[Clinical picture, diagnosis and treatment of metastatic melanoma of the brain].

The morphological and clinical features of the disease were studied in 73 patients with malanoma metastasis to the brain. A morphological examination revealed predominance of the epithelial-like structure of the tumors over fusocellular, infiltrative growth of metastases in the brain, and many newly formed defective vessels in the metastatic tumors which were conducive to frequent hemorrhages. The clinical picture of the disease was marked by the predominance of general cerebral symptoms over focal. With regard to the diagnosis, much importance is attached to medical history and peculiarities of the clinical manifestations of the disease and to the results of an auxiliary examination (radiocontrast, electrophysiological, etc). Treatment of patients with melanoma metastases in the brain should be combined and should include, whenever indicated, surgical intervention, hormonotherapy, radiotherapy, and chemotherapy.


[Pericranial sinus (sinus pericranial)].

The authors had under the their care 6 patients with sinus pericranii. Sinusography with puncture of the sac of the sinus and administration of a contrast medium was performed in all of them. In 4 patients the sinus pericranii was not connected with the extracranial vessels, in 2 retrograde filling of the intracranial venous sinuses and the veins of the face occurred. All the patients were operated on. The  sac of the sinus was totally removed in 5 patients and opened and tamponed with muscles in one pateint. The etiology, differential diagnosis, and surgical management of the disease are discussed.


[Abscess of the liver (author's transl)].

A case of liver abscess is analysed in the light of recent data from the literature. The attention is drawn on the increase in frequency of this disease over the last 10 years. The diagnosis is difficult to set on clinical and biological grounds but can be established with certainty by means of scintigraphy and hepatic angiography. Identification of the micro-organism is difficult and impossible in more than half of the cases. Treatment which is essentially surgical, in association with antibiotherapy specific of the anaerobic and gram negative micro-organisms, can reduce total mortality to 10%.


[A case of arteriopathy due to ergot intoxication. Revue of the literature (author's transl)].

The authors present a case of ergot intoxication with ischemia from arterial lesions in all four limbs. Angiograms are presented. The treatment comprises interruption of ergotamine and a bilateral lumbar sympathectomy. Etiology, clinical picture, angiologic characters and the different treatments are described after a revue of the literature.


[Modified radical mastectomy. Experience of the Institut J. Bordet (author's transl)].

The authors report the results of a homogeneous series of 319 modified radical mastectomies where both pectoralis muscles are respected, in the treatment of breast cancer. Operative mortality is nill and morbidity is low. Persistant lymphedema of the arm is not marked. The frequency of axillary nodes is 64%. Local recurrences occur in 12% of cases. Total 5 year survival was 50.1%. It was 89% for stage I, 57.3% for stage II and 43.7% for stage 222. It was 61.5% if there were no involved nodes, 63.9% when 1 to 3 nodes were involved and 32% when 4 or more nodes were involved. The authors recommend this type of operation of tumors of state II and III as the 5 year survival is identical to that of other techniques, as morbidity and mortality are low and distant sequellae are unimportant.


[The problem of the internal mammary chain (author's transl)].

Two hundred and ninety patients operated for breast cancer underwent systematic resection of internal mammery chain. Block resection of this lymphatic drainage is performed without opening the thorax by a personal technique. We have shown these nodes can be involved whatever the site of the primitive tumor. Involvement depends on the local and regional extent of the tumor. Result of frozen section examinations of the mammary chains, internal and external, makes it possible to control and complete the clinical examination. We have thus formed a homogeneous series in which conservative treatment was applied with maximal chances of success.


[Controlled study of oral administration of antibiotics in the preparation of digestive surgery (author's transl)].

Between November 30, 1971 and March 15, 1976, 46 patients underwent surgery on the colon or rectum. They were randomized into 2 groups, one receiving a mechanical preparation together with lincomycline, neomycine, polymyxine, kanamycine, bacitracine and nystatine, the other a mechanical preparation alone. Analysis of results reveals no statistically significant difference in the frequency of infections, neither local (11/24 with antibiotics vis 13/22 without; chi2 = 0.25) neither general (16/24 and 9/22; chi2 = 0.92). Nor was the postoperative use of antibiotics for local or general infection different in the 2 groups. No influence of age or preoperative radio-therapy could be shown. This randomized trial suggests that there is little advantage in associating antibiotics to mechanical preparation before colorectal surgery. The authors contemplate a new randomized trial in high-risk patients suffering from cancer.


[Hepatic peliose, nodular focal hyperplasia of the liver: a propos two cases (author's transl)].

This is a report on the pathology of the liver in two patients under continuous and prolonged oral contraceptives (11 and 8 years): the first had peliose, the other had focal nodular hyperplasia. Present etiopathogenetic theories are reminded: anabolic steroids in peliose and contraceptives in focal nodular hyperplasia. These lesions should be searched systematically in such patients at any laparotomy.


[The problem of the treatment of the operable breast cancer (author's transl)].

Breast cancer is a chronic disease, often generalized at the time of diagnosis. Present treatments are efficient only if the tumor is still localized so that results are relatively disappointing. Careful clinical appraisal will define the chances of a disabling treatment and the limits of a curative treatment. Systematic histologic study of axillary nodes completes the clinical examination, is a reliable measure of the risk of dissemination at the time of treatment and indicates the necessity for complementary chemotherapy. The main choices of treatment for initial stages are presented. Radical mastectomy, according to the literature appears best as it adds a precise diagnosis to a safe result. Mastectomy without resection of the pectoralis major is a cosmetic alternative with statistical and experimental soundness. Complementary prophylactic irradiation for radical mastectomy should be reserved for high risk of local recurrence and for control of metastases to the internal mammary nodes.


[A propos a case of strangulated properitoneal hernia].

The properitoneal hernias are very rare and their diagnosis is very difficult. The authors report one case and discuss the classification.


Gastric lipoma and mucocele of appendix. Case history.

An interesting coexistence of two rare diseases in the same patient is presented. A 51 year old female was operated for a benign tumor of the stomach, a lipoma of about 5 cm of the gastric antrum. After the tumor removal, a mucocele of the appendix was surprisingly found, for which an appendectomy was necessary. The clinical course was uneventful and one year after the operation the patient is in a good state of health. A short review of the literature accompanies the description of the case.


[By-passes of the arteries in the leg and the foot (author's transl)].

The author presents the 50 first cases of his serie of by-passes on legs and feet arteries. The various stages of the angiography, anesthesia and operation technique are discussed. The results are divided into three groups; the by-passes always permeable, the patients deceased from another disease still with a permeable by-pass, and the precocious or late failures. The latter are studied more in detail in order to bring out, the reasons of failures and the factors which could improve the present results. The analysis of the results, compared to those of the published cases, shows a satisfying percentage of good results, seen the symptoms and lesions.


The significance of sympathetic nervous activity for the development of the intestinal mucosal lesions in shock.

A 2-hour period of regional hypotension at 30-35 mmHg in the feline small bowel was produced by partial occlusion of the superior mesenteric artery. In one series of animals the sympathetic fibres in the splanchnic nerves were stimulated bilaterally at 6 Hz throughout the hypotension. In another group of animals no such stimulation was performed on the denervated intestinal segments. A mucosal damage was observed in both series and it was graded histologically according to Chiu et al. (1970). The two groups were also compared as regards the magnitude of the blood pressure fall occurring during the first hour after the period of intestinal hypotension. No statistically significant difference could be demonstrated between the two series of experiments with regard to mucosal damage or blood pressure fall. It is hence concluded that sympathetic nervous activity does not contribute to any measurable extent to the development of mucosal damage and cardiovascular deterioration observed in connection with regional intestinal hypotension. The explanation for this is discussed.


Energy and protein intake in elderly patients in an orthopedic surgical ward.

A study was made during a 3-month period of the food intake of all patients older than 60 years, who were admitted to a ward of acute orthopedic surgery. This amounted to 31 women and 15 men, whose average age was 74 years. Each patient's diet was studied for 16 days on an average. The mean daily energy intake was 1 163+/-341 kcal (4 868 +/- 1 427 kJ) for women and 1 558+/-539 kcal (6 521+/-2 856 kJ) for men. 44 of 46 patients received fewer calories than is recommended for healthy persons the same age, and 25 of 46 patients consumed less calories per day than the basal metabolism. The mean daily protein intake was 0.7+/-0.3 g/kg/day for both men and women. 28 of the patients received less than 0.8 g/kg/day which is the amount of protein recommended healthy adults and none of our patients received 1.5 g protein/kg/day, the protein intake recommended patients in hospital. The low protein intake was due to a poor intake of energy as well as a high consumption of refreshing drinks and titbits, both a little nourishment.


Peritoneal lavage in the diagnosis of intraperitoneal bleeding.

The ability of peritoneal lavage with normal saline to disclose intraperitoneal haemorrhage requiring surgical intervention was assessed in a prospektive study of 30 patients admitted after blunt abdominal trauma or on suspicioun of ruptured ectopic pregnancy. The results were compared with the results of a meticulous clinical examination including simple laboratory tests, and were found significantly more reliable in the management of these patients.


Proximal gastric vagotomy with suprapyloric mucosal antrectomy for duodenal ulcer.

The feasibility of doing proximal gastric vagotomy with suprapyloric mucosal antrectomy for duodenal ulcer was investigated in a pilot study of seven patients. The aim was to reduce the risk of recurrent duodenal ulcer after proximal gastric vagotomy without causing a simultaneous increase of the risk of dumping and diarrhoea. The patients were subjected to pre- and early postoperative gastric secretory tests, radiologic and endoscopic examinations of gastric motility 2 months later, and a clinical follow-up 1 year after the operation. Basal and maximum acid secretion was reduced by 86 and 70% in average in 6 patients. One patient developed mild dumping. Neither recurrent duodenal ulcer nor diarrhoea was accounted. However, 3 patients developed severe gastric stasis and 2 of these had to be reoperated, one having an anastomotic ulcer between fundic and suprapyloric mucosa. The results of this rather timeconsuming and tedious operation did not encourage further trial, but suggested proximal gastric vagotomy alone as being the operation of choice for duodenal ulcer without pyloric or duodenal stenosis.


Carcinoid tumors of the appendix in children. A report of 25 cases.

Carcinoid tumors of the appendix in 25 children (21 girls, 4 boys) below 15 years corroborated the previously reported preponderance of females. 17 children were operated upon because of acute appendicitis, one because of oxyuriasis in the appendix and the remaining 7 because of diffuse recurrent abdominal pain. All the patients were subjected to appendectomy and one of them later also to right-sided hemicolectomy because of carcinoid in the margin of the resection of the appendix but not in the cecum. Despite deep infiltration of the wall of the appendix to the serosa in 9 children and lymph node metastases in one, no signs of a recurrence have been seen during follow-up of 5 to 17 years (mean 12 years).


Visceral ischaemia following coeliac- and superior mesenteric artery occlusion. Report of a case.

A patient with acute ischaemia of the abdominal organs after coeliac- and superior mesenteric artery occlusion is reported. Following vascular reconstruction and resection of gangrenous colon and ileum the main early postoperative problem was hepatic failure. A grave malabsorption syndrome developed necessitating periodic i.v. hyperalimentation. The patient showed no improvement of intestinal function and died 5 months postoperatively from peritonitis.


Iatrogenic hyperstimulation of the ovary with ascites. Report of a case and considerations and management.

The authors describe a case of iatrogenic hyperstimulation of the ovary with ascites in a patient with primary amenorrhea and hypogonadotropic hypogonadism. They present the results of total urinary estrogen assays stressing the advisability of a technical check in the presence of an apparently abnormally high estrogen excretion during HMG therapy. The patient's biochemical and hematological data during the stage of clinical hyperstimulation are set out and management is discussed. Finally, the usefulness of timely and adequate albumin administration under CVP control is stressed and the possibility of clinical application of the result of recent experimental research (viz. antihistamines is discussed.


[Carcadian variations of plasma delta4-androstenedione in normal and castrated adult males].

The plasma concentration of delta4-androstenedione has been assayed by a radioimmunological method, preceded by chromatographic purfication, in 11 normal adult and 4 adult castrated males at various times of day. The circadian variations observed are critically evaluated.


Histological and ultrastructural changes of the endometrium in women using inert and copper-coiled IUDs.

The authors examined biopsy material obtained from women wearing inert and copper-coiled IUDs, under the light and electron microscopes. Examination of this material leads to the conclusion that there are no specific lesion attributable to either type of IUD. It can also be said that lesions characteristic for an inflammatory reaction prevail over all other possible endometrial changes.


Fertility following adnexal surgery.

A total of 154 patients after adnexal operations between 1969-1973 were queried in order to establish fertility rate after operation. Out of the 154 questioned 122 submitted their reply. i.e. 69.2 per cent. These women were divided into three groups. The first one comprised 46 patients operated because of extrauterine pregnancy, the second consisted of 50 patients operated because of ovarian cyst and the third one included 18 women operated because of bilateral adnexal pathology. In the first group 90 per cent of the patients who desired so succeeded to become pregnant. In the second group 87 per cent succeeded and 66.6 per cent in the third group. The possible ethyological factors of sterility after adnexal operations were discussed and conservative operations were proposed as the most convenient policy in cases of bilateral adnexal pathology.


Foam test, amniotic fluid cytology, creatinine and fetography in evaluation of fetal maturity.

Amniocenteses were performed in 73 pregnant women for maturity assessment in cases of high risk pregnancies, pregnancies of unknown gestational age and before an elective cesarean section. The evaluation of fetal maturity was based on: 1) foam test; 2)amniotic fluid cytology; 3)creatinine concentration; 4) fetography and 5) clinical criteria. The results which were assessed as to the proven infant maturity were as follows: Foam test 84.3%, lipid laden cells 75%; Creatinine 62.5% and fetography 56.3%.


A rare case of ante partum fetal death due to funicular pathology.

The authors describe a case of ante partum fetal death due to a true funicular knot combined with relative shortness of the cord as a results of a double nuchal coil. Separately, these complications are common occurrences and do not lead to fetal pathology except during labor. If, however, they are combined they may be responsible, as in the case described above, for ante partum fetal death as a result of vascular strangulation during sudden changes in the fetal position. The possibilities of diagnosing funicular complications are discussed but these are not apt to avoid the rare cases of sudden fetal death as a result of vascular occlusion in the ante partum period.


Inhibitory effect of prostaglandin F2alpha (PgF2alpha) on puerperal lactation.

Twenty puerperal women in 4th day after delivery were treated with a saline infusion containing 10 mg of PgF2alpha. Milk secretion, breast engorgement, prolactin plasma levels and side effects were determined. In all patients lactation disappeared within 48 hours after PgF2alpha infusion. During the following 12 hours after PgF2alpha treatment the prolactin plasma levels showed an important and significant decrease in all cases. In the following days the prolactin plasma levels decreased such as in normal puerperium. In some cases low gastralgia and in one case diarrhoea compaired. These results can be explained by PgF2alpha double action either on pituitary-hypothalamic function or on mammary gland cells.


[Effect of large doses of manganese on erythropoietic activity].

The effect of intraperitoneal administration of 3 different doses of MnCl2 on erythro-poiesis was investigated in rats. Significant changes in 59Fe uptake by erythrocytes, bone marrow and spleen were observed in rats given the highest dose of 1 mg Mn/100 g of body weight. Six injections were necessary to produce a rise in the basic haematological indices, with the exception of reticulocytes whose number changed considerably during the period of investigations. The results of rat plasma filtrate administration to mice and total circulating blood volume determination which was unchanged after administration of MnCl2 suggested that the observed effects were produced by manganese. Histological examination of the liver, spleen and kidneys showed congestion and stasis of blood in them, especially in glomerular vessels.


[Fetal hemoglobin in various pathological conditions in adults].

Fetal haemoglobin concentration was determined in the blood of 122 adult patients. Raised level of this haemoglobin was found in cases of anaemia during chronic renal failure and in certain cases of malignant neoplasms. Besides that, fetal haemoglobin level was determined in anaemia associated with other diseases (liver failure, hyperthyroidism, myasthenia gravis). The obtained results are discussed.


[Detection of Hemophilia A carrier state].

Factor VIII biological activity and factor-VIII-related antigen were measured in the plasma of 78 definite, probable or potential carriers of haemophilia A and in a control group of 74 normal women. Low values of factor VIII activity could be detected in 11 of 24 definite carriers, in 11 of 26 probable carriers and, in 10 of 28 potential carriers. On the other hand, the ratio of factor VIII activity to factor-VIII-related antigen was significantly lowered in 79 percent of definite carriers, in 50 percent of probable carriers and, in 21 percent of potential carriers. These studies indicate that determinations of both factor VIII activity and antigen is more reliable procedure in the detection of the carrier state for haemophilia A than determinations of factor VIII activity alone.


Monitoring of blood oxygen tension during and after anesthesia with a bed-side PO2 meter.

Monitoring of the state of oxygenation of surgical patients during and after anesthesia has been a problem of increasing interest, especially in those cases in which clinical judgment of skin colour alone is unreliable. Therefore a clinical trial is described with a bed-side PO2-measuring device. Results of duplo measurements in arterial blood samples show good correlation with laboratory control values. It is concluded that--if periodically checked by a laboratory apparatus -- the PO2 bed-side analyser could be an useful instrument for semicontinuous monitoring of blood PO2 during anesthesia and in recovery room and intensive care unit.


Treatment of gas gangrene. Interest of hyperbaric oxygen therapy.

We report 27 cases of gas gangrene treated at the University Hospital of Liège since the Anesthesiology Department has been using a caisson for hyperbaric oxygen therapy. Frequency of gas gangrene does not appear to have decreased during recent years. The etiologies now encountered are mainly of post-traumatic and post-operative origin (especially  surgery on the digestive tract); arterial insufficiency is a predisposing factor. The prognosis depends on the speed with which an effectual treatment is started; the latter consists in intensive hyperbaric oxygen therapy, antibiotic therapy and resuscitation. Surgery should be as conservative as possible and is undertaken only when progress of the disease has been checked by hyperbaric oxygen therapy. The association of these various modes of treatment proves effectual despite a still significant mortality.


Surgery of acoustic neuromas. Preliminary experience with a translabyrinthine approach.

Inspired by the works of William House, the authors formed an otoneurosurgical team in order to improve the results after surgery for acoustic neuromas. This paper deals with the preliminary results obtained with the translabyrinthine approach in 13 patients with acoustic neuromas. In 9 patients it was possible to remove the tumor totally with this approach, in 4 patients a second suboccipital operation was necessary to secure total removal. One small, 7 medium and 5 large tumors were encountered. The facial nerve was preserved in 83 per cent of the patients. One patient with a large tumor died after the second suboccipital operation. The relation between size of the tumor and the outcome of the operation is stressed, and in order to reduce the number of large tumors it is suggested that all patients with unilateral hearing loss should be suspected of having a neuroma, until the diagnosis has been disproved. It is concluded that the surgery for acoustic neuromas is otologic-neurosurgical teamwork, and that the treatment should be centralized.


Motor neuron disease. Prognosis and epidemiology.

In order to evaluate the prognosis and possible prognostic factors associated with a bening course, 118 cases of motor neuron disease diagnosed 1948-1975 were followed up. Survival curves, based on the actuarial method showed a survival rate of 18.7 per cent (95 per cent confidence limits: 11.4-26.0) and 7.6 per cent (95 per cent confidence limits: 2.7-12.5) after 5 and 10 years respectively. Comparing the survival curves of males/females, cases with bulbar/spinal- and upper/lower extremity onset, cases with/without upper motor neuron signs, only bulbar onset was associated with a significantly poorer prognosis. However, cases with bulbar onset had a significantly higher mean age of onset. Based on cases from Funen county with a 1970-population of 432,699 we found an average annual incidence rate, mortality rate and period prevalence rate of 0.85, 0.86 and 2.5 per 100,000 respectively. Comparing the incidence per 5-year period through 1948-1972, no significant deviations indicating a changing environmental factor were found.


Platelet hyperaggregability in young patients with completed stroke.

In a consecutive series of 11 young patients with clinical evidence of cerebral infarction, platelet function and plasma lipid levels were examined. The results show that increased platelet aggregability characterizes the patient group as a whole. Hyperlipidemia was frequently found, and the number of heavy smokers was high. It is suggested that all younger patients with cerebrovascular disease are examined with regard to these presumed risk factors.


Acute hypertension causing blood-brain barrier breakdown during epileptic seizures.

The influence of shortlasting (less than 1 min) epileptic seizures on the permeability to protein of the blood-brain barrier (BBB) was studied in rats. The protein tracer, horseradish peroxidase (HRP) was used as marker substance. Monitoring arterial blood pressure (BP) and electroencephalogramme (EEG) seizures were induced electrically after HRP was given intravenously. Following a single electroshock seizure slight staining of brain tissue was seen, while after 10 electroshock stimuli followed by sustained seizure activity, this phenomenon was more pronounced. If 10 electroshock stimuli were preceded by transsection of the spinal cord, blood pressure increase was abolished and no tissue staining was seen in spite of epileptic seizure activity recorded on EEG. This means that the acute hypertension and not the seizure activity per se is the mechanism behind the breakdown of the BBB during epileptic seizures. Electron microscopy revealed an increased vesicular transport (pinocytosis) across the endothelial cells, while the vascular structure remained intact.


Low cerebral blood flow in hypotensive perinatal distress.

Hypoxic brain injury is the most important neurological problem in the neonatal period and accounts for more neurological deficits in children than any other lesion. The neurological deficits are notably mental retardation, epilepsy and cerebral palsy. The pathogenesis has hitherto been poorly understood. Arterial hypoxia has been taken as the obvious mechanism but this does not fully explain the patho-anatomical findings. In the present investigation we have examined the arterial blood pressure and the cerebral blood flow in eight infants a few hours after birth. The 133Xe clearance technique was used for the cerebral blood flow measurements. The study confirmed that perinatal distress may be associated with low arterial blood pressure, and it was shown that cerebral blood flow is very low, 20 ml/100 g/min or less, in hypotensive perinatal distress. It is concluded that cerebral ischaemia plays a crucial role in the development of perinatal hypoxic brain injury.


Clear-cell sarcoma of tendons and aponeuroses. Report of two cases.

Two cases of clear-cell sarcoma of tendons and aponeuroses are reported. The first patient was a 19-year-old man with a tumor in the medial collateral ligament of the knee. The tumor was enucleated, and after postoperative radiotherapy a wide local excision was done. The patient was symptomless 4 1/2 years after the operation. The other patient was a man aged 68 with a tumor between the medial malleolus and the Achilles tendon. He also received postoperative radiotherapy after enucleation. Three months later a metastasis was noticed in the ipsilateral para-iliac nodes. The patient died 16 months after the operation. The histology and clinical course of the two cases are analyzed. Some integrative remarks based on earlier reports of 33 cases and the present two cases are presented.


Metal sensitivity in patients treated for tibial fractures with plates of stainless steel.

In three patients a local dermatitis developed 3-3 1/2 months after tibial osteosynthesis with plates and screws of stainless steel 316 L (AO). Two of the patients had a positive patch test for chromium (and cobalt) and one for nickel. Infection was not indicated and it is suggested that the dermatitis was caused by a metallic sensitivity. The skin affection disappeared after removal of the metal.


The effect of impact loading on rabbit knee joints.

Eighteen mature male Whiteland rabbits received repetitive impulse loads slightly larger than body weight (4 kp) through one knee joint for periods from 1 to 6 weeks. Mechanical compression of subchondral bone cores from impacted tibiae showed progressive increased deformation under a constant force. Cartilage degeneration occurred concurrently with alterations in the mechanical properties of the subchondral bone. The cartilage degeneration may be explained by: (i) the deleterious effect of repetitive mechanical compression, (ii) the decreased mechanical support of the underlying subchondral bone.


The effect of osteotomy and cartilage damage on mitotic activity. An experimental study in rabbits.

In 15 rabbits, osteotomy and osteotomy including cartilage damage were performed. With autoradiography (3H-thymidine) it was shown that only one knee in the osteotomy group had labeled chondrocytes in the tibial cartilage. In the knees with articular damage, labeled chondrocytes were found in the femur as well, which could be the result of a factor liberated from the damaged cartilage, a factor stimulating mitotic activity.


The in vitro effect of oestradiol on collagen metabolism in metaphyseal rat bone.

Surviving bone pieces from the femoral and tibial metaphyses of young castrated female rats have been incubated for 6 hours with concentrations of oestradiol-17-beta ranging from 10(-9) M to 3 x 10(-5) M, and the in vitro collagen metabolism studied. The addition of oestradiol did not produce any change in the resorption patterns of bone collagen, expressed as release of hydroxyproline to the medium. Parathyroid hormone in the incubation medium increased the resorption and decreased the incorporation rate insignificantly. Addition of both parathyroid hormone and oestradiol to the incubation medium produced a significant increase in resorption and a decrease in incorporation rate as compared with the control incubations. The bone pieces incubated with oestradiol-17-beta 3 x 10(-5) synthesized and incorporated significantly less hydroxyproline than the control bone pieces. This is, however, a very high concentration of the hormone and the physiological significance of the observation is doubtful.


The spinal abnormalities in thalidomide embryopathy.

In 1968 a study was made of the spinal changes in 32 children with multiple congenital abnormalities due to thalidomide. Twenty-eight of these children have been traced and their spinal changes reviewed. Only four patients had normal spines on radiography. In eight children, scoliosis was present and had progressed though it was still of mild degree. Disc and end-plate abnormalities were seen in 14 children, and in some appeared to be progressive, leading to intervertebral fusion.


The changed pattern of bone and joint tuberculosis in Norway.

The reduced incidence of bone and joint tuberculosis in Western countries and the change in the age groups afflicted are well known facts. In addition, there are other less conspicuous changes: multiple lesions and involvement of the spine and sacro-iliac joints are rarer than before, while trochanteric involvement is becoming more frequent. In spinal cases the lesion is now more often localized to the dorsal region. All these changes may be due to the change in age distribution of the patients.


Osteomylelitis of the spine.

A study of a series of 82 cases of pyogenic osteomyelitis of the spine has shown that the clinical features at the initial stage of the disease often present such a varied picture that the correct diagnosis may easily be overlooked for a long time. Once radiographic changes are demonstrated, the primary consideration in differential diagnosis is tuberculous spondylitis. Bacteriological verification by needle biopsy or surgical exploration is recommended in order to institute an adequate antibiotic therapy. Surgical evacuation is advocated in cases with extensive vertebral destruction. The majority of patients recovered within 1 year from the onset of illness. In slightly more than half of the cases the spinal lesions healed with spontaneous interbody fusion. This tendency was most pronounced in cases of cervical and upper thoracic involvement. No deaths occurred as a result of the spinal disease.


Endoprosthesis as treatment for necrosis and pseudarthrosis after transcervical femoral fractures. A clinical review.

This report concerns 105 patients who developed painful necrosis or pseudarthrosis after nailed transcervical femoral fractures and were treated by Moore's arthroplasty. The mean age at the time of secondary arthroplasty was 68 years, the operation being performed on average 2 years after the fracture and nailing. The mortality within 6 weeks of operation was 3 per cent. Complications not producing late sequelae were seen in 11.4 per cent of cases, and complications producing late sequelae occurred in 5.7 per cent. At the follow-up examination 2 to 8 years after arthroplasty (mean 3.7 years), 37 per cent of the patients were completely free from pain, and the functional result was acceptable in 91 per cent. The remaining 9 per cent had other debilitating illnesses. The results are compared with other reports in the literature.


Stress radiographical measurements of post-traumatic knee instability. A clinical study.

In a prospective, consecutive, clinical and stress radiographical study, comprising 153 traumatic knee injuries, the value of stress radiographical measurements, gonylaxometry, was studied. Clinical evaluation, gonylaxometry and preoperative evaluation under general anaesthesia were carried out in that order. Then the operative findings were recorded as drawings on standard diagrams. These were used as a basis for evaluation of the preoperative tests. Of all the methods evaluated, gonylaxometry was found to provide the most accurate information regarding the knee injury. Very close to this result were the findings under general anaesthesia. Anterior drawer sign was measured gonylaxometrically when damage to the anterior cruciate ligament was present; posterior drawer meant damage to the posterior cruciate ligament. Partial ruptures of cruciate ligaments did not allow antero-posterior displacements exceeding the critical levels of the test. Small positive medial instability was found with ruptures of profound medial structures, higher values with total rupture of the long superficial collateral band, and still higher values when cruciate ligament ruptures were also present. The predictive values of a positive radiographical test were 100 per cent as regards medial instability and 98 per cent for drawer looseness. The predictive values of a negative test were 96 per cent for drawer and 92 per cent for medial instability. These figures are based on the total material. 95 per cent confidence limits are given.


Below-knee amputation for ischaemic gangrene. Prospective, randomized comparison of a transverse and a sagittal operative technique.

In a prospective, randomized study a comparison was made of the results of primary below-knee amputation for ischaemic gangrene carried out by two methods: In 47 cases by the transverse technique with a long posterior musculo-cutaneous flap and in 41 cases by the sagittal technique using equally large medial and lateral musculo-cutaneous flaps--in both instances followed by 2 weeks in a half-open plaster cast with extended knee. The sex ratio and age distribution were the same in both groups. Minor differences in the vascular condition between the groups, assessed by the duration of rest pain, pulsation findings, extent of gangrene, and frequency of diabetes, wholly or partially equalized each other. The course of healing was the same in both groups, primary healing being attained in 38 per cent and 41 per cent, respectively (0.70 less than P less than 0.80). There was also no difference between the results as regards limb fitting, ambulation, occupational, or social status. It is concluded that the choice between the two methods can be based merely upon surgical skill and the ischaemic changes in the lower leg.


Fracture of the body of the talus.

Fifty-one patients with fracture of the body of the talus were seen at follow-up examination an average of 23 months after treatment. Osteonecrosis had developed in 8 out of 17 patients with displaced shearing or crush fractures of the trochlea. Malunion as well as subluxation predisposed to osteoarthrosis in the subtalar and talocrural joints. Thus, osteoarthrosis was present in 9 out of 21 patients without malunion, in 8 out of 16 patients with malunion, and in 11 out of 14 with malunion as well as subluxation. Judging from the nature of the complaints, the difficulties in rehabilitation, and the disability assessment, the prognosis was fairly grave, also after the small, usually non-displaced fractures of the posterior and lateral tubercles. Out of 20 patients with fractures of this type only 6 obtained almost complete relief from their symptoms, only 8 could go back to their previous work on a full-time basis, and 11 were assessed to be 10 per cent or more disabled. Fractures in the posterior and lateral tubercles must therefore be interpreted as links in more extensive injuries involving the subtalar joint and possibly the talocrural joint with associated injuries to articular cartilage, joint capsules, and ligaments.


Supination deformity of the forefoot.

Supination deformity of the forefoot is rare. Observations of eleven cases and the production of the deformity in rabbits suggest that loss of function of the peroneus longus muscle in combination with the effect of a strong tibialis anterior muscle is decisive for the appearance of the deformity. Primary conditions causing deformity were: spina bifida, talipes equinovarus, poliomyelitis, trauma and muscular dystrophy. Treatment by wedge resection of the first cuneiform and the first metatarsal bones and transfer of the tibialis anterior tendon was successful. Operations for supination deformity were carried out in nine cases.


Arterial embolization for radical tumor resection.

Two contemporary measures, selective transarterial embolization (Almgard et al. 1973) and controlled hypotensive anesthesia (Davis et al. 1974), have been combined in an effort to reduce the risk of operative bleeding in a case of massive bone and muscle resection of a highly vascular carcinoma lesion in the proximal third of the femur. This approach may be helpful in such cases.


Incidence of fracture in epileptics.

In 87 epileptics on diphenylhydantoin, the occurrence of non-seizure-related fractures, over a period of 7 years, was six times greater than that found in the normal population. The significant increase in fracture incidence was found to lie within the 45-64 age group indicating that eipleptics are not only more prone to fractures but also have an earlier fracture début.


Penetration of antitubercular drugs in clinical osteoarticular tubercular lesions.

In 79 consecutive cases of skeletal tuberculosis the concentration of streptomycin and ethambutol was analysed. The material for analysis was obtained from the diseased joints of 14 patients and from cold abscesses from spinal or osseous lesions in 65 patients. The concentration of the drugs in the serum and in the tuberculous material was measured 3 hours after the systemic administration of the drugs in therapeutic doses. The concentration was expressed as microgram per ml of the tuberculous material and the data were subjected to statistical analysis. Streptomycin and ethambutol penetrated freely into the tuberculous joints; their concentration in the cold abscesses, however, was half to one third of the concentration in the serum. There was a wide range of concentrations; however, in the tuberculous joints as well as in the cold abscesses the concentrations were much higher than those considered to have an inhibitory effect on mycobacterium tuberculosis in clinical material.


Isolated dislocation of the carpal scaphoid.

A case of isolated dislocation of the carpal scaphoid is presented and the literature on the subject reviewed. An analysis has been made of the cases reported and attention is drawn to certain features which are common to most of the cases.


Madelung's deformity. A follow-up study of 26 cases and a review of the literature.

Madelung's deformity, the history, aetiology, pathogenesis and prognosis, is discussed, on the basis of the literature. The author's material of 26 cases has been followed up. Thirteen of them were treated by resection of the ulna head or shortening of the ulna, with or without wedge osteotomy of the radius. The result was an improvement in pain and a cosmetic improvement, but mobility was unaltered. Spontaneous improvement in the symptoms is common, so that a waiting policy, and observation of the patient until growth ceases, is recommended.


Processus supracondyloidea humeri with concomitant compression of the median nerve and the ulnar nerve.

Compression of the median nerve and the nerve due to the anatomical anomaly processus supracondyloidea humeri is a rare condition. A case of combined median and ulnar nerve compression is described. Diagnostics and treatment are discussed in the light of the present case history and those described in the literature. The conclusion is that the treatment should be superiosteal resection of the process together with the origin of the pronator teres muscle.


The Monk hip arthroplasty. Preliminary report on the uncemented standard Monk prosthesis.

The Monk hip prosthesis is a one-piece block prosthesis consisting of a metal femoral component with the head enclosed in a polyethylene cup. The standard type is fixed without cement. Most of the hip movements take place between the metal and the polyethylene cup. 104 Monk arthroplasties were performed. 95 hips in 84 patients have been available for regular examination and follow-up. The follow-up period was from 12 to 30 months, an average of 19 months. Out of the 95 cases, 72 were classified as excellent, 10 as good and 13 as unchanged. The results obtained during the first year were comparable to those obtained with the Ring prosthesis, but during the following 1 1/2 years eight revisions had to be performed. The main reason for the deterioration was loosening of the femoral component, probably because in the standard type it is too short and the neck has too great a varus inclination, resulting in a rather strong tilting force. Because no cement has been used the revisions have been quite easy to perform. Another reason for failure has been wear of the polyethylene cup, in one case with a massive foreign body reaction. In spite of a short follow-up period this report illustrates the failures due to the design of the prosthesis, and therefore an improved construction is now in use.


Perthes' disease. A study of radiological features.

A study is presented of the radiographs of 68 patients with unilateral Perthe's diseasemtwo types of Perthe's disease are identified: 'fragmenting' and 'non-fragmenting'. The two radiological types of the disease showed no significant differences in the age at diagnosis, the duration of symptoms before diagnosis and the duration of the disease. However, the radiologically-measureable results at healing, in terms of the epiphyseal, acetabular, acetabulum-head and comprehensive quotients were all very significantly worse when fragmentation had developed.


Ultimate bony fusion of lower limb joints following severe trauma.

Three patients presented with limb deformity some years after being run over and sustaining degloving injuries of their lower limbs. Spontaneous joint fusions were observed in each patient; The causes of these could be: i) Extensive intra-articular fracture, ii) Prolonged immobilisation due to the scar tethering the joint, or most likely, iii) A chronic low grade infection following compound joint injury with degloving.


Macula utriculi in four cases with Meniere's disease.

Four patients suffering from Meniere's disease were labyrinthectomized. Maculae utriculi were removed and studied by electron microscopy. The neuro-epithelia from all four patients appeared fairly normal, considering the age of the patients. However, two types of degenerative change, which could be related to the inner ear disorder, could be distinguished. One was vacuolation of the sensory cell cytoplasm, followed by pycnosis of the nucleus and cell death. The other was cystic degeneration. This started with localized separations between the sensory cell and the nerve chalice. These separations developed into a single cystic cavity. A few large intra-epithelial cysts were found, probably representing the final stage of the cystic degenerative process.


The influence of linear acceleration on optokinetic nystagmus in human subjects.

The influence of linear acceleration on optokinetic nystagmus (OKN) was studied in human subjects. Linear acceleration was applied to the subjects by means of the parallel swing and also by the transfer of the subjects in one direction, either right or left. The cortical form of OKN increased the frequency, amplitude, and eye speed of the slow phase. Of the three, the increase in eye speed was the most pronounced. The subcortical form of OKN was not only increased but was also disturbed by the linear acceleration. When the compensatory eye movement with linear acceleration and the slow phase of OKN were in the same direction, the nystagmus increased remarkably. Contrarily, when the two directions were opposed to each other, nystagmus was inhibited. These results proved that the otolithic organs are not only able to promote but also to inhibit visual function.


Gentamicin-induced changes in RNA content in sensory and ganglionic cells in the hearing organ of the lizard Calotes versicolor. A cytochemical and morphological investigation.

The effect of short-term administration of gentamicin on RNA content in isolated sensory and ganglionic cells in the hearing organ of the lizard Calotes versicolor was investigated. The effects of the drug on this biochemical parameter are compared with ultrastructural changes in sensory cells from the same material. In the first test group, daily intraperitoneal injections for 3 to 6 days resulted in a 30-50% decrease of the amount of RNA in sensory and ganglionic cells. No constant ultrastructural changes were recorded in the sensory cells at this point in time. A second test group received 3 or 5 injections of gentamicin and the animals were then left untreated for 21 days. The reduced RNA content persisted in both sensory cells and in ganglionic cells from animals that received 5 injections, whereas the content of RNA in ganglionic cells from lizards that received 3 injections was restored almost to control values at the end of this 21-day period. In the second test group, definite morphological derangements were observed in the sensory cells. The correlation between cytochemical and morphological findings as well as possible modes of action of gentamicin on inner ear ganglionic and sensory cell RNA content are discussed.


Electrocochleography used as a clinical hearing test in difficult-to-test children.

Thirty difficult-to-test children have been tested with transtympanic ECoG. When possible, informal hearing tests and/or free-field testing were performed. Children in whom no action potential (AP) could be recorded were submitted to conventional radiography of the inner ear, and vestibular tests. The correlation between free-field test thresholds and AP "thresholds" was good, especially in subjects with relatively good hearing. Response amplitude increased, and latency decreased, with increasing frequency of the stimulus implying that different parts of the basilar membrane are stimulated according to the frequency of the stimulus. Input-output curves of response amplitude and latency were plotted, and three different types were distinguished. ECoG can contribute to the evaluation of peripheral hearing in difficult-to-test children, and vestibular tests should always be performed on a child with suspected deafness or sensorineural hearing loss. Conventional radiography of the inner ear, however, seems to be of little value.


Peroperative temporary threshold shift in ear surgery. An electrocochleographic study.

TTS resulting from drilling in the temporal bone was detected by means of pre- and post-exposure ECoG recordings taken during ear surgery for chronic otitis media. The TTS obtained varied between 5 and 40 dB at 4 and 8 kHz. The correlation between duration of noise exposure and magnitude of TTS was statistically significant. The results indicate that drill-induced noise in ear surgery may result in postoperative high-tone sensorineural hearing loss, and support the view that manipulation of the ossicular chain during ear surgery causes mainly a threshold shift at the lower frequencies.


Bone-conducted stimulation in electrocochleography.

The mechanical vibration patterns close to the cochlea in intact skulls of human cadavers have been studied by means of a miniature accelerometer. A Radioear B70A vibrator and a Brüel & Kjaer Mini Shaker have been used, fed with filtered clicks and with short tone bursts. The tone bursts were found to be superior to the clicks with regard to the vibration spectrum. At 500 Hz a considerable distortion was observed in the accelerometer signal, also when using tone bursts. This distortion was presumably due to resonant vibrations in the skull itself, and may be a source of error not only when using stimuli of short duration as in bone-conduction ECoG but also in conventional bone-conduction audiometry. When the vibrations were applied to the exposed bone surface of the mastoid, vibration levels increased by 10-25 dB compared with when soft tissues covered the point of application. This could be of advantage in bone-conduction ECoG performed at ear surgery.


[Value of the nose provocation test in the allergic patient. A comparative study of the correlation skin inhalation, and lung tests provoked with various allergens].

The authors make a comparative study in 55 CNLSD children and 10 healthy children. In all those children, provocation tests were performed as wel at the level of the skin, as at the level of the lung and nose. The provocation tests were performed with the following allergens: house dust, mites, human dander and pollen, and with histamine. Only in the control group (10 healthy children) no lung provocations with histamine were done. From the investigation follows that skin tests are not always reliable. Furthermore, in many cases a nose provocation test (combination of aerosole. Furthermore, in many cases a nose provocation test (combination of aerosol provocation with a allergen and PAR rhinomanometry) can replace a lung provocation test.


The frequency and importance of bronchial hyperreactivity in patients with allergic and non-allergic rhinitis.

A trial was undertaken to evaluate the occurrence of bronchial hyperreactivity, typical of bronchial asthma, in 50 patients with hay fever (rhinitis allergica) and 45 patients with rhinitis vasomotorica nonallergica, as opposed to a group of healthy subjects and patients with bronchial asthma. All the patients were subjected to spirographic examinations at rest (VC, FEV1, ETT, SI), after exercise (PWC170), and after histamine inhalation. The authors believe that it is expedient to study bronchial hyperreactivity in patients with hay fever and rhinitis vasomotorica nonallergica in that it affords possibilities for the prevision of the conceivable unfavourable evolution of the disease towards the atopic or non-atopic bronchial asthma, as well as for the taking of adequate preventive and therapeutic measures.


[Aspergillus mycetoma of the maxillary sinus].

The author describes a new case of aspergillosis in maxillary antrum, treated by surgery. A particularity of this case was an eosinophilia that disappeared after the treatment. Correlation with fungus infection was made probable by presence of a great amount of eosinophilic blood cells in hyperplastic mucosa involving the lesion. A review is made of literature.


Changes in human nasal resistance associated with exercise, hyperventilation and rebreathing.

The nasal resistance to airflow determined in four subjects for periods of up to 7 hr. Cyclic changes in the resistance of each nasal passage were demonstrated in 13 or 24 experiments. After exercise on the cycle ergometer the total nasal resistance decreased and this change in nasal resistance was found to be directly related to the work rate. After oral rebreathing, the total nasal resistance decreased, and after hyperventilation the total nasal resistance increased. These changes in resistance are believed to be caused by changes in arterial pCO2 and mediated by the autonomic innervation of the nasal vasculature.


The reliability of level-diagnostic examinations in acute, peripheral facial palsy.

In acute non-traumatic peripheral facial palsy where the cause is not known, it does not seem to be justified to draw conclusions as to how far to the centre in the course of the nerve the lesion may be located, based on an examination of tear secretion, stapedial reflex, and taste. This is demonstrated in two cases.


Nuclear bodies in laryngeal papilloma.

Electron microscopy of Juvenile Laryngeal Papilloma from Nigerian children has revealed the presence of nuclear bodies in the neoplastic cells. These bodies were round or oval in shape and varied from 0.3 to 0.5 micrometer in diameter. The immature forms consisted of fine fibrous units, whereas the mature forms displayed central and peripheral zones. The central zone consisted of dense, coarse, granular filaments, whereas the peripheral zone showed fine filaments of low electron density. Some intermediate forms were also noted. These bodies were similar to those reported in other viral infections and in tumour cells.


Acupuncture and phonostimulation in pollenosis and vasomotor rhinitis in the light of psychosomatic investigations.

Patients with vasomotor rhinitis (28) and pollenosis (23) were subjected to psychosomatic examination and treated either by acupuncture or phonostimulation exclusively. Acupuncture was performed after the classical method in 22 patients and phonostimulation in 29. Evaluation of the results was based on laryngological examinations and appraisals entered by the patients in special personal diaries. In pollenosis the condition was unchanged by the treatment. In vasomotor rhinitis, on the other hand, in which psychic factors were of importance, some of the patients usually improved temporarily at the beginning of treatment, whereas a few suffered exacerbation. These effects may be attributable to suggestion.


[Various advantages of rigid bronchoscopy as shown by a case report].

The clinical effect of a large biopsy of a bronchial adenoma via the bronchoscope is described. The author explains why, for diagnosis and therapy of bronchial adenoma, the use of the bronchoscope is to be prefered to the use of the fiberscope.


Acidic glycosaminoglycans in the ground substance in paranasal sinus diseases.

Acidic glycosaminoglycans (AGAG) in the normal maxillary sinus mucosae were analysed by electrophoretic separation and densitometric quantitation, and then compared with those in chronic maxillary sinusitis, nasal polyps and maxillary sinus cancer. The total amount of AGAG in the edematous maxillary sinusitis and nasal polyps increased significantly. Both increases were almost twice as large as the normal content. When the changes of each AGAG in the total amount were compared with the normal content, chondroitin sulfate A and C showed the most conspicuous increase, chondroitin sulfate B was rather stable and hyaluronic acid showed a roughly twofold increase, in all the tissues examined. The ratio of %hyaluronic acid divided by %chondroitin sllfate B increased the most in maxillary sinus cancer.


Linear growth of children with limb deformities following exposure to thalidomide in utero.

The growth of 202 children exposed to thalidomide in utero and having upper (139 children) or lower (63 children) limb deformities has been assess towards the end of pre-pubertal growth. The analyses show that children exposed to thalidomide are shorter than normal children but grow at a normal velocity later. These findings may help in consideration of the mechanism by which thalidomide exerted its teratogenic effect. Analyses of growth may find a wider use in the retrospective assessment of drugs which are potentially harmful in pregnancy.


The early detection of pneumothorax with transthoracic impedance in newborn infants.

During the treatment of IRDS with assisted ventilation pneumothorax is a common and dangerous complication where an early diagnosis is important for the successful treatment. In this case report the continuous monitoring of transthoracic electrical impedance has proven to be a sensitive and non-invasive method to detect the development of pneumothorax long before clinical signs are manifest.


Influence of oral lysozyme administration on serum immunoglobulin and intestinal secretory IgA levels in infants.

The influence of lysozyme feeding on the production of serum immunoglobulins and intestinal secretory IgA was studied in full-term and premature infants, from birth up to the age six months. Serum immunoglobulins were not influenced by lysozyme administration. An increase in secretory IgA was found in stool filtrates of full-term lysozyme-fed infants; no secretory IgA was detected in controls. In this way lysozyme feeding partly substituted for passive transfer of secretory IgA from maternal milk.


Patients at a paediatric out-patient clinic. A study with particular reference to psychological and social background factors. I. The problem, material, methods and actual visit.

A large proportion of the children who attend paediatric clinics present with indefinite somatic symptoms or complaints which are clearly or possibly of a psychological nature. At the same time it is known that patients with serious psychological problems tend to seek help far too late. This study is an attempt to find out whether the patients who are liable to become problem cases in the long term can be identified by the paediatrician at an early stage and, if so, in what ways these patients differ from others in a paediatric clientele. All the patients who attended the Paediatric Out-Patient Clinic at Umeå Hospital during the course of one year were assessed by the physicians there. It was judged that psychological factors of importance were involved in 5.2%, that the importance was doubtful in 8.3% and that no psychological factors were involved in 86.5%. The proportion of cases involving psychological factors of importance increased with age and amounted to 17% amoung the 10 to 15-year-olds.


Patients at a paediatric out-patient clinic. A study with particular reference to psychological and social background factors. II. Earlier contacts with the health service, social background, parents' morbidity, general discussion and recommendations.

Psychological factors were considered by the examining physicians to play an important part in 5.2% of approximately 4 000 initial visits to a paediatric clinic. These cases are compared with a matched control group representing the cases where the physicians judged that psychological factors were not involved. As compared with the controls, then a considerably larger proportion of the patients with symptoms associated with psychological factors had a previous history of contacts with child psychiatrists or attendence at the paediatric clinic for problems of a psychological nature. Their parents, the mothers in particular, had a higher frequency of registered sickness for mental-nervous disorders and their families had more frequently been the subject of special social inquiries or assistance. To a large extent the examining paediatrician was unaware of these background conditions. With a better case history and proper follow-up one could probably reduce the number of X-ray examinations, consultations and laboratory tests. Further training and better contacts would be facilitated if members of a children's psychiatric team were stationed within the paediatric clinic.


Fetal risks due to warfarin therapy during pregnancy.

Two mothers with heart valve prosthesis were treated with warfarin during pregnancy. In the first case a caesarean section was done one week after replacement of warfarin with heparin. The baby died of cerebral and pulmonary hemorrhage. The second mother had a male infant by caesarean section. The baby showed warfarin-induced embryopathy with nasal hypoplasia and stippled epiphyses (chondrodysplasia punctata). Nasal hypoplasia with or without stippled epiphyses has now been reported in 11 infants born to mothers treated with warfarin during the first trimester, and a causal association is probable. In view of the risks to both mother and fetus in women with prosthetic cardiac valves it is recommended that therapeutic abortion be advised as the first alternative.


The growth of the kidneys in children with vesicoureteric reflux.

In a retrospective study, 69 kidneys with VUR were divided into 2 groups: One group (A) where VUR stopped within 1 year after operation or conservative treatment and a second group (B) where VUR continued for more than 1 year. Group A had somewhat more severe grades of reflux than group B. The number of infections were practically the same in the two groups. The length of the kidneys was measured at the time of diagnosis and compared with the length at the most recent urography after VUR stopped (group A) on average 2 years and 3 months later and with the most recent urography while VUR was still present (group B) on average 1 year and 9 months later. It was found that 85% in group A had increased in absolute length while the figure was 60% in group B. If the relative growth is calculated (the kidneys' length in relationship to L1-L3 distance), 60% in group B had decreased while only 30% in group A had decreased.


Bilirubin inhibits hexose-monophosphate shunt activity of phagocytosing neutrophils.

Neutrophil hexose monophosphate (H.M.P.) shunt activity was measured by the conversion of 14C-1-glucose to 14CO2 during ingestion of polystyrene latex particles. Unconjugated bilrubin at the concentration of 1 X 10(5) M was found to markedly inhibit H.M.P. shunt activity. Since H.M.P. shunt activity of neutrophils is an important prerequisite of microbicidal function, it is suggested that jaundiced newborns may be more susceptible to bacterial infections.


Drug usage and adverse drug reactions in paediatric patients.

The development of epidemiological methods for the study of adverse drug reactions is reviewed in connection with the presentation of data obtained by intensive monitoring of 1 000 admissions to a medical paediatric unit. Compared with adults and American children, the patients received fewer drugs and experienced fewer reactions while in hospital. The drug usage pattern was different from that of American paediatric practice and general practice in the United Kingdom. Fifty-one (6%) patients experienced 119 adverse drug reactions. These occurred more frequently in children suffering from serious disorders and in the majority of cases the basic therapy was continued regardless of the severity of the drug side-effects. Treatment was required for the effects of 66 (55%) adverse reactions. It appears that drug monitoring in paediatric practice may be of greater value if surveillance programmes are designed to provide a "therapeutic audit" and extended to include children receiving drugs in the community.


Familial dysautonomia in a non-Jewish child.

Few documented cases of Riley-Day syndrome fulfilling current diagnostic criteria have been recognized in non-Jews. In our case the diagnosis was established in a Norwegian child despite the absence of Jewish origin. It represents a report of this syndrome with bilateral pathological changes in the hypothalamus in addition to extensive abnormal findings in the spinal cord and the autonomic ganglia. These findings may have significance with regard to the pathogenesis of the disease.


Trisomy 20 mosaicism.

The first known case of trisomy 20 mosaicism is described. As in other cases of (partial) trisomy 20, the patient showed scarce physical malformations. It is suggested that trisomies for chromosomes of the F group are rare not because they are lethal but as a result of the morphology of the chromosomes involved.


Experimental studies on the role of satellite cells in regeneration of rat skeletal muscle fibers.

The process of degeneration, necrosis and regeneration of skeletal muscle fibers of rats administered dimethyl-para-phenylenediamine was studied by light and electron microscopy. Electron microscopy revealed satellite cells between the basement membrane and plasma membrane of unaffected as well as affected muscle fibers. The cytoplasm of satellite cells was enlarged or elongated and contained many ribosomes, polysomes, rough-surfaced endoplasmic reticulum and well-developed Golgi apparatus. In some satellite cells myofilaments were formed attached to the ribosomes and polysomes. In the process of muscle regeneration many myogenic cells appeared in the vicinity of unaffected muscle fibers. The properties of the cytoplasmic organelles of the myogenic cells resembled those of satellite cells. The differentiation between satellite cells and myogenic cells could be made only by the presence or absence of preexisting muscle fibers. From these results it is not only suggested that the satellite cells are the precursor of myogenic cells but also the regenerated muscle fibers, at least a part of them, originate from satellite cells.


Transplantable lymphoma producing type K Bence-Jones protein in NZB mouse.

Spontaneous lymphoma occurring in the retroperitoneum in a 13-month-old New Zealand Black female mouse, as transplantable to the same strain mice, was subjected to immunological studies by serial transplantation as subcutaneous solid tumor (66A) and bloody ascites tumor (66B). The transplanted tumor-bearing mice showed M component in the plasma, urine and ascites. It was confirmed as type K Bence-Jones protein. Speculations were made on the relation between abnormal immunity in NZB mice and lymphoma.


[5 adult cases of cerebral aqueduct stenosis caused by ependymitis granularis].

In the present report five autopsy cases of adult aqueductal stenosis arising from granular ependymitis have been reported. In all cases the aqueduct was obstructed or markedly stenosed by subependymal gliosis mainly consisting of fibrillary astroglia. Islands and tubules of ependymal cells were embedded in a dense bed of subependymal glia with the loss of ependyma. The walls of all ventricles showed the same pathologic findings with the aqueduct, although the degree was not so marked. Such findings support the view that some type of chronic infection produces the aqueductal stenosis, because it is impossible to produce such diffuse ependymal changes by congenital anomaly. It is of particular importance in this report that all cases were adults. In comparison with the microscopical findings in cases of aqueductal stenosis of infants and children arising from granular ependymitis, which have been reported in the literature, there were no principle differences between infants, children and adults.


Increased permeability for plasma components of the cerebral vessels during acute angiotensin hypertension in rats.

Experimentally induced acute angiotensin hypertension has been shown to increase the permeability of cerebral arterioles, venules and veins to plasma components whthin a few hours. This increase in permiability was demonstrated by means of circulating homologous fluorescent serum proteins and colloidal carbon particles. The results support the view that an increased permeability of the cerebral vessels to plasma components is either a causal or an additional pathogenetic factor in the development of the hypertensive encephalopathy.


DNA-variations in neighbouring epithelium in patients with bladder carcinoma.

Histologically atypical urothelium taken from bladder mucosa neighbouring transitional cell carcinoma showed similar, though less marked, DNA-changes as observed in the corresponding tumours. A definite increase in the number of non-diploid DNA-values was found in 6 (of 12 urothelial specimens. The clinical significance of urothelial DNA-changes is discussed.


Cytoplasmic effects of X-irradiation on cultured cells 2. Alterations in lysosomes, plasma membrane, Golgi apparatus, and related structures.

Topoinhibited human glia cells in vitro were exposed to X-radiation generated by an 8-MeV linear accelerator at a dose of 20,000 rad. Transmission electron microscopy of irradiated cells at intervals varying between 30 min. and 5 days following irradiation revealed alterations mainly in the plasma membrane and the lysosomal vacuome. Increased ruffling of plasma membranes, augmented endocytosis and extensive intracellular autophagy developed within 24 hours after irradiation. The implications of the plasma membrane alterations are discussed, and a tentative model covering possible mechanism involved in the development of autophagic vacuoles is presented. The possibility is entertained that alternative mechanism may be operative during the formation of the autophagic vacuole in irradiated glia cells. The origin of the isolation membrane appears to be (a) preexisting lysosomes; and (b) flattened vacuolar cytoplasmic elements.


Congenital solitary fibromatosis of soft tissues, a variant of congenital generalized fibromatosis. 2 cases reports.

A report of 2 cases of solitary fibromatosis in a 10-day-old boy and a girl 3 years and 10 months old is presented. Both lesions were deep-seated and showed a nodular and infiltrating growth, predominantly buil-up by immature fibroblast-like cells and including hemangiopericytoma-like areas. One of the lesions also showed leiomyoma-like areas. An ultrastructural study however, revealed no intra-cytoplasmatic myofilaments. At follow-up examinations after 21 years and 1 year, respectively, there were no signs of recurrences or metastases. These 2 cases are considered to represent a solitary form of congenital generalized fibromatosis. The differential diagnosis from infantile hemangiopericytoma and fibrous lesions seen in infancy and early childhood, such as infantile fibrosarcoma, diffuse infantile fibromatosis, extra-abdominal desmoid, fibrous hamartoma of infancy and juvenile aponeurotic fibroma, is discussed.


Endothelial structure in rabbits with moderate hypercholesterolaemia. A scanning electron microscopic study.

The aortic surface of rabbits given a supplement of 0.1--0.3 per cent cholesterol to the diet was studied by scanning electron microscopy. In regions where increased haemodynamic strain was anticipated, similar structural changes were observed in normal and hypercholesterolaemic rabbits. However, changes indicating cell injury were more wide-spread in cholesterolfed animals. This suggests that hypercholesterolaemia may increase cell susceptibility to injury. In the same regions, the development of intimal thickenings was observed in cholesterol-fed rabbits. The central parts of such thickenings had been reendothlialized, whereas a region with cell injury surrounded each lesion. In regions with low haemodynamic strain, a loss of fine-structural details was observed in hypercholesterolaemic rabbits. It is suggested that these changes may be related to the deteriorated functional properties of the intact endothelium in such rabbits. In view of these data it is suggested that the interrelationship between hypercholesterolaemia and atherosclerotic arterial disease may partly be due to a deleterious effect of hypercholesterolaemia on the functional and structural integrity of the arterial endothelium.


Cause of the continuous rise in plasma renin concentration after removal of manipulated submaxillary glands in nephrectomized mice.

After gentle manipulation with subsequent removal of the submaxillary glands in nephrectomized mice there is a vast increase in the concentrations of high molecular weight renin ("prorenin"?) as well active renin in plasma. The increase in active renin is continuous even after removal of glands as well as kidneys. Using in vitro incubation and replacement transfusion experiments, the continuous rise was found not to be due to activation of the high molecular weight renin. The continous increase could instead be shown to be due to a rapid transfer of submaxillary lymph and (or) interstitial fluid to the surrounding tissues, with a subsequent slower release from these tissues to the blood. Continued release of renin from extra-submaxillary tissue-depots is probably also the cause of the continuance of the high plasma renin concentrations for several hours after the removal of the manipulated glands, which contrast with the much more rapid decline in the concentration after injection of extracts of submaxillary glands as well as after injection of pure submaxillary renin.


Re-appraisal of malignant melanoma diagnosis in the Swedish cancer registry.

In many countries the registration of malignant melanoma of the skin shows an increased incidence; this may partially be due to an over-diagnosis. From the group of 3,268 adults and 21 children classified as suffering from malignant melanoma of the skin in the Swedish Cancer Registry between 1959-1968, a one-in-ten systematic sample survey was the object of a retrospective examination. 349 adults and 2 children had a uniform histopathological evaluation performed by one of the authors (B.L.). Slides were not available in 8 cases (2 per cent) and in the remaining 343, the diagnosis was regarded as incorrect in 13 (3.7 per cent). All these 13 cases, (2 children and 11 adults), showed no special predilection as to age, sex, location, or year of registration. In view of such a slight degree of error, the Swedish Cancer registry's melanoma group from 1959-1968 would seem suitable for further epidemiological studies.


Nitrofurantoin-induced alterations in pulmonary tissue. A report on five patients with acute or subacute reactions.

Three patients with acute and two with subacute nitrofarantoin-induced pulmonary reactions were studied clinically and by examinining microcoscopically needle biopsy specimens of their lungs. In all five patients slight vasculitis and a few interstitial eosinophils were found in the pulmonary tissue 1-2 weeks after the withdrawal of nitrofurantion therapy. Alveolitis, fibrinous alveolar exudate and perivascular granulomas were also seen in some specimens. The patients with acute reactions had marked blood eosinophilia. In all patients, pulmonary diffusing capacity (DLCO) was below normal, but ventilatory function was not appreciably affected. Withdrawal of nitrofurantion resulted in complete or partial improvement in 4-8 weeks. Our clinical and histological findings support the suggestion that a type III immune-complex-mediated reactions is involved in acute and subacute hypersensitivity reactions to nitrofurantoin.


Glial changes in pigs with porto-caval anastomosis and temporary or total hepatic artery clamping.

The number and size of astrocyte, oligodendrocyte, and neurone nuclie were determined in cortex and corpus striatum (putamen) of pigs with porto-caval anastomosis (PCA) and total or temporary clamping of the hepatic artery. Animals with PCA and total clamping became comatose and died on average 18 1/2 hours postoperatively. Their brains showed slight oedema but no changes in the glial and neurone nuclear numbers. Animals with PCA and temporary clamping of the hepatic artery (30-60 min.) all survived without clinical symptoms of encephalopathy. However, the brains showed vacuolization of the deeper cortical layers, diffuse occurrence of Alzheimer type II astrocytes, and the counts revealed an increased number of astrocytic nuclei. The total number of glial cells decreased due to loss of oligodendrocytes, but the number of neurones was unchanged. The findings indicate that the neuropathological changes after PCA and temporary hepatic artery clamping are concerned primarily with changes of the glial cells.


Cutting fluids and their effects on the skin of mice. An experimental study with special reference to carcinogenicity.

Reports of skin malignancies due to occupational exposure have decreased since the introduction of solvent-refining of mineral oil fraction in the manufacture of oil based cutting fluids. Commercial mineral oil based cutting fluids caused local and general pathological changes after repeated application to the skin of mice in the present study. Forty-eight per cent of the mice exposed to oils showed severe dysplasia or malignancy of the skin on histological examination. The corresponding figure for the control group, where various additives were used was 8 per cent. The frequency of papillomas was also increased in the mice exposed to oils. The systemic lesions included focal necrosis of the liver, associated with amyloid deposition, as well as amyloidosis of the skin, spleen and kidneys. The substances responsible for these apparent carcinogenic properties of the complex mixtures may be polycyclic hydrocarbons; the latter are still present in the commercial products despite solvent refining; on the other hand the carcinogens may be additives to the cutting oils the composition of which is generally a trade secret.


Transplantability and metastasibility of an MCA-induced sarcoma in nude mice. Influence of transfer of thymus cells and adoptive immunity.

Challenge of C57(nu/nu) mice with an MCA-induced sarcoma, MCG101, induced in C57BL/6J mice, disclosed a higher resistence subcutaneously and intravenously than in syngenic C57/(+/+) mice. Transfer of 5 X 10(7) thymus cells to the nude mice brought their resistance to subcutaneously injected tumour cells back to the level of the C57/(+/+) mice, but only with the highest tumour cell doses tested, i.e. 5 X 10(4) and 10(5) cells. Against intravenously injected tumour cells a similar effect by the thymus cells was only suggested. Spontaneous metastases from the same tumour transplanted to the tail did occur in the nude mice and were possibly facilitated by specifically sensitized spleen cells. The results indicate that the resistance to subcutaneously injected tumour cells in nude mice may well be dependent on their incapability to develop thymus-dependent immuno-responses and that spontaneous metastases can be facilitated by a weak immuno-response.


The nephrotoxic effect of the ototoxic compound atoxyl.

The arsenical compound atoxyl has been used in labyrinthine research because of its documented effects both on cells engaged in an active transport of ions (secretory epithelia) and sensory epithelia (cochlear hair cells and vestibular sensory cells type I and type II.) In the present experiments both the kidney and the structures of the inner ear were studied. The renal tubules were damaged by exposure to atoxyl. Tubular casts, haemorrhages (both in the tubules and in the renal calices) and tubular epithelial cell necrosis occurred. A common denominator in the ototoxic and the nephrotoxic actions of acute atoxyl poisoning might be a disturbance of the very active ion transport systems of the cells involved.


Agglutinins to rabbit erythrocytes in extracts of human malignant tissues.

Agglutinins to rabbit erythrocytes in extracts from human malignant tissues were identified as the naturally occurring IgG antibodies in human serum to rabbit erythrocytes. This was revealed by agglutination, absorption, antiglobulin and inhibition tests, immunization of rabbits and immunochemical analyses. The agglutinins can therefore be used as convenient markers for both extracellular immunoglobulin and unspecifically bound immunoglobulin in tumour tissues. Apparently the extracts also contained small amounts of IgA antibodies to rabbit erythrocytes.


Adenylate cyclase activity in corpus striatum of rats with porto-caval anastomosis.

Altered catecholamine receptor sites within the striatum have been proposed to be an important pathogenetic factor in hepatic and porto-systemic encephalopathy and coma. The unstimulated, fluoride-, norepinephrine- and dopamine-stimulated adenylate cyclase activity were measured in the corpus striatum of rats with a four weeks old end-to-side porto-caval anastomosis. There was no difference in unstimulated, fluoride- or hormone-stimulated adenylate cyclase activity between porto-caval shunted and sham-operated rats. The in vitro dose-response curves of norepinephrine and dopamine were similar in both groups of animals. Half-maximum and maximum stimulation were achieved in shunted and sham-operated rats by identical concentrations of norepinephrine and dopamine, respectively. The results indicate that neither changes in unstimulated adenylate cyclase activity nor changes in the response of adenylate cyclase activity to fluoride, norepinephrine and dopamine had developed in the rats at the stage studied.


Central and regional circulatory effects of adding arm exercise to leg exercise.

7 young, healthy, male subjects performed exercise on bicycle ergometers in two 20 min periods with an interval of 1 h. The first 10 min of each 20 min period consisted of arm exercise (38--62% of Vo2 max for arm exercise) or leg exercise (58--78% of Vo2 max for leg exercise). During the last 10 min the subjects performed combined arm and leg exercise (71--83% of Vo2 max for this type of exercise). The following variables were measured during each type of exercise: oxygen uptake, heart rate, mean arterial blood pressure, cardiac output, leg blood flow (only during leg exercise and combined exercise), arterio-venous concentration differences for O2 and lactate at the levels of the axillary and the external iliac vessels. Superimposing a sufficiently strenuous arm exercise (oxygen uptake for arm exercise greater than 40% of oxygen uptake for combined exercise) on leg exercise caused a reduction in blood flow and oxygen uptake in the exercising legs with unchanged mean arterial blood pressure. Superimposing leg exercise on arm exercise caused a decrease in mean arterial blood pressure and an increased axillary arterio-venous oxygen difference. These findings indicate that the oxygen supply to one large group of exercising muscles may be limited by vasoconstriction or by a fall in arterial pressure, when another large group of muscles is exercising simultaneously.


Effect of teasing and sham feeding on plasma glucagon concentration in dogs.

Plasma glucagon concentration was determined by radioimmunoassay during fasting and following teasing and sham feeding. Teasing and sham feeding for 1--10 min raised the plasma glucagon concentration which then within a short period of time returned to the basal level. Atropinization (0.2 mg/kg) almost abolished the glucagon response to 10 min of sham feeding. Glucose concentration was slightly elevated in response to 10 min of sham feeding. The results show that physiological stimulation that is induced by the smell, sight and taste of food releases glucagon in the dog. The release is mediated by a cholinergic mechanism.


Pressure-independent inhibition of sympathetic activity by noradrenaline: role of baroreceptor C fibres.

The effect of i.v. infusion of noradrenaline on activity in the renal sympathetic nerve was studied in rabbits anesthetized with chloralose and urethane. Noradrenaline (3--8 microgram/kg-min) initially increased mean arterial pressure 20--40 mmHg and consequently reduced renal nerve activity. However, studies over a wide range of pressures--obtained by changing the blood volume, revealed that noradrenaline after a few minutes had induced a pressure-independent reduction of sympathetic discharge. The effect disappeared with baroreceptor denervation. An unchanged relationship between arterial pressure and integrated activity in the whole left aortic nerve (which is largely a measure of activity in A fibres) suggested that the sympathetic depression was due to excitation of aortic nerve C fibres. This conclusion was supported by studies of sympathetic responses to selective stimulation of aortic nerve A and C fibres at equal pressures before and during infusion of noradrenaline. Compared to the reflex activity from A fibres, C fibre stimulation was invariably less effective in suppressing renal nerve activity during the infusion. Our studies indicate that noradrenaline may effect a negative feedback control of sympathetic discharge through activation of baroreceptor C fibres.


On the cation exchanger properties of rat mast cell granules and their storage of histamine.

Mast cell granules free of a surrounding membrane were isolated from water-lysed rat peritoneal and thoracic mast cells by differential centrifugation. The granules were depleted of their histamine by suspension in 10 mM sodium phosphate buffer and the sodium-charged granules then converted into the "hydrogen form" by repeated washing in slightly acid deionized water. The cation exchanger properties of the mast cell granules were investigated by testing the applicability of the Rothmund-Kornfeld equation for cation exchangers to the binding of Na+ and Hi+ ions to granule sites. The results lend further support to the view that the mast cell granule acts as a cation exchanger with the exchanger function localized to protein carboxyls in the protein-heparin complex of the granule matrix.


Early oestrogen-induced changes in uterine albumin exchange in mice.

The effect of the oestrogens, oestradiol and oestriol, on plasma albumin dynamics in the uterus was studied in mice. A double isotope technique with 125I- and 131I-labelled human serum albumin was used. The optimum conditions to measure the extravascular accumulation of albumin were to use one labelled albumin as "permeability marker" (30 min circulation time) the other as plasma volume indicator (3 min circulation time). The oestrogens increased the extravascular accumulation of labelled albumin in the uterus but not in diaphragm or heart muscle. The accumulation was maximal after 4 h (75% higher than in controls) and was significant as early as 2 h after oestrogen administration. It cannot be decided whether the increase in labelled albumin accumulation was due to an increase in permeability and/or to an increase in the total surface area of perfused capillaries.


Responses of reindeer to water loading, water restriction and ADH.

Two female reindeer were hydrated by administration of (10% of b.wt.) water into the rumen. The diuretic response was very fast and strong but the urea and electrolyte excretion were little affected. Dehydration was carried out by not giving the reindeer water for 48 h. This water deprivation caused a loss of up to 20% of their body weight. The urine osmolality did not exceed 840 mosm/kg H2O, although the plasma osmolality rose from 300 to 346 and 368 mosm/kg H2O respectively. The plasma and urine urea concentrations were elevated during dehydration, while the urine urea excretion did not increase. Urine sodium concentration did not increase. When the urine flow rate, after two days of water deprivation, decreased to half of the original, the urine Na+ concentrations, instead of increasing, went down to half of the original. So did the potassium excretion. When ADH was injected intravenously into hydrated animals a dose of 30 mU of ADH was needed to induce antidiuresis or increased excretion of potassium. The resistance to ADH and the low relative thickness of the medulla confirm the limited capacity of reindeer kidney to concentrate urine or to excrete a solute load. On the other hand, reindeer is able rapidly to excrete surplus water without affecting the electrolyte or nitrogen balance.


Oxygen consumption and contractile force during vibrations of cat soleus muscle.

The influence of longitudinal vibrations (50 Hz, 0.4 mm) on isometric twitch force development (4 Hz), blood flow and oxygen consumption was studied in the acutely denervated soleus muscle of the anesthetized cat. It was found that the sinusoidal vibrations reduced the twitch amplitude by 60 per cent whereas oxygen consumption and blood flow were lowered by 15 per cent only. Similar reduction in twitch force was also obtained by lowering the nerve stimulation intensity (4 Hz). This was associated with a diminution in oxygen consumption, the degree of which was linearly related to the attenuation of active force, i.e. the number of activated motor units. The results are in agreement with previous observations as to the mechanical effect of vibrations on active force in smooth and striated muscle. They demonstrate that vibrations prevent the contractile response with maintained high oxygen consumption which adds further support to the hypothesis forwarded by Joyce et al. (1969) that vibrations cause increased rate of detachment of actin-myosin cross-links. In addition it appears possible that vibrations to some extent prevent formation of such cross-links.


Comparative study of some isolated mammalian smooth muscle effectors of penile erection.

Spontaneous rhythmic activity, responses to drugs and effects of field stimulation of nerves of the retractor penis (rp) and/or corpus cavernosum urethrae (ccu) of macaque, rabbit, guinea-pig, rat, dog, cat, horse, boar, elk, bull, ram and goat, as well as of the penile artery (pa) of bull were studied. A basic property of all these muscles was automaticity. Their responses to 5-hydroxytryptamine, histamine, adenosine triphosphate, prostaglandins E1, E2, AND F2alpha, oxytocin, vasopressin, substance P, bradykinin and angiotensin exhibited considerable species variations. Their excitatory innervation seems to be adrenergic. They also have an inhibitory innervation. In spite of comprehensive pharmacological analysis the inhibitory mediator remains obscure. The frequency--response relationship to inhibitory nerve stimulation was characterized by a rapidly achieved maximum at low frequencies, indicating high efficiency of the neuroeffector unit.


Relationship between sarcomere length and active force in rabbit papillary muscle.

Isometric peak twitch force (stimulation frequency 0.5/s; 29.5-30.5 degrees C) was correlated with sarcomere length in isolated papillary muscles of the rabbit. Sarcomere length was measured from photographic recordings (1.5 ms exposure time) performed at rest between contractions and at the time of isometric peak twitch force. The sarcomere length at rest was found to be relatively uniform throughout the preparation and to be linearly related to the overall muscle length within the range Lmax-0.85Lmax. The distribution of sarcomere lengths increased considerably as the muscle went from rest to activity. Studies of surface markers showed different degrees of shortening (or elongation) of individual segments along the length of the  preparation. The mean resting sarcomere length at Lmax (the optimum muscle length for force production) was 2.44 +/- 0.01 micron (grand mean +/- S.E., 7 muscles). The means active sarcomere length at Lmax was 2.29 +/- 0.04 micron. Active force declined steeply as the muscle length was reduced below Lmax. At a resting sarcomere length of 2.0 micron, active force was approximately 1/3 of the maximum. The observed differences between the length-tension relat-onships in myocardium (twitch responses) and skeletal muscle (tetanic contractions) are discussed on the basis of a length dependency of the activation process in  cardiac muscle.


The interrelation between hypothalamically induced changes in sympathetic discharge to the gastrointestinal and cardiovascular systems.

In chloralose-anesthetized, adrenalectomized cats, the sympathetically conveyed effects of topical hypothalamic stimulations on gastric volume, blood pressure and heart rate were systematically explored. The vagal nerves were cut but could be kept  active by graded efferent stimulation. In the absence of such vagal activity, hypothalamic  stimulation had no appreciable influence on gastric volume, even though the stomach maintained considerable myogenic tone. When, however, a vagal excitatory activity was present, hypothalamic stimulation could markedly affect gastric tone, indicating that the sympathetic fibres exert their inhibitory influence on the stomach via its cholinergic intramural neurons. Hypothalamic stimulations that induced reductions in pressure or heart rate also usually caused an enhancement of gastric tone. Similarly, pressor responses were associated with decreases in gastric volume whereas stimulation-induced tachycardia was not linked to any particular type of gastric response. Thus, the hypothalamic sympathoinhibitory influences on the cardiovascular system seem closely connected to a supression of the sympathetic outflow to the stomach. There is, on the other hand, no regular association between hypothalamic sympathoexcitatory influences on the cardiovascular and gastrointestinal systems; in fact, there is in many areas even a suppression of sympathetic discharge to the stomach in association with cardiovascular stimulation.


Motility of the urinary bladder in cats during filling at physiological rates. II. Effects of extrinsic bladder denervation on intramural tension and on intravesical  pressure patterns.

The influence of extrinsic innervation on bladder wall tension (tonus) and on intravesical pressure patterns was studied  with a new cystometric procedure (Controlled Slow Cystometry, CSC) and during natural filling. After parasympathectomy, but not after sympathectomy, the basal intravesical pressure was markedly increased. At low filling rate the partial or completely denervated bladder was filled from small initial volumes without any increase in intravesical pressure. At higher rates of filling a pressure rise occurred, and this reaction was not affected by either parasympathectomy or sympathectomy. As in the intact cat, the new pressure level was retained when the filling rate was gradually reduced. The various intravesical pressure patterns observed during filling were preserved in the partial or completely denervated organ. Thus, bladder adaptation during natural filling occurs independently of extrinsic innervation.


Effect of atropine and SC-15396 on stimulated gastric acid secretion in the atlantic cod, Gadus morhua.

Gastric acid secretion was measured in swimming codfish surgically equipped with a catheter draining the stomach. Gastric acid secretion was stimulated by histamine (5 or 15 microgram/kg-h) or by carbachol (5 microgram/kg-h). Pretreatment with atropine (1 mumol/kg-h) completely prevented the acid secretion induced by carbachol, but did not influence the secretion induced by histamine. Atropine had marked effects on the motor functions of the stomach, and seriously reduced the volume draining from the stomach. Infusion of  phenol red indicated that the decrease in volume was due to a decrease in recovery of ingested  water. SC-15396, "antigastrin", significantly depressed acid secretion induced by histamine, and reduced carbachol-stimulated secretion, although the later was statistically insignificant. The effects of SC-15396 is discussed with reference to the absence of receptors for gastrin related to gastric acid  secretion in the codfish stomach.


Fatigue and EMG of repeated  fast voluntary contractions in man.

A fatigue test consisting of repeated fast maximal contractions of the left quadriceps muscle in an isokinetic apparatus was performed by 12 healthy male subjects (19-25 yrs). EMG signals recorded from the surface of the left vastus lateralis muscle, from which also biopsies were obtained for muscle fibre classification. Only minor changes were observed in the EMG variables despite a decrease in muscle strength performance, in terms of peak torque, work and power to about 50% of initial values after 100 contractions. The concomitantly obtained positive correlation between the increase in EMG/torque ratio and the individual percentage of  fast  twitch (FT) muscle fibres indicated that local factors in the muscle, primarily in FT fibres, were causing the development of fatigue during repeated dynamic contractions with high power outputs.


Effects of sympathetic nerve stimulation in the presence of a slow parasympathetic secretion in the parotid and submaxillary glands of the rabbit.

Sympathetic secretory responses from the parotid and the submaxillary glands of the rabbit were  studied; sympathetic excitation occurred either alone or during a slow parasympathetic background secretion, imitating the resting secretion normally present. The fairly rapid sympathetically evoked flow of saliva from the parotid gland was, in the background secretion, further increased and obtained at low frequencies, which at sympathetic stimulation alone were subthreshold. The effects, which could be repeated with sympathomimetic drugs in a pilocarpine induced secretion, were abolished by alpha and beta-adrenoceptor blockade in combination. The submaxillary gland gave a very scanty secretion on sympathetic excitation, the effects being mediated via beta-adrenoceptors. The responses were not increased in a background secretion but the main effect of sympathetic activation was to retard the salivary flow. The retardation was attributed to vasoconstriction accompanying sympathetic excitation. Eliminating the vasoconstrictor responses, while retaining the sympathetic secretory effects, did not reveal any increase of the sympathetic salivary responses in the submaxillary gland.