Chordoma: radiologic evaluation of 20 cases.

Experience with 20 cases of chordoma is summarized. Three of four intracranial tumors presented as sellar tumors. The clivus remained intact for 2, 3 1/2, and 4 years, respectively, in three patients despite extensive destructive lesions of the sellar region. Our data and those of others indicate that approximately half the patients with chordomas have erosion of the clivus at the time of initial medical evaluation. The other half mainly have sellar destructive lesions with or without associated clival erosion. Calcification occurs in 50%-70% of intracranial chordomas. A nasopharyngeal mass is present in one-third. Vertebral chordomas often involve two or more vertebrae, producing destructive lesions which often have a sclerotic rim. The intervertebral discs are commonly affected. A paraspinal soft tissue mass, half the time containing calcification, is often present. Sacral lesions are characterized by a midline destructive lesion, occasionally associated with expansion, with or without osteosclerosis. A firm, fixed, extrarectal, presacral mass which may contain calcification or fragments of bone is almost always present.


The value of consultation among radiologists.

The value of group consultation in improving the accuracy of radiologic diagnosis was assessed. Abnormalities on 24 films were pointed out to six groups of three radiologists each. They were asked to reach a specific diagnosis for each case. Accuracy was compared in three settingss: (1) without consultation; (2) with consultation leading to a diagnosis by group consensus; and (3) with consultation followed by independent diagnoses. The accuracy of over 75% of the radiologist improved after consultation in either setting. The extent of improvement was inversely related to the initial accuracy level of the individual. When two or three radiologists agreed initially, they were more frequently correct than not. Group discussion followed by individual diagnosis is a practical approach to radiologic consultation.


RAPORT radiology system: results of clinical trials.

RAPORTTM, an automated radiology management and reporting system is currently operational in more than 25 hospital departments of varying sizes and types. Data have been gathered from 19 installations in operation for 6 months or longer and four systems which failed. Findings were as follows: 1. Mark sense forms were used in 71% of cases (29% dictation) and for an average of 70% of all pathologic material. 2. Report turnaround time ranged from 0.1 to 6 hr (average 2.5 hr) depending on departmental priorties and organization. 3. Rejection of the system was based upon inadequate documentation of needs prior to installation, poor preparation of staff members, and underestimation of the impact on computer systems on existing organizations. 4. System downtime averaged 2.5 hr per month. 5. The ratio of pathologic to normal reports did not vary significantly among university, government, and private hospitals. 6. RAPORT can no longer be considered an experimental system. Properly managed, it is an effective administrative tool which can significantly improve departmental service.


Gray scale cholecystosonography: an evaluation of accuracy.

The accuracy of gray scale cholecystosonography is evaluated by comparing oral cholecystography and ultrasonography findings on 141 patients. Confirmation of findings by oral cholecystography or surgery was available in 123, and there was agreement by cholecystosonography in 111, for an accuracy of 90%. Of 39 patients with gallstones, 30 were correctly diagnosed by ultrasound. These results represent an improvement in the accuracy of gray scale ultrasonography for evaluation of the gallbladder compared to previous reports and demonstrate the potential usefulness of the procedure for evaluation of the nonvisualized gallbladder.


The dependence of radiographic mottle on beam quality.

The dependence of radiographic mottle on beam quality has been studied for a variety of film/screen combinations. The measurement technique consisted of scanning the radiographs with a microdenitometer; the analogue signal from the microdesitometer was gated and recorded with a multichannel analyzer. The sampling aperture was 500 mum in diameter and was chosen because its spatial frequency response approximates that of the eye. The standard deviation of the density fluctuations was calculated directly from the number versus density spectrum accumulated in the analyzer. The range of standard deviations' for the various combinations and x-ray tube kilovoltages studied from approximately 0.009 to approximately 0.021 density units. For commonly used combinations, very little kilovoltage dependence was observed. The relative amount varied for different screen phosphors and is attributed to differences in the absorption characteristics.


An evaluation of procedures used in staging carcinoma of the cervix.

A review of 227 cases of invasive carcinoma of the cervix was undertaken to determine the efficacy of procedures using in the staging of this disease. All patients had a pretreatment chest radiography and intravenous pyelogram. 96.5% had pretreatment cystoscopy, 98.6% had pretreatment proctoscopy, and 92% had a pretreatment barium enema. These patients were retrospectively staged on the findings of physical examination only. Each additional procedure was then evaluated by comparison with the initial staging. Cystoscopy and chest film findings each would have changed the clinical stage in fewer than 1% of cases, barium enema in 1.4%, and proctoscopy in 2.2%. No patient had a positive barium enema without a positive proctoscopy, while two patients had positive proctoscopies with negative barium enemas. The overall yield of positive findings by pretreatment intravenous pyelography was 7.3%. Lymphangiography, although inconsistently done, yielded positive findings in all stages. Chest radiographs, intravenous pyelography, proctoscopy, and lymphangiography are recommended as part of the pretreatment workup of patients with carcinoma of the cervix. Routine barium enema is no longer recommended, and cystoscopy is only recommended in patients with clinical stage IIB disease or greater.


Results of involved field and extended field radiotherapy in patients with pathologic state I and II Hodgkin's disease.

A series of 44 previously untreated patients was found to have stage I or II Hodgkin's disease on the basis of a diagnostic workup which included laparotomy and splenectomy in 39 cases. The patients were randomized to either involved field or extended field radiotherapy. No difference was found in overall survival rates between the two groups. Regional recurrences were seen in four patients in the involved field group and in none of the extended field group. Regional recurrences were seen in four patients in the involved field group and in none of the extended field group. Radiotherapy to the extended field treatment port (generally an extended mantle) can be given with acceptable side effects. Staging laparotomy was of definite value, changing the classification and resulting therapy of two groups: (1) patients with clinical stage (CS) I or II, pathologic stage (PS) III involvement, who were treated with appropriately larger radiotherapy fields; and (2) patients with CS III, PS I or II, who were spared unnecessarily extensive radiotherapy.


Successful transcatheter embolic control of massive hematobilia secondary to liver biopsy.

A 43-year-old female alcoholic had massive hematobilia secondary to arterial trauma of a liver biopsy. The arterial bleeding site was successfully embolized through an angiographic catheter with Gelfoam sponge. No liver ischemia occurred and the patient has remained well.


Treatment of symptomatic hepatic cyst by percutaneous instillation of Pantopaque.

A large, symptomatic, simple hepatic cysts was managed by the percutaneous instillation of Pantopaque. The method was based on reports of similar percutaneous treatment of renal cysts. In 6 months the patient was asymptomatic and radiographs demonstrated evidence of a fibrous reaction within the cyst. The patient remains asymptomatic 16 months after puncture. These results suggest that percutaneous instillation of sclerosing agents may provide an alternative to operative procedures.


The limbus vertebra: an anterior disc herniation demonstrated by discography.

Limbus vertebra results from an intrabody herniation of disc material. It can be mistaken for a fracture, infection, or tumor, resulting in unnecessary invasive diagnostic procedures. A case is presented in which the lesion was diagnosed by discography. Most radiologists are unfamiliar with discograms, yet they are useful because they opacify the anteriorly herniated portion of the nucleus pulposus.


Patellar giant cell tumor.

Primary patellar neoplasms are distinctly unusual. A rare case of patellar giant cell tumor which caused clinical, radiographic, and histologic confusion is described. The lesion progressed rapidly, underscoring the potential aggressive behavior of the tumor. Amputation is the preferred treatment. A review of the literature is also presented.


Esophageal aperistalsis secondary to metastatic invasion of the myenteric plexus.

A case of aperistalsis of the esophagus secondary to isolated invasion of the myenteric plexus of Auerbach by metastatic carcinoma is presented. The unique pattern of tumor involvement and the resultant aperistalsis supports the contention that involvement of the neurons in the deep myenteric plexus, either by inflammation or tumor, may be the key factor in producing aperistalsis. No similar cases were found in the literature.


Salicylate-induced pulmonary edema.

A case of pulmonary edema secondary to salicylate intoxication is described. The pulmonary wedge pressure was normal, excluding cardiogenic pulmonary edema. Thus salicylate intoxication should be considered as a rare cause in the differential diagnosis of pulmonary edema with a normal heart size. The pulmonary edema resolved gradually over 8 days. Literature relative to salicylate-induced pulmonary edema is reviewed.


Depression of hypoxic ventilatory response by nitrous oxide.

Ventilatory responses to CO2 and hypoxia were measured in four normal volunteers breathing 30-50 per cent N2O  with and without added inspiratory resistance. CO2 response was measured by a steady-state technique, hypoxic response by a non-steady-state progressive technique. Added inspiratory resistance depressed ventilatory responses to both CO2 and hypoxia. N2O had no effect on CO2 response either with or without resistance. N2O depressed the ventilatory response to hypoxia without added resistance and further depressed the response measured with added resistance. It is thought that this was probably the result of selective depression of peripheral chemoceptor function by N2O.


Internal carotid artery stump pressure and cerebral blood flow during carotid endarterectomy: modification by halothane, enflurane, and innovar.

Carotid endarterectomy requires temporary surgical occlusion of the involved carotid artery. During occlusion, the minimally acceptable (critical) internal carotid artery stump pressure is reported to be 50 torr, whereas for regional cerebral blood flow (rCBF), a critical range is reported to be 18-24 ml/100 g/min. During 90 carotid endarterectomies, rCBF and stump pressure were measured and the EEG continuously monitored. A positive correlation between rCBF and stump pressure (i.e., when both were either above or below their respective critical values) was observed in only 58 per cent of the cases. In 28 per cent stump pressures of less than 50 torr were observed despite rCBF's above 24 ml/100 g/min and normal EEG's. In 8 per cent stump pressures were more than 50 torr but rCBF's were less than 18 ml/100 g/min and EEG changes of ischemia were commonly observed. In the remaining 6 per cent rCBF's were marginal (18-24 ml/100 g/min) while stump pressures were more than 50 torr and EEG changes were not observed. The relationship between stump pressure and rCBF was influenced by the anesthetic. In the absence of transient ischemia during occlusion (that is, rCBF greater than 18 ml/100 g/min), halothane and enflurane anesthesia were associated with significantly higher rCBF's and lower stump pressures than was neuroleptanesthesia. Pre-occlusion and post-occlusion rCBF measurements also demonstrated cerebral vasodilation by halothane and enflurane (halothane greater than enflurane) and vasoconstriction by neuroleptanesthesia. It is concluded that stump pressure is an unreliable index of CBF during carotid occlusion and that its relationship to CBF is considerably influenced by the anesthetic.


Neurobehavioral responses and drug concentrations in newborns after maternal epidural anesthesia with bupivacaine.

The neurobehavioral status of 20 newborn infants was evaluated after two to four hours of life following maternal epidural anesthesia with bupivacaine for labor and vaginal delivery. All infants were normal products of uncomplicated full-term gestations. The 20 infants, whose mothers had received continuous lumbar epidural anesthesia with bupivacaine, demonstrated no measurable difference from control infants and did not have the decrease in muscle tone and strength observed in infants whose mothers had received continuous lumbar epidural anesthesia with lidocaine or mepivacaine in a previous study.


Amnesic actions of diazepam and scopolamine in man.

In man, diazepam alone and in combination with scopolamine interferes with the memory of visual and painful stimuli. With a 15-minute interval between injection of the drug and the showing of emotionally neutral pictures, scopolamine (0.5 mg/70 kg) produces 14 per cent forgetting when evaluated 24 hours later. Under these conditions diazepam (10 mg/70 kg) produces 41 per cent forgetting, while the combination causes 64 per cent. Under conditions designed to insure selection of subjects in whom registration was clearly quite intact at the time of the initial exposure to the pictures, memory was still found to be impaired when tested 24 hours later. Graded doses of diazepam to as much as mg/70 kg in combination with 0.5 mg/70 kg scopolamine produced a virtually linear dose-response curve for amnesia. These results are compatible with the interpretation that the diazepam-scopolamine mixture interferes with memory by blocking consolidation of the memory trace.


Effects of halothane on DNA synthesis and the presynthetic phase (G 1) in dividing fibroblasts.

The effects of halothane on deoxyribonucleic acid (DNA) synthesis and  events preceding DNA synthesis have been examined in Chinese hamster fibroblasts in culture.DNA synthesis was studied by the uptake of 3H-thymidine during short periods of incubation that minimized effects on cells in the presynthetic phase (G1). Halothane produced slight but significant dose-related depression of 3H-thymidine uptake (20 per cent depression with 2 per cent halothane). In a separate series of experiments, synchronized cultures were exposed to 1-3 per cent halothane in G 1 phase for three or five hours. Halothane caused a postponement of onset of DNA synthesis (S phase), indicating a delay in G 1. This delay roughly equalled the duration of exposure to 3 per cent halothane but was less with 2 per cent halothane. The delay was only about one hour with 1 per cent halothane.


Closing capacity measurement during general anesthesia.

A modification of the single-breath nitrogen closing volume (CV) test allows measurement of closing capacity (CC) during general anesthesia. In the modification, inspiration and expiration are mechanically produced by a hydraulically powered cylinder. For 14 awake, normal subjects results of the CV test performed using this mechanical method differed that those obtained following spontaneous inspiration and expiration. Mean (+/-SE) CC's were 2.25 (+/-0.15) and 2.42 1 (+/-0.14) (P less than 0.01) using spontaneous and mechanical methods, respectively. The slopes of Phase III of the CV traces were 2.24 (+/-0.27) and 2.66 per cent N2/L (+/-0.32) (P less than 0.01), respectively. To eliminate differences due to measurement technique, the modified CV test was used both before and during anesthesia with halothane in 70 per cent N2 in 11 normal, supine, spontaneously breathing subjects. CC's were 1.89 l (+/-0.16) before and 1.84 l (+/-0.15) during anesthesia (P greater than .5). Mean functional residual capacities (FRC) by the closed-circuit helium method were 1.77 l (+/-0.15) before and 1.45 l (+/-0.17) during anesthesia (P less than .001). With CC unchanged and FRC decreased following induction, CC/FRC increased from 1.07 (+/-0.08) to 1.37 (+/-0.11) (P less than .005), suggesting increased small-airway closure during anesthesia.


Fluoride in bone of rats anesthetized during gestation with enflurane or methoxyflurane.

Fluoride concentrations in maternal and fetal bones were measured following exposure of pregnant rats to methoxyflurane and enflurane anesthesia. Fluoride content in fetal bone increased significantly only after exposure to methoxyflurane, and then only when methoxyflurane was administered after 12 days of gestation, when ossification of fetal bone begins. Fluoride concentrations in maternal bone increased following both anesthetics, except in rats exposed to methoxyflurane after 15 days of gestation, when ossification of many fetal skeletal parts is in progress and fluoride is preferentially deposited in the fetal skeleton.


Distribution of waste anesthetic gases in the operating room air.

Epidemiologic and animal studies identify a strong relationship between chronic exposure to anesthetic gases and health hazards. Efforts to reduce exposure of personnel require an understanding of the distribution of anesthetic waste gases in the operating room air. Concentrations of nitrous oxide and halothane were measured at numerous stations throughout an operating room and a delivery room in the absence of personnel. Air conditioning flow rates and flow patterns were varied, as was the height of the anesthetic gas source. Air flow patterns were found to dominate the anesthetic gas distribution, while buoyancy effects were negligible. Venting waste gases at the floor does not significantly reduce exposure of personnel. Areas of high concentration were observed; their occurrences and locations varied strongly with air flow patterns. The exhaust grille is the best location for a single measurement of the average room concentration. Recirculating air-conditioning systems reduce energy costs; however, only the non-recirculating portion of the air exchanges reduces waste gas concentrations.


Enflurane depresses myocardial function, perfusion, and metabolism in the dog.

Trained dogs with chronically implanted catheters and left ventricular (LV) pressure transducers were anesthetized with 2.3 per cent (1 + MAC) and 3.6 per cent enflurane. Left ventricular function and metabolism were studied while the dogs were awake and during exposure to the two anesthetic concentrations. Enflurane depressed LV function in a dose-dependent fashion. Myocardial blood flow and oxygenation mirrored the functional changes. Myocardial oxygen extraction decreased and lactate extraction increased to the myocardium. Low concentrations of halothane in the same dogs on different days had similar effects. However, 2 MAC halothane resembled 1.6 MAC enflurane, suggesting that the cardiovascular dose-effect curve for enflurane is steeper than that for halothane. Both anesthetics produce dose-dependent negative inotropic effects in the intact dog, accompanied by equivalent decreases in cardiac oxygen demand. Contrary to previous suggestions, enflurane appears to be at least at depressant to the dog heart as halothane.


Pulmonary shunting during anesthesia with deliberate hypotension.

Pulmonary shunting (Qs/Qt with FIO2 = 1) was measured in 18 anesthetized patients during deliberate hypotension. Hypotension was induced in 12 patients with sodium nitroprusside and light halothane anesthesia and in six others with deep halothane anesthesia and mechanical hyperventilation. Similar results were observed in the two groups. During the hypotensive period mean arterial pressure (MAP) was reduced to 49 +/- 2 torr, a 37 per cent decrease from the control level after the onset of operation and a 40 per cent decrease compared with the recovery level during closure of the wound. Qs/Qt, however, remained unchanged throughout the study: 5.2 +/- 0.9 per cent initially, 5.4 +/- 0.8 per cent during hypotension, and 4.7 +/- 0.5 per cent during recovery. It is concluded that pulmonary shunting need not develop during deliberate hypotension induced with either technique.


Acid-base balance nomogram--a Boston-Copenhagen detente.

Quantitation of actual and expected complete compensation for chronic hypercapnia in man is facilitated by addition of data of Brackett et al. in the form of an arc to the Siggaard-Andersen alignment nomogram. Percentage of compensation is defined as 100 times the ratio of observed to predicted (fully compensated) base excess at the patient's PCO2. Extracellular fluid base excess, defined as BE3, is estimated from a 3-g hemoglobin line added to the nomogram.


Primary aldosteronism with uncommon complications.

In a patient who had primary aldosteronism and severe total-body potassium depletion muscular tonic contractures developed during induction of anesthesia. After correction of the potassium deficit, the patient underwent uneventful anesthesia and transabdominal right adrenalectomy. Neither serum potassium level nor EKG seems to provide a reliable index of correction of potassium deficit. Measurement of potassium balance provided a method of quantitating the potassium depletion and of determining when the potassium deficit had been corrected. Balance studies should be utilized preoperatively when long-term potassium loss is suspected to reduced complication secondary to hypokalemia.


Does measles really predispose to tuberculosis?

In recent years, textbooks and reviews on mechanisms involved in cellular immunity have emphasized that measles adversely influences tuberculous lesions. The medical literature was critically investigated for the basis of this claim. All field studies reviewed possessed strong deficiencies in the pertinent data and the methods of their collection. These deficiencies rendered invalid conclusions concerning the ability of measles to activate tuberculosis. Indirectly, there are also no adequate epidemiologic data to support the concept that measles suppresses tuberculous immunity when it suppresses tuberculin skin reactivity. Considering all the available information, one may conclude that if measles does have a deleterious influence on tuberculosis, it is probably at low frequency in most populations.


Use of fibrinogen/fibrin degradation products and soluble fibrin complexes for differentiating pulmonary embolism from nonthromboembolic lung disease.

To help differentiate pulmonary embolism from other lung diseases, we measured the degradation products of fibrinogen and fibrin and soluble fibrin complexes in normal control subjects and patients with pulmonary embolism, lung cancer, pneumonia, chronic obstructive pulmonary disease, tuberculosis, asthma, and several miscellaneous disorders. A separate group of patients, who were suspected of having pulmonary embolism but had negative pulmonary angiography, were also tested. Many nonthromboembolic lung diseases frequently were associated with positive fibrinogen/fibrin degradation products or soluble fibrin complexes, but those with high positivity rates for one test tended to have low rates for the other test. Both fibrinogen/fibrin degradation products and soluble fibrin complexes were positive in 55 per cent of patients with pulmonary embolism but only in 4 per cent with nonthromboembolic conditions (P less than 0.001), in 7 per cent of patients with negative pulmonary angiography (P less than 0.001), and in none of the normal subjects (P less than 0.001). Both tests were negative in only 3 per cent of patients with pulmonary embolism but in 35 per cent of nonthromboembolic diseases (P less than 0.005), 54 per cent of those with negative pulmonary angiography (P less than 0.001), and 79 per cent of normal control subjects (P less than 0.001). The combination of fibrinogen/fibrin degradation products and soluble fibrin complexes is more valuable than either test alone in the diagnostic separation of thromboembolic from nonthromboembolic pulmonary diseases.


Effects of intravenous histamine on static lung compliance and airway resistance in normal man.

Static lung compliance and airway resistance were measured in 30 experiments on 6 healthy subjects after intravenous injection of a bolus of histamine (4 mug per kg of body weight). Analysis of the pooled results showed a significant decrease in static lung compliance (maximal mean decrease,--16 per cent occurring 20 sec after injection). There was no significant change in functional residual capacity or vital capacity after injection of the histamine. Administration of propranolol (a beta-adrenergic blocking agent) did not significantly enhance the responses to histamine. The results suggested that humans, like other species, can constrict peripheral airways sufficiently to produce alterations in the static elastic properties of the lungs.


The relationship between symptoms and functional abnormalities in clinically healthy cigarette smokers.

Because a number of "early tests" may now be used to measure abnormalities of lung function in cigarette smokers with normal airflow rates, we evaluated the symptoms of cough, sputum, wheezing, and shortness of breath in 60 nonsmokers and 49 smokers to determine whether these symptoms correlated with measurements of lung function that are believed to be altered by mild obstruction. One or more symptoms were present in 5 per cent of the nonsmokers and 90 per cent of the smokers. Individual symptoms, sums of symptoms (symptoms score), and various combinations of symptoms correlated poorly or not at all to measured values for dynamic lung compliance, closing volume, closing capacity, slope of Phase III, and helium flow-volume curves. The symptoms score correlated negatively (P less than 0.05) with forced maximal expiratory flow at 50 per cent of vital capacity. Inasmuch as the serious consequences of chronic airway obstruction are related to abnormalities of lung function, it is likely the function tests will prove more useful than symptoms to reveal smokers at risk to develop chronic obstructive pulmonary disease. Symptoms cannot be used to detect smokers who are liable to have functional abnormalities suggestive of mild peripheral airway obstruction.


Effect of meperidine on occlusion pressure responses to hypercapnia and hypoxia with and without external inspiratory resistance.

In 5 normal subjects we measured ventilation and P0.1, the pressure generated by the first 0.1 sec of inspiratory effort against a closed airway, in response to hypercapnia and hypoxia with and without added inspiratory resistance before and after oral meperidine (1.1 to 1.3 mg per kg). CO2 responses were studied in the steady state, whereas progressive hypoxia was used to elicit hypoxic responses. In general, resistance decreased ventilatory responses to hypercapnia but increased P0.1 responses to both hypoxia and hypercapnia. Meperidine depressed both ventilatory and P0.1 responses, more so in hypoxia than in hypercapnia. The combination of resistance and merperidine was additive in depressing responses to hypercapnia but in hypoxia produced little more depression than did meperidine alone. In both hypercapnia and hypoxia, meperidine decreased the augmentation of P0.1 that was associated with increased resistance. Normal subjects responded to acute increases of inspiratory resistance by increasing inspiratory motor output; this increase was distinctly blunted by meperidine.


Effect of elastic loading on mouth occlusion pressure during CO2 rebreathing in man.

In 7 normal subjects, mouth occlusion pressure was evaluated as an index of neural drive to the respiratory muscles during CO2 rebreathing, with and without the addition of 2 degrees of elastic loads. During control and loaded rebreathing, changes in both mouth occlusion pressure and ventilation were linearly related to changes in end-tidal PCO2. With elastic loading, the slope of occlusion pressure versus end-tidal PCO2 response consistently increased from control values in all subjects and was greater with the higher load in 6 of 7 subjects. The ventilatory response to elastic loading was variable and inconsistent owing to the variable increase in frequency of breathing, the tidal volume always being diminished. In normal subjects, both mouth occlusion pressure and ventilation appeared to assess neural drive to the respiratory muscles in response to CO2 rebreathing; with elastic loading, only occlusion pressure continued to reflect neuromuscular output. This increased pressure response could have been mediated by neural reflex and/or intrinsic muscle mechanisms. The data suggest that mouth occlusion pressure may be a useful parameter for evaluating neuromuscular control mechanisms under conditions of increased lung elastance.


Lung surface area in various morphologic forms of human emphysema.

The relation between lung surface area and the extent and morphologic type of emphysema was examined at autopsy in 69 men. It was found to be conceptually preferable to express the area as internal surface area per unit lung volume (specific surface area) rather than to use the more conventional, inversely related, mean linear intercept for comparison with other morphometric data. In the whole group, fixed inflated lung volume generally increased with increasing per cent involvement of lung parenchyma by emphysema, and total internal surface area decreased, but those changes were not so regular as the decline in specific surface area with increasing per cent emphysema (r=-0.574). Lungs with no emphysema had a significantly higher specific surface area than did lungs with very little emphysema (1 to 9 per cent), suggesting noticeable effects on the physical properties of lung by minimal degrees of this disease at high levels of inflation. The way in which specific surface area decreased with increasing percentage of emphysema was not noticeably different among patients with centrilobular, panlobular, or mixed forms of emphysema, although lungs with only centrilobular emphysema were much more common and had a significantly lower mean percentage of emphysema than did those with only panlobular emphysema; the prevalence and mean percentage of emphysema of the mixed group were intermediate. These observations, coupled with the association of older mean age with increasing percentage of emphysema, were interpreted as support for the concept that many examples of panlobular emphysema are derived from confluence of extensive centrilobular emphysematous lesions.


Pulmonary sporotrichosis: Treatment with miconazole.

Intravenous miconazole, an investigational, broad-spectrum, antifungal imidazole drug, was clinically effective when used for the first time in a patient with life-threatening sporotrichosis. Miconazole was used after drug resistance and treatment failure occurred in a patient with extensive, cavitary, pulmonary infection with Sporotrichum schenckii. He had first been treated with amphotericin B, and then with amphotericin B and flucytosine in combination. Side effects of miconazole included itching, diarrhea, and phlebitis. Clinical improvement occurred despite plasma concentrations below those needed for complete inhibition of the patient's organisms in vitro.


Antioxidants and cancer. Part VI. Selenium and age-adjusted human cancer mortality.

The possible epidemiologic relationship between selenium occurrence and cancer mortality was studied in cities and states located in areas with different levels of selenium bioavailability. Statistically significant differences were found in age-specific cancer death rates among states with high, medium, and low selenium levels. The death rates for specific types of cancer showed a larger difference in males than in females in the states with high selenium levels. The greater difference between males and females may be related to sex difference or to the fact that males are heavier smokers and are aslo more likely to be exposed to industrial pollution. In the states with high selenium levels, there was significantly lower mortality in both males and females from several types of cancer, particularly the environmental problem indicators, such as gastrointestinal and urogenital types of cancer.


Respiratory effects of occupational exposure to an epoxy resin system.

A standardized respiratory questionnaire and pulmonary function tests were used to examine thirty-four employees of a snow-ski manufacturing plant, including twenty-five workers who were exposed to an epoxy resin system containing the amine hardener 3-dimethylamino propylamine (3-DMAPA). Maximum expiratory flow-volume curves were obtained on Monday and Thursday, before and after each shift, and FVC, FEV1.0, MEF50%, and MEF25% were caculated. Environmental measurements of the total amine levels were found to range from 0.41 to 1.38 ppm. The group with the greatest exposure (0.55-1.38 ppm) showed significant decreases in lung function over Monday and over the week. Although all employees in this group showed decreases in pulmonary function, acute changes were greater in present cigarette smokers and in subjects who reported respiratory symptoms upon exposure to the epoxy resin system. There was no evidence of permanent loss of lung function in subjects with either the highest or longest exposure.


Cell vs. noncell airway temporal response in rats exposed to sulfur dioxide.

A modification of the sulfur dioxide (SO2)-exposed rat model proposed by Reid for the study of chronic bronchitis was employed to evaluate mucus retention and cytologic changes. Rats were exposed to from 600 to 700 ppm of SO2 for 3 hours per day, and groups were examined after 0, 9, 18, and 30 hours of cumulative exposure. Tracheal mucus retention and statistically significant increases (two- to four-fold) in the amount of solid material (cellular and mucus) recovered by bronchia lavage developed as a function of exposure time. The increase in bronchial solids was primarily due to inflammatory cells. The goblet cell population in secondary bronchi declined initially, with a significant increase after 30 hours of exposure (P less than .001). The cytologic data provide additional support to Reid's suggestion that the SO2-exposed rat may be considered as a chronic bronchitis model.


Adult mortality in two communities with widely different air pollution levels.

Mortality experience was determined over a 13-year period (1960-72) for sample populations in two small Pennsylvania communities with widely different air pollution levels. The sample populations had been the subject of a Public Health Service study at the beginning of the period and air quality measurements were made at that time. The influence of smoking on mortality was clearly evident. A relationship was suggested between mortality rate and length of residence in the polluted community (age-adjusted), but not in the control community. The hypothesis is suggested that immigrants to a polluted area are a self-selected, unusually healthy group. While the small population size precluded definitive conclusions on the influence of air pollution on mortality, it appears that those with over 20 years exposure to air pollution in the polluted community (151 mug/m3 suspended particulate, 3.7 mg/100 cm2/day sulfation rate) have about one-tenth the excess mortality of those smoking one pack of cigarettes a day in the control community (109 mug/m3, 0.6 mg/100 cm2/day). The data are consistent with the hypothesis that the effects of smoking and air pollution are additive.


Trace metal studies in Bushman hair.

Bushman women appear to have sufficient stores of iron and zinc during pregnancy and lactation; as a result, iron deficiency anemia is rare in Bushman women, even in pregnancy. Hair samples from Bushman women (young nonpregnant, lactating, and postmenopausal) and men were analyzed for iron, zinc, and copper content. Values obtained were compared with those for groups of Bantu and American inner-city mothers. Mean iron levels in the hair were found to be high (173 ppm) for lactating Bushman women, as compared with 43.2 ppm in the group of Bantu women, and 22.9 ppm in the group of American inner-city women. Zinc levels also were higher in the Bushman women. Mean copper values were much higher in the American inner-city mothers (19.9 ppm) than in the Bushman women (8.0 ppm) or in the lactating Bantu women (9.9 ppm). The sum of the metals may be more important than the individual concentrations.


Low-tar and high-tar cigarettes.

Mice were exposed for 7 to 8 minutes on weekdays to fresh smoke from high-tar (HT) or low-tar (LT) cigarettes for varying periods of up to 36 weeks. Mice exposed to HT cigarettes exhibited more marked alterations in humoral immune responsiveness, hematological profiles, and pulmonary pathologic findings than those exposed to LT cigarettes. However, cell-mediated immune responsiveness to both bacterial and tumor-specific antigens was depressed similarly in animals exposed to HT or LT cigarettes. Furthermore, the growth rates of subcutaneously established tumors were enhanced similarly in the two groups, with respect to those in control animals.


[Plant antigens with immunological properties. II. Further studies of the chemical characteristics and immunological properties of a grass pollen extract].

This second study carried out on an extract of two grass pollens (Poa pratensis and Phleum pratense) demonstrated the presence of N-acetilglucosamine and sialic acid in the extract (RFEX). Moreover the extract has confirmed its characteristics biologic activity i.e. the inhibition of the phenomenon of immune hemolysis with a different technique too, even having the antibodies of the treated animals the complement fixing activity. No appreciable changes of the immunoelectrophoresis pattern in the serum of the immunized mice have been noticed.


Vagotomy and drainage procedure for duodenal ulcer: The results of seventeen years' experience.

During the 10 years prior to January, 1968, 455 duodenal ulcer patients were operated upon at the University of Florida affiliated hospitals. The early results were reported in 1969. The present study is a followup of the same patients now 7 to 17 years after vagotomy and drainage. Twenty-four per cent were lost to followup. The ulcer recurrence rate was 5.8 per cent. All the recurrent ulcers that were not gastric in location (4.9%) occurred within 5 years after the original operative procedure with a mean of 2.6 years. The gastric ulcers (0.9%) occurred at a much later date with a mean of 6 years. It is concluded that vagotomy and gastric drainage is a satisfactory modality of therapy for duodenal ulcer. It can be accomplished with an acceptable morbidity and mortality and the long-term recurrence rate is low. If recurrences due to incomplete vagotomy do not occur within 5 years, they are unlikely to recur.


A porspective study of parietal cell vagotomy and selective vagotomy-antrectomy for treatment of duodenal ulcer.

A prospective, randomized, study involving 92 patients who required elective operation for treatment of duodenal ulcer was performed to compare the results of Parietal Cell Vagotomy (PCV) and selective vagotomy-antrectomy Billroth I (SV-A-BI). The protocol was broken twice. One patient was unable to undergo PCV because of pyloric stenosis and one patients underwent Billroth II anastomosis instead of Billroth I because of post-bulbar stenosis. Performance of PCV was never aborted because a patient was obese. There were no deaths. Diarrhea, dumping and other gastric complaints were less frequent after PCV than after SV-A-BI for all time periods studies up to two years. Two months after operation, the Hollander tests were negative in 59% of patients after PCV and in 100% after SV-ABI. Inhibition of Bao and MAO were also significantly less after PCV than after SV-A-BI. Since vagotomy of the parietal cell mass was identical in both groups of patients it was concluded that the differences in the secretory rates and the fewer negative Hollander tests in the PCV group than in the SV-A-BI group were due to retention of the antrum irrespective of its innervation. There was no explanation for the gradual increase in the BAO in the PCV group. One recurrent ulcer occurred in the PCV group in a patient who overindulged in alcohol and aspirin. After 4 days of medical management, this superficial ulcer healed as demonstrated by endoscopy. There were no recurrent ulcers after SV-A-BI. As a result of this study, it is concluded that PCV is superior to SV-A-BI because of the lower frequency of postoperative complications, diarrhea, dumping and other symptoms associated with gastric surgery. PCV may be the operation of choice for the elective treatment of duodenal ulcer; however, it remains undetermined whether the recurrent ulcer rate following PCV will be sufficiently low that the procedure can retain a position of superiority over SV-A-BI.


[Studies of the enterotoxin production capacity of L forms derived from enterotoxic strains of Staphylococcus aureus].

The production of enterotoxin by L-forms obtained from strains of Staphylococcus aureus (10 enterotoxin A-producing strains, 7 enterotoxin B, 2 enterotoxin C and 1 which produced both enterotoxins A and C) has been studied by agar-gel diffusion technique. Using a proper technique, enterotoxin could be detected for 4 L-forms; 3 of these produced the same enterotoxin as parent strain (2 enterotoxin A and 1 enterotoxin B). As regards the other L-form, obtained from strain of St. Aureus which produced both enterotoxins A and C, only enterotoxin A could be detected.


Complications of vagotomy in the treatment of hiatal hernia.

Inclusion of vagotomy and pyloroplasty in the surgical treatment of gastroesophageal reflux associated with hiatal hernia has long been controversial. To evaluate the morbidity of vagotomy in the treatment of reflux esophagitis, a retrospective study of 311 patients treated by the Hill posterior gastropexy technique of hiatal hernia repair was tabulated. Vagotomy with the anti-reflux operation was performed upon 159 patients (51%). Vagotomy was not included for 152 patients (49%). The incidence of postoperative symptoms with or without vagotomy was almost equally divided--41% without vagotomy and 47% with vagotomy. However, the major postoperative symptoms that occurred in both groups were abdominal cramps and bloating which usually disappeared in the early postoperative period and were attributed to the anti-reflux procedure and not to vagotomy. When vagotomy was included with the anti-reflux operation, the incidence and duration of long term, disabling postoperative symptoms were significantly increased. Diarrhea occurred two times more frequently. Nausea and vomiting occurred ten times more frequently and dumping was present only in vagotomized patients. Long term postoperative symptoms, judged on a basis of symptoms lasting longer than three months duration, occurred in 1% of patients without vagotomy and 26% when vagotomy was included. This study revealed that no additional protection against recurrent symptoms of gastroesophageal reflux or radiographic evidence of recurrent hiatal hernia was provided by inclusion of vagotomy. In conclusion, vagotomy is contraindicated in the treatment of gastroesophageal reflux except in the presence of peptic ulcer disease.


Acute demeton poisoning in a child.

An acute case of demeton poisoning in a child is described. Intially, typical signs of organophosphate poisoning were not present, and the illness was thought to be aliphatic hydrocarbon (fuel oil) intoxication. When correct diagnosis was first suspected, treatment with pralidoxime chloride and atropine sulfate produced some perilous complications, but was probably life-saving ultimately. Plasma (pseudo) cholinesterase levels 15 to 41 hours after exposure ranged from 0.24 to 0.48 international units (IU). Approximate normal value (2.5 IU) was not reached until 5 1/2 days after exposure. Transdermal poisoning by demeton was confirmed by its presence (15.4 mg/l) in the suspected fuel oil and, at high levels, in several articles of the child's clothing. Verification of expected urinary metabolites helped confirm the diagnosis of demeton poisoning. The availability of rapid blood cholinesterase field tests in hospital laboratories, especially in agricultural areas, is pointed out as an urgent need.


Total duodenal diversion for treatment of reflux esophagitis uncontrolled by repeated antireflux procedures.

The operations of Nissen, Hill, and Belsey are adequate in controlling esophaegeal reflux in the majority of patients. In a small percentage however, objective and subjective evidence of esophagitis persists in spite of repeated operations to restore lower esophageal sphincter competency. These failures are then usually treated by operative procedures of great magnitude involving organ interposition. Repeated antireflux operations directed to the gastroesophageal area may in some instances result in impairment of blood supply with an increased risk of both esophageal and gastric fistulae. In the past many observers have felt that reflux esophagitis resulted solely from the effects of acid-pepsin secretions bathing the distal esophagus. Recently experimental and clinical data have indicated the importance of duodenal contents in the etiology and perpetuation of reflux esophagitis. During a recent two year period, 6 patients with persistent reflux esophagitis uncontrolled by repeated antireflux procedures have been seen on our service. These 6 patients, underwent 12 unsuccessful antireflux operations elsewhere. Three of the 6 patients had also been subjected to vagotomy-antrectomy for a coexisting duodenal ulcer. A marked lowering of gastric acidity took place but esophageal reflux and esophagitis persisted. These three patients were treated on our service by takedown of the Billroth I anastomosis, closure of the duodenal stump and diversion of the duodenal contents into a Roux-en-Y limb. Three other patients who had undergone unsuccessful antireflux procedures alone were subjected to antral resection, Roux-en-Y diversion and transthoracid vagotomy. This simplified appraoch to the treatment of persistent esophageal reflux uncontrolled by repeated antireflux procedures has given satisfactory results. The operation should be considered when technical considerations preclude further surgical attempts to perform another effective antireflux operation. Total duodenal diversion should, however, not be considered as the primary operation for the patient suffering from reflux esophagitis. However, in circumstances discussed above this direct approach appears preferable to major resectional procedures.


[Studies of some biochemical characteristics and antibiotic sensitivity of 30 L strains of Staphylococcus aureus].

The production of coagulase, DNase and haemolysins by 30 L-forms obtained from as many strains of Staphylococcus aureus having these properties, has been studied using different techniques. All of L-strains produced coagulase, for the most part after incubation for 24 h, but only some produced DNase and haemolisins. At the same time, the sensitivities of various antibiotics of staphyloccal L-forms and the parent strains has been determined. All of L-forms, as regards to bacterial form from which they were derived, showed an high resistance to antibiotics of which the primary site of action is upon cell wall (penicillin, ampicillin, methicillin, cephalosporins, vancomycin), with the exception of bacitracin. The tetracycline was more effective against the L-forms, while the group that includes chloramphenicol, novobiocin, streptomycin, gentamycin and kanamycin inhibited coccal and L-forms about equally.


A current appraisal of problems with gangrenous bowel.

Gangrenous bowel most often results from hernia, adhesions and mesenteric insufficiency. The overall mortality rate for 151 cases was 37%. This figure was 20% for hernia, 23% for adhesions and 74% for mesenteric insufficiency. In the latter category where bowel resection was feasable the mortality rate was 40%. Other causes of bowel gangrene had a mortality rate of 28%. In many instances the pathophysiologic processes were of such a nature that current medical expertise has not reached a level of development to effectively cope with the situation. There were, however, a significant number of cases where survival may have been achieved had it not been for deficiences on the part of the patient, the primary health care personnel or those in attendence at the referral center. The basic keystone for a successful outcome in the management of patients with the gangrenous bowel problem is early surgical intervention. All will be lost if patient exposure to this source of lethal toxins is allowed to proceed to an irreversible stage. Liberal antibiotic administration probably postpones the arrival of intractable hypotension. Other factors which can be expected to improve the survival rate include minimization of technical errors, repair of incidental hernias, elemination of dependence upon nasogastric tubes for the definitive management of patients with complete bowel obstruction (with one or two exceptions), and a firm commitment to the diligent pursuit and early definitive management of postoperative complications.


[Lipids in Taenia saginata].

Lipids of Taenia saginata were analyzed by means of thin layer chromatography and gas liquid chromatography. Total lipids comprised about 3.3% of the fresh weight and consisted mainly of triglycerides (65.62%), sterols (19.58%), phospholipids (10.16%). The fatty acids of the triglycerides were mainly unsaturated and differed from those of phospholipids. The parasite has practically no "de novo" fatty acid biosynthesis, although this cestode did synthetize complex lipids from single lipids provided by the diet.


Use of aminoglycosides in surgical infections.

Most infections on the surgical ward are due to one or more gram-negative rods, acting either as the sole pathogens or as principal components in a polymicrobial flora. To date, parenteral aminoglycosides have proven to be the most effective antibiotics for control or treatment of such sepsis. Unfortunately, however, serious complications as well as therapeutic failures do occur. During a 40-month period, 405 surgical patients receiving aminoglycosides (Gentamicin, Tobramycin, Sisomicin, or Amikacin) were prospectively studied with respect to: indications for antibiotic; patient population; serum concentrations of antibiotic according to route of administration, dose in mg/kg/day, and renal function; rapidity of antibiotic excretion in the urine; causative bacteria and their sensitivities to each aminoglycoside as determined by both disc and tube dilution methods; severity and frequency of drug complications; and clinical efficacy of each study antibiotic. Results supported the contention of a superior effectiveness from aminoglycosides for established abdominal and unspecified surgical infections, more rapid development of therapeutic blood levels by intravenous administration, need to alter drug dose according to frequent serum creatinine determinations, increased drug toxicity in dehydrated and shocked patients, preventability of complicating Candida sepsis, and the importance of early as well as adequate surgical debridement and drainage.


[Detection of anti-Toxoplasma gondii antibodies in subjects with repeated abortions, perinatal mortality and malformed infants].

The AA. investigated the frequency of antibodies against Toxoplasma gondii in 426 women with repeated abortions, perinatal mortality and malformed newborns. They showed on the whole a low incidence even if they demonstrated a high incidence (77.7%) of antibodies in women with malformed newborns. The meaning of the observations are briefly discussed.


Diagnosis and management of blunt abdominal trauma.

The records of 437 patients with blunt abdominal trauma admitted to Charity Hospital, New Orleans, from 1967-1973 have been reviewed and computer-analyzed. There was an 80% increase in the incidence of blunt abdominal trauma when compared with the preceding 15-year experience. Forty-three per cent of all the patients presented with no specific complaint or sign of injury. Blunt abdominal injury was usually diagnosed preoperatively using conventional methods including history, physical examination, and routine laboratory tests and x-rays. Abdominal paracentesis via a Potter needle had an 86% accuracy. The incidence and management of specific organ injuries with associated morbidity and mortality have been discussed. Mortality and morbidity continue to be significant in blunt abdominal trauma. Isolated abdominal injuries rarely (5%) resulted in death, even though abdominal injuries accounted for 41% of all deaths. Associated injuries, especially head injury, greatly increased the risk. The insidious nature of blunt abdominal injury is borne out by the fact that more than one-third of the "asymptomatic" patients had an abdominal organ injured. A high index of suspicion and an adequate observation period therefore are mandatory for proper care of patients subjected to blunt trauma.


The healing of liver wounds.

Cases of traumatic hemobilia are often characterized by a protracted history with recurrent episodes of hemorrhage over many years. It seems that while the liver regenerates quickly and profusely it heals slowly and poorly. This is in contradistinction to the kidneys where lesions often heal within a short time. In order to investigate the cause of this peculiar behavior a series of experiments was performed where local lesions were produced in the musculature, in the kidneys and in the liver of dogs. The healing process was studied at different intervals. There was essentially no difference between the rate and character of healing in the three localities. As the lesions that produce hemobilia are open to the biliary tract, another series of experiments was performed where the healing took place in presence of bile. The effect of this was striking with a very diminished production of fibrinous exudate, granulating tissue and fibrous scar.


Selective operative treatment for tetraology of Fallot: rationale and results.

Eighty-one patients with tetralogy of Fallot malformations evaluated between July 1, 1971 and November, 1975 are presented. Fifty-one patients underwent primary intracardiac repair; three died. Twenty-seven patients were corrected after a previous palliative shunt; there was one death. Three additional patients have been palliated and are awaiting repair. While the overall mortality in these patients was less than 5%, the infants undergoing total correction before the age of two years appeared to be at greater risk (25%). There were no deaths in the group of patients undergoing palliative procedures. Based on these data it appears that a safely performed palliative shunt in the symptomatic small infant is a reasonable first step, particularly if the outflow tract of the right ventricle is diffusely hypoplastic.


Peripheral arterial injuries: a reassessment.

Ninety-four patients with peripheral arterial injuries were subjected to acute repair, negative exploration, or late repair of the complications of the arterial injury (false aneurysm, A-V fistula, and/or limb ischemia). The causes of failure after acute injury include extensive local soft tissue and bony damage, severe concomitant head, chest or abdominal wounding, stubborn reliance on negative arteriograms in patients with probable arterial injury, failure to repair simultaneous venous injuries, or harvesting of a vein graft from a severely damaged extremity. There is a positive correlation between non-operative expectant treatment and the incidence of late vascular complications requiring late arterial repair. Delayed complications of arterial injuries occurred most frequently in wounds below the elbow and knee.


Tibial and peroneal bypass in severe occlusive disease of the lower extremities.

Symptomatic arteriosclerotic occlusive disease involving the femoral and proximal popliteal arteries is currently best treated by reversed autogenous saphenous vein bypass graft. Severe occlusive disease frequently includes the popliteal and/or origin of the trifurcation vessels with reconstitution of one or more of the vessels in the lower leg. We have used distal bypass 97 times in 90 patients during the past decade. There was only one postoperative death in the series in spite of the advanced age and concurrent disease in the majority  of the patients. Our indications for operation continue to be relief of pain or salvage of an extremity. We rely on high quality preoperative angiograms for selection of vessels to receive the bypass. The posterior tibial artery was used in 63 of the cases, while the anterior tibial and peroneal were used in 24 and 10 cases, respectively. There were 11 immediate inhospital failures in this series of 97 cases requiring amputation in five. Three additional patients had amputations during the ensuing several months. Of the 85 grafts functioning at the time of discharge from the hospital, 16 or (18.8%) failed during the first years. Grafts that remained patent for one year have a high incidence of long term patency which is in keeping with other reported series.


Pneumonectomy: review of 351 cases.

Among 351 patients undergoing pneumonectomy, the mortality was 6%, and when the operation was performed for malignant disease, the mortality was 8.5%. Much of the risk of the operation is associated with the age, physiologic state, and associated diseases which are prevalent in patients who require pneumonectomy. The conduct of the operative procedure itself is of paramount importance since complications clearly increase the mortality. Operative mishaps predispose to postoperative complications, and the addition of postoperative problems to the operative complications combine to bring the mortality to 24%. Careful hemostasis, meticulous technique, fluid and blood replacement, as well as careful preoperative and postoperative management combine to produce an acceptable mortality in this serious procedure.


Repair of inflammatory tracheoesophageal fistula.

Benign acquired tracheoesophageal fistula is uncommon. Erosin of the membranous wall of the trachea and the anterior esophageal wall by the high-pressure cuff on a tracheostomy tube, often against the anvil of a nasogastric tube, may produce such fistulas. Techniques for closure have included patching the tracheal defect with muscle and, often, multiple staged procedures, planned or unplanned. Since any cuff lesion severe enough to cause a fistula necessarily damages the trachea circumferentially at the same level, definitive correction must include circumferential tracheal resection as well as closure of the fitstula. Five patients with tracheoesophageal fistula due to cuff perforation had repair by such a single-stage procedure. Through an anterior approach the involved trachea was resected, primary anastomosis was done, and the esophagus was closed in layers. In 3 of these 5 patients muscle was interposed for added security. One patient had undergone a prior attempt at repair elsewhere. One required a second resection of trachea for subsequent stomal stenosis. Repair in 2 additional patients with fistulas of complex origin related to direct trauma, sepsis, and foreign body involved adaptation of the basic technique to the special problem; 1 of these procedures was necessarily staged. Results in all 7 patients have been good.


Interruption of patent ductus arteriosus in premature infants with respiratory distress syndrome.

In infants with respiratory distress syndrome (RDS) hypoxemia inhibits closure of the patent ductus arteriosus (PDA), resulting in increased pulmonary blood flow with subsequent increased hypoxemia. In an attempt to interrupt this cycle 42 consecutive premature infants with RDS and PDA, weighing between 550 and 2,000 gm (average, 1,383 gm) and with an average gestational age of 31 weeks, were arbitrarily treated either medically (13 patients) or by interruption of the PDA (20 patients). Eleven patients who were initially treated medically could not be weaned from the respirator and later underwent operation. There were no operative or anesthetic deaths; late survival was 65% (20 patients). The last 31 patients were randomly divided into operative and nonoperative groups. Preliminary results revealed no significant differences in late survival between the two groups. Since the operative risk is minimal, further investigative efforts are indicated to settle this issue.


Patent ductus arteriosus ligation and respiratory distress syndrome in premature infants.

Ligation of a patent ductus arteriosus was carried out in 22 premature infants, 20 with concomitant respiratory distress. The duration of high-volume shunting is critical in determining the prognosis for these infants. Because of the low surgical mortality and morbidity and the high incidence of bronchopulmonary dysplasia in babies managed conservatively, infants with respiratory distress syndrome (RDS) who are respirator dependent should undergo ligation as soon as the presence of large left-to-right shunting is detetmined. Premature infants without RDS or those with mild RDS who are not respirator dependent can be managed medically or with elective ligation. Surgical intervention is strongly indicated in patients with persistent congestive heart failure and respiratory failure. Echocardiography offers an accurate and risk-free approach to the early diagnosis of a large left-to-right shunt through the ductus.


The ductus debate: ligation in prematurity?

This report describes 20 premature infants who have undergone surgical ligation of a patent ductus arteriosus (PDA), diagnosed solely by physical examination in all but 2 instances. There were no operative deaths. Eleven of these 20 infants had severe associated hyaline membrane disease (HMD) necessitating mechanical ventilatory support from the first or second day of life. Only 3 of these 11 infants (27%) ultimately survived to leave the hospital. In contrast, 8 of 9 premature meonates (89%) with severe congestive heart failure but without HMD were discharged alive. Surgical ligation of the PDA in a premature infant is an appropriate and successful mode of treatment when congestive heart failure is refractory to medical management. Proof is lacking, however, to establish the efficacy of PDA ligation in the premature infant with HMD.


Outpatient management of intercostal tube drainage in spontaneous pneumothorax.

In a series of 226 patients with spontaneous pneumothorax, 167 (74%) were managed successfully on an outpatient basis by observation (20%) or by intercostal tube drainage and a flutter valve (54%). Only 59 patients (26%) were hospitalized, and 42 of these were treated surgically (18.6%). Outpatient management with a flutter valve has proved to be safe, efficient, and economical.


Cardiac performance and oxygen consumption during intracardiac operations in children.

Cardiac performance and oxygen consumption in 30 patients undergoing surgical treatment for congenital cardiac disease were determined from intraoperative measurements. Arterial pressure, cardiac index, mean left ventricular hydraulic output power, pulmonary artery oxygen saturation were obtained at average mean left atrial pressures of 8.1 and 15.2 cm H2O after cardiopulmonary bypass in 20 patients. These same variables were measured at an average pulmonary artery saturation of 65 and 75% in 30 patients. A composite of measurements of cardiac performance was desirable to guide precise patient care intraoperatively, especially if myocardial function was compromised. It is suggested that left atrial pressure be maintained at a level that results in a pulmonary artery saturation greater than 65%.


The effects of sterilization and storage treatments on the stress-strain behavior of aortic valve leaflets.

An investigation was made of the feasibility of using tensile tests to detect alterations in the molecular structure of aortic valve tissue brought about by sterilizing or storage treatments. Stress-strain tests were carried out on fresh valve leaflets from pigs and repeated with the same specimens after specified sterilization or storage treatments. It was found that the stress at a given strain was increased by treatment with ethylene oxide, buffered formalin, and tissue culture solution and decreased by treatment with antibiotics. The least change was with tissue culture solution and antibiotics. It has been suggested that the best method of allograft sterilization should involve minimal structural alteration to the collagen and elastic  components of the tissue. Thus, treatment with tissue culture solution and antibiotics seems appropriate.


Carbon monoxide accumulation during extracoporeal membrane oxygenation for acute respiratory failure.

A marked increase in the carbon monoxide level in the blood sufficient to interfere with oxygen binding of hemoglobin was observed in a 43-year-old man during the course of extracorporeal membrane oxygenator support for acute respiratory failure from viral pneumonitis. The increased carbon monoxide level in this man was temporally related to the transfusion of large amounts of old bank blood. The etiology of an increased level of carbon monoxide in the blood during extracorporeal circulation is discussed and solutions to this problem are suggested.


[Value of fibrinogen level measurement in neonatal infections due to maternal  contamination].

Fibrinogen, factors V, II and VII + X assays have been performed by micromethod on day 1, 2 and 3 in 275 newborn infants (full-term and premature) over a period of one year -- 20 infants had proved bacterial infection (from maternal contamination) with positive cultures. The control group included 20 normal newborns in the same range of gestational age. The increase of the fibrinogen level in the infected infants appeared to be significant on day 1 and 2 but not on day 3 (Day 1: 4,06 g/l +/- 0,74 g/l versus 2,06 g/l +/- 0,28 g/l in normal newborn. p less than 0.0001; on Day 2: 4,20 +/- 0,86 g/l versus 2,32 g/l +/- 0,09 g/l p less than 0.001; on Day 3: 3,68 g/l +/- 0,62 versus 3,36 +/- 0,66 g/l). The level of fibrinogen measured in the newborn period by the micromethod was in a accordance with former works showing that it is up th the adult value after the 3rd day of life. Since the micromethod on capillary blood requires only 140 microliters of blood (whereas 2 ml with macromethod) this fibrinogen determination appears to be a rapid and reliable method for the diagnosis of neonatal infection due to materno-fetal contamination.


[Kniest's disease, (a familial case)].

Kniest's disease (spondylo-epiphyseal dysplasia) was recently described by Maroteaux and Spranger. A second familial case is studied. Transmission of the disease occurred as a dominant trait.


[Infantile and juvenile hypothyroidism with the gland in place and low radio-iodide uptake].

27 hypothyroid infants of children, with a low iodine uptake in spite of a thyroid gland or thyroid tissue in normal pretracheal place, have been studied. 21 cases are related to primary thyroid involvement leading to vanishing iodine or technetium uptake. In 8 of these cases, clinical onset in late childhood, high frequency of antithyroid antibodies and of familial thyroid dysfunction were similar to those found in childhood's thyroiditis. 8 other cases had a precocious onset (first months in 6, first year in 1, second year in 1) with some pretracheal iodine uptake when first studied and no uptake at further examinations, 1 patient having received no treatment from first to second study, the others being without treatment from more than two months and certain of them receiving injections of TSH. The last 5 cases of this group were those of children born to 2 mothers with treated hypothyroidism, with low iodine uptake in pretracheal place. The role of genetic factors and auto-immunity in theses cases is discussed. The 6 other patients had clinically isolated hypothyroidism secondary to TSH deficiency, eventually associated to clinically inapparent GH or ACTH deficiencies, most of them by hypothalamic defect with normal response to TRH.


[Stimulation by the propranolol-glucagon test of somatotropin secretion in 71 children. Results, statistical study and comparison with the insulin-arginine test].

Two tests of stimulation: insulin + arginine and propranolol + glucagon were successively performed in 62 children who were either normal or had essential growth retardation. Average peak value was 10.6 +/- 1.1 ng/ml in the first test and 22.8 +/- 1.4 ng/ml in the second. In 56 cases the response obtained with propranolol + glucagon was higher than that obtained with insulin + arginine. Twenty-four false negative results were obtained employing insulin + arginine, stimulation by propranolol + glucagon resulting in normal values. The determination of the confidence interval at 95% and of the 3rd percentile did not allow to establish the lower threshold for the insulin + arginine test. For the propranolol + glucagon test 7.6 ng/ml for the interval at 95% and 8 ng/ml for 3rd percentile were found as minimal threshold. Therefore, a response below 8 ng/ml should be considered as pathological with the latter test.


[Incidence of mother-child contamination by Candida albicans during labor].

Two different studies assessed that materno-fetal contamination at time of delivery is not the usual way of colonization of newborns with Candida albicans. In a first study, occurence of Candida albicans in neonate units disappeared owing to prophylactic measures, such as strict care in hospital hygiene. In a second study, detailed herein and performed in an obstetric ward, it was found that despite a rate of vaginal Candida carrier of 19 %, candidiasis in newborns was exceptional.


[Salt-losing syndrome in newborn infants with hyperaldosteronism. Presenting a sensitivity to mineralocorticoids. Pseudohypoaldosteronism].

A case of salt-loosing syndrome in infancy with hyperaldosteronism is reported. This patient was given high doses of 9 alpha Fluorocortisol (0.1 mg/kg/24 h), together with salt supplements. This treatment corrected the abnormality, while higher doses of salt supplements without such large amounts of Flurocortisol were ineffective.


[Hemophagocytic reticulosis with hypertriglyceridemia].

This syndrome is characterized by a hyper-triglyceridemia associated with a deficiency of the plasma lipolytic activity induced by heparin infusion. All signes ascribed to familial lymphohistocytosis were found in this patient. When a diagnosis of acute reticulosis in children is made, such biological characteristics should be searched for. Since in systemic lupus erythematosus an acquired and analogous type of hyperlipidemia has been described, the hypothesis of an immunological pathogenesis in familial lymphohistiocytosis may be plausible.


An electron microscopic study of the ciliated cells in the human gastric mucosa.

Ciliated cells were found in the mucosa of the human stomach in three patients. In two cases they occurred in the pyloric mucosa of patients with intestinal metaplasia who were operated on for duodenal ulcer. In the other case, they occurred within a polypoid lesion. They were located in small limited areas. The cells were densely ciliated, each cilium showing a typical 9+2 fibrilar pattern. Ciliated cells are not found in normal gastric mucosa and this suggests that they occur only in pathologically altered mucosa.


Interosseous muscles in claw finger.

The third and fourth fingers of the normal hands of 75 adult subjects were tested for active finger extension with the wrists in neutral position. Seventy-two of the subjects could not actively extend the interphalangeal (IP) joints when the metacarpophalangeal (MCP) joints were passively and maximally extended. However, the IP joints could be passively extended without pain in 67 subjects and with pain in 5 subjects. This indicated that the inability to actively extend the IP joints when the MCP joints were maximally extended is seldom due to tightness of the flexor tendons. Electromyographic recordings of the interossei muscles in one subject showed voluntary activity of these muscles with the MCP joints maximally extended while the IP joints remained flexed. A macrospoic study was made of the dissected third and fourth fingers of five embalmed cadaver hands and, in two of these specimens polygraphic recordings were made with the use of the strain gauge. In each of these specimens, when traction was applied in the appropriate interosseous muscle, movement of the lateral band of the extensor aponeurosis was noted when the MCP joint was at neutral or slight flexion, while no motion could be detected when the MCP joint was in maximal extension. Thus, maximal extension of the MCP joint blocks not only the action of the extensor digitorum communis tendon, as shown by Mulder and Landsmeer, but also blocks the action of the interossei in extension of the fingers. This explains the mechanism of development of claw finger in those cases without intrinsic hand muscle paralysis.


Hand dominance and scoliosis in Duchenne muscular dystrophy.

Twenty-three patients with Duchenne muscular dystrophy and scoliosis were studied. In all but one patient the major convexity was to the side of the dominant hand. The unsupported growing spine is easily unbalanced by asymmetrical forces imposed on it. From our observations we believe major use of a single upper extremity will result in scoliosis with the major convexity toward the side of the dominant hand. Management should include counterbalancing the postural abnormality imposed by hand dominance as well as unloading the spine frequently during the patient's waking hours.


Benign hydroarthrosis of knee in patients with spinal cord injury.

Swelling of the knee joint occurred in 8 of 35 patients with spinal cord injury; in seven of the eight patients the swelling developed within the first eight months after injury. Six of the eight patients had flaccid paraplegia. None of the patients showed any constitutional or local changes other than swelling. No laboratory evidence of inflammation could be detected. Swelling disappeared in two to six weeks and no sequelae were noted. Although trauma appeared to be the most likely cause of the swelling. Only one of four joints showed hemarthrosis on aspiration.


Marriage and divorce after spinal cord injury.

The outcome o,f marriages contracted after spinal cord injury suffered by males was examined via the questionnaire method. Of those whose first marriage occurred after their injury, the divorce rate was 24.4%. Of those whose were married prior to injury and then remarried following injury, 16.4% were divorced. If all post-injury marriages are considered, the divorce rate is 23.1%. This is close to the divorce rate of the United States as a whole. The outcome of post-injury marriages was also examined with respect to time since injury, level of injury, presence of post-injury children, and post-injury education and employment. Particular attention was given to those males who had never been married prior to their injury.


Ankle-knee synchronous in a new endoskeletal above-knee prosthetic mechanism: a preliminary report.

A new above-knee prosthetic mechanism with synchronous motions of the knee and ankle has been designed based on kinematic principles. Knee flexion is synchronized with ankle dorsiflexion by a synchronizer rod and lever. Unlike other above-knee units, the knee joint is aligned about one inch in front of a line between the hip and the ankle joints, which appears to decrease the energy requirements of gait. The swing-phase control system provides constant friction during ordinary cadence and variable friction during rapid swinging of the leg. The addition of a quadrilateral socket, a modified SACH foot and a cosmetic foam plastic cover provides the complete endoskeletal above-knee prosthesis. The resulting gait has been found to be faster, easier and more natural, and the three optional knee settings serve the needs of different amputees and activities.


A mechanical resting surface: its effect on pressure distribution.

This study demonstrates the potential effectiveness of a dynamic resting surface which, at regular intervals, provides sitting patients complete relief of pressure for short periods of time. Resting pressure extremes ranged from 0 mm Hg to 160 mm Hg, depending on the position of the roller supports. At all positions, including the area beneath the ischial tuberosities, the pressures were well within the range of capillary pressure and usually dropped to zero pressure at regular intervals. This mechanical surface may be the beginning of a new concept in resting surfaces. In addition to providing intermittent relief of pressure to the sitting area, the surface lends itself and the patient to a mobility that has not been heretofore possible.


Inhibition of cellular DNA synthesis in hamster kidney cells infected with western equine encephalitis virus.

Infection of BHK cells with western equine encephalitis (WEE) virus resulted in rapid inhibition of cellular DNA synthesis. The rate of inhibition of DNA synthesis depended on the multiplicity of infection, and was closely related to virus replication. Cellular DNA synthesis was not inhibited in infected BHK cells that had been irradiated with ultraviolet radiation. These results indicated that a functional viral genome was required for the inhibition of DNA synthesis by WEE virus. The sharp decrease in thymidine incorporation into the acid-insoluble fraction was not due to a change in the intracellular pool of the acid-soluble fraction. Sedimentation analysis in alkaline sucrose gradients was used to show that cellular DNA was not degraded during WEE viirus infection. DNA polymerase activity in infected cells was not significantly reduced.


Characterization of Orungo virus, an orbivirus from Uganda and Nigeria.

Orungo virus was studied in cell culture and mice by light and electron microscopy. The virus developed in the cytoplasm of infected cells in mouse brain and cell culture in association with a specific viral granular matrix and accompanying filaments. Virus particle size was 63 nm with a core diameter of 34 nm. Most particles were released from infected cells by lysis, but some budded through membranes and assumed a "pseudoenvelope". In its morphology and mode of morphogenesis, Orungo virus was indistinguishable from other described orbiviruses.


Kinetics of heat inactivation of Venezuelan equine encephalomyelitis virus.

Thermal inactivation of Venezuelan Equine Encephalomyelitis Virus (VEEV) was studied at temperatures from 26 degrees to 55 degrees C. Inactivation of infectivity took place by two thermodynamically different reactions, one of which predominated at temperatures below 44 degrees C and the other at higher temperatures. The presence of 1 or 2 M NaCl stabilized the VEE virus at low temperatures but enhanced the inactivation at high temperatures. This latter effect at temperatures higher than 50 degrees C, is associated with the occurrence of two-component survival curves. The different effects of hypertonic NaCl concentrations at the two ranges of temperature, are related to different mechanisms of inactivation operating at each range (protein denaturation and nucleic acid-RNA breakdown). Different kinetics of thermal inactivation at 55 degrees C were observed between virus strains with different virulence. However, no significant correlations was found between the virulence of the eleven VEE virus strains studied and their thermostability at 37 degres and 55 degrees C.


Demonstration of non-infectious hemagglutinating particles of rabies virus and isolation of the hemagglutinin by disruption of the virion with Nonidet P-40.

Non-infectious hemagglutinating particles of rabies virus accumulated in the fluid phase of chick embryo cell cultures at 6 days post-infection, though they were undetectable at 4 days. They were characterized as looped filaments resembling viral envelope as revealed by electron microscopy. Another form of hemagglutinin (HAnin) was obtained by solubilization of partially purified virions with Nonidet P-40 (NP-40) followed by successive high speed and CsCl density gradient centrifugations. The density of the isolated HAnin averaged 1.28 g/cm3. SDS-polyacrylamide gel electrophoresis of the HAnin demonstrated that it was mainly composed of a glycoprotein (G) with a molecular weight of 83,000. Electron microscopically, it differed from the above non-infectious hemagglutinating particles, being much smaller in size and showing a star- or rosette-like appearance with a diameter of about 25 nm, composed of a central particle surrounded by particles resembling envelope-spikes. Virus-neutralizing (VN) and hemagglutination inhibiting (HI) antibodies were produced in rabbits immunized with the HAnin isolated from virions.


Disease markers in acute multiple sclerosis.

Three serum components that are known to become elevated during inflammation and tissue destruction, C-reactive protein, C3 proactivator, and orosomucoid, which are acute phase reactants, and serum lgM were measured in patients with multiple sclerosis (MS) hospitalized with acute exacerbations. Significantly elevated levels of one or more of these serum components were found in 12 of 13 patients with clinically active MS. Serial studies in two patients revealed that clinical improvement was accompanied by a decline in the serum levels of these factors. These findings suggest that measurement of these serum proteins may be of value in assessing progress of disease activity in MS patients.


Perioptic meningiomas. Syndrome of long-standing visual loss, pale disk edema, and optociliary veins.

Three patients had a syndrome of progressive or long-standing visual loss, pale disk edema, and optociliary veins, indicating that a spheno-orbital meningioma had invaded the anterior perioptic meninges. To diagnose this syndrome, one must distinguish "disk edema" from "papilledema"; although both result from increased pressure within the perioptic subarachnoid space, disk edema is caused by a variety of lesions just behind the globe, whereas papilledema is caused by remote lesions that raise intracranial pressure. Optociliary veins reflect the slowness of progression of both processes. This ophthalmoscopic diagnosis carries important implications, namely, that the tumor grows very slowly and that surgical treatment will not improve vision. Therefore, excision may not be the treatment of choice.


Progressive spastic paraparesis and adrenal insufficiency.

A 10-year-old boy with progressive paraparesis, personality change, and seizures had laboratory evidence of adrenal insufficiency. Pathologic study showed cerebral edema, but no loss of myelin. Notable pathologic changes were limited to the spinal cord, where the corticospinal and spinocerebellar tracts were demyelinated. Lipid analysis of the brain was normal apart from the finding that galactocerebroside contained a higher proportion than normal of alpha-hydroxy fatty acids. We suggest that this case represents a distinct disease, differing importantly from adrenoleukodystrophy. The underlying defect appears to be in the early enzymatic pathway before cholesterol synthesis, although it is also possible that the defect is at the cell membrane.


Acute renal failure. A complication of cerebral angiography.

Acute renal failure after cerebral angiography is, to our knowledge, previously undescribed, yet well documented after other forms of angiography and intravenous urography. We will describe four patients with this complicaton and discuss factors in its pathogenesis.


Somatic anxiety attacks and propranolol.

Patients with acute anxiety-like attacks are often evaluated for various medical conditions, and, when nothing is found, their symptoms are attributed to psychogenic causes. "beta-Adrenergic hyperactivity" should be considered in these patients. Six patients are described who, we believe, are suffering from this condition. Low rates of isoproterenol hydrochloride infusion-precipitated symptoms that mimicked their spontaneous somatic anxiety attacks. Treatment with propranolol hydrochloride produced longterm symptomatic relief.


Hypothenar Dimpling. A peripheral equivalent of Hemifacial Spasm?

In two patients, the skin over both hypothenar eminences underwent intermittent, spontaneous, irregular, dimpling contractions. The dimpling was benign, and was the result of spontaneous discharge of motor units in the palmaris brevis muscle. Electrophysiological investigations localized the site of origin of the discharge to the ulnar nerve, possibly at the wrist, but there was no clinical or physiological evidence of neuropathy or of nerve compression. In many respects, the clinical and electrophysiological features of hypothenar dimpling resemble hemifacial spasm.


Cell volume and permeability of oxygen-and glucose-deprived retina in vitro.

Rabbit retina was deprived of O(2) and glucose in vitro for up to four hours at 37 C. Intracellular volume was measured, using inulin as an extracellular marker. After a 30-minute latency, cells swelled rapidly to more than twice normal volume while extracellular volume was unchanged. Intracellular accumulation of water was not reversed by resupply of oxygen and glucose. Permeability to small molecules was assessed with mannitol. The ratio of mannitol space to inulin space averaged 1.0 in controls. This ratio remained 1.0 up to 30 minutes of deprivation, but increased to 1.2 by 60 minutes. Permeability to large molecules was assessed from the rate of loss of isotopically labeled cell protein into the medium. There was no difference between control and deprived retinas up to three hours.


Retina subjected to components of ischemia in vitro. Selective vulnerability and minimum lethal exposure of neurons and glia to oxygen and/or glucose deprivation and to loss of exchange with incubating medium.

Rabbit retinas were incubated at 37 C in media lacking oxygen, glucose, or both, or sealed in a small compartment without medium to convert them to a "closed system." They were then returned to control medium before being fixed for microscopy. Other retinas were incubated only in control medium and then fixed. Conversion of the retina to a closed system caused irreversible damage to all cell types within 40 minutes. Combined deprivation of oxygen and glucose also irreversibly damaged the neuronal cells within 40 minutes, but Mueller cells,the principal glial cells of the retina, were not irreversibly altered by 90 minutes of the deprivation. Deprivation of oxygen alone caused irreversible damage to receptor cells in 80 minutes, but the cells of the inner nuclear layer, ganglion cells, and Mueller cells retained normal structure for at least 180 minutes. Deprivation of glucose alone damaged receptor cells in 160 minutes and the other neuronal cells in 180 minutes, but did not irreversibly damage Mueller cells by 200 minutes.


Progressive rubella panencephalitis.

A patient with progressive rubella panencephalitis developed initial symptoms of neurologic deterioration 12 years after childhood German measles. Progressive rubella panencephalitis should be considered in adolescents with progressive dementia attended by pyradmidal and cerebellar dysfunction.


Brain stem auditory-evoked responses in suspected central pontine myelinolysis.

Central pontine myelinolysis was suspected in two chronic alcoholics who developed and recovered from a progressive spastic paresis of all muscles, that derived innervation at and below the level of the pons. In both cases, short-latency auditory-evoked responses aided in the diagnosis by indicating a slowing of conduction in the pontine auditory pathway, which varied in degree with the severity of the clinical manifestations of pontine demyelination.


Perforating diathermy coagulation for retinal angiomas.

Perforating diathermy coagulation can be used efficiently to destroy large angiomas of the retina. Five patients who had developed large angiomas (greater than 5 disc diameters) in association with various retinal diseases were treated with this technique. The follow-up period ranged from 1 1/2 to 7 years, except for one case in which the patient died five days after the surgical procedure.  Several techniques of perforating diathermy are described, and the indications, surgical precautions, and complications of each method are discussed.


Visual effects of pilocarpine in glaucoma comparative study of administration by eyedrops or by ocular therapeutic systems.

Eighteen glaucoma patients each received four pilocarpine regimens in random sequence: 1% and 4% eyedrops and 20mug/hr and 40mug/hr ocular therapeutic systems. Unimportant changes in refraction, near vision, and distance vision occurred during the use of either ocular therapeutic system. Miosis with ocular therapeutic systems was almost always less intense and variable than with eyedrops. Refractive changes occurred in 12 patients following 1% pilocarpine and in 16 patients following 4% pilocarpine drops; decreased distance vision occurred in nine patients after 1% drops and in 12 patients after 4% drops. Fewer patients showed decreases in near vision. In all cases, visual effects peaked one half hour after eyedrop instillations and returned gradually toward normal in the next two to three hours. Intraocular pressure levels were within comparable ranges during all four treatments, but the ocular therapeutic systems maintained pressure at a more constant level.


Autosomal recessive retinitis pigmentosa and Coats disease: a presumed familial incidence.

Three of four siblings of normal parents had a combination of Coats disease and retinitis pigmentosa bilaterally. Our report of their respective cases is, to our knowledge, the first report of a familial incidence of the combination of the two diseases in an individual and supports the implication that Coats disease may be a genetic abnormality. The pathological process was essentially the same in all three patients, although it occurred differently in one of the three siblings and gave rise to an altered functional and clinical picture. The similarities may indicate that the convenient categories of "tapeto-retinal degenerations" are clinical variations of the same genetic abnormality.


The conjunctiva in senile lens exfoliation.

Conjunctival biopsy specimens from both eyes of a series of seven patients with evidence of unilateral senile exfoliation of the lens were examined by electron microscopy. Exfoliation fibers were found in both eyes of each patient. This evidence suggests that the conjunctiva is an independent source of exfoliation that precedes the development of exfoliation in the lens.


Clinicopathologic correlations in diabetic retinopathy. I. Histology and fluorescein angiography of microaneurysms.

A patient with adult-onset diabetes mellitus was referred with a diagnosis of malignant melanoma of the choroid of the left eye. A nonproliferative type of diabetic retinopathy was present, which was studied and documented by stereoscopic fundus photographs and fluorescein angiograms. Following enucleation, the microangiopathies were correlated histologically, using the retinal trypsin digest technique. Four types of microaneurysms were seen histologically that were believed to represent stages in the development of this lesion. Most thin-walled aneurysms tightly packed with erythrocytes did not fluoresce. Aneurysms that were hypercellular and those with thick walls showed early and late fluorescence. Intraretinal microvascular abnormalities were hypercellular dilated channels. Those that take origin from terminal arterioles are believed to represent attempts at neovascularization.


Phakomatous choristoma of eyelid: electron microscopical confirmation of lenticular derivation.

This article presents the sixth recorded example of phakomatous choristoma of the eyelid. The tumor occurred in a 4-month-old boy and was located in the lower lid near the inner canthus. The findings from light microscopy included epithelial, tubular structures with associated patches of thick, irregular basement membrane. The results of electron microscopy (ie, epithelial cells with a scarcity of organelles, homogeneous type of basement membrane, cytoplasmic microfilaments, segments of fascia occludens, and degenerated cells with peculiar interdigitations of their plasmalemmas) are all consistent with lenticular derivation, as originally proposed by Zimmerman.


Human corneal endothelial layer repair during organ culture.

Circular freeze-thaw endothelial wounds were created on paired human corneas. Ultrastructural and physiological studies were performed after organ culture (OC) incubation at 37 C from 1 to 21 days as well as on fresh noncultured controls. As early as 24 hours after injury, OC corneas demonstrated ultrastructurally intact endothelial cells at the margin of the wound, elongating and sliding toward its center. All OC corneas were completely covered by ultrastructurally intact and physiologically functioning endothelial cells by seven days of OC. These cells were approximately twice normal size. Enlarged endothelial cells that maintained deturgescence function were seen in the wounded area after 14 and 21 days of OC. None of the fresh controls demonstrated deturgescence function and in none could ultrastructurally intact endothelial cells be found in the area of the wound. This confirms our hypothesis that during 37 C OC incubation, human corneal endothelium repairs defects in its layer by cells that are physiologically and ultrastructurally intact.


Examination and Photography of donor corneal endothelium.

In a method for the routine examination of the endothelium of donor corneas before transplantation, the donor endothelial cells are examined and photographed as they undergo preservation or culture in liquid media. A specular microscope with a modified objective lens is used (working distance, approximately 9 mm). The donor corneas are kept in a special storage container that allows a direct view of the endothelium from outside the container. The endothelium of any cornea preserved in a liquid medium may thus be examined and photographed at high magnification without opening the storage container.


Mental illness in the biological and adoptive families of adopted individuals who have become schizophrenic.

In a sample of 5483 adults who had been legally adopted early in life by persons not biologically related to them, 33 were identified, from mental hospital records for whom a diagnosis of definite schizophrenia (chronic, latent, or acute) could be agreed upon by four raters. An equal number of matched controls were selected from the sample of adopted individuals who had never been admitted to a mental hospital. Ninety percent of the living parents, siblings, and half-siblings, biological and adoptive, cooperated in an extensive psychiatric interview permitting a consensus diagnosis by three blind raters. Schizophrenia and uncertain schizophrenia were found to be significantly concentrated in the population genetically related to the schizophrenic adoptees. Their adoptive relatives did not differ from the control populations in the prevalence of schizophrenic illness.


Discussion of genetics and mental health.

The preceding articles by Kety, Gershon et al., and Omenn are discussed. Ongoing research on children of one or two schizophrenic parents is described as representing the opportunity to study precipitating environmental factors.


Genetic analysis of behaviors related to the solution of a detour learning task.

A diallel cross involving five noninbred (purebred) lines of Japanese quail indicated that additive and nonadditive genetic effects had important influences on behaviors involved in a detour learning task. Social isolation for 3 hr was used to provide additional motivation which enabled detection of differences among strains. The percentage of quail, within purebred lines, that solved a 4-min detour task three or more consecutive times ranged from 52 to 72. Differences among purebreds were significant for most of the components of the learning task. Further, the data suggested strain differences associated with the successful attainment of the desired goal when there was a similar level of general activity.


Homeostatic drive counteracting selection for positive and negative phototaxis and geotaxis in Drosophila pseudoobscura.

Tested in Hirsch-Hadler mazes, Drosophila pseudoobscura is on the average geoneutral and photoneutral. Strongly geo- and photopositive and geo- and photonegative populations can be obtained by artificial selection, but upon relaxation of the selection they tend to relapse toward neutrality. This genetic homeostasis is due to natural selection favoring neutrality. Experiments are described in which artificial selection for positivity and for negativity was deliberately made so weak that it only counterbalanced the nautral selection or "homeostatic drive" and the effects of cross-migration. Under these conditions, the behavior of the population artificially selected for positivity diverges only slightly from that of the population selected for negativity, but, at least in females, both populations move closer to neutrality.


The Maudsley reactive and nonreactive strains of rats: a clarification.

The origin of the Maudsley reactive and nonreactive strains of rats and the construction of the survey of researches using them are briefly reviewed in the light of Archer's criticisms. The reasons for reasserting that they represent a valid dichotomy in emotionality are summarized.