Tracheal reconstruction with perichondrial grafts.

Since 1972 a series of experiments (Skoog, Ohlsén & Sohn, 1972; 1975; Ohlsén, 1976) has been performed to elucidate the potential of perichondrial grafts to generate cartilage. In 1974 Sohn & Ohlsén demonstrated in rabbits that tracheal cartilage could be reconstructed from free perichondrial grafts.  As these studies were carried out with an intact tracheal mucosa a series of experiments was conducted in rabbits, and reported in this paper, in which a tracheal section containing two cartiliages and the covering mucous membrane was removed and replaced with a free perichondrial graft taken from the ear. New cartilege formed in all animals.  The reconstructed portion of trachea was partly covered by ciliated cells of normal appearance, partly by low epithelium with microvilli.  These latter areas were mainly within the central parts of the regenerated mucosa. The use of perichondrial grafts for tracheal reconstruction was also studied in two series of dogs. In four dogs a tracheal section, consisting of two comlete cartilages with the covering mucosa, was completely removed.  The circumferential defect was reconstructed by free perichondrial grafats from rib cartilage.  They were placed on two fascial flaps which had been raised from the adjacent muscles, rotated into the defect and sutured for complete coverage. Regeneration of cartilage occurred in all dogs, producing a biologic framework.  The lining of the reconstructed tracheal section was completely restored by epithelialization from the surrounding mucosa.  Low epithelial cells were successively replaced by columnar ciliated cells typical of the respiratory tract. The morphological development of the regenerated epithelium was demonstrated by electron microscopy. The regenerated mucosa exhibited normal function by passing mucus across the reconstructed area. This was recorded by filming at low speed using Cardio-green as indicator. All the animals of this series developed tracheal stenosis within the reconstructed portion. Another experiment was therefore carried out in which four dogs were subjected to the same operative procedure. Postoperatively, however, during the phase of healing, a silicon tube was inserted and left in situ to maintain expansion of the reconstructed portion. By this means stenosis could be prevented with good regeneration of the mucosal lining.


Carcinoma of the external ear.

An analysis of 246 operated patients with 260 carcinomas of the external ears from the periods 1949-57 and 1962-67 is presented. Carcinoma of the external ear occurs in Denmark with a frequency of 1.2 cases per 100 000 inhabitants and constitutes approximately 6% of all skin cancers. In the present material 67% of the tumours were squamous-cell carcinomas and 30% were basal-cell carcinomas. These forms of tumours were most frequent in elderly men who have had outdoor employment. Half of these tumours were sited on the helix and lobe, while one quarter, respectively, were sited medially and laterally. 15% of the squamous-cell carcinomas recurred, 3% of the these with metastases of the regional lymph nodes. Of the basal-cell carcinomas 18% recurred but with no metastases of the regional lymph nodes. The frequency of recurrence did not depend on the site of the tumour on the ear, but it did increase with increasing tumour size. The 5-year survival rate without recurrence was 56% +/- 4% for the squamous-cell carcinomas, and for the basal-cell carcinomas 59% +/- 6.5%. It is concluded that surgical treatment is best suited for these tumours, and the minimum excision distance for basal-cell carcinomas of less than 3 cm in size should be 8 mm, while for squamous-cell carcinomas of the same size the distance should be 10 mm. For both forms of tumour where the greatest extent is more than 3 cm the excision distance should be at least 15 mm.


Cellular patterns in the early phase of healing wounds in children.

Cellular patterns of the healing incisional wound were studied in 55 pediatric surgical patients by the CELLSTIC method. This wound drain, specially developed for this purpose, consists af a standard-sized, viscose cellulose sponge, inside a thin silicone rubber tube. When left between the wound edges, wound exudate flows outwards through the drain, allowing its cells to attach to the sponge surface. The sponge serves as a framework where the cells may migrate, divide and transform. During the first 12 hours the cellular pattern in the sponge resembles that of peripheral blood, whereafter the number of polymorphonuclear leukocytes, almost exclusively neutrophils, gradually increases. Later on lymphocytes and monocytes invade. The first fibroblasts were seen at the end of the third postoperative day.


Studies on healing of Debrisan-treated wounds.

Debrisan (Pharmacia AB, Sweden) is a highly hydrophilic dextran polymer in the form of dry, spheric beads. When dry Debrisan beads are placed on a wound, the wound secretions are sucked up into and between the beads. No crust is formed on the wound. Bacteria granular substances are removed with the secretions. Treatment with Debrisan was found to be very effective in cleansing discharging wounds. Since Debrisan treatment removes substances from the wound area, e.g. prostaglandins, this might affect the process of repair. The morphology of wounds was studied with the aid of histological and histochemical methods. In 15 patients, donor sites on one thigh, treated with Debrisan, were compared with donor sites on the contralateral thigh, subjected to open treatment. In pigs, comparison was made between Debrisan-treated with Vaseline-gauze-covered dermal burns. In man, the inflammatory reaction was less pronounced in the Debrisan-treated wound and located more superficially then in the wound left open, where perivascular inflammatory cell infiltrates were found even deep in the dermis. In pigs the burns exhibited similar differences. Thus the inflammatory reaction in the Debrisan-treated wounds was less pronounced than in the control wounds. Debrisan beads were never seen below the wound surface. No unfavourable influence of Debrisan treatment was observed on the process of repair.


Exposure to trichloroethylene I. Uptake and distribution in man.

Fifteen healthy male subjects were exposed to about 540 and 1,080 mg/m3 of trichloroethylene (TRI) in the air during rest and exercise on a bicycle ergometer. Each subject was exposed during four 30-min periods. The arterial blood concentration increased linearly with the concentration in the alveolar air. The uptake of TRI was about 55% of the supplied amount at rest. At a work load of 150 W during the fourth period the percentage uptake decreased to about 25%. For one fairly thin subject the uptake was near zero at the end of exposure. This development was probably due to the relatively low solubility of TRI in blood and tissues. The uptake of TRI may be estimated from pulmonary ventilation and the concentration in alveolar and inspiratory air.


Exposure to trichloroethylene II. Metabolites in blood and urine.

Fifteen men were exposed to trichloroethylene (TRI) in three different ways with regard to the concentration of TRI in the air as well as exercise on a bicycle ergometer. The total amount of TRI supplied and taken up by each person was measured. The concentrations of trichloroethanol (TCE) and trichloroacetic acid (TCA) were determined in blood and urine. In spite of large differences in uptake, there were only small differences in the concentration of TCA in blood during the day of exposure. There was a large scatter for the values of TCA in urine within each group. The concentration of TCE in arterial blood increased during exposure. Thereafter the concentrations were almost constant for 2 h and differed among the groups. These results can be interpreted as being due to balanced rates of the formation and elimination of TCE. The levels mentioned were related to the uptake of TRI. The same was found for the rate of excretion of TCE in urine when calculations were made from the morning sample obtained the day after exposure.


Exposure to trichloroethylene III. Psychological functions.

The effect of exposure to the solvent trichloroethylene (TRI) on the performance of tests of numerical ability, reaction time (simple and choice), and short-term memory was studied in 15 healthy male subjects. The subjects were tested individually on three different occasions during exposure to 540 and 1,080 mg/m3 of TRI in inspiratory air and under control conditions, respectively. At predetermined times during the three 70-min exposure periods, samples were taken of the subjects' alveolar air. Neither the reaction time tests nor the short-term memory test showed any signs of performance decrement during exposure to TRI as compared to those administered under control conditions. However, a statistically significant decrement in performance was obtained on the test of numerical ability during exposure to TRI. The results as a whole indicate that there should not be any risk of an acute effect on central nervous functions at concentrations which do not considerably exceed the Swedish threshold limit value for the solvent (160 mg/m3).


Relationships between lead absorption and peripheral nerve conduction velocities in lead workers.

The motor sensory, and mixed nerve conduction velocities of median and posterior tibial nerves were measured in 39 lead workers whose blood lead (PbB) concentrations ranged from 2 to 73  mug/100 g with anaverage of 29 mug/100 g. The PbB concentrations significantly correlated with the maximal motor nerve conduction velocities (MCV) and mixed nerve conduction velocities (MNCV) of the median nerve in the forearm and with the MCV of the posterior tibial nerve. Erythrocyte delta-aminolevulinic acid dehydratase (ALAD) activity correlated similarly with the MCV and MNCV of the median nerve in the forearm, and the 24-hour urinary lead excretion following the intravenous administration of CaEDTA (20 mg/kg) (lead mobilization test) correlated with the MNCV. But no parameter correlated with the sensory nerve conduction velocities. By multiple regression analysis, a combination of the three parameters of lead absorption was found to correlate significantly with the MCV and MNCV of the median nerve in the forearm. The MCVs of the median and posterior tibial nerves in lead workers were significantly delayed in the PbB range of 29-73 mug/100 g (mean 45), in the lead mobilization test range from 173 to 3,540 mug/day (mean 973), and the ALAD activity range from 4.4 to 19.4 u. (mean 14.0), respectively.


Magnetic measurements of pulmonary contamination.

The magnitic determination of pulmonary contamination is based on the remanent magnetization of ferromagnetic contaminating particles. The remanent field of the externally magnetized particles is proportional to their amount and shows their distribution. Although only magnetizable particles are detected with this method, the amount of the inhaled ferromagnetic substance can be used when the total dust exposure of the worker is estimated. In this work five shipyard welders were studied. First the particles disposed to the lungs were externally magnetized and then their distribution was mapped with a sensitive magnetometer. The magnitudes of the remanent fields measured from the welders differed from the fields measured from controls by several orders of magnitude. The radiographic findings showed a good correlation with the magnetic measurements, and further experiments will prove whether this method can partly replace presently used radiological investigations.


Cryosurgery for benign and malignant skin lesions: treatment with a new instrument.

The Foster "Froster" unit is a new and simplified liquid nitrogen system for use in dermatologic cryosurgery. The details of its operation are described and its use in various benign, premalignant, and malignant lesions is discussed. In malignant lesions, not only type, but frequently location, is important when deciding whether to use cryosurgery as the first, alternate, or adjunctive choice of therapy. Benign and premalignant lesions which respond best are sebaceous hyperplasia, dermatofibromas, actinic keratoses, leukoplakias, lentigines, and certain seborrheic keratoses and verrucae. Initial promising results have been reported in cases of swimming pool granuloma and chromoblastomycosis. Application of the described technics in one's clinical practice must depend primarily on the level of knowledge of skin lesions and on the degree of skill attained in cryosurgical methods.


Changes in the clinical picture of schizophrenia.

Records of all patients admitted to inpatient facilities of a state department of mental health from 1948 to 1952 and from 1965 to 1969 and diagnosed schizophrenic were reviewed to determine diagnostic trends, if any. The percentage of diagnoses of the catatonic subtype showed a general decline, the hebephrenic subtype showed a marked decline, the paranoid subtype a general increase, and the nonclassical subtypes a marked increase. Analysis of the symptoms for the subtypes and comparison between subtypes did not reveal any particular symptoms to be totally characteristic of a specific subtype. Many symptoms occurred with approximately equal frequency in all subtypes. Comparison of patients' symptoms for the two periods did not reveal wide qualitative variation between periods. However, there were large quantitative variations. We conclude that the apparent change in schizophrenia is but a moderation of primary symptoms.


Diagnostic value of a chemistry test profile.

Serum chemistry test results were correlated with discharge diagnoses of 4,295 persons admitted to an acute care general hospital in a seven-month period. The diagnostic value of the test results, separately and in combinations of up to 12 tests, were calculated at each of ten levels as measured from the mean of normal in standard deviations. All patients had a serum profile consisting of total calcium, inorganic phosphorus, glucose, urea nitrogen, uric acid, cholesterol, total protein, albumin, total bilirubin, alkaline phosphatase, lactic dehydrogenase, and glutamic oxaloacetic transaminase levels. Analysis by manual and computer technics is illustrated. Computerized analysis of a chemistry profile is reported as a list of diagnostic possibilities in ranking order, with the calculated probability for each. In this preliminary report individual diseases are replaced by categories of disease taken from The International Classification of Diseases, Adapted (ICDA).


Polytomography in an otologic practice.

The polytome should be used as an adjunct to conventional roentgenograms of the temporal bone and not as a substitute. The purpose of this paper is to demonstrate how the polytome has been used to great advantage in a private otologic practice.


Basilic vein to brachial artery fistula: a new access for chronic hemodialysis.

A new vascular access for chronic hemodialysis is developed by creating a fistula in the upper arm between the end of the relocated basilic vein and anterior aspect of the brachial artery. The procedure has been used 24 times in 23 patients over the past 15 months (average eight months) with minimal complications and low failure rates. This fistula provides a straight, long, easily accessible conduit with high flows; it has only one vascular anastomosis and maintains the anatomic continuity of its venous end with the axillary vein. It also obviates the need for autologous, prosthetic, or heterografts. The procedure is indicated when suitable vessels in the forearm have been exhausted or are unavailable. However, additional clinical trials and continued long-term follow-up are necessary for more definite conclusions.


Etiologic factors in lead nephropathy.

The rare occurrence of lead nephropathy in widely differing circumstances has suggested that additional causative factors might be required for its production. Seventeen cases of interstitial nephritis associated with severe chronic lead poisoning were reviewed in an attempt to identify these. Data suggested that alcoholism and preexistent hypertension, and also previous or minor urinary tract disease, may potentiate the injurious effects of lead. We recommend that the diagnosis of lead nephropathy should be a positive one, not one of exclusion, and that stored lead should be removed, particularly in persons with hypertension or previous urinary tract diseases.


Surgical treatment of reflux in completely duplicated ureters.

Vesicoureteral reflux occurs in approximately 50% of duplex systems that undergo evaluation and most commonly involves the lower renal segment ureter. The therapeutic approach can be tailored for each case after careful evaluation of the anatomic and functional status of each renal unit. If reparative srugery is indicated and only one ureter is involved, then ureteropyelostomy or ureteroureterostomy have yielded excellent results. If more than one ureter is involved with either relfux or obstruction, then reimplantation of the paired ureters is indicated if the renal units are slavageable.


Tay-Sachs disease: a pilot screening program for the detection of the heterozygote in the Charleston Jewish community.

A pilot screening program for the detection of the carrier (heterozygote) of the Tay-Sachs disease (TSD) gene has recently been completed at the Medical University of South Carolina. A fluorometric assay for serum hexosaminidase A and B was performed on the serum of 181 individuals from the Charleston Jewish community. One hundred seventy-six of these individuals were classified as normal based on the percent hexosaminidase A (Hex A) in their serum; five persons were classified as carriers of the Tay-Sachs gene, including a young married couple who were later referred for genetic counseling.


Ovarian pregnancies with Dalkon Shield IUCDs in situ: laparoscopic visualization.

Two ovarian pregnancies coexistent with intra-uterine contraceptive devices are described. In one case, the ovary appeared to contain a cyst at laparoscopy and rupture of the cyst and extrusion of the fetus were witnessed. In the second case, a hemorrhagic ovarian cyst bled at laparoscopy and laparotomy resulted in the diagnosis of ovarian pregnancy. These two cases reveal that laparoscopic examination could be misleading and result in inappropriate management if the diagnosis of ovarian pregnancy is not entertained. The cases described add to the growing number of reports of extrauterine pregnancies occurring in patients using intra-uterine contraceptive devices.


Management of patients with modified Hunt pouch esophagojejunostomy after total gastrectomy for carcinoma of stomach.

The Hunt pouch and its various modifications have been used as an esophagojujunostomy technic after total gastrectomy or esophagogastrectomy for benign and malignant conditions. This pouch procedure may be particularly useful for palliative gastric resections in which the patient's ability to ingest adequate foodstuffs might be enhanced by a larger reservoir, thereby improving nutritional status and possibly facilitating chemotherapy or radiation therapy or both. Intravenous hyperlimentation has been used to advantage preoperatively and postoperatively to help nutritionally depleted patients better tolerate such an operation and has been useful during treatment of complications related to the procedure. Three recent cases are discussed to illustrate the above propositions.


Superior mesenteric artery (Wilkie's) syndrome: report of three cases and review of the literature.

Of the three cases of superior mesenteric artery (Wilkie's) syndrome presented, one was associated with anorexia nervosa; this association has not been reported before. Two patients were treated surgically with a duodenojejunostomy, and one was treated medically. Vascular compression of the duodenum is a controversial subject. The syndrome probably is more common than generally recognized and is underdiagnosed due to its exclusion from the differential diagnosis of small-bowel obstruction. Its recognition is important because early diagnosis of a partial obstruction may allow for medical rather than surgical intervention, as exemplified by our third case.


Hypnosis in surgery--why and when.

Hypnosis offers an excellent alternative to conventional anesthesia in certain selected or complicated cases. Ten different patients were selected from a group of 38 and were studied thoroughly. Good surgery and a smooth recovery were possible through hypnosis, alone or with conventional anesthesia.


Bridging: an effective and practical method of preventive skin care for the immobilized person.

Various methods have been used in an attempt to decrease prolonged pressure on skin, especially over bony prominences, and thus prevent pressure sores in immobilized patients: turning frames, circle beds, flotation beds, and special mattresses. Bridging is one means of relieving pressure on bony prominences which is both simple and inexpensive. Through the proper positioning of pillows, a patient is supported above the surface of the bed with free space between the bony prominences and the bed surface. Several different positions for pressure relief are possible. Advantages of the technic include its low cost, patient acceptance, lack of mechanical components which can fail, and ease of training personnel or family members to carry it out.


Postoperative infection of lumbar intervertebral disk space.

Sixteen cases of postoperative intervertebral disk space infection are reviewed. Most occurred after diskectomy, but one followed an unsuccessful attempt at a spinal anesthetic and two followed diskography. Treatment varied from aggressive surgery, either by a posterior, lateral, or anterior approach, to drain the infected disk space or spaces, to more conservative immobilization. Antibiotics were used in all cases. Needle biopsy is valuable in establishing diagnosis and identifying the organism and its antibiotic sensitivities. In some cases fusion occurred spontaneously from the infection; in others, fusion was a result of surgical fusion preceding or following the infection.


Pulmonary vein obstruction by bronchogenic carcinoma.

Two patients with obstruction of the pulmonary veins by bronchogenic carcinoma, an unusual cause, are presented. These and other cases reported have had features suggestive of mitral stenosis. The differential diagnosis is discussed.


The detection of glass foreign bodies.

Roentgenography is a reliable method for detecting glass foreign bodies resulting from trauma. The density of glass in comparison to surrounding tissue almost always provides sufficient contrast for roentgenographic differentiation. This method is slightly compromised by the relative size of the foreign body and the body part being examined, but setting the roentgen ray beam for bone technic and having the patient in different positions facilitate detection of such a foreign body.


Fracture-dislocation of the dorsal spine.

A patient with fracture-dislocation of D9 on D8 had considerable posterolateral displacement. The neurologic injolvement of his left leg proved to be progressive. Treatment consisted of posterior decompression, exploration, open reduction and stabilization by means of Harrington rods, and fusion. All neurologic findings resolved completely. Final evaluation 18 months later showed a good and serviceable spine with no residual neurologic deficits. In my opinion, the treatment used in this case under given circumstances represented a reasonable modality of therapy.


Migrating placenta previa.

A case of third trimester bleeding from placenta previa is presented in which serial ultrasonograms were obtained from the 30th to the 36th gestational week and confirmed by isotopic scanning. Evidence is presented showing a migration of a placenta previa marginalis away from the cervical os followed by vaginal delivery at term. The concept and mechanism of placental migration are reviewed.


Inflammatory subluxation of the atlantoaxial joint.

A case of atlantoaxial subluxation accompanying pharyngitis is reported in a 4-year-old child. Diagnosis was made by examination and roentgenograms of the lateral cervical spine. Treatment consisted of halter traction and bracing. The patient responded well to treatment and is normal in all respects one year later. Atlantoaxial subluxation should be considered when treating pharyngitis, especially if the patient presents with torticollis.


Reye's syndrome in a neonate.

This case substantiates the fact that Reye's syndrome can occur in newborns. The clinical features appear to be slightly different in the neonate, in that respiratory distress was the presenting sign in this case and in the one other reported case in a newborn, with no mild preceding illness or vomiting. Thus, Reye's syndrome must be considered when a newborn presents with respiratory distress and evidence of central nervous system and hepatic involvement.


Dumbbell granulomatous abscess of the chest wall following needle biopsy of the pleura.

A 38-year-old woman who had a Cope needle biopsy of the pleura was treated for plural tuberculosis on the basis of a positive PPD-S skin test and presence of caseating granulomas in the pleural biopsy. Ten months later she developed a tender, subcutaneous nodule in the area of the previous needle biopsy. Surgical exploration revealed a dumbbell abscess through the chest wall communicating with an area of consolidation in the right middle lobe. En bloc surgical resection of the abscess and peripheral portion of the right middle lobe was curative, although all pathologic and cultural studies of the resected tissue were non-diagnostic.


Multiple myeloma on polycythemia vera following radioactive phosphorus therapy.

A 74-year-old white man with established polycythemia vera was treated with radioactive phosphorus after phlebotomies alone failed to control his disease. About 2 3/4 years later he died of multiple myeloma. The mutagenic effect of radioactive phosphorus may have caused or possibly accelerated preexisting myeloma. Basic nonmalignant disease deserves careful consideration before radiation or radiomimetic agents are used. One might consider a probably less mutagenic drug such as hydroxyurea in patients with polycythemia vera when phlebotomy alone does not give good control of red cell mass and thrombocytosis.


Mesenteric thrombosis after penetrating cardiac trauma.

Survival of the severely injured trauma victim through aggressive therapy results in new complications. We report the first instance of mesenteric thrombosis in association with penetrating cardiac trauma. Selective visceral angiography should be obtained early in a patient with persistent abdominal pain following a period of prolonged shock; such cases should have a more favorable prognosis if diagnosed early in view of the limited period of cardiac dysfunction and the younger age group.


Dissecting popliteal cyst: an unusual complication of Reiter's syndrome.

A case of Reiter's syndrome associated with a dissecting popliteal cyst mimicking deep vein thrombophlebitis is reported. The cyst was diagnosed by arthrography and responded to intra-articular injection of corticosteroids. The diagnosis of a dissecting popliteal cyst should be considered in a patient with arthritis of the knee joint from any cause and who develops signs and symptoms of thrombophlebitis.


Adverse psychologic reactions to ileal bypass surgery.

Of 33 patients who underwent ileal bypass surgery for morbid obesity and were followed up with psychiatric interviews and consultation postsurgery, five appear to have had adverse psychologic sequelae related to the procedure. The emotional problems of these five patients were in part related to or precipitated by their drastic weight loss after ileal bypass. In most cases, the patients generally had depressive symptoms and, in dynamic terms, were dependent individuals with lifelong problems in object relations. The coping styles demonstrated, while not rigorously classified as psychiatric illness, appeared to predispose them for certain difficulties even when weight had been lost. Ileal bypass surgery apparently is not psychologically innocuous as previously thought, and psychiatric follow-up of patients is indicated.


Pneumatosis intestinalis in association with connective tissue disease.

Pneumatosis intestinalis in association with connective tissue diseases is an unusual combination whose pathogenesis is not yet understood. Furthermore, steroid medication, often used to treat these diseases, may itself cause pneumatosis. Three cases of scleroderma, systemic lupus erythematosus, and amyloidosis in association with pneumatosis and without prior steroid therapy are presented. The small vessel occlusive pathologic processes in these diseases may cause focal areas of mucosal ischemia resulting in small, perhaps transient ulcerations that allow gas to enter the gut wall from the lumen.


Exophthalmos and epidural hematoma.

The development of a right exophthalmos in a patient with a left hemispheric epidural hematoma is reported. The parallel development of these two conditions in this unusual case suggests some direct relationship, although it must be recognized that a coincidental relationship is possible. The exact cause of the exophthalmos remains obscure.


Long-term follow-up of hip fractures.

Hip fractures on 117 patients treated surgically and followed up for an average of 10.2 months are reviewed. Among the parameters analyzed were complications, mortality, clinical follow-up by the operating surgeon, and the ability to ambulate after surgery. Postoperative surgical complications occurred in 36% and medical complications in 18% of the patients. Mortality was 25% within the first year after surgery. Sixty-one percent of the patients returned at least once to the surgeon's office for follow-up; only 38% were followed for more than six months. In the surviving patients who were good ambulators before hip fracture, 60% to 70% became good ambulators postoperatively. Only 20% to 30% of the surviving patients who were poor ambulators preoperatively ever walked again.


Induced hypothermia: electrocardiographic abnormalities.

Hypothermia was induced intermittently in a patient to combat hyperpyrexia. The electrocardiogram taken during the hypothermic phase displayed typical abnormalities and consisted of: pronounced sinus bradycardia, marked prolongation of the Q-T interval, muscle tremor artifact, and the characteristic "Osborn wave." Spontaneous rewarming resulted in disappearance of the electrocardiographic alterations, underscoring the functional and reversible nature of the abnormalities.


Autoimmune atrophic gastritis with hypergastrinemia.

Elevation in fasting serum gastrin levels was found in three patients being evaluated for persistent upper abdominal pain without radiographic evidence of peptic ulcer disease. Fiberoptic endoscopy of the upper gastrointestinal tract in each patient revealed characteristic changes of chronic atrophic gastritis. Gastric biopsies showed diffuse chronic inflammation in the lamina propria, a decrease in the number of parietal cells, and "intestinalization" of gastric mucosa. Total achlorhydria was demonstrated after a maximal histalog stimulus; however, serum levels of vitamin B12 and Schilling test values were normal in all three patients. Parietal cell antibodies were found in the serum in all patients in a dilution of 1:20 to 1:80. These cases represent autoimmune (type A) chronic atrophic gastritis and should be distinguished from chronic simple (type B) gastritis, in which serum gastrin levels are normal and no parietal cell antibodies are found in the serum. Patients with autoimmune gastritis should be observed at frequent intervals for the occurrence of pernicious anemia or gastric carcinoma.


Mediastinal and subcutaneous emphysema in labor.

The recent world literature on mediastinal emphysema has been reviewed and two cases added. This condition is relatively benign, and the supportive treatment is discussed. Subsequent pregnancies have been uncomplicated.


Pelvic lipomatosis.

A case report of pelvic lipomatosis in a woman is presented. This condition is a benign, apparently self-limited disease in which mature adipose tissue is deposited in the pelvis. The clinical presentation is discussed.


Complications of total hip replacement.

The most common complications of total hip replacement are infection, loosening, dislocation, phlebothrombosis and embolism, neurovascular deficity, periarticular calcification, nonunion of the greater trochanter, malposition of components, fractures, and discrepancy in leg length. The cause, prevention, and treatment of these complications are reviewed.


Sequestration of the lung in children.

Three instances of intralobar pulmonary sequestration are reported to call attention to the occurrence of this lesion in children. In all three patients, the sequestration was diagnosed by arteriography and treated by lobectomy. Extralobar and intralobar sequestrations are described and the differential diagnosis is discussed.


Hair transplant surgery: planning the procedure.

Factors important in planning hair transplant surgery are presented. The procedure must be designed for each patient individually. Success with hair transplantation depends upon developing surgical skill and having an appreciation of esthetically pleasing designs.


The diagnosis of subcapsular hematoma of the liver by scintigraphy.

The diagnosis of subcapsular hematoma of the liver following blunt abdominal trauma has assumed clinical importance with recent reports of improved mortality with conservative management. There is increasing use of hepatic scintigraphy in evaluation of upper abdominal trauma. Two recently observed cases are used to illustrate the typical findings in this entity.


Psychotherapy as adjunct in treatment of vomiting during pregnancy.

Adjunctive psychotherapeutic measures were used to treat ten consecutive pregnant women referred to a psychiatric consultation service because of severe intractable vomiting. In addition to customary medical measures, they received three types of psychotherapy: (1) supportive psychotherapy (establishment of positive relationship, frequent reassuring conversations, and encouragement of expression of thoughts and feelings); (2) hypnotherapy (trance induction and suggestions of comfort in the gastrointestinal tract, desirability of feeling of substance in stomach, and ability to retain and digest food eaten); and (3) behavior modification (positive reinforcement for retaining food and gaining weight, through granting desirable considerations such as visitors, radio, television, and being up in or outside the room). Results were encouraging. Nine patients recovered and completed normal pregnancies, while one improved but later aborted due to other complications. When compared with a control group of routinely treated patients, recovery was more rapid.


Teaching sex education and counseling for the primary physician.

Today's family physicians are being confronted by increasing numbers of patients who desire and need sex education and counseling. It is suggested that the family and primary physician can approach the multiple sex-related needs of the family by understanding the family life cycle and by using permission-giving, limited information, and specific suggestions with patients as needed and as appropriate. The experience of the University of Miami's Department of Family Medicine in teaching human sexuality to medical students, residents, and faculty of the medical center is cited to help other residency programs include sex counseling and sex education in the armamentarium of residents.


Case clustering in cancer.

There is little evidence that time-space clustering is important in the epidemiology of leukemia, lymphoma, Burkitt's tumor, and myeloma. Clustering by interpersonal contact, particularly in Hodgkin's disease, does appear to occur, but more study is needed to warrant the conclusion that such contact is necessary for subsequent illness to develop. Future epidemiologic studies should include the use of laboratory analysis to evaluate the role of viruses, genetics, and environmental factors in cluster studies.


Preparation of tables for medical articles: guidelines for physician-authors.

This review of the basic purposes and principles of tables is oriented toward their preparation by physician-authors for use in medical manuscripts. The guidelines suggested are consistent with the general format and style current in scientific and medical writing, with emphasis upon the latter. Style and usage do evolve, though, and even at any given time there may be in existence several acceptable variations of "standard" practices. Therefore, the value of style of the journal to which a manuscript will be submitted is again emphasized.


Occult sclerosing carcinoma of the thyroid.

A case of occult sclerosing thyroid carcinoma is reported. The primary requirement for diagnosis is that the cancer is less than 1.5 cm in diameter. In addition, a fibrosing component with varying degrees of sclerosis is present. Lymph node metastases are frequent and may appear as benign thyroid follicles. Occasional direct invasion or vascular invasion may occur. Distant metastases were not reported in the series reviewed. Adequate therapy would seem to be total thyroidectomy of the involved lobe and radical subtotal thyroidectomy of the opposite lobe with excision of all enlarged or involved lymph nodes.


Granular cell myoblastoma (schwannoma) of the carina in a patient with sarcoidosis.

The sixth case report of granular cell myoblastoma (schwannoma) of the carina, occurring in a 22-year-old black woman, is presented. Incidental coexistent carcoidosis was present. The various theories of the histogenesis of the lesion are reviewed briefly.


Thrombophlebitis and pulmonary embolism with surgical intervention in the third trimester.

A case of acute deep vein thrombophlebitis and pulmonary embolism in late gestation has been presented with a discussion of diagnostic modalities, therapeutic regimens, and theoretical considerations. It is our belief that aggressive medical management is best accomplished by giving heparin intravenously as the primary anticoagulant. When medical management is best accomplished by giving heparin intravenously as the primary anticoagulant. When medical management is not effective or if embolism occurs, surgical intervention, consisting of vena caval clipping and ovarian vein ligation with scrupulous attention to detail, is indicated. Further, support to prophylaxis of abruptio placenta secondary to the mechanism espoused by Mengert et al is added by the course of this patient.


Serum immunoglobulin levels in White and Black patients with virus-A and-B hepatitis.

Serum immunoglobulin G, M and A levels were measured in 106 White patients with acute virus-A (hepatitis-B surface antigen-negative) hepatitis and 27 White patients with acute virus-B (hepatitis-B surface antigen-positive) hepatitis and compared with the values previously obtained in Black patients with these diseases. The mean serum IgM level in the White patients with virus-A hepatitis was significantly higher than that in virus-B hepatitis (p less than 0,001). This difference was much more obvious than that in Black patients, mainly due to a much lower mean serum IgM response in Black patients with virus-A hepatitis. The reason for the blunted IgM response in Black patients with virus-A hepatitis is not known, but it may be related to a difference in the reaction against altered host tissues rather than any difference in antibody production against the virus per se. The mean serum IgG and IgA levels were not significantly different in the White patients with virus-A and virus-B hepatitis and they were lower than the corresponding figures in Blacks.


Laboratory studies on the vector capability of Aedes (neomelaniconion) unidentatus McIntosh and Aedes (Aedimorphus/ dentatus (Theobald) with West Nile and Sindbis viruses.

Laboratory tests were made with Aedes (Neomelaniconion) unidentatus McIntosh and Aedes (Aedimorphus) dentatus (Theobald) collected from the Highveld region of the Transvaal, South Africa, to determine their ability of transmit West Nile and Sindbis viruses. Viraemic hamsters or a viraemic chick were exposed to the mosquitoes as infective meals. Infection of mosquitoes was determined by testing mosquitoes individually for the presence of virus 10-26 days later. Transmission of virus, attempted between the 10-20th days by exposing hamsters to groups of mosquitoes, was not achieved. With West Nile virus, the high concentrations of virus required to infect each species led to the conclusion that neither is an important vector of this virus. With Sindbis virus and A. unidentatus the 10 per cent infection threshold was less than 2,6 logs of virus, while with A. dentatus it was about 3,5 logs. This suggests that both species, but more particularly A. unidentatus, could be vectors of this virus.


The feeding pattern of the fruit bat Rousettus aegyptiacus in captivity.

An electrical apparatus was designed to record continuously the feeding activity of either a colony of 30 fruit bats (Rousettus aegyptiacus) or single bats in captivity. The endogenous feeding activity rhythm was synchronized by change in the external light-dark cycle. During June to August (winter), the bats consumed an average of 96 g sliced banana, equal to 76 g wet weight/100 g body weight per 24 hours or 15 g dry weight/100 g body weight per 24 hours. The feeding period began shortly after sunset and continued for 10,6 h. Feeding consisted of 6-14 separate small meals. The mean or overall feeding rate was 9,1 g banana/h, and the feeding rate during the first 3 h, 13,1 g/h. The bat regulated its food intake by varying the rate of food consumption and not by changing the duration of  the feeding period. It is suggested that clustering of the bats may influence the caloric intake by reducing the energetic cost of thermoregulation.


GLC determination of paracetamol and d-propoxyphene.

d-Propoxyphene and d-norpropoxyphene were determined in rat plasms, rat brain homogenates and human plasma by means of GLC utilizing extracts obtained by micro-phase extraction of the drugs. Paracetamol was determined in the same samples by GLC separation of the O-butyrate derivative using caffeine as internal standard. The problems associated with the GLC determination of d-propoxyphene and d-norpropoxyphene in biological material are discussed and attention is drawn to the particular advantages of the micro-phase extraction procedure for the quantitative determination of these drugs.


Management by objectives in a hospital social service unit.

A Management By Objectives (MBO) system has been installed in the Social Service Department of the University of Minnesota Hospitals. MBO involves administering organizations through establishment and follow-up of goals. In order to accomodate a human service milieu two additions have been made to the usual MBO format: (a) a statement of program philosophy, and (b) a statement of essential program functions. Staff reaction to the system has been mixed, while hospital administration has been uniformly favorable. In the future the MBO system will be integrated with a management information system, and "significant others" will be surveyed to get more outside input inot the formulation of objectives. MBO meets organizational needs for effective planning, management of resources and control, while at the same time maximizing staff input into the overall operation.


The status of graduate-level social workers teaching in medical schools.

At present, relatively little national data are available concerning the involvement of social workers in medical education. This article presents the results of a study conducted recently to obtain a comprehensive, up-to-date profile of graduate-level social workers teaching in medical schools and to survey the opinions of medical school deans regarding their present and future status. Continuing research in this area is essential if we are to acquire a greater understanding of the contribution social workers make to contemporary medical education. Only then will we be better equipped to assess social work's potentials for the future and take those steps necessary to bring them to fruition.


The HMOs: new models for practice.

New areas of practice are open to innovative social workers in an existing and expanding comprehensive health care delivery system--the health maintenance organization (HMO). In this article, four health plan models are described that document the experience of social workers in established HMOs. These illustrations demonstrate the necessity and opportunity for expanded social work roles in humanizing and corrdinating patient services in complex multidisciplinary health care delivery systems.


Education for social work in health care organizations.

The American health care delivery system stands on the brink of major change and reorganization. There are many opportunities for the social work profession to increase its influence and expand the scale of its activities within health care. These opportunities represent a challenge to the vision, creativity, and flexibility of social work educators. This article discusseses educators' roles within the context of a system conceptualization of the inputs throughputs, and outputs of education for social work in health care organizations.


Interdisciplinary education for community health: the case for nursing and social work collaboration.

A nurse educator and a social work educator developed an interdisciplinary team-taught course in community health for both social work and nursing students. This account of their experience elaborates the implications of interdisciplinary education for the student learning experience including theory and practice content, socialization, and transition; faculty development; and the larger university community. Although this particular instance is limited to baccalaureate education, the authors underscore the potential of interdisciplinary course work for the enrichment of all levels of nursing and social work education.


Social work education for the field of health: a report of findings from a survey of curricula.

This paper presents the findings of a survey of programs in schools of social work made with specific reference to content germane to the field of health. The 62 schools responding to this inquiry constituted a representative sample of the 85 members of the Council on Social Work Education in 1972-73 in almost all regions of the United States and Canada. The inquiry included questions regarding; (a) specialization; (b) courses in health care systems; (c) courses in social work practice; (d) field practice; (e) interdisciplinary collaboration; (f) educational innovations; and (g) faculty coordinating the health component in the curriculum. Findings suggest a remarkably modest thrust in the direction of health and specialization at a time when health care is undergoing uncommonly rapid change.


Psychosocial factors in low-incidence genetic disease: the case of osteogenesis imperfecta.

Osteogenesis imperfecta (OI), a dominant genetic disorder, was examined in an exploratory case study of psychosocial implications. The cross-sectional survey sample consisted of 13 OI-affected adults and 21 families with an OI-affected child who were interviewed. Findings revealed numerous psychosocial concerns and problems in addition to their complex and lifelong medical problems. Specific problem areas differed according to the severity of the disease, type, and mode of genetic inheritance. The results indicate the need for local as well as national policy changes through legislation and extensions of existing services for low-incidence disease groups such as OI-affected persons. Implications for social work practice interventions call for greater involvement with genetic diseases, more aggressive approaches in case identification and service coordination, and performing longer-range monitoring functions than is usually the case.


Crisis intervention in a newborn nursery intensive care unit.

Premature birth of a defective infant challenges personal and family integrity, and immediate intervention is optimal in reaching a positive outcome. The G. case exemplifies many aspects of crisis theory; worker intervention was built around them. As the G. family struggled with the impact of a severely damaged infant, a broad range of worker techniques, based on the parents' strengths and personal backgrounds, was required. Intervention was significant in effecting a positive resolution. This article details the events endured by the G. family, and the way in which they experienced them during their baby's first 3 weeks of life.


Participatory governance: a model for shared decision making.

The sharing in departmental decision making is viewed as a responsibility to be borne collaterally with the director by practitioners delivering direct services. While the process is viewed as consonant with professional growth and therefore properly evolutionary, the authors after facilitating premises and structures as well as a delineation of risks and rewards.


Unmet social service needs in skilled nursing facilities: documentation for action.

The skilled nursing facilities in Hennepin County were surveyed to measure 21 specific social services in five general categories of service. Quantitative distribution summaries were made on understanding, performance, and satisfaction for each social service, and the five general categories of service were compared. Cross-tabulations indicate a significant difference in facilities with social work staff. Further study is recommended, and immediate actions to rectify current social service deficiencies are cited.


Social work and liaison psychiatry.

The Liaison Team of the Department of Psychiatry at Cook County Hospital uses a generic, multidisciplinary, crisis intervention approach to mental health consultation to facilitate humane and comprehensive yet cost-effective care for the medically indigent. Social work functions on the team include diagnosis, short-term individual and group treatment, referral, follow-up, staff development, in-service training, program planning, and interdisciplinary clinical instruction.


Social work in a pediatric primary health care team in a group practice program.

The inclusion of a psychiatric social worker as a member of a pediatric team in a prepaid group practice extends the range of pediatric mental health services to children. This paper discusses the collaboration of the social worker with the pediatricians and allied health personnel on the team in dealing with the emotional problems of referred children and their parents. Case examples are included. All cases seen by the social worker during a 6-month period are reviewed. With available psychiatric backup a wide range of emotional problems are identified, and effective mental health care is provided.


The doctor-relative relationship: an exercise in interview techniques in the "relatives' clinic".

The importance of the physician's relationship with the patient's relative is discussed, and the content of a series of interviews with relatives is analyzed. Their significance in adding to the doctor's knowledge of the patient is delineated.


Public accountability, quality assurance and social work.

The growing demand for public accountability and quality assurance mechanisms affords the social work profession an opportunity to take a more forceful hand in the shaping of the health care delivery system. This paper surveys the impact of public accountability developments on the practice of social work in the health care fields, analyzes what has been done in social work qualtiy assurance, and suggests some strategies for enlarging the scope of social work to include productive new endeavors. Emphasis is placed upon resolution of the conflict between medical and human service treatment models.


Improving the effectiveness of program consultation.

In a recent project concerned with the evaluation of consultation, experienced health program consultants demonstrated difficulty in two areas: (a) integrating mutnd (b) setting objectives and specifying criteria by which to measure attainment of those objectives. This paper outlines the purposes of this project, its background and methodology, and discusses in depth the areas of concern. Through an exploration of these issues in program consultation evaluation, health professionals can understand and hopefully improve their skills in this important area of functioning.


Social work and genetic counseling.

Genetic counselors often impart anxiety-producing information to the patient and his family. A social worker should be available to help these individuals deal with the emotional impact of the genetic facts given them. Areas of concentration for the social worker in the genetics setting include aid in family planning, identification of psychosocial aspects of genetic disorders, and help in interpreting and understanding the genetic diagnosis and medical recommendations. The individual who discovers he possesses or transmits a defective gene needs help in improving his self-image and in relieving his guilt load.


Group work with emphysema patients.

This article describes group work services to ambulatory emphysema patients in a community hospital. The group is viewed as an essential component in the treatment of patients with a chronically disabling illness. These patients experience devastating changes in their lives in the community, in the world of work, and in their families. Physical and respiratory therapy and medication comprise the medical treatment, group work provides the peer support necessary for coping with the disease in a way as to assist with maintaining health and improving the quality of life.


Potential partners: attitudes of family practice residents toward collaboration with social workers in their future practices.

The study examines attitudes of family practice residents toward social work collaboration in their practices. Residents valued social work services highly, and almost three-fourths want a social worker in practice with them. Residents valued the broad range of services offered by social workers, and over half could see no disadvantages to such collaboration.


Social work fees in medical care: a review of the literature and report of a survey.

This paper is based on a study undertaken to determine the advisability of establishing fees for social work service in a Family Practice Residency Program as a way of providing a funding base to assure continuing this professional service in the model Family Practice Unit at the University of Washington; and as a way of providing social worker services in other medical clinics.


Staffing patterns: issues and program implications for health care agencies.

Unsolved staffing pattern issues are viewed in the current context of funding pressures, third party payment, and management necessity for program and cost projections. Relevant factors are mustered for consideration with their implications. Use of differentiated skill levels and response as well as development of departmental services mandate are considered. The author also shares his experientially derived thoughts on staff ratio to certain institutional assignments.


Social science, social work and pharmacy.

In an effort to make pharmacy a more patient oriented health profession, pharmacy students at the University of Pittsburgh are required to take a course entitled, Social Sciences in Pharmacy. Besides drawing from the diverse social and behavioral sciences this course also includes material from the field of social work. This article describes the course and the students' reactions to it. It also provides an overview of some of the recent trends in the field and suggests areas where consultation between pharmacist and social worker may be indicated.


Total body hyperthermia and preliminary results in human neoplasms.

We believe the hyperthermia is an effective adjunct to current modes of cancer therapy and warrants further study. The method described is safe and effective in achieving controlled total body hyperthermia. Monitoring techniques and life support measure are discussed. Limits of tolerance in humans are defined in this series as 41.8 C for 5 hr and 42 C (108F) for 2 hr, with the heart and liver as the limiting organs.


Light and dark adaptational changes in the accessory eye of the shrimp, Palaemonetes.

The fine structure of the accessory eye of the shrimp, Palaemonetes, was studied after light and dark adaptation. Adjacent to the principal compound eye, the accessory eye is a small compound eye composed of about 20 ommatidia which are smaller in structure to the ommatidia of the principal compound eye. During dark adaptation, rhabdomal microvilli increase in length; however, little pigment migration occurs. The implications of these changes in relation to the function of the accessory eye are discussed.


Quantitative and comparative ultrastructure of the vertebrate cornea. I. Urodele Amphibia.

The cornea of the urodele amphibian Triturus c. cristatus was studied ultrastructurally in order to provide the basis for a comparison among corneas throughout the vertebrate phylum. The cornea of this salamander consists of relatively thick epithelium and basement membrane and thin Descemet's membrane, unlike the mammalian corneas. The outermost epithelial cells contain Ruthenium Red stainable extracellular filaments and intracellular vesicles which are thought to play a role in the process of lubricating the corneal surface. Occluding junctions have been observed in the apical region of the superficial epithelial cells and are considered as barriers to the intercellular passage of material. A thin substantia propria (stroma) consists of about 40 collagenous highly organized lamellae. The thicknesses of the basement membrane, Descemet's membrane and the epithelium are believed to represent the primitive situation in the process of corneal evolution.


Quantitative changes and ultrastructural alterations of the cornea in response to ultraviolet light. II. Effects of amphibia; elucidation of desmosomal structure and basement membrane synthesis.

The effects of far ultraviolet light irradiation upon an amphibian cornea were studied to compare the effects observed both quantitatively and ultrastructurally with data obtained after UV irradiation of mammalian corneas. The ultimate goal of this series of investigations is the elucidation of the alterations and the regeneration mechanisms, which might reflect existing morphological diversities among the species, observed in vertebrate corneas following exposure to UV light. It was found that while the epithelial cells undergo oedema after low dose exposures and are gradually damaged after high doses of UV light, 2-4 days leter a new epithelium has been formed. Intercellular permeability is increased by low dose exposure as was detected by the penetration of Ruthenium Red into the intercellular clefts. Under these conditions desmosomal structure revealed a 21-laminar configuration. The basement membrane of the amphibian, unlike that of the mammal, does not dissolve away upon exposure but shows localized disruptions which are thought to accommodate the passage of leucocytes from stroma to epithelium. That a new basement membrane is subsequently formed is evident by the existence of extracellular and intracellular secretion granules. In comparison to irradiated rabbit corneas, this stroma remains remarkably at the same thickness following a high dose exposure although a noticeable disorganization of collagen arrangement is apparent. Finally, as in the case of the rabbit corneas, a secondary degeneration of endothelium was observed 4 days after a moderate dose exposure.


Fine structure of the spermatozoon of an onychophoran, Peripatopsis.

The spermatozoon of the Onychophoran Peripatopsis moseleyi is described. This cell is characterized by the general filiform shape, the absence of an acrosome, the presence of mitochondrial derivatives, of an annulus and of nine accessory tubules and a manchette of microtubules around the axoneme. All of these characters are typical of highly evolved sperm models, like those of insects and mammals, and suggest a long evolutionary history. Only the position of the mitochondria, inserted between nucelus and axoneme, is reminiscent of annelid features.


The morphology of regeneration of skeletal muscles in the rat.

Muscle regeneration was studied by light and electron microscopy in soleus muscles of rat. After segmental crushing the number of fibres increased in some muscles within 30 days, indicating that numerical hyperplasia can take place. Locally applied Ringer solution of 60-70 degrees C caused necrosis of myofibres but left satellite cells and blood supply largely intact. Following phagocytosis, four mechanisms of regeneration were seen. (1) Lost fibres were replaced by clusters of myotubes formed by satellite cells within persisting basal lamina tubes. These clusters displaced the surrounding endomysium and looked like longitudinally 'split' fibres. (2) Viable fibre fragments fused with satellite cells. (3) Satellite cells of surviving fibres proliferated and fused to myotubes localized beneath the basal lamina. (4) Thin new fibres occurred in the interstitium. Their origin remained unknown. After 6 months the mean size of the new myofibres was normal, but the scatter of diameters was increased, central nuclei, fibre 'spliting' and branching, and fibrosis were prominent. Staining for acetylcholinesterase revealed that many fibres were short and not innervated. The similarity with dystrophic muscles in man suggested, that the most prominent histological changes in myopathic muscles may be due to attempts of regeneration.


The investigation of vinylcyclohexane dioxide as a polar dehydrant for the improved retention of lipids in the Spurr embedment.

The use of vinylcyclohexane dioxide (VCD) as a polar dehydrant with subsequent embedment in Spurr was studied. The utilization of Epon 812 resin (E 812), hydroxyethyl methacrylate (HEM) and hydroxypropyl methacrylate (HPM) as polar dehydrants for Epon embedment were re-examined, and a polar Epon mix was introduced. The most effective dehydration sequence was: first 90%, then 95% VCD in water for 5 min. followed by two 20 min changes of 100% VCD. After 1 hr in equal quantities of VCD and Spurr mix, tissues were infiltrated with Spurr embedment (two 1 hr changes and overnight) and finally embedded in Spurr and polymerized at 60 degrees C for 16 hr. The most utilizable polar Epon mix was determined to be Epon 812 = 50 ml, NMA=42 ml, DMP-30=1-2 ml. It was somewhat brittle but cut well with both glass and diamond knives. All four polar dehydrants were found to retain lipids and carbohydrates equally well in thin section in striated and cardiac muscle, liver, kidney and brain from the rat. The E 812 was the only dehydrant that retained lung multilamellar bodies. The possible carcinogenic effects of VCD were considered and the probably metabolism and excretion of VCD were discussed.


Hyperinsulinemia: effects on body weight, obesity and motivated behaviors.

Five experiments were performed to evaluate the physiological and behavioral similarities between lesions of the ventromedial hypothalamus (VMH) and injection-produced hyperinsulinemia. It was found that the rate of weight gain and fat deposition in both adult and weanling rats was essentially the same for both VMH and hyperinsulinemic rats. Measures of activity and taste preference measures yielded no differences between hyperinsulinemic rats and intact rats. Electric shock thresholds revealed a decrease in reactivity for hyperinsulinemic rats compared to intact rats. A hypothesis was suggested in which a combination of hypophysectomy, gonadectomy, and hyperinsulinemia might produce most of the physiological effects seen with VMH lesions. It was also suggested that since these physiological alterations radically modify the organism's internal environment, the behavioral effects of VMH lesions may be the results of the attempts of a brain-damaged animal to maintain new physiological conditions.


'Self-correcting' spherical bioelectrode.

Most of the widely used biopotential macroscopic and microscopic bioelectrodes do not enable proper measurements while in contact with 'problematic' tissues, such as myocardial and other muscular tissues, cortical and intracavital tissues. A quantitative spherical electrode was designed as an example in the family of bioelectrodes enabling application in moving or vibrating media. The electrode developed is insensitive to its contact area. Decreasing the contact area to 40% causes 25% increase in measured resistance only. The electrode shows excellent performance in alternating current conditions combined with well-defined direct current characteristics.


Adriamycin plus cyclophosphamide in advanced bronchial carcinoma.

Adriamycin (40 mg/m2 i.v., on day 1) plus cyclophosphamide (200 mg/m2 orally, day 1 to 5) were given to 23 patients with advanced lung cancer. Administration cycles were repeated every 3 weeks. No patient had been previously treated with chemotherapy, 5 received prior radiotherapy. Objective improvement was observed in 7 patients, partial remission was observed in 3. The median duration of response was 2 months.


Hysterosalpingography in the sequels of conisation of the uterine cervix.

A hysterosalpingographic survey was made of 65 women of reproductive age who had undergone conisation of the uterine cervix for carcinoma in situ or severe dysplasia at least one year before. None of the patients investigated radiologically had undergone uterine surgery before conisation. In a high percentage of cases morphological changes of the cervical canal and, less frequently, the isthmus were found. Most of the changes are attributable to scar retraction, and the hysterosalpingographic findings did not differ appreciably from those following other types of gynecological surgery, namely, segmental or total stenosis and ectasia of the cervical canal and isthmus. A control series of patients with preoperative and postoperative hysterosalpingograms is now under consideration to confirm the radiological findings and to correlate them with clinical data.


[Study of the geographical pathology of laryngeal, bladder and childhood tumors in the Province of Turin].

A previous report has shown that in the non-metropolitan areas of the province of Torino the incidence of cancer of the larynx in men during the period 1965-1969, although lower than in the town of Torino and its suburbs, was 3-6 times higher than in Great Britain, Norway, Sweden and Denmark. In the present study the distribution of these cancers was investigated in the 12 ecological areas and/or subareas forming the non-metropolitan areas of the province. A similar study for bladder cancer in adult men and all cancers (including leukaemias) in children, is also reported. In subareas 36, 37 and 42 of ecological area 01 (i.e., located NW of the capital and its suburbs) as well as in area 02 (located North of the province, around the town of Ivrea) a significant excess of laryngeal cancers have been diagnosed in adult men during the period 1965-1969. Cancer of the bladder was found in excess in men residing in subareas 37 and 43 of area 01 (geographically related to the town of Ciriè, where an epidemic of bladder cancer was recognized among workers of a chemical factory where 2-naphthylamine and benzidine have been widely used in the past), as well as in men residing in area 02. In addition, laryngeal cancer was found in excess among residents in Balangero (where a large asbestos-chrysotilemine has been in operation for a long time) and adjacent towns (observed 12, expected 5.14, p less than 0.01). Bladder cancer was particularly frequent among residents in Ciriè and adjacent towns (19 cases vs. 9.18 expected, p less than 0.01) as well as in those residing in Ivrea and adjacent towns (24 vs. 14.61 expected, p less than 0.02). On the contrary, the whole area situated East and South of Torino and its suburbs seems to be a low-incidence area for both laryngeal and bladder cancer. For both tumor types the highest incidence was found in the town of Torino. Men residing in the 23 suburbs of Torino showed a high incidence of laryngeal cancer and a low incidence of bladder cancer. Cancers in children were fairly uniformly distributed throughout the whole province, including the capital.


Biological properties of cell lines derived from Moloney virus-induced sarcoma.

Two cell lines derived from a primary MSV-M-induced tumor in a BALB/c mouse were studied. One line (MS-2) was subject only to continuous tissue culture transfer (tct). After 21 tct, MS-2 cells produced progressive tumors (MS-2 tumors) in syngeneic hosts. The second cell line (MS-2T) was established by cultivation of a MS-2 tumor. The ability to produce progressive tumors decreased with increased number of tct, in both cell lines. The virus content of MS-2 and MS-2T cells was very low, as shown by uridine incorporation and electron microscopy. Immmunofluorescence tests demonstrated that antigens different from the viral MSV-M antigens were present on the cell lines, and that antigenic changes occurred with increased number of tct. Serum of mice bearing progressive MS-2 tumors reacted with MS-2T cells when these cells produced progressive tumors and did not react with MS-2 cells when they produced regressing tumors. MS-2 cells producing regressing tumors reacted with serum from mice in which the MS-2 tumor had regressed and with serum from mice immunized with MS-2T cells at late tct when they were poorly oncogenic. The antigenic changes seemed, therefore, to parallel the decrease of malignancy. A chromosomal analysis carried out on MS-2 and MS-2T cells, when both produced progressive tumors, showed a modal number of 48 and 44, respectively. MS-2T cells showed a large acrocentric chromosome. In contrast, the MS-2 cells at late tct, when they gave regressing tumors, showed a modal number of 60 and a wide range of distribution of chromosome number.


Skin tests in childhood lymphoma and neuroblastoma.

Intradermal skin test antigen (Varidase, Mumps, Candidine) and contact sensitization with 2,4-dinitrochlorobenzene (DNCB) were employed in 35 previously untreated children with neuroblastoma and malignant lymphoma, to evaluate delayed cutaneous hypersensitivity. Cutaneous responses were correlated to stage of disease and survival. The limited number of patients prevents any definitive conclusion. It is apparent, however, that in childhood non-Hodgkin's lymphoma anergy to DNCB is correlated to advanced stages with rapid progressive disease. In neuroblastoma and Hodgkin's disease patients skin test sensitization seems to be of questionable clinical value.


[Controlled pilot study with combination chemotherapy in testicular carcinomas (author's transl)].

In 24 previously untreated patients with advanced testicular carcinoma, the combination of adriamycin, vincristine and methotrexate (AVM) was tested in a prospective randomized study against a combination of non-cross resistant drugs including vinblastine, bleomycin and mithramycin (VBM). Complete and partial (greater than 50%) remission was observed in 4 out of 13 patients treated with AVM and in 3 out of 11 given VBM. In one patient receiving AVM and in two patients treated with VBM, the response at the level of previous inoperable retroperitoneal metastatic lymph nodes allowed a subsequent radical lymph node dissection. After cross-over a partial response for 6 months was obtained in only one patient treated with VBM while none was observed in 4 patients receiving AVM. Both combinations were well tolerated. However, their therapeutic activity seems to be definitely lower with respect to treatment with vinblastine followed by continuous infusion with bleomycin.


The importance of metastic cervical lymph nodes on the prognosis and therapy of malignant neoplasias of the head and neck.

The author in a study of 667 patients submitted to unilateral or bilateral radical neck dissection presents a critical analysis of clinical palpatory and histopathological methods in the evaluation of the metastatical lymph nodes in head and neck cancer. The advantages of the last one are pointed out showing the real prognostic value of the histopathological metastases.


[Clinical examination and 131 Cs scanning in the diagnosis of cold nodules of the thyroid (author's transl)].

The usefulness of 131Cs scanning in preoperative diagnosis of 131I cold nodules of the thyroid that present no clear clinical sign of malignancy is discussed. The results of clinical examination of 283 thyroid nodules, associated in 139 cases with 131Cs scanning, are correlated with the histologic nature. In nodules that were classifided as cold, warm or hot in the 131Cs scan, the incidence of malignancy was 2.6, 12.3 and 25%, respectively. In the nodules that, on the basis of clinical examination, were classified as probably benign, dubious or suspected for malignancy, the incidence of cancer was, respectively, 3.6, 26.3 and 72.7%. Malignancy ocurred in 16 of 144 patients that were selected for surgical treatment only on the basis of clinical data and in 17 of 139 patients that were selected on the basis of clinical examination associated with 131Cs scanning. The accuracy of clinical preoperative diagnosis of thyroid cold nodules does not seem to be significantly improved by association of 131Cs scanning.


Ultrastructural changes produced in cultured, adriamycin-treated myocardial cells.

The ultrastructural evaluation of the early alterations adriamycin-induced on cultured mice heart cells is reported. The major effects are hypertrophy of the sarcoplasmic reticulum and a market increase of the number and total extension of the gap junctions. These findings are discussed in the light of the information available in the literature.


Myocardial injury induced by a single dose of adriamycin: an electron microscopic study.

Adriamycin cardiomyopathy has been studied under the electron microscope using myocardial ventircular cells of CRF mice, previously treated with 10 mg/kg body weight of the drug given in a single intravenous injection. Within 10 min myocardial cell nucleoli show a nucleolonema fragmentation, and during the following 3 hours they acquire the nucleolar segregation pattern. Fourteen hours after drug injection, nucleolar morphology again becomes normal, while areas of focal degeneration, characterized by damaged mitochondria and enlarged smooth reticulum cisternae, appear in the sarcoplasm. One to 3 days later the degeneration process involves the myofibrillar component, and after 50 days the great majority of myocardial ventricular cells is damaged. The early appearance and the functional significance of nucleolar segregation support the hypothesis that adriamycin cardiotoxicity might be dependent on its ability to bind to myocardial cell DNA. The consequent failure of RNA and protein synthesis, impairing the continuous renewal of myofibrillar and mitochondrial components of the cell, might explain the progressive myocardial damage.


ABH secretor status in patients with bladder tumours.

The ABO blood groups and secretor status of a group of patients with bladder tumours were investigated and compared with those of a group of patients of a similar age suffering from a variety of genito-urinary diseases. Some of the control patients were known to have been exposed to potential carcinogens, and the findings in this group were analysed separately. No significant differences were found when comparisons of these three groups of patients were made.


Modifications of ureteric peristalsis by local anaesthetic. An experimental study in dogs.

An in vivo study of the response of the dog ureter to local anaesthetics administered systemically and by ureteric perfusion, revealed that lidocaine, procaine, and mepivacaine, caused hyperperistalsis. The intravenous use of a near toxic dose produced hyperperistalsis of limited duration, whereas, intraureteric administration produced a prolonged and constant response with low dosage. The mode of action of these drugs is unclear as they are generally regarded as being non specific smooth muscle depressants. Continued peristalsis after prolonged exposure to local anaesthetic favours a myogenic rather than neurogenic conduction of the ureteric contraction wave.


Urinary oxalate in summer and winter in normal subjects and in stone-forming patients with idiopathic hypercalciuria, both untreated and treated with thiazide and/or cellulose phosphate.

Urinary oxalate excretion has been measured by a specific enzymatic method in normal subjects and stone formers with idiopathic hypercalciuria. In every group studied urinary oxalate was higher in the summer than in the winter. These differences were slight and not significant in normal subjects but were considerable and statistically significant in the stone formers both untreated and when treated with thiazide. Thiazides raise urinary oxalate only very slightly but cellulose phosphate leads to large rises in urinary oxalate both in the summer and the winter. The highest values of urinary oxalate were seen in the summer in patients treated with cellulose phosphate. The mean rise in this group was 70% above normal and this must be viewed with some anxiety.


Iatrogenic breaks in Buuch's membrane in choroidal melanoma.

Three patients with choroidal melanoma have been observed to develop subretinal hemorrhages associated with their ocular examinations. One hemorrhage appears to have been caused by transillumination, while two others have occurred during radioactive phosphorus testing. Histopathology confirms defects in Bruch's membrane through which blood or tumor cells have entered the subretinal space.


Clinical experience with presumed hemangioma of the choroid: radioactive phosphorus uptake studies as an aid in differential diagnosis.

A total of 27 cases of choroidal hemangioma was evaluated with radioactive phosphorus uptake studies. In each case the diagnosis of malignant melanoma was initially entertained, but the 32P test was unequivocally negative in every instance. Follow-up studies in every case have supported the clinical diagnosis. In 22 patients, the lesion was treated with photocoagulation, and in every treated case the serous macular detachment disappeared. The importance of early and correct clinical diagnosis is stressed, since these are salvageable and potentially useful seeing eyes.


A comparison of the sensitivity of carotid compression tonography with ophthalmodynamometry in the diagnosis of internal carotid artery occlusive disease.

The cases of 100 consecutive patients with arteriographic evidence of carotid occlusive disease were reviewed. All 100 patients had undergone ODMY and CCT prior to carotid arteriography. A comparison of the sensitivity of ODM testing with CCT testing revealed the ODMY pressure differences were reliable in detecting carotid occlusive disease in only 70 of these 100 patients, whereas CCT testing detected decreased blood flow on the involved side in 95 of the 100 patients. The advantages of CCT testing are discussed, comparing certain limitations and contraindications often encountered with ODMY testing. The CCT test is more sensitive than ODMY testing and is easier to perform. In addition, the results of CCT are more objective and provide a permanent record which can be analyzed at any time to check for reproducibility. Overall, the CCT test appears to be a more suitable screening test than ODMY to study carotid occlusive disease.


Radiotherapy of malignant melanoma of the choroid.

Twenty-two patients with choroidal melanomas were treated conservatively using radioactive radon rings with a mean follow-up of 43 months. In 14 patients there was successful tumor regression. Eight eyes were enucleated because of inadequate tumor response. Of the patients whose tumors were apparently destroyed, two have subsequently died of metastases and one eye was enucleated due to scleral rupture. Of the eight cases unsuccessfully treated, one has subsequently died of metastases. Radiation therapy is likely to be effective in patients with tumors 7 mm in diameter and 2 mm in elevation or less. Tumors larger than 12 mm in diameter and 3 mm in elevation do not respond adequately to irradiation. Relatively large doses of radiation (at least 8,000 rads to the tumor apex) must be used if the tumor is to be effectively obliterated. We believe that radiation effectively can destroy small choroidal melanomas.


Lipofuscin pigment over benign and malignant choroidal tumors.

This study has shown that lipofuscin pigment may accumulate in RPE cells and macrophages over several types of benign and malignant choroidal tumors. The color of the pigment, however, varies with the nature and color of the underlying lesion. On the surface of deeply pigmented tumors the lipofuscin pigment may produce an orange color, whereas over amelanotic lesions it may appear brown or reddish-brown. On the surface of vascular tumors, such as choroidal hemangiomas, the lipofuscin is almost invisible ophthalmoscopically but may be demonstrated with fluorescein angiography. Although the presence of such pigment accumulation is suggestive of a malignant melanoma, it is not diagnostic and may occur over benign simulating lesions as well.


The Girard-Storz assistant's microscope: a new accessory for the Zeiss operating microscope system.

A bracket has been designed for the Zeiss 1 and Zeiss 6 operating microscopes, enabling the mounting of two accessory microscopes for the surgeon's assistants. These accessory microscopes operate independently of the primary microscope and in many cases may be preferable to beam-splitter systems which drastically reduce illumination to the primary microscope and preclude the use of photographic accessories.


A new binocular scotometer.

A new method of binocular scotometry is described based on an intriguing binocular phenomenon and using a new binocular scotometer and a retinoscope with its head reversed. Shortcomings in previous attempts have been corrected by objectively aligning a "blind" eye with the center of a translucent opalescent screen. This was made possible by having the patient rotate the retinoscope to induce conjugate eye movements in cases of manifest eye deviation. The examiner could then observe the "blind" eye directly through a central opening in the screen, by reinforced assistance through dependence on the corneal light reflex and, if necessary, by circumferential plotting.


A new machine for irrigation-aspiration.

This new irrigation-aspiration system (Fig 9) demonstrates application of basic physical principles to a particular medical problem, maintaining the integrity of the anterior chamber during aspiration of cataractous material. This system is readily incorporated into the standard procedure of irrigation-aspiration of soft cataractous material at relatively low cost. The surgical procedure and the operation of this system with irrigation-aspiration and "prevent-collapse" components are under direct control of the physician.


Retinal cryoring: a new instrument for retinal surgery.

The retinal cryoring, a doughnut-shaped cryoprobe, has been developed to allow continuous cryocoagulation around retinal holes.


Reduction of nasal orbital fractures and simultaneous dacryocystorhinostomy.

A technique for restoration of structure and function in naso-orbital fractures has been described. Three case reports demonstrate a few of the final results. The case reports also indicate that many of these fractures require late definitive surgery in spite of optimal surgical treatment immediately subsequent to injury.


Malignant ameloblastoma of the maxilla.

This case illustrates a rare occurrence of an ameloblastoma arising in the maxilla and metastasizing to the neck and lungs within a three-year period following the initial resection. A discussion of the pathology is presented and the necessity for aggressive initial therapy with close follow-up is emphasized.


Introduction of missing enzymes into the cytoplasm of cultured mammalian cells by means of fusion-prone liposomes.

It is therefore possible to introduce enzyme-laden liposomes into two sites within the cytoplasm of cells previously lacking such enzymes. The first site is gained after enzyme-laden liposomes are phagocytosed into the lysosomal apparatus. Liposomes coated with immunoglobulins engender their own uptake by inducing the Fc receptor of phagocytic cells to launch ingestion of the vector as if it were an opsonized bacteria or virus against which the host had mounted an immune response. As for the second site, described here, involving enzyme deficiencies of the free cytosol, these may be corrected when liposomes have lysolecithin incorporated as a fusogen. The fusogen induces merger of the liposomal membrane with that of the plasma membrane presumably by virtue of the capacity of lysolecithin to engender mixed, fusion-prone micelles. Introjection of enzymes or other sequestered molecules is accomplished without access of these to external solutes, such as calcium. Consequently, uptake of enzyme cannot be due to trivial factors such as pinocytosis induced by lysolecithin or to phagocytosis per se. These two new techniques of cellular engineering now render it possible to introduce either into phagocytic or into non-phagocytic cells, enzymes or macromolecules in which these cells are genetically deficient.


Management of prostatic fistulas.

Prostatic fistulas communicating with the rectum or perineal skin are unusual complications of a prostatic operation, pelvic trauma, prostatic abscess or other iatrogenic injury. A third of these fistulas may close spontaneously with proper urinary drainage and avoidance of fecal soilage. The many operative procedures described for the repair of these fistulas indicate that no ideal method of repair can be applied to every case. Operative management should be mandated by the size, location and duration of the fistula as well as by the surgeon's experience with the various anatomic approaches.


[Preoperative correction of volemic disorders in thyrotoxicosis].

The investigations conducted by the authors enabled them to pinpoint further the complex of symptoms determining a phase character of volemic disturbances in thyrotoxicosis. The phases somewhat reveal the volemic substrate of thyrotoxicosis, allowing an aimed management of some stages of the preoperative preparation. The latter is conventionally divided according to Sh. Milk into three periods: initial, intermediate and final. The main aim of the preoperative correction is to normalize hydration correlations, that is likely to be gained by excreting excessive sodium and replenishment of potassium deficit.


[Diagnostic possibilities of peritoneography in surgical practice].

Peritoneography with diagnostic purposes was employed in 53 patients. 24-45% water soluble iodine-containing contrast substances were infused intraabdominally. In 48 patients pathological processes in the abdominal cavity were revealed. No pathology was found in 5 patients.


[Importance of the method of timely external drainage of the pancreatic duct in transduodenal papillectomy and pancreatoduodenal resection].

With the aim of prophylaxis against postoperative pancreatitis in transduodenal papillectomy and pancreatoduodenal resection the authors have elaborated the technic of a provisional external drainage of Wirsung's duct by means of a controlled transnasal drainage. Ten operations were performed using this technic. There were two deaths. The recommended technic provides a free outflow of the pancreatic juice from the pancreas outwardly during several days after the operation.


[Disorders of motor function of the stomach in acute appendicitis].

The authors have studied the motoric activity of the stomach in 40 patients with acute appendicitis and in 15 patients with other lesions. In appendicitis the strength and depth of gastric contractions were found to be mostly labile, while the number of waves of gastric contractions was relatively constant.


[Results of treatment of patients with appendiceal infiltrate].

In the clinic a differential therapeutic tactics is employed in appendicular infiltration (570 patients). If pain attacks following appendicular infiltration are absent then only a detailed examination of a patient is able to give indications to a planned appendectomy.


[Thiamine and pyruvic acid content in the urine of patients with ununited fractures and pseudarthroses].

The authors report the results of studies on the thiamine and pyruvic acid content in the urine of 170 individuals (34 healthy persons and 136 patients with no union of fractures and pseudarthrosis). In patients with nonunited fractures and pseudarthrosis a deficiency of vitamin B1 is observed.


[Clinico-roentgenological characteristics of acute lung abscess].

Based on an analysis of the clinico-roentgenological picture of the disease in 48 patients with acute lung suppuration, the authors have detected some peculiarities in clinical manifestations of the disease, and also characteristic features of the roentgenological semiotics, which enabled them to define the pathological process as "a primary" acute abscess of the lung.


[Use of dimexide in the treatment of acute hematogenic osteomyelitis in children].

Under observation were 132 children with acute hematogenous osteomyelitis. The complex treatment of an acute stage of hematogenic osteomyelitis included also the local use of 33% dimexide (DMSO) solution together with antibiotics. The observations indicated a high efficacy of the suggested therapeutic method.


Survival rate in lung cancer.

The authors followed the survival rate in 927 patients with lung cancer treated in the oncological dispensary of the Plovdiv City during 1965--1972. 41.3% of the patients were in stage 1--11, 19.9%--in stage III, 38.8%--in stage iv. Of all the patients 8.2% were operated upon, in 14.7%--radiotherapy was employed, 9.9% of the patients were treated pharmacologically, 67.5% of cases were not treated at all. As a result of all kinds of treatment 21.4% of the patients survived for one year, and 1.1%--for 5 years. It is concluded that the search for new methods of the treatment and early diagnosis of lung cancer is quite essential.


[Mass screening in the diagnosis of precancerous diseases of the stomach].

The authors emphasize the importance of diagnosticating and systematic observation of cancer preneoplasms for earlier detection of stomach cancer. For this purpose a clinico-laboratory test for thiocompounds in the urine has been used. The former has been found to be convenient for mass screening because of its prompt performance. Nearly 3.5% of 10000 healthy persons under examination have been screened by means of the mentioned test. The effectiveness of the test was checked up through an x-ray examination of the stomach of the screened persons, i.e. of those who have shown the positive result. Cancer preneoplasms have been detected in 32.5% of the x-ray screened persons. It is concluded that the used mass screening test, followed by an x-ray examination of those patients who showed a positive result for thiocompounds in the urine, could be used as a pattern for the detection of pretumor lesions.


[Indicators of nonspecific immunity in cirrhosis and primary cancer of the liver].

The study of some factors of nonspecific immunity in 85 patients with cirrhosis and in 9 patients with primary cancer of the liver revealed a decrease of all factors of nonspecific immunity under consideration, while in primary cancer of the liver--selective and more sharp fall of properdin level. The complement, as compared with the control, was not changed, whereas lysozyme was statistically reliably higher than in healthy persons.


[Endoscopic diagnosis of postoperative stomach cancer].

The authors examined endoscopically the esophagus and stomach in 309 patients, previously operated upon for gastric cancer (258), ulcer of the stomach or duodenum (36) and benign gastric tumors (15). They estimated the value of this method for establishing diagnosis of the operated stomach cancer and also the importance of histological and cytological methods in the complex diagnosis of this pathology. Moreover, roentgeno-endoscopic correlations were made. Cancer of the operated stomach was detected in 59 patients, it was suspected in 8, other lesions were found in 194. no changes in the operated stomach were found in 48. It is stated that endoscopy is more advantageous than roentgenological examination in establishing the diagnosis of tumor pathology of the operated stomach. Histological and cytological findings are of considerable value in making the correct diagnosis. These methods are mostly informative in an exophytic form of the tumor growth.


[Cellular immunity in patients with melanoma].

The main part of tumor-associated antigens of malignant melanoma in both USSR and USA preparations is similar. Both samples have an antigen of glycolipoprotein nature. This antigen induces a delay of hypersensitivity in patients with malignant melanoma. These data suggest that antigens, used for the study of cell-mediated immunity in patients with malignant melanoma, can be used for an estimation of the immunological status. Both antigens are closely similar in their main characteristics and, therefore, further comparison of the results to be obtained seems to be possible in both countries.


[Postoperative pneumonia in oncological patients].

The authors have analysed the incidence of postoperative pneumonias in patients with malignant tumors of different localization, who were operated in the N. N. Petrov Research Institute of Oncology of the USSR Ministry of Health during the period of 1969--1973.


[Reorganization of oncological service in the Czechoslovak Socialist Republic and the long-term oncological program].

Some statistical data on the malignant tumors morbidity and mortality among the population of CSSR are reported. A description of the reogranization of oncological aid in CSSR is given, as well as a brief description of long-term program on oncology till 1990. It is hoped that the scientists of CMEA member states will successfully solve the tasks of the complex problem "Malignant neoplasms".


[Reaction of inhibition of macrophage electrophoretic mobility in differential diagnosis of carcinomas].

The reactivity of the lymphocytes from 40 carcinoma patients and 19 patients without detectable malignancies was tested by means of the macrophage-electrophoresis-mobility (MEM) test exposing lymphocytes from one individual to a large spectrum of antigenic preparations. Besides the encephalitogenic protein (EP) and the carcino-embryonic antigen (CEA) hypertonic KCl-extracts from human cancer and normal tissues were used as antigens to be tested. When performed in such a complex manner, the MEM-test resulted in characteristic reaction patterns allowing one not only to discriminate between cancer and noncancer, but also to draw a conclusion in which organ a carcinoma has arisen. The characteristic "immunological tumor profiles", thus obtained, are obviously due to the existance of common antigens in carcinomas of the same tissue origin. The CEA seems to be another antigen of high diagnostic value in that system, since the lymphocyte response to CEA was restricted to patients with tumors of the colon, rectum and stomach. The results show for the first time that lymphocytes of the tumor patients mentioned are able to react to CEA. The human lymphocyte response to CEA seems to be far more cancer- and (or embryo-specific than the reactions obtained with xenogenic hyperimmune sera) which areused for the detection of CEA in human sera or plasma samples. The "immunological tumor profile" opens a new step of quality among the attempts to develop immunological tumor tests.


[Determination of benzopyrene in the seeds of plants before and after their germination].

The possibility of BP synthesis in plants was studied. Seeds of pea, lupine, rye, oats, garden-cress were investigated in hydroponic systems with substrates containing carbon and without it. The results indicated that the quantity of BP in the seeds increased in the course of germination in solutions with carbon from 1 to 7 mug/Kg of dry weight. No increase of BP was observed after germination in media without carbon.


[Papillomas of the urinary bladder induced by N-nitroso-N-methylurea in rats].

N-nitroso-N-methylurea (a total dosage--6 mg per animal), administered by a catheter in the urinary bladder cavity in female rats, following 9--56 weeks induced in 16 of 23 rats tumors of the vesical mucous membrane (mostly transitional cell papillomas).


An evaluation of "informed consent" with volunteer prisoner subjects.

"Informed consent" sets a goal for investigators experimenting with human subjects, but little is known about how to achieve or evaluate it in an experiment. In a 3-year, double-blind study with incarcerated men, we attempted to provide a "free and informed consent" and evaluated our efforts with an unannounced questionnaire administered to subjects after they completed the experiment. At that time, approximately two-thirds had sufficient information for an informed consent, but only one-third was well informed about all key aspects of the experiment and one-third was insufficiently informed to give an informed consent. We found that institution- or study-based coercion was minimal in our experiment. From our evaluation of the questionnaire and experience at the study institution, we conclude that an experiment with human subjects should be designed to include an ongoing evaluation of informed consent, and active attempts should be made to avoid or minimize coercive inducements. Experiments with significant risk, which require a long duration and/or large sample size relative to the institution's population, should probably not be performed on prisoner subjects. The experimenter should be independent of the penal institution's power structure. Presenting and explaining a consent form to volunteers on one occasion is probably an in adequate procedure for obtaining and maintaining an informed consent.