Comparisons of calorimetric and ionometric measurements in graphite irradiated with electrons from 15 to 50 MeV.

Extensive experimental comparisons of calorimetric and ionometric measurements have been made that cover a broader range of electron energies and depths in graphite than previously reported. Electron beams of 15, 20, 25, 30, 40, and 50 MeV were used. Calorimetric absorbed-dose measurements and ionometric specific-charge measurements in air were compared in graphite at depths from 1 to 51 g/cm2. The medium was irradiated with uncollimated electron beams produced by scattering after passing through a 0.1-g/cm2 aluminum vacuum window, various thicknesses of lead foils, and air. The variation in the quotient of the two measurements was studied as a function of lead-foil thickness, depth in the medium, beam energy, foil-to-detector distance, and off-axis distance. These studies permitted the measurements to be corrected and compared with theoretical calculations that assume a broad medium irradiated with broad, parallel, monoenergetic electron beams. The overall experimental uncertainty is estimated to be 1%. The results are generally in good agreement with theoretical and experimental results of other investigators. The calorimeter received close to 1 Mrad during preliminary measurements and from 1 to 2 Mrad during the measurements reported. The results showed no detectable heat defect in graphite after prolonged periods of exposing the calorimeter to air at atmospheric pressure.


State-of-the-art of single-transducer ultrasonic imaging technology.

This paper attempts to take note of some recent improvements in ultrasound  echo-ranging technology and make some observations on the single versus multiple-transducer element approach. It would appear at this time that the problems encountered with visualization systems may not be solved by using multiple transducers per se, and that the unique advantages that accrue to the multiple-transducer systems have yet to demonstrate that they fulfill and important clinical need.


State-of-the-art in two-dimensional ultrasonic transducer array technology.

Attention is given to means of sensing ultrasonic energy distributions over an area. Under the restraints appropiate to real-time imaging of deep body organs, piezoelectric arrays offer the most promising method. Adaptation of integrated circuit techniques to array assembly permits very large arrays of small elements to be batch fabricated. Further, special semiconductor switching devices specifically designed for addressing the array have been produced and applied. These permit both the passage of weak received signals and the application of voltage and current levels sufficient for transmission without significant disturbance of the basic piezoelectric element properties. Emphasis is placed on the complete data acquisition, processing, and display flexibility that arises from an array capability. Operation becomes possible in any of the presently used A or time motion (TM), in real time B or C scan, or in novel scan patterns adapted to specific organs. Further development with acoustic and electronic focusing, taking advantage of the unique possibilities obtained with the bidirectional array structure, is discussed.


Analysis of in vivo volume measurements obtained with diagnostic ultrasound.

A study was carried out to investigate the errors involved in obtaining volumes by means of ultrasound echograms and a small computer. The work was done  on live pigs' kidneys (130-200 cm3). The errors include those associated with the scanner itself, those invloved in the interpretation of the contour boundaries, and those relating to the algorithms used to determine the volumes from the contours. An average deviation of 25.4 cm3 from actual volumes was found, while 58% of the measurements were within +/-10%. Computer programs allowing for the display of contours and intercepts of corresponding orthogonal scan planes were used to reanalyze the data resulting in an average deviation of 14.7 cm3 with 78% of  the data resulting inan average deviation of 14.7 cm3 with 78% of the measurements with "/-10%.


Spectroscopy of diagnostic x rays by a Compton-scatter method.

A method is described for measuring the energy spectra of diagnostic x rays using a high-resolution intrinsic germanium spectrometer. The method is applicable over the wide range of x-ray exposure rates normally used in radiography. Reduction of the high x-ray beam intensity to a level acceptable to the germanium spectrometer is achieved by measuring the spectrum of photons scattered through 90 degrees by a lucite disc. From this measured spectrum the primary spectrum is obtained by calculation. Some typical x-ray spectra are presented.


Modified transit dosementer system for 60Co rotational therapy.

The transit dosemeter has been used in obtaining inhomogeneity corrections for 60Co rotational therapy. A modified approach is presented which features a rapid electronic system for determining the average tissue-air ratio (TAR) for a 360 degree rotation. Experimental results and early clinical experience show that this system is capable of providing a TAR value directly, and more rapidly. It can be readily incorporated in a therapy system which already includes a transit dosemeter.


Digital display plug-in module for the Victoreen model 555 integral and rate exposuremeter.

A digital display plug-in for use with the Victoreen 555 exposuremeter is described. The device is a readout subsystem for displaying numerical and dimensional information in a clear, legible form, with both probe and range scale factors accounted for in the display itself. In addition to facilitating data gathering with the 555, the device circumvents nonlinearity in the analog meter movement. Minor modifications required of the 555 mainframe are described.


Calibration methods for measuring splenic sequestration by external scanning.

Conventional methods for measuring splenic sequestration of labeled cells rely on stationary probe counting over the liver and spleen. A quantitative spleen-scanning method is proposed as a means of performing a more accurate diagnosis of the degree of splenic sequestration. Improved methods for calibrating a rectilinear scanner employing "constant resolutions" collimators, designed for the in vivo measurement, are reported, Clinical evaluation of this method was performed by scanning several patients scheduled for splenectomy. Good correlation between in vivo and in vitro measurements of splenic radioactivity for 29 patients was obtained. A least-squares fit to the data yielded a coefficient of determination r2=0.93.


Calibration instrumentation used by the AAPM Radiological Physics Center.

The Keithley model 602 electrometer-Farmer ionization chamber combination has served as the standard dosimetry system for calibration measurements made by the AAPM Radiological Physics Center at 156 different institutions. The constancy of this system is compared to that for the Baldwin-Farmer Secondary Standard Dosemeter type 2502, and is based on measurements made over a 3-yr period on a Cobalt-60 gamma-ray source. A Strontium-90 check source is also shown to be a reliable standard, and frequent checks with such a source can prevent serious calibration errors.


Heuristic model for understanding x-ray film characteristics.

A simple, heuristic model of a photographic emulsion is described for the purpose of illustrating the fundamental physical processes and emulsion properties which determine the characteristics of an x-ray film (viz., the shape of the H - D curve, film gamma, and film speed). By means of this model, it is shown that the contrast multiplication afforded by an x-ray film (i.e., a film gamma greater than unity) is a direct result of the exponential attenuation of the viewing light by the developed film, and that film gamma is proportional to grain size, grain density, and emulsion thickness. The difference in the H - D curve that is observed when the same film is exposed to light from an intensifying screen or directly to x rays is also predicted by the model.


Evaluation of nuclear-reactor-produced iodine-123.

Iodine-123 has such great potential to nuclear medicine that all possible production methods should be considered. In this report an experimental study related to 123l production at a high-intensity fast flux reactor using the reaction 124Xe(n,2n)123Xe is considered. The conclusion is that 123l could be made in small quantities and the cost would be higher than the cyclotron methods presently used.


Polynomial and power law of central axis backscatter factors for external and gamma-ray sources.

A third-degree polynomial and power-law analysis with the method of least-squares fit are computed for backscatter factor with a continuous variation of field size and different beam quality of radiation from 1.0-mm Al external x ray to 60Co gamma ray. Three coefficients are required for a third-degree polynomial and two coefficients for power law method of each beam quality.


Organisms associated with abortion and reproductive problems in cattle.

In 14 herds totaling over 2000 cattle the bacterial species most frequently isolated from the vagina, fetus, and fetal membranes following abortion or reproductive failure were Streptococcus, Corynebacterium, Bacillus, and Staphylococcus, less often E coli. About 5% of the total 1810 isolations included various other agents. Although most of the aborted fetuses had undergone autolysis, pulmonary, hepatic, renal, and placental lesions were observed in a few cases.


Rearrangements at the mating type locus in fission yeast.

Crosses involving the partially defective mating type mutant B102 (functional in conjugation, defective in meiosis) have confirmed the notion that, in Schizosaccharomyces pombe, certain mating type mutations can arise by transposition. A copy of the mat2P segment (specifying + mating type) is transposed and inserted into the mat1M segment (usually specifying - mating type). The mat1M segment affected by the insertion loses its former - function entirely. The - function is, however, fully regained upon excision of the transposed and inserted mat2P segment. At either position, the mat2P segments can undergo inactivations to different states of residual activity. These events can occur about as frequent as other mutations of the mating type locus (ca. 10(-4) per cell division). In certain diploid strains, such inactivations were significantly correlated with recombination. Spontaneous reversions to full activity were also observed.


Thermal inactivation of maltase and its application to temperature-sensitive mutants of yeast.

Three maltases have been detected in each of a variety of strains of Saccharomyces. These are present in constant relative amounts in a particular strain and are characterized by reproducible first order thermal decay constants. Four of six mutants, temperature-sensitive for maltose fermentation, lack the maltase of intermediate stability. This deficiency appears to be the basis of the temperature sensitivity, and it is concluded that these strains carry a mutation in the structural gene for that maltase.


The dependence of HNO2 mutagenesis in phage T4 on ligase and the lack of dependence of 2AP mutagenesis on repair functions.

A temperature sensitive ligase allele of phage T4 reduced or eliminated HNO2 induced reversion of am mutants. Since at the temperatures used, the ligase mutant is defective in the repair of some types of lethal lesions (i.e., UV, MMS and EMS induced lesions) these results indicate that HNO2 mutagenesis may occur through a ligase dependent repair pathway. In contrast, 2AP induced mutation was not inhibited by mutants defective in the gene 30 ligase or in genes 32, 39, 41, 42, 44, 45, 46, 47, 49, 52, 56, 58-61 and v. This indicates that 2AP mutagenesis probably does not depend on a repair pathway in phage T4.


Studies on the mechanism of metabolic stimulation in polymorphonuclear leukocytes during phagocytosis. Activators and inhibitors of the granule bound NADPH oxidase.

The effects of several known inhibitors and activators of peroxidase-catalyzed reactions have been studied on the NADPH oxidase activity of granules isolated from polymorphonuclear leukocytes at rest or during phagocytosis. Redogenic substances, such as ascorbate or hydroquinone, and superoxide dismutase, which are known to inhibit peroxidase-catalyzed reactions, also inhibited the NADPH oxidase activity of granules. Oxidogenic substances, such as guaiacol or resorcinol, and manganese, which are known to stimulate peroxidase-catalyzed reactions, also activated the NADPH oxidase activity of granules. Cyanide, an inhibitor of peroxidase-catalyzed reactions, inhibited the NADPH oxidase activity of granules isolated from resting leukocytes but only slightly affected that of granules isolated from phagocytosing cells, as previously reported. A list of the properties of the NADPH oxidase activity of granules and of peroxidase oxidase activity is given. The arguments in favor of and those against a possible identity of the two activities are discussed.


[Improved prognosis of Ewing-sarcoma by combined irradiation and chemotherapy (author's transl)].

Until recently Ewing's sarcoma has been considered the most lethal malignant bone tumor with the poorest prognosis. An 8-year-old girl with Ewing's sarcoma is described who survived without recurrent disease for nearly 5 years now. 5-year-survival rates among large groups in the literature are reported, and different kinds of therapy compared. There are indications for a tendency that combined radio- and chemotherapy probably have the best results, since in most cases at the time of diagnosis the tumor already has metastasized or, like Lichtenstein believes, Ewing's sarcoma, primarily is of multicentric origin.


[Generalized progressive vaccinia in a child with primary humoral and cellular immunodeficiency (author's transl)].

A case of generalized progressive vaccinia with lethal outcome after smallpox vaccination observed in an 8 months old girl during 1968 is reported. This complication was the first sign of an underlying immune deficiency in this child. The most conspicious findings suggesting a humoral immune defect were an absent serum IgM in combination with decreased IgA and IgG levels. An additional cellular defect was suggested by a generalized hypoplasia of the thymus and the entire lymphatic system as shown during autopsy. Vaccinia virus could be found not only in skin eruptions intra vitam but also in lung, liver and brain tissue in post mortem studies.


[Peritoneal dialysis for treatment of hemolytic-uremic syndrome in children (author's transl)].

After a short introduction on etiology, symptomatology and therapy the authors present 4 cases of hemolytic-uremic syndrome. All children were treated with peritoneal dialysis which was repeated many times, when the anuric-condition lasted for a long time. Indications and the technique of the peritoneal dialysis are given. The authors prove that the peritoneal dialysis therapy of hemolytic-uremic syndrome has good results at different ages.


[Hypocomplementemic membranoproliferative glomerulonephritis in a child with ulcerative colitis (author's transl)].

A 5 1/2 year old girl with hypocomplementemic membranoproliferative glomerulonephritis suffered from severe nephrotic syndrome. Despite intensive treatment with corticosteroids and immunosuppressive drugs the clinical state deteriorated. Three years after clinical onset of the disease the girl entered our regular hemodialysis program because of terminal renal insufficiency. After two weeks of intermittent hemodialysis she presented intestinal bleeding, which could not be stopped. One week later complete ileus developed and the child died. Before the onset of melaena no occult blood or mucus could be detected in the faeces. The autopsy revealed a severe ulcerative colitis with pseudopolyposis of the whole colon. In serum specimens still available colonic antigen could be detected by means of immunodiffusion using a rabbit antiserum against fetal colonic extract. Immunofluorescence studies showed granular deposits of immunoglobulins and complement along the glomerular capillary walls suggesting an immunogenesis of the glomerulonephritis by circulating immune complexes. The possibility of an interrelationship in the pathogenesis of both diseases is discussed. It should not be excluded that immune complexes formed in excess of colonic antigen have caused or perpetuated chronic glomerulonephritis.


[Sphingomyelin lipoidosis (author's transl)].

The case of a girl is described who was 3 1/4 years of age and was admitted of the hospital because of hepato-splenomegaly. In addition to this, there were peculiar alterations in the lungs, an increase of lipoids in the blood, a characteristic alteration of the retina, and bone marrow and liver cells storing lipoid. The diagnosis of sphingomyelin lipoidosis (Niemann-Pick) was confirmed by electronmicroscopic and biochemical investigation of a percutaneous liver biopsy specimen.


["Lublin syndrome". A case of generalized haemangiomatosis of the skin, and hydrocephalus (author's transl)].

The authors describe a new syndrome published first by Polish investigators. The syndrome is called "Lublin-syndrome" after the original authors. Generalised haemangiomatosis of the skin and severe irreversibile cerebral damage are the essential symptoms of the disease. The assumed pathogenesis, morphological changes of the disease, and the therapeutical attempts are discussed.


[Vegetative disorders in children with cerebral palsy. Results of an inquiry of parents].

Many of the disturbances resulting from dysregulations in the autonomous nervous system of children with cerebral palsy are rarely discussed in the doctor's praxis. Nevertheless, they are causes of trouble and worry for the parents. For this reason we started an inquiry into this matter. Questionnaires were sent to the parents of 452 C.P. patients. 374 were answered with sufficient care. The following factors were evaluated: sleep, bladder and bowel activity, temperature regulation, vomiting, sweating, blood circulation, growth. The C.P. children were compared to their own siblings especially to the next younger ones. The diagnoses were as follows: Spastic tetraplegia 197 patients. Spastic hemiplegia 44 patients, Athetosis 33 patients, Mixed cases of spasticity and athetosis 82 patients, Other 15 patients. The degrees of handicap in terms of motor development were: severe (unability to sit unsupported) 166 cases, moderate (unability to kneel or walk unsupported) 118 cases, mild (ability to kneel and/or walk unsupported) 87 cases. Summarized, the statements of the parents gave the following results: sleep disturbances: 169 cases (46%), constipation: 145 cases (39%), tendency towards temperature dysregulation: 112 cases (30%) , tendency towards increased vomiting: 91 cases (25%), sweating increased or decreased: 110 cases (30%), irregular and frequent voiding of bladder: 92 cases (25%), unstable regulation of blood circulation: 101 cases (27%), cold skin: 264 cases (71%), body-length deficit: 119 cases (32%), low-weight: 177 cases (48%), feet too small for age: 252 cases (68%). Results are related to diagnosis and severeness of handicap. In addition, it is discussed, whether there are relations between several of the investigated factors. The influence of the patients sex is discussed.


[Dysfunction of Granulocytes in Children with Frequent Infections].

Eight children with various diseases, who has frequent infections were examined for abnormalities of serum proteins and leucocyte function. Inborn or secondary defects could be recognized by the tests for chemotaxis, the intracellular killing of bacteria as well as yeast and the oxydative metabolism of the granulocytes. The defects were serum- or cell-dependent and they could be detected alone or in combination with other dysfunctions. Three children showed a reduced stimulation of the lymphocytes in addition to the impairment of chemotactic activity or fungicidal cavity.


[Blood Pressure of Premature Infants within the First 3 Weeks of Life (author's transl)].

Technical difficulties which prevented routine blood pressure measurements in premature infants are nowadays overcome by the application of the ultrasound Doppler-technique. Normal values for premature infants with respect to birth weight and age are reported. They are needed for the detection of abnormal values and the therapy.


[On Endocrine Hypothalamic Systems (authors transl)].

The article summarizes under morphological aspects, the most important results of neuroendocrinology as far as hypothalamus and hypophysis are concerned.


[The Restless Child (author's transl)].

Physiological unrest of children seems to originate from a basic need for activity in humans. It becomes apparent as "enjoyment of action" during age-specific periods, particularly during emotional phases of development. Apart from clearly neurological diseases, psychomotoric unrest as a pathological symptom can be observed in three forms different in artiology and psychodynamics: as cerebral unrest, psycho-vegetative unrest, and neurotic unrest. Causes, psychodynamics and appearances of the unrest as mentioned before are discussed and illustrated by details of case histories. Basically, the psychomotoric unrest is an expression of frustrated emotion, preventing the child from adjustment to reality, thereby causing a deficit of experience, which inturn is the reason for a secondary lack of success, to which the child reacts again with psychomotoric unrest. Therapy has to interrupt this vicious circle by three recommended approaches: drug therapy, child guidance, and psycho-therapy. Sociological aspects of the "restless child" are mentioned.


[Mass screening for histidinaemia:rationalization by selective thin layer chromatography. First results].

Since 1974 histidine and urocanic acid was estimated by thin layer chromatography (TLC) in all newborn infants in whom histidine blood levels had to be controlled because of an abnormal Guthrie-test. This entailed using dried blood spotted on filter paper to rationalize newborn screening for histidinaemia thus reducing the work involved. Three cases of histidinaemia were found amongst 66.064 newborn infants. In order to find these, 830 initialy suspicious Guthrie tests had to be checked. This is a control frequency of 1:80. 384 controls were necessitated by inhibition-zones, 482 by initialy elevated blood levels. Histidine and urocanic acid concentrations generally correlated well in the TLC; only 9 newborn infants showed results suggesting histidinaemia (elevated histidine and absent urocanic acid). All three histidinaemias discovered by Guthrie-test aswell were among them, so that in the end, with only 9 controls combining Guthrie-test and TLC, the same effectiveness could have been reached, as compared to 830, when using the Guthrie-test alone.


[About the further development of a 6 year old boy with essential hyperlipaemia (fat induced hypertriglyceridaemia)].

1961 the authors observed and described a rare form of Essential Hyperlipaemia seen in a 6 year old boy. On a diet poor of fat food the patient has been in good health without any complaints for the last 13 years. The disease did not show any tendency to recur. The child grew and lived through puberty quite normally. Only at the age of 19, during military service, the symptoms of the disease were noticed again. When released from the military service and put back to his usual diet his condition normalised quickly.


[Spinocerebellar ataxia with monilethrix, typical facial features, and dental anomalies].

The authors present a form of heredodegenerative spinocerebellar ataxia with concomitant involvement of ectodermal structures, different from other variants. The disease was characterized by spinocerebellar ataxia (the complete form); curly, thin, short and dense hair, mikroskopically monilethrix; a characteristic face (hypertelorism, flattened and wide base of the nose, prominent nostrils, large mouth, thick lips); and abnormal teeth which were reduced in number and had gaps inbetween. The psycho intellectual development and the voice of the patient were normal. The first neurological symptomes were observed at the age of 3 years and progressively developed until now at the age of 6 years. Data necessary to establish the mode of hereditary transmission were not available.


[More recent aspects of treatment for hypothyroidism and goitre in children and adolescents (author's transl)].

According to more recent knowledge L-thyroxine alone is recommended for thyroid hormone replacement therapy, no longer the combination of L-thyroxine and triiodothyronin, since L-thyroxine is converted to triiodothyronine in the periphery of the body. Additional application of triiodothyronine causes unphysiological elevations of blood levels of triiodothyronine. When changing from the combined thyroid hormone therapy to treatment with L-thyroxine alone it is enough in most cases to replace the previous amount of L-thyroxine only; previous recommendations for the dosage of thyroid hormone were rather high. Average requirements of adults for L-thyroxine are around 170 mug per day. Children need about 90--100 mug per m2 body surface per day. -- When hypothyroidism is suspected in newborns or infants no protracted diagnostic procedures are justified with respect to brain development and its requirement of thyroid hormone during this period of life. Replacement therapy should be started within 1--2 days. The exact diagnosis can be established later, for instance during the third day of life when a temporary interuption of treatment for diagnostic purposes has no longer such negative effect on normal brain development. As long as physiological doses of L-thyroxine are used no side effects are to be expected for patients who later turn out to be euthyroid. -- Following exclusion of hyperthyroidism goitres in children and adolescents equally need thyroid hormone replacement therapy to reduce the size or prevent further enlargement or even the development of nodules within the gland. The dosage for this is about half to three quarters of the full replacement dose. The nature of thyroid nodules should be investigated, even surgically, since malignancies can develop in children and juveniles as well as in adults.


[Leucine-sensitive hypoglycaemia and its treatment with diazoxide (author's transl)].

A seven months old infant suffered from convulsions due to leucine-sensitive hypoglycaemia. The convulsions could not be stopped by a diet lacking in leucine, but ceased after additional application of diazoxide; hypoglycaemia was no longer observed the mental development of the child is hoped to be normal.


L-Tryptophan administration in man: effects on gonadotrophin, growth hormone and cortisol secretion and on sexual motivation.

Long-lasting administration of L-tryptophan in neurologic patients caused a slight reduction of plasma luteinizing hormone levels without modifications of sexual motivation. Plasma follicle stimulating hormone concentrations were not altered by L-tryptophan. Short-lasting loading of L-tryptophan caused a statistically significant increase of plasma growth hormone levels, and a fall of plasma cortisol values in neurologic patients without neuroendocrine disorders. The pattern of plasma cortisol response to L-tryptophan loading was different in patients with neuroendocrine disorders. Plasma gonadotrophins seemed to be slightly reduced after the L-tryptophan loading.


Monoamine oxidase defect in essential arterial hypertension. A single dose pargyline test.

A defect in the level of monoamine oxidase activity of platelets was observed in essential arterial hypertension. This defect seems dependent upon a lower rate of synthesis of the enzyme and not to the presence of an isoenzyme, as the net rate of return of the enzymatic activity after pargyline inhibition does not significantly differ between hypertensive and normotensive subjects.


A computer method for the kinetic analysis of enzyme activity.

A computer method is described in which an estimate of Km and V parameters is obtained by fitting a Michaelis-Menten hyperbola to experimental data. The frequency distribution of calculated parameters is far from normality. A statistical evaluation of the differences between kinetic parameters must be obtained by the use of non-parametric statistics.


Plasma total and free tryptophan concentration in 'neurotic' and 'psychotic' depressive patients.

Plasma levels of total and free tryptophan were measured in patients with depressive neurosis and depressive psychosis, before and after recovery. No significant differences were found in total or free plasma tryptophan levels between 'neurotic' and 'psychotic' groups, and no change in these levels was found on recovery from depressive illness.


Changes in serotonin metabolism during migraine attacks.

The concentration of 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), kallikrein-like enzymes and beta-glucuronidase were quantified in the cerebrospinal fluid (CSF) during spontaneous migraine attacks. Plasma levels of kallikrein-like enzymes and beta-glucuronidase, as well as urinary levels of 5-HIAA as free acid and glucuronides were also measured. Correlation of these biochemical findings with various clinical variables showed that 5-HIAA in the CSF did not correlate with either the time sequences of migraine attacks or with clinical division of migraine into classical and common migraine. CSF 5-HIAA correlated positively with HVA, EEG photostimulation, the triggering of food and the therapeutic effect of the so-called antiserotonin treatment, and negatively with esterase activity. Urinary 5-HIAA showed a significant increase during the early headache stage.


Clinical and animal pharmacology of migraine: new perspectives.

Animal and clinical pharmacological studies show in certain vascular beds a biphasic action [potentiation and inhibition of serotonin (5-HT) responses] of some anti-migraine drugs, such as ergotamine, methysergide and more recently Org GC 94. Potentiation occurs at therapeutic drug concentrations. The present investigations seem to support the 5-HT theory of migraine and other essential headaches. In this theory, anti-migraine drugs, such as ergotamine, methysergide, pizotifen, and Org GC 94 could reduce the occurrence of pain in migraine and other esscutial headaches by acting as partial agonists tending to correct a deficiency of central 5-HT concentrations or turnover.


Insulin secretion in migraine: influence on the blood levels of tryptophan.

The blood levels of free tryptophan, glucose and insulin were determined in different groups of patients suffering from headache, initially and after a glucose tolerance and a tolbutamide tolerance test. The control group consisted of subjects without neurological or psychiatric disturbance. A sharp drop of blood tryptophan levels was observed in migraine patients during the tolbutamide tolerance. Migraine attacks may be induced in certain subjects by a disturbance of 5-hydroxytryptamine turnover.


The content and manipulation of cognitive maps in children and adults.

Comparison of cognitive maps generated by first graders, fifth graders, and college students using a triangulation task revealed that the first graders possessed very accurate, coherent cognitive maps. However, analyses of the cognitive maps generated when Ss were asked to imagine either the room rotating (mental rotation) or themselves moving within the room (perspective-taking) revealed that the accuracy and completeness of the mental manipulation increased dramatically with age. Only the cognitive maps of the college students were coherent and accurate during mental rotation than during perspective-taking. Careful attention was given to the types of errors made, and several systematic error patterns were identified which reflected qualitative differences. These qualitative differences indicated mental manipulation was a two-stage process. In the first stage, a strategy of transformation was applied to the ordinal spatial relationships contained within the cognitive map. First graders evidenced difficulty here. In the second stage, more specific relationships between self and spatial layout were reconstructed. Fifth graders evidenced difficulty here. In contrast, college students were able to complete both stages of the process.


Foam stability predictions of respiratory distress in infants delivered by repeat elective cesarean section.

Amniocentesis for assessment of lung maturity has been recommended before delivery by elective repeat cesarean section because respiratory distress may occur in infants delivered in this manner. To test this hypothesis, foam stability tests of amniotic fluid (84 cases) or gastric aspirate (25 cases) were used as interchangeable indexes of pulmonary maturity in 109 infants born by repeat elective cesarean section. Of the 81 infants with a positive foam stability test, only 2.5 per cent had transient respiratory distress, but 8.3 per cent with intermediate or negative foam stability tests had respiratory difficulty (P less than 0.025). The results support recommendations that fetal lung maturity should be assessed before elective repeat cesarean section to minimize the risk of respiratory morbidity.


Risk factors associated with nasopharyngeal carcinoma.

We performed a case-control study of nasopharyngeal squamous-cell carcinoma to identify risk factors associated with the disease. Interviews with 156 patients and 267 controls revealed that increased risk was significantly associated with a prior history of ear, nose or throat disease (relative risk = 1.8, P = 0.006) and occupational exposure to fumes (relative risk = 2.0, P = 0.006), smoke (relative risk = 3.0, P = 0.008) and chemicals (relative risk = 2.4, P = 0.006). Among Chinese, other Asians and Mexican-Americans, increased risk was also associated with foreign birthplace (relative risk = 2.1, P = 0.04), probably reflecting childhood exposure to carcinogens in inhaled smoke. In Chinese patients the risk associated with foreign birthplace and occupational exposure increased among those with HLA-A2 and less than two antigens at the B locus, suggesting a genetic variation in susceptibility.


The intrauterine device and deaths from spontaneous abortion.

To evaluate the intrauterine device as a risk factor for mortality associated with spontaneous abortion, we analyzed all deaths from spontaneous abortions reported in the period 1972-1974. Women dying from spontaneous abortions with a device in place were more likely to be young, white and married than those not wearing a device. Risk of death from spontaneous abortion was over 50 times greater for women who continued their pregnancy with a device in place than for those who did not. The Dalkon shield carried an increased risk of death, as compared to other devices, even after rates were adjusted for duration of use. However, pregnant women with either a loop or a coil in place also had a higher risk of dying from spontaneous abortion than those without any device. The results support the clinical recommendation that any device should be removed when pregnancy is first diagnosed.


Prenatal diagnosis of alpha-thalassemia. Clinical application of molecular hybridization.

The technic of DNA-DNA hybridization was used for prenatal diagnosis of a pregnancy at risk for homozygous alpha-thalassemia. Fibroblasts were cultured from amniotic fluid, and the number of alpha-globin genes in the DNA was quantified by hybridization with radioactive DNA complementary to alpha-globin mRNA sequences. As compared to control studies of DNA from patients with alpha-thalassemia syndromes and from unaffected subjects, the results indicated that the fetus had alpha-thalassemia-1. The diagnosis was confirmed by umbilical-cord blood studies.


Mechanism of increased renal clearnace of amylase/creatinine in acute pancreatitis.

We investigated three possible causes of the increased ratio of amylase/creatinine clearance observed in acute pancreatitis. The presence of rapidly cleared isoamylase was excluded by studies of serum and urine, which demonstrated no anomalous isoamylases. In pancreatitis, the ratios (+/-1 S.E.M.) of both pancreatic isoamylase (9.2+/-0.6 per cent) and salivary isoamylase (8.6+/-1.6 per cent) were significantly (P less than 0.01) elevated over respective control values (2.4+/-0.2 and 1.8+/-0.2 per cent). Increased glomerular permeability to amylase was excluded by the demonstration of normal renal clearance of dextrans. We tested tubular reabsorption of protein by measuring the renal clearance of beta2-microglobulin, which is relatively freely filtered at the glomerulus and then avidly reabsorbed by the normal tubule. During acute pancreatitis the ratio of the renal clearance of beta2-microglobulin to that of creatinine was 1.22+/-0.52 per cent, an 80-fold increase over normal (0.015+/-0.002 per cent), with a rapid return toward normal during convalescence. Presumably, this reversible renal tubular defect also reduces amylase reabsorption and accounts for the elevated renal clearance of amylase/creatinine observed in acute pancreatitis.


The Johns Hopkins experience in Columbia, Maryland.

A university-related prepaid group practice was established in Columbia, Maryland, in 1969, by the Johns Hopkins Medical Institutions with the cooperation of the Connecticut General Life Insurance Company. Objectives were based on the traditional triad of service, teaching and research. The effort continues. There has been visible success in the achievement of each of the objectives. It is evident, however, that the development of the Columbia Medical Plan would have been facilitated if there had been a larger population base in which to market membership in the Plan, if marketing had been under the direction of the health-care provider, and if the burden of the building and running of a hospital had not been assumed. Overall, the experience suggests that the Health Maintenance Organization movement has only modest ultimate potential as an option in health-care delivery in the current economic milieu of American medicine.


Reciprocal relation between renin dependency and sodium dependency in essential hypertension.

To investigate the roles of angiotensin II and sodium in essential high-renin, normal-renin and low-renin hypertension, 14 patients received the competitive antagonist of angiotensin II, saralasin, during periods of sodium depletion and repletion. Blood-pressure response to saralasin was determined by the state of sodium balance. Patients from all three renin subgroups exhibited a fall in blood pressure when sufficiently sodium depleted, and an elevation in blood pressure when sodium replete or insufficiently depleted. However, those with low renin required loss of substantially more sodium (sufficient to elicit compensatory stimulation of renin) before depletion could be achieved. In patients with essential hypertension of all three renin subgroups, sodium balance determines the degree of participation of the renin-angiotensin system in sustaining high blood pressure. Even the low-renin type can become renin dependent with sufficient sodium depletion.


Platelet survival and morphology in homocystinuria due to cystathionine synthase deficiency.

In homocystinuria due to cystathionine synthase deficiency thromboembolism is a major cause of mortality and morbidity. Recent studies by others identified an abnormally shortened platelet survival and increased platelet vacuolization in patients with homocystinuria. When we studied six additional patients, however, we found the platelet survival to be within normal limits for each. The mean survival (+/-1 S.D.) was 9.75+/-0.94 days (normal, 9.27+/-1.06). In addition, platelets from five patients with homocystinuria and three obligate heterozygotes could not be distinguished from those of seven normal control subjects by electron microscopy. Specifically, no increased vacuolization was observed. Genetic heterogeneity, technical differences of differences in plasma homocystine concentrations could account for these descrepant results. The mechanism of thrombosis in homocystinuria remains an open question.


Alimentary-tract ganglioneuromatosis. A major component of the syndrome of multiple endocrine neoplasia, type 2b.

Although the syndrome of multiple endocrine neoplasia, type 2b, is known to comprise mucosal ganglioneuromatosis, medullary thyroid carcinoma, pheochromocytoma and skeletal anomalies, we wish to document the importance of the alimentary-tract components. In nine patients with this syndrome, we found diffuse ganglioneurmatosis extending from the lips to the rectum. Alimentary symptoms, constipation or diarrhea or both were present in six of these patients. Similar symptoms were present in six of seven other affected patients from whom alimentary-tract tissue was not obtained. Five of the 16 patients had megacolon, which led to operation in four, and a sixth patient had colectomy for diverticulitis complicating diffuse diverticulosis. The alimentary manifestations warrant greater emphasis, not only because they were prominent in the patients whom we studied but also because in 14, these manifestations were present before the endocrine neoplasms were detected.


Enzyme replacement therapy for adenosine deaminase deficiency and severe combined immunodeficiency.

To evaluate their role as a form of replacement therapy, frozen irradiated red blood cells were administered to a child with adenosine deaminase deficiency associated with severe combined immunodeficiency disease. In vitro lymphocyte responses to mitogens and allogeneic cells were restored. Subsequently, a "thymus shadow" appeared, and immunoglobulin synthesis was demonstrated. Frozen irradiated plasma, which alone had no effect on lymphocytes numbers or responses, promoted lymphocytosis when given with frozen irradiated red blood cells. The patient received the transfusions with or without irradiated plasma at four-week intervals and remained free of infection for 17 months. The patient's lymphocyte adenosine triphosphate levels were elevated before therapy, which consistently reduced them without altering the lymphocyte adenosine deaminase activity. Enzyme replacement therapy may provide a way to treat patients with adenosine deaminase deficiency associated with severe combined immunodeficiency disease who do not have histocompatible bone-marrow donors.


Clinical syndrome of variant angina with normal coronary arteriogram.

We compared patients with variant angina (ST-segment elevation during pain) who had normal or near normal coronary arteriograms (Group 1) with 20 in whom variant angina occurred in the presence of obstructive coronary lesions (Group 2). A long history of nonexertional angina without angina of effort or previous infarction was the rule in Group 1, whereas recent-onset unstable angina preceded by effort angina and infarction predominated in Group 2 (P less than 0.001). Normal electrocardiograms at rest, with ischemic ST-segment elevation in the inferior leads, and ischemia-induced heart block and bradycardia, characterized Group 1, whereas abnormal electrocardiograms, ischemic involvement or fibrillation were more common in Group 2 (P less than 0.001). Variant angina with normal coronary arteriogram generally has a benign course and is probably unrelated to atherosclerosis.


Treatment and prognosis of hemiballismus.

Acute hemiballismus due to a cerebrovascular lesion may have a grave prognosis. In the past nine years, we have treated 11 patients who had an acute onset of hemiballismus believed to be the result of an acute vascular lesion with neuroleptic drugs (most frequently haloperidol). None of the 11 died, and the movement disorders were greatly reduced or eliminated. In eight patients the drugs were withdrawn within six months, without recurrence of the movement disorders. Spinal-fluid homovanillic acid levels were increased in three patients, suggesting that altered dopaminergic feedback mechanisms may be involved in the pathophysiology of hemiballismus. Our observations suggest that the prognosis of hemiballismus is not necessarily as grave as has been believed, and that neuroleptic therapy may alter the outcome of this disorder.


Neutrophil kinetics in hereditary and congenital neutropenias.

Neutrophil production and distribution were studied in two families with autosomal dominantly inherited neutropenia to distinguish their illness from other neutropenic disorders. In addition to a reduced post-mitotic pool of bone-marrow neutrophils and neutrophil precursors, mitotic pool size was also reduced, ranging from 1.1 to 2.9 X 10(9) cells per kilogram (normal, 3.8 +/- 0.4 X 10(9) per kilogram). In vitro committed stem cells were reduced as well, ranging from 2 to 12/10(5) marrow cells (normal, 30 to 120/10(5)). In three patients neutrophil counts were observed to return to normal when they were adults. In one such subject studied, however, both the mitotic pool of neutrophil precursors and marrow committed stem cells were reduced. These abnormalities were in contrast to studies of a patient with chronic benign neutropenia of childhood and an infant with Kostmann-type congenital neutropenia, both of whom had increased marrow committed stem cells. These studies demonstrate several different mechanisms for production of neutropenia in these syndromes.


Detection of intrapulmonary hemorrhage with carbon monoxide uptake. Application in goodpasture's syndrome.

We devised a noninvasive measure of pulmonary hemorrhage of value in the management of Goodpasture's syndrome. We reasoned that alveolar uptake of inhaled carbon monoxide during breath holding would increase in the presence of extravascular blood, but clearance of its radioisotope (C15O) from a lung field would be delayed. Thus, the ratio of uptake to clearance would indicate lung hemorrhage. In 15 controls and six patients with renal failure without hemorrhage, this ratio ranged from 0.73 to 1.5. In eight patients with Goodpasture's syndrome the ratio ranged from 1.5 to 16.5, returning to normal between episodes  of bleeding. Measurements of carbon monoxide uptake alone in 10 patients with Goodpasture's syndrome were at times well above that predicted for their hemoglobin level, whereas in renal failure with acute pulmonary edema increased carbon monoxide uptake was rarely found. Thus, monitoring of the single-breath carbon monoxide uptake alone can detect episodes of lung hemorrhage.


Deaths from paracervical anesthesia used for first-trimester abortion, 1972-1975.

Since January 1, 1972, five women in the United States are reported to have died from paracervical anesthesia used for first-trimester abortions. This report describes the three most recent deaths. Toxic doses of lidocaine, substantiated by post-mortem blood levels of 5 and 9 mug per milliliter, probably led to two deaths; an intolerance to or inadvertent intravenous administration of mepivacaine probably caused the third. Administration of an appropriate dose of local anesthetic appears to be the single most important factor in preventing catastrophic reactions.


Nucleotide rigidity.

It is show that in aqueous solution the backbone conformation of adenosine is as much flexible as that of 3'-AMP, 5'-AMP and 3', 5'-ADP indicating that nucleotides are not any more rigid than nucleosides. The flexible conformation of the monomeric components is conserved in the nucleotidyl units of destacked ApA, ApApA and poly(A), but it is not conserved in base stacked conditions. The findings are extended to guanosine, uridine and cytidine systems. It is projected that in aqueous solution, conformations of the individual nucleotidyl units of yeast tRNAhe are confined to the classically stable domains in the base stacked region and non-rigid flexible structures populate in the unstacked region comprising D16, D17, G20, U47 and A76.


Antibody response and protective ability of rabbits inoculated with Staphylococcus aureus strain CH-91.

Rabbits were inoculated subcutaneously with the protease-producing strain, CH-91, of Staphylococcus aureus of chicken origin. Dermatolysis was observed at the site of inoculation in them. Then the lesion outwardly healed up 5 to 6 weeks after the inoculation. When these recovered rabbits were reinoculated subcutaneously with the same number of viable cells as used in the first inoculation, none of them were affected with dermatolysis; that is, they had acquired a protective ability against an experimental challenge with viable cells. Antibodies against staphylococcal cells, alpha-hemolysin, and protease were detected in the serum of these rabbits 10 or 20 days after the first inoculation, but antibody against nuclease or beta-hemolysin was not. After the reinoculation, those antibodies showed a remarkable rise in most of the rabbits. These results suggest indirectly that the inoculated cells might have produced sufficient amounts of alpha-hemolysin and protease in the cutaneous tissue of rabbits. When rabbits were immunized with detoxicated culture supernatant of S. aureus strain CH-91, they exhibited antibody responses to alpha-hemolysin and protease mainly. Moreover, they were proved to have acquired a protective ability to an experimental challenge with viable cells when examined for the occurrence of dermatolysis as a marker of infection. On the contrary, when rabbits were immunized with killed cells, they presented a remarkable antibody response to staphylococcal cells. The immunized rabbits, however, acquired no protective ability.


Accumulating process and concentration ratios of ingested blood meals in larvae and nymphs of ten species of ticks.

The accumulating process and concentration ratios of ingested blood meals in the larvae and nymphs of Amblyomma testudinarium, Haemaphysalis campanulata, H. concinna, H. formosensis, H. hystricis, H. kitaokai, the bisexual and parthenogenetic strains of H. longicornis, H. megaspinosa, and Ixodes persulcatus on rabbits and Argas japonicus on chickens were comparatively investigated. The larvae and nymphs of the ixodid ticks examined and the larvae of A. japonicus concentrated the ingested blood meals up to about 3 times. In general, the larvae showed low concentration ratios due to their tendency to imbibe a certain proportion of non-blood components. The nymphs generally showed high concentration ratios. H. kitaokai belongs to the subgenus Alloceraea, the members of which are unique rapid feeders. It showed a high activity in concentrating ingested blood meal and presented the same general pattern of feeding as the other ixodid ticks which are very slow feeders.


Comparative observations on some bionomics of Japanese ixodid ticks under laboratory cultural conditions.

Seventeen species of Japanese ixodid ticks of the genera Amblyomma, Boophilus, Haemaphysalis, Ixodes, and Rhipicephalus were reared in the laboratory under almost the same cultural conditions. Their major biological characters, such as feeding, molting, oviposition, and hatching, were summarized in tables. There were some differences in these bionomics among the species. The general characteristics common to all the ticks, except Amblyomma testudinarium, were as follows. The feeding period in immature stages and adult females was 3 approximately 5 and 7 approximately 14 days, respectively. The engorged body weight in larvae, numphs, and females was 0.3 approximately 0.5, 3.5 approximately 5.0, and 100 approximately 300 mg, respectively. The potential sexuality could be estimated from the nymphal engorged weight in five species. The larval and nymphal molting periods at 25 degrees C were alike, or 10 approximately 20 days, and there were no significant sexual differences in nymphal molting period among six species. The body weight just after molting in nymphs, males, and females was 0.25 approximately 0.3, 1 approximately 2, and 2 approximately 3 mg, respectively. The pre-oviposition, oviposition, and egg-incubation periods at 25 degrees C were 4 approximately 10 days, 2 approximately 3 weeks, and 1 month, respectively.


Nomograms for obtaining a necessary, minimum sample size. II. When distribution of proportions from binomial data is approximately normal.

Two different nomograms corresponding to finite and infinite populations were devised to obtain a necessary, minimum sample size at a 95% confidence rate when the distribution of sample proportions calculated from binomial data was approximately normal. They could also be used for obtaining the 95% confidence limits of the population proportion from a sample proportion after having carried out a work.


[Evoked potentials of the somatosensory regions of the brains of healthy subjects].

Somatosensory evoked responses were recorded in 37 healthy adults, male and female, at the age of 18-53. These responses were polyphasic aperiodic and consisted of 7-9 waves. The early components of the response were more marked in monopolar recording. Differences in the fluctuation of the latent periods and amplitudes were found as dependent on the age. Ipsilateral responses contrary to the contralateral ones were more variable, had a less amplitude and frequency of appearance of separate components. The latent periods of ipsilateral responses were longer (3-7 ms) as compared to the contralateral ones.


[United neurons in the cat motor cortex].

Vertically oriented bundles of apical dendrites in the cat motor cortex are described by means of light and electron microscopy. Existence of desmoidal and dendro-dendritic contacts in the bundles is considered as the structural basis of neuronal electrotonic interaction within the limits of one column. Sliding axo-spinal contacts are described between the descending pyramidal axon in layer III and the pyramidal apical dentrite in layer V which, probably, serve for the purpose of regulating activity of the main cortical output elements.


[Effect of strychninization of the visual cortex on evoked activity in the rabbit lateral geniculate body].

Changes in responses of low-frequency and high-frequency LGB neurons were studied on anesthetized and paralyzed rabbits after strichninization of the visual cortex. It was found that in the group of low-frequency neurons the average discharge frequency of responses increased and latencies decreased indicating a dominance of corticofugal facilitation. On the contrary, in the group of high-frequency neurons the average discharge frequency of responses decreased and latencies increased. This suggests a dominance of corticofugal inhibition. The existence of reciprocal corticofugal influences on the neurons of different components of the visual pathways is assumed.


[Reticular inhibition of evoked potentials of the ventro-basal thalamus and somatosensory cortex of the rat brain].

In rats immobilized with d-tubocurarine conditioning electrical stimulation (100/s, 300 ms) of the central grey matter, reticular formation of the midbrain and medulla depressed focal potentials in thalamic ventro-basal complex and somatosensory cortex evoked by electrical stimulation of the forelimb or medial meniscus. The average threshold current for conditioning stimulation of these structures was 70, 100 and 120 muA. A comparison of intensity and duration of evoked potentials depression (for two-fold threshold stimulation of the brain stem) is failed to detect any difference between the stimulated structures: immediately after conditioning stimulation the amplitude of the cortical evoked potentials and post-synaptic components of the evoked potentials in the ventro-basal complex were 50-60% less than control amplitude (p less than 0.01) the depression persisting for 0.5-1 s. The presynaptic component of the thalamic evoked potentials was depressed only after three five-fold threshold conditioning stimulation. The brain stem stimulation did not cause any facilitatory effect on focal potentials evoked by maximal and submaximal stimulation of the forelimb or medial lemniscus.


[Properties of rhythmic discharge by cat motor cortex neurons evoked by a continuous current through their membranes].

The properties of rhythmic discharge of motor cortex neurons evoked by dc depolarizing current through the membrane were studied in acute experiments on immobilized cats. Linear relation between the rate of rhythmic discharge and the strength of current was revealed, the slope of this relation being 18-10.7 imp/s nA. Correlation between input resistance and the slope of the discharge frequency current curve was demonstrated. Two types of adaptation to current were observed: exponential and undamped oscillations. The relation of the latency of the first spike and first interspike interval to current was hyperbolic. The role of dendrites in the observed phenomena is discussed.


[Electrophysiologic analysis of the functional organization of cortico-cerebellar connections].

The influence of associative (orbital-anterior, parietal) and projective (auditory, sensomotor) cerebral cortex areas stimulation on activity of the Purkinje neurons of cerebellar cortex was studied in adult cats under chloralose-nembutal or nembutal anesthesia. These reactions were compared with the responses to peripheral stimuli. Definite similarity in responses of the Purkinje cells to different cortical (associative, projective) stimuli was found both for types of neurons and their responsiveness. In responses of the Purkinje cells to peripheral stimulation there was no sharp similarity as it was in responses to cortical stimuli. So, in cortical stimulation almost similar number of neurons (above 50%) was excited and in peripheral stimulation the responsiveness of neurons had marked difference: to electrical stimulation of skin there were 44.6%, to auditory 34.2%, to visual 18.8% of neuron responses.


[Electrotonic interaction of secondary neurons of the carp olfactory bulb].

Responses of the olfactory bulb secondary neurons provoked by olfactory tract electrical stimulation were studied in carp, using the intracellular recording technique. Spike responses in most neurons were identified as antidromic. Values of their latent periods ranged from 2.5 to 55 msec. In addition, two kinds of responses with a constant latent period were revealed: pseudoantidromic spikes and low-amplitude fast depolarizing potentials. It is supposed that both kinds of responses are generated by an antidromic spike of the neighbouring secondary neuron electrotonically coupled with the neuron recorded.


[Reaction of caudate nucleus neurons to direct stimulation].

Extracellular recording from the caudate nucleus neurons were performed in experiments on immobilized cats during electrical stimulation of different parts of the same nucleus. Latencies varied from 3.5 to 40 msec. Most neurons could be excited by stimulation of the most rostral part of the caudate nucleus head. In most cases responses were independent of the stimulation place. The responses consisted of one or rarely two spike followed by inhibition of background activity. Then activity gradually restored without rebound. Afterdischarges were not observed. The caudate neurons hardly reproduced stimulating frequencies more than 30 per second and retained in most cases their own frequency level (on the average 5-15 spikes/sec.). The results are discussed in connection with participation of the caudate nucleus in the origin of spindle activity.


[Electrophysiologic study of propagation of excitation in the cat pterygopalatine ganglion].

Action potentials were studied in nerves of the cat pterygopalatine ganglion evoked by stimuli applied to other nerves of the ganglion (in situ). It is established that most fibres passing through the ganglion are continuous sympathetic postganglionic fibres (not less than 3 groups). Most parasympathetic preganglionic fibres are synaptical on the ganglionic neurons and are represented by a group of fibres with the same threshold of excitation. Intracellular recording from single neurons of the pterygopalatine ganglion showed that stimulation of the Vidian nerve caused orthodromic spikes with short latency in one group of neurons and spikes with long latency in other neurons (2.5-6 ms and 10-40 ms respectively). Only fast fibres appear to terminate on most neurons of the ganglion, and only slow fibres do on some other neurons. Tonic activity was not observed when was performed from intact nerves of the pterygopalatine ganglion. The interacellular recording from single neurons of the ganglion showed that frequency of spike potentials either is low (1-3 per second) in some neurons or the potentials are absent in general in other neurons.


[Types of locomotion in Ophiuroidea].

Locomotor movements of two species of ophiura from the Sea of Japan: Ophiura sarsi vadicola Djakonov and Amphipholis kochii Lütken, were filmed. Ophiura sarsi moves by means of two symmetric pairs of arms which perform rhythmical rowing movements, the fifth arm is passive and directed backwards. Animals of this species do not use tube feet in locomotion. In Amphipholis kochii, three main modes of locomotor movements were found. (1) "Breast stroke" in which two symmetric side arms periodically move forwards, and then push forwards the body and three other arms. In this mode, one arm (leading) is directed forwards, while two others backwards. When the side arms move-forwards or backwards, a wave of successive flexions and extensions propagates along the arm segments. (2) "Pushing" by means of the hind arm and "pulling" with the help of the leading arm. (3) Locomotion by means of the tube feet which perform stepping movements. These three modes of locomotion are observed either separately or in various combinations with each other. In (1) and (2) modes of locomotion the tube feet perform also the coupling of the active arms with the ground which is necessary for the animal movement.


[Coordination of arm movement during locomotion in Ophiuroidea].

Ophiura Amphipholis kochii Lütken can move with any one of five arms directed forwards; therefore, each arm performs various functions during locomotion. The arm amputated together with the adjoining part of the central nervous ring is capable of complicated behaviour, particularly, of locomotion. Transection of the central nervous ring results in disturbances of the arms coordination. Experiments with amputation of a part of the arms showed that afferent signals from arms are important for determination of the leading arm and mode of locomotion. The experimental data suggest that each arm has an autonomous nervous centre, and coordinated activity of all arms is acheaved by an interaction of the nervous centres. The interaction results in function distribution among the arms and in synchronization of arm movements. The leading arm prevails, since the influences exerting by its centre determine activity of adjacent centres.


[Postactivation inhibition of processes in interneurons transmitting the activity of lateral "descending" systems].

After-discharge depression of excitability is found in the interneurons specialized on transmission of activities from "lateral" descending systems. Many of these cells are propriospinal units sending axons to the lateral funicle (LF). Anti- und orthodromic spike potentials in these cells are followed by significant hyperpolarization. In some cells post-activation depression increased with a rise in intensity of LF stimulation that evoked antidromic discharge; inhibitory post-synaptic potentials were recorded in several units after LF stimulation subthreshold for evoking such discharges. Existance of inhibitory synaptic connections between neurons of the investigated group similar to recurrent connections in the motoneuronal pools is supposed.


Immune response to rauscher virus-induced leukemia in DBA mice. I. Role of cellular and humoral immunity in spontaneous regression.

DBA/1 and DBA/2 mice infected with the Rauscher leukemia virus developed a biphasic erythroleukemia. Transitory regression of the disease was closely associated with the appearance of tumor-specific antibodies and the exacerbation was preceded by the gradual decrease of antibody titer. The antibody-dependent cellular cytotoxicity could be detected earlier, than the complement-dependent cytotoxicity. Moreover, in each case the titer of antibody-dependent cellular cytotoxicity was higher than that of complement-dependent cytotoxicity. The results suggest that the antibody-dependent cellular cytotoxicity is mainly responsible for the rejection of tumor cells.


Lung colony assay in normal, irradiated and tumor bearing mice.

Lung colony assay performed in normal, X-ray whole body irradiated and tumor bearing mice showed that both irradiated and tumor bearing animals developed much more lung metastases than normal animals.


Sacharose density gradient separation of Ehrlich ascites carcinoma and L-5178Y tumor cells in different cell cycle phases.

Optimal conditions were determined for the distribution of Ehrlich ascites carcinoma (EAC) and L-5178Y mouse tumor cells, proliferating in vivo, by their age within the cell cycle by sedimentation in a buffered linear sacharose density gradient. Measurements of cell size, DNA content and incorporation of tritiated thymidine in successive parts of the gradient confirmed the actual separation of cells of different age: in the upper fractions there were cells in G1 phase, in the middle fractions in S phase and in the lower layers of the gradient there were cells in G2 and/or M phase.


Excretion of Dische positive compounds in rats after irradiation and after administration of some cytostatic drugs.

In order to verify some pathophysiological aspects in radio- and chemotherapy of tumors the excretion of Dische positive compounds in rats was followed. During fractionated whole-body irradiation of animals it was found that up to the exposure with 50 R/day the organism is able to repair the disturbances provoked by irradiation for a certain time and that within the course of irradiation a permanently higher excretion of Dische positive compounds occurs. On the contrary, following the exposure of 100 R/day after a short increase continual decrease occurs lasting until the death of the animal. The excretion of Dische positive compounds in rats was followed also after the application of Cyclophosphamide, cis-dichlorodiammineplatinum (II) and Vinblastine. All these three cytostatic drugs produce an increased excretion of Dische positive compounds on the first day after the application. In the case of Cyclophosphamide, it was demonstrated that the excreted amount of Dische positive compounds was dose dependent.


Mechanism of development and morphology of secondary carcinomas of the oviducts in primary uterine corpus carcinoma.

The rate of incidence and morphology of metastases in 284 Fallopian tubes from 148 patients with primary uterine corpus cancer have been investigated. In 44 patients metastases were discovered in inner organs, of which in 17 (11.5% patients) in 23 oviducts. In 10 of these patients the Fallopian tubes were the only localization of metastases. Macroscopical alterations in the form of thickening and condensation, tumor nodules on the surface of the affected oviducts were discovered in 7 cases. In the remainder no macroscopical changes have been noted. There predominated lymphogenic metastases, in a smaller number of cases there were implantation and lymphogeno-implantation type metastases, localized mostly in the ampullary regions of the oviducts. More often, one could observe involvement by lymphogenic metastases of the subserosal layers together with muscular tissue, less frequently of mucosal layers, and total involvement of all layers of the wall of Fallopian tubes in the form of single or multicentric tumor nests, or diffuse tumor infiltration of tissues of the oviduct wall. Implantation metastases in the form of micronodules, multicellular agglomerates were discovered on the serosa more often than on the mucosa of Fallopian tubes. Secondary oviduct carcinomas differ from primary ones by their histological structure and character of growth. The Fallopian tubes play an essential role in the dissemination of metastases in the presence of primary uterine corpus carcinoma.


Hodgkin's lymphoma -- prognosis as related to histology, clinical stage and treatment.

The rapid advances in modern chemotherapy and actinotherapy of Hodgkin's lymphoma and an improvement in its diagnosis have ushered in numerous novel procedures. This is a preliminary analysis of the results of treatment of 117 patients with actinotherapy, polychemotherapy, consisting of a chemotherapeutic four-combination as substitution for MOPP and a combined actino-chemotherapy. Actinotherapy was found more efficient in localized disorders of stages I and II, while polychemotherapy proved the more suitable when the disease was generalized -- stages III and IV. The analysis of our results has brought only partial support to the prognostic significance of the histological classification of Hodgkin's lymphoma according to Rye. No difference of statistical significance has been noted between the histological types of lymphocyte dominance, nodular sclerosis and mixed cellularity. Lymphocyte depletion alone showed a conspicuously worse prognosis than the other histological types.


Cerebral vasospasm after brain injury.

Severe vasospasm of the supraclinoidal portion of the internal carotid artery and the proximal part of the anterior and middle cerebral arteries was displayed by cerebral angiography in a 45 year old female patient who had developed progressive disturbance of consciousness and marked meningism with extremely bloody lumbar CSF within a few days after craniocerebral trauma. Aneurysm could be excluded angiographically and operatively. One and a half weeks after evacuation of a subdural haematoma and an intracerebral contusional bleeding, when the patient was discharged without any neurological deficit, control angiography showed that angiospasm had disappeared. The scanty literature on cerebral vasospasm after brain trauma is reviewed. The role of traumatic angiospasm in prognosis and the necessity for broad indications for cerebral angiography in cases with brain contusion is emphasized.


[Ultrasonic doppler technique for microvascular bypass (author's transl)].

Following an operative microvascular extraintracranial bypass, 50 patients were re-examined by the ultrasonic Doppler technique. The findings were compared with the results achieved by post-operative angiography. This examination of the patency of extraintracranial anastomoses with the ultrasonic Doppler technique can be conducted on an outpatient basis, is noninvasive and can be frequently repeated. It has a high degree of accuracy (96%). In addition, there were indications that, in certain areas, a gauge could be established for the function of the anastomosis by comparing the amplitude indices from the bypass and the afferent vessels. Key-words: Ultrasonic Doppler technique - microvascular bypass - cerebral blood flow - cerebrovascular disorders


[False negative myelography in surgically confirmed lumbar intervertebral disk prolapse].

A consecutive series of 821 lumbar myelograms in patients operated on for prolapsed disks were analysed. 47 or 5-7% had to be listed false-negative in spite of excellent technical quality. To find out, whether anatomical variations or a special functional state of the subarachnoid space could have prevented a correct diagnosis, clinical symptoms and some special radiological parameters were examined and statistically evaluated: 1. Distances between peduncles of L4, L5, S1 2. Width of subarachnoid space in a coronal section of L4, L5, S1 3. Width of subarachnoid space in a sagittal section of L5 4. Distance between the posterior limit of the body of L5 and the anterior limit of the subarachnoid space. Measurement and statistical correlations did not reveal any correlation between false-negative myelograms and any of the anatomical variants measured. We still cannot rule out false-negative myelograms.


Lumbar spondylosis and narrow spinal canal.

Thirty four cases of spondylosis and narrow spinal canal were analysed and the possible mechanism of the syndrome of the narrow canal discussed. In spondylotic cases early operation is advisable.


Congenital intracerebral epithelial cysts.

The problem of intracerebral congenital epithelial cysts is discussed with reference to five clinical cases. On the basis of their morphological structure the author differentiates the intracerebral cyst with a ciliated, columnar epithelium from the ependymal cyst proper (more frequently located in the lateral recess of the medulla oblongata) and the posterior cerebellar cyst of meningeal arachnoid origin. The cyst with a ciliated columnar epithelium appears to be an ectopic intracerebral tissue, whose neuroepithelial or endodermic origin still remains to be demonstrated. This cyst has been commonly described as a colloid (epithelial) cyst of the 3rd ventricle but may also be localized at other points in the central nervous system. One of the cases studied was an epithelial cyst in the frontal lobe, without any connexion with the ventricle, and evolving as a cerebral tumour.


The tolosa-hunt syndrome: report of two cases.

The Tolosa-Hunt Syndrome consists of intermittent painful ophthalmoplegia resulting from a non-specific inflammatory process in the cavernous sinus and superior orbital fissure, which responds to steroid therapy. We report two additional cases to the literature of the Tolosa-Hunt Syndrome and we are interested in pointing out the importance of orbital venography in the diagnosis of this syndrome. Orbital venography demonstrates the partial occupation of the cavernous sinus and the lack of visualization of the 3rd segment of the superior ophthalmic vein.


A case of persistent hypoglossal artery.

A personal case of persistent hypoglossal artery is presented and the literature on the subject from 1967 to the present reviewed. The 16 cases collected, following on the 26 already reported in the well-known monograph of T.A. Lie on congenital anomalies of the carotid arteries, complete the statistical picture of this malformation. After discussing the embryonic origin and describing the radiological anatomy of the anomaly, the authors briefly present their case and discuss, in the light of the cases collected, the possible role of persistent hypoglossal artery in the pathogenesis of vascular diseases of the head.


[Diagnostic value of cerebrospinal fluid oxyhemoglobin and bilirubin determination in cerebrovascular diseases].

The levels of oxyhaemoglobin and bilirubin were determined in the cerebrospinal fluid in 46 cases of subarachnoideal haemorrhage and cerebromeningeal haemorrhage, 18 cases of haemorrhagic infarction. Autopsy confirmation was available in 18 cases of haemorrhages and 18 cases of infarction. Determination of oxyhaemoglobin and bilirubin levels in the cerebrospinal fluid is not sufficient as a reliable basis for differentiating between cerebral haemorrhage and haemorrhagic infarction. High values of oxyhaemoglobin and bilirubin seem to indicate bleeding into the cerebrospinal fluid spaces. Assessment of oxyhaemoglobin level and cerebrospinal fluid sediment suggests in some cases the diagnosis.


[Disappearance of blood from cerebrospinal fluid following subarachnoidal hemorrhage (preliminary note)].

On the basis of cerebrospinal fluid investigations in 17 patients with subarachnoideal haemorrhage admitted to the hospital in the time period from Nov. 1 1973 to March 15 1975 the authors observed that the blood disappears from the fluid usually 8 days after the onset and they suggest that control lumbar tap and angiography should be performed at that time for possible referral of patients for surgical treatment. From the 8th day on there is no need of administration of drugs increasing blood clotting.


[Results of short and long-term treatment of parkinsonism with L-dopa].

The results of substitutive treatment of Parkinson's disease with L-dopa were assessed using a special chart for periodical examinations. This chart contains, among others, a 100-point scoring scale of parkinsonian disability which makes possible objective comparison of the condition of patients after various duration of treatment. The obtained results were compared according to age, sex, duration of disease, results of previous anticholinergic treatment. Ophthalmological examinations were carried out determining the width and reactions of pupils, accomodation and intraocular tension as well as side effects. The results of scoring demonstrated a high therapeutic effectiveness of L-dopa, lack of significant ophthalmological abnormalities and mild degree of side effects due to peripheral and autonomic-system reactions to L-dopa.


[Effect of diphynylhydantoin on the histological appearance of internal organs in cat (preliminary study)].

The effects of DPH on internal organs of cats were investigated. The drug (Hydantoinal POLFA) was administered orally in doses 8 to 20 mg/kg daily during from 27 to 560 days. The initial dose was 1.5 mg/kg and it was increased gradually. Consistently occurring changes were found in the liver, kidneys, salivary glands and spleen. In the liver and kidneys the character of changes was mainly degenerative (fatty infiltration of hepatocytes and renal tubular epithelial cells). In the salivary gland the number of mucus-producing cells was increased, in the spleen proliferation of connective tissue and congestion were present.


[Nervous system diseases in workers of a large metallurgic plant].

Epidemiological investigations were carried out in an industrial plant in a population of about 16 000 people. The overall morbidity was 1 241.8 cases of nervous system diseases per 100 000 of population and the annual prevalence of neurological diseases was 473.7 per 100 000. The most frequent disease was sciatic pain, followed in order of frequency by epilepsy, vasomotor headaches, subjective symptoms after craniocerebral trauma, Parkinson's disease, clinically evident cerebral atherosclerosis and disseminated sclerosis. No significant effect of the type of occupation on the development of nervous system diseases was observed.


[Cerebrospinal fluid lactates following craniocerebral injuries].

CSF lactate concentration was determined in 37 patients after craniocerebral injury. In 26 cases the lactate concentration was raised above the normal value (15 mg/100 ml) and in 11 cases it was above 30 mg/100 ml. All fatal cases were in the group with lactate level above 30 mg/100 ml. The study confirms the fact that CSF lactate concentration is related to the severity of cerebral tissue damage and has a prognostic significance.


[Statistical correlation between lactate concentration and acid-base equilibrium in cases of brain tumors, craniocerebral injuries and meningitis].

Statistical significance of correlations between lactate concentration and pH value as well as pCO2 in the cerebrospinal fluid was assessed in patients with brain tumours, craniocerebral injury and meningitis. After calculation of correlation indices it was found that with increasing lactate level the correlation between this level and the pH and pCO2 of the cerebrospinal fluid increases. Correlation coefficients were far from their maximal values (+1 or -1) which indicates absence of a direct cause-and-effect relationship between lactate concentration and both remaining values. The analysis of results in the group with lactate level exceeding 30 mg/100 ml demonstrated lowest correlation coefficients between these values in patients with meningoencephalitis.


[Traumatic arteriovenous fistula of the middle meningeal artery closed spontaneously].

The authors describe a case of traumatic arteriovenous fistula developing between the branches of the middle meningeal artery and the meningeal and intraosseous veins. The fistula closed spontaneously.


[Subdural empyema as a complication of maxillary sinusitis (description of 3 cases)].

The authors report 3 cases of subdural empyema with different course and outcome. In all of them subdural empyema developed as a complication of chronic maxillary sinusitis. In the first case a coexistent brain abscess was the cause of death. In the second case operation carried out when the patient was in extremely severe condition failed to prevent death since the diagnosis had been made too late. Complete recovery was obtained in the third case owing to early clinical diagnosis confirmed with angiography, followed by early surgical treatment of the primary focus and early craniotomy. The importance of early diagnosis is stressed and the methods of surgical treatment are discussed.


[Case of Hakim's syndrome].

The authors report a case of Hakim's syndrome developing in a 53-year-old man. Manifestations of parkinsonian syndrome prevailed. After implantation of a Pudenz-type valve significant improvement was obtained which confirms the clinical diagnosis.


[Differential diagnosis of the level of traumatic damage of cervical spinal nerves and brachial plexus].

In 80 patients with paresis or paralysis of the upper extremity due to injury to the brachial plexus or cervical roots, EMG with muscular test, skin thermometry and radiculography were done. The comparison of EMG investigations and Lovett's test with the diagram of segmental and peripheral innervation gave only an approximate determination of the level and extent of injury. Skin thermometry demonstrated vasomotór disturbances in 330 patients. Vasodilating activity was present, in the first place, in patients with complete paralysis of the extremity. These cases showed no significant improvement after rehabilitation management. Radiculography permitted to determine exactly the number of damaged spinal nerve pouches and this damage was found in 16 out of 18 patients. The character and location of pain in the upper extremity were without any significant diagnostic value in relation to the site and degree of injury.


[Combined surgical and physical treatment in traumatic painful syndromes of the cervical spine].

Clinical observations suggest the need for changing therapeutic management to a more active one in cases of cervical spine injury with damage to the spinal cord and nerve roots or brachial plexus. In 248 patients with these injuries treated initially conservatively the incidence of cervicobrachial pain was analysed. Neuralgic pains were present in 31.5% of cases, causalgic pains in 2.4% and sympathalgic pains in 2%. Conservative treatment conducted in these patients (89 cases) during many months after trauma had no effect on return of mobility. Long-term application of physioterapy prevented only temporarily the development of trophic changes and only partially relieved pains. Only surgical decompression of the spinal cord or spinal nerves with stabilization of damaged vertebrae caused disappearance of painful syndromes and improvement in the motor activity of the extremities. These observations show that early surgical intervention for decompression of the spinal cord, roots or brachial plexus should be advocated in these cases.


[Pathomechanism of pain in vertebral column diseases].

The pathological mechanism of pain in vertebral column diseases is discussed in accordance with the theory of Melzack and Wall taking into account both systems of pain sensation control at the spinal level and reticular formation level. The action of pain mediators is discussed as well. The main pathogenetic factors are: compression, stretching and ischaemia. Other factors, functioning particularly at the cervical spine level are, most frequently, developmental anomalies in the occipito-cervical area and faulty posture assumed during occupational work, as well as injuries which may be remote in time and forgotten. Elimination of pain perception may be obtained with surgical methods or by physicochemical means blocking the conduction of pain impulses.


[Combined pharmacological and traction treatment in cases of painful syndromes of the cervical spine with degenerative and deformative changes].

In a group of 35 patients with cervical painful syndromes due to degenerative changes the authors applied traction treatment together with pharmacological agents. The patients were chosen because of long-standing symptoms, frequent recurrences or poor therapeutic effects. Using Glisson's loop for traction applied to the cervical spine the authors obtained good results, i.e. shortening of the treatment time, and prolongation of improvement. The most frequent complication of this method was vertigo.


[Spa treatment of shoulder pains at Swieradów].

The authors present the results of spa treatment of painful shoulder in 50 patients. The mean age of patients was 47 years. Radon baths and peat poultices were given to all, most patients had also massage and therapeutic exercises. In 38 cases improvement was obtained, in 6 cases pains decreased, in another 6 cases no improvement was achieved. The authors recommend possibly early balneological treatment in this syndrome.


[Traction and kinesitherapy in the management of painful syndromes of the cervical spine].

Painful cervical spine syndromes caused by discopathy become ever more frequent. Conservative treatment of cervical discopathy includes mainly traction, kinesitherapy, thermotherapy, massage and electrotherapy. Traction treatment and kinesitherapy are particularly important. The author carried out investigations in 90 cases of cervical discopathy divided into 3 groups of 30 cases in each. In each group cervical traction was applied using Glisson's loop at different traction force and duration of traction. It was observed that three factors were of decisive importance for the end-result of traction: a) a proper position of the patient during the procedure and a proper direction of traction force, b) a proper duration of traction, c) a properly selected weight. Electromyography demonstrated bioelectric activity in the trapezius muscle and deltoid muscle on the affected side before treatment. After application of traction the bioelectric activity of these muscles was significantly reduced at rest. It is concluded that cervical traction and kinesitherapy are effective methods in treatment of cerival spinal painful syndromes.


[Spa treatment of sciatic pains at Swieradów].

The authors report therapeutic results obtained in 190 patients with sciatic pains (110 men and 80 women). In 115 cases discopathy was the cause of sciatica, in 75 degenerative vertebral disease was present. The duration of the disease ranged from 6 months to 36 years. Four sets of procedures were used depending on the manifestations of the disease. In evaluation of therapeutic effects the mobility range of the spine, the tone of paravertebral muscles and disappearance of pain were taken into account. Complete improvement was obtained in 76% of cases on the average. It was observed that radon baths had mainly an analgesic effect, peat or paraffin poultices as well as diadynamics were particularly useful in cases with increased tonus of paravertebral muscles. Massage was contraindicated in these cases. Therapeutic exercises were useful in this disease, increasing significantly the mobility range of the spine.


Human spinal arachnoid villi and granulations.

Human spinal arachnoid villi and granulations were studied after distension by a subarachnoid perfusion of Berlin blue and trypan blue. These proliferations were distributed on almost every nerve root in the thoracic and lumbar region. Human spinal arachnoid villi and granulations were divided into those located entirely internal to the dura, those that extended into the dura, and those that penetrated the dura completely. Venous sinuses were closely related to most arachnoid proliferations.


Embolization of cerebral angiomas by catheterization of cortical arteries.

A method of combined direct embolization of submillimetric cortical arteries, after preoperative arteriography, is described and 3 cases of cerebral angiomas presented with striking symptomatic improvement after embolization. Postoperative angiography in one case showed considerable diminution in the size of the angioma.


Radioisotope choroid plexography. A preliminary report.

Radioisotope plexography seems as easy and innocuous as routine brain scanning. An introductory method is given which could be improved. The choroid plexuses of the four ventricles were well visualized in 15 patients. Consideration is given to the possible labeling process. Besides its morphological value, the test could give interesting clues in the dynamic study of hydrocephalus.


Neurological manifestations of rhabdomyosarcomas in the head and neck in childhood. Neuroradiological study.

Two cases of rhabdomyosarcoma in the head and neck with neurological manifestations are presented. Brain scan demonstrated an apparent area of increased uptake of 99mTc in the tumor. Cerebral angiography revealed a sharply demarcated but rather faint tumor stain. The contributing vessels were hypertrophied branches of the external carotid artery, a dural branch of the internal carotid artery, and branches of the vetebrobasilar systes emphasized because the recent combination of chemotherapy in conjuction with surgery and irradiation seems to be encouraging.


Application of xeroradiography for pneumencephalography.

The feasibility of xerotomography with pneumencephalography is demonstrated. One of the advantages of a xerotomogram is that it reduces the lack of sharpness caused by tomography. The wide recording latitude of a xerotomogram makes a more detailed evaluation of the bone structure and the outlines of the soft tissue possible when these are contrasted be means of air. The characteristic edge effect of a xerogram also facilitates better detection of the small structures which are less well discerible on a film tomogram.


The third ventricle. Normal anatomy and changes in some pathological conditions.

An anatomical study of the normal anterior inferior part and the floor of the third ventricle has been made and its radiological appearance shown. Specimens and casts were analyzed and correlated with ventriculograms using watersoluble contrast media. The detailed appearance of the optic recess and sulcus of Monro, which has not been well described in the neuroradiological literature, is illustrated and detailed. The changes in the optic recess in hydrocephalus are discussed. Deformities of the different segments of the floor as a result of tumors of the posterior fossa and hydrocephalus are shown.


Aqueductal stenosis and hydrocephalus: rare sequelae of mumps virus infections.

A case of a rare acquired form of aqueductal stenosis and hydrocephalus developing as a late sequela of mumps virus infection of the central nervous system is presented. The experimental studies of mumps induced aqueductal stenosis in hamsters and mice and the four previously reported cases in the literature are reviewed.


Spinal cord angiomas diagnosed by gas myelography.

Three cases with spinal cord arteriovenous malformations are reported with characteristic changes evident on gas myelography. The malformations were confirmed by selective spinal angiography in all cases and surgically removed in 2 of the cases.


Unilateral endocrine exophthalmos. Diagnostic problems in association with computed tomography.

Swollen orbital extraocular muscles may mimic an orbital apex tumor on computed tomography. In five of our patients, in spite of highly suggestive findings on CT scanning, indicating the presence of an orbital apex lesion, the correct diagnosis proved to be endocrine exophthalmos. The value of complementary CT projections and of orbital ultrasonography to assist in the differential diagnosis is discussed, and the additional contribution of orbital phlebography for the confirmation of lesions in the orbital apex is emphasized.


Widening of the cervical intervertebral foramen.

Case reports of seven patients in whom unusual abnormalities caused widening of the cervical intervertebral foramen are presented. Plain roentgenographic and tomographic changes may be quite distinctive, especially in a patient with an absent pedicle or a tortuous vertebral artery. However, angiography has proved to be a useful adjunct to determine the etiology in many of these lesions.


Computer tomography of the cerebrum in multiple sclerosis.

One hundred and ten patients with multiple sclerosis (MS) were examinated with computer tomography (CT) of the brain with the 160 X 160 matrix EMI scanner. Eighty-two areas of low X-ray attenuation around the ventricular system were found in 40 cases (36%), particularly adjacent to the anterior and posterior horns and trigones. These brain volumes with low attenuation are considered to represent the well known large periventricular plaques of MS. The mean plaque volume was 1.26 cm3 and mean attenuation value 9.5 EMI units, which was more than 5 units lower than that of the surrounding brain tissue. Contrast enhancement provided no further information. Periventricular plaques were concomitant to ventricular enlargement and cortical atrophy. By comparison with normal values 49 cases (45%) with atrophy and no plaques were found, while only 20 MS patients (18%) had normal EMI scans. There was no difference between duration of disease and age at onset in the three different groups of MS cases.


The DES story.

During the last 6 years, there has been a marked increase in the incidence of vaginal and cervical clear cell adenocarcinomas occurring in young females. A relationship between maternal ingestion of synthetic estrogens occurs in about 75% of these cases. DES was used in a variety of pregnancy complications between 1940 and 1970 with the peak years being 1945 through 1960. There is no explanation for the increased number of cases occurring in patients whose mothers did not ingest synthetic estrogens. The number of women who took these drugs during pregnancy and their at-risk daughters is unknown. Vaginal adenosis is an associated finding in about 90% of the vaginal and 30% of the cervical adenocarcinomas. The reported incidence of adenosis in DES-exposed offspring varies from 30 to 90%. Gross cervicovaginal abnormalities occur in about 20% of the exposed patients. The relationship between adenosis and clear cell adenocarcinoma is not clear; however, many investigators feel adenosis is a precursor. Both adenosis and the clear cell tumors are of Müllerian origin, and it appears that any dose of synthetic estrogens ingested prior to the 18th week of pregnancy alters the normal embryogenesis of the vagina.


Cytology of 575 young women with prenatal exposure to diethylstilbestrol.

The vaginal and cervical cellular changes encountered in 575 postpubertal females exposed prenatally to diethylstilbestrol (DES) were compared with those of an unexposed population with particular reference to the role of cytology in the detection of vaginal adenosis and cervical ectropion (erosion). Several methods of obtaining specimens were utilized, the most effcacious of which was scraping of the vagina, especially the fornices, and the portio vaginalis of the cervix. With this technic, columnar cells of the mucinous type and metaplastic squamous cells were observed in 34% of the vaginal scrapes and 54% of the scrapes of the cervical portio. A higher incidence was apparent among those patients in whom iodine staining of the vaginal mucosa was abnormal or vaginal adenosis was proven by biopsy. Moderate to severe dysplasia of the squamous cells or atypical glandular cells were found in 1% of the exposed subjects. This study indicates that the presence of mucinous columnar or metaplastic squamous cells in vaginal scrapes is suggestive of vaginal adenosis but that vaginal cytology cannot be considered a uniformly reliable screening technic for detecting the presence of this disorder.


The use of prophylactic partial exchange tranfusion in pregnancies associated with sickle cell hemoglobinopathies.

Sickle cell anemia is associated with an alarming attrition rate during pregnancy. The maternal morbidity rate, perinatal wastage rate, and the incidence of severe morbidity in both mother and child are elevated above acceptable limits. In most cases, these statistics have been compiled using conservative therapeutic modalities. In contrast, this report utilizes prophylactic partial exchange transfusion therapy in patients with severe sickle cell hemoglobinopathies. The protocol involves the introduction of 750-1000 cc of buffy coat, poor washed red cells exchanged with 1000-1500 cc whole blood during phlebotomy at 28 weeks' gestation and again prior to term. Thirty-six consecutive pregnant patients with sickle cell anemia have been managed in this fashion. The one maternal mortality occurred in a patient who did not complete the protocol. Major maternal morbidity and perinatal wastage rates were significantly decreased. Two cases of serum hepatitis occurred. It appears from these data that the use of prophylactic partial exchange transfusion in pregnant patients with severe sickle cell hemoglobinopathies can be of benefit. Further trials of this method seem justified by these results to assess completely the benefit-risk ratio of this procedure.


Vasopressin response and terbutaline inhibition of the uterus.

A study of the effects of 8-lysine vasopressin (LVP) and its long-acting analogue N-a-triglycyl-8-lysine vasopressin (TGVP) on the myometrium and vasculature of the normal human nonpregnant uterus was undertaken. The results suggest that the vasopressins decrease local endometrial blood flow both directly by effects on the uterine vascular bed, and indirectly by increasing myometrial activity. The effects in vivo can be effectively counteracted by beta2 receptor stimulation.


Enterovaginal and enterocutaneous fistulae in women with gynecologic malignancies.

From 1957 to 1975, 43 women with gynecologic malignancies had associated enterocutaneous or enterovaginal fistula. Thirty-four of these women underwent surgical correction of the fistula. The etiology, diagnostic evaluation, preoperative complications, and surgical correction of such fistulae are discussed. In addition, a staged planned management of these fistulae is outlined.