxic effects observed (depression and hypophagia on the one hand, marrow suppression on the other) occurred separately or together in individual dogs.


The clinical disease and patterns of excretion associated with three different strains of feline caliciviruses.

Three groups of cats were infected intranasally with three different feline calicivirus strains: A3, 68/40 and M8. Each strain produced a uniformly muld upper respiratory tract disease, with glossal ulceration being the most prominent clinical sign. Virus was most consistently isolated from the oro-pharyngeal region and, in non-euthanised animals, excretion continued long after clinical signs had disappeared. It is suggested that an asymptomatic phase of excretion may be a normal sequel to FCV infections.


In vitro stimulation of ovine lymphocytes by various mitogens.

A technique for the separation and in vitro culture of ovine lymphocytes is described and applied to the study of their blastogenic responses to various mitogens. Lymphocytes were separated on a Ficoll-Triosil gradient, resuspended in RPMI 1640 medium supplemented with 10 per cent serum to a concentration of 1 x 10(6) cells/ml and cultured in 200 microliter volumes in microculture plates in the presence of mitogens for varying lengths of time. A total culture period of 66 h was found to be satisfactory with 1 muCi of [3H]-thymidine being added to each well 18 h before termination of culture. Optimal blastogenic stimulation of the lymphocytes occurred with phytohaemagglutinin at 2-5 microliter/ml, pokeweed mitogen at 10 microliter/ml, concanavalin A at 6-25 microgram/ml and lipopolysaccharide of Escherichia coli (LPS) at 6-25 microgram/ml. Proliferation due to stimulation by LPS appeared to be of a lower order than that achieved with the other mitogens tested.


The formation of 2-hydroxymethylquinoline and quinaldine in greyhound urine.

2-Hydroxymethylquinoline and quinaldine are found in nonfresh greyhound urine as putrefactive bases. Their production as a function of time was investigated. This is affected by preservatives or refrigeration. 2-Hydroxymethylquinoline forms in greyhound urine, if non-preserved, in three or four days at room temperature while quinaldine takes as much as 10 days longer to form. Production of 2-hydroxymethylquinoline or quinaldine is not arrested but merely retarded by preservation or refrigeration. Sodium fluoride is one of the more effective preservatives. A method for the measurement of quinaldine and 2-hydroxymethylquinoline using gas chromatography is described. The columns used are Carbowax 6000 + potassium hydroxide on Chromosorb G and SE-30 on Chromosorb W.


Mean air space diameter, lung surface area and alveolar surface tension.

Results from pressure-volume studies indicate that lung surface area is directly proportional to volume rather than to volume raised to the two thirds power as has been assumed previously. Mean air space diameter was found to decline with an increase in lung volume which is indicative of a significant degree of alveolar recruitment. Calculation of alveolar surface tension during 20-min inflation-deflation cycles reveals a minimum surface tension of 15.9 +/- 2.3 and a maximum surface tension of 42.7 +/- 4.2 dyn/cm (mean +/- SE). Comparison of surface tensions obtained from the surface balance and calculated alveolar surface tension reveals no significant difference between the means and a significant correlation between the two values.


Diagnosis, definition and classification in chronic generalized respiratory disorder. A proposal to come to a manageable clinical classification system in the human being. An answer to the stimulating report of the ACCP-ATS joint committee on pulmonary nomenclature.

It appears that the definition of a syndrome is to a large extent determined by the approach of the researcher. Particular emphasis is given to the very great interest of a classification as meticulous as possible, using all relevant clinical data not only as snapshots, but also over the longest possible observation period. Such a classification of carefully followed individual cases may contribute essentially to the identification of syndromes and to the detection of pathomechanisms and pathogenesis.


Early discrimination between intrinsic and extrinsic factors in chronic obstructive lung disease.

15 subjects, divided into (1) normal, (2) with small airway obstruction (SAO) and (3) with chronic obstructive lung disease (COLD), were studied to understand the mechanism of the obstruction. The curves of maximal expiratory flow versus static pressure are particularly useful for this purpose, when we have a SAO. In fact, only at this early stage, we can identify by this way two different groups: subjects obstructed by a pure extrinsic mechanism, and subjects obstructed by a pure intrinsic mechanism.


[Pulmonary damage following assisted ventilation and oxygenotherapy in the cat (author's transl)].

Groups of 6 cats were curarized and maintained under assisted ventilation with either air or a 35% oxygen mixture. Lungs were then fixed and divided in small pieces, some of which were chosen at random for histological studies. Pulmonary lesions after assisted ventilation with air were rather discrete, even after 72 h. On the contrary, after the same period of ventilation with 35% O2, all cats showed capillary dilatation, interstitial edema and intra-alveolar hemorrhagic exsudate.


[Statistical study of the correlations between spirometric data and arterial blood gas tensions. II. During a 40-watt exercise (author's transl)].

PaO2 and PaCO2, after 5 min of a 40-Watt exercise, and spirometric data have been statistically evaluated in 152 patients with chronic obstructive bronchitis. In these patients, the hypoventilation syndrome increases during exercise. The correlation between age and PaO2 is identical during rest and exercise, but the correlation between PaO2 or PaCO2 and FEV1 (% predicted) is closer during exercise than during rest. The value 50 of the FEV1 (% predicted) divides the patients into two groups: the patients who stay normocapnic and those who become hypercapnic or increase their hypercapnemia. These data show the interest of the FEV1 (% predicted) values and allow to explain the evolution of the arterial blood gas tensions during exercise.


Lung cancer. A statistical study based on autopsy data from 1928 to 1972.

The analysis of autopsy data from 1928 to 1972 shows that the relative frequency of lung cancer has undergone a fourfold increase till about 1962, and has since then remained practically constant. The right lung is more often the seat of carcinoma than the left lung and upper lobes more often than the lower lobes. For females the upper-lower lobe asymmetry is not significant. The nonuniform distribution of tumor sites is explained on the basis of 'contact hypothesis'. Some age and sex factors have been studied.


Histology of nasal polyps of different etiology.

The aim of the present study is to elucidate the correlation between etiology and histology in nasal polyps with special regard to cystic fibrosis (CF). Nasal polyps from 15 children with CF and a control group of non-CF polyps from 15 adult patients were examined by light-microscopy. The histological evaluation was carried out on a blind basis in order to avoid bias. Among the parameters used, the tissue eosinophilia proved to be the most valuable factor in the differentiation between CF and non-CF polyps, as only few eosinophils were found in the CF-polyps. The polyp glands were few and generally pathological. Some characteristics abnormalities in the grandular morphology are apparently more common in CF polyps. It is concluded, that the histological examination of nasal polyps is of importance for the correct classification of the patient, but the diagnosis of CF cannot be made based on microscopy of polyps. Further studies including blinded histological examination of nasal polypous tissue might contribute to a more differentiated diagnose of nasal polyposis.


Quantitative histology of the maxillary sinus.

The entire mucosa from 10 normal maxillary sinuses was removed post-mortem and stained by the PAS-alcian blue whole-mount method. The density of goblet cells and of mucous glands was investigated. The median density of goblet cells was 170 cells/field, corresponding to 9,600 cells per mm2, with wide individual variations, but there were no significant differences in density between the various walls. The density of goblet cells was somewhat higher than in the nose. Glands were very scarce and small in the maxillary sinus. Their median density in most walls was 0.15-0.20 gland/mm2, but in the medial wall significantly higher, 0.5 gland/mm2. The lower density of glands in the maxilly sinus than in the nose, where it is 8-9 glands/mm2, is in complete agreement with lesser requirement of the antral mucosa for moistening, cleaning, and warming of the air. Quantitative histological studies of normal mucosa will form the basis for studies of abnormal mucosa.


[Effect of carbamazepine on free and protein-bound tryptophan in the blood of epileptic patients and healthy volunteers].

The Authors estimated the influence of carbamazepine on both free and linked albumin triptofane in the plasma of 6 epileptic patients and of 6 healthy volunteers, during a period of observation lasting 7 days. The relation free/linked triptofane decreased significantly in the epileptic patients after the first day of treatment, while an analogous phenomenon was observed in healthy people only after the seventh day. Part of triptofane disappeared from plasma thus suggesting a cerebral uptake of the synthesis of serotonin. Carbamazepine displaced some unknown compounds from their links with plasmatic albumin, thus allowing triptofane to link itsel. The Authors therefore confirm the role played by anticonvulsive drugs in modifying the pool of free aminoacids in plasma.


Polycythaemia vera terminating in acute leukaemia. A clinical, cytogenetic and morphologic study in 8 patients treated with alkylating agents.

A total of 120 patients with polycythaemia vera (PV) were observed between 1971-1976. 8 of them developed acute leukaemia (AL). The clinical course, cytogenetic and morphologic findings of these patients are described in detail. Alkylating agents were the main treatment for all patients who developed AL. 4 of them obtained alkylating drugs alone. Deaths in AL constituted 36% of the deaths observed in the groups treated with alkylating agents and 23% of the total number of deaths in these series. All patients who developed AL had active disease but they had no distinctive features predicting a malignant development. The time interval between PV diagnosis and development of AL was relatively short for those patients who were induced and maintained with alkylating agents alone. It is remarkable that 3 out of 8 patients had erythroleukaemia. Cytogenetic pretreatment studies were performed in 3 patients and all were normal. 7 patients were studied with banding techniques during the leukaemic state and all but one have shown multiple and complex abnormalities indicating several super-imposed cell lines. It seems probable that PV patients treated with alkylating agents for remission induction and maintenance may run even a greater risk for AL development than those treated with 32P.


Serum thrombopoietic activity following administration of vinblastine.

A possible role of humoral factors in the pathogenesis of vinblastine-induced thrombocytosis was examined. The thrombopoietic activity in serum of experimental animals was tested for its ability to stimulate the incorporation of 75-Se-selonemethionine into platelets of thrombocythaemic mice. The administration of low doses (0.1--0.5 mg/kg body wt.) of vinblastine to rabbits caused a significant increase in serum thrombopoietic activity. Higher doses of vinblastine (1--5 mg/kg body wt.) also increased the serum thrombopoietic activity, but this increase was preceded by a transient drop in the platelet count of peripheral blood. This thrombocytopenia could have been a stimulus for an increase in thrombopoietic activity, through a compensatory feedback mechanism. The vinblastine-induced increase in thrombopoietic activity was abolished by bilateral nephrectomy but not by bilateral ureteral ligation. These data suggest that kidney tissue may be a major source of the serum thrombopoietic factors.


Obesity, plasma lipids and polymorphonuclear (PMN) granulocyte functions.

20 obese subjects were compared with 20 controls with normal weight regarding their polymorphonuclear (PMN) granulocyte functions, and plasma lipids. The obese subjects showed a significantly decreased PMN bactericidal capacity, and increased PMN adherence. No differences were found in their mean PMN chemotaxis and opsonic capacity of plasma. The values of plasma triglycerides and free fatty acids were higher in the obese, while plasma cholesterol and phospholipids corresponded to the control values. The changes in granulocyte function did not correlate significantly to plasma lipid levels or to body weight and Broca's index in either group. --It is concluded that changes in granulocyte function occur in obesity, but are not related to plasma lipids or degree of overweight.


The effect of vincristine on haemoglobin synthesis.

Vincristine in a concentration of 0.5 and 4 X 10--(5) M causes a decrease of 16% and 73% respectively, in the synthesis of globin by peripheral blood reticulocytes. At the higher drug concentration alpha/beta ratio is significantly lower than the normal ratio of unity and is 0.83 +/- 0.09. These effects of vincristine are probably related to the ability of the vinca alkaloids to bind to ribosomes and their subunits.


Microcalorimetric measurements of heat production in erythrocytes of patients with liver diseases.

Erythrocyte metabolic activity has been investigated in 12 patients with severe liver disease. The erythrocyte resting heat effect value has been found to be 25% higher than normal (P less than 0.005). A normal value was obtained when heat effect was measured under maximal stimulation with 10(-4) M methylene blue (MB). Glucose consumption was found to be normal, both in unstimulated and methylene blue stimulated erythrocytes. The present calorimetric results do not give support to the hypothesis that haemolytic anaemia in patients with liver disease is related to decreased activity of the pentose phosphate pathway.


Genetic control of primary and secondary IgG responses to sheep erythrocytes in mice.

The genetic control of the primary and secondary IgG responses to sheep erythrocytes has been studied by using inbred, H-2-congenic, and intra-H-2-recombinant mouse strains. According to our results, the primary IgG respone is under multigenic control. There is a correlation, however, between the titer of primary IgG antibodies produced and the H-2 phenotypes among the mouse strains tested. One H-2-linked gene maps at the I-B subregion, whereas another gene can be mapped at or closely linked to the H-2D region. Low and high responsiveness were associated with H-2b, H-2f and H2a, H-2d, H-2k phenotypes, respectively. By comparison of the responses of inbred and congenic strains having the same H-2 phenotype, it can be concluded that background genes influence the primary response only slightly but have almost complete control over the secondary response.


Damage of liposomes in antibody-dependent cell-mediated cytotoxicity.

Lymphoid cells bearing Fc receptors are able to lyse antibody-coated animal target cells in an antibody-dependent cell-mediated cytotoxicity reaction. The results presented here show that liposomes consisting of sphingomyelin, cholesterol, and cardiolipid and coated by cardiolipidic antibodies could be destroyed by spleen or thymus cells. No alteration of liposomes was observed when normal rabbit serum was used or when the effector cell population was depleted of cells bearing Fc receptors. The lysis of antibody-coated liposomes by effector cells could be carried out in two steps. In the first step, the fixation of antibodies on the cardiolipidic antigens could lead to a reorganization of the liposomal membrane. In the second step, the effector Fc-receptor-bearing cells might amplify this alteration of the liposomes.


Responses of alloantigen-primed lymphocytes in vitro. The contribution of increased frequencies of responding lymphocytes to differences between reactivity of normal and primed lymphocyte populations.

Sensitization of lymphocytes against allogeneic cells in vitro results in significant enrichment of alloreactive lymphocytes. Such enrichment was found to profoundly influence the conditions for measuring proliferative responses. Fewer primed lymphocytes than unprimed ones had to be cultured to favor optimal proliferation. Second, proliferative responses could be detected using 10 to 20 times fewer primed responding cells than when using unprimed responders. Finally, although responses of both unprimed and primed lymphocytes were dependent on the number of stimulator cells in culture, the primary mechanism(s) through which this dependence was expressed appeared to differ. The results demonstrate that, under the same conditions, comparisons of responses of two populations that contain different proportions of reactive lymphocytes may not be justified.


Effector mechanisms in allograft rejection. III. Kinetics of killer cell activity inside the graft and in the immune system during primary and secondary allograft immune responses.

The cells recovered from sponge matrix allografts and from various lymphoid organs of recipient mice were tested for their ability to perform relevant target cell lysis in vitro. In the primary response, the peak cytotoxic activity was detected 8 days after transplantation, inside the graft, in regional lymph nodes, and in the spleen. In the secondary response, the peak cytotoxic activity in the regional lymph nodes and in the spleen took place promptly, 4 days after transplantation. The peak activity inside the graft was recorded on day 7. In the primary response, the activity inside the graft had declined. In the secondary response, the cytotoxic activity in the blood was low, and significant cytotoxic activity appeared only after the activity in the blood was high and demonstrated a biphasic profile, with one peak on day 3--4 and another activity peak on day 14. Killer cells were detected inside the graft for a far longer time in the primary (4 weeks) than in the secondary (2 weeks) response. I conclude that cellular kinetics in the secondary anti-allograft response is qualitatively but possibly not quantitatively different from the primary response.


Oligoclonal measles virus-specific IgG antibodies isolated from sera of patients with subacute sclerosing panencephalitis.

Measles virus-specific antibodies isolated from sera of six patients with subacute sclerosing panencephalitis (SSPE) were all composed of oligoclonal IgG proteins, in contrast to the polyclonal IgG antibodies isolated from sera of healthy individuals. Periods of disease progression were associated with an increase in number and amount of oligoclonal IgG antibody proteins, and a decrease was observed in disease remission. A correspondence between the oligloclonal measles-specific IgG of serum and the oligoclonal IgG proteins of cerebrospinal fluid (CSF) occurred in each case. It is concluded that sera from patients with SSPE may be used instead of CSF as a source for the isolation of measles antibodies of restricted heterogeneity.


IgG1 subclass restriction of oligoclonal measles virus-specific IgG antibodies in patients with subacute sclerosing panencephalitis and in a patient with multiple sclerosis.

A restriction to the IgG1 subclass was demonstrated for measles virus-specific IgG antibodies isolated from the sera of five patients with subacute sclerosing panencephalitis, from the cerebrospinal fluid of one of the patients, and from brain extract from a sixth patient. A predominance of IgG1 was also observed in measles antibodies isolated from the serum and brain extract of a patient with multiple sclerosis. Evidence is presented that the IgG1 restriction is associated with the occurrence of oligoclonal measles antibodies in these patients. A similar restriction to the IgG1 subclass was not observed in measles antibodies isolated from the serum of a measles-convalescent child or from pooled normal serum and IgG.


Occurrence of amyloid-related serum proteins in patients with benign monoclonal gammopathy.

The serum protein SAA, which is related to the amyloid fibril protein AA, was detected by double immunodiffusion using anti-protein AA antiserum. The SAA level was elevated in 16 to 32 patients with benign monoclonal gammopathy (BMG). In addition, two BMG sera reacted with an antiserum to amyloid fibril protein of immunoglobulin light-chain type, V lambdaI (EF), and one reacted with antiamyloid protein VlambdaV (AR). The reactivity of the BMG sera with antisera to the various amyloid fibril proteins was strikingly similar to that of 35 sera from patients with myelomatosis. In the age group of 50--70 years the proportion of SAA-positive sera in BMG (53%) and myelomatosis (56%) was strikingly higher than that of the normal controls (5%). In older subjects (70--90 years), however, the frequency of SAA in BMG or myelomatosis, although increased (53%--54%), was not significantly greater than that of a control group of apparently healthy individuals (44%).


Immunoglobulins in families of myeloma patients.

The serum immunoglobulin levels of 200 first-degree relatives and 23 spouses of 32 patients with myelomatosis were compared with those of age- and sex-matched control persons. First-degree relatives of myeloma patients appeared to have higher serum levels of IgG (P less than 0.05), IgA (P less than 0.05), and IgM (P less than 0.01) than their age- and sex-matched controls. The spouses as a group did not differ from their controls in this respect. No statistically significant difference in the incidence of M-components among family members (0.6%) and spouses (4.3%) was found compared with the incidence in the general population (0.9%). Myelomatosis as such appeared to be more frequent than in the general population (P less than 0.05).


Similarities of Fcgamma receptors on trophoblasts and placental endothelial cells.

The trophoblastic tissue and endothelium of fetal stem vessels in cryostat sections of first-trimester and term human placentae adsorbed erythrocytes sensitized with IgG antibodies of human, rabbit, and guinea pig origin. Native and heat-aggregated human and rabbit IgG, and human IgG subclasses except IgG2 inhibited the hemadsorption. However, the Fc fragment of IgG2 inhibited the hemadsorption similarly to the Fc of pooled IgG. No inhibition was obtained with other immunoglobulin classes or fragments. The inhibitory activity of IgG and Fc fragments was abolished by partial reduction and alkylation, indicating that inter-heavy-chain disulfide bonds are required for the binding. Immune complexes prepared at slight antigen excess showed an eightfold stronger inhibition than antiserum alone. Both receptors were sensitive to formaldehyde, periodic acid, and heat. The Fcgamma receptors on the trophoblasts and on the endothelium in human placentae are apparently similar.


Rubella antibodies and acute viral hepatitis.

High antibody titres against rubella and measles viruses have recently been associated with certain chronic disorders such as chronic active hepatitis and occasionally with acute hepatitis. The present study was designed to evaluate the frequency of this association with acute hepatitis. Haemagglutination inhibition (HI) and complement fixation (CF) antibodies to rubella, measles and influenza A viruses were determined in 97 consecutive patients with acute viral hepatitis and in 97 control persons matched by sex and age. In patients, particularly in those over 30 years of age, a small but statistically significant increase in rubella HI titres was seen. In 3 hepatitis cases the rubella HI titres were very high (greater than or equal to 2 560). The antibody levels against measles and influenza A viruses did not differ from the controls. The present data indicate that a small proportion of acute hepatitis patients show a transient strong humoral immune response to rubella virus. The reason for this is not known.


Antibodies to hepatitis B surface and core antigens in haemophiliacs and their contacts among hospital personnel.

In a group of 65 haemophilia patients one was a chronic carrier of hepatitis B surface antigen (HBsAg) and the remaining 64 patients had antibody to hepatitis B surface antigen (anti-HBs). The antigen carrier and 63 of 64 haemophiliacs with anti-HBs also had antibody to hepatitis B core antigen (anti-HBc). In a second group consisting of 6 younger haemophiliacs, whose treatment with clotting-factor concentrates was started after the initiation of HBsAg tests of all blood products, 3 showed evidence of ongoing or past infection with hepatitis B virus. The prevalences of anti-HBs and anti-HBc among the personnel of the Coagulation Laboratory did not differ from that of the normal population. Anti-HBs was detected by passive haemagglutination and radioimmunoassay, and anti-HBc by immunoelectroosmophoresis.


Myalgia nuchae as a manifestation of epidemic influenza.

Two cases of acute cervical myalgia in connection with symptoms of malaise and fever are presented. Both patients had serologically proven influenza infections, types A and B. No previous reports have been found of any association of the present syndrome with influenza infection.


Immunologic investigation in children with recurrent pneumonia.

In vitro lymphocyte stimulation by phytohemagglutinin (PHA) and pokeweed mitogen (PWM) and tests for granulocyte function were performed in 12 children with recurrent pneumonia. Reduced lymphocyte stimulation was found at repeated tests in 2 children and transiently decreased lymphocyte stimulation in 6 more children. In 3 patients, reduced bactericidal capacity of granulocytes was demonstrated, and in 1 cast stimulation showed decreased NBT activity of granulocytes. One patient examined had immunoglobulin deficiency.


Pathogenic free-living amebae (PFLA) from frozen swimming areas in Oslo, Norway.

Water samples were taken from 4 frozen swimming areas in Oslo, Norway and examined for pathogenic and non-pathogenic limax amebae. All samples contained amebae and 2 of the areas yielded pathogens (Acanthamoeba castellanii). The relationship between distribution and temperature is discussed.


Endocarditis caused by Pasteurella multocida.

A 51-year-old previously healthy man developed endocarditis with low grade fever, aortic insufficiently and multiple arterial emboli. An atypical strain of Pasteurella multocida was isolated from each of 3 consecutive blood cultures. Protracted treatment with high doses of penicillin G was necessary to eradicate the infection. Following resection of the damaged aortic valves and implantation of a valve prosthesis, the patient recovered. P. multocida should be regarded as one of the possible causes of subacute bacterial endocarditis.


Fulminant septicemia caused by Yersinia enterocolitica.

A lethal case of septicemia caused by Yershia enterocolitica serotype 3 is described. A 59-year-old male, previously healthy, presented with 6 weeks of fever, abdominal pains and gradual prostration ending in overhelming septicemia and death before a conclusive diagnosis was established. Necropsy showed cirrhosis, haemochromatosis and numerous abscesses in the liver.


[Taphophobia and resurrection mania].

There are two rare psychopathological phenomena: The fear to be buried alive (taphophobia) and the delusion to rise again from the grave (delusion of resurrection). These cases are given as illustration. Taphophobia is counted among the neuroses, the delusion of resurrection is a cardinal symptom of the psychosis "phantastic paraphrenia" Both states are rooted in unconscious fears and and wishes in man, especially in superstition. The theoretical concept behind these psychopathological phenomena is twofold--using an eclectic open system of interpretation--taphophobia is seen in the light of psychoanalysis, delusion of resurrection is explained in terms of the psychiatric thinking of K. Leonhard.


[Don-Juanism. Sexual formation of style as a culture-historical phenomenon and psychiatric problem].

This is a representation of the developing of "Don Juan" from a dramatic figure into a prototype of a particular human behaviour. First was described a general view of the literary dramatic essay on this theme, of the philosophical, psychoanalytic, anthropological, sexual-pathological aspects of the figure of Don Juan and of "Don Juanism". Then a case of Don Juanism was discussed. The special characteristic style of sexual behaviour was not seen isolatedly, but was regarded as an expression of a special structure of social behaviour. Finally an attempt was made to depict the different interpretations of the figure of Don Juan within our cultural reach in a common perspective. The interpretation and evaluation of this phenonmenon essentially refer to the anthropological conception of v. Gebsattel and Giese.


[Diagnoses in the Camberwell-register, a cumulative psychiatric register of cases].

The reported investigation indicates that the diagnostic labels applied to mentally ill patients are changed frequently. Of a sample of 100 such patients, 20 received a second diagnosis, differing from the initial one, within 4 weeks, while within 2 years the diagnostic category had been changed for over half the cases. How far these changes reflect the frequency with which psychiatric conditions succeed one another, and how far the extent to which different psychiatrists apply different names to the same clinical picture, remains an open question. It was further established that even a model psychiatric case register such as the Camberwell Register, which is well organized and has highly-experienced staff, could not monitor all diagnostic changes.


[Mass-hysteria with Koro-symptoms in Thailand].

Koro, a psychogenic anxiety syndrome interfering with genital body image and sexual functioning, has hitherto been described as occurring mainly in isolated cases of South Chinese males. The present communication reports an epidemic outbreak in November 1976 in Northeastern Thailand where within a few days at least 200 patients, most of them Thai and two-thirds males, were treated at local hospitals. Main presenting symptoms were acute anxiety, in some cases leading to fainting, (subjective) shrinking of the penis and impotency in men, shrinking and/or itching of the external genitals and frigidity in women; further complaints included initial nausea and dizziness, abdominal pains, headaches, facial numbness. All patients recovered after brief symptomatic intervention. Popular opinion and news media echoed the patients' paranoid projection of viewing the epidemic as caused by Vietnamese food and tobacco poisoning in a hideous assault against the sexual vitality and general health of the Thai people, in the context of a specific socio-cultural and politico-historical situation. It appears that an adequate interpretation of Koro and of analogous hysterical symptom formation would have to go beyond the hitherto applied psychoanalytic models by considering the specific sociodynamic factors involved in the pathogenesis of such phenomena.


[Concept determination and classification of the so-called epileptic psychoses].

Some concepts and classifications of the epileptic psychoses are discussed with special regard to their capacity of being integrated into a multiconditionel view. In epileptics, too, the term of "psychosis" should no longer be connected to the axiom of the somatic origin of the psychic syndrome. The term of "twilight state" should be reserved to those among the epileptic psychoses which go along with troubles of consciousness. The socalled episodic morbid moods of the epileptics are no more merely to be understood as psychoses of somatic origin. They may as well develop as a psychic reaction. If one conceptualizes the psychic troubles of the epileptics as "transient syndrome" (Durchgangssyndrom), as functional psychosis, or as psychosyndrome originating from local or diffuse brain damage, their classification must be limited to the undoubtedly somatogenic psychoses. The term of "epileptic psychosis", however, includes the somatogenic, endogenic, as well as the psychogenic psychoses of the patients with epilepsy. The question of the psychogenesis of schizophrenia-like, maniac or depressive psychoses in epileptics until now cannot be answered because the psychosocial patterns which might condition them have not jet been investigated upon. Anyhow, the exclusive psychogenesis of a schizophrenialike epileptic psychosis leaves to be proved.


[The field of suicide. Empirico-statistical study on 3086 examined persons of both sexes and from 2 cultural spheres].

With the aid of an instrument constructed by the author especially for the purpose, this study examined the suicidal behavior of a representative sample of the normal population (3086 subjects). The results make it possible to describe a suicidal-depressive personality along the dimensions of its basic elements, its accompanying phenomena and consequences, and finally the genetic aspects of depression. The main elements of both the suicide attempt and the suicidal tendency are identical, although they are more intense and clearcut in the suicide attempt. Another noteworthy result of this study is the frequency data: the suicide tendency was found in 15 to 35% of the cases, according to the various sub-groups; and the suicide attempt in 2.5-13%. These percentages lie far above the currently known estimations.


[Contact disorders as a problem of the civilized society].

Emotional chillness of human living together in modern civilized societies is provoking not only an increasing amount of neurotic diseases on the one hand and unsteadiness on the other, but also beyond that some distinct kinds of mental disorders. Psychodynamic sources of those disturbances are discussed, guided by case reports on paranoic reaction, cardiac neurosis, depressive reaction, delusion of being beloved, alcoholism after getting widowed, and paranoid hallucinatory Psychosis as a result of loneliness.


[Methodology of a long-term study of senile dementia].

The longitudinal method aims to point out phenomena that are bound with time. It is thus particularly fit for the study of ageing as it is proved by many large American research programs. It is also useful to follow during a limited period (short term) the natural history of pathologic entities as degenerative illnesses. After mentioning the fundamental conditions of any longitudinal approach, the program of this study on senile dementia is described. Each case is followed for 2 years, with an examination every 6 months. This later is based on anamnestic, psychiatric, neurologic and functional items as well as on intellectual functions and EEG. A sample of 50 cases should be collected. After a period of 3 years prospection 91 cases were found of which on 31 fitted. The difficulty of recruitement is bound to several factors: the little knowledge of senile dementia frequency in the general population, the poor criteria used in their choices by non-specialists as the directors of homes, the refusals and the withdrawals. Difficulties in establishing contact with patients showing behavioral troubles are underlined as well as cooperative problems with the surroundings. The repetition, at regular periods, of psychological tests sets the problem of learning. In the way of senile dementia it should decrease with the illness evolution thus bringing the overestimation of initial capacities, the gap becomming artifically greater between performances at the beginning and at the end of the observation.


[Neurologic accidents and oral contraceptives].

The frequency of cerebrovascular accidents in women taking oral contraceptives (OC) is at the second place after phlebitis of the legs. Arterial infarcts and transient ischaemic attacks are recorded. Their mechanisms are poorly understood. Embolism is likely. In some cases arterial dissecting aneurysms have been demonstrated or are very likely. Venous occlusions may also occur. In many cases headache or transient attacks have occured prior to the major accident. OC have more than 50 metabolic effects among which changes in antithrombin III, in serum lipids, in the chemistry of the arterial wall. Neurological evaluation is mandatory in women taking OC.


[Cerebrospinal sarcoidosis (with reference to 2 personal cases)].

Two cases of leptomeningo-cerebro(-spinal) sarcoidosis which were not clinically diagnosed in two women (22 and 33 years old) are described. The two women died because of this disease, 8 months, and 1 1/2 years, resp., after the first manifestation. In the first case there was a largely isolated local affection of the hypothalamus and neurohypophysis. In the second observation, beside an involvement of the bifurcate lymph nodes and of the lungs, it was only the central nervous system that showed massive diffuse changes partially due to a granulomatous angiitis of cerebral and visceral vessels. On the basis of pathohistology, the differential diagnosis to the histiocytosis X for case 1 and to the granulomatous giant cell angiitis for case 2 are discussed.


[A case of total hemipherectomy].

The author described a case of extensive total hemispherectomy extending to the red nucleus, gave a review of the literature of such conditions together with a brief historical review. He analysed in detail the secondary degenerative changes of the nervous tracts within the brainstem. The histological study of the remaining hemisphere, the cerebellum and the membranes revealed the following: 1) a false sub-dural membrane within the surgical space, proliferation of the arachnoidal cells and a granular ependymitis, changes which were interpreted as an attempt to fill the empty space resulting from the operation; 2) an inflammatory meningo-encephalitis with rare intra-nuclear inclusions quite suggestive of a reaction due to a slow virus or of a slow resorptive process. From a clinico-pathological point of view, this case, an almost experimental model, illustrated the possibility that only one hypothalamus would be sufficient to maintain a good hormonal equilibrium.


Mortality and functional prognosis in a geriatric population.

The prospects of survival and changes in function (need for care) are evaluated after a two-year period for the 1486 persons resident in the geriatric institution "De Gamles By", Copenhagen, on January 15, 1967. It is shown that the logarithm of the survival percentages is approximately a linear function of the time. The prospect of survival is slightly better for the females than for the males because of a significantly higher mortality among the dependent men than among the dependent women. There is no difference as regards sex in the mortality rate for the independent patients (25%). The prospect of survival is poorest in the heavily dependent patients, regardless of sex. Only 5% of the patients were discharged to their homes or transferred to a hospital or some other institution. There was an improvement in the care status, regardless of sex, in 4%, the condition was unchanged in 61%, and there was deterioration in 35% of the 870 patients who survived the two-year period. On the basis of the prospects of surviving whilst waiting for admittance, the saving in institutional places is discussed. The increased need for more accomodation in geriatric institutions is emphasized in order to reduce the unfortunate consequences of the time spent in waiting for admission.


Medical ethics and child abuse.

The practice of good medical ethics is of particular importance in cases of juvenile maltreatment. In a number of court cases concerning battered children doctors' statements have been presented to the effect that maltreatment has not taken place. In twelve cases reported during the period 1971-75 the doctors' statement was misleading. In each of twelve cases it should have been the doctor's duty to record in his statement that this was a case of child abuse and/or neglect. It appears that as far as the individual doctor was concerned, he often state "these things should be dealt with by the child welfare authorities", who in their turn mereley referred to the doctor's statement. It is unlikely that this is maltreatment", the child welfare officer will reiterate. In six cases this statement was used in court before any evaluation had been made on the basis of the sequence of events. In all twelve cases the doctor had failed to make an adequate examination of the symptoms. It seems as if the doctor was not sufficiently interested in providing evidence of assault. In some cases, even, pathognomonic findings must have been kept secret. Psychological or emotional maltreatment need to be evaluated by a child psychologist who is a practical diagnostician. Injuries arising from physical abuse are most successfully diagnosed on surgical and casualty wards. Pediatricians must be cautious about dismissing diagnoses of maltreatment that have been established by other specialists, especially child psychologists.


Records based on clinical examination as an indicator of alcohol involvement in injuries at emergency stations.

Clinical detection of alcohol involvement (AI) and its recording (ethyl sign) in accident patients was evaluated by comparing the ethyl signs with blood alcohol concentrations (BAC) in 1012 injury victims. Of the 337 BAC-positive cases 50% had a positive ethyl sign, while an additional 13% had some reference to alcohol in their patient notes. Thus, the overall recording rate was 63%. Computer analysis of the statistics from the same emergency station revealed positive ethyl signs in 13.5% of all the 44 372 patients in 1973. The drunken victims of falls (44%) and fights & assaults (26%) formed the main bulk (70%) of all drunken injury patients. Ethyl sign was found to be a specific, though not a sensitive, indicator of AI and a useful device for studying the strain alcohol places upon the emergency services, statistically.


Standard of living, health, and utilization of social and health services. A survey of the population of three districts in Malmö.

A survey of the social and medical conditions of the population in three well-defined districts in Malmö was made in order to obtain background data for the planning of open care. A random choice was made of 70 households from each of the three residential areas for interview purposes. Available data concerning actual individuals were collected from the social and health authorities. Wide variations existed between the three districts. The inhabitants of Kroksbäck, mostly young families with children, were comparatively healthy somatically, whereas many had social problems; mental troubles were common too. In Lorensborg, the inhabitants did not conspicuously deviate from the average, as regards complaints. In Ellstorp, with its elderly population, two in three had impaired health, mostly in the form of somatic complaints; moreover their teeth were in poor condition. One in three of all interviewees had felt ill in some respect during the fortnight preceding the interview, and more than half had some current health problem. Eleven percent of all interviewees had sought medical advice during this fortnight. One in three of the interviewees was using prescribed remedies at the time of the interview. Eleven percent of those in the gainfully employable age range had been sick-listed for some part of the fortnight. The need for a general practitioner service, continuity of care, health centres and integration of social and medical care is discussed.


[Serologic-nephelometric method for the detection of allergic reactions to small-molecular drugs using polystyrene sodium particles instead of soluble polystyrene sulfonate sodium as pharmaceutic aids].

The previously developed two-step method using soluble polystyrene sulfonate-Na for the detection of allergic reactions to small molecular drugs has been replaced by a one-step method using particles of the same substance. The new method is simpler to perform. Particulate polystyrene sulfonate is commercially available. The drug is added in increasing concentrations to diluted serum samples and the light scattering is measured with a highly sensitive nephelometer. Both the specific serum factor in the patient's serum (globulins) and the non-specific factor contained in most fresh human sera are particularly labile.


[Course, prognosis and therapy of enterococcal meningitis as compared with other streptococcal meningitides].

Seventy-five cases of enterococcal meningitis and 182 cases of meningitis caused by other streptococci are collected from the literature and discussed. Enterococcal meningitis occurs preferentially in debilitated patients at the extremes of life, i.e. in infants, small children and the elderly sick. Streptococcal meningitis, by contrast, may occur at any age in infected individuals. Enterococcal meningitis not uncommonly occurs in the presence of mixed infections. Residual defects following recovery are found in both forms of the disease even where therapy was apparently adequate.


[Bleeding cerebral aneurysm: indication and timing of angiography and surgery].

Recent experience with cerebral aneurysms suggests that it is unadvisable to abide by the principle that angiography should be delayed for 7-10 days and surgery still longer. There is no hard and fast rule for the timing of angiography and surgery: this must be determined in the light of the clinical condition. The following guideline may prove of help: in cases of slight hemorrhage, angiography with 24 h and operation within the first few days. In suspected intracranial hematoma, emergency angiography and surgery are of course mandatory. Surgical intervention, but not angiography, should be delayed in severe bleeding with lasting disturbance of consciousness, neurologic deficit and markedly bloody cerebrospinal fluid. The prognosis can be improved by rapid diagnosis, proper selection and early operation.


[Prospective study of the 1st 197 endoscopic retrograde cholangio-pancreatographies (ERCP) in Basel (1973-1975)].

Cannulation of the papilla has been successful in 144 out of 197 ERCPs. The rate of success increases with the experience of the endoscopist. The intended filling of the pancreatic duct was successful in 87%, of the bile ducts in 64% and of both duct systems in 28%. The correct diagnosis was made in 77% of pancreatic affections, 71% of biliary diseases and in 43% when both duct systems had to be evaluated. 10 ERCP findings disagreed with the final diagnosis, mainly because the distinction between acute and chronic pancreatitis was not correct. The differentiation of chronic pancreatitis from pancreatic carcinoma is not easy and the evaluation of processes localized to the papilla may be difficult. Complications occurred in 6.6%. It is concluded that the ERCP should be limited to regional hospital centers and should be performed only in cases with well defined indications.


[How great is the risk of hepatitis due to travel? Retrospective study in the region of Zurich 1971-1976].

Between 1971 and May 1976 221 adult persons originating from the region of Zurich (Switzerland) developed acute viral hepatitis within the incubation period after a usually brief trip abroad. In those returning from European countries the ratio of HBsAg positive and negative infections was similar to that in the Canton of Zurich. From other continents the proportion of non-B hepatitis was 66-94%. On the basis of travel statistics the risk of this disease was assessed as highest in West Africa and Mexico; trekkers are especially exposed. The indication and dosage for immunoprophylaxis are discussed in detail.