Clinical experience with infusion cholegraphy using iotroxamide (Biliscopin ) (author's transl).

Forty-three cholangio-cholecystographies were carried out with iotroxamide. A the same time, the behavior of various serum enzymes was controlled. Iotroxamide satisfactorily demonstrated the biliary tract for the diagnosis in 37 of our patients (86.5%). Only an inadequate or incomplete evaluation was possible for 6 of our patients (13.5%). Due to the pharmacokinetic characteristics of iotroximide, the time-density ratio is very favorable. As a result, the contrast radiograph of the biliary tract including the gallbladder was available for evaluation as early as 30 minutes after the infusion and almost always within 60 minutes. Minor subjective side effects were observed in only 4 cases. With the exception of 2 cases with obstructed bile flow, the serum-enzyme level was not significantly altered after administration of the contrast medium.


Unique eosinophil granules in a case of T-cell lymphoma.

A 41-year-old man developed intense itching without visible cutaneous changes, epigastric pressure pain, and a slight intolerance to alcohol. He was found to have persistent blood eosinophilia. The eosinophil granulocytes were of abnormal appearance in the light microscope: larger than normal, the nuclei were multilobulated (4-6 lobes), the cytoplasm contained atypical, large granules, ample glycogen, and up to 12 vacuoles. In the electron microscope too the eosinophil granules were entirely atypical, having an electron-dense matrix, often with a light central inclusion body which was inhomogeneous, having longitudinally oriented structures with a periodicity of about 10 nm. These findings are quite contrary to normal eosinophil granules. Enzymic studies of cytoplasmic enzymes from the granulocytes revealed a greatly reduced content of eosinophil cationic proteins, whereas 5 (7) other enzymes were present in a normal or slightly reduced quantity. The phagocytic capacity of the eosinophils against latex particles was normal. The patient developed generalized lymphomas, histologically very malignant, of the convoluted, acid phosphatase positive cell type (T-cell lymphoma). Sub-population studies of lymphocytes from a lymph node revealed 58% TE cells, while the remainder were B cells. At death, 3-1/2 years after the onset of symptoms, severe endomyocardial fibrosis was found. The thymus could not be identified. It is concluded that lymphomas should be described on the bais of clinical, histological, and histochemical criteria as well as studies of lymphocyte sub-populations and that the highly unusual eosinophil granulocytes still deserve particular attention. The endocardial fibrosis is assumed to have been due to substances liberated from the eosinophil cells.


The investigation of collagen induced platelet aggregation by the screen filtration pressure technique.

A modification of the screen filtration pressure technique has been developed to allow platelet response to collagen to be measured. Using a commercial collagen suspension this method has been found to be both simple to perform and to give highly reproducible results. Changes in platelet response to collagen after administration of acetylsalicyclic acid were clearly detected and this suggests that collagen screen filtration pressure may provide a sensitive method for evaluating the effect of platelet release inhibiting drugs.


Renal salvage of haemoglobin iron.

Recycling of radioiron by renal tubular cells was studied in rats labelled by the i.v. injection of free 59Fe-Hb. Within 24 h, most of the renal radioactivity has been transferred from Hb to cellular ferritin and haemosiderin. Between day 1 and 14 of the study, urinary loss of radioactivity was less than 1% and most of the reduction in renal radioactivity represented transfer of renal iron into the circulation. An unexpected flexibility in the ability of rat kidney to recycle iron into the body has been found ranging from 13% in hypertransfused rats to 70% in bled animals. The high rate of renal iron transfer in bled animals was maintained under experimental conditions simulating chronic haemoglobinuria when most of the Hb removed by bleeding has been reinjected in the form of soluble Hb. Thus, epithelial cells in rat kidney as well as in the gut, appear to be able to transport iron with a much greater efficiency than in man, thereby contributing to the supply of iron for the rapid rates of growth and reproduction characteristic of this animal species.


A radioisotope dilution assay for unlabelled vitamin B12-intrinsic factor complex employing the binding intrinsic factor antibody: probable evidence for two types of binding antibody.

A new radioisotope dilution assay for vitamin B12-intrinsic factor complex is described. The method is based on the use of the binding type intrinsic factor antibody (the binding reagent), which when combined with the intrinsic factor-vitamin B12 complex (labelled ligand), is quantitatively adsorbed onto zirconium phosphate gel at pH 6.25. The new assay has been shown to provide a measure of intrinsic factor comparable with other intrinsic factor assays, but it has the important advantage of being able to measure the unlabelled vitamin B12-intrinsic factor complex (unlabelled ligand), and will, therefore, be valuable in the study of physiological events in the gastrointestinal tract. During the study, it was found that there is some evidence for a least two types of binding intrinsic factor antibody: One which combines preferentially with the intrinsic factor-vitamin B12 complex and one which combines equally well with this complex or with free intrinsic factor.


Heterogeneity of acid phosphatase, beta-glucuronidase, and alpha-naphthyl-acetate esterase in normal and leukaemic lymphocytes.

Comparative study of isoenzymic patterns of acid phosphatase, beta-glucuronidase and alpha-naphthyl acetate esterase of normal and chronic lymphocytic leukaemia (CLL) lymphocytes was carried out by means of polyacrylamide gel electrophoresis. The isoenzymograms of acid phosphatase and beta-glucuronidase of leukaemic cells were similar to that of normal lymphocytes. However, different patterns were found in the case of alpha-naphthyl acetate esterase. Two prominent anodal bands were present in CLL lymphocytes; these bands were either absent or very weak in normal cells.


The effects of chronic administration of cyclophosphamide on haemopoietic stem cells.

The effects of cyclophosphamide given for 18 weeks in small daily doses on CFU-S, CFU-C, and CFU-E content in mice bone marrow and spleen were studied. In the bone marrow, after an initial drop, the stem cell content rises above the normal values and remains there throughout a long period. In the spleen the stem cell content shows an initial several fold increase followed by a steady decline. It seems possible that this behaviour reflects a compensative effect to the toxic action of the drug at more differentiated levels of the haemopoietic cells.


Prolonged survival of implanting rat blastocysts in the uterus of congenitally athymic mice.

Rat blastocysts were transferred to the uteri of either immunodeficient, congenitally athymic (nu/nu) 'nude' mice or immunocompetent, heterozygous (nu/+) mice. Histological analysis showed that there was a similar frequency of implanted blastocysts in the two types of mice, that blastocysts transferred to nude athymic mice outlived those in heterozygous controls by at least 3 days, and that blastocysts in nude mice showed delayed and abnormal development and were eventually rejected. These findings suggest that the T-cell deficiency in nude mice may prolong the survival of implanting blastocyst but that other immune or non-immune factors still limit their development.


IgD and the fetal immune response.

IgD was detected in 84% of cord sera at term by an inhibition-of-hemagglutination test, in contrast to low incidences reported earlier. Cord blood IgD and maternal serum IgD values were unrelated to each other, consistent with a fetal origin of the IgD. The cord blood IgD failed to correlate, either directly or inversely, with cord blood IgA or IgM, suggesting that its presence does not reflect fetal synthesis of specific antibody but rather may be developmental.


Antibody-dependent cell-mediated cytotoxicity in various orders of vertebrates.

By using chicken antibodies and chicken lymphoid cells, we could demonstrate antibody-dependent cytotoxicity (ADCC) against haptenated chicken erythrocytes. ADCC could be demonstrated either by treating the target cells with antibody (sensitization) or by treating the effector cells (arming). Approximately ten times higher antibody concentrations were required for arming than for sensitization. Chicken lymphoid cells did not co-operate with mammalian antibodies in either type of ADCC, and thus the situation was reciprocal to that observed earlier with mammalian lymphoid cells. In a further attempt to characterize the arming phenomenon we used biofiltered (aggregate-free) mouse antibodies for the arming of rat spleen cells. They were as efficient as nonfiltered antibodies, and this confirms that individual antibody molecules are efficient in arming.


Otitis media in young children in different types of day-care.

The occurrence of otitis media was studied in 108 Sweden children attending 14 day-care centers and compared with that in 57 children cared for in their own homes (usually with one or no sibling) and with that in 42 children in family day-care homes (where a woman cared for both her own and 1 to 4 other children in her home during the day). The children were 6 months to 2 years old. In the day-care centers 37% of the children had otitis media at least once during 8 months with an average of 2.2 episodes each. Otitis media was more common in 6- to 17-months-old children in the day-care centers than in children of the same age cared for in their own homes. The occurrences of otitis media in the day-care centers and in the family day-care homes were approximately equal. Children attending centers where those with signs of infection were excluded had otitis in about the same frequency as those attending centers where children with infections were accepted.


Nitroblue tetrazolium test in pulmonary thromboembolism and pneumonia.

The histochemical nitroblue tetrazolium (NBT) test was performed in 88 patients with acute pulmonary thromboembolism or lobar pneumonia and in 88 healthy control subjects. In the control group, the mean NBT score was 5.4%. In the group of 55 patients with pulmonary thromboembolism the mean NBT score was 6.5% which is insignificantly different from the control mean. Only 3 of these patients had scores above normal. 35 embolism patients were followed by repeated examinations for 1 week after admission. The NBT scores remained within normal limits. 29 of the 33 patients with lobar pneumonia had elevated scores, and the mean NBT score was 33.5%. Endotoxin stimulated NBT test disclosed normal enhancement of NBT reduction by neutrophils from patients in either group as well as controls. The NBT test is of value in the differential diagnosis of pulmonary infection and thromboembolic disease. However, the results should be interpreted in the light of other pertinent laboratory and clinical findings.


Check-ups after tours of duty to the tropics.

Out-patient check-ups of 603 persons returning from an average of 2 years and 8 months tour of duty to the tropics were completed in 99.3%. Only 14 (2.3%) cases of strictly tropical disorders were detected, but no serious disease. A long-term (3-5 years) follow-up questionnaire revealed no additional cases. It is concluded that check-up of asymptomatic travellers has a very low benefit-cost rate.


Recurrent sterile meningitis as a manifestation of systemic lupus erythematosis.

In view of the rarity of recurrent sterile meningitis in systemic lupus erythematosis a case of this syndrome in a 54-year-old man is reported. This association should be considered in patients with a meninigitic picture in whom pathogenic organisms are not identified, especially if the meningitis is recurrent.


African trypanosomiasis: a danger for tourists visiting Gambia?

A 30-year-old Swedish woman visiting Gambia in 1975 acquired trypanosomiasis probably of the Gambian type. The first sign of her disease appeared as a trypanosomal chancre on her right thigh, soon followed by lymphadenitis in her right groin. One week later she became febrile and therefore hospitalized after returning to Sweden. The diagnosis was established by demonstrating numerous trypanosomes in a blood smear. 10 pentamidine injections (200 mg once daily intramuscularly cured her disease. The risk of acquiring trypanosomiasis in Gambia seems to be extremely small for tourists, but not quite negligible.


Coenzyme-B12 therapy in acute viral hepatitis.

Extra vitamins are needed to repair tissue damage and compensate for diminished hepatic storage during viral hepatitis. Coenzyme-B12 has recently been synthesized and ought to have a favourable effect on the damaged liver cell as has previously been reported for cyanocobalamin, since it is better absorbed by oral administration and to a greater extent accumulated in the liver. Two groups of patients from the same hepatitis A epidemic were treated with either coenzyme-B12 or cyanocobalamin. A more rapid return of serum aminotransferase (S-ALAT) levels to normal was observed in the group treated with coenzyme-B12.


Echovirus type 7 isolated from conjunctival scrapings.

Echovirus type 7 was isolated from 7 conjunctival scrapings obtained during an epidemic of meningoencephalitis caused by the same virus. The patients suffered from conjunctivitis or keratoconjunctivitis, and also had gastrointestinal symptoms, fever, headache and lymphadenopathy early in their illness. Two characteristics of the isolated strains were not in agreement with those of the standard echovirus type 7: they adapted only slowly to cell cultures, and no viral hemagglutinin for human red blood cells could be demonstrated. Our data suggest an etiologic association of echovirus 7 with eye disease.


Vitamin C as a preventive medicine against common colds in children.

During 7 weeks in the spring of 1973 a double-blind pilot study on 172 children in the age group 8-9 was carried out to test the possible effect of 1000 mg vitamin C daily as a prophylactic agent against common colds. During the autumn of 1973, a main study was carried out on 642 children of the same age. The investigations had the same pattern and lasted for 3 months. Both studies have been processed on the same principles. The results were somewhat divergent but, like previously published studies on children, seemed to indicate that the duration and severity of the cold were reduced while, on the other hand, the incidence remained unaltered or indeed increased. The total number of days of upper respiratory tract infection was smaller for the vitamin C group only in the pilot study (not in the main study). No proven biochemical effects were obtained. Preventive treatment of healthy children with vitamin C in large doses this had no definitely proved effect against colds.


Urodynamic studies in boys with disorders of the lower urinary tract. I. Urethral strictures. A pre-and postoperative study.

Sixteen boys with urethral strictures underwent urodynamic investigation pre- and postoperatively. The intravesical pressure preoperatively showed wide variations during micturition and was increased in only half of the patients. The urinary flow pre-operatively displayed a uniform picture with a decreased maximum flow in all the patients, plateau-formation and slow initiation of the flow curve. The maximum exit velocity of the urinary stream was decreased and the urethral energy losses were very high. After treatment, the out-flow situation was generally improved, but restored to normal only in some cases. Patients with short strictures showed the highest degree of urethral obstruction, but they also seemed to have the best prognosis, some of them even reaching supernormal flows. Flow measurement alone is recommended in the long-term follow-u, which is necessary in these patients. After-contraction was not present in any of the patients pre-operatively, blt occurred in about half of them postoperatively. This and some other findings may indicate the existence of functional changes in the bladder neck in patients with urethral stricture. On case with partial detrusor muscle insufficiency is reported.


Urodynamic studies in boys with disorders of the lower urinary tract. II. Stenosis of the external urethral meatus. A pre- and postoperative study.

Nineteen boys with stenosis of the external urethral meatus underwent urodynamic investigation. The intravesical pressure pre-operatively was essentially normal in all but two patients. The urinary flow preoperatively was characterized by slow initiation, plateauformation in the flow curve and, in all but two patients, a decreased maximum flow. The urethral resistance was increased in all patients. The maximum exit velocity of the urinary stream was generally increased and the urethral energy losses essentially within normal limits. Urodynamic investigation proved to be of value in respect of diagnosis and follow-up. The outflow situation was satisfactorily improved in most patients after treatment, but in one third there was little or no change for the better.


In vitro binding of tritiated hormone-cytostatic complexes in the cytosol of various rat tissues and the incorporation of these complexes into nuclei.

Cytosols from rat ventral prostate, liver and muscle were incubated with tritiated estrogen-cytostatic complexes or tritiated estrogen alone. Considerably more radioactivity was recovered in the 4 S region when samples from ventral prostate cytosol were analysed by sucrose density gradient centrifugation compared with samples from liver or muscle cytosols. Similar results were found using Sephadex gel filtration. However, when cytosols were incubated with tritated estrogen alone only unspecific binding was registered. After in vitro tissue incubation with the tritiated hormone-cytostatic complexes, radioactivity was found in purified nuclei of both ventral prostate and liver tissue. The possible nature of the macromolecules which bind hormone-cytostatic complexes is discussed.


The effects of some anticholinergic compounds on the rabbit ureter.

Atropine, emeprone, and PR 197--a new anticholinergic compound--were examined for their possible effects on the rabbit ureter in situ. Ureteral pressure, recorded at two levels simultaneously, and intravesical pressure were studied. The effects of the substances were recorded in both normal (unobstructed) and obstructed ureters. It was found that all the substances, but especially PR 197, produced a fall in the basic intra-ureteral pressure, which was most pronounced in animals with obstructed ureters. PR 197 also temporarily abolished the ureteral peristalsis, while atropine and emeprone did not have this effect.


Compensatory renal hypertrophia in patients undergoing unilateral nephrectomy.

Estimations of the residual glomerular filtration rate (GFR) were made from renography and GFR measurements before unilateral nephrectomy in 28 patients aged 42-77 years. The GFR was measured one week and three months after the operation and comparisons were made between the function of the remaining kidney and the preoperative estimate. In 23 patients where the removed kidney had some function, the mean GFR increased by 32% and 22% after one week and three months, respectively. In 5 patients where the removed kidney had no function, no compensatory hypertrophy occurred.


The influence of warm ischaemia on renal function and pathology.

Temporary occlusion of the left renal artery for 0-180 min after contralateral nephrectomy was undertaken in 51 rabbits. The correlation between the injury of warm ischaemia and kidney function, survival and histology was evaluated. After 0, 60, 90 and 120 min occlusion, all animals survived and normal renal function was restored. After occlusion for 150 min only 4 of 10 animals survived, and normal renal function was not re-established. 180 min occlusion was detrimental to the animals. Only one out of ten survived with severely damaged kidney function. Histological findings were consistent with the experimental observations of renal function.


The effect of chlorpromazine and heparin pretreatment on kidney viability and function after warm ischaemic damage.

The influence of chlorpromazine and heparin pretreament on kidney function and histology has been investigated in rabbit kidneys damaged by warm ischaemia. Three experimental groups were investigated. One in which animals were pretreated with heparin, one group pretreated with heparin and chlorpromazine, and one group without pretreatment. The left renal artery was temporarily clamped for 3 hours and the kidneys recirculated. After 2-3 weeks a delayed contralateral nephrectomy was made, and after another 2-3 weeks all kidneys were studied histologically. Kidney function was measured by determination of serum-creatinine. The experiments showed, that all animals survived with impaired renal function. Pretreatment with chlorpromazine and heparin did not affect the final results. Secerity of the ischaemic damage, histologically evaluated was the same in all groups.


Renal revascularization after splenic artery implantation into the kidney. Studies on angiography ex vivo, microangiography and histology in dogs.

Twenty-eight mongrels were subjected to splenic artery implantation into the left kidney for a period of time varying from 7 days to 32 weeks. In 25 of the kidneys a renal artery stenosis was created. Angiography ex vivo, microangiography and histological examination showed that direct implantation of the splenic artery into the renal parenchyma regularly was followed by an initial thrombus formation in the implanted artery and an early recanalization of this thrombus. Newly formed vessels could be demonstrated in the vicinity of the intrarenal portion of the artery already during the second week after implantation. By way of these newly formed vessels three different types of communications were established between the implanted artery and the original intrarenal arteries.


Renal endometriosis. A case report.

In a 23-year-old woman with lumbar pain, an expansive process in the right kidney was demonstrated by I.V.P., retrograde pyelography and renal angiography. The histological examination subsequent to nephrectomy showed endometriosis in association with localized xanthogranulomatous pyelonephritis. Renal endometriosis has been described only eight times previously in the literature. The current case is discussed and compared with previous reports.


Osmic acid in rheumatoid synovitis. A controlled study.

In 24 adult RA patients with knee joint synovitis and bilateral hydrops, the worse joint clinically was treated with osmic acid and 50 mg of hydrocortisone acetate, while the better joint clinically was treated with 40 mg of methylprednisolone acetate (Depot Medrol). After 6 months, hydrops was palpable in 8 joints treated with osmic acid and in 15 joints treated with corticosteroid only. Pain relief was more marked in joints treated with osmic acid.


Cauda equina lesions in ankylosing spondylitis.

Three patients with the combination of long-standing ankylosing spondylitis (AS) and cauda equina syndrome are described and compared with 17 from the literature. The nerve root lesion has been of gradual onset and has since the time of diagnosis either been stationary or progressed slowly. Radicular pain in the feet and legs, and genito-urinary complaints have been the dominant and most disabling symptoms. Typical myelographic findings were expansion of the dural sac and arachnoidal diverticula. There is a highly probable relationship between AS and the neurological syndrome. The pathogenesis is probably related to early arachnoiditis with subsequent loss of meningeal elasticity. Earlier recognition of the root lesion may result in a more effective treatment.


Effect of gold treatment on the progression of erosions in RA patients.

The progressive of erosive X-ray changes over a period of 5-6 years was evaluated in RA patients with a low or high dose of gold during the follow-up period. The "low gold" group included 18 patients whose treatment was discontinued because of side effects at a mean dose of 254 mg of Myocrisin. The "high gold" group included 32 patients who received a mean dose of 1858 mg of Myocrisin. Both the number of eroded joints in the hands and feet and the X-ray stage had deteriorated more in the "low gold" group. The inter-group difference was statistically significant. Thus, gold treatment has a retarding effect on the progression of erosions in RA patients.


The nitroblue tetrazolium test in juvenile rheumatoid arthritis and the stimulation of granulocytes by patients sera.

The spontaneous NBT test was used in 57 children with juvenile rheumatoid arthritis (JRA) and another connective tissue diseases. The patients were grouped according to the various manifestations and divided into different stages of activity. The patients with tendosynovitis and unknown arthralgia showed a negative test. Patients with morbus Wissler without exudative joint manifestations were also NBT-negative, to a large degree. By contrast, all manifestations with joint involvement showed a high per centage of positive results in the NBT test. In a second investigation, the granulocytes of normal persons were stimulated by sera of patients with various manifestations of JRA. The sera of patients with joint manifestations all caused a stimulation of the granulocytes of normal persons, compared with the controls, in which pooled human serum was employed. Stimulation of granulocytes with serum of Wissler patients proved impossible, however.


Acid glycosaminoglycans in plasma. I. Determination.

Plasma glycosaminoglycans (GAG) were isolated from 10 ml of plasma by a modification of the method of Calatroni et al. (3). DE-52 anion-exchange cellulose was used in the isolation of the fraction operationally defined as free GAG. Chondroitin sulphate and heparin added to plasma were quantitatively recovered in this fraction. After proteolysis with papain the fraction operationally defined as bound GAG was isolated using anion-exchange resin AG 1 X 2. GAG were measured as hexuronate with the m-hydroxydiphenyl method of Blumenkrantz and Asboe-Hansen (7) which was superior to various modifications of the carbazole/borate carbazole procedures. In 15 healthy females and in 15 healthy males the concentrations of the free GAG (mean +/- S.D., expressed as microgram per 10 ml of plasma) were: 12.2 +/- 2.8 and 16.8 +/- 3.8 (P less than 0.001); of the bound GAG 40.4 +/- 7.7, and 40.2 +/- 11.6; and of the total GAG 52.7 +/- 9.0 and 57.0 +/- 10.4, respectively. With the isolation procedures used, plasma GAG were obtained in sufficient quantity for their electrophoretic characterization. Assay of plasma GAG can be performed with satisfactory accuracy and precision within two days by the present method. In clinical chemistry its application to the study of proteoglycan and GAG metabolism in various diseases may prove valuable.


(D)-penicillamine treatment in systemic sclerosis (scleroderma). Effect on nutritional capillary circulation.

Four patients with systemic sclerosis (scleroderma) were treated with (D)-penicillamine (1.2-1.8 g/d) for 18-60 months. All patients improved. Vital capillary microscopy demonstrated that the number of visible skin capillaries increased during therapy, thus indicating a more efficient nutritional circulation.


Reflex dystrophy. Resting blood flow and muscle temperatures as diagnostic criteria.

Fifty-one patients were examined following an injury of the upper extremity. Clinically, 25 patients were estimated as having reflex dystrophy, while the rest was categorized as either having a possible reflex dystrophy or acted as controls. Temperature and blood flow measurements were carried out on both extremities of the patients. The temperature of the brachioradial muscle and resting blood flow of the same segment of the forearm gave highly significant elevated values on the reflex dystrophic arms as compared with the healthy side, while the control patients revealed no such differences. Combination of these two parameters proved to give a specificity and sensitivity that high that they can be recommended as a diagnostic tool. A quantitative measurement and exact diagnosis make controlled trials on this group of patients easier in the future.


The biomechanical influence of traction on the cervical spine.

The effects exerted on the cervical spine by a traction of 150 N was studied by means of an improved radiographic technique. The technique is presented together with results from a study including fifteen test subjects with and without clinical symptoms of neck pain. In a minority of discs a widening not exceeding 1 mm was seen. This widening was not correlated to presence of roentgen signs indicating degenerative disease of the disc nor to clinical symptomatology.


Post-traumatic syringomyelia. Review of the literature and two new autopsy cases.

Two cases of post-traumatic syringomyelia studied macro- and microscopically are reported and compared with three previous autopsy cases described in the literature reviewed. The histological findings suggest that the pathogenesis may be explained by a pressure gradient in a small primary cavity. Although syringomyelia is a rare complication of traumatic spinal cord lesions, it is important to draw attention to the condition because it may be improved by surgical intervention.


Somatosensory cerebral evoked potentials in diagnosing brachial plexus injuries.

Seven patients, 5 months up to 7 years after closed injury of the brachial plexus, were stimulated in the wrist, elbow and axilla of the extremity affected in order to invistigate average somatosensory cerebral evoked potentials (SCEP). Avulsion of most of the roots C5-Thl from the spinal cord could be objectively proved. All available clinical, contrast X-ray, and electrophysiological methods were used as well as surgical approach in the supraclavicular region or laminectomy. Sensation was objectivized by the galvanic skin reflex. Sensory nerve action potentials (NAP) were registered from the ulnar, median, radial nerves. Absence of SCEP in normal NAP helped to localize injury at the preganglionic dorsal root level. Absence of both SCEP and NAP, as seen in one case only, was of no use in the localization. Reduced SCEPs were found in most cases (with or without NAP), with prolonged latency. SCEP can be induced by even a small part of the preserved dorsal roots, e.g. part of a single one, as actually found. The presence of reduced SCEP then does not rule out avulsion of other spinal roots. SCEP from the axilla and upper arm medial side can be conducted--not along the plexus root pathway, but along the intercostobrachia nerve (Th2-3), which normally supplies that skin region.


Lean and fat component of the human thigh. The effects of immobilization in plaster and subsequent physical training.

Changes in thigh components were investigated with the one-legged inactivity- and training-model using 22 young healthy male soccer players, who for 4-5 weeks had one leg immobilized in a cast. They were investigated before and after the cast period and after 4 weeks' physical training of the inactivated leg. Immobilization induced a significant increase in the subcutaneous thickness and a significant decrease in the circumference of the thigh (p less than 0.01). The calculated lean thigh volume was reduced from 4.93 1 to 4.10 1 (p less than 0.01), whereas the calculated fat thigh volume (1.5 1) was unchanged. The changes reversed after four weeks of progressive dynamic training, but did not reach the pre-immobilized values. Body weight decreased from 73.4 kg to 70.8 kg (p less than 0.01) during the immobilization period and was regained after the training period. The fat fraction of the body was unchanged. It is concluded that the loss in total thigh volume during inactivation in a cast is due to waste of the muscle tissue, and further that this loss is partly concealed by an unchanged fat thigh volume.


Verbal learning in aphasic and non-aphasic patients with severe head injuries.

The performances of two groups of patients, one aphasic and one non-aphasic, with severe head injuries, and a control group were compared on tests of: auditory-verbal memory span, rote learning, learning of unrelated words, concrete and abstract, and substance recall. The non-aphasics scored significantly lower than the controls in all tests but substance recall (immediate) and the aphasics did so in all tests. The aphasics were significantly worse on rote learning and learning of unrelated words than patients without aphasia.


Vocational and functional assessment of clients reopened for service.

Former clients (107) of the Massachusetts Rehabilitation Commission were evaluated to determine the reasons for their return to the Commission a second time. Clients returned to obtain physical restoration services, employment or training such as in a vocational school or college. Clients were given a vocational interview (the Goldberg Scale) and the Tufts Programmed Functional Assessment, embracing the Barthel and PULSES Profile. Work status at follow up was significantly predicted by the Goldberg Scale and the PULSES Profile. A significant number returned to work after receiving services a second time.


Prevention of bleeding tendency after open-heart surgery for Tetralogy of Fallot.

Postoperative blood losses after open-heart surgery for Tetralogy of Fallot made re-operation imperative in 15 out of 44 patients (34%, Series A). A surgical bleeding point proved to be the causative factor in only 2 cases; the others were believed to be caused by disturbances of the haemostatic mechanism, particularly by low platelet counts, apparently due to extracorporeal circulation. Administration of a platelet suspension after disconnection of the extracorporeal circuit diminished the number of bleeding complications significantly: in a series of 58 patients (Series B), 8 re-operations (14%) were necessary. In 3 of these cases, technical reasons could be found for the blood losses. Haemodilution was carried out routinely in both series. However, the diluent contained a pasteurised protein solution in Series A and fresh frozen plasma in Series B in order to minimize the deficit of coagulation factors as much as possible.


Mitral valve replacement. A comparative clinical and haemodynamic study of the new Lillehei-Kaster and Björk-Shiley prostheses.

A comparison is made between the clinical and haemodynamic results after mitral valve replacement with the Lillehei-Kaster and the Björk-Shiley disc valve prostheses, which were used alternatively in 54 patients with isolated mitral valve disease. No difference in functional improvement in the two groups was noted. Haemodynamic studies indicated a striking decrease in left atrial and pulmonary artery pressure, irrespective of the type of prosthesis inserted. Cardiac output incresed after operation, but was significantly different from the pre-operative value only in patients with the Björk-Shiley prosthesis, which also had a more favourable relationship between cardiac output and oxygen uptake during excercise than the Lillehei-Kaster prosthesis. One major advantage of the Björk-Shiley prosthesis is probably its favourable ration between tissue diameter and orifice area in contrast to the relatively large seating ring with a more unfavourable corresponding ratio in the Lillehei-Kaster prosthesis. In addition, the former valve possesses a more definite ability to increase its effective valve area during exercise.


Monitoring coronary artery blood flow by Doppler shift ultrasound.

By monitoring arterial blood flow signals across the chest wall in the area of the heart and timing them to the electrocardiogram or the heart sounds, it is often possible to differentiate between coronary artery flow and systemic artery flow. A Doppler ultrasound technique was used for the postoperative follow-up coronary artery reconstruction in ten patients suffering from intractable angina pectoris. Pre-operative coronary angiography showed stenosis or occlusion of the coronary arteries in all the patients. The ultrasound measurements were made pre-, per- and postoperatively with the Doppler flowmeter. Flow signals in all patients could be visualized on sonagrams. There was no postoperative occlusion as proved by postoperative angiography. The signals recorded outside the chest were smaller than those recorded directly from the arteries inside the chest, due to attenuation of the audio signal passing through the tissues of the chest wall. The characteristic pattern of postoperative bypass blood flow was a broad continuous flow over the diastole. The noninvasive character of ultrasound techniques and the safety of the method make Doppler ultrasound scanning an important adjunct to patient monitoring and renders it valuable for post-operative follow-up of arterial graft patency.


Accessory diaphragm with total anomalous right pulmonary venous drainage and aplasia of the middle lobe. A case report.

A patient with accessory diaphragm, aplasia of the middle lobe and total anomalous right pulmonary venous drainage is reported. Diagnostic difficulties and possibilities in the surgical treatment of cases with anomalous pulmonary venous drainage are briefly discussed.


Occlusion of the abdominal aorta in a 29-year-old patient.

Following a period of two years with gradually increasing dyspnoe, the patient, a 29-year-old man, suddenly developed acute respiratory distress. On admission to hospital, blood pressure was 260/110, and there were no femoral pulses. Cine-angiography of the aorta revealed a total occlusion from the level of the first lumbar vertebra to the renal arteries. An extensive collateral circulation was visualized. Kidney function was normal. At operation, the aorta was as hard as stone, but the calibre was normal from the diaphragm down to the renal arteries. A dacron graft was inserted, end-to-side between the thoracic aorta and the abdominal aorta distal to the inferior mesenteric artery. Postoperatively, the systemic and ankle blood pressure became near normal. The aetiology of the aortic changes remains unknown. Several possibilities are considered, among them abdominal aortitis and cystic necrosis of the media. Coarctation of the abdominal aorta is less likely, as no narrowing of the aorta was seen at operation.


Intestinal angina. Report on two operated cases.

In spite of the fact that the concept of intestinal angina is more than 70 years old, it is not generally accepted and only 400 cases of elective revascularization of the celiac/mesenteric arteries are reported in the literature. Two typical cases of intestinal angina treated with elective revascularization are presented and the pertinent literature is reviewed. An aggresive approach to the problem, followed by adequate reconstruction, is recommended.


Leg blood and central circulation at varying blood volumes. A peroperative study of nine young patients with varicose veins.

Cardiac output, central pressures and leg blood flow wre studied in a group of nine young individuals undergoing surgery for varicose veins. These subjects did not differ from older ones in an earlier, corresponding study in respect of central or femoral blood flow. The haemodynamic affects of peroperative variations of the blood volume were also the same. Thus, the common femoral arterial blood flow decreased by 40% from a mean of 450 to 260 ml/min during the operation. After transfusion of 900 ml of blood the flow  increased to 575 ml/min. As a low blood predisposes to thrombosis, it is concluded that, irrespective of age, adequate peroperative volume substitution is of great importance in counteracting such a risk.


Femoro-femoral cross-over grafting. A limb-saving operation in poor-risk patients with obliterative arteriosclerosis.

A series of 12 femoro-femoral cross-over grafting procedures is reported. Eleven patients were operated on for severe ischaemia and one for disabling claudication. Nine of the reconstructions were profunda revascularizations. Concomitant femorotibial reconstruction was carried out in one case. There were no operative deaths or postoperative complications. Peroperative blood flow measurements and clinical symptoms gave no evidence of any "steal" phenomenon. One graft became occluded primarily, but the others remained patent during an observation period ranging from two months to four years and ten months. Despite a functioning graft, one major amputation was necessary due to severe distal arteriosclerotic lesions. In all other patients, either the limb was saved or claudication was relieved. This operation seems to be suitable for poor-risk patients with predominantly unilateral iliac arteriosclerosis together with impending gangrene or disabling claudication.


Axillo-axillary bypass for subclavian artery occlusion. Report of a case with impending gangrene of the hand.

A 72-year-old woman with occlusion of the right subclavian artery and impending gangrene of the hand was succssfully treated with a subcutaneous axillo-axillary vein bypass. This method was chosen because of atrophic skin changes due to radiation therapy for breast cancer. The operation may, however, be used in the treatment of atherosclerotic obstructions of the subclavian artery in general and may be particularly advantageous in old and poor risk patients.


Present indications for a myocardial pacemaker electrode.

A myocardial electrode was implanted in 43 patients on special indications at a pacemaker centre, where the transvenous technique was used as the routine method for implantation of a stimulating electrode. The electrode was inserted through a small anterior thoracotomy or at open-heart surgery. The complications and deaths during the follow-up period of two-and-a-half years are reported. The results to date are quite satisfactory. Indications are suggested and the main advantages of a myocardial electrode in clinical use are discussed. The Medtronic myocardial electrode model 6917 should be resorted to as a very good alternative on failure of pacing with an endocardial lead. The hazards of thoracotomy must, however, be borne in mind. This approach should be used with restraint in very old patients and in patients with severe heart disease, particularly those with a recent myocardial infarction.


Continuous measurement of the oxygen tension in blood. A comparative study in the dog.

An equipment constructed by the International Biophysics Corporation, the Differential Oxygen Analyzer, which was designed for continuous recording of the oxygen tension in the blood, particularly during extracorporeal circulation, was tested. It proved to react rather slowly to changes in the PO2 and the magnitude of the error of the single measurements is far too high at the present stage of development.


Moderate and extreme haemodilution in open-heart surgery. Blood requirements, bleeding and platelet counts.

Requirements of donor blood, bleeding and platelet counts were investigated during moderate and extreme haemodilution in patients undergoing aortic valve replecement. A preliminary study of 60 patients, divided in two groups of 30 patients each, was first made. A moderate haemodilution was used in one group and an extreme haemodilution with the aid of autologous transfusion was utilized in the other. As the results were interesting and encouraging, a randomized study was performed. Thirty patients, divided in two groups of 15 patients each, were investigated. The degree of dilution was essentially similar to that of the corresponding moderate and extreme haemodilution groups in the preliminary study. An average reduction of 71% in the requirement of donor blood and of 47% in postoperative chest tube drainage was found in the patients in the extreme dilution group. The circulating platelet counts fell less during and after the operation in this group than in the moderately diluted patients. After adjustment for the dilution, the platelet counts fell to about 60% in the moderate dilution group during the perfusion, but rose to about 130% in the extremely diluted patients. These findings are discussed.


[Accidental hypothermia in man].

Accidental hypothermia, in contrast to medical hibernation, corresponds to a sudden, unforeseen lowering of the body temperature below 35 degrees C. This may occur endogenously in association with various diseases. On the other hand, it may be due to the exogenous influences of very low environmental temperatures. An impressive observation of accidental hypothermia is described and the pathophysiological findings in accidental hypothermia are reviewed.


[Acute kidney failure in hypothermia].

Two cases with acute renal failure after prolonged hypothermia are presented. Both patients were found in come, became rapidly uremic and required hemodilaysis treatment. Although the laboratory findings were typical of severe muscle damage, e.g. elevated levels of serum creatinine phosphokinase, serum lactic dehydrogenase and serum aldolase activities, visible "crush-injuries" were not found. Acute renal failure was characterized by extreme catabolism and severe metabolic acidosis. After 4 and 10 hemodialyses respectively, the patients became polyuric and finally were discharges with normal renal and muscle function. Hypotension with diminished renal perfusion and nontraumatic rhabdomyolysis due to prolonged hypothermia are regarded as the dominant pathogenetic factors in the acute renal failure.


[Hemolysis-inducing substances in gastric secretion, incidence-rate of lysolecithin].

Samples of gastric contents from 152 patients with pyloric reflex were taken during gastroscopy after an overnight fast and examined for hemolytic activity. Hemolysis was induced by 97 specimens (64%). The hemolysis test was positive in 45% of patients with a histologically normal gastric mucosa, in 76% of patients suffering from chronic atrophic gastritis with intestinal metaplasia, in 83% with gastric erosions and in 67% with gastric ulcer. No lysolecithin was found in 9 of the 97 positive specimens. The other aspirates contained widely differing values up to 320 mg/100 ml. The average quantities of lysolecithin in gastric contents varied in the different patient groups from 20 to 60 mg/100 ml. These values are much higher than the mean value of 0.9 mg/100 ml quantified in patients without pyloric reflex during an earlier investigation. It is now widely accepted that pyloric reflex promotes gastritis. Furthermore, it has been shown on several occasions that bile constituents exert a damaging effect on the gastric mucosa barrier. The same is true of lysolecithin, which promotes (for example) acute cholecystitis under experimental conditions. These findings, together with the results of our investigation, seem to afford evidence that lysolecithins may exert a pathogenic influence in the development of different gastric lesions.


[Results of radical radiotherapy in breast cancer].

In 17790 examinations over a 5-year period, 1174 breast carcinomas have been detected and treated in the Department of Senology, University Hospital, Strasbourg, France. 467 carcinomas were treated by radiotherapy alone. Five-year survival has been studied. Over half of the carcinomas treated were T3 and T4-sized. Overall survival is 46%.


Surgery and chemotherapy in early breast cancer.

The updated results are reported of a prospective controlled clinical trial employing combined chemotherapy with cyclophosphamide, methotrexate and fluorouracil (CMF) as adjuvant treatment in patients with operable breast cancer and positive homolateral axillary lymph nodes (N+). At 36 months from surgery, actuarial analysis shows that there is a significant difference in the relapse rate in favor of adjuvant chemotherapy (45.7% in the control group vs. 26.3% in the CMF group). Distant recurrences were the most frequent site of treatment failure and occurred particularly in the skeleton. The therapy was fairly well tolerated. Both the influence of adjunctive therapy on overall survival after mastectomy and the incidence of long-term side effects are still unknown.


[Behavior of individual immune parameters in patients with locally-regionally circumscribed breast cancer].

Significant and long lasting depression of lymphocyte function and distribution was demonstrated in 15 patients with breast cancer at varying clinical stages after postoperative radiotherapy.


[Definition of the population groups with high-risk for breast cancer].

Based on the epidemiologic literature, the major risk factors for mammary cancer are discussed. The problem in defining population groups with a high potential for breast cancer stems from the fact that for most of the criteria of higher risk only a two- or threefold increase in incidence is observed. In addition, many of the risk factors are not independent but show interactions with other factors. In the individual woman it is possible to decide whether she has a high potential for developing breast cancer or not, but the criteria for high or low risk are not at present sufficiently contrasted to justify the exclusion of certain low-risk groups from screening procedures.


[Locally and regionally limited breast cancer from the pathologist's view point].

The role of the pathologist in breast cancer is discussed from the practical viewpoint. For primary diagnosis surgical biopsy is preferred. Of prognostic significance are the size of the tumor and the number of regional lymph nodes affected. The different histological patterns have little prognostic bearing, with the exception of some rare special types such as medullary or mucinous carcinomas. Histological and/or cytological "grading" is too time-consuming for practical purposes. The pathologist is confronted with new problems by non-palpable "minimal breast cancer" detected by mass screening methods. The solution to these problems requires close interdisiplinary cooperation. In In the broad field of cystic diseases of the breast there is a need for a better histological definition of what constitutes a true premalignant lesion. Finally, the problems of multicentric and bilateral breast cancers are mentioned.


[Diagnostic procedures in the evaluation of malignancy degree in breast cancer. Radiological view point].

The value of mammography and thermography for evaluation of breast cancer malignancy is reviewed. The only radiologic finding that changes the prognosis is peritumoral edema, either localized or involving the whole breast; when present, this edema has unfavourable implications for prognosis. Thermography, on the other hand, provides a much better idea of prognosis when the tumor is palpable. In this case the prognosis is influenced much more by the degree of hyperthermia than by the clinical size of the lesion.


[2-step diagnosis and conservative treatment of breast cancer].

Regular screening of women for early breast cancer is now possible by a completely noninvasive technique comprising thermography, clinical examination and ultrasound echography. Since it is completely harmless, this screening may be repeated when required.  Its accuracy is very good (about 96%) even in small T1 tumours, and infraclinical cancers also may be detected. This first diagnostic step is carried out in every woman, whether symptomatic or not, attending the Jolimont Breast Unit. The second step serves for confirmation of diagnosis and consists of mammography (and related techniques) and thin-needle aspiration cytology. A conservative treatment has been developed for the small lesions (infraclinical, T1 and small T2). It consists of external radiotherapy (telecobalt), tumorectomy and axillary curage, and finally interstitial curietherapy with iridium 192 wires. In some selected cases chemotherapy is started immediately. Local control of the disease is achieved in 97% of cases and cosmetic results are good in 80% of the treated women. In only 5% of cases has a secondary mastectomy to be performed, due to local recurrence or treatment complications. Metastatic spread and survival rates favorably compare with results of conventional treatments involving mastectomy. The authors therefore consider that conservative treatment should be recommended in early-detected small breast cancers.


[Cytologic examination under radiologic guidance in the diagnosis of nonpalpable lesions of the breast].

A breast aspiration technic for non-palpable radiological abnormalies, as used in the Senology Department of Professor CH. GROS. Strasbourg, is presented and illustrated by an example.


[Puncture and marking methods in the diagnosis of breast tumors].

The indication, problems and performance of puncture and marking methods in breast tumors are discussed and a new relief procedure for breast tumor diagnosis, involving peritumoral X-ray contrast medium injection, is described. Only normal X-ray equipment is required for this method.


[Hydroxyproline in the diagnosis of bone metastases in breast cancer].

15 patients with breast cancer and proven bone metastases have been studied. Free serum and total urinary hydroxyproline were measured and the ratio (hydroxyproline/creatinine) - 100 in a morning urine specimen was calculated. The preliminary results show elevated free serum hydroxyproline in 8 of 15 patients; total urinary hydroxyproline in a 24-h collection and the ratio hydroxyproline/creatine in a morning urine specimen were elevated in all cases. These results agree with those of the literature. Further studies of free hydroxyproline and of the ratio hydroxyproline/ creatinine in a morning urine specimen in similar patients with provide more information on the possibility of using these measurements, alone or in combination, for the early detection or follow-up under therapy of bone metastases.


Surgical treatment of primary breast cancer.

Radical mastectomy should be replaced by a number of different types of operation which are either more conservative or more extended according to the spread of the disease. For T1N0 cases a new procedure consisting of removal of a quadrant of the breast, with axillary dissection plus radiotherapy on the residual breast tissue, is under evaluation. In T2N0 cases modified radical mastectomy is suggested as a procedure of choice, whilst T3 cases and all N1 cases should still undergo radical mastectomy. Cases with tumor of inner quadrants with positive axillary nodes with benefit from removal of internal mammary nodes. Superradical mastectomy is limited to selected special cases with extensive lymphnode invasion. All N+ cases receive adjuvant chemotherapy (CMF). In locally advanced cases "reductive" surgery may form part of an aggressive chemotherapy programme.


[Prognosis of local primary breast carcinoma under current therapy].

A retrospective study is presented on 225 selected patients with local primary carcinoma of the breast treated from 1963 to 1973 at the Surgical Clinic of the Cantonal Hospital, St. Gallen, Switzerland. All patients were under 70 years old. The results are compared of our two therapies, namely radical mastectomy of Halsted and a modified radical mastectomy consisting of mastectomy with dissection of the axilla but without removing the pectoral muscle. Both operations were followed by postoperative irradiation. In view of the short postoperative interval after modified radical mastectomy (from 1969), a five-year diseasefree survival is indicated. There was no statistically significant difference between the two therapies. Depending on age, patients with histologically negative lymph nodes of the axilla had a probability of 45-60% for 5-year diseasefree survival, against only 15-40% for those with positive axillary lymph nodes. The quality of survival is deemed important, and the authors therefore recommend the modified radical mastectomy, which disfigures a woman less than the Halsted operation.


[Treatment of locally recurrent breast cancer using the double-net technic].

The best treatment for local recurrence of breast carcinoma without skin metastases in the surrounding area is surgical excision. If this recurrence adheres to the chest wall, the whole wall including ribs and pleura must be resected. However, the difficulties in closing these defects have often been a deterrent to such surgical treatment. A technique for easy closure of these defects is presented. It consists in closing with a nylon net for reestablishment of stability, and air-tight covering of the net with the greater omentum for prophylaxis of infections. The wound can be covered with split skin grafts within 10-14 days. Local healing with this double-net plasty has so far been successful in 3 patients.


[Contribution of radiotherapy in the local-regional treatment of breast cancer].

The role of radiotherapy in the treatment of mammary carcinoma is reviewed. The indication for postoperative radiotherapy in cases of primary tumors T2 and T3, particularly in the presence of metastatic lymph nodes (N1), is still given. For stage 1 (T1/T2 N0), postoperative radiotherapy may be omitted or can be limited to the lymphatic area which has not been surgically explored. Pre-operative radiotherapy for the more advanced stage (T3/T4 and N2) has proven more effective than postoperative irradiation. Radiotherapy as an exclusive procedure in the sense of a curative, non-mutilating treatment for small breast cancers(T1/T2 NO) provides, if correctly administered, the same 5- and 10-year survival rate at surgical amputation. The arguments against the use of radiotherapy (lymphopenia, diminished immunological reactions, frequency of hematogenic metastases) are discussed.


[Dr. Atkins' dietetic revolution: a critique].

Very fat people die earlier than people of normal weight because hypertension, diabetes and coronary disease are more frequent among the markedly obese. Most obese subjects, however, are only slightly overweight and their mortality is not elevated. Reasons for dieting are more often psychological than somatic. 2. Reducing diets are ineffective because the obese rarely follow them. Total fasting and intestinal bypass may provide better results, but are more dangerous. 3. Atkins' diet eliminates carbohydrates from food without restricting protein and fat intake. Deprived of carbohydrates, the body uses fat for fuel. A small part of metabolized fat is eliminated in the urine as ketone bodies, and this is why such diets are called "ketogenic". They have been known at least since 1863. 4. Caloric loss due to ketonuria does not exceed 100 Cal/day in the non-diabetic. It is maximal during total fasting and cannot be increased by a ketogenic diet. 5. In the short run, such diets produce rapid weight loss due to polyuria. On the other hand, refeeding carbohydrates causes water retention and weight gain. 6. The diet decreases appetite: patients eat less without feeling severe hunger and without measuring their food intake. 7. Orthostatic hypotension, fatigue, and nausea are frequent, despite what Dr. ATKINS claims. 8. The diet increases plasma cholesterol and uric acid. It may be dangerous in diabetes (anorexia, acidosis) and in heart or kidney failure (hypokalemia). 9. The diet, though far from good, is better than the book. ATKINS' theories are at best half-truths, and the results he claims lack credibility. The obese subject's disappointment with traditional reducing diets and the book's hard-sell style account for ATKINS' success.


[Acute kidney failure as a complication of fasting therapy].

Acute urate nephropathy during starvation for weight reduction has been observed in 2 patients. Under these conditions ketoacidosis causes impaired renal uric acid excretion and hyperuricemia. Uricosuric agents or sudden intake of normal calorie diet induces massive uricosuria and kidney damage. Uricosuric agents should be avoided and steps taken to promote abundant diuresis, while allopurinol should be prescribed.


[Swiss family with chronic relapsing calcifying pancreatitis].

A further Swiss family with hereditary chronic relapsing pancreatitis is reported. Five members definitely have the disease, while in 4 subjects the condition is suspected. The five proven cases are a mother and her four children. All suffer from recurrent attacks of abdominal pain which started between the 8th and 20th year of life, and in all of them exocrine pancreatic insufficiency and pancreatic calcifications can be demonstrated. The mother has had diabetes mellitus since the age of 40 and 3 of the 4 children also have the disease, with age of onset between 15 and 29. In 3 patients insignificant traces of aminoacids could be detected in the urine. At 16 years one male patient had a pseudocyst of the pancreas surgically removed. All the others are treated conservatively. Reports on approximately 25 families with this disease have been published so far. The condition is inherited as an autosomal dominant disorder. Typically, the clinical symptoms begin during childhood or early adolescent life. The pathogenesis is unknown. It is possible that an abnormal pancreatic juice is produced which causes the intracanalicular calcifications. The treatment is identical to that in the non-hereditary forms, i.e. generally conservative. Recently some authors have favored a more aggressive approach consisting of pancreatico-jejunostomy or partial resection of the pancreas.


[Treatment of heart failure with phentolamine (Regitin)].

Vasodilative treatment of severe heart failure with infusions of phentolamine leads to ventricular unloading and in many cases brings about a dramatic improvement of the patient's condition. Phentolamine is the only one of the vasodilators so far used in the treatment of heart failure that has a positively inotropic effect. In contrast to sodium nitroprusside and nitroglycerin, it also increases stroke volume at normal filling pressures. Although vasodilative therapy has resulted in a notable decline in the mortality from severe heart failure among hospitalized patients, the long-term prognosis after discharge remains poor. One of the chief reasons is that there has hitherto been no effective orally administrable drug suitable for protracted therapy. Initial clinical studies with a newly developed slow-release formulation of phentolamine have shown that the preparation produces remarkably good effects in patients with chronic heart failure: systolic pressure rises, the amplitude of the blood pressure is augmented and there is an increase in urinary excretion accompanied with a corresponding reduction in weight. In practically all cases, there is a distinct decrease in the size of the heart and in pulmonary congestion.


[Effect of aluminium-hydroxide-containing antacids on the intestinal absorption of iron in patients on long-term dialysis].

In 6 patients on maintenance hemodialysis the influence of an aluminium hydroxyde containing antacid (administered to prevent hyperphosphatemia) on the intestinal absorption of iron was measured with 59Fe and with a whole body counter. Iron absorption was 3.4% of the dose administered (geometric mean) while the patients were on antacids. After omission of the medication it rose slightly on 4.1%, the difference being not statistically significant (p greater than 0.5). It is concluded that aluminium hydroxyde containing antacids do not impair intestinal iron absorption in patients on maintenance hemodialysis.


[Arterial CO2- and O2 partial pressure at rest and during exertion in pulmonary emphysema].

In 83 patients with severe, largely irreversible bronchial obstruction (FEV1/VC less than 40% and FEV1 after orciprenaline inhalation less than 120% of the control value) and radiologie evidence of AD-emphysema, arterial PCO2 and PO2 were measured at rest in supine position and on the bicycle ergometer during a steady-state exercice of 5 min. Alveolar hypoventilation (PCO2 greater than 45 mm Hg) was most often observed in the cases with FEV1 less than 1.01 (in 22 patients [27%] at rest and in 26 patients [31%] during exercise). However, there was no significant correlation of the PCO2 increase with the degree of bronchial obstruction. In all patients there was a marked inhomogeneity of the alveolar ventilation or the alveolar-capillary O2 transfer in relation to alveolar blood perfusion. Indeed, the alveolar-arterial PO2 difference was increased (40 mm Hg at rest and 45 mm Hg during exercise). The additional increase of this gradient during exercise was due to an unequal distribution of alveolar O2 diffusing capacities in connection with the alveolar blood flow (preceding measurements of the N2 gradient between alveolar air and arterial blood revealed a mean fall from 18 at rest to 8 mm Hg during exercise). The observed deterioration of hypoxemia during exercise (without additional hypercapnia) is to a great extent related to the degree of bronchial obstruction measured by simple spirometry. Thus, measurements of PCO2 and PO2 at rest and during exercise appear to be a helpful adjuvant to routine spirometry in the diagnosis of subclinical emphysema.


[Arthritis in thalassemia minor].

Seven cases with the syndrome of thalassemia minor and pauciarticular, non-erosive, seronegative arthritis are described. Other known causes of seronegative arthritis had been excluded. There was a predilection for middlesized joints such as ankles, wrists and elbows. Usually the synovitis was asymmetrical from onset, with one to eight joints affected. Finger or toe joint were usually spared. Extraarticular synovitis such as tenosynovitis or bursitis were not observed, nor were nodules, signs of vasculitis or visceral involvement. The course of this arthritis showed chronicity and mild, persistent, non-erosive synovitis without joint effusions. X-ray revealed juxtaarticular osteoporosis of the affected joints, characterized by a diminution of the number of trabeculae (hypertrophic atrophy) combined with broadening of the singular trabeculae; this picture is typical of hemoglobinopathies. - Computed tomography showed a probable slight deficit of bone mineralization. Laboratory investigations including ESR, routine immunological tests, blood chemistry, and HLA-tissue typing were all normal. - The combination of this peculiar arthropathy with thalassemia minor would appear to be worthy of note and requires a further search among the forms of arthritis of unknown origin.


[Hemarthroses complicating anticoagulant therapy (heparin, oral anticoagulants)].

Three patients with hemarthrosis complicating anticoagulant therapy are described. Two had acute hemarthrosis of the knee joint occurring during long term oral anticoagulant therapy for cardiovascular disorders. Joint symptoms disappeared rapidly after arthrocentesis and diminution of the dose of oral anticoagulant medication. The third patient has been on chronic hemodialysis for the last three years. After 2 years of this therapy he developed periarthritis of the right shoulder, followed suddenly by hemarthrosis of the right shoulder which remained symptomatic for 9 months in spite of several joint aspirations and reduction in the dosage of heparin administered during hemodialysis. Resolution of the hemarthrosis of the right shoulder occurred only when the vascular access for the dialysis sessions was displaced from the right to the left forearm. It is assumed that there was communication in the venous draining territories of the arterio-venous fistula and the shoulder articulation.


Carrier-mediated photodiffusion membranes.

Reversible photochromic reactions can be coupled to carrier-mediated transport processes in membranes to bring about the separation or concentration of selected permeants. Carbon monoxide has been pumped against of fourfold concentration gradient by differentially illuminating a hemoglobin membrane. The extent of concentration of photochromic ligands increases with light intensity and is reversible. Nonphotochemically sensitive ligands can also be transported by coupling with phostosensitive carrier-mediated systems.


Timekeeping by the pineal gland.

N-Acetyltransferase, an enzyme involved in melatonin production in the pineal gland, exhibits a circadian rhythm in chickens with peak values in the dark-time and low values during the light-time, commencing at lights-on. When pineal glands of chickens killed during the dark-time (with high N-acetyltransferase activity) were organ-cultured, there was a decline in enzyme activity to light-time values. Regardless of the time of the dark at which the chickens were killed, the enzyme activity reached light-time levels at precisely the same time.


Aluminum absorption and distribution: effect of parathyroid hormone.

In rats, gastrointestinal aluminum absorption and tissue distribution were altered by parathyroid hormone; the resultant tissue concentrations were similar to those observed in dialysis patients with a fatal encephalopathy. In dialysis patients, serum aluminum and endogenous parathyroid hormone concentrations are significantly correlated. These data suggest that aluminum toxicity in dialysis patients results from oral aluminum ingestion in the presence of hyperparathyroidism.


Competition of delta 9-tetrahydrocannabinol with estrogen in rat uterine estrogen receptor binding.

Direct competition experiments with delta 9 -tetrahydrocannibinol (delta 9-THC) and estradiol in binding assays with rat uterine cytosol estrogen receptors showed that delta 9-THC was a weak, but nevertheless significant, competitor for binding to cytoplasmic estrogen receptors. These data support, at the molecular level, the observations that delta 9-THC has a weak estrogenic activity (at least the ability to bind to estrogen receptors). Moreover, estrogen-like binding suggests that delta 9-THC, acting at the level of estrogen receptor, causes a primary estrogenic effect rather than an indirect or secondary phenomenon.


Long-term unit recording from somatosensory neurons in the spinal ganglia of the freely walking cat.

A new technique has been developed for stable, long-term recording from groups of individual primary afferent neurons in the freely walking cat. A number of fine, flexible wires are inserted into dorsal root ganglia via a small laminotomy in the lumbar spine. The cut end of each wire can record stable and separable action potentials from one to three dorsal root ganglion neurons; each unit has typically held for 1 to 4 days. A broad range of myelinated somatosensory afferent (conduction velocities of 30 to 120 meters per second) have been studies during locomotion. Most cutaneous and proprioceptive afferent studied have been sensitive monitors of complex combinations of step-cycle components, and their firing patterns would often have been difficult to predict from existing information.


Cholera toxin crystals suitable for x-ray diffraction.

Large crystals of the cholera toxin were grown; their dimensions, symmetry (P21), order, and resistance to radiation make them ideally suited for a high-resolution x-ray structure determination. There is one molecule (approximately 84,000 daltons) per asymmetric unit, and therefore the lattice reveals no molecular symmetry. Two distinct bioassays indicate that the protein from dissolved crystals retains full biological activity.


Infectivity reacquisition by Trypanosoma brucei brucei cultivated with tsetse salivary glands.

Reacquisition of infectivity four mice was observed in cultures of Trypanosoma brucei brucei grown in the presence of tests fly salivary gland explants in a medium based on the amino acid composition of Glossina hemolymph and containing fetal bovine serum. High infection rates were obtained in mice inoculated with about 1.5 X 10(8) organisms. Infectivity reacquisition was correlated with invasion of the salivary glands by the parasites. Few small trypanosomes with subterminal kinetoplasts (metacyclic-like forms) were found in the infective inoculums. The parasitemias in mice consisted of pleomorphic cultivable trypanosomes. Cultures initiated by these organisms and then placed with the head-salivary gland preparations became infective for mice.


Sperm autoantibodies in vasectomized rats of different inbred strains.

An immune response to antigens of spermatozoa occurs after vasectomy in rats of some inbred strains, but not in others. Antibodies to rat spermatozoa were detected by indirect immunofluorescence in some of the serums of vasectomized rats of the following strains: 80 percent of Lewis, 47 percent of Brown Norway, 13 percent of Buffalo, 12 percent of Wistar-Furth, and 11 percent of ACI rats. No such antibodies were detected in the serums of vasectomized Fischer, Dark Agouti, and Sprague-Dawley rats.


A method for detecting 8-methoxypsoralen in the ocular lens.

The use of 8-methoxypsoralen for treating psoriasis could prove hazardous if this photosensitizing agent enters the ocular lens. Phosphorescence spectra of intact rat lenses reveal concentrations of 8-methoxypsoralen on the order 10(-5)M after intraperitoneal injection of 8-methoxypsoralen. There is evidence that this drug can function as a photosensitizing agent, enhancing ultraviolet-induced changes within the lens.


Butylated hydroxytoluene protects chickens exposed to Newcastle disease virus.

Dietary butylated hydroxytoluene, an antioxidant widely used in food and feed processing, prevents mortality of chickens exposed to virulent Newcastle disease virus and prevents the serological response of chickens exposed to avirulent Newcastle disease virus. This chemoprophylactic effect is evident when chickens are fed diets containing concentrations of butylated hydroxytoluene normally used for antioxidant purposes (100 to 200 parts per million of total diet).


Auditory evoked potentials as probes of hemispheric differences in cognitive processing.

The amplitude of auditory evoked potentials recorded from the cerebral hemispheres to pairs of task-irrelevant tones was related to differential hemispheric engagement in ongoing cognitive activity (for example, verbal versus musical). The hemisphere hypothesized to be most engaged in the ongoing cognitive task, as compared to the unengaged hemisphere, produced a greater potential difference between the temporal and reference electrode to the second of the tone pairs. These findings are related to "fast habituation" and "recovery cycle.".


Vasoactive intestinal polypeptide occurs in nerves of the female genitourinary tract.

The vasoactive intestinal polypeptide occurs in a richly developed population of nerves that are abundant in the female genitourinary tract. In pigs, cats, rats, and mice these nerves seem to innervate vessels and smooth musculature. Evidence indicates that vasoactive intestinal polypeptide represents a peptide neurotransmitter. Its effects on uterine blood flow and contractility, for example, may be considerable.


Complexes of stannous fluoride and other group IVB dihalides with mammalian hemoproteins.

Stannous fluoride, the widely used anticaries toothpaste additive, and other tin and germanium dihalides form complexes with hemoproteins such as hepatic cytochrome P-450, hemoglobin, and peroxidase. These complexes are characterized by visible spectra closely similar in shape, molar absorptivity, and absorbance maxima to those obtained with analogous complexes of carbon monoxide. Evidence is presented that the observed complexes are formed with uncharged MX2 or LMX2, moieties (where L is a neutral Lewis base, M is a metal, and X is a halogen) acting as pi-acceptor ligands.


Molecular graphics: application to the structure determination of a snake venom neurotoxin.

Atomic coordinates have been determined for a snake venom alpha-neurotoxic protein by fitting a molecular model to a crystallographically derived 2.2-angstrom electron density map. The fitting was carried out entirely on a computer-operated molecular, graphics system without going through any mechanical model stage.


Neuron duplications and deletions in locust clones and clutches.

Duplications and deletions of identified neurons can occur with a high degree of genetic control and specificity, as shown by examining the ocellar interneurons of locusts from different breeding populations, clutches from single mated pairs, and isogenic animals from parthenogenetic clones.


Brain self-stimulation: direct evidence for the involvement of dopamine in the prefrontal cortex.

Rats were trained to self-stimulate the medial prefrontal cortex, a region rich in dopaminergic terminals. After the region adjacent to the electrode site was labeled with [14C]dopamine, it was perfused repeatedly by means of push-pull cannulas. Electrical stimulation of this cortical area in six animals enhanced the release of dopamine and its associated metabolites in nine of 16 experiments. Thus in vivo evidence is provided that dopamine is involved in the brain self-stimulation mechanism within the frontal cortex.


Impact of federal regulations at a university.

Last year the University of Iowa conducted an in-house study of how federal regulations, executive orders, and agency administrative policies affected the day-to-day operations of the university on all levels. This article is an analysis and reassessment of the federal impact issue based on the information uncovered in the University of Iowa survey.


Cancer mortality in U.S. counties with petroleum industries.

A survey of cancer mortality from 1950 to 1969 was conducted in U.S. counties where the petroleum industry is most heavily concentrated. Male residents of these counties experienced significantly higher rates for cancers of the lung, the nasal cavity and sinuses, and the skin (including malignant melanoma) compared to male residents of counties with similar demographic characteristics. Further study is needed to determine whether these patterns result from exposure to chemical carcinogens, including polycyclic hydrocarbons, involved in the manufacturing of petroleum.


Bifunctional intercalators: relationship of antitumor activity of diacridines to the cell membrane.

The in vivo antitumor effectiveness [as measured by the percentage increase in life-span (ILS%)] of 28 diacridine bis-intercalators of nucleic acids shows a highly significant correlation with their effect on phenomena associated with plasma membrane as well as a high degree of structural specificity. In contrast, the ILS% does not correlate with the uptake of these diacridines by cells, nor with the inhibition of RNA synthesis or of DNA synthesis or with the inhibition of growth of cells in culture. The possibility that the antitumor effectiveness of actinomycin D, another DNA intercalator, is associated with sites of action other than the hibition of RNA synthesis is discussed.


Alpha blocking: absence in visuobehavioral deprivation.

Subjects with congenital deficits that allowed only diffuse light perception through one eye were examined for blocking of the alpha rhythm. With only the deprived eye open the electroencephalogram is dominated by alpha rhythm that is not blocked by photic stimulation, even though the stimuli evoke a response from occipital cortex.


Mental set alters visibility of moving targets.

An observer's knowledge of a moving target's direction and velocity enhances detectability. In addition, knowledge of direction and velocity speeds an observer's reaction to the motion of a previously stationary target. Since rival, nonperceptual hypotheses can be ruled out, these effects represent a direct modulation of vision by mental set.


Striatal efferent fibers play a role in maintaining rotational behavior in the rat.

Rats in which ascending dopamine-containing neurons have been unilaterally destroyed by injections of 6-hydroxydopamine are known to rotate after being injected with apomorphine or L-dopa. The rotation is markedly reduced by either (i) ipsilateral electrocoagulations of the caudate-putamen or internal capsule or (ii) ipsilateral coronal knife cuts immediately rostral to the substantia nigra. Neostriatal efferent fibers, in particular the strionigral projection, appear to be required for the expression of this dopamine-dependent behavior.


Clockwise growth of neurites from retinal explants.

When retinal explants from goldfish are grown on a polycation substratum, a marked tendency for directionality of neurite outgrowth is observed. While the direct relevance to nerve growth in vivo is not known, the phenomenon is interpreted as reflecting an inherent helicity of the neurites.


Neuronal circadian rhythm: phase shifting by a protein synthesis inhibitor.

A potent inhibitor of protein synthesis, anisomycin, was applied  (10(-6)M) in 6-hour pulses at specific phases in the circadian rhythm of endogenous compound action potential (CAP) activity recorded from the eye of Aplysia in vitro. The phase of the circadian rhythm was systematically advanced or delayed (up to 15 hours) depending on the specific phase at which the pulse was applied. The resultant phase response curve implicates protein synthesis on the eukaryotic ribosome as a fundamental part of the controlling processes that constitutes the circadian clock.


Cortical mechanisms that augment or reduce evoked potentials in cats.

The augmenting or reducing of flash-evoked potentials in paralyzed cats was significantly correlated with their previously videotaped behaviors. Augmenting reducing was due to alterations in cortical rather than subcortical responsiveness, and was duplicated by increasing cortical arousal by means of reticular stimulation while the animal was exposed to visual stimuli of constant intensity. Brainstem activation of cortical inhibition may underlie the behavioral results as well as the results obtained with the evoked potentials.


Imitation of facial and manual gestures by human neonates.

Infants between 12 and 21 days of age can imitate both facial and manual gestures; this behavior cannot be explained in terms of either conditioning or innate releasing mechanisms. Such imitation implies that human neonates can equate their own unseen behaviors with gestures they see others perform.


Transplantable pancreatic carcinoma of the rat.

Pancreatic carcinoma, which developed in a male Fischer 344 rat fed 0.1% nafenopin for 20 months, is being successfully transplanted into weanling rats. The tumor cells contain variable numbers of zymogen granules, and the endoplasmic reticulum and the Golgi apparatus appear prominent. This transplantable tumor, which displays substantial amylase and lipase activity, should serve as a useful model system for immuno- and chemotherapeutic experiments, as well as for the study of synthesis, storage, and release of zymogen proteins in neoplastic cells.


Distribution of physicians in family practice and other medical specialties in Texas, 1969-1973: a statistical review.

This article documents distributional patterns of allopathic family practice physicians (including general practitioners) in Texas as compared with allopathic physicians in all other medical specialties in the state during the period 1969-1973, for which there are reliable data. Statistical analysis of this information shows that there was a significant difference between the growth of family practice compared to all other medical specialties in both metropolitan and nonmetropolitan counties. This study draws no conclusions that the medical needs in many of these areas are not being met, since patient travel may, to some degree, compensate for disproportionate physician distribution. There is no unanimous agreement on what constitutes an ideal ratio of physicians in any specialty to a population in so-called "medically underserved" areas.


Practical role for ultrasound in diagnosis of deep venous thrombosis of lower extremities.

The Doppler Ultrasonic Velocity Detector has been shown to be of significant value in the evaluation of patients with suspected deep venous thrombosis. Our experience in 121 patients demonstrates a false-negative rate of 10% for "minimal" thrombophlebitis and 3.2% for ileofemoral thrombosis when the Doppler was used as a diagnostic aid. Since ileofemoral thrombosis represents the greatest threat to the patient in terms of pulmonary embolism, this appears to be a sensitive and specific technic for the detection of ileofemoral thrombosis.


Hypocalcemia after thyroidectomy: mechanisms and management.

Hypocalcemia persists as a problem after thyroidectomy. We reviewed our experience with 245 thyroidectomies to define the spectrum of hypocalcemia, elucidate the mechanisms of hypocalcemia, and formulate a rational basis for its management. Postoperative hypocalcemia occurred in 8.6% of all patients undergoing thyroid surgery with incidence the highest in patients with total thyroidectomy for cancer (28%) and those with subtotal thyroidectomy for thyrotoxicosis (23%). Incidence was low in patients having subtotal thyroidectomy for other diseases (1.5%) and lobectomy (0%). The high incidence of hypocalcemia following subtotal thyroidectomy for thyrotoxicosis but not for other diseases suggests that a mechanism other than removal or damage of the parathyroids is responsible for the hypocalcemia. This may well be thyrotoxic osteodystrophy. This hypocalcemia usually occurs early, is of moderate degree, and is transient. Management includes calcium gluconate for acute symptoms and calcium lactate with vitamin D2 for chronic symptoms.


Hereditary (familial) renal disease: clinical and genetic studies.

Four or more generations of three Oklahoma-Kansas families in which multiple members have been found to have glomerulonephritis or interstitial nephritis have been studied. Twenty-five of 146 members in kindred A, 16 of 50 members in kindred B, and 33 of 156 members in kindred C were identified as probably to definitely afflicted. Renal tissue from members of the first two families showed an acute or chronic glomerulonephritis. Renal failure often appeared by the third decade. The lesions were less frequent but more rapidly lethal in the male members. Renal tissue from members of the third kindred showed an interstitial nephritis. This appeared later in life and followed a more chronic course. Hearing loss was common in both groups. The hereditary studies are consistent with the hypothesis that the disease is transmitted by an autosomal dominant gene with imcomplete penetrance (not all members carrying the gene develop renal disease) and variable expressivity. Male-to-male transmission was present in all three families but less frequently than would be predicted, suggesting a reduced clinical expression of the disease in males who receive the mutant gene from their father.


Management of infantile asthma.

Infantile asthama is an important pediatric problem and may cause substantial morbidity and mortality in this age group. The pathophysiology of allergic asthma involves a type I hypersensitivity reaction that is mediated by reaginic antibodies of the IgE class. Various factors predisposing to infantile asthma have been suggested but not confirmed. The differential diagnosis of infantile wheezing is of particular importance in this very young age group. An appreciation of the natural history and clinical characteristics of the disease, and of the important causative factors (foods, environmental inhalants, and respiratory infections), will aid the physician in the management of this problem.


Anisometropic amblyopia and its treatment.

Full optical correction and closely supervised occlusion were effective in producing substantial visual improvement in 15 of 17 patients with anisometropic amblyopia. The age of patients varied from 2 to 12 years and all were followed for at least one year.


Thoracic duct injuries.

Chylous fistulas are an infrequent result of injury to the thoracic duct during radical neck dissection. Leakage of lymph from a fistula which is allowed to persist will cause such serious postoperative problems as metabolic deficiencies, flap elevation, suture breakdown with hemorrhage, and infection. There appears to be no valid justification for extended conservative management if it fails to slow the leak within 48 hours. We recommend prompt exploration of the wound with an operating microscope and microsurgical ligation of the lacerated duct with nonabsorbable sutures.


Wound management after trauma to the colon.

The records of 62 patients with injury of the colon were reviewed to ascertain the contribution of technics in wound care to morbidity. Primarily closed wounds had a very high frequency of infection (56%). Wounds treated by delayed primary closure or secondary intention developed infection in 19% of patients. Infection in an open wound was associated with intraperitoneal abscess in 73% of cases.


Is postoperative proximal decompression a necessary complement to elective colon resection?

Postoperative nasogastric suction is not a necessary complement to elective colon resection. We studied two groups of patients who had elective colon resection: nasogastric suction was used in the postoperative management of 53 patients, while 23 patients were managed without nasogastric suction. The morbidity and mortality rates were comparable in the two groups.


Value of bone marrow biopsy in the diagnosis of amyloidosis.

Amyloid involvement of the bone marrow is not commonly diagnosed before necropsy. Paraffin sections of the trephine bone biopsy specimen are superior to marrow aspiration cell smears for the antemortem diagnosis. Thirteen cases of amyloidosis were diagnosed from the bone biopsy specimen during a ten-year period. Amyloid was detected in only two of the corresponding aspirates. Three morphologic patterns of marrow involvement were found: vascular, focal extravascular/perivascular, and diffuse. Five (38%) of the cases were associated with multiple myeloma. An abnormal immunoglobulin was detected in the serum or urine or both in ten of 11 cases when determined. Although the bone marrow may not be the best site for the diagnosis of amyloidosis, it should not be neglected and marrow biopsies taken for other diagnostic reasons may "incidentally" reveal amyloid. Amyloidosis should be included in the list of non-primary hematologic conditions of the bone marrow in which the trephine biopsy may prove useful for diagnosis.


Hepatitis-B surface antigen (HBsAg) and antibody (anti-HBs) prevalence among laboratory and nonlaboratory hospital personnel.

HBsAg and anti-HBs positivity was determined in hospital laboratory workers and nonlaboratory hospital workers (controls) matched for race and sex and adjusted for age. The combined prevalence of antigen-antibody positivity among white female technicians was 12% versus 0 of controls (P less than 0.005). The highest prevalence (18%) among laboratory workers was found in chemistry technicians, and significantly elevated frequencies also were noted in histocytologic, hematologic, and general laboratory technicians and blood collectors; this was not explained by a history of previous blood transfusions or hepatitis. Prevalence among pathologists (16%) was significantly greater (P less than 0.05) than among radiologists not routinely performing angiography (2%). Prevalence among black female housekeepers, both laboratory (25%) and nonlaboratory (36 %), was the highest, and was significantly greater (P less than 0.05) than among black female technicians (10%). Positivity was not correlated with current residence census tract socioeconomic indicators in black or white females. The data emphasize the need for continued identification of risks and improved protection measures in hospital workers.


Surgical repair of old fourth-degree perineal lacerations.

There are four basic surgical procedures for repair of old fourth-degree (complete) perineal lacerations: the layer closure, the Warren flap, Bowers' modification of the usual layer closure, and the Noble procedure. The Noble procedure avoids the deficiencies of the other procedures, and it is recommended as the best choice for this type of repair because it produces an intact rectal tube uncompromised by a suture line, is anatomically correct, is simple and easily mastered, and apparently has a near-zero failure rate.


Simplified hiatus herniorrhaphy.

A  brief synopsis of problems with hiatus herniorrhaphy surgery over its 25-year history includes extensive surgery, recurrences, and postoperative swallowing difficulties. A review of the simple central tendon hiatal herniorrhaphy technic and seven-year results include the adoption of a mersilene strip rather than external rectus fascia in anchoring the esophagogastric junction to the central tendon. The same excellent exposure and visibility allowing the lower esophageal segment to be well secured definitely within the abdomen is completely illustrated. Seven-year results in 138 patients operated upon are reviewed including mortality, recurrence rates, postoperative dysphagia, gas-bloat, and loss of regurgitating ability.


Polycentric total knee arthroplasty.

Polycentric total knee arthroplasty in 56 patients provided significant relief of pain in 90.7% and a stable knee in 92.7%. Postoperative increase in range of motion averaged 13.7 degrees for all patients (18.5 degrees in rheumatoid arthritis and 8.7 degrees in degenerative arthritis). This increase in excursion is attributed to the design of the prosthesis, a vigorous postoperative rehabilitation program, and careful surgical technic. A failure rate of 12.7% was due to infection, mechanical instability and unexplained pain. Contraindications to surgery and technical recommendations are noted.


Liver size in normal infants and children.

Liver span of normal infants and children 2 months to 5 years of age was found to be significantly correlated with body height, weight, surface area, and age. However, it was best correlated with body surface area, reflecting a constant relationship between body size and liver size. Assessment of liver span is a useful test for evaluation of a child with apparent liver enlargement.


Ultrasonographic abdominal aortography.

B-mode ultrasonography is an easily performed and accurate method of studying the abdominal aorta. The procedure is totally noninvasive and does not require patient hospitalization to detect aortic aneurysmal dilatation. Aneurysm size, extent, and associated aneurysmal clot formation can be determined more accurately than with contrast aortography. Para-aortic abdominal masses or organs that transmit pulsations can be detected where an aneurysm was originally suspected. Studies for serial size determination or postoperative follow-up are quickly and inexpensively performed, making this procedure the choice diagnostic modality for abdominal aortic aneurysms.


Pasteurella multocida pneumonia and bacteremia.

A 76-year-old man with chronic obstructive pulmonary disease who developed P multocida pneumonia and bacteremia has been described. The infection was treated with antibiotics, and the patient recovered. Pasteurella multocida is known to infect many species of animals. The instances of human infection due to this organism are frequently associated with exposure to animals. Pulmonary infection occurs principally in patients with underlying chronic bronchopulmonary disease.


Rhabdomyolysis with cardiac and respiratory involvement.

A case of acute nontraumatic rhabdomyolysis in a heroin addict is described. In addition to respiratory failure, the patient's course was complicated by life-threatening arrhythmias and electrocardiographic changes compatible with primary cardiac involvement. This case suggests that rhabdomyolysis may involve cardiac muscle on rare occasions.


Massive hemothorax complicating heparin anticoagulation for pulmonary embolus.

A case of massive hemothorax complicating heparin anticoagulation for pulmonary thromboembolism is presented. Hemothorax complicating anticoagulant therapy for PTE usually occurs within the first week of treatment and is invariably on the side of the initial clinical symptoms, suggesting intrapleural rupture of a hemorrhagic pulmonary infarct. Late hemothorax is unusual and may not be on the side of the initial symptoms, suggesting a different pathogenesis. Hemothorax may occur as the only bleeding complication of anticoagulation and when coagulation studies are within an acceptable therapeutic range. Cessation of anticoagulation therapy and prompt evacuation of the pleural space are recommended.


Focal glomerulonephritis and interstitial nephritis in methicillin-treated, heroin-related infective endocarditis.

A drug addict with staphylococcal endocarditis treated with methicillin, who developed massive proteinuria and acute nephritic syndrome is described. Discontinuation of methicillin therapy and appropriate antibiotic treatment of endocarditis led to clinical improvement, emphasizing the need to promptly discontinue potential nephrotoxic agents when abnormalities in renal function appear. The clinical course and results of renal biopsy studies suggest multiple causes of the renal lesions in this patient.


Cholelithiasis after mitral valve replacement in a teen-ager.

A 17-year-old girl with cholelithiasis associated with mitral valve replacement four years earlier is presented. The potential for the development of cholelithiasis after cardiac valve replacement in children and adolescents is emphasized.


Prolonged muscle rigidity following administration of succinylcholine.

Succinylcholine should be avoided in any patient with known myotonia because of the possibility of an abnormal rigid response. In addition, the possibility of undiagnosed myotonia should be considered in any myopathic patient. While not all myotonic responses are associated with malignant hyperthermia, the anesthetic should be discontinued immediately and the patient should be closely observed for elevation of temperature.


Massive pulmonary gangrene.

A 49-year-old man suffered massive necrosis of the lung subsequent to a pneumococcal lobar pneumonia. Development of massive hemoptysis required emergency lobectomy. The patient is doing well six months after surgery. Pulmonary gangrene is a rare but grave complication of the lobar pneumonia. Both pneumococcal and Klebsiella pneumonias may progress to massive pulmonary gangrene despite antibiotic treatment. Survival seems to depend on the surgical removal of the necrotic tissue, which removes the danger of sudden massive hemoptysis.