[Rehabilitation of patients who have suffered a stroke with an aphasic syndrome].

A total of 70 patients with aphasic syndromes following a cerebral stroke were treated in a neurological department, a polyclinic and at home. The main diseases which led to the brain stroke were hypertensive disease and general atherosclerosis. The aphasic disturbances were due to hemorrhagic strokes in 19 patients and ischemic-in 51 patients. Training of speech rehabilitation began from the end of the first and the beginning of the second week after the stroke. The inclusion of logopedic lessons into the general complex of restorative therapy, a continuity in conditions of a hospital and a polyclinic, a possibility of a dynamical observation of the patients, dispensarization-all these measures according to the authors' opinion are important and necessary for rehabilitation of the patients who had strokes with the aphasic syndrome.


[Lipoprotein metabolism disorders in hypertension with a cerebral syndrome and their diagnostic value for medico-occupational expertise].

On the basis of a profound clinico-biochemical study of 182 patients with hypertensive disease the authors established that the development of chronic insufficiency of cerebral circulation in this disorder is accompanied by quantitative and physico-chemical changes in the lipoprotein metabolism. These indices do not change significantly following short sessions of heparinotherpy and comprehensive treatment. Their diagnostical significance for medico-occupational examinations is discussed.


[Electroencephalographic characteristics of cerebral atherosclerosis in patients of different ages].

On the basis of clinical and EEG studies of 500 patients from the age of 45-105 with diffuse cerebral atherosclerosis the author comes to the following conclusion. With an intensification of atherosclerosis there is an increase of alpha-rhythm disorganization, a slowing down of the frequency, a drop in the amplitude and index of alpha-rhythms, a decrease in the electrical brain reactivity with an increase of delta-and theta-waves. It is shown that the EEG changes are to a greater extent determined by the severity of cerebral atherosclerosis than by age factors. Normal variants of the EEG in patients with expressed atherosclerosis is conditioned by the compensatory intactness of the cortico-subcortical systems generating these rhythms.


[Age and features of adrenal cortical function in cerebral circulatory disorders].

The indices of glucocorticoid and androgen activity in the adrenal cortex (the level of circulating eosinophils, the daily urine excretion of 17 OCS and 17 CS) and the functional reserve after an ACTH loading was studied in 2 groups of patients with disorders of cerebral circulation under 45 years of age (247 cases) and over 55 (234 cases). In the acute period of a cerebral stroke there was an increase of the glucocorticoid activity which was more definitely expressed in the younger group and a certain inhibition of the androgen function seen mainly in the older group. In transient disorders of cerebral circulation significant age difference in the functioning of the adrenal cortex was not established. In the period following a stroke the established and potential reserves of the adrenocortical glands were distinctly decreased in patients above 55 years and practically unchanged in the younger group.


[Cerebral and general hemodynamics in elderly patients with cerebral circulatory disorders].

The report is concerned with clinico-electrophysiological study of 112 patients of middle and old age with disorders of brain circulation. The obtained results depicting a cardio-vascular insufficiency were mainly seen in patients over 70 years of age. Changes of the heart activity negatively influenced the state of brain circulation. In the pathogenesis of cerebro-vascular changes especially in elderly and senile patients of special importance is cardiovascular insufficiency.


[Effect of papaverine on cerebrospinal fluid and blood acid-base balance in patients with vascular diseases of the brain].

The authors studied the acid-base balance of the CSF, arterial and venous blood in patients with disorders of cerebral circulation by Astrup's method. An analysis of the obtained results detected a certain correlation between the dynamics of clinical signs and changes in the concentration of H ions in the CSF. THese indices may point to connections between the cerebral circulation and changes in the concentration of H ions in the CSF under the influence of papaverine.


[Efficacy of transecting the anterior scalene muscle in the scalenus anticus syndrome (syndrome of the scalene muscle)].

The authors observed 111 cases with the anterior scalenus syndrome. Ninety-three patients underwent surgical treatment. Acknowledging the predominant role of the anterior scalenus muscle in the pathogenesis of this disorder the authors performed scalenotomia. In the group of patients with a noncomplicated development of the disease (48 cases) the operation appeared to be effective in 93.7% of the cases, while in vascular complications (45 cases) the effectiveness of the operation was significantly reduced. A positive result in these cases was attained only in 51.1%. On the basis of these data the authors come to the conclusion that scalenotomia performed in the initial, noncomplicated stages of the disease is a good prophylactic measure for severe complications in the magistral vessels and is an effective method of treatment of the scalenus-anticus syndrome.


[Confabulation in atrophic and vascular disease of old age (clinico-psychopathologic findings)].

The paper is concerned with a study of confabulation seen in 95 patients. A gradual development of the confabulatory syndrome (from mnemonic confabulations to ecmnestic) was seen in senile dementia (5 cases) and in its combination with vascular atherosclerosis (61 cases). An acute development of confabulations (with a prevalence of mnemonic false reminiscence over ecmnestic) was seen in cerebral atherosclerosis (9 cases). Rudimentary ecmnestic confabulations, without mnemonic were seen in Alzheimer's disease (20 cases). The author established a certain correlation between ecmnestic confabulations and disturbances of fixation, between mnemonic confabulations and disorders of selective reproductivity, between their expressiveness and emotional liveliness and the degree of actualization of the past events. In a complacent-euphoric and anxiety affect the confabulations were spontaneous and were accompanied by psuedoactivity. In depressive states they were fragmentary and were detected only in response to questions. Aphatic disorders and the severity of dementia influence the mnestic confabulations making them poorer and incomplete.


[Morphologic basis of psychoses associated with vascular and senile pathology].

The paper deals with a study of 100 patients diagnosed as combined senile and vascular psychoses. It is marked that in classical cases of such combinations the disorder has 3 stages. On the first stage there is a predominance of vascular pathology. After 60 years of age (the second stage) the senile sumptomatology disguises many symptoms of vascular lesions. The third stage is characterized by a vascular catastrophe. In many cases of combined psychoses there may be complications of other somatic pathology and mainly of lung and liver disorders.


[Korsakoff syndrome of traumatic genesis (development, structure, course)].

The conducted study of the development and structure of the Korsakoff syndrome of a traumatic origin shows that the syndrome has its own regularities of development. An analysis of its course demonstrates an expressed development of sequalae due to brain injuries. The evaluation of the Korsakoff syndrome and its components permits to predict at the initial phase of its appearance the clinical outcome and consequently the tactics of treatment and possible social readaptation.


[Dynamics of the dementia syndrome].

The author discusses some modern problems concerning the clinical pictures of dementia which have a certain theoretical and practical significance. The paper contains some results related to the dynamics of syndromes in acquired dementia and of the most frequently seen variants in the development of such conditions. The possibility of diagnosing dementia corresponding to the phases of mental disorders are discussed. The dynamics  of dementia syndromes are considered from the point of view of their nosological specificity.


[Mental disorders in meningiomas of the olfactory fossa].

In 19 patients with meningiomas of the olfactory fossa the author established a certain development of the psychopathological symptomatology. First of all asthenia ensues, eventually a complacent mood with an underestimation of the severity of the disease and an emotional crudeness is seen. These disorders are gradually substituted by euphoric dementia with a tendency towards foolish jokes, anosognosia of the disease, severe intellectual disorders and a desintegration of the "personality nuclei" with desinhibited drives. The intellectual disorders are expressed not in formal disturbances (logic operations), but in insufficient goal-directness and uncritical thinking.


[Clinical picture and dynamics of psychopathologic disorders in subacute leuko-and panencephalitis].

The report contains the results of clinico-dynamic studies of mental disorders in patients with Schilder's leukoencephalitis and subacute sclerosing panencephalitis after van-Bogart. The authors come to the conclusion that only parallel comparisons of the psychopathological symptomatology with focal neurological signs and a simultaneous study of the EEG and other paraclinical indices may facilitate the differential diagnosis of encephalitis.


[Direction of the clinical pathomorphosis of alcoholic delirium].

An examination of 348 patients with alcoholic delirium permitted to detect the main directions in the evolutional variability of the clinical picture. The authors distinguished 3 types in the development of a delirium: short-term with a complete and incomplete (abortive) variant; typical delirium with mono-and polymorphic structure of the syndrome; a protracted development in the form of a severe psychoses of a complex structure and a sluggish protracted variant with an obliviated symptomatology.


[Clinical characteristics of psychopathologic changes induced by medicinal anti-epileptic therapy].

On the basis of 48 clinical observations the authors describe some psychopathological changes due to certain anticonvulsive drugs used in the treatment of epilepsy (phenobarbital with diphenin or hexamindin, phenobarbital with finlepsin and bensodiazepine). The report contains an analysis of the causes leading to complications: a relative and absolute overdosage, a negative and positive interference of drugs.


[Interaction of psychotropic and anticonvulsive drugs].

Experiments on rats of the Wistar strain has  shown that preliminary repeated introduction of phenobarbitals and chlordiazepoxide weakens the pharmacological effect of medications, increases the liver weight and the protein content, RNA, R-450 cytochrome, accelerates the oxidation of substrates, but to a higher degree of hexobarbital. Aminazine and mellipramine do not significantly influence these indices changing, however, the affinity of R-450 cytochrome to different substrates and the speed of their oxidation.


Studies on the oogonial cycle in Puntius ticto (Ham.) I. Formation of primary oocytes.

Histologically, the ovary of Puntius ticto (Ham.) is covered with three layers, namely peritoneum, tunica albuginea and germinal epithelium. The last two give rise to the ovigerous nests in the ovocoel. The new crop of oocytes is either derived from the germ cells present in the ovigerous nests, or from the epithelium of the outer wall of the ovary, or from the epithelium of the ovigerous folds.


The arterial supply of the urinary bladder.

(1) The urachal artery has a primary origin from the umbilical artery itself, and is at first bilateral. (2) The arterial pattern in newborn infants is not identical to that of adults. Obliteration of the umbilical artery in older infants carries with it obliteration of some of its branches, especially at their origin from its distal part, with a resulting change in arterial pattern. (3) The middle vesicle artery is a fairly constant branch of the umbilical artery, supplying the bladder neck and the front of the bladder above the neck. (4) The urachal and middle vesicle arteries, when unilateral, occur with equal frequency on both sides. (5) The anastomosis between superior vesical and inferior episgastric arteries was confirmed in the subperitoneal tissues, but was very rare in the wall of the bladder, occurring only when an abnormal obturator artery was the source of a superior vesical branch. (6) The constancy of the vesiculo-deferential artery is confirmed.


Cholinergic innervation of vessels of the base of the brain.

Distribution and activity of acetylcholinesterase in the intramural nerve apparatus of vessels of the base of the bran have been studied with the histochemical method of Koelle-Gomori. On the whole, 268 arteries have been examined. The activity of the ferment is detected in the effector nerve fibers in the wall of all cerebral vessels constituting the system of the circle of Willis. The periarterial nerve apparatus of cerebral arteries of the anterior and posterior regions of the circle of Willis consists of two cholinergic plexuses - superficial and deep plexus forming a multilayered neural cover. The terminal parts of cholinergic nerve fibres at the border with the muscular coat show a granular structure. Moreover, nerve cells rich in active ferment are found in the cholinergic plexuses. Difference in the character of cholinergic innervation of vessels of the internal carotid and the vertebrobasilar region has been shown. The obtained data indicate that the vessels of the circle of Willis possess a reliable cholinergic system of nerve regulation which along with other systems, such as that of adrenergic nerve fibers, maintains the homeostasis of the cerebral blood flow.


Wool follicle characteristics in the Awassi fat-tailed sheep.

In Awassi sheep, the total number of wool follicles per square millimetre was affected significantly by age, sex, and type of birth. The density of the primary follicles was only significantly affected by age and type of birth. The secondary follicles to primary follicles (S/P) ratio values were 2.0 at birth, 4.0 at 2 months and 4.2 at 6 months of age, in Awassi sheep. The males exceeded the females, in most ages of the experiment. The single lambs surpassed the twins in the S/P ratio values. The effect of age and type of birth on the S/P ratio was highly significant. The external diameter of wool follicles increased with higher values at 2 months of age than afterwards, till 6 months of age. The contrary was the case in the internal diameters of wool follicles. The increase was higher in the primary than in the secondary follicles, during the period of the study. The males surpassed, in general, the females in the values of the external and internal diameters of the primary and secondary follicles. Single lambs showed higher values than twins in the external and internal diameters of primary and secondary follicles in most ages of the experiment. Age and type of birth affected significantly the diameters of follicles, while sex effect was only highly significant on the external diameter of the secondary follicles. The length of the primary and secondary follicles and the thickness of skin increased significantly, as the animals grew older. Sex showed no significant effect on the length of follicles, while it affected significantly the thickness of the skin. Single lambs showed higher significant values than twins, in length of follicles and skin thickness. The bulbs of each of the primary and secondary follicles increased significantly, as the animals grew older. Sex had no significant effect on the bulb diameters of the two types of follicles. The single lambs surpassed the twins in the values for follicle bulb diameter, in most ages of the experiment. The effect of the type of birth on the bulb diameter of the two types of follicles was highly significant.


Observations on the effects of alpha-chlorhydrin on the testes and pituitary gonadotrophs of gerbil (Meriones hurrianae) and rat.

(1) Lower doses of alpha-chlorhydrin caused high selectivity of lesions in the seminiferous tubule of rat and gerbil. (2) The seminiferous epithelium became systematically depleted of spermatogonia, spermatocytes, spermatids and finally spermatozoa in this sequence. (3) The suppression of RNA concentration in the testes and seminal vesicle is conspicuous. (4) The growth of androgen-dependent organs, i.e. seminal vesicles, ventral prostate, epididymes and perineal complex, is suppressed. (5) These effects are reversible. Repopulation of testis tubules occurs followed by a 40-day recovery period in rat and gerbil. (6) alpha-Chlorhydrin administration brings about hypertrophy of pituitary gonadotrophs which is also reflected in the increased basophilic cell percentage (control: 15.5% alpha-chlorhydrin: 21.5%; p less than 0.01).


The action of the hind limb musculature of the dog in walking.

This study was performed by means of cinephotography and electromyography. The results were correlated with earlier investigations concerning the forces exerted by the pads of walking dogs. A concept about the action of individual muscles of the hind limb during a stride was formed. The principal conclusions are: (1) The hamstrings are divisible into a cranial and a caudal group, the first consisting of the cranial parts of the M. biceps femoris and M. semimembranosus, the second of the caudal parts of these muscles, together with the M. semitendinosus. The chief function of both groups is to extend the hip; the caudal group also flexes the stifle. (2) Activity is present in the greatest number of muscle s during the change in the sense of movement of the limb. (3) During the last stages of the stance phase the number of muscles showing electrical activity diminishes, while the force exerted by the pads in a horizontal direction increases. Non-muscular forces, e.g. inertia, play an important role during movement.


Adaptive differences in the body proportions of large felids.

Body proportions of eight species of large felids were studied and the relationship between their morphology, habitat structure and habitat utilization was analyzed. Both Panthera onca and Neofelis nebulosa are exclusive forest dwellers (found exclusively in high densly structured habitats). These felids have the relatively shortest anterior limbs and lumbar spine. In addition, P. onca has the relatively shortest posterior limbs of the large felids, while the posterior limbs of N. nebulosa are relatively long when compared with those of P. onca which seems to be an adaptation for jumping. All large fields use the anterior limbs to make primary contact with their prey. In addition, the prey taken by the forest fields can exceed their own body weight. On the other hand, the cheetah is found in low structured habitats (savanna), and it has the relatively longest limbs and lumbarspine of the large felids. But the cheetah's prey usually weigh less than its own body weight. The cheetah also employs a 'rapid pursuit phase' in hunting and is capable of overtaking its prey. The lion, however, was found to have the body proportions of a forest felid, yet it also resides in low structured habitats. It is postulated that the utilization of large prey by the lion limits the possibilities for morphological adaptations for speed. To increase hunting efficiency, reproductive success, and territorial defense on the plains, lions form prides.


Experimentally induced osteoarthrosis in the temporomandibular joint of the mouse.

(1) 6-week-old ICR mice were injected daily with pharmacologic doses of triamcinolone diacetate (1.5 mg/kg body weight) for 8 consecutive weeks. (2) The temporomandibular joint served as a model for histological and histochemical examinations concerning the effect of glucocorticoid hormone upon bone and cartilage. (3) Histochemical reactions indicated a large number of lipid droplets within the peripheral vasculature. (4) Histological examinations revealed pathologic features, indicative of primary osteoarthrosis.


[Aneurysm at the bifurcation of the internal carotid artery (author's transl)].

The authors analyse 14 cases of aneurysm occurring at the point of bifurcation of the internal carotid artery into the middle and anterior cerebral arteries. Distinguishing features of this aneurysm are often its fairly large size and extensive implantation on the artery. Clinical symptoms are not specific but various neurological signs are frequent. The bifurcation of the carotid artery is not always readily visible; oblique views and angiotomography are often necessary. Owing to the usual severity of the natural evolution of this type of aneurysm (death in six out of eight cases), surgical treatment is advisable. Ligation of the carotid artery is disadvised because of the unpredictable nature of its results (further fatal haemorrhage in one out of three cases).


The arterial angioarchitecture in lacunar state.

The statistical data, obtained in seventy five brains with lacunar state, show that the lenticular nuclei and the periventricular arterial end-and borderzones are the main seats of the infarcts. In teen brains the relationship between the deep arterial angioarchitecture and the location of thirty lacunes is studied by means of the translucidation technique after filling the arterial system with a colloîdal barium sulphate solution. The deep perforating arteries are poorly filled and show several narrowings and post-stenotic dilatations. In twenty-four lacunes, an occlusion of the responsible artery is found. In the six remaining lacunes, no occlusion of the main artery is observed but the side-branches are not demonstrated. The significance of these findings and the relationship between the location of the occlusion and the topography of the lacune are discussed.


Total 5-hydroxyindoles in blood related to migraine attacks.

The total 5-hydroxyindoles (5HI) in whole blood were measured in 20 migraine patients during spontaneous migraine attacks and in headache-free periods. A statistically significant fall in blood 5-HI was found during headache in 17 patients suffering from classical and common migraine. In one patient with complicated migraine no change was found, and in two patients, one with common migraine and one with migraine and associated symptoms, there was a rise in total blood 5-HI during migraine attacks. The results are compared with previous findings in this field, and it is suggested that during migraine attacks there might be a rise in the plasma 5-HI. The possibility of using the 5-HI fall during spontaneous migraine attacks as a simple test for the diagnosis of migraine is discussed.


Periodic electroencephalographic compleses and subacute sclerosing panencephalitis. A case report and a survey of literature.

The authors report the case of a child with a presumable diagnosis of subacute sclerosing panencephalitis (SSPE). But pathological examination of the brain showed only a moderate neuronal loss in the cortical and subcortical grey matter. From this case and from the data in the literature it is concluded that the electroencephalogram in stage II of SSPE is characterized by the appearance of paroxysmal wave complexes which recur pseudo-periodically against a disorganized basic activity. The criteria for these complexes are not as strict and the periodicity is not as regular as formerly believed. Such a tracing is not pathognomonic of SSPE and may also occur-although rarely-in other brain diseases. The theory that the periodic discharges originate from a diffuse alteration of cortical and subcortical grey matter seems the most plausible.


Arginine esterase in cerebrospinal fluid and pro-arginine esterase in plasma from patients with migraine.

Estimates of prekallikrein levels in plasma specimens from patients with migraine and from healthy individuals were obtained by determining the benzoyl-arginine ethyl ester (BAEe) esterase activities developed on activation with kaolin, as suggested by Costerase level- 'n the patients and in the control material, and kinetic data provided no evidence of a difference in inhibitor levels. Only very low BAEe esterase activity was registered in samples of cerebrospinal fluid obtained from the patients and no significant difference between attacks and free intervals was detected. When citrated EDTA-treated plasma was activated with acetone-incubated normal plasma containing prekallikrein activator (factor XIIf), no significant difference in BAEe esterase activity was noticed between plasma from the patients and that from the control persons. When, however, citrated plasma without EDTA  was used, a significantly higher peak level of esterase activity was registered in the patient plasma. This observation might suggest the presence of a factor positioned between active factor XII and prekallikrein, and present in higher amounts in plasma from patients with migraine than in healthy individuals.


[Periodic discharges observed in a cerebral vascular accident (author's transl)].

The authors report a case of cerebral softening in which almost entirely unilateral periodic discharges were observed. They consisted of isolated high-voltage spiked waves predominating distinctly on the side of the lesion. The interval between spikes was always 2-3 seconds. The origin of these signs is discussed. The fact that they are not necessarily related to an infectious or metabolic disease is underlined.


A prospective study of parapareses in western Sweden.

As a consequence of a WHO inquiry about possible complications to poliomyelitis immunization, a prospective incidence study was performed during 1971 in the western region of Sweden, in order to obtain data relevant to the inactivated vaccine used here. After rejection of surgical and secondary cases, the study consisted of 10 Guillain-Barré cases, three incipient MS cases, two infectious and one probably vascular case. By using a procedure of retrospective controls it was demonstrated that the efficiency of prospective case ascertainment is dependent on diagnosis. The incidence of de novo parapareses as defined was approximately 1.7/100,000/year of which 1.0/100,000/year was due to MS. CSF and virological investigations were performed early in prospective cases, in MS cases within 5 to 11 days after onset, and it was shown that no changes occurred in later CF titrations. Routine virological tests did not contribute to diagnosis in patients having paraparesis. No vaccine-associated cases of paraparesis occurred during the 1-year period of the study.


[Programmed rehabilitation of a case of agraphia (author's transl)].

The authors describe a programmed method of rehabilitation suitable for patients with writing disorders resulting from cerebral lesions. The use of a visual display screen permits differential display and the immediate correction of errors. The application of the method is illustrated in the case of a patient with aphasic agraphia, and its general utility is briefly discussed in relation to the nature of various graphic disorders.


[Cardiomyopathy and rapidly developing proximal myotonic amyotrophy in an athlete (author's transl)].

The authors report the clinical history of a young athlete who, without any notable family antecedents, developed cardiomyopathy followed by proximal anyotrophy at the age of 24 years. The electromyogram revealed frequent myotonic salves and a typically myogenic tracing. The autopsy showed substantial generalized cardiac enlargement and marked atrophy of the muscle fibres in the girdles, together with grouping of the nuclei into hyperchromatic clusters. The reported case thus shows some characteristics of Steinet's disease and others of non-dystrophic myotonia (Becker, 1964) but cannot be classified as either of these diseases.


Epileptic seizures in women related to plasma estrogen and progesterone during the menstrual cycle.

Nine periods in seven women with partial epilepsy have been invetigated with respect to frequency of fits, and estrogen-progesterone levels in blood plasma. Six cycles with ovulation showed a positive correlation between the number of secondary generalized seizures and the mean estrogen/progesterone (E/P) ratios and a negative correlation to plasma progesterone levels. Three periods without ovulation showed an increase in the number of fits during days of high estrogen. The number of fits seemed not to be correlated to changes in body weight.


Electroencephalographic examination of 50 women with Turner's syndrome.

An EEG study has been made of 50 women with Turner's syndrome, 39 found outside institutions and 11 in institutions for the mentally retarded. We found paroxysmal EEG abnormalities in 23 per cent of the former and in 55 per cent of the latter. We found indications of occipital lobe defects in the mentally retarded Turner women.


The influence of prostaglandin E2 on the electroencephalogram of normal subjects and epileptic patients.

In 1973 R.C. Lyneham and others warned against the possible epileptogenic effect of prostaglandins. We studied the influence of this substance on the electroencephalogram of 53 subject (31 non-epileptics and 22 epileptics) before and during the administration of PG E2. Forty-eight tracings remained unchanged, four showed a slight improvement and one showed some worsening during infusion of PG E2. One patient, suffering from daily psychomotor attacks had, accidentally a fit during the trial. It can be concluded that PG E2 does not alter the electroencephalogram in a significant way and that it does not induce epileptic seizures.


[Cerebrospinal fluid shunt in cases of dementia (author's transl)].

The authors distinguish between two evolutive forms of dementia, one being chracterized by prpgressive deterioration (for instance in the course of arteriopathic, degenerative or infections processes) and the other in which dementia sets in after the clinical picture has improved (for instance after meningeal haemorrhage, craniocerebral injury, endocrinous, metabolic or circulatory disorders, etc.). Ventricular drainage (according to Pudenz-Heyer) was performed in 20 patients presenting dementia: the results were favourable in the seven patients presenting dementia: the results were favourable in the seven patients presenting the first evolutive form and in almost all 13 patients presenting the second form. The pathogenic problems.


Cerebral blood flow changes in cluster headache.

Serial cerebral blood flow studies performed by the intra-carotid 133Xenon method were fortuitously determined during the course of a cluster headache in a 32 year old man. The initial study was performed about 10 min after the headache began and showed values at the upper limit of normal. Twenty min after the headache started a second procedure showed that the autoregulatory response on hyperventilation was normal. Ergotamine tartrate was given intra-muscularly 23 min after the headache began and there was partial relief. A third cerebral blood flow estimation showed abnormally high values. The probable reasons for this are discussed.


A prospective study of drugs and pregnancy. 4. Miscellaneous drugs.

The results are presented of a prospective study on drug use during pregnancy involving antibiotics, analgesic drugs and iron and vitamin preparations. The study was conducted in Malmö between 1963 and 1965. No unfavourable effect of the use of antibiotics, mainly penicillin and sulphonamides, could be demonstrated. Among 15 women who had an infant with hypospadias, three had used penicillin during the first trimester, but this may well be coincidental. Analgesic drug use shows a variability which resembles that previously described for psychopharmaca. No effect on the malformation rate or infant survival could be found. A possible lengthening of the mean duration of pregnancy occurred after the use of analgesic drugs during the 2nd or 3rd trimesters. Women who are going to have a dead or malformed infant use iron and/or vitamin preparations less often during late pregnancy than women who prove to have a normal infant. When such drugs were used, the percentage of pregnancies ending in birth before the 38th week is reduced, and the birth weight among term babies is higher. The associations between pregnancy outcome and the use of iron and vitamin preparations is probably indirect, due to social factors associated with drug use.


Histamine metabolism during the menstrual cycle.

The urinary excretion of histamine and its metabolites methylhistamine (MeHi) and methylimidazoleacetic acid (MeImAA) was measured during the menstrual cycle in nine healthy women, one allergic woman and three non-pregnant women with anovulatory regular cycles. Simultaneous urinary analyses of luteinizing hormone (LH) and total estrogens were performed. The healthy women showed individual variations in the excretion of histamine, MeHi and MeImAA. This observation has been interpreted as an expression of minor individual differences in the catabolism of histamine. At midcycle an increase in the urinary excretion of histamine metabolites was sometimes evident and a statistically significant correlation could be established between MeHi and estrogen in urine. These results may support previous findings of histamine release by estrogens in uterine tissue but may also reflect an elevated histamine formation. The allergic woman excreted constantly increased amounts of histamine and its metabolites, especially when her allergic symptoms became aggravated pre-menstrually. She did not exhibit any change in MeImAA excretion at midcycle but the MeHi-excretion varied with the excretion of estrogens in the urine. The subjects with anovulatory menstrual cycles had low values of histamine and metabolites although within the normal variations.


Epidural analgesia in labour. IV. Influence on uterine activity and fetal heart rate.

The influence of epidural block with bupivacaine (Marcaine-adrenalin) on fetal heart rate, uterine activity, and the frequency and intensity of contractions was studied in twenty-five nulliparae at term. Uterine activity was found to decrease during the first 30 minutes following epidural block. In the time interval 30 to 40 minutes after epidural block uterine activity increased again and attained the same level as during the last 10 minutes before analgesia. The frequency of uterine contractions did not decrease after the block. The lower levels of uterine contractility were due only to a lower amplitude of the contractions. The regularizing effect of epidural analgesia on incoordinate uterine action was noted. The recording of fetal heart rate in the time interval studied revealed no pathological findings. Mode of delivery, mean labour duration and Apgar scores after epidural block were comparable with earlier studies of a larger patient population. This study suggest that epidural analgesia does not induce any important changes in fetal heart rate but temporarily decreases uterine activity.


Survey radiography of abdomen following caesarean section, with particular reference to caecal diameter and the presence of free subdiaphragmatic gas.

The literature concerning perforation and imminent perforation of the caecum is reviewed. The greatest importance is attached to 5 cases of perforation of the caecum associated with paralytic ileus following Caesarean section. The caecal diameter was determined by radiography in 100 patients on the 3rd and 5th day after Caesarean section. At the same time the volume of subdiaphragmatic free gas was assessed. An average caecal diameter of 6.4 cm was found, which is not different from the findings in the normal population. Increasing caecal diameter during the puerperium gives rise to suspicion of the caecum. In 90% of the patients free subdiaphragmatic gas disappeared by the 5th day after Caesarean section.


Studies on the mode of action of clomiphene citrate.

In order to further investigate the mode of action of clomiphene citrate, 5 oophorectomized women in the age range 28 to 41 years were followed with weekly determinations of serum FSH and LH for 20 weeks after the operation. They received no treatment during the first 4 weeks but during the next 16 weeks they were given estradiol 2 mg X 2 daily orally, and from the 12th to the 16th week in addition clomiphene citrate 50 mgX2 daily. The high level of FSH after the oophorectomy decreased gradually during the treatment with estradiol alone, but this effect was partly neutralized by clomiphene citrate, as we observed a significant increase in FSH within 1 week of initiating treatment with clomiphene citrate. On the other hand, we did not find any significant changes in FSH within 4 weeks after treatment with clomiphene citrate was discontinued. The high level of LH after oophorectomy did not show any significant changes during the whole treatment period. It is concluded that clomiphene citrate primarily stimulated FSH secretion, most probably by a competition with estradiol for the receptor sites in the hypothalamus or the pituitary. In addition, it is concluded that clomiphene citrate has a prolonged effect, probably because of a tight binding to the receptor sites.


The behaviour of microsomal mono-electron carriers in human placenta during late pregnancy.

The activities and the content of enzymes involved in mixed function oxidase systems (cytochromes P-450 and b5, NADPH-cytochrome c reductase and NADH cytochrome b5 reductase) in microsomes from 114 human placentae were found to increase from the 34th up to the 38th-39th week of gestation and later to decrease until the 43rd week. Such a process can be related to the following: (i) the phospholipid content of microsomal membranes; (ii) the protein synthesis possibly induced by steroids such as androstenedione and testosterone.


Amniotic fluid lecithin concentrations in pregnancies complicated by hypertensive disorders and intrauterine growth retardation.

Amniotic fluid lecithin has been measured in 92 samples from 75 patients with hypertensive disorders and in normotensive pregnancies complicated by intrauterine growth retardation (IUGR). For the group with hypertensive disorders the lecithin concentrations were not significantly different from a reference material at any stage in gestation. Pre-eclampsia associated with moderately elevated blood pressure and complicated by IUGR showed significantly higher lecithin concentrations than any other diagnostic subgroup. The lecithin concentrations showed no relationship to maternal urinary estrogen excretion. The value of serial estrogen measurements in predicting IUGR has been emphasized. An evaluation of the amniotic fluid lecithin concentration in relation to respiratory function has been made. Respiratory distress syndrome may occur even in growth retarded babies.


Cervical cancer in women belonging to a cytologically screened population.

Women belonging to the cytologically screened population of Stockholm in 1968 to 1974 and developing cervical cancer of stage I to IV were studied. The purpose was to find out the number of women, in whom the cancer or its preclinical stage was not detected at routine screening, and the reasons for this fact. It was found that 34 out of 177 women had never been cytologically screened. The remaining 143 women had been checked at mass screening and/or at private specialists or hospitals. In 51 screened women the cancer was not detected until the women themselves attended a doctor because of symptoms. Thus in 85 women, or 48% of the series, the cancer escaped detection at an asymptomatic stage. Errors causing a delay or interruption of the follow-up of patients with suspicious smears or colposcopic atypia were observed in 25 cases. Sixty-four patients, or 45% of all screened women, had had at least one negative smear within 4.5 years prior to discovery of the malignancy. Out of these, 53 patients had got a negative smear within 3 years. Whatever might be the true evaluation of these negative smears, their influence on the continued management of the women was important. In view of the results of this study the 4 years interval of rescreening practiced in Stockholm seems to be too long. Moreover the statement is supported, that the value of health screenings is counteracted by the fact that the people most at risk are the least likely to attend.


Outcome of pregnancy after clomiphene therapy.

Of 159 pregnancies conceived after clomiphene therapy, 141 ended in childbirth, including seven sets of twins. There was a probable increase in the number of infants born with major malformations. These were exclusively to women who had not previously borne a normal infant. The incidence of malformed infants compares well with that published after gonadotropin therapy. The possibly higher incidence of malformations seen after drug-induced ovulation would therefore seem to be due to the underlying subfertility state and thus not a direct drug effect.


Dope is to get high: a preliminary analysis of intracultural variation in drug categories among heavy users and dealers.

Users' definitions and classifications of drugs diverge from officially recognized systems and vary among themselves. They manifest a preoccupation with the experience of being high and reflect the relationship of the drug-using subcultural coalition to the mainstream of American life. Types of categorizations support recent descriptions of types of users reported in the literature as well as indicating areas of diffusion of drug use.


Polyelectrolyte effects in gel chromatography.

When polyelectrolytes (i.e., lignosulfonates) are eluted from Sepfected by steric exclusion, polyelectrolyte expansion, ion exclusion, and ion inclusion effects. The last-mentioned effect arises from the interaction of charged sites in the high-MW macroions, which are more or less excluded from the gel phase with charged sites in more permeable macroions. The ion inclusion effect depends on the counterion in such a way that the fractionation of polyelectrolytes with a univalent counterion is affected to a greater extent than is the fractionation of polyelectrolytes with a divalent counterion. This is attributable to the existence of a higher density of free charges in the former case, since univalent counterions have a lesser tendency to form ion pairs with the charged sites of the macroion than have divalent counter-ions. The ion inclusion effect may have a favorable influence on the resolution of components of relatively equal molar volume, but of different charge densities. Polyelectrolyte effects are suppressed if the elution is carried oe polyelectrolyte behaves as a nonionic polymer. However, since the separation effected by differences in charge densities is eliminated (swamped out), resolution may deteriorate; nevertheless, the fractionation order is independent of the composition of the sample, the concentration of sample solution, and other fractionation variables. If one wishes to acquire a general picture of the composition of a certain polyelectrolyte, a solution of a simple electrolyte may be the most appropriate eluent. However, if polyelectrolyte components with small differences in hydrodynamic volume are to be separated, an eluent comprising a solution of a high-MW polyelectrolyte, completely excluded by the gel (e.g., dextran sulfate), can be used.


Vitamin D status of patients with femoral neck fractures.

Thirty-nine patients admitted to hospital with fractures of the neck of the femur had mean serum 25-hydroxycholecalciferol (25-(OH)D3) levels markedly lower than that of young healthy controls. There was also a significant seasonal variation in these 25-(OH)D3 levels, values in winter being about half those in summer. It is suggested that vitamin D deficiency plays an an important role in the pathology of old age.


Ulnar deviation of the fingers as a clinical sign in the elderly.

A significant percentage of elderly women has been found to have ulnar deviation. As measured at the middle finger, the mean deviation of 73 degrees is small, but nearly 25% of subjects showed a clinically visible deviation of between 11 degrees and 25 degrees. Ulnar deviation has been noted in subjects who are not suffering from the diseases and states commonly regarded as being important to its aetiology. In those it may represent the end-point of the progressive drift considered by some to be a normal ageing process. Whether the aetiology lies here or in one of the other diseases of the locomotor or central nervous systems is uncertain, but caution should be used when interpreting the clinical sign in the elderly.


Observations on thyroid function tests in the elderly.

One hundred elderly men and women living in old people's homes and 95 in a long-stay geriatric hospital were investigated for thyroid function by measuring the serum thyroxine, T-3 uptake and calculating the free thyroxine index. The values obtained were found to be within the normal adult range in 97% of the subjects studied. No significant correlation was found between albumin and T-3 uptake, except in men in hospital.


Wheat bran in dyschezia in the aged.

A trial of wheat bran added to the diet of aged dyschezic hospital patients (12 men, 13 women) is reported. This significantly reduced the need for aperients and suppositories but revealed unexpected differences in response by sex. In men, bran produced more bowel actions, fewer constipated days and an increase in stool size. In women there was much less effect upon the number of bowel actions and reduction of constipated days. In men there were fewer constipated days and need for aperients after the bran was withdrawn. Side-effects were only seen in men. Most patients received 15 g/day (range 5-25 g/day). Although cheap and effective in replacing aperients, there were problems in administration and control of incontinence for the nursing staff. The value of added wheat bran in the bowel management of the long-stay hospital patient is discussed and an effective method of combining bran in the diet (e.g. with bread) might be further investigated.


Effect of a lathyrogen (aminoacetonitrile hydrochloride) on aortic physiosclerosis and skeletal mineralization in growing rats of different age.

In one experiment, four groups of six-week-old-male PVG rats were, respectively, given tap water ('control group'), 0.00125M, 0.0025M, and 0.005M lathyrogen (aminoacetonitrile hydrochloride: AAN) solutions ad libitum for a period of 20 weeks. In a second experiment, 12-week-old male rats were similarly treated. It was found that the younger rats were far more susceptible to lathyrogenic influences than the older rats. For example, the rate of aortic physiosclerosis was significantly retarded in the six-week-old rats at dosages of 0.00125M and 0.0025M (the six-week-old rats exposed to 0.005M AAN were eliminated from the experiment before its completion), whilst physiosclerosis was unaffected even in those 12-week-old rats exposed to 0.005M AAN. The degree of mineralization of the femur (as reflected by its ash, Ca, Mg, Na, and K content) was retarded in approximately dose-dependent fashion in the rats of both ages, the effect being somewhat more pronounced in the younger animals. These results were discussed in the context of the known effects of lathyrogenic compounds on the biochemical maturation of connective tissue components, and also in the context of previous attempts to modify the lifespan of laboratory animals by lathyrogen administration.


Geriatric day hospitals: counting the cost compared with other methods of support.

The past decade has seen a great expansion of the day-hospital element in geriatric and psychiatric care, and the merits of such therapeutic agencies have been described quite often--but with little reference to the economic benefit to the community. We have described an enquiry into the true cost of a typical 'intermediate' day hospital and introduced valid comparisons with other methods of caring for the elderly sick or frail: these comparisons inevitably led to the inclusion of the acute general hospital when considering the integrated health and welfare service which we require. The surprising financial implications should be recognized as we enter another era of stringency which must restrict development of the National Health Service.


Follow-up study of two hundred admissions to a residential home.

Two hundred admissions to a local-authority Residential Home in Edinburgh were followed up for four years to study subsequent morbidity and mortality in the Home or after transfer. Their survival was compared with that of patients transferred from a Geriatric Assessment Unit to Long-stay Units. The mortality of both groups was greater than expected, particularly in the early weeks and in those suffering from cerebrovascular disease.


Cephazolin treatment of pneumonia in the elderly.

Cephazolin, a semi-synthetic cephalosporin for parenteral use, was evaluated in 39 elderly hospital patients. Thirty-three of these patients were seriously ill at the start of treatment, suffering from pulmonary infections. In the other six patients, the drug was used post-operatively as a prophylactic, and it was effective in all cases in preventing any subsequent infection. Cephazolin was very effective in the treatment of 27 of the severely ill patients; the primary pathogen was eradicated and there was good clinical improvement. In two patients the primary pathogens were resistant to cephazolin, and the antibiotic therapy was changed after sensitivities were known. Of four patients with Haemophilus influenzae infection, clinical cure was obtained in two. Cephazolin therapy was discontinued in one woman because she developed a rash. However, there were no major toxic effects of therapy in terms of hepatic, renal or haematological function. No patient complained of pain when the intramuscular therapy was given. A dose of 1 g IM twice daily was shown to produce consistently high serum concentrations. Thus, in the elderly, the advantages of cephazolin are its lack of nephrotoxicity even when diuretic therapy is being administered concurrently, its lack of pain on intramuscular injection, and its sustained concentrations in the blood and urine so that it only requires to be given twice daily. In vitro studies showed that cephazolin is more active than cephaloridine against hospital pathogens.


The stricken: the social consequences of stroke.

Of 76 patients admitted consecutively to a stroke rehabilitation ward at Lightburn Hospital Glasgow, 35 were discharged home, and 29 of these were followed at home for three years or until they died. Eighteen of the patients survived for three years, the survivors being mainly the younger patients. Most remained reasonably fit physically, but none returned to employment and few undertook any activities outside the house. Many became depressed and frustrated. This group received little in the way of domiciliary health and social services, rehabilitation services and financial help. There is a need to improve the services for survivors of strokes after their discharge from hospital.


The effect of parity and time between pregnancies on maternal hair chromium concentration.

Values for hair chromium concentration of nulliparous women and parous women who had just given birth to a child were determined by atomic absorption spectrophotometry. Mean values for hair chromium concentration of nulliparous and parous subjects were 309 +/- 23 and 117 +/- 10 ppb, respectively. The difference was highly significant (P less than 0.001). No further significant decrease in hair chromium was observed in women who had borne more than one child. Hair chromium concentration increased significantly with the amount of time between pregnancies, especially when at least 4 years had passed since the end of the last pregnancy (P less than 0.001). These data suggest a state of suboptimal chromium nutrition during pregnancy.


Wine versus ethanol in human nutrition. I. Nitrogen and calorie balance.

There are implications in the literature that wine is different from other alcoholic beverages and that it may even have a beneficial effect on the nutritional process. A metabolic study was undertaken in an attempt to document the effects of wine versus ethanol on absorption of various nutrients. Nitrogen and caloric data are presented here. During each of four 18-day experimental periods, six healthy, young men were given, in random order, a liter per day of the following test beverages: Zinfandel wine (9.3% w/v alcohol); dealcoholized Zinfandel wine; pure ethanol (9.3% w/v aqueous alcohol solution); and deionized water. These beverages were divided into four equal feedings and administered with a carefully controlled isocaloric diet over a 12-hr period. The subjects tended to lose weight on alcohol-containing regimens, suggesting that calories from alcohol may not be as efficient as those from fat and carbohydrate. Urinary excretion of nitrogen was significantly greater during wine and ethanol administration than during feeding of the other test beverages. This was reflected in an increase in uric acid and urea nitrogen output, primarily, the latter, suggesting that alcohol may directly affect protein catabolism. There was no significant difference in fecal nitrogen excretion between experimental periods.


25-Hydroxycholecalciferol levels in bedouins in the Negev.

25-Hydroxycholecalciferol (25-HCC) levels were measured in 31 bedouin females and eight bedouin male tribesmen and compared with the levels in Jewish males and females in Beersheba. In nonpregnant bedouin women the mean 25-HCC level was 25.4 ng/ml +/- 9.78. In pregnant bedouin women the mean was 23.4 ng/ml +/- 8.52. In bedouin males the mean level was 25.7 ng/ml +/- 3.03. In Jewish females, both pregnant and nonpregnant, the levels were higher (32.7 ng/ml +/- 6.02 and 44.3 ng/ml +/- 9.24). Jewish males had levels of 32.8 +/- 6.29 ng/ml. No bedouin had plasma levels below 10 ng/ml, and there was no evidence to suggest deficiency of vitamin D in bedouin males or females.


Calorigenic response in obese and nonobese women.

The calorigenic response to a high protein test meal was studied in women with a history of childhood onset obesity. Obese and nonobese individuals were fasted overnight and basal oxygen consumptions determined the following morning. A semisynthetic 823 kcal high protein test meal was ingested within a 1-hr period followed by hourly determinations of oxygen consumption and plasma levels of insulin, free fatty acids, triglycerides, glucose, amino acids, and urea nitrogen. Amino acid levels increased faster and to a higher plateau in the nonobese group, while insulin levels increased and eventually decreased in a similar fashion in both groups. No differences in basal metabolic rate were detected. The postprandial increment in oxygen consumption was significantly less among the obese subjects. Diminished calorigenesis after each meal would result in accumulation of extra calories provided that caloric consumption is not appropriately decreased. These data suggest that a physiological aberration of energy metabolism may contribute to the development of childhood onset obesity.


A longitudinal study of the protein, nitrogen, and lactose contents of human milk from Swedish well-nourished mothers.

The contents of total nitrogen, nonprotein nitrogen, lactose, and individual milk proteins have been determined in human milk from well-nourished Swedish mothers. Breast milk samples from 50 mothers at different stages of lactation (up to 170 days) were collected. Furthermore, three mothers gave samples repeatedly throughout the whole lactation period. The protein content in mature milk was found to be 0.8 to 0.9% by amino acid analysis. The nitrogen content and the contents of the major human milk whey proteins, alpha-lactalbumin and lactoferrin, are very high for the first few days, then decrease rapidly and reach, thereafter, the more slowly declining level of mature milk. Nonprotein nitrogen and the nonspecific milk protein serum albumin are present in constant concentrations throughout lactation. The daily milk volumes were determined and found to be 500 to 600 ml in the very early part and 700 to 800 ml in the later part of the lactation period.


Breast milk composition in Ethiopian and Swedish mothers. II. Lactose, nitrogen, and protein contents.

Breast milk from underprivileged and privileged Ethiopian mothers was collected at different stages of lactation and analyzed for total nitrogen, nonprotein nitrogen, lactose, and individual milk proteins (lactoferrin, alpha-lactalbumin, serum albumin, IgG and IgM). These values and the milk volume of one meal were compared to corresponding results from well-nourished Swedish mothers. No significant differences between the levels of these constituents or the milk volumes were found between the two groups of Ethiopian mothers. When comparison was made between breast milk from these two Ethiopian groups and the Swedish group, the former two showed significantly higher values for the iron-binding protein lactoferrin.


Food iron absorption in human subjects. IV. The effects of calcium and phosphate salts on the absorption of nonheme iron.

The influence of physiological levels of calcium and phosphorus on the absorption of nonheme iron from a semisynthetic meal was evaluated. Each of the 34 participating subjects received two to four test meals. In three studies where both calcium and phosphate were added, absorption of nonheme iron was reduced to 27 to 47% of that absorbed when no salts were added. However, with the single addition of either calcium or phosphate to the test meals no significantly inhibiting effect was observed. As the absorption of nonheme iron was significantly reduced only with the combined addition of calcium and phosphate, it is suggested that a calcium-phosphate-iron complex forms which inhibits iron absorption.


The incidence of anemia in residents of Missouri.

A state-wide nutritional health survey of Missouri residents conducted in 1973 included hemoglobin, hematocrit, and serum iron determinations on approximately 1,164 persons and dietary iron intake estimates, based on a diet history, for 530 persons. Based on the criteria used for interpretation of the Ten-State Nutrition Survey data, over 19% of all preschool age white children and over 10% of the white children six to 10 years old had low or deficient hemoglobin levels. Between 8 and 17% of the white males between 10 and 60 years old and over 30% of the white males over 59 years old were anemic. Between 3 and 9% of all white females over 9 years of age had low or deficient hemoglobin levels. The levels of anemia for most age and sex groups of Negroes were at least twice as great as for corresponding groups of white persons. Low or deficient hemoglobin levels within the age and sex groups were associated with low hematocrit and serum iron levels; suggesting that some of the anemia was a reflection of iron deficiency. Estimates of the dietary intake of iron indicated that less that 20% of the females 10 to 35 years old and less than 60% of older females and boys under 17 years of age were consuming the Recommended Dietary Allowances. Over 35% of the preschool children and females between 10 and 60 years old were consuming less than two-thirds of their Recommended Dietary Allowances for iron. At least part of the iron deficiency was, therefore, indicated to be related to insufficient dietary intake.


Some factors related to obesity in the Japanese sumo wrestler.

Sumo is an ancient sport in Japan and there are at present over 800 professional sumo wrestlers (rikishis). After entrance into the wrestler society a wrestler takes strenuous daily training together with a very high calorie diet (more than 5,000 cal). Frequency of food intake is twice a day. The average diet of Japanese people contains of 2,279 calories and the meal frequency is generally three times a day. In 96 wrestlers average actual body weight and modified Broca index was 100.4 kg and 143.5%, respectively. In this group the prevalence of overweight with obesity, overweight without obesity, nonoverweight with obesity, and nonoverweight without obesity was 53.4, 39.1, 1.0, and 6.5%, respectively. Also mean serum levels of triglyceride, phospholipid, uric acid, and total protein were significantly higher than those obtained in 89 age-matched healthy males. The incidence of diabetes mellitus, gout, and hypertension in wrestlers was 5.2, 6.3, and 8.3%, respectively, all values being considerably higher than in controls. Weight correlated significantly with skinfold thickness, diastolic blood pressure, total cholesterol, and uric acid in each group. Multiple regression analyses were made treating weight or uric acid as dependent variables in both groups. Obesity, hyperlipidemia, and hyperuricemia in wrestlers were presumed to be caused chiefly by the high calorie diet and partially by the infrequent meal intake.


Food and children with Prader-Willi syndrome.

Observations regarding caloric intake, growth, and food-related behavior of 14 children with Prader-Willi syndrome have shown that they need fewer calories than normal children to maintain their weight in an appropriate weight channel, and that they exhibit peculiar food-related behavior that in some instances is present before the onset of obesity. Most of them can be prevented from gaining excessive weight or can lose weight if they and their caretakers receive appropriate counseling on how to provide low-calorie food and how to make other food inaccessible. In 12 of the 14 children, a reasonably successful weight-control program was achieved for up to five years. A biological basis for many of the noted observations is assumed, but the exact nature of the defect remains elusive.


Perinatal methylmercury poisoning in Iraq.

The signs and symptoms of methylmercury poisoning and the concentrations of mercury in samples of blood, hair, and milk are reported and compared in two infant-mother pairs exposed in the recent Iraq outbreak. In one pair, the infant was born prior to the exposure of the mother, and was exposed only from ingestion of methylmercury in mother's milk. In the other pair, the mother was exposed during pregnancy and did not breast feed the infant, who died 30 days after birth. Both mothers had some signs and symptoms of poisoning, but the infants did not. The infants had maximum estimated blood mercury levels between 500 and 1,000 ng/ml, well above the minimum toxic levels for adults. Hair and blood concentrations of mercury correlated closely, the average hair-blood ratio being about 250. Maternal milk averaged 8.6% of the simultaneous blood level, but the relationship was nonlinear at blood mercury levels below 50 ng/ml. Postnatal exposure by suckling led to substantial infant blood mercury concentration (over 600 ng/ml), and prenatal exposure resulted in blood mercury levels in the infant at birth higher than those in the mother, even after corrections for differences in hematocrit level.


Serologic response to revaccination with two rubella vaccines.

Three years after receiving rubella vaccine, 1,060 elementary school children living on the island of Maui, Hawaii, were revaccinated with either HPV-77 DE-5 or RA 27/3 rubella vaccine given subcutaneously or intranasally in order to compare the effectiveness of these two vaccines in raising antibody titers. RA 27/3 was the more effective booster vaccine, producing fourfold or greater titer rises in 20.1% of recipients, including 80% of children with hemagglutination-inhibiting antibody titers less than or equal to 1:40 at the time of revaccination, intranasal revaccination was not significantly more effective than subcutaneous revaccination, although it did elicit higher titers in children who responded. Responses differed according to the vaccine that children had received three years earlier. Because antibody titers have persisted in vaccinated children, routine administration of a second dose of rubella vaccine is not currently recommended.


Evaluation of Wistar RA27/3 rubella virus vaccine in children.

Because the Wistar RA27/3 strain rubella virus vaccine has potentially important advantages over rubella vaccines currently licensed in the United States, a field trial was conducted in Minnesota and Wisconsin in 1974 to evaluate RA27/3 in this country. Two hundred eighty-five (99.7%) of 286 susceptible children given RA27/3 subcutaneously seroconverted, with a geometric mean hemagglutination inhibition (HI) titer of 81.2. Twenty-eight (23%) of 122 children with rubella antibodies before immunization had fourfold or greater rises in rubella HI titers. The highest percentage of booster responses occurred in children with low preimmunization titers. Side effects were reported in 34% of subjects, but only one reaction associated with RA27/3 was serious: in a 5-year-old boy, arthritis of the left hip developed 31 days after immunization. This study indicates that RA27/3 vaccine produced a very high rate of seroconversion with high postimmunization HI titers. The ability to elicit significant booster responses in children with low levels of HI antibodies suggests that RA27/3 could be used to boost immunity in women of childbearing age whose rubella titers have declined to undetectable levels.


Vaccination caveat. The off-the-shoulder look.

To avoid the difficult problem of upper shoulder scarring, a plea is made for vaccination in the lower deltoid region.


Benign paroxysmal vertigo of childhood.

Thirty-three cases of benign paroxysmal vertigo in childhood have been seen at our institution since the disorder was recognized ten years ago. Progression from paroxysmal torticollis of infancy to paroxysmal vertigo of childhood is documented. Ear infections and allergy appeared causative in a few, but not most, of the cases. The most important consideration for the pediatrician is to rule out epilepsy and brain tumor. Parents should be reassured that the condition is benign, and that the attacks will cease in a few months or years.


Juvenile diabetes mellitus and serum lipids and lipoprotein levels.

Cholesterol, triglyceride, and lipoprotein levels were determined in serum from 40 children with diabetes and from controls. Mean cholesterol levels in the children with diabetes (205 +/- 78 mg/dl) were statisically higher than for controls (155 +/- 27 mg/dl), as were mean triglyceride levels (120 +/- 63 vs 85 +/- 23 mg/dl). Eight of the children with diabetes had hypercholesterolemia, five had hypertriglyceridemia, and nine had combined hypercholesterolemia and hypertriglyceridemia. Low-density lipoprotein levels were statistically higher and high-density lipoprotein levels statistically lower for children with diabetes compared with control children. Increased urine glucose spillage  was found to correlate with higher serum triglyceride levels, suggesting that the elevated triglyceride levels may have been related to diabetes control. With the known association between hyperlipidemia and coronary heart disease (CHD) and between diabetes and CHD, the results of the present study indicate that all children with juvenile diabetes mellitus should have a serum lipid analysis annually.


Gelastic Epilepsy. Onset in neonatal period.

The phenomenon of gelastic epilepsy was first described in 1873, yet fewer than 100 patients with this disorder have been reported on to date. The purpose of this article is to report on the first two patients to our knowledge with the onset of these seizures in the immediate neonatal period. Both patients have been shown to have posterior hypothalamic mass lesions presumably of congenital origin, and have remained free of neurologic progression of the disease with conservative treatment.


Primary leiomyosarcoma of the lung in childhood.

Primary leiomyosarcomas of the lung and trachea are rare tumors. Only five cases have been reported in children (two of a lung, one of a mainstem bronchus, one of the carina, and one of the trachea). We report a new case in a 14-month-old boy and review the previous cases.


Eosinophilic infiltration of the gastrointestinal tract in children.

Three children had eosinophilic infiltration of the gastrointestinal tract. This entity has two forms--diffuse and circumscribed. The diffuse lesion is confined mainly to the gastric antrum. Surgical resection of this form is seldom necessary. Involvement of the appendix with this form has not been previously described. The polypoid lesion, which may arise in any segment of the gastrointestinal tract, commonly produces secondary gastrointestinal symptoms and is amenable to local surgical excision.


Hypokalemic crisis simulating intestinal obstruction in a 4-year-old girl. A consequence of 17alpha-hydroxylase deficiency.

A 4-year-old girl had abdominal distention, muscular weakness, renal tubular dysfunction, and hypertension associated with hypokalemic metabolic alkalosis. There were no clinical symptoms of cortisol deficiency, but there was excessive deoxycorticosterone and cortisocsterone production. Basal plasma aldosterone levels were undetectable; however, adrenocorticotropic hormone (ACTH) stimulation brought plasma aldosterone levels up to normal. The urinary pregnanediol, tetrahydro-deoxycorticosterone (THDOC), and tetrahydrocorticosterone (THB) concentrations were elevated. Stimulation of ACTH failed to increase urinary 17-ketosteroid, 17-hydroxycorticosteroid, or plasma cortisol levels significantly, while urinary THDOC, THB, and plasma corticosterone concentrations were further elevated. The elevated plasma corticosteroid intermediates were suppressed by dexamethasone administration. When physiologic doses of dexamethasone were administered, the hypertension, electrolyte imbalance, and abnormal corticosteroid secretion were all corrected. The studies indicated a partial 17alpha-hydroxylase defect in this patient.


Relapsing polychondritis and retroperitoneal fibrosis in an 8-year-old boy.

An 8-year-old boy with symptoms of relapsing polychondritis for five years developed retroperitoneal fibrosis and ureteral obstruction. In addition to involvement of the cartilage of his joints, ear, and nose, there was significant arterial involvement. The patient had a very good response to adrenal corticosteroid therapy. After one year of follow-up, he has had a definite increase in joint mobility and has normal renal function.


Diagnosis of death in comatose patients under resuscitation treatment: a critical review of the Harvard report.

In this Article, which draws primarily on continental West European views on death and dying, the author contends that the Harvard criteria for irreversible coma (1968) are not reliable for diagnosing death in comatose patients under resuscitation treatment. The Article suggests that use of the Harvard Criteria to diagnose death leaves such patients legally unprotected against surgical assaults such as organ removal and biomedical experiments while they still may be living and capable of perception, possibly including the perception of pain and the spoken word. An alternative to the Harvard Criteria--angiography--is offered, and several additional issues related to the definition and diagnosis of death are discussed. Finally, the author suggests that even prior to death, termination of resuscitation treatment of irreversibly comatose patients, though followed by death, should be lawful.


Clinical approaches to teaching legal medicine to physicians: medicolegal emergencies and consultations.

Physicians-in-training generally have insufficient exposure to legal medicine to prepare them for the medicolegal problems they will encounter in practice. This Article outlines the current structure of the field of legal medicine in America, and sets forth two strategies with clinical orientations for teaching legal medicine to physicians-in-training: (1) providing a didactic course offering accurate and practical information on medicolegal emergency situations; and (2) establishing a consultation service in legal medicine capable of providing clinical information or training in such settings as the emergency room, the outpatient departments, and the inpatient wards.


State legislation on abortion after Roe v. Wade: selected constitutional issues.

Over the past three years, a great volume of legislation on abortion has been produced by state legislatures in an attempt to fill the vacuum created by the United States Supreme Court's 1973 decision in Roe v. Wade. This Article examines several of the most common types of statutory provisions and assesses their constitutionality in light of Roe v. Wade and other applicable federal and state legal standards.


Compatibility of antineoplastic, antibiotic and corticosteroid drugs in intravenous admixtures.

Through the use of absorption spectroscopy and visual observations, the compatibility of selected oncologic, antibiotic and corticosteroid drugs in intravenous admixtures was determined. The six drugs used in this study were methotrexate sodium, prednisolone sodium phosphate, sodium cephalothin, 5-fluorouracil, cytarabine and vincristine sulfate. These were cross-matched in pairs, using 5% dextrose injection as the vehicle. By obtaining the ultraviolet absorption spectrum of each of the drugs alone in the 5% dextrose injection, reference of standard spectra were obtained which could be used as a comparison for the spectra of the drugs in admixture. This comparison permitted detection of any alterations in the spectrum which would suggest chemical (nonvisual) incompatibility. Of the 13 combinations examined, four pairs appeared to be chemically incompatible. These were: 5-fluorouracil and methotrexate sodium; 5-fluorouracil and cytarabine; prednisolone sodium phosphate and methotrexate sodium; and methotrexate sodium and cytarabine.


Improved taste acceptability for an oral hyperalimentation dosage form.

Various flavoring agents were evaluated as to their ability to improve the taste acceptability of Vivovnex-HN, a potent oral hyperalimentation diet. Several imitation flavors were incorporated into the Vivonex-HN powder in different concentrations with and without an artificial sweetener. The mixtures were rated by a taste panel. Among the unsweetened flavors, spray-dried orange juice, Sealva imitation mint No.381 and cherry mint imitation appeared to be the most acceptable flavors. Among the individual flavors sweetened with 0.025% sodium saccharin, rum, strawberry and raspberry proved to be the most acceptable. Among all of the formulations studied, a combination of rum, strawberry and raspberry with 0.025% sodium saccharin was found to be optimal.


Pharmacy-based special infant formula service.

The preparation of infant formulas by a hospital pharmacy for a 280-bed department of pediatrics is discussed. A formulary of acceptable special therapeutic formulas was developed in conjunction with the pediatricians. Space and equipment originally intended for intravenous admixture and total parenteral nutrition services were supplemented to include special infant formula services. The personnel and equipment requirements, and quality control procedures, of the service are discussed.


Organizing patient data for use in clinical pharmacy practice and education.

A simple, low-cost manual data retrieval system, which  provides selective access to all patient cases monitored by pharmacists, is described. The system uses notched cards which are coded by clinical descriptors. The codes are based on a modification of the International Calssification of Diseases, Adapted, disease-diagnosis coding system. This multiple entry system is flexible and can be easily converted to a computer-based system.


A drug experience registry.

The Drug Exerience Registry is a system for the recording and filing of drug-related patient events in a readily retrievable form. The purpose of the registry is to accumulate information on adverse drug reactions, unusual therapeutic successes of failures, and other experiences that may be useful for education, research or promotion of rational drug therapy. Data are recorded on case report forms which are categorized by organ-disease system affected, the clinical event and involved drug(s). These are then filed in the clinical event file along with literature synopses that serve as guides in evaluating the incidents and determining proper therapy. A drug file serves as a cross index to the clinical event file and allows one to quickly locate clinical events involving a drug. Both files contain sufficient hospital data to allow later retrieval of additional information if needed.


Computerized medication monitoring system.

A computerized medication monitoring system for alerting and warning of potential adverse drug reactions is described. The system integrates computerized data on each hospital patient (medications, clinical laboratory, blood gas, ECG, ALLERGIES, DIAGNOSIs, etc.) and returns to the pharmacist warning messages and suggestions regarding patient drug therapy. The broad data base allows for nearly complete drug therapy monitoring. When a warning message is received, the pharmacist contacts the physician or nursing staff and explains the potential problem. The system also generates prescription labels and patient drug profiles which are used in a unit dose dispensing system. Five percent of 13,727 patients monitored have had drug alerts. Of these alterts, 44.9% were drug-laboratory contraindications and only 28.9% were drug-drug interactions. Of the 690 alerts received, 77% resulted in the physician changing the patient's therapy.


Comparison of stability-indicating assay methods: ultraviolet, high pressure liquid chromatography and acid dye.

Three techniques--ultraviolet, high pressure liquid chromatography (HPLC) and acid dye--were compared as stability-indicating assay methods. Investigations on six drugs (codeine phosphate, ephedrine hydrochloride, morphine sulfate, procaine hydrochloride, pyrilamine maleate and thiamine hydrochloride) indicate that HPLC is the most reliable method.


Iron poisoning: report of a fatal case in an adult.

A fatal case of iron poisoning in a suicide attempt is reported, and the toxicity and pathophysiology of iron are discussed. The four phases of the clinical features of iron poisoning are presented, and the general treatment of iron toxicity is discussed.


The short- and long-term prognosis of patients with transmural and nontransmural myocardial infarction.

To compare the long-term prognosis in patients surviving transmural with patients surviving nontransmural myocardial infarctions, the records of 188 consecutive patients with clinical histories and enzyme elevations consistent with acute infarction were reviewed. According to standard electrocardiographic criteria the patients were divided into two groups: 148 with transmural myocardial infarction (group 1) and 40 with nontransmural myocardial infarction (group 2). Of the patients who survived hospitalization, follow-up data were obtained on 119 of 124 patients in group 1 and 36 of 37 patients in group 2 at a mean follow-up period of 36 months. In group 2, the patients had a high incidence of sudden death after discharge (33 per cent in group 2 versus 15 per cent in group 1, p less than 0.02) as well as a significantly higher incidence of death from all cardiac causes (41.6 per cent in group 2 versus 24.3 per cent in group 1, p less than 0.05). Furthermore, the patients in group 2 still alive at the end of the follow-up period had an increased incidence of angina pectoris and of recurrent infarction. The data suggest that patients with nontransmural myocardial infarction carry a particularly guarded prognosis.


Effects of alternating phosphorus and calcium infusions on osteoporosis.

The osteoblastic effect of inorganic phosphorus and the inhibitory action of calcium on parathyroid hormone secretion formed the basis for a therapeutic trial in which both elements were given intravenously in an alternating sequence for one year to five patients with severe osteoporosis. During treatment, calcium and phosphorus balances were positive, and serum phosphorus concentrations decreased. Iliac crest bone biopsy specimens obtained one year after beginning treatment demonstrated an increase in the thickness of cortical bone. All patients experienced lasting relief of bone pain, and the rate of spontaneous fractures decreased from at least one fracture per year to none following the beginning of treatment. These findings suggest that long-term treatment with alternating phosphorus and calcium infusions may result in lasting relief of symptomatic osteoporosis. It is proposed that the observed improvement reflects an increase in bone mass resulting from enhanced bone formation.


Steroid myopathy in connective tissue disease.

In eight women with polymyositis (three patients), systemic lupus erythematosus (SLE) (three patients), rheumatoid arthritis (one patient) and shoulder-hand syndrome (one patient), weakness developed during high dose prednisone therapy. These women were studied using serial functional and manual muscle tests, determination of serum glutamic oxaloacetic transminase (SGOT), creatine phosphokinase (CPK) and serum aldolase levels, and urinary excretion of creatine. Insidious onset of weakness was characteristic. Myalgias were seen in five patients and unusual sudden weakness in two. Weakness was always most severe in the pelvic girdle muscles; there was a lesser involvement of shoulder girdle and distal muscles. Serum muscle enzyme levels were normal in all cases, but urinary creatine excretion was invariably increased and proved to be the most sensitive laboratory indicator for clinical diagnosis and for monitoring patient improvement. Serial urinary creatine excretion and serum enzyme studies were of value in differenting steroid myopathy from a flare of myositis in patients with connective tissue disease. Diagnosis and effective management were achieved by the use of readily available laboratory and clinical procedures without resorting to muscle biopsy.


The course of pregnancy in patients with artificial heart valves.

Twenty-five women with prosthetic heart valves (PHV) became pregnant 28 times. Twenty-six of the pregnancies occurred while the patients were receiving oral anticoagulants and these were continued throughout in 25 pregnancies. Dipyridamole or dipyridamole and acetylsalicyclic acid were used in 22 pregnancies. Eighteen infants were delivered, one with a congenital corneal leukoma; none had hemorrhagic complications; their psychomotor development was normal. Nine women aborted 10 times, including patients with two PHV, pelvic trauma and self-induced abortion. We could not detect excess anticoagulation in eight of the nine who had spontaneous losses; excess anticoagulation occurred five weeks before an abortion. There were no maternal deaths despite numerous complications; in two women, brain embolism was related to short interruptions of anticoagulation. The details of management are mentioned. We lack enough evidence to suggest routine sterilization, routine interruption of coumarin therapy during pregnancy or routine interruption of pregnancy in women with certain types and models of PHV; however, pregnancy under such conditions, plus antithrombotic therapy, carries a high risk for the product and a potential teratogenic effect. Women with one or two PHV can have children if their management is closely supervised and if extreme care is taken with the use of oral anticoagulants.


Splenic abscess. Report of 10 cases and review of the literature.

Ten cases of splenic abscess seen between 1964 and 1974 are reviewed. Pain referable to the abscess was the most common symptom, but was present in only five cases. Fever was present in all but one case. Tenderness in the region of the spleen was noted in six cases, in three cases the spleen was palpable and in one case a large mass in the upper left quadrant of the abdomen was palpated. Abdominal films were suggestive of the diagnosis in two cases, and the liver-spleen scan demonstrated a defect in three cases. Seven abscesses were caused by gram-negative bacilli of bowel origin; the etiologic agents in the other three were Staphylococcus aureus, Streptobacillus moniliformis and a Nocardia species. Associated conditions predisposing to splenic abscess included trauma in three cases, splenic arteritis or embolization in five cases, and foci of infection elsewhere in the body in six, including two cases of endocarditis. The mortality was 60 per cent. Half of the deaths were due to the underlying illness, but failure to diagnose splenic abscess contributed to a fatal outcome in three cases.


Unusual electrocardiographic finding--bifascicular block due to hyperkalemia.

A unique case in which the patient had bifascicular block consisting of right bundle branch block and left posterior hemiblock as a result of marked hyperkalemia is presented. To our knowledge, this is the first reported case in which such unusual electrocardiographic abnormalities due to hyperkalemia were demonstrated. The electrocardiographic abnormalities produced by hyperkalemia in this case disappeared promptly by hemodialysis, as the serum potassium level returned to normal. It has been stressed that hyperkalemia should be considered as an important etiologic factor in the differential diagnosis of bundle branch block, hemiblocks and bifascicular block, particularly when these intraventricular blocks are produced suddenly.


Bilateral scalp necrosis in temporal arteritis. A rare complication of Horton's disease.

In an elderly man bilateral temporal scalp necrosis complicating temporal (systemic giant cell) arteritis developed. The patient also demonstrated other features characteristic of this entity: (1) exquisite scalp tenderness and headache, (2) onset late in life, (3) visual disturbances, (4) general debility, (5) diagnostic temporal artery biopsy, and (6) gradual healing with glucocorticosteroid therapy. A computer assisted review revealed 13 similar cases of scalp necrosis associated with temporal arteritis published in the English literature.


Immunoblastic lymphadenopathy. Evolution into a malignant lymphoma with plasmacytoid features.

In the patient described progressive lymphadenopathy, splenomegaly and interstitial pulmonary disease developed two months after the development of immunoblastic lymphadenopathy. Light microscopic examination of a lymph node biopsy specimen suggested a diagnosis of immunoblastic sarcoma. Evolution of this malignant lymphoma into a leukemic phase allowed detailed studies of the malignant cells by electron microscopy, cytochemical staining and immunologic technics. Evidence is presented that this is a case of malignant lymphoma with plasmacytoid and not lymphoid features. Review of the literature on immunoblastic sarcoma suggests that light microscopy and clinical setting are not sufficient to define a homogeneous clinicopathologic disease.


C1q deficiency associated with urticarial-like lesions and cutaneous vasculitis.

We describe a 46 year old women with a seven year history of urticarial-like symptoms and cutaneous vasculitis with marked deficiency of C1q in the presence of normal levels of C1r and C1s and high titers of low molecular weight (7S) C1q precipitins. Hemolytic C1 activity, which was greatly reduced, was restored upon the addition of purified C1q. The other complement components were present in moderately reduced or normal levels. This patient bears resemblance to several other persons previously described with urticarial-like lesions in association with selective deficiency of C1q. The similarity of the clinical features, pathologic diagnosis, C1q levels disproportionately deficient in relation to other complement components and low molecular weight C1q precipitins support the conclusion that these are causally related in a symptom complex. The underlying basis is yet to be defined.


A complement independent erythropoietic inhibitor acting on the progenitor cell in refractory anemia.

An erythropoietic inhibitor was detected in the serum of a patient with refractory anemia. Using an in vitro heme synthesis method, the patient's serum produced tenfold inhibition of erythropoietin-stimulated radioactive iron (Fe59) incorporation into heme of normal human marrow at 72 hours, as compared with AB serum. In a separate experiment the patient's serum produced threefold inhibition, whereas immunoglobulin G (IgG) prepared from the same serum sample produced 12-fold inhibition. To identify the site of action of the inhibitor, serum was tested in a cell culture system whereby human marrow cells, grown in a plasma clot, respond to exogenous erythropoietin with the appearance of nucleated erythroid colonies. Each colony arises from a committed erythroid progenitor. The patient's serum produced a two- or tenfold reduction in the number of colonies from normal human marrow. The effect was also demonstrated on autologous marrow obtained when the patient was in "partial clinical remission". Serum samples obtained at various times during the course of the patient's illness all demonstrated a suppressive effect on colony growth. All serums were heat-inactivated, and total hemolytic complement could not be detected in either culture system. It is concluded that the anemia is due to an inhibitor, probably of IgG class, that acts on the erythroid progenitor cell. The absence of heat-labile complement components in the culture systems suggests that the mechanism is not due to immune cytolysis.


Hypertension, hyperreninemia and a solitary renal cyst in an adolescent.

Solitary renal cysts associated with hypertension and documented hyperreninemia are relatively uncommon. A 13 year old boy with these findings is described (pressure 160/120 mm Hg). Contrast studies of the urinary tract and arteriography with selective renal vein sampling demonstrated a solitary cyst in the right kidney. The ratio of plasma renin activity in the right renal vein to left renal vein (RRV:LRV) was 2.35:1. After drainage of the cyst, there was a marked reduction in both systolic and diastolic pressures (126/84 mm Hg). Hypertension has not recurred during 14 months' follow-up.


The angiographic appearance of benign renal oxyphilic adenoma.

Four cases of oxyphilic cortical renal adenomas identified by angiography are described. A suggestive angiographic appearance is outlined for adenomas limited to the cortex: avascularity or hypovascularity; renal vessels splayed and stretched around tumor base; faint parenchymal blush during nephrograpm phase; and tumor well marginated, appearing to arise from the renal cortex. Masses that fulfill the above criteria are adequately treated with excisional biopsy if frozen section confirms their benignity.


Asymmetry of the pelvic ureters in normal females.

A total of 65 cases showing asymmetry of the pelvic ureters of greater than 1.4 cm for which no cause could be identified are presented. Only one was a male. The right ureter was situated more medially in 61 of the 64 females. Comparison of the characteristics of these patients with 51 females with symmetrical pelvic ureters revealed no differences except for a significantly more frequent left-sided position of the uterus in the asymmetrical group. Gross medial displacement of the right ureter in a female probably represents a normal variant in a large majority of patients.


The radiologic manifestations of idiopathic intestinal pseudoobstruction.

Six patients with idopathic intestinal pseudoobstruction underwent extensive radiographic evaluation of the gastrointestinal tract. Propulsive motor activity was consistently absent. All had smooth muscle dysfunction of the esophagus, small bowel, and colon, and two had abnormal gastric emptying. Two forms of the syndrome were observed, characterized by either hyper- or hypoactive smooth muscle. In the hyperactive form chaotic, spontaneous contractions of the esophagus and small intestine occurred and extensive diverticular disease of the colon was present. In the hypoactive form the esophagus was atonic and there was marked widening and hypomotility of the small intestine and colon. The presence of two forms of smooth muscle dysfunction suggests that the syndrome has a heterogeneous pathology and pathophysiology.


Radiographic evaluation of complications after jejunoileal bypass surgery.

A retrospective analysis of 89 patients who underwent jejunoileal bypass surgery for morbid obesity disclosed 33 complications that were detected radiographically. Intestinal obstruction (10.1% of patients), cholecystitis (5.6%), renal stones (4.5%), peptic ulcer (3.4%), megacolon (6.7%), and elongation of the small intestine with hypertrophy of the mucosal folds of the jejunum (6.7%) were diagnosed solely by radiographic means.


The small bowel enema: experience with 150 examination.

Clinical application of the small bowel enema has received waxing and waning enthusiasm since it was first described in 1929. Our experiences with 150 small bowel enema studies is presented. The Sellink method was used for patients without ileostomy, (140), and retrograde studies for those with ileostomy. The merits of the small bowel enema compared to the conventional technique are discussed. The small bowel enema is the preferred method for radiologic assessment of the small bowel in patients whose clinical picture suggests small bowel disease.


Pneumoperitoneum: importance of right upper quadrant features.

Supine abdominal radiographs of 59 patients with documented pneumoperitoneum were evaluated for findings of pneumoperitoneum. The commonly described signs were seen in only 17%. Localized intraperitoneal air in the right upper quadrant was the most frequent finding, seen in 49% of patients. Identification of these collections of air is dependent upon knowledge of the anatomy of the perihepatic spaces.


Necrotizing enterocolitis after open heart surgery employing hypothermia and cardiopulmonary bypass.

Three patients, 1-11 months of age, who underwent open heart surgery with cardiopulmonary bypass and profound hypothermia, developed necrotizing enterocolitis postoperatively leading to death. Pneumatosis intestinalis and portal vein gas were demonstrated radiographically. Necrotizing enterocolitis has not been previously reported as a complication of cardiopulmonary bypass and profound hypothermia.


Radiology in primary hyperaldosteronism.

Autonomous hypersecretion of aldosterone (primary hyperaldosteronism) is caused by either hyperplasia (usually bilateral) or an adenoma (frequently unilateral) of the adrenal cortex. Systemic hypertension due to an aldosteronoma is a potentially curable condition through surgical extirpation of the offending organ. In our experience with 37 patients clinically suspected to have primary hyperaldosteronism, radiological methods contributed significantly in preoperative diagnosis. These included (1) selective bilateral adrenal vein catheterization and blood sample collection, (2) adrenal venography, and (3) radioisotope adrenal scan. Unilateral hyperfunction could be accurately detected by the aldosterone assays from the collected samples. When adrenal venography was technically satisfactory, a nodule or aggregate of nodules measuring at least 7 mm and located on the margin of the gland or 1.5 cm or more in diameter when located in the center of the gland were readily identified. Enlarged adrenal gland on venography, in itself, was not a dependable index of a hyperfunctioning gland. Presence of a higher uptake on one side on the radioisotope adrenal scan did not always indicate the hyperfunctioning gland, but lack of lateralization of adrenal hyperfunction was more accurately predicted on the radioisotope scan than by venography. Four histopathological patterns were recognized in the surgically removed adrenal glands, but no correlation between these patterns and clinical behavior or postoperative course was found.


Angiographic manifestations of ruputured abdominal aortic aneurysm.

Abdominal angiography was performed in five cases of ruptured abdominal aortic aneurysms. In four the diagnosis of a ruptured aneurysm was not suspected clinically. Angiographic findings included (1) an irregular collection of contrast outside the opacified aortic lumen or calcified aneurysm which persisted after contrast cleared from the aorta, (2) localized saccular dilatation of the aorta in which contrast remained after being cleared from the aorta, and (3) an aortocaval fistula.


Posttraumatic osteolysis of the distal clavicle with emphasis on early radiologic changes.

Erosion of progressive resorption of the distal clavicle following trauma has been described but merits greater attention due to its frequency. Six cases of posttraumatic osteolysis of the distal clavicle are reported with emphasis on early radiographic detection. Soft tissue swelling, deminerlization, and loss of the subarticular cortex at the injured clavicular tip antecede the more commonly recognized gross erosion. Recognition of this early stage, with consequent immobilization, may shorten the course of this process and decrease the prolonged disability. The pathogenesis of the process is discussed and illustrated.


Radiographic findings in early acquired syphilis: case report and cirtical review.

The radiographic and pathophysiologic features of early acquired syphilis are discussed. Bone changes occur in early acquired syphilis and should not be confused with gummas of late syphilis. The radiographic findings are protean and may exist without a clinical history of a cutaneous lesion. The skull, clavicle, and tibia are the sites most frequently involved.


Cancer in the "cold" breast thermogram.

The hallmark of the normal breast thermogram is relative symmetry of vascular configuration and thermal content with preservation of the breast contour. Accepted criteria of abnormality are predicated upon graphic and thermal asymmetry with emphasis placed upon elevated temperature, an increase in the number of discernible vessels, and distorted vascular patterns. The association of a confirmed breast cancer and an avascular thermogram has been labeled a false negative. Avascularity ("cold" breast), particularly in the lower half, with normal vessels in the same location of the opposite breast is suggested as an additional characteristic of abnormality. Illustrative cases are presented.