The microsurgical treatment of labyrinthine vertigo.

In summary, (1) the fact that VNS spares auditory function makes it preferable to labyrinthectomy. A comparison of VNS and the "Conservative" operations on the inner ear shows that they have much the same effect on hearing. VNS by controlling vertigo may also provide an additional benefit by eliminating one of the stress factors concerned in the perpetuation of hydrops. (2) In the treatment of vertigo, VNS is now the most effective method of treatment. Because the elimination of vertigo is what chiefly concerns most of our patients, we suggest that when medical treatment and surgical decompression of the saccus endolymphaticus fail to control vertigo, then VNS is the surgical method of choice.


[Phonetically balanced lists for children from six to 10 years].

Two French-Canadian phonetically balanced lists, for children from six to 10 years, have been tried experimentally on a population of 100 children. The results indicate that they are equivalent to the French lists and can be used for speech discrimination testing.


Cochlear and vestibular dysfunction resulting from physical exertion or environmental pressure changes.

Inner ear damage due to physical exertion or environmental pressure changes has been described only recently. According to Goodhill there are two possible mechanisms of injury: the explosive and the implosive. The former is triggered by increased C.S.F. pressure transmitted to the perilymph space; the latter by increased pressure in the middle ear transmitted to the perilymph space through the two windows. Sudden hearing loss or dizziness, or both, are the main symptoms. The diagnosis will be established by the history, the audiogram, and the electronystagmogram (ENG). The treatment is still controversial. As the formation of a fistula is a real possibility, an exploratory tympanotomy is suggestive on suspected cases. Due to the variety of symptoms every case has to be assessed individually. A detailed history is of utmost importance.


Electrophysiologic assessment of the lower portion of the auditory pathway in the human subject. A preliminary report on auditory evoked eighth nerve and brain stem potentials including their relation to the electrocochleogram.

The electrophysiologic approaches to the assessment of electrical activity of the various portions of the human auditory pathway are reviewed. A method of detection of click evoked eighth nerve and brain stem responses with the use of surface electrodes is described. Preliminary observations in the normal subject with different stimulus parameters and in patients with unilateral deafness are presented. Simultaneous recordings of the eighth nerve and brain stem responses with the cortical evoked response and with the extratympanic electrocochleogram are described. The technique of click evoked eighth nerve and brain stem potentials offers us an additional method of objective assessment of auditory function in a human subject.


The use of electro-acoustic impedance measurements in detecting early clinical otosclerosis.

The first evidence that sodium fluoride (NaFl) can stop the otosclerotic process was recently presented. This development has placed new emphasis on the early detection of clinical otosclerosis. Electro-acoustic impedance measurements often detect minute changes in absolute impedance and compliance of the ossicular chain. The most valuable diagnostic information, however, is a negative on-off (biphasic) type of acoustic reflex. These results are often evident prior to the detection of positive clinical signs of otosclerosis. The negative on-off acoustic reflex is reviewed in this paper along with case discussions involving medical/surgical management of early otosclerosis.


Osteogenesis imperfecta of the stapes: an histological study.

Two cases of Van der Hoeve's Syndrome are presented with histological findings consistent with the diagnosis of osteogenesis imperfecta. These findings support the view that otosclerosis can be clearly differentiated histologically from osteogenesis imperfecta. Pre-operative impedance studies are recommended on each patient with osteogenesis imperfecta as a useful diagnostic adjunct to determine whether the conductive component in the hearing loss is secondary to stapedial crural deformity and/or footplate fixation.


Meningitis following stapedectomy: its occurrence in the immediate postoperative period.

Meningitis following stapedectomy occurring in the immediate postoperative period has not been previously described. This case report documents a case of diplococcus pneumoniae meningitis occurring within 36 hours following surgery with survival of the patient.


Cochleo-vestibular manifestations of jugular foramen pathologies.

Patients presenting pathologies of the jugular foramen are presented, for whom the main symptoms are of cochleo-vestibular nature. A classification of the various pathologies is attempted, the anatomy reviewed and hypotheses capable of producing the symptom elaborated.


Click evoked eighth nerve and brain stem responses (electrocochleogram)--experimental observations in the cat.

The origin of waves two to five occurring in the first 10 milliseconds after repetitive click stimuli is not definitely established. Published studies have suggested that waves two and three are derived from the cochlear nucleus and superior olivary complex respectively and that waves four and five are generated by the inferior colliculus. Our studies of the effect of chronic brain stem lesions in the cat do not support this hypothesis of specific localization, but reveal that a more general reduction in amplitude, and at times prolongation in latency, occurs with lesions in the pons and lower midbrain and that wave one amplitude is also diminished with brain stem lesions.


The extrathoracic airways.

Evidence is presented in support of the view that the extrathoracic airways are more than an anatomical pathway, and that they play an important and dynamic role in respiratory upper and lower respiratory tracts are cited. The importance of rhinomanometry to functional nasal surgery is recognized and it is advocated that tests of extrathoracic airway function be further developed and standardized and that they be taken into consideration together with pulmonary tests function. Examples of pathophysiological relationships between the in the assessment of respiratory function.


An acrylic dental protector in peroral endoscopy.

A simple acrylic dental prosthesis is described which achieves successful dental protection during peroral endoscopy. This prosthesis is not advocated for all cases, but certainly is well warranted for those patients whose upper dentition is at risk during endoscopy because of the prominence of the incisors, the presence of loose teeth, or with extensive restorative work. In present experience, approximately 10 per cent of patients undergoing endoscopy have such an acrylic prosthesis prepared pre-operatively. The commercially available flexible plastic dental guard is used in approximately 25 per cent of cases, and the remaining cases need no specific attention. It is felt that this prosthesis could be constructed by any dentist conversant with the technique.


[Substitution of venous valves in animal experiments].

60 to 70 per cent of properly transplanted autologous venous grafts with intact valves maintain the functional capability of their valves. The procedure might be of clinical importance in the treatment of the postthrombotic syndrome.


[Assisted circulation. The effect of cardio-synchronous peripheral arterio-arterial counterpulsation on perfusion and metabolism in the area of acute transmural myocardial ischemia].

After establishing a model of ischemia, perfusion in the ischemic area was considerably disturbed. Examination by means of 133xenon-clearance after intramyocardiac injection showed strongly delayed flowing-off compared with controls. Counterpulsation accelerates the flowing-off (perfusion). Untreated control animals reveal after inducing the model ischemia a crucial decrease of ATP concentration and an excessive increase of lactate concentration in the ischemic area. Counterpulsation may inhibit further decrease of ATP in the ischemic area.


[The importance of drainage and the postoperative interval in truncal vagotomy for the prevention of stress ulcers in rats].

The effectiveness of truncal vagotomy to prevent stress ulcers was examined in rats. Truncal vagotomy protects safely from stress ulcer caused by immobilization. This protection continues for a longer postoperative period. After vagotomy, even repeated immobilizations cause no ulcer. There are no different results after truncal vagotomy with or without drainage operation.


[Blood clotting and thrombocyte function in reversible hemorrhagic shock].

In experiments on 12 mongrel dogs, serving as models of reversible hemorrhagic shock, the influence on blood clotting and thrombocyte function was studied. Initial hypercoagulability, observed already after introduction of anesthesia, and multiplying of pathological aggregation stages dissociated from decreased number of thrombocytes suggest a considerable influence of the proceeding of reversible hemorrhagic shock on the clotting system. It is concluded that the initial hypercoagulability is not causally related to the changes of platelet function, which represent a starting mechanism for the arising of consumptive reaction in protracted and irreversible shock.


[Pyruvate and alpha-ketoglutarate levels in the after parenteral fat emulsion (Lipofundin) administration].

In various kinds of tests the metabolites pyruvate, lactate, and alpha-ketoglutarate were estimated after a single application of Lipofundin, resp. sorbitol solution. Within 24 hours after infusion significant changes of concentration occurred. The results are discussed. It is emphasized that Lipofundin caused no additional metabolic alterations compared with sorbitol, thus the concentration changes of pyruvate, lactate, and alpha-ketoglutarate after Lipofundin probably being caused by its content of sorbitol. Accordingly, parenteral application of fat during the immediate postoperative period is not necessary. After this period it is indicated in order to meet requirements of essential fatty acids and of energy.


[Liver-damaging action of halothane--an animal experiment study].

After long-term exhibition to halothane (up to 96 hours), centrolobular hepatic damage (fatty degeneration, necrobiosis and necrosis) developed in rats, proportionally to the number of anesthesias and shortening of the intervals. From these results no hepatotoxic effect of halothane can be derived, since the alterations might be caused by hypoxia alone.


[Vibrational and coupling characteristics of psychophysiological function rhythms in patients with Fallot's tetralogy before and after correction of the cause].

In 24 patients (aged from 5 to 21 years) afflicted with the tetralogy of Fallot and in 11 healthy subjects of the same age, the authors studied, using correlation and spectrum analysis, the coupling and the vibrational behaviour of modulated oscillations (in a rhythm of ca. 1 min.) of some psychophysiologic functions (heart and respiratory rates, blood pressure, sensomotor reaction times, short-time memory for ten-digit numbers) as expression of the central nervous coordination. The examinations were performed when the individuals were in the lying position, in the erect position and again at rest, during 10--30 min. In the subjects afflicted with the tetralogy of Fallot, the degree of synchronization or coupling (35%) was significantly lower than in the control subjects (65%). The decrease in the degree of coupling under orthostatic load was significant (P = 0.05) only in in the patients. One year after causal correction, the degree of coupling was normal (63%). From more than 400 autocorrelation functions and performance spectra (calculated to verify frequency and performance) it was deduced that the mean cycle of oscillation of the 1-minute rhythm was significantly shorter in the pre-operative state than in the postoperative state and in the control subjects. A change from the lying to the erect position manifested itself by a non-significant tendency towards period extension. The frequency deviations occurring in case of cyanotic vitium are discussed as an expression of the overall frequency behaviour of the oscillations which are continuously generated in coupled metabolic multienzyme systems, e. g., in case of anaerobic energy generation.


[Beta-propiolactone for cold sterilization of heart valve transplants].

Biologic cardiac valve substitutes were sterilized at room temperature using beta-propiolactone with a 0.5 vol.% solution within 120 minutes, with a 1.0 vol.% solution within 90 minutes, and with a 1.5 resp. 2.0 vol.% solution within 60 minutes. The physico-chemic properties of the graft can be influenced by appropriately chosen concentration and sterilizing period. Enlarged procedures for decontamination are not necessary because of the rapid dissolution of aqueous beta-propiolactone solutions.


[Dye-marking and hydrogen clearance in demonstrating acute ischemic myocardial areas].

After acute myocardial infarction (produced by ligation in the dog), the authors marked the borders of infarction with disulphine blue or methylene blue and determined, by means of hydrogen clearance, the blood supply in the centre and at the margin of infarction as well as at different distances from the latter. At the margin of infarction, the value for blood flow amounted to almost 17% of the value measured prior to ligation. Only at a distance of 1 cm. from the visible margin of infarction, 50 to 80% of the initial value were obtained. The extension of the area of infarction beyond the marked visible margin must be considered in surgical interventions.


[An experimental model of electrically-induced coronary thrombosis in the closed chest].

The authors report on an experimental model of coronary thrombosis, electrically induced in the closed thorax. By this technique they succeeded inducing coronary thrombosis with myocardial infarction in 13 cases out of 21. In three cases just disseminated myocardial necrosis was proved. All of the other animals showed vast myocardial infarctions. Coronarography, arterial pressures, typical shifts of serum enzymes, decrease of thrombocytes and fibrinogen and elevation of spontaneous fibrinolysis during the first hours proved to be valuable for the confirmation of successful inducing of thrombosis; in individual cases, however, these estimations yield no absolute certainty.


The effect of laser irradiation on the regeneration of muscle fibers (preliminary report).

The authors studied the process of muscular regeneration on experimental models after simple muscle injury and under the effect of low-energy laser-irradiation. It is stated that the stimulating effect not only accelerated the wound healing, but most likely influenced also the qualitative improvement of regeneration.


[A model of thromboembolism in the femoral artery of the dog].

A method for inducing peripheric white thrombosis in the dog is described. Thrombogenesis was initiated by continuous current 10 mA for 15 minutes. In each case the intravascular electrode was inserted in the femoral artery, the intima lying close to the electrode. Electromagnetic flow measurements and angiography proved the thrombosis.


[Experimental and clinical results of autotransplantation of part of the spleen].

Eleven patients with traumatic rupture of the spleen were subjected to splenectomy and autotransplantation of part of the spleen. The technique of the operation is described: 5--20% of the spleen is incised into transversal slices of 2--3 mm of thickness which are placed along the periphery of omentum majus, they are enveloped in it and are studied. The number of the applied transplants is 3--6. By means of hematological tests the authors prove that the transplants have functions close to those of the spleen. The clinical and laboratory investigations have revealed that in 9 of the patients operated no symptoms of asplenia were present, whereas in another two patients signs of hyposplenism were detected. Immune studies have demonstrated that no autoimmune reactions have followed autotransplantation of part of the spleen. The indications for the operation are mentioned: traumatic rupture of the spleen, benign tumours and cysts of the spleen with splenic parenchyme being preserved. Contraindications for autotransplantation of part of the spleen are all cases with the syndrome of hypersplenism and systemic blood disorders--lymphogranulomatosis, leucemia, reticuloses and others.


[Plastic closure of a bladder wall defect by use of a pedicled auto-alloplastic prosthesis in experiments].

The problems of substituting larger areas of the bladder wall are not definitely solved. Experiments on implantation of auto-allografts resulted in complications, which prevented correct epithelization of the interior surface, due to ischemia. In successful experiments on 34 rabbits, the authors obtained sufficient blood supply of the implantate and re-epithelization of the graft's interior surface in a two-stage operation.


[The basis of tumor verification using thermography].

The gradient between interior body temperature and external temperature was gradually measured in young pigs, since their skin resembles the properties of human skin. The interior temperature appeared to extend to 2.5 cm under the surface of skin. Then it drops, at first slowly and from 1 cm under the surface rapidly. Tumors or inflammations can only warm the skin directly when their site is 1 cm or less under the skin. Tumors which lie deeper may warm the skin via reflex zones. Warming by heat conduction is prevented by convection. Heating plates inserted 1.8 cm and 2 cm under the skin surface and heated 5 degrees beyond surrounding temperature do not warm the skin surface. This can be demonstrated by thermography. The importance of these results for thermographic tumor diagnosis is discussed.


Peripheral and gastric fibrinolysis in patients with gastric carcinoma.

The fibrinolytic system was studied in blood-samples from gastric and peripheral veins of patients with gastric carcinoma. There was a slight decrease in plasma-euglobulin fibrinolytic activity, a rise of plasma-fibrinogen level and antithrombin VI activity, and a decrease in antiplasmin activity. The changes observed are more marked in blood-samples from gastric veins. Some therapeutical implications and the role of fibrinolytic agents in malignant diseases are briefly discussed.


[Research based on clinical observations].

The author tries to define the field of "Clinical observations research". According to this definition there are three main causes for several false developments in medicine: the valuation of observations and statements on the level of hypothesis, the identification of statistical correlations with causal connections, and the stopping of investigations on the level of twodimensional analysis. To get a high level of probability of results in "Clinical observations research" it is necessary to use methods of multivariante analysis, as it is demonstrated in three examples from the field of general surgery and traumatology.


Effects of arterial or portal ischemia on survival and metabolism of partially and totally depancreatized dogs.

The role of arterial blood flow in hepatic metabolic functions was compared to that of portal flow in two groups of totally depancreatized dogs. Survival times and glucose and nitrogen excretion were significantly greater in dogs with ligation of the hepatic artery than in dogs with an Eck fistula. The dogs with ligated hepatic arteries also showed a significantly slower rise in plasma ketones. The course of diabetes was compared in three additional groups of partially depancreatized dogs consisting of a) dogs with ligated hepatic arteries, b) dogs with Eck fistulas, and c) controls. Hepatic arterial ischemia: 1) increased survival, without insulin treatment (a--650, b--167, c--124 days) 2) did not decrease tracer-determined rate of glucose production 3) led to a greater urinary excretion of glucose, ketone bodies and nitrogen than portal ischemia. Partially depancreatized dogs with either arterial or portal hepatic ischemia maintained a high rate of glucose disappearance on acute deprivation of endogenous insulin (clamping of vessels of their pancreatic remnant) due probably to decreased insulin degradation by the ischemic liver. The dogs died in coma after losing all fat depots. There was severe fatty change in the livers of dogs with hepatic artery ligation, slight in those with Eck fistulas and no fat in the livers of controls.


[Dose-response relationship of repeated injections of pentagastrin on the vagally innervated rat stomach in perfusion experiments].

In the perfusion model under urethane anesthesia Wistar rats were two times injected pentagastrin subcutaneously in a distance of 150 minutes in dose rates of 50, 100, 150, 200, 250 and 300 microgram/kg b. w. The results may be summarized as follows: 1. The dose of 200 microgram/kg b. w. of pentagastrin produced the maximal answer. Higher doses showed a diminished acid secretion. 2. The diminished effect of higher doses of gastrin may be caused by a hypothetical inhibitor which may be more effective after truncal vagotomy. 3. The repeated injection of pentagastrin did not show a significant difference of the answer. The second injection was given after the acid secretion has returned to the basal level. No tachyphylaxy was seen under these conditions.


[Mechanical testing of hardness, tensile strength and ultimate elongation of prosthetic materials of plastic and elastic].

Mechanical examinations of endothesis materials were carried out aside from microscopic, physical, and chemical trials in a program of testing the biostability of such materials. The results are reported, and the changes of their using value by the course of time are discussed.


[Modification of cortisol-induced wound healing disorder by vitamin A].

Wound healing under application of cortisol and treatment with vitamin A was investigated in experiments on rats. Cortisol worsens the wound healing significantly, whereas it is improved by vitamin A, and even becomes normal in cortisol treated animals. The authors explain this effect by an antagonistic influence of cortisol and vitamin A on inflammation and by this on the amount of collagen. This opinion is supported by increased alpha-1 and alpha-2 globulin and decreased albumin levels in serum under vitamin A treatment, as well as by strongly decreased leucocyte count under cortisol treatment.


Activity of catecholamines inactivating enzymes in heart muscle during anoxic cardioplegia in cardiosurgical patients.

On the model of anoxic cardioplegia in cardiosurgical patients the influence of anoxia on the activity of monoamine oxidase (MAO) and catechol-O-methyltransferase (COMPT) in right auricular tissue was studied. It was found out that the activity of COMT does not change during anoxia, the activity of MAO considerably increases. With regard to catecholamines stimulating effect upon cardiac metabolism as well as to their calorigenic and oxygen wasting effect the raise of MAO activity may be regarded as favourable phenomenon, because the hastened degradation of released catecholamines at least to a certain degree diminishes the disproportion between oxygen supply and actual oxygen need of the heart and by means of that mitigates the anoxic damage of myocardium.


Some methodological problems in age comparisons of EEG sleep patterns for C57BL/6J mice.

Some methodological problems encountered in age comparisons of EEG patterns are discussed in the context of an analysis of open field activity scores before and after preparation for, and recording of EEG sleep patterns. Plasma corticosterone levels 11 days after surgery for EEG electrode implantation were also measured. Activity levels were modified more for three older than for a younger group of animals following surgery/recording sessions. Corticosterone levels were appreciably elevated for the oldest group of animals. The possibility was raised that procedures designed to allow recovery from post surgical shock and adaptation to electrode connections may result in disproportionate differences across age groups.


Misuse of analysis of covariance in aging research and some partial solutions.

Gerontological researchers are reminded of the inappropriateness of analysis of covariance wherein the covariate is correlated with the independent variable, typically age. Two partial solutions are suggested that deal with the confounding of age effects with such uncontrolled variables as, for example, initial ability level or level of education.


Effects of immobilization stress on open field behavior and plasma corticosterone levels of aging C57BL/6J mice.

Four age groups of C57BL/6J mice (2.2, 6.2, 12.0, and 23.3 months) were subjected to either immobilization or handling (control) procedures. Open field behavior was observed before and after experimental treatments and plasma corticosterone levels were assessed 11 days following the immobilization or handling procedures. Eleven days following immobilization elevated corticosterone levels were observed for all but the 12.0 month group of mice. No behavioral effects were observed for the experimental groups, although both locomotor activity and exploratory behavior declined with advancing age. The age-related decrease in activity was entirely accounted for by scores on the initial open field test. Exploratory behavior was observed to be a more complex function of both age and experience.


Age differences in backward dichoptic masking.

An investigation of age differences in backward dichoptic visual noise masking was carried out with young, middle-aged and old subjects. Older subjects were found to be significantly more susceptible to the backward masking effect over longer delays between the target and masking stimuli. These results indicate a decrease with age in the rate at which stimuli can be cleared through the central mechanisms concerned with perceptual processing. These data appear to support the "stimulus persistence" and "arousal" models of aging.


Perceived latitude of choice of institutionalized and noninstitutionalized elderly women.

An Importance, Locus and Range of Activities Checklist, designed to assess self-perceived latitude of choice, a self concept and a life satisfaction scale were administered to 25 institutionalized and 25 noninstitutionalized elderly females. The checklist contained statements about 37 activities of daily living which subjects rated for personal importance and degree of choice available to them. The derived latitude of choice score was based jointly on importance and choice ratings for each activity. Institutionalized respondents, living in a relatively restrictive environment, earned significantly lower latitude of choice scores than did noninstitutionalized subjects. Latitude of choice, self concept and life satisfaction scores were significantly correlated. These findings attest to the appropriateness of the technique used to assess perceived latitude of choice. Modifications of the Importance, Locus and Range of Activities Checklist designed to provide a more profound measure of latitude of choice and to improve the applicability of the scale to different categories of respondents were discussed.


Age differences in evoked potential correlates of a memory scanning process.

Elderly subjects when compared to young, mature subjects in a memory-scanning task were shown to have longer response times (RT). A late positive component (LPC) of the average evoked potential did not reflect this difference between groups. However, in both groups, the LPC was seen to occur with longer latency at RT increased. LPC amplitudes also declined with increasing RT. There were greater differences between left- and right-hemisphere LPC amplitude and between LPC recorded along the midline scalp in the younger group than in the older subjects.


Effects of genetic and nutritional factors on post-natal reflex and behavioral development in the mouse.

The development of a number of reflex activities, of the electrocorticogram (ECoG), and measures of brain and body weight were assessed at different ages from birth to maturity in mice belonging to Swiss-Webster stock and two inbred strains (C57BL/6J and SEC/1Re). The animals also were tested at 60 days of age for exploratory activity and avoidance behavior. These effects of postnatal undernutrition on the measures of reflex and ECoG activity, brain and body weight and avoidance learning were determined at different ages after birth and in adult animals following dietary rehabilitation. Undernutrition during suckling period was introduced by increasing the litter size from 4 pups to 8 or 16 pups per litter. The results indicate that early malnutrition delayed the development of the reflex and ECoG activities and permanently altered brain growth and avoidance learning. The effects were different, depending on the genotype considered. The data indicate that strains characterized by a slower development of brain function do not show early signs of brain malfunction following undernutrition.


The effects of subjects' age and expectations regarding an interviewer on personal space.

How close individuals seat themselves to an interviewer was studied as a function of subjects' age and expectations regarding the interviewer. An experimental approach situation was used and the subjects were 10 college students and 10 residents of a county home. Those subjects who had been told to expect an unpleasant interaction seated themselves significantly farther from the interviewer than did those who expected a pleasant interaction. Also, the older subjects seated themselves significantly farther from the interviewer than the younger subjects did. The difference between the age groups was minimal when the subjects' expectations were positive, but was pronounced when the subjects' expectations were negative. The results appear to reflect a greater susceptibility among older individuals to feeling threatened and ill-at-ease in an interpersonal situation.


Experimental unconfounding of age and maternal responsiveness in rodents: prenatal CER conditioning to neonatal ultrasounds.

Prior to mating, virgin female Long-Evans Rattus norvegicus received 30 classical CER trials with shock as the UCS and either taped neonatal ultrasounds or a belltone as the CS. Additional animals were placed in groups controlling for exposure to shock, the ultrasounds, the belltone, and placement in the conditioning apparatus. Following mating and parturition mother-infant observations revealed that those mothers previously conditioned to neonatal ultrasounds spent more time in the lactation posture than did mothers from the other groups. The results suggest that naive mothers can be "primed" to exhibit greater maternal responsiveness than is characteristic of primiparous mothers.


Organization and recall of related sentences by elderly and young adults.

Differences between elderly and young adults in storage organization of sentence material were investigated using a modification of Mandler's (1967) sorting technique. The elderly were expected to be relatively poor at sorting organization, and would then recall less sentence material. The age groups were also compared on time taken to organize the sentences, recall organization, and performance on a short sentence comprehension test. There were no age differences in conceptual type of organization or clustering of sentences in sorting groups and recall storage organization was not related to the amount of recall. The elderly adults did require more time to acquire the sentences, and had lower recognition test scores. It was concluded that the sorting technique and measures related to it failed to detect the elderly adults' apparent difficulty in acquiring the sentences.


Age differences in life satisfaction as a function of discrepancy between real and ideal self concepts.

Six age groups were compared with respect to discrepancy between real and ideal self concepts and the relationship between life satisfaction and discrepancy in self concepts. The subjects, ranging in age from 20 to 75 years, completed two self descriptive adjective rating scales which assessed real and ideal self concept and a life satisfaction index. Significant differences were found among age groups for real and ideal self concepts, life satisfaction, and discrepancy between real and ideal self concept scores. Age was significantly correlated with real and ideal self concept, discrepancy between real and ideal self concepts and life satisfaction. Life satisfaction was significantly correlated with real self concept and discrepancy between real and ideal self concepts. Trends in the data suggested that the younger subjects (20-25 years) had lower real and ideal self ratings and were less satisfied with their lives than the elderly subjects (60-75 years).


Age-dependent changes in hippocampal theta.

The hippocampal theta rhythm in rats exhibited an age-dependent slowing in modal frequency. However, the theta rhythm of young rats with chronic respiratory infections showed a similar slowing. Respiratory disease-free hamsters also exhibited an age-dependent slowing of modal frequencies. These findings emphasize that the health status of the animal must be examined carefully in order to establish an age-dependent slowing in hippocampal rhythm.


Regional brain catechol-O-methyl transferase: age related differences in the mouse.

Activity levels of COMT were measured in the frontal cortex, hippocampus, hypothalamus and amygdala of two strains of male mice, C57BL/6J and DBA/2J, at various ages between 2 and 30 months. Determinations were made in mice housed under normal conditions and in mice exposed to a form of mild stress, an open-field apparatus, for 5 minutes. There were no major significant differences between the two strains as a function of age. However, after the open-field experience, C57BL/6J mice appeared significantly more responsive to the environment, as interpreted by increases in COMT, than DBA/2J mice. Interpretation is offered that C57BL/6J mice possess a more labile norepinephrine system, in spite of aging, than DBA/2J mice.


Behavioral differences in young and aged mice: strain differences for activity measures, operant learning, sensory discrimination, and alcohol preference.

Young and aged mice of the A/J and C57BL/6J inbred strains were given a series of behavioral tests which measured activity of various kinds, emotionally, operant learning, sensory discrimination, and alcohol preference. In general, compared with young mice, aged mice were less active, similar in emotionally, learned the operant discrimination as well, but extinguished more slowly, had poorer discrimination for sweet and bitter taste stimuli, and preferred alcohol to a lesser degree. Strain differences were obtained for most of these tests, and age-strain interactions occurred frequently indicating that behavioral changes occur at different rates for groups which differ in genetic constitution.


Slowing of response time in young and middle-aged hypertensive patients.

Reaction time (RT) was compared in 160 hypertensive and 43 normotensive adults. After being screened for coronary and cerebrovascular disorders, each subject completed 12 variations of a serial RT task. Subjects were blocked into normotensive, nonmedicated hypertensive, and medicated hypertensive groups, and into three age groups: 18-31; 32-45; 46-59. Response slowing was observed with increasing age. Significant slowing was also seen in the medicated but not the nonmedicated hypertensive group. Plasma renin activity (PRA) interacted with the medication factor; longest RTs were obtained for treated subjects with low and normal PRA and untreated subjects with high PRA. These results were interpreted in terms of changes in ability to autoregulate cerebral blood flow as a result of vascular damage.


The ontogeny of ultrasounds in two strains of Rattus norvegicus.

The developmental course of ultrasonic signaling by neonatal rat pups (Rattus norvegicus) was monitored under varying degrees of hypothermic stress. Signal rate, peak frequency, duration, and complexity of signals were analyzed separately for two different laboratory stocks. Sprague-Dawley and Wistar/Furth. Additionally, preliminary data were obtained on maternal retrieval latencies during the 1st 4 days post-partum and compared with the emission rate of neonatal ultrasounds. On the basis of these and other data, there is evidence that mothers play an important role in mediating many early experience effects. The data suggests that rate of neonatal ultrasounds may provide an index of some aspects of rat of maturity; that there may be different periods of maximum sensitivity to external stimulation in various stocks of laboratory animals; and that differential maternal responsiveness in different stocks of laboratory animals may correlate with differences in neonatal ultrasonic calling. Implications for comparative, genetic, and developmental studies are discussed.


Item recognition following a multiple-item study trial for young and middle-aged adults.

The presence study contrasted young and middle-aged subjects on two components of a recognition memory task (a modified verbal discrimination task) that differed in level of difficulty. No age decrement was found for the easier component requiring discriminability between the oldness and newness of items. In addition, age was not a factor in determining the effects of prior relevance or irrelevance of item information on old-new discriminability. An age decrement was found for the more difficult component requiring discriminability in terms of an old item's prior function in the study list. The decrement occurred for the identification of prior function of both right and wrong items.


"Spontaneously" hypertensive mice: a potential genetic model for the study of the relationship between heart size and blood pressure.

Mice selected genetically for high and low blood pressure (BP) were compared with regard to heart weight and heart/body ratios. Two experiments were performed with mice ranging in age from 1.3 to 9 months and 11 to 23 months respectively. In a third experiment C57BL/6J mice were compared to the high and low BP mice. Heart/body ratios and heart weights, adjusted fo body weight via covariance analysis, were significantly greater for the high BP mice, but no Age x BP Genotype interaction was observed. Results were discussed in terms of a possible relationship between heart weight and BP via genetic linkage or pleiotropy. The possibility was also raised that compensatory mechanisms for high blood pressure, e.g., cardiac hypertrophy, may operate very early in development for animals who are hypertensive by virtue of selective breeding for blood pressure extremes.


The work-satisfaction, retirement-attitude typology: profile examination.

After a typology is developed based on work satisfaction and attitude toward retirement, profiles are examined of respondents appearing in four typological categories. Data at three points in time (1964, 1966, 1974) from 1,922 older (50+) employed males suggest that membranes of some types will be more susceptible to negative consequences of life-cycle change (work to retirement) than others. Findings from socioeconomic status, age, social participation, health, community, housing, family, work, morale, and longevity variables indicate pre-retirement planning approaches should be developed for those having different work-retirement attitudes.


Structure of the self-concept from adolescence through old age.

The continuity over the major portion of the life-span (ages 9-89 yrs.) of the connotative structure of the self-concept was examined by factor analysis of a semantic differential instrument and found to be essentially constant. Significantly age and sex differences in scores on the four components (Achievement/Leadership, Congeniality/Sociability, Adjustment, and Masculinity-Femininity) emerged and were interpreted.


Hemisphere-hand interactions for the matching of letters.

Young, middle aged, and older subjects were given a Posner-type physical-name matching task, in which stimuli were presented to one or both hemispheres, and a simple discrimination reaction time (DRT) task. Reaction time differed between young and middle aged groups for both tasks with shorter RT for the DRT task. Reaction time for the older group did not differ significantly from that of the middle aged group for either task, although the reaction time for the older group was longer. Reaction time was faster for all age groups when Stimulus 1 and Stimulus 2 were presented to different hemispheres for the matching task than when both stimuli were presented to the same hemisphere. Ipsilateral finger responses (hand relative to hemisphere) were slower than contralateral responses but this was true only with regard to the visual field of presentation for stimulus 2. These data indicate that sharing of information between hemispheres under certain circumstances increases the efficiency of information processing relative to that observed with unilateral visual half-field (hemisphere) presentations and that hand or finger response relative to visual field of presentation is an important factor which must be controlled and examined relative to visual field of presentation.


The total time principle as a substitute for the pacing variable in paired-associate tasks with the aged.

Information provided by Monge and Hultsch in support of the pacing variable was reinterpreted i terms of the total time principle. The re-analysis of the transformed data suggests that the total time principle provides a more parsimonious explanation of the data.


An analysis of the effect of age on respiratory and digestive functions of the rat.

There is little published information on the pulmonary function of aged rats. The data available indicate that the elastic properties of the lung-thorax system of the rat changes with age in a fashion similar to that seen in the case of man and other mammals. However, unlike the situation observed with man, neither the internal surface area of the lungs nor the diffusing capacity of the lungs declines as the rat ages. The diffusion O2 from blood to tissues does not seem to decline with age in the rat and the utilization of O2 by the tissues is either not affected by old age or affected in a subtle fashion. There is no information on how old age influences either the motility or the secretory activity of the exocrine glands of the alimentary tract of rats. There is abundant evidence to indicate that the processes involved in the absorption of dietary carbohydrate and protein are not adversely affected by old age in rats. The data on the effect of age on the enzymatic digestive process are not totally clear, but it seems unlikely that if such changes do occur that they are of a magnitude to seriously hamper the digestive function of the senescent rat.


Semi-quantitative estimation of changes in noradrenaline content and intraneuronal distribution in the rat vas deferens by fluorescence histochemistry.

A semi-quantitative histochemical assay for noradrenaline was developed, based on the assumption that the rate of reaction of noradrenaline with paraformaldehyde depends on transmitter concentration. Changes in organ noradrenaline content caused by drugs or cold-stress were associated with similar changes in fluorescence intensity of organ samples taken for microscopy. Differences in the fluorescence intensity of experimental and control tissues were also found when there was no change in total noradrenaline content, suggesting that fluorescence intensity is not a simple function of whole organ noradrenaline content. Changes in the relative fluorescence of experimental tissues with different paraformaldehyde exposures suggested that the intraneuronal distribution of noradrenaline may affect the rate of development of fluorescence. Analysis of the time course of the fluorescence reaction showed that this was best described by the sum of two first-order exponential components of different half-life. Further results suggested that the first, fast component represents vesicle-bound noradrenaline, while the slow component represents extrangranular transmitter.


Cryostat technique for central nervous system histofluorescence.

This paper offers a technique for obtaining monoamine histofluorescence in the CNS by means of formaldehyde perfusion followed by cryostat sectioning. No freeze-drying is involved. Cryostat sections are exposed to formaldehyde vapor to complete the fluorophore formation. The fluorescence thus obtained is bright, well localized, and does not require loading the animals with precursors. The anatomical distribution of the pathways is identical to that obtained with the classical technique. Furthermore, the fluorescence is reversible by sodium borohydride, and exhibits the expected changes in intensity with pharmacological manipulations. The sections can be exposed to a cold aqueous medium for as long as 15 min with minimal diffusion of fluorophore; this suggests potential for combining monoamine histofluorescence with other visualization techniques.


Alexithymia, 'pensée opéatoire' and predisposition to coronopathy. Pattern 'A' of Friedman and Rosenman.

The 'behavioral pattern A' and the 'B' pattern in selected groups of male populations in the framework of a prospective and predictive study of a large population of civil service employees is compared. The Personality Inventory of Lazare, Klerman and Armor and the auto-questionnaire of Bortner were used to differentiate the 'A' and 'B' group populations. Selected cards from Murray's TAT seem more appropriate in this respect and demonstrate the lack of efficiency of certain questionnaires in areas of psychosomatic research. Moreover the selected TAT card responses provide some evidences of 'pensée opératoire' or alexithymia in 'A' group subjects whatever its metapsychological implication.


[Control of pyruvate dehydrogenase in loach embryo oocytes].

The activity of pyruvate dehydrogenase (PDH) increases during the oocyte maturation in the loach Misgurnus fossilis due, apparently, to the decrease of pyruvate utilization in the reactions of gluconeogenesis. The activity of PDH decreases twice at the stage of gastrula. These changes in the PDH activity are not related to intertconversion of the enzyme active and inactive forms of PDH; the total PDH of oocytes and embryos is in the active form only.


Assay for the two different types of lymphocyte complement receptors.

This paper describes the assay system for two different types of lymphocyte complement receptors, the immune adherence receptor (C3b receptor) and the C3d receptor.


The effect of formaldehyde on the toxicity and potency of pertussis vaccine.

Storage of concentrated suspensions of Bordetella pertussis organisms at 5 C for long periods of time in the presence of 0.02% thimerosal as well as heating at 56 C for 30 minutes cannot be relied upon to detoxify the vaccines. Our data show that the toxic thimerosal-killed vaccines can be rapidly detoxified by adding formalin to a final concentration of 0.025-0.05% and incubating at temperatures of 5-20 C for from one to three months. These formalin-detoxified vaccines are protective and meet present potency requirements for pertussis vaccine. Addition of larger amounts of formalin at higher temperatures may detoxify the vaccine but may also reduce the protective effect.


Further evidence for the humoral stimulation of the liver: effect of a pituitary peptide.

The capacity of a peptide isolated from hypophysis (HTH) to affect liver function is further supported by the results of pilot experiments on lipid and protein metabolism. Administration of purified peptide to rats induces reduction in plasma proteins and increase in plasma cholesterol with an abnormal free/esterifield cholesterol ratio in liver. Cholesterol in bile and bile volume excretion increase above normal and the concentration of other substances known to be modified by liver activity shows values different to normals.


[Etiology of childhood psychoses].

When studying etiology of childhood psychosis, causes may be divided in biological and psychodynamic. The present paper focuses on the first, which are divided in infectious, toxic, neurologic, endocrine, biochemical and genetic; these last include chromosomic alterations and hereditary factors. The relevant bibliography is reviewed. In spite of a growing list of research work, a single etiologic factor has not been found. It is probable that brain disorder in the psychotic child is psychological, mediated by chemical disturbance and with environmental correlates.


Sex ratio in twin births.

1. Data on more than 2 1/2 million twin births suggest that the regression of sex ratio in twins on maternal age does not decline monotonically like that of singletons, but, like the incidence of dizygotic twinning, seems to rise and then fall with maternal age. 2. Accordingly it is hypothesized that the sex ratio in monozygotic twins is lower than that in dizygotic twins or that in singletons. This would account also for the low overall sex ratio in twins. 3. The data are consistent with the hypotheses that the monozygotic twin sex ratio is constant for all maternal ages at a value of about 0.496, and that the dizygotic twin maternal age-specific sex ratios are the same as the singleton sex ratios for the same maternal ages. 4. The hypothesized low sex ratio in monozygotic twins is reminiscent of that in some congenital malformations: possibly some aetiological factor is common to monzygotic twins and such congenital malformations. 5. It is suggested that the total-birth sex ratio of triplets is underestimated in national vital statistics records.


A genetic analysis of the normal body-height growth and dental development in man.

A twin and family study on the significance of genetic factors for the variation in certain new variables of dental and body-height development is presented. Evidence of a rather strong genetic regulation of most of the variables was obtained from the analysis of the twins and sibs. The data on cousins did not allow any definite conclusions, and it was not possible to obtain a parent--offspring material. Therefore, the study did not give any information concerning the relative significance of additive genetic variation.


The inheritance of scholastric abilities in a sample of twins. I. Ascertainments of the sample and diagnosis of zygosity.

A sample of 149 twin pairs was ascertained by extracting all pairs of candidates with the same surname, birth date and address from the files of a public examination taken by about two thirds of the 15-year-old cohort in South Australia. Of these there were 39 opposite sex pairs and 100 same-sex pairs whose zygosity was determined by postal questionnaire. This diagnosis was checked and found to be accurate by typing 47 pairs for ten independent genetic markers. Several analyses suggest that the ascertained twin samples is fairly representative of the fraction of the cohort who took the examination so there is no evidence to suggest that between families components of variance will be underestimated for this reason.


The inheritance of scholastic abilities in a sample of twins. II. Genetical analysis of examinations results.

1. Examination results for 98 pairs of same-sex and 39 pairs of opposite-sex twins were available for analysis as well as measurements of IQ and height for 47 of the same sex pairs. 2. The choice of subjects taken for examination is not influenced by genetic differences within DZ pairs but seems to be mainly determined by between family cultural differences. 3. Neither the sex difference in opposite-sex pairs nor the difference between first and second born twins in same-sex pairs contributes appreciably to within pair environmental variance. However, same-sex DZ pairs are more often found in different school classes than MZ pairs. 4. No evidence for interaction between genotypes and within-family environments was found for any character. 5. The simple environmental model fails to fit the data for English, French, Geography, Mathematics and IQ whereas the simple genetical model fits. For the remaining subjects it is not possible to exclude either hypothesis. The heritablities of the examination performances are of the same magnitude as that for IQ. 6. Sampling inadequacies are revealed in the data for height but there is evidence for a substantial genetics component of phenotype variation. 7. There is evidence for heterogeneity of gene action in the subjects English and Mathematics supporting the view that there are genetically determined specific abilities acting independently of general intelligence.


Nucleotide sequence of salmon testes and salmon liver cytoplasmic initiator tRNA.

Initiator tRNAs from the cytoplasm of salmon testes and salmon liver have been purified. The nucleotide sequence of these initiator tRNAs has been determined and found identical to that of initiator tRNA from mammalian cytoplasm. The only difference is the extent of modification of the nuceloside located between the dihydrouridine and the anticodon stems. In the salmon tRNAs, this modified nucleoside is predominantly N2N2-dimethyl guanosine, whereas in the mammalian initiator tRNA it is N2-methyl guanosine.


Acute effects of calcitonin on osteoclasts in man.

To determine the mechanism by which calcitonin acutely decreases bone resorption in man, salmon or human calcitonin was administered intravenously to five patients with Paget's disease of bone immediately after an iliac crest bone biopsy. After 30 min an adjacent bone biopsy was taken and both were evaluated by light and electron microscopy. The results indicated that calcitonin both decreases the number of osteoclasts and alters the ultrastructure of these cells. Thes acute effects of calcitonin on osteoclasts confirm findings in other species and provide evidence in man that calcitonin, at least in part, retards bone resorption by inhibiting osteoclastic activity.


The ectopic secretion of calcitonin by lung and breast carcinomas.

Many patients with advanced non-thyroid malignancies have elevated plasma immunoreactive calcitonin concentrations. Breast and bronchial carcinomas contain immunoreactive calcitonin and an epidermoid bronchial carcinoma has been shown to produce immunoreactive calcitonin in vitro. We have established monolayer cultures of breast carcinomas and eight out of fifteen consecutive carcinomas released immunoreactive calcitonin; some released HCG (human chorionic gonadotrophin) or CEA (carcinoembryonic antigen). In addition, a primary human breast carcinoma has been shown to release and contain calcitonin after being passaged in 'nude' mice over 1 year. Chromatography of extracts and culture media of a bronchical carcinoma demonstrated that, in contrast with the other tumours, it secreted a form or forms of calcitonin having size, charge and immunological differences when compared to calcitonin M. Preliminary evaluation of plasma immunoreactive calcitonin estimations in patients with breast carcinoma showed that twenty-three out of twenty-eight patients with metastatic disease had elevated plasma calcitonin concentrations, whereas only one out of thirteen with localized disease had high levels.


The genetic contribution to coronary heart disease through lipoprotein concentrations.

Many factors both genetic and environmental contribute to the liability to coronary heart disease and one of the genetically determined risk factors is the concentration of lipoproteins in the blood. The evidence so far is that serum cholesterol level is polygenically determined, but that in a minority of the population it is determined by a single mutant gene of large effect. There is evidence that the risk of coronary death for affected individuals is very high and that the condition warrants a maximum effort at identification and treatment. For the remainder of the population whose hyperlipidaemia is polygenically determined, the liability to coronary heart disease might be substantially reduced by simple and appropriate environmental measures aimed at reducing the total liability. The measures if correctly applied should effectively improve the population risks of early coronary death.


[Behaviour of DNA-RNase A complex in the presence of formaldehyde].

A formaldehyde-produced fixation of defects caused by a despiralizing action of a protein was studied in the case of DNA-RNAase A complex. The concentration of the defects fixed was measured by kinetic formaldehyde method (KF-method). It was shown that following processes take place in the complex in the presence of formaldehyde: (a) fixation of defects; (b) unwinding of DNA; (c) inactivation of the protein. The rates of all these processes depend on the concentration of formaldehyde, phi. At formaldehyde concentrations above some critical value phic the protein is inactivated before the defects are fixed. At phi less than phic the protein inactivation proceeds more slowly than the fixation of defects; at sufficiently low formaldehyde concentration no inactivation of protein occurs practically during the fixation time (20 min). The number of new defects formed during the time of fixation is linear with the formaldehyde concentration in the region where no inactivation of the protein occurs. Therefore the initial concentration of defects can be determined through an extrapolation to zero concentration of formaldehyde. On the basis of the data obtained a method is proposed for the evaluation of the number of defects in DNA caused by the despiralizing action of proteins. A model is proposed describing the behaviour of the complexes of DNA with despiralizing proteins in the presence of formaldehyde.


[Rate of DNA replication and size of replicons in human diploid cells].

The rate of DNA replication and the distances between initiation sites (size of replicons) have been studied in human cultured fibroblasts. The modified Huberman and Riggs technique of DNA fiber autoradiography has been used: the pulse-labelled regions were analysed in DNA fibers preliminarily labelled along the whole length. This enabled us: a) to analyse the arrangement of replicons along the length of labelled DNA fibers with the lengths of 200-750 micron, reaching 2700 micron in some cases; b) to select only single DNA molecules for the analysis. This technique decreases the danger of a mistake when minor labelled regions belonging to different DNA molecules are referred to the same one. The rate of DNA replication varies from 0.2 to 1.2 micron/min, the average of 0.6 micron/min. This conforms with findings of other authors. The distances between initiation sites vary from 15 to 140 micron with the modal interval of 50-60 micron. This value is twice higher than those obtained by other authors. The possible reasons for such difference are discussed.


Eustachian tube function in children.

Eustachian tube function of children with bilateral serous otitis media was studied in 14 ears following myringotomy and pressure equalizing tube insertion. Cases with non-Eustachian tube pathology potentially contributing to Eustachian tube dysfunction were excluded from the study. Eustachian tube function was evaluated utilizing an impedance audiometer to document neutralization of positive and negative middle ear pressures. All cases showed persistent tubal dysfunction for up to six months. Partial incomplete neutralization of positive pressure occurred in 64 per cent, but in no case could negative pressure be partially neutralized even when "locking" was relieved with valsalva. Continuous ventilation of the middle ear for up to six months did not allow a return to normal Eustachian tube function. This is extremely effective palliation, and should be recognized as such.


Behavioral characteristics of C57BL/6J. DBA/2J, and B6D2F1 mice which are potentially useful for gerontological research.

This review summarizes the behavioral characteristics of C57BL/6J, DBA/2J, and B6D2F1, hybrid mice which are most likely to be of interest to gerontological scientists. Where possible, the characteristics of young and old mice are included. Where no information exists about the behavior of older mice of these genotypes, but there is reason to believe that information about mice might be useful for aging research, this information is included. The purpose of the review is to acquaint gerontologists with the availability of genetically defined animal models for aging research, to present what is known about these models, and to suggest areas of research which could profit from more attention.


[Influence of formaldehyde on the melting temperature of DNA].

It has been shown that formaldehyde has no marked physical effect upon DNA resulting in lowering of its melting temperature. The effect of lowering of DNA melting temperature observed earlier by other authors resulted from the process of unwinding of DNA due to chemical reactions of formaldehyde with reactive base groups.


[Current concepts about the determinants of germ cells].

The cytoplasm of the egg vegetal hemisphere plays the determining role in the isolation and differentiation of germ cells. Cytoplasmic factors of unknown nature prevent certanin blastomeres from somatic differentiation. In the developing germ cells, a large amount of material (in which acid proteins are a constant component) passes from the nucleus to the cytoplasm. This fine fibrous material may take the form of nucleolus-like bodies or dense granules (polar granules in the insect eggs, dense bodies in the amphibian germ plasm, intermitochondrial cement in oocytes of various animals, chromatoid body in spermatocytes). The application of the term "determinants of germ cells" for designation of these structure, as it takes in the electron microscopy literature, appears to be incorrect. Their appearance is a consequence of the determining influence of cytoplasmic factors, rather than their cause. In lower invertebrates, the germ cells may arise in adult specimens due to the embryonic reserve of totipotent elements (neoblasts or interstitial cells). The transformation of these cells in the germ ones is accompanied by the release of a great amount of fine fibrous material from the nucleus to the cytoplasm as well. The problem of determinants of germ cells is considered with respect to the problem of ooplasmic segregation.


[Effect of actinomycin D and sibiromycin on the embryonic and larval development of Nereis virens (Sars.)].

The morphogenetic function of nuclear apparatus has been studied by means of "chemical enucleation" using actinomycin D (60 microgram/ml, 3 hrs) and sibiromycin (10--100 microgram/ml, 3 hrs) at different developmental stages of Nereis virens (Sars.). The embryos were subjected to the effect of the inhibitors at the successive stages every 6 hrs beginning from the fertilization. The development proceeded in the normal way til the throchophore stage in spite of the inhibition of DNA-dependent RNA synthesis what agrees with the concept of P. P. Ivanov on the existence in Polychaeta of a developmental tendency to trochophore. The first period of morphogenetic activity of the genome which ensures the transition from trochophore to metatrochophore coincides with the gastrula stage and the second period which ensures the transformation of metatrochophore into nectochaete with the final phases of the trochophore stage.


Treatment of hyperthyroidism with a large initial dose of sodium iodide I 131.

A retrospective study was undertaken of 229 patients with hyperthyroidism due to Graves disease treated at the Cleveland Clinic with a large initial dose of sodium iodide I 131 (mean dose, 12.7 +/- 7.5 millicuries). The results indicate that a large initial dose is the most effective therapy for this disorder. Ninety percent of this group of patients required only one dose and recovered from hyperthyroidism within 12 weeks. Because we are convinced that there is no way to prevent the development of hypothyroidism in these patients, we have prescribed permanent thyroid hormone replacement after the hyperthyroidism has been controlled. In a mean five-year follow-up of 190 patients, 174 (91.5%) were still taking thyroid hormone.


Chronic lymphocytic leukemia and lymphosarcoma associated with multiple myeloma: report of three cases.

Three patients had the rare occurrence of multiple myeloma coexisting with chronic lymphocytic leukemia or lymphosarcoma. It is not possible at present to resolve the question as to whether these two diseases represent part of the spectrum of a single B-cell disease or wether multiple myeloma and lymphoproliferative disorders are two separate entities, which may rarely occur by coincidence in the same patient.


[Effects of ketamine on the pressure of the cerebrospinal fluid. Variations of its effects].

Effects of chlorhydrate of Ketamine upon CSF pressure were studied in 10 patients with different intracranial pathology. In opposition to the results of other authors, in 5 patients there was no increase of pressure after the drug was applied. This difference is ascribed to the individual pathology of the patients studied, emphasizing that 4 of them were bearers of a diffuse vascular encephalopathy with intelectual damage, added to an acute vascular accident in 3 cases. For these reasons, it is presumed that a deficient auto-regulation of cerebral circulation, with diminished vasomotor reactivity, is reasponsible for the absence of hypertension after application of the drug. The study of the variations of cerebrospinal fluid pressure after chlorhydrate of Ketamine is applied may enable to measure the efficiency of the mechanisms of auto-regulation in any determined patient.


[Memory disorders in posterior vertebrobasilar cerebral artery insufficiency].

A clinical and neuropsychological study of 10 vascular patients with signs of circulatory insufficiency in the vertebro-basilar-posterior cerebral territory in whom the dominant symptom was loss of memory with relative idemnity of other intelectual functions is presented. In 5 cases clinical signs of acute infarct in the posterior cerebral artery territories existed in the form of amnesic infarct. The disturbances and the localization of the lesion confirmed by paraclinical examinations (EEG, angiography of the posterior circulation, radioisotope scan) are discussed.


Epileptic seizures as an early complication of neurosurgery.

The appearance of epileptic seizures in the early postoperative period (first 10 days) after neurosurgery is an uncommon complication. A retrospective study of 600 patients operated on for glioma, meningioma, metastatic tumor, hydatid cyst, cerebral hemorrhage and head injury (100 cases each) is the subject of this report. In 6% of the total group, seizures were found during the first 10 days following surgery. They usually appeared during the first 48 hours. In most cases (78%), fits were of the partial motor type, originating in the frontoparietal (central) region. The clinical course was benign in most cases. Good control of seizures was usually obtained by common anticonvulsants and except for a few cases, the prognosis was not worsened by the appearance of these early fits. The pathophysiology of early seizures, which are not related to cerebral scarring, is discussed. It is concluded that they are related to biochemical alterations produced by surgery, similar to what happens in early post traumatic epilepsy or in cases of seizures appearing in the early stages of cerebrovascular accidents.


[Spinomedullary compression caused by neurinomas and meningiomas].

A series of 30 spinal neurinomas and meningiomas studied in the Instituto de Neurología of Montevideo from 1958 to 1973 is analyzed. Seventeen neurinomas and 13 meningiomas are included. The following conclusions, in accordance with previous studies, were obtained from the clinical study and operative observations. Meningiomas were more commonly observed in females, in the sixth decade of life and were localized most frequently in the dorsal region. Neurinomas showed no preference for sex or site of the spine, and although they were more common in the sixth decade, they showed a greater dispersion in age. Clinical manifestations were similar in both groups but parasthesias were a more common initial symptom in meningiomas. Protein content of CSF was clearly greater in neurinomas. Radiological alterations of vertebrae were more frequently seen in neurinomas, but inespecific nature. Positive contrast mielography was in all cases useful for precise topographic diagnosis. Surgical results were satisfactory even in cases with severe preoperatory motor deficit.


[Abdominal complications of the ventriculo peritoneal derivations].

Thirty-nine ventriculo-peritoneal shunts in children have been analyzed since 1962 to 1976 at the Neurological Institute in Montevideo. In these cases there were 8 important abdominal complications (20%): 7 were associated with ventriculitis, all with infiltration or fistula on the trajet, 3 cases were operated on because of intestinal occlusion, 1 of them with perforative acute peritonitis. In the others, gastric distention, abdominal distention, and transient ileus were found. Five patients died, 4 of them with ventriculitis, 3 children who had suffered ventriculitis, survived. They overcame their hydrocephalus by means of ventriculo-atrial shunts, afterwards their infection was cured. From the result of the test of these cases it is gathered in view of a ventriculo-peritoneal shunt disfunction, that it is necessary to: 1) As far as possible rule out ventriculitis. 2) In cases in which ventriculitis should be proved to exist and with a peritoneal reject, after the infection has been cured, one should not insist with the ventriculo-peritoneal diversion, because in this case the possibility of the relapse taking into account the abdominal intolerance, increases. After the ventriculitis should be got over with a proper bacteriological control, a ventriculo-atrial shunt must be performed. 3) The changing of the form of the divertion system is considered immediately after an abdominal aseptic intolerance is present (ileus, ascites, etc.), due to the double risk of intestinal occlusion or ventriculitis.


[Fracture luxation of the cervical spine. Different treatments].

There exist situations, such as cervical spinal cord injury which are treated by orthopedic specialists and/or neurosurgeons, with dissimilar methods. In is necessary to unify criteria or better still not commit mistakes which may worsen neurological déficit in these injured patients. The medical history and treatment of 16 patients with cervical spinal cord injury are discussed. The therapeutic procedures included: decompressive laminectomy, anterior fibula bone graft, Clowards' procedure and (minerva) exterior neck fixation. The evolution and complications are analyzed and in some cases connections are made in the hope of better results.


[Cauda equina syndrome caused by vertebral disk hernia].

Thirteen cases of cauda equina syndrome of discal ethiology are analyzed. The clinical characteristics and course are studied. The factors which influence the prognosis and the possibilities of treatment are analyzed.


[Possibilities in the field of craniofacial surgery].

Four cases which illustrate possibilities of a new field in craneofacial surgery are presented. Using certain surgical principles, various conditions whose previous treatment was unsastisfactory, can be corrected. Hope is thus given to many persons with severe facial deformities.


[Rupture of intracranial aneurysm during angiography. Report of a case and review of the literature].

A case of rupture of an intracranial aneurysm during angiography is presented. The possible mechanisms and pathological aspects of this complication are discussed. A review of the literature was done, and correlations were made. It was found that rupture in this condition is more frequent among aneurysms of the carotid artery, in female patients, with a high incidence of mortality.


[Pott's disease of cervical topography. Apropos of a case].

The authors present a case of cervical Pott's disease with severe neurological impairment and with a favourable course with medical and surgical treatment. The diagnostic difficulties and the possibilities of treatment at the present stage are discussed.


Pupillary sparing in oculomotor palsy from temporal lobe astrocytoma. Report of two cases.

Two cases are reported of pupillary sparing in oculomotor palsy from temporal lobe astrocytoma. In one of them it was the first manifestation of recurrence of tumour. Tumour infiltration with resultant nerve ischemia is suggested to be the responsible pathological process.


[Epidemiology of 500 adult epileptics from a hospital population].

On the basis of 500 epileptic patients treated in the Out-Patient Department of the "Instituto de Neurología", Hospital de Clínicas, Montevideo, Uruguay, an epidemiological study is undertaken. Data obtained correspond to the period extending between 1965 and 1975. A precodified data registering system was used and the analysis was done by mechanical processes. It is mainly a descriptive analysis of the group of patients and their seizures, including 20 items. As far as social aspects are concerned, education levels and occupation are analyzed, encountering similar levels as those of the general population in this country. As to etiological factors, a high incidence of familiar history of epilepsy (17%) and of perinatal pathology (19%) is found. An analytical study of the seizures and their provoking factors is performed. Etiological factors are analyzed dividing the patients in two groups according to the age of beginning of seizures (before or after 25 years) and in the younger groups perinatal factors and epilepsy of unknown origin predominate, while in the older group vascular and tumoral causes are more frequent.


Specific hydrolysis of methionyl-tRNA Met f catalyzed by a purified peptide.

A peptide initiation factor purified from rat liver and promoting the binding of initiator tRNA and model initiators to 40S and 80S ribosome at an acid pH liberates methionine and N-acetylmethionine from Trna Met f at neutral reaction. Phenylalanyl-tRNA, N-acetylphenylalanyl-tRNA and methionyl-tRNA Met m are not hydrolyzed under the same conditions. Hydrolysis of methionyl-tRNA Met f is stimulated by the presence of the 40S ribosomal subunit and preceeds at 37 degrees C until all the substrate has been split. No hydrolysis of initiator tRNA or N-acetylmethionyl-tRNA Met f occurs at 0 degrees C. Hydrolysis is slightly stimulated by GTP and MG2+ but not by KCl. The binding and hydrolyzing activity associated with a single protein factor may have an important function in regulating the rate of peptide initiation.


Renal cortical outline evaluation in excretory urography.

Capillary phase nephrogram films and tomography were used to evaluate renal cortical outlines and renal parenchymal masses. The method of examination and the results are presented, showing the capillary phase film to be beneficial and to play a significant role in excretory urography. No increase in the incidence of side effects was noted with the rapid injection technique.


Detection of renovascular hypertension: saralasin test versus renin determinations.

Angiotensin blockade was established in hypertensive patients with the competitive inhibitor saralasin and the blood pressure response was compared to prior renin determinations. Two patients with subsequently confirmed renovascular hypertension had normal peripheral renin and non-lateralizing renal vein renin ratios, yet both showed a clear-cut lowering of blood pressure after administration of the blocking agent, indicating the presence of renin-mediated hypertension. Thus, direct in vivo testing with saralasin appears to offer certain advantages over renin determinations.


Renal vein thrombosis.

The manifestations, clinical course and treatment of 14 patients with non-malignant renal vein thrombosis are described. Most patients (10 of 14) had generalized vague illness and nephrotic syndrome but 4 were initially seen with acute symptoms of flank pain, hematuria or hypertension. Renal vein thrombosis affected young men 2.5 times more often than women and occurred on the left side 2.6 times more commonly than on the right or both sides. Red blood cell casts in the urinary sediment, heavy proteinuria and hypoalbuminemia were useful indicators of the disease. Excretory urographic signs were suggestive of renal vein thrombosis in all patients and these were corroborated by angiographic studies. Systemic anticoagulation with or without a renal failure program and diuretics, or simply a combination of the last 2 modalities, was used in 9 patients. In 2 of the 9 patients who were unresponsive the adjuvant use of cyclophosphamide and steroids effected a cure. The remaining 5 patients underwent nephrectomy or thrombectomy. All 14 patients were followed for 1 to 7 years (mean 1.6 years). Ten patients were cured or improved, 1 patient was unchanged, and in the remaining 3 patients the condition deteriorated and they subsequently required a renal allograft. The rationale for various forms of treatment is discussed.


Selective transcatheter arterial embolization of renal carcinoma: an original technique.

The association of pharmaco-angiography with norepinephrine and transcatheter arterial embolization is a technique used to obstruct arteries invaded by renal carcinoma. We treated 4 patients with this method before nephrectomy and recommend its use as a complement to an operation for renal carcinoma or as definitive treatment in poor surgical candidates.


Management of the ureterotomy incision in 100 consecutive ureterolithotomies.

We reviewed retrospectively 100 consecutive ureterolithotomies in an attempt to determine if the choice of the ureterotomy closure significantly altered the postoperative course and morbidity rate. No dramatic difference was found when comparing ureterotomies left open, those closed loosely with interrupted sutures and those closed with continuous sutures. Parameters studied were the duration of postoperative urinary drainage, hospital stay and fever. Postoperative radiographic findings among the 3 groups are discussed.


The flush versus the protruding urinary stoma.

All too often arbitrary or theoretical considerations are the determinants of the external stomal dimensions at the time of ureterointestinal diversion. To the patient this facet of the operation becomes one of immediate, lasting and paramount importance. A comparative analysis of the experiences of 125 stoma patients suggests that there are distinct advantages to the protruding nipple insofar as the patient is concerned. Management and clinical problems of the flush and the protruding urinary stoma are discussed.


Pelvic exenteration: complications of urinary diversion.

We report complications directly related to urinary diversion among 32 patients who underwent pelvic exenteration for gynecologic malignancy. Eight patients (25 per cent) sustained 10 major complications, including 8 urinary fistulas and 2 fistulas from the entero-enterostomy sites. The frequency of these complications was greater among patients who had had total exenteration than among those who had had anterior exenteration. We attempt to identify factors responsible for these complications and discuss methods for reducing the morbidity related to urinary diversion in these patients.


Retroperitoneal iliac fossa abscess presenting as primary disease of the genitourinary tract.

An iliac fossa abscess is a clinical entity that has not been described in the urologic literature. Three patients presenting with urologic symptoms were evaluated and found to have iliac fossa abscesses. It is important for the urologist to be aware of the existence, diagnosis and treatment of this entity.


Urethral calculi.

The diagnosis and management of 34 men and 13 women with urethral calculi are reviewed. A majority of patients presented with dysuria, weak stream and perineal pain. Diagnosis was made radiographically in only 42 per cent but was confirmed in all patients who underwent cystourethroscopy. All patients had lower urinary tract lesions or previous prostatic operations and 47 per cent were infected. Migrant urethral calculi were encountered 10 times more often than were native stones and a metabolic cause was found in 10 of 18 patients studied. In men penile urethral calculi were removed transurethrally and all bulbous and most posterior urethral stones were guided endoscopically into the bladder. Most of these stones were irrigated out or removed by transurethral litholapaxy; the remaining few, together with vesical calculi, required cystolithotomy. In all 13 women calculi were removed at the time of urethral diverticulectomy. A majority of 17 men (76.5 per cent) and the 4 women who were followed for an average of 5.3 years have remained free of trouble.


Urethral strictures: treatment with intralesional steroids.

A review of steroid management of urethral strictures is presented. The 96 patients were followed for a year or more after urethral injection with triamcinolone. Intralesional steroid may be used in many types of strictures but it is especially useful in those cases with strictures in the distal urethra or the meatus, those occurring after radical prostatectomy and in some cases when 1 or more urethroplasties have been done. Every practicing urologist can benefit from using stricture injection in selected cases.


Benign periurethral masses in women.

Benign periurethral masses were encountered in 4 women. The masses included 2 vaginal leiomyomas, 1 of which was found simultaneously with a urethral diverticulum, a fibrocystic urethral mass and hyperplastic glandular tissue obstructing the bladder outlet and resembling male prostate. The physical and endoscopic features were helpful in establishing the benign nature and extent of the lesions. Although the bladder base was deformed on an excretory urographic cystogram in each case the radiographic features were non-specific except as they applied to a urethral diverticulum. Transvaginal needle biopsy is recommended in contemplation of open surgical excision. Leiomyomas are best approached transvaginally and anterior urethral masses can be reached suprapubically.


Carcinoma of the penis.

This study updates the experience at our hospital with cancer of the penis, which now includes 122 consecutive cases seen between 1940 and 1974 with 100 per cent followup. Historical, clinical, pathological, therapeutic and followup data were extracted for all cases in a digital code for transfer to computer storage. Life tables giving cumulative survival rates through 10 years with standard deviations and age corrections were calculated for each variable. The data were tabulated for publication to emphasize the prognostic significance of individual variables for the purpose of prospective research planning. The data were then evaluated regarding indications for prophylactic inguinal lymph node dissections, if any.


Separation of X and Y spermatozoa.

Results with different methods to separate X and Y spermatozoa and a diversity of findings are described. Results with the filtration of spermatozoa have been reported, possibly leading the way to enhance pre-conceptional selection of male offspring aided by artificial insemination.


The seminoma decoy: measurement of serum human chorionic gonadotropin in patients with seminoma.

Serum human chorionic gonadotropin levels were determined in 20 patients with histologically proved seminoma. The test was positive in 2 of the 20 patients and was predictive of non-seminomatous metastasis in each case. Serum human chorionic gonadotropin is a useful tumor marker in detecting and following non-seminomatous metastases in men with pure seminoma of the testis.


More than 10 years of experience with reconstructed scrotums.

Relatively few cases of genital injuries are reported in Japan except during times of war. One of the problems in severe genital avulsion may be the plastic surgical repair of the injured structures. In Western countries the Howard technique is considered the most practical method of scrotoplasty. Two patients with extensive scrotal avulsions were treated, one in 1959 and the other in 1960, by a method of plastic repair that retained the intact testes hanging between the thighs. By coincidence, both injuries were caused when the patients' clothing was caught in the revolving cylinder of a windlass on a ship. Both patients have been followed for more than 10 years after scrotal reconstruction. The method used for scrotal reconstruction and the long-term results are discussed.


Use of radioisotope scan in evaluation of intrascrotal lesions.

There were 98 patients with a variety of intrascrotal lesions studied with a radioisotope 99mtechnetium-pertechnetate scanning technique. Retrospective analysis in 50 patients subjected to an operation revealed a 94 per cent accuracy of the scan in the differential diagnosis of testicular torsion and epididymitis as compared to a clinical accuracy of 48 per cent. In 7 patients with a scan diagnosis of epididymo-orchitis with abscess the diagnosis was confirmed during the operation or by followup examination. While the scan has been a simple, safe, rapid and reliable technique to differentiate acute and subacute lesions, it has proved to be of limited diagnostic significance in cases of chronic intrascrotal lesions and carcinoma.


The management of post-prostatectomy vesical neck contracture.

Current evidence suggests that the small fibrous hyperplastic intraurethral prostate traumatized by wide extensive electroresection is the most important etiologic factor in post-prostatectomy vesical neck contracture. The preferred mode of management has not been well defined. Although transurethral resection is most often used recurrent contractures occur frequently. We report the complete objective and symptomatic relief of obstruction in 8 patients with post-prostatectomy bladder neck contracture treated with cold knife incision. This simple technique appears to obviate recurrent contracture and may well be the treatment of choice for this condition.


Modification of lymphocyte responsiveness by hormone used in the treatment of urologic malignancies.

Recognition that the immune system may be important in regulating the clinical evolution of tumors and that corticosteroids suppress immune responses lends relevance to determining the concentrations in which sex hormones, currently used in the treatment of urologic malignancies exert immunosuppressive effects. We have investigated the effects of the sex hormones, diethylstilbestrol, diethylstilbestrol diphosphate, testosterone and progesterone, on in vitro lymphocyte blastogenesis as determined by 3H thymidine incorporation after stimulation with phytomitogens and alloantigens, and compared their effects to the effects of cortisol. Compared to cortisol these sex hormones are relatively weak suppressors of lymphocyte blastogenesis (cortisol 10(-7) M, progesterone 5 times 10(-6) M, testosterone 5 times 10(-5) M, diethylstilbestrol 5 times 10(-5) M and diethylstilbestrol diphosphate 10(-3) M) and probably are not significantly immunosuppressive in commonly used pharmacologic dosages. Similar results were observed with the T lymphocyte mitogens, phytohemagglutinin and concanavalin A, and in the combined T and B cell mitogen pokeweed. The fact that alloantigen-stimulated lymphocyte blastogenesis also was suppressed by diethylstilbestrol indicates that sex hormones exert their effects on the lymphocytes and not on the mitogens. Furthermore, sex hormones were not found to be cytotoxic to lymphocytes. It is postulated that the sex hormones tested act by suboptimal binding to glucocorticoid receptors in the lymphocytes and that the relative immunosuppressive potency of a given hormone is related to its affinity for the glucocorticoid receptor.


Sphincterometry in the diagnosis of male bladder outflow obstruction.

Pressure patterns recorded during urethral sphincterometry in 281 male patients have been analyzed and measurements of prostatic length, peak, plateau height and pressure area have been made. These parameters show significant correlations with the established pressure-flow index of urethral resistance. Sphincterometry is a useful adjunct to the established urodynamic techniques for the diagnosis of bladder outflow obstruction in the male patient.


The syndrome of detrusor-sphincter dyssynergia.

The syndrome of detrusor-sphincter dyssynergia is described in a series of patients with a variety of neurological diseases. Bladder function studies using cystometry, sphincter electromyography and electromyelography revealed that sphincter dyssynergia may be associated with detrusor hyperreflexia as well as detrusor areflexia. Impaired function of the pyramidal tracts was documented in all patients and the majority showed impaired segmental innervation of the bladder and urethra.


Experience with the artificial urinary sphincter at Michigan.

Between August 1973 and May 1975, 9 patients with various causes of urinary incontinence were treated with the implantable artificial sphincter. Of these 9 patients 6 remained continent on long-term followup. Complications, observed in 5 patients, were corrected successfully in 2 but were treated unsuccessfully in 3 and resulted in partial or complete removal of the prosthesis. The need for screening the patient preoperatively, meticulous operative techniques and continuous postoperative surveillance is emphasized. An orderly method of evaluating the problem is presented.


The demonstration of vesicoureteral reflux under general anesthesia.

With the improved quality and increased availability of voiding cystourethrography in children while they are awake many have considered obsolete the static cystogram done with the child asleep in conjunction with cystoscopy. Our review of 100 girls undergoing both studies as part of the same urological evaluation for urinary tract infection reveals that they are useful and complementary at times.


Comparative results of urological evaluation of children with initial and recurrent urinary tract infection.

Complete urologic evaluation was done on male and female children having initial or recurrent urinary tract infection. Of 200 girls having recurrent urinary tract infection 43 per cent showed ureterovesical reflux on the cystogram. Of 39 boys with recurrent urinary tract infection 41 per cent had reflux. Thus, the incidence of reflux is comparable in male versus female patients. Of 47 girls studied after only 1 episode of urinary tract infection 36 per cent had reflux and of 20 boys studied after initial infection 45 per cent had reflux. The data indicate that initial or recurrent urinary tract infection in boys or girls is of equal significance. All other factors being equal, failure to evaluate a patient urologically after 1 or more episodes of urinary tract infection solely because of the sex of the child could mean that a potentially severe urinary tract abnormality can be undetected and untreated.


Obstructive uropathy in the neonate: the case for early definitive correction.

Recently, early temporary supravesical urinary diversions undoubtedly have saved the lives of many neonates with severe obstructive uropathy. These procedures will continue to have an important role in the management of such patients. However, the initial success of these procedures should not obscure the difficulties that they might initiate in the ultimate rehabilitation of the urinary tract. In many instances it may be safer and more reliable to carry out a primary, definitive, corrective procedure initially.


Bilateral renal vein and inferior vena cava thrombosis with nephrotic syndrome treated by thrombectomy: case report with 3-year followup.

A previously healthy 19-year-old woman taking anovulatory medication presented with symptoms of the nephrotic syndrome and lupus erythematosus. Diagnosis of inferior vena cava and bilateral renal vein thrombosis was made angiographically. The patient was treated successfully by thrombectomy and anticoagulation, and remains well 3 years later. Laboratory data indicate normal renal function and only mild proteinuria. This is the longest followup of a patient with this entity reported in the literature.


Late complications of abdominal aortic grafting: urologic aspects.

After an abdominal aortic operation late suture line failure with hemorrhage and false aneurysm formation can produce symptoms and/or findings of urologic disease. The urologist should be aware of the non-urologic implications in such instances.


Prostatectomy in hemophilia.

The advent of factor VIII concentrates has made it possible for true hemophiliac patients to survive to an age when prostatic obstruction is common. Formerly, operative procedures in these patients were limited to life-threatening situations but now prostatic operations should not be feared as long as adequate serum levels of factor VIII can be achieved and maintained throughout the wound healing period. Allergic reactions, hepatitis and cost are significant factors to consider when the concentrates are administered but hemophiliac patients are able to undergo treatment without a significantly increased risk to their lives.


Symposium: Methods of reconstruction in tympanoplasty. I. Management of fixation of malleolus head and incudal body in tympanoplasty.

Depending upon the presence or absence of stapedial mobility, treatment of ossicular fixation will vary. Methods and indication to preserve the fixed malleolar head and neck are discussed and positive indications for removal of the incus are enumerated. A description of various surgical techniques of interposition of the incus between the mobile malleus and stapes to relieve stapes fixation and restore continuity are described in detail.


Symposium: Methods of reconstruction in tympanoplasty. III. The anterior canal wall bulge: indications and techniques for removal.

The bulge of the osseous anterior canal wall frequently prevents visualization not only of the margins of the perforation but also of the pathologic changes in the middle ear. In such instances, removal of this bone is absolutely necessary. In other instances, removal of the bulge facilitates both the surgical procedure and postoperative care. While the skin over the bulge may be sacrificed, it is preferable to preserve the skin by creating either a laterally or medially based flap. This provides access to the bone which is removed with motor driven burrs. The techniques are essentially the same whether the approach is through the canal or from behind the ear.


Symposium: Methods of reconstruction in tympanoplasty. IV. Conchal perichondrium as a tympanic graft with maintenance of drum conization.

Tympanoplasty reconstruction of the eardrum approached normal anatomy and function with the use of connective tissue to replace the substantia media. Perichondrium taken from the concha is preferred because it lies flat and is easy to manipulate. Grafts placed on the outer surface of the remnant tend to lateralize with loss of drum conization. Grafts placed on the undersurface of the remnant do not have this disadvantage.


Symposium: Methods of reconstruction in tympanoplasty. V. Prevention of blunting the anterior canal drum head contour--Plester technique.

A technique of grafting tympanic membrane perforations which incorporates the sandwiching of a temporalis facial graft between the epithelial and connective tissue layers of the remaining drumhead is presented.


Maintenance of conization of the drumhead in tympanoplasty.

Temporal fascia placed medially to the tympanic remnants with the malleus handle exteriorized has been used successfully in over 1,200 tympanoplasties with adequate conization of the drumhead produced in most cases.


Homograft replacement of the tympanic membrane.

This paper presents the authors' experiences with one method of reconstruction of the tympanic membrane when it is totally absent or when there is a fixed, retracted, defective, or absent malleus. Ten patients undergoing surgery for chronic suppurative otitis media between April, 1971, and January, 1973, had homograft tympanic membranes and/or ossicles used to reconstruct the defect in the tympanic membrane or ossicular mechanism. The patients had certain clinical and surgical characteristics in common: 1. all had either an absent tympanic membrane or almost total perforation of it; 2. all were operated upon in the absence of acute infection or active drainage; cholesteatoma, if present, was totally removed; 3. all had patent eustachian tubes; 4. all had intact middle ear mucosa at the time of utilization of the homograft; 5. all patients were operated upon by the same surgeon; 6. all of the homografts were obtained within 24 hours and were used within one month after the death of the donor; 7. all of the homografts used had been preserved in 70 percent ethyl alcohol; 8. all of the homograft materials came from donors who were under 40 years of age at the time of death and who died of accidental causes. (None of the donors was known to have any pre-existing disease); 9. all homografts, after being placed in proper position in the recipient, were covered with ear canal skin; 10. all patients received homografts that were from the corresponding ear of the donor. (In other words, right ear homografts were used in the patient's right ear, etc.); 11. whenever the tympanic ring was greater than the size of the homograft, the patient's temporalis fascia was used in conjunction with the homograft tympanic membrane to bridge the defect; 12. all patients had the middle ear packed with gelfoam prior to inserting the homograft (compressed gelfoam was used also for the outer packing); 13. none of the patients had tissue-typing procedures carried out in an effort to match the donor and the recipient, nor was any attempt made to match the sex of the donor and the recipient; and 14. all patients received antibiotics postoperatively; however, none received immunosuppressive therapy postoperatively. In 3 of 10 patients receiving homografts, the malleus was normal, and only the tympanic membrane was reconstructed. In seven others there was a fixed, retracted, defective or absent malleus in addition to the tympanic membrane defect.(ABSTRACT TRUNCATED AT 400 WORDS)