[External biliary fistula following severe rupture of the liver (author's transl)].

A patient with post-traumatic rupture of the liver was reported. The patient developed an external biliary fistula following removal of a cholecele the size of a child's head which was accompanied by copious drainage. Radiologic methods mor examining liver injuries and their later complications were discussed.


[Long-term infusion-cholangiocholecystography as a routine method (author's transl)].

The efficiency and informative values of long-term infusion-cholegraphy was examined in 30 patients with hepatic elimination dysfunction or previous negative intravenous cholangiocholecystography. It could be shown that a diagnostically useful demonstration of the biliary tract could be obtained in 29 out of 30 cases by increasing bilirubin up to 3 mg% and by infusing contrast medium for 3 hours. In spite of the increase in iodine content, the infusion of contrast medium was better tolerated than the intravenous application of contrast medium. Hepatic toxicity could not be established.


[Studies regarding a new contrast medium for demonstrating the patency of bile ducts (author's transl)].

The contrast medium Endomirabil was tested in 103 patients. It produced few side-effects when 20 ml was injected pro examination over a 5 minute period. The rate of visable heterotopic contrast medium elimination is very low. The optimal time for making an x-ray to demonstrate bile ducts and gall bladder is 60-90 minutes after the injection. As a result, the number of x-ray films pro examination can be reduced. The unusually long filling of the bile ducts makes it possible to use tomography up to 90 minutes after the injection. This should be advantageous for radiological departments with limited capacity for tomography. Parenchymal damages induced by contrast medium could not be reduced from the chemical analyses.


[About the advantages of the sonographic diagnostic in the field of the radiologist (author's transl)].

1. Ultrasound techniques as a new diagnostical method are included in the work and administration of an already existing institution of a central hospital, i.e. the X-ray department. Avoiding a special organizational unit in the hospital or an organization depending on a department which e.g. a gynecology could not be asked to undertake (considering the amount of work and qualification needed) means an advantage from the economic point of view. 2. The radiologist is able to learn the interpretation of the B-Scan of the ultrasound method very quickly because the visual imagination necessary to handle both methods is the same. 3. Sonography is an important supplement for radiological diagnosis. 4. Suspecting a lesion of an retroperitoneal or intra-abdominal organ sonography can be used as the first check-up. Renal sonographie could prove to be a screening-method. Often the ultrasound finding indicates the further diagnostical procedures which are successful, saving X-rays and time. Under certain circumstances X-ray investigations can possibly be avoided. Considering the last two points would mean for the future that the radiologist indicates the diagnostical method to be used - not only the ultrasound but also the X-ray method. Five cases demonstrated confirm this conclusion.


[Diagnostic native roentgenology of operated pituitary adenomas (author's transl)].

Cases showing the value and limitations of diagnostic native roentgenology in recurrent pituitary adenomas were selected from a total of 217 patients. Recurrence is recognized by progressive intrasellar space occupation. Bone apposition at the contours of the sella turcica resulting in reduction of volume and calcifications of the sellar region permit exclusion of intrasellar recurrence. Marking the area of operation improves native roentgenology. Bone apposition of acromegaly may obscure recurrences. According to the literature, about 50% of recurrences can be diagnosed roentgenologically. On the contrary recurrences can be excluded in 10-20% of roentgenologically successfully operated patients.


[Radiation exposure of patients and personnel in the endoscopic retrograde cholangiopancreaticography (author's transl)].

The results of the measurement of radiation protection in 54 patients and the involved personnel exposed to radiation (physician performing the endoscopy and the radiologist) during ERCP were analyzed. The radiation exposure values were relatively low and were within the range of those doses to be expected for gastroenterologic radiodiagnostics. After many years of experience, the radiation exposure for patients and physician can be further reduced. Actual danger from radiation need not be feared for the patient or the exposed personnel. The range of maximum values for radiation exposure set-up in the regulations for x-rays is so broad that, with endoscopic centers need not be decreased. Rather it can still be considerably increased.


Binding of IgA to protein-A-containing staphylococci: relationship to subclasses.

Among 54 human monoclonal IgA proteins, 5 inhibited the binding of labeled human monoclonal IgM (IgM Se and IgM Ba) to protein-A-containing staphylococci, whereas 48 did not have this ability. One protein (IgA Ha) showed discordant findings in the IgM Se and IgM Ba inhibitions assays. Among the 54 IgA proteins, 49 were of the IgA1 and 5 of the IgA2 subclass. All of the 5 IgA2 proteins inhibited the binding of IgM Se and IgM Ba to staphylococci, whereas the 48 proteins that reacted negatively in the two inhibition assays belonged to the IgA1 subclass. These findings show that the ability to react with staphylococci is a property of the IgA2 subclass. IgM proteins may also be divided into two groups based on different reactivities with protein A. It is proposed to call the two IgM subclasses IgM1 and IgM2, where the latter is defined by ability to react with protein A.


Interactions between ricinus agglutinin and human IgA.

By affinity chromatography on Sepharose columns containing insolubilized ricinus agglutinin, all immunoglobulins of the IgA2 subclass and the polymers of IgA1 were retained and could be eluted with lactose. Monomeric IgA1 showed a more heterogeneous reaction with ricinus agglutinin. The major part was unretarded, whereas some of it was weakly bound to the column and could be eluted with lactose.


Genetic control of the in vitro responses of rat blood lymphocytes. II. Number of loci involved and linkage with in vivo antibody formation.

Blood lymphocytes from the inbred rat strains AS and BN differ in the magnitude both of their in vitro proliferative response to different mitogens and of their in vivo antibody response to the mitogenic fraction of phytohemagglutinin (PHA). We have examined the segregation of in vitro responsiveness to PHA in (AS X BN)F1 X BN backcross rats and have tried to correlate it with other characters that vary in backcross rats. In vitro responsiveness is regulated by one or a few loci, is linked to the in vitro responsiveness to B lymphocyte mitogens and the in vivo antibody response to the mitogenic fraction of PHA, but is not linked to the major histocompatibility locus (Ag-B) nor to the frequency of short-lived small Ig-negative lymphocytes in blood. Lymphocytes from high-responder rats have a shorter lag period before the onset of DNA synthesis in vitro than low-responder rats, and possibly also a higher number of in vitro responsing cells. To explain our findings, that the same gene og genes regulate in vitro responsiveness to different mitogens and in vivo antibody response to the mitogenic fraction of PHA, we suggest that the gene or genes act in an immunologically unspecific manner on the regulation of lymphocyte proliferation in vitro as well as in vivo.


Genetic control of antibody responses to PHA in inbred rats.

Phytohemagglutinin (PHA-P; Difco) contains four immunogenic components. The antibody response in rats to two of these components is shown to be genetically determined: AS rats are high responders and BN rats are low responders to both antigens. Responsiveness to the two components segregates independently as autosomal, dominant traits in a manner that is compatible with a one-gene hypothesis for both responses. The antibody response to the mitogenic fraction of PHA segregates together with the in vitro mitogenic response to PHA and to other mitogens. These responses are not linked to the major histocompatibility complex (MHC) of the rat. The antibody response to a nonmitogenic fraction from PHA is, however, linked to the MHC.


Immune response in asymptomatic paraproteinemia. I. Primary and secondary antibody response to Helix pomatia hemocyanin.

In a group of 20 patients with asymptomatic paraproteinemia, as judged after at least 3 years of follow-up, the primary and secondary antibody response to Helix pomatia hemocyanin (HPH) was defective as compared with the response in controls. The class of antibody was assessed by mercaptoethanol (ME) treatment of serum. A lowered response was found not only in the total but also in the ME-resistant (mainly 7S, IgG) antibody titer. Low anti-HPH antibody titers were preferentially found in the patients with high serum paraprotein levels, whereas in half of the patients with low serum paraprotein levels a completely normal antibody response was found. No differences in the total or 7S anti-HPH antibody response were found between patients with IgG, IgM, or IgA paraproteinemia. The polyclonal serum Ig levels were not predictive for the measured anti-HPH response. The anamnestic diphtheria and tetanus antibody response was not different from that of controls.


Arming of lymphoid cells by IgG antibodies treated with protein A from Staphylococcus aureus.

Mouse spleen lymphocytes treated with rabbit IgG anti-sheep erythrocytes (SRBC) complexed with protein A of Staphylococcus aureus (SpA) form rosettes with SRBC. The attachment of SRBC to lymphocytes was due to the binding of the SpA-IgG antibody complex to the surface of the lymphocytes and was thus considered "arming" of the cells. Normal mouse spleen cells "armed" with SpA-rabbit IgG anti-chicken erythrocytes (CRBC) kill specifically 51Cr-labeled CRBC "in vitro" in the absence of free antibodies. The killing by these "armed" cells is an effect of the cell-bound SpA-IgG antibody complex. Both the SRBC rosette formation and the cell-mediated CRBC killing was dependent on the concentration of the SpA-IgG antibody complexes used for "arming" the cells. A 100-fold increase in rosette formation or in killing of target cells was recorded for lymphocytes treated with SpA-IgG antibody complexes in comparison with cells treated with noncomplexed IgG antibodies. The specific binding of SpA-IgG antibody complexes to the Fc receptors of mouse spleen cells was demonstrated by inhibition studies. More than 60% inhibition of the rosette formation and in the killing of target cells was shown for cells treated with normal rabbit IgG or its Fc fragment before addition of the SpA-IgG antibody complex.


A method for the detection and quantitation of Fc receptor sites on cells.

A new rosette technique for identification of Fc-receptor-bearing cells is based on the ability of sheep erythrocytes coated with protein A of Staphylococcus aureus (ES) to form rosettes with cells treated with monomeric IgG or aggregated IgG. The IgG is attached to lymphocytes through its Fc region and binds to a trypsin-resistant but pronase-sensitive receptor (considered an Fc receptor). The ES rosette technique facilitates studies of the interaction of IgG with Fc receptor sites; the binding of any IgG preparation reacting with protein A of Staphylococcus aureus (SpA) can be studied by the technique. Inhibition of rosette formation by SpA was used for quantitation of IgG fixed to the cell surface (that is, the number of Fc receptors/cell). The sensitivity of the method permits quantitation of less than 10(5) IgG molecules bound to the Fc receptors. The relative affinity constant between Fc receptors and IgG ligands was estimated by plotting the percentage of ES rosettes as a function of IgG concentration and calculating the reciprocal of the IgG concentration giving half the maximal number of ES rosettes.


Tuberculin reactions related to interval between BCG vaccination and skin testing in guinea pigs.

Groups of BCG-vaccinated guinea pigs were given a single Mantoux skin test 4 to 69 weeks after vaccination. The skin reactions tended to develop more slowly the longer the interval since BCG vaccination. Relatively quickly developing tuberculin skin reactions may be characteristic not only for repeated testing, but also for skin tests taken shortly after BCG vaccination.


[Long-term course of anorexia nervosa].

A follow-up study has been recently conducted in 20 female patients with severe anorexia nervosa who had undergone stationary psychotherapeutic treatment at our clinic 8-16 years ago. Whilst according to our findings the prognosis for anorexia nervosa still remains poor, it does not seem quite so hopeless as is frequently presumed. Out of the 20 patients followed up, 5 now have chronic anorexia nervosa and in 2 cases transition to an endogenous psychosis has occurred (schizophrenia simplex with chronified anorexia in one, and endogenous depression after improvement of anorexia in the other case). 1 patient died in the interval between observations as a result of her anorexia. The general results of our investigation roughly confirm the rule-of-thumb predictions for many psychotherapeutic treatments of neurotic diseases, i.e. 1/3 unimproved, 1/3 improved, 1/3 cured. Although free from illness, the majority of the patients must be described as conspicuous within the norm. The typical personal characteristics of the anorectic are maintained, their weight remains below normal level, and they suffer from eating problems. According to our investigation a positive prognosis correlates with onset of the illness before the age of 18, absence of laxative abuse, and subsequent marriage, whereas premature interruption of the treatment with return to the parental home proves to have a negative effect. In apparent contradiction to the persistence of the characteristic anorectic features is the evidence that out of the 20 patients in question 12 married and 8 had children. On the other hand, the fact that during the interval between observations 4 patients relapsed into severe anorexia in connexion with engagement or pregnancy indicates that acceptance of a mature female or maternal role often remains a problem. Of gynecologic interest is the fact that long-lasting secondary amenorrhea (up to 10 years, with an average of 5 years) has not led to fertility problems for any of the married patients who wanted children.


[Vitamin B 1 deficiency in chronic alcoholics and its clinical correlation].

50 chronic alcoholics reporting to the medical emergency ward of Basle University Hospital with alcohol-related illness were examined with respect to thiamine nutritional status by means of the transketolase activation test of erythrocytes (ETK). 46% of the chronic alcoholics, compared to only 2% of the control population (1152 healthy adults), had transketolase activation quotients indicating a strong probability of thiamine deficiency (alphaETK greater than 1.25). The most important symptoms associated with the biochemical parameters of thiamine deficiency were: anemia, pathologic liver functions (bilirubin, gamma-globulins), low diastolic blood pressure and Wernicke's encephalopathy. There was a statistically significant correlation (p less than 0.05) between these symptoms and the biochemical parameters for thiamine deficiency. Therefore, when treating chronic alcoholics, these symptoms should direct attention to a possible vitamin B1 deficiency. Since the enzymatic vitamin B1 parameters correlate with the patients' hemoglobin, our results would be consistent with anemia influenced by provision of thiamine.


[Effect of an oral contraceptive (ethinylestradiol/D-norgestrel) on growth hormone and insulin secretion].

The growth hormone, insulin and blood glucose values were measured during a glucose tolerance test in 12 women before and after 3 months' use of a contraceptive of the sequential type (11 pills containing 0.05 mg D-norgestrel and 0.05 mg ethinylestradiol and 10 pills containing 0.125 mg D-norgestrel and 0.05 mg ethinylestradiol). Neither fasting blood glucose nor glucose tolerance are altered during administration of the contraceptive steroids. On the other hand, the reactive insulin level is significantly increased in comparison to the basal value, thus showing the signs of hyperinsulinemia. Both the gestagens and the estrogens appear to contribute to this disturbance of insulin secretion. Presumably the hyperinsulinemia is an expression of decreased sensitivity of the peripheral tissue to insulin. The growth hormone, a so-called insulin antagonist, is not responsible for the "insulin resistance" observed. The values measured by us after administration of the contraceptive do not significantly differ from the basal values.


[The anti-hypertensive effect of timolol maleate (blocadren) in gradated combination with a diuretic].

In a controlled double-blind crossover study followed by an open longterm continuation period, the antihypertensive effect of timolol (Blocadren), a new beta-receptor antagonist, was investigated in 24 ambulatory patients with mild to moderate essential hypertension who were concomitantly receiving Moduretic as baseline diuretic therapy. The addition of timolol to one tablet daily Moduretic resulted in a clinically and statistically significant further reduction of supine and upright systolic and diastolic blood pressures. The average total daily dosage schedule for timolol ranged between 15 and 20 mg, with the same blood pressure lowering effect whether the divided dose was given twice or three times. Significant sinus bradycardia was consistently observed but well tolerated, with only one patient requiring dose reduction. After 48 weeks of treatment (comprising 46 weeks Moduretic and 36 weeks timolol) 20 of 22 patients were normotensive (supine diastolic blood pressure below 90 mm Hg) while in two the hypotensive response proved inadequate. One patient was dropped from the study after 3 days of timolol treatment because of acute bronchial asthma. When specifically questioned, one-third of the patients admitted experiencing cold extremities. One patient exhibited Raynaud's syndrome which was treated symptomatically while continuing in the study. In terms of electrolyte balance, the fixed combination of hydrochlorothiazide and the antikaluretic amiloride (Moduretic) as baseline therapy essentially proved adequate. On occasion, however, two subject revealed hypokalemia requiring short-term oral potassium supplement. During the initial 10 to 16 weeks a steady decline in serum potassium was observed but this stabilized itself thereafter. The concomitant administration of Moduretic and timolol (Blocadren) was shown to be an effective therapeutic regimen in patients with mild to moderate essential hypertension. This combination is particularly suitable for patient compliance in longterm therapy, as timolol can be given twice daily.


[The spontaneous course of coronary disease].

The natural history of coronary atherosclerotic heart disease was studied in a retrospective analysis of 160 patients, who underwent coronary arteriography from 1965 to 1969. All had at least one angiographically documented significant stenosis of more than 50%; the survivors were followed for at least 5 years and a maximum of 9 years. For the entire group, 5-year survival was 81%. Subdivided into single, double or triple vessel disease categories, the 5-year survival rates were 91, 85 and 63% respectively.


[Coronary lesions in type II and IV hyperlipoproteinemias. Coronarographic study].

Coronary arteriography was performed in 24 patients with type-II and in 22 patients with type-IV hyperlipoproteinemia. The findings of the present study allow definition of several angiographic characteristics which seem to be linked to the type of hyperlipoproteinemia. Patients with type II generally have more widespread disease in the coronary tree at younger ages than do those with type IV. Type-II patients usually have proximal and distal disease, whereas type-IV patients have more often proximal disease only. Significant stenosis of the main left coronary artery is frequent in type-II but very rare in type-IV patients. Extensive calcification of the ascending aorta, sometimes associated with narrowing of the proximal aortic root, is present in 25% of type-II but in none of type-IV patients.


[The mobile coronary unit in Basel. Report on its use in 1974].

A comparative study has been conducted in two groups of patients with fresh myocardial infarction: 168 brought to the hospital by mobile coronary care unit and 200 hospitalized by the conventional patient transport system. Pre-hospital mortality differed markedly (8.6% in the former group and 26.5% in the latter) but there was no difference in hospital mortality (17.7 vs. 19.8%). The possible implications of these findings are discussed.


[Frequency and prevention of ventricular arrhythmias after acute myocardial infarct].

In a controlled study using mexiletine and placebo, the incidence of ventricular arrhythmias after acute myocardial infarction (AMI) has been compared. The study covered 40 male patients who had sustained AMI and who in the first 48 h after onset of infarction had exhibited ventricular tachycardia, R on T-, multiform or close-coupled ventricular ectopic beats. Half of the patients were given either mexiletine (250 mg 8-hourly) or placebo. On the 4th and 10th day after onset of infarction a continuous 24-hour ECG was performed. 76% of the patients receiving placebo showed serious ventricular arrhythmias compared with 32% receiving mexiletine (p less than 0.05). These results demonstrate (1) the frequency of ventricular arrhythmias in a group of patients already at risk, and (2) the efficacy of an oral antiarrhythmic agent like mexiletine in the management of these rhythm disorders.


[Echocardiography as a method for the determination of the severity of aortic insufficiency].

4 groups of patients with different degrees of aortic regurgitation (mild n = 7, moderate n = 3, severe n = 21, and aortic regurgitation combined with organic mitral stenosis n = 5) were examined by means of echocardiography and compared with a control group of 10 healthy subjects. The purpose was to determine what information echocardiography may provide in regard to the severity of aortic regurgitation and whether patients with organic mitral stenosis can be distinguished from patients with Austin Flint murmur. Patients with mild or moderate aortic regurgitation could not be clearly distinguished by echocardiographic features from subjects with normal cardiac findings. However, patients with severe aortic regurgitation were likely to show the following characteristic changes: (1) early mitral valve closure, (2) diastolic flutter, (3) absence of the a-wave. If a premature mitral valve closure, i.e. a negative QC time or a diastolic flutter or absent a-wave are found, the aortic regurgitation is likely to be of severe degree. This finding will be particularly useful in patients with acute aortic regurgitation, no left ventricular enlargement and no left ventricular hypertrophy in the ECG. Being a noninvasive method, echocardiography may also be used in follow-up examinations. Furthermore, organic mitral stenosis can be distinguished from Austin Flint murmur.


[Hemodynamic significance of myocardial bridging and milking effect of the anterior interventricular artery: a mild variant or source of angina?].

A hemodynamic study was conducted in 11 patients with myocardial bridging and milking effect (ME) of the left anterior descending artery (LADA), but with otherwise normal coronary arteries. During pacing, patients with grade III ME (over 75% narrowing of arterial size during systole) showed anterior wall ischemia, lactate production and severe angina. Thus, grade III ME observed on coronary arteriography may result in significant obstruction of the LADA with typical angina. Surgical treatment is worth considering in symptomatic patients with this rare anomaly.


[Hemodynamic changes under metoprolol compared to propranolol in hypertensive patients].

The effect of the new beta-receptor-blocking drug metoprolol on hemodynamics and plasma renin activity was studied at rest and during exercise. 5 patients with essential hypertension were investigated before, 4 weeks after and 8 weeks after oral treatment (3 X 50 mg day). The results were compared to data of 5 patients under propranolol matched according to age, arterial blood pressure, and renin concentration. Metoprolol leads to a significant fall in renin and heart rate, whereas cardiac index is depressed only during exercise. Peripheral resistance remains unchanged and left ventricular filling pressure rises slightly. This results in a slight fall in arterial blood pressure. In comparison with propranolol the hemodynamic and renin patterns under metoprolol are similar, the only difference being the slighter fall in blood pressure due to a less depressed cardiac index.


[Electrocardiograms of digitalis intoxication. Reevaluation].

Serum digoxin concentration and ECG were recorded 111 times in 96 patients taking digoxin. The generally accepted ECG criteria of digoxin concentration seem greatly to overestimate the incidence of toxic cases. According to these criteria 63 ECGs in this study would have been regarded as toxic, whereas toxicity (defined by the association of serum digoxin elevation and clinical symptoms of toxicity) was actually present in only 11 cases.


[Differential diagnosis of the deviation of the QRS left axis in ECG].

100 ECGs with left axis deviation have been analyzed with respect to left anterior fascicular block (LAFB). On the basis of conventional criteria LAFB was diagnosed in 59 cases, but could be rules out in 26. Of the remaining 15 ECGs which at first seemed doubtful, 4 were identified as LAFB on the basis of a new criterion: duration of qR in a VL at least 40 msec longer than in V6.


[Complications due to endocardial and epimyocardial electrodes in 171 patients with artificial pacemakers].

On the basis of experience with 171 patients the advantages and disadvantages of a sutureless, corkscrew-like myocardial electrode are compared with those of endocardial electrodes. Electrode complications were significantly less frequent in patients with sutureless myocardial electrodes and never lead to death. However, a benign postpericardiotomy syndrome was frequent (16% of cases). Electrode dislocation was the main complication in patients with endocardial electrodes.


[Surgery of mitral valve stenosis: open or closed commissurotomy?].

Up to October 1975 a total of 206 mitral commissurotomies were performed in Berne. 170 patients underwent closed commissurotomy (CMC). In the period from 1973, 36 patients underwent open commissurotomy (OMC). To compare results and operative risk as between OMC and CMC, the last 36 consecutive patients of the CMC group were selected for critical evaluation. Though not coinciding chronologically the 2 groups turned out to be essentially comparable with regard to preoperative clinical and hemodynamic findings. In neither group was there a hospital death. Frequency and severity of postoperative complications did not prove to be greater following OMC. Cerebral embolism was observed in 3 cases after CMC, whereas this complication occurred only once following OMC. On the basis of clinical, radiological and electrocardiographic data, OMC must be considered superior to CMC. The incidence of significant residual stenosis and the risk of causing mitral regurgitation appear to be lower. Without involving a higher operative risk, the open approach to mitral commissurotomy offers the following main advantages: safe removal of intraatrial thrombi, precise and complete incision of the fused commissures under direct vision, avoidance of leaflet tears, separation of fused chordae tendineae and incision of papillary muscles in order to remove subvalvular stenosis, debridement of calcium from leaflets, and repair of concomitant mitral regurgitation by valvuloplasty.


[Electrocardiographic diagnosis of coronary insufficiency by means of right atrial pacing].

In 285 patients who underwent selective coronary arteriography and atrial pacing for electrocardiographic diagnosis of suspected coronary failure, the sensitivity of this test was found to be rather poor: 43% positive results for atrial pacing compared to 50% for the submaximal exercise test, 75% for the maximal exercise test and 63% for the isoprenaline infusion test. In our experience atrial pacing is of diagnostic value only where uncertainty persists after a negative isoprenaline infusion test and an exercise test likewise negative but for some reason submaximal.


[Effect of coronary flow reduction on the coronary flow distribution, the myocardial metabolism and left ventricular hemodynamics].

Myocardial blood flow, left ventricular performance, regional myocardial metabolites (ATP, CrP, lactate) and a-v differences of oxygen, lactate and pyruvate were determined in 6 open chest dogs with cannulated left coronary artery. A mean flow reduction from 92 to 43 ml/min/100 g heart weight resulted in marked heart failure accompanied by extensive flow reduction to the endocard with nearly 10 fold increase of lactate and a decrease of CrP content to 50% of control. In contrast, flow and metabolic parameters of the epicardial part changed only slightly. Furthermore, the DPTI/SPTI-ratio showed a good correlation with the subendocardial CrP content (r = 0.93, p less than 0.01).


[First evaluation of plasma L-lactate measurements by means of the "lactate analyzer 5400"].

The instrument used can measure lactate instantaneously by a semi-automatic method using an electrochemical-enzymatic sensor. In order to test the instrument, 3 series of measurements were carried out simultaneously by the Analyzer and by the conventional enzymatic method (Boehringer, Mannheim): "normal" plasma and "normal" blood was obtained from venous blood of healthy adults; pathological plasma, obtained by addition of a known concentration of lactate to normal plasma, was also tested. The correlation curves for these three series are reported. The coefficient r is between 0.95 and 0.98, which bears out the reliability of the measurements. Since a short period, this lactate analyzer is used in our research laboratory in obstetrics.


[The relative therapeutic value of drugs in international comparison: differences between Switzerland and Canada].

In Switzerland the relative therapeutic value of various drugs (e.g. pyrazolone analgesics, phenacetin, clindamycine, clioquinol) is placed demonstrably higher than in Canada. In Canada, rare but possibly dangerous complications of drug therapy are considered to be of greater importance. Two factors might be responsible for these differences: 1. Compared with similar publications in Canada, drug advertisements in Swiss medical journals contain fewer warnings of untoward effects. This can be interpreted as an "information lag". 2. Since the link between an untoward effect and a drug is very difficult to establish with absolute certainty, it may be concluded that the drug is relatively inoffensive. This conclusion is drawn more often in Switzerland than in Canada. Uniformization of the way in which the physician is presented with information concerning untoward drug effects would be an important step towards the establishment of internationally accepted standards of drug therapeutic value.


[Arthroscopy of the knee joint].

The clinical usefulness of arthroscopies of the knee joint has been evaluated on the basis of 282 examinations. The procedures were performed under general anesthesia with sterility precautions as for arthrotomy. In nearly all cases, direct observation of articular surfaces, synovial membranes and the menisci of the ventral two thirds of the joint was possible. The dorsal recessus, the posterior third of medial meniscus, the posterior cruciate and Baker's cyst could not be inspected. The diagnostic accuracy of arthroscopy was compared with that of double contrast arthrography. The results are as follows: incipient degenerative lesions of articular cartilage, especially chondromalacia of patella, and dislocated bucket handle tears of menisci are more accurately diagnosed by arthroscopy. For other meniscal lesions double contrast arthrography provides better results. - Arthroscopy allows the taking of synovial biopsies in cases of chronic synovitis. However, the results of histological examination are rarely of decisive value, though undetected lesions of articular cartilage have been frequently brought to light.


[Effectiveness and tolerance of the rabies vaccine Lyssavac Berna].

Rabies vaccine derived from human diploid cells (Wyeth, Merieux) and the duck embryo vaccine Lyssavac Berna are prepared from beta-propiolactone-inactivated Pitman-Moore vaccine virus strain. A group of 113 seronegative veterinary students was vaccinated with Lyssavac Berna according to the 4-dose immunization schedule recommended by WHO. Seroconversion was obtained in all test persons. The vaccine was very well tolerated. In agreement with the literature we also found a relatively fast decline in the neutralizing antibody titer after this immunization procedure. However, a booster injection after one year resulted in an antibody rise with titer values comparable with or higher than those obtained after the primary vaccination course. An annual single revaccination dose should be sufficient to protect people at risk.


[Diphenoxinhydrochloride, a new anti-diarrhea agent].

The new antidiarrheal drug difenoxin hydrochloride is a preparation with a broad range of action; it is suitable for symptomatic treatment of acute and chronic diarrhea of varying etiology and may be administered as additional medication in cases of specific intestinal infections accompanied by diarrhea. Difenoxin hydrochloride was tested in two studies involving 220 patients with acute diarrhea and 41 patients with chronic diarrhea respectively. Side effects were extremely rare and stool frequency and consistency returned to normal at a daily dose of about 6 tablets. This dose could be reduced for the chronic cases after initial treatment with the higher dose. Positive results were obtained within a very short time in more than 80% of the acute cases and in more than 70% of the chronic cases.


[Late results after surgical treatment of carpal tunnel syndrome. A clinical follow-up study of 60 cases].

In a follow-up study 60 hands of 49 patients were examined 1-12 years after operation for carpal tunnel syndrome. The syndrome was diagnosied in the majority of cases on clinical examination only. Paresthesia, hypesthesia or anesthesia in the 3 1/2 radial fingers of the hand are typical signs. Some patients complained of severe pain irradiating towards the elbow and shoulder. The method of surgical treatment is described in detail. Of the 49 patients only 2 were dissatisfied with the result. Both patients suffered from stenosing arteriosclerotic disease of the peripheral arteries of the hand and their pain and paresthesia were relieved by thoracic sympahtectomy. 58% of patients had complete relief from from symptoms while the remaining cases had a significant reduction of symptoms and were satisfied with the result of surgical treatment. The results were better in those patients who were operated on soon after the onset of symptoms. From the results of this study it is clear that surgical treatment of carpal tunnel syndrome provides good results and that surgical treatment should be recommended without delay if conservative treatment is unsuccessful.


[Radioimmunologic determination of TSH in dried blood stains: a possible screening method for the diagnosis of hypothyroidism in new born infants].

By a modification of the radioimmunoassay of TSH in plasma, a method has been introduced for the measurement of TSH in dried blood spotted on filter paper. On incubation of filter paper discs (6.5 mm diameter, corresponding to approx. 10 mul blood) for 38 hs has the lower limit of detection was 10 muU/ml TSH 68/38. In 100 blood samples, TSH was measured in plasma as well as in dried blood; the results were comparable and showed complete agreement in patients with high TSH concentrations suffering from primary hypothyroidism. In 16 out of 72 newborn children examined during the first 8 hs of life. TSH was slightly elevated. It would appear that our method is sensitive enough for detection of the physiological postnatal rise in TSH. Among 1400 infants in whom Tsh was measured on the 5th or 6th day simultaneously with routine screening for phenylketonuria (PKU), we found 1 case with markedly elevated TSH levels of greater than 100 muU/ml. The child suffered from congenital goiter. The results of our study show that the measurement of TSH in dried blood spots is possible without particular difficulty. Becasue of the simplicity of blood-sampling, the stability of the TSH, the relatively low cost and the low number of false positive results, this method seems to be suitable for screening of new born infants. It could be carried out conveniently in combination with the screening program for metabolic diseases, which covers practically 100% of infants born in Switzerland. Congenital hypothyroidism is a relatively frequent disease (1:3000-1:7000) in which early commencement of treatment is of great importance for mental development. It would therefore be desirable for all infants to be screened during the first days of life for congenital hypothyroidism.


[The radiation load of the Swiss population due to radiodiagnosis].

It is recommended that the so-called "genetically significant dose" (GSD) be applied as a quantitative index of the radiation exposure of the genetic material of a population, i.e. the dose which, if received by every member of the population, would be expected to produce the same total genetic injury to the population as do the actual doses received by the various individuals. The GSD of the Swiss population for the year 1971 was calculated on the basis of information received from physicians concerning approximately 60 000 patients. Exeripmental determination of the gonad dose was done in various hospitals with the aid of TLD dosimeter, and sensitive high-pressure and normal-pressure ionization chambers. The results show that the annual rate of increase of X-ray diagnostic examinations is 3-4% in Switzrland as elsewhere. The GSD for Switzerland amounted in 1971 to 42-43 mrad per person as compared with 22 mrad in 1957. The "annual mean marrow dose of a population" can be calculated from the single doses received from each part of active bone marrow irradiated in the course of an X-ray examination and, as in the case of the genetically significant dose, from the demographic figures mentioned. The annual mean marrow dose (1971) for the Swiss population was tentatively calculated using the values of the mean marrow dose per examination of the UK survey of 1957/58 and amounts to about 121 mrad. Barium meal contributes about 30% of the total, while intravenous pyelography, carium enema, lumbar spine and mass miniature radiographies each account for about 10%.


[Public hypertension screening and problems of individual long term control].

Four months after public screening for hypertension during the Swiss Trade Fair 1974, a random sample of 302 hypertensives referred to private practitioners were interviewed to determine the impact of the screening on longterm control through private practice. 201 hypertensives went for further blood pressure control: the previously aware did so more frequently than the previously unaware (p less than 0.01). 112 of 201 were confirmed as hypertensives by private practitioners: this occurred in 80% of aware but in only 36% of unaware patients. 94 were started on therapy. 76 of 112 (2/3) received further appointments. Another 101 hypertensives did not seek care. Main determinants were insufficient knowledge about hypertensive disease and a shorter period of formal education; half of them claimed "they felt perfectly well". In summary one third did not seek care, another third were not confirmed as hypertensive or were lost to follow-up, and only one third (50% of the aware and 10% of the unaware) were still under regular care. While community-wide screening provided an opportunity for educational compaigns and positively affected the behaviour of hypertensives who were already aware, the yield in terms of newly identified hypertensives still under control 4 months later was extremely low. Before further developing community screening programs, feasibility studies must define mechanism for improved longterm control.


Abnormalities of autonomic nervous control in borderline hypertension.

The systemic hemodynamic was investigated in 145 young male patients with borderline hypertension and 85 control subjects. Response of the cardiac output, stroke volume and the heart rate to sequential parasympathetic, beta-adrenergic and alpha-adrenergic blockade was used for assessment of the autonomic nervous tone. These investigations suggest that the apparently "innocent" minimal blood pressure elevation in borderline hypertension is associated with a number of physiologic abnormalities: The cardiac output, heart rate and stroke volume can be elevated. In all patients the peripheral resistance is abnormal. An abnormal distribution of plasma renin values is detectable. The plasma volume is decreased in a proportion of patients. A number of these abnormalities can be explained by a neurogenic mechanism. The elevation of the cardiac output is entirely neurogenic. In a substantial minority of patients, the elevation of peripheral resistance is attributable to increased sympathetic drive. Indirect evidence indicates that the plasma renin elevation in borderline hypertension may also be neurogenic. Hypothetically the decreased plasma volume may stem from sympathetic effects on postcapillary vessels, but at the present there is no experimental evidence of support this view. The change in autonomic function in borderline hypertension involves both the sympathetic and parasympathetic efferents. Increased sympathetic stimulation is coupled with decrease parasympathetic inhibition. This points toward abnormal integration of the autonomic control, presumably in the medulla oblongata. The mechanism of the autonomic abnormality is not fully elucidated. The role of baroreceptors requires further investigation. In some patients the altered autonomic integration appears to be related to psychosomatic mechanisms.


The problems of morbidity and therapy in borderline hypertension.

The aim of the trial was to see whether it was possible to improve morbidity and mortality in both males and females with diastolic pressures between 90 and 109 mm Hg. The initial calculations suggested that it would be necessary to screen between 250-500,000 people to obtain 18-36,000 subjects. This was the number predicted to obtain a statistically significant end-point on current knowledge of morbidity and mortality in this age range. The initial aim was to mount a trial of feasibility with the following objectives: (1) To recruit up to 1000 adults of both sexes aged 35 to 64 years with diastolic pressures in the 90-109 mm Hg range. (2) To determine the acceptability of the trial to asymptomatic subjects as well as their physicians. (3) To show that selected drugs (bendrofluazide and propranolol) adequately control pressure without undue side-effects. (4) To assess the psychological effects of inclusion in the trial. (5) To examine the cost and efficiency of different types of recruitment and supervision. These objectives have now been largely achieved with over 1500 subjects in the study at 2 1/2 years and a drop-out rate of about 13% in all. It appears that the best method of recruitment and supervision is through family practices with supporting staff, particularly in the screening phase. Both the selected drugs reduce the blood pressure significantly and although the placebo groups also show a maintained fall of pressure, the difference from the treated groups is significant. There is no evidence of increased psychological stress by inclusion in the trial and those with psychological symptoms at the outset improve in comparison with their control subjects outside the trial. In order to reach an end-point which will give data of statistical significance, the trial should now be expanded as rapidly as possible towards the goal of recruiting 18-36,000 subjects.


[Non-specific effects of a drug study in hypertensive patients].

During the first phase of a drug study, 33 hypertensive patients received 2 placebo tablets daily for 2 weeks as the sole treatment. Analysis of the blood pressure readings during this placebo phase shows that the study in itself creates a psychological climate which tends to decrease blood pressure. This effect should be taken into account when analyzing results of drug studies; only in studies with a double blind design is drug effect adequately judged.


[Plasma renin activity and plasma aldosterone in essential hypertension: effect of age and diastolic blood pressure].

In patients with essential hypertension a gradual decrease in basal and stimulated renin secretion was found with increasing age. Stimulated plasma aldosterone decreased similarly; however, the observed changes were less pronounced. Young patients (less than 35 years) with high renin hypertension had lower diastolic blood pressure than patients with low renin hypertension in the same age group. Contrary to these findings, a markedly higher diastolic blood pressure was observed in patients over 35 years of age with high renin hypertension than in the group of patients with low renin hypertension. These results indicate that neither high nor low renin essential hypertension patients represent homogeneous groups. Furthermore, the dissociation between changes in renin activity and plasma aldosterone points to a disturbed relationship between the renin angiotensin system and aldosterone secretion in essential hypertension.


[Effect of the angiotensin antagonist saralasin (1-sar-8-ala-angiotensin II) on the blood pressure in secondary hypertension].

The angiotensin antagonist saralasin (1-sar-8-ala-angiotensin II) was given to 27 patients with different forms of secondary hypertension. The blood pressure fell in 6 of 7 patients with renal artery stenosis and in 4 of 10 patients with terminal renal failure on regular hemodialysis. No change or a rise in blood pressure was observed in 3 patients with Cushing's syndrome, 4 patients with primary aldosteronism, 3 patients with hypertension and a unilateral small kidney of other than renovascular origin, and 6 patients with terminal renal failure. It can be concluded from the results that angiotensin II is involved in the pathogenesis of renovascular hypertension and in some cases of hypertension accompanying chronic renal failure.


[Correlations between blood pressure, blood volume, plasma renin and urinary catecholamines in normal subjects and in patients with benign essential hypertension].

Interrelations between blood pressure, circulatory volume, plasma renin activity (PRA) and urinary catecholamine excretion rates were studied in normal subjects and patients with benign essential hypertension. Mean plasma or blood volumes related to lean body mass, products of blood volume and the logarithm of PRA, and catecholamine excretion rates did not differ significantly as between normal and hypertensive subjects. In both normal subjects and hypertensive patients, blood pressure correlated positively with noradrenaline excretion rate (r = 0.40 and 0.36 respectively; p less than 0.025), but not with adrenaline excretion, circulatory volume or the volume-renin product. The logarithm of PRA correlated inversely with mean blood pressure in normal subjects (r = -0.40; p less than 0.001), but not in hypertensive patients; however, there was no convincing evidence of an inappropriate blood pressure-PRA relationship as a prominent feature in the hypertensive patients. PRA did not correlate with blood volume. Patients with low PRA relative to sodium excretion (21% of hypertensive population) were consistently normovolemic, but tended to be older and excreted less (p less than 0.025) adrenaline than normal or high-PRA patients. The patient subgroup with high PRA relative to sodium excretion (11% of population) was hypovolemic (p less than 0.02); despite this, urinary sodium output was high (172 +/- 64 meq/24 hr). These data reveal no evidence for major roles of PRA, circulatory volume and free peripheral catecholamines in the maintenance of benign essential hypertension. Low-PRA essential hypertension is usually not a hypervolemic state, but may reflect diminished adrenergic activity, factors associated with aging and effects of a high systemic pressure. High PRA in benign essential hypertension may be at least partly a consequence of hypovolemia resulting from high blood pressure-induced sodium diuresis.


[Spontaneous perforation of the colon in patients in hemodialysis].

Two cases of spontaneous perforation of the colon in hemodialysed patients have thus far been published. Our observation of 5 new cases seems to indicate that this complication is more frequent in hemodialysed patients than in patients without renal failure (27 cases in the literature). An abnormal tissue fragility and very hard fecal masses appear to be responsible for this dangerous complication. The association of aluminium hydroxyde and substances with antiperistaltic effect should be avoided, and constipation must be alleviated.


[Comparative study on the elimination of pindolol (visken) and antipyrin in patients with liver diseases].

25 patients suffering from different hepatic diseases were studied in order to investigate the elimination of the beta-receptor blocking drug pindolol in hepatic disease. Following an overnight fasting period the patients received simultaneously 3 mg pindolol intravenously and 1000 mg antipyrine orally. Plasma samples were taken at certain time intervals for 24 hs and urine was collected for 72 hs for the measurements of drug concentrations in plasma and urine. From these measurements different pharmacokinetic parameters were calculated for both drugs used in the present study according to a one-compartment open model. The total body clearance of antipyrine was selected as a parameter of the metabolic capacity of the liver microsomal enzyme system and was compared with the pharmacokinetic parameters calculated for pindolol by means of linear regression. There was no significant correlation between the total body clearance of antipyrine and the kinetic parameters of pindolol in any of the 25 patients irrespective of the differences in liver disease. On the other hand, 14 patients suffering from cirrhosis of the liver showed a significant correlation between the total body clearance of antipyrine and the overall elimination rate constant or metabolic clearance of pindolol. No correlation was found between antipyrine clearance and total body clearance of pindolol, as some patients with intact renal function excreted a higher proportion of pindolol in the urine as liver function decompensated. The mechanism of such compensatory elimination is unknown. In conclusion, the total body clearance of antipyrine known to represent metabolic liver function showed a significant correlation with the metabolic clearance of pindolol in patients with cirrhosis of the liver. For the other liver diseases investigated, too few patients were studied to calculate an adequate correlation.


[Physiopathology of arterial hypertension. Role of the nervous system and of the hormones].

Maintenance of normotension rests upon the overall salt and water balance, which, in the event of disequilibrium, modifies body fluid, cardiac output and total peripheral resistance. The kidneys play a central role in this hydro-saline regulation. The central and autonomous nervous systems, the renin-angiotensin system, the mineralocorticoids, the antidiuretic hormone and the kallikrein-bradykinin-prostaglandin system all affect this regulation and are closely interrelated. The role of each of these nervous and endocrine systems in hypertension, and their close interrelationship, is briefly reviewed.


[Angiotensin II inhibitors for the diagnosis and treatment of hypertension].

Specific antagonists of the renin angiotensin system have been used to investigate the role of this hormonal system in blood pressure homeostasis and in different types of experimental and clinical hypertension. Using this approach it was possible to show that renin via angiotensin participates actively in blood pressure maintenace, particularly following sodium depletion. Such antagonists, if available for oral administration and taken together with a diuretic, would be useful therapeutically.


[Swiss Society Against Hypertension].

The Swiss Association Against High Blood Pressure was founded recently to improve the detection and treatment of hypertensive patients. Efforts will be directed towards increased awareness among the population and the medical profession and generalization of blood pressure measurements.


[Increasing the bronchial resistance by means of aortic occlusion in the dog].

In 11 spontaneously breathing, anesthetized dogs, suprarenal occlusion of the aorta was produced by means of a ballon-tipped catheter and maintained for 20 min. The obstruction led to an increase in O2 saturation in arterial blood (the rise in wedge pressure alters pulmonary perfusion), in aortic pressure and in bronchial resistance. Bronchial resistance could be partially diminished by inhalations of atropine or terbutalin.


[Intermittent pneumatic compression of leg and thigh: a new successful method for the prevention of postoperative thrombosis].

In a prospective study, 54 patients undergoing joint-replacement operations were randomized into a control and a treatment group. In the treatment group low pressure intermittent compression (Phlebo-Dynastat) to calves and thighs was started on the day of operation and continued until patients were fully mobilized. In 34 evaluable patients undergoing total hip arthroplasty the incidence of deep vein thrombosis (DVT) as determined by venography was 43% in the control group and 22% in the treatment group (p = 0.18). In 17 patients undergoing total knee replacement, DVT occurred postoperatively in 70% of the control group but in none of the treatment group (p = 0.002). The difference between the control and Phlebo-Dynastat group when comparing all patients was highly significant (p less than 0.005). Low pressure intermittent venous compression offers a welcome alternative method of thrombosis prophylaxis in patients with increased risk of bleeding.


[Folic acid determination in the serum and erythrocytes by means of a competitive binding method with 125 iodine labeling].

Folic acid concentration in serum and erythrocytes was measured by radio assay according to the principle of competitive binding to proteins with 125I as marker. The method yielded a linear regression with readily reproducible results. The mean value in controls was 7.05 -+/ 3.4 ng/ml in serum and 386.8 -+/ 215.1 ng/ml in erythrocytes. In chronic alcoholics the respective values were significantly lower: 4.79 -+/ 2.02 ng/ml for serum and 344.4 -+/ 198.9 ng/ml for erythrocytes. The clinical importance of folic acid estimations arises from the general frequency of folic aicd deficits. Latent folic acid deficiency is associated with lowered folic acid concentrations in serum and normal values in red cells. In manifest folic acid deficiency both concentrations are decreased.


[The systolic time intervals in functional disorders of the thyroid: a simple and fast screening test].

The systolic time intervals (LVET, PEP, and ratio LVET/PEP) were determined in 53 patients presenting with signs or symptoms of thyroid dysfunction. Patients with clinical evidence of congestive heart failure, with arterial hypertension or old myocardial infarction, and patients receiving cardioactive drugs, were excluded from the study. Thyroid function was evaluated by means of T3-RIA, serum thyroxin and TRH stimulation test.


[Industrial fluorosis].

43 potroom workers (aluminium industry) with fluorosis have been compared with 18 foundry workers of the same age, but who had never been exposed to fluorides. Clinical examination revealed a higher incidence of articular pain and limitation of motion in the exposed group. The diagnosis of fluorosis is not only clinical but calls for other investigations such as urinary fluoride determination, bone radiology and, above all, bone biopsy for fluoride determination, histology and microradiography.


[Sporadic adult hypophosphatemic vitamin D resistant osteomalacia (phosphate diabetes) and hyperparathyroidism].

Report on a patient with osteomalacia due to renal phosphate loss. At onset the patient was aged 43 years. No other tubular defects were detected except glycinuria. The patient was followed over a period of 12 years. 3 years after treatment with oral phosphate and vitamin D3 persistent hypercalcemia developed with highly elevated levels of parathyroid hormone. After removal of one enlarged parathyroid gland serum calcium normalized, but elevated parathyroid hormone levels still persist. The spontaneous occurrence of hypophosphatemic osteomalacia in an adult male and its connections with the development of hyperparathyroidism are discussed.


[Cranial polyradiculitis or the so-called Fisher syndrome].

In the light of 3 personally observed cases a description is given of polyradiculitis cranialis or socalled Fisher's syndrome, a separate form of Guillain-Barre-Strohl polyradiculitis. It is a combination of acute ataxia, areflexia and ophthalmoplegia. The cause is probably an immunological reaction to a harmless infectious disease. Reversible or limited demyelination is assumed. The demyelination occurs particularly in the peripheral nerves and their spinal roots, but also in the spinal-cerebellar pathways and possibly in the nuclei of the cranial or optic nerves. Diagnosis is based on detection of "albumino-cytologic dissociation" in the cerebrospinal fluid and the finding of a lesion of the peripheral motor neuron in the EMG. Special drug therapy is unnecessary. The prognosis is good: complete remission is usually observed.


[Diagnosis of myocardial infarct by means of a quick determination of the MB fraction of serum creatinephosphokinase].

A rapid method of determining creatine phosphokinase (CPK) isoenzymes using dithiothreitol, a reducing agent which activates the main fractions of the CPK molecule (MM and MB), was assessed in 68 subjects (34 with myocardial infarction, 18 with skeletal muscle lesions, 16 normal). In acute myocardial infarction, the mean peak of CPK-MB in serum increases to 13.3% of the total CPK (range 8.8% to 21%) from the 18th to the 24th hour after onset of symptoms, whereas in skeletal muscle lesions CPK-MB reaches only 1% of total CPK (range 0% to 2.9%), and in normal subjects CPK-MB is absent. This highly significant difference (p less than 0.001) makes it possible to distinguish accurately between myocardial infarction and skeletal muscle lesions (trauma, hematoma, myositis, hypothyroidism). By its sensitivity (100%) and specificity (97%) this rapid and inexpensive method finds its optimal sphere of application in emergency wards and coronary care units.


[Course and therapy of malignant melanoma].

The 3-, 5- and 10-year survival rates in 353 well documented cases of malignant melanoma in stages I, II and III are discussed in relation to condition of the patient when the disease was diagnosed, methods of treatment and the histological classes of CLARK and MIHM. The different forms of therapy (X-ray followed by excision, excision followed by X-ray, X-ray alone, excision alone) produce similar recovery rates. Significant differences observable are due to variations in the patients' condition (differences in the malignancy index). Histological classification confirms the benign nature of lentigo maligna melanoma (LMM) and superficial spreading melanoma (SSM) in comparison with nodular melanoma (NM).


[Group psychotherapy in psychiatry].

Psychiatry has learned to regard the human being not only as an individual but as a social being. Accordingly, group psychotherapy has come increasingly to the fore in recent years and decades. In general the term "group psychotherapy" means simultaneous psychotherapy of a number of patients by one or two therapists. Sociological-interactional-horizontal and deep psychological-motivational-vertical components combine in the therapeutic group to produce a resultant. Insight into unconscious motivations and social learning are stimulated in the therapeutic group. Through group psychotherapy, which can be administered as a treatment method alone or in combination with other therapies, inpatients and outpatients experience a framework which activates former experiences of collective life situations, e.g. in the family, and social valencies. Irrespective of the method of group psychotherapy (activity group psychotherapy, directive-suggestive group psychotherapy, group analysis, psychodrame or one of the accelerating methods) the group should always be group- and not leader-centered. Hitherto published results of group psychotherapy show that the treatment depends much more on the therapeutic commitment of the therapist (moderator, facilitator) than on the psychotherapeutic school to which the belongs.


[Studies of potassium and sodium in ischemic changes of the human myocardium].

The results are presented of investigations concerning the potassium-sodium ratio in the human myocardium under ischaemia in correlation with macroreaction to dehydrogenases. The values found, though approaching those of the familiar experimental results, can hardly be regarded as reliable in diagnosing early ischaemic changes in autopsy material since they are affected by post-mortem changes.


[Findings in protracted cyanide poisoning].

The authors describe instances of 16-hour, 7- and 18-day survivals as well as one case of cured cyanide poisoning from the clinical and morphological points of view.


[Unusual fatal thoracic injury due to glass splinters].

The authors report on a case of unusual lethal penetrating puncture-incised thoracic wound in a male aged 33 following an incidental fall into the glass panel of a glass-panelled door. The glass splinters of the bre. The case as well as the pertinent literatury data and to the diagnostic problems pertaining to the determination of the injurious mechanism.


Abrupt fall in the fetal heart rate during labour.

Cardiotocograms of 6044 patients in labour were examined for evidence of an abrupt fall in the fetal heart 50 beats within 3 minutes, without a demonstration of signs of recovery in the following 2 minutes. Only 9 instances could be found -- an incidence of 0,15%. Umbilical cord entanglement possibly played a role in 6 of these instances, and 2 of the infants concerned were stillborn. Intra-uterine growth retardation was associated with deceleration in 3 infants, 1 of whom was stillborn.


False interpretation of fetal heart role monitoring in cases of intra-uterine death.

Spiral scalp electrodes were applied in 30 cases of diagnosed intra-uterine death during labour to establish different patterns caused by maternal fetal conduction of the ECG. In 10 cases the signal was of high quality and in 20 cases the signal was of low quality, but nevertheless spurious fetal heart rate recordings were produced. The maternal heart rate is interpreted as apparent "fetal bradycardia" in all cases but 1. Maternal heart rate accelerations, most of them occurring during uterine contractions, were demonstrated in 12 cases and decelerations in 3 cases. Changes in beat-to-beat variation were, however, rare.


[Influence of umbilical cord entanglement on fetal heart rate].

Umbilical cord entanglement was found in 34% of 555 women in labour. One loop of cord around the neck of the fetus was seen in 29% of the women and two or more loops in 5%. Cardiotocograms of these patients were examined for abnormal heart rate patterns. Cord involvement did not influence the incidence of basal bradycardia or tachycardia, early or late decelerations, loss of beat-to-beat variation or acceleration patterns. Variable decelerations, however, were seen in 23% of the patients with cord entanglement and in 7% without cord involvement. This difference is statistically significant (P less than 0.001). Subclassification of variable deceleration into different grades according to the amplitude of the deceleration, demonstrated the presence of cord involvement in 50% of the patients with moderate variable decelerations. This incidence rose to 65% when severe variable decelerations were demonstrated and to 75% when decelerations had increased during labour. Low Apgar scores at 1 and 5 minutes occurred 2 and 3 times more often, respectively, when cord involvement was present.


A comparison of the uterine beta2-adrenoreceptor selectivity of fenoterol, hexoprenaline, ritodrine and salbutamol.

A study was undertaken to compare the uterine beta2-adrenoreceptor selectivity of fenoterol, hexoprenaline, ritodrine and salbutamol. The drugs in doses having an equivalent effect on uterine activity, were randomly administered as an intravenous bolus to 10 patients who had been induced at term. The cardiovascular and uterine effects of the drugs were recorded. The rise in maternal pulse rate was significantly less (P less than 0,001) after the administration of hexoprenaline when it was compared with fenoterol, ritodrine, and salbutamol. Hexoprenaline proved to be the most chronotropically beta2-selective drug, having the least effect on the beta1-adrenoreceptors of the heart, for an equivalent effect on the uterus. Blood pressure changes were less significantly different between the drugs. The clinical use in obstetrics of a highly beta2-selective sympathomimetic drug is discussed.


The differential enlargement of the neurocranium in the full-term fetus.

There is a wide range of variation in the cephalic index in the full-term fetus. The index rises as birth weight increases. The correlation between birth weight and the cephalic index is significant (r = 0,65) at the 0,05 level. Increasing neurocranial size is associated with differential growth of the dimensions which determine endocranial capacity. A higher cephalic index is achieved by a disproportionately large increase in the biparietal diameter relative to the occipitofrontal dimension. This results in a more globular neurocranial form.


Delivery of Siamese twins by Caesarean section.

The diagnosis of a pair of Siamese twins and their delivery by Caesarean section are described. A major cardiac anomaly precluded surgical separation.


Effect of different pre-operative vaginal preparations on morbidity of patients undergoing abdominal hysterectomy.

Three methods of vaginal preparation carried out before abdominal hysterectomy are compared. The lowest post-operative morbidity was associated with the use of a povidone-iodine douche and gel during the pre-operative preparation of the patient.


Neonatal and maternal cranial form.

The mean cephalic index (CI) in the normally grown full-term neonate is in the lower eighties. Because intra-uterine growth retardation causes a greater proportionate reduction in the biparietal than in the occipitofrontal diameter, the resultant CI is significantly lower (P less than 0,01) than in neonates who have grown normally. There is no significant correlation between maternal and neonatal cranial form as judged by the CI. In man, hereditary factors operate in the long period of postnatal growth and differentiation.


Chronic granulomatous disease of childhood.

Two boys and one girl suffering from recurrent severe bacterial infections were investigated. All 3 exhibited normal cellular and humoral immunity, normal neutrophil phagocytic ability, and defective neutrophil bacterial capacity. The clinical features and laboratory findings in these patients are diagnostic of chronic granulomatous disease. A sex-linked inheritance pattern was confirmed in 1 patient by the demonstration of a heterozygous carrier state in the mother.


The diagnostic value of the tine and Mantoux tests in a general hospital.

Tine and Mantoux tuberculin tests were compared in 193 hospitalised White patients with a variety of illnesses. With the Mantoux test 52 (27%) were tuberculin-positive and 19 (9.8%) were positive with the tine test. Had the tine technique alone been used, 33 of 52 tuberculin reactors would have been missed. Additional findings were (i) a 73% positivity for Monilia antigen; (ii) the optimal time for reading the Mantoux tests was on the third, rather than the second day; (iii) tuberculin reactivity was not suppressed by either pyrexia or elevation of the sedimentation rate; and (iv) the use of avian PPD demonstrated very few reactors in this population. It is recommended that the tine test be replaced by the intradermal Mantoux test with stabilised freeze-dried PPD tuberculin supplied in test kits with diluent. This matter should be given high priorty in South African general hospital practice and population surveys.


Surgical treatment of gallstone ileus.

Seven cases of gallstone ileus are presented. It is suggested that the mechanism of intestinal obstruction is not by progressive enlargement of the stone. Recurrent gallstone ileus is reviewed. At the time of the primary operation for the relief of the intestinal obstruction, the gallbladder should be palpated, if possible. When stones are palpable they should be removed by a cholecystostomy to prevent early recurrence of gallstone ileus. The decision to do further immediate surgery on the biliary tree depends on the condition of the patient.


Some aspects of the hepatic metabolism of ethrane.

From our studies of the rat we report observations on three aspects of the interaction of ethrane and liver. 1. Interaction of ethrane with cytochrome P450 in vitro. 2. The effect of ethrane administration on glutathione levels in vivo. 3. The effects of repeated ethrane administration in the absence and presence of microsomal enzymic induction on liver morphology. We conclude that ethrane has little or no propensity for damaging the liver.


The value of the postoperative temperature chart as an aid to the diagnosis of deep vein thrombosis.

Forty consecutive patients with an abnormal postoperative pyrexia were investigated for deep vein thrombosis (DVT). All 80 lower limbs were examined by means of Parks 801 or 806 Doppler ultrasound apparatus. Doppler findings were confirmed by ascending peripheral venography or by the 125I-fibrinogen uptake method, or by both methods, in all cases. DVT was present in 9 limbs (11%). In 89% of the limbs DVT was excluded. An abnormal postoperative pyrexial response, as defined in this text, is thus a poor sign of DVT. It should, however, not be ignored, as it was indicative of venous thrombosis in 15% of the patients in this study. Confirmation of DVT should be obtained wherever possible by ascending peripheral venography, Doppler ultrasound, or some other available method. The use of anticoagulants should be restricted to those patients in whom the diagnosis has been confirmed.


South African underwater diving accidents, 1969-1976.

Since 1969 a survey of diving accidents involving South African amateur divers was undertaken. The South African Underwater Union diving accident report form was used, and various State agents (SA Police and inquest courts) and individual divers and club instructors were questioned. This survey covers the period up to the end of June 1976. Data acquired during the 8-year period 1969 - 1976 are compared. A conservative estimate from the number of certificates issued to club divers indicates a 25% increase in diver population, while the number of fatilities has decreased from 0,1% in 1971 to 0,016% in 1976, indicating the importance of accident reporting in determining safety trends. In general, a change in pattern is observed during the last 4 years, showing more SCUBA than breath-hold fatalities. The formation of the Decompression Sickness and Diving Accidents Investigation Panel as a further measure to decrease fatal diving accidents is discussed.


Foot pigmentation in Blacks.

Pigmentation of the soles of the feet was studied during postmortem examination of 70 Black patients. Forty-eight (57%) showed some pigmentation (grade II) of the soles of the feet and 4 (6%) showed definite black spots, i.e. focal areas of dense black pigmentation (grade III). A distinction between clinical grade II or grade III lesions could not be made on the basis of microscopic appearance. No true naeyi were seen. Increases of melanin pigmentation and minor degrees of melanocytic proliferation were all that was apparent. Although the development of malignant melanoma may be related to the presence of black spots on the feet of darkly pigmented races, all such spots are certainly not naevi.


A survey of ocular trauma.

A four-year survey of all ocular trauma cases admitted to a large metropolitan eye hospital was conducted for the purpose of generally documenting ocular trauma and evaluating prophylactic, demographic and etiologic factors. Of 6254 eye admissions, 7.5% were for ocular trauma; hyphema was the most common diagnosis. Injuries were evaluated according to site, cause, and age, sex and race distribution.


Aspirated foreign bodies in the tracheobronchial tree: report of 250 cases.

During the last 14 years, 250 patients with aspirated foreign bodies in the tracheobronchial tree were admitted to Kuwait Chest Diseases Hospital. Ninety-six per cent of the cases were under 10 years of age and 38% gave a clear history of foreign body inhalation. The rest were diagnosed either clinically, from the chest radiograph findings or because of unexplained pulmonary symptoms. In 247 cases, bronchoscopy under general anaesthesia was successful in removing the foreign bodies. In only three cases was bronchotomy needed. Seventy per cent of the foreign bodies were melon seeds. Asphyxia and cardiac arrest occurred in four cases during bronchoscopy but the patients were successfully resuscitated. In 10 cases a tracheostomy was done before bronchoscopy and the removal of the foreign body, while in five it was needed after bronchoscopy. Fifteen patients developed late complications such as recurrent pneumonia or atelectasis of the lung. Early diagnosis and adequate treatment are essential to prevent pulmonary and cardiac complications and to avoid radical lung surgery.


Bronchial carcinoma in patients with pre-existing unilateral lung disease.

Forty-six cases of primary bronchogenic carcinoma occurring in patients with other unilateral pleuropulmonary diseases were studied. In 37 cases (80-4%) carcinoma developed in the previously healthy lung. All but one squamous-cell carcinoma and all of five undifferentiated small-cell carcinomas developed in the previously healthy lung while 7 of 15 adenocarcinomas were in the lung with impaired ventilation. It is suggested that the bronchial epithelium of the healthy lung is more exposed to exogenous carcinogens than that of the diseased, underventilated lung, resulting in a higher risk of development of squamous-cell and undifferentiated small-cell carcinoma.


Refractory pneumothorax treated by parietal pleurolysis.

Pneumothorax, persisting in spite of efficient drainage, may in some cases be caused by discrepancy between lung volume and size of the pleural cavity. The logical treatment is reduction of the pleural cavity simultaneously with a traditional surgical procedure on the pulmonary tissue. An increasing number of refractory pneumothoraces--both spontaneous and istrogenic--is probably due to the fact that more people are living with and suffer the sequelae of pulmonary disease. During a 15-year survey a parietal pleurolysis, tailored to fit the size and shape of the lung, was performed in 10 patients as the main surgical procedure in 100 thoracotomies for 1130 cases of spontaneous and 62 cases of iatrogenic pneumothorax. The results were encouraging.


A manometric assessment of oesophagogastrostomy.

Intraluminal pressures were recorded in 14 patients who had undergone oesophagogastrectomy. Seven of these had a mid-thoracic and seven a high cervical oesophagogastrostomy. The incidence of postoperative reflux complications in each group was noted. No pressure gradient across the anastomosis was detected in any patient but the upper oesophageal sphincter was shown to be retained as a functioning unit in all cases. It is considered that the thoracic anastomosis provides no demonstrable barrier to reflux. In addition, a high cervical oesophagogastrostomy does not adversely affect the upper oesophageal sphincter. The wider application of this latter procedure may be associated with a decreased incidence of postoperative reflux complications.


Sarcoidosis of the upper respiratory tract and its association with lupus pernio.

In a series of 34 patients with sarcoidosis affecting the upper respiratory tract and nose, 26 had lupus pernio (LP) and 17 had sarcoidosis of the upper respiratory tract (SURT). In nine patients these features coexisted. A patient presenting with SURT carried a 50% risk of developing LP although one feature could be present without the other. Both were disorders of women of the child-bearing years of life. SURT, like LP, was an indicator of chronic fibrotic sarcoidosis, developing insidiously and progressing indolently over the years. It was complicated by ulceration, septal perforation, and LP. Three patients had nasal septal perforations, in two instances following submucous resection. This operation is contraindicated in patients with active sarcoidosis, particularly when granulomas are found on nasal biopsy. The Kveim-Siltzbach skin test was positive in all patients with SURT, making it invaluable in the differential diagnosis of granuloma of the nasal cavity.


Respiratory mechanics in airways obstruction associated with inspiratory dyspnoea.

Inspiratory muscle strength and the flow and elastic pressure opposing inspiration were measured in seven patients with severe airways obstruction who found inspiration difficult at rest. A comparison was made of measurements obtained from seven normal subjects and five patients with airways obstruction not experiencing inspiratory dyspnoea at rest. Measurements were also obtained when inspiratory dyspnoea was induced in the normal subjects by adding an inspiratory resistance or by voluntarily increasing lung volume. Compared with the controls the inspiratory muscle strength of the patients was reduced but was not significantly less than that of the patients without inspiratory dyspnoea. The pressure required to produce inspiratory flow was significantly greater when inspiratory dyspnoea was present (P = 0-01). However, there was considerable overlap in the pressures of those with and without inspiratory dyspnoea. A better relationship was obtained when muscle strength was considered. The ratio of inspiratory muscle strength to the pressure required to produce flow was 0-24 +/- 0-07 (mean +/- SD) in patient with inspiratory dyspnoea, 0-10 +/- 0-03 in patients without inspiratory dyspnoea, and 0-033 +/- 0-019 in normal subjects. There was no overlap between the two patient groups. The ratios of the normal subjects were increased when inspiratory dyspnoea was induced and, with the exception of two cases, were all above those obtained when inspiratory dyspnoea was absent. Inspiratory dyspnoea was experienced with lower ratios in the normals than in the patients with airways obstruction.


Particle deposition in the trachea: in vivo and in hollow casts.

The pattern of deposition within the respiratory tract of potentially harmful particulates is a major factor in assessing any risk from individual and community exposures. Although the trachea is the most easily observed of the conductive airways, very little information concerning its particle collection characteristics is available, information which is essential for a complete and realistic description of particle deposition patterns within the entire respiratory tract. Data on tracheal deposition are also needed for development of accurate predictive models for particle deposition. The pattern of particle deposition in the trachea, and its relation to air flow, was studied in a hollow cast of the human larynx-tracheobronchial tree. Results were compared with data obtained in humans in vivo and from previous studies in hollow casts. In addition, the relevance of tracheal deposition in the hollow cast test system to deposition in vivo was examined by a direct comparison of deposition in a cast prepared from the lungs of donkeys previously studied in a series of in vivo tests. The disturbance of the air flow within the trachea caused by the larynx promoted the deposition of suspended particulates throughout the length of the trachea, and especially in proximal regions. This proximal deposition was due both to direct impaction from the air jet coming from the glottis and to effects of the tubulent flow. Turbulence produced inhomogenous deposition patterns within the trachea for particles of all sizes, although its effect was more pronounced as size decreased. Tracheal deposition in the human cast was within the range of normal in vivo tracheal depostion only when a larynx was used during cast test exposures; this emphasizes the need for the use of realistic experimental test systems for the study of particle deposition patterns. The relative patterns of deposition in casts of the donkey trachea and in the same tracheas in vivo were similar.


Pattern of total and regional lung function in subjects with bronchoconstriction induced by 15-me PGF2 alpha.

Closing volume (single breath nitrogen test), regional ventilation and perfusion (using intravenous xenon-133), and total lung function (TLC, VC, and FEV) were measured before and after intramuscular administration of 250 mug 15-methyl prostaglandin F2alpha (15-me PGF2alpha) in 10 healthy women. The cardiac output was measured with the Minnesota impedance cardiograph model 304A and the transthoracic impedance was used as an expression of the thoracic fluid volume. The slope of the alveolar plateau on the closing volume tracing showed a 271% increase 20 minutes after the prostaglandin administration, at which time the closing volume per cent (CV%) had decreased (P less than 0-01) and the closing capacity (CC%) had increased (P less than 0-05). Vital capacity (VC) decreased (P less than 0-01), residual volume (RV) increased (P less than 0-01), and the total lung capacity (TLC) remained unchanged. The maximal decrease (9%) in FEV1 was seen after 20 minutes. All these measurements except the slope of the alveolar plateau returned to control levels after 60 minutes. The redistribution of regional ventilation was more pronounced than that of the regional pulmonary blood flow. No change was observed in cardiac output and transthoracic impedance. None of the patients experienced any dyspnoea. Our results are consistent with a more pronounced effect of prostaglandin F2alpha on the small airways (the alveolar plateau) than on the larger airways (FEV1). In cases where an increase in the slope of the alveolar plateau is observed, the closing volume per cent should not be used as a measurement of the lung disease. It is concluded that the single breath nitrogen test (N2 closing volume) is more sensitive than the conventional tests.


Aspects of serum and sputum antibody in chronic airways obstruction.

Immunoglobulin levels and precipitating antibody against a range of microbial antigens were measured in simultaneously collected serum and sputum samples from patients with chronic bronchitis (11), cystic fibrosis (9), bronchiectasis (9), and asthma (4). Sputum was prepared by dialysis and high-speed centrifugation methods. Results showed that it was possible to detect precipitating antibody in the sputum, and the rate was increased when both methods were used. A discrepancy was noted between the detection rate in the sputum and serum. This, combined with the lack of correlation between sputum and serum immunoglobulins, lack of relationship between bronchial inflammation and sputum immunoglobulins, and the lack of IgM in the sputum suggested that the antibody and immunoglobulin were locally produced. Sputum IgA (7S) in patients with chronic bronchitis was significantly lower (P less than 0-05) than that found in patients with cystic fibrosis and bronchiectasis. Significant differences (P less than 0-05) were also noted in serum IgG levels between patients with chronic bronchitis, bronchiectasis, and cystic fibrosis while serum IgM levels in patients with chronic bronchitis were significantly lower (P less than 0-05) when compared to serum levels in patients with cystic fibrosis. The presence of precipitating antibody in the sputum raises the possibility that type III reactions may be important in the pathogenesis of these conditions.


Degradation of porstaglandin F2alpha in the human pulmonary circulation.

Degradation of prostaglandins (PGs) during passage through the human pulmonary circulation was investigated by measuring the transpulmonary plasma PGF2 alpha difference during continuous intravenous infusion of PGF2 alpha (5-10 mug/min). Seven patients with cardiological disorders and two patients with extensive pulmonary abnormalities were investigated during diagnostic cardiac catheterization. PGF2 alpha levels were measured by radioimmunoassay. The seven cardiac patients were found to have transpulmonary PGF2 alpha differences of 47-88%, indicating metabolism of the PG in the lungs. A patient with extensive bronchiectasis had an apparently normal transpulmonary PGF2alpha difference despite gross abnormalities in routine lung function tests. A patient with primary pulmonary arterial hypertension showed no metabolism of PGF2alpha in the pulmonary circulation. The results show that PG degradation is an aspect of normal lung function and suggest that it becomes imparied when extensive pulmonary vascular damage exists.


Histamine levels in plasma, blood, and urine in severe asthma, and the effect of corticosteroid treatment.

Plasma, whole blood, and urinary histamine levels have been determined in 64 normal subjects, in 10 patients with severe asthma, and in 10 control patients with other illnesses. The mean whole blood levels did not differ between the three groups. The mean plasma level in the asthmatics was significantly greater than that of the normal subjects but not of the control patients. The urinary histamine output was lower in the control patients than in the normal subjects but in the asthmatics did not differ from that of the normals. Corticosteroid therapy caused a marked fall, often to barely detectable levels, of the whole blood histamine concentration of the asthmatic patients and restored the plasma levels to normal but did not affect urinary histamine levels.


Transitory cerebral microvascular blockade after cardiopulmonary bypass.

Dogs were submitted to cardiopulmonary bypass (CPB) carried out under conditions calculated to generate large numbers of microbubbles and microemboli. On the day following the procedure the dogs showed evidence of neurological damage including impaired consciousness and ataxia. These abnormalities largely cleared within a week. When the animals were sacrificed at intervals after the procedure, the cerebral microvasculature was demonstrated by injecting a suspension a lamp black into the carotid artery. This revealed that multiple filling defects were present in the microcirculation of the brain immmediately after CPB and for two days thereafter. However, by seven days the microvascular blockade had disappeared, and the vascular blockade had disappeared, and the vascular pattern of the brain had returned to normal. Neuropathological findings were sparse and restricted to the cerebellum. This study suggests that the transient neurological syndromes that sometimes follow cardiopulmonary bypass for heart surgery may be due to a transient microvascular blockade, perhaps by microbubbles and microparticles.


Surface ultrastructure of silicone rubber aortic valve poppetts after long-term implantation. A scanning electron microscope study of four poppets.

The surface ultrastructure, demonstrated by scanning electron microscopy, is described in four implanted Silastic aortic valve poppets. Ball variance was discovered at necropsy in two patients and clinically in one in whom the poppet was replaced. The fourth patient underwent reoperation, but ball variance was neither suspected nor found. All four poppets were densely coated with biological debris and microthrombi. The 'coat' was soluble in a weak solution of sodium hydroxide. The true Silastic surface beneath the coat was little altered compared with unimplanted poppets, even after 10 years' implantation.


Degenerative changes in aortic root allografts placed in the right ventricular outflow tract of growing puppies.

Differently prepared aortic root allografts were implanted in the right ventricular outflow tract of growing puppies to determine the site of origin and progress of degenerative changes in these conduits. The three preparations assessed were as follows: group A, fresh and sterile grafts; group B, antibiotic sterilized grafts in nutrient medium; and group C, beta-propiolactone sterilized grafts. Although calcification of the aortic wall occurred in all groups, the aortic leaflets were minimally affected. A correlation between viability and lack of calcification and between viability and long-term function is emphasized.


Symptomatic mitral myxomatous transformation in the elderly.

The clinical and pathological features of four patients with intractable heart failure, due to myxomatous change in the mitral valve, are described. It is suggested that this change may represent a response of ageing connective tissue to mechanical stress.


Fragile lung in the Marfan syndrome.

Two cases of the Marfan syndrome presented with spontaneous pneumothorax. Both had chest radiographs showing bilateral bullae in the upper lung zones and pulmonary function tests consistent with mild emphysema. There were dereases in forced expiratory flow rates at low lung volumes, carbon monoxide transfer factor, and lung elastic recoil. It is suggested that pneumothorax and bullous emphysema in this syndrome are caused by a weakness in the pulmonary connective tissue framework.


Pulmonary blastoma: a report of two cases and a review of the literature.

Pulmonary blastoma is the rarest malignant tumour of the lung. Two more cases are reported and the literature is reviewed. The first case, a woman, is the longest recorded survivor. An examination of all the reported cases shows that the tumour is less common and less agressive in women.


A large intrathoracic parathyroid adenoma.

A case is described in which an unusually large parathyroid adenoma was visible on the plain chest radiograph taken during the investigation of hypercalcaemia. This was diagnosed preoperatively and a scheme is suggested whereby such a disgnosis can now readily be made. The differential diagnosis is discussed ant the literature is reviewed.


Necrosis of a pulmonary lobe in a dog.

A six-year old female pug had very severe dysponea. A radiographic opacity was observed in the right cranial area of the thorax. After thoracotomy, the cranial lobe of the lung was removed. Microscopic examination revealed necrosis of the lung and vacular thrombosis. The possibility of a torsion of the affected lobe is discussed.


The relation between sperm quality and the effect of ouabain on the motility of spermatozoa.

This paper reports the results of an investigation into the effect of ouabain on spermatozoa which have suffered from aging, sudden changes in temperature and deep-freezing. Normal spermatozoa of different boars under standard conditions show an evident variation in ouabain sensitivity. A definite relation could be established between the fertility of the semen of a boar and the ouabain sensitivity of this semen. Spermatozoa exposed to aging, sudden temperature changes or deep-freezing, showed a greater sensitivity for 10(-3)M ouabain than corresponding controls. We concluded that factors which are harmful to membrane quality of spermatozoa can be revealed by exposing them to ouabain.


Use of the lysozyme test in the diagnosis of kerato-conjuctivitis sicca in dogs and cats.

Comparative studies of the lysozyme test (LT) and the Schirmer tear test (STT) revealed that the LT was not reliable in the diagnosis of kerato-conjunctivitis sicca (KCS) in dogs and cats. This is in contrast to its successful use in human patients. No M. lysodeikticus lysating substrates were detectable in the tear fluid of the normal cat.


The effect of storage at 4 degrees C on antibiotic residues in kidney and meat tissues of dairy cows.

A method is described for the quantitative assay of antibiotic residues in the body of slaughtered farm animals by means of 3 types of agar media and 3 test organisms. With the help of programmed calculation procedures, data from large-scale tests for antibiotic residues could be analyzed accurately and rapidly. The concentrations of penicillin G, ampicillin, amoxycillin, cloxacillin, cephapirin, cephacetrile, neomycin, kanamycin, and oxytetracycline in the kidney, and also of tylosin in meat from the diaphragm muscle of cattle treated parenterally with these antibiotics were measured periodically in samples kept at 4 degrees C for up to 7 days after slaughter. The concentrations of penicillin G, ampicillin, amoxycillin and the cephalosporins in the kidney decreased rapidly upon storage whereas the levels of the other antibiotics remained essentially unchanged. Antibiotic stability in the meat was considerably greater than in the kidney upon storage for 4 days, and neomycin meat tissue levels were not reduced during storage for up to 144 hours. Results are discussed in relation to the conduct of the official qualitative Sarcina lutea Kidney Test and the most desirable procedure for preparing meat samples for assay.


Some steroids in the blood of mares suffering from endometritis and post-partum mares as compared to normal cycling mares.

It appeared that in mares suffering from endometritis the concentrations of pregnenolone, of the compound "5.4", and of progesterone in the blood during the first 2 days of the heat period were significantly higher than in normal cycling mares, in which the concentrations of all steroids were less than or equal to 1 ng/ml. In five endometritis mares the "5.4" and progesterone concentrations decreased after the first days of the heat period, and at about two days before ovulation the values were comparable to those of normal cycling mares. Eight mares suffering from a severe endometritis did not ovulate, their oestrous period was prolonged, and the follicles became atretic. Possibly the relatively high progesterone content found in these mares, caused the reduction of the follicular growth, and this might explain the prolonged oestrous period which is observed in many mares suffering from endometritis. Often we observed in post-partum mares the same changes in concentration as in endometritis mares. An elevated level of these steroids was sometimes found in the blood a few days after foaling and, in four of eight post-partum mares, during the foal heat. Most probably this was caused by infection or stimulation of the uterus. The hypothesis is advanced that progesterone originating in the uterus can influence ovarian activity and that it may be one of the factors responsible for the anoestrous periods which can occur in mares with endometritis and in post-partum mares.


[Destruction of Salmonella in fresh and deepfrozen broiler chickens by gamma irradiation (author's transl)].

Salmonella organisms present on poultry carcases after processing, were almost totally destroyed by gamma irradiation using a dose of 250 krads. This was the case with carcases irradiated in the fresh as well as with those irradiated in the deepfrozen state.


[Results obtained after synchronisation of oestrus by prostaglandins in dairy cows (author's transl)].

Twenty-five mg. of PGF2 alpha were injected in forty-three lactating cows and eighteen young heifers at ten-day intervals to produce synchronisation of oestrus. Only twenty-four lactating cows (58 per cent) and fifteen young heifers (83 per cent) came on oestrus with two, three or four days after the second injection of prostaglandin. Within eighty hours after the second injection, all animals were inseminated with semen of good quality. This resulted in pregnancy in eight (19 per cent) dairy cows and ten (56 per cent) young heifers. Rectal examination at the time of the second injection revealed a number of changes in the lactating cows. There was undue follicular activity, follicular cysts were observed in several cases and a corpus luteum measuring more than 15 mm. in diameter was not present in 25 per cent of the animals. In addition, twenty-seven cows were synchronised by injection of 0.5 mg. of Estrumate (a synthetic prostaglandin analogue) during the puerperium. Injections were made twenty and thirty days post partum. Eighteen cows (67 per cent) came on oestrus within two, three or four days after the second injection. Insemination which was carried out during oestrus, resulted in pregnancy in five cows. Rectal examination did not reveal any abnormalities in these animals.


[Rotavirus infection in calves (author's transl)].

Several laboratory workers have demonstrated a viral agent, suspected of playing an important role in the aetiology of calf diarrhoea during the first weeks of life. Based on its morphology this agent was designated a Reo-like virus. Later the name Rotavirus was introduced. Rotaviruses were proved experimentally to induce diarrhoea in calves. Usually the course of the disease after similar experimental infection is mild, but could become worse with secondary bacterial infections. The available information on the virus itself, the clinical aspects of the infection, its pathogenesis, diagnosis, epidemiology and prevention are reviewed.