The effects of somatostatin on hormonal and metabolic responses in chronic pancreatitis.

Unmodified synthetic somatostatin, given as a 200-microgram intravenous bolus, plus 200 microgram infused over 3 hours, had no effect on basal plasma insulin and pancreatic glucagon-like immunoreactivity (GLI) levels, both in controls and in patients with chronic pancreatitis. Somatostatin inhibited insulin-hypoglycaemia-induced pancreatic GLI release in controls and in patients with pancreatitis, and prolonged the insulin-induced fall in blood glucose in the patients. Arginine, presumably via insulin release, caused a fall in free fatty acids (FFA) in controls, which was inhibited by somatostatin. Somatostatin abolished the rebound rise in plasma FFA in patients with pancreatitis after insulin-hypoglycaemia. This effect may be related to inhibition of pancreatic GLI release or may be a direct action of somatostatin on lipolysis.


A plea for routine radiographic examination of the cervical spine after head injury.

Patients with unrecognized fractures of the cervical spine associated with head injuries run the risk of developing spinal cord compression and paralysis while undergoing treatment. A case history demonstrating such a sequence of events is presented. The frequent association of fractures of the cervical spine and trauma to the head is discussed. Routine radiographic examination of the cervical spine in all patients who have sustained significant injuries to the head or face is advocated. The technique for performing simple lateral radiography of the cervical spine without moving the patient is described.


Advantages of the plasma uptake method for measuring vitamin B12 absorption.

The plasma uptake method for determining vitamin B12 absorption is reassessed. The results of this study demonstrate the ease with which normal controls can be separated from patients with intestinal malabsorption of vitamin B12 and from those with pernicious anaemia. This method is also shown to be a sensitive index of improved vitamin B12 absorption after treatment of small-intestinal disease and with the addition of intrinsic factor in pernicious anaemia. The advantages, particularly for developing countries, over the more commonly used Schilling test are discussed. It is emphasized that, because of the lack of a universally accepted normal value, healthy controls should be studied to define the normal range for the community under investigation.


Use of capnography to monitor pulmonary circulation during cardiac resuscitation.

Three cases are described where capnography gave very early warning of ineffective cardiac massage or impending cardiovascular failure. Life-saving information can be obtained at an early stage if the capnograph is used routinely in the care of critically ill patients.


Primary isolated extramedullary plasmacytoma of the colon: a case report.

A tenth case of extramedullary plasmacytoma (EMP) of the colon is reported. The term 'primary isolated extra-medullary plasmacytoma' is preferred to those terms previously used. A broad classification of plasmacytoma of the gastro-intestinal tract is suggested and a management policy, based on this classification, is outlined.


The metabolism of phenobarbitone, phenytoin and antipyrine in Black patients.

The half-lives of phenytoin, phenobarbitone and antipyrine were studied in adult Black patients to attempt to ascertain the cause of low phenytoin concentrations previously found in Black epileptics. The following half-life values were observed: antipyrine 5,7 +/- 1,9 hours, phenytoin 15,9 +/- 7,9 hours, phenobarbitone 63,0 +/- 18,2 hours, and phenytoin after 1 month of phenobarbitone therapy 31,5 +/- 11,9 hours. No explanation was obtained for the low phenytoin levels previously observed.


Ehlers-Danlos syndrome associated with keratoconus. A case report.

A case of keratoconus in a patient with probable type IV Ehlers-Danlos syndrome is described. We believe this to be the first such case reported. The patient has undergone successful corneal grafting.


Progressive familial heart block--two types.

Two types of heart block which occur extensively in families in the Republic of South Africa are reported. A type I heart block tends to have the pattern of a right bundle-branch block and/or left anterior hemiblock occurring individually or together, and manifesting clinically when complete heart block supervenes, either with syncopal episodes, Stokes-Adams seizures or sudden death. The condition is inherited as an autosomal dominant gene and appears to be progressive in nature; the risk to life appears to be greatest at 3 particular periods:at or soon after birth, during puberty and the early 20s, and again towards middle age. The type II condition also appears to be progressive and is inherited as an autosomal dominant gene. The pattern, however, tends to develop along the lines of a sinus bradycardia with a left posterior hemiblock, again presenting clinically as syncopal episodes. Stokes-Adams seizures or sudden death when complete heart block supervenes. Both conditions are likely to be widely prevalent throughout the Republic of South Africa. The pathogenesis is discussed in relation to the patterns of the conduction disturbances.


The treatment of established iliofemoral deep vein thrombosis with streptokinase.

Sixteen patients (mainly Blacks) with iliofemoral deep vein thrombosis were treated with streptokinase and the results assessed by venography. Clear improvement in the venographic appearance was limited to 3 patients, but clinical improvement in the affected leg occurred in all patients. The thrombolytic effect of streptokinase cannot be assessed on clinical criteria alone. The purpose of this report is to draw attention to the poor clearing of main venous channels by streptokinase therapy.


Effect of atropine and metoclopramide on serum gastrin response to protein in patients with duodenal ulcers.

The serum gastrin response to Oxo or to a meal was studied in 35 patients with duodenal ulcers and in 28 control subjects. Neither the integrated gastrin response nor the mean peak gastrin concentration was significantly higher in patients with duodenal ulcers compared with the controls, whatever stimulus was used (Oxo or a meal). Atropine 0,5 mg injected intramuscularly half an hour before the meal did not significantly affect the integrated gastrin response or the peak gastrin concentration of controls or of patients with duodenal ulcers. Metoclopramide 10 mg injected intramuscularly half an hour before the meal significantly reduced the integrated gastrin response and, to a lesser degree, the peak gastrin concentration in controls, but it did not affect these variables in patients with duodenal ulcers. The failure to suppress the gastrin response with metoclopramide in patients with duodenal ulcers has not been explained.


Endotracheal intubation and head posture in infants.

The movement of an endotracheal tube relative to the carina has been studied with the head in different positions. The dangers of malposition and displacement are stressed. Some precautions necessary to avoid these hazards are given.


The house-dust mite and childhood asthma in the Cape Peninsula.

Sensitivity to house-dust and the mites Dermatophagoides pteronyssinus and D. farinae was the commonest cause of asthma in children living in the Cape Peninsula. Of 103 asthmatic children examined, 65,5% had positive skin tests to these allergens. Only a small number of the children were sensitive to pollens, feathers, moulds or food. The median serum IgE level was 496 U/ml, with a range of 18-15972 U/ml, and the median blood eosinophil count was 691/microliter (range 93-8 159) in 102 of the children.


Neonatal nutrition.

Doctors should redouble their efforts to encourage mothers to breast feed. This is advantageous both in developed and in developing countries, for in developed countries, morbidity is lowered, while in developing countries, morbidity and mortality are drastically lowered. If the advantages of breast feeding cannot be impressed on the mother, then those formulas which most nearly simulate breast milk should be used. This is economically feasible in any society because of the lowering of morbidity due to conditions such as intestinal disorders, anaemia, eczema and, perhaps, poor brain development; the cost of these diseases should be included in the calculations for formula feedings. Other countries have already made the error and have later improved on feeding cow's milk formulas. Developing countries can avoid this error.


Blastomycosis of the tongue: a case report.

A clinically malignant tongue ulcer in a 63-year-old White man was proved by histological examination and culture to be due to Blastomyces dermatitidis. In addition, pulmonary lesions caused by B. dermatitidis were found at autopsy.


Pre-operative angiographic assessment of portal venous hypertension.

Fifty-three patients with portal venous hypertension underwent angiographic evaluation of the portal venous system. Arteriography was found to provide adequate opacification of the portal system in 52 patients. Arterial portography is a safer method than splenoportography and provides informaiton not obtainable by the latter method. Thus, hepatic arteriography demonstrated 2 unsuspected hepatomas in the present series. Catheterization of the hepatic veins and measurement of the wedged hepatic venous pressure provide a reliable estimate of the total portal pressure and of the severity of the portal venous hypertension. Vena caval pressure measurements and inferior vena cavography are helpful in the diagnosis of surprahepatic causes of portal hypertension, such as constrictive pericarditis and inferior vena caval diaphragm, and are also useful in the diagnosis of vena caval hypertension due to caudate lobe enlargement. Combined arteriography and venous studies are recommended as the initial radiological approach in all patients with portal hypertension who are being considered for portal-systemic shunt surgery.


Unreliable drug histories, analgesics, and changes in renal function.

One hundred and nine outpatients were questioned on their use of analgesics and asked to provide urine and blood samples. Forty-one per cent said they used analgesics daily and 54% said they had ingested analgesics during the 3 days before questioning. The analgesics used were mainly aspirin or paracetamol, alone or in combination. Five (42%) of the patients who denied the use of analgesics, and 10 (29%) of those who denied intake during the preceding week, had detectable amounts of paracetamol or aspirin in their urine. Mean serum urea, although still within the normal range, increased with increasing use of analgesics. The mean serum urea of patients who used aspirin and paracetamol in combination was significantly higher than that of those who used either of the drugs alone. The findings suggest that one should not rely heavily on the history of analgesic use, and that by replacing phenacetin with paracetamol one might not have achieved much as far as renal function is concerned.


Effect of vitamin or amino acid supplementation on plasma free amino acid levels in South African Blacks.

The object of this study was to determine the effect of large oral doses of L-leucine, vitamin B1, vitamin B2, vitamin B6 or vitamin C, given over a period of days, on the plasma free amino acid levels and protein nutrition index values of South African Blacks on a maize diet. In addition, single loads of L-tryptophan or L-kynurenine were given before and after the above regimen of L-leucine or vitamin to determine the effect of tryptophan or kynurenine with and without the influence of these factors on the plasma free amino acid levels and protein nutrition index values. Vitamin C therapy or a single dose of L-tryptophan increased the total plasma free amino acid levels. L-leucine therapy or a single loading dose of L-tryptophan increased the protein nutrition index. Single loading doses of L-kynurenine decreased the protein nutrition index. The levels of non-essential amino acids in the plasma of Blacks were much higher than those of Whites, and consequently the protein nutrition index values were much lower.


Autonomic neuropathy in Black diabetic patients.

Seventy adult diabetic patients were assessed for the occurrence of autonomic neuropathy by means of simple clinical tests. Objective evidence of autonomic dysfunction was present in 72%, pure sympathetic dysfunction in 28%, pure parasympathetic dysfunction in 10% and impotence in 57% of patients. Approximately 10% of patients had nocturnal diarrhoea and gustatory sweating.


Gangrene of the extremities in measles.

Gangrene of an extremity is very uncommon in measles, but we have encountered 3 cases. One patient had a peripheral variety with gangrene of the toes, while the other 2 had major vessel thrombosis. Evidence from the literature is advanced to support the hypothesis that disseminated intravascular coagulation on an immunological basis may be an important precipitating factor. Treatment is briefly discussed.


Use of SI and standardization of laboratory reports in haematology.

The change to the reporting of haematology laboratory results in the SI is now occuring in South Africa. To facilitate uniformity and standardization, the recommendations of a subcommittee of the Southern African Society for Haematology are presented.


Homocystinuria in two South African Negro siblings.

This, to our knowledge, is the first report of homocystinuria in the South African Negro. Two siblings are presented who developed normally until the age of 5 years but then showed mental retardation. Both were tall and thin, had genu valgum and arachnodactyly. The elder sib also had kyphoscoliosis, pes cavus and bilateral ectopia lentis. The diagnosis was confirmed by the presence of homocystine in the urine, elevated plasma homocystine and methionine and diminished plasma cystine levels.


Subaponeurotic haemorrhage of the newborn.

Five newborn infants who developed subaponeurotic haemorrhage are described. Three infants were delivered by vacuum extraction, and 3 infants died. The importance of early diagnosis and prompt treatment is emphasized.


The present status of breast augmentation.

In breast augmentation the pattern which has clearly emerged with respect to possible complications shows that those encountered a few years ago have now, in experienced hands, almost all been eliminated, with one exception, viz. undue postoperative firmness (capsular contraction). This complication is reviewed in detail, with special reference to its possible aetiology, prevention and treatment. It is concluded that despite this complication, breast augmentation is today a very good and safe operation. Excellent results have been achieved in about 90% of cases, and this figure can be improved upon with further treatment for any complicating firmness.


Calcification of the left atrium.

Three cases of left atrial wall calcification complicating long-standing mitral valve disease are presented. Its possible pathogenesis and influence on further treatment are discussed.


Perforated duodenal ulcer in Black patients.

Sixteen cases of perforated duodenal ulcer in Black patients admitted to Tembisa Hospital during a 1-year period are reviewed. They constitute 0,4% of all surgical admissions. Duodenal ulcer has been considered a rare disease in South African Blacks, but we believe that the incidence is increasing in Black urban populations. The literature is reviewed and possible aetiological factors are discussed.


Control of auto-immune thrombocytopenia by removal of an atrophic spleen: a case report.

We report a patient with systemic lupus erythematosus in whom resection of a completely atrophic spleen (weight 5 g) reversed steroid-refractory thrombocytopenia. The spleen plays a central role in the pathogenesis of autoimmune thrombocytopenia by synthesizing antibodies directed against autologous platelets and by sequestering these immunoglobulin-coated cells. Both functional disturbances occur without splenic enlargement, and splenectomy wll, in selected cases, improve thrombocytopenia. A similar rise in platelet count may follow resection of much smaller masses of splenic tissue such as splenunculi. We have, however, been unable to find documentation of this phenomenon after removal of a completely atrophic spleen.


Problems experienced in a diabetic clinic for Blacks.

One hundred and seventy Black diabetic patients who regularly attend the Baragwanath Diabetic Clinic were studied. Just over 50% of patients suffered from hypertension, and 10% had angina pectoris. Retinopathy was present in 25% of the patients. The incidence of hypertriglyceridaemia and hypercholesterolaemia was much lower than has previously been found among White diabetic patients in Johannesburg. Attention is drawn to the lack of adequate health education given to Black diabetic patients and also to the reliance on oral hypoglycaemic agents in preference to dietary therapy. It is suggested that there is a need for health educators from the patient's own ethnic group if these problems are to be overcome.


Prophyrin precursors in blood, urine and cerebrospinal fluid in acute porphyria.

Four patients suffering from variegate prophyria were investigated during acute attacks. Porphyrin and prophyrin precursor concentrations were determined in the urine, serum, cereborspinal fluid (CSF) and stools. Levels of delta-aminolaevulinic acid (ALA) and porphobillinogen were found to be very much lower in CSF than in serum sampled concurrently, and were well below levels at which these substances have been shown to exert effects on neural tissue in vitro. These findings cast doubt on the possibility that ALA or porphobilinogen is responsible for the production of the neural manifestations of acute porphyria.


Children with thyroid carcinomas.

The presenting symptoms and the clinical findings in 4 children with histologically proven thyroid carcinomas are described. The child with a single nodule in the thyroid gland, the child with a dyshormonogenetic goitre, the child with a thyroglossal duct remnant and the child with thyroid carcinoma and metastatic cervical lymph node involvement are discussed separately.


Problem in prescribing for ambulatory Black children.

A study to assess patient, pharmacist and physician compliance was carried out in a group of 200 ambulatory Black children. Patient non-compliance was observed in 45.5% of instances, and physician non-compliance in 62.5%, while non-compliance on the part of pharmacists was trivial. Other problems, such as inappropriate prescribing and an apparent lack of communication between physician and pharmacist, came to light. These observations are discussed and a series of recommendations are proposed.


Endocrine studies on the San ('bushmen') of Botswana.

Gonadal and gonadotrophic hormones were assayed in members of !Kung population who live in north-western Ngamiland, Botswana, and who are true San ('Bushmen') hunter-gatherers. An attempt was made to correlate their hormonal secretion and morphology. Peripheral serum levels of gonadotrophins and gonadal steroids were measured by means of radio-immune methods. Female San appear to have suppressed circulating levels of gonadal steroids, while gonadotrophins were in the normal range. No evidence for elevated circulating levels of oestrogen could be found. Male San showed hormone levels similar to Caucasoid and Negro ('Bantu') values.


A psychophysiological re-evaluation of Eysenck's theory concerning cigarette smoking. Part I. The central nervous system.

According to Eysenck, extraverts are characterized by inhibited cortical activity accompanied by prominent alpha brain rhythms. This prevents efficient cortical functioning. They have a 'stimulus hunger' in order to increase cortical efficiency. Assuming that nicotine is a stimulant drug, Eysenck puts forward his theory that extraverts will also have a 'stimulus hunger' for the nicotine in cigarettes and will therefore smoke more than introverts, to whom the reverse applies. Implicit in Eysenck's theory is a positive, causal relationship between the amount of alpha brain rhythms and the number of cigarettes smoked. Inspection of the literature, however, indicated that small doses of nicotine stimulate the nervous system, whereas large doses tend to inhibit it. Eysenck's theory was therefore challenged by the alternative hypothesis that light smokers are characterized by prominent alpha brain rhythms and smoke for stimulation. Heavy smokers are, however, characterized by a small amount of alpha activity (overactivated cortex which also prevents efficient functioning), and therefore smoke for inhibition to enhance their cortical efficiency and thus their alpha activity. The results were reconcilable with this hypothesis. The positive relationship implied by Eysenck's theory only held good for light and moderate smokers. Heavy smokers probably smoke for cortical inhibition.


Interhemispheral subdural empyema.

Five cases of localized interhemispheral suppuration are reported. A short description of the 'falx syndrome' is given. The angiographic features of the cases are described.


Blindness from metabolic cataract--a presenting manifestation of diabetes mellitus.

Metabolic cataracts in diabetic patients usually develop within the first 3 years of the disease and cause little or no visual disability, but may progress to blindness. We report our findings in 3 patients who previously had normal vision and who presented with virtual blindness from cataract formation at the time of detection of their diabetes.


Late-onset intestinal obstruction in cystic fibrosis--meconium ileus equivalent.

Four patients who suffered from cystic fibrosis and late-onset bowel obstruction (meconium ileus equivalent), and who were treated by surgery, are discussed. The importance of early correct diagnosis is stressed, since surgery may be prevented if bowel washouts and oral medications are given before the condition becomes complicated.


Effectiveness of nursing sisters in primary paediatric care.

A comparison was made of the management, by nursing sisters and a paediatrician, of 76 children attending primary care clinics. In 95% of consultations, the treatment and the presumed outcome of treatment were identical. The nursing sisters identified correctly all children for whom a second opinion was needed. If nursing sisters are responsible for primary care, they can be expected to refer approximately 10% of the children they see.


A psychophysiological re-evaluation of Eysenck's theory concerning cigarette smoking. Part II. The autonomic nervous system.

Eysenck states that neuroticism is a function of the autonomic nervous system (ANS). In contrast to extraversion, no study undertaken by Eysenck could reveal any relationship between neuroticism and cigarette smoking. In view of the fact that small doses of nicotine stimulate the nervous system, whereas large doses depress it, the hypothesis was tested that light and moderate smokers have a less active ANS than heavy smokers. They therefore smoke for the stimulation afforded by small doses of nicotine. Heavy smokers, however, smoke for the inhibition afforded by large doses of nicotine. None of the autonomic variables fully confirmed this hypothesis. The results for pulse volume and heart rate were only partly reconcilable with the hypothesis. These results are interpreted in terms of the complex action of nicotine on the cardiovascular system, as well as the probability that smokers smoke primarily for the effect of nicotine on the central nervous system (CNS), and that the concomitant changes in the ANS are coincidental.


An obscure inherited neuropathy characterized by pain and weakness.

Two brothers with inherited muscular atrophy and particular proneness to painful limbs are described. Symptoms of disease began at an early age with severe pains in the extremities. The pain is particularly aggravated by heat or fever and over the years has been associated with progressive muscular atrophy and sensory loss. A prominent feature of biopsy specimens was the tomaculous swellings which affected the myelin of the nerve axon and the motor nerve terminals.


The basis of general practice, its content and relation to training.

The present status is the newly defined discipline of general practice is briefly outlined. The reasons for its worldwide upsurge in the past decade and the relative failure of South Africa to keep abreast are reviewed. A brief exposition is given of the knowledge and skills required for general practice, the consultation, the clinical process and the content of what in some countries is regarded as family medicine. The difference in ethos between 'doctor-orientated' and 'patient-orientated' medicine is discussed. The latter approach is essential to general practice, in which the attidudes of both doctor and patient and their interactions are known to have an effect on the clinical process. The non-directive educative approach is discussed in relation to undergraduate and postgraduate training, and the attempts to make postgraduate general practice examinations valid and reliable, so that they evaluate the actual day-to-day activities of the doctor, are alluded to. The content of general practice is as yet not clearly identified and the problems encountered in delineating these as well as suggested approaches are presented. It is concluded that in South Africa no serious attempts have been made by legislative bodies and most medical educational institutions to recognize general practice as a new displine in spite of pioneering work achieved by the Faculty of General Practice of the College of Medicine of South Africa.


Toxicity of Callilepis laureola.

Callilepis laureola, which has been found to cause fatal liver necrosis in the Black population of Natal, is widely used as a herbal medicine. Chemical extraction has yielded a product, identified as atractyloside, which is responsible for the nephrotoxic and hypoglycaemic effects of Callilepis laureola. The hepatotoxic principle has not yet been isolated.


Impressions of eye diseases among Rhodesian Blacks in Mashonaland.

A study of ophthalmic patients at Harari Hospital indicates that Rhodesian Blacks in Mashonaland constitute a population with interesting ophthalmic features. There is a low incidence of refractive error, with a total incidence of 8,5% of myopia in adults. Functional concomitant squint is uncommon, with an incidence of 0,8% in children under 15 years of age. Non-traumatic, idiopathic primary retinal detachments occur rarely, while secondary retinal detachments occur with low frequency (about 0,55 per 100 000 population per year). Acute and painful congestive angle closure glaucoma is not seen, although chronic angle closure glaucoma is sometimes encountered. Hypertensive retinopathy is not infrequently seen, while diabetic retinopathy is uncommon. Visual loss and blindness from corneal disease are wide-spread. The population has a remarkably low incidence of senile macular degeneration (1,13% of adults over 65 years of age).


Hirschsprung's disease.

Hirschsprung's disease is one of the most common causes of intestinal obstruction in the neonatal period. In Hirschsprung's disease the aganglionic segment extends for a variable distance along the bowel, and there are three types: (i) short-segment, (ii) long-segment, (iii) total aganglionosis of the bowel. The long-segment group forms +/- 20% of the total group. In approximately 5%, however, the entire colon and even the small bowel may be involved; one such case is described together with its management, some of the problems encountered, and the operation of choice.


Alcohol and road traffic injury.

Blood alcohol concentrations were determined in 115 patients who were involved in motor vehicle accidents (MVAs) and admitted to the Johannesburg General Hospital over a 1-month period in April and May 1976. Seventy-eight per cent of the patients who had alcohol in their blood were seen on Friday and Saturday nights and approximately one-third of all victims had blood alcohol values which exceeded the legal limit of 0,08 g/100 ml. Alcohol appears to play a larger role in causing accidents and injuries than has been previously presumed. It is recommended that all casualty department doctors liaise more closely with the police authorities in the matter of blood sampling.


Atlanto-axial subluxation in systemic lupus erythematosus: a case report.

The clinical course and management of a 37-year-old woman with systemic lupus erythematosus (SLE) who developed atlanto-axial subluxation as an acute transient phenomenon are presented. The musculoskeletal manifestations of SLE and their pathogenesis are discussed in relation to this manifestation.


Massive benign cyst at the site of bone plating: a case report.

A patient with a massive benign cyst occurring in relation to a Sherman plate which had been inserted 30 years previously is reported, and the literature is reviewed. It is suggested that the probable cause was a low-grade inflammatory response to the metal.


Spontaneous neonatal and fetal intestinal perforation.

Apparently spontaneous neonatal intestinal perforation may be difficult to diagnose if the condition is not kept in mind. It may present with free perforation or with the late effects of meconium peritonitis. Five cases are described. There is a high mortality associated with bacterial peritonitis, and the importance of early diagnosis and energetic resuscitation is underlined.


Evaluation of serum levels during prolonged combination therapy with phenytoin and phenobarbitone.

When phenobarbitone was added to the treatment regimen of epileptic patients who received phenytoin only, the serum levels of phenytoin increased significantly within 6 weeks. Eleven weeks after the introduction of phenobarbitone, phenytoin levels had returned to those existing before phenobarbitone therapy. In view of possible complex pharmacokinetic interactions which might occur when phenobarbitone is added to a regimen of phenytoin, or vice versa, frequent measurement of serum drug levels appears to be indicated for up to 10 weeks after effecting a change in treatment. During this period a constant change in serum levels could be expected, resulting either in toxicity or lack of efficacy.


The effect of acute hyperglycaemia on hormonally stimulated pancreatic exocrine secretion in man.

The effect of intravenous dextrose infusion on hormonally stimulated pancreatic exocrine secretion has been studied in man. Hyperglycaemia increases bicarbonate secretion and inhibits protein secretion.


An aspect of community medicine. The medical care implications of manpower and other resources, with the rural Black population as an example.

The problems and needs of the rural Black communities are very real--although circumstances and diseases among Blacks differ to an extent from those encountered in sophisticated, developed urban areas, they still require advice, education and treatment appropriate to their problems. Because the problems confronting the health services are so great and the costs and benefits involved so difficult to assess, this paper is concerned with the problems of the rural Blacks and the role of existing medical care in their alleviation, as well as the problems faced by health planners, which in turn are directly or indirectly related especially to the Black medical personnel in the field. Any improvements in health services can be achieved only if our planning is based on objective investigation of experience, periodic reconsideration and refinement of methods and training that are practical, adaptable and directly related to the health priorities of the area concerned. Recognition and understanding of impeding factors in the delivery of medical care are urgently needed to ensure that wrong planning does not lead to maladministration, which in turn causes misunderstanding, failure of communication and possibly rejection of essential health services.


A controlled study of combined methotrexate, BCG, and INH therapy for squamous cell carcinoma of the head and neck.

In a randomized prospective study of patients with advanced squamous cell carcinoma of the head and neck, treatment with MTX plus BCG and with MTX plus BCG plus INH produced no better response rate or survival time than treatment with MTX alone.


Soft tissue necrosis and gangrene complicating treatment with the coumarin derivatives.

Skin and soft tissue necrosis, in association with the coumarin derivatives, characteristically afflicts females between the third and tenth days of treatment. Anatomic regions abundant in subcutaneous fat are most commonly affected. Many of these patients have underlying serious medical problems. Three additional patients with tissue infarction complicating coumadin therapy are presented. Possible etiologic mechanisms are discussed, but the basic physiopathologic condition remains an enigma. Venous thrombosis can be a related clinical phenomenon. Treatment perspectives are outlined.


Localization of glucagonomas by catheterization of the pancreatic veins and with glucagon assay.

In two patients with the glucagonoma syndrome, percutaneous transhepatic puncture of the portal vein and catheterization of the pancreatic veins were performed simultaneously with catheterization of the inferior vena cava and abdominal aorta. Blood samples obtained from the vena cava, aorta and portal branches were assayed for glucagon. In both patients, clearcut arteriovenous glucagon differences allowed preoperative localization of the tumors. A comparison with other localization techniques, such as scintiscan, ultrasound, arteriography and pancreatic phlebography, showed the present method to be superior. Postoperatively, the same investigations were performed revealing arterial and venous glucagon levels comparable to the levels measured in a reference group of three patients without glucagonomas. The triple catheterization technique is advocated for all patients with clinical and laboratory findings that suggest pancreatic endocrine tumors.


The avoidable complications of splenectomy.

Operative injury to the spleen and consequent accidental splenectomy is neither an infrequent nor an inconsequential occurrence. It still accounts for 25 per cent of all splenectomies performed. The morbidity rate resulting from this accident is well above 50 per cent, and the mortality may be as high as 15 per cent. Appreciation of the peritoneal anatomy of the spleen with prophylactic division of the splenoperitoneal folds will lessen the incidence of capsular avulsion injuries. When capsular avulsion injuries do occur, they may be effectively treated with topical hemostatic agents, such as microfibrillar collagen, Avitene. Twenty-one instances in which splenectomy for capsular avulsion injury was averted have been reported. In the last 15 of these, the topical hemostatic agent used was Avitene.


Scintiscanning in venous thrombosis of the lower extremities.

Venous scintiscanning was performed once or serially in 252 patients in whom deep vein thrombosis of the lower extremities was suspected, representing a total of 494 limbs examined and 1,266 venous scintiscans performed. When controlled with roentgenologic contrast phlebography, the diagnostic accuracy rate of the isotopic method was 94.4 per cent, which increased up to 98.5 per cent when the thrombotic process was located in a major vein of the upper thigh or pelvis. There were 5.6 per cent false-positive and no false-negative diagnoses. The parameters that we have considered to be the most significant for the accurate interpretation of venous scintiscanning of the lower extremities are mentioned. Venous scintiscanning is a safe, simple and highly reliable method for the study of deep venous thrombotic disease of the lower extremitites.


The use of steroids in inhalation injury.

Steroids exert no beneficial effect upon acute pulmonary dysfunction created by nitrogen tetroxide inhalation and may worsen small airway obstruction in the early phases of injury. Treatment, therefore, is still largely symptomatic and supportive.


Blood surface interactions in extravascular salvageable blood pools.

Anticoagulation largely prevents clotting and defibrination in extravascular blood pools. Systemic or local heparin may be more effective than local citrate phosphate dextrose in preventing coagulation in extravascular blood, if there is to be a lag period greater than 60 minutes between blood loss and collection. Nonanticoagulated extravascular blood in the thorax or peritoneal cavity is completely defibrinated within 20 minutes and is a potential risk in large autotransfusions. Blood in the thorax is better preserved than peritoneal blood after local or systemic heparinization.


Importance of microscopic vascular invasion in primary cutaneous malignant melanoma.

Invasion into blood vessels by malignant melanoma at the primary cutaneous site is a superior discriminant for an adverse prognosis. However, until the question of relative prognostic values is resolved conclusively, surgical pathologists should document the collection of histopathologic observations recommended by McGovern and co-conferees.


Early stage carcinoma of the female breast and axillary lymph node dissection.

Stage I carcinoma of the female breast can be treated effectively by total mastectomy and post-operative radiation therapy to the chest wall and regional lymph nodes. Identification of positive axillary lymph nodes for prognostic purposes or for definition of patients who might benefit by adjuvant chemotherapy is not a requisite to the successful management of early stage carcinoma of the breast.


Evaluation of cholestatic jaundice by computed tomography.

Computed tomography of the abdomen can aid the clinician in distinguishing intrahepatic from extrahepatic causes of jaundice. Hepatobiliary and pancreatic disease may be clearly defined. The timing and selection of further diagnostic and surgical procedures can be guided by computed tomography and unnecessary operations and prolonged hospitalization can be reduced. Computed tomography of the abdomen should not be used as a screening procedure but should be used after simpler techniques fail to establish a definitive diagnosis.


Intraventricular hemorrhage in adults.

A series of 54 adult patients with intraventricular hemorrhage diagnosed by computed tomography (CT scan) is described. Hypertension, arterial aneurysm, and arteriovenous malformation (AVM) accounted for 83% of the cases. Three categories of clinical presentation are defined. CT scan reliably demonstrated the presence and distribution of blood within the ventricular system, including the third and fourth ventricles. The increased density caused by intraventricular blood was seen to disappear in 12 days. An intracerebral hematoma was identified in 78% of cases. Surgical treatment was beneficial in only a small number of cases.


Use of surgical laser in the removal of an osteoma of the skull.

The laser beam can be adapted for use as a surgical cutting instrument. It was chosen for this purpose in the extirpation of an osteoma of the skull. Its removal by conventional means was believed to be too dangerous, because of surrounding vascularity. The nature and properties of the beam and its surgical applications are discussed briefly.


Carotid-ophthalmic aneurysms: direct microsurgical approach.

A series of 30 carotid-ophthalmic aneurysms, some of them bilateral, is reported. All of them were treated by a direct surgical approach. There were 25 patients in this series, 23 female and two male. In some cases there were associated pituitary adenomas and other aneurysms. The anatomy, clinical manifestations, and surgical treatment are discussed. There were no deaths among these 25 patients. Twenty-two of these patients recovered completely.


Arteriovenous malformations of the brain stem in childhood.

Two children are presented with arteriovenous malformations of the upper brain stem, emphasizing the clinical presentation, diagnosis, and surgical therapy. The lesions were located on the pia mater, facilitating total surgical removal. The importance of detailed angiography with subtraction technique is discussed.


Intracranial arteriovenous malformations: conservative or surgical treatment?

Of 89 patients with arteriovenous malformations of the brain, 47 were conservatively treated, nine of these died (19%), four with the first bleed, five of recurrent bleeding. Of 42 surgically treated patients, five died, a mortality of 12%. Four of these deaths occurred with patients in a deteriorating clinical condition caused by large intracerebral haematomas. The fifth death occurred with a recurrent bleeding where a ligation of feeding artery was the only treatment. There were no deaths in those patients in good clinical condition who underwent an excision of the malformation. Total excision of arteriovenous malformations should be performed whenever possible.


Occult intrasacral meningocele.

A case of occult intrasacral meningocele in a 22-year-old female is reported. The clinical and radiological features of this condition are discussed. Its relationship to other cystic sacral conditions is considered. The pathogenesis of this lesion is not perfectly clear.


Prolonged induced hypertension in the management of incipient cerebral infarction.

A patient operated upon for a carotico-cavernous fistula developed incipient cerebral infarction. Metaraminol was used for a period of eight days to produce a therapeutic elevation in blood pressure to prevent this complication. Its possible role in the management of similar complications in the post-operative period of intracranial aneurysms and post angiography is discussed.


Increased sensitivity of the basilar artery to norepinephrine and 5-hydroxytryptamine following experimental subarachnoid hemorrhage.

The reactivity of rabbit basilar artery to norepinephrine and 5-hydroxytryptamine was tested in vitro three days following cisternal injection of 1.0 ml autologous blood to simulate subarachnoid hemorrhage. Following this treatment the artery became three to five times more sensitive to norepinephrine compared with vessels from untreated animals. This was reflected in a parallel shift of the log dose-response curve towards lower concentrations of norepinephrine in a way resembling that seen after cocaine treatment of sympathectomy and interpreted as a prejunctional supersensitivity of the vascular alpha-receptors. The injection of blood also increased the amount of vasoconstriction with 5-hydroxytryptamine to a level which was three times higher than that obtained in untreated vessels. The results suggest one type of mechanism whereby monoamines might be involved in cerebral vasospasm following subarachnoid hemorrhage.


Traumatic suprasellar arachnoid cyst.

The case is reported of a suprasellar archnoidal cyst in a five-year-old boy who developed symptoms of hypothalamic involvement. It appears to have been of traumatic origen. It was operated upon, resulting in a remission of symptoms.


Spontaneous fracture of the dorsum sellae associated with post-irradiation empty sella syndrome.

A case is presented of a pituitary adenoma which was treated with radiation. Subsequently an empty sella developed and the dorsum sellae was found to be fractured forward. Possible etiological factors and the significance of this finding are discussed.


A pre-formed methyl methacrylate cranioplasty.

The use of a pre-formed methyl methacrylate cranioplasty prosthesis reinforced with stainless steel wire is described. The prosthesis is non-reactive, virtually unbreakable, and undentable. Pre-forming of the prosthesis in the dental laboratory using a mold of the patient's bony defect as a model saves considerable operating time, and when employed for a large cranial defect the three dimensional cosmetic effect is superior to intra-operatively fashioned prostheses.


Solitary cerebral falx plasmacytoma.

An unusual lesion, a solitary plasmacytoma of the falx cerebri is reported. Surgical treatment and subsequent radiotherapy have been effective therapeutic modalities with no signs of recurrence or disseminated disease after two and a half years.


Role of glucose-6-phosphate in cerebral dysfunction following hypoxia and hypotension.

Rats were "stressed" by a 30-minute period of breathing 7.5% oxygen combined with hemorrhagic hypotension (x arterial pressure = 25 mm Hg), and then "resuscitated" by restoring the inspired oxygen concentration to 30% and reinfusing the blood previously removed to produce hypotension. We have previously noted in initial return of brain adenosine-triphosphate to normal after this "stress" followed by a progressive decline during the post-resuscitation period. In this study, substrate deficiency was investigated as a possible etiology for the decreased adenosine-triphosphate. Glucose and glucose-6-phosphate concentrations in the brain were measured before "stress" and after resuscitation and were found not to change, indicating no deficiency of substrate.


Estrogen in patients with chronic subdural hematoma.

The urinary estrogen value in 30 cases with chronic subdural hematoma have been assayed before treatment, and also in 16 cases after recovery. Very often the value of estrogen was higher in these patients than the normal range. The relationships between the high estrogen value and the cause of chronic subdural hematoma are discussed.


Experimental extracranial-intracranial anastomosis.

A new experimental model for the study of extracranial-intracranial anastomosis has been developed. Canine external ethmoidal arteries have been anastomosed to the middle cerebral arteries. A 100% patency rate has been achieved ten days after operation. The surgical techniques are described. Using this model, we studied the changes of cortical intraarterial pressure and tissue O2 tension under a variety of conditions. From the results of this experiment, it is concluded that the restoration of the cortical intra-arterial pressure may be expected after anastomosis, that tissue O2 tension value depends upon restoration of the cortical intra-arterial pressure in the acute stage, and that O2 and CO2 inhalations have little effect on the brain ten days after middle cerebral arterial occlusion in spite of recovery of intra-arterial pressure with anastomosis. The experimental results suggest that the restoration of the intra-arterial pressure after anastomosis may be of no use in supplying oxygen to ischemic cortex in the chronic stage because of dysfunction of the cortical microvasculature.


Neutrophil chemotaxis in cerebral astrocytoma.

Neutrophil chemotaxis was evaluated for five patients with a primary intracerebral malignancy. All patients had intratumor cysts and these fluids with corresponding serum and cerebrospinal fluid were tested for their chemotactic ability. The ability of cyst fluid to effect neutrophil chemotaxis was diminished in comparison to serum from either patients or control population. Cyst fluids had lower complement levels than serum and did not have a humoral chemotactic inhibitor. The neutrophils for both the patient and control groups had similar chemotaxis to a given chemotactic stimulus suggesting that this malignancy does not have an accompanying peripheral blood phagocytic cell chemotactic defect. Chemotaxis, the migration of phagocytic cells, is a fundamental requisite for the inflammatory and the immune response.


Disseminated intravascular coagulation.

The diagnosis of disseminated intravascular coagulation associated with intracranial pathology is discussed. This pathological entity is characterized by a diffuse bleeding diathesis. Laboratory studies suggest a consumption of all clotting and fibrinolytic factors with an elevation of fibrin split products as a sign of the fibrinolytic activity. The treatment consists of the administration of packed platelets and fresh frozen plasma to replace the consumed coagulation factors. Heparinization is recommended early to prevent further consumption of coagulation factors and epsilon-aminocaproic acid is recommended later after acute fibrinolysis is diagnosed. Constant coaguloanalytic monitoring is necessary. Although the etiology with massive injury to brain tissue is possibly secondary to autotransfusion of brain tissue thromboplastin, other causes such as hypotension, anoxia, acidosis and hemolysis must be considered.


Calvarial, orbital and dural vascular anomalies in hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia is an autosomal inherited defect. Associated neurological abnormalities may occur. A case is reported with cutaneous and visceral lesions associated with calvarial, dural and orbital vascular malformations. Striking radiological abnormalities were present.


Intracranial chondroma.

Two cases of intracranial chondroma are reported. In both cases, the tumor was located extradurally in the middle cranial fossa. The tumors were removed piecemeal, but total removal proved to be impossible.


Hyperdipsia associated with hypothalamic-midbrain hemorrhage.

A case of diencephalic-midbrain hemorrhage presenting with excessive thirst, coma, and death is discussed. Some diencephalic dysfunction syndromes are reviewed, as well as their physiological basis. Thirst and drinking behavior can provide a valuable localizing symptom and sign in clinical-pathological correlations.


Genito-femoral neuralgia.

A 46-year-old male with bilateral genito-femoral neuralgia is presented. The patient complained of groin and testicular pain, the onset following asynchronous bilateral inguinal herniorrhaphy. Relief was effected by genito-femoral nerve resections. The operative approach is discussed. The differentiation between this syndrome and ilio-inguinal nerve entrapment is tabulated.


Intracranial hemorrhage in achondroplasia.

The neurological manifestations of achondroplasia include megalencephaly, hydrocephalus, and progressive myelopathy or radiculopathy secondary to spinal stenosis. Subarachnoid and intracerebral hemorrhage have not been previously reported in association with achondroplastic dwarfism. This report describes two patients with achondroplasia who have died secondary to intracranial hemorrhage. At autopsy, the source of hemorrhage was found to be an arteriovenous malformation of the choroid plexus in one case and a ruptured aneurysm of the left middle cerebral artery in the other.


Diagnosis and treatment of postoperative cerebral vasospasm.

A series of 17 patients who developed severe neurologic deficit due to postoperative cerebral vasospasm is presented. All underwent confirmatory postoperative cerebral angiography. Treatment included controlled hypertension, hyperventilation, over-transfusion of whole blood and colloids, and infusion of low molecular weight dextran. Neurologic deficits were reversed promptly and completely in 12 patients and partially in three patients. The authors propose that methods designed to increase cerebral blood flow can reverse the ischemic deficits of vasospasm.


Meningioma with subdural hematoma.

A subfrontal meningioma which presented by development of a subdural hematoma is reported. The tumor was detected by cerebral angiography and radionucleotide flow study and was subtotally excised. The relationship between meningioma and subdural hemorrhage is discussed.


Spinal subdural haematoma: an unusual complication of lumbar puncture.

A case in which a spinal subdural haematoma obscured the diagnosis of spinal stenosis is described. The haematoma resulted as a complication of the lumbar puncture necessary for the myelogram. No other aetiological factors were found, but it is suggested that this condition may become more frequent as the result of iatrogenic haemostatic defects.


Snell's Law: optimum pathway analysis.

An analysis is made of the various possible paths traveling from one medium to another. It is  demonstrated that the most efficient possible path for traveling in the shortest possible time is the path determined by Snell's Law. Conversely, when light is refracted as it passes from one medium to another, it is completing the trip in the minimum possible time, less time than if it had passed through the various media in a straight line.


Vascular endoscopy: useful tool or interesting toy.

A prospective protocol was designed to evaluate the efficacy and practically of intraluminal endoscopy in vascular reconstructive procedures. The choledochoscope and the arthroscope which utilize the Hopkins Optical System, as well as other available fiberoptic endoscopy units, were evaluated in 91 vascular reconstructions, including 42 carotid endarterectomies, 24 femoral artery reconstructions, 13 popliteal artery anastomoses, seven aortic and iliac procedures, one renal reconstruction, and one tibial reconstruction. In three cases the internal surface of an occluded limb of an aortic graft was examined endoscopically following thrombectomy. The optical resolution of the Hopkins Optical System was superior to the fiberoptic units. Vascular endoscopy required 5 minutes or less in 53 cases, between 5 to 10 minutes in 29 cases, and more than 10 minutes in nine. There were no infections. The single complication was a 1 cm linear tear in the intima of an internal artery. Positive findings were noted in 60 endoscopic studies, for an incidence of 66%. These consisted of intimal shreds in 47, elevated or irregular intimal flaps in 25, clot in five, and stenosis in three. In 26 cases the endoscopic findings were considered to be significant enough to possibly affect the ultimate outcome of the reconstruction.


Ultrasonic scanning in postcholecystectomy choledocholithiasis.

Ultrasonic scanning of the right upper quadrant was performed in four patients with jaundice and fever. Each patient had undergone a previous cholecystectomy with common bile duct exploration for biliary tract calculi. No patient at that time revealed retained stones on either intraoperative or postoperative cholangiograms. In none of the patients studied was the exact nature of the obstruction appreciated by the clinical and laboratory data available. All patients revealed biliary duct dilatation on ultrasound, and the majority demonstrated a bile duct calculous as well. Based on our experience, we do not recommend that ultrasonic scanning be substituted for oral or intravenous cholangiography when the latter can be performed. Nor should ultrasonic scanning be used to replace endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, or even liver biopsy if these procedures are indicated and can be completed with a reasonable degree of safety. However, we have found that ultrasound can be very helpful in the occasional patient whose biliary tract obstruction defies exact diagnosis when routine dye studies and invasive diagnostic procedures are neither accurate nor feasible.


Thoracoscopy.

Poor results in the treatment of lung cancer have led to the development of several techniques designed to obtain tissue for diagnosis and to determine the feasibility of resection. Although mediastinoscopy has obtained great popularity, we have been dissatisfied with it because of the low yield of positive results and the attendant increases in length of operations and hospitalizations. We have modified the old technique of thoracoscopy, using a sterilized sigmoidoscope inserted through an intercostal space with the patient positioned and prepared for thoracotomy. Although most frequently used in patients with lung cancer, this procedure also has been helpful in patients with coin lesions, mediastinal tumors, and penetrating wounds of the chest. Although we agree that mediastinoscopy is useful in selected patients, we believe that thoracoscopy offers a greater number of patients a reliable means of obtaining the proper diagnosis more efficiently.


Spontaneous regression of retinoblastoma.

Clinicopathologic evidence of bilateral spontaneous regression of retinoblastoma in three brothers is presented. The buphthalmic right eye and phthisical left eye of one of these persons were examined histopathologically. The two brothers of this patient both had phthisical left eyes, and those eyes were examined histopathologically. Both of those brothers also had clinically detected chorioretinal scars in their right eyes from regressed retinoblastoma. Three of eight children of one of the two brothers had bilateral retinoblastoma, and two of seven children of the other brother had bilateral retinoblastoma. Reports in the literature of 50 previous cases of total spontaneous regression of retinoblastoma from 1911 to 1975 are reviewed.


Survival distribution in breast cancer.

It has been stated that breast cancer survival rates follow an exponential distribution. This would mean that the mortality rate is constant. Survival distribution was analyzed by the clinical life table method in one series of 10,752 patients and in another of 656 patients followed up to 8 and 18 years, respectively. Part of the larger series' table is (table: see text). Necessarily, clinical survival data are censored progressively. These kinds of data are analyzed best by examining the hazard function, which is the instantaneous death rate, or force of mortality. If an exponential distribution described survival in breast cancer correctly, the hazard function would be constant. These data clearly are not consistent with an exponential distribution, as the hazard function decreases. The survival distribution calculated from these data shows that the chance of dying of cancer decreases the longer a patient survives. This is more optimistic and consistent with clinical experience than is the exponential distribution.


Conversion of a Scribner shunt to an arteriovenous fistula for chronic dialysis.

Since July, 1972, we have converted 14 Scribner shunts, which we had used for the initiation of hemodialysis in 14 patients with end-stage renal disease, to arteriovenous fistulas in the same peripheral artery and vein of the shunts for maintenance chronic dialysis. The shunts were converted to fistulaes electively in three patients and because of malfunction in 11. We did not convert infected shunts. Dialysis was resumed within 24 to 72 hours of conversion to a fistula in all 14 patients. Thirteen patients were followed from 14 to 1,505 days with pump speeds of about 300 cc/minute. The fistulas continued to function without complication. One patient developed a small pseudoaneurysm, which required excision. The overall patency rate was 93%. The autogenous peripheral vessels of a patient on chronic hemodialysis are a limited resource. This conversion or recycling technique will give the patient a preferred vascular access for dialysis for prolonged periods.


Twenty-five years of experience with radical surgical treatment of carcinoma of the extraperitoneal rectum.

Between the years 1950 and 1975, 1,100 patients with carcinoma of the rectum were seen at the Toronto General Hospital. Of these, 519 had tumors below the peritoneal reflection. The resection rate in this latter group of patients was 94%. One hundred and thirty-three patients were treated by low anterior resection (LAR) and 316 by combined abdominoperineal resection (APR). Although the incidence of postoperative complications was high (LAR 41%, APR 53%), the operative mortality was low (LAR 2.2%, APR 2.9%). Recurrent tumor appeared more frequently in the pelvis (24%) than at distant sites (18%), was more common in more advanced disease, and correlated with the incidence of late death. The overall (actuarial) survival figures were 50% at 5 years and 37% at 10 years, with no significant difference between LAR and APR. For curative resections, the 5- and 10-year survival figures were 59% and 44%, respectively. Clinical staging (Dukes) influenced survival greatly, both at 5 years (Dukes A 77%, B 65%, C 33%, D 3%) and at 10 years (Dukes A 55%, B 53%, C 20%, D 0%). The level of the lesion did not influence either recurrence rate or survival.


"Conservative" versus "liberal" approach to parathyroid neck exploration.

Is the recent trend toward more radical parathyroid surgery justified? Surgical outcomes in three groups of 50 patients undergoing operation for primary hyperparathyroidism at the Mayo Clinic between January, 1974, and May, 1976, were compared. One group of patients was operated on by Surgeon A who used a "conservative" approach (removal of grossly enlarged glands only, with or without biopsy of one normal-sized gland). A second group was operated on by a Surgeon B, who used a more "liberal" approach (almost routine removal of at least two glands, removal of three and one-half glands when more than one gland was enlarged, and liberal use of biopsy identification). Symptomatic hypocalcemia requiring treatment occurred in 24% of patients after liberal neck exploration, as compared with 4% in the conservatively treated group. The liberal approach did not yield any higher cure rate. A third group of 50 patients was operated on by Surgeon B using the conservative approach. The incidence of postoperative hypocalcemia was reduced to 2%; one patient remained hypercalcemic. Symptomatic hypocalcemia, even if temporary, represents significant morbidity. A conservative approach to neck exploration in patients with primary hyperparathyroidism is recommended because it is associated with a very low incidence of temporary postoperative hypoparathyroidism (2 to 4%) and a high cure rate (99% in this series).


Experimental fundoplication: comparison of results of different techniques.

After the creation of a hypotensive lower esophageal sphincter (LES) by circular myectomy, several techniques of fundoplication were employed to assess the effect of variations in the degree and length of fundoesophageal encirclement on LES function. In series A, 360 degrees wraps were constructed around varying lengths of esophagus: group I, 1 cm; group II, 2 cm; and group III, 3 cm. In series B, 2 cm long fundoplications of varying circumference were performed: group I, 90 degrees; group II, 180 degrees; and group III, 360 degrees. LES evaluation included measurement of LES amplitude and length, the adaptive response of the LES to increased intragastric pressure, pH reflux testing, and LES response to parenterally administered pentagastrin. In series A, 2 and 3 cm wraps restored resting LES pressures to normal (18.8 +/- 0.5 and 20.7 +/- 0.3 cm H2O) in contrast to the 1 cm wrap (12.9 +/- 0.8 cm H2O), and both provided more effective protection against reflux when compared to the shorter variation (pH, 6.2 +/- 0.1 and 6.6 +/- 0.1 versus 4.2 +/- 0.1). In series B, the 360 degrees wrap proved to be more effective than partially encircling techniques. Fundoplication optimally restores normal LES function when it encircles the esophagus completely over a length equivalent to the normal high-pressure zone (1.8 +/- 0.1 cm in the cat).


Evaluation of the teratogenic potential of tertiary butylhydroquinone (TBHA) in the rat.

Tertiary butylhydroquinone (TBHQ), and approved antioxidant used alone or in combination with other antioxidants produced no teralogenic effects after administration via the diet to pregnant rats at concentration of 0.125, 0.25 and 0.50% during the sensitive period of gestation. The mean body weight and feed consumption of the dams were unaffected. The average number of corpora lutea, implantation sites, viable fetuses, resorptions and fetal body weights and mortality did not differ between the control and treated groups. A significant number of rudimentary ribs were seen in all groups. However, the incidence of this variation was two times greater in the control group than in any treatment group. It is concluded that TBHQ is not teratogenic in rats at 62.5, 125 and 250 times the approved use level for humans.


Effect of intraamniotic administration of vitamin A on rat fetuses.

The present study examines the effect of intraamniotic (i/a) administration of vitamin A to rat fetuses. Vitamin A aquasol in concentrations of 50 I.U., 100 I.U., and 300 I.U., was mixed in 5 microliter of saline. On day 13 of gestation, each of the tree experimental subgroups were injected i/a with varying  doses of vitamin A. The four control subgroups consisted of: (1) i/a injection of 5 microliter of saline only, (2) amniotic puncture only, (3) laparotomy or (4) i/a injection of sorethytan oleate. The fetuses were recovered on day 18 of gestation, and were weighed and examined for gross malformations. The viable fetuses from the experimental groups showed various malformations such as cleft palate, micrognathia and limb defects. The percentage of resorbed fetuses was significantly high. The control fetuses showed a moderate number of resorptions; however the percentage of malformations was small. The results show that the i/a method can be used effectively to study the direct teratogenic effect of vitamin A on the fetuses.


T1Wh, a promising mouse strain with chromosomal markers for cleft palate research.

Attainment of the horizontal position by the secondary palatal shelves and fusion in relationship to morphological and chronological ages in T1Wh, and albino strain of mice homozygous for a 5;19 Robertsonian translocation, was found to be late and slow in comparison to other strains previously investigated. Spontaneous and cortisone-induced cleft palate frequencies of 3.5% and 100% respectively, were found in this strain. Its slow and late palatal closure, high susceptibility to cortisone, obvious marker chromosomes, and good breeding performance promise to make T1Wh a useful strain for cleft palate research.


Toxicity studies with dieldrin: teratological studies in mice dosed orally with HEOD.

Dose of 1.5 and 4.0 mg/kg/day of HEOD in corn oil and 0.25, 0.5 and 1.0 mg/kg/day of HEOD in dimethyl sulphoxide (DMSO) were administered to pregnant CF1 mice on days 6 to 14 (inclusive) of gestation. Some maternal and foetal toxicity was seen in the HEOD in DMSO and DMSO control groups compared with the untreated controls, such as reduced body weight gains, some maternal deaths, lower foetal body weights and increased incidence of delayed ossification of the foetal bones. No maternal or foetal toxicity was seen in the HEOD in corn oil or the corn oil control groups. No compound-related teratogenic effects were observed.


Cytosine arabinoside-induce transplacental dysgenetic hydrocephalus in mice.

Pregnant mice were injected with 30 mg of cytosine arabino side/kg body weight on 13-1/3 and 14 days of gestation. Within six hours after the first injection, pyknotic nuclei and nuclear debris were found at the matrix layer surrounding the lateral ventricles of the embryonic brain. Autoradiographic studies using tritiated thymidine revealed that most of the matrix cells exposed to cytosine arabinoside during DNA synthesis were killed by this dose of the drug. Twenty-four hours after the second injection, most of the matrix cells had disappeared. When experimental animals were examined after birth, they showed marked dilation of the lateral ventricles. The dilatation of the lateral ventricles was more pronounced in the parieto-occipital region. The young showed rapid enlargement of the cranial vault and subsequently died by 35 days of age.


[A rotary rasp as an aid in the foot care of cattle (author's transl)].

The use of a rotary metal rasp, mounted on a right-angled, as in aid in the foot care of cattle is described. The results obtained with this instrument were satisfactory. This device will save a considerable amount of (physical) labour as well as time, especially in cattle with particular hard feet (such as A.I. bulls) or in mass foot care.


[Results obtained using de "Meckrognost Harnstoff" strip method in estimating plasma urea concentrations in dogs (author's transl)].

The "Merckognost Harntoff" strip method described in a previous paper was recently modified by the manufactures. An important alterations consisted in the method by which samples were applied to the strips, viz. using micropipetters rather than by dipping. In view of the findings in the comparative study reported, the results obtained on dipping are regarded as superior, the method also being easier to handle. However, the prescribed correction factor should be used.


[The revascularization of the profunda femoris artery (author's transl)].

The revascularization of the profunda femoris artery, the minimal vascular operation, is described in this paper. After the anatomic and pathological relations of the femoral arteries the indications and the position of the profunda-revascularization in vascular surgery of the thigh are reported. During a period of 15 years (1959-1974) a profundaplasty was performed in 357 cases on 308 patients in the Munich University Surgical Clinic. The result of the operation could be controlled in 320 cases. The lethality-rate of operation is 3,8%. The operation was successful after 5 years in 75,3%, after 10 years in 62,6% in the whole period in 60% of the living patients. If there is a vascular disease of the deep femoral artery, the profundaplasty proves to be a standard technique in the vascular surgery of the thigh.


Cerebral protection during open heart surgery. A comparison between a disk oxygenator and two bubble oxygenators.

A disk oxygenator (Björk-AGA HLM) with a moderate hemodilution prime and two bubble oygenators (Harvey H 800 and Galen Optiflo 42-201) with a clear fluid prime are compared in regard to their effect upon postoperative intellectual function as measured by psychometric tests. There was no difference between the two bubble oxygenators. There was a marked, statistically significant difference between the bubble oxygenators and the disk oxygenator, the disk oxygenator yields considerably worse results. The reason for this is obscure but probably lies in the different microembolic output. The literature, however is not consistent on this question. At the present time, only bubble oxygenators are used in our unit.


[Anemia in patients with artificial heart valves (author's transl)].

The pathogenesis of anemia in 84 patients with valvular protheses of the heart was investigated. A secondary deficiency of serum iron and folate, caused by chronic hemolysis, was found. There was no indication of vitamin-B12-deficiency.


[Open combined thoracic and abdominal wounds (author's transl)].

We report 27 open wounds of the thorax and abdomen combined, which were treated during one year on the hospitalship "Helgoland" in Vietnam. The patients came from every age group. 12 of the wounded were male, 15 were female. Hemopneumothorax was the most frequent finding in the thoracic wounds. With abdominal wounds the organs of the upper abdomen were mainly involved. We found it best to begin treatment with closed chest-tube drainage in order to bring the chest wound under control, then to proceed with laparatomy. Only in a few cases was a thoracotomy necessary. 4 of the 27 wounded died.


The use of pooled sera for HLA cytotoxicity crossmatching.

A two-stage procedure is described for cytotoxicity tests in which three different sera from a prospective kidney recipient are pooled in each well of a standard microcytotoxicity test plate. The results are reproducible and as sensitive as those obtained with single sera tests. The technique permits a reduction in time required for a test and the number of wells that must be evaluated to screen a series of sera. It enables a laboratory to run all available sera on patients for cadaver kidney crossmatching and to eliminate hyperacute rejections. Serum pooling may also be used for screening of many sera against random cell panels.


The effects of low temperature on myelin formation in optic nerves of Xenopus tadpoles.

To test the effect of cold on CNS myelin formation, optic nerves of stages 52-55 Xenopus tadpoles were examined electron microscopically after maintenance at 15, 10, 7 and 4 degrees C for 1-7 days. Nerves from tadpoles maintained at 15 degrees C resembled 22 degrees C (room temperature) controls. After 3 days at 10, 7, or 4 degrees C, tongue processes and perikarya of many myelin forming oligodendrocytes were swollen and filled with vesicular membrane profiles. The number of axonal microtubules was decreased in affected fibers but the lamellar structure of their myelin sheaths remained normal. Astrocytes were hypertrophic and contained large aggregates of filaments. Longer exposure to 10 or 7 degrees C increased the number of affected fibers but the changes were not more severe or associated with degeneration. The delayed onset, lack of progression and reversibility of the changes indicated that cold has a direct metabolic effect on myelin forming oligodendrocytes. Alterations produced by nerve transection or exposure to mitotic inhibitors differed, suggesting that cold induced changes were not due primarily to either axonal degeneration or reduced axonal transport.


Midgut ultrastructure of Culex tarsalis (Diptera: Culcidae) before and after a bloodmeal.

The midgut ultrastructure of rasin-and blood-fed female mosquitoes, Culex tarsalis Coquillentt, was examined. The raisin-fed midgut is characterized by: (1) large nuclei, (2) small mitochondria, (3) short segments of rough endoplasmic reticulum, (4) rough endoplasmic reticular vesicular vesicles in the posterior midgut only, and (5) increased autophagic acitivity with age. Blood feeding elicits drastic changes in midgut epithelial structures: (1) nuclei are smaller, (2) mitochondria are much enlarged, (3) rough endoplasmic reticular vesicles disappear, (4) rough endoplasmic reticular whorls appear, (5) residual lyosomal figures are abundant, and (6) an intercellular accumulation of an electron-opaque material is noted. The significance of rough endoplasmic reticular whorls and vesicles in bloodmeal digestion is discussed. In addition, the concept of a functional host  'gut barrier' to infection by pathogens is examined as related to a possible by-pass mechanism.


Hyposmotic fluid formation in Hydra.

A detailed model for hyposmotic fluid formation in Hydra is presented. We propose that enteron fluid formation occurs in two steps: (1) segregation of an isosmotic fluid in large intercellular vacuoles with (2) subsequent reabsorption of solute in the intercellular channels to form the hyposmotic fluid of the enteron. Intercellular spaces in Hydra have been studied by light microscopy and thin-section electron microscopy, as well as by electrophysiological methods. These spaces are of two types: (1) large vacuoles which are located in the cells of both the epidermis and gastrodermis, being more numerous in the epidermis; and (2) lateral intercellular channels which run from the intercellular vacuoles, leading eventually to the enteron. These vacuoles and channels are highly convoluted, forming a complex three-dimensional network. We suggest that the network is involved in the water balance of Hydra.


Anatomical studies of simple invertebrate synapses utilizing stage rotation election microscopy and densitometry.

The radial nerve cords of starfish and the central ganglia of a gastropod mollusc were examined for the presence of chemical synapses. No structures with the degree of specialization of synapses in the vertebrate CNS were observed. Presumed chemical synapses, which possessed slight but variable paramembrane densities, were examined with a tilting stage. This showed that such densities were frequently due to overlap of vesicle and axon membrane within the section, which were resolved at the correct angle of tilt. Many structures resembled demonosomes. The necessity for care in interpreting the structure of chemical synapses in vertebrates is emphasized.


The fine structure of developing locomotor muscles of the pelagic tunicate, cyclosalpa affinis (Thaliacea: Salpidae).

Salps are free-swimming tunicates whose peculiar life history renders them ideal for developmental studies. The solitary salp reproduces asexually by budding a stolon containing the complete developmental sequence of the aggregate generation. The ultrastructure of developing locomotor muscle of the aggregate generation of Cyclosalpa affinis was studied. The early muscle contains essentially non-striated myofibrils. However, in transverse sections, , areas indicating early I-band A-bands can be recognized. As development continues, the number of fibrils increases, the Z-line appear, and the fibrils contain more recognizable striations. The fully developed muscle has the caracteristic structure of striated muscle. Longitudinal sections show sarcomeres with irregular and discontinuous (perforated) Z-lines; H-zones are not apparent. No M-lines are seen. Throughout development, the ratio of thin to thick myofilaments is always 2:1, the ratio found in all vertebrate striated muscle. Other finding in C affinis suggest that: (1) multinucleated muscle cells are formed by the fusion of mononucleated cells, (2) membranes of adjacement mononucleated cells destined to fuse form myelin figures, and (3) these myelin figures become closely associated with mitochondria.


The brain of the horseshoe crab (Limulus polyphemus). II. Architecture of the corpora penduculata.

The corpora pedunculata, or mushroom bodies, of the horseshoe crab, Limulus polyphemus, form a bulbous ventral hemisphere composed of two internal lobes that are highly branched like a caulifower. This organ is clothed with a deep layer of small association neurons called globuli or Kenyon cells. In an animal that is 50 mm in width, they number 3-7 X 10(6), a value that rises to about 1 X 10(8) in an adult (250 mm width). The neuropil of each corpus peduculatum converges from its peripheral lobules toward several major peduncles, which are in communication with the protocerebral neuropil by a narrow stalk containing about 5000 fibers in a 50 mm animal. The numberical relations suggest that presumptive second-order chemosensory fibers enter the corpora pedunculata and synapse divergently onto Kenyon cells. The axons of Kenyon cells, in turn, converge onto efferent fibers that leave through the stalk.


The morphology of cilia in sponge larvae.

Sponge larvae posses cillia with unusual terminal expansions which are curled or biconcave in shape externally, as seen by scanning electron microscopy. Thin sections, passing through the point where the ciliary shaft enters the expanded area reveal the ciliary axoneme to be surrounded by many membranous folds, some of which are vesicular. The 'club footed' cilia occur in disparate groups of Demospongiae and most frequently, all larval cilia are of this type. There is no immediately obvious correlation between the type of movement displayed by the larvae and the occurrence of terminally expanded cilia.


A helical, polymeric extracellular protein associated with the luminal surface of Haemonchus contortus intestinal cells.

The structure of the intestinal cells of the parasitic nematode Haemonchus contortus is described. The cells have numerous microvilli about 0-09 micron in diameter; most being 5-5-7-5 micron in length. The microvillar (plasma) membrane is coated with a layer of amorphous material (glycocalyx) about 60 A thick which is electron dense in sectioned preparations. Associated with the surface of this material, and filing the spaces between the microvilli, are filaments in the form of helices about 400 A in diameter and of variable pitch. The helices appear to be flexible but they are aligned approximately with the long axes of the microvilli. There are up to ten helices per microvillus; they extend beyond the tips of the microvilli and are up to 10 micron long. The material has been obtained nearly pure in small amounts. It is primarily protein and it is proposed that it should be called contortin. The monomeric form (of molecular weight about 60,000) has been identified with a Y-shaped structure with arms about 45 A long and 25 A wide seen in negatively stained preparations. The helical filament appears to be formed by lateral polymerization of patirs of these units.


Ultrastructural observations on the body wall of the leech, Batracobdella picta.

A series of closely spaced annulations surround the surface of the body of Batracobdella picta. The epidermis is covered by a thin cuticle which is composed of several layer of orthogonally arranged, fibrous bundles. Numerous fine projections carpet the surface of the cuticle and appear to be derived from microvillar processes which extend through the cuticle from subjacent epithelial cells. Septate junctions occur between adjacent epithelial cells, and hemidesmosomes with associated tonofilaments appear to anchor the epithelium to the overlying cuticle and to the basal connective tissue. The epithelial cells contain abundant organelles including granular endoplasmic reticulum, mitochondria and Golgi complexes. The cytology of the body wall of B. picta is compared with that of other annelids.


Fine structure of the first optic ganglion (lamina) of the cockroach, Periplaneta americana.

The stuctural organization of the first optic ganglion (lamina) of the cockroach (Periplaneta americana) was investigated by the use of light and electron microscopy. Each compound eye of the cockroach is composed of up to 2000 visual units (ommatidia) of the fused rhabdom type. The ommatidia themselves consist of eight receptor cells which terminate as axons in either the first or second optic ganglion. Three different short visual fibre types end in two separate strata in the lamina, and one long fibre type ends in the second optic ganglion. Monopolar second-order neurons with wide field branching patterns in the middle stratum of the first synaptic region have postsynaptic contacts with sort visual fibres. Horizontal fibre elements with branching patterns at different levels of the lamina apparently from three horizontal plexuses with presynaptic and/or postsynaptic connections to first-and second-order neurons. The lack of well-organized fibre cartridges containing a constant number of first and second order neurons in each fascicle and the presence of only unistratified wide field monopolar cells could represent, as compared to other insect orders, a primitive stage in the development of the first optic ganglion.


Origin, structure, composition and age-dependence of mineralized dense bodies (concretions) in the midgut epithelium of the adult housefly, Musca domestica.

The epithelial cells of the midgut in 1-40 day old adult female houseflies were examined by electron microscopic X-ray microalnalytic and histochemical techniques in order to study the mode of genesis, chemical nature and age-associated distribution of dense bodies. Dense bodies contain high concentration of phosphorus sulphur, chlorine, calcium, iron and copper; they are therfore termed concretions. Concretionary material is initially deposited within Golgi vesicles, lamellar bodies and residual bodies. The average size of the concretion granules and the concentration of the sequestered material increases with age, while new concretions are continually formed throughout life. With advancing age, concretions accumulate in the epithelial cells and occupy a considerable proportion of the cytoplasm in old flies. It is postulated that the concretions sequester superfluous minerals and may play an important role in the excretory system of the adult housefly.


A difference in the effects of ethanol on ion movements in cerebral tissue slices from alcohol preferring and alcohol avoiding rats.

The sodium and potassium contents in cerebral cortex slices incubated in bicarbonate medium from alcohol preferring (AA) and alcohol avoiding (ANA) rats were measured during electrical stimulation and subsequent recovery. The intracellular quantities were estimated on the basis of the inulin distribution. The amount of intracellular potassium in unstimulated slices from the two strains was different, the AA rats showing a higher level. No differences in the entry of sodium were observed for the two strains when slices incubated with ethanol were subjected to electrical stimulation, but the loss of potassium was 46% greater in the AA rats. During recovery no ethanol-induced inhibition of theloss of sodium ions was seen in either strain, whereas the gain of potassium ions was inhibited in the ANA rats and not in the AA RATS. The potassium gain in the presence of ethanol was 42% greater during the recovery period in the AA rats.


A study on the physiology and biochemistry of the flank gland of the musk shrew, Suncus murinus viridescens (Blyth).

The flank gland becomes functional by about the 9th day after parturition and exhibits a secretory rhythm with a nocturnal peak. Lipids constitute the major biochemical constituent of the total solids. Relatively, cholesterol, ascorbic acid and alkaline phosphatase contents of the flank gland were much higher than those of the control skin samples. Disc electrophoretic pattern of glandular secretion reveal that male and female shrews have 6 & 8 protein fractions respectively. The flank gland was observed to be androgen-dependent in male shrews. Ethological observations indicate that secretions of this gland are used for marking purposes.


Biochemical studies on populations with long- or short-term exposure to environmental pollution.

Three groups of populations were studied: I. living for about 10 years, II. living for about 3 years near copper smelteries, and III. living in rural area, far from any source of air pollution. Lead content in blood was found to be 182.0 and copper 274.6 microgram/100 ml for group I, Pb - 69.2 and Cu - 253.3 microgram/100 ml for group II, and Pb - 43.8 and Cu - 143.3 microgram/100 ml for group III. Inhibition of glycolytic cycle enzymes and delta-aminolevulinic acid dehydratase was proportional to the duration of exposure to environmental pollution. Ceruloplasmin concentration in serum, as well as serum and red cells aminotransferases activities, were increased in group II and decreased in group I, suggesting certain mechanism of adaptation.


Cutaneous cross-modal interactions: variations in punctate pressure sensitivity with skin surface temperature.

We determined the effects of adapting the skin surface to temperatures 3 degreees C, 8 degrees C, or 12 degrees C above and below physiological zero for 0, 2, 5, 10, 15, or 30 min on punctate pressure sensitivity. Temperatures above physiological zero reduced punctate pressure sensitivity and temperatures below physiological zero enhanced punctate pressure sensitivity. As the skin adapted to warmth, punctate pressure sensitivity increased suggesting a cross modal adaptation effect, however there was no indication of a decrease in punctate pressure sensitivity as the skin adapted to cooling. The results are considered to be consonant with a system of mechanoreceptors which also respond to temperature changes and a system in which there are points of convergence in the somesthetic pathways at which pressure and temperature information interact and are integrated.


Effect of some antithrombogenic drugs on the polyethylene-Krebs solution interface.

The effects of some antithrombogenic drugs on the streaming potentials found in the interface polyethylene-Krebs solutions were studied. Drugs such as dypiramidol, heparin and apsirine were tested in different concentrations. The variation of streaming potentials with the pressure gradient (fluid velocity) were experimentally determined, surface charge densities and degrees of coverage calculated. Surface charge densities were in the order of 4 X 10(-10) C/cm2, with very low degrees of surface coverage.


[Radiation therapy in patients with electronic cardiac pacemakers: interferences with the pacemaker's function by ionizing radiation and other sources of disturbances (author's transl)].

In the course of radiation therapy and connected diagnostical measures ionizing radiation and other sources of disturbance may interfere with the function of permanent pacemakers. The conditions of such hazards are investigated in theory and practice making allowance for the different susceptibility to trouble of various models of permanent pacemakers. It appears that no extension of long-term follow-up of the cardiac pacemaker's function is needed with regard to possible late effects of ionizing radiation, but that the follow-up of pacemaker-patients during their first period of treatment should not be neglected, since other sources of electronic interference may be present. Routine checks as radiotherapy installations should also include possible sources of disturbance to electronic pacemakers.


[Consideration of the volume dependence of tolerance doses (author's transl)].

A general formula for consideration of the dependence of tolerance doses upon volume is obtained by mathematical evaluation of known skin tolerance doses. The validity for different organs is verified using available data of literature. It is recommended to introduce the volume dependence into the Ellis-formula for tolerance doses.


Effect of irradiation on testicular cells of opossum.

Five months old male opossums were exposed  to 5000 rd wholebody 60Co gamma-radiation. Testes tissues from animals sacrificed at 16, 40 and 90 hours post-irradiation and from nonirradiated animales were used for enzymatic and histological studies. Electrophoretic pattern of lactate dehydrogenase and glucose-6-phosphate dehydrogenase was slightly disturbed in early hours in irradiated animals, but it did not persist beyond 40 hours postirradiation. Histological study indicates 31% survival of type A spermatogonia suggesting high radioresistance of testes tissue in comparison to other animals.


[Radioprotection during clinical and laboratory utilization of tritium-labeled thymidine (author's transl)].

In view of the new prescriptions for radioprotection of the Helevetic Confederacy (Eidgenössische Strahlenschutzverordnung) the problems of radioprotection connected with utilization of the pure beta-ray emitter tritium are exposed, since the latter frequently is used as a marker substance in biomedical investigations. Inorganic tritum is regarded as the least toxic radionuclide. With tritiated thymidine, very often used for study of cell proliferation and cellular kinetics because of its incorporation into DNA, the radiation risk has to be considered quite differently. Its radiotoxicity is estimated to be superior by a factor up to thousand. The increased risk, thus resulting, is discussed with regard to the findings by animal experimentation and to the toxicity in man. Practical recommendations for the use of tritium-thymidine are given.


Intestinal enzyme distribution after supralethal irradiation.

The activity of some intestinal enzymes has been studied after 2 kR irradiation. Brush border enzymes, maltase and leucineaminopeptidase (LAP) show an increase 20 hours after irradiation, while after 72 hours their activities are reduced to very low levels. Lysosomal enzymes show a completely different behaviour: acid phosphatase activity increases only 72 hours after irradiation, whereas beta glucuronidase increases significantly after 20 hours and reaches values two or three times higher than controls after 72 hours. The histologic picture at the first interval after irradiation shows gross alterations in the crypt region, but the villi appear nearly normal. Seventy-two hours after irradiation the whole epithelium is affected and very numerous leukocytes are present in the stroma.


[The influence of biophysical factors on biological oxidation and redox processes. 16. The possibility of influencing flavine coenzymes in liver mitochondria by means of ultrasonic treatment (author's transl)].

The quantity of FAD and FMN in mitochondria isolated from the liver of albino rats was determined before and after application of ultrasonic energy with the intensities 0,2,0,6 and 1,0 w/cm2 in a short-term test, and the intensity 0,2 w/cm2 applied at ten successive days in a long-term test. The total amount of the two coenzymes as well as their percentages were ascertained. The following results derive from our experiments: 1. A quantitative increase of FAD in liver mitochondria. This suggests that the capacity of the shortened respiratory chain has increased, since redox systems represent a factor determining its stage. 2. The flavine-mononucleotide responds to ultrasonics as a relatively instable biological macromolecule. 3. The total amount of flavine coenzymes is influenced especially by the quantity of FAD, and, correspondingly, by changes of the latter.


[The influence of biophysical factors on biological oxidation and redox processes. 17. Changes in electron transfer and of oxidative phosphorylation steps in liver mitochondria after ultrasonic treatment (author's transl)].

Ultrasonic treatment in vivo brought about distinct changes in liver mitochondria which developed in two directions as to oxygen consumption and oxidative phosphorylation. An increase of oxygen incorporation occurs with short term as well as with long-term experiences. The ratio P/O which expresses the step of oxidative phosphorylation decreases to 1 in the course of one hour after ultrasonic treatment. The results obtained and the supposition that they are related to modifications of NAD-coenzymes and flavoproteins, likewise of the activity of succinic dehydrogenase, of NADH2-cytochrom-c-reductases and cytochrom-c-oxidase, lead to the conclusion that ultrasonic energy is a factor intensifying the transfer of reduced equivalents in the shortened respiratory chain, a factor disturbing electron-proton transfer in the normal respiratory chain of NAD-coenzymes, and a releasing factor for two of the sites of coupling electron transfer with oxidative phosphorylation.


Changes of the activity of certain lysosomal enzymes in the blood serum of whole-body irradiated rats.

The activities of acid phosphatase, beta-glucuronidase, beta-galactosidase, acid ribonuclease, and acid deoxyribonuclease were studied in the blood serum of rats after total, either single or franctionated, exposure. After the single, total exposure to 800 R of X-rays, remarkable increases in the activities of acid phosphatase and acid deoxyribonuclease were observed in the blood serum immediately after the irradiation. At later stages were observed statistically significant decreases of beta-glucuronidase and beta-galactosidase in the rat blood serum after the total, single exposure. The serum acid ribonuclease activity remained essentially unaltered over the whole time interval of interest. In the blood serum of the rats exposed to total, fractionated irradiation, statistically significant decreases in the acid phosphatase and beta-glucuronidase activities were observed 1 and 8 days after completing the irradiation. In the case of beta-galactosidase, this decrease lasted even up to the 15th day after the end of irradiation. The activities of serum acid deoxyribonuclease and acid ribonuclease exhibited no statistically significant changes.


The effect of X-irradiation on phytohemagglutinin (PHA)-stimulated rat lymphocytes.

The effect of X-irradiation on PHA-stimulated rat lymphocytes has been investigated. The animals were exposed to doses of 100 to 800 R. Blood obtained by cardiac puncture was defibrinated and the lymphocytes sedimented by Dextraven. Lymphocytes were separated from supernatant and cultivated for three days in standard medium supplemented with rat serum and PHA. It was found that irradiation reduces the percentage of blast cells in function of the doses of irradiation. This reduction is accompained by an increased number of macrophage-like cells. The labelling index with tritiated thymidine in PHA-transformed lymphocytes was also reduced following irradiation.


[Carcinoma of the penis: symptomatics, therapy and prognosis (author's transl)].

During the period from 1912 through 1970, 150 cases with a carcinoma of the penis have been examined and treated in the clinics of the university of Göttingen. The preferred age of incidence was between fifty to sixty years. Primary phimosis could be verified in 17.3%, a secondary phimosis, caused by the tumor, in 5.3%. Eighty patients were graded stage I, seventy stage II and more advanced stages. Metastases to the inguinal region were observed in 60.6% out of 99 patients who had undergone lymphadenectomy. Distinctly enlarged inguinal lymph nodes proved to be metastases in only a third of the cases. The staging of a case with carcinoma of the penis, therefore, is not possible by means of clinical criteria alone but needs also a biopsy from the inguinal region. The 3-year, 5-year, and 10-year survival rates amounted to 52.5%, 46.7% and 32.4% and did not depend on treatment techniques. The most promising survival rate resulted from a combination of surgical treatment with high-voltage therapy.


[Irradiation therapy of vertebral angionomas: results in 62 patients during the years 1939 to 1975 (author's transl)].

62 cases with vertebral hemangiomas and clinical symptoms from 1939-1975, treated by radiotherapy are reported. In about 60%, radiotherapy resulted in permanent significant improvement or freedom of angioma related symptoms. In 7 cases with symptoms of severe compression of the myelon, decompressive laminectomy was performed, followed by radiotherapy. The radiation dose in the vertebrae were: 3000-5000 rd, 100-200 rd single dose, 5 times per week. Hemangiomas of the vertebrae are an accepted indication for irradiation. We recommend doses about 4000 rd, 150-200 rd single dose, 5 times per week. In cases with severe cord compression decompressive surgery is to be performed first.


[Struma maligna after X-ray irradiation of the neck (author's transl)].

Case report of a papillary thyroid gland carcinoma which was possibly induced by the irradiation of a parotid gland carcinoma.