Uptake and transport of exogenous proteins by respiratory epithelium.

The tracer proteins, horseradish peroxidase and ferritin, placed in the trachea of guinea pigs were taken up by epithelial cells and transported to the extracellular space. The interval between the introduction of the tracer proteins into the lumen of the trachea and the morphologic demonstration of the porteins in the extracellular space or within the basal portion of the cells was between 30 and 60 minutes. The proteins were transported in vesicles and no penetration of the epithelial intercellular tight junctions was found. The intercellular tight junctions were made permeable to horseradish peroxidase by anesthetic ether and this permeable epithelium was compared to the vesicle type transport. Transepithelial transport of proteins is a possible mechanism for the introduction of antigenic material into the subepithelial lymphoid tissue and this transport may also be of importance in the late onset type of asthma.


Isolation of phagocytic cells from the rat renal glomerulus.

A method is described for the dissociation of rat glomerular cells in vitro. Isolated endothelial cells were characterized by the persistence of fenestrae. Mesangial cells showed a variety of morphologic appearances; if dissociation was performed after an intravenous injection of ferritin, such cells were identified by the presence of large ferritin-filled vacuoles. Intact epithelial cells were rarely seen, presumably because they did not survive the separation procedure. In culture, a high proportion of cells adhered to glass surfaces, were phagocytic, and had labeled heavily in vivo with ferritin; they were, thus, considered to be mesangial in origin. Receptors for immunoglobulin (Fc) and complement (c3) were also detected in such cells after 24 hours in culture, but not immediately after dissociation. Our findings suggest that a population of isolated glomerular cells, probably comprising mainly mesengial cells, is highly phagocytic and has the potential to develop Fc and C3 receptors. We propose that this technique offers a useful approach for the delineation of glomerular cell properties and functions.


Indentations of the glomerular basement membrane in renal diseases. A light and electron microscopic study on ultrathin serial sections.

Indentations of the glomerular basement membrane were observed by light microscopy in ultrathin Epon-embedded serial sections from the renal biopsies of patients who had membranous glomerulonephritis, minimal change glomerulonephrits, acute or resolving exudative glomerulonephritis and focal glomerulonephrits, interstitial nephritis, amyloidosis, rheumatoid arthritis, or ankylosing spondylitis. In patients with membranous glomerulonephritis, acute or resolving exudative glomerulonephritis, amyloidosis, or rheumatoid arthritis, the occurrence of indentations in the glomerular basement membrane differed significantly from that in controls. The presence of indentations did not correlate with proteinuria, hematuria, leukocyturia, arterial hypertension, or with the nephrotic syndrome or its treatment with steroids. Examination of alternate serial sections by light and be electron microscopy showed that the indentations that were light microscopically visible corresponded to craters on the epithelial surface of the glomerular basement membrane seen in the electron microscope. These craters contained protruding portions of the epithelial cells, extracellular electron-lucent material or electron-dense amorphous or striated membranous material. They were often surrounded by spikelike protrusions of the lamina densa. These indentations might represent solitary remnants of former subepithelial deposits.


Loss of sulfated proteoglycan from the surface of rabbit platelets during adenosine 5'-diphosphate-induced aggregation.

Rabbit platelets were labeled in vivo by intravenous injection of 35SO4=60 hours before the animals were exsanguinated. The labeled platelets were washed and resuspended in Tyrode's solution containing 0.35 per cent albumin. The aggregated normally upon the addition of ADP and during aggregation 14.0 +/- 2.7 per cent (mean +/- standard deviation) of the labeled material was lost into the suspending medium. The extent of loss was dependent on ADP concentration and was inhibited by inhibitors of ADP-induced aggregation (AMP, ATP, adenosine, prostaglandin E1, parachloromercuribenzensulfonate and lack of calcium). Since neither release of granule contents nor lysis occurs when rabbit platelets are aggregated by ADP, it was concluded that the labeled material that was lost had been part of the surface coat of the platelets. The labeled material has been identified in other studies as a proteoglycan in which the mucopolysaccharide is principally chondroitin sulfate A. Loss of this material did not make the platelets unresponsive to ADP. The platelets did not reincorporate labeled proteoglycan from plasma. Thrombin caused the release of 50 to 80 per cent of the total platelet-labeled material, presumably from both the granules and the surface. The functional significance of the loss of surface proteoglycan during platelet aggregation is unknown.


A morphologic study of rabbit bronchial lymphoid aggregates and lymphoepithelium.

Ultrastructural studies of the rabbit bronchial mucosa were performed with scanning and transmission electron microscopy. The former revealed that the bronchus-associated lymphoid aggregates could be distinguished from the surrounding tissue, since they were covered with epithelial cells possessing microvilli but not cilia. These lymphoepithelial cells were irregularly placed and provided crevices of varying dimensions at their junctions with other cells. On transmission electron microscopy, these cells showed scanty cytoplasm, several mitochrondria, few other organelles and only rare phagosomes. Just below the epithelium in the lymphoid aggregates, basophil-like cells were seen regularly and were also found in the lymphoepithelium and adjacent normal bronchila epithelium, here lying between cells above the basement membrane. The possible origin of these cells and their potential relationship to lung defense and hypersensitivity disease are discussed.


Scanning electron microscopy of hepatic ultrastructure: secondary, backscattered, and transmitted electron imaging.

Several methods of tissue preparation and different modes of operation of the scanning electron microscope were used to study the ultrastructure of rat liver. Rat livers were perfusion fixed with buffered 2 per cent paraformaldehyde or a mixture of 1.5 per cent paraformaldehyde and 1 per cent glutaraldehyde and processed as follows. Tissue blocks were postfixed in buffered 2 per cent osmium tetroxide followed sequentially by the ligand-mediated osmium binding technique, dehydration and cryofracture in ethanol, and critical point drying. They were then examined without metal coating in the scanning electron microscope operating in the secondary electron and backscattered electron modes. Fifty-micrometer sections were cut with a tissue sectioner, stained with lead citrate, postfixed with osmium, dehydrated, critical point dried, and examined in the secondary electron and back-scattered electron modes. Frozen sections (0.25 to 0.75 mum. thick) were cut by the method of Tokuyasu (Toluyasu KT: J Cell Biol 57:551, 1973) and their scanning transmission electron microscope images were examined either with a scanning transmission electron microscope detector or with a conversion stub using the secondary electron detector. Secondary electron images of the liver prepared by ligand-mediated osmium binding and subsequent cryofracture revealed such intracellular structures as cisternae of the endoplasmic reticulum, lysosomes, mitochondria, lipid droplets, nucleolus and nuclear chromatin, as well as the usual surface morphology, Lipocytes in the perisinusoidal space were readily identified. Backscattered electron images. Unembedded frozen sections had little drying artifact and were virtually free of freezing damage. The scanning transmission electron microscope image revealed those organelles visualized by the secondary electron mode in the ligand-mediated osmium binding-treated tissue.


The initial structural lesion in serum-induced demyelination in vitro.

Myelinated cultures of mouse spinal cord were exposed to sera obtained from rabbits affected by experimental allergic encephalomyelitis following challenge with whole white matter in complete Freund's adjuvant. In the presence of complement, the tissue response begins with an increased birefringence of its myelin sheaths. This is rapidly followed by a gamut of changes leading to demyelination. This study reports that, in the absence of complement, the response is arrested at the stage of increased birefringence. In this way, this early stage of the demyelinating process was available for detailed examination by light and electron microscopy. The brightened myelin sheaths appeared with a few hours of exposure and were seen around all axons and sometimes around cell bodies. This was often accompanied by abrupt breaks in the sheaths and angularly shaped myelin figures. Examination by electron microscope revealed a uniform increase in the myelin period from 11 nm. to 22 nm. The normally double intraperiod line was increased to four electron-dense leaflets, the additional two appearing to be derived from the close apposition of an additional electron-dense layer on the outer surface of the myelin sheath or oligodendrocytic membrane. Oligondendrocytes responsed with a prolific growth of processes whose membranes compacted to form swollen myelin. Neurons, astrocytes, and neuropil showed no changes. In its early stages, at least, the swelling was reversible. It would appear, therefore, that we have isolated the first stage of antiserum-induced demyelination in vitro, a stage which is now available for further study.


Some relationships between punishment, stuttering, and galvanic skin responses.

The simultaneous effects of response-contingent punishment on stuttering behaviors and the frequency of galvanic skin response (GSR) deflections for 10 subjects were investigated. GSR's and stuttering responses were recorded during base rate, treatment, and extinction conditions. The subjects demonstrated a 50% or greater decrease in stuttering frequency during the treatment condition. Combined data for all subjects indicated that the mean frequency of GSR deflections remained stable or declined across conditions of the study. Analysis of individual data revealed that GSR deflections during treatment as compared with base rate increased for four subjects, remained essentially the same in two subjects, and decreased for four subjects. These results suggest that experimental procedures which result in functional punishment effects on stuttering frequency may not be associated with any predictable pattern on concomitant autonomic arousal.


The influence of duration on the effects of time-out from speaking.

The influence of the variable of duration on the effects of time-out from speaking was investigated. Forty-five adolescent and adult stutterers participated in a study which examined the relative effects of time-out of one, five, 10, and 30 seconds and no time-out. Response-contingent time-out from speaking of all four durations resulted in significant reductions in stuttering frequency while the no time-out control showed no change. Although longer durations tended to effect greater reductions in stuttering frequency, no reliable differences between time-out durations were found. It was concluded that the punishing effects of the time-out from speaking procedure were predominantly due to its involving contingent interruption of speaking, and that the actual duration of the period of silence was comparatively unimportant. Present findings seems to provide little support for the notion that time-out from speaking primarily represents time-out from positive reinforcement.


Damage risk: an evaluation of the effects of exposure to 85 versus 90 dBA of noise.

The purpose of this study was to compare the damage risk of 85 and 90 dBA of white noise for equivalent full-day exposures. The damage risk of the two noise levels was determined by comparing the temporary threshold shift (TTS) of 12 subjects exposed to either 85 or 90 dBA of white noise for equivalent half- and full-day exposures. TTS was determined by comparing the pre- and postexposure binaural audiograms of each subject at 1, 2, 3, 4, 6, and 8 kHz. It was concluded that the potential damage risk, that is, hazardous effect, of 90 dBA is greater than 85 dBA of noise for equivalent full-day exposures. The statistical difference between the overall effects of equivalent exposures to 85 dBA as compared to 90 dBA of noise could not be traced to any one frequency. The damage risk of a full-day exposure to 85 dBA is equivalent to that of a half-day exposure to 90 dBA of noise. Within the limits of this study, TTSt was as effective as TTS2 for estimating the damage risk of noise exposure.


An electromyographic study of velopharyngeal function in speech.

Electromyographic (EMG) recordings were obtained from the levator palatini, superior pharyngeal constrictor, middle pharyngeal constrictor, palatoglossus, and palatopharyngeus muscles of three talkers of American English. Bipolar hooked-wire electrodes were used. Each subject read nonsense words composed of three vowels (/i, a, u/), six stop consonants (/p, b, t, d, k, g/), and two nasal consonants (/m, n/) to form various stop-nasal and nasal-stop contrasts. Multiple repetitions of each utterance type were recorded and subsequently processed by computer. The levator palatini was found to be the primary muscle of velopharyngeal closure for each of the subjects. The palatopharyngeus also showed consistent oralization activity for each of the subjects, although the activity of this muscle was strongly affected by vowel environment. Two subjects showed pharyngeal constrictor muscle activity related to oral articulation, but pharyngeal constrictor activity for the third subject was related to vowel quality. Nasal articulation was accomplished by suppression of oral articulation for each subject. Vowel quality affected the strength of EMG signals for lateral and posterior pharyngeal wall muscles. In those cases where activity was different for the three vowels, activity was greatest for /a/.


Self- versus investigator-administered presumed fluency reinforcing stimuli.

The effects of self-administered and investigator-administered presumed fluency reinforcing monetary rewards for perceived fluency increases on the disfluency frequency rate of 17 adult stutterers were studied. Subjects read aloud during 11 one-minute segments under three conditions: one in which no reinforcer was administered at the end of each one-minute segment, a self-administered reinforcement condition, and an investigator-administered reinforcement condition. Although less stuttering was found in the two experimental conditions (with significantly less stuttering occurring in the self-administered fluency reinforcing condition than in the control condition), an increase in stuttering was observed in those reading segments which followed the administration of presumed fluency reinforcing stimuli. These results were interpreted to suggest that although the concept of self-reinforcement may be clinically useful, the operant learning paradigm may be insufficient in providing an adequate description of the events taking place following the administration of fluency contingent reinforcing or punishing stimuli.


A cineradiographic study of articulation in two talkers with temporarily induced oral sensory deprivation.

Cineradiography was used to study the behavior of the lips, tongue, and mandible in two subjects talking normally and under the influence of trigeminal nerve-block anesthesia. The speech sample consisted of isolated words and sentences. The nerve block was administered to eliminate somesthetic sensation in all of the oral articulators except the jaw. Frame-by-frame measurements of lip protrusion, tongue position, and jaw placement were taken from the film data for selected stops, glides, fricatives, and vowels in the speech sample. Comparison of these measurements from the normal and nerve-block condition revealed the following changes in the nerve-block data: (1) reduction in context-appropriate lip protrusion and loss of precision in lip closure activity, which was more noticeable for the upper than the lower lip; (2) a reduction in the precision of tongue articulations particularly on contacts for lingua-alveolar and lingua-velar consonants, apical retroflexion on glides, and steady state postures for lingua-palatal fricatives and vowels; and (3) noticeable alterations in inferior/superior jaw position which was systematically closer to the maxilla for bilabial consonant closures and often reduced or extended in excursion for vowels and other consonants. The data are discussed in terms of the relative effects of an oral somesthetic feedback deficit on speech production, and also with respect to compensation within the articulatory system under conditions of sensory deprivation.


Traits attributed to stuttering and normally fluent males.

To determine if a stereotype of the "typical stutterer" exists and to identify possible differences in that sterotype due to exposure to stuttering, seven groups of subjects having a wide range of possible exposure to stutterers rated four hypothetical concepts (typical eight-year-old male, typical eight-year-old male stutterer, typical adult male, and typical adult male stutterer) on 25 scales arranged in a semantic differential format. These bipolar scales were derived from words previously judged by speech clinicians as descriptive of stutterers and antonyms of those words. It was concluded that a strong stereotype of a stutterer's personal characteristics exists, that the stereotype is predominantly unfavorable, that the stereotype is essentially unaffected by amount of exposure to actual stutterers, and that the traits attributed to boys and men who stutter are similar. Some implications of the study are discussed.


Second formant transitions of selected consonant-vowel combinations in the speech of deaf and normal-hearing children.

Although it is well known that the speech produced by the deaf is generally of low intelligibility, the sources of this low speech intelligibility have generally been ascribed either to aberrant articulation of phonemes or inappropriate prosody. This study was designed to determine to what extent a nonsegmental aspect of speech, formant transitions, may differ in the speech of the deaf and of the normal hearing. The initial second formant transitions of the vowels /i/ and /u/ after labial and alveolar consonants (/b, d, f/) were compared in the speech of six normal-hearing and six hearing-impaired adolescents. In the speech of the hearing-impaired subjects, the second formant transitions may be reduced both in time and in frequency. At its onset, the second formant may be nearer to its eventual target frequency than in the speech of the normal subjects. Since formant transitions are important acoustic cues for the adjacent consonants, reduced F2 transitions may be an important factor in the low intelligibility of the speech of the deaf.


The ability of stutterers and nonstutterers to initiate and terminate phonation during production of an isolated vowel.

This study tested the hypothesis that stutterers have difficulty initiating and terminating phonation independent of the acts of running speech and stuttering. Ten young adult stutterers served as the experimental group. They were matched as a group for age and sex with 10 normal speakers. Subjects from both groups were tested individually. The experimental task required that subjects start and stop phonation as quickly as possible upon hearing each member of a seried of 1000-Hz pure tones appear and then disappear. Subjects' vocalizations were permanently recorded on an optical oscillograph. Results showed that both groups improved (shortened) their voice initiation and termination times from the beginning to the end of the experiment. Typically, however, the stutterers were significantly slower than the control subjects on most of the temporal measures.


Temporal acuity in listeners with sensorineural hearing loss.

Temporal acuity, the minimum time interval within which the auditory system can discriminate the order of auditory events, was measured for three listeners with normal hearing and for 10 listeners with sensorineural hearing loss. Eight of the 10 listeners with sensorineural loss showed better temporal acuity for conditions with greater loss. The remaining two listeners showed the opposite effect. The temporal acuity results are not well correlated with either speech discrimination scores or measures of recruitment. The temporal acuity results do appear to be correlated with results observed in studies of temporal integration or brief-tone audiometry. Listeners with sensorineural loss tend to have both poor temporal integration and good temporal acuity. This suggests that the two temporal measures may reflect a single time constant in the auditory system.


An examination of the semantic relations reflected in the language usage of normal and language-disordered children.

Language samples were obtained from 40 children in order to examine semantic relations reflected in language usage as a function of chronological age (three and five years) and linguistic status (normal and language disordered). Normal-disordered comparisons were made under both matched utterance length and matched age conditions. Results are interpreted as supporting the notion that the disordered-language usage reflected semantic relations consistent with an earlier level of development.


Anatomical and neuromuscular maturation of the speech mechanism: evidence from acoustic studies.

This paper surveys acoustic studies of speech development and discusses the data with respect to the anatomical and neuromuscular maturation of the speech mechanism. The acoustic data on various aspects of speech production indicate that the accuracy of motor control improves with age until adult-like performance is achieved at about 11 or 12 years, somewhat after the age at which speech sound acquisition usually is judged to be complete. Other topics of discussion are (1) problems in the spectrographic analysis of children's speech, (2) formant scale factors that relate children's and adults' data, and (3) identification and diagnosis of developmental disorders through acoustic analyses of speech sounds.


Complement structures in the language of deaf students.

Four hundred and twenty-seven deaf students (age 10 to 19 years) and 60 hearing children (age eight to 10 years) judged the grammaticality of sample sentences which contained infinitival or gerundive complements. Results indicated improvement with increasing age for deaf students. Even the youngest hearing students consistently obtained higher scores than most of the deaf students. Although the function of the complement (as subject or object) did not make a difference in performance, the type of complement did. POSS-ing complements were easier than for-to complements. Verb type also influenced performance.


The effects of stimulability on the articulation of /s/ relative to cluster and word frequency of occurrence.

This study investigated the effects of stimulability on the articulation of cluster nested /s/ in high- and low-frequency clusters and words. A good stimulability group and a poor stimulability group of /s/-defective seven-year-old children were investigated. Statistical analysis did not reveal significant differences between the articulatory performances of the two groups on words or clusters occurring with high or low frequency. Subjects in the good stimulability group obtained significantly fewer errors on the test stimuli than did subjects in the poor stimulability group. Correlational analyses indicated that stimulability was positively correlated with correct numbers of /s/ productions in both clusters and words occurring with both high and low frequency. Subjects' spontaneous /s/ errors on the Templin-Darley screening test were not found to be correlated with their stimulability scores or their imitative /s/ productions in words and clusters occurring with high or low frequencies.


The influence of three phonological rules of black English on the discrimination of minimal work pairs.

Minimal word pairs that are presumed to be perceptually difficult to differentiate when spoken in black English were examined relative to (1) black children's performance in differentiating the meanings of their own word pair productions and those of other blacks and whites and (2) white children's performance in differentiating the meanings of word pairs produced by black children. Perceptual errors were significantly greater for whites listening to word pairs produced by blacks than for blacks listening to themselves, other blacks, or whites. No significant differences were found among blacks listening to themselves, other blacks, and whites. Perceptual errors followed predictable patterns that were influenced by three phonological rules of black English. Also, the data suggest that there are phonemic cues that are imperceptible to non-black-English speakers which allow black-English speakers to differentiate word pairs.


Factors contributing to the reduction of stuttering during singing.

This study was conducted to determine if the reduction of stuttering typically observed during singing is associated with altered vocalization or the familiarity of the melody and lyrics of the song sung by the stutterer, or both. Subjects were eight adult male stutterers. Prior to testing, each of these individuals demonstrated that he knew the melody and lyrics of a well-known song from memory. Subsequently, subjects were asked to read these lyrics aloud and then sing them. Next, subjects had to read aloud and then sing a set of unfamiliar lyrics to the conventional melody of the same song. The stutterers' reading and singing performances were audiotaped. The dependent measures of utterance duration and stuttering frequency were extracted from the tapes. Results showed that subjects' utterance durations were significantly longer during singing than reading. The main effects of singing and familiarity were both associated with significant reductions in stuttering frequency. The greatest decrement in stuttering occurred in the condition where subjects sang the familiar melody and lyrics. These findings were interpreted to mean that changes in vocalization cannot account for all of the decrease in stuttering that occurs during singing. During song, the familiarity of the melody and lyrics being produced may also affect stuttering frequency.


Latency of vocalization onset: stutterers versus nonstutterers.

Eleven stutterers and matched controls were asked to produce as quickly as possible each of 26 different syllables following a visual stimulus. Three trials were given for each syllable. Responses were filtered to remove supraglottally produced sounds, and the time between the visual stimulus and the onset of vocalization was measured by a voice-operated relay and a computer's internal clock. The results suggested that stutterers are slower in initiating vocalization across a wide variety of syllables, and the difference averages about 65 msec. Furthermore, when phonologic conditions delayed voice onset by a comparable amount, the stutterers gained enough time so that no significant differences were observed between the two groups. The results are interpreted as suggesting that auditory dysfunction cannot be a cause for slower vocalization reaction time in stutterers but that either vocal dysfunction or a lack of cerebral dominance may be responsible for these differences.


Elicited imitation of selected features of two american English dialects in Head Start children.

Three measures were used to check the bidialectal imitative facility of 100 black, white, and Spanish-speaking Head Start children. In general, blacks and Spanish-speaking subjects performed more accurately on black English markers than on Standard English markers and whites, the reverse. When the children did make an error on the feature marker they usually substituted the opposing dialectal marker. Blacks and Spanish-speaking subjects were more apt to be accurate on the total sentence when it was given in black English. Several explanations are offered for group similarities and differences.


Stuttering: discoordination of phonation with articulation and respiration.

Complexity of phonatory and respiratory adjustments was systematically simplified in 30 adult stutterers under three speaking conditions: voiced, whispered, and articulated without phonation. Stuttering was reduced considerably when whispering and was practically eliminated when articulating silently. The possibility that stuttering consistently results from complexity of phonatory coordinations with articulation and respiration was strongly supported. Increased speaking rates under conditions that decreased stuttering seemed to be evidence that efficient rhythmical flow of speech is facilitated by simplification of phonatory and respiratory adjustments.


The influence of selected masking noises on Lombard and sidetone amplification effects.

The present experiments were designed to test the notion that the Lombard and sidetone amplification effects are related to the masking ability of a presented background noise. In Experiment 1, eight normal-hearing college students spoke in quiet and while listening to five frequency bands of noise which were equated for intensity but differed in ability to interfere with speech intelligibility. Vocal intensity increased as the frequency band, and thus the masking ability of the noise increased. In Experiment 2, eight additional students spoke in quiet and while listening to four of the frequency bands of noise used in Experiment 1. The noises were equated for loudness rather than intensity. Again, vocal intensity increased as the masking ability of the noise increased. In Experiment 3, 20 additional students spoke while listening to 0 and 20 dB of sidetone amplification mixed with three of the noise bands from Experiment 1. The noises were equated for intensity and mixed with sidetone. The sidetone amplification effect increased as the masking ability of the noise increased. The results of these experiments indicate that interference with speech intelligibility is directly related to elicitation of the Lombard and sidetone amplification effects. The loudness or intensity of a noise has little control over vocal intensity independent of the contribution to masking of speech.


Some aspects of the verb system in the language of deaf students.

Approximately 480 deaf students (age 10 to 19 years) and 60 hearing students (age eight to 10 years) were asked to judge the grammaticality of sentences containing auxiliary verbs, of sentences where the verb had been deleted, and of sentences in which the verb tense was not marked. The results indicated that deaf students have considerable difficulty with the verb system of English. This difficulty was most pronounced in the formation of tense and voice and in agreement in number and tense. A possible ordering for the acquisition of tense did emerge; from earliest to latest it is: simple past, future, present progressive, perfective, and passive. Improvement in grammaticality judgments appeared to come from an increase in recognition that incorrect sentences were ungrammatical.


Performance of adult aphasics on a sentence evaluation and revision task.

Adult aphasics completed a sentence evaluation and revision task to test some aspects of their linguistic competence. Grammatical and ungrammatical sentences served as the stimuli. Ungrammatical sentences were characterized by violations of syntactic or semantic structure, or both. Aphasics evaluated correctly the grammaticality of most stimulus sentences. Incorrect evaluations were associated with sentences characterized by violations of syntactic structure. Aphasics' revisions of sentences that they judged to be ungrammatical were in the direction of appropriate grammatical structures. Omission of morphological endings was the most frequent sentence revision error. Aphasics' errors on both tasks could be accounted for by performance deficits such as inattentiveness to syntactic detail, auditory perceptual impairments, and inefficient lexical retrieval. These findings lend support to the argument that aphasia is best characterized as a performance rather than competence disruption.


Rapid auditory processing in normal and disordered language development.

Four-and-one-half- to eight-and-one-half-year-old children with normal language development, normal adults, and dysphasic children were tested for their ability to perceive binary sequences of nonverbal auditory stimuli. Performance was studied in relation to the rate of presentation of stimulus sequence, as measured by the time interval between stimulus elements. Of the normal children studied, only the eight-and-one-half-year-old group responded as well as the adult group to auditory patterns composed of complex tones presented in rapid succession (8-305 msec intervals). Normal children six-and-one-half years and older were able to respond to these same auditory patterns when they were presented more slowly (947-4026 msec intervals). The overall pattern of performance of the dysphasic children was not similar to that of any age group of children with normal language development. The dysphasics' performance was significantly poorer than that of even the four-and-one-half-year-old normal group on rapidly presented auditory sequences, but not significantly different from normal children their own age or adults on the same patterns which were presented more slowly. The interrelation of normal development of rapid auditory processing and normal language development is discussed.


Lead and lag effects associated with the staggered spondaic word test.

This study was designed to determine to what extent onset times of overlapping spondaic words were controlled in the development of the Staggered Spondaic Word Test (SSW) (List EC), a measure which is used to detect central auditory dysfunction. The results showed that the SSW (List EC) was not well controlled relative to onset times. Further, the scores of 10 normal-hearing listeners who were administered the SSW were found not to suffer when the onset times were closely matched. The results were related to thn of dichotically presented stimuli.


The "heart" of categorical speech discrimination in young infants.

Categorical discrimination of place of articulation in the stimuli [dae] and [gae] was investigated in three- to four-month-old infants using a 20/20 cardiac orienting response paradigm. In this procedure infants were presented with 20 tokens of one syllable followed immediately by 20 tokens of a change stimulus. Each infant received a between-category shift, a within-category shift, and a no-shift control condition, with the order of conditions completely counterbalanced across subjects. Discrimination was indexed by an orienting response to the onset of the second 20 stimuli. The data were analyzed for evidence of categorical discrimination both within subjects (each condition pooled across orders of presentation) and between subjects, as is typical of infant-categorical discrimination studies. Both sets of results revealed that infants discriminate the cues for place of articulation categorically. These findings demonstrate the generality of the infant categorical discrimination observed with the nonnutritive operant sucking paradigm and indicate the usefulness of the heart rate paradigm employed in the present study for the collection of within-subject speech discrimination data across a wide-range of subject populations.


Pretreatment factors associated with the outcome of stuttering therapy.

Measures of stuttering behavior, personality, and attitudes about speaking were obtained from 20 stutterers at the beginning of treatment. These measures were correlated with three measures of stuttering behavior a year after treatment. Pretreatment attitudes were most highly related to outcome. followed by pretreatment stuttering behavior, and then personality measures. Multiple regression analyses of the pretreatment measures demonstrated that combinations of these variables correlated moderately high (r = 0.79, 0.66, 0.73) with outcome. Prediction equations derived from the multiple regression analyses were used to predict outcomes for an independent group of 18 stutterers. Predicted and actual outcomes were shown to be correlated moderately high (r = 0.75, 0.73, 0.51). Suggestions for clinical use of predictive factors are given. Implications for the design of treatment and understanding the nature of stuttering are discussed.


A new technique for measuring velopharyngeal orifice area during sustained vowel production: an application of aerodynamic forced oscillation principles.

A new technique for measuring velopharyngeal orifice area during sustained vowel production is described. The technique is based on a simple oscillatory flow balancing procedure between two aerodynamic branches, a mechanical model of the human upper airway and the subject's upper airway. The area of the velopharyngeal orifice in the model is adjusted until identical oscillatory flows traverse it and the subject's velopharyngeal orifice in response to a common forced oscillatory pressure. When identical oscillatory flows are observed, the area of the adjusted orifice is taken as a measure of the area of the subject's velopharyngeal orifice.


Effects of dorsal and ventral lateral hypothalamic lesions on voluntary alcohol consumption by rats.

Ventral lateral hypothalamic lesions, made before electrical stimulation, blocked the acquisition of a preference for alcohol by rats; but dorsal lateral hypothalamic lesions did not alter their alcohol consumption. Rats offered alcohol on alternate days, without stimulation, increased their alcohol intake but did not develop a stable preference for alcohol.


Food effects on absorption and metabolism of alcohol.

The concomitant ingestion of various foods with alcohol resulted in a decreased area under the blood alcohol concentration curve, a lower peak concentration and an increased time to reach peak. Michaelis-Menten kinetics indicated a decreased alcohol metabolism rate after the ingestion of carbohydrates or fats.


The diagnosis of pathological intoxication.

Subjects with a history of violent or psychotic behavior while under the influence of alcohol were infused with a 25% alcohol solution. Based on electroencephalograms, blood alcohol concentrations and behavioral observations, the results confirm the probable existence of a discrete syndrome of pathological reaction to alcohol without reference to the amount of alcohol consumed.


Personality characteristics of alcoholics and drug addicts in a merged treatment program.

Groups of alcoholics and drug addicts in a mixed inpatient treatment facility were compared on personality characteristics by sex, age and type of drug. Sex and drug type showed few significant differences; however, age, regardless of drug or sex, proved to be significant on many personality variables.


Evaluation of training of alcoholism counselors.

During a 14-month training program for paraprofessional alcoholism counselors some counselors were markedly more successful than others in keeping patients in treatment and these differences persisted over time.


A diagnostic formula for alcoholism.

Clinical pathologies with unusually high morbidities in alcoholic populations were analyzed to determine their capacity to diagnose alcoholism. On the basis of five systemic variables it was possible to diagnose correctly nearly 75% of alcoholic and matched control subjects.


Loss of control, heavy drinking and drinking problems in a longitudinal study.

The utility of conceptualizing alcoholism as a typically progressive disease process with regular, predictable stages is questioned. "Loss of control" was found to be only one variable among others in predicting drinking problems. It was not possible to confirm the importance that some disease conceptions of alcoholism assign to it.


Sex differences in adolescent alcohol and drug use. A disappearing phenomenon.

In a study of junior and senior high-school students in two Massachusetts communities, few consistent sex differences were found in patterns of alcohol and drug use.


Sex and marital status in relation to the characteristics of alcoholics.

Data on 392 married and unmarried men and women alcoholics suggest that certain social antecedents and drinking patterns represent genuine sex differences and are independent of marital status. However, marital status was related to severity of alcoholism, particularly with respect to personal background characteristics and to psychological functioning at the time of treatment.


Lack of association of genetic traits with alcoholism; C3, Ss and ABO systems.

A study of association between markers of the Ss system, the C3 system and the ABO system showed no evidence of any association between alcoholism and specific phenotypes.


Drinking and smoking behavior of hospitalized medical patients.

In a sample of hospitalized medical patients, problem drinking was found to be associated with heavy smoking.


Pharmacological aversive counterconditioning to alcohol in a private hospital; one-year follow-up.

Of 261 patients treated for alcoholism with pharmacological aversive counterconditioning, 63% remained abstinent for 1 year following treatment.


Social-skills training to teach alcoholics to refuse drinks effectively.

Two alcoholics who received social-skills training in ways of refusing drinks reported some success in applying their new skills in actual social situations after they left the hospital.


Comment on "A national study of adolescent drinking behavior, attitudes and correlates".

A national study of adolescent drinking is criticized on methodological and conceptual grounds, and it is concluded that its results exaggerate the prevalence of problem drinking among adolescents.


Opitmal age and results in repair of large ventricular septal defects.

The hospital mortality rate was 9.1 per cent (three deaths) in 33 patients less than 2 years old undergoing primary repair of single large ventricular septal defects (VSD's) since January 1972, and was not related to age; it was zero in 50 patients older than 2 years (Group A). The mortality rate with multiple VSD's was 36.4 per cent, not related to age. Age at operation, preoperative pulmonary vascular resistance, and pulmonary artery pressure were directly related to mean pulmonary artery pressure 5 or more years later in 74 patients (Group B) operated upon between 1955 and 1968. Over-all probability of "surgical cure" for single large VSD (surviving the early and late postoperative period with normal or near-normal pulmonary artery pressure 5 years later) is 92 per cent when pulmonary vascular resistance is 4 units - sq. M. and operation performed at age 27 months, 87 per cent when resistance is 8 and operation done at age 6 months, and 80 per cent when resistance is 12 and operation done at less than 6 months of age. These and other probability curves are examined and compared with natural history to determine optimal age for elective repair for large VSD's.


Pulmonary neoplasm with solitary cerebral metastasis. Results of combined excision.

Twenty-two patients underwent excision of a primary pulmonary neoplasm and solitary cerebral metastasis. Six patients had metastatic tumor removed on two occasions and there was one operative death in 28 craniotomies. Seven of 22 patients (32 per cent) survived one year following craniotomy and were free of significant symptoms for one year. Survival for at least 9 months and freedom from significant symptoms was achieved in a total of 12 patients (55 per cent). Relief of severe neurologic symptoms for a minimum of 3 months was achieved in 17 patients (77 per cent). The over-all one-year survival rate was 45 per cent and the average survival period is 14 months with 3 patients still living. The following factors had a favorable bearing on the outcome: Stage 1 lung cancer at pulmonary resection, whole-brain radiation therapy, and a longer interval between pulmonary resection and cerebral metastasis. The experience encourages us to pursue an aggressive surgical approach to pulmonary neoplasm and solitary cerebral metastasis.


Gallium-67 scanning for carcinoma of the lung.

Gallium-67 citrate scanning was prospectively evaluated in 55 patients who had lung lesions suspected to be primary carcinoma on chest x-ray films and in whom subsequent histologic diagnosis was obtained. Of 47 patients with histologically proved carcinoma of the lung, 44 (94 per cent) had a positive 67Ga scan. No patient with a positive scan had a benign lesion, so that the positive scan accuracy rate was 100 per cent. All 8 patients with a benign lesion and 3 patients with a malignant lesion had negative scans, for a negative scan accurary rate of 72 per cent for benign lesions. These results give statistical validity for the usefulness of the 67Ga scan in diagnosing carcinoma of the lung (p less than 0.001). Tumor cell type had little effect on the sensitivity of 67Ga scan. The 67Ga scan was equally useful in the evaluation of peripheral and central lesions. There was little difference amount T1, T2, and T3 classified lesions in their ability to take up 67Ga. The 67Ga scan was competitive with mediastinoscopy in assessing mediastinal lymph node metastases and provides a noninvasive method of assessing hilar lymph node metastases. There was a good correlation between the clinical staging of patients with lung cancer based on a chest x-ray film and 67Ga scanning and the staging after surgical treatment based on the histology of the resected specimens.


Acute aortic dissection from cross-clamp injury.

Acute dissection of the ascending aorta secondary to cross-clamp injury can be successfully managed if the problem is recognized immediately. Bypass must be instituted after recannulation at a point distal to the innominate artery so that proper exposure of the site of injury can be obtained. Systemic as well as local hypothermia for myocardial preservation are both necessary. Direct suture closure of all layers at the site of dissection over Teflon felt can terminate this process.


Traumatic rupture of the aorta. A five-year experience.

In the five-year period ending in October, 1975, 31 consecutive patients with traumatic rupture of the thoracic aorta underwent surgery at the University of Maryland Hospital or the Maryland Institute for Emergency Medicine. All cases were confirmed by preoperative aortogram. Rupture was confined to one or more sites in the descending thoracic aorta at or distal to the origin of the left subclavian artery. The age was a mean of 26 years. Operation was done within an average of 18 hours after injury. Significant nonthoracic injuries were present in every case. Six patients with positive findings on peritoneal lavage underwent exploratory laparotomy prior to thoracotomy because of shock. Surgical repair was done by use of left heart bypass in 2 cases (one death), a passive aorta-aorta shunt in 23 cases (5 deaths), and without shunt or bypass in 6 cases (no deaths). An end-to-end tubular Dacron graft was used to reconstruct the aorta in all but one patient. Over-all survival rate was 25 of 31 patients (81 per cent). Paraplegia developed in one patient and renal failure in 3 patients (2 deaths) in the aorta-aorta shunt group. Hypertension was present in 18 (72 per cent) of the survivors. Palsy of the left recurrent laryngeal nerve persisted in 8 (32 per cent) of the survivors. Two of the deaths were related to technical problems of the shunting procedure and 2 to intrapleural exsanguination before proximal aortic control could be achieved. Complications and blood loss were reduced in the group with no shunt. The series lends support to the rigorous aortographic search for ruptured thoracic aortas in trauma patients with widened mediastinum. Once experience has been gained with shunting techniques, tears of the descending thoracic aorta may be safely repaired without shunt if done expeditiously.


The contribution of anticoagulants to platelet dysfunction with extracorporeal circulation.

This investigations evaluates the effects of anticoagulants on platelet function. Fresh human blood from 40 nonmedicated volunteers was anticoagulated with 4.3 units per milliliter heparin and/or acid-citrate-dextrose (ACD) solution 1:9. Retention of platelets from whole blood on glass beads was performed by the method of Bowie. Platelet retention of heparinized blood averaged 88.1 +/- S.E. 1.5 per cent; ACD platelets averaged 24.6 +/- S.E. 2.8 per cent. Platelet retention with citrate-phosphate-dextrose (CPD) and ethylenediaminetetraacetic acid (EDTA) yielded 26.0 +/- S.E. 3.9 per cent and 19.1 +/- S.E. 7.5 respectively. The addition of ACD to heparinized blood decreased platelet retention (19.7 +/- S.E. 3.1 per cent). The addition of heparin to ACD or CPD blood did not alter the original decreased retention. Calcium added, even in excess, to blood containing heparin and ACD did not reverse the depressed retention (29.3 +/- S.E. 4.6 per cent). The substitution of CPD gave similar results. With mixtures of separately collected ACD and heparininzed blood, depression of platelet retention was directly proportional to the amount of ACD blood present. Altering the pH of the ACD blood did not affect its depressed retention of platelets. Neutralizing heparinized blood 50 per cent with protamine or Polybrene also significantly depressed platelet retention 34.6 +/- S.E. 5.8 per cent and 35.5 +/- S.E. 4.0 per cent, respectively. Neither protamine nor Polybrene had any effect upon ACD blood. These data indicate that anticoagulants may play a significant role in the depressed platelt function observed during and following extracorporeal circulation.


Effects of pulsatile and nonpulsatile coronary perfusion on performance of the canine left ventricle.

This study compares the effect of pulsatile (Group C, Fib/P) and nonpulsatile (Group B, Fib/NP) coronary perfusion on myocardial performance during 2 hours of normothermic ventricular fibrillation. Group A (BH/NP), used as a base-line observation, consisted of 2 hours of nonpulsatile coronary perfusion in beating hearts. The assessment of ventricular performance included diastolic ventricular compliance, myocardial oxygen consumption and lactate extraction, regional myocardial blood flow, and histology. After 120 minutes of ventricular fibrillation, Group C showed normal ventricular diastolic compliance as compared to a 50 per cent decrease in Group B (p less than 0.01). Myocardial oxygen consumption was not significantly different from that in Group B. Because of a 70 per cent increase in oxygen extraction above Group B (p less than 0.05), total left ventricular myocardial blood flow was reduced (103 +/- 23 versus 260 +/- 36 ml. per 100 Gm. per minute, p less than 0.05) and had near-constant resistance. Lactate extraction was significantly greater and more stable as compared to Group B (9.28 +/- 1.33 versus 1.8 +/- 1.08, p less than 0.05). Left ventricular endocardial/epicardial flow ratio was greater in Group C (1.21 +/- 0.08 versus 1.06 +/- 0.06, p less than 0.05). Minimal subendocardial histologic changes were present as compared to the marked patchy subendocardial ischemic changes seen in Group B. The results demonstrate that the addition of pulsatile flow to coronary perfusion minimized the deleterious effects of prolonged ventricular fibrillation on myocardial performance.


Clinical and hemodynamic criteria for use of the intra-aortic balloon pump in patients requiring cardiac surgery.

In order to establish criteria for elective use of the intra-aortic balloon pump (IABP) in patients having cardiac surgery, we conducted a retrospective study of 43 patients who required counterpulsation, because of inability to be weaned from cardiopulmonary bypass, between May, 1972, and June, 1974. Patients in cardiogenic shock preoperatively were excluded. The 43 patients included 23 (Group A) who had severe preoperative left ventricular dysfunction with a mean cardiac index less than 1.8 L. per minute per square meter, ejection fraction less than 30 per cent, and end-diastolic pressure greater than 22 mm. Hg; 20 patients (Group B) had a combination of moderate cardiac dysfunction (cardiac index less than 2.2, ejection fraction less than 40, end-diastolic pressure less than 18) in the presence of acute infarction or severe aortic stenosis (gradient greater than 80 mm. Hg) with or without coronary disease. An inverse relationship was noted between survival and delay from completion of operation to the use of 1ABP. Thirty-two of 43 patients were weaned off bypass and were balloon assisted for 12 to 96 hours postoperatively; 25 patients were discharged (58 per cent). In Subgroup A, 14 of 23 (60 per cent) and, in Subgroup B, 9 of 20 (45 per cent) were long-term survivors. Based on these findings, 45 patients were operated upon between June, 1974, and December, 1975, with elective use of 1ABP and were assessed by serial hemodynamic studies. Sixteen had severe preoperative left ventricular dysfunction similar to Subgroup A and 29 had moderate dysfunction in combination with pathology similar to Subgroup B. Fifteen of these patients were hemodynamically unstable at time of arrival in the operating room; 1ABP was inserted under local anesthesia. Thirty-nine patients (87 per cent) were weaned off bypass and were hospital survivors. In Subgroup A, 13 of 16 (81 per cent) and, in Group B, 21 of 29 (72 per cent) were long-term survivors. Criteria for elective use of 1ABP in cardiac surgery should include severe preoperative left ventricular dysfunction or a combination of moderate dysfunction with coronary or valvular pathology. Elective 1ABP improves the survival with trivial iatrogenic morbidity.


Fresh platelet-rich plasma from a flow-through centrifuge for lamb heart perfusion at 13degrees C. Protective effect of added erythrocytes.

Isolated lamb hearts perfused at 13degrees C. with acellular perfusates developed progressive intersitital edema and a rise in vascular resistance. They did not exhbit any electrical or mechanical activity. In contrast, hearts perfused with whole fresh blood remained well preserved, had no edema or change in vascular resistance, and contracted vigorously while being perfused at 10degrees and 13degrees C. This study was designed to determine which particular component(s) of whole blood contributed to improved cardiac preservation. Isolated lamb hearts were perfused for 18 hours at 13degrees C. with plasma containing platelets and some or no red blood cells. Continuously fresh plasma was obtained from a donor animal by means of a flow-through centrifuge. Hearts perfused at 13degrees C. with fresh plasma of either low or high platelet count contracted during the initial 2 to 4 hours of the perfusion only and were as poorly preserved as hearts perfused with acellular microfiltered plasma. A hematocrit value of 2 to 5 per cent in the plasma perfusate resulted in the hearts being preserved almost as well as with fresh whole blood; they showed a forceful cardiac activity at 13degrees C., there was no edema, the vascular resistance was stable, and after rewarming they had good ventricular function. The improvement in cardiac preservation brought about by addition of a minimal amount of red blood cells suggests a specific effect of erythrocytes on the cardiac microcirculation.


Warm ischemic injury of the lung.

Canine left lower lobes which were subjected to 3 hours of warm ischemia in an atelectatic condition were compared to lobes which had not been stored. During short-term reimplantation studies, the injured lobes were characterized by marked weight gain, diminution in blood flow, increased vascular resistance, and peak airway pressure. The ventilation/perfusion ratios were high and considerable dead-space ventilation was present. Hypoxic vasoconstriction occurred in both control and stored lobes, and shunt determinations did not vary because of the low blood flows observed. Some or all of these physiological changes may serve to develop a simple screening method to evaluate techniques of pulmonary preservation.


Cardiac manifestations of ochronosis.

A 68-year-old woman with ochronosis was admitted with congestive heart failure. A typical ejection murmur of aortic stenosis was ausculated and was documented on a phonocardiogram. The patient subsequently died, and at autopsy extensive deposition of ochronotic pigment was found on the aortic valve. This valve had no other anatomic abnormalities. Thus ochronosis should be considered in the differential diagnosis of aortic stenosis.


An alternative approach to the closure of the Blalock-Taussig anastomosis at open-heart surgery.

Dissection for closure of a Blalock-Taussig shunt can occasionally be difficult or hazardous at the time of corrective operation. The technique traditionally used for closure of a Potts anastomosis, in which profound hypothermia and circulatory arrest are used, has been applied successfully in 11 operations for control of 12 Blalock-Taussig anastomoses. The technique is described.


Pulmonary blastoma.

Two cases of pulmonary blastoma are reported. One occurred in a 29-year-old man 31 months after a cyst had been excised from the same pericardial-pleural area. The cyst appeared to be of mesothelial origin and, although supported by a cellular stroma, was originally considered to be benign. The morphologic features, location, and possible relationship to a mesothelial lesion suggest an embryonal-mesothelial origin of the tumor. The patient died of recurrent and metastatic disease 9 years after the first resection. The second case is that of a now 74-year-old woman who, over a period of 19 years, has had six separate small peripheral lung tumors excised. They originally resembled fibrous hamartomas but included embryonal-type immature areas and became increasingly more cellular and sarcomatous. The fine structure of the recurrent tumors is that of primitive stroma with few fibrils but no other differentiating features.


Infantile achalasia. Brief clinical report.

Achalasia of the esophagus is an unusual lesion in childhood and is quite rare under the age of one year. The case of a 3-month-old child with esophageal achalasia treated with a Heller esophagomyotomy is illustrated. Seven previously documented cases of achalasia in children under the age of one year are reviewed and the difficulties of diagnosing this lesion in childhood are discussed.


[Complications following vaginal hysterectomy].

The author analyses complications following 817 vaginal hysterectomies (VH). The mortality rate was 0.24%. Laparotomy during VH was performed in 3 patients (0.36%): twice the commenced VH was completed abdominally (once owing to the overlooked fixed uterus in a very obese patient and once owing to the previously performed Doleris operation). These are so-called unsuccessful vaginal hysterectomies. In the third patient laparotomy was applied owing to the bleeding from the retracted, cut uterine artery. Injuries of the urinary pelvis during the VH procedure occured in two patients: once during the opening of the plica vesico-urinaris and once during the opening of the Douglas sac (in the patient with a previous Doleris operation). Both injuries were cured vaginally. Early complication were recorded in 34.02% (278 cases). Most infections occurred in the small pelvis. Late complications were encountered in 41.07% (207 cases) out of 504 followed-up patients. Granulation tissue has proved to be the most frequent complication in this group of women (33.13%). Incontinentia urinae was found in 2.5% (13 cases).


[Sarcomatous alteration in leiomyoma].

A patient with a histologically verified leiomyosarcoma is presented. Hysterectomy with bilateral adnexectomy was performed in 1973. Then radiation therapy was applied. Now, five years after the beginning of the therapy, the patient is in a very good condition.


[Dysgerminoma ovarii].

The authors present a case of a unilateral, encapsuled, and distinctly defined ovarian dysgerminoma treated by a radical removal of the affected ovary. There were remote isolated metastases in the supraclavicular lymph node one year after the operation. No relapses or other metastases have as yet observed.


[Torsion of the pregnant Fallopian tube with simultaneous intrauterine pregnancy].

The author describes a rare case of the torsion of the pregnant fallopian tube with the macerated fetus and simultaneous intrauterine pregnancy. He points out dignostic difficulties in such cases.


[Prolonged and postmature pregnancy terminated in non-hospital institutions].

Out of 4023 deliveries, the authors came across 291 prolonged ones, of which 39 were postmature deliveries. They followed the issue of these pregnancies in the conditions of non-hospital health care. The mortality rate of postmature deliveries was 10.2%. It is recommended that all prolonged and postmature pregnancies are referred to larger hospital-type maternity wards where more help can be offered to the pregnant woman and where the actual state of the fetoplacental unit can be properly followed. However, in cases when prolonged and postmature pregnancies are to be terminated in a non-hospital institution because of the women's refusal to go a larger maternity ward, it is proposed in present conditions to use as a diagnositc means also amnioscopy in addition to cytohormonal analysis.


Juvenilna Metroragija.

Following the definition and etiology, cases of juvenile bleeding in 66 patients were analysed in connection with the time of its occurrence, its clinical picture and therapy. In the authors' own material the percentage of juvenile bleeding was 4.18. It was noted that juvenile bleeding occurred most frequently in virgins (95.45%), that is in the first three gynecological years (78.79%). The mean value of menarche in juvenile bleeding is 12.7 years. The values of Hb at examination, that is on admission to hospital, illustrate the degree of anemia. There were 38 hospitalized patients, and in 28 patients blod transfusion was applied. The termination of bleeding was achieved by hormone therapy. A successful combination of estrogen-gestagen therapy in the sense of substitution was applied. Only in one case was exploratory curettage performed and this vas due to suspicion of residue following abortion.


[2 intrauterine pregnancies after 2 tubal pregnancies].

A woman with two intrauterine pregnancies after two ectopic tubal pregnancies is presented. The first operation removed the left Fallopian tube (on 4 November 1970), while during the recurrent ectopic pregnancy, plastic surgery was applied in the remaining right tube (24 October 1972) with the enucleation of the fertilized egg after Prochownik's method. The patient became pregnant 3 months after the operation and had spontaneous abortion, with a fetus two-and-a half months old; the second time she became pregnant 17 months after the operation and gave birth to a female live-born, 26 days before the term, weighing 2,900 g and 49 cm high. The authors conclude that best results are obtained when the plastic surgery made in the fallopian tube is as small as possible and when postoperative instillation of the tubes is applied.


[Adrenogenital syndrome in an adolescent].

A case is presented of primary amenorrhea resulting from the hyperfunction of the adrenal cortex. The condition developed in prepuberty. The mode of the establishment of the diagnosis and the effect of dexamethason treatment are discussed.


Impaired myocardial contraction in the chronic stage.

The consequences of ischemia for the affected myocardium are highly variable. As a result, in chronic coronary heart disease there is little correlation between coronary arterial obstruction and myocardial dysfunction. Dysfunction can be permanent and related to replacement fibrosis or fixed disruption of the chain of events leading to effective contraction. Dysfunction can also be transient, as a direct consequence of acute myocardial ischemia. The mechanical lesions include generalized and localized myocardial dysfunction, mitral incompetence, and rarely, a left-to-right shunt through loss of integrity of the interventricular septum. Diagnosis per se is not difficult, but deciding on the true contribution of any given lesion to the overall symptoms and disability of the patient is. Therapy must be individually planned according to the total set of factors in each patient.


Natural history of coronary heart disease.

We now possess enough data concerning prognosis so that we can highlight the areas of concentration for the practicing physician. A history of congestive failure, hypertension,or diabetes is of greatest importance. Smoking is in a similar category, but cholesterol elevation is not. Electrocardiographic findings can be used as an immediate discriminator, depending on whether they are normal or abnormal. Further refinements are possible, depending on whether there are ST-segment depressions or elevations, ventricular conduction defects, repetitive ventricular dysrhythmias, left ventricular hypertrophy, or Q waves of prior infarctions. The exercise electrocardiogram provides additional important information and, if markedly abnormal, can detect with reasonable degree of accuracy the presence and degree of ischemic heart disease. The coronary arteriogram, which influences many of the preceding clinical criteria, permits an accurate prediction of five-year mortality and in a preliminary fashion can be integrated with electrocardiographic and ventriculographic abnormalities to derive a significant measure of prognosis. Finally, cardiac function, if assessed according to specific criteria, becomes an extremely important variable in predicting natural history in coronary heart disease.


Polydepsipeptides. 5. Experimental conformational analysis of poly(L-alanyl-L-lactic acid) and related model compounds.

In this paper we report an experimental conformational analysis of the depsipeptide model compounds acetyl-L-alanine methyl ester, acetyl-L-lactic acid N-methylamide, and acetyl-L-alanyl-L-lactic acid N-methylamide and of the sequential polydepsipeptide poly(L-alanyl-L-lactic acid). The model depsipeptides were examined in dilute organic solutions by infrared and nuclear magnetic resonance spectroscopy. Neither acetyl-L-alanine methyl ester nor acetyl-L-lactic acid N-methylamide assumes an intramolecularly hydrogen-bonded conformation. Acetyl-L-alanyl-L-lactic acid N-methylamide, on the other hand, in dilute chloroform or dilute carbon tetrachloride solutions, strongly favors a conformation with an intramolecular hydrogen bond between the N-H hydrogen atom of its N-methylamide group and the carbonyl oxygen atom of its acetyl group. Comparison of theoretical and experimental circular dichroism suggests that poly(L-alanyl-L-lactic acid) is partially ordered in chloroform solution with approximately 50% of its repeat units in the R10 helix, an ordered conformation found by our previous theoretical analysis to have a low intramolecular conformational energy.


Statistical mechanical treatment of protein conformation. 4. A four-state model for specific-sequence copolymers of amino acids.

One-dimensional short-range interaction models for specific-sequence copolymers of amino acids are being developed in this series of papers. In this paper, our earlier three-state model [involving helical (h), extended (epsilon), and coil (or other) (c) states] is extended to a four-state model by preserving the h and epsilon states, introducing the chain-reversal state (R and S), and redefining the c state. This model involves six parameters (wh, vh, vepsilon, vR, vS, and uc) and requires a 6 X 6 statistical weight matrix. A nearest-neighbor approximation of the four-state model is also formulated; it requires a 5 X 5 matrix, involving the same six parameters. By expressing the statistical weights relative to that of the epsilon state, only five parameters (wh, vh, vR, vS, and uc) are required in both the 6 X 6 and 5 X 5 matrices. The statistical weights for the four-state model are evaluated from the atomic coordinates of the x-ray structures of 26 native proteins. These statistical weights, and the four-state model, are used to develop a procedure to predict the backbone conformations of proteins. Since the prediction of helical and extended conformations is carried out by the procedure described in papers 1-3 of this series, we focus particular attention on chain-reversal conformations in this paper. The conformational-sequence probabilities of finding a residue in h, epsilon, R, S, or c states, and of finding two consecutive residues in a chain-reversal conformation, defined as relative values with respect to their average values over the whole molecule, are calculated for 23 proteins. By comparing these conformational-sequence probabilities to experimental X-ray observations, it was found that, in addition to the prediction of helical and extended conformations (reported in paper 3), 219 chain-reversal regions out of 372 observed by x-ray diffraction studies of 23 proteins were predicted correctly. These results suggest that the assumption of the dominance of short-range interactions in determining chain-reversal (as well as helical or extended) conformations in proteins, on which the predictive scheme is based, is a reasonable one. Finally, in the Appendix, the property of asymmetric nucleation of helical sequences is introduced into the (nearest-neighbor) four-state model.


[PAS-positive substances in endometrial cells during the course of irregular bleeding].

Cytologic smears of the endometrium in 81 cases of irregular bleeding were analysed for carbohydrates by the modified PAS method after Hotchkiss (1948). The positive issue of the cytochemical reaction was determined semiquantitatively. The intensity of reaction was numerically scored fy differentiating positivity in cells. Statistical analysis of data and the testing of the significance of differences have shown that are statistically highly significant differences in the intensity of reaction between the group of the secretion phase on the one hand and, on the other, the group of the proliferation phase, glandular cystic hyperplasia, and glandular hyperplasia. It has also been found that differences in the intensity of reaction between the group of the proliferation phase and the group of glandular cystic hyperplasia, as well as between the group of glandular cystic hyperplasia and glandular hyperplasia were only accidental.


[New radiologico-clinical classification of changes in stress incontinence in women].

Setting forth their experience in over 800 colpocystographies applied in genital prolapse and stress incontinence, the authors propose an original classification of changes in urinary stress incontinence with a view to unifying clinical and radiological findings. Along with classical, wellknown radiological aspects (urethral vesicalization and the prolapse of the urinary bladder) one new type of changes is described. It is named the slipping prolapse of the urinary bladder and is determined by the deterioration of the urethro-vaginal septum leading to a completely isolated dislocation of the lower urinary organs and the frontal vaginal wall. The combination of these aspects gives the three types and six variants of stress incontinence which, from the clinical point of view, may be manifest, masked, and potential. The pathogenesis of different types of the disease is analysed, as well as the principles of their therapy. The authors plead for the widest possible use of colpocystography in the preoperative preparation on patients, especially in relapses, since the method is simple and harmless, yielding extremely useful informations in the study of the morphotopography of pelvic organs.


Coronary anatomy.

The coronary arteries have a serpentine but interdependent relationship to one another. The left artery supplies the majority of the left ventricular myocardium irrespective of right or left arterial "dominance." A coronary artery obstruction begins to assume significance when it approaches 75% of the cross-sectional area of the vessel. Increasing degrees of stenosis impose limitations to blood flow during stress and finally even under resting conditions. Analysis of the arteriogram requires not only knowledge of normal anatomy and its variations but also appreciation of difficulties in distinguishing a normal from an abnormal artery and in quantifying the functional severity of an obvious obstruction.


Coronary collaterals.

Coronary collaterals are probably enlargements of pre-existing channels which respond to local vasodilators and which function whenever pressure differences exist across them. Thus, in human coronary atherosclerosis collaterals are only seen when there is a severe intervening arterial obstruction (in excess of 75%). Coronary collaterals follow epicardial and intramycardial pathways, and the intermediary connections may be at vessels of highly varying caliber. The flow potential of most collateral pathways in man is possibly adequate for segmental myocardial function at lower than normal demands but clearly is inadequate for most, if not all, stressful interventions. In the last analysis, coronary collaterals in man are more an indication of severe regional ischemia (present or potential) than a sign of biological "compensation'' for a perfusion deficit.


[Intraoperative cytodiagnosis of ovarian tumors].

The authors report on their experience in applying rapid intraoperative cytologic analysis in 83 benign and 54 malignant ovarian tumors of various pathohistologic types. The entire procedure, from the receiving of the material, fixing and staining, up to the cytologic diagnosis, did not last longer than 6 minutes. The cytologic findings were negative in all benign tumors except one (99.3%). In cases of malignant tumors the cytologic diagnosis was correct in 49 cases (96.4%). On the basis of cytomorphologic criteria it was also possible to predict the pathohistologic type of most of investigated tumors. The high overall accuracy rate of intraoperative cytologic examination permits the surgeon to make a quick and adequate therapeutic decision concerning the extent of intervention.


Physiology of myocardial blood flow and metabolism.

In this chapter the normal functioning of the coronary circulation has been described with major emphasis placed on the hydraulic and small vessel resistance factors in its regulation. The impact of various forms of disease to compromise effective delivery of blood flow either in general or segmentally has also been stressed. The vulnerability of the deep or subendocardial layers to ischemia has been emphasized. The distinction has been drawn between primary and secondary vasodilatation, the primary type representing effects on the arteriole, irrespective of effects on myocardial mechanical and metabolic activity, while the secondary type represents changes in response to changes in the metabolic rate. An interrelationship has been demonstrated among the several factors which regulate blood supply and affect myocardial mechanical activity.


The high rate of appendectomy in Japan.

During the past 25 years in Japan, a change has occurred in the number of appendectomies performed. The results of an investigation in a private (N) hospital showed that 63 per cent of the operations was for "catarrhal appendicitis" that had no inflammatory findings. This "catarrhal type" was found at the highest level in young women. We also investigated the rate of appendectomy by age, and computed the yearly rate increase. It was found that a significant increase in the operation rate began about 1950, and the annual rate thereafter amounted to about 0.75 per cent-or about threefold that in England. This annual increase was attributed to the number of cases in which no inflammation was found in the operated appendix. We discussed the cause and concluded that this high rate of appendectomy is believed to be secondary to the fee-for-service system in the medical insurance programs that were instituted in Japan after World War II.


Common manifestations of degenerative arterial disease.

The major focus of preventive medicine in the aged must be on the clinical consequences of peripheral arteriosclerosis rather than the disease process itself. Treating risk factors may be of some limited benefit. However, of most crucial importance is careful attention to premonitory symptoms and the state of the peripheral pulses including the abdominal aorta.


[Early complications and long-term results after total gastrectomy. A contribution to finding a method of gastric replacement, based on own observations (author's transl)].

In the years 1963 up to 1973 in the Department of Surgery of the University of Düsseldorf a total gastrectomy was performed in 53 patients. For reconstitution of gastrointestinal continuity in 22 cases we interposed a single jejunal loop between the esophagus and duodenum, in 15 patients we performed an esophagojejunostomy with a long enteroanastomosis between the afferent and efferent loop. The procedure described by Tomoda was done in 11 patients. An esophagojejunostomy Roux-en-Y we used in 3 and an esophagoduodenostomy in only 2 cases. The hospital mortality was 21%, the cause of which were predominantly complications of the lung. A dehiscence of an anastomosis never was a cause of death. A follow-up we could perform in 15 patients. On the basis of clinical, roentgenological and chemical data received in the follow-up we prefer at this time the interposition of a single jejunal loop, the length of which should be no less than 40 cm.


[The surgical treatment of villous tumours of the large bowel (author's transl)].

The treatment of 12 patients with villous tumours of the rectum is described. In benign lesions a sphincter conserving operation should be employed. With the technique of submucosal local excision per anum which was described by A.G. Parks it is possible to remove large villous tumours of the rectum. If there is malignant change with invasion of the muscularis muscosae which is found in about 20% of the cases resection therapy is necessary.


[Uncusectomy and uncoforaminectomy according to Jung. Technique, indications and results (author's transl)].

The authors described the technique of uncusectomy and uncoforaminectomia according to A. Jung. The Jung-operation can be defined as the opening of the intervertebral foramina through the anterior approach. The aims of this operation are the liberation of a displaced or narrowed vertebral artery and to free compressed or irritated nerve roots by means of opening and widening the intervertebral foramina from the front. This report is based on 180 such operations performed by A. Jung and colleagues. The operation is indicated whenever cervical uncarthrosis leads to a vertebrobasilar insufficiency syndrome or a cervical-brachial irritation syndrome. Both syndromes commonly occur together. The results of operative treatment are analysed and the success rate lies around 80%.


[Complications of the vagotomy during the operation and in the early postoperative period (author's transl)].

426 subdiaphragmatic vagotomy operations were performed by the authors. On basis of the results obtained they give full details of the complications arising in the course and in the early postoperative period after vagotomy, and also of the possibilities preventing these complications. They call the attention to the more frequent injuries of the spleen and the oesophagus, and to the increasing number of the subphrenic abscess. Finally, they emphasize the low mortality rate of the vagotomy in comparison to the traditional gastric resections.


[Massive hemorrhage caused by acute solitary gastric erosion Dieulafoy. Change of prognosis due to preoperative endoscopy (author's transl)].

In this report of three successfully operated cases of acute solitary gastric erosion--Ulcus Dieulafoy (U.D.), the anatomical and clinical characteristics of this rare gastric lesion are discussed. Due credit is given to reports of the literature. As born out by experience, conservative treatment of bleeding U.D. is usually lethal. Judged from statistical evaluation, surgical intervention has proven to be unsuccessful in many cases. This is directly related to the problem of intraoperative localisation, which, in turn, may lead to illadvised procedures. With acurate localisation of the lesion, surgical management yields good to excellent results. Acute endoscopy as a routine procedure in gastrointestinal hemorrhage in our experience is the key to success, leading to a possibly decisive change in the prognosis of U.D.


[Experimental treatment of the lesion of the flexor tendon, by means of tendon sheath substitution using a vein and diphasic flexor tendon plasty. A new method for the reconstruction of peritendinous slipping surfaces (author's transl)].

In dog experiments the surgical treatment of flexor tendons is discussed by the authors: the lesions of the tendons have been repaired according to the method of Paneva-Holevitch, with biphasic flexor tendon plasty; and for the substitution of the injured tendon sheath and the peritendinous slipping surfaces freely transplanted, autologous vein has been used. In the preparations removed after 8 weeks both the macroscopic and microscopic examinations showed satisfactory vascularity of the vein used as tendon sheath and of the tendinous tissue, as well as normal tissue structure. Between the vein and the tendon only small, ligamentous adhesions developed. On the basis of the good results obtained in experimental examinations the method is applied by the authors also in men with satisfactory result.


[Experimental bone replacement with resorbable calcium phosphate ceramic (author's transl)].

Compact cylindrical implants (5 x 15.5 mm) of seven calcium phosphate ceramics of different formulations that had been implanted for 6 weeks without fixation in the tibia of dogs were examined histologically. The tissue compatibility of the implant turned out to be dependent on the mineralogical and chemical composition of the material: the ceramic material was biocompatible at a CaO/P2O5 ratio between 2:1 and 4:1, the optimum ratio being about 3:1 (tricalcium phosphate). In addition, cylindrical tetracalcium phosphate implatns with an entirely porous structure were implanted in the same manner. After 6 months, they were resorbed to a minor extent. Implants of different calcium phosphate mixtures, on the other hand, were resorbed to a large extend after the same time. The ceramic material was replaced by mineralised bone tissue which had formed directly on the ceramic implant as well as within the pores. There were no foreign body reactions. Investigations with segment-shaped implants which were implanted in the tibia of dogs and fixed with AO-plates or splints extra-cutaneously for about 8-10 weeks, provided information abouth the maximum stress that can be borne by the implants. While implants with a porosity of 75 percent did not sustain the stress after the fixation had been removed, those with a porosity of 45 percent could be subjected to physiological stress after removal of the splints.


[Epithelial dysplasia in ulcerative colitis. Histological possibility for the early diagnosis of "colitis"-carcinoma (author's transl)].

From 249 histologically examined cases with ulcerative colitis (within the years 1967 to 1974) 20 cases were selected, which had an onset of the disease before the 20th year of age and/or a duration of more than 10 years. These cases were checked-up for "prae-cancerous" epithelial dysplasia. Four of these 20 cases showed medium to severe epithelial dysplasia together with carcinoma (= 1.61% of the entire collective). In 2 cases low grade to severe dysplasia occurred in different parts of the colon without demonstrable carcinoma. In 1 case epidermoid epithelial metaplasia were found in the splenic flexure and in the rectum. The biological significance of these metaplasia remains unclear. With reference to the formal pathogenesis these lesions are probably "indirect" metaplasia. The early diagnosis of "colitis"-carcinoma can be improved by systematic colonoscopic examinations resp. by colonoscopic biopsies. "Prae-cancerous" epithelial dysplasias, which occur in a high rate together with carcinoma, are found not only in the rectum but also in other parts of the colon. Multiple biopsies from different parts of the colon as well as the rectum would thus seem to be desirable if mucosal sampling is to be employed as a screening test.


[A panel on vascular surgery (author's transl)].

For this second panel by correspondence, we have asked 3 distinguished experts to answer 7 questions and to comment on 3 case histories concerning vascular surgery. Although a direct discussion between the participants was not possible an impressive degree of agreement is here being demonstrated.


[Compression of the celiac trunk (author's transl)].

Besides the vascular changes caused by arteriosclerosis the compression stenosis is the most frequent form of the isolated restriction of the arteria coeliaca. The compression of the arteria coeliaca, caused by the ligamentum arcuatum medianum or a fribromatous ganglion tissue, can cause complaints similar to the symptoms of angina abdominalis: pains in the epigastrium, postprandial pains, loss of weight, nausea/vomiting, diarrhea, 93% of the patients with severe vascular compression have an abdominal vascular murmur. Of 31 patients with angiographically proved compression stenosis, 11 patients suffering from occlusion or intense stenosis had to be operated because of heavy complaints. The angiographic and intraoperative findings allow the conclusion that there is a connection between the extent of the stenosis and the clinical appearance. The decompression of the arteria coeliaca, in other words the detachment of the compressing tissue leads to total complaintlessness in 83% of the patients. If the arteria coeliaca is hypoplastic a vessel widening or a bypass operation is necessary to establish normal blood circulation in the epigastric organs.


[The development of diverticulosis and diverticulitis (author's transl)].

The cause of colonic diverticula is myostatic spasm. A low-residue diet contributes to this state as transit time through the bowel is slowed. Information gathered in 102 cases was analysed. The smooth muscle architecture of specially prepared operative specimens of diverticulosis were examined. In every case an asymmetric contracture of the smooth musculature led to the formation of gaps. Here the mucosa and muscularis mucosae can protrude through the bowel wall. The muscular spasm is responsible for incarceration of the diverticula. Inflammatory diverticulitis is compared to appendicitis.


[A special closure system of the gastrointestinal tract of the rat (author's transl)].

As a result of animal experiments, morpho-histologic and surgical findings, the presence of a new closure system of the gastrointestinal tract is described. The mode of action is different from that of all the known muscle sphincters. It is found in the ascending colon of the rat and consists of a specially arranged and adjustable mucosal folds with aunique vascularisation. A functional unit which comosed of a pair of folds and a vascular plexus constitute the valvular mechanism. We, therefore, consider appropriate to call it the Angioplical Closure System. Surgical reversion of even a very small portion of the system causes a lethal ileus.


[Appearance of a localized peritoneal mesothelioma seven years after resection of pericardium on account of localized pericardial mesothelioma (author's transl)].

For the first time appearance of a localized benign pericardial mesothelioma and peritoneal mesothelioma in one and the same patient is described. The experiences made in the course of the treatment, the diagnostic difficulties, symptomatology, histology and prognosis are discussed.


Prevention of stress ulcer by somatostatin in rats.

In animal experiments it was examined, to what extent prophylactic application of Somatostatin is able to prevent the stress-induced ulcer of the rat. 32 male Wistar rats were exposed to a combined immobilisation-hypoxia-stress. Somatostatin was given intraperitoneally as bolus and intravenously as a continuous infusion. The results indicated that Somatostatin lowers significantly the incidence rate of stress-induced gastric ulcers in the rat.


[Pathogenesis and clinic of pancreatic fistulas (author's transl)].

At the Surgical University Clinik of Mainz 53 patients with a pancreatic fistula have been observed in 12 years (1964-1975). Most frequently these fistulas occurred after operations for acute pancreatitis (20%), after exstirpation of insulinomas (20%) or after trauma (19%). In 44 cases an external and in 9 cases an internal fistula was seen. Pathogenetic differentiation in tryptic and non-tryptic fistulas allows some prognostic conclusions. So tryptic fistulas are often complicated by internal fistulas with preference for the colon and must be operated more often. In 15 patients the persisting pancreatic fistula has been treated operatively. In seven cases pancreatic resection and in 4 cases the resection of a part of the colon was necessary. Conservatively treated fistulas in most cases closed within 6 weeks.


Experiences in lateral pharyngotomy.

Lateral pharyngotomy offers good exposure for the removal of many laryngeal and hypopharyngeal tumors. The simplified operation I present avoids damage to voice, deglutition or airway. This approach can be expanded to reach almost any tumor of the pharynx and radical neck dissection can be incorporated. The cosmetic result has been satisfactory, but if individual consideration prompts it, a more horizontal skin-fold incision can easily be substituted.


Thorium dioxide granuloma of the neck: a report of four cases.

Four patients with Thorotrast granuloma are reported. The first patient had a radical neck dissection performed; however, postoperative hemorrhage and fistula occurred with a six-month delay in healing. The granuloma in this patient had totally occluded his carotid system with a greatly enlarged vertebral artery. A second patient presented with spontaneous bleeding in the neck from a granuloma followed by encephalomalacia, hemiparesis and aphasia. The third and fourth patients presented as hoarseness with a hard mass in the neck. All four patients had Thorotrast in the liver and spleen. The latter three had laryngoscopies and incisional neck biopsies as their only surgical treatment. Neck malignancy from Thorotrast is very rare. Despite legal decisions suggesting removal and similar suggestions in the literature, the authors feel only small extravasations have had uncomplicated operations. Neck dissection is rarely indicated. Hoarseness can be improved by vocal cord injection. These patients, of course, must be followed periodically as any other tumor, checking the neck mass, liver, and carotid circulation.


Intact canal wall tympanoplasty in the management of cholesteatoma.

There are presently two schools of thought on the proper surgical management of cholesteatoma associated with chronic ear disease: one feels that the ear should be exteriorized and left "open"; the other takes the position that the disease can be removed, and the ear left in its normal anatomical and functional state. The latter group are known to favor a "closed" or more conservative procedure. The purpose of this paper is to review a series of patients who have had cholesteatoma managed by an intact canal wall procedure that prevents a postoperative cavity. Out of a series of 590 chronic ear surgeries performed between January 1, 1970, and December 31, 1974, there were 179 done for cholesteatoma (30 percent). There were 153 patients, 26 of whom had bilateral disease. Twenty-three patients were lost to follow-up, giving an overall total of 154 surgeries with from one to five-year information. The overall follow-up rate was 85 percent. Recurrent cholesteatoma was the most bothersome complication and occurred in 14 percent of the series. Residual cholesteatoma was managed by doing all procedures in two stages. The authors feel that the intact canal wall tympanoplasty is a procedure that will gain acceptance and will be more widely used in the future.


Papillomas of the larynx and pharynx: two case reports.

Two unusual cases of papillomas are presented: the first is that of a young boy with extensive papillomas of the larynx who was treated successfully without tracheotomy using endolaryngeal surgery and steroids at the time of each procedure. This case adds to the clinical evidence that the most probable cause of juvenile papillomas is a virus, since the mother had condyloma acuminata during pregnancy and at term. The second case is that of a young girl with rapidly recurring papillomas of the mouth and pharynx who was treated successfully with an autogenous vaccine and cryosurgery after other measures failed. This case demonstrates the effectiveness of cryosurgery in the treatment of papillomas and the possible efficacy of the autogenous vaccine suggests a viral etiology for papillomas of the pharynx and larynx.


Temporal bone findings in Pierre Robin syndrome.

This is the first complete report on the histopathologic study of the temporal bones from an infant with a well-documented Pierre Robin syndrome (micrognathia, glossoptosis and cleft palate), demonstrating multiple middle and inner ear anomalies. The anomalies are basically architectural malformations rather than neutral or end organ developmental anomalies. The anomalies in this case, except for a few points, are somewhat similar in both ears. Multiple anomalies include: abnormal narrowing of the crus commune-utricle junction, superiorly located crus commune and posterior semicircular canal, underdeveloped modiolus, absence of the bony septum between the middle and apical coil (existence of scala communis in left ear), abnormally small internal auditory meatus, and abnormal direction of internal auditory canal, large cartilaginous mass around the superior semicircular canal and in the tympanic end of the fissula ante fenestram, small facial nerve, large facial bony canal dehiscence, anomalic stapes, etc.


Zinc therapy in otology.

At a recent panel on Otology, I asked the audience for a show of hands of those using Zinc for delayed healing and granulations. It was surprising to note that not more than 4 physicians out of 100 had tried Zinc. The need to report our encouraging results was apparent. From 1971 to 1975, 544 tympanoplasties and 122 mastoidectomies were studied for delayed healing due to granulations. Forty-six patients were found to have resistant granulations. Thirty-three of these healed within two weeks of therapy, 10 more required a total of four weeks for healing, and three did not respond well. Sixteen patients had recurrence when the medication was terminated as soon as healing had occurred but responded well when the medication was continued for four weeks after healing was complete. Five patients had nausea, which subsided when the dosage was reduced from the usual 200 mg. of Zinc Sulfate, three times daily with meals to 100 mg., t.i.d. or b.i.d. One patient developed mild urticaria. Zinc therapy is apparently indicated in granulomata of the ear when healing does not occur with conventional therapy, especially in the post-operative patient; however, it will not suffice when there is massive involvement of the mastoid or middle ear, where surgical removal is indicated.


Current adjuncts for surgery of the sphenoid sinus and pituitary gland.

Surgical intervention in the region of the sphenoid sinus pituitary gland requires extreme precision because of enveloping vital structures. The rhinologic approach to the pituitary gland, once abandoned due to limited visibility and the risk of meningitis, has experienced a renaissance as a result of recent medical and technical advances. Antibiotics have almost eliminated the risk of meningitis, and the operating microscope and televised radiofluoroscope now provide sufficient illumination, magnification, and orientation that injury to nearby structures can be avoided. A mid-line rhinologic approach provides ample exposure and further minimizes operative hazards.


Auditory thresholds in the guinea pig: a preliminary report of a behavioral technique employing a food reward.

Guinea pigs have been trained to press a lever for a food reward. Then the behavior was used to obtain the auditory thresholds for six guinea pigs. The thresholds obtained in the present study agree with those previously obtained by Heffner, et al. The most important aspect of the training process was the habituation of the guinea pigs. Once the guinea pig was accustomed to the food and training cage, he could be trained in a manner similar to that used to train many other species.


An unusual application of a CROS hearing aid.

This paper describes the use of the CROS hearing aid principle on cases of congenital atresia. This young girl has had several operations which attempted to create a canal and tympanum, but the canal persisted in closing. A bone vibrator eyeglass hearing aid was fitted but was largely unsuccessful. Having a 50 db air-conduction loss was handicapping to this youngster, but the usual head worn hearing aid could not be fitted because of the lack of any canal, causing feedback. She refused a body type aid. The solution is this case was a CROS behind-the-ear hearing aid. She enjoys about a 25 db useful gain from this fitting.


Nasal obstruction caused by a pituitary chromophobe adenoma.

Nasal obstruction as the only clinical manifestation of a pituitary tumor is rare. A case is reported of a 58-year-old white male with obstruction of the nose and nasopharynx due to a massive pituitary tumor, which recurred 21 years after primary radiation treatment. At autopsy, extensive destruction of the sphenoid and base of the skull was noted. Final pathologic diagnosis was Chromophobe Adenoma. Common clinical features of chromophobe adenomas are discussed.