[Some forms of disease associated with impaired locomotion in sheep (author's transl)].

A number of flock diseases in sheep associated with impaired locomotion, which are of importance or may assume importance in the Netherlands, are reviewed. Attention is paid to the following metabolic disorders and deficiencies: acetonaemia, hypocalcaemia, hypomagnesaemia, some forms of osteopathy, enzootic ataxia and cerebrocortical necrosis. The following forms of infectious diseases are described: listeric encephalitis, purulent meningitis following injury to the throat, scrapie, visna, Aujeszky's disease and border disease. Finally, a number of viral forms of encephalitis are discussed, which are of minor importance or negligible in the Netherlands, though they are of importance in neighbouring countries. No attempt was made exhaustively to describe the above diseases. The aetiology and pathogenesis usually were not discussed in greater detail than that required for the diagnosis, treatment and prevention of the disease. Efforts were made to be of some help to the veterinary practitioner in controlling some forms of ovine disease in cases in which this is necessary and possible.


[The incidence of diseases of the lung and liver in slaughtered pigs as a criterion in the detection of herds in which the disease is a recurrent problem (author's transl)].

Diseases of the lung and liver in swine are two forms of disease which often result in considerable economic losses. They occur in pigs throughout the world. Studies in the Netherlands showed that from 40 to 50 per cent of the lungs and from 60 to 80 per cent of the livers were affected. In the Animal Health Service of the province of North Brabant, it was found to be possible to differentiate between pig-fattening farms and piggeries on these farms (a differentiation based on the severity of the disease) by recording the incidence of diseases of the lung and liver in slaughtered pigs. Ever since April 1, 1975, the number of cases of disease of the lung and liver among all slaughtered pigs (approximately 1,000,000 pigs per annum) are recorded in the slaughter-house of the Meat and Cattle Centre in Boxtel as a routine measure. The method of examination adopted in the slaughter-house is described. The results of investigations during the second, third and fourth quarters of 1975 are discussed. A total number of 653,540 pigs were studied. Severe disease of the lung was observed in 20.2 per cent of the swine. Of the livers, 13 per cent were severely affected and 3.3 per cent were entirely condemned. Pleurisy was found to be present in 3.1 per cent of the pigs.


HLA antigens and immunoresponsiveness to insulin in insulin-dependent diabetes mellitus.

HLA-A and B antigens were determined in 112 patients with insulin-dependent juvenile onset diabetes mellitus, who could be subdivided into "non" and "high responder" to insulin. The data revealed a trend of an association of these diabetes subgroups with only one of the diabetes-associated antigens HLA-B8 and HLA-BW15 and indicated the existence of at least two different genetic constellations for susceptibility to juvenile diabetes mellitus. One form with a strong immune-response to insulin seemed to be associated with HLA-BW 15 and the other form without humoral immunoreactivity to insulin seemed to be associated with the presence of HLA-B8 and the absence of HLA-B7.


Some parameters of lymphocyte antibody activity through pregnancy and further eluates of placental material.

One hundred and sixty-nine pregnancies with lymphocyte cytotoxic antibody activity were found out of 851 full term pregnancies. A rise in incidence of antibody activity was found through first, second and third pregnancies. The average scores for antibody titre and avidity were similar for antibodies to the A and B loci in first, second and third pregnancies though individual scores varied greatly. Five cases are reported where antibody activity was not detectable till the 6-month post-natal stage. ABO compatibility did not have any effect on antibody production. A further 40 placental eluates are reported with the same findings as reported previously.


Interrelationship between sugar-evoked increases in transmural potential difference and sugar influxes across the mucosal border in the small intestine.

The relationship between changes in the transmural potential induced by actively transported sugars(deltaPDs) and influxes of the sugars(Js's) was investigated in the isolated guinea pig small intestine. Under the condition that medium electrical conductivity. remains unchanged, deltaPD and Js were closely correlated, e.g., both showed very similar patterns of regional difference along the intestine, and the values of the half saturation concentration (Km) for a sugar estimated from electrical and flux measurements were nearly identical. No such correlation was observed when medium conductivity varied. However, a simple correction of the sizes of deltaPDs for medium conductivity restored a close parallelism between deltaPDs and Js's. The sugar-induced increase in Na+ flux estimated from the increase in short-circuit current varied in parallel with Js regardless of the medium conductivity, and a fixed stoichiometrical relationship (approximately one-to-one coupling) was seen between Na+ and sugar fluxes. It is concluded that the dominant factor affecting the interrelation between deltaPD and Js is the resistance of the paracellular shunt which is directly proportional to medium electrical conductivity


Preventive procedure of dysuria after radical hysterectomy by adnexal flap fixation to the bladder.

To prevent postoperative dysuria, which occurs inevitably after the radical hysterectomy, several surgical procedures have been tried. The principal method is to suture adnexal flaps to the bladder trigone and fundus. Of four procedures so far tried sequentially, the best one was to fix the bladder trigone and to support it with round ligament flaps sutured with the bladder fundus covered by tubal flaps (Type IV). In follow-up studies, Type IV proved more preferable than the other three types or the non-sutured control group in regard to the following aspects: (1) days necessary for the disappearance of residual urine, (2) appearance of urinary sensation, (3) acquirement of urinary sensation, (4) incidence of urinary incontinence, (5) residual urine/bladder capacity ratio, (6) cystometric findings, and others. Effectiveness of our procedures, particularly of Type IV, may be ascribed to the supported bladder trigone and fundus by sutured tissues and to the acquirement of urinary sensation, rather than to the restoration of nervous contact between the bladder and the micturition center in the spinal cord.


Diagnosis and prognosis of early cancer of the colon and rectum.

Diagnostic methods for the cancer of the colon and rectum  were compared in two groups of patients, i.e., patients of stage A malignancy in the Dukes classification, and those with the so-called "early cancer of the colon and rectum", and the best way to find cancer of the colon and rectum in its early stage was investigated. At the same time, the prognosis of early cancer of the colon and rectum was studied by the use of the relative survival rate. The following results were obtained. 1) The so-called "early cancer of the colon and rectum", of which invasion was limited to the mucosa and submucosa, can be correctly diagnosed by the combined application of both biopsy and exfoliative cytology under direct vision even before surgery and/or polypectomy. 2) Cancer of the colon and rectum is considered to be a curable disease, if discovered and resected at or before the stage A in the Dukes classification, in which the cancerous proliferation is limited to the wall of the colon and rectum without any metastasis.


Analysis of 6,293 routine proctosigmoidoscopies.

7,679 proctosigmoidoscopies were performed on 6,293 patients during a period from 1962 to 1974 at the Third Department of Internal Medicine, Tohoku University Hospital. Results were summarized as follows: Polyps were observed in 470 patients (7.5%) and cancer was found in 178 patients (2.8%). 129 patients (2.0%) were observed to have ulcerative colitis. There were 57 patients with melanosis coli, 12 radiation proctitis, 7 amebic colitis, 5 granulomatous colitis, 2 endometriosis coli, 2 carcinoid and 2 intestinal tuberculosis. Thus, 879 out of 6,293 patients examined had some forms of disease, an over-all incidence being 14.0%. Biopsies were performed under the proctosigmoidoscopic observation in 82.4% out of 273 patients with polyps during the 6-year period from 1969 to 1974 and 105 patients (46.7%) were observed to have adenomatous polyps. The age-specific distribution pattern and incidences of these patients with adenomatous polyps were mostly consistent with those of 178 patients with cancer of the large bowel, which were observed by proctosigmoidoscopy during the 13-year period from 1962 to 1974. Thus, it is suggested that etiological correlation exists between polyps of adenomatous type and cancer of the large bowel.


Peripherally and centrally mediated bradycardiac effects of clonidine in anesthetized or spinal rats.

The bradycardia-inducing  effects of clonidine were examined in anesthetized or spinal rats by injecting the drug intracisternally (i.c.) or intravenously (i.v.). Clonidine (1-25mug i.c.) caused a bradycardia dose-dependently in anesthetized rats. The bradycardia in response to clonidine (5mug i.c.) was significantly reduced after a treatment with phentolamine (100 mug i.c.), but not influenced with atropine (1 mg i.v.) or sectioning bilateral cervical vagal nerves. In spinal rats, an acceleration in heart rate by electrical stimulation of cervical sympathetic nerves was frequency-dependent and that due to desmethylimipramine (DMI) was dose-dependent. Clonidine (30 mug i.v.) significantly inhibited the acceleration induced by electrical stimulations only at a low frequency (0.3-3 Hz) or DMI (0.3 mg i.v.). This inhibition by clonidine was antagonized by phentolamine (5 mg i.v.). Clonidine (30 mug i.v.) did not significantly influence the acceleration in heart rate of spinal rats induced by norepinephrine (1 mug i.v.), tyramine (100 mug i.v.) or 1,1-dimethyl-4-phenylpiperazinium (DMPP, 50 mug i.v.). Therefore, it is suggested that clonidine causes a bradycardia by stimulating both peripheral and central alpha-adrenoceptors, the sympathetic trunk is the main pathway, and that the peripheral mechanism for clonidine-induced bradycardia is different from the action of guanethidine or hexamethonium on a release of catecholamines from the cardiac nerve terminals.


Inorganic phosphorus content in human aqueous humor in relation to hours postmortem.

It appears possible to utilize the inorganic phosphorus content in the aqueous humor for estimation of postmortem interval, especially if the factors relating to the body temperature are known in detail.


Mobilization of folate from liver into blood stream following histidine injection in rats.

A marked reticulocyte response following intraperitoneal injections of histidine monohydrochloride was observed in rats which were fed on a folate-free diet immediately after weaning for a period of 20 days or more. This finding was taken as an evidence for mobilization of folate stored in the liver into blood stream following histidine injection.


Effects of inhibitors of DNA and protein syntheses on mitogenic factor production by PPD-stimulated guinea pig lymphocytes.

The effects of inhibitors of DNA synthesis and mitosis and of protein synthesis on mitogenic factor production by lymph node cells from guinea pigs sensitized to tuberculin was studied. All inhibitors used in this study were added to the medium at the beginning of culture. Cytosine arabinoside, vinblastine and mitomycin-C reduced markedly the incorporation of tritiated thymidine in DNA, but had no effect on the production of mitogenic factor. Mitomycin-C at higher concentrations, however, induced the partial reduction of mitogenic factor production. On the other hand, puromycin and cycloheximide, inhibitors of protein synthesis, suppressed markedly the production of mitogenic factor. These results indicate that mitogenic factor production requires protein synthesis, but is independent of DNA synthesis.


Reduction of myocardial reactive hyperemia during oxygen breathing in dogs.

In 7 open-chest anesthetized mongrel dogs the left anterior descending coronary artery was occluded for 20 sec. Myocardial reactive hyperemia was recorded during air and oxygen breathings. The excess blood flow during the reactive hyperemia was smaller and the duration of the reactive hyperemia was shorter during oxygen breathing than during air breathing. It is suggested that the reduction of oxygen demand during oxygen breathing is a possible reason for the decreased reactive hyperemia and oxygen administration is beneficial in relieving myocardial ischemia.


Measurement of intrahepatic shunted blood flow by ethanol-1-14C method as compared with D-galactose-1-14C method.

Ethanol-1-14C method for the measurement of intrahepatic shunted blood flow was compared with the method of continuous infusion of D-galactose-1-14C. In controls, in chronic hepatitis, and in hepatic cirrhosis, per cent intrahepatic shunt measured by the ethanol-1-14C- method was about a half or one-third of that measured by the D-galactose-1-14C method. Study of radioactivity-dye concentration ratio of the blood sampled from the inferior vena cava showed that per cent intrahepatic shunt was underestimated by the ethanol-1-14C method because of permeability of ethanol-1-14C through the capillaries. In patients with hepatic carcinoma, in whom the carcinomatous tissue was supplied mainly by the hepatic artery, there was no significant difference in per cent intrahepatic shunt between both methods.


Mercury in cigarettes.

Mercury in cigarettes of domestic and foreign products was measured by Magon's method, and the sample of a domestic brand was burned by a smoking machine and the smoke was collected for the measurement of mercury. In tobacco leaf and paper, only inorganic mercury was found in both domestic and foreign products. Its amount in tobacco leaf and paper of a piece of cigarette was about 60 ng in domestic products and about 30 ng in foreign products. By burning, the unit length of a cigarette released about 5-7 ng of mercury into smoke.


Relationship between insulin secretory function and endogenous hypertriglyceridemia in obese humans with insulin resistance.

Eighteen obese inpatients with insulin resistance revealed by i.v. insulin test and expressed in various grades of hyperinsulinemia and hyperglycemia were examined for plasma lipid levels. A significant positive correlation was found to be present between the plasma triglyceride (TG) level and the insulin response to glucose load. A stepwise multiple regression analysis revealed that the insulin secretory response, the plasma cholesterol level and the relative body weight contributed to the level of plasma TG. No difference was found in the grades of insulin resistance between patients with and without elevated TG. The ratio of sum of plasma insulin values to that of blood glucose values during glucose tolerance test was markedly increased in patients with elevated TG. The patients with relatively blunted insulin response and impaired glucose tolerance curves showed only slight slight hypertriglyceridemia. Endogenous hypertriglyceridemia in obesity seems to be more closely correlated with plasma insulin level, and therefore, with insulin action rather than insulin resistance.


Angiocardiographic findings and morphogenesis of criss-cross heart with situs solitus, concordant artrioventricular relationships and L-transposition.

A case of so-called criss-cross heart is presented. The right atrium drained to the left-sided morphologic right ventricle from which the aorta originated anteriorly and leftward. The left atrium drained to the right-sided morphologic left ventricle, from which the pulmonary artey originated posteriorly and rightward. These angiographic findings are morphogenetically interpreted as a clockwise rotation of approximate 90 degrees looking toward the base (from the inferior view) of d-bulboventricular loop following the truncal septation.


Two cases of left-sided tricuspid atresia with situs solitus L-bulboventricular loop and L-transposition of the great arteries.

Two cases of extremely rare type of tricuspid atresia are presented. Both possessed left-sided tricuspid atresia, situs solitus of viscera and atria, 1-bulboventricular loop and 1-transposition of the great arteries. These anomalies are typical tricuspid atresia with 1-transpositions. The importance of bulboventricular loop in tricuspid atresia is emphasized because the atretic tricuspid valve is right-sided in the heart with solitus and d-loop, and is left-sided in the heart with solitus and 1-loop.


Effects of change in concentration of calcium on myocardial contractility depressed by thiamylal and halothane.

The effects of change in the concentration of Ca++ on myocardial contractility depressed by thiamylal and halothane were studied in isolated dog heart muscle. The concentration of Ca++ in the bathing medium was increased stepwise from 1.9 to 20.9 mM. An increase in Ca++ concentration resulted in an increase both in net-shortening (delta1) and in maximum velocity of shortening at 0.4 g preload (V'max) which reached the maximum values at 11.4mM of Ca++. A further increase in Ca++ concentration rather decreased delta1 and V'max. The concentration-response relation curves in the presence of thiamylal (3.3 mg%) shifted to the right almost parallel to the control curve, with the peaks at 15.2 mM of Ca++. The result indicates that the depression of myocardial contractility produced by thiamylal is counteracted competitively by Ca++. However, the curves in the presence of halothane (5.0 +/- 0.4 mg%) were kept lower than those of the control, with the peaks at 7.6 mM of Ca++. The result shows that the counteraction of Ca++ to the depression of myocardial contractility was limited in the presence of halothane. A similar tendency was observed in maximum force of isometric contraction (Fm). Moreover, in the presence of halothane, the administration of higher concentrations of Ca++ almost always accompanied "after-contraction". From the result obtained and the literature concerned it was suggested that the mechanism for producing the depression of myocardial contractility might be different between thiamylal and halothane in relation to Ca++ movements at the Ca++ storage sites within the myocardium.


Changes in hypophysio-ovarian endocrinological function of post-menopausal and castrated women.

The serum levels of estradiol, progesterone, LH and FSH were determined by radioimmunoassay in post-menopausal and castrated women and the data obtained at the same periods after menopause and castration were compared. The serum levels of estradiol and progesterone in post-menopausal women within 1 year after menopause were higher than those of castrated women. The result suggested that ovarian function was indeed depressed in the post-menopausal women but was still preserved for 1 to 2 years after menopause. In the post-menopausal women, the levels of serum LH and FSH rose gradually to reach a peak at 1 to 3 years after menopause, when the production of ovarian sex steroid hormones presumably ceased. On the contrary, the serum LH and FSH levels of castrated women began to decrease gradually 4 to 9 years after castration. It is highly suggestive from these findings that a negative feedback mechanism is elicited by ageing.


Malignant lymphoma initiated with malabsorption syndrome due to Isospora belli infection and lymphocytosis.

A 47-year-old man had diarrhea in 1965. Four years later, malabsorption syndrome was diagnosed and the patient was found to have mild lymphocytosis. Abdominal lymphoma was suspected, but exploratory laparotomy was normal except for partial villous atrophy of small intestine and slightly enlarged mesenteric lymphnodes which were normal microscopically. In vitro lymphocyte blastformation with phytohemagglutinin was depressed markedly throughout the course and the result predicted the developement of malignancy of the lymphocytic system. Infection of Isospora belli was found thereafter, and sulfamethoxazole was quite effective for diarrhea. In August, 1974, he noticed cervical lymphadenopathy for the first time and it was diagnosed as undifferentiated type of malignant lymphoma. He died in December, 1974. In this case diarrhea was most probably caused by the intestinal infection of Isospora belli without obvious lymphoma. The symptom was swept away by peroral sulfamethoxazole. In this patient coccidiosis was presumably induced and prolonged by suppression of cellular immunity which might have already begun to progress at the onset of diarrhea.


Evidence for a familial form of hypertriglyceridemia as disorders coupled with insulin resistance.

To evaluate the role of insulin in familial hypertriglyceridemia, 34 relatives of the pedigrees of 3 index cases of endogenous hypertriglyceridemia and hepatic steatosis as well as 9 spouses were examined for plasma lipids and responses of blood glucose and plasma insulin during oral glucose tolerance tests. The combined disorders of hypertriglyceridemia and hyperinsulinemia plus glucose intolerance--insulin resistance--were most commonly found among the relatives, which were often accompanied by an impaired liver function. Some relatives showed hyperinsulinemia without hypertriglyceridemia. Obesity was frequent, but its incidence was similar to the controls. Thus, the observed form of familial hypertriglyceridemia was apparently coupled with insulin resistance; and hyperinsulinemia, or insulin resistance by itself, might be a basic genetical trait in this form of lipid disorder.


An illuminator for ultramicrotome knife orientation and block approach.

The construction and operation of a simple, inexpensive illuminator that produces high quality illumination of the ultramicrotome knife edge and the edge to block face gap resembling dark field is described. Use of the illuminator greatly speeds knife adjustment and reduces the likelihood of specimen or knife edge damage. The illuminator uses a grain-of-wheat light bulb and an adjustable bulb holder fashioned from bent paper clips. The holder permits both lateral and axial adjustment of the bulb position, which is necessary to achieve satisfactory illumination with different specimens and knives. The illuminator, with slight modification, can be adapted for use on any ultramicrotome.


[Results of radiotherapy of malignant testicular neoplasms].

It is very difficult to compare the therapeutic results of malignant testicular tumours because of the different histological classification systems, the uncertainty in the definition of the different stages, the error rate of the lymphography which amounts up to 35%, and the multitude of surgical, radiation, and chemotherapeutic methods. A histological classification and an exact determination of the stage is required as a condition of beginning a radiotherapy. The desirable focal dose for seminomas is between 4000 and 5000 rad, the maximum dose for teratomas is 6000 rad. For the stages T1-3N0 the iliac and the paraaortic lymph nodes are irradiated, for the stages T1-4N1-2 the interpleural space andthe supraclavicular region are included. For a group of 91 patients there was reached a five-year survival rate of 85,5% in case of seminomas and of 64% in case of teratomas.


[Thyroid malignant neoplasms. Therapeutic results in 305 patients].

Between 1960 and 1972, 305 patients with malignomas of the thyroid gland were surgically treated, irradiated (megavoltage therapy and/or iodine-131), and treated with thyroid hormone according to principles formerly stated. Differentiated adenocarcinomas (34.4% of all the patients) were observed more frequently in women and younger patients, whereas dedifferentiated carcinomas (33.8%) are found relatively more often in men and in an advanced age. Only in 12% of the cases the tumor was discovered in an early stage; thus, an early diagnosis is much too rare so far. In almost two thirds of the patients a spread of metastases occurred. Of these, 11% grew manifest later than five years following the therapy. Distant metastases from differentiated adenocarcinomas accumulated I-131 in sixty per cent, those from undifferentiated carcinomas still in twenty per cent. Treatment results are influenced decisively by histology, tumor spread, age and sex, women less than forty years old with differentiated adenocarcinomas and a circumscribed extension of the tumor having the best prognosis. More prognostic importance is due to the extension of the primary tumor than to the presence of metastases to regionary lymph nodes. Patients with metastases accumulating I-131 have a better chance of survival than those whose metastases do not accumulate. By means of standardized therapeutic rules, utilizing modern therapeutic techniques and based on interdepartmental cooperation, it was possible to improve the results partly by the two- or threefold as compared to a previously treated group of patients.


[Results of radiotherapy of prostatic carcinoma as monotherapy].

A report is given of the results of histopathologic examinations of subsequent biopsies carried out on 54 patients with prostate carcinomas and of the clinical development of the prostate carcinomas of 89 patients. All these patients were treated only by therapeutic radiology. Then follows a discussion whether the radiation or the hormone therapy has the preponderant values. The possible complications of the two therapy methods are compared.


[Clinical relevance of histological differentiation of malignant lymphomas according to the "Kiel classification". A retrospective study of correlations in 228 cases from Schleswig-Holstein].

The correlations between histological type and clinical picture are reported by a retrospective study of 228 cases in Slesvig-Holstein with malignant non-Hodgkin lymphomas who were scheduled by th "Kiel classification".


[Influence of radiotherapy on lymphocyte stimulation].

More than 300 lymphocyte cultures of 12 patients with seminomas were examined during the prophylactic radiotherapy and, in several cases, during an extended period until 20.5 months after the end of the treatment. The object of this study was to find out by measuring the capacity of the lymphocytes to be stimulated in vitro wheather they could be damaged by the radiotherapy. Among other reasons, the above mentioned patients were chosen because they had been submitted to irradiations of vast volumes of lymphatic tissues at a uniform focal dose of 4000 rad. The different opinions expressed in the literature (stimulation decreassed resp. increased resp. unchanged) are reflected by our results in such a way that we did not find a qualitative loss of the capacity to be stimulated cultures. The problem of the different opinions about the capacity of lymphocytes to be stimulated after a radiotherapy appears; among other things, to be based on different examination methods. According to these methods- morphological determination of the relative number of lymphoblasts, synthesis of DNA by fluid scintillation counting, or determination of the number of surviving cells in vitro -different results are obtained. It seems not possible to use the lymphocyte stimulation in vitro as a method of testing clinical sideefects occuring during the characteristics of immunity and radiation biology are not differentiated in a more precise manner.


[Sonographic and roentgenologic course controls following radiotherapy of retroperitoneal neoplasms].

Twelve patients with retroperitoneal tumors were examined sonographically and roentgenologically before and after radiation therapy. The sonograms were evaluated quantitatively by planimetry. Nine cases revealed analogous results in roentgenologic and in sonographic examinations. In three cases sonography revealed a tumor regression which was not verifiable with X-rays. In consideration of these results, sonography is used by us as a primary method for examination of retroperitoneal tumors during the follow-up control.


[Consideration of inhomogeneities in irradiation planning. I. Influence of inhomogeneities on course of depth dose curve in water for cobalt60 gamma rays].

In radiation therapy, the focal doses during irradiation of a tumor are based on the values for water, since water has almost the same absorption coefficient as muscular tissue, even for different kinds and energies of radiation. But calculation of the tumor dose will become inaccurate if inhomogeneities in the ray path are not considered such as fat, bones, plaster, metal plates, Küntscher nail, endoprothesis. These materials, having a density phi different from water, represent inhomogeneities relative to water with regard to absorption of high-energy radiations. The experiments yielded the following results: All measurements revealed that the change in the course of the depth dose curve caused by inhomogeneities in water depends essentially on the density phi and on the thickness d of the inhomogeneity. If the density phi of the inhomogeneity exceeds one, a shift of the depth dose curve in water results in direction to the surface: if the density phi is smaller than one, the depth dose curve will move towards greater depth because of the inhomogeneity. With Co-60 gamma radiation, the shift of the depth dose curve in water due to an inhomogeneity occurs almost parallel. A correlation obtained empirically allows a calculation of the extent of the shift, the depth dose is subjected to, for different inhomogeneities. With the density of the inhomogeneity phi2 and the thickness d, the shift V in water (phi1=1) will result from V=0.5 (phi2-1) d (cm) in direction to the surface if phi2 greater than 1, towards greater depth, if phi2 less than 1.


[Skip technique as a variant of moving field irradiation].

The skip-technique may be used either for screening or lessening the radiation load to sensitive sound organs or for an adjusted formation of the isodoses or for both. To show the possibilities of application of this elegant and quite practicable method, some examples are reported concerning spondylous processes, para-aortic lymph nodes and tumors in the small pelvis. The loss of radiation dose because of the additional opening and closing procedure of the diaphragm demands a correction of the duration of irradiation.


[Inhibition of epidermis proliferation by borderline rays].

Treatment of guinea pig flanks with very soft X-rays (borderline rays) may stop the uptake of 3H-Tdr during the DNA synthesis phase of epidermal germinative cells. Evidence of increased proliferative activity at any time after the irradiation can only be seen as a symptom of secondary reactive repair processes.


[Influence of a preliminary irradiation once or twice on radioresistance of mice*].

The radioresistance of mice was tested in order to find out in which way it was influence by one or two preliminary irradiations. The thirty-day survival rate after a single total irradiation was taken as a criterion of the radioresistance. Only one test group showed a significant increase of radioresistance after two preliminary irradiations, whereas the resistance of three other groups was reduced remarkably after irradiation doses of 300 resp. 400 R. From these facts we draw the following conclusion: either radiotoxins and the remote effects produced by them are only playing a minor role in NMRI/Han mice or these mice are particular "low-responders" as far as the produciton of antibodies against radiotoxins is concerned.


Liver dysfunction following whole-body Co-60 irradiation in gerbil (Meriones Hurrianae Jerdon) and house rat (Rattus rattus Rufescens).

Liver dysfunction following whole-body Co-60 irradiation has been studied in domestic and desert rat species. A significant elevation in the serum transaminases activity was noticed both in gerbil and house rat. Alkaline phosphatase and plasma cholesterol levels were also increased indicating an early radiation impairment of the liver tissue, which was later confirmed by histological studies. A steady fall in liver glycogen in irradiated gerbils was strikingly in contrast to an increase in irradiated house rat. Drastic depletion in liver glycogen, changes in the serum enzyme levels and the severity of the hepatic necrosis in gerbils point out that desert mammalian species are much more sensitive to radiation hazard as compared with domestic ones.


Aplastic anemia in Japanese radiological technicians.

Among the Japanese radiological technicans, four deaths from aplastic anemia have been reported after 1930. On the other hand, during the period from 1930 to 1960, the population of radiological technicians is estimated to be 74,400 man-years, in which 0.5 aplastic anemias are expected. However, actually three died from aplastic anemia. This difference is statistically significant at the 1% level. While, in the period from 1961 to 1973, the observed value is 1 against 0.7 expected. It is concluded that aplastic anemia had been induced frequently among the Japanese radiological technicians in the era when there was much exposure to occupational radiation.


Radiation protection of the patient during radiotherapy.

Systematic studies of gonadal doses to patients undergoing therapy on 60Co and X-ray machines were carried out using thermoluminescence dosimeters (TLD). Phantom and in vivo measurements were performed for various field sizes and for different positions of the centre of the field on the patient's body with exception of fields including the gonads during radiotherapeutic treatment. It was shown that there is no effect of various SSD and that most radiation reaching gonads is transmitted axially through the body and therefore, it is impossible to reduce this dose with a simple shielding. The figures presented allow prediction of gonadal doses at various conditions. The efficiency of lung, mouth etc. shielding during radiotherapy was also investigated.


Decreased levels of androgen binding protein in the reproductive tract of the restricted (Hre) rat.

A simple method was developed for assay of androgen binding protein (ABP) in the reproductive tract of male rats. Dextran-coated charcoal was employed to separate bound and free steroid. The number of binding sites quantified by this technique was the same as those determined by other procedures. The ABP levels in testis and epididymis of Hre rats was much lower than those from normal littermates. This abnormality was correlated with defective spermatogenesis in these animals.


Synthesis of new steroid haptens for radioimmunoassay. Part I. 15beta-Carboxyethylmercaptotestosterone-bovine serum albumin conjugate. Measurement of testosterone in male plasma without chromatography.

A radioimmunoassay (RIA) procedure has been developed for measurement of testosterone in male plasma after ether:chloroform (4:1) extraction of the plasma sample without resorting to chromatography. The highly specific anti-testosterone serum was generated from both rabbits and sheep immunized with 15beta-carboxyethylmercapto-testosterone-BSA conjugate. The synthesis of 15beta-carboxyethylmercaptotestosterone and the preparation of its BSA conjugate are described. The high affinity (Ka=2.38 X 10(9) liters/mole) antiserum binds 50% of 50 picograms of tritiated testosterone at working dilutions of 1:100,000 to 1:200,000. Both 5alpha and 5beta-dihydrotestosterone compounds exhibited less than 2% cross-reaction. The only other steroids that showed minor cross-reaction were 11beta-hydroxytestosterone (3.8%), progesterone (2.1%), corticosterone (1.6%), and deoxycorticosterone (7.7%).


A simple radioimmunoassay for the measurement of testosterone glucosiduronate in unextracted urine.

A simple, reliable and rapid radioimmunoassay (RIA) for the determination of testosterone glucosiduronate (TG) in crude urine is described. Two protein-TG complexes were investigated in raising antibodies: a) Bovine serum albumin (BSA)-TG and b) human plasma Cohn's fraction IV-4 (CF)-TG. In rabbits, high titers of antibodies were obtained after the injection of CF-TG. The specificity of the antiserum was sufficiently high (cross reaction with free testosterone 27%, with 5alpha-dihydrotestosterone-glucosiduronate 20%). TG was estimated in small aliquots of male and female urine after evaporation overnight at 50 degrees C in order to eliminate interfering material. The intraassay coefficient of variation (CV) was found to be 6% and the interassay CV 11%. TB has been determined in 40 samples of urine simultaneously by "direct" RIA and by a "classical" RIA following hydrolysis with beta-glucuronidase. The coefficient of correlation was found to be 0.89. The mean excretion of TG in the urine of 26 healthy men amounted to 164+/-51 mug/24 hours with a range from 97 to 346 mug/24 hours. In a group of 16 women a mean urinary excretion of TG of 24+/-10 mug/24 hours was determined. The method allows a technician to assay 40 samples per day.


Radioimmunoassays for aldosterone and deoxycorticosterone in plasma and urine.

Radioimmunoassays for aldosterone and deoxycorticosterone (DOC) are described in which a simple separation procedure using ammonium sulfate stabilization of bound steroid and extraction of free steroid into toluene scintillant allows an "in vial" assay without mechanical separation of the two phase system. Extraction and thin layer chromatographic methods for purification of aldosterone and DOC are free of solvent and plate blank effects. Normal values are given for unconjugated aldosterone and DOC in urine, for aldosterone and DOC in plasma and for aldosterone 18-glucuronide in urine.


Behavior of 3alpha- and 7alpha-hydroxysteroid dehydrogenases on chenodeoxycholate substituted Sepharose.

Chenodeoxycholate (3alpha-, 7alpha-dihydroxy-5beta-cholanoate) was linked to Sepharose 4B by an ethylenediamine bridge. When 3alpha-hydroxysteroid dehydrogenase and 7alpha-hydroxysteroid dehydrogenase preparations were applied to a column of covalently linked chenodeoxycholate, both enzymes were retarded at pH 6.7; the 7alpha-OH oriented enzyme more than the 3alpha-OH enzyme. Approximately forty-fold purification of 7alpha-hydroxysteroid dehydrogenase was achieved in one step. Although no significant purification of 3alpha-hydroxysteroid dehydrogenase occurred, the background value in the fluorometric enzymatic estimation of bile acids by eluted 3alpha-hydroxysteroid dehydrogenase was markedly reduced. Molecular weight estimation by Sephadex G-200 gave the values of 47,000 for 3alpha-hydroxysteroid dehydrogenase and 105,000 for 7alpha-hydroxysteroid dehydrogenase.


Effect of endogenous corticosterone on the determination of dexamethasone receptor levels in rat liver cytosol.

The effect of endogenous corticosterone on the quantitative measurement of dexamethasone receptors in liver cytosols from developing rats has been studied. Liver cytosols from adrenalectomized rats were preincubated with increasing concentrations of nonlabeled corticosterone and the levels of detectable dexamethasone receptors were subsequently determined either directly or after removal of unbound corticosterone. Corticosterone concentrations of 50 nM or lower had no significant effect on the specific binding of labeled dexamethasone. Higher concentrations of corticosterone resulted in under-estimation of dexamethasone receptor levels. The mean levels of endogenous corticosterone in liver cytosols from 19.5- to 21.5- day fetuses, 22-day fetuses, 6-day-old immature rats and adult rats were 27.40, 11.91, 0.81 and 4.05 nM, respectively. It is concluded that variations in the levels of circulating corticosterone in the rat under normal physiological conditions have no significant effect on the quantitative measurement of total (occupied and unoccupied) receptor sites for dexamethasone in liver cytosol. This is supported by the finding that prior treatment of liver cytosols, from rats at different stages of development, with charcoal to remove unbound steroids has no effect on the amount of detectable dexamethasone receptors.


Prostaglandins inhibit testosterone secretion by mouse testes in vitro.

Production of testosterone (T) by decapsulated mouse tests in vitro was significantly inhibited by adding prostaglandin (PG) A1, PGA2 or PGE1 to the incubation medium. Prostaglandin A1 at a concentration of 10(-6)M inhibited T production in this system both in the presence of moderate amounts of hCG (12.5 or 25.0 mIU/ml), and in the absence of gonadotropins. However, in the presence of very high levels of hCG (125.0 mIU/ml), all PGs tested appeared to have had a slight potentiating effect on T production when added in concentrations ranging from 10(-7) to 10(-5)M, and the inhibition of T accumulation in the medium was consistently observed only when the concentration of PGs was increased to 10(-3)M. These results suggest that a direct effect of PGs on testicular steroidogenesis may account for, or contributes to, the decrease in peripheral T levels observed after administration of PGs in vivo.


A new class of long-acting hormonal steroid preparation: synthesis of dimeric androgenes coupled at C3-C3 and C17-C3 and of an androgen-progestogen combination.

3beta-Hydroxy-4-androsten-17-one was prepared from 4-androsten-3,17-dione according to the method of Klimstra and Colton (1) and dimerized by means of esterification with succinic acid. The reduction with lithium-tri-t-butoxyaluminium hydride gave a testosterone derivative coupled between C3-C3 which showed after a single injection of 10 mg a protracted but relatively weak androgenic effect in castrated male rats. The direct esterification of testosterone hemisuccinate with 4-androsten-3beta, 17beta-diol gave the testosterone derivative coupled between C17-C3 which showed a more even and more protracted time response curve than testosterone enanthate. The testosterone-ethynodiol succinate also coupled between C17-C3, showed an androgenic depot-effect similar to that of the dimeric C17-C3 testosterone derivative.


Hemodynamic derangement for the induction of cerebrovascular fat deposition in normotensive rats on a hypercholesterolemic diet.

Cerebrovascular ring-like fat deposition, which was noted only in hypertensive rats but never observed in normotensive rats even after they had been fed a high-fat cholesterol (HFC) diet for a long time, was successfully developed in the posterior communicating or other cerebrobasal arteries in normotensive rats fed an HFC diet for ten weeks after bilateral or unilateral carotid artery ligation or basilar artery ligation. These posterior communicating arteries with fat deposits were clearly dilated to a significant extent. These findings corroborated the fact that not only high blood pressure but also hemodynamic derangements induced by hypertension or other causes were important factors for the development of fat deposition in cerebral arteries.


Components of blood pressure and risk of atherothrombotic brain infarction: the Framingham study.

From a study of the evolution of atherothrombotic brain infarction (ABI) in the Framingham cohort of 5,209 men and women over 18 years of follow-up, it has been ascertained that hypertensionis the most common and most powerful precursor. Atherothrombotic brain infarction developed in hypertensive patients seven times more often than in normotensive patients, and the risk was proportional to the blood pressure throughout its range.


Intracranial neurosurgical treatment of occlusive cerebrovascular disease.

Anastomosis of the extracranial superficial temporal artery to the intracranial middle cerebral artery offers an additional source of blood to the cerebral circulation in patients with transient ischemic episodes. Fourteen cases are reported. Two representative cases with three anastomoses demonstrate the use of this technique in occlusion of the internal carotid artery, occlusion of the middle cerebral artery and stenosis of the middle cerebral artery. Indications and contraindications of the procedure are discussed.


Noninvasive measurement of velocity profiles and blood flow in the common carotid artery by pulsed Doppler ultrasound.

A computer-controlled 14-channel pulsed Doppler ultrasound instrument was used as a noninvasive means to evaluate instantaneous velocity profiles and flow in the comlon carotid arteries of 22 healthy persons and in 22 patients. Of the later, 13 had severe obstructions of the extracranial portion of the carotid artery, four had obstruction of the intracranial portion, and five had severe aortic valve insufficiency (AI), with more than 60% regurgitation in all cases. Measurements could be performed within an accuracy of about +/- 20% under clinical conditions and revealed perfusion values of 5 to 8 ml per second (300 to 480 ml per minute) in healthy persons. Of the patients, values less than 3 ml per second (180 ml per minute) were detected in nine, between 3 and 5 mm per second (180 to 300 ml per minute) in four, and normal values in another four, while significant backflow was observed only in patients with severe AI. Consecutive blood flow profiles were recorded every 4 msec; these demonstratedthat, for a period lasting from 40 msec to 280 msec after the initial systolic peak, blood flow decelerated more rapidly in the central portion of the vessel lumen than near the wall. This situation was present in all healthy persons and in most patients with pathological flow. In patients with AI, flow reinversion from reverse to normal began near the vessel wall, while in the middle third of the vessel lumen, blood was still flowing backward. These phenomena seem to be in agreement with the theoretical and experimental findings of Wormersly, Müller, and others. The AI patients who underwent artificial valve implantation were studied ten days after operation and showed no or little backflow in the common carotid artery at that time.


The reliability of clinical predictors of extracranial artery disease.

The records of 628 patients admitted to the Joint Study of Extracranial Arterial Occlusion with transient symptoms of carotid system ischemic disease were examined to determine the accuracy of predicting disease of the extracranial internal carotid artery on the basis of clinical information alone. A patient with a history of episodes of amaurosis fugax is more likely to have a lesion of the internal carotid artery on the same side than if he were having only transient cerebral ischemic attacks. In patients with transient symptoms and a carotid bruit on the appropriate side, the incidence of an angiographically normal carotid artery was 15%. In those patients with transient symptoms and no palpable pulsation in the cervical region on the appropirate side, the incidence of an angiographically normal carotid artery was zero.


Isolated ophthalmic migraine in the differential diagnosis of cerebro-ocular ischemia.

Thirty-three of 129 patients who incurred isolated ophthalmic migraine had monocular attacks of scotomatous visual field loss. Fifteen of 33 patients with monocular attacks had immediate or remote evidence of vascular disease. Four patients had carotid bruits on the same side as the monocular attacks and low ophthalmodynamometer readings. One patient had ischemic optic neuropathy and two had atheromatous disease (advanced stage in one patient). Forty-five percent of the patients with monocular attacks and only 13% of the remaining patients with homonymous attacks had vascular complications. This represents an important finding even in such a small group of patients. It is felt that, whether the vascular problems are trigger mechanisms or coexistence pathology to the migraine-type attack, one should strongly suspect such an association when a patient describes a monocular attack and one should look for a possible vascular explanation other than migraine.


Noninavasive angiography for the diagnosis of carotid artery disease using Doppler ultrasound (carotid artery Doppler).

To detect stenosis in the carotid artery with a bidirectional continuous-wave Doppler ultrasound device, the following noninvasive procedure, applied on 800 patients and compared with 249 angiograms of 186 patients, has proved to be about 90% reliable. Measurements of flow signals were taken over the terminal branches of the ophthalmic artery (supratrochlear and supraorbital arteries) and averaged. Compression of superficial temporal and facial arteries revealed flow direction and common carotid artery compression revealed the supplying blood vessel and the effectiveness of the circle of Willis. Measurements over the common carotid arteries were used to evaluate peripheral resistance. A set of eight criteria was used; the diagnostic value of each criterion was calculated by comparing 138 pathological Doppler findings in 123 patients with the angiograms. If reverse flow direction in supratrochlear or supraorbital artery was used alone, only 43% correct diagnoses would have resulted. A more severe stenosis is not necessarily correlated with a more weighted criterion; a subset of criteria is less efficient than the combination of all criteria. Application during 32 extracranial endarterectomies on 28 patients informed the surgeon immediately about the hemodynamic effect of the surgical intervention. Rethrombosis was diagnosed in two patients by postoperative Doppler examination.


Respiratory rate and pattern disturbances in acute brain stem infarction.

Respiratory rates and patterns were studied in 23 patients with acute brain stem infarction using impedance pneumography. Autopsy was obtained in six of eight fatal cases. Pontine lesions were present in all patients, with coexistent infarction of midbrain in four and of medulla in nine. Respiratory rate and pattern abnormalities observed included Cheyne-Stokes respiration, Cheynb-Stokes variant pattern and tachypnea. Abnormalities of respiratory rate and pattern of varying duration were observed at some time in all patients. All patients in whom prominent Cheyne-Stokes respiration or tachypnea were observed had extensive bilateral pontine lesions involving both basal and tegmental portions. However, not all patients with large pontine infarcts had Cheyne-Stokes respiration or tachypnea. Cheyne-Stokes respiration was prominent in four patients (two fatal, two nonfatal). Cheyne-Stokes variant pattern was present frequently in four patients (one fatal, three nonfatal). Sustained tachypnea developed in five patients, four of whom died. In ten patients (one fatal, nine nonfatal), normal respiratory rate and pattern predominated with only rare or occasional apperance of Cheyne-Stokes respiration or Cheyne-Stokes variant pattern, especially during sleep. The types of respiratory rate and pattern abnormalities in acute brain stem infarction were not specifically related to the level of lesions, but rather to the size and bilaterality of the lesions. Respiratory alkalosis was present in varying degrees in most patients with either tachypnea or prominent CSR.


Fibromuscular dysplasia and multiple dissecting aneurysms of intracranial arteries. A further cause of Moyamoya syndrome.

A 16-year-old boy, who had sudden left-sided hemiplegia, died two weeks following onset of symptoms. A right carotid angiogram showed stenosis at the termination of the internal carotid artery. The middle cerebral artery had a beaded appearance and some of its branches were occluded. A basal "moyamoya" syndrome and transdural anastomoses were present. At autopsy, multiple intracranial dissecting aneurysms were found. Arteries of the body displayed fibromuscular dysplasia (FMD). The relevance of dysplastic changes of intracranial arteries and the relationship to moyamoya syndrome are discussed.


Flow and compartmental weight in relation to the cours of stroke.

Using a scintillation camera system, hemispheric and regional cerebral blood flow was measured repeatedly during the course after a stroke. In 20 patients who improved clinically mean hemispheric and regional flow and relative weight of rapidly perfused compartment increased, while these values decreased in 15 patients, on an average, whose clinical condition deteriorated or did not change. The changes of flow and relative weight were significantly different between the two groups. Futhermore, the relationship between changes in clinical condition, scored according to a rating scale, and changes in flow and compartmental weight was proved by significant Spearman rank correlation coefficients. In six cases hyperperfused areas in locations of disturbed neurological function were observed; these areas were found to be ischemic at measurements done early and late in the cours after the stroke. This type of hyperperfusion was related to beneficial prognosis. The results indicate a shift of tissue form fast to slowly cleared compartment after a cerebrovascular attack. If tissue morphology is not entirely destroyed, recovery might occur; this results in an increase of recorded weight of rapidly clearing compartments, which correlates to the clinical course.


Noninvasive angiography for the diagnosis of vertebral artery disease using Doppler ultrasound (vertebral artery Doppler).

A transoral noninvasive procedure in the oropharynx using local anesthesia was applied to detect flow in the vertebral arteries with a bidirectional continuous-wave Doppler ultrasound system. Common carotid artery compression was used to identify the vertebral artery. Flow direction, amplitude of flow signals, diastolic flow, and reaction of flow on common carotid artery compression served as diagnostic parameters. The procedure was applied in 90 patients of whom 42 underwent angiography. The method has proved to be 82% accurate. It was most reliable in the diagnosis of occlusion or aplasia, subclavian steal and normalcy, and was less reliable in the detection of stenosis or hypoplasia of a vertebral artery. Eleven patients with subclavin steal, five patients with a missing vertebral artery  three patients with hypoplasia or stenosis, and 15 patients with normal angiorgraphical findings were correctly diagnosed by Doppler; normal Doppler findings were present in three patients with a mission or stenosed vertebral artery. Those patients (five) with Doppler indications of subclavian steal (one patient), missing vertebral artery (two patients), or stenosis (two patients) had normal angiograms. Application of the Doppler procedure, after 11 subclavin endarterectomies, informed the surgeon immediately about the hemodynamic effect of surgical intervention. Rethrombosis was diagnosed in two patients by postoperative Doppler examination.


Cerebral atherosclerosis in Uganda.

A study of arterial circles of Willis from a series of 715 consecutive autopsies in Ugandan Africans shows that severity of cerebral atherosclerosis increases with age. No significant difference exists between men and women nor among main tribal groups. The severity is less in Ugandan Africans than in United States blacks but is approximately the same in United States Caucasians. However, the Ugandan Africans show a more severe cerebral atherosclerotic involvement than do the Nigerians.


Platelet aggregability measured by screen filtration pressure method in cerebrovascular diseases.

Platelet aggregability was measured using the screen filtration pressure (SFP) method in 50 elderly healthy people, 93 persons with essential hypertension, 166 patients with cerebral thrombosis at the recovery stage (more than two months after onset), and 74 patients with cerebral hemorrhage at the recovery stage. SFP by 3 muM ADP in the healthy persons, the hypertensive patients, and the patients in the recovery stages of hemorrhage and thrombosis were 148.7 +/- 53.5, 176.2 +/- 74.4, 189.8 +/- 58.3 and 206.3 +/- 58.9 mm Hg, respectively. The differences of the SFP between the Healthy and each of the diseased groups were statistically significant (P less than 0.01 to 0.05). Meanwhile, SFP of nine patients with cerebral thrombosis and 18 patients with hemorrhage was measured during their time course of disease from the onset to 180 days. SFP in the acute stage of thrombosis showed an increase and a gradual decrease during the time course, while SFP in the acute stage of hemorrhage showed the opposite -a decrease and a gradual increase. A statistically significant difference was observed between both groups within 30 days from onset (P less than 0.001). Screen filtration pressure in the acute stage of hemorrhage showed 95.2 +/- 17.7 mm Hg in nine survival cases and 194.0 +/- 96.2 mm Hg in nine deaths with ten days from the onset. The difference was statistically significant (P less than 0.001). Such results suggest a role of platelets in cerebral thrombosis and hemorrhage and a usefulness in differential diagnosis of both diseases.


Mechanisms of postischemic brain edema: contribution of circulatory factors.

Controlled cerebral ischemia was produced in rabbits by bilateral occlusion of the common carotid arteries and restriction of collateral blood flow by a decrease of the systemic arterial pressure to a desirable level (by hemorrhage into a pressurized reservior system). The following circulatory parameters were simultaneously monitored: systemic arterial pressure (SAP), pressure in the circle of Willis (Pcw), systemic venous pressure (SVP), and pressure in the sagittal venous sinus of brain (Pvs). The cerebral blood flow (CBF) was measured by means of the H2-clearance method, and the brain volume (BrV) changes were evaluated with a mechanical system of the sterotaxic device. It has been concluded that the pre-edematous changes in the brain tissue arise during deep ischemis but an important factor in the brain edema development is the recovery of the CBF with and increase of the intravascular pressure closely related to the brain blood volume augmentation. The latter may be pronouced because of diminution of the blood outflow from the brain when the SVP is increased. The compensation for the BrV increase (caused either by brain blood volume augmentation or by brain edema) is obtained by Pcw decrease probably due to resistance rise in the internal carotid and vertebral arteries. The brain edema may be additionally compensated by an active decrease of the systemic arterial pressure.


Doppler sonography diagnosis of cerebrovascular disease.

Sonographic patterns for the Doppler ophthalmic test (DOT) were determined by reviewing the type of graphic record obtained from 25 patients who had undergone angiography. Three principal patterns were identified, depending upon whether there was augmentation (Type 1), diminution (Type 2) or no change (Type 3) in the character of the supraorbital Doppler signal upon temporal artery compression. Type 1 records were seen in 28 of 33 instances where the carotid arteries remained patent. Type 2 records occurred in 10 of 14 instances where there was significant carotid stenoses or tortuosity and in two instances in a patient with a subclavian steal syndrome. A "false-positive" test was recorded in one instance in a patient with vascular headaches. There were three Type 3 records.


An evaluation of hypocarbia and hypercarbia during carotid endarterectomy.

One hundred consecutive patients were randomly given hypocarbic (PaCO2 less than 25 torr) or hypercarbic (PaCO2 greater than 60 torr) general anesthesia during carotid endarterectomy to test the effect of the two regimens upon the incidence of postoperative neurological deficit. An indwelling shunt was not used. One patient died, two have permanent neurological deficits and two have temporary neurological deficits. Although hypocarbic patients had fewer neurological complications than hypercarbic patients, the difference was not statistically significant (p less than 0.13). Hypercarbia significantly increased the incidence of intraoperative arrhythmia. Also, no relationship was found between the incidence of postoperative stroke and the internal carotid back pressure or the time of carotid occlusion.


Carotid blood velocity during cough studies in man.

Utilizing a Doppler ultrasonic flowmeter catheter, right carotid artery blood velocity was measured during 91 coughing episodes in 16 patients. Such coughing reduced carotid blood velocity by 40 +/- 22% (control = 34 +/- 8 cm per second, cough = 20 +/- 9 cm per second, p less than 0.001). There was an insignificant low degree of corrleation between the level of simultaneously recorded mean right pressure and the percent decline of peak carotid blood velocity, suggesting that impaired venous return was not the only factor responsible for the observed changes. It is concluded that (1)coughing diminishes phasic carotid blood velocity and (2)reduced cerebral perfusion may play a role in the pathogenesis of cough syncope.


Acute gastric changes in patients with acute stroke. Part 2: gastroendoscopic findings and biochemical observation of urinary noradrenalin, adrenalin, 17-OHCS and serum gastrin.

To investigate the relationships between gastric change accompanying patients with acute stroke and the function of the autonomic nervous system and pituitary-adrenal system, studies on the gastroendoscopic technique and biochemical observations were done in 122 patients. The mean urinary noradrenalin and adrenalin excretions were elevated in patients with acute gastric changes, especially in patients with multiple erosions and acute ulcers. An elevation of the mean fasting serum gastrin concentration was found in patients with acute ulcers and no acute gastric changes. The mean urinary 17-OHCS excretion was increased in patients with multiple erosions, petechiae and acute ulcers. In conclusion, the sympathetic and parasympathetic nervous system and the pituitary-adrenal system have respectively different roles in the production of various types of acute gastric changes in patients.


Pharmacological control of local oxygen regulation mechanisms in brain tissue.

The effect of several agents active on autonomic nervous system functions was tested on brain oxygen autoregulation parameters. It was found that atropine, propranolol and isoproterenol had no influence in abolishing the measured parameters. Phenoxybenzamine, tolazoline and dibenamine all suppress autoregulation. In an additional experimental series, a phenoxybenzamine infusion was given during O2 breathing. The infusion induced, in most cases, an additional rise in TpO2 (tissue pressure of oxygen, which refers to the partial pressure [in mm Hg] of this gas at the measuring tip of the electrode). It is concluded that an alpha-adrenergic mechanism is part of the autoregulation process. Also, the increase in brain TpO2 induced by 59% O2-5% Co2 breathing seems to be blocked or reversed by alpha-adrenolytic drugs, thus supporting the thinking that the effect of CO2 on cerebral blood flow is at least in part mediated through an alpha-adrenergic response.


Prognosis of occlusive cerbrovascular diseases in normotensive and hypertensive subjects.

Comparison of the clinical features, especially prognosis, in cerebral infarction was made between nine normotensive subjects and 16 hypertensive patients with an 80% stenosis or occlusion of the intracranial or extracranial arteries. Our own criteria for evaluating hypertension were employed on the basis of the following items: a past history of hypertension, blood pressure levels on admission and during hospitalization, degree of retinopathy, and ECG changes. In 17 of 25 cases, brain circulation was measured by the intravenous RISA technique. Abnormalities of the EEG and reduction of cranial blood flow were greater, and an early prognosis for neurological deficits in the first two months after the onset of stroke was poorer in the hypertensive group than inthe normotensive group. These results are contradictory to the observations of others.


Vascular clips for the microsurgical treatment of stroke.

A synopsis of the types of vascular clips (malleable clips, screw clips, and spring clips) used by neurosurgeons during this century is presented. A review of the pertinent literature is included.


Prognosis of patients with middle cerebral artery occlusion.

The long-term prognosis of 78 stroke patients with occlusion of the middle cerebral artery (MCA) or its branches is described. The mean age of the patients was 44 years. The mortality rate in the acute phase was 5%. The acute and total mortality rates of men were higher than those of women (p less than 0.05). Life-table analysis gave 94% probability for one year's survival, 84% for three years' survival, and 78% for five years' survival. Subsequent strokes were twice as common as cardiovascular events as the cause of death. Seventy-two percent of the survivors became fully independent in activities of daily living (ADL) , 27% required assistance, 1% was totally disabled, and 43% returned to work. Left-sided occlusion was overrepresented in those who died (p less than 0.00(1) and those who returned to work (p less than 0.05), and right-sided occlusion was overrepresented in those who required assistance in ADL (p less than 0.05).


Pyramidal tract responses (PTR) during hypoxia and hypotension.

In rats with unilateral carotid artery ligation pyramidal tract responses were studied during hypoxia and during trimethaphan-induced hypotension. Observations on EEG activity during hypoxia suggest that unilateral carotid artery ligation produces a more severe perfusion defect in lateral portions of the hemisphere. During hypoxia and during trimethaphan-induced hypotension indirect PTRs disappeared first from the hemisphere on the side of carotid artery ligation and next from the opposite hemisphere. This was followed by loss of direct PTRs in the same order. Animals could not be resuscitated once the direct PTR from the non-ligated hemisphere had disappeared. Hypotension appears to be a late contributing factor in impairing electrocerebral activity during hypoxia in this study.


Abortion research in Latin America.

Surveys dealing with abortion in Latin America have provided useful information despite problems in the collection and use of the data. Considerations that should be taken into account in designing abortion surveys and using the resultant information have been discussed here. Special attention has been paid to the need for a broad definition of "abortion" in order to overcome difficulties in gathering information about abortion in Latin America. Surveys have shown increasing incidence of abortion throughout Latin America in the recent past. In examining changes over time it is crucial to interpret clearly and carefully the summary measures of proportion of pregnancies ending in abortion and abortion rates per 1,000 women. It is also important to realize that the level and direction of change of the abortion rate depends on both the rate at which women are becoming pregnant and the proportion of pregnancies ending in abortion. Better survey design and techniques and more careful use of the resulting information will aid in the planning and evaluation of programs aimed at reducing abortion in Latin America.


The impact of liberalized abortion legislation on contraceptive practice in Denmark.

During the fifteen months following the 1973 Danish abortion legislation, the mean annual rate of induced abortion was 23 per 1,000 women aged 15-44 compared with a mean annual rate of 14.5 during the 15 preceding months. Though use of legal abortion has increased, the rate is not of a magnitude to suggest large-scale abandonment of contraception. On the contrary, preconceptive fertility control continues to be widely practiced.


Coincidental multiple asymptomatic intracranial aneurysms and symptomatic carotid stenosis.

A patient experiencing transient cerebral ischemic attacks (TIAs) was studied angiographically and found to have a symptomatic stenosis of the appropriate internal carotid artery (ICA) and three asymptomatic intracranial aneurysms. A therapeutic approach to this type of problem is discussed in this article.


Scanning electron microscopic appraisal of a new micro T-tube.

A new micro T-tube, 0.6 mm in outer diameter, has been constructed. Use of this tube has allowed 1-mm common carotid artery (CCA) bypass ofr periods of time up to 22 minutes. After bypass, scanning electron microscopic observation of sutured CCA endothelium showed widespread destruction, scattered attached platelets and other formed blood elements, as well as microthrombi both at suture lines and in areas in contact with T-tubes. Despite microthrombi, 41 of 42 CCAs were patent after anastomosis. Silicone cuffs and 8-0 ties secured T-tubes inside vessels with no apparent difference in underlying endothelial destruction.


Cerebrovascular CO2 reactivity in normotensive and hypertensive man.

Cerebrovascular reactivity to CO2 inhalation and voluntary hyperventilation was studied in seven normotensive subjects and nine hypertensive patients without clinical or angiographical signs of arteriosclerosis. Cerebral blood flow (CBF) was measured by the intracarotid 133Xe clearance method and calculated as the initial slope index. Three to five CBF measurements were made in each patient in the PaCO2 range of 20 to 55 mm Hg. No difference was observed in reactivity between hypertensive and normotensive patients, either during CO2 inhalation or during hyperventilation. The shape of the CBF:PaCO2 curve suggested a decrease in reactivity below a PaCO2 of 30 to 35 mm Hg in both groups. Above a PaCO2 of 35 mm Hg, exponential regression analysis yielded a mean reactivity of 6 +/- 2%, whereas below a PaCO2 of 30 mm Hg it was about 2%. The rise in CBF during CO2 inhalation was not influenced by the intravenous infusion of a small dose of trimethaphan which blocked the concomitant rise in blood pressure.


The influence of induced abortion on Taiwanese fertility.

Data on the outcomes of more than 15,000 pregnancies originating between May 1966 and February 1969 were analyzed. The accuracy of the data was evaluated, rates of induced abortion and stillbirth were reported, and the demographic effect of induced abortion was estimated. The demographic effect was defined as the percentage increase in fertility that would have occurred in the absence of induced abortion, assuming no compensating change in alternative fertility control practices. Our principal findings were as follows: 1. We were unable to determine the completeness with which induced abortion was reported in the Registration Study. During the three years covered by the study, rates of induced abortion increased by 54 percent, reflecting a trend in the incidence or in the reporting of events or in both. We concluded that, in any case, the data for the final year of the study, 1968, were more complete than for the earlier two years. 2. Age-specific rates of induced abortion for 1968 displayed a strong urban-rural gradient, being much higher in the city areas than in the rural areas. Within each urban--rural stratum, the rates increases monotonically with age and reached maximum values in the age group 40 and older (553, 436, and 374 per 1,000 pregnancies for city, urban, and rural areas, respectively). 3. Estimates of the demographic effect indicated that, in the absence of induced abortion, the TFR for all Taiwan would have been 12 percent higher in 1968. Under the same assumption, it was estimated that the TFR would have been higher by 16 percent in city areas, 11 percent in urban areas, and 9 percent in rural areas. This urbanization gradient implies that induced abortion contributed to urban-rural fertility differentials. We estimated that about one-third of those differentials were due to induced abortion. 4. Estimates of the demographic effect were also made after adjusting the rates of induced abortion for an assumed level of underreporting of 50 percent. The adjusted estimate of the demographic effect for all Taiwan in 1968 was 19 percent.


Prognosis of patients with unilateral extracranial occlusion of the internal carotid artery.

One hundred fifty-five patients (121 men and 34 women) had an angiographically verified unilateral internal carotid artery (ICA) occlusion immediately after carotid bifurcation. The median follow-up period was 53 months. Forty-five percent of the patients were fully independent in the activities of daily living (ADL), 22% required assistance in ADL, 11% were disabled, and 22% died within the follow-up period. The mortality rate was exceptionally low compared with previous series. A life-table analysis of the material gave a 94% probability of surviving the first year, 84% the third year, and 78% the fifth year. Young age was favorable in regard to functional recovery, but it had no influence on mortality. The condition at the acute stage was the most important clinical sign in predicting the prognosis. The prognosis of mortality and functional recovery was poorer for smokers than for nonsmokers, and hypertension had no effect on prognosis. Cerebrovascular disease and coronary heart disease were found to be the cause of death with equal frequency in this study.


Intracranial fibromuscular dysplasia: report of two cases, one with autopsy verification.

We report two patients with fibromuscular dysplasia (FMD) involving intracranial arteries. In the first patient the diagnosis was made at autopsy. Both patients were symptomatic from this disease and, in addition, displayed unusual hormonal abnormalities which may well have contributed to the genesis or evolution of FMD.


Aphasia outcome in stroke: a clinical neuroradiological correlation.

Fourteen aphasic patients with acute onset of thromboembolic cerebrovascular insults demonstrable by angiography or radioscintigrams who were available for long-term follow-up have been studied. Their aphasia evolution was compared with acute angiographical and radioisotopic findings, and the lesions shown by follow-up computerized axial tomography (CT). Angiographical site of occlusion, evidence of early reopening of occluded vessels, and radioisotopic flow asymmetries including the "hot-stroke" luxury perfusion failed to correlate with aphasia outcome. Radioisotopic static images were more helpful by depicting lesion location and number but lacked the definition seen on the CT scan. The long-term CT scan by showing the size, location and number of lesions had a good correlation with aphasia outcome. Those patients with large dominant hemisphere involvements, either one large or many smaller lesions, fared poorly while those with lesser lesions did better. Bilateral lesions, at times evasive clinically, helped to account for significant aphasia residuals.


The prevalence of diabetes mellitus in three population groups in the Republic of Mali.

Three different adult population groups in Mali were screened for diabetes mellitus by means of a post-prandial blood glucose determination. The prevalence of diabetes for the entire population sampled was found to be 1-4%. Diabetes mellitus was strongly suspected in an additional 8-4%. The prevalence of elevated post-prandial blood glucose levels was found to be the lowest (5-1%) among a group of Bambara farmers who live an active rural life and whose total daily caloric intake is less than 1,000 on the average, only half of it provided by carbohydrates.


A tuberculosis treatment survey in Singapore: results at five-years.

A National Tuberculosis Treatment Survey was instituted in the Republic of Singapore in 1969 with the aim of evaluating the Tuberculosis Treatment Services in Singapore. This five-year follow-up study of the 1969 survey was based on the assessment of the first 1000 consecutive patients who were registered for treatment during the year. Two hundred and forty-six cases were excluded for various reasons, leaving 754 cases for analysis. At the end of 5 years, only 2 (0.3%) were culture positive, 677 (89.8%) were culture negative, 48 cases (6.4%) had died from tuberculosis and 27 cases (3.6%) were lost. The most notable factor which influenced bacteriological positivity was lack of co-operation leading to interruption of chemotherapy. It is concluded that with an efficient organisation highly satisfactory results can be achieved by routine treatment services and prolonged observation of adequately treated patient is not necessary.


Biochemical background of some enzymatic tests used for the differentiation of mycobacteria.

The break-down of benzamide, acetamide, malonamide and allantoin in M. smegmatis was investigated. It has been stated that the uptake of liberated NH3 into the cells, favoured by the presence of an organic acid, occasionally results in a negative NH3 determination. This difficulty can be overcome by an increase of the substrate concentration from 0.8 up to 4 mM. All antoinase activity in mycobacteria can be demonstrated only by an NH3 determination, when all the enzymes necessary for the complete break-down of allantoin are present. Bacteria containing allantoinase but not urease will be negative in this test. Using high amide concentrations (4 mM) some doubtful results concerning the degradation of acetamide, benzamide, nicotinamide and pyrazinamide can be eliminated as could be demonstrated for different strains of mycobacteria.


Differences in biochemical tests performed on photochromogenic mycobacteria isolated from human sources.

The photochromogenic mycobacteria do not all belong to one homogeneous species. With a simple heat-stable esterase (HSE) test it is possible to divide photochromogenic mycobacteria into two groups: HSE-positive--strongly pathogenic strains; and HSE-negative--weakly pathogenic strains. HSE-positive strains are mostly associated with pulmonary disease. HSE-negative strains are seldom associated with pulmonary disease, but are often associated with renal disease. It is rather difficult to draw a clear dividing line between pathogenic and non-pathogenic photochromogenic mycobacteria; and such a distinction probably does not exist in nature.


Observations on the reduction of the renal elimination of urate in man caused by the administration of pyrazinamide.

The urinary excretion of pyrazinamide, pyrazinoic acid, 5-hydroxypyrazinoic acid and uric acid were determined in a healthy subject after giving single or multiple doses of pyrazinamide or its metabolite pyrazinoic acid. The results obtained demonstrated that 5-hydroxypyrazinoic acid is a major metabolite of pyrazinoic acid in man and supported previous evidence indicating that the retention of uric acid caused by the administration of pyrazinamide is mediated by pyrazinoic acid. After giving 3 g pyrazinamide the urinary excretion of uric acid was maximally suppressed for 24 hours and partially reduced for a further 24 hours. Prolonged exposure to pyrazinoic acid resulted in a net reduction in the urinary excretion of uric acid. The findings suggested that the degree of uric acid retention in patients treated with pyrazinamide-containing regimens could be reduced by giving pyrazinamide intermittently.


[Change in the hexokinase activity of the rat myocardial and skeletal muscle mitochondria and cytoplasm in fasting and on a carbohydrate diet].

Dynamics of the hexokinase activity was stuided in mitochondria and cytoplasm of skeletal muscle and myocardium in rats which were subjected to fasting for three days and then were given a carbohydrate diet. It is established that the hexokinase activity in mitochondria (especially in the miocardium) lowers during fasting to a less extent as compared to cytoplasm and is not restored when feeding on carbohydrates, evidently, due to different quantitative ratio of isoenzymes. It is shown that hexokinase from the myocardium solubilizes more easily that from the skeletal muscles.


[Effect of hypoxia on mitochondrial stability].

The mitochondria isolated from the liver of rats subjected to acute hypoxia (10 km, 2h) are established to 0e less stable to the damage effect of incubation in the substratefree medium than the mitochondria of the control animals. A long interrupted adaptation to hypoxia as well as a single introduciton of p-chlorophenoxyacetic acid diethylaminoethylamide prevents a decrease in stability of the mitochondrial structures which is observed in rats during hypoxia. Addition of p-chlorophenoxyacetic acid diethylaminoethylamide into the incubation medium also inhibits the damage of the liver mitochondria.


[Monamine oxidase activity of the brain and liver mitochondria under the action of high-pressure oxygen on animals].

The monoamine oxidase (MAO) activity with tryptamine, 5-hydroxytryptamine and noreponephrine as substrates was studied as affected by different conditions of hyperbaric oxygenation. Exposure of rats to oxygenation at 1 ati resulted in a 75% activation of the brain mitochondria. MAO activity with norepinephrine and in an insignificant increase in the activity with the other substrates. Oxygenation at 2,4 and 6 ati decreased the brain MAO activity with all the substrates. The reduciton in the activity correlated with oxygen tension increase and with exposure time. The MAO 100% inhibition observed in some animals at 4 ati and ain most animals at 6 ati. In the liver the activity changes to a less extent than in the brain. At 1 ati it is somewhat increased and at 2, 4 and 6 ati it decreases.


[Pentosephosphate shunt enzymatic activity in the liver in its disordered innervation].

Partial denervation of the liver evoked the dissection of subphrenic vagus nerves and nerves of the hepatogastric duodenal ligament tissue stimulates synthesis of pentoses in the liver due to the oxidative mechanism and inhibits the process of unoxidative formation of pentoses. Three-four weeks after the operation one may observe a 72% increase in the activity of glucose-6-phosphate dehydrogenase in the liver tissue and a 29 and 21% drop in the activity of transketolase and enzymes, respectively, participating in metabolism of ribose-5-phosphate. The content of soluble proteins in the liver with deneravation is unchanged. A correlation is observed between these changes and those in the content of nucleic acids, an opinion is confirmed on the autonomous character of the oxidative and unoxidative phases of the pentose cycle.


[Effect of hypothermia and hyperoxia on the ammonia-glutamic acid system in the brain of rats].

The content of ammonia, glutamine, dicarboxylic amino acids and GABA was studied in the brain under 1, 2, 4-fold separate and simultaneous effect of hypothermia (19-20 C) and hyperoxia (3 atm.). A two-fold hypothermia of rats is accompanied by a greater increase of ammonia in the brain than a three-fold one. The content of glutamine under two-fold cooling is unchanged and under three-fold cooling it is twice as low as compared to its content in the brain of the control rats. The content of glutamic acid decreased after two-fold hypothermia is almost unchanged by the third seance of hypothermia. The repeated actions of hyperoxia also cause a considerable increase in the ammonia content but the dynamics of changes in the content of the nitrogenous metabolic products is contary to that in animals subjected to repeated seances of hypothermia. A simultaneous combined action of hypothermia and hyperoxia produces no additive effect on the system ammonia-glutaminic acid.


[Role of the blood bicarbonate buffer system in the mechanism of fish adaptation to different levels of carbonic acid in an aqueous medium].

The role of a bicarbonate buffer system of fish (Cyprinidae family) blood was studied in their organism addaptive reactions to different levels of CO2 in the aqueous medium. The fish is established to prossess rather effective for maintaining blood acid-base balance. It permits the fish to endure for a long time essential fluctuations of carbonic acid concentration in water. In prevention of possible development of carbonic acid acidosis an essential role belongs to formation of bicarbonates as a blood buffer system stablizing pH is shown to be significant for preventing possible development of acidosis. The adaptation potentialities of Cyprinidae family permit them to endure an increase of CO2 in water and are determined by the ability of their organism to formations of bicarbonate and their retaining in blood.


[Carboxylation intensity in the liver of birds of different ages].

Carboxylation intensity was studied in the liver of young and adult cocks, 14C-bi-carbonate was used as an indicator of the amino acids, proteins and lipids turnover. It is established that the amount of dry residue in the liver tissue of the adult cocks is 22% higher and that of pyruvate and dicarboxylic amino acids is twice as low. The relative weight of the liver changes with age: in the 18-month-old cocks it is 1.5%, in the one-month-old cocks, 2.75%. The maximum of 14C incorporation into the tissue, dicarboxylic compounds, proteins and lipids of young cocks in the in vivo experiments is at a shorter exposure of the isotope. 14C removal from these compounds in the young cocks occurs more quickly as well. A higher radioactivity of the compounds under study in the adult cocks liver with prolongation of the isotope exposure is due to the effect of factors which are not related to the synthesis. The experiments established that radioactivity of proteins and lipids in the young cock liver slices is 6 times as high at 60-minute exposure. The mentioned above evidences for a higher rate of carboxylation in young cocks as compared to adult ones. When interpreting the data of metabolism study by means of isotopes in animals of different age a corrections should be made for a change in the liver relative weight during the growth process.


[Effect of glutamine, thymidine and orotate on the nucleic acid content in the cell nuclei of the regenerating liver in sodium fluoride poisoning].

Sodium fluoride inhibits an increase of nucleic acids in the cells nuclei of the rat liver after a partial resection of this organ. Introduction of thymidine to the animals poisoned with sodium fluoride, contrary to glutamine and orotate, causes a sharp decrease in the amount of nuclei in 1 mg of tissue and normalization of the nucleic acid content in them. Changes in the mitotic activity may be connected with a disturbance in the normal ratio of the nucleic acids synthesis precursors.


[Fructose content and aldolase activity in the tissues of chickens under ultraviolet irradiation].

The effect of UV-irradiation was studied as applied to the content of fructose and activity of aldolase in the liver tissue and muscles of chickens and embryos obtained from eggs eight months after the chicken irradiation. It is established that the content of fructose and activity of aldolase in the tissues of 19-day embryos are approximately the same as in 40-140 day chickens. Under the effect of UV-irradiation the content of fructose in the liver increases in 140-day chickens and in embryos of the group under experiment, and it decreases in the muscular tissue of 80-day chickens. In the liver of embryos obtained from the irradiated bird the activity of aldolase lowers and in young chickens no essential difference is observed between the groups. The value of the ratio of the aldolase activity for both substrates in the liver of embryos and chickens of the group under study at the age of 40 and 140 days is somewhat higher than in the control, and in the muscular tissue it is lower (in embryos and chickens at the age of 40- and 80-days).


[Separation of thiamine phosphoric esters on cation-exchange Saphadex].

A new method is suggested for separation of thiamine phosphoric esters (TPE) from biological materials. The aliquote of evaporated extract from tissue was applied to the column with Sephadex SE-C-25 (25X2.5), TTP passed through Sephadex with 0,005 M acetate buffer, pH 3.8-4.0, TDP was eluated with 0,05 M acetate buffer; TMP and T--1 M NaC1 in 1.0 M acetate buffer. Yield of each phosphoric ester was about 100%. The method allows separating thiamine phosphoric esters without preliminary purification of charcoal. It may be preferable to determine the content of TTP in tissue.


Influence of sympathetic nerve activity on renal haemodynamics and release of renin. A preliminary communication.

The role of the sympathetic nerve system is still unknown in different types of hypertension. The procedure used in the evaluation of suspect renovascular hypertension has been revised in such a way that renal blood flow, renal arterial blood pressure and plasma renin activity in renal vein could be determined prior to and after splanchnic blockade. A new divice-videovolumeter-has been used to investigate the blood flow. Some preliminary data are given.


Segmental arterial spasm in patients with total brain infarction.

An arteriographic investigation has shown that segmental spasm occurs in a relatively high frequency of patients with total brain infarction (12 of 30), and if spasm at the origin of arterial branches is included, the frequency is still higher (19 of 30). The phenomenon is possibly a sign of changed sympathetic tone, the pathophysiological significance of which is discussed.


Arterial venography of the dog's leg.

Good visualization of the veins of the leg in the dog were obtained simply by increasing the dose to ca. 2 ml per kg tissue weight of contrast agent containing 282-300 mg I/ml. This is equivalent to the dose used in celiac, cerebral and coronary arteriography in man. Moderate increase in flow induced by injection of roentgen contrast agents gave some improvement in the visualization  of the veins. Infusions of bradykinin and attempts at reactive hyperemia did not improve the visualization of the veins.


Relation between erythrocyte and plasma lithium concentrations as an index in psychiatric disease.

In longitudinal and transverse studies, lithium was measured in plasma, serum and red blood cells (erythrocyte) of healthy male and female subjects as well as in patients of both sexes suffering from manic-depressive disease or schizophrenia. The results confirm that lithium in erythrocytes is lower than in plasma in all groups. The lithium concentration gradient between plasma and erythrocytes is not caused by a slow rate of diffusion through the erythrocyte membrane. The new result of the present study is the importance of sex, disease and age on the erythrocyte/plasma lithium ratio, which is significantly higher in female subjects with manic-depressive disease. This difference persists even during long-term lithium therapy. Older female schizophrenics also have a higher ratio of erythrocyte to plasma lithium than males of the same age. The findings emphasize the importance of endocrine investigation in mental disease and support the view that plasma lithium in humans does not always reflect the intracellular levels. The erythrocyte plasma ratio may also be of value in revealing diagnostic subgroups within the classical psychiatric framework.


Changes of reactive hyperaemia after clinical bed rest for seven days.

As an indication of peripheral circulatory function reactive hyperaemia was studied in the forearm and calf muscle in 14 healthy young men before and after clinical bed rest for one week. Blood flow was measured after different arterial occlusion times with venous occlusion plethysmography. After bed rest peak flow values in the calf after arterial occlusion for 3 or 5 minutes decreased moderately (by about 20-23%) and significantly. Peak flow in the forearm decreased as well although not significantly.


Gastric evacuation and propulsive intestinal motility in acute afferent loop syndrome in the rat.

The acute afferent loop syndrome, i.e. occlusion of the afferent loop after partial gastrectomy by the Billroth II method, was produced in the rat. In a primary session a gastrojejunostomy with division of the pylorus was performed. 2-3 months later the afferent loop was ligated. The gastric evacuation and the propulsive motility of the intestine were studied quantitatively, using an inert radioisotope. Both the gastric evacuation and the propulsive intestinal motility were considerably delayed in ALS, both in relation to the laparotomized controls and in relation to previous findings in mechanical intestinal obstruction and paralytic ileus due to retroperitoneal irritation or bacterial peritonitis.


[Kidney function test after partial nephrectomy (author's transl)].

A new method for testing the function of the kidney after partial nephrectomy is reported. By means of radioisotope renography, urography and radioisotope clearance ('single-shot' method) it is possible to prove the function of the single kidney. The clearance in regard to the size of the shadow of the kidney assessed by urography allows to estimate the specified kidney function. We used these methods in ten patients and we detected that the loss of function is more extensive than expected by the operative reduction of the kidney parenchyma only. The causes for this are discussed.


[Urinary continence after radical prostatectomy: the urodynamic proof of an anatomical hypothesis (author's transl)].

Prostatic carcinoma can be cured by a radical operation. In radical prostatectomy the whole so-called internal sphincter is removed. It is generally accepted and often proved that the external sphincter which is mostly somatically innervated cannot resume the funciton of continence. The postoperative urinary incontinence after radical prostatectomy is frequent and therefore the radical prostatectomy is not performed in many places. The problem of postoperative continence as well as incontinence after enucleation of the adenoma will be briefly discussed. In 1966, HUTCH described the so-called 'baseplate'. It is a bundle of smooth muscle fibers, circulary arranged around the bladder neck, which are also responsible for passive continence. He proposed that a certain sphincter function can be achieved by a tubular anastomosis of this anatomical substratum with the distal urethral stump. We were able to prove this anatomical hypothesis urodynamically. A specially constructed double-lumen perfusion catheter enabled us to register the so-called functional urethra profile and simultaneously register a new sphincter pressure wave in the transformed 'baseplate' which was responsible for the continence. We could observe this new sphincter region in all continent patients after radical prostatectomy whereas in the incontinent patients it was absent. Since 1972 we have employed the procedure proposed by HUTCH and have performed 20 radical prostatectomies. All these patients have been postoperatively completely continent. We are of the opinion that undue restraint concerning radical prostatectomy is no more justified.


[Treatment of urinary tract infections caused by unknown bacteria (author's transl)].

The treatment of acute febrile urinary tract infections in urological patients has to start in most cases without knowledge of bacteria and their sensitivity. The results of 2,000 antibiograms and clinical observations showed good efficiency in initial therapy if combined treatment with gentamycin and cephalothin was used. Using recommeneded doses in permanent control of serum creatinine and blood-urea nitrogen, no decrease of renal function was observed in 131 patients treated with this combined therapy.


The adreno-renal-ureteral sheath: surgical-anatomical study.

The adreno-renal-ureteral sheath is described, showing the continuity of the anterior and posterior leaves of the sheath along the entire length of the retroperitoneum of each side. The study is based on anatomical dissections and on surgical observations. Anatomical and pathological considerations are discussed.


[Experience with the Cryosurgical treatment of the prostatic diseases in 100 patients (author's transl)].

Cryosurgery of the prostate should be performed only in high risk patients on which other conventional methods of treatment cannot be applied. 82% of the patients could void after cryosurgery without indwelling catheter. Cryosurgery of the prostate became one of the routine procedures in the treatment of the prostatic diseases.


[Lyophilized pig bladder as a partial bladder wall substitute (author's transl)].

Lyophilized pig bladder was used as partial replacement of the urinary bladder wall on 22 rabbits. This material is not suitable for this purpose. Lyophilized pig bladder shows no advantages compared to human dura as a bladder wall substitute.


[Grouping of urinary stones and exactness of analyses (author's transl)].

The composition of 1,327 urinary stones by X-ray diffraction is statistically analyzed, and the exact analyses are discussed. The representative test portion of the urinary stone is important to the result. A comparison of different results of urinary stones with that of other authors is only possible when we know the exactness of the method.


[Micturitional disorders in multiple sclerosis (author's transl)].

Micturitional disorders in multiple sclerosis have often an insidious onset; they aggravate during acute attacks of the nervous disease and are strongly influenced by the general condition of the patient, the evolution of his muscular spasms and the therapeutical measures. This changing behaviour of the bladder makes it necessary to perform repeated cystometries, uroflowmetries and electromyographies of the striated sphincter in order to adapt vesical therapy to the evolutive stadia of the disease. Although good results are frequently obtained by drugs (sympathicomimetics, sympathicolytics, muscle relaxants, parasympathicomimetics, parasympathicolytics), by transurethral resections of internal and/or external sphincters and by phenolisation, we feel that urinary derivations remain indicated for some patients, especially in order to facilitate social integration.


[Clinical and genetic aspects of the horseshoe kidney (author's transl)].

The horseshoe kidney is a not so rare fusion anomaly of the urinary tract system. Clinical and genetic aspects of this phenomenon are shown in a case of familiar occurrence. Genetic consultation of the family must consider various inheritable possibilities and sources of this disease. The difficulty of an exact genealogical tree analysis is pointed out.