Inhibition of food intake in the rat following complete absorption of glucose delivered into the stomach, intestine or liver.

1. Solutions of glucose or other carbohydrates were administered during the dark or light period of the circadian cycle to rats which had been only briefly deprived of food. 2. food was restored to the animals at various times after administration of a glucose load by stomach tube. With delays between loading and access to food of up to 3 hr by night and 2 hr by day, subsequent food intake was less than intake after non-nutritive loads. 3. measurement of the glucose content of the gastrointestinal tract at various times after glucose loading showed that this depression of intake was still apparent even when the rat was offered food some time after complete absorption of the stomach load. 4. infusion of a glucose solution into the duodenum or the hepatic protal vein also inhibited subsequent food intake. 5. in all cases, the inhibition of food intake was expressed as a decrease in the size of the first meal after restoring access to food. 6. these results provide the first demonstration that the entry of normal amounts of carbohydrate into the body by the physiological route is followed by depression of food intake which lasts until after absorption is complete.


Respiratory modulation of barareceptor and chemoreceptor reflexes affecting heart rate and cardiac vagal efferent nerve activity.

1. Brief stimuli were delivered to the carotid chemoreceptors or baroreceptors in dogs anaesthetized with chloralose. Chemoreceptor stimulation was achieved by rapid retrograde injection of 0.2-0.5 ml. CO2 equilibrated saline through a cannula in the external carotid artery. Baroreceptor stimulation was achieved by forceful retrograde injection of 2-5 ml. air-equilibrated saline into the external carotid artery after first clamping the common carotid artery. 2. prompt decreases in heart rate were elicited by brief sudden chemoreceptor or baroreceptor stimuli when these were delivered during the expiratory phase of respiration. The stimuli did not modify the control heart rate pattern when delivered in the inspiratory phase of respiration. This respiratory modulation of reflex effectiveness persisted when the animals were completely paralysed and the phase of the respiratory cycle was monitored through a phrenic electroneurogram. 3. single cardiac vagal efferent nerve fibres were dissected from the cut central end of the right cervical vagus nerve. They were classified as cardiac efferents by their cardiac and respiratory rhythmicity, and by their increased activity in response to stimulation of a carotid sinus nerve or to mechanical elevation of the systemic arterial pressure. These efferent fibres increased their activity in response to brief chemoreceptor or baroreceptor stimuli delivered in expiration, but did not respond to stimuli delivered in inspiration. This respiratory modulation of both reflexes persisted after bilateral cervical vagotomy.


Stretch reflex and servo action in a variety of human muscles.

1. In the long flexor of the thumb the latency of the stretch reflex and of other manifestations of servo action is some 45 msec, roughly double the latency of a finger jerk. 2. Tendon jerks are feeble or absent in the long flexor of the thumb even in subjects with brisk long-latency stretch reflexes in this muscle. This, and other facts, suggests that the nervous mechanism of the tendon jerk is different from that of the stretch reflex. 3. A muscle that has feeble tendon jerks may show a late component in the response to a tendon tap, with a latency similar to that of the long-latency stretch reflex. 4. On the hypothesis that the excess latency of the stretch reflex over that of a tendon jerk is because the stretch reflex employs a cortical rather than a spinal arc, the excess would be expected to be larger in magnitude for the long flexor of the big toe and smaller for the jaw closing muscles. This is confirmed, 5. An alternative hypothesis that the long latency of stretch reflexes in thumb and toe is because they are excited by slow-conducting afferents is made improbable by the finding that stretch reflexes with an equal or greater excess latency are also found in proximal arm muscles. 6. The long-latency stretch reflex in proximal muscles was seen most distinctly in a healthy subject who happened to have feeble or absent tendon jerks. In ordinary subjects there is often a large, short-latency, presumably spinal component of the stretch reflex in proximal muscles; and short-latency responses to halt and release are also seen, The significance of this spinal latency servo action in proximal muscles remains to be explored. 7. The Discussion argues that the available data on conduction time to and from the cerebral cortex are compatible with the hypothesis that the long-latency component of the stretch reflex uses a transcortical reflex arc, and that none of the experiments described in the present paper are inimical to this view.


Respiratory and cardiovascular interactions in ducks: the effect of lung denervation on the initation of and recovery from some cardiovascular responses to submergence.

Lung denervation in ducks, by sectioning all vagal branches to one lung following mid-cervical vagotomy on the other side, resulted in immediate bradycardia and fall in breathing frequency. Some 3-5 weeks after lung denervation breathing frequency was within the normal range but the lung inflation reflex, present in unilaterally vagotomized sham-operated ducks, was abolished. During 2 min dives there were no significant differences between sham-operated and denervated ducks in heart rate, arterial blood pressure, blood gas tensions and pH(a). However, during recovery from diving heart rate increased more slowly in denervates and breathing rate was significantly below that attained by shams, although tidal volume rose to a maximum increase of 139% to a maximum of 225% of the pre-dive value in denervates in contrast to a maximum increase of 139% of pre-dive in sham-operated ducks. Both sham-operated and denervated ducks exhibited a significant fall in diastolic blood pressure 60 sec after emergence...


Calcium conductance in relation to contractility in frog myocardium.

1. Ca inward current and the corresponding phasic component of tension were measured in frog atrial muscle under voltage-clamp conditions in Na-free (Li) Ringer solution with tetrodotoxin (TTX) added. 2. The quantity of Ca ions entering the cell upon depolarization, delta[Ca]i, was linearly related to peak phasic tension. 3. The voltage dependence of the steady-state inactivation of the Ca-carrying system, f infinity, against voltage yielded similar relationships whether determined directly from variations of Ca inward current or peak phasic tension. The Ca system was almost fully available at potentials more negative than -45 mV and almost fully inactivated at potentials more positive than +10 mV. 4. It was established that the time- and voltage-dependence of Ca current and of phasic tension are directly related. The time constants of Ca activation, tau f, were comparable in the range of membrane potential investigated (-20 to +25 mV), whether determined directly from the decay of Ca current or indirectly from peak phasic tension. 5. It was concluded that the Ca current, ICa, directly activates phasic contraction and that either parameter can be used as an indicator of the kinetics of the Ca-carrying system. Peak phasic tension was used to determine tau f further in the membrane potential range in which interference by other membrane currents renders direct analysis of Ca current difficult. 6. The tau f against voltage relationship determined from phasic tension showed that the inactivation process of the Ca-carrying system is slowest at membrane potentials around -13 mV (tau f = 55 msec) and that the rate of inactivation increases with both increasing and decreasing depolarizations. 7. It is suggested that normal repolarization in frog myocardium depends mainly on the decay of Ca inward current rather than on an increase of outward current.


Calcium-sodium antagonism on the frog's heart: a voltage-clamp study.

1. In double sucrose-gap voltage-clamped frog atrial fibres the influence of [Ca]o and [Na]o on membrane current and contraction was investigated. 2. The slow (secondary) inward current varied with [Ca]o but was almost insensitive to changes in [Na]o. In contrast, the phasic (transient) contraction initiated by the slow inward current was affected by both [Ca]o and [Na]o. 3. With moderate changes of [Ca]o and [Na]o from normal, the strength of phasic contraction at a given depolarization followed the [Ca]o/[Na]2o ratio approximately. This was best seen at membrane potentials near zero level. 4. Under the same conditions, tonic (sustained) contractions associated with prolonged depolarizations were strictly correlated to the [Ca]o/[Na]2o ratio at any potential. No interrelation between tonic tension and steady-state current was found. 5. With extensive changes in [Ca]o and [Na]o, the sensitivity of both phasic and tonic tension to the [Ca]o/[Na]2o ratio declined, the negative effect of [Na]o becoming smaller than was expected from this ratio. 6. In Na-free choline-Ringer, a strong contracture developed followed by a spontaneous relaxation. Starting from the relaxed state, application of depolarizing clamps gave rise to phasic contractions with a very slow relaxation while tonic contractions were apparently lacking. 7. The results are interpreted in terms of an energy-dependent carrier mechanism exchanging one Ca for two Na ions across the cell membrane. The model implies a strong asymmetry in the rate constants governing the chemical reactions on both sides of the membrane. The system is thought to operate close to equilibrium at any potential, thereby determining the steady level of myoplasmic Ca. The equilibrium itself is considered to shift upon depolarization. Assuming that [Na]i is constant, the steady level of [Ca]i is expected to be proportional to the [Ca]o/[Na]2o ratio, the scale factor being a function of membrane potential. 8. The carrier model suggests the occurrence of a depolarization-induced inward transfer of Ca which might be involved in the generation of tonic contractions. 9. The apparent lack of tonic contractions in the absence of external Na ions may be explained by a suppression of carrier-mediated Ca influx normally occurring upon depolarization. 10. The antagonistic effects of [Ca]o and [Na]o on phasic contraction are understood as being due to alterations of the Ca pumping system rather than changes in slow inward current.


Threshold setting by the surround of cat retinal ganglion cells.

1. The slope of curves relating the log increment threshold to log background luminance in cat retinal ganglion cells is affected by the area and duration of the test stimulus, as it is in human pyschophysical experiments. 2. Using large area, long duration stimuli the slopes average 0-82 and approach close to 1 (Weber's Law) in the steepest cases. Small stimuli gave an average of 0-53 for on-centre units using brief stimuli, and 0-56 for off-centre units, using long stimuli. Slopes under 0-5 (square root law) were not found over an extended range of luminances. 3. On individual units the slope was generally greater for larger and longer test stimulus, but no unit showed the full extent of change from slope of 0-5 to slope of 1. 4. The above differences hold for objective measures of quantum/spike ratio, as well as for thresholds either judged by ear or assessed by calculation. 5. The steeper slope of the curves for large area, long duration test stimuli compared with small, long duration stimuli, is associated with the increased effectiveness of antagonism from the surround at high backgrounds. This change may be less pronounced in off-centre units, one of which (probably transient Y-type) showed no difference of slope, and gave parallel area-threshold curves at widely separated background luminances, confirming the importance of differential surround effectiveness in changing the slope of the curves. 6. In on-centre units, the increased relative effectiveness of the surround is associated with the part of the raised background light that falls on the receptive field centre. 7. It is suggested that the variable surround functions as a zero-offset control that sets the threshold excitation required for generating impulses, and that this is separate from gain-setting adaptive mechanisms. This may be how ganglion cells maintain high incremental sensitivity in spite of a strong maintained excitatory drive that would otherwise cause compressive response non-linearities.


Lithium transport by the colon of normal and sodium-depleted rats.

1. The transport of Li by colonic epithelium has been examined in normal and Na-depleted rats. 2. Substitution of Li for Na with lumen of the conon causes the transepithelial electrical potential difference (p.d.) and short-circuit current to fall to low levels and the electrical resistance of fall moderately. Recovery occurs by fairly slowly after removal of Li. 3. Li absorption increases linearly with increasing concentration in the lumen and is significantly faster in Na-depleted rats. Increasing the luminal Na concentration reduces Li absorption from solutions of low Li concentration. 4. Comparison of absorption rates with secretion rates in rats given Li systemically, together with measurements of Li distribution across the epithelium in relationship to the transepithelial p.d. indicate that Li transport is predominatly or entirely passive. Interference with Li absorption by Na suggests, however a mucosal membrane carrier which, since Li absorption rises after Na depletion, may be increased in the Na-depleted state.


The effect of lithium on the transport of sodium, potassium and chloride by the colon of normal and sodium-depleted rats.

1. The effect of Li, given systemically or placed in the gut lumen, on the transport of Na, K and C1 and on the transepithelial electrical potential difference (p.d.) was studied in vivo in the distal colon of normal and Na-depleted rats. 2. The specific effect of Li appeared to be on the Na transport system with K and C1 transport affected only indirectly. Active Na absorption was impaired and p.d. reduced when either Li was in the lumen or given systemically. In addition with Li in the lumen, a considerable rise in the plasma-to-lumen Na flux was observed, the flux increasing progressively with rising intraluminal Li concentration. The effects were greater in Na-depleted rats. 3. The greater part of Li absorption from the colon of the rat takes place by exchange for Na, the secretion of which is much enhanced while the p.d. is reduced. This contrasts with human colon in which potassium is the ion exchanged for Li with the p.d. increased.


Effects of antrectomy or porta-caval shunting on the histamine-storing endocrine-like cells in oxyntic mucosa of rat stomach. A fluorescence histochemical, electron microscopic and chemical study.

1. The argyrophil (enterochromaffin-like) cells in the oxyntic gland area of the rat stomach contain histamine, which can be demonstrated fluorescence microscopically after exposure to gaseous OPT. After administration of L-dopa (or L-5-hydroxytryptophan), these cells produce and temporarily store dopamine (or 5-hydroxytryptamine), demonstrable by its characteristic formaldehyde-induced fluorescence. Ultrastructurally, the enterochromaffin-like cells, which have the appearance of polypeptide hormone-secreting cells, comprise two main cell types, the most predominant one having vesicular type granules (EGL cells), the second most predominant one having smaller, uniformly electron dense granules (A-like cells). 2. Rats were subjected to the following surgical treatments: antrectomy; porta-caval shunting; antrectomy+porta-caval shunting; or sham-operation. Three to eight weeks after surgery the histamine-storing cells (enterochromaffin-like cells) of the oxyntic mucosa were analysed by fluorescence histochemistry, light and (quantitative) electron microscopy, and fluorometric determination of amines. 3. After antrectomy, fluorescence histochemistry and silver staining revealed a reduced number of enterochromaffin-like cells. The histamine content in the oxyntic mucosa was reduced by about 50%. As in unoperated injection of pentagastrin seemed to mobilize histamine. Feeding or injection of insulin failed to do so in antrectomized as opposed to control rats. Ultrastructurally, the cytoplasmic granules of both endocrine-like cell types were less numerous than in the unoperated rats. The reduction in cell number and granularity was particularly conspicuous with regard to the EGL cells. 4. After porta-caval shunting the number of enterochromaffin-like cells increased markedly. Chemical determination revealed a twofold increase in the histamine concentration of the oxyntic mucosa. Feeding or injection of insulin or pentagastrin lowered the histamine concentration. As judged by electron microscopy, the proliferation of endocrine-like cells induced by porta-caval shunting was restricted to the ECL cell type. Besides occurring in greater number, these cells were larger than those in unoperated controls, and their cytoplasm was densely packed with granules that were increased in size. 5. Following antrectomy of the porta-caval shunted rats the number of enterochromaffin-like cells and the oxyntic histamine concentration was reduced. 6. The results support the idea that gastrin exerts trophic as well as excitatory effects on oxyntic endocrine-like cells.


Functional adaptation of sarcomere number of normal cat muscle.

1. Physiological and histological data were obtained from soleus and tibialis anterior muscles of normal adult cats to study to what extent fibre length and sarcomere number varied between animals and how this was related to the physiological characteristics of the muscles. 2. For a given muscle, the variation in the sarcomere number of individual muscle fibres between animals was found to be about 25%. These difference could partly be explained by comparing the number of sarcomeres and the length of the fibula, which was chosen as an index of the size of the animal. The average sarcomere number in the tibialis anterior muscle was about 60% greater than in the soleus. The variations between animals and between the anterior tibialis and soleus muscles were significantly greater than the variations observed within the same muscle. 3. The sarcomere length is dependent upon the articular angle, that is to say, the length change imposed on the muscle. These length changes are more extensive in the soleus muscle (100%) than in the tibialis anterior muscle (60%). A very significant correlation was found between articular angle and sarcomere length (for soleus r = 0.98, for tibialis anterior r = 0.94). 4. Although fibre length did vary considerably within a given muscle, the sarcomere length showed only minor variations at any given angle. This suggests that sarcomere number is determined in each individual muscle fibre. Such an adaptation implies a concomitant adaptation of the tendinous part of the fibre. This adaptation, resulting in definite sarcomere length at a definite angle, has obvious physiological implications. 5. Conventional length vs. active tension curves were established for the soleus and the tibialis anterior muscles. It is suggested that the difference between the sarcomere number of the two muscles may result in the difference between the shape of curves of these two muscles. 6. Active torque-angle curves were established for the two muscles in situ. The shapes of the curves for soleus and tibialis anterior are similar in spite of the different mechanical conditions of the two muscles. This fact helps to explain why the two muscles, despite their similar articular range, had very different sarcomere number.


The oxidation of glucose, ketone bodies and acetate by the brain of normal and ketonaemic sheep.

1. The utilization and oxidation of glucose, acetate and ketone bodies by the brain of sheep has been determined from measurements of arteriovenous (A-V) differences and cerebral blood flow, as well as by infusing 14C-labelled metabolites. 2. The A-V difference for glucose was generally more than one sixth, on a molar basis, that of oxygen. 3. The mean rate of glucose utilization by the brain of conscious sheep (0-508 +/- 0-063 mumole/g per minute) was maintained even when the capillary glucose concentration was below 1-4 mM. 4. The amount of 14CO2 produced from [U-14C]glucose by the brain was consistent with glucose being the only energy source for the brain, even during hypoglycaemia and hyperketonaemia. 5. There was no appreciable production of lactate or pyruvate by the brain. 6. There was no significant A-V difference for acetate across the brain in normal or undernourished pregnant sheep. The small A-V differences that were measured show that less than 5% of the CO2 produced could be derived from acetate, a conclusion that is supported by experiments using [U-14C]acetate. 7. No significant A-V difference was detectable across the brain for 3-hydroxybutyrate or acetoacetate in normal fed, pregnant ketonaemic or even anaesthetized sheep infused with acetoacetate. Experiments in which [U-14C]-D(-)-3-hydroxybutyrate was infused also showed that less than 5% of CO2 was derived from ketone bodies. 8. In anaesthetized sheep infused with acetoacetate, measurements were made simultaneously across brain, heart and skeletal muscle. In contrast to the non-significant uptake of ketone bodies by the brain, uptake by heart and skeletal muscle was sufficient to account for nearly 60% of their oxygen consumption. 9. Experiments using [14C]hydroxybutyrate confirmed that during infusion of acetoacetate most of the CO2 produced by the heart, but not by the brain, was derived from ketone bodies. 10. In anaesthetized sheep ketone bodies penetrate only slowly into cerebrospinal fluid. 11. It is proposed that mechanisms for the utilization of ketones by the sheep brain have not evolved because glucose utilization by the brain is a smaller fraction of whole body glucose utilization than in man and rats.


Horseradish peroxidase localization of masticatory muscle motoneurons in cat.

Horseradish peroxidase has been injected into individual masticatory muscles in young and adult cats in order to determine the topography of the corresponding groups of motoneurons in the motor nucleus of the Vth nerve. The results obtained show a clear dorsoventral somatotopic distribution; the superior muscles have their motoneurons located dorsally in the nucleus and the inferior muscles ventrally; the two main jaw closers, temporalis and masseter, are represented in the dorsal and central parts of the nucleus; located more ventrally are the motoneurons for the pterygoideus medialis and lateralis, the jaw closers and abductor muscles; finally motoneurons for the jaw openers, and the anterior belly of the digastricus and mylohyoideus, occupy the ventromedial part of the nucleus. All muscles have been found to be represented along the entire length of the nucleus, with the same dorsoventral layering.


[Technic of long term neuron unit-recording on the free animal].

Technique of long-term recording from single neurons in brain of freely moving animals with floating mobile microelectrodes.


A cognitive model of musical sight-reading.

The author, a professional flutist and psychologist, interviewed four pianists noted for their sight-reading abilities. The results of the interviews are considered from several points of view. Sight-reading is analyzed as a problem in pattern recognition: a movement from a sonata by Handel is used to illustrate the principle of scanning for familiar patterns. The close relationship between musical sight-reading and the reading of conventional texts is also suggested. Finally, drawing on the findings of other studies, a congnitive model of musical sight-reading is proposed. The schematic model of interlocking information-processing systems explains the differences between skilled and unskilled sight-readers: it also explains why some experienced, professional musicians are poor sight-readers. Verification of the model is provided in an additional section in which conversations with unskilled sight-readers are reported.


[The development of arterial thrombi].

The factors involved in arterial thrombosis include the endothelial and subendothelial cells of the arterial wall, platelets and other blood cells, plasma factors and blood flow. An arterial thrombus arises from an interaction between platelets and the subendothelium (basement membrane and microfibrils) which has been shown by recent experiments to have a thrombogenic propensity. The particular structure of the subendothelium and its glycoprotein membrane receptors for platelets is implicated on thrombogenesis which requires the intervention of von Willebrand's factor; the well-known role of collagen is also important. An arterial thrombosis may evolve into a mural thrombus or may spread or form an embolus.


["Cirrhotic's lund". A new radiological entity? 182 CASES (AUTHOR'S TRANSL)].

The authors studied the chest X-rays of 182 patients with alcoholic cirrhosis. They eliminated the abnormal films of patients with severe clinical or biological changes. After double reading, they isolated ten cases in which chest X-ray revealed changes in the pulmonary interstitium. The question as to the nature of this interstitial pneumopathy is posed.


[The treatment of hemoptysis by embolization of the systemic arteries (author's transl)].

The authors present their still limited experience of embolization of systemic arteries as the treatment of hemoptysis. Their cases illustrate the indications, contra-indications, causes of failure and effectiveness of this therapeutic method in pneumology. They had to refuse who patients: in the first, the pathological bronchial artery arose from a common trunk with the intercostal which gave rise to an anterior spinal artery. The second patient showed signs of medullary involvement on injection of a pathological right intercostal artery, which in their opinion is also a contra-indication of embolization, although no anterior spinal artery was demonstrated on the arteriogrammes. Six patients were treated by embolization. In the case of one patient, treatment was a failure owing to incomplete embolization. A main esophageal pedicle supplied a high flow bronchial artery anastomosis. These important collateral esophageal vessels compromize the effectiveness of bronchial embolization.


[Arterial radio-anatomy of the extrahepatic biliary system (author's transl)].

The uni-arterial vascularisation of the lateral bilary duct makes it impossible to systematise the arteries which supply the common bile duct. Only the cystic artery is seen at coelio-mesenteric catheterization. The techniques essential for visualisation of the cystic artery are discussed, on the basis of one hundred coelio-mesenteric arteriograms: frequency of demonstration, origin, course, termination, calibre and length. The frequent finding of opacification of the wall of the gall bladder under normal conditions is stressed.


[Radiological exploration of pulmonary systemic hypervascularization. Study of our results concerning 83 cases. Confrontation of the angiographic results with the existence of hemoptysis (author's transl)].

The authors present the results of selective bronchial and parietal arteriography of pulmonary systemic hypervascularization, in 83 cases. They emphasize the advantages of previous pulmonary venous angiography and overall aortography for the success of selective injections. Failures are evaluated at 6 to 7%. On occasions, a medullary branch was opacified. No medullary accidents were noted. The angiographic appearances of the lesions encountered are described. A comparative study of the angiographic results of non-tumoral acquired lesions was carried out in those patients with hemoptysis and in those who were free from them.


[Varicoid carcinoma of oesophagus (author's transl)].

Two cases of diffuse squamous cell carcinoma of the oesophagus simulating the roentgenographic appearance of oesophageal varices are presented. Careful fluoroscopic examination may permit accurate diagnosis; however if the lesions are equivocally demonstrated by X-ray examination, oesophagoscopy confirms the diagnosis of carcinoma. R94.


[A rare hemopathy: urographic diagnosis (author's transl)].

A case of papillary necrosis was discovered by chance when doing a systematic urography  on a black woman suffering from subacute pains in the abdomen. This radiological information leads us to the finding of two hemoglobinopathies associated with a heterozygous shate: drepanocytemia and hemoglobin C disease. Clinically this list, nearly asymptomatic, is closed up by distinctive osseous lesions, the pains in the abdomen were due to a biliary lithiasis.


[A case of ascaridiosis of the common bile duct].

The authors present a case of ascariasis of the common bile duct in a 45 year old Portugese woman. Perfusion cholangiography showed a lacunar ribbon shaped image of the common bile duct and radiolucent gall-stones. The diagnosis of intracholedochal ascariasis was made and the patient operated: there was in fact an ascaris which was extracted by choledochotomy. Cholecystectomy. Straightforward aftermath.


[Secreting paragangliomas of the organ of Zuckerkandl. A report on two cases (author's transl)].

The authors describe two cases of secreting paragangliomas of the organ of Zuckerkandl, beinging the number of known cases to 78. They underline the interest of arteriographic and phlebographic explorations which define more accurately the origin and spread of these tumours.


[A simplified radiological technique for measurement of the angle of anteversion of the femur and of the cervico-diaphyseal angle (author's transl)].

Description of a technique for measurement of the angles of the upper extremity of the femur, applicable to all patients, without mobilisation, and using a remote controlled table with two localised films in a frontal projection, and a simple construction using a ruler and protractor.


A study of bereavement in general practice.

Forty six bereaved relatives were assessed by a general practitioner four to eight weeks after the bereavement. In 36 (78.3 per cent) the immediate reaction to bereavement was one of numbness or stupefaction; in seven (15.2 per cent) emotional relief occurred; and in three cases (6.5 per cent) there was no obvious immediate reaction. The numbness reaction was limited in duration to a week or less in 31 of the 36 instances.At four to eight weeks after bereavement 29 (63.0 per cent) of the subjects continued to experience difficulty in coming to terms with their loss. Twenty subjects reported guilt feelings and a similar number expressed aggressive reactions. The bereaved subjects tended to increase their consumption of cigarettes and alcohol, while their appetite and weight tended to be reduced. Thirty six (78.3 per cent) of the subjects reported physical symptoms, notably headache, dizziness, generalised aches, and abdominal complaints.THE MOST PROMINENT PSYCHOLOGICAL FEATURES OF BEREAVEMENT WERE FOUND TO BE: preoccupation with thoughts of the deceased, idealisation of the lost person, depressive mood, and loneliness.The findings are discussed and reference made to the role of the family doctor in the management of bereavement reactions.


[Techniques for opacification of the lumbar spinal venous plexuses (author's transl)].

No single technique exists for lumbar phlebography. Whilst catheterisation of the ilio-lumbar veins is always the first step, it should be routinely followed by injection of the lateral sacral veins whenever the leel L5-S1 is clinically suspicious. Finally, when only poor opacification of the longitudinal epidural plexuses is obtained by filateral injection of the ilio-lumbar or ilio-lumbar and sacral systems, catheterisation of the vein in L2 on the right or L3 on the left makes it possible in virtually all cases to obtain satisfactory filling of the lumbar plexuses. It may be considered at the present time that, from a technical standpoint, failures of lumbar phlebography by bilateral femoral catheterisation do not exceed 1% of cases.


[The treatment of herpes zoster by ultraviolet actinotherapy. Study of 200 cases (author's transl)].

The authors analysed the cases of 200 patients treated for early herpes zoster by ultraviolet actinotherapy. This simple treatment should ideally be applied: - to clean skin, without dye nor ointment; - over the entire root area, and not only to the vesicles; - obtaining from the outset frank erythema, uniform, and without a healthy skin interval. Under these conditions, 95% of successful results were obtained in 3 to 8 days. The occasional failures appear to be related either to faulty technique or to a deep-seated localisation beyond the fied of action of the ultraviolet rays.


Examination of the P wave in lead V1 of the electrocardiogram: its value in routine electrocardiography.

While reporting on the electrocardiograms recorded in this Department during the past four-and-a-half years, interest was aroused by the occasional appearance of a terminal negative component in the P wave in lead V(1). I tried to find out what significance, if any, it had. In the ensuing study a relationship between such a negative component-expressed as a terminal negative force (-ve Ptf V(1) for short)-and the presence of ischaemic heart disease emerged. Such a negative Ptf V(1) is not an in-fallible marker of ischaemic heart disease nor does it necessarily persist in the repeat electrocardiogram of any given patient. It is, however, suggested that attention be routinely paid to the morphology of the P wave in lead V(1) and that when a negative terminal component is present in this wave follow-up study of this feature in serial electrocardiograms may help in the assessment of prognosis in any given patient.


The treatment of pain trigger areas in migraine.

In many patients with migraine, several localised areas usually on the scalp or neck can be identified. The local injection of lignocaine one per cent and adrenaline 1/200,000 often leads to considerable relief of the symptoms of migraine including visual phenomena. The common sites of the trigger areas are shown and several uncontrolled case reports of the effect of the treatment are described.


A survey of the effects of a drug promotion campaign.

A postal survey which tried to test the impact of a drug-promotion campaign is described. One hundred and twenty randomly-selected general practitioners were circulated and a 74.8 per cent response was obtained. Of the responders, 92 per cent were aware of the existence of the preparation, and of these responders 69 per cent were unaware either of the pharmacologically approved name of the drug, or the fact that its pharmacologically active constituent was already available under another brand name.


A research project as a means for continuing education.

A project designed to encourage general practitioners to provide care in the earliest phases of coronary heart disease is reported from South Africa. A total of 129 general practitioners were actively involved and over 3,000 practitioners showed interest and attended at least one meeting.


Symptoms perceived and recorded by patients.

Health diaries were kept by 198 randomly-chosen women between the ages of 20 and 44. Symptoms were recorded on one day in three and on 57 per cent of symptom-days self-medication occurred. Even a minor shift from self-care to doctor care could make intolerable demands on the general-practitioner service in this country.Only a minority of symptoms (one in 37) are taken to the doctor and patients are highly selective in deciding which symptoms are appropriate for medical care. The perception of symptoms and the response of seeking medical advice are both significantly related to anxiety as measured by a personality questionnaire.


Non-attenders in general practice.

Non-attenders for five years or longer (77 men and 27 women; i.e. 1.9 per cent of the practice) in a general practice of 5,750 patients were identified and paired with controls in the same practice. A survey by questionnaire was carried out.The conclusions were:(1) A higher proportion of non-attenders are self-employed,(2) A lower proportion of them had retired than their attending counterparts,(3) They are spread over the whole age-range, but with a higher concentration in the ages 35 and over,(4) They are evenly spread over the social classes,(5) They seldom seek other sources of medical advice or treatment,(6) They are significantly slimmer than their fellows,(7) Their non-attendance does not, on the whole, cloak serious but remediable illness.


Self-medication in a small community.

(1) Simultaneous recording of doctor/patient contacts and chemists' sales were made during a period of two weeks in a small self-contained community.(2) The conclusion of previous studies, using different methods, that non-prescribed medicines are taken twice as often as those prescribed by doctors, is confirmed.(3) The possibility that self-medication may conceal the onset of serious disease is discussed.


Measuring learning by trainees in general practice.

Twenty simulated consultations with patients having a respiratory illness were carried out by 20 trainees at the start and finish of a training year in general practice, using the same method as used in a previous study of principals in general practice.During the course of the year, the trainees as a group closely approached the behaviour-in the defined terms of the study-of principals as a group. The trend was more marked for doctors on a three-year training programme than for those on a one-year programme.In 11 cases direct comparison between trainee and trainer was possible. It was difficult to identify changes in behaviour as being due to either group influences or individual trainer influences, but it appeared that atypical trainers do not necessarily produce atypical trainees and typical trainers do not prevent the development of individuality in trainees.The technique of simulated consultation may assist the difficult task of evaluating training for general practice.


Hospital admission rates and the primary health team.

The use of hospital beds was studied for a period of one year in a practice under the care of a closely co-ordinated team composed of the family physician, the family nurse, and a medical social worker. Admission rates and mean duration of stay in hospital are analysed and discussed in relation to selected socio-demographic variables.The results showed that the study population used only half as many hospital beds when compared with national rates in Israel. We consider that this was achieved by the provision of planned co-ordinated comprehensive medical nursing and social services for patients suffering from long-term illness. Such a team is able to provide a high quality medical care and can significanlty reduce the use of in-patient hospital services.


Cold sores-an epidemiological survey.

A survey was carried out in a general practice in North Wales to determine the incidence, frequency, duration, and severity of cold sores. Of the 1,855 adults interviewed, 46 per cent gave a definite history of having had a cold sore at some time while 28 per cent continued to have one or more a year. More than half of the latter considered their sores of moderate or severe inconvenience.


Second opinion. A study of medical referrals in a seminar for general practitioners at the Tavistock Clinic, London.

An experienced seminar made a special study of the psychological aspects of referrals for second opinions, investigations, or hospital admission. The cases were a random selection, incidentally forcing the seminar to examine some of the poor medical practice that is rarely published and to recognise the disturbing force of the doctor-illness relationship, as distinct from the doctor-patient relationship. General practitioners use referrals in many ways and select consultants for quite unexpected qualities, often to preserve the relationship with their patients, and contrary to many superficial impressions otherwise. Referrals are part of the continuous flux of patients in and out of a doctor's life and this movement is important to his sense of identity and to his defences against anxiety.


First encounters.

Some conclusions are reported from a series of seminars involving several experienced general practitioners over a period of three years. The aim was to examine first consultations in general practice.We found that these were often handled superficially and that both doctors and patients seemed hesitant in their new relationship. We believe that the loss of a trusted family doctor can create a bereavement reaction in patients, especially where the relationship has been long and when the doctor leaves or dies suddenly.We are investigating the possibility that the death rate is increased among patients who have recently lost their general practitioner suddenly.


Breast feeding--a year's experience of one group practice.

Dissatisfaction at the lack of support and encouragement in the immediate post-partum period of mothers in hospital wishing to breast feed is expressed in their own words. Analysis indicates that mothers in the upper social classes are more likely to breast feed and that those who manage to sustain breast feeding for one week are likely to continue this method of feeding for at least six weeks and possibly for much longer. There is also evidence indicating that women who are encouraged during pregnancy to breast feed have a high success rate. Those responsible for supervising infant feeding need to be better educated in all its aspects.


Treating sexual dysfunction in general practice.

A method of training general practitioners in the treatment of sexual dysfunction is described, using fortnightly seminars at which the doctors discussed the continuing care of their patients.Doctors took on patients presenting in their practices and treated couples together, where possible, using a mixture of insight-directed and behavioural techniques similar to those used by Masters and Johnson (1970). Interviews were reported back to the group which gave advice and support. The doctors, all beginners in this type of work, were able to help substantially 72 per cent of 47 couples treated.


A retrospective survey of over 1,000 patients on oral contraceptives in a group practice.

The side-effects encountered by 1,090 patients taking the oral contraceptive pill were reviewed. The main side-effects were migraine, headaches, weight gain, depression, and irregular bleeding. Reasons for changing the Pill are discussed, and recommendations are suggested for a way of monitoring patients taking the Pill. Analysis of the results show that 50 per cent of patients are happy with their first Pill, and that the 30 microgram pill produces fewer side-effects.


The first three months of free contraception in a market-town group practice.

Contraceptive services became free to patients of general practitioners in the British National Health Service on 1 July 1975. We report the numbers of patients advised in a practice of 6,612 patients during the first three-month period and found that in a sample of 211 women, just over half had received medical advice. The financial implications are discussed.


Hormonal changes associated with experimentally produced cystic ovaries in the cow.

Cystic ovaries were experimentally produced by i.m. injection of 5 mg oestradiol valerate on Day 16 of the oestrous cycle or by s.c. injection of 100 ml antiserum to bovine LH before the onset of oestrus. The length of the cycle after both treatments was altered. The cysts formed after oestradiol injection were relatively small (2-5-3 cm diameter) and thin-walled, and were accompanied by relatively low plasma oestrone and high oestradiol levels; those after LH antiserum treatment were large (5-0-6-0 cm) and firm and associated with relatively low oestradiol and high oestrone levels. The results of the hormone assays after treatment support the theory that cystic ovaries could result from premature LH release or an insufficiency of LH at the time of ovulation.


The ultrastructure of the thecal cell of the teleost, Oryzias latipes, during ovulation in vitro.

Ultrastructural examination of the follicular envelope of the teleost, Oryzias latipes, during ovulation in vitro showed that the follicle cell layer became increasingly dissociated. Microfilaments, measuring 50-70 A, were sparse in the thecal cells at the start of incubation, but were organized into bands after 5 hr, and into bundles after 10 hr of incubation. It is suggested that these microfilaments are contractile and are involved in cell movement during ovulation.


Effects of dietary caffeine on the testis of the domestic fowl, Gallus domesticus.

Roosters were fed 0-1% caffeine mixed by weight into a standard ration. With continued dietary caffeine administration, the average fertility of eggs collected for 2 weeks from untreated pullets inseminated with semen from the treated males at 0, 7 and 14 days after the start of treatment was 30-8, 33-5 and 3-3%, respectively. After 14 days of treatment fertility was significantly lower (P less than 0-001) than before (0 days) or 7 days after treatment. Semen output and sperm concentration were markedly reduced 17-21 days after treatment, and no semen could be collected from the roosters after they had received caffeine for 30 days. Removal of dietary caffeine resulted in resumption of semen production and a return of fertility to the control level. Testicular histology showed that spermatocyte divisions ceased and spermiogenesis was abnormal, although Leydig tissue and the response of the males to massage for semen collection was not affected. The effects on spermatogenesis and fertility were reversible after treatment for 30 days.


Effects of androgens on sexual behaviour and somatic variables in the male golden hamster.

Comparisons were made of the sexual behaviour of sham-operated male hamsters and castrated males receiving testosterone, dihydrotestosterone or androstenedione (1-5 mg/week), or oil alone. Tests of short duration (10 min) were conducted at Week 3 (when the animals were sexually naive), Week 6 and Week 9. Sham-operated males showed marked increases in many elements of behaviour between Weeks 3 and 9, while castrated males receiving no androgen replacement showed marked decreases. Males receiving each of the three androgens showed marked increases in behaviour, but androstenedione-treated males showed less facilitation of sexual behaviour than controls. Dihydrotestosterone was as effective as testosterone. The three androgens were comparable in maintaining seminal vesicle weight after castration and in preventing the customary rise in pituitary and body weights. These data suggest that, unlike the situation in the rat, aromatization of androgens is unnecessary for the display of sexual behaviour in the hamster.


Mechanisms of action of the antifertility agents U11, 100A and U11,555A in the rat.

Mature female rats were given U11,555A and U11,100A on orally on Day 2 of pregnancy and the number of implantations counted on Day 9. Using doses which reduced the implantation number to approximately 40% that of the controls, it was shown that the reduced number was not due to an effect on egg transport or to a delay of implantation.


The lipids of buffalo spermatozoa and seminal plasma.

Lipids were extracted from the spermatozoa and seminal plasma of buffalo and were analysed by column and thin-layer chromatography. Buffalo spermatozoa (10(9) cells) contained 1-15 mg total lipids, 0-285 mg neutral lipids, 0-396 mg glycolipids, 0-547 mg phospholipids and 0-015 mg gangliosides. The corresponding values for 1 ml seminal plasma were: 1-50, 0-439, 0-581, 0-594 and 0-010 mg. The sperm neutral lipids were comprised of 3-2% hydrocarbons, 4-5% cholesterol esters, 46-7% triglycerides, 17-5% 1,3-diglycerides, 3-1% 1,2-diglycerides, 17-6% cholesterol, 0-6% free fatty acids and 2-4% monoglycerides. The corresponding values for seminal plasma were: 4-2, 6-2, 33-0, 19-8, 4-2, 18-5, 3-8 and 4-7%. In the sperm phospholipids, there was 30-4% phosphatidyl choline; 19-4% phosphatidal choline; 10-8% phosphatidyl ethanolamine; 3-4% phosphatidal ethanolamine; 11-3% sphingomyelin; 1-5% phosphatidyl serine; 0-6% phosphatidyl inositol; 3-9% lysophosphatidyl choline; 4-4% lysophosphatidyl ethanolamine; 0-7% lysophosphatidyl serine; 5-5% diphosphatidyl glycerol and 0-3% phosphatidic acid. The corresponding values for seminal plasma were: 21-7, 17-3, 11-7, 4-1, 13-1, 2-8, 3-9, 5-6, 1-0, 7-4 and 0-5%. Comparative data for bull spermatozoa and seminal plasma were also obtained.


Fatty acids and fatty aldehydes of buffalo seminal plasma and sperm lipid.

Analysis of the fatty acids of total and neutral lipids, glycolipids, phospholipids and gangliosides of buffalo spermatozoa and seminal plasma showed that there were high levels of polyunsaturated acids. Neutral lipids were the richest in polyunsaturated acids (55% in spermatozoa and 61% in seminal plasma). The major saturated acid of all the principal classes was stearic acid and the major unsaturated acid was docosahexaenoic acid (22:6omega3) except in the neutral lipids in which it was arachidonic acid (20:4omega6). The major aldehyde was palmitaldehyde (16:0) in buffalo sperm lipids and docosanal (22:0) in seminal plasma. More than 50% of the total aldehydes was contributed by aldehydes with a chain length greater than 18 carbon atoms.


Low temperature preservation of rabbit embryos.

Rabbit embryos (4-cell, 8-cell and morulae) survived freezing and thawing in the presence of 1-5 M-DMSO. Highest survival rates, assessed by continued development in vitro for 48 to 72 hr, were obtained with cooling rates of 0-74 to 0-90 degrees C/min and thawing rates of approximately 12 and approximately 15 degrees C/min (76%, 83%, 77% and 69% respectively). Transfer of embryos directly to liquid nitrogen after cooling at optimal rates to -110 degrees C instead of -80 degrees C significantly reduced the incidence of rupture of the zona pellucida and mucin coat and increased the rate of recovery. Viability after transfer was low (7% liveborn) and was not correlated with the higher rates of development in vitro to the morula and blastocyst stage.


The influence of prostaglandin F-2alpha on pregnenolone metabolism by the autotransplanted ovary of the ewe.

Eight ewes each with an autotransplanted ovary received infusions of tritium-labelled pregnenolone (41 muCi/hr) for 8 hr into the artery supplying the ovary, together with prostaglandin (PG) F-2alpha (30 mug/hr) for 3 hr beginning 2 hr after the start of the pregnenolone infusion. All animals exhibited oestrus 2-3 days after the start of the experiment. During the PGF-2alpha infusion blood flow through the ovaries was increased by 13%, but subsequently returned to pre-infusion levels. Secretion rates of endogenous progesterone and 20alpha-hydroxypregn-4-en-3-one dropped rapidly 5 hr after the PGF-2alpha infusion had started from values of 250 mug/hr and 25 mug/hr to values below 60 mug/hr and 8 mug/hr, respectively. At this time the conversion of radioactive pregnenolone to progesterone was reduced by 50% of its initial value, but the secretion of endogenous pregnenolone and the formation of radioactive metabolites other than progesterone were not diminished. In 4 control animals, which received pregnenolone only, no changes in ovarian blood flow, steroid secretion rates, or in the conversion of labelled pregnenolone were observed. These results suggest a possible involvement of PGF-2alpha in the regulation of progesterone biosynthesis by an action on the 3beta-hydroxysteroid oxidoreductase-delta5(-4) isomerase enzyme system.


The relationship between semen evaluation methods and fertility in the bull.

The results are presented of two experiments in which the quality of samples of bull semen was assessed by a number of laboratory tests and then correlated with the 112-day non-return percentage obtained by the use of those samples in A.I. The results reveal the inadequacy of the laboratory tests used as methods of predicting the fertility of semen samples but show that limits may be set outside which poor semen samples could be discarded.


Isolation and characterization of the perforatorium of rat spermatozoa.

The perforatorium of rat spermatozoa was isolated and its protein composition determined. SDS-polyacrylamide gel electrophoresis showed that the organelle is composed of a single polypeptide component with a molecular weight of 13,000. The perforatorium becomes more resistant to solubilization during epididymal transit due to an apparent increase in disulphide bond content. Amino acid analysis of the perforatorium polypeptide revealed a content of 6-5% cysteine.


Effects of oviducal cells on the survival and fertilizing ability of fowl spermatozoa.

Oviducal epithelial cells were cultured and the effects of the cells on the survival and fertilizing ability of fowl spermatozoa were investigated. When spermatozoa were incubated at 41 degrees C with cells from the infundibulum, shell gland or uterovaginal junction, their motility, assessed at room temperature (20-23 degrees C), was maintained for 5 to 6 days. Fertilizing ability was also retained after culture at 41 degrees C for at least 4 days. During incubation at this temperature, the spermatozoa were almost immotile and rested in close proximity to the oviducal cells. At 23 degrees C, the same spermatozoa were highly motile.


Differentiation of cholesterol compartments in the immature chick testis.

The behaviour of testicular free and esterified cholesterol during early posthatching development and after stimulation with human chorionic gonadotrophin was studied in the immature chick using combined electron microscope and biochemical techniques. The interstitial cells represented about 65% of the testicular tissue and the lipid droplets in the cytoplasm of these cells were considerably depleted after HCG treatment. The lipid droplets isolated from 7-day-old testis contained about 95% of the total esterified cholesterol which was significantly reduced in the testis and isolated lipid droplets after HCG stimulation. The bulk of free cholesterol was associated with the microsomal fraction whose membranes and cholesterol content increased during normal maturation and after gonadotrophin-induced differentiation.


Uterine secretion-like proteins in the seminal plasma of the rabbit.

The results of polyacrylamide disc electrophoretic, gel chromatographic and agar gel immunoelectrophoretic analyses of rabbit seminal plasma were compared to those for uterine secretions and serum. Two of the seminal plasma proteins seemed to be identical with the uterine proteins uteroglobin and prealbumin.


Ovarian blood flow in conscious and anaesthetized pregnant rabbits near term and the influence of arterial blood gas tensions.

Total ovarian, luteal and stromal blood flows were measured with radioactive microspheres (25 mum diameter) in 7 rabbits anaesthetized with sodium pentobarbitone and 23 conscious rabbits at Day 28 of gestation. Despite major differences in cardiac output, arterial PO2, PCO2, pH and base status, ovarian tissue blood flows were similar in both groups. In the conscious rabbits total ovarian blood flow was negatively related to arterial pressure, and luteal blood flow was negatively related to pressure and arterial pH. In the anaesthetized rabbits ovarian stromal blood flow was positively related to arterial PO2.


The influence of in-vitro culture and cooling on the survival and development of cow embryos.

Cow morulae cultured in a phosphate-buffered medium containing serum developed normally and retained viability when transferred to recipients. Unlike earlier cleavage stages, cow blastocysts tolerated cooling to 0 degrees C and retained viability after storage for 48 hr at 0 degrees C when transferred to recipients.


Inhibition of multiple ovulation in hypophysectomized hens treated with gonadotrophins.

Administration of PMSG or FSH to hypophysectomized hens prevented the multiple ovulation (2-3 ova) induced by an OIH. Inhibition of multiple ovulation did not occur when FSH was injected 1/2-2 hr before the OIH injection. The results are believed to support the theory that withdrawal of FSH stimulation sensitizes a follicle to the OIH in the normal hen.


The management of DES-exposed women: one physician's approach.

The female offspring of DES-treated mothers are examined cytologically and colposcopically annually, starting at the age of seven years no treatment is indicated until a colposcopic atypical transformation zone occurs. With its occurrence all the abnormal epithelium(squamous or columnar) is excised from the vagina and cervix under colposcopic guidance in the hospital or in the office under local anesthesia. The procedures are done in stages to minimize scarring and to eliminate the possibility of vaginal-cervical adhesions or vaginal shortening. The finding of an incidence of 47% of cervical or vaginal intraepithelial neoplasia in 34 patients aged 10 to 26 years so treated to date indicates a high risk of potential candidacy for squamous carcinoma of the vagina or cervix in later years.


Sex ratio in the progeny of mothers with toxemia of pregnancy.

Maternal-fetal incompatibility may be an essential component in the etiology of toxemia of pregnancy. A prior study found an abnormally high sex (male:female) ratio, suggestuve of Y-dependent histoincompatibility. We studied the records of 373 patients alleged to have some indication of toxemia among 3,246 births and applied standard criteria for classification. There were no significant differences for any group compared with the sexondary sex ratio expected of the population(94.6% Black).


Ovarian dysgerminoma: an ultrastructural study.

A case of ovarian dysgerminoma, found in a 14-year-old girl, is described. The ultrastructural study showed three different types of cells-two kinds of tumor cells(the main tumor cells of the germ-cell type and the second type with deeply indented nuclei and scanty cytoplasm) and stromal cells. The tumor also showed a typical lymphocytic infiltration, and the cells appeared to be embedded in a matrix of collagen fibers and ground substance.


Management of cervical neoplasia with colposcopy.

During a 44-month period the introduction of colposcopy to a metropolitan dysplasia clinic resulted in 1, 144 colposcopic examinations on 442 patients. Agreement between colposcopically directed biopsy and final diagnosis was found in 84%, and directed biopsy revealed the most advanced lesion in 42.5%. Satisfactory colposcopy was performed on 93% of patients, and some degree of histologic abnormality was obtained in 86% of patients with colposcopic abnormalities. Undetected invasive cervical cancer occurred in both cervical conization and colposcopic examinations with equal frequency. Endocervical curettage detected two cases of occult invasive cancer, and increased use of this procedure is recommended. Guidelines for management of cervical neoplasia are suggested.


Intrauterine spontaneous depression of fetal skull: a case report and review of literature.

Intrauterine depression of fetal skull, with or without fracture, unassociated with any known trauma during pregnancy or delivery, is extremely rare in Western countries though not so rare in Africa among African women. Usually fetal skull depression is caused by forceps or digital pressure of the obstetrician during manual rotation. Forty such cases are reported in the literature-nine in Western countries and the remaining 31 over a period of three years at Harare Hospital Maternity Centre, Salisbury, Rhodesia, Africa. There, an incidence of one in 4,000 deliveries was observed among the African women but none in 6,000 deliveries of European women during the same period at a nearby hospital. The presentation of this paper is made in view of the rarity of intrauterine spontaneous fetal skull depression in Western countries and the not so infrequent occurrence in African and possibly other  developing countries and because of the persistent controversy about the treatment of this condition.


Laminaria augmentation of midtrimester pregnancy termination by intramuscular prostaglandin 15 (S) 15-methyl F2 alpha.

A group of 15 midtrimester gravid patients underwent intracervical laminaria tent insertion prior to repeated intramuscular injections of 250mu g of prostaglandin 15 (S) 15-methyl F2 alpha at two-hour intervals for elective termination of pregnancy. This group was compared with a previously reported group of 80 patients who had received identical treatment without laminaria insertion. A significant reduction in mean abortion time and an increased 24-hour abortion rate were observed with the addition of laminaria. There was a proportionate decrease in gastrointestinal side effects as well as a reduced need for analgesia in the laminaria group with no complications attributable to the laminaria insertion.


Three and one-half years' experience with a lower-dose combination oral contraceptive.

Updated data are presented that span 43 cycles of use of norgestrel 0.030 mg as a lower-dose combination oral contraceptive. Active participation by 1,633 women in 20,312 treatment cycles has resulted in a use-effectiveness rate of 0.13 per 100 woman-years. Satisfactory cycle control, minimal menstrual irregularities and a low incidence of side effects produced high acceptability among users. No drug toxicity was demonstrated. The incidence of discontinuance for medical reasons was low.


Female sterilization via minilaparotomy.

A simple, safe, economical and potentially reversible technique for female sterilization via minilaparotomy is evaluated in 204 patients (not recently pregnant and postpartum). Only light general anesthesia is required, and the procedure is performed with only equipment normally available in any hospital or outpatient clinic. A 2cm circumumbilical or suprapubic incision is made, and the physician manipulates the uterus to bring the fallopian tube in line with the incision. As the cornu passes the incision, the release of intraabdominal pressure at the site of the wound usually pushes the tube out of the peritoneal cavity. A majority of the procedures were performed in less than five minutes. No surgical difficulties were encountered, and no immediate complications or complaints were reported. Patients were usually hospitalized for one or two nights. Early postoperative complications or complaints were reported for 8.4% of the not-recently-pregnant patients and for 4.1% of the postpartum patients at the 7-to-21-day follow-up visit. The most frequently reported complications and complaints were fever and lower abdominal pain. Further studies to determine the effectiveness of this type of sterilization and whether the procedure can be performed safely with local anesthetics and on an outpatient basis are being planned.


Steroid delivery systems for contraception.

Scientific disciplines not normally associated with pharmaceutical development have been employed to enhance the effectiveness and attractiveness of two approaches to steroidal contraception. The use of a bioerodible polymeric carrier for predictable systemic steroidal administration has removed the largest hurdle to the development of a subcutaneous contraceptive implant. A polymeric progesterone delivery system has provided a method for localizing hormonal contraception in the uterine cavity. Extensions of these technologies may provide two useful tools in limiting fertility in an already overcrowded world.


Ethical issues arising from human genetics.

Advances in understanding genetic disorders have been rapid in the last few years and with them the need and desire for genetic counselling have grown. Almost simultaneously, particularly in the USA, several large screening programmes have been initiated to screen large numbers of people who may be carriers of such deleterious genes as those of Tay-Sachs disease and sickle cell anaemia. The authors of this paper, clinical medical students at University College Hospital, London, spent some time studying the ethical issues raised. The first part of their study, which is not published here, relates to the biochemistry of certain genetic disorders, so leading up to the aspect of the subject which must concern readers of this journal, genetic counselling. At present genetic counselling is generally the province of the medical practitioner working with clinical biochemists, and in this paper their function is described and how programmes of screening for carriers are designed. Whether the subjects of the screening tests are found to be 'innocent' or 'guilty' psychological problems confront them, and of these the genetic counsellor must be aware. In fact the range of ethical problems raised by such counselling is wide and can only be sketched in this article.


Is a moral consensus in medical ethics possible?

At the moment in Britain and elsewhere the debate inside and outside of Parliament on various medical issues which are essentially moral never ends. Everybody has his own point of view--or principles. But what emerges for society to adopt can often be called in lay terminology 'compromise'. Professor Mitchell argues in this paper that a moral consensus is possible and indeed ought to be achieved, as today the medical practitioner can no longer make his decision only in accordance with the strict code of ethics of the medical profession. The task of the philosopher, says Professor Mitchell, is to interpret the actions and attitudes demanded by modern medical practice.


Limits of confidentiality.

A patient is described, a woman of 60, who at that age was diagnosed as having Huntington's chorea, a genetic disease which is transmitted as an autosomal dominant. She had one daughter, who was married and lived abroad. The patient's mother and maternal aunt, it emerged during the consultations, had had the disease, and shortly after the diagnosis had been made the patient's sister was admitted to hospital with a repiratory condition, and in the course of treatment Huntington's chorea was diagnosed in her also. She had one daughter. Throughout, the problem was not only that of treating the patient herself, but the situation of all those of the family affected in any way. The patient's husband had not known of her medical history at the time of the marriage. At no time had the daughter been told. The discussion, in which seven doctors, a moral philosopher, and a social worker took part, centered on the basic issue of confidentiality in the case of a disease, from which would stem problems for the affected family through several generations. All were agreed that in these circumstances those affected must be told, but differed as to who should make some of the subsequent decisions. Some thought that having told of the diagnosis and its implications, the doctor should leave further decisions to those concerned; others that in a disease such as Huntington's chorea one is looking at part of a whole chain of genetic material, and, although the individual patient or potential patient is of course important, he or she must be seen in the genetic setting of the community. The participants also considered the psychological.


The Karen Quinlan case: problems and proposals.

Karen Quinlan, a young American girl, has lain in hospital since 15 April 1975 without any prospect of recovering consciousness. Her breathing is assisted by means of a respirator and she is fed through a tube inserted in her stomach. Her adoptive parents applied to the courts for permission for the respirator to be switched off. The judge refused permission. Using the Quinlan case as an exemplar, Mr. Kennedy analyses the medical points one by one against the legal background. He would like to see established a code of practice to assist doctors in such cases who at present have no legal guidance. A set of rules arising as a consequence of a series of court decisions would be undesirable; rather a code should be drawn up as the result of discussion between the many people concerned and the consensus so arrived at.


Diaphragmatic hernia in the south-west of England.

A retrospective anatomical, family, and epidemiological study was made of 143 patients (81 female and 62 male) with diaphragmatic hernia who were born in the south-west of England between 1943 and 1974. Thirty-nine cases were stillborn. Seventy-five per cent of patients had a left-sided diaphragmatic defect, 22% had a right-sided defect, and 3% had a bilateral defect. Fifty per cent of the patients had other congenital malformations, most frequently of the nervous system. No maternal age or birth order effect was noted. Cases of diaphragmatic hernia without other malformations had in general a normal fetal growth rate. Eight per cent of the cases were illegitimate. There were two pairs of twins discordant for diaphragmatic hernia, one pair being dizygotic and the other monozygotic. In no case of diaphragmatic hernia was there a relative affected with a diaphragmatic hernia. The most common type of diaphragmatic defect was a posterolateral hernia (92%), followed in frequency by an eventration of the diaphragm (5%), the least common defect being a retrocostosternal hernia (2%). Diaphragmatic hernia appears to be aetiologically as well as anatomically heterogeneous. In this series there were two cases of trisomy 18, one case of trisomy 21, one case trisomic for a small part of chromosome 20, and two cases with the Pierre Robin syndrome. It seems likely that diaphragmatic hernia is a non-specific consequence of several teratological processes.


Syndrome designations.

Because syndrome designations permit the collection of data, they are much more than just lables. As new syndromes become delineated, their names connote (1) their phenotypic spectra, (2) their natural histories, and (3) their modes of inheritance or risk of recurrence. Various methods for designating new syndromes are reviewed, including naming them after (1) the basic defect, (2) an eponym, (3) one or more striking features, (4) an acronym, (5) a numeral, (6) a geographic term, and (7) some combination of the above. None of these systems of nomenclature is without fault. The advantages and disadvantages of each are discussed.


Pfeiffer syndrome: report of a family and review of the literature.

A 5-year-old boy and his father with Pfeiffer syndrome are described. They had acrocephaly, hypertelorism, antimongoloid slant of the palpebral fissures, protrusion of the eyes, large and broad nose, small mandible, irregularly placed teeth, additional upper canine, high-arched palate, partial syndactyly of fingers and toes, brachydactyly of toes, valgus deformity of hypertrophied triangular great toes, broad phalanges of the great toes and broad first metatarsals, accessory epiphyses lateral to the interphalangeal joint of the great toes, and normal intelligence. To our knowledge, this is the first family in which the syndrome is almost totally confined to the head and feet--it spares the upper limbs except for partial skin syndactyly between the fingers--and the third family showing inheritance through three successive generations suggesting an autosomal dominant mode of inheritance. The published papers are reviewed and the clinical and x-ray signs are tabulated.


Ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome: dominant inheritance and variable expression.

An infant is reported with a complete form of the ectrodactyly-ectodermal dysplasia clefting (EEC) syndrome, inherited from his mother, who has a partial expression of the condition, without clefting. This observation stresses the phenotypic variability of the EEC syndrome, which in most cases is inherited as an autosomal dominant with reduced penetrance.


Chronic spinal muscular atrophy of facioscapulohumeral type.

Chronic spinal muscular atrophy of FSH type affecting a mother and her son and daughter is reported. The relevant literature is reviewed and the relation between this conditon and Kugelberg-Welander (K-W) disease is discussed. Chronic spinal muscular atrophy of FSH type is considered to be a different entity from the eponymous K-W disease. Each type of muscular dystrophy, e.g. limb-girdle, FSH, distal, ocular, or oculopharyngeal type, has its counterpart of nuclear origin. A classification of the chronic spinal muscular atrophies is suggested following the classification of muscular dystrophy.


Alkaline phosphatase activity in cultured skin fibroblasts from fibrodysplasia ossificans progressiva.

Alkaline phosphatase activity in four strains of cultured skin fibroblasts obtained from a patient with fibrodysplasia ossificans progressiva was at the low normal range. The enzyme activity in normal fibroblasts significantly increased at late confluency. It appears that the high levels of alkaline phosphatase activity reported in biopsies of lesions are not genetically determined but are secondary events of local tissue reaction.


Topographic approach for analysis of palm crease variants.

As the variability and possible clinical significance of palm increase abnormalities receive greater attention, an accurate and objective method for evaluating the palm increase variants is required. A new method is described employing a topographic approach. A network of co-ordinates drawn on the palm prints enables an accurate and reproducible description to be made of unlimited numbers of variants of palm crease configurations. This method makes possible quantitative studies rather than merely qualitative descriptions of the palm crease patterns. To determine its usefulness, this method was employed in a comparative study of 100 individuals with Down's syndrome and 100 controls. Significantly higher total degree of transversality (T-DoT), as defined in this paper, was found in the Down's syndrome group. T-DoT may be a useful parameter in the evaluation of crease patterns of patients with congenital and genetic disorders.


Further studies on the genetic heterogeneity of cebocephaly.

The detailed morphological description of 4 cases with cebocephaly, 3 of which were karotyped (one with D trisomy and 2 with normal karyotypes), are presented. Analysis of all cytogenetically studied cases with this malformation reveals that cebocephaly with a normal karyotype may result from more than one mutant gene, and so it may be accompanied by different extracranial abnormalities. On the other hand an absence of visceral malformations does not exclude chromosomal aberrations; thus 18p- syndrome, where cebocephaly is frequent, may have no visceral abnormalities.


Non-disjunction of an unusual X chromosome.

Because of multiple abnormalities in her children, a young mother was investigated and shown to have a 47,XXX chromosome constitution. Additional C group chromosomes without visible centromeric constrictions were found in a number of cells from the peripheral blood, and using C and Q banding techniques these chromosomes were identified as X chromosomes. Analysis of the banding karyotypes of 300 cells revealed that the acentric X chromosomes had the ability to replicate and that this replication was associated with non-disjunction leading to aneuploid cells. Even though cultured skin cells did not have acentric or extra chromosomes in addition to the triple-X, examination of buccal mucosa cells for the presence of X-bodies suggested that the phenomenon of non-disjunction was present in the epithelial cells of the patient. In addition to the X without a visible centromeric constriction, either acentric D or E chromosomes were found. The data suggest that a functional defect in the cells per se is responsible for the appearance of the acentric chromosomes.


Multiple congenital defects associated with trisomy for long arm of No. 4.

The clinical and cytogenetic findings of a male infant with multiple congenital anomalies and trisomy for the distal third of the long arm of No. 4 are described. The abnormal chromosome was inherited from the mother who had a balanced translocation, t(4;9)(q31;q34). Trisomy for the long arm of No. 4 has previously been described in only 3 patients.


Tetraploidy in a liveborn infant.

A congenitally malformed infant with a tetraploid chromosome complement who survived to 1 year of age is reported. The relationship of the polyploidy and the anomalies is discussed.


46,XY/46,XY,21q- mosaicism in an infant with neutropenia and properdin deficiency.

An infant with neutropenia, properdin deficiency, and a 46,XY/46,XY,21q- mosaicism is described. It is not known whether these two findings are related to the missing 21q material. The propositus is normal in appearance, and has none of the phenotypic features associated with the G-group deletion syndromes.


Graduate medical education viewed from the national intern and resident matching program.

The total number of applicants for first-year programs in graduate medical education through the National Intern and Resident Matching Program in 1976 exceeded the number of positions offered for the second consecutive year. The number of positions available for U.S. medical school graduates in 1976 was approximately 1.22. Based on student preferences for their first-year graduate medical education programs, there were deficits in the number of openings offered in the primary care specialties and surfeits in medical and surgical subspecialties, pathology, psychiatry, and radiology.


The mystification of meaning: doctor-patient encounters.

The symbolic and communicative aspects of illness and treatment are examined. A number of factors that complicate interpersonal communication are identified and found to exist in their most extreme form in medical settings. New directions in research and training are suggested that might prepare medical personnel to respond more sensitively and flexibly to the symbolic aspects of illness.


Marital satisfaction as perceived by the medical student's spouse.

This is a report of student marriages as perceived by spouses of medical students at the Southwestern Medical School, University of Texas Health Science Center at Dallas. Between August and November 1974 a questionnaire was sent to all spouses (239) of sophomore, junior, and senior students and 1974 graduates. The questionnaire examined: areas of stress within marriage, congruence between expected and actual behavior in the marital partner's role performance, and the spouse's attitudes toward marital counseling and whether a marital counseling service should be made available. Stress factors frequently cited were student's preoccupation due to school pressures, limited finances for recreation and nonessentials, student's inaccessibility due to school and loneliness. Most respondents stated satisfaction with their marriage; however, 38 percent indicated that their marriage could have benefited from counseling some time during medical school.


Six years of experience with a summer program for minority students.

This artical summarizes six years of experience of the University of Texas Medical Branch at Galveston (UTMB) with a summer program for the recruitment of minority students. During the six years, UTMB conducted six summer experiences for 112 Mexican-American and black premedical students and made numerous contacts with undergraduate college faculty and administrative staff for the purpose of increasing minority student enrollment in medical schools in general and in UTMB in particular. The program, which emphasized experiences which would increase the potential student's motivations, information, and academic skills, has resulted in numerous minority students entering medical school; but the impact on UTMB enrollments has been disappointing. Implications of the results of the program on future efforts to recruit minority students are discussed.


Training medical students in interpersonal relationship skills.

A review of the literature on training medical students in interviewing skills reveals a neglect of experimentally controlled studies as well as methods based on the most thoroughly researched approach to training, the Rogerian "core facilitative qualities." This paper reports a description and experimental evaluation of a training method designed to increase the student's comfort in dealing with emotionally intense material and to increase his skills in the core facilitative qualities. Comparison of the experimental and control groups reveals a training effect on the student's ability to recognize and communicate empathic understanding and on attitude and personality variables.


Comparison of the psychiatry learning system and traditional teaching of psychiatry.

Pressures of time, changing curricula, and increased enrollment in medical schools require the development of more efficient teaching methods to replace or supplement the traditional lecture format. The faculty of the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina has developed an individualized course in basic psychiatry which can replace approximately 50 hours of lectures ordinarily delivered to students during the rotation on clinical psychiatry. The individualized course, referred to as the Psychiatry Learning System (PLS), was received by half the class during the year 1973-74, and the lecture course was delivered to the other half. These two groups were compared on several learning outcomes, including attainment of theoretical knowledge about psychiatry, observational skills, interviewing ability, and problem-solving ability. Overall performance ratings by clinical supervisors were also obtained. The PLS group scored no worse on any of the measures but statistically better on half of them than did the lecture group.


Behavioral self-analysis in the medical curriculum.

Medical students in a first-year behavioral science course were required to conduct a behavior change project in accordance with a model based upon behavioristic principles. Most students conducted projects designed to alter their own behaviors, such as studying, eating, sleeping, and exercising. Student feedback, as well as formal evaluation of the projects that were conducted, provided a basis for the view that such procedures can make a significant contribution to the teaching of behavioral change technology in the medical curriculum.


Problems and concerns among medical students--1975.

Students at the University of Colorado School of Medicine were surveyed using an inventory of problems and conerns relating to their personal and academic lives. Results were to provide a data base for improvement of their educational environment via the ecosystem design process. The survey revealed that chief among student conerns are a lack of personal freedom, excessive academic pressures, and feelings of dehumanization. A marked trend toward increasing difficulty with thoughts of having chosen the wrong profession is noted over the four class levels. The authors offer several hypotheses relating to the underlying conditions responsible for these findings and discuss their possible relation to the current malpractice insurance crisis.


Prediction of screening decisions in a medical school admission process.

To study and predict a set of screening decisions in a medical school admission process, a stratified sample (n = 864) was drawn to represent the range of applicants to the Yale University School of Medicine during a single year. A smaller sample from the following year's applicants was drawn in a similar fashion for purposes of cross-validation. Prior to the prediction of screening decisions, a set of independent variables was selected by a factor analytic procedure from credentials in an applicant's admission folder. These folder variables ranged in nature from quantitative measures of academic performance to demographic information and types of extracurricular activity. Two multivariate statistical procedures, Sonquist's Automatic Interaction Detection (AID) and linear discriminant analysis (LDA), were used to predict screening decisions. Measures of academic performance and ability proved to be the most effective predictors of screening decision, as evidenced in the final AID tree and the discriminant function.


The Medical Polyclinic: an approach to conflicting needs in a teaching hospital.

University teaching hospitals have become increasingly aware of their responsibility to improve both the teaching of ambulatory care and the quality of care provided in their clinics. This paper describes how one department of medicine met this challenge by forming a "Medical Polyclinic." The majority of the department's faculty and house staff, at all academic and training levels, participate in a system of ambulatory care with the following objectives: each patient has a single physician whom he sees by appointment and who coordinates his care; all medical subspecialties are available in the same clinic session; the clinic is attractive and efficient. While these goals are not infrequently met in private group practices, they are unusual in a university teaching hospital, where faculty, house staff, students, and patients each have unique needs, not always compatible. The success and problems of the polyclinic approach are discussed.


Systematic instruction in interpretive aspects of laboratory medicine.

It is increasingly important for physicians to develop competence in ordering and interpreting laboratory tests. A review of the literature revealed no formal discussion of systematic instruction in the interpretive aspects of laboratory medicine. The goals, organization, instructional approaches, and assessment of a course offering such instruction are described here. Students are expected to develop an algorithmic approach to ordering and interpreting laboratory tests in the course of diagnosing and managing clinical problems in the major areas of medicine. Instructional approaches include lectures, case problem-solving sessions, and independent study. There has been an exponential growth in the number of students electing to take this course. Students respond enthusiastically to most aspects of the course. They are rated significantly higher on appropriate criterion measures in subsequent clinical electives than students who have not had such formal instruction in laboratory medicine during the senior years.


Validity and use of written simulation tests of clinical performance.

The outcome of a simulated clinical problem (drug-induced agranulocytosis) was compared with the outcome of similar cases in real medical service. The total performance of 100 sixth-year medical students at the end of their clerkship in internal medicine resulted in a mortality of 10 per cent in the simulation exercise. This mortality rate is the same as that which occured in the medical service during a four-year period. The total performance of the students was at about the same level at the end of the first clinical term and at the beginning of the clerkship in internal medicine (sixth term) but significantly better at the end of the latter.


The results of a 13-year training program in maternal and child health for physicians.

This paper describes the 13-year experience of one school of public health in preparing physicians for the field of maternal and child health. Some 256 (87.7 percent) of the 292 graduates have remained in community health work. Of the 292 graduates, 106 (36.3 percent) are engaged in some teaching responsibilities.


Acinetobacter and similar organisms in ear infections.

Fifty-seven strains of acinetobacter-like organisms were isolated over a period of 26 months from the ears of 55 patients with acute or chronic otitis media, or otitis externa, and one strain was isolated in a survey of 50 normal ears. After comparison with eight reference strains, 32 of the isolates were identified as Acinetobacter anitratus, 22 as Acinetobacter Iwoffii, three as Moraxella spp. and one as Achromobacter sp. Analysis of the clinical findings suggests that although most of these organisms played little part in the disease process, a few strains were probably pathogenic in this situation.


The detection and avoidance of false-positive reactions in tests for rubella-specific IgM.

Serum specimens tested for rubella-specific IgM by the haemagglutination-inhibition technique may give false-positive results due to (a) storage at -20 degrees C, (b) bacterial contamination, or (c) inactivation at 56 degrees C. These false-positive reactions can be distinguished from rubella-specific IgM activity by their resistance to 2-ME.


Anatomy and ultrastructure of the excretory system of the lizard, Sceloporus cyanogenys.

The anatomy and ultrastructure of the lizard kidney (Sceloporus cyanogenys) have been studied by light and electron microscopy. The number of glomeruli was counted in serial sections and estimated to be 2,000 (in the two kidneys). Beginning with the glomerulus and Bowman's capsule the nephron segments are sequentially: (a) proximal tubule; (b) intermediate ciliated segment consisting of a proximal and distal part; (c) distal tubule, which can be divided into two segments, followed by (d) connecting tubule and (e) initial collecting duct. The initial collecting ducts from several nephrons open into the collecting duct. Tubular epithelium in this lizard has similarities to that of other reptiles. The lateral borders do not overlap like in mammals, but interdigitate by fingerlike projections. The length of the nephron segments was measured in disected tubules and the diameter was measured on light and electron micrographs. From these measurements estimates of inner tubular surface area were made. Together with data from physiological studies (Stolte et al., '76; Schmidt-Nielsen, '76) the estimated surface area was used to calculate transport rates per unit area across the epithelium. Comparisons of structure and transport rates per unit area across the epithelium. Comparisons of structure and transport rates were made between S. cyanogenys and other reptiles and mammals.


Laser microbeam irradiation of rat kangaroo cells (PTK2) following selective sensitization with bromodeoxyuridine and ethidium bromide.

Ethidium bromide (10 mug/ml) and bromodeoxyuridine (25 mug/ml) were used to sensitize selective cell organelles to visible wavelengths of an argon ion laser (488 and 514 nanometers). Ethidium bromide was shown to be selective in sensitizing nucleoli, chromosomes, and the centriolar region of PTK2 cells to the laser microbeam. Similarly, BrDU sensitized chromosomes to the microbeam irradiation. The lesions produced on the chromosomes when either agent was used appeared as a phase paling of the irradiated segment. Nucleolar lesions also appeared as a phase paling, and the centriolar region alteration appeared either as a phase paling or a phase darkening.


Ultrastructural investigation of the mechanism of muscle attachment to the gastropod shell.

The ultrastructure of the muscle-shell attachment was investigated in the land pulmonate snails Helix aspersa, Anguispira alternata, in the freshwater pulmonate Laevipex sp., and in the freshwater prosobranch Pomacea paludosa. In all cases, a collagenous intercellular matrix and a specialized epithelium (tendon cells) intervene between the columellar muscle and the shell. These tendon cells are characterized by hemidesmosomes at both apical and basal ends, connected by thick bundles of microfilaments. The tendon cells do not insert into the shell directly by microvilli, as formerly thought, but by an extensive network of extracellular organic fibers.


The development of the septum primum relative to atrial septation in the mouse heart.

The septum primum in the mouse originates as a thickened primordium with a straight rather than a sickle-shaped ventral border. It is covered on its ventral border by anterior cushion material which is continuous over the roof of the atrium with the principal anterior cushion mass. A process of cavitation thins the septum primum and precedes actual fenestration. This process shifts the membranous septum to the left thereby providing room for the septum secundum to overlap on the right side. The septum primum cannot contact the posterior cushion until closure of the sinus venosus gutter which is described. The closure of the interatrial foramen, later the foramen primum, is accomplished by cell growth of the anterior cushion material. The ventral thick border of the septum primum contributes to the ventral limbus and the caudal thickened boundary of the fossa ovalis with some contribution from the left venous valve. These boundaries as well as the membranous portion of the interatrial septum are derived from the same primordium, namely the septum primum.


The response of transplants of cultured fetal mouse ovaries in kidneys of ovariectomized adult mice.

Whole ovaries from 16-day fetal mice were cultured for 6 to 20 days and then transplanted to the kidneys of ovariectomized adult mice where they remained for one to four weeks. After three weeks in the host's kidneys, many follicles developed within the transplants and became vesiculated. Many of the oocytes within these follicles had formed the first metaphase spindle of meiosis and several had completed the first polar body. Host mice bearing transplants that contained vesiculated follicles showed uterine stimulation and keratinization of their vaginae. However, ovaries that had been in culture for more than ten days before transplantation showed a limited response to the gonadotropins and never matured sufficiently to stimulate the host's reproductive tract. No ovulations occurred in any of the transplants.


The application of the Maatz-spreading-nail in operative treatment of distal tibial fractures.

The treatment of fractures located in the distal two fifths of the tibia offers some difficulties for anatomic and physiologic reasons. For operative treatment the conical form of the medullary cavity requires a special form of nail. Maatz developed a spreading-nail in 1943, which was applied in 107 cases between 1956 and 1974 by the present authors. Retrospective analysis of 64 cases showed advantages and limitations of this nail. If applied with proper indications very satisfactory results were seen. The operative technique described is simple.


The role of thoracic aortic occlusion for massive hemoperitoneum.

Forty patients with abdominal injury and massive hemoperitoneum had left thoracotomy and thoracic aortic occlusion. All 40 patients had tense abdominal distention and 37 patients were hypotensive at the time of skin incision despite aggressive resuscitation with blood and crystalloid solution. Laparotomy was performed initially in 11 patients; seven patients had sudden cardiovascular collapse as the abdominal wall tamponade was released and four patients remained hypotensive. With thoracotomy and thoracic aortic occlusion six of the 11 patients were resuscitated and had their injuries repaired. Thoracotomy and thoracic aortic occlusion were performed before laparotomy in 29 patients: seven patients remained hypotensive and expired; blood pressure was promptly restored in 22 patients and 11 of them survived the operative procedure. Left thoracotomy and thoracic aortic occlusion, before laparotomy, is offered as an alternative approach in patients with refractory hypotension and tense, abdominal distention. This technique aids in rapid restoration of vital signs, insures continued perfusion of the brain and myocardium, provides proximal arterial control, and prevents sudden cardiac arrest as the abdominal wall tamponade is released.


Intraoperative autotransfusion: equipment, protocols, and guidelines.

Blood obtained by intraoperative autotransfusion is: 1) readily available 2) sterile 3) compatible 4) normothermic 5) inexpensive and may be infused rapidly for volume support. We have made extensive modifications to commercially available equipment in order to provide a safe, effective IAT. The effects of IAT in our series of 85 patients are outlined below. Red Cell Mass is reduced after IAT because of irretrievable blood loss and hemolysis, and may be controlled by homologous transfusion when necessary. Red Cell Survival is normal after IAT. Hemolysis. Plasma free hemoglobin is consistently elevated after IAT, but clears within 24 hours. Platelets are normal for patients autotransfused less than 3,500 ml; micropore filters should not be used in cases where greater than 3,500 ml blood is expected to be reinfused; in cases where greater than 3,500 ml is reinfused, 10 units of platelets are recommended for every 3,000 ml of blood reinfused; IAT does effect platelets function; however, platelets circulating within the patient function normally. Coagulation. We use local ACD to eliminate extracorporeal surface clotting. Even with massive IAT we have never demonstrated any clinical or laboratory evidence of intravascular coagulopathy. "Dilutional coagulopathy" may be procuced when greater than 5,000 ml are reinfused, and may be controlled with fresh frozen plasma and platelet concentrates. Bilirubin levels were normal after IAT despite gross hemoglobinuria. Fat emboli were not noted after IAT. Air emboli must be a concern in IAT; HOWEVER, PROPER OPERATION AND EQUIPMENT MODIFICATION MAY ELIMINATE EMBOLI. Renal Failure was not noted after IAT. Alveolar-arterial Oxygen Difference and Blood Gases were normal after IAT. We feel IAT is not necessary if a blood loss less than 1,000 ml is expected. Also, if greater than 3,500 ml is expected additional backup (i.e. homologous transfusions, platelets, fresh frozen plasma) may be required. As banked donor blood reserves become more limited, IAT may become a routine part of general surgical procedures.