Primary hyperparathyroidism in Black South Africans.

Despite the presence of stimuli to parathyroid activity, such as low dietary intake of calcium and low serum calcium levels, primary hyperparathyroidism is extremely uncommon in the indigenous population of Africa south of the Sahara. We report the occurrence of primary hyperparathyroidism in 3 black patients, all of whom presented with gross bone disease, high serum calcium levels, short histories of hyperparathyroidism and large parathyroid tumours. The clinical manifestations of hyperparathyroidism in these patients are probably due to the rapid rate of tumour growth and high level of hormone production.


Total electrical alternans in a patient with tuberculous pericarditis.

Total electrical alternans is an uncommon electrocardiographic abnormality in which alternation in the direction and/or amplitude of all the components (P, QRS and T) of the tracing is present. The phenomenon is seen only in association with occasional cases of pericaditis with large effusion's. Knowledge of this fact may help in the often difficult differentiation between a pericardial effusion and cardiomyopathy. An illustrative case report is presented, with a résumé of the mechanisms postulated to explain total electrical alternans.


Some problems in the hospital management of criminal mental patients.

In view of impending new legislation in Rhodesia, a survey of 256 criminal mental patients admitted to Ingutsheni Hospital was undertaken. These patients were all treated by the author and were admitted during the 5-year period 1 January 1970-31 December 1974. Among these patients there were 113 schizophrenics (44%) and 57 epileptics (22%); these proportions are not significantly different from those previously found among civil patients. The outcome was that 86 patients (33, 6%) were discharged to stand trial, 107 (41, 8%) were discharged in terms of a recommendation by the Mental Hospital Board and 57 (22, 3%) were returned to prison. Recommendations are made for the provision of a new forensic psychiatric unit, and some of its functions are discussed.


The clinical assessment of ageing and problems of diagnosis in the elderly.

The elderly patient presents special problems to the clinician. Accurate diagnosis in the elderly requires an understanding of the interrelationship between mental and physical illness, the altered physiology of the aged and the realisation that multiple pathology is the rule rather than the exception. The onset of illness is frequently insidious and the presentation often atypical.


The doctor's problems.

A problem is defined and its purpose is described. The doctor's personality is analysed in its various aspects, and the patient and his complaints are dealt with. Their relationship reveals their respective needs and the scheme presented is an attempt to find a satisfactory solution to the multiple problems of human existence.


[Pancytopenia and aplastic anemia: a retrospective study].

During January 1971--June 1975 we examined 195 patients with pancytopenia. The cause was bone marrow failure in 67.7% of cases (classic aplastic anaemia in 11.3%) hypersplenism in 7.7%, massive blood transfusions in 1.5%, severe infections in 9.7% (Gram-negative in 3%), and various other conditions in 7.8%. Records were insufficient for diagnosis in 5.6% of cases. Analysis of the 22 patients with aplastic anaemia showed no apparent aetiology in 16 (72.7%), previous phenylbutazone ingestion in 2, and Fanconi-type anaemia in 4 of 7 children. One-year survival was 73.7%, 2-year survival 71.4%, 3-year survival 63.6% and 4-year survival 57.1%. Marrow-investigation of the 21 available samples showed that 6 were acellular, 11 hypocellular and 4 normocellular. All patients received at least temporary therapy with anabolic steroids but its effectivity could not be satisfactorily assessed. Five patients died within 7 months and 5 patients went into remission, needing no further therapy. The initial haematological features of the 5 patients who died were not significantly different from those of the rest of the patients.


The Peutz-Jeghers syndrome: a report of 3 cases.

Three cases of the Peutz-Jeghers syndrome are reported and the literature is reviewed. The difficulties in the management of these patients are described and the importance of radiology and endoscopy is emphasised.


Treatment of frigidity in general practice.

The commonest causes of female sexual frigidity in general practice are outlined. Thirty-four couples were interviewed, and an approach to female frigidity is explained, which can be used by the general practitioner.


A review of colonoscopy in 200 patients.

During the examination of the colon by fibre-optic colonoscopy in 200 consecutive patients it was possible to reach the caecum or suspected lesion in 80% of cases. Careful bowel preparation, sedation and detailed attention to techniques described are necessary for safe and successful performance of this procedure. In 85% of examinations, colonoscopy produced positive results including the definition of uncertain radiological lesions in 45 patients, finding of a cause for rectal bleeding not shown on barium studies in 15 patients, the assessment of inflammatory bowel disease in 28 patients, and the removal of polyps in 40 patients. Important was the finding of a normal colon in 49 cases, which obviated unnecessary surgery. Colonic perforation occurred in 2 patients. The limitations and complications of the procedure must be realised, but it is concluded that the colonoscope provides a valuable and effective means of diagnosis and therapy of lesions in the large bowel.


Buccal administration of fenoterol aerosol in young children with asthma.

A new technique for the administration of a bronchodilator aerosol, fenoterol, in young children with asthma is described. Rapid and effective bronchodilatation can be obtained in many patients simply by directing the jet of the bronchodilator aerosol onto the buccal mucosa. This method will frequently obviate the need for painful or potentially dangerous injections of adrenaline or aminophylline as a first-line treatment in children with acute attacks of asthma.


A necropsy study of diabetes mellitus in natal blacks.

During a period of 10 years (1965 - 1974) necropsies on 126 Black diabetic patients were performed at King Edward VIII Hospital, Durban. Metabolic factors accounted for 39% of deaths and infection for 34% of all deaths in diabetes mellitus. Sixty-two per cent of the patients who died were below the age of 55 years. These findings are similar to those pertaining in the pre-insulin era.


Combined liver-lung gamma imaging in subphrenic abscess.

Combined scintigraphy of the lung and liver provides a sensitive, simple and non-invasive method of evaluating the subphrenic space. Since the surgical approach is different in subphrenic, subhepatic and intrahepatic abscesses, accurate localisation and recognition of single or multiple abscesses provides the basis for an operative approach which may avoid unnecessary violation and contamination of the peritoneal cavity. The importance of correlation of the scintiscans with companion roentgenograms of the abdomen and chest, and accurate localisation of the diaphragm using serial scanning, is emphasised. Negative good-quality scans reliably rule out subphrenic abscess.


Lead encephalopathy: case reports.

Six cases of lead encephalopathy in Black children are described. There was a delay in the diagnosis of the first 4 cases, partly owing to a lack of awareness of the possibility of exposure to lead in this population. The importance of the safe disposal of industrial wastes is stressed.


Pseudopneumoperitoneum: a case report.

A case of post-traumatic pseudocyst of the pancreas is presented. The elevated and compressed stomach showed an appearance on X-ray film which might be interpreted as free peritoneal air. The term pseudopneumoperitoneum is defined and other causes of this condition are mentioned.


Dilation of the upper urinary tract in pregnancy: a case report.

A case is presented in which the upper moiety of the pelvicalyceal system and ureter in unilateral duplication was spared the dilatation which affected the lower moiety and opposite upper urinary tract during pregnancy.


Computerised axial tomography of the head.

The technique and applicaton of computerised axial tomography of the head is briefly reviewed with regard to both normal and some pathological tomographic features.


Cranial and intracranial tuberculosis.

The radiographic appearances of cranial and intracranial tuberculous lesions are reviewed. The manifestations of cranial and intracranial tuberculosis vary according to the location, severity of involvement and the chronicity of the disease.


Syringomyelia secondary to paraplegia due to fractures of the thoracic spine.

The clinical, radiological and operative findings in 3 patients with paraplegia consequent upon fractures of the thoracic spine are presented. Myelography revealed widening of the cervical spinal cord in all 3 patients and this finding was confirmed at operation. The incidence of this condition in the Spinal Injuries Unit is shown to be similar to that noted in other large units. The principal theories as to the aetiology of this condition, i.e. cavitation secondary to haematomyelia or myelomalacia caused by circulatory disorders, are reviewed.


Microsurgical removal of acoustic neuromas.

This article reviews the selection and use of instruments for the microsurgical removal of acoustic neuromas by the suboccipital-transmeatal approach. The accurate use of carefully selected instruments for perineural dissection when combined with the use of the operating microscope can lead to frequent preservation of the facial nerve and occasional retention of hearing.


A technique for early Pantopaque myelography in cervical spinal cord injuries.

A simple, reliable method for early Pantopaque myelography in patients with traumatic injuries of the cervical spinal cord is presented. Myelography is accomplished with the patient prone on a Stryker frame after vertebral reduction and alignment have been achieved with axial skeletal traction. A lateral C1-2 spinal puncture and a portable ""C-arm'' image intensifier with televised fluoroscopy are used. There have been no complications and no occurrences of vertebral re-dislocation with this technique.


Reversal of experimental cerebral vasospasm by intravenous nitroprusside therapy.

Cerebral vasospasm was induced in dogs by intracisternal injection of blood. After angiographic demonstration of spasm, sodium nitroprusside was infused intravenously and its effect on the diameter of the basilar artery was studied angiographically. Ten experiments were performed within 90 minutes of the induction of spasm and nine experiments were performed 24 or 48 hours later. Significant dilatation of the basilar artery was achieved in all cases and it persisted for as long as the infusion of nitroprusside continued. The drug produced a modest degree of systemic hypotension. In six experiments it was possible to avoid hypotension by a simultaneous infusion of dopamine.


Giant aneurysm of the middle cerebral artery.

A case of a giant aneurysm of the middle cerebral artery, (4.5 X 4.5 X 9.5 CM) presenting as a mass lesion, which was successfully excised is described. This case is compared to the few previous accounts of giant aneurysms of the middle cerebral artery larger than 3 cm in diameter.


The value of sequential scanning in the detection of metastatic tumors.

The usefulness of sequential scanning, three and 24 hours after injection of 197Hg chlormerodrin in the detection of metastatic tumors of the brain has been demonstrated. The 24-hour scan was positive in 29% of the cases in which a metastatic lesion was suspected although the three-hour scan was negative, and the 24-hour scan also revealed additional masses in another 20%. The delayed scan helped to demarcate the actual location of the lesion in 24% of the cases in which the three-hour scan was graded merely suspicious. It is concluded that the addition of a 24-hour scan strongly reinforces the statistical accuracy of the 197Hg brain scan, and thus is of practical clinical importance.


Treatment of experimental spinal cord injury in ferrets.

A variety of treatment modalities upon a compressive model of spinal cord injury in ferrets was tested. Several of the treatments seemed to increase the degree of anatomical and/or functional sparing, but only dexamethasone did so in a statistically significant manner.


The management of intracranial calcified subdural hematomas.

Calcified subdural hematomas are associated with signs and symptoms similar to those of chronic, uncalcified subdural hematomas. Those found incidentally or in patients with long-standing nonprogressive neurological deficits should be left alone. If a calcified subdural hematoma is discovered in the evaluation of a patient with an acute or a progressing neurological disorder, an operation should be considered.


""Non-communicating'' syringomyelia: a non-existent entity.

Encroachment by man's overlarge forebrain is responsible for the anatomic substrate of syringomyelia, i.e. a hindbrain hernia developing in fetal life with persisting hydromyelia. Communication between the syrinx and 4th ventricle is readily disclosed at operation, but because of postmortem shrinkage, almost never at autopsy. Syringomyelia developing in 16 of 864 post-traumatic paraplegics has been classified non-communicating. However, the syrinx, its fluid, and the ultimate clinical picture are the same as in the non-traumatic, and surgical exposure has disclosed the communication. The symptoms develop because the traumatic subarachnoid block exaggerates the causative intracranial fluid pulse waves by eliminating the dampling effect of the yielding dural sac below. A non-traumatic spinal block also may result in syringomyelia.


Ischemic colitis incidence following abdominal aortic reconstruction: a prospective study.

With few exceptions, the incidence of left colon ischemia following abdominal aortic reconstruction has been reported to be one to 2 percent. All reports of such ischemic events are retrospective analyses of clinically manifest or autopsy. Fifty patients were studied prospectively to determine more accurately the incidence of this complication. Aortic reconstruction was performed in 23 patients for occlusive disease (OD) and in 27 for aneurysm disease (AD). No emergency operations were performed. All patients underwent colonoscopy within 4 days of operation. Three instances of colon ischemia were noted, an incidence of 6 percent (OD 4.3 percent, AD 7.4 percent). Each patient recovered uneventfully. Two patients had diarrhea, but only after colon ischemia was recognized. Arteriographic opacification of the inferior mesenteric artery by the superior mesenteric artery collateral (meandering mesenteric artery) was documented in 35 percent of patients with OD and in 27 percent of patients with AD. Colon ischemia did not develop when this collateral was identified. The inferior mesenteric artery was patent at the aorta in all who developed colon ischema. Although clinically significant colitis following aortic reconstruction is rare, colonoscopy after operation may prove to be valuable for early recognition of ischemic changes before clinical manifestations preclude effective management.


Radiation injuries to the bowel associated with the treatment of carcinoma of the cervix.

Advances in radiation techniques and increased dosage have improved the cure rate of patients with cancer of the cervix to 65 percent. Associated with this increased dosage (betatron, 5,250 r and intracavitary 137-cesium, 4,000 r at point A) has been a serious complication incidence of 10 percent. Major intestinal complications usually become manifest within an 8 to 24 month period following radiation. Few are associated with tumor and the majority are amenable to surgical correction. Rectosigmoid stenosis is a common and frequently unrecognized complication. The 8 to 12 cm. segment of rectosigmoid, with its rigid wall and narrowed lumen, can be recognized on barium examination. The symptoms are those on incomplete obstruction and deterioration, frequently confused with tumor progression. Thirty-one patients have been treated by resection and low anterior anastomosis with relief of symptoms. Rectosigmoid stenosis progressing to necrosis, perforation, or fistula (an additional 29 patients) is treated best by the Hartmann operation as a first stage. This procedure has been less complicated than either colostomy alone or resection and anastomosis. Fifteen patients with low level rectovaginal fistula or stenosis were treated by defunctioning sigmoid colostomy. A loop transverse colostomy was unsatisfactory. Ileorectovaginal fistulas occurred in an additional six patients. Preoperative investigation should establish the presence or absence of an ileal component in all fistulas. Radiation ileitis is rare as an isolated finding but frequently is associated with severe rectosigmoid damage. Surgical treatment is seldom necessary but, if indicated (ten patients), resection appears to be preferable to bypass.


Intraoperative autotransfusion: an underutilized technique.

Although interest in intraoperative autotransfusion increased when commercial equipment became available, this technique still is utilized rarely in most hospitals. Our experience began with sporadic use in 1972 and has evolved to regular use at least ten times a month. The machine is operated by a technician, and we heparinize the autotransfusion system (ATS) reservoir. Our series includes 47 patients who had elective vascular operations and 141 who had emergency operations, usually for trauma. In the latter group, seven patients who were autotransfused with blood contaminated by intestinal contents survived near fatal injuries and did not develop complications attributable to the procedure. Morbidity and mortality rates in both groups did not appear to be increased as a result of intraoperative autotransfusion. Controversy over methods of anticoagulation and apprehension about effect on blood are not valid reasons for underutilization of this technique. Although significant administrative commitments are required to implement its use and to treat the coagulopathy that accompanies massive reinfusions, they are justified by the value of intraoperative autotransfusion in most cases in which two or more units of blood would be required ordinarily.


Gallstone pancreatitis: pathophysiology.

The stools of 45 patients with proven gallstones pancreatitis were screened for gallstones. An equal number of peripheral with gallstones but without pancreatitis served as the control group. Gallstones were found in the stools of 38 of the 45 patients (84 percent) with gallstone pancreatitis and in only five (11 percent) patients of the control group. The patients with gallstone pancreatitis experienced a relief of symptoms and a decrease in the levels of serum amylase and bilirubin prior to rectal passage of the stones. Operative cholangiography revealed reflux of contrast material into the pancreatic duct of 67 percent of the patients with gallstone pancreatitis and in only 18 percent of the controls. Of the 38 patients that passed stones, 30 cholangiograms (79 percent) demonstrated a functioning common channel. it would appear that a functioning common channel is necessary for reflux and in addition favors stone passage. This study suggests that the pathophysiology of gallstone pancreatitis relates to the temporary impaction of migrating stones at the ampulla of Vater.


Jejunoileal bypass for morbid obesity: early results and body composition changes in forty-five patients.

Forty-five patients who underwent a 14 by 4 inch jejunoileal bypass for morbid obesity were studied before the operation and at periodic intervals after operation to determine the complications and changes in body composition resulting from this procedure. Body composition studies were determined using 3H2O and 42K. Rapid weight loss occurred in the first 3 months, with a mean loss of 30 percent of excess weight. This weight loss was accompanied by a decrease in exchangeable potassium (Ke) and total body water (TBW) during this interval by 14 and 10 percent, respectively. Although most patients continued to lose excess weight Ke and TBW stabilized at the end of the first year and returned to preoperative values in six patients at the end of 24 months. Analysis of the ratios of body cell mass and total body water to weight shows an improvement of body composition 12 months after operation. Body composition studies permit a quantitative assessment of the nutritional status in patients undergoing jejunoileal bypass. In spite of significant complications (23 percent), surgery for morbid obesity appears to satisfy the objective of allowing desirable loss of fat with relative sparing of muscle and other supporting tissues.


Gastric bypass for morbid obesity: results and complications.

Seventy-five patients underwent a 90 percent distal gastric bypass for morbid obesity. The average weight was 121.4 kilogram, height 164 centimeters, and age 31.4 years in these 70 women and five men. There was a total of 20 surgical complications in the 75 patients, with wound infection being the most common. Sixteen chronic complications were noted and consisted of vomiting, diarrhea, reflux esophagitis, dysphagia, and vitamin deficiencies. None of the above complications were life-threatening or required dismantling of the bypass. Of 54 patients followed for 12 months or more after gastric bypass, there was a 24.5 percent average weight decrease at 6 months, and this progressed to 35.8 percent by 12 months. Fifty-two patients undergoing small bowel bypass previously at the same institution had a 25.4 percent weight reduction at 12 months. Of 54 patients, 83 percent followed for one or more years after gastric bypass have had an excellent or good clinical result, whereas only 42 percent of the 52 patients undergoing small bowel bypass have had an excellent or good clinical result with the same criteria. It is concluded that the Mason 90 percent distal gastric bypass is a suitable form of surgical treatment for the morbidity obese patient who cannot lose weight by dietary measures.


Comparative value of four methods of investigating the pancreas.

In a prospective study for the diagnosis of pancreatic cancer, ultrasonography, radionuclide scanning, selective arteriography, and endoscopic retrograde cholangiopancreatography (ERCP) were compared. Eighty-nine consecutive patients were investigated; 58 underwent laparotomy, and 36 were found to have periampullary cancer; seven had other malignant tumors within the abdomen, and nine had pancreatitis on biopsy. Five had other benign disease, and there was one negative laparotomy. Thirty-one patients who did not have laparotomy have shown no evidence of cancer at one year follow-up. Ultrasonography was found to be more reliable than scan or arteriography in the detection and diagnosis of a mass in the pancreas. ERCP achieved the highest rate of correct definitive diagnosis.


Delineation of critical factors in the treatment of pancreatic trauma.

An analysis of 100 patients sustaining multiple injury and pancreatic trauma was completed. Sixteen patients with penetrating injury died within the first 24 hours, 14 of whom died intraoperatively from major hepatic and/or retroperitoneal venous injury. Eighty-four patients survived long enough to permit evaluation of treatment. There was no statistically significant relationship between mode (p = 0.3) or anatomic area (p = 0.5) of injury and death. However, death was more common in the presence of duct injury (p less than 0.0001). Thirty-nine patients were determined to have duct injury and 45 did not. These two groups were equivalent, with the exception of a higher incidence of concomitant bowel injury (p less than 0.05) in those with duct violation. Combined sump and Penrose drainage was found to be adequate treatment of both proximal and distal nonductal injury with no significant difference in mortality or morbidity rates (p = 0.5). Resection of distal ductal injuries as opposed to drainage alone resulted in significantly lower morbidity and mortality rates (p less than 0.05), comparable to those of drained nonductal injuries. No conclusions could be made relevant to proximal duct injuries, except that drainage alone is inadequate. Seventeen (20 percent) of the 84 patients evaluated died. Pancreatic related mortality rate was 17 percent (14 patients). Two of 23 patients with blunt injury (9 percent) and 12 of 61 patients with penetrating injury (20 percent died). Gram-negative sepsis (82 percent) was the most common cause of death (p less than 0.01), and sepsis was correlated with the presence of pancreatic duct (p less than 0.0001) and bowel (p less than 0.001) injury.


Massive gastrointestinal hemorrhage: a twenty-five year experience with vagotomy and drainage.

Old age and massive hemorrhage long have been recognized as ominous prognostic signs in the management of patients with peptic ulcer disease. The authors present the results of their long-term evaluation of 73 such patients. The group was unselected, critically ill, and treated surgically for the arrest of profuse hemorrhage. Accurate follow-up was achieved for 100 percent of the group; this follow-up spanned periods extending to 25 years. In comparison to published reports of similar high risk groups treated with resectional therapy, the vagotomy and pyloroplasty is shown to be comparable in long-term results and vastly superior in terms of operative mortality rate. The mortality rate for the advocated procedure was 8 percent, with a proven recurrence rate of 3.1 percent.


A comparison of wedge and segmental resection of the lung.

In the past few years there has been increasing use of limited resection for pulmonary carcinoma, especially in patients with restricted cardiorespiratory function. Because there is frequently a choice as to the type of limited resection, it was considered worth while to review the safety and efficiency of the two principal types. In total, 212 wedge resections and 281 segmental resections are reported. Despite certain theoretical advantages to segmentectomy, wedge resection carried a lower complication rate. Seventy-one per cent of wedge resections were free of complications compared to 54% of segmental resections. Minor complications were defined as apical air space and apical haematoma. The incidence of minor complications was similar for each group, 22% for wedge resections and 27% for segmentectomies. However, there was a significantly higher major complication rate in the segmental resection group (19%) compared to the wedge group (7%). This is understandable, considering the amount of raw lung surface exposed after segmental resection. It appears that where it is surgically feasible, wedge resection should be practised.


Spontaneous pneumothorax: the sharp rib syndrome.

Of 49 patients undergoing operation for benign spontaneous pneumothorax, 28 (57%) were found to have a sharp first or second rib. In a series of 100 patients undergoing thoracotomy for other conditions, only eight (8%) were found to have a sharp rib. The association between sharp ribs, apical scars and bullae, and spontaneous pneumothorax is discussed.


Infective endocarditis: a survey of cases in the South-East region of Scotland, 1969-72.

The incidence and characteristics of infective endocarditis were studied in a defined community over a four-year period. Seventy-eight cases were found, giving an incidence of 16 cases permillion per year. The commonest presenting features were those of infection; 53% had cardiac failure and 37% evidence of emboli when first seen. Twenty-three cases occurred on rheumatic heart valves, 13 on valvular prostheses, and 19 in previously normal hearts. Streptococcus viridans was the commonest organism, but there was a relatively high incidence of staphylococcal infection. Only four cases were preceded by dental manipulation, and no source for the infection was found in 46 patients. The mortality rate was 46%, cardiac failure and embolic phenomena accounting for 65% of deaths. It is unlikely that earlier diagnosis or cardiac surgery would have reduced the mortality appreciably.


Pericardiectomy in children.

Thirty-five children under 16 years of age were prepared for pericardiectomy on account of constrictive pericarditis; three died in the immediate preparatory period. Pericardiectomy was undertaken in 32; in 28 the cause was tuberculous. The purpose of this report is to draw attention to the high incidence of constrictive pericarditis in African children in Natal.


An evaluation of Potts' aortopulmonary shunt for palliation of cyanotic heart disease.

The results of 28 Potts' aortopulmonary shunts created for the relief of cyanotic heart disease are reviewed in this study. The shunt gave excellent symptomatic relief, but the incidence of immediate and late complications is high. Regular follow-up of patients is mandatory to detect evidence of increasing pulmonary vascular disease and to under take corrective surgery whenever feasible before its occurrence. Although Potts' anastomosis has been largely replaced by alternative shunt procedures, there may still be a place for its application in selected situations. Only a few problems were encountered at the time of closure of the shunt in 11 patients during corrective surgery using a transpulmonary technique and hypothermia with circulatory arrest.


Surgical treatment of congenital valvular aortic stenosis.

Twenty-two patients with congenital valvular aortic stenosis were surgically treated between 1967 and July 1975. Five (23%) were under 1 year of age (group I) and 17 (77%) were between 2 and 24 years (group II). All infants exhibited severe congestive heart failure and electrocardiographi (ECG) evidence of left ventricular hypertrophy (LVH) with strain pattern. In group II, angina was present in three cases, syncope and fatigue in two; the ECG indicated LVH in 10 cases (59%) with strain pattern in five (29%). A bicuspid aortic valve was present in 77% (17/22) of the cases; 32% had other cardiac anomalies. Aortic valvotomy was performed on cardiopulmonary bypass in 20 cases, and with deep hypothermia and circulatory arrest in two. Three infants under 1 month of age with associated anomalies died (hospital mortality 14%). Intraoperative average peak left ventricular-aortic systolic pressure gradient decreased from 86 to 21 mmHg (P less than 0.001). Late clinical (in all cases) and haemodynamic (26%) follow-up showed severe restenosis in two patients of group II; one of them had a second operation, the other one died three and a half years postoperatively. Results assessed on the basis of symptoms, ECG changes, aortic valve function, and/or haemodynamic findings were fair in the two surviving infants. Results in group II were excellent in three, satisfactory in seven, fair in four, and poor in two cases. In infants, aortic valvotomy is a palliative procedure which carries a high risk. In the older age group, early and late results are more gratifying.


Cellular aggregation and destruction during blood circulation and oxygenation.

Platelet and leucocyte aggregation and severe haemolysis may occur in blood during the preparation of an extracorporeal circuit for open-heart surgery. Experiments with dog blood showed that both processes result from bubble oxygenation but not from circulation of diluted blood and that they appear to be inhibited by the presence of acid citrate dextrose and heparin, or citrate phosphate dextrose and heparin, but not by heparin alone.


Effects of alternate-day prednisone therapy on respiratory function in myasthenia gravis.

To determine the effects of alternate-day prednisone therapy on respiratory function in myasthenia gravis, eight patients were evaluated during "days on" and "days off" prednisone. The patients were treated with long-term (up to three years), high-single-dose, alternate-day oral prednisone. After patients had been controlled with alternate-day prednisone they had no episodes of acute respiratory insufficiency or myasthenic crises. Although a small reduction in respiratory function during the day off prednisone was seen in some patients, the change was not statistically significant for the group and was probably physiologically unimportant in most patients. The data indicate that in myasthenic patients who have no underlying lung disease respiratory function is not significantly compromised by administering the prednisone on alternate days.


Complement components and IgE in patients with asthma and aspirin idiosyncrasy.

Levels of circulating IgE, total haemolytic complement, and components C4 and C3 were measured in 16 asthmatics with aspirin idiosyncrasy and in control subjects. IgE levels were mostly within normal limits. No differences were found between the complement profiles-in particular the C4 levels-in the two groups. As low levels of C4 have been found in patients with intrinsic asthma, these results would suggest a fundamental difference between asthmatics with aspirin idiosyncrasy and others with intrinsic asthma.


Regional lung function in ankylosing spondylitis.

Xenon-133 was used to study regional pulmonary function in nine patients with chest cage rigidity due to ankylosing spondylitis. In comparison with normal subjects, the patients showed an overall diminution in lung volume and the proportion of inhaled xenon reaching the lung apices was reduced but the distribution of injected xenon was normal. The possible relationship between these findings and apical lung disease in ankylosing spondylitis is mentioned.


Regional lung function in unilateral diaphragmatic paralysis.

Radioactive xenon-133 was used to study the regional lung function of five patients with unilateral diaphragmatic paralysis unassociated with intrathoracic disease. All patients showed a reduction in total lung capacity to which the affected side contributed an average of 37%. There was a decrease in the amount of inhaled xenon and a lesser decrease in the amount of injected xenon reaching the lung base on the paralysed side.The distribution in the opposite lung did not differ significantly from that found in normal subjects although the proportion of inhaled xenon reaching the lung base was rather less than in the normal group. The washout of injected xenon was normal except for slight impairment at the lung base on the paralysed side in one patient and at both bases in another.


Electron microscopy in the cytological examination of metastatic pleural effusions.

In a previous publication the ultrastructure of pleural effusions in cases of pleural mesothelioma was reported. The same method has now been applied to a study of effusions produced by pleural metastases. The findings are considered sufficiently conclusive to justify the use of electron microscopic cytology in determining the nature and sometimes the origin of such effusions.


Persistent hypoplasia of the lung after repair of congenital diaphragmatic hernia.

Quantitative analysis has been used to assess growth in a lung from an infant aged 21/2 months in whom a diaphragmatic hernia was repaired at birth. The lungs had been abnormally small at birth but at 21/2 months were of normal volume. Alveoli had multiplied at the normal rate after birth but had not reached the number normal of age. The number per acinus was normal but the alveoli were increased in size, particularly in the left lung. The airway number, and thus alveolar, acinar, and arterial number, were all reduced in both lungs, the ipsilateral being most affected. The pulmonary blood vessels in both lungs showed an increased muscularity that did not correlate with lung volume or alveolar number, a feature that may have been present at birth. The degrees of hypoplasia in the two lungs were different at birth and this difference had been maintained. The effect of the disturbance to lung growth on the functioning of the lung is discussed.


Acute thoracic inlet obstruction in achalasia of the oesophagus.

A case of acute thoracic inlet obstruction presenting as a rare complication of achalasia is described. The probable mechanism, diagnosis, and management are discussed.


Spontaneous pneumopericardium.

Spontaneous pneumopericardium is a relatively rare event, although cases have been recorded over the past 130 years. Many were associated with malignancy, trauma, infection or as a complication of recent surgery. Attempts at surgical resolution have been infrequent and survival extremely rare. We describe a patient in whom pneumopericardium developed spontaneously and insidiously, probably being present for some weeks before hospital investigation. Surgical exploration revealed the cause to be a benign gastric ulcer without an hiatus hernia or other diaphragmatic defect. Repair was attempted but the patient died in the early postoperative period. From an extensive review of the literature it is clear that spontaneous perforation of a gastric ulcer into the pericardium must be less rare than some authors have suggested.


Successful surgical repair of congenital total cleft sternum with partial ectopia cordis.

Total bifid sternum with or without ectopia cordis is a rare congenital anomaly which is treated successfully in a limited number of cases. Several methods of correction have been described using tissue grafts (cartilage, bone), inert artificial prostheses (acrylic plaques, marlex mesh), and techniques to approximate the sternal bands by relaxation of costal cartilages. In our case the method described by Verska was used to approximate the bifid sternal bands. The successful result in our patient proves the efficiency of this technique.


Constrictive epicarditis following Coxsackie virus infection.

A case is presented of the rare condition of constrictive epicarditis, which was treated successfully by removal of the epicardium. This appears to be the first account of constrictive epicarditis following proven Coxsackie viral infection.


[Shortening of the upper jaw (brachygnathia superior) as a clinical feature of atrophic rhinitis in approximately eight-week-old piglets (author's transl)].

Determining the degree of shortening of the upper jaw is described as an effective and simple method by which piglets affected with severe atrophic rhinitis may be identified as early as the eighth week of life. A positive high correlation (r2 = 0.61) between shortening of the upper jaw and atrophy of the ventral conchae was found to be present in pigs at this age. Clinical and pathological studies of 2,000 heads of swine of various ages revealed changes of the conchae and nasal bones as well as shortening of the upper jaw in animals affected with atrophic rhinitis. Over 99 per cent of the affected animals showed changes of the conchae at an age of eight weeks. In 95 per cent of the cases, the nasal bones were also involved. In 92 per cent of the animals showing lesions of the conchae, which were pigs of two herds, the shortening of the upper jaw was given a grading of one or higher. In view of these findings, the piglets were selected for severe shorting of the upper jaw and deviation of the axis of the head. The losses caused by atrophic rhinitis were reduced to nil on these fattening farms.


[Role of bovine respiratory syncytial virus in the aetiology of viruspneumonia in calves and yearlings ("pinkengriep") (author's transl)].

The clinical picture of "pinkengriep", an enzootic form of bronchopneumonia in young cattle, is described. In addition to cough, conjunctivitis and a soporous state, accelerated respiration initially is an outstanding clinical symptom. In some cases, symptoms of fog fever appear during the second stage of the disease. In the autumn of 1973 and that of 1974, a total number of 292 animals with "pinkengriep" were serologically examined for known respiratory virus infections and Chlamydia. Complement fixation tests showed that there was significant increase in antibodies to respiratory syncytial virus in 76 per cent of the animals studied. In the case of para-influenza virus 3, virus diarrhoea virus, the adenoviruses of the antigen groups 1, 2 and 3, those of the antigen groups 4 to 10 inclusive and Chlamydia, these proportions were 48, 13, 12, 11 en 10 per cent respectively. On the other hand, symptoms of infection with infectious bovine rhinotracheitis virus were absent in the herds studied. These findings suggest a possible role of bovine respiratory syncytial virus in "pinkengriep".


[Co-operation between veterinarian and farm adviser, still an undeveloped field? (AUTHOR'S TRANSL)].

In actual practice it does not often happen that the veterinarian gets into touch with the farm adviser, or vice versa, to exchange views on a particular farm or on problems in their fields of activity. As a rule, this is due to lack of time and/or insufficient acquaintance with each other. There are two fields in which effective co-operation between the two is possible, viz. the management of problem herds and in herd health practice. Interest is centering increasingly in the latter and it is precisely this field in which the farm adviser may also play an important role. It is claimed that working together at the solution of a (veterinary-agricultural) problem on a particular farm will contribute to a closer acquaintance on both sides. The initiative may be taken either by the veterinarian or by the farm adviser. This will possibly result in a happy collaboration in the future, not only in dealing with problem herds but also in hered health practice on those farms on which this is required (or desired).


A rapid HLA-D matching method using PHA blasts as responding cells (preliminary data on PHA blasts HLA-D typing).

Day 3-4 PHA stimulated lymphocytes were found to respond against HLA-D without any period of latency, thus allowing a discriminative MLR reading as early as 24-48 h. The test is therefore characterized by the minute number of responding cells necessary (5 X 10(3)), a one-way reaction without additional treatment of the stimualtion normal lymphocytes (5 x 10(4)), and the rapid obtaining of data. We found the preliminary data testing its concordance with classical HLA-D typing encouraging and worthy of being tested on a larger scale. Using mitogen stimulated recipient cells stored frozen, HLA-D matching with potential donors was found to be feasible within 24-48 h. The mechanism of such a prompt response by mitogen stimulated lymphocytes is unknown but appears to be independent of the nature and dose of a given mitogen.


Psoriasis, sacro-iliitis and peripheral arthritis occurring in patients with the same HLA haplotype. A preliminary family report and a hypothetical explanation of the interaction between MHS products.

The present family investigation has shown that genes within the MHS are mainly responsible for the development of psoriasis or psoriasis-associated arthritic lesions (peripheral arthritis and sacroiliitis). We have hypothetically discussed the possibility that multiple genes, all located within the MHS, act in concert to increase the risk of developing disease to very high levels. This implies that at least two MHS linked genes act in complementary fashion for the development of disease, these genes seem to be able to operate both in the cis and in the trans position. One of these genes would be situated in the chromosomal portion of the MHS which carries the HLA-D locus. Families with a high incidence of disease would show inheritance according to the cis position of genes, when it can be shown that most of the carriers of the specific disease-associated haplotype are affected by disease, whereas in other families, complementarity between two distinct HLA haplotypes with genes acting in the trans position would result in disease.


A "natural" anti-HLA-A2 antibody reacting with homozygous cells.

In the serum of a young normal male, never transfused, a cold cytotoxic IgM antibody was found reacting exclusively with A2 homozygous cells on a French panel, as shown by population and family studies. This antibody needs about two to five times more lymphocytes or platelets to be absorbed than an immune anti-A2 of the same titre. The antigen recognized by this antibody seems to be covered by the same molecule as HLA-A2, according to redistribution experiments.


Rga (Rodgers) and the HLA region: linkage and associations.

In 19 families with 97 children the segregation of Rga (Rodgers) was found to be compatible with Mendelian inheritance and five backcross and 14 intercross families were found among HLA and Bf typed families. Close linkage (lods + 17.82) without recombination was found between Rg and the HLA region, with a direct count of 96 nonrecombinant meioses for Rg-HLA-B. Rg- was strongly associated with HLA-B8 (29 of 30 haplotypes) and probably associated with Bw40, but did occur on other HLA-B haplotypes. By inference Rg- is negatively associated with Ch- (Chido). The Rg-Ch- haplotype has not been observed. Rga and Cha may or may not be coded for by different sites of the same cistron closely linked to HLA-B:C and cannot as yet be excluded from being parts of B or C.


Behçet disease and the HLA system.

Seventy-three unrelated patients with Behçet disease together with 33 members of seven families with at least two patients per family were tissue typed for 26 antigens of the HLA system. The patients with the complete type of Behçet disease were found to have HLA-B5 more significantly than healthy individuals. Family studies suggest that the genes closely linked to HLA locus influence the degree of severity of Behçet disease.


The carcinogenic response in mice to the topical application of propane sultone to the skin.

The carcinogenic effects of limited and repeated skin applications of propane sultone were investigated in three strains of mice, CF1, C3H and CBah (a hairless strain). Propane sultone was shown to be carcinogenic when given as a single application of a 25% w/v solution in toluene and also following twice weekly application of a 2.5% w/v solution for up to 58 weeks. More limited exposure to 2.5% w/v solutions of propane sultone resulted in a few skin tumours, although the incidences were not statistically significant. Most neoplasms were papillomas or carcinomas, although a small number of mesenchymal tumours of dermal origin also developed. No skin neoplasms were found in any control mice. The skin application of propane sultone was associated with a statistically significant increase in the incidence of systematic neoplasia in CFl and C3H mice. The exposed CFl mice had a higher incidence of neoplasms of lymphoreticular and lung origin, while female C3H mice showed a higher incidence of mammary gland and uterine tumours. In mice exposed to beta-propiolactone as a positive control, neoplasms developed at the site of application but, there was no evidence of increased systemic neoplasis in contrast to the findings with ptopane sultone.


Subacute toxicity studies with sodium saccharin and two hydrolytic derivatives.

The subacute toxicity of sodium saccharin and 2 hydrolytic derivatives, o-sulfamoylbenzoic acid (Compound I) and ammonium o-carboxybenzene sulfonate (Compound II) was evaluated by feeding each of the compounds alone at a dietary level of 20 000 ppm to both beagle dogs and albino rats. Additionally, groups of dogs and rats were fed combinations of the 3 materials at levels up to 20 000 ppm (2000 ppm sodium saccharin, 9000 ppm of both Compound I and II). Dogs were maintained on the test diets for 16 weeks, rats for 13 weeks. No signs of a pharmacotoxic response to the test materials were observed. Parameters determined for treated animals, including growth, food consumption, hematologic profiles, clinical blood chemistry studies, urinalyses, organ weight and ratio data, and both gross and microscopic pathologic evaluation, were not significantly different from control values. From these findings, it is suggested that there is little toxicologic hazard associated with ingestion of the 2 hydrolytic derivatives of sodium saccharin.


Normal and lethal mercury levels in human beings.

Ethyl mercury in the form of Granosan M was used as a fungicide in dressing grains in Iraq. Disregarding warnings and precautions by the authorities, some villagers used this grain in making their bread. Tissue specimens of poisoned people were analysed for total mercury contents using the flameless atomic absorption spectroscopic technique. The analytical method used is highly sensitive (1 ppb/1% absorbance), and the precision in terms of relative standard deviation (RSD) was about 1.5%. The ranges of mercury content in ppm units in the two cases of poisoning were 8-9 for the kidneys, 6-7 for livers, 3-5 for the cerebella, and about 15 for the blood. The analyses included some other tissues as well. Control values were also present. These were obtained from human beings who died by accident and showed no signs of mercury poisoning.


Inhalation toxicity studies on cigarette smoke. I. A versatile exposure system for inhalation toxicity studies on cigarette smoke.

A detailed description is given of the design and operation of a new smoking machine built for inhalation toxicity studies with small laboratory animals. Brief details are given of smoke monitoring carried out to determine the extent of loss of particulated matter along the smoke path through the machine.


Inhalation toxicity studies on cigarette smoke II. Tobacco smoke inhalation dosimetry studies on small laboratory animals.

A newly developed exposure system has been used to carry out smoke dosimetry studies on rats, mice, hamsters and guinea pigs. In all species, smoke total particulate matter (TPM) deposited in significant amounts in the lower respiratory system (LRS) at dose levels ranging from 0.515 to 1.710 mg TPM/g respiratory tissue. Nasal deposition of smoke particulates did occur in all of the species examined. The significance of these dosimetry data in relation to the conduct of long-term comparative inhalation toxicity studies with tobacco smoke is discussed.


[Toxicokinetics of a thioquinoxaline component: the oxythioquinox (author's transl)].

The absorption and distribution of Morestan 35S in the organism of the rat were studied after administration by stomach tube. It was shown that Morestan, in vivo and in vitro, forms a complex with plasma proteins and particularly with albumins. Most of the plasma Morestan is distributed like this. After intravenous admininstration, the constant of elimination, K13, and the biological half-life determination show that plasma Morestan 35S is eliminated very slowly. The K12 and K21 constants indicate that there is an equilibrium between the plasma compartment and a peripheral compartment. After intragastric administration, the increase of radioactivity in epididymal adipose tissue, indicate that the peripheral compartment should include the adipose tissue.


Inhalation toxicity studies on cigarette smoke III. Tobacco smoke inhalation dosimetry study on rats.

Smoke inhalation dosimetry studies have been carried out on rats, using a new exposure system. A range of cigarettes, tobacco types and smoke concentrations was used. Penetration of smoke into the lungs was clearly demonstrated, and loads of total particulate matter (TPM) of up 1 mg were detected in the lower respiratory system of rats. The mass of TPM deposited was affected by the smoke concentration during exposure. Deposition of TPM in the head of the rat was low in relation to total respiratory system deposition. A pattern of predominantly lung deposition was achieved under the conditions used for this series of experiments. This pattern was not affected by changes in smoke dilution level, cigarette or tobacco type.


[Practice of computer use in radiotherapy planning].

The main problems of radiotherapy planning are discussed with respect to use of computers now being available for a greater number of centers. One of the most essential premises is apart from clear ideas on a modern target volume concept - a sufficiently high speed in producing realistic summarized isodose contours for any radiation therapy arrangement in any individual patient's cross section outline. This problem being solved, those individual summarized isodose figures have to be critically evaluated and therefore the importance of applicable meaningful optimization criteria come into account. The properties of such criteria, which must be quantifiable, generally applicable and really relevant for judgement on quality of a plan, had to be accepted, before automatic optimization procedures could be developed; principles involved are presented. By means of a short series of examples, namely 60Co fixed field combinations with and without use of wedges, combinations of arc therapy for a number of clinical tasks. It has been pointed out, that most experienced estimate by the eye would have been by far insufficient when compared to the automized computer optimization when using such simple criteria as 1. homogeneity of absorbed dose within target volume, 2. numerically limited absorbed dose within areas of risk, 3. as low as possible radiation effects to all "outside areas". It seems to be a real danger, that so called isodose libraries, how high their merits might be estimated, may change into an "isodose bcemetery", unless we'll be successful for each individual clinical case by use of computers, which are now prepared to supply the best possible variant of the standard plan or the primary radiotherapy idea. Regular use of computers in such a way will furthermore give an incomparable documentation material.


Inhalation experiments with 14C-labelled cigarette smoke. III. Body size dependent distribution of particulate matter in small rodents during cigarette smoke inhalation.

Syrian golden and European hamsters were exposed to 14C-labelled cigarette smoke. The deposition of the 14C activity in the respiratory and digestive tracts was determined immediately after the exposure. From the results obtained it can be seen that the distribution of particulate matter between the upper and lower respiratory tract, as well as, between the respiratory and digestive tracts is related to the body weight of the experimental animals.


[Additive treatment of metastasizing breast cancer with special reference to postmenopausal age (results of a randomized study)].

Two therapy groups were formed at random out of 82 patients with progressive carcinoma of the breast. One was treated with estrogens, namely 17-ethinyl 1,3,5-estratriene 3,17 diol (SH 8.1083). The second group was treated with depot preparations consisting of a combination of estrogens and gestagens; these patients received 90 mg estradiol valerianate and 300 mg 17-hydroxy-19-norprogesterone caproate (SH 8.0834) weekly. The estrogen therapy resulted in a remission rate of 48% (complete remission 21.1%, partial remission 26.9%). The remission rate of the combination treatment was 46.6% (complete remission 23.3%, partial remission 23.3%). There was no considerable difference between the remission rates produced by the two therapeutik methods. It is remarkable that much more osseous remissions were found under the combination therapy of estrogens and gestagens. There were no substantial differences between the remission rates of the soft-tissue metastases and the pleuropulmonary metastases. In the estrogen group the remissions took 7.7 months, whereas an average remission period of 8.3 months was observed in the estrogen-gestagen group.


Time-dependent disappearance of ochratoxin A residues in tissues of bacon pigs.

Crystalline ochratoxin A was administered to bacon pigs for one month. After termination of toxin exposure the pigs were slaughtered at different intervals and analyses for ochratoxin A residues in four tissues were conducted. Kidneys contained the highest concentrations, and fat the lowest, at each interval. Ochratoxin A disappeared from muscles and fat after 2 weeks, from liver after 3 weeks, and from the kidneys after 4 weeks. The toxin disappeared from tissues exponentially. All the pigs would have passed the meat inspection because no pathologic lesions were developed although tissues contained mycotoxin residues. The results of this study indicate that contamination of meat by ochratoxin A may be avoided by feeding pigs ochratoxin-free feed during the last 4 weeks before slaughter.


[Experiences with mammography, plate thermography and cytology as triple diagnosis].

A report is given on 814 patients who had undergone a mamma examination by means of mammographies, plate thermographies, and, if indicated, punction cytologies. On the basis of our experiences with this triple diagnosis we drafted a preliminary control scheme.


The incidence and treatment of intestinal and urological complications after combined radiotherapy for uterine carcinomas.

OPNE HUNDRED AND SIXTY-FOUR PATIENTS WITH GYNECOLOGICAL CARCINOMAS (104 ca colli uteri, 60 cacorporis uteri) were examined retrospectively two to seven years after combined internal-external radiotherapy. Thirty-seven per cent of the patients displayed mild intestinal symptoms during the therapy. The frequency of symptoms remained unchanged after the termination of therapy, though they tended to become more severe. Twenty-five per cent of the patients had urological symptoms during the therapy. Their rate remained the same during the arly follow-up, but increased subsequently, because the frequencies of infections and hematuria had increased. Fourteen patients developed a complication requiring operative treatment five to fifty-seven months after the discontinuation of therapy. Three of them had both intestinal and urological complications, while six had only urological complications. The intestinal complications were repaired with smallgut resections and colostomies, while the urological complications (ureteral strictures) were repaired with different diversion operations with good operative results. Thirteen of the patients with serious complications are alive. One patient had died of profuse rectovaginal bleeding. The mean radiation doses employed were not different in the group with serious complications. Evleven of the patients with complications suffered from different concurrent diseases, which may have diminished their radiation tolerance. The radiotherapy of gynecological malignancies ought to be preformed individually noticing the intestinal reactions during the therapy and the concurrent disease. The value of renography in early detection of urinary tract complications is stressed.


Procedure for field axes measurement, beam indication adjustment, and figure of convergence determination within performance tests for radiation therapy equipment.

A routine measuring procedure for the verification of radiation field axes and figure of convergence within a spatial resolution of +/- 0.5 mm is described. Measurements are done in two parallel planes in a certain distance before and behind the presumed isocentre. The used test arrangement permits rapid check and controlled adjustment of the alignment of beam or isocentre indicating devices for all isocentic radiation therapy equipment.


Effects of tritiated thymidine on cell population kinetics.

This paper reports growth-kinetic data of Chinese Hamster tissue culture cells exposed at various times to differnt activities (0.05 muCi/ml up to 10.0 muCi/ml of tritiated thymidine. The analysis of the results aims at the determination of colony-size distribution and to the cellular capacity of reproduction after treatment which is reflected in the cell division spectrum within dialy intervals. The results of the growth-curves represented were converted into integrated curves of colony-size distribution, and their alteration as exponential curves for estimation of the cell cycle as a function of culture time was established. The recovery process and course determination of population kinetics following the 3H-TdR-treatments were evaluated.


Mutagenicity studies on irradiated potatoes and chlorogenic acid; micronucleus test in rats.

The micronucleus test was used to study possible mutagenic effects of (1) Irradiated potatoes extracted (a) immediately and (b) after 24-h storage following irradiation; (2) Irradiated and unirradiated chlorogenic acid; and (3) Trenimon. It was observed that irradiated potatoes (groups 1 a, b) and chlorogenic acid (group 2) did not cause mutagenic effects in the bone-marrow cells of rats. The Trenimon group (group 3), which was used as the positive control group, did show significant mutagenic effects.


The relationship between the population size and the postirradiation mortality of mice with respect to individual differences in stress reactivity.

Differences in radiosensitivity, expressed by the death rate up to the 30th day after irradiation by single whole-body exposures in the region of LD50, were followed in mice caged in groups by five, 15 and 25 individuals. No marked differences in the whole=group mortality of differently sized collectives were detected. Preirradiation as well as postirradiation leucocyte counts (after a sublethal irradiation) exhibit, however, differences, which correspond to an assumed different degree of the adrenocortical activity in differently sized collectives. Also the follow-up of the stress reactivity of the animals by measuring the Na/K ratio in 24-hour-samples of urine prior to irradiation demonstrated marked differences between the groups with low number and high number of animals in a cage. By correlating values of this indirect indicator of the adrenocortical activity with manifestations of the individual radiosensitivity it was found that the extremely hyporeactive animals (belonging to groups with five animals per cage) and the extremely hyperreactive ones (belonging to groups with 25 animals per cage) exhibit a markedly higher mortality. The absence of differences in the whole-group mortality of differently sized collectives can be explained by the existence of nonlinear "U"-shaped relations between the adrenocortical activity and the individuals' radiosensitivity. The results support the conception on the unfavorable prognostic significance of unbalanced reactions of homeostatic functions of system regulation under conditions of radiation syndrome.


Fertility and contraceptive practice: Bogota, 1964-74.

The results of a 1974 survey of 6,692 Bogota women aged 15-49 conducted by the Colombian Association for Population Studies show that, in the last decade, approval of family planning practice increased 34 percent, contraceptive practice nearly doubled, and fertility declined by over 45 percent. Life-table analysis shows unusually high continuation rates for Bogota women. Data concerning crossovers between Bogota's three family planning programs and the commercial sector indicate that the manufacturers of contraceptives benefit from program activities. The study demonstrates, for the first time in Latin America, the feasibility of using a probability sample of the general female population to evaluate family planning programs.


Effectiveness of the Iranian auxiliary midwife in IUD insertion.

In Iran, a traditional rural midwife is allowed to perform pelvic exams and insert IUD'S under conditions of almost total independence after she has received one month of intensive training in the procedures. The present study compared two groups containing 232 village women each, matched for age and parity. One group had IUDs inserted by rural midwives and the other by physicians or nurse-midwives at ubran clinics. The one-year and two-year closure rates for the two groups were very similar, as were the net closure rates for various categories of termination. No cases of severe complication were known to have occurred in either series. This evidence indicates that a rural midwife, following short, intensive training in the technique, can insert IUDs as safely and effectively as physicians and nurse-midwives.


Influence of separation techniques on the distribution and function of lymphocyte subpopulations. A comparison of three techniques.

The effect, if any, of three different lymphocyte separation techniques on the composition and functional characteristics of the purified cell suspensions has been studied. Each separation technique was shown to yield a cell population with highly specific and reproducible characteristics. The Ficoll-Hypaque technique led to good lymphocyte yields but low yields of sheep erythrocyte-rosetting (E-rosetting) T cells, and the separated cell population responded least well to phytohemagglutinin. The glass sand filtration technique led to lowest overall yield of small lymphocytes and of EAC-rosetting cells. There was significantly lower total yield of E-rosetting T cell as well, but the separated lymphocyte suspension had excellent purity, had relatively high percentage of E-rosetting T cells, and they responded extremely well to phytohemagglutinin (PHA) and pokeweed mitogen (PWM). The Technicon separation involving magneticremoval of phagocytic cells by exposure to iron particles consistently led to large yields of small lymphocytes with good purity, the largest total harvests of E-rosetting T cells, as well as EAC-rosetting cells while the separated population had the highest percentage of E-rosetting cells and responded very well to PHA and PWM. These results show that lymphocyte losses during purification are not nonspecific and that the choice of the separation technique profoundly affects the characteristics of the purified lymphocyte population obtainable.


Cell interaction in tumor allograft immunity. Suppressor cell in the spleen of allogeneic tumor-sensitized mice.

The cytotoxic activity of lymphoid cells from allogeneic tumor-sensitized mice in three different strain combinations was tested at various intervals after i.p. sensitization. Peritoneal cells (PC) gave the highest cytotoxic index. The cytotoxic activity of the PC was due to both peritoneal lymphocytees (PL) and peritoneal macrophages (PM). Splenic macrophages, on the other hand, exerted an inhibitory effect as evidenced by increased cytotoxic activity of spleen treated with antimacrophages serum (AMS). Increased cytotoxic activity was also found in: (1) the nonadherent fraction of spleen after absorption on glass; (2) the effluent fraction of spleen after nylon wool column filtration; and (3) the medium density band after centrifugation of spleen on a discontinuous bovine serum albumin gradient. The results suggest the presence of an AMS-sensitive, glass- and nylon wool-adherent spleen cell which could have a suppressor role in allogeneic tumor-sensitized mice.


Inhibition of parental tumor colony formation by cells from a semi allogeneic mixed spleen cell reaction.

Cells capable of inhibiting colony formation by the DBA/2 fibrosarcoma SaD2-AG and mammary adenocarcinoma CaD2 are generated in vitro during semiallogeneic histoincompatibility reactions between DBA/2 and (C3H/He X DBA/2)F1 hybrid spleen cells. These colony-inhibiting cells adhere strongly to plastic, develop from nonadherent precursors, and retain colony-inhibiting ability even after receiving 5,000 rads of ionizing radiation.


The history of the ox warble fly in Cyprus.

The eradication of ox warble fly from Cyprus is described. Initially, the major part of the eradication consisted of dressing every bovine animal with derris at monthly intervals between December and May (inclusive), but in the final and critical stages when the level of infestation had fallen to 0-2 per cent, it was found that the most efficient and economical approach was to offer a financial reward to any stock-owner reporting the presence of warble fly.


Haematological values of Nigerian goats and sheep.

Haematological parameters were determined in healthy Nigerian breeds of goats and sheep. Most values in the Nigerian goats were similar to those reported for temperate breeds of goats although the haemoglobin concentrations and the MCHC were lower. The haematocrit, haemoglobin concentrations and red cell counts of the West African Dwarf sheep were lower while the MCV were higher than those reported for sheep in the temperate climate. RBC values decreased with age in both Nigerian goats and sheep. Although sex pregnancy appeared to have little or no influence on the erythrocytic values, pregnant ewes had higher haematocrit and haemoglobin values. The low erythrocytic values were attributed to a low but constant parasitic burden which affected the flocks studied. Total leucocyte counts were considerably higher in the Nigerian goats and sheep than those reported for temperate breeds of animals. Young goats had higher total leucocyte counts while pregnant goats had reduced leucocyte counts. The leucocytic values were not affected by age and sex. Pregnant ewes also had higher leucocyte counts than non-pregnant ewes and rams.


Differences among cattle and farms as related to beef cow reproduction in the eastern plains of Colombia.

In the tropical savannas of Colombia, the Llanos Orientales, a field survey of 40 beef herds leased by farmers through a cooperative indicated that these herds had mean annual calving rates of 52 and 55 per cent in the Plains and Piedmont zones, respectively. Within zones, very large differences in reproductive rates were found between herds. The differences seemed to be associated with the soils and climates of the areas, condition and weight of cows and breed of cow. Only 9 to 13 per cent of nursing cows were found to be pregnant. Conception was seasonal, occurring mostly in the dry and early rainy seasons. Control of the time of weaning of calves, routine mineral supplementation and improved pasture management appeared to offer immediate possibilities for economically improving output of calves.


Growth and carcass characteristics of cattle and buffalo breeds reared on a dry zone pasture in Sri Lanka (Ceylon).

Growth and carcass characteristics were measured on calves from three cattle breeds-the Sinhala, Red Sindhi and Friesian-and two buffalo breeds-the local buffalo and Murrah. The growth study was carried out on Brachiaria brizantha pasture over a period of 48 weeks. The two buffalo breeds grew fastest followed by the two Bos indicus breeds. The Friesian cattle grew at the slowest rate. The Sinhala and local buffalo had normal haematocrit values while the values for all other breeds were lower. The Sinhala and local buffalo had the highest carcass dressing percentages  and the highest muscle; bone ratios. Tenderness measured by Warner-Bratzler shear force values and palatability scores by a taste panel were similar for meat from cattle and buffalo.


The maintenance of the argasid tick Ornithodoros moubata (Murray) on embryonated hen eggs.

A laboratory colony of O. moubata was maintained entirely by feeding on the exposed membranes of embryonated hen eggs at the 17-19th day stage of incubation at 37 degrees C. There was no loss of either vigour or fecundity. The method gave markedly superior results to those obtained by feeding on rabbits, rats, mice and guinea-pigs. More convenient and economical than any alternative, the method has valuable advantages in its applicability to a wide range of pathogens.


The effect of calf lymph and bovine red blood cells on in vitro cultivation of Theileria parva-infected lymphoid cells.

Calf lymph introduced to cultures of Theileria parva-infected lymphoid cells caused a stimulation of both cells and parasites resulting in the formation of rapidly dividing cells and the developmental stages of the parasite. The presence of piroplasms was confirmed when washed bovine red blood corpuscles were added to the culture


Effects of head-out water immersion on cardiorespiratory responses to maximal cycling exercise.

Our objectives were to determine effects of head-out immersion (HOI), scuba breathing, and water temperature on cardiorespiratory responses to maximal aerobic work. Measurements of VO2, VE, and heart rate (HR) were obtained on seven men (27 yr, 177 cm, 67 kg) as they performed the same upright bicycling exercise to exhaustion (4-5 min) in 23 degrees C air and 30 degrees C water. Maximal oxygen uptake (VO2 max) during HOI was 3.18 liters - min-1, which was not statistically different from the mean of 3.29 liters- min-1 in air. When compressed air was breathed via scuba during HOI, VO2 max was 3.12 liters- min-1 and not significantly different from that when room air was breathed and a low-resistance valve in water was used. HOI decreased VE by 15.7 liters - min-1 and HR by 10 beats (b) - min-1. Scuba breathing further reduced VE by 22.0 liters - min-1. Similar measurements were made on four of the subjects after 18 min of HOI in water temperatures of 35,30, and 25 degrees C. Water temperature had no significant affect on VO2 max, although HR was 8 b- min-1 lower in 30 degrees C and 15 b - min-1 lower in 25 degrees C as compared to 35 degrees C water. The results show that VO2 max was not significantly changed by HOI, scuba breathing, or brief exposures to 25, 30, and 35 degrees C water, despite significant reductions that occurred for VE and HR.


Diving at diminished atmospheric pressure: air decompression tables for different altitudes.

Fifty subjects performed 106 simulated dives at a final ambient pressure of 0.7 at (3000 m above sea level). One hundred and forty-three subjects performed 278 actual controlled dives at altitudes 900-1700 m above sea level. From the experience of these dives, air-decompression tables for altitudes 0-3200 m above sea level were calculated. Tables up to 2000 m above sea level were tested on humans under wet conditions.


Longitudinal study of performance after deep compressions with heliox and He-N2-O2.

This study concerns three hyperbaric experiments. During SAGITTAIRE iv, compression to 610 msw was accomplished in 11 days with an atmosphere of helium-oxygen. For the two CORAZ experiments, compression to 300 msw was done in 4 hours with He-N2-O2 trimix, varying nitrogen concentration from CORAZI (2.8 ATA N2 =9%) to CORAZ II (1.4 ATA N2=4.5%). Oxygen partial pressure was always maintained at 0.4 ATA except during decompression. The same two subjects participated in all three experiments and underwent the following psychometric tests: manual dexterity, visual choice-reaction time, and number ordination. Results show a large decrement in performance at 610 msw after slow compression (-50% and -47% on the number ordination test, -34% and -24% on the visual choice-reaction time). Test performance was less affected after the rapid compressions to 300 msw, and recuperation to control values occurred within 1 day at 300 msw. Our data show that 1.4 ATA N2 is less detrimental to performance than 2.8 ATA N2 for trimix compressions to 300 msw in 4 hours.


Effects of increased O2-N2 pressure and breathing apparatus on respiratory function.

The ventilatory response of four subjects was measured at rest and various intensities of exercise. Experiments were conducted in a dry pressure chamber (1) at 1 ATA and 4 ATA with the subjects breathing from a low-resistance mouthpiece, and (2) at ATA with the subjects breathing from open-circuit breathing apparatus (Royal Naval Swimmers' Air Breathing Apparatus). At 4 ATA there was significant hypoventilation and hypercapnia, together with an increased tidal volume and lower respiratory frequency. The use of the breathing apparatus tended to amplify these changes in ventilatory response. In addition, the extent of hypercapnia at 4 ATA was related to the exercise intensity. When subjects breathed from a low-resistance mouthpiece, oxygen uptake was significantly greater at 4 ATA than at the surface for the same ergometric work load, but when they breathed from the breathing apparatus, the increase in oxygen uptake was not significant in comparison to surface values. At 4 ATA bradycardia was evident at all levels of exercise but was not affected significantly by the presence of the breathing apparatus.


Critical flicker frequency (CFF) and subjective fatigue during an oxyhelium saturation dive at 62 ATA.

Two divers spent over 50 hours at 610 msw in a helium-oxygen mixture (PO2:0.38-0.52 ATA). The dive duration was 27 days, including predive stages of confinement, compression, time at maximum pressure, and decompression. The divers were asked to answer 30 questions on their feelings of mental and physical fatigue and to indicate on a nine-point scale their estimation of a general feeling of fatigue. Subjective feelings of fatigue reported in this dive suggested that the divers were in good condition. Hyperbaric arthralgia and physical complaints were reported, especially during decompression, with some postdive persistence, but they should be considered as distinct signs of feelings of fatigue. The critical flicker frequency (CFF), measured throughout the dive for the two divers, showed systematic variations and a relationship between compression and pressure. These variations were grossly parallel to EEG modifications reported in other studies and probably reveal neurophysiological troubles that were not apparent from subjective reports.


Reversal of nitrogen narcosis in rats by helium pressure.

Changes in operant behavior were obtained for rats breathing nitrogen, helium, and both gases combined. Exposure to 12.9 ATA of nitrogen (O2 maintained at normobaric value of 0.2 ATA) produced complete cessation of responding on a fixed-ratio reinforcement schedule for 1 hour. The addition of elevated pressure of helium (12.1, 18.2, and 24.2 ATA) to the 12.9 ATA of nitrogen resulted in a reinstatement of responding during 1-hour hyperbaric exposures. The reinstatement of responding indicated a reversal of the nitrogen effects on behavior by increased helium pressures. The functional changes in behavior appeared to parallel the pressure produced reversal of anesthesia obtained at much higher pressures.


Pressure-reduction limits for rats following steady-state exposures between 6 and 60 ATA.

The role of pressure reduction in the formation and growth of bubbles is universally recognized and its significance in decompression theory has been accepted. Yet the allowable limits of pressure reduction for man and animal are uncertain. This study sought to evaluate the pressure-reduction limits for rats following steady-state exposures at pressures greater than 1 atm. To define the relationship, 350 albino rats were exposed to 1 of 12 specified pressure levels between 6 and 60 ATA and then abruptly decompressed to a preselected reduced pressure level for observation. The pressure-reduction levels were selected to determine for each saturation-exposure level an ED-50 (i.e. the effective dose that will produce decompression sickness in 50% of the animals). The results demonstrate three consistent findings: (1) there is a linear relationship (r = .99) between the magnitude of a safe pressure reduction and the saturation exposures between 6 and 43 ATA; (2) at pressures greater than 43 ATA, there is a qualitative change in the decompression sickness symptoms and a reduction in the precision of the mathematical relationship (r = .44); and (3) the magnitude of the pressure change required to increase the incidence of decompression sickness from 10% to 90% is directly related to the magnitude of the exposure pressure. The implications of these results for deep operational diving are discussed.


The response of fish blood cells, particularly thrombocytes, to decompression.

The effects of decompression on various blood-cell types in chinook salmon (Oncorhynchus tshawytscha) were investigated using a 4-liter hyperbaric chamber. Thrombocytes (platelets) were found to decrease significantly in numbers following lethal and nonlethal decompressions. The response was highly dependent on depth, gas solubility, and rate of decompression, whereby increasing depth or gas solubility caused greater and faster declines of thrombocyte levels. Return of thrombocyte numbers to normal values usually occurred within 48 hours, except after the more severe decompressions where recovery was never fully attained during the sampling period. Erythrocyte levels increased significantly 1 day after a severe decompression, suggesting hemoconcentration. Leucocytes appeared not to respond to decompression; they were not decreased compared to normal levels, although they were significantly decreased compared to levels of the chamber controls in the nonpressurized chamber. The results are discussed in relation to possible involvement of the fish's blood-coagulation system after decompression.


Scanning electron microscopy of normoxic and hyperoxic hyperbaric exposed lungs.

Lungs from adult guinea pigs exposed to 1 ATA He-O2 with 200 mm Hg PO2 and 20 ATA He-O2 with 200, 400, and 600 mm Hg PO2 were studied with scanning electron microscopy. The appearance of normal alveoli is described. Even before pulmonary O2 toxicity became symptomatic, subtle changes occurred in the alveoli, such as an increase in macrophages and a marked increase in length of alveolar type-II cell microvilli. These changes occurred in animals exposed to 400 mm Hg PO2, heretofore considered below toxic levels. With increased toxic involvement, the number of alveolar type-II cells increased. A thick layer of material appeared in some of the alveoli, obscuring the Kohns pores and type-I and -II cell surfaces. The alveolar-capillary network with underlying erythrocytes was no longer observable. Lungs with the greatest toxic involvement possessed large numbers of macrophages encompassed by a fibrin-like matrix. The alveolar walls were broken down in many instances, and the alveoli were no longer discrete units but took on the appearance of an amorphous mass of lung tissue.


[Localization of urinary infection after antireflux surgery (author's transl)].

Bladder wash-out tests were performed in a series of patients after successful antireflux surgery. The majority (65.5%) of infections were localized in the bladder, even if the IVP demonstrated signs of pyelonephritis (renal scarring and calcieal clubbing). 21.3% of the tests demonstrated a participation of the upper urinary tract. The bladder bacteriurias were interpreted as reinfections, and also some of the supravesical bacteriurias. In other cases, this differentiation could not be made.


Subcapsular pyelolithotomy for recurrent renal calculi.

Subcapsular pyelolithotomy was performed in 28 patients who had earlier undergone either one or more operations in the same kidney for renal calculi. This approach was useful in salvaging the kidney even in the presence of dense perirenal and periureteric adhesions obscuring the normal anatomy of these structures. Serious consideration should be given to this procedure before making the decision to perform nephrectomy in such cases. Surgical technique and the results are discussed.


Effects of prolactin and dihydrotestosterone upon the rat prostate gland.

The simultaneous subcutaneous injections of dihydrotestosterone (0.5 mg/kg) and/or ovine prolactin (5 or 50 IU/kg) to mature castrate rats for periods of 5-10 days led to an augmentation of prostate gland levels of RNA, DNA and protein. Of the various lobes of the prostate gland, the dorsal portion seemed to be particularly sensitive to the effects of the combined hormone treatment. In general, the highest dose of prolactin (50 IU/kg) and the longer duration of administration (10 days) produced the most consistent augmentation responses between dihydrotestosterone and prolactin as compared to those rats receiving only androgen. These findings reveal that certain lobes of the prostate are more responsive to hormonal interactions, but do not clarify the mechanisms involved in causing such enhancements of prostate cell growth and proliferation.


[The use of human dura in urology, except as a substitute of urinary bladder (author's transl)].

The human dura cannot only be used to replace the urinary bladder wall, but also to replace the capsula fibrosa of the kidney for transposition of aberrant vessels in hydronephrosis, for interposition in vesicovaginal fistula, for suspension of the urethra in stress incontinence and to replace the tunica albuginea of the corpus cavernosum penis after resection of plaque in Peyronie's disease.


Right ovarian vein syndrome with contralateral ovarian cyst.

A 39-year-old woman with right ovarian vein syndrome accompanied by contralateral ovarian cyst is reported. Removal of the left ovarian cyst with right ureterolysis for removal of the mechanical obstruction gave a good result. It is concluded that the etiology in this case was compression of the ureter by the enlarged ovarian vein, which had an increased blood flow from contralateral venous anastomose.


[Experience with a one-stage hypospadias repair (author's transl)].

33 single-stage hypospadias repairs are reported, which were performed within 2 years. The operative technique is described. In two cases, fistulas developed and required operative treatment. The average follow-up was 13.5 months. 28 cases showed good functional and cosmetical results. Three cases required additional surgery to improve the cosmetical result. The Allen-Spence-Hoffman-Hall one-stage technique has proved to be suitable to correct a distal hypospadias without chordee.


Leiomyosarcoma of renal vein.

Primary leiomyosarcoma of the renal vein has not been previously reported in the urologic literature. A case report with long-term survival is described and the literature reviewed.


Splinting in pyeloplasty.

Over a ten-year period, 129 patients with idiopathic pelviureteric obstruction were randomly selected for splinted or unsplinted pyeloplasties. Of these groups, the patients with splinted pyeloplasties had a lower incidence of postoperative complications. The long-term results were similar in both groups.


Prostatic carcinoma. relationship between primary tumor, histologic grade, and response to chemotherapy.

This National Cooperative Study has randomly compared the usefulness of 5-fluorouracil (5-FU), cyclophosphamide (Cytoxan) and standard therapy in patients with advanced carcinoma of the prostate (Stage D). All patients studied were endocrine failures and were in progression. Favorable responses were seen with all three treatments regardless of histologic grade. Actual tumor regression occurred only in patients who received either 5-FU or cyclophosphamide. In patients with poorly differentiated or anaplastic tumors treated with cyclophosphamide, progression of disease was significantly less rapid than in patients treated with 5-FU or standard therapy. However, favorable responders could not always be identified in advance on the basis of histologic grade alone.


Simple screening test for significant bacteriuria in urine. Catalase determination by disk flotation method.

Colony count cultures and catalase determinations were done on 294 urine samples in two series of patients at Royal Victoria Hospital. Thirty-six specimens were reported to be positive by colony count and by catalase determination. A total of 135 specimens found to be negative by colony count were also negative by the disk flotation test. Catalase activity in 4 urines reported as false negative were found to contain 6,000 or less colonies per ml. More than 50 per cent of the false positive results could be attributed to the presence of red blood cells. Data were insufficient to explain the remaining false positive catalase determinations. However, catalase determinations by the disk flotation method proved to be a successful screening test for significant bacteriuria.


Problems associated with Gibbons ureteral catheter.

Two recent cases of bilateral ureteral obstruction secondary to benign retroperitoneal  fibrosis were treated initially with Gibbons indwelling ureteral catheters. Inadequate catheter length, calyceal stone formation, catheter encrustation, and distal migration form the basis for this report.


Preoperative irradiation and cystectomy in 135 cases of bladder cancer.

The updated experience of the McGill Teaching Hospitals in treating cancer of the bladder with short course, high-dose radiation and immediate cystectomy is presented. Five-year life table survival for the 135 patients so managed was 43.9 per cent. Survivorship at five years was 34.5 per cent in high-stage disease and  64.1 per cent in low-stage disease. It was concluded that preoperative radiation and surgery as outlined in selected cases remains an effective method of management.


Ectopic penile testis.

A case of a rare form of penile testicular ectopia is reported. The embryology is discussed, and ectopia is differentiated from cryptorchism.


Necrotic testicle with increased blood flow on Doppler ultrasonic examination.

A twelve-year-old male with a five-day history of scrotal swelling and pain had increased blood flow on ultrasonic examination. A testicular flow and scan indicated an ischemic testicle. Surgical exploration revealed complete torsion of the spermatic cord. In chronic cases of torsion, the Doppler stethoscope may give a false negative result because of reactive hyperemia.


Diagnostic significance of levels of immunoglobulin A in seminal fluid of patients with prostatic disease.

Immunoglobulin A (IgA) levels in semen and in prostatic fluid of 48 patients with benign and malignant diseases of the prostate were estimated. It is speculated from this small study that the IgA levels rise in benign prostatic hyperplasia; in early adenocarcinoma of the prostate (Stages A and B) the rise if furthered, while in the late stages (Stages C and D) the levels fall.


Extraosseous myelomatosis. Clinical presentation with symptoms in lower urinary tract.

We believe this to be the first case reported of extraosseous myelomatosis seen clincally with lower urinary tract symptoms. Extraskeletal spread of myelomatosis which reportedly occurs in two thirds of cases is discovered postmortem. Immunoglobulin A prevails in this type of myelomatosis. Clinical course and autopsy findings are discussed.


Nephrogenic metaplasia (adenomatoid tumors) of bladder.

Two cases of rare nephrogenic metaplasia of the bladder (adenomatoid bladder tumor) support the theory that these tumors originate as an atypical metaplastic response of urothelium to chronic infection or irritation. That these may also represent mesonephric or mesothelial choristomas is considered. Although benign, they may recur. Therapy should consist of antibiotics and transurethral resection or fulguration.


Renal masses with unusual angiographic appearances.

Despite modern methods in evaluating renal masses a small percentage of cases remain elusive to preoperative diagnosis. The authors discuss ten renal masses with heterogeneous pathology seen at their service within the last two years. An outline of the difficulties in arriving at a correct preoperative diagnosis is discussed. The clinical findings and pathology encountered are evaluated.


Radiologic features of adrenal metastases.

The incidence of adrenal metastasis is surprisingly high with certain types of malignant neoplasms such as carcinoma of the breast and lung, and melanoma. Since adrenal metastases are usually clinically silent, radiologic findings assume greater importance. The radiologic features found in 21 patients with proved adrenal metastases are presented.


Ureteral changes in Gardner's syndrome simulating retroperitoneal fibrosis.

The development of desmoid tumors in patients with Gardner's syndrome may produce ureteral findings on excretory urogram which, by themselves, are indistinguishable from other causes of retroperitoneal fibrosis.


Ring-shaped calcification of renal mass.

A case of peripherally calcified renal mass is presented which was interpreted as being a benign, calcified, developmental nephrogenic cyst. A differential diagnosis of calcified renal masses is presented.


[Use of gelvisol in the early postoperative period in patients with diseases of the abdominal organs].

The substance gelvisol obtained in Leningrad Research Institute of Hematology and Blood Transfusion was employed in 198 patients with abdominal organs pathology. There was noted a positive effect of the peroral plasma substitutor on the circulatory blood volume and its components, electrolytic balance, general condition of the operated patients. The authors have elaborated the method of gelvisol administration both per os (30-50 ml each 1-2 hours; up to 1000-2000 ml a day) and in intraintestinal administration via a sound.


[Clinical characteristics, selection of the method and results of treatment of nonspecific spontaneous pneumothorax].

Under observation were 144 patients, aged from 16 to 74 years, examined and treated for nonspecific spontaneous pneumothorax observed in 161 cases. Most patients (96) were under 40. The development of pneumothorax in most of them might be related with previously suffered diseases of the respiratory tract and lung. The clinical picture of spontaneous pneumothorax and its therapy are described.


[Selection of the methods of functional examination of patients with lung diseases in the preoperative period].

The authors report indications and contraindications to using different methods of functional diagnosis of the ventilatory and circulatory systems in patients with lung diseases in the postoperative period. It is felt that in each particular case different methods of functional diagnosis should be employed differentially, taking into consideration individual peculiarities of the patient and his affection. It is necessary to use the methods that would provide the maximum useful information, but not to use them following the principle of transfer from simple to more complex procedures.


[Certain properties of the extravasate effused into pleural cavity after thoracic surgery].

Data on morphological and biochemical properties of the postoperative extravasate are reported in 102 patients in different terms postoperatively. There is a reduced number of erythrocytes, amount of hemoglobin and thrombocytes in the extravasate. The number of leucocytes in the latter corresponds to their amount in peripheral blood. Free hemoglobin ranged from 6 to 125 mg%, and its concentration depends on traumatism and duration of surgery. There is no fibrinogen in the extravasate and a decreased fibrinolytic activity. Bacterial contamination of the extravasate is dependent on the character of a surgical procedure. The extravasate sterility is supported by its apyrogenic and nontoxic action on rabbits and mice. Determination of the amount of leucocytes, sugar, alpha-2 and beta golbulins in the extravasate 18 hours following the operation is of a diagnostic value for early recognition of inflammation in the pleural cavity.


[Causes of recurrences of mitral stenosis].

The authors present an analysis of the late results of closed mitral commissurotomy in 364 patients (maximum terms of observation--17 years). Main causes of recurrent mitral stenosis were recognized: activation of a rheumatic process (50%), nonspecific scarring processes (27%), inadequate commissurotomies (11.1%) and others (11.1%). The routine antirheumatic therapy (bicillin+salicylates) was found to be ineffective in prophylaxis against mitral restenoses. Recurrent mitral stenosis proved to occur more frequently in patients operated upon in young age (under 30).


[Possibilities of using the internal jugular vein as an autovenous transplant in surgical treatment of portal hypertension].

As an autovenous graft in surgical treatment of portal hypertension the authors suggest to use the one obtained by means of resection of one of internal jugular veins. Based on studies of the literature data and personal experiments with 500 anatomical preparations of the skull and 49 fresh cadavers, the authors substantiate physiological permissibility of resection of one of internal jugular veins in the absence of marked asymmetry of internal jugular foramena of the cranial base, that is a criterion of symmetric venous outflow from the cranial cavity and of the possibility of its redistribution. The mentioned operative technic was employed by the authors clinically in one patient with a extrahepatic form of portal hypertension, subjected previously to splenectomy. The result of this intervention after a year and a half was estimated as being quite favourable.


[Immediate and remote results of treatment of hepatic echinococcosis].

The immediate results of treatment in 493 patients, in whom 573 operations were accomplished, are analysed. Postoperatively, complications developed in 47.5%. The longterm results were studied in 284 patients within the the terms from 1 to 25 years. The signs of hepatitis were observed in 72, chronic fistulas--in 68, postoperative hernias--in 13, a decreased working capacity and disability--in 32. Recurrences were noted in 52 cases, including true recurrences in 11.


[Blood coagulation and blood electrolytes in obstructive jaundice].

An examination of 76 patients with obstructive jaundice of cholelithic and tumor origin indicated an association of manifest hypocoagulation properties of blood with the absolute kalium deficiency in blood. In 54 patients postoperatively following restoration of bile passage in the bowel a progressive decrease in kalium concentration and an increase of sodium in erythrocytes were associated with a simultaneous enhancement of coagulation properties, and vice versa an increased kalium and decreased sodium content in erythrocytes was associated with a hypocaugulation tendency. It is evident that activation or suppression of hemocoagulation is dependent on the state of multiple factors of blood coagulation system in altered electrolytic medium and on eletrolytic reconstruction of erythrocytes.


[Diffuse polyposis of the large intestine as a precancerous condition].

In 86 (49.4%) of 173 patients cancer of the colon of various localizations against the background of diffuse polyposis was diagnosed, rectal involvement being noted in 50%, cancer involvement of the cecum involvement of the cecum and ascending colon--in 5.4% and 7.2% accordingly. These data made it possible to revise an existing concept of preservation of the rectum in radicalsurgery for diffuse polyposis in favour of remaining right portions of the colon.