The evoked potential in pharmacopsychiatry.

Somatosensory, visual and auditory evoked potentials (EP) were recorded in different psychatric populations before as well as during psychotropic drug treatment. Drug-free schizophrenic patients showed shorter latencies, smaller amplitudes and an increased intraindividual variability in their EP than controls. Psychotic children but also children of schizophrenic mothers (so-called high-risk children) exhibited similar differences as compared to controls, suggesting a CNS overarousal as the pathoneurophysiological substrate of schizophrenia. Shorter latencies were also seen in children  of psychopathic fathers. Regression and correlation analysis of psychopathological and EP measurements in hyperkinetic children revealed the following findings: the shorter the latencies and the higher the amplitudes, the sicker was the child. During psychopharmacotherapy, significant changes occurred in the EP measurements, which were found to be significantly correlated with clinical improvement or deterioration. Neuroleptics induced a latency increase and an amplitude decrease in schizophrenic patients and psychotic children.  Interestingly, amphetamine produced in hyperkinetic children a latency increase too, thus explaining the 'paradoxical' clinical response to amphetamine observed in these children. Differences between therapy-responsive and therapy-resistant patients are described and, finally, some data concerning the role of the pretreatment EP as a predictor of therapeutic outcome are discussed.


Dysgenesis of the deep venous system as a diagnostic criterion for holoprosencephaly.

The angiographic features of three cases with holoprosencephaly are reported. In all of them, the galenic venous system seemed to be deficient and the basal ganglia were drained by peculiar veins which coursed laterally and drained directly into the lateral sinus. These peculiar veins are considered to be remnants of the embryonic diencephalic veins, suggesting that these patients retain their early embryonic pattern of venous drainage. The diagnosis of alobar holoprosencephaly is established by the demonstration of the azygos anterior cerebral artery coursing along the frontal bone with excessive undulations. But with lobar holoprosencephaly, this characteristic feature is not present, and dysgenesis of the deep venous system is important for the diagnosis of holoprosencephaly.


Spiral spring effect in catheters as a complicating factor of femorocerebral catheterization.

This paper describes a complication of selective femorocerebral catheterization which was due to iatrogenic embolization of atherosclerotic material originating from the bifurcation of the common carotid artery. After analysis of the catheter maneuvers inherent to the special shape of the type of catheter used (Sidewinder, Cordis Corporation), it is concluded that this complication resulted from incorrect catheter manipulation and an incorrect choice of the dimensions of the preshaped part of the catheter in relation to the diameter of the aortic arch. Two recommendations to avoid this complication are made.


Normal limits of the lateral cerebral ventricles on the lateral phlebogram: a statistical analysis.

The highest points of the subependymal veins of the lateral cerebral ventricles (frontal horn, body and atrium) and the height of the body have been evaluated in selected patients. Through a statistical analysis, they have been demonstrated to depend on the height of the supratentorial compartment of the skull. Taking into account this relation, the results obtained furnish reliable criteria for evaluating ventricular enlargement or sectional deformity.


Calcified intramedullary aneurysm in spinal angioma.

A case of a calcified intramedlllary aneurysm in a spinal angioma is presented. The value of preoperative angiography in the evaluation of intraspinal calcifications is discussed.


Computed tomography and subarachnoid hemorrhage.

CT scans have been made on 39 of 41 patients who presented with subarachnoid hemorrhage. Blood could be visualized in the cisterns of 18 of 32 examinations performed within five days of the hemorrhage all having aneurysms. Among the other 14 there were three in whom no aneurysm was found on angiography. The distribution of blood in those that showed it was useful in pointing to the position of the aneurysm. Much other information was obtained, for instance about rebleeding and infarction. CT should routinely be the primary examination, followed by selective angiography.


Potentiation of Amipaque epileptogenic activity by neuroleptics.

Experiments conducted on rabbits confirmed that chlorpromazine potentiates the weak epileptogenic action of Amipaque (metrizamide). Chlorpromazine withdrawal for a period of 48 h suppresses this potentiating effect in the rabbit. Neuroleptic drugs should therefore be avoided in patients examined with Amipaque. In patients under chronic treatment, neuroleptics ought to be discontinued at least 48 h before examination with Amipaque. With the doses and methods used in the present study, diazepam was not as effective as phenobarbital in preventing epilepsy produced by Amipaque. When premidication is needed or when convulsions occur after Amipaque examinations, combined diazepam and phenobarbital therapy ought to be instituted in order to achieve the best control of epileptic reactions.


The value of computed tomography for the diagnosis of hourglass tumors of the spine.

A case of cervical hourglass tumor is reported with a brief review of the litterature. The diagnostic and preoperative value of CT investigation is emphasized.


Congenital fusion of the anterior arch of the atlas demonstrated by computed tomography.

The computed tomographie demonstration of congenital fusion of the anterior arch of the atlas with the axis is reported and compared with the normal anatomy.


Pantopaque pulmonary embolism following myelography.

A patient with radiological evidence of Pantopaque embolism in the lungs following myelography is reported.


The management of anterior sacral meningocele with computed tomography.

This report concerns a case of anterior sacral meningocele (ASM) with an evaluation of the diagnostic reliability of the CT scan for the management of this condition and others concerning the vertebral column and pelvis. This technic makes a precise preoperative survey possible by the direct demonstration of the lesion and its extension, by the measurement of its density and by the visualization of its pedicle, as well as easy and atraumatic postoperative control. ASM is a congenital meningeal cyst, herniating through a bony defect of the sacrum. It often remains undetected, since it is a rather rare condition and difficult to visualize with simple diagnostic procedures. An early diagnosis of this basically benign condition is nevertheless very important, because of the serious pitfalls that may arise.


[Study of cutaneous electrophysiology applicable to viscerocutaneous reflexes].

A description is given of the important part played by the skin as a site of electrical charges, as shown by the data offered by cutaneous electrophysiology. Personal research on 150 subjects is described. The results have useful applications in semeiotics and viscerocutaneous therapy. They also provice an explanation for the results achieved by acupuncture, a subject at present in the forefront of scientific investigation.


[Interpretations of uptake defects in hepatic scintiscanning].

The absence of precise parameters for the interpretation of defective uptake means that personal experience is of great assistance in the examination of scintiscans. Classification of uptake defects in 208 cases was carried out by two experts in accordance with the following parameters: 1) irregular uptake or distinct defects; 2) central or peripheral defects; 3) increased size of the liver picture; 4) uptake by the spleen. Irregular uptake or central or peripheral uptake defects (with or without spleen uptake in each case) were observed as categories. The series as a whole showed that peripheral defects are associated with a greater frequency of false positives, and diagnosis must therefore be checked, spleen uptake is an accurate pointer to diffuse chronic hepatopathy, and central defects are indicative of substitutive pathology.


[Classification of acute bacterial enteropathies].

The first part considers pathogenic microorganisms (Vibrio cholerae and parahaemolytic vibrio, Clostridium welchii, enteropathogenic E. coli, Shigella, Salmonella, other enterobacteria and pseudomonas. Yersinia, simply enterotoxic Staphylococcus and that producing acute enteritis) and the process of infection (formation of a surface link without endocellular penetration with elaboration of hexotoxins, formation of a surface link with subsequent intracellular penetration, submucosa penetration). The second part discusses Salmonellae on the basis of personal experience. Particular attention is paid to current aspects of Salmonella microbiological pathomorphosis, the various isolated serotypes in relation to carriers or patients, biochemical atypias of Salmonellae strains, present-day aspects of resistance to chemoantibiotic treatment and the transfer of Salmonella Wien resistances.


Specificity of the disaccharide effect in the rat.

Male rats were starved and refed diets containing 40% disaccharides (maltose, trehalose, sucrose, turanose), trisaccharide (melezitose), starch, or the monosaccharide equivalents. Responses of hepatic glucose-6-phosphate dehydrogenase (G6PD), malic enzyme (ME), fatty acid synthetase (FAS), and total liver lipid (TLL) or changes in concentration of portal blood total carbohydrate and fructose were determined following refeeding of the different carbohydrate diets. Maltose, trehalose, sucrose, and turanose refeeding resulted in G6PD and ME responses which were higher than the responses to their component monosaccharides (disaccharide effect). Starch refeeding decreased the responses of G6PD, ME, and FAS when compared to refeeding of glucose. Refeeding diets containing fructose (sucrose, turanose, melezitose, and monosaccharide equivalents containing fructose) increased the responses of G6PD, ME, FAS, and TLL. No correlation between portal blood carbohydrate concentration and hepatic enzyme levels could be demonstrated. It is concluded that readily digestible disaccharides produce an effect which is greater than the effect produced by their monosaccharide equivalents. If these disaccharide configurations are fed as part of a trisaccharide or polysaccharide, the disaccharide effect is no longer discernible.


The high-risk perinatal registry. A systematic approach for reducing perinatal mortality.

A systematic and comprehensive review of all 320 perinatal deaths occurring in Nassau County in 1973 reveals that one-quarter of these deaths might have been prevented if modalities of care that were known and available at that time had been utilized appropriately. Preventability--the presence or absence of avoidable factors which might have materially lessened the risk of death --was determined for each perinatal death. Preventable deaths were disproportionately higher among postmature (P less than .01) and large-for-gestational-age (P less than .05) perinatal deaths, neonatal deaths after the first day of life (P less than .05), intrapartum fetal deaths (P less than .01), and perinatal deaths secondary to anoxia and idiopathic respiratory distress syndrome (P less than .01). The study concludes that rigorous application of currently available medical knowledge, the establishment of local perinatal mortality review committees, and vigorous outreach to practitioners are urgently needed to bridge the time gap between the development of new modalities of care and their application.


Fetal monitoring in a community hospital. A statistical analysis.

This paper is an evaluation of 2 years of experience with fetal electronic monitoring in a community hospital. It compares Apgar scores and intrapartum and neonatal mortality in 2 groups: 1) monitored cases, comprising 1935 high-risk patients and 2293 normal patients; 2) nonmonitored cases, comprising 1139 high-risk patients and 1855 normal patients. Monitored cases had significantly higher Apgar scores and fewer intrapartum and neonatal deaths than did nonmonitored cases (P less than .001). There was an increase in the primary cesarean section rate and postpartum endometritis in the monitored population.


The results of a five-year study of continuous fetal monitoring on an obstetric service.

A 5-year experience of the effects of fetal monitoring at the University of Utah College of Medicine (1971-1975) are reported. During this period there were 5087 deliveries, of which 4237 (83%) were monitored electronically during labor. During this time the primary cesarean section rate increased from 3.19% in the year before monitoring has begun to 10.5% in the last year of the period studied. This increase, however, was due primarily to a number of changes in obstetric practice and to an increase in the number of high-risk patients followed at our institution. The rate of primary cesarean section as compared to total deliveries due to fetal distress resulting from observations made with electronic monitoring was a fairly stable 3-3.5%. The number of cases of Apgar scores at 1 minute of 6 or less dropped markedly during the period of study and cases of 5-minute Apgar scores of 6 or less decreased slightly. The number of patients demonstrating early, late, and variable deceleration patterns remained fairly stable throughout the years of the study. Variable and late deceleration patterns correlated well with cord compression and small placentas, respectively.


The closure of maternity services in Massachusetts. The causes, process, and hospital impact.

There has been a decline in the number of maternity services in Massachusetts from 120 in 1960 to 65 in 1975. Further consolidation must be carefully thought out with all options and possible outcomes thoroughly explored. The Massachusetts Maternity and Newborn Regionalization Project and the Massachusetts Hospital Association conducted a preliminary survey of Massachusetts Maternity services that had closed to understand the causes, process,, and hospital impact. The findings of this preliminary investigation, in addition to identifying areas for more intensive future research, provide some observations that should be of assistance to those considering a maternity service closure.


Utilization of antibiotics for prevention of symptomatic postpartum infections.

This analysis determined the incidence, indications, and efficiency of postpartum antibiotic therapy. At Wilford Hall USAF Medical Center, 384 of 2000 consecutive delivered patients (19.2%) were treated with antibiotics during the postpartum period. The greatest utilization of antibiotics was prophylactic or for subclinical infection (290 patients; 75.5%) as compared to treatment for symptomatic infection. The most frequent indications for therapy were for patients at high risk to develop pelvic infection or to prevent urinary tract infection. The failure of antibiotic therapy and the development of infections other than those for which therapy was given were evaluated. Of the 290 patients treated prophylactically or for subclinical infection, only 11 patients (3.8%) did have subsequent infection necessitating a change in antibiotic therapy. Careful selection of antibiotic therapy in the obstetric patient is essential for effective control of puerperal infections.


Physiomorphology of twin transfusion syndrome. A study of 86 twin gestations.

The placentas of 86 pairs of twins were examined and correlated with the clinical characteristics of the neonate. The incidence of twin pregnancy in this group was 1 : 108 deliveries. Fetal prematurity and associated complications in twin pregnancy were the cause of increased perinatal and neonatal mortality.


Hemodynamic studies in experimental toxemia of the dog.

The following experiments demonstrate that the severity of toxemia is proportional to the degree of reduction in blood flow to the pregnant uterus. Blood pressure and blood flow variations were studied in 21 nonpregnant and pregnant dogs following the placement of a progressive stricture on the abdominal aorta below the renal arteries. The immediate effect of the stricture was a mild hypertension in half of the pregnant dogs; in addition, in all the dogs, the blood flow progressively dropped in the arteries below the stricture (femoral and uterine) while it remained constant in the arteries above (ovarian and renal). In 3 of 5 pregnant dogs the delayed effect of the aortic stricture was hypertension associated with all the other signs of experimental toxemia. Removal of the aortic stricture after 10 days immediately improved the blood flow below the stricture. No noticeable preferential distribution of blood toward the pregnant uterus was noted during the constriction.


The effect of uterine vascular insufficiency on fetal arterial pressure and heart rate in the near-term sheep.

Fetal hypoxia secondary to uterine vascular insufficiency was induced by injecting norepinephrine or PGE2 into the maternal circulation of near-term sheep. With these drugs the uterine blood flow fell to 41 and 40% of its control value, respectively. The fetal responses to the PGE2-induced uterine contraction were a bradycardia which was apparent within 10 seconds (P less than 0.05), and a hypertension which was also apparent within 10 seconds (P less than 0.03). After the norepinephrine-induced uterine vasoconstriction, there was no observable change in the fetal arterial pressure. The fetal heart rate started to fall after 30 to 60 seconds and started to return to the control value within 90 seconds. The fetal response to uterine vascular insufficiency induced by a contraction may not have been caused by hypoxia alone as these responses were more rapid in onset than the fetal responses observed subsequent to uterine vascular insufficiency produced by vasoconstriction.


Umbilical cord plasma cortisol levels in association with pregnancy complications.

Cortisol concentrations in umbilical cord plasma at birth were determined in association with pregnancy complications which may affect the time of pulmonary maturation of the fetus or otherwise influence its survival. No statistically significant change in these cortisol levels was observed in either term or premature pregnancies with the following complications: maternal disorder (preeclampsia, diabetes, pruritus), prolonged rupture of membranes, antenatal isoxsuprine treatment, maternal cigarette smoking, and neonatal asphyxia. Significant increases were observed in premature births in association with intrauterine fetal growth retardation and with the appearance of meconium. Cortisol concentrations in more severe forms of diabetes were significantly less than in Class A diabetes, in premature cases, and also tended to be low in association with various fetal congenital abnormalities. The possible physiologic significance of these results is discussed.


Serum bile acids in cholestasis of pregnancy.

Using routine liver function tests, cholestasis of pregnancy was diagnosed in 86 pregnant women with pruritus. Serum aminotransferase levels were elevated in all cases, ASAT in 99%, and ALAT in 100%. In these patients serum concentrations of cholic, chenodeoxycholic, and deoxycholic acid were determined using a gas chromatographic method and were compared with those in a group of 40 uncomplicated pregnancies. Of these bile acids, cholic acid levels were most frequently elevated, ie, in 92% of the patients. The frequency of elevation of serum levels of alkaline phosphatase, and total and conjugated bilirubin was lower. Thus, it appears that in addition to serum aminotransferase levels the serum cholic acid concentration is a sensitive indicator of cholestasis of pregnancy. The cholestasis series was divided into 3 subgroups of increasing severity of cholestasis as assessed by maternal serum cholic acid levels, and the occurrence of signs of fetal distress was compared between these subgroups. The only intrauterine fetal loss in the series belonged to the severe cholestasis group. The incidence of meconium-stained amniotic fluid also increased significantly in this group, and 21 of the 24 cases with other signs of fetal distress were in the groups of moderate and severe cholestasis.


Response to mitogen during pregnancy and the postpartum period.

The influence of pregnancy, pregnancy plasma, and pregnancy-associated lhormones on the response of peripheral blood lymphocytes to two phytomitogens (PHS and PWM) was examined in a group of 17 healthy women during pregnancy and the postpartum period. No consistent disparity between pregnancy, postpartum, and control tests was noted in either intrinsic lymphocyte responsiveness or in the effect of autologous plasma or four pregnancy-associated hormones (estriol, progesterone, hPL, and estradiol-17 beta) on lymphocyte responsiveness.


Cryosurgery for urethral prolapse.

A urethral prolapse occurring in an 80-year-old woman was successfully treated with cryosurgery. The procedure was painless and accomplished without loss of urethral length and without subsequent stricture.


Vulvovaginoplasty in gynecologic oncology.

Eight patients from M.D. Anderson Hospital underwent Williams' vulvovaginoplasty for sexual rehabilitation following pelvic exenteration. In 7 of the 8 patients the functional results were excellent, and none of the patients experienced morbidity. This surgical procedure is less extensive than other reconstructive methods and skin grafting or mechanical dilatation are rarely required.


Measurement of fetal cells in the maternal circulation.

There is evidence that the quantitation of fetal-maternal hemorrhage may be useful in reducing some of the RhoGAM failures in preventing Rh sensitization. The Betke-Kleihauer technique is a well-established method that has been used to estimate the amount of transplacental hemorrhage. Recently, a kit (Fetaldex) has become available for use in the detection and quantitation of fetal-maternal hemorrhage. Using control blood smears, we compared the results of the Fetaldex kit with those results obtained by the Betke-Kleihauer technique. The data indicate that the Fetaldex method is as accurate as the Betke-Kleihauer technique in detecting and measuring fetal red cells in the maternal circulation.


Failure of pyridoxine to improve glucose tolerance in gestational diabetes mellitus.

Intrigued by the potential simplicity and far-reaching benefits of the amelioration or prevention of gestational diabetes mellitus by pyridoxine, as reported by others, an attempt to confirm this effect was made. No beneficial effects on abnormal glucose tolerance in pregnancy was demonstrated in 4 cases studied. It is likely that the dietary alterations made during pyridoxine therapy in the previous report had a greater effect on outcome than the authors had suspected. The failure to confirm their results was statistically significant (P = 0.005).


Serum complement levels in patients with digestive tract carcinomas and other neoplastic diseases.

Total hemolytic complement activity was measured in the serum of 17 patients with digestive tract carcinomas, 24 patients with a variety of other malignant diseases, and in 34 normal controls. Mean complement levels and standard deviations associated with all neoplastic diseases tested were found to be significantly higher than normal values. However, no difference was found between mean complement levels associated with digestive tract carcinomas and the other neoplastic diseases. Mean complement levels in females were found to be higher than those in males regardless of diagnosis. However, the increase in mean complement levels of females with respect to males was more pronounced in the group harboring neoplastic diseases than in the control group. The data suggest that carcinomas of the digestive tract and certain other malignant disorders give rise to increases in serum complement activity, although the response of individuals may depend on sex and other yet unidentified factors.


A clinical trial adriamycin (NSC 123127) in advanced sarcomas.

22 patients with advanced sarcomas received adriamycin, 20--25 mg/m2/day for three days each three weeks. Two patients manifested objective response for a median of five months. Eight patients had stable disease for a median of three months. Nausea and vomiting occurred in 21 of 22 patients; leukopenia in eleven of 22; thrombocytopenia in four of 22. There was no clinically significant cardiotoxicity. Our study indicates that this regimen for adriamycin was relatively ineffective in the management of these inoperable or metastatic malignancies.


Repair of ptosis using frontalis muscle and fascia lata: a 20-year review.

The results of an analysis of the surgery ("Repair of Ptosis using Frontalis Muscle and Fascia Lata") carried out on 316 lids is presented. The main indication for this operation is a large congenital ptosis with minimal levator function. Conclusions from the study indicate that autogenous fascia is an ideal tissue for lid suspension, and is better than stored fascia. Stored fascia does present some problems but is useful in small children or when the patient does not want a scar on the leg. Bilateral repair for unilateral ptosis is recommended for symmetrical results. The best ages for surgery is between 3-1/2 and 6 years of age, as these young corneas rapidly adapt to the exposure problems. It is very important to check the corneal sensation before carrying out the surgery. When this operation is done on older patients with acquired ptosis, e.g. ptosis associated with myasthenia gravis, corneal exposure problems frequently result.


A simplified method of nasolacrimal irrigation.

A simplified method of nasolacrimal irrigation is presented. Use of the air cannula minimizes possible edema and trauma because it usually eliminates the need for dilation. In addition, its smaller diameter reduces the possibility of injury during the actual irrigation.


An unusual knife injury to the orbit: a case report.

A perforation of the left orbit by a five-inch knife blade was sustained by a 30-year-old woman. In spite of the knife's course through a myriad of vital structures, the only significant injury was a laceration of the lateral canthal tendon. Following surgical repair the patient recovered with no residual problems.


Senile entropion.

129 cases of senile entropion operated on by the Oculo-Plastic Service of the Manhattan Eye, Ear and Throat Hospital were reviewed. There was an overall success rate of 84 percent. Age, sex, race and suture material were of no importance to the eventual outcome of the surgery. A Basedown-Tarso-Conjunctival resection greater than 7 mm had 100 percent results. The orbicularis transplant with insertion at the infero-lateral border of the orbit was found to be the most effective procedure for re-operations for non-cicatricial entropion.


Intravitreal ciliary body neovascularization.

Two patients demonstrated an unusual conformation of intravitreal neovascularization, in which the abnormal blood vessels originated from the ciliary body. One of the patients had recurrent anterior chamber and vitreous hemorrhages. Both patients had undergone thermal ablative therapy of the ciliary body for the control of intraocular pressure. In one patient, fibrovascular tissue emanated directly from old cyclocryotherapy scars on the pars plana. Such neovascularization may represent a previously unrecognized complication of attempts at therapeutic destruction of the ciliary body.


Phacoemulsification visual results and complications: report of 800 cases.

The visual results and complications of 700 Kelman-Phacoemulsification operations have been presented. Early in this series, corneal opacification and vitreous loss were a major concern. Complications decreased with experience and at the present time visual results are at least as good as they were with routine intracapsular cataract extractions. Kelman has stated that the phacoemulsification operation is not an easy operation to learn. It is, to say the least, not a watch-one, do-one, teach-one procedure. If one is an average surgeon, however, he can with persistance and perseverance master the technique. The procedure, however, I feel is not for the occasional operator. The phacoemulsification operation has essentially been under trial these past few years. Its advocates, however, have continued to grow in number and as the statistics come in, it appears that at least for the present, the Kelman-Phacoemulsification operation in one form or another is going to take a very active part in the treatment of the patient with cataract formation.


Optical attachment to the O'Malley photocoagulator.

An optical attachment (originally developed for the Zeiss-Oberkochen photocoagulator), which provides slitlamp observation and energy delivery through a fundus contact glass, can also be coupled to the Clinitex Log-2 photocoagulator described by O'Malley. Excellent image quality out to the far periphery is obtained. The system has been successfully used for the prophylactic treatment of retinal detachment in the presence of retinal hole formation, the treatment of various conditions of diabetic retinopathy, localized fluid accumulations occurring after retinal surgery, and irradiation of the iris.


[Can intubation of stenotic tear passages replace major surgical intervention?].

In a short survey the technical difficulties occurring at the intubation of stenotic tear passages are presented. In conclusion, a simple 'blood free' method is advised as promising; consisting of the putting through of a 'Silastic tube' through both lacrymal points with the help of a curved canula probe (Fulmek).


Significance of fundal hemorrhage in predicting the state of the patient with ruptured intracranial aneurysm.

The authors have elaborated the data of 201 patients with ruptured intracranial aneurysms. In 49 cases (24.6%) they found fundal hemorrhages (FH) uni- or bilaterally. They have classified FH according to their sites and shapes of appearance. They emphasize that the presence of FH indicates a bad prognosis in patients with SAH. This is why FH should always be regarded as an additional risk factor. They discuss the possible ways of the development of FH which acoompanies SAH.


[The inheritance of senile macule degeneration].

Senile macular degeneration is due very often, if not always, to a genetic factor, as it is demonstrated by the concordance in monozygotic twins. The inheritance is iether autosomal recessive or and more frequently autosomal dominant. The penetrance and the expressivity of the gene of senile macular degeneration is variable, but the appearance of various forms in the same family demonstrates that there is no fundamental difference between these forms.


Oculomotor anomalies in sellar and parasellar pathology.

The authors report 19 cases where diplopia was the initial symptom of sellar pathology, Additionally, 5 cases with doubtful, diagnosis are discussed. Considering a series of 134 adenomata, the onset in 7 cases was intermittent diplopia with involvement of the third nerve.


[Has photocoagulation improved the prognosis of diabetic retinopathy?].

In 192 diabetic retinopathy cases, Xenon light coagulation was performed. Afterwards, the eyes treated were examined half yearly for at least 4 years. Fundus photography and fluorescein angiography were made and the visual acuity was checked. In 64 cases the comparison could have been made in the same patient between one treated and the other untreated eye. The statistical results of this study permit us to assess the therapeutic value of light coagulation for diabetic retinopathy.


Expulsive hemorrhage: management without sclerotomy.

Expulsive hemorrhage occurring during cataract extraction was successfully treated by immediate wound closure, without evacuation of blood through the sclera. Only two such cases have been reported previously. Modern micro-surgical techniques are not ideal for the management of this condition.


Posterior unbuckled part of a giant tear behind the oblique encircling silastic 3 mm band operation. Surgical prevention and treatment.

(1) In operable giant tear extending slightly behind the equator, the oblique encircling silastic 3 mm band without evacuation of subretinal fluid gave a 70% success rate. In 30% of the cases a small most posterior part of the tear was seen unclosed behind the band effect. This was because of thick sclera opposite the tear area preventing proper buckling. (2) This gave an occasion to see during reoperation the effect of segmental silastic 5 mm rod buckling opposite the unclosed part of the tear. (a) Two rods placed radially between the band and the sclera opened the whole giant tear again. (b) One rod placed circumferentially behind the band succeeded in closing the unclosed part of the tear. (3) To have a sufficient wide buckle in cases of thick sclera opposite giant tears one of the best, safest and easiest solutions is to weaken the sclera behind the tear by incising about half scleral thickness opposite the anterior and posterior margins of the oblique band (or even lamellar scleral resection underneath the oblique band) in a wider area than the tear meridans extent (Mortada modified operation). This helps buckling at a lower band tightness, thus avoiding any complication of pressure uveopathy.


Prostaglandin and nerve-mediated response of the rabbit eye to argon laser irradiation of the iris.

Irradiation of the pigmented rabbit iris with a moderately low dose of argon laser light (5 applications of 750 mW, 500 micron, 0.5 sec) caused an immediate ocular response consisting of miosis, a rise of intra-ocular pressure and is accompanied by a disruption of the blood-aqueous barrier. Prostaglandin-like material was present in the aqueous humour withdrawn 60 minutes after irradiation. Prior treatment with indomethacin intravenously (20 mg/kg) or benoxinate topically (Novesine; 0.4%) greatly reduced the response and the combined use of the two drugs virtually abolished the ocular changes.


Speedy assessment of visual acuity in amblyopia by the evoked potential method.

As an objective means of assessing visual acuity in young children and of monitoring acuity changes during occlusion therapy, the value of conventional evoked potential recording is restricted by lengthiness and by variability. This article describes one way of circumventing these disadvantages. A graph of evoked potential amplitude versus stimulus check size was continuously plotted while the child viewed a rapidly-oscillating chequerboard pattern whose check size was slowly zoomed up and down. Empirically, the shape of this graph gives an index of acuity and of the acuity difference between the amblyopic and fellow eye. The child's attention could be held for the 2-4 min required by superposing a movie cartoon on the chequerboard pattern, though the movie had a negligible effect on the chequerboard evoked potentials. The briefness of the procedure had the additional advantage of reducing variability.


[Adrenochrome deposits in the cornea ("Black cornea"). A clinical-pathological case report].

A case of 'black cornea', occurring 6 years after commencement of a therapy with adrenaline derivative eye drops, is reported. Enucleation was performed because of suspected malignant melanoma. The eye was sent to our laboratory for histopathological examination. The clinical and histopathological findings are described, and the pathogenesis of the 'black cornea' is discussed.


Sickle-cell disease. A clinicopathologic case report.

Report of the clinical history and the histopathologic findings of the globe of a 38-year-old male patient from Ghana. The clinical picture of sickle-cell disease and Eales' disease is very similar, however, the race of the patient and hemoglobin electrophoresis leave no doubts as to the correct diagnosis.


[Thyroid carcinoma metastases in choroid membrane of a 9 year old girl].

Report on a case of a total serous retinal detachment which manifested itself by inflammation and rise in tension. It was associated with an undefinable tumour of the posterior portion of the eye which had become visible after puncture of the subretinal fluid. Fluorescein angiography revealed a pattern similar to Hippel-Lindau's disease, although the clinical course was unusual. Histologic examination of a lump detected on the neck proved to be a metastatic thyroid carcinoma. This diagnosis could be confirmed after enucleation. The literature shows that ocular involvement in metastatic thyroid carcinoma seems to be extremely rare.


Aphakic retinal detachment.

The incidence of aphakia in our series of retinal detachment is 14.82%. The incidence of retinal detachment in aphakia is 2.74%. The use of alpha-chymotrypsin does not influence this incidence. In our own patients, we did not find a sex predominance, although there was a predominance of the male sex in the referred group. The mean age of the patients affected by aphakic retinal detachment was 65.87 years and 82.6% of the cases occurred above the age of 56 years. There was no statistical significant difference between the right and the left eye involvement. Finally, 38.37% of the detachments appeared during the first year after the cataract extraction, 24.4% were myopic and 14.66% bilateral.


A sensitivity index F, useful to classify patients with glaucoma simplex.

Using a new method to determine the scotoma pressure by means of an Amsler grid chart and an ophthalmodynamometer in addition to three other parameters (the brachialis blood pressure and the intra-ocular pressure), a sensitivity factor F was calculated, useful to classify patients with visual field defects due to glaucoma simplex.


Routine ERG recording with LED light stimulus.

An apparatus for ERG recording in clinical practice using light-emitting diodes as stimulation light is described and evaluated. By introducing special electronic devices, slow potentials (c-wave) can be recorded and there is no need for a shielded cage. The function of the set-up is trouble-free and the reproducibility is very satisfying.


Spatial localization with paralyzed eye muscles.

Four subjects suffering from a unilateral peripheral paralysis of the 3rd or the 6th nerves have been studied in spatial localization tasks, with their normal eye occluded. When peripheral targets were presented in the hemifield corresponding to the paralysis, the saccadic eye movements (recorded from the normal occluded eye) were of an exaggerated amplitude. 'Staircase' oculomotor patterns, closely similar to those occurring in 'open-loop' visual stimulation, could also be observed. Our patients also presented the classical hypermetric misreaching when attempting to point by hand at visual targets in an otherwise dark room. This effect (past-pointing) was likely to be due to a monitoring of the exaggerated oculomotor signal: in one subject past-pointing disappeared when reaching at the targets on the basis of the sole retinal cues. Finally, the classically described illusory visual effects of ocular paralysis were limited to a feeling of instability during self-motion.


Microcirculation of the anterior part of the optic nerve.

In 85% of the cases the central retinal artery gives off branches for the blood supply of the optic nerve. In this series of 35 optic nerves no central optic nerve artery was found, but frequently and axial vascular system, formed by branches of the central retinal artery was observed. In the region of the lamina cribrosa the central retinal artery gives no important branches.


Phakomatous choristoma of lower eyelid. A lenticular anlage tumour.

A female infant was found to have a congenital, firm, pea-sized tumour nasally in the lower left eyelid. A dermoid cyst was suspected, but microscopy showed structures simulating a lens. The tumour has been considered to have an origin in surface ectoderm induced to dip down into the mesoderm of the lid, there forming lenticular anlage structures. This so-called phakomatous choristoma has only been reported five times previously, all cases outside Europe.


[Isolated orbitobulbar sarcoidosis].

Communication about a rare form of Boeck's disease. A primary orbital sarcoidosis is described with probable optic nerve involvement and later intraocular invasion in the form of a single candle spot-shaped chorioretinitis. No other clinically noticeable extensions of this disease could be noticed. Clinical and histological findings were described and discussed, in view to the existing literature on that subject.


Tuberous sclerosis without mental deficiency or epilepsy. The abortive Bourneville disease.

Three cases of abortive Bourneville's disease, without detected involvement of the CNS, are reported. Two were in the same family and had a 20-year follow up. The importance of fluoroangiography in studying the retinal manifestations of this disease is stressed.


Secondary glaucoma accompanied with primary familial amyloidosis.

22 patients were diagnosed as having primary familial amyloidosis by the histological examination of biopsy specimens, clinical course of the disease, and family history, having a focus in the Nagano Prefecture in Japan. All patients belonged to the Andrade type of the neuropathy form in the primary familial amyloidosis. 15 out of 22 patients underwent ophthalmological examination, and secondary glaucoma, due to primary familial amyloidosis, was found in 4 patients. The clinical characteristic features of the secondary glaucoma were described as follows: (1) having the systemic symptoms of primary familial amyloidosis; (2) belonging to relatively older age groups and having a longer duration of the course of the disease; (3) having vitreous opacities; (4) having the wide open angle with pigment deposition in the gonioscopical examination; (5) having white flocculent materials in the pupillary margin, and (6) having flaky substances on the surface of the lens. The ophthalmological symptoms mentioned in 4, 5, and 6 were very similar to those of glaucoma capsulare. The tissue specimens obtained at the time of antiglaucoma surgery were subjected to light and electron microscopy. Amyloid fibrils were found in the iris and trabeculum, and the pathogenesis of secondary glaucoma was speculated to be a deposition of amyloid fibrils in the trabecular meshwork.


Internal ophthalmoparesis: an uncommon complication of varicella, a common disease.

Two cases are represented with ocular complications after varicella. In one case the complication was diagnosed as internal ophthalmoparesis and in the second patient the complication could be the same; at any rate an iridoplegia was present. From the cases presented in the literature we found that there seems to be a predilection for males to contract this type of ocular complication. The association of this complication and meningo-encephalitis is rare. Recovery of the pupillary reactions and accommodative power is almost never complete. The interesting observation that decrease in cell-mediated immunity but not in humoral immunity decides whether the clinical disease will manifest itself as herpes zoster or varicella is brought forward.


[Cornea preservation in a continuous tissue culture medium at +37 degrees C].

Seven human corneae were preserved 1 or 2 weeks in a continuous tissue culture medium at +37 degrees C. 200 microgram/ml gentamycin and 2.5 microgram/ml amphotericin B were added, and no infection was noted after 2 weeks. Histological and electronmicroscopical findings presented a picture of well-kept cellular and subcellular structures. Comparable electron-optical examinations taken on seven corneae kept at +4 degrees C in a modified medium 199 showed the beginning of endothelial necrobiosis.


Posterior vitreoretinal malformation. A clinicopathologic case report.

A pathological examination was performed on the eye of a 2-year-old male child. The basic abnormality was a vitreoretinal malformation. Study of the tissue by light and electron microscopy provided evidence to suggest that the case should be considered as a primary abnormality of the posterior vitreous and that the retinal changes were the result of a traction deformity.


Choristomatous malformation in a cystic colobomatous eye.

The clinical and histopathological picture of a brain-like choristomatous malformation in a cystic colobomatous eye having remnants of the primary optic vesicle cavity without continuity to the ventricular system of the brain in an otherwise healthy boy, is presented.


Microsurgical technique--fundamentals of the microsurgical laboratory.

It is imperative that the reconstructive surgeon master microsurgical technique prior to engaging in clinical microsurgery. The primary task of developing this expertise is most efficiently performed in the microsurgical laboratory. The immediate availability of the materials necessary to establish a laboratory, their low cost, and the numerous microsurgical exercises that can be performed in such a facility make the microsurgical laboratory a practical and necessary addition to surgical training centers. Postoperative examination of repaired vessels, including light and electron microscopic studies, is important in pointing out errors and weaknesses so that they can be, respectively, corrected and strengthened. The surgeon wishing to learn microsurgery must earnestly devote much time and energy to the pursuit of perfection. With the aid of a microsurgical laboratory, practice, and strict adherence to the established guidelines of microsurgical technique, the reconstructive surgeon can develop the skills necessary to master the art of microsurgery.


An intraluminal silastic stent for small vessel repair.

An intraluminal stent fashioned from medical grade Silastic was used for technical assistance in performing 23 microvascular anastomoses. Twenty control and 20 stent arterial anastomoses were completed. Patency rates of 100 per cent in both the stent and control anastomoses were found by radical pressure testing immediately postoperatively and after an interval of two weeks. Electron microscopic and light microscopic studies showed no increase in damage to the vessel wall or increase in connective tissue reaction. Under the conditions of this experiment the Silastic stent can be used safely for assistance in performing microarterial anastomoses. Preliminary studies in six microvenous anastomoses have also shown no significant difference postoperatively between the stent and control anastomoses, both having a 100 per cent patency rate.


Models and techniques for microsurgery research.

Microsurgery is used today to salvage severed parts and to reconstruct previous damage. Much remains to be learned in this field and laboratory research will direct future developments. Laboratory experience prior to clinical use is mandatory and takes several months of conscientious application. Various rat models are useful. Rat hind leg replantation and muscle autotransplantation provide experience in microdissection and vascular anastomoses with unequivocal end points. Finally, clinical cases have to be well chosen and meticulously planned.


Microsurgical approach to thumb reconstruction.

Thumb reconstruction either immediately after injury with replantation or electively with microsurgical transfer of a toe dramatically expands the ability of the reconstructive surgeon to care for his patients. The availability of larger vessels for anastomosis in the toe transplant has decreased the risk factor of this operation considerably so that it now compared favorably in terms of risk involved with other methods of elective thumb reconstruction.


Thumb reconstruction by digital transposition.

In traumatic loss or congenital aplasia of the thumb, transposition of a digit on its neurovascular pedicle is the preferable method for thumb reconstruction. The index finger is the digit of choice, but any other finger or a portion of a finger can be used, especially if it is damaged. The operative techniques differ considerably, depending on the level of thumb loss. In total amputation or total aplasia all the parts of the new thumb have to be constructed with the structures of the transposed index finger. The skeletal readjustment consists of shortening in the metacarpal region, rotation on the longitudinal axis, and fixation in palmar abduction; the metacarpophalangeal joint has to be preserved. A well established muscular stabilization is essential for good function. The skin cover is obtained by a dorsally pedicled skin flap in contrast to the palmar based skin flap in cases of partial loss or partial aplasia of the thumb. Here the muscle balance is easier to obtain by suturing the distal tendons of the index finger to the present thumb muscles. The amount of shortening depends on the length of the transposed digit (an intact or a partially amputed one). Operative technique, complications, and results in 223 cases are described and illustrated.


Formation of amino acids on heating glycine with alumina.

The conversion of glycine into amino acids on heating at 240 degrees C with basic manganous carbonate and alumina is investigated. Alanine, alpha-aminobutyric acid, norvaline, norleucine, sarcosine, N-ethylglycine, N-methylalanine, N-ethylalanine, aspartic acid and glutamic acid are identified among the products of the reaction. Paper chromatography, ion-exchange chromatography and nuclear magnetic resonance are used for the analysis. A scheme for the observed transformations is presented and it is suggested that it may have been a pathway for the synthesis of amino acids from glycine under primitive Earth conditions.


On the origin of biological chirality via natural beta-decay.

Experimental evidence that longitudinally polarized electrons having the handedness characteristic of terrestrial beta-decay electrons preferentially remove D-leucine from a racemic mixture, coupled with the probable presence of 14C in pre-biotic molecules, offers a plausible hypothesis for the origin of biomolecular handedness.


A model for a non-chemical form of life: crystalline physiology.

A definition of fundamental living units is given according to which they are constituted by the material support of some 'memory'; the latter is required--to be stable,--to contain rich information,--to diffuse it into the surrounding medium. It is then shown that the complex dislocation networks encountered in crystals can in some cases follow these criteria and lead to a crystalline physiology. The places of possible occurrence in nature of this kind of physiology, terrestrial and extraterrestrial rocks, interplanetary dust, white dwarfs and neutron stars are then discussed.


Symbiosis and the origin of life.

The paper uses chemical kinetic arguments and illustrations by computer modelling to discuss the origin and evolution of life. Complex self-reproducing chemical systems cannot arise spontaneously, whereas simple auto-catalytic systems can, especially in an irradiated aqueous medium. Self-reproducing chemical particles of any complexity, in an appropriate environment, have a self-regulating property which permits long-term survival. However, loss of materials from the environment can lead to continuing decay which is circumvented by physical union between different kinds of self-reproducing particles. The increasing complexity produced by such unions (symbioses) is irreversible so that the chemical system evolves. It is suggested that evolution by successive symbioses brought about the change from simple, spontaneously arising, auto-catalytic particles to complex prokaryotic cells.


A possible mechanism for the influence of geomagnetic field on the evolution of life.

The mechanism through which the geomagnetic field might have influenced the extinction of the species has been proposed. It has been assumed that the concentration factor for essential trace elements is dependent on the magnetic field.


Traumatic lesions of the salivary glands.

Injuries to the region of the major salivary glands, especially the parotid, may have important sequelae and require insight and persistence to manage. This is an area in which microsurgery comes into its own, especially for repair of the duct or nerve. In cases of severe injury or complications, the removal of the involved gland is always an option.


Salivary gland involvement in systemic diseases.

The salivary glands participate in systemic illnesses because they are secretory structures allied with the gastrointestinal tract. Thus they are involved in systemic inflammatory, allergic, and neoplastic conditions. Perhaps the most common condition is that of mumps in the acute phase. Of the chronic diseases, Mikulicz's disease or Sjögren's syndrome is most frequently noted. In most instances of systemic involvement, the salivary gland enlargement is the rule, with the gland being tense, soft, and enlarged, and with progressive growth over a period of time. Usually all glands are involved. The diagnosis should be suspected from the history and the physical examination, noting that all the glands are equally involved by the enlargement. If there is any question, a biopsy should be performed. In the case of Sjögren's syndrome, the biopsy specimen may be taken either from a major salivary gland or from one of the minor ones, or the nasal mucous membrane or oral cavity. In general, definitive therapy is unsuccessful for the systemic illness involving the salivary glands, and in most instances has to be supportive.


Sialography and scanning of the salivary glands.

This discussion is a brief review of the current status of sialography and salivary gland scanning in the diagnosis of salivary disorders. Both techniques are in current use; the contrast sialogram is most useful in evaluating recurrent inflammatory disorders, and the radiosialogram finds its greatest value in evaluating patients with suspected neoplasms. These examinations should not be used in lieu of a histologic diagnosis in tumor cases except when a smooth margined radiopositive lesion corresponding with a clinically evident Warthin tumor is noted; in this case a presumptive diagnosis of a benign neoplasm may be established. The utilization of these radiographic techniques depends upon the facilities available, the needs of the particular patient, and the experience and clinical judgment of the salivary gland surgeon.


Non-neoplastic salivary gland diseases in children.

Parotid enlargement in childhood is a diagnostic challenge to all physicians. A frame of reference has been established wherein the disease spectrum involving the child's parotid glands can be outlined in a stepwise manner. In some instances after sialography, specific hematologic tests, and cultures the diagnosis will remain obscure until a biopsy is performed. Protracted conservative management should be instituted prior to the consideration of ablative surgical procedures.


The role of radiotherapy in salivary gland neoplasms.

The role of radiation in the treatment of carcinoma of the salivary glands is expanding. It has a definite role in controlling the primary tumor, particularly in those postoperative cases with microscopic residua in the surgical field. Radiotherapy also plays a significant role in controlling the primary tumor in carcinomas that are inoperable or have recurred after surgery. The doses employed must be high (between 6000 and 7000 rads, given over six to seven weeks). The complications are tolerable and depend upon the area irradiated.


Metastatic disease of the parotid gland.

Metastatic lesions of the parotid gland represent the spread of a neoplasm from the primary site to parotid paraglandular, intraglandular, or parenchymal locations. These lesions are frequently difficult to differentiate from primary parotid gland neoplasms. The most common histologic type of neoplasm that metastasizes to the parotid gland is the melanoma. The melanoma is generally found superficial in its metastatic spread. Squamous cell carcinoma is also frequently found, but is usually intraglandular in its metastatic pattern. Although the melanoma and squamous cell carcinoma represent 80 per cent of the metastatic lesions involved in the parotid gland, a variety of other histologic types have been reported. The surgeon must be ready to deal with this complex problem when he enters into an exploratory operation. Even though vigorous treatment is carried out, the histologic types of neoplasms and the anatomic complexities of the area contribute to survival rates between 10 and 15 per cent over a five year period.


Management and rehabilitation of the facial nerve in parotid surgery.

The facial nerve is the single most important consideration in the surgical management of most parotid disorders. Its surgical anatomy should be well known by the head and neck surgeon. Very few conditions of the parotid gland necessitate the sacrifice of the facial nerve. When this decision is made, the benefits to be derived should be very thoughtfully measured against the tremendous cosmetic and functional sequelae that follow, and the patient should understand preoperatively to the fullest the magnitude of this decision and all its consequences. Most facial nerve deficits resulting from injury or sacrifice of the nerve can be and are best repaired by either direct anastomosis or autografting using a donor sensory nerve. Such restorations of the neuromuscular mechanism yield a physiologic result that is as close to the preinjury state as possible, and this is reflected in cosmetic and functional recoveries that are generally superior to any other of a variety of rehabilitative techniques. In all patients with a paralyzed face, extremely close attention must be given the involved eye to minimize the hazards of corneal injury.


[Bloodvolume determination in the newborn using blood of adults as an indicator (author's transl)].

A method allowing the determination of the bloodvolume of newborns by means of transfused blood of adults, is presented. Hb A containing erythrocytes of the adult can be distinguished from mainly Hb F containing erythrocytes of the newborn by means of the Kleihauer staining method. The ratio of the red blood cell volume of the donor to that of the patient is represented by the ratio of Hb A to Hb F containing erythrocytes. Bloodsmears taken before and after transfusion are stained with the "Fetal Hemoglobin Set" (BOERINGER), then photographed and approximately 1000 cells counted on the photo. The bloodvolume is calculated from the dilution of Hb A-containing in Hb F-containing erythrocytes. The reproducibility of the method was tested on 10 newborns, who were transfused twice and whose bloodvolumes were determined four times (two correlating bloodvolumes twice). The error of the method lies between 7.5 and 10% of the total bloodvolume. While an optimal determination of the bloodvolume through the first transfusion is already obtained by counting about 1000 cells, increasing the number of counted cells raises the quality of the bloodvolume determination through further transfusions. The bloodvolumes found are lower than those described in the literature. Its causes are discussed.


[Accidental digitalis intoxication in small children (author's transl)].

Life-threatening, glycoside-induced cardiac rhythm disturbances are often seen following accidental digitalis intoxication in small children. Modern therapeutic management should take into consideration the pharmacokinetics as well as the mechanisms responsible for cardiac and extracardiac symptoms. Discussed are the possibilities of eliminating and inactivating the ingested glycosides, the indications and contraindications for administration of electrolytes, as well as the use of anti-arrhythmic drugs and pacing for cardiac arrhythmias. Special consideration should be given to close observation and instrumental monitoring; ideally these should be carried out in an intensive care unit. Unnecessary loss of time in the management of such cases should be avoided through proper organization of diagnostic and therapeutic activities.


[Mental development of children suffering from chronic insufficiency of digestion under dietary therapy for several years].

73 children suffering from malabsorption, galactosaemia, and fructose intolerance had been treated for many years. They were investigated psychologically in regard of their mental development. The nutritional condition was very bad before and in the first time of therapy, nevertheless a normal intelligence and an inconspicuous social behaviour was founded. The considerable retardation of the bodily and intellectual development was not sufficiently compensated in the preschool-age. But there is a better arrangement during school-age.


[Polycythemia in the newborn infant (author's transl)].

Respiratory distress syndrome and cyanonis in newborns (first neonatal week) may be caused by polycythemia. During 14 months twentyone newborns with symptoms of cardiorespiratory or neurological distress caused by polycythemia on the neonatological division of our hospital were observed. The values of hemoglobin ranged between 22.7 and 28.6 g% (mean 25.65 g%), the values of hematocrit ranged between 72 and 90% (mean 81%). The central venous hematocrit measured on 14 patients ranged between 65 and 77% (mean 71%). On 20 newborns isovolemic haemodilution by 5% plasma was performed. The volume of exchange was calculated according to the formula: Sign and symptoms seemed to improve rapidly following treatment, clinically reflecting the fall in hemoglobin and hematocrit.


[Trichomoniasis in the newborn (author's transl)].

Trichomonas vaginalis was diagnosed in two girls out of 948 newborn babies (0.21%) admitted for various reasons to the Universitäts-Kinderklinik Graz during a 21 months period. One of the patients revealed leukocyturia and vulvovaginitis, the other had both bacterial urinary tract infection and vulvovaginitis being controlled but incomplete with antibiotica therapy. The radiologic finding of the urinary tract were normal. In both cases trichomonas vaginalis was identified in a routine urine specimen. The infants mothers both had vulvovaginitis trichomonalis. After a 5 days course with metronidazole given orally, the symptoms ceased and the urinary tract infection healed. The influence of maternal hormones on the epithelium of the infantile vagina facilitating trichomoniasis in the newborn is discussed.


Spinal cord injuries: male infertility aspects.

In a study of 16 married paraplegic patients, it was found that without electrostimulations, erections occurred in eight patients and ejaculation in three of them. Rectal electroejaculation performed in all the patients for the purpose of collecting sperm showed poor results. Sperm analysis revealed severe distubrances in spermatogenesis and spermiogenesis, the etiology of which was not clear since hormonal and sperm metabolic substrates were found to be in the normal range.


Problems in the radiological interpretation of the X-ray appearance of the bladder wall and bladder neck obtained on micturating cysto-urethrography in patients with neurogenic bladders [proceedings].

The technique in performing micturating cysto-urethrography is described. Technical difficulties in obtaining micturating films and positioning of paraplegic patients are discussed. A previous author has stated that radiological assessment of the bladder neck is of no value. Analysis of intravenous pyelograms (IVP) and micturating cysto-urethrogram (MCUG) on 71 paraplegic patients confirms that there is no correlation between the diameter of the bladder neck and the presence of pathological renal changes or vesico-ureteric reflux. Difficulties in the radiological assessment of bladder capacity and contour due to marked differences in appearance on MCUG and IVP are discussed.


Management of neurogenic bladder dysfunctions following acute traumatic cervical central cord syndrome (incomplete tetraplegia) [proceedings].

Based on the experience to date with central cord syndrome, most or all of the following conditions should be present before considering transurethral sphincterotomy: (1) minimal neurological recovery within 6 months of injury; (2) four plus spasticity in patients over the age of 50 years; (3) prolonged intermittent catheterisation over 6 months, with persistent residual urine over 300 ml; (4) persistent and repeated use of diazepam, dantrolene sodium to control pelvic floor spasticity; (5) demonstrable detrusor-sphincter dyssynergia.


Metabolic effects of sodium restriction and thiazides in tetraplegic patients.

The metabolic effects of sodium restriction, alone or with thiazide, were studied in 12 healthy subjects, in 24 tetraplegics during the intial 8 months of paralysis (early) and in 16 others during the subsequent period (late). The diuresis caused by both treatments led to more haemoconcentration in early than in late patients. In contrast with the healthy subjects on low sodium, the tetraplegics had a delayed urinary sodium retention and no fall in calciuria. During thiazide, urinary sodium depletion occurred early and the urine calcium fell after 3 days in all tetraplegics. During both treatments, aldosterone and renin increased more in early patients than in the other groups. The clinical implications of inducing dehydration and a sustained stimulation of the renin-angiotensin-aldosterone axis in recently injured tetraplegics with severe orthostatic hypotension are discussed.


Intermittent catheterisation: follow-up studies [proceedings].

One hundred twenty-six  male spinal cord injury patients whose acute bladder management included indwelling urethral catheters were converted to an intermittent catheterisation programme and most of them subsequently achieved a catheter-free state. A higher prevalence of pyelocaliectasis was observed in these patients compared to previous reports of similar changes in patients upon whom intermittent catheterisation was initiated immediately after injury. Right side predominance of pyelocaliectasis was demonstrated but requires further study. The extent of neurological deficit (complete or incomplete lesions) does not appear to influence the development of pyelocaliectasis. These findings support our contention that intensive urological follow-up is necessary for all spinal cord injury patients even though a catheter-free state has been achieved through use of intermittent catheterisation.


Scoliotic growth in children with acquired paraplegia [proceedings].

1. 166 children with paraplegia occurring before the age of 15 are presented, of whom 116 are available for the study. 2. Scoliosis of more than 15 degrees developed in approximately one-half of the children. 3. Children with thoracic paralysis appear to be particularly endangered. 4. The primary spinal column injury as a result of an accident plays only a minor role in the development of scoliosis. 5. The asymmetric neurological level of paralysis is seen as a significant cause of scoliosis. 6. As prophylaxis, a spinal support as well as standing and walking exercises, including balance exercises, are recommended. 7. As possible therapy in cases with proven asymmetric neurological paralysis, rhizotomy of several thoracic spinal nerves may be discussed in order to achieve a balanced paralysis.


Spinal cord injury in children and adolescents: diagnostic pitfalls and therapeutic considerations in the acute stage [proceedings].

Traumatic spinal cord lesions in children are infrequent (2 to 5 per cent of all cases admitted to specialised paraplegic centres depending on whether the upper age limit is set at 10 or 15 years). Traffic accidents are responsible for at least 50 per cent of the lesions; playground accidents and various sports add another 35 per cent. A large proportion of the accidents have been found to be related to the child's normal desire for adventure and exploration. The segment most frequently involved in our own series of 18 cases was the cervical and upper thoracic spine. Histopathological studies have shown that splitting of the cartilaginous end-plate in the growth zone of the vertebrae is a common finding. Radiological signs of spinal trauma are less evident than in adults; they may be totally missing. Precise neurological assessment must rely on repeated examination and close clinical observation, especially in the comatous child with a head injury. Spinal cord involvement must be suspected and the child treated as a paraplegic until definite proof of a normal neurological status is available. Due to a highly labile water electrolyte balance in the early post-traumatic stage and considerable fluctuations in plasma volume and temperature regulation, permanent monitoring of the cardiovascular function, body temperature and diuresis is mandatory. In children below the age of 10, deep vein thrombosis and embolism are exceptional (sepsis creates a high-risk situation requiring anticoagulation). In the initial treatment of spinal injury only conservative measures should be considered; there are no indications for laminectomy, nor for spinal fusion. In the tetraplegic child below the age of 6, skull-traction should be avoided and immobilisation of the cervical segment achieved by bilateral padded head-rests.


Correction of scoliosis due to paraplegia sustained in paediatric age-group [proceedings].

At the present time our preventive methods do not fully prevent the occurrence of scoliosis subsequent to juvenile paraplegia. The methods of management must be: (a) preventive; (b) early non-operative correction, such as braces; and by (c) operative correction. The operative correction must be both an anterior and posterior procedure to give good spinal alignment. Further follow-up over many years will be necessary to watch these cases, but the initial results are satisfactory re correction. Function has been improved in both (a) respiration and (b) mobility, but at the 'expense' of reduction in some areas of recreation.


[Certain theoretical and methodological problems of phytoparasitology].

At present stills is lacking the general theory capable to explain the essence of factors determining the nature of relationships between the parasitic organisms and higher plants. This is associated with the crisis of the dominant theoretical system which suggests that plants possess active protective reactions to definite species and races of parasites having developed in the process of the evolution. Heuristic analysis of various conceptions and hypotheses has shown that the general theory of parasite resistance of plants can be based only on the ecological conception of parasitism and V. P. Efroimson's theory of uncomplete medium.


[Sensitivity of the females of Ixodes persulcatus and Dermacentor silvarum (Ixodidae) to baytex and the possibility of their overcoming poisoning with this substance].

Females of I. persulcatus and D. silvarum are very sensitive to baytex, the value of LD50 for both species are similar. The development of injury after exposure to baytex proceeds very quickly and the subsequent stages of injury development correspond to those caused by DDT (Uspensky and Levikov, 1974). The overcoming of baytex poisoning during the sucking of the host's blood is possible only at the initial stage of the injury. The simulatneous feeding on the same rabbit of ticks treated with baytex and control ones has shown a system effect of baytex on the second group of ticks.


[Distribution and ecology of Ixodes pavlovskyi (Ixodidae) in Sykhote-Alin].

I. pavlovskyi is absent from the eastern macroslope of Sykhote--Alin, rare in the central part of the ridge and is quite common in western Sykhote--Alin where it accounts for no more than 10% of total collections with I. persulcatus. An average density of ticks in forests of western Sykhote--Alin is 50 to 80 active adults per hectare, maximum density - 150 specimens. Larvae feed on various small mammals and birds, nymphs--on birds and mammals larger than Sibirian chipmunk. Adults feed on hedgehogs, hares and birds, preferrence being given to hazel hens.


[Ultrastructure of Nosema diplostomi - hyperparasite of the trematodes of the genus Diplostomum].

Studies were undertaken of the fine structure of microsporidian, schizont, sporoblast and spore of Nosema diplostomi Schigina et Grobov, 1972 parasitic in metacercariae of fish eyes. The spore wall with outer membrane of the nuclear substance, polar filament, polaroplast, sporoplasm and rough endoplasmic reticulum are described. The diameter of a partially ejected filament is larger than the polar filament inside the spore.


[Tetraonchus alaskensis Price, 1937 and its epizootic role].

Mortality of pelyad (Coregonus peled) caused by Tetraonchus alaskensis took place in winter 1973 in the Voikara and Syn rivers (the Ural tributaries of the Lower Ob) during anadromous and catadromous migrations. The highest infection rate was observed in older fished. Up to 2330 specimens of the parasite were recorded from the gills of one pelyad. A low infection rate with T. alaskensis was recorded from Coregonus nasus, C. lavaretus pidgian and Stenodu. The mortality coincided with the period of the greatest abundance of the Ob pelyard stock.


[Invasiveness and developmental forms of 3 Babesia species and piroplasmids (Piroplasmida) in the eggs of ixodid ticks].

The paper presents the materials on the identification and study of the developmental forms and morphology of B. colchica and P. bigeminum in eggs of Hyalomma anatolicum. The description of developmental forms of B. colchica in eggs of Boophilus calcaratus is given for the first time. P. bigeminum and P. beliceri were detected in eggs of B. calcaratus and H. anatolicum from the first day of egg production up to the emergence of larvae while B. colchica was found beginning from the 4th-5th day of egg production up to the 5th-7th day before larvae emergence. The invasion rate of eggs of B. colchica is considerably smaller than that of B. bigeminum and P. beliceri. In piroplasmids and babesians there were observed sigar--like, roundish, amoebapear-, rod-shaped and oval forms. Some indivisuals of piroplasmids had projections of cytoplasm of different size. Individuals of B. colchica are smaller than those of P. bigeminum and P. beliceri that enables an easy differentiation of babesians from piroplasmids.


[Change in the fish crystalline lens in experimental diplostomatosis].

Experimental infection of roach with cercariae of Diplostomum spathaceum has shown that the pentration of larvae into the eyeball proceeds in hematogenous way. Metacercariae are localized in the cortical layer of the crystalline lens thus causing destructive changes of its fibres and the dimness of the lens. The appearence of the dimness of the lens carries out without any apparent reactive changes in its epithelium. This enables to distinguish a parasitic cataract from all other varieties of cataracts.


[Copepodid stage of Dichelesthium oblongum (Abildgaard, 1974), a parasitic copepod of the sturgeons].

The morphology of a copepodid found on Huso huso near the delta of the Volga is described and illustrated. The copepodid bears general resemblance to those of Caligidae but differs from them in absence of the frontal filament and in possession of a primitive first maxilla. It is concluded that the copepodid belongs to Dichelesthium oblongum and that Dichelesthiidae might be more closely related to Caligidae than has hitherto been suspected.


[Development of the neural apparatus of Triaenophorus nodulosus (Cestoidea, Pseudophyllidae) during ontogenesis].

The anatomy of the nervous apparatus of Triaenophorus nodulosus at all stages of its life cycle was studied by means of Zherebtsov's hystochemical method. Judging by the cholinesterase activity the mass of nerve cells is situated in the oncospheres of the coracidium. At the procercoid stage the ortogonal nervous system arises with three pairs of the longitudinal nervous trunk. In plerocercoids the number of longitudinal trunks increases up to 7 pairs, the rough nervous plexus and inner plexus develop too, In mature, cestodes only secondary changes take place associated with the development of the genital system. Both in larvae and adults all longitudinal trunks are situated at the same level, on the border of the cortical and medullary parenchyma, and only the inner nervous plexus first described by the authors from cestodes passes through the medullary parenchyma. The arrangement of all elements of the nervous apparatus at the same level corresponds from the authors point of view to the most primitive state of the nervous system in the order Pseudophyllidea.


[Cestode larvae among the planktonic invertebrates of the Atlantic Ocean near the shores of Northwest Africa].

Larval cestodes were described from chaetognaths and some other planktonic animals of the north-west African coastal waters. They are species of the Trypanorhynchidea (Eutetrarhynchus sp.) and of the Tetraphyllidea (Scolex pleuronectis O. F. Müller of uni and trilocular type). Tetraphyllidea are represented also by blastocysts of the family Phyllobothriidae. Life cycles were discussed and specimens of the last group were compared to those of Rio de Janeiro.


[Monogenea in 2 species of fish of the order of the garfish (Beloniformes) from the Indian and Pacific Oceans].

Two fish species, Euleptorhamphus viridis and Cololabis saira, were studied for monogeneans. 284 specimens of E. viridis collected in nearly all parts of its area in the Indian and Pacific Oceans have been examined. Five species of monogeneans were found in this species: Axine parini, Axinoides kola, Diplaxine popovae and two species of gastrocotylid larvae. None of them were recorded in E. viridis before. In both oceans the infection of E. viridis with Axine parini and Gastrocotylidae g. sp. I larvae was the most extensive. In the Indian Ocean the infection extensiveness of E. viridis with A. parini was higher than in the Pacific. The areas of all parasites were more restricted than that of the host. None of 190 specimens of the saury had any monogeneans.


[Studies of the corticosteroid hormones in the nematode, Ascaris suum].

Four steroids from tissues of Ascaris suum were isolated and identified by means of the thin-layer chromatography and fluorimetric methods as corticosterone, cortisol, alodosterone and dehydrocorticosterone. Corticosterone, cortisol and alodosterone are corticosteroid hormones while dehydrocorticosterone is a product of a metabolic transformation of corticosterone. It seems likely that the presence of corticosteroid hormones in tissues of A. suum is indicative of their participation in the metabolism of the latter.


[Flea Ceratophyllus fasciatus as the vector of the Altai-mountain strain of plague microbe].

The work was conducted with a typical strain of the plague agent, which is virulent to white mice and little virulent to guinea pigs (subcutaneous infection), and with C. fasciatus. The fleas of this species can be infected, form the block of proventriculus within 4 to 35 days, transmit the agent during bloodsucking to healthy animals and cause the death both white mice and guinea pigs.


[Biological aspects of the problem of opisthorchiasis].

The paper reports the latest data concerning genesis and structure of opisthorchiasis area; biology, ecology, position in the system and distribution of the first intermediate hosts of Opisthorchis felineus; peculiarities of infections with Opisthorchis of the first and second intermediate hosts. The methods of chemical control of mollusks, the first intermediate host of Opisthorchis, are discussed.


[Electron microscopic study of Haller's organ in the tick, Ixodes persulcatus (Ixodidae)].

Haller's organ consists of the capsule, in which are arranged 7 thin-walled porous olfactory hairs, and an anterior group of sensillae situated in the cuticular recess before the capsule. The anterior group is represented by one thick-walled porous, one conical, two thin and two grooved hairs. The porous hairs are characterized by "plugs", the grooved ones--by a complex system of cavities and tubules. Before the organ there are hairs resembling tactile and gustatory receptors of arthropods, behind the organ there arrange hairs with a system of cavities and tubules. Sensible elements of all sensillae studied are bipolar receptor cells bearing one modified cilium on the surface of peripheral processes. The details of the structure of perceptive and accessory apparatus of the above receptors were investigated.


[Indices of blood lipid metabolism in chicks infested with a large dose of Eimeria tenella oocysts].

20-, 40- and 60-day old chicks were infected with E. tenella (100000 oocysts). The nature of changes in cholesterol, general fat and lecithin of chicks' blood is the same as at the infection with a small dose (5000) of oocysts of E. tenella. Changes in the lipoid components differ only quantitatively: they are greater at the infection with a greater dose of oocysts that at the infection with a small one.


[Basic taxonomic groupings of the organisms participating in the formation of nest-burrow microbiocenoses].

The transition of arthropods, other invertebrates and microorganisms to the nest-burrow habitats was accompanied (if presented in a historical aspect) by an intensive speciation resulting in a rise of a peculiar life form, nidicoles. Now nidicoles are reported in such large taxons as Protophyta, Mycophyta, Protozoa, Nematoda and Arthropoda. The main part of nidicoles is represented by arthropods, members of the orders Acariformes, Parasitiformes, Blattoidea, Saltatoria, Mallophaga, Anoplura, Heteroptera, Coleoptera, Diptera and Siphonaptera.


[Nucleic acid and protein synthesis in the body of chicks infested by various species of Eimeria].

The infection of chicks with optimal immunogenic doses of oocysts of E. tenella and E. acervulina results in the activation of biosynthesis of proteins and nucleic acids in the Fabricius bursa, spleen, thymus and blind processes of the intestine. The infection causes the increase in the quantity and synthesis intensity of immunoglobulins G and M that suggests a stimulation of cellular and immunity factors in the ogranism of an immunized bird. Maximum changes in biosynthesis of compounds studied are reported four days after the infection that confirms high immunogenic properties of the second generation schizonts. A study of protein synthesis in limphoid organs of chicks infected only with E. tenella has yielded the same results. The infection with E. acervulina caused but negligible changes in the protein metabolism, i.e. coccidians of E. tenella possess more immunogenic properties.


[Changes in the argyrophil stroma of the liver of fishes infested with the pleurocercoids, Triaenophorus nodulosus and Diphyllobothrium dendriticum (Cestoidea, Pseudophyllidae)].

The argentaffine stroma of the liver of some fishes (Perca fluviatilis, Exos lucius, Paracottus kessleri, Coregonus autumnalis migratorius, Thymallus arcticus) is described. The nature and depth of pathological changes in the argentaffine stroma of the liver at its infection with pleurocercoids of pseudophyllids depend on the infection intensity, host's specificity and on the biocoenotic relationships of hydrobionts in a waterbody.


Vascular rings and tracheobronchial compression in infants.

Five  common types of vascular anomalies have been reviewed. The entities should be kept in mind when a child has stridor, respiratory distress, recurrent croup, or pulmonary infections. Use of the plain radiography, barium esophagram, bronchoscopy, and angiography has been discussed in the diagnostic workup of vascular rings. Treatment of true encircling or compressive rings is surgical.


Evaluation fo recurrent respiratory tract infections.

We have outlined the appropriate study of patients with recurrent respiratory tract infections. A detailed history and a complete physical examination, together with a chest roentgenogram, will, in most instances, give clues to a possible diagnosis. Among the laboratory studies listed in Table 2, the easily available and relatively informative tests consist of routine hemoglobin, white blood cell and differential count, sputum and throat culture for bacteria isolation, screening pulmonary function tests. Most of the other laboratory tests (including sweat tests) and diagnostic procedures require experienced and trained personnel and special facilities and equipment that are available in pediatric pulmonary centers. Any patient suspected of having a complicated or serious pulmonary disease or a congenital anomaly that is correctable by surgery should be referred to a pediatric pulmonary center for a complete diagnostic evaluation. It is important that this be done as soon as possible so that early institution of appropriate therapy may lead to a cure of the pulmonary disorder.


A critical evaluation of bronchial hygiene in pediatric pulmonary disease.

The variables inherent in analyzing the effectiveness of modalities used to achieve bronchial hygiene are numerous. Treatments may be given in a variety of settings, including intensive-care units, pediatric wards, respiratiory therapy departments, physical therapy departments, chronic-care hospitals, special education centers, and patient homes. Treatments are administered by a variety of medical professionals, allied health personnel, and lay volunteers. Motivation of the care providers as well as of the patients may vary greatly. Also, efforts are needed to study patients at comparable stages in their growth and development and in the progression of their particular diseases. Rather than perpetuating the unquestioning use of these various treatments, a series of carfully constructed and controlled studies done in collaborative fashion need to be performed. Until that time, the recommendations we have outlined dealing with each of the various segments of bronchial hygiene may serve as useful guidelines.


Reduction of cerebral palsy by neonatal intensive care.

Neonatal mortality has declined since the advent of intensive care. The incidence of cerebral palsy has likewise decreased in spite of increased survival of low birth weight infants.


Regionalization: a time for new solutions.

We are at a time when solutions must be found to the problems of facilities, personnel, transportation, and re-imbursement which face us in the delivery of neonatal health care. No one system can be perfect for each situation or area. Each city, country, state, or region must implement systems which will bring us to our goal. Simply stated, that goal is the provision of appropriate care for high-risk newborns as close to their place of birth as is medically and financially feasible.


Inguinal herniation of the ureter.

A case of ureteral herniation into the inguinal canal is reported in a 6 week old boy with a solitary functioning kidney.


The Weissenbacter-Zweymuller syndrome. A case report with review of the world literatue.

This report describes a patient with a form of chondrodysplasia characterised by a rhizomelic shorteining of the limbs, metaphyseal widening, vertebral coronal clefts and retrognathia. This syndrome was first described by Weissenbacher and Zweymuller in 1964. All the relevant literature available has been reviewed and it has been concluded there are mild and severe forms of this syndrome.


Sporadic idiopathic acroosteolysis with cranio-skeletal dysplasis, polycystic kidneys and glomerulonephritis. A case of the Hajdu-Cheney syndrome.

A case of the Hajdu-Cheney syndrome in a 15 year old boy is described. The manifestations were: 1. isiopathic progressive acro-osteotions; 2. mutiple cranio-skeletal abnormalities; and 3. polycystic kidneys complicated by a rapidly progressive glomerulonephritis.


Congenital dysplasia of C2--6.

Neural arch dysplasia of the cervical vertebrae is a rare occurrence. The authors present a case with dysplasia of cervical bodies and posterior arch elements at multiple levels. The embryogenesis of these anomalies is discussed.


Seizures and demineralization of the skull. A diagnostic presentation of rickets.

We present four infants with seizures, and one without seizures, in whom the diagnosis of rickets was first suggested because of a demineralized skull. A review of the skull films in all of our patients with rickets showed that 20 of 25 (80%) showed demineralization. Demineralization of the skull is a common and important feature of rickets. Furthermore, as demonstrated by our cases, it may be the first clue to the presence of rickets in certain infants.


The anatomy of the heart in the sonogram. A comparison between anatomic and ultrasonic cross-section.

Cardiac sonography has only recently been introduced as a diagnostic procedure. In order to facilitate the interpretation and evaluation of the ultrasonic cardiac cross-section displayed by this two-dimensional technique, we performed anatomic cross-sections corresponding to ultrasonic cross-sections. The ultrasonic cross-sectional images were taken from children with a real-time-motion scanner. The anatomic cross-sections were taken from adult hearts. Two ultrasonic transverse cross-sections are compared with the two corresponding anatomic cross-sections and three ultrasonic longitudinal cross-sections with one corresponding anatomic cross-section. The direct comparison between anatomic and ultrasonic cross-sections best promotes the understanding of the latter: such a comparison shows certain gaps of information in the ultrasonic display, mostly due to the physical prerequisites of the technique. Morphological details, therefore, should be interpreted with great care. In spite of these disadvantages, sonography is the only non-invasive method that provides an exact analysis of the heart's structure. In addition to this, the real-time-motion technique allows observation of the movements of cardiac structures.


Persistent fetal circulation: an evolving clinical and radiographic concept of pulmonary hypertension of the newborn.

The roentgenographic presentations of 11 newborn infants with hypoxemia secondary to pulmonary vasospasm and subsequent right-to-left shunting of blood through the foramen ovale and/or ductus arteriosus (persistent fetal circulation) are described (P. F. C. Syndrome). One infant had radiographically normal lungs, while ten had pulmonary parenchymal abnormalities including hyaline membrane disease [4], meconium aspiration syndrome [4], or an ill defined pattern of retained lung fluid [2]. The roentgenographic appearance of the lungs, however, was discordant with the severe hypoxemia observed in most. Heart size was variable but some degree of cardiomegaly was commonly present. Tolazoline, a potent vasodilator, was useful diagnostically and may have resulted in increased survival. An expanded clinical and roentgeonographic concept of the PFC syndrome is suggested.


The significance of abnormal duodenal loop on radiological and clinical cure in infants with sliding hiatal hernia.

In a study, partly retrospective and partly prospective, there were 29 infants who had sliding hiatal hernia: their principal clinical features, the diagnostic criteria, treatment and cure rate were similar to those of other series. The study highlights associated duodenal anomalies which seem to influence the radiological but not the clinical cure rate. The findings can be contrasted with those in adults who have duodenal abnormalities with sliding hiatal hernias in that 21 out of 29 infants with sliding hiatal hernia had a normal duodenal loop. Severe dyspepsia, with malnutrition initially, did not have any influence on physical development in 27 out of 29 patients.


Oto-Palato-Digital syndrome with severe X-ray changes in two half brothers.

The first two cases, reported in Australia of Oto-Palato-Digital syndrome, in two half brothers and described. They show the most severe X-ray changes ever reported in this syndrome, and were already full-blown in one of the brothers who was radiographed at the age of 1 day. These two cases also broaden our clinical and radiographic spectrum of the disease.


Relation between arterial blood pressure and blood volume and effect of infused albumin in sick preterm infants.

The relation between directly measured arterial blood pressure and blood volume was studied in 61 sick preterm infants. Mean blood volume (derived from plasma volume [T1824 ten-minute albumin space] and hematocrit value) of 26 hypotensive infants (89.1 +/- 17.26 ml/kg) was not significantly different from that of 35 normotensive, but otherwise comparable, infants (91.4 +/- 14.57 ml/kg). There was no relation between arterial mean blood pressure and blood volume. Twenty-one infants with arterial mean blood pressure less than 30 mm Hg were given 1.0 g/kg of 10% salt-poor albumin. Significant increases in blood pressure occurred but were small in magnitude; more than one half of infants had arterial mean blood pressures persistently less than 30 mm Hg. Arterial/alveolar PO2 ratio decreased significantly with albumin infusion in six infants with hyaline membrane disease not receiving continuous distending-airway pressure, suggesting an association between infused albumin and impaired oxygen exchange.


Sleep apnea in a child with the pickwickian syndrome.

A 3-year-old girl with a history of excessive weight gain from birth presented with obesity, somnolence, and cyanosis, characteristic of the Pickwickian syndrome. Obesity was familial and exogenous without endocrine or neurologic anomaly. Respiratory center sensitivity to carbon dioxide was normal. Excessive somnolence was due to the obesity, which during sleep caused airway obstruction, apnea, and awakening, finally resulting in sleep deprivation. The sleep apneas and the daytime somnolence disappeared with weight reduction, showing that obesity alone had been responsible for the disorder.


Controlled study of child health supervision: behavioral results.

Extensive child health supervision, with emphasis on counseling and anticipatory guidance, was provided for the first three years of life to an experimental series of 47 normal first-born black infants from low-income families living in the environs of Children's Hospital in Washington, D.C. The mothers were unmarried schoolgirls in normal physical and mental health. A control series consisted of 48 similar mother-child dyads from the same area. Data were collected, in part by an outside evaluator, at yearly intervals on both experimental and control series in a form suitable for coding on computer cards. Comparison of differences in behavioral results between the two series showed statistically significant findings in favor of the experimental children, as well as numerous favorable trends during the first six years of life. Positive effects became evident in diet and eating, habits, in some developmental problems of growing up (such as toilet training), and in certain abstract qualities including self-confidence. Significant differences were also noted between the experimental and control mothers for various child rearing practices and personality characteristics. No significant difference or trend favored the control series. We believe that a causal relationship existed between the intervention and at least some of the significant findings.


Hypocalcemic coma following two pediatric phosphate enemas.

Coma, tetany, dehydration, hypotension, tachycardia, and hyperpyrexia developed in a 2 1/2-year-old girl following two hypertonic phosphate pediatric enemas. She had marked hyperphosphatemia, hypocalcemia, hypernatremia, and acidosis. Hypocalcemia due to hyperphosphatemia can explain all of these findings. Calculations indicate that about one third of the phosphorus and sodium contents of the enema were absorbed. Physicians should be aware of the potentially lethal complication of this treatment, which is part of everyday practice.


Light filtration during transillumination of the neonate: a method to reduce heat buildup in the skin.

Filtration of the light used for transillumination of neonates is employed to reduce heat buildup in the skin during transillumination. Clinical and experimental evaluation of the effects of filtration are presented.


The electroencephalogram in pediatric practice: its use and abuse.

Utilized appropriately, the EEG is a helpful diagnostic tool; however, it is currently much abused and much overutilized. Understanding its limitations and its usefulness may lead to less frequent but more appropriate requests for EEGs. Realization that the EEG alone neither diagnoses nor rules out epilepsy and that it is not crucial in the diagnosis or management of "minimal brain damage" should decrease the utilization and abuse of the procedure.


Symptomatic trigeminal neuralgia in a 5-year-old child.

Trigeminal neuralgia is a rare symptom in childhood. In the idiopathic variety, no objective neurological deficit is demonstrable, but in the symptomatic or secondary form, deficits of trigeminal function may be found. In the latter circumstance, underlying causative pathology must be looked for vigorously, as emphasized by the present case of symptomatic trigeminal neuralgia in a 5-year-old child, determined to be secondary to an infiltrating embryonal rhabdomyosarcoma.


Defects of neutrophil chemotaxis and random migration in thalassemia major.

Chemotactic and random migrations in a group of 11 patients with thalassemia major were found to be defective. This may be partially the basis for the predilection to infection occasionally observed in these patients. These findings may reflect a primary defect of polymorphonuclear leukocytes or may be secondary to associated liver disease and/or diabetes mellitus. Further studies are required to define the mechanisms involved.


[Fascioliasis in sheep in South-western Jutland (author's transl)].

The frequency of fascioliasis in sheep of south-western Jutland has been determined on the basis of slaughterhouse registration of infected livers over a 5-year period (1969-1973). The average yearly percentage of adult sheep found to be infected ranged from 83.9 to 91.2%, whereas less than 1 % of the slaughtered lambs proved infected. The high infection percentage among adult animals and the strikingly low frequency among slaughter lambs could be explained by the characteristic management system of the marshland: In summer the sheep graze the dike and the foreland on its seaward side, and in winter the animals graze in the marshland. Lymnaea truncatula is not found on or at the seaward side of the dike, whereas it is abundant all over the marshland. Thus the lambs graze exclusively the snail-free area from which they are taken directly to the slaughterhouse. The summer grazing also protects the adult animals as they avoid the massive uptake of metacercariae which normally takes place in fluke infected areas in late summer.