Pulmonary management of the urologic patient.

Morbidity and mortality from pulmonary complications following urinary tract operations can be reduced by preoperative identification of the high risk patient. Pulmonary function tests and arterial blood gases are necessary to identify these patients and to delineate the severity of their pulmonary disease. Respiratory complications can be prevented in many patients with the proper use of pre- and postoperative chest physical therapy and oxygen therapy. Despite the most careful pulmonary management, some patients develop acute respiratory failure following urologic operations. Respiratory failure results from a combination of physiologic abnormalities which impair alveolar ventilation and oxygenation. Utilizing controlled ventilation, supplemental oxygen, and a physiologic approach to treating the underlying cause of respiratory failure, three fourths of urologic patients in respiratory failure may be expected to survive.


The hematologic evaluation of the urologic patient.

This article provides a framework for the hematologic evaluation of the urology patient. The discussion is based on an analysis of test results obtained from routine screening laboratory studies as the complete blood count and platelet count. The use of automated blood counts also provides quantitative indices of red cell morphology which facilitate the diagnosis of red blood cell disorders. To aid in categorizing hematologic disorders, abnormalities of the red blood cells, white blood cells, and platelets are discussed separately. In some circumstances where a disease process, such as bacteremia, alters more than one of the formed elements of the blood, this speparate analysis approach is less appropriate. Nevertheless, this division is generally useful in arriving at the correct interpretation of hematologic abnormalities. Within each category of abnormal test results, a variety of etiologies is listed. Elaboration is reserved for the entities commonly seen in hospitalized patients. For a more detailed discussion of the common disorders or for a more inclusive listing of the less common disorders, the bibliography lists a selection of useful references.


Pre- and postoperative renal failure.

The acute onset of oliguria and azotemia in the postoperative setting may be caused by pre-renal causes or intrinsic renal damage. The first step in arriving at a diagnosis is to review the history as noted above for clues regarding fluid balance, treatment with nephrotoxins, etc. The typical patient with prerenal azotemia will present with evidence of the recent onset of worsening of pre-existing cardiac disease, renal or gastrointestinal fluid loss, or the accumulation of acites, edema, or retroperitoneal fluid. In the absence of very recent diuretic therapy, he will be excreting a scant amount of concentrated (greater than 400 mOsm per L) sodium free (less than 10 to 20 mEq per L) urine. The serumBUN/Cr ratio is often greater than 15 to 20:1, and their urinary sediment will be bland. In an occasional patient in whom these studies give equivocal results, additional help may be obtained with measurements of central venous pressure (CVP) or pulmonary wedge pressure (PWP) and by noting their response to intravenous fluid loading. A rising CVP or PWP in the face of salt loading is, of course, evidence against prerenal azotemia. Patients with obstructive uropathies may be oligoanuric or polyuric-occasionally a characteristic alternating polyuria and oliguria is found (due to displacement of a stone or relief of edema). When oliguric their urine typically contains substantial amounts of sodium (greater than 20 mEq per L), is isotonic, and their OsmU:OsmP is les s than or equal to 1.2. Their urinary sediment will reflect the cause of their obstruction as noted above. A renal scan, ultrasound study, or infusion IVP are mandatory to rule out the possibility of obstructive uropathy. If these nonivasive studies are equivocal, one must consider doing a unilateral retrograde. The development of ATN usually occurs in the setting of hypotension, sepsis, dehydration, and with exposure to nephrotoxins. Most patients with be excreting scant amounts of isotonic urine containing more than 20 to 30 mEq per L of sodium. Their CrU:CrP is less than or equal to 20:1 and their urinary sediment reveals many epithelial cells and casts. Those patients with nonoliguric ATN have urine outputs which may exceed 2 liters per day. Despite this output they demonstrate a stepwise increase in serum urea and creatinine. Urine sodium and osmolality are not very helpful in this setting. Many such patients do have low (less than 20 mEg per L) urine sodium concentration and excrete isotonic urine.


Hazards to bladder and intestinal tissues from intravesical underwater electrical discharges from a surgical electronic lithoclast.

Previous studies have shown that electronic lithoclast discharges produce effects resembling an underwater explosion. It was predicted that the shock wave produced by each discharge could damage nearby gas-containing gut through a mechanism known to be associated with underwater detonations. Effects associated with rapid oscillation of the vapour bubble produced could cause damage to the wall of the bladder. Investigation of lithoclast discharges in vivo on goat, and in vitro on sheep bladders demonstrated perforation of both. In vitro studies in the rabbit demonstrated the predicted greater susceptibility of air-filled gut over that filled with fluid. These hazards would be even greater in the ureter and caution in the use of electronic fragmentation of vesical and ureteric calculi is urged in the light of these findings.


Denudation of the urinary bladder mucosa in the cat by formaldehyde.

Chemical Stripping of the urinary bladder mucosa was studied in 38 cats using 5 to 25% formaldehyde solutions. The contact time varied from 1 to 20 min. With a 20% solution and contact time of 1 min, total denudation was possible without necrosis of subepithelial layers. In such cases, complete reepithelialisation and normal bladder dynamics were seen within 3-4 weeks after formaldehyde instillation. Signs of formaldehyde intoxication due to vesical resorption were not observed.


A morphological study of the prostatic lobes and the seminal vesicles of castrated rats injected with oestradiol and/or insulin.

The growth of the ventral and dorsolateral prostate, the coagulating glands and the seminal vesicles was studied morphologically in castrated rats following 21 daily injections of oestradiol benzoate or protamine zinc insulin alone or in combination. Oestradiol benzoate was given in daily doses of 0.010 mg, protamine zinc insulin in daily doses of 10 IU. In the ventral and dorsolateral prostate oestradiol had an androgen-like action inducing epithelial growth and secretory activity in the epithelium. In the seminal vesicles and coagulating glands oestradiol induced an increased fibromuscular growth. Protamine zinc insulin induced growth and secretory activity in the dorsolateral prostate, while no such effect was observed in the other accessory reproductive glands. Protamine zinc insulin accentuated the androgen-like action of oestradiol benzoate on the epithelium of the dorsolateral prostate but did not influence on the increased fibromuscular growth seen after oestradiol in the coagulating glands and the seminal vesicles.


[New aspects in the treatment of oxalate lithiasis (author's transl)].

The causes of hypercalciuria and simple diagnostic criteria for the various forms of hypercalciuria are outlined. Indications, effectiveness, limitations, and side effects of cellulose phosphate are described. Emphasis is placed on the biochemical pathogenesis and classification of hyperoxaluria. The problems of measuring and controlling oxalate excretion in patients with hyperoxaluria and calcium oxalate stones are discussed. Succinimide offers a partly successful approach to the reduction of endogenous oxalate synthesis.


[Calcium and magnesium concentrations in "Healthy" and lithiasic human kidney (author's transl)].

Calcium and magnesium levels in the cortex, medulla, and papilla of human kidney from 32 so-called healthy patients and from eleven patients with calcium-oxalate lithiasis were determined by atom-absorption spectralphotometry. A positive calcium gradient with the highest calcium concentration in the papilla was found in all kidneys. Compared to the control group, that calcium concentration in the lithiasic kidneys was reduced by 50% in the papilla, but in the cortex and medulla, the levels were the same. A relative depletion of calcium in the papilla in hypercalciuria goes against the theory that the papilla is the main center of development of calcium-containing stones. The magnesium concentration was practically the same in cortex, medulla, and papilla, and no significant difference was found between lithiasic and healthy kidneys. These findings underline the central role of calcium in the genesis of calcium-containing stones.


[Intraoperative use of an image intensifier in coral calculus operations (author's transl)].

The applicability of the image converter in kidneys stone operations, and particularly in coral calculus operations, is discussed. A comparison is made with other X-ray methods and the advantages of an extended area of use of the image converter is presented.


[The bladder-stone punch--a new principle of visual lithotripsy (author's transl)].

Description of a bladder-stone lithotriptor which works similarly to a punch resectoscope. This 24 French instrument can be used in simultaneously with electrohydraulic lithotripsy (Urat I), i.e., stones of the size of a cherry can be simply punched, while all larger stones may be destroyed first by electrohydraulic lithotripsy and then cut into smaller pieces for removal with the punch. The instrument, with irrigation qualities and a sight like a resectoscope, allows a quick operation, so that lithotripsy and TUR of the prostate may be performed opportunely.


[Electrial aspects of transurethral resection with high-frequency currents (author's transl)].

With the help of electrical models the current-density distributions within the human body during transurethral resection have been measured for systems with various electrodes. The results lead to rules for avoiding mistakes.


[Gastrointestinal fistulae of the upper urinary tract (author's transl)].

A case of ureteroduodenal fistula is presented. The subject of gastrointestinal fistulae of the upper urinary tract is reviewed. These fistulae usually exhibit a sparse atypical symptomatology in contrast to fistulae of the lower urinary tract. Retrograde ureteropyelography proves to be the most helpful diagnostic tool. Removal of the involved kidney has been found to be necessary in most of the published cases.


[Development of an implantable artificial urinary sphincter (author's transl)].

Fifteen years experience with investigations of the neurologic aspects of lower urinary tract function has produced a therapeutic rationale that includes utilization of prosthetic devices in selected patients. Development of an implantable artificial sphincter evolved as a necessity for restoring urinary continence became apparent. The experimental design of animal models and the technologic methods in device development are herein described.


[Inverted urothelial papilloma (author's transl)].

Casuistic report dealing with the observation of an inverted papilloma arising from the pars prostatica urethrae. By means of the literature, clinical and pathologic problems of this scarcely known neoplasm, which was not delimitated in the German literature before 1963, are discussed.


[On the size of the male urethra. Consequences of transurethral prostatic resection (author's transl)].

More recently it has been claimed by some authors that a disproportion between the size of the resectoscope and the lumen of the urethra is supposedly the cause of urethral strictures following transurethral prostatic resection. For this reason the use of resectoscopes no larger than 24 F in size has been urged. Reports in the literature as well as our own investigations in connection with the transurethral resection by cold punch technique cast some doubt on the wisdom of this statement as long as other causes, such as thermal damage during electroresection, are not definitely excluded.


[Transurethral resection in patients with cardiac pacemakers (author's transl)].

Problems of transurethral resection in patients with cardiac pacemakers are discussed. Various complications caused by interference of cutting and coagulating currents with the pacemaker system and their possible prevention are pointed out. It is concluded that transurethral resection by cold punch technique has significant advantages over electroresection in patients with a cardiac pacemaker.


[Influence of anthraquinones on the formation of urinary calculi in experimental animals (author's transl)].

The growth-inhibiting influence of hydroxy-anthraquinone derivatives of root of rubia in various calcium offerings was investigated using a foreign-body bladder calculus model in rabbits. Following oral doses of glycoside-bound and free aglycemics a pronounced calcium-complex binding effect and a significant reduction in the growth rate of the calculi was observed. Use of anthraquinone glycosides to prevent recurrence of calcium-containing urinary stones is recommended.


On the structure and importance of the epithelium in the human ductus epididymidis (author's transl).

In the wall of the ductus epididymidis rosette-like crystalloids and in the epithelium three types of cells are to be found: round basal cells, pale cylindrical epithelium and dark cylindrical epithelium. The latter shows a high metabolic activity with lamellar rough ergastoplasm and low vesicular secretion. Apocrine separation of drops of secretion is seen only sporadically. The functional relations between these states, the possibilities of biosynthesis in the epididymis, and the maturing of spermatozoa are discussed.


Renal arteriovenous fistulas.

A review of the literature reveals that aggressive treatment of symptomatic intrarenal arteriovenous fistulas, whether by surgical or radiologic techniques, is generally indicated. The exception is those fistulas which result from closed renal biopsy since these usually heal spontaneously. The ultimate goal of any form of therapy is the maximal preservation of renal tissue. Methods of treatment are discussed, and a review of classification, etiology, incidence, symptoms, physiologic consequences, and means of diagnosis is given. A case of post-traumatic intrarenal arteriovenous fistula with ipsilaterally elevated renal vein renin and hypertension, cured by partial nephrectomy, is presented.


Control of renal arterial bleeding after percutaneous biopsy.

Transcatheter arterial embolization is becoming an accepted method of controlling massive acute hemorrhage, including that secondary to blunt and penetrating renal trauma. Two patients with retroperitoneal bleeding postrenal biopsy and angiographically proved pseudoaneurysms at the biopsy sites had successful embolization without sequelae. Experimental and clinical experience with transcatheter embolization is reviewed. It appears that this modality is a safe, effective way of controlling renal hemorrhage.


Medical management of refractory hematuria in sickle-cell trait.

Hematuria secondary to sickle-cell trait has on occasion proved refractory to medical management. We have adopted a new six-drug regimen to deal with this difficult problem. Herein is reported our experience with this protocol in 2 patients. Our results have been excellent, with hematuria clearing within twenty-four hours. The drug regimen is used in an attempt to alter the conditions that are favorable for sickling in the renal medulla.


Nonoliguric renal failure after transurethral prostatic resection.

Six cases of acute nonoliguric renal failure following transurethral prostatectomy were studied. This condition usually has a milder clinical course than the oliguric type; but some patients will need dialysis and fatalities can occur. Although it is relatively rare, every urologist shoud be aware of the entity. The first clue is usually increasing azotemia despite a normal or increased urine output.


Clinical significance of serum acid phosphatase levels in advanced prostatic carcinoma.

This cooperative study was sponsored by the National Prostatic Cancer Project to determine the usefulness of serum acid phosphatase levels as a predictive indicator with regard to performance status, sites of metastases, response to treatment, and survival in patients with advanced prostatic carcinoma. The results indicate that survival was significantly shorter for those patients who had elevation of thier on-study (pretreatment) total serum acid phosphatase ler cent reduction of primary tumor mass, relief of pain, and acid phosphatase activity. No correlation could be demonstrated between serum acid phosphatase and performance status, site of metastases, and other criteria of response to therapy. It is concluded that this test as currently determined spectrophotometrically at this stage of disease and if employed alone is not sufficient to allow for total evaluation of the response of therapy. It is, however, helpful when used in correlation with the previously mentioned positive factors.


Urinary amino acid excretion patterns in cancer of prostate.

The excretion of urinary amino acids obtained from acid hydrolysates were studied by gas chromatographic analysis in 16 normal male subjects and 48 patients with cancer of the prostate. There were no significant differences of the most commonly excreted amimo acids in normal or patient groups or between patients with different stages of the disease because of the large variances of excretion within groups as a whole. However, with few exceptions, the patient group excreted isoleucine whereas isoleucine excretion was not detected in the normal subjects under the same experimental conditions. These findings suggest that measurement of the urinary  excretion of isoleucine may be a useful parameter for the early detection of prostatic cancer.


Prostatic tissue and fluid concentrations of trimethoprim and sulfamethoxazole: experimental and clinical studies.

The concentrations of trimethoprim and sulfamethoxazole were determined in prostatic fluid and tissue of the dog after constant intravenous infusion. Concentrations of trimethoprim in both prostatic fluid and tissue exceeded the simultaneous serum concentrations, whereas the sulfamethoxazole prostatic fluid and tissue concentrations were much lower than the simultaneous serum concentrations. Prostatic tissue obtained from patients undergoing transurethral resection of the prostate also contained trimethoprim in higher but sulfamethoxazole in lower concentrations than the simultaneous serum concentrations after oral administration of these drugs preoperatively. In a patient with urinary diversion, trimethoprim was found in prostatic fluid in concentrations as high as forty-four times the simultaneous serum concentrations whereas sulfamethoxazole was found in concentrations representing only a fraction of the simultaneous serum concentrations. These findings lend support to the use of trimethoprim in the treatment of bacterial prostatitis.


Use of dantrolene sodium in external sphincter spasm.

In various neurologic and non-neurologic diseases inappropriate hypertonicity of the external sphincter during micturition may cause outlet obstruction. Heretofore therapy for these disorders has been surgical: pudenal neurectomy or external sphincterotomy. These procedures are not without complication (incontinence, impotence, hemorrhage). A medical approach to this disorder is therefore warranted. In a selected group of patients with external sphincter spasm diagnosed by concitant sphincter electromyography, cystometrography, and voiding cystourethrography, dantrolene sodium (Dantrium) therapy was instituted. Follow-up studies have shown this drug to be effective in treating this disorder.


Management of priapism by: cavernoglandular shunt.

Cavernoglandular shunt is a new simple operation consisting of the formation of a window between the corpus cavernosum and glans penis to establish drainage of trapped blood from the corpora cavernosum.


Hypospadias: results of surgical treatment and perspectives in management.

An institutional experience with the repair of hypospadias over a fifteen-year period is reviewed. The 119 patients treated surigcally serve as the substance of this report. Recommendations concerning options in surgical treatment are predicated on this experience and the contemporary literature.


Malignancy associated with horseshoe kidney.

A compilation of the reported cases of cancer in horseshoe kidney from 1895 to 1975 is presented along with a comparison of the incidence of the various types of tumor involved from 1895 to 1966 and 1966 to 1975. An additional case of hypernephroma is added to the literature for a total of 111 cases reported to date. The increase incidence of both carcinoma of the renal pelvis and nephroblastoma is discussed.


Traumatic rupture of horseshoe kidney with partial ureteral duplication associated with supernumerary kidney.

The first reported case of traumatic rupture of a horseshoe kidney with partial ureteral duplication and an associated supernumerary kidney is presented. A review of the incidence, hypothesis of embryogenesis, associated anomalous development, and acute surgical management of this unique renal anomaly is provided.


Congenital varicella syndrome with genitourinary anomalies.

A female child, born at term to a mother who contracted varicella in early pregnancy, presented with multiple congenital defects. These included mental retardation, numerous skeletal anomalies, and absent uterus and vagina. Urologic anomalies included bilateral chronic pyelonephritis secondary to vesicoureteric reflux. This pattern of congenital abnormalities has not been reported previously.


Bilateral successive testicular cancer of different cell types.

The fourth case of bilateral successive testicular tumors of different cell types is reported (seminoma and embryonal carcinoma), and the English literature on bilateral testicular tumors from 1965 to 1975 is reviewed. The absence of direct organ extension or demonstrable metastatic lymphatic or vascular involvement points to the primary origin of these lesions.


Endometrial carcinoma of prostatic utricle with osseous metastases.

Endometrial carcinoma of the prostatic utricle is a rare pupillary prostatic tumor arising in the region of the prostatic urethra and verumontanum. Since the first description by Melicow and Pachter in 1967, 8 additional cases have been reported. This case is the tenth reported, and the first in which metastases to bone have been proved by biopsy. Transurethral resection of the tumor with postoperative radiation therapy to the prostatic region and metastases has resulted in clinical improvement. The importance of accurate diagnosis of this neoplasm is emphasized to avoid unnecessary delay in the appropriate choice of therapeutic modalities.


Benign fibrous paratesticular tumors.

Utilizing the criteria of Goodwin, a case each of chronic proliferative periorchitis and multiple fibromas of the tunica vaginalis testis causing paratesticular tumors is presented and discussed. Both of these rate processes appear to be distinct and separate clinical entities, although they appear to be similar histologically. With increased awareness by those treating intrascrotal masses, these processes may be correctly recognized and more testes may be salvaged.


Coexisting avascular lesions and renal cell carcinoma.

An analysis of 99 cases of coexisting renal avascular lesions and renal cell carcinoma suggests that: (1) a direct pathogenetic relationship exists in the majority; (2) the cyst-related carcinoma tends to occur at an earlier age; (3) angiography alone is not reliable for the diagnosis of an apparently benign renal mass, and (4) individuals with polycystic kidneys share at least an equal risk of renal carcinoma as the general population.


Intrarenal pheochromocytoma: preoperative angiographic diagnosis.

This report documents the angiographic, urographic, and tomographic findings in a patients with a pheochromocytoma within the renal capsule and separate from a normal adrenal gland.


Recertification of professional competence. American Board of Ophthalmology.

Recognizing the steady expansion of medical knowledge, the societal desire to ensure the best possible medical care, and governmental concern for verification of physician competence, the American Board of Ophthalmology is preparing to offer a voluntary recertification program for Diplomates of the Board who wish to establish current professional competence. Pertinent to this program, consideration is given to the rationale for periodic recertification, relevant actions by representative specialty boards and the American Board of Medical Specialties, and fuidelines for development of a recertification process by the American Board of Ophthalmology. These guidelines are set forth to provide a basis for study and evaluation by all interested parties. By  thoughtful, broadly based, and coordinated consideration, policies will evolve to serve concurrently the best interest of the general public and of the ophthalmic profession.


Pars plana vitrectomy. Microsurgical pars plana lensectomy.

Pars plana lensectomy, wherein the entire lens within the pupillary area (the anterior capsule, anterior cortex, nucleus, posterior cortex, and posterior capsule) is removed, is now a well-established technique. It is to be considered as a method of choice for the removal of presenile cataracts in patients under the age of 40, developmental cataracts, cataracta complicata secondary to uveitis, subluxated and luxated cataracts. Pars plana lensectomy of the senile cataract is limited to a grade 2 nuclear sclerosis on a scale of 4. The use of ultrasonic instrumentation via the pars plana in conjunction with vitreous instrumentation permits the removal of the grade 3 nuclear sclerotic cataract. A pars plana two-instrument technique is used for the extraction of the totally luxated senile cataract no matter how sclerotic the nucleus may be.


Pars plana vitrectomy. Vitrectomy treatment of vitreous opacities.

Twenty-one patients suffering from vitreous opacities caused by central- and branch-vein occlusion, sickle cell retinopathy, retinal vasculitis, endophthalmitis, hypertensive retinopathy, and uveitis underwent pars plana vitrectomy with the vitrophage. Intraoperative complications included retinal tears in two eyes with sickle cell retinopathy and tractional retinal detachment. Both were successfully treated. Postoperative complications were recurrent vitreous hemorrhage, hemolytic glaucoma, and corneal blood staining in a patient suffering from sickle cell retinopathy. Long-standing corneal edema was observed in patients suffering from endophthalmitis. Visual acuity improved in 95% of our patients and was worse in 5% of the patients.


Pars plana virectomy. Preoperative evaluation.

We have outlined the essential considerations in evaluating patients for closed vitrectomy and have attempted to show the importance of each. In general, we recommend closed virectomy under the following conditions: (1) vitreous opacities showing no resolution after six months of observation, (2) vision which is worse than 20/200 but has at least light perception with accurate projection, (3) there is no rubeosis iridis or glaucoma, (4) ultrasonography, ERG, and VER reveal a functional retina and optic nerve, and (5) the benefit outweighs the risk of surgery.


Pars plana vitrectomy. Vitrectomy in diabetic retinopathy.

In spite of the rather high rate of complications, it is clear that in selected cases of proliferative diabetic retinopathy with massive long-standing vitreous hemorrhage, significant improvement can be accomplished by pars plana vitrectomy. However, the number of eyes recovering 20/40 vision or better remains small (7% in our series at 9 to 15 months postvitrectomy), and consideration needs to be given to means to improve these figures. Whether vitrectomy at an earlier stage of the retinopathy can accomplish this is the subject of an upcoming cooperative study under the sponsorship of the National Eye Institute.


Pars plana vitrectomy. Vitrectomy technique in anterior segment surgery.

Instrumentation and techniques developed primarily for vitreoretinal surgery were used to treat 20 eyes with an occluded or inadequate pupillary space and 5 aphakic eyes with complications caused by formed vitreous in the anterior chamber. A pars plana approach was used in 19 eyes and a limbus approach was used in 6 eyes. In every eye an adequate pupillary space was provided and all formed vitreous was removed from the anterior segment. No intraoperative complications occurred. This new approach to selected cases of  anterior segment surgery offers several advantages over conventional techniques. A larger number of cases and longer period of follow-up are necessary to further define the specific indications and limitations of this technique.


Pars plana vitrectomy. The role of vitrectomy in penetrating ocular injuries.

Pars plana vitrectomy and related procedures occupy an important role in the management of perforating injuries. Vitreous surgery is particularly important in rendering retinal detachments observable and operable. The frequent postvitrectomy complication of delayed retinal detachment appears to be reduced with prophylactic encircling scleral buckle procedures. Although certain categories of injuries continue to carry a poor prognosis, earlier surgical intervention promises improved results.


Pars plana vitrectomy. The role of vitrectomy in traumatic vitreopathy.

Debridement of the vitreous from perforating injuries can be more effectively and expeditiously accomplished with the aid of vitreous suction and cutting instruments than with conventional sponge-forceps technique. This technique is of great value as part of primary closure of perforating ocular injuries. In addition, trauma which results in (1) lens rupture with expulsion of the lens material into the vitreous; (2) massive vitreous hemorrhage with ciliary body laceration or posterior globe laceration; (3) retinal detachment with vitreous hemorrhage; or (4) retained reactive intraocular foreign body, requires vitrectomy. Because of inflammatory and fibroplastic changes, the earliest possible surgical intervention is recommended in these situations. Removal of lens material, reactive foreign body, or traction membranes, and early repair of retinal detachment may all be facilitated by new vitrectomy instrumentation.


Pars plana vitrectomy. Removal of preretinal membranes.

Removal of preretinal membranes in pars plana vitrectomy is achieved with the two-instrument technique by using a hooked needle or vitreous scissors, in addition to the vitrectomy instrument. Preretinal membranes are found in proliferative diabetic retinopathy, perforating injuries, and in retinal detachments with massive periretinal proliferation. Technique and results have been described in the text.


Ultrasonic fragmentation for vitrectomy and associated surgical procedures.

Ultrasonic fragmentation (USF) can be used to fragment various tissues such as the lens, the vitreous, the iris, and the ciliary body, so that they may be aspirated through a 23-gauge canula. Since the technique was first described in 1973, it has been used in 148 eyes in a variety of conditions with encouraging results. In aphakic bullous keratopathy, the corneas and vision improved in 78% of the cases. Pupillary block was relieved in 100% of cases. Cystoid macular edema improved in 63%. Vitreous opacification from other than hemorrhage cleared in all cases, and vision improved in 71%. Massive vitreous hemorrhage was cleared in 86%, and vision improved in 58%. In massive vitreous hemorrhage and retinal detachment, the vitreous was cleared and the retina reattached in 80% of cases. In massive vitreous contraction, the vitreous was removed in all cases and the retina reattached in all (100%) of cases. In massive vitreous membranes and retinal detachment, the membranes were successfully removed in 100% and the retina reattached in 82%. Lens remnants in the vitreous were removed in 100% of cases. Secondary membranes were removed successfully in 100% of cases. Vitreous presentation in the anterior chamber, caused by a ruptured posterior capsule during extracapsular extraction or actual vitreous loss during intracapsular extraction, was treated successfully in 100% of cases. One case of medullo-epithelioma of the ciliary body was removed but recurred twice after ultrasonic fragmentation. Complications occurred in seven of 148 cases (4.8%) and consisted of five cases of retinal detachment (probably because of lens material reaction) and two cases of epithelial downgrowth in cases where the wound was not closed with sutures. Ultrasonic fragmentation appears to be a fairly simple procedure, performed with a machine with no moving parts, through two 1-mm incisions and using two 0.6-mm cannulas, with a minimum of complications and encouraging results. It should be tried before more radical procedures are recommended. A good anatomic result was obtained in 129 of the 148 consecutive cases (88%). The technique is described and the results reported.


The natural history of senile retinoschisis.

The natural history of senile retionoschisis was studied by observing a series of 193 eyes of 108 nonreferred patients who had no history of significant ocular disease, while refraining from the use of any form of prophylactic intervention, for follow-up periods ranging from 2 to 11 years. One patient at the outset of the study had double layer holes, which had already led to a localized subclinical retinal detachment that had been left untreated, and did not progress during observation for more than two years. One patient developed a small asymptomatic nonprogressive retinal detachment from an outer layer hole. Four eyes showed posterior extension, but in only one was this serious. Nine eyes developed new retinal breaks, one in both layers, but none progressed in extent of retinoschisis or to retinal detachment. Of particular interest were seven eyes which showed unmistakable regression, the retinoschisis disappearing completely in six eyes. Based on reported cases, an estimated computation is made which places the probable risk of frank, progressive, symptomatic retinal detachment resulting from retinoschisis at about 0.07%. Four indications for treatment are given which are considered justified at the present state of our knowledge.


Subretinal tracts in ophthalmomyiasis.

Three cases of presumed infestation of the human globe by the maggot of a true fly (order of Diptera) are presented. In each case, migration of the maggot through the subretinal space produced widespread ophthalmoscopic and fluorescein angiographic changes which are believed to be pathognomonic of subretinal ophthalmomyiasis. Despite extensive changes in the retinal pigmented epithelium, each of the three patients expressed few symptoms and manifested minimal visual deficit.


Round atrophic holes in lattice degeneration--an important cause of phakic retinal detachment.

Round atrophic holes in lattice degeneration are an important cause of phakic retinal detachment. Detachments due solely to round holes in lattice accounted for almost 2.8% of all retinal detachments treated at Wills Eye Hospital from January 1970 to August 1973. These detachments had the following important characteristics: 1. One of the patients were under the age of 30 years. 2. Over 75% of the patients had refractive errors more myopic than -3 D spherical equivalent. 3. Inferior detachments were slightly more common than superior detachments. When located inferiorly, there was a tendency for slow progression as indicated by the frequent presence of pigmented demarcation lines. 4. Surgical repair with standard scleral buckling techniques was successful in 98% of these detachments. Young, moderate to highly myopic patients with round holes in areas of lattice degeneration seem to have a greater risk of developing this type of detachment. Patients with the triad of youth, myopia, and round holes in lattice degeneration deserve close observation.


Nuclear lacrimal scan vs dacryocystography.

The lacrimal drainage systems of 78 eyes were studied by technetium scanning at the University of Iowa and, of these, 25 were also subjected to conventional contrast dacryocystography. Twenty-six eyes were asymptomatic for epiphora and normal scans were recorded on all of them. All of the remaining 52 symptomatic eyes had an abnormal lacrimal scan with either a presac or a postsac blockage. In general, there was good correlation with dacryocystography, with the exception of three cases of functional block which had a normal dacryocystogram. Technetium scanning should serve as a valuable tool for diagnosing and localizing lacrimal obstruction.


Socket reconstruction: what really happens.

Reconstruction of contracted sockets can be extremely difficult and may result in a number of complications. Adherence to certain contraindications in attempting socket reformation can avoid some of these problems. Complications of socket reconstruction as discussed previously are (1) infection and (2) recurrent socket contracture, manifested either by extrusion of the acrylic plate placed in the orbit or by eyelid retraction.


Treatment of acute eyelid trauma to prevent late complications.

A checklist for preventing late complications of acute eyelid trauma should include recognizing injury to the globe, preventing infection, and achieving proper coaptation of the wound margins. Recognition and immediate management of lacrimal, canthal, and levator injuries and occult orbital foreign bodies may prevent late complications that are more difficult to repair.


A profile of patients with intractable blepharospasm.

Of those patients seeking surgical correction for intractable blepharopasm, the spasm was more commonly bilateral than unilateral by a ratio of about 7:1 and the bilateral form was more common in women than men by a ratio of about 3:1. The unilateral disease had an equal sex incidence. The disease seemed to be the same in men and women. The median age of onset was 59 years old, and the median interval between onset of symptoms and surgery was three years. Most of these patients had seen many physicians, and all prior medical and surgical treatments had been unsuccessful.


Glaucoma in the beagle.

Glaucoma in the beagle is an inherited disease that is exhibited clinically in dogs of 6 to 18 months of age. The genealogy, clinical signs, gonioscopy, tonometry, tonography, water provocative response, and scanning electron microscopy of the iridocorneal angle of the glaucomatous beagle are summarized.


Keratoconjunctivitis sicca.

KCS in man is often associated with a systemic disease whose pathogenesis is still obscure. A spontaneous animal model resembling Sjögren's syndrome has been developed in the NZB and NZB-NZW mouse. Other spontaneous animal models analagous to lupus erythematosis and polyarteritis have been found in dogs and Aleutian mink, respectively. Studies of the eyes and lacrimal glands in such animals, and in dogs with distemper, should be pursued. A viral etiology is implicated in each of the models. The roles of both the main and accessory lacrimal glands in normal and KCS eyes have been discussed, as well as drug-induced KCS and opportunities for its further investigation and treatment.


Retinitis pigmentosa and allied retinal diseases: electrophysiologic findings.

The subnormal ERG can be used in young patients to establish the diagnosis of hereditary progressive forms of retinitis pigmentosa and to determine visual prognosis even when changes visible with the ophthalmoscope are minimal or absent. Different waveforms have been demonstrated in patients of comparable age with different genetic types. Defects must exist in the photoreceptors or pigmented epithelium or both to explain the reduced ERG a-wave amplitudes and reduced ERT amplitudes. Marked delays in cone or rod ERG b-wave implicit times or both reflect the wide-spread involvement of cone or rod photoreceptors or both, even in the early stages. These delays also have been recorded from the taurine-deficient cat with nutritionally induced retinal degeneration and from dogs with hereditary retinal degenerations. Attention should be given to those animals with retinal disease that have electrophysiologic abnormalities similar to those seen in patients with retinitis pigmentosa and allied degenerations.


An examination of an electrochemical mechanism for noise-induced hair cell loss: noise with amino-oxyacetic acid (AOAA).

Pretreatment of guinea pigs with AOAA was found to reduce the incidence of hair cell loss due to noise exposure. Since AOAA reduces the endocochlear potential, we propose an electrochemical model as an extension of the Davis model to explain the protective effect of AOAA.


Tone burst electrocochleography in humans.

Using tone burst stimuli with fixed parameters of rise time and duration, a functional relationship has been demonstrated between frequency and intensity of the stimulus and peak latency of electrocochleographic recordings. The feasibility of a "map" of the human cochlear partition has been shown for frequencies above 2 kHz.


Masquerades of myocardial infarction.

I summarize these observations in Figure 1. It represents every person in a hypothetical population who has myocardial infarction. A large but unknown number, some believe almost half, never get help. Mobile coronary care units are reducing this group, but so far only a little. When the diagnosis is not understood the disease is not recognized. Then come discovery and popularization. Hereafter masquerades hide some cases and the diagnosis is missed. Somewhere fairly early the diagnostic fad leads to false positive diagnosis. As new techniques are discovered, perfected and mastered, false positive errors and masquerades leading to oversights diminish but still exist. All the skill and technical virtuosity in the world will not be applied if we do not think of the disease. When we think of it, even obscure cases may be resolved easily.


Self-administered cardiopulmonary resuscitation by cough-induced cardiac compression.

Repeated rhythmic (every 1-3 sec.) coughs were documented to maintain consciousness up to 39 seconds in 3 patients developing ventricular fibrillation during coronary arteriography. The arterial pressure wave resulting from a cough exceeded that induced by external chest compression in 2 individuals in whom both techniques were employed and in 5 others treated by external compression alone. Cough-induced cardiac compression is self-performed, and compared to external chest compression is less likely to traumatize the chest wall or heart and can be performed in any position on any surface. It is recommended that patients undergoing coronary arteriography be previously trained to cough abruptly and repeatedly every 1-3 seconds.  The potential for utilizing this technique in other areas (i.e., CCU, home) is less favorable than in catheterization-induced ventricular fibrillation, but it might be employed successfully in patients with premonitory symptoms of ventricular arrhythmias or Stokes-Adams seizures. The prior training of high risk individuals (and their spouses) to induce effective coughing in the victim might be lifesaving.


The Jeremiah Metzger lecture of The American Clinical and Climatological Association 1975. New genetic insight into old diseases.

With these three examples, examined in some detail, I have attempted to indicate new directions in medical genetics. Some of the recognizable generalities are the following: 1. With the application of cell culture techniques in the area called human somatic cell genetics, human genetics has become essentially an experimental science. Somaticcell studies have provided insight into genetic disorders that would not have been possible from studies in the whole organism. Even therapeutic possibilities can be explored. Somatic cell hyubridization has substituted for controlled matings in permitting linkage studies for mapping of the human chromosomes...


Tracheostomy in the first year of life.

Three series totaling 301 infants under 1 year of age who had tracheotomies during three successive decades are reviewed. The first series (62 infants) was seen prior to 1953, the second (86 infants) was seen between 1954 and 1963, while the latest series (153 infants) was seen between 1964 and 1973. A comparison of the three series with reference to etiology, incidence, indications, management, and mortality leads to significant conclusions. (1) The incidence of tracheotomy is increasing. More aggressive approach to many problems, previously considered inoperable, resulted in an increased number of infants undergoing tracheotomy for postintubation problems and ventilatory support. (2) The incidence of congenital malformations of the airway necessitating tracheostomy has remained constant, while the downward trend in the incidence of inflammatory conditions was reversed. (3) Infants in the latest series underwent tracheotomy, on the average, at a later age than the 1954 to 1963 series, largely as a result of the increased number of patients with cardiac anomalies undergoing corrective cardiovascular surgery and subsequent tracheotomy at a later age. (4) A review of the 77 deaths in the latest series again shows the death rate to be dependent on the underlying systemic condition which necessitated tracheotomy, rather than the tracheostomy itself. (5) The importance of temporary intubation to relieve respiratory obstruction in infants is stressed, while the significant laryngeal damage following prolonged intubation and delayed tracheotomy is apparent.


Histoplasmosis: twenty years experience in a general hospital.

This report summarizes the clinical and laboratory data on 57 patients with histoplasmosis, including 13 with progressive disseminated disease. The experience in general is supportive of that of others in that although infection with Histoplasma capsulatum is prevalent, clinical disease is uncommon and disseminated disease actually rare. The data again emphasize the limitations of diagnostic methods, and in particular point up the need to obtain cultures of biopsy material from mucocutaneous lesions.


Left ventricular performance in coronary artery disease by systolic time intervals and echocardiography.

Determinations of systolic time intervals and echocardiographic measures of left ventricular performance were made in twenty-five normal subjects and 37 patients who had convalesced from a previous transmural myocardial infarction. On group analysis the patients with previous myocardial infarction demonstrated significant differences from the normals in each of the noninvasive measures. Among the noninvasive measures the PEP/LVET and deltaD% proved to be the most sensitive indicators of left ventricular dysfunction. Deviations from the normal range in PEP/LVET and deltaD% occurred in 65% to 70% of patients asymptomatic for dyspnea and fatigability (20 patients) and in 85% of patients asymptomatic for angina pectoris (13 patients). Neither the presence of phonocardiographically documented S3 or S4 or the finding of an abnormal C/T ratio on standard chest x-ray reliably detected patients with abnormal left ventricular performance. Among 26 patients studied by coronary arteriography, abnormal left ventricular performance by PEP/LVET and deltaD% occurred in less than 30% of those with obstruction (70% or greater) of one coronary artery and in over 80% of those with obstruction of two or three major arteries. A close correlation existed between the level of left ventricular performance measured by the PEP/LVET and the deltaD% (r = 0.93). These studies document the high degree of sensitivity of the noninvasive measures and demonstrate their superiority over clinical methods for detecting abnormal left ventricular performance in patients with previous myocardial infarction.


[Resection and plastic surgery of the arteries in malignant tumors of soft tissues of the lower limbs].

An experience of the vascular surgery department with reconstructive interventions on large arteries of patients with malignant tumors of the lower extremities soft tissues, located in the zone of large vessels of the inguinal region, femur and popliteal fossa, is reported. According to the author's opinion, it is necessary to take into account the fact that in reconstructive procedures on large arteries in patients, subjected to massive repeated radiotherapy, there is an increased danger of occurrence of arrosion hemorrhage, extensive thrombosis of vascular grafts and arteries changed under the effect of ionizing radiation.


[Clinical and experimental grounds for the method of spontaneous respiration with difficult exhalation (lung inflation) in children].

Three methods of inducing difficulty in breathing out in spontaneous ventilation are described: by means of a valve attached to an intubation tube (I), with a polyethylene sac secured hermetically on patient's head and connected to a source of oxygen (2), and also with the help of a low-pressure chamber for patient's body (3). Experiments and clinical observations (40 therapeutic seances in 23 children aged from 1 day to 7 years) have evidenced that this method is mostly more advantageous than artificial ventilation, it is highly efficient in treatment of aspiration pneumonia and pulmonary edema, also it may be used with prophylactic purposes following aspiration, artificial ventilation, in the immediate postoperative period, and after hyperbaric oxygenation.


[Obstruction of the vesico-urethral segment in children].

Within a 5-year period (1970-1974) in the Child Surgery Clinic of Leningrad Pediatric Medical Institute 63 children, aged from 2 months to 14 years (55 boys and 8 girls), were treated for the obstruction of the vesico-urethral segment. It is believed that timely performed surgical removal of the obstruction with simultaneous resection if a non-functioning kidney with the phenomena of vesico-urethral reflux allows an effective treatment of secondary pyelonephritis.


[Importance of structural characteristics of the esophagus and tracheo-esophageal fistula in surgical treatment of esophageal atresia in newborn infants].

The anatomical structure of the upper and lower segments of the esophagus and tracheoesophageal fistula in esophageal atresia in newborn in newborn infants conditions the clinical picture, character of surgical intervention and postoperative course. The gravity of pneumonic changes in the lung is dependent not only on terms of child's admission, but also on the width of esophagotracheal fistula, while bifurcation fistulas, sometimes, cause diagnostic erros.


[Pellegrini-Stieda disease (shadow)].

The Pellegrini-Stied disease (shadow) (calcification periarthritis of the knee) is characterized by the presence of ossification of the medial condyl of the femur. The author's observations of 51 patients (sportsmen) suffering this lesion are described. The methods of conservative and operative treatment and the results obtained are reported.


[Remote results of treatment of injuries of large arteries of the limbs].

The results of treatment of 115 patients with vascular injuries were studied within the terms from 3 to 20 years after the operation. In 7 patients the vessels were ligated, in the remainder--repaired. The functional state of the extremity and blood vessels was studied using oscillo- and rheography, angiography, ergometry and other methods. In 81 patients (70.5%) the extremity function was normal, in 24 (20.8%)--moderately restricted, and in 10 (8.7%)--poor.


[Microclots of perfusion mixtures during open heart surgery with artificial circulation].

During 9 experimental and 93 clinical operations on the open heart under circulatory bypass the authors studied microclots of multicomponent perfusion mixtures. They observed an increased number of microclots after infusion of high-molecular plasma-substituting solutions and long-term intraapparatus recirculation. During the bypass there was an increased number of microclots in the "machine-patient" system. The complex of measures suggested by the authors contributes to a delay in additional formation of microclots during the perfusion and also reduces the number of posttransfusion complications.


[Prevention and treatment of postoperative broncho-pulmonary complications with ultrasonic aerosols].

The method and results of applying ultrasonic aerosols in 485 patients, operated upon on abdominal organs, are presented. Ultrasonic aerosols were included in the complex of prophylactic and therapeutic measures in the postoperative period. Prophylactic measures were started immediately after patient's being returned from the operating room. Special attention was given to patients in whom ventilatory disturbances developed during anesthesia, to patients with obesity, chronic bronchitis, emphysema, pneumosclerosis and also those, who negated the rationality of prophylactic measures. The use of finely dispersed aerosols after the method suggested by the authors allowed a 6 times reduction in the incidence of pulmonary complications and more than twice shortening of the postoperative pneumonia course.


[Function of the lungs after tracheo-bronchial resections].

Experimentally on 20 dogs, using the method of xenon-133 radiography, angiopneumo- and bronchography the lung function was studied after tracheobronchial resections, performed in young ages. The pulmonary function was not found to be appreciably changed, the observed alterations are of a compensatory character.


[Age aspects of remote outcome of acute lung suppuration].

Among 375 patients (adults and children) having acute suppurative processes in the lung, treated conservatively, 165 were examined in later terms up to 15 years, using modern bronchological methods, considerable changes being revealed in 66.2%: residual cavities, chronic abscesses, bronchitis deformans and bronchiectases. In children suppuration in the lung showed a more grave course, but reparative processes were much better pronounced. The studies conducted allowed a conclusion on the rationality of widening indications to radical surgical treatment in adult patients and the necessity of a dispensary control over children and adult patients, including those discharged with a recovery.


[Surgical treatment of aortic coarctation in adults].

During a 18-year period the authors operated 305 patients with aortic coarctation, the mortality being 2.2%. Sixty three patients (20.6%) aged from 20 to 40 years were operated upon with the mortality in 7.9%. A direct anastomosis of the aorta was constructed in 31 patients, alloprosthesis of the aorta was employed in 23 cases, indirect isthmoplasty--in 8 cases, in one case an aortic prosthesis was replaced. The most frequent intra- and postoperative complication was intrapleural hemorrhage. In estimating the efficacy of surgery within the terms up to 14 years the best results were obtained after an end-to-end anastomosis.


[Measurement of thoracic complex electrical resistance (impedance)].

Experimental grounds for using clinically the chest impedence recording are presented. The method allows recording of ventilatory and hemodynamic parameters mainly in the minor circulatory circuit under conditions of surgery on thoracic organs and postoperatively, as well.


[Functional state and structure of gastric mucosa in patients with ulcer disease after vagotomy and pyloroplasty].

107 patients were examined in different terms after vagotomy (up to 6 years) performed for ulcerous disease of the duodenum, 43 of them--prior to and after the operation. It is found that the suppression of the acid- and enzyme secretory function of the stomach is not related to the development of the mucosa atrophy, but it is conditioned by eliminating the resolving role of vagus nerves and by a reduced sensitivity of fundic glands to humoral stimuli.


[Large stump of the cystic duct].

The authors concluded that a large stump of the gall-bladder duct is of no independent importance as a cause of the affection. However, concretions may be formed in the stump, that was evident in three cases, therefore, the gall duct stump should be no more than 0.5 cm.


[Benzoylarginine amidase activity of blood serum and plasma in acute pancreatitis].

In 40 patients with acute pancreatitis, examined 3-2 and 18-24 hours following the onset of the disease, benzoylarginine-amidase activity in blood serum and plasma was determined, as well as the activity of lipase and amylase in blood serum. A correlative dependence was found between the activity of amylase and lipase in blood serum, the activity of amylase in blood serum and trypsin-like activity in blood plasma of patients investigated in different time.


[Perforative peritonitis as a complication of abdominal tuberculosis].

In the paper, data on 502 patients with abdominal tuberculosis are reported, including 21--with perforative peritonitis due to the perforation of tuberculous intestinal ulcers. In its manifestations perforative peritonitis may show a latent or "an acute abdomen" course. Among 12 operated patients there were 5 lethal issues. Such high postoperative mortality is accounted for late terms of establishing the correct diagnosis and admission of patients in a poor and hopeless condition.


[Evaluation of the changes of natural resistance in patients with diffuse peritonitis].

A suppression of humoral and cell mechanisms of natural nonspecific resistance was found in patients with diffuse peritonitis. A considerable degranulation of basophilic leucocytes was indicated by the direct Shelley reaction, that evidences alterations in the functional state of these cells. Postoperatively, there is a break in restoration of the activity of properdine and its cofactors, and a considerable suppression of the phagocytic capacity of microphages is noted, that leads inevitably to a reduction of immune reactivity.


[Extraorganic forms of abdominal localization of echinococcosis].

The author has analysed 66 pateints (5.4% of all cases of the disease) with extraorganic abdominal echinococcosis. The forms of retroperitoneal (lumbar, pelvic, mesenteric and omental) and intraperitoneal echinococcosis (primary cystic and adhesive-disseminated) are differentiated. The problems of diagnosis, the differential diagnosis and selection of an appropriate therapy are discussed. The mortality in multiple and associated affections was within the range of 10 per cent.


[Disorders and correction of lymph outflow in chronic venous insufficiency of the lower limbs].

An analysis of 176 lymphograms, made in 102 patients with venous pathology of the lower extremities, is presented. In 14 of them varicosity in a decompensation stage, an uncomplicated form, in 32--varicosity in a decompensation stage, a complicated form, in 20--postthrombotic disease of an edematous and algesic form, in 36--an edematous-ulcerous form. The duration of the disease was from 3 to 25 years. It was found that the depth of changes in the lymphatic system was dependent on the rate of decompensation in the venous one.


[Reconstructive operations in post-thrombophlebitis syndrome of the pelvis and the lower limbs].

Based on the analysis of serial phlebograms (in 155 patients), kinematophlebograms (in 51 patients) and operative findings (in 42 patients), the authors differentiate 7 types of localization of venous occlusions of the lower extremities and pelvis in post-thrombophlebitic syndrome. The suggested classification is an aid in selecting the technic of surgical intervention. Further, the authors share their experience with reconstructive operations on the venous system in postthrombophlebitic syndrome of the lower extremities in 40 patients.


[Characteristics of disorders of body functions in post-thrombophlebitic disease].

397 patients with chronic diseases of the extremities veins were examined, 256 of them suffered postthrombophlebitic disease. Along with the general clinical examination special investigations were conducted: ECG under orthostatic stress conditions, test tube and instrumental auto-coagulograms, thromboelastograms, biomicroscopy of the anterior ocular segment, studies of the intraocular pressure, ocular fundus, rheovasography, skin thermometry, oscillometry (with nitroglycerin stress), the extremity volume under orthostatic stress conditions, myography, non-contrast roentgenography of the lower extremities, and also the phenomenon of intradermal diffusion and pheblography. It was found that with the progress of postthrombophlebitis trophic disorders are observed in all tissues of the involved extremity. Postthrombophlebitic disease is associated not only with local involvement of vessels, but also with functional disturbances of other organs.


[Surgical treatment of congenital hemolytic anemia in children].

In the paper, an experience with surgical treatment of 67 children suffering inherited spherocytosis is summarized. In most patients the first signs of the disease appeared in early age. It is concluded that splenectomy is indicated in all children with inherited spherocytosis irrespective of the form of the disease at the age from 3 to 5 years. In a grave course and the appearance of signs of functional hepatic insufficiency the operation should be accomplished as earlier as posisble.


[Parellel blood circulation with oxygenation of blood in severe poisoning with carbon monoxide fumes].

The authors present an analysis of treatment in 141 patients with acute carboxyhemoglobinemia, in 110 of them severe intoxication was noted. All these patients were treated taking into account the degree of intoxication, the period of time elapsed since the moment of the intoxication till the onset of therapy, and the presence of biochemical shifts in blood. In 31 patients being in an extremely poor comatous state with considerable disorders in gas balance, persistant hemodynamic disturbances and manifest humoral shifts a parallel perfusion with extracorporeal oxygenation of blood was performed with medical drug therapy in the background. The immediate effect was found to be quite favourable, however, 19 patients died in different terms as a result of subsequent complications, most frequently due to pneumonia and meningoencephalitis.


[Use of biological antiseptic tampon (BAT) for treatment of infected wounds and fistulas after abdominal surgery].

In the paper, based on the experience with the treatment of 42 patients having extensive purulent wounds and fistulas, the use of a biologial antiseptic tampon (BAT) for treatment of persistantly unhealing wounds and fistulas after various abdominal operations is discussed. The mechanism of BAT therapeutic effect, the method of its application and the results of treatment are described.


[Accessory artificial circulation in complex treatment of experimental acute toxic pulmonary edema].

In experiments on 50 dogs with toxic acute edema of the lung, induced with intravenous injection of 0.1% silver nitrate, the authors have studied the efficacy of accessory artificial circulation and "conservative" therapy. During the perfusion a discharge of the right portions, adequate extracorporeal gas metabolism, normalization of blood gas and acid-base balance were noted; an intensity of pulmonary edema is descreased. An intensive therapy for pulmonary edema was found to be more effective in association of "conservative" treatment with venoarterial perfusion and blood oxygenation.


[Early adhesive intestinal obstruction].

In the paper, on the basis of 54 observations the incidence of early adhesive intestinal obstruction, its diagnosis and operative treatment are discussed. In case of jejunal overfilling a modified I. D. Zhitnjuk enterostomy is recommended, the lessens the danger of the operative wound contamination, accelerates an insertion of a drainage tube in the intestinal lumen and provides an opportunity to accomplish continuous suction both during the process of intestinal drainage and in the postoperative period.


[Dialectics of the objective and subjective in the diagnosis of diseases].

The reader's attention is drawn to the fact that the dialectics of the objective and subjective in the cognition process is one of the most important and "enternal" philosophic problems. At each historical step of development of the science and public practice, in each sphere or cognition activity the former is of a definite specificity. It is the authors' opinion that the same is fully refered to such complicated field of cognition as the diagnosis of diseases.


[Surgical importance of the topography of the vessels and bile ducts in the hepatic portal in case of their atypical branching and formation].

The portal triad was studied on 100 specimens of porta hepatis, using the methods of preparation, roentgenography and corrosion. An unusual origin of hepatic arteries was observed in 36%, atypical formation of bile ducts--in 33%, and a specific branching of the portal vein--in 15%. Different variants of vessels and bile ducts related with their specific development can be intercombined. Due to it, during surgical procedures in the region of porta hepatis it is necessary to bear in mind not only an atypical structure of each element of the Glisson system, but also the possibility of frequent combination of their different variants.


[Functional morphology of the liver in obstructive jaundice].

The conducted clinico-experimental study (an investigation of the functional and morphological state of the liver in impaired bile outflow) indicated different compensatory reactions. It is the authors' opinion that bile congestion in the liver is accompanied with proliferation of bile ducts; a damaging effect of bile components, in the first place bilious acids, is manifested in pericholangitis, periductal fibrosis and later in the development of biliary cirrhosis; alterations of the parenchyma occur secondarily also as a result of the toxic effect of bilous components and show a focal character.


[Perforation of hydatid cysts of the liver into the abdominal cavity].

Perforation of hydatid hepatic cysts in the abdominal cavity was observed in 35 of 231 patients (14.7%). In its typical course the following periods in the clinical picture may be distinguished: anaphylactic shock, a period of subsidence, peritonitis. Asymptomatic perforation can result in the development of "echinococcic pseudotuberculosis of the peritoneum" with a favourable course or dissemination of the peritoneum with subsequent development a progressive ascites, cachexy and anemia.


[Volemic indicators in patients with acute cholecystitis].

The work is concerned with changes in extracellular fluid and its ingradient--interstitial volume, in particular, as well as TCB and its components influenced by an operative intervention, performed in patients over 50 years of age for acute cholecystitis. Based on the data obtained, it is concluded that in the early postoperative period along with parenteral injection of fluids also it is essential to correct the deficiency of TCB and its components by administration of high-molecular compounds, protein substances, plasma.


[Roentgenocontrast study of pancreatic ducts in surgery of the pancreatic-biliary system].

The authors report the data obtained as a result of exploration of the main pancreatic duct pre- and intraoperatively. The study was carried out in 34 patients with pancreatic fistulas. Endoscopic catheterization of the papilla duodeni was undertaken in 80 patients, it proved to be a success in 71. Pancreaticograms was made in 63 observations. Contrasting of the duct of Wirsung was noted in 167 of 263 patients in whom operative cholangiography was performed. The data obtained indicated that pre- and intraoperative pancreaticography is a valuable method of investigation, which aids in determining surgical policy in chronic pancreatic lesions and in formulating rational grounds for direct operative interventions on the pancreas.


[Disorder of regional mesenteric circulation as a cause of functional intestinal obstruction].

It is shown experimentally that an impaired mesenterial blood circulation is of primary importance for development of dynamic intestinal obstruction, that is in contrast with the existing opinion on the primary importance of disorders in the bowel motility. The data obtained were utilized to explain the mechanisms of a stimulating effect of different procedures in combating against dynamic intestinal obstruction, namely an elimination of the suppressive sympathetic effect on abdominal vessels and an increase of the volume blood flow.


[Sphincter-preserving operations in rectal cancer].

Among 418 rectal operations for cancer in 63 cases abdomino-anal resection (amputation) of the rectum was performed with descending of the colon, if indicated. The following postoperative complications were observed: necrosis of the descended colon, scarring strictures, various urinary disturbances, peritonitis. The postoperative mortality made 3 per cent.


[Rationale for the right-side puncture of the subclavian vein in patients undergoing heart surgery].

Based on the study of the literature data and personal author's clinical material (682 punctures) the author was able to reveal the advantages of repeated left-sided puncture of the subclavian vein. An attempt is made to systematize complications relative to this procedure, depending on the side of puncturing in cardiosurgical patients.


[Pathophysiological and anatomical prerequisites of hemodynamic disorders in the system of small saphenous vein].

112 patients with varicose small sephenous vein were operated upon. The operation was preceded by a careful clinical investigation, including phlebography. The observed changes were correlated with operative findings. It is shown that varicosity may be conditioned by an obstruction of blood outflow in the popliteal vein or small saphenous vein ostium. A relationship between some structural variants of the small saphenous vein and hemodynamic disturbances was noted.


[Dynamic pressure in the superficial and deep crural veins in uncomplicated varicosity without incompetence of communicant veins].

Synchronous phlebotonometry was performed on 30 lower extremities in 27 patients. Various pressure dynamics was observed in the proximal and distal segments of profound veins. Dynamic phlebohypertension was found not only in superficial but also in deep-seated veins. The escape of superficial veins resulted in normalization of pressure in both systems. The more intensive muscle contractions under conditions of normal blood circulation the greater a reduction of pressure phases in the crural vein distal segment this factor may be used as a test for estimation of the vein-muscle pump function.


[Complications in surgical treatment of varicose veins of the lower limbs and their prevention].

To prevent hemorrhage and hematomas in the bed of subcutaneously removed large saphenous vein after Babcock the authors somewhat modified tactically the order of manipulations during the operative procedure. This method was employed while operating 42 patients with primary and secondary venous varices. It was feasible to prevent hemorrhage and hematomas along the vascular bed in every case. The suggested tactical modification of the removal of venous varices wound improve the postoperative course and shorten the terms of patients' stay at the hospital postoperatively.


[Bilateral coxarthroses and avascular necrosis of the femur head in adults].

Based on the authors' personal experience, it was concluded that in surgical treatment for coxarthrosis intertrochanteric osteotomy is to be preferred, since it proved to be effective even in advanced cases of the lesion in the extent of residual motions of 30--40degrees. If indicated, the procedure may be bilateral. The operation yielded the best results also in avascular articular trophesy with resorption of sequestrae. In grave cases it is rational to begin with prosthesizing of one of the joints.


[Alkaline phosphatase of granulocytes in open fractures of the long tubular bones].

Investigations carried out in 60 patients with open fractures of long tubular bones in osteosynthesis with the Ilizarov apparatus indicated that alkaline phosphatase (AP) of granulocytes fully reflects the postoperative course. 10--24 hours following the trauma the level of AP in patients with grave injuries exceeds that in patients with slight ones. The differences are found to be reliable from the 1st to the 5th day after the injury.


[Surgical tactics in severe combined injuries of the face and other body regions].

The results of treatment in 67 patients with associated injuries of the face and other regions of the body are analysed. Sixteen of them died. Their poor state was conditioned not by facial injuries but by traumas of other organs and system of the organism. It is concluded that such patients should be treated not in stomatological but in special traumatological departments for polytraumas. Surgery is first to be performed in the region where the damage is most hazardous. But the first step is to prevent aspiration of blood from the oral cavity into the respiratory tract followed by the fixation of jaw fragments.


[Prevention and treatment of staphylococcal infections and their complications, in surgical practice with biological products].

In the clinic 307 patients with suppurative lesions were observed, in 183 of them (the main group) staphylococcic anatoxin was administered with prophylactic and therapeutic purposes, 124 patients (the control group) were treated with antibiotics, including 231 patients with acute appendicitis, 23--with osteomyelitis, 48--with mastitis and 5 patients with various purulent complications of staphylococcic etiology. Among 231 patients with acute appendicitis 125 comprised the main group who were injected staphylococcic anatoxin, and 106--the control group. In the latter the incidence of the operative wound suppuration was observed thrice as frequently.


[Compression-distraction osteosynthesis in pseudarthroses of long tubular bones].

An experience of the clinic with treatment of pseudarthrosis of tubular bones in 163 patients, using compression-distraction osteosynthesis is reported. In their anatomical localization pseudarthroses were distributed as follows: the femur-22, the crus-112, the shoulder-22, the forearm-7. The Ilizarov and Gudushauri compression apparatus was employed in 143 patients, compression osteosynthesis after Greifensteiner was performed in 20 patients. The results of treatment were studied in 155 patients within the terms from 10 months to 5 years. Good issues were obtained in 95 (61.3%) patients, satisfactory- in 45 (29%), poor--in 15 (9.7%).


[Remote results of treatment of compression fractures of the calcaneus].

Late results of treatment in fractures of the calcanean bone were studied in 72 patients within the terms from 2 to 11 years. In 41 of these cases a grave compression fracture of the calcanean bone was observed, in 9--there was a damage of both calcanean bones. 37 patients were treated clinically and 4--under outpatient conditions. Skeletal extension was used in 12 patients during 10--25 days, in 3--it was complicated with suppuration. Manual reposition was employed in 19 cases, and it was not used in 6. It is the author's opinion that permanent and one-moment skeletal extension by multiple pins inserted under general aneshesia and roentgeno-telecontrol should be preferred.


Combined immunodeficiency with failure of colostral immunoglobulins transfer in foals.

Foals with combined immunodeficiency (CID), a fatal genetic defect in the production of both B and T lymphocytes, are born without immunoglobulins and are unable to synthesise them. CID foals receiving immunoglobulins via the dam's colostrum may live up to four months of age. Those CID foals with failure of passive transfer (FPT) die at a much earlier age. The occurrence of CID is of value in studying passive transfer of immunoglobulins, as no confusion exists as to when passive transfer ends and active synthesis of immunoglobulins begins. A high correlation has been found between early foal disease and deaths and lack of passive transfer of immunoglobulins, even though many of these foals appear to nurse normally during the first few hours post partum. Evaluation of immunoglobulin levels in 24 hour post suckle samples would prove of value not only in diagnosing CID foals, but in recognising FPT in otherwise normal foals.


Retention of the fetal membranes in cattle.

An investigation of the possible significance of 'stress' as a factor in the retention of bovine fetal membranes has been carried out, together with the investigation as to the possible variation of progesterone levels at parturition, as a cause of retention. No evidence of abnormal progesterone levels has been established, but from the evidence it is concluded that retention may well be yet another example of production disease.


The selection of antibiotics.

The usefulness of an antibiotic depends not only upon its antibacterial potency and spectrum but also on the prevalence of resistant organisms and the extent and severity of the adverse reactions to which it may give rise. Variations in formulation of the same compound are reflected in differences in bioavailability. These may be intentional, as in the development of long-acting preparations, but may also be unexpected following differences in drug purity, content and gastro-intestinal absorption. Individual and species differences in treated animals also result in variations in bioavailability. The merits of combination products of two or more antibiotics are often equivocal and some combinations are definitely disadvantageous. Practical rules for the selection and use of antibiotics emphasise the need for full doses of effective compounds used for limited periods with monitoring of patterns of sensitivity so that problems of large-scale resistance can be avoided.


Design and farm animal welfare.

Farm animal welfare and the design of farm buildings and equipment are interrelated. The animals' requirements and preferences should first be estimated and ways in which this can be done are discussed, as are methods of assessment of their environment. Some examples of the influence which housing and equipment design can have are given. Attention is drawn to the difficulties inherent in the assessment of farm animal welfare and the postulation made that the veterinarian is well fitted to carry out such assessments.


Equine artificial insemination.

The use and techniques of artificial insemination for horses in Germany over the last 30 years is described. Artificial insemination appears to produce pregnancy percentages equal to those from normal breeding methods and its continued availability under veterinary supervision is recommended in conditions where disease, disability or distance debar normal service.


[Method for computing the milk losses from sterility in cows].

An attempt was made to work out a method and establish the indices in calculating the losses of milk due to sterility in cows, along with recording the level of productivity and the duration of the period of sterility. The differences were established between: 1. The size of the average daily milk yield per normative day (a day of the period between calvings of 365 days) and that per day of the actual period between calvings. 2. The average daily milk yield per normative day and that per day of the period of sterility. The milk losses calculated in both ways gave almost comparable results. It is , therefore, suggested when calculating the losses due to sterility to use the established indices of milk losses per sterility day (Table 2) at a varying milkiness of the cows and a varying length of the period between calvings, resp., the period of sterility.


[Epizootiological and parasitological status of the flocks at a poultry combine].

A comprehensive epizootiologic study has been carried out at one of the large poultry dressing combines in this country. Results have shown that the part played by infections as against the remaining diseases established in the various technologic categories is as follows: 9 to 23.8 per cent in growing parents; 16.0 to 24.6 per cent in adult parents; and 4.8 to 13.4 per cent in broilers. So far as parasitic diseases are concerned the respective figures are 3.2 to 9.9 per cent, 3.0 to 3.3. per cent, and 2.9 to 3.0 to per cent. The import of birds from France and England intended for satisfying the needs of the poultry dressing combine in Roussé has contributed to the introduction of infections which have later on assumed an epizootic course, such as infections encephalomyelitis, infectious bronchitis, and Marek' disease. The epizootic status has been aggravated with the development of a number of diseases already existing in this country--fowl pox, lymphoid leukosis, chronic respiratory disease, salmonellosis, and above all infections caused by the so-called occasionally pathogenic agents--coli organisms, staphylococci, and Pseudomonas. Of the parasitic diseases only coccidiosis has developed, being caused by a variety of species: Eimeria acervulina, Eimeria necatrix, Eimeria maxima, Eimeria muvati and Eimeria tenella. The absence of helminth infections is due to the routinely adopted technological practice of raising birds in confinement and the strict veterinary control and guard. On the basis of the results obtained and the conclusions drawn some more effective prophylactic measures are suggested correcting and supplementing the existing prophylactic programme.


[Changes in the total protein and protein fractions in cow's milk irradiated with ultraviolet rays].

Comparative experimental electrophoretic studies were carried out to establish the effect of ultraviolet treatment on cow's milk at various rates of irradiation (5, 10 and 15 min) with a view to raising and regulating the content of the total protein and the protein fractions in milk intended for the feeding of calves. Results showed that there were no substantial changes in the level of the total protein, the albumins having a rising trend that was manifested best at a 15-minute treatment. Most characteristic were the changes taking place in the immunoglobulin fraction which rose by 4.7 per cent. The beta-lactoglobulin fraction dropped by 4.5 per cent, on an average, at all rates of treatment, and the level of alfa-lactoglobulin at 5- and 10-minute irradiation underwent almost no changes, it rising by about 2.09 per cent, on an average, at 15-min treatment. Similar was the trend manifested by the proteoso-pepton fraction showing a rise as early as the first ten minutes of treatment.


[Effectiveness of Deptavac HVT vaccine on broiler parents during the egg-laying period].

Experiments were carried out with 4 flocks-a total of 16,940 layers of the White Plymouth Rock breed (10,865 vaccinated and 6075 untreated) and 3000 cocks of the White Cornish breed (502 vaccinated and 1498 untreated). The test birds had been vaccinated at the age of one day. The average month mortality rate among the vaccinated birds was 1.5 per cent, and among the untreated it was 4.9 per cent; for the whole exploitation period these values were 15.35 and 47.17 per cent, respectively. Mortality rate caused by Marek's disease and lymphoid leukosis (specific mortality) in the test groups was 4 times lower as compared with that of the control groups (11.54 as against 44.75 per cent), and the coefficient of epizootiologic effectiveness was 74.4 per cent. Considerable variation was established in the intensity and dynamics of the epizootic process with the vaccinated and unvaccinated birds, on the one hand, and the layers and cocks, on the other. White Cornish cocks proved more resistant to Marek's disease and more sensitive to lymphoid leukosis, while the layers of the White Plymouth Rock breed were more sensitive to Marek's disease and more resistant to lymphoid leukosis. These differences could explain the dynamics peculiarity of the specific mortality exhibited by layers and cocks. The egg-laying capacity of a "forage" layer up to the age of 62 weeks of age in the test flocks was 9.2 (7.2) per cent higher than that of the untreated layers. In exploitation up to the 70th week of age each test layer gave 23 eggs more as compared to the untreated. It is calculated on the basis of the experimental data that a total of 55,200 eggs and more could be obtained from 6000 parental birds vaccinated against Marek's disease during a 10-month laying period.


[Characteristics of the staphylococci isolated from the udder of cows with mastitis].

A total of 175 strains of Staphylococcus aureus and 67 strains of Staphylococcus epidermidis were studied, isolated from 486 samples of milk secretion taken aceptically from the individual quarters of the udder of cows affected with subclinical and purulent (clinical) mastitis. The staphylococci were referred to as the causative agent of mastitis in case they were the only microflora in the seedings of the investigated material. Tests were applied as given in Fig. 1 to characterize the strains. It was found that mastitis in cows could be due to both plasma coagulating staphylococci (Staphylococcus aureus) and coagulase-negative Staphylococcus epidermidis organisms. The two Staphylococcus species were isolated from cows with clinical and subclinical mastitis. The division between pathogenic and nonpathogenic Staphylococcus strains by the plasma-coagulating symptom proved impossible, and this made it necessary to use other tests for pathogenicity. It became evident that the thing Staph. aureus and Staph. epidermidis had in common when isolated from cows with mastitis was the production of a gold-like pigment and delta hemolysin. Similarly to Staph. aureus isolated animals, the bovine Staph. epidermidis organisms did not possess fibrinolysin and rarely produced hemolysin. The isolated organisms belonging to the coagulase-positive staphylococci corresponded by their basic properties to Staphylococcus aureus var. bovis as described in the literature. The cultures of Staphylococcus epidermidis isolated under similar conditions showed in a considerable per cent of the cases somewhat different behaviour.


[Comparative studies of methods for the diagnosis of Aujeszkh's disease].

The virologic studies of a total of 383 organs taken from 183 pigs using a rabbit as a test animal and cell cultures of chick embryo fibroblasts and pig kidney revealed that the per cent of the positive results obtained by the three methods was varying with regard both to the organs and the various categories of animal used. The biologic test proved appropriate in the cases of acute diseases, while with diseases with atypical and symptomless course the cell culture methods are to be used, most suitable for the mass laboratory diagnosis being the chick embryo fibroblasts. The successful diagnosis requires a complex study method with the use of greater number of viscera.


[Study of Mycoplasma from the genital apparatus of cattle].

The study on vaginal mucous secretion in cows with metritis and vaginitis, on fetuses and placentae of cows that had miscarried as well as on preputial secretion of bulls revealed the presence of Mycoplasma organisms associated with V. fetus and other bacterial species. By their reaction to cholesterol, digitonin, sodium polyanetol sulfonate as well as their serum and temperature requirements, the formation of films and spots, their phosphatase activity and biochemical and serologic behaviour the mycoplasmas isolated from the genital tract of cows were specified as A. laidlawii and A. axanthum. From both cows and bulls T-forms of mycoplasmas were isolated. The strains determined as A. laidlawi showed deviations from the species characteristics by the fermentation of glucose, hydrolysis of esculine, and reduction of 2,3,5-triphenyl-tetrazolium chloride.


[Effect of different amounts of carbamide on nitrogen digestibility and metabolism in broilers. II].

Experiments were carried out with one-hundred broiler birds of one and the same age group, breed, and origin, divided into five groups in order to follow up the effect of various amounts of urea on their physiologic state. A balance experiment was conducted to establish the effect of urea on the digestibility of nutrient matter and the metabolism of nitrogen with the use of nine birds per group, divided into three subgroups. Urea was added to a protein-balanced diet from the 20th to the 60th day in the following amounts by groups: I--2 percent; II--4 per cent; III--5 per cent; and IV--6 per cent. It was also found that with the increase of urea in the ration at the rates indicated above there was a progressive rise of both the amount of urea and the nonprotein nitrogen in the blood as well as the amount of nitrogen excreted with the urine. The intake of such amounts of urea lowered the assimilation of nitrogen by 4 to 9 per cent as against its initial level in the ration, and by 7 to 11 per cent--as against the level of digested nitrogen.


[Lysogeny in Pasteurella multocida].

Studied was the possibility of lysis-producing factors (the phenomenon of lysogeny) with 59 strains of Pastuerella multocida isolated in Bulgaria, Cuba, and Czechoslovakia. It was found that eleven of them were lysogenic in terms that a total of 12 bacteriophage strains were isolated from them; one of them yielded 2 phages. Established were three different indicator strains of Pasteurella multocida-97, SHD, and R-II--by means of which 3 different groups of P. multocida phages were isolated. The latter were stabilized and allowed to multiply up to 10(11) phage particles per 1 cc through continuous passaging, and they could be be stored at + 4 degrees C. In accordance with the host strain for multiplying the isolated P. multocida phages were divided into three different groups: phages 3, 4, 5, 6, 22, and Sl fell into group II, and phages 1075 and S-2--to group III.


[Study of the pathogenicity and drug sensitivity of staphylococci isolated from poultry].

Studied were the pathogenicity and drug sensitivity of a total of 64 Staphylococcus strains isolated from chickens and chick embryos. A high per cent value of coincidence was established between the tests of positive plasma-coagulase reaction, hemolysis, golden-yellow pigment production, glucose-positive reaction in anaerobiosis and the lethal sequela following the experimental infection of young chickens and albino mice. The complex use of these tests proved to be a dependable criterion of pathogenicity. Most of the Staphylococcus strains were shown to be strongly and moderately sensitive to kanamycin gallimycin, oximycin, chloramphenicol, and persistent to oxitetracyclin.


[Biochemical and technological characteristics of the milk from Black-and White Dutch].

Studied were the composition and the technologic properties of the milk of Dutch Black pied cattle under this country's conditions. Milk samples were taken for analysis once in a month on a cow farm founded in 1964 with a total of 67 impregnated heifers and having at the time of investigation 88 cows, twelve of them remaining from the initial animals imported from Holland and the others being the offspring of the herd. It was established that the annual milk yield per forage cow, amounting to 44881 has the following index values; dry matter--12.63 +/- 0.48 per cent; butterfat per cent--4.07 +/- 0.2%; total protein--3.37 +/- 0.16 per cent; casein--2.56 +/- 0.16; slids-nonfat--8.54 +/- 0.24 per cent; calcium--0.126 +/- 0.002 per cent; phosphorus--0.079 +/- 0.003 per cent. The technologic properties of milk proved unsatisfactory: coagulation capacity--359 s; rheologic value--112.93 X 1.10(-5) V/cm3; and technologic coeficient--1.32. The data on the composition and the technologic properties of Dutch Black-pied cow's milk showed, on the whole, that most profitable is its processing into butter as against processing into cheese in which case the yields would be unsatisfactory.


[Biochemical properties of different serotypes of Pasteurella haemolytica].

Studied were the morphologic and biochemic properties of 85 Pasteurella haemolytica strains belonging to the known 12 serotypes after Biberstein, Gills (2). The biochemical properties of the strains were studied after the pattern of Bosworth and Lovell (4) with regard to arabinose, trehalose, xylose, manose, salysin, and lactose. It was found that the biochemical properties correlated with the biotype classification of the strains. Thus, the biochemical reaction with trehalose and arabinose may be used as a characteristic feature in determining the biotype. The reaction proved more dependable with the strains of the T biotype as compared to those of the A biotype, as not all strains of the A biotype fermented arabinose in the course of the first seven days, while with the strains of the T biotype trehalose was acted upon during such a period. It was also established that xylose is attacked by the strains of the A biotype only, and manose and salycin--by the strains of the T biotype, which did not ferment lactose. All strains of Pasteurella haemolytica turned out to be negative so far as the production and indol was concerned; they were shown to reduce the nitrates into nitrites, were MP and VP negative, and gave growth in McConkey's agar medium.


[Drug resistance of the Salmonella isolated from poultry].

A total of 92 Salmonella strains, isolated from birds, were studied through graded dilutions in a solid nutrient medium for their resistance to penicillin, streptomycin, chloramphenicol, tetracycline, furazolidon and norsulfazol. Greatest was the number of strains resistant to penicillin (81.5 per cent), and lowest was it of strains resistant to tetracycline (27.1 per cent), norsulfazol (21.7 per cent), streptomycin (15.2 per cent), and furazolidon (1.08 per cent). No resistant strains were found to chloramphenicol. Both furazolidon and chloramphenicol are suggested for the control of Salmonella infections in birds.


Agglutination of group Ax erythrocytes by anti-A sera (group B).

Four random examples of group Ax erythrocytes were tested with anti-A sera (group B). Microscopic examination demonstrated a high incidence of reactivity of these cells with the anti-A sera (group B) obtained after immunization with group A substance.


Studies on new process procedures in plasma fractionation and industrial scale. III. Removal of precipitates by filtration through a horizontal leaf filter with centrifugal cleaning (Funda filter) as an alternative to tubular-bowl centrifuges.

The possibilities for replacing the time-consuming and labor-intensive centrifugation step in the plasma fractionation process with a filtration technique using filter aids were explored using a Funda filter (pat. Dr. Ing. Hans Müller). The filtration technique proved effective in the separation of the impure plasma fractions. On the other hand, its use in the separation of pure albumin and gamma-globulin fractions appears doubtful.


[A new method for determining the body composition with the aid of a displacement balance and low-pressure volumetric analysis (author's transl)].

A new method for determination of the specific weight of the gas-free human body is presented. Volume measurement is facilitated by extremely precise scales, by means of which a well-defined amount of water which was removed from a "patient container" is weighed. After the test subject has entered the container and is standing up to the neck in water, the container is closed. The combined gas volume consisting of the subject's lung volume, his intestinal gas and the air around his head is measured by lowering the pressure by an exactly-defined amount. This is done by opening a valve at the bottom of the container, which results in the outflow of a certain amount of water, the volume of which corresponds to the volume expansion inside the container. The gas volume prior to expansion can then be calculated by application of the gas laws. The advantages of this measuring device are its relatively small size, the high precision and the fact that the procedure is not unpleasant for the subject, as the head is not submerged under water.


[Quality control of coagulation tests (author's transl)].

The results of quality control of coagulation tests from intralaboratory control programmes are reported and compared with interlaboratory surveys. The test programme includes the following assays: the thromboplastin time (Quick), the partial thromboplastin time and the thrombotest. It can be seen from the results of the thromboplastin time that reliable figures were obtained from intralaboratory quality control examinations only (CV=7% to 13%). In comparison to these results great differences were found in interlaboratory surveys (CV=15% to 30%). The result of interlaboratory surveys of the thrombotest demonstrated a CV of 15% to 20%. The intralaboratory quality control of the partial thromboplastin time showed satisfactory reliability (CV=7.4%). Satisfactory conformity of results was obtained between different laboratories only by using common reagents (CV=8.7%). Possible factors responsible for deviations in laboratory examinations are discussed and proposals for improvement in the realibility of coagulation tests are made.


[The place of plate thermography in the diagnosis of breast cancer (author's transl)].

A report is presented of 319 unselected patients investigated by the method of plate thermography according to Tricoire, which is a comparatively new method in the diagnosis of breast cancer. 281 cases were additionally examined by mammography and those cases in whom malignancy was suspected underwent further cytological and histological investigation. The results of plate thermography and mammography are compared. The high degree of diagnostic accuracy achieved in the present series of cases by the use of plate thermography indicates that this procedure is not only a valable adjunct in the diagnosis of breast cancer but, moreover, seems to be recommendable as a screening method.