An investigation of fluoride protection against dietary induced osteoporosis in the rat.

The purpose of this study was to determine whether the accumulation of substantial levels of fluoride in the skeleton during bone formation would significantly reduce, or prevent, the occurrence of osteoporosis experimentally induced at a later time with a low mineral-containing diet. Male weanling rats were pretreated for 15 weeks with either 0 or 50 ppm F in their drinking water, followed by treatment for four to twelve weeks with diets either optimal or deficient in both Ca and P. Intake of the Ca and P deficient diet resulted in a progressive loss of bone mass (per unit volume of femur), with little effect on the remaining bone. High skeletal F offered no protective effect. Ca and P depletion caused a significant decrease in bone breaking strength but produced only slight reduction in percentage ash in bone. Fluoride offered little protection against either. Neither skeletal F nor dietary Ca and P levels influenced the concentration of Ca, P or Ca/P ratios in bone ash. Skeletal Mg levels were slightly lower in the Ca and P depleted rats; however, F treatment essentially eliminated this. Ca and P depletion resulted in higher F levels in both incisors and bone. We conclude that osteoporosis was produced by feeding the Ca and P deficient diet. High skeletal F did not prevent nor reduce the severity of this dietary-induced osteoporosis.


Assessment of the ischemia of the femoral head in idiopathic avascular necrosis. A preliminary report.

Hemodynamic (CATELIX/DF32P system) assessment of circulatory disturbances in idiopathic avascular necrosis (12 femoral heads of 10 patients), demonstrate that vascularity in the necrotic portion was less than 15 per cent (mean, 9%) of normal levels. In 2 cases reassessed after surgery, the recovery of vascularity was to 98 per cent. The vascularity in the translucent portion was fairly well maintained at 50 to 139 per cent. From a histological point of view, vascularity of less than 15 per cent is indicative of ischemia and necrosis of the bone. Hemodynamic methods demonstrate the presence of focal necrosis, long before there are obvious roentgenological abnormalities. The CATELIX/DF32P system is better than the G-M probe/32P system in some respects and is now readily available.


An irreducible juxta-epiphyseal fracture of the proximal phalanx. Report of a case.

The causes of irreducibility of juxta-epiphyseal fractures of the proximal phalanx are illustrated in a patient with button hole rent in the periosteum and extensor hood mechanism causing trapping of the distal fragment. The entrapment, in the manner of a Chinese finger trap, was aggravted by traction on the digit. Open reduction was necessary to reduce the fracture.


Brachial plexus palsy in the newborn. Incidence and prognosis.

The problem of the accuracy of current data regarding prognosis of brachial plexus palsy in the newborn infant was studied by means of a retrospective review of hospital records, letters to parents of affected infants, and follow-up examinations of available children. Only 11 cases of mild upper plexus injuries were found in a review of 19,314 newborn infants' charts, an incidence of 0.57 per 1,000 live births. Four cases were available for examination and 4 others were evaluated from follow-up records. Three were lost to follow-up. No instance of permanent paralysis was found, thus raising the possibility that while permanent paralysis is still seen, it may now represent a diminishing minority of the total, at least in the United States with modern obstetrical care. This is in contrast to the opinion one might formulate from a review of the orthopedic literature on this subject.


Fracture of femoral prostheses in total hip replacement. A clinical study.

The clinical features are presented of 17 fractured Charnley femoral prostheses occurring over a period of about ten years and arising from some 6,500 operations, with more than a 3 1/2 year follow-up. The patients especially at risk are males weighing over 170 lb (75.5 kg) and from these is an obvious need for a heavier design of prosthesis. Whereas the overall fracture rate is only 0.23 per cent, the rate for males over 196 lb (88 kg) is 6.0 per cent. It is believed that defective surgical technique, in failing to provide adequate support by cement to the concavity of the upper levels of the prosthesis is probably the main cause of fracture and reasonably good cement technique explains why the fracture rate is not higher in the present series. Indications for improving cement technique are outlined.


Scheuermann's juvenile kyphosis. A histologic study.

The case histories and gross and microscopic findings of two adolescent patients with Scheuermann's kyphosis demonstrate that the anterior longitudinal ligament is bowstrung across the apex of the hyphosis. The microscopic findings include markedly irregular end plates and end plate disruption with protrusion of disk material into the vertebral body. The ring apophysis does not show avascular necrosis. The intervertebral disk is interpreted as normal both by routine histology and electron microscopy. It is postulated that Scheuermann's kyphosis may be secondary to vertebral osteoporosis occurring during the juvenile period rather than to an intrinsic abnormality in the intervertebral disk or ring apophysis.


Osteochondritis dissecans of the elbow.

The clinical findings, roentgenographic findings, and results of various forms of treatment of osteochondritis dissecans in 50 elbows were reviewed in a study of the records of 42 patients. All the patients were males; two-thirds were between 9 and 15 years of age when they first had symptoms. Pain, loss of motion, locking, and clicking were the most common symptoms. Roentgenographically, rarefaction and flattening of the capitellum were common features. Some form of surgical treatment was used for 38 elebows; removal of loose bone and curettage and trimming of the crater were the most frequent procedures. The results of treatment were generally satisfactory. This review suggests that loose bodies should be removed and that, in most instances, no other procedures are indicated.


Early ambulation following spinal fusion and Harrington instrumentation in idiopathic scoliosis.

Eighty-six patients with idiopathic scoliosis managed by Harrington instrumentation and spinal arthrodesis were ambulated 10 days following surgery. Preoperative reduction of the curves was obtained by Cotrel traction and modified Cotrel localizer cast. Patients were kept immobilized in plaster cast for 7 months following operation. No significant loss of correction was found in these patients ambulated early as compared to a previous group kept recumbent for 3 to 6 months and reported by the authors (DBL). The only exception to this was a patient with double structural curve patterns. A successful surgical program for most cases of idiopathic scoliosis included: (1) Preoperative reduction and balancing of curves by non-skeletal traction and/or correction body cast; (2) Meticulous spinal arthrodesis and employment of Harrington distraction internal fixation; (3) Autogenous iliac bone graft; (4) Ambulation at two weeks following surgery in a well fitting body cast and removal of this cast after 7 months. Deep infection rate was 1 per cent without the use of routine prophylatic antibiotics. One neurological complication resulted from the use of a single distraction rod bridging two curves where the rod was not prebent to allow for kyphosis. There were no pseudarthroses. The average follow-up was 28 months with a range of 18-39 months.


The Milwaukee brace in paralytic scoliosis.

The Milwaukee brace possesses excellent passive properties in addition to the well known dynamic action, and is of definite value in the bracing of paralytic curves in children in whom a fusion should be de-delayed. This application is a temporary but at the same time a long term expedient to allow spine growth prior to surgery.


Range of motion studies for total hip replacements. A comparative study with a new experimental apparatus.

Significant differences in ROM exist between different THR prosthesis designs: several of the prosthesis designs tested are marginal in flexion; several millimeters of socket wear will decrease the ROM. The results also emphasize the importance of proper component orientation at surgery. The surgeon has less latitude in orienting the components of a THR with limited ROM. Subluxation and dislocation due to rim contact can be minimized with most prosthetic units by instructing the patients to abduct and/or externally rotate their hips during acute flexion. Analyses suggest that impingement of prosthesis neck and socket rim may lead to increased risk of dislocation and increased rim wear. Prostheses with adequate ROM for everyday activities should provide stability, less frequent neck and socket contact with decreased rim wear, less force transmission to acrylic-bone interface, and less diminution of ROM with wear of the socket wall.


Stablization of the spine in the surgical treatment of severe spinal tuberculosis in children.

This is a 5- to 10-year survey of 160 children, all with severe surgically-treated spinal tuberculosis. The treatment consisted of: anterior spinal fusion alone, anterior with posterior fusion, posterior fusion alone and posterior with anterior fusion. The results indicate that in the less severe cases, where an abscess is not evident on plain radiographs, psoterior fusion alone can be of value in the growing spine. In severe cases, especially where an abscess is seen, the combined approaches give the best results. The risk of posterior fusion alone is an unsatisfactory, long term neurological outcome in too many patients. The combined procedure of anterior fusion with posterior fusion is the treatment of choice for all immature spines with this disease.


Bladder fistula following total hip replacement using self-curing acrylic.

A case of a bladder fistula following total hip replacement is attributable to thermal injury by self-curing polymethylmethacrylate projecting into the retropubic space.


Fixation of the femoral head prosthesis with methylmethacrylate.

The techniques used in fixation of the femoral prosthesis in total hip replacement are often based on empiricism and raise questions about: venting the medullary canal with a catheter during the insertion of cement; the inclusion of blood into cement during insertion with possible deleterious effects; recementing a prosthesis; increased strength imparted to an endoprosthesis by cement itself. Biological variables are minimized by the use of paired wet formalin preserved femurs; one acting as control. A single static load was applied until failure. The results show trends and gross differences and are not statistically evaluated. The methylmethacrylate-bone-metal system consistently produces good results with reasonable but not careless variations in technique. A hemiprosthesis is presented which can easily be converted to a standard Charnley prosthesis by using a small amount of fresh cement.


Antibiotic bone penetration. Concentrations of methicillin and clindamycin phosphate in human bone taken during total hip replacement.

Clindamycin phosphate or methicillin was given preoperatively to 47 patients undergoing hip operations for arthritis. Serum, cortical and cancellous bone specimens were simultaneously obtained during the operation and assayed for antibiotic concentrations. Both gave levels in bone/serum concentration ratio significantly higher for clindamycin than methicillin. No patients studied developed deep infection. It is concluded that clindamycin phosphate and methicillin give comparable concentrations in bone which exceed the minimal inhibitory antibiotic concentration of gram-positive pathogens that frequently cause infection after orthopedic surgical procedures.


Viscoelastic behaviour of deformed spines under correction with halo pelvic distraction.

The applied tensile tractive force between skull and pelvis of the Halo Pelvic Distraction appliance has been measured using a simple compression spring device. Details of these external force measurements with daily distraction and correction of spinal deformity are illustrated for 10 patients which include tuberculous kyphoses, paralytic scolioses, and congenital and idiopathic scolioses. The relationships between applied load, time, amount of distraction, and extent of spinal curvature were studied in terms of the biomechanical proerties of elasticity and plasticity. A linear relationship exists between the total distraction distance and the reduction in the angle of the spinal deformity. For this correction procedure the rates of distraction, the total distraction amount, the total duration of the distractional period, and the maximum load depend on each individual spinal deformity with its particular peculiarities.


The operating room environment as affected by people and the surgical face mask.

The microbiological counts were determined in an operating room suite of 8 rooms and a hallway. The bacterial counts in an empty operating room jumped statistically from 13 CFU/ft2/hr (+/- 31) to 24.8 (+/- 58.8) when the doors were left open (people in the hallways) and 447.3 (+/- 186.7) when 5 people were introduced. The wearing of a surgical face mask had no effect upon the overall operating room environmental contamination and probably work only to redirect the projectile effect of talking and breathing. People are the major source of environmental contamination in the operating room.


Evaluation and optimum use of directed horizontal filtered air flow for surgeries.

Airborne micro-organisms, a suspected cause of surgical wound infection, are significantly reduced by the use of filtered unidirectional air flow (UAF) in operating rooms. A horizontal UAF system was installed at UCLA for evaluation and to determine procedures which would optimize its use. Major findings are listed: though the air flow was found to be somewhat turbulent and non-uniform in velocity downstream from the filter-bank entrance, the gross flow direction was maintained throughout the protected region; airborne particles were swept downstream with little vertical drop and no large scale recirculation; proper orientation and placement of objects in the clean air stream maximized its purging effect; correlation of non-viable with viable particle counts was not possible; better control of sources of contamination, particularly the operating team, would further reduce the potential for airborne infection; as yet there is no definitive proof that the addition of filtered UAF in a modern operating room reduces occurrences of deep wound sepsis.


Combined staged anterior and posterior correction and fusion of the spine in scoliosis following poliomyelitis.

The problems with severe forms of scoliosis following poliomyelitis include the associated muscle imbalance, soft tissue contractures and pelvic obliquity. Such deformities militate against optimal correction and maintenance of that correction and their treatment is often marred by pseudarthroses. Seventeen patients with an average curve of 93 degrees have been treated and followed for up to 38 months. Preliminary traction was used in 8 patients, then a staged anterior and posterior correction and fusion was done, using Dwyer's instrumentation of the major curve in all and a Harrington rod to supplement the posterior fusion in eleven patients. With this technique the major curve was corrected by 80 per cent with an average 2 per cent loss over 18 months. No pseudarthroses were seen when the Harrington rod was used. Great care must be taken if halo-pelvic traction is to be used for patients with pelvic obliquity, for preliminary correction halo-femoral traction will often be adequate. In the more severe forms of paralytic scoliosis a combined staged anterior and posterior correction and fusion should be considered if the aim is maximal correction of the scoliosis and avoidance of pseudarthroses.


Treatment of distal femoral fractures with early weight-bearing. A preliminary report.

Ten patients with 11 supracondylar fractures of the femur were treated with early weight-bearing and early knee motion. All fractures united. A good functional range of painless knee motion was restored in each case. No deformity or shortening developed during treatment in the cast-brace.


Ossicles of knee menisci. Report of seven cases.

Seven cases of ossicles in the posterior horn of the medial meniscus revealed that: trauma is not necessarily an antecedent; some knees with ossicles are asymptomatic; some knees may be treated conservatively and without surgery; ossicles can be distinguished from loose bodies under fluoroscopic examination. Microscopically the ossicles are living bone. Although the etiology is not proven, perhaps merit should be given to the theory of a vestigial or sesamoid-like bone.


Ultrasonic study of normal and fractured bone.

Ultrasonic velocity measurement in bone can be used as a clinical tool that will accurately and objectively monitor the progress of fracture healing. This technique may provide a rational basis for evaluating the effectiveness of various modalities in clinical treatment. The eventual goal of this technique is to determine the status of healing fractures, prescribe appropriate treatment, give the rationale for the timing and form of a rehabilitative program that would accelerate the patient's return to productivity. An instrument has been developed to measure ultrasonic velocity in the long bones of the extremities. Serial measurements of tibial fractures and the measurement of a large group of normals shows no statistically significant differences in ultrasonic measurements have been found on the basis of race, sex, or pregnancy among normals. But a numerically small but statistically significant variation with age was found. While the number of fracture cases observed was small, the evidence is clear that ultrasonic measurement in fractured tibia may give a more reliable indication of the general pattern of healing response than the clinical and roentgenographic examination.


Some new observations on the functional anatomy of the lower cervical spine.

The ligaments are a major stabilizing component of the cervical spine and are critical for spinal stability as well as stabilization therapy. Relatively little information is available on the anatomic details and function of the cervical ligaments. Fifteen fresh cervical spines were dissected and the ligaments examined grossly and functionally. Eight different intrinsic ligaments of the lower cervical spine were identified. The largest and most rigid of these are the annulus fibrosus, posterior longitudinal ligament, and capsular ligament. By virtue of their size and certain biomechanical observations, these ligaments stabilize the cervical spine. The other ligaments play a more specialized and secondary role. The intertransverse ligaments, although thin and frail, are consistently found and appear to limit rotation and lateral bending, the anterior longitudinal ligament limits extension and the interspinous and supraspinous ligaments limit spinal flexion. Under physiologic conditions, the elastic ligamentum flavum permits extension of the spine without impinging upon the spinal cord or nerve roots. As a group, the ligaments of the cervical spine control motion within finite limits without jeopardizing spinal cord or nerve root function.


Giant-cell tumors of the spine and sacrum causing neurological symptoms.

Pain and neurological disturbances were the most frequent symptoms in patients with giant-cell tumors of the spine (4 cases) and sacrum (1 case). A good prognosis is possible in patients with vertebral tumor localization. There were no recurrences at follow-up 6 to 16 years after the first admission. The patient with a sacral tumor is alive more than 15 years after the first admission with some remaining neurological symptoms. Early surgical and/or radiation therapy is important. If institution of treatment is delayed more than three months after the onset of nerve root symptoms, there is a great risk of development of irreversible neurological lesions.


Intrapelvic protrusion of the acetabular component following total hip replacement.

Protrusion of the acetabular component into the true pelvis following total hip replacement has occurred in 5 patients, 4 with severe rheumatoid arthritis and 1 with a destructive type of degenerative hip disease. Preoperatively all hips had severe protrusio acetabuli, a markedly thin acetabular medial wall and advanced osteoporosis. Four had a McKee-Farrar prosthesis, a metal-to-metal device with high frictional torque, particularly when the contact is equatorial, and no damping capacity against marginal impingement in the extreme range of motion. In order to reduce the incidence of intrapelvic protrusion, extreme care should be given to preserve the medial bone stock of the acetabulum, more so when it is already damaged or defective. If anchoring holes are used they should be restricted to the superior ilium, pubis and ischium and should not perforate the medial wall. Once loosening is present, reoperation is indicated to avoid progressive bone reabsorption by the abrasive motion of the loosened prosthesis, that might lead to irreparable bone loss. To reduce the stress transmitted to an already weakened acetabulum, select a total prosthetic device with low friction; fix it with acrylic cement in order to distribute the stress over a large surface; carefully orient both components to avoid marginal impingement; be certain to preserve the medial wall as much as possible and if it is already defective reinforce it by bone grafting and/or wire mesh.


The effect of movement on the holding power of screws in bone.

Movement between screw threads and bone inhibits bone formation, revascularization and remodeling of dead bone. Movement causes the screw to become enveloped by fibrous tissue in response to necrosis and resorption of adjacent dead cortical bone. This results in a radiologically discernible radiolucent "halo" about the screw, a certain sign of screw loosening.


The reaction of cortical bone to compression by screw threads.

Cortical bone subjected to compression by screw threads retains its integrity and is not resorbed. Screws which generate compression at the interface of their threads with bone can be expected to provide adequate fixation until bone union occurs.


Trabecular stress fractures.

This study was conducted to evaluate the theory that increased rigidity in the subchondral cancellous bone and trabecular stress fractures are responsible for the development of osteoarthritis. Histological sections of the entire femoral head were examined in 80 normals, 50 cases with early degenerative changes, and 50 cases with advanced osteoarthritis. It was found that trabecular stress fractures occur normally and show no greater incidence in early osteoarthritis. Increase in thickness of the trabeculae not associated with fractures is seen, but only after considerable cartilage disruption. It is concluded that trabecular stress fractures are not of importance in the development of osteoarthritis.


An experimental study on the significance of muscle tissue interposition on fracture healing.

Ten ulnae of mongrel dogs were osteotomized and a 3 to 5 mm cylindrical segment of bone removed from each shaft. In 10 ulnae of the opposite forelimb, living muscle tissue was placed in the resection site. The control ulnae (Set 1, Set 2) revealed 60 per cent unions, while the experimental ulnae revealed 100 per cent non-unions as determined by radiological and histological examination. Although necrotic muscle will be invaded by primitive bone, healing is certainly delayed or does not occur. A large muscle mass contributes a barrier too large to be successfully incorporated into the healing process of a fracture of the shaft of a long bone. On the basis of this experiment fractures should be opened and obstructing tissue removed whenever conservative measures fail to remove muscle interposition.


Reversibility of joint changes produced by immobilization in rabbits.

Rabbits knee joints which had been immobilized for only 2 weeks regained motion during the first 2 months of remobilization. Histologically, joint tissues were normal. Only 9 of the 14 rabbits immobilized for 6 weeks regained normal or partial knee motion. Animals that regained knee motion generally did so during the first 4 months of remobilization. There are 2 types of repair of the damaged cartilage; replacement by fibrocartilage and proliferation of chondrocytes. Normal chondrocyte alignment and normal collagen fibril orientation was not restored. Repaired cartilage did not withstand normal joint stress.


Cervical spondylotic myelopathy: a cooperative study.

A series of 521 cases of CSM in 22 clinics in Spain and Portugal were studied. The severity of the clinical picture, both before and after the operations, was graded following a six point scale (a modification of Nurick's). The operations the patients underwent were classified into eight types and their results expressed by using the same scale. Some improvement has been attained in all grades of myelopathy with all types of operations, but better results, especially in advanced cases, have been obtained when surgical fixation of the spine, as well as laminectomy, has been carried out.


Electro-oculographic study of caloric vestibular reactions in patients with severe head injuries.

In this study electro-oculographic recordings were made after caloric vestibular stimulation (C.O.G.) in 42 patients with severe head-injuries. The curves with eyes open and the changes when eyes were closed were evaluated and scored. A correlation was found between the C.O.G. and the state of consciousness but only the degree of improvement of the C.O.G. showed a good correlation with the clinical improvement. The presence of a paradoxical response in patients with a prolonged coma was found to predict possibilities of further improvement. It was proposed that in the patients with a paradoxical response a rather diffuse biochemical dysfunction of the brain-stem was present, which could be influenced by treatment. In the second part of this study the results of the trials with a treatment with L-Dopa and physostigmine are given. It was found that patients in a vegetative state or in a state of prolonged coma could be stimulated with the therapy only when the paradoxical response had been present. L-Dopa and physostigmine respectively improved the motor pattern and the contact activities.


Treatment of the chronic progressive form of multiple sclerosis with a combination of cyclophosphamide and prednisone.

32 patients with the chronic progressive form of the multiple sclerosis were treated with high doses of cyclophosphamide and prednisone during 20 days, to produce immunosuppression. The effect of treatment was measured by scoring three different Kurtzke scales just before treatment (1), just after treatment (II), and 3 months after treatment (III). The results indicate that in the treatment period I to II most patients improve, some dramatically. The improvement continues in 15 of 25 patients scored between 6 and 33 months after treatment. Better results were found in patients with shorter duration of their disease. More improvement is found as the IgG percentage of the spinal fluid at I is higher. The improvement is less when the initial condition (I) is more serious.


Antibiotics--1975.

In the author's opinion, nearly all common pediatric infections can be treated with penicillin G, oxacillin or nafcillin, ampicillin, sulfa, or kanamycin. Nevertheless, the pediatrician should also be knowledgable concerning the indications for use of the other antibiotics mentioned in this review.


A case study of neurosis secondary to trauma in an eight-year-old girl. Comments on the tendency for psychogenic illness to become chronic.

This case study deals with an eight-year-old girl who developed persistent abdominal pain and vomiting for which no physiological cause could be discovered. After two months of unsuccessful treatment for her illness, the girl was referred for a psychiatric consultation. During the psychiatric interview, the psychogenic nature of the girl's illness became readily apparent, as did the nature of the conflict which had produced it. The tendency is strong for psychogenic illness, such as this, to become chronic without psychiatric treatment. Many physicians are reluctant to apply clinically basic psychiatric techniques to the treatment of physical illness. A suggestion is made that closer collaboration between psychiatry and other medical specialties could be of great value in preventive medicine.


Mild cystic fibrosis presenting as an asymptomatic distended appendiceal mass: A case report.

A case of cystic fibrosis presenting as a right lower quadrant mass in a five-year-old white female is presented. At laparotomy, a mucoid, impacted appendix was found which microscopically suggested the diagnosis of cystic fibrosis. Cystic fibrosis must be added to conditions presenting with abdominal masses.


Can the growth of a neuroblastoma be influenced by a child's nutritional state? Observations in a patient treated for kwashiorkor and later given a restricted diet.

A 17-month-old Thai female with neuroblastoma presented with an abdominal mass and the classical findings of kwashiorkor. Concomitant with effective repair of the child's protein deficit, the mass enlarged dramatically and metastases were noted. This is the first known report of such an occurrence.


Incontinentia pigmenti with unusual features.

A case is presented of incontinentia pigmenti with severe neurological handicaps and unusual features such as single umbilical artery, pigmented lesion at birth, and biochemical changes including elevated alkaline phosphatase and immunoglobulin M.


Distribution of salicylate between neonatal and maternal serum at diffusion equilibrium.

The post-distributive neonatal:maternal plasma salicylate concentration ratio following salicylate administration to the mother before delivery is appreciably higher than unity. The protein binding of salicylate and the albumin concentration in one such plasma pair were considerably higher in the neonatal than in the maternal plasma. Equilibrium dialysis of neonatal plasma or serum from 6 newborn infants against that of their mothers produced a neonatal: maternal salicylate concentration ratio above unity in all cases even if the albumin concentration in the neonatal serum did not exceed that in the maternal serum. However, there was a strong correlation between the neonatal:maternal concentration ratios of salicylate and albumin. These observations demonstrate that conclusions concerning the distribution of a drug across the placenta in relation to its plasma protein binding characteristics must be based on the results of binding studies with plasma or serum from neonates and their mothers, and not from other adult subjects.


EPEG, a new antineoplastic epipodophyllotoxin.

Nine patients were studied with tritium-labeled EPEG, a new epipodophyllotoxin antineoplastic agent. Four patients received 220 and 5 received 290 mg/sq m body surface area intravenously in 500 ml in 1 hr. Postinfusion plasma decay was biphasic with mean values for the parameters at 220 mg/sq m, A, 25.8 mug/ml; B, 3.35 mug/ml: alpha, 0.50 hr-1; beta, 0.074 hr-1, and mean values at 290 mg/sq. m, A, 33.7 mug/ml; B, 4.35 mug/ml; alpha, 0.36 hr-1; beta, 0.066 hr-1. Mean volume of distribution was 32.07% of body weight. Urinary recovery was 43.5%, of which 66.8% was unchanged drug. Penetration of drug into the cerebrospinal fluid was poor. The results indicate that both renal excretion and metabolism are important for elimination of the drug.


PTG, a new antineoplastic epipodyphyllotoxin.

The pharmacology of 4'-demethylepipodophyllotoxin 9-(4,6-0-thenylidene-beta-D-glucopyranoside) PTG, a new anticancer drug, is reported. Six patients with advanced cancer were treated with PTG (67 mg/m2 of body surface area intravenously) specifically labeled with tritium as the first dose of a weekly x 6 course. Recovery of drug in the urine was 44.49 +/- 8.2% of the administered dose in 72 hr, of which 78.7 +/- 5.1% was metabolite. Recovery in the feces was 0 to 10.05% in 4 patients. Plasma decay fitted the equation Cp = Ae(-alphat) + Be(-betat) + Ce(-gammat) by nonlinear least-squares regression. Mean values for the parameters (after infusion) were A 14.3 +/- 5.5, B 9.66 +/- 3.98, C 2.44 +/- 1.33 mug/ml; alpha 2.05 +/- 1.25, beta 0.26 +/- 0.15, gamma 0.038 +/- 0.016 hr(-1). Levels of drug in the cerebrospinal fluid (CSF) were less than 1% of plasma levels in 3 patients at 24 hr after treatment and 27% in 1 patient who had had brain surgery and brain radiotherapy. Four of 4 patients considered evaluable for toxicity (greater than 2 consecutive weekly doses) developed leukopenia (WBC les than 5,000/mm3). Mean nadir of WBC was 3,600/mm3. The most marked leukopenia (WBC, 2,300/mm3) was seen in the patient with the longest terminal phase plasma half-life (38.5 hr). Two of 5 patients evaluable for response received clinical benefit (1 laryngeal carcinoma, 1 histiocytic lymphoma). It is concluded that PTG has a long terminal phase half-life (11-38.5 hr), is largely metabolized, and does not penetrate the normal blood-brain barrier.


The management of traumatic tattoos.

Blast injury traumatic tattooing is a discouraging problem, because concomitant injuries so often preclude adequate preventive measures at the time of injury, and treatment is frequently less than satisfactory. The patient must be cautioned that all of the tattooing is not likely to be eliminated. We favor planned staged excisions, using deep dermabrasion as a final step.


Reconstruction of the lower face and lips.

The first step in rehabilitation of massive lower face injuries is usually control of drooling by the Wilkie operation. When destruction is extensive, the floor of the mouth, chin, upper neck, and mandible should be first restored as a foundation on which the lower lip is independently reconstructed. Local tissue should be used as much as possible. All remnants of normal lip tissue should be conserved and utilized in the reconstruction. When both lips are damaged, upper lip segments are often best used to fill out the lower lip, with total reconstruction of the upper. Although many of the principles of treatment of these injuries are well established, there are still major unsolved problems. These include adequate support of the lower lip, maintenance of the flat shape of the lips, and determination of the end-point of surgery.


Phase analysis of platelet aggregation in acute disturbances of cerebral circulation.

In 120 patients with atherosclerosis, complicated in 43 patients by a haemorrhagic, in 47 patients by an ischaemic, and in 30 patients by a transient cerebral insult, phase analysis of platelet aggregation was performed by the turbidimetric method according to Born with graphic recording according to O'Brien. An increase in the platelet activity was found in ischaemic insult, manifesting itself by the occurrence of spontaneous aggregationin 60% of the cases, an acceleration of ADP-induced aggregation, and the second aggregation phase in all patients examined. A direct correlation was revealed between the secondary aggregation and the intensity of spontaneous and of ADP-induced aggregation, and the possibility of a transformation of the spontaneous into the secondary aggregation of platelets was demonstrated. Haemorrhagic insults were characterized by the absence of spontaneous and secondary aggregation and by the suppression of ADP-induced aggregation. In a transient insult, the mean values of the aggregatogram items did differ from normal. In vitro, the role of increased permeability of platelet membranes in the mechanism triggering off spontaneous aggregation and the second phase of ADP-induced aggregation was documented.


Characteristic structural features of fibrous rings and their connexion with the human cardiac conduction system.

In surgical treatment of acquired defects of mitral, aortic, and tricuspid valves, in many instances severe disturbances of cardiac conduction are observed. With due regard to the individual and typical anatomical features of human heart, the author investigated the structures of fibrous rings and triangles and their interrelationships with the cardiac conduction system. The material studied consisted of 230 hearts obtained from persons aged 20-80 years. The author assumes that within the heart cavity "dangerous zones" have to bbe singled out, whose traumatization in heart surgery may produce a disturbance of elements of the conduction system. The "dangerous zones" are situated at the base of the right-side surface of the interatrial septum above the fibrous ring of the septal cusp of the tricuspid valve, along the base of the membranous segment of the interventricular septum, in front of the posterior fibrous triangle, and at the fibrous ring encircling the bases of the posterior and right aortic semilunar valves.


Vasodepressor activity of renal medulla of spontaneously hypertensive rats.

A parallel study of plasma renin activity, renin content in the kidneys and renal prostaglandin - like activity (PGE2, A2 and F2alpha) in 10 spontaneously hypertensive (SHR) rats (Pkamoto-Aoki), and 10 control normotensive Wistar rats was carried out in order to investigate the role of humoral factors in the pathogenesis of spontaneous hypertension in rats. Peripheral plasma renin activity was assayed by the method of Serebrovskaya, while renal renin activity was estimated by the author's own modification of the method of Serebrovskaya. Prostaglandin-like activity of the renal prostaglandins was assayed by the method of Lee et al. The final evaluation of the PGE2 and PGF2alpha activity was made by biological assay on isolated rat stomach and chicken rectum strips, while PGA2 - like activity was assayed by its vasodepressor effect on the arterial blood pressure of anaesthetized, vagotomized and atropinized rats. It was established that peripheral plasma renin activity was normal, while renin activity in the kidneys of SHR with a long (11 months) duration of hypertension was decreased. Renal prostaglandin activity of SHR did not significantly differ from the controls. It is pointed out that lack of changes in the pressor and depressor renal systems indicates that renal humoral factors are not of prime importance in the patho-genesis of the chronic stage of spontaneous hypertension in rats.


Effects of papaverine, chloracyzine, and bencyclane on local blood flow and oxygen tension in cat brain.

In experiments on 100 cats with multichannel recording, the effects of three vasodilators - papaverine, chloracyzine, and bencyclane (Halidor) - on the volume velocity of the blood flow (by microthermistor technique) and on oxygen tension (by polarography) in the carotid artery, the cerebral cortex, the thalamus, and in white matter were tested. Considerable differences were found in the effects of the drugs mentioned, although all of them augment the total and local blood flow in the brain, and in most instances elevate the oxygen tension in arterial blood and cerebral tissue. Characteristic of papaverine is a uniform augmentation of blood supply to the cerebral cortex, the thalamus, and white matter, whereas chloracyzine, and especially bencyclane, primarily augment the blood supply to the cerebral cortex. In an analogous way the drugs tested influence the cerebral blood flow and oxygen tension in experimental cerebral ischaemia induced by intracarotid infusion of a serotonin solution.


Combined administration of quinidine with the beta-adrenolytic agent inderal and the local anaesthetic of the beta-aminoketone group, hexacaine, in various experimental models of arrhythmias.

If the antiarrhythmic agents mentioned above are administered in combinations of their respective isoeffective doses, following the "principle of isoeffectivity", a potentiation of their effects takes place. The authors describe methods for the preparation of combined solutions and for the toxicity testing of combined antiarrhythmic agents. When combinations are administered, the toxicity does not increase but on the contrary tends to decrease. If antiarrhythmic agents are combined without regard to the principle of isoeffectivity, the antiarrhythmic effect of the combination deteriorates, and adverse effects may be produced. The basic prerequisite of the potentiation of antiarrhythmic effects in combinations is, in the authors' opinion, the use of drugs differing in both chemical structures and mechanisms of antiarrhythmic actions.


Acute lesion of rat myocardium by a single injection of cobalt dichloride.

The formation of infarctoid areas in rat myocardium following intraperitoneal injection of cobalt dichloride (30 mg/kg) is connected with metabolic (toxic) and ischaemic lesions of myocardial cells. The ischaemic lesions are sequelae of thrombosis taking place after 3-8 hours in consequence of thrombocytic aggregation in the capillary lumen. With the aid of polarization and electron microscopy, the myocardial-cell changes in the affected zones were classed into four morphological types, as follows: contracture type, intracellular myocytolysis, primary clumpy disintegration of myofibrils, and intravital autolysis of ischaemized cells.


The role of the vascular wall in the mechanism of control of blood coagulation and fibrinolysis on stimulation of the vagus nerve.

In experiments on 50 dogs it was found that on stimulation of the vagus nerve, tissue thromboplastin and activators of fibrinolysis are released from arterial and venous walls. The release of these factors elicits changes in the blood coagulation, with a resulting acceleration of blood coagulation and an activation of fibrinolysis.


Some risk factors of ischaemic heart disease in the Prague male population.

In a representative sample of men aged 50-54 years (N = 400), the frequency and distribution of individual risk factors of ischaemic heart disease were established. In 10.3% (41 persons) no risk factor was present, whereas 36.9% (147 persons) exhibited 3-7 risk factors each. With the number of risk factors, the prevalence of ischaemic heart disease and the incidence of exercise coronary insufficiency rose statistically significantly during a 3-year follow-up period. The most frequent risk factors appear to be low physical activity, excess cigarette consumption, and body overwieght.


Electrocardiogram of posterior wall infarction.

The purpose of the study was to assess the frequency of infarction of the posterior wall of the left ventricle which shows a high R wave in leads V1-2 on electrocardiogram. Serial electrocardiograms of 1 452 patients with myocardial infarction were analyzed. Features of posterior wall infarction were found in 106 cases (7.3%). In 13 cases, the area of infarction was limited to the posterior wall; in 12 cases, concomitant features of lateral wall infarction were found; in 38 cases, the changes involved the inferior wall as well, and in 43 cases, the inferior and lateral walls were involved concomitantly. A high R wave in V1-2 was observed already in the first ECG obtained on the day of the onset of the disease in 32 out of 106 cases, while in 74 cases it appeared only in the subsequent days. High voltage of R wave was found in V1 exclusively in 20 cases, in V2 exclusively in 36 cases, and simultaneously in V1 and V2 in 50 cases. The analysis suggests that posterior wall infarction is fairly frequent (7.3%) but occurs in only 1% of cases as an isolated process. Knowledge of the features of posterior wall infarction is of practical importance; simultaneous detection of features of infarction of the posterior and the inferior or lateral walls is proof of a widespread myocardial necrosis and may be of prognostic significance.


A simple intracavitary bedside method for estimation of the P-R interval.

A simple bedside intracavitary electrocardiographic technique is described. Two electrode catheters are used: one tripolar catheter positioned across the tricuspid valve in order to record the His electrogram, and a hexapolar catheter positioned through the superior caval vein near the sinus node with the proximal electrode and 6 cm lower in the right atrium with the tip electrode. This technique allows a better analysis of intraatrial conduction, widening the interpretation of the P-A interval obtained by the His bundle electrogram.


The automated physiologic profile.

The automated physiologic profile provides the critical care physician with hemodynamic, oxygen consumption and tissue utilization data at reasonable cost. A paramedical assistant performs all data acquisition, recordings and blood sampling procedures. Data reduction is performed through use of off-the-shelf desk-top calculator equipment and accessories and a standardized graphic display is provided for the physician in charge. The physiologic profile has been utilized in high-risk patients requiring medical and surgical interventions. It is routinely employed in postoperative monitoring of cardiac patients and patients undergoing major surgical procedures with associated cardiovascular decompensation. Diagnosis of cardiac and pulmonary deterioration and promptness of advanced support interventions represent additional areas of effective clinical application.


Management of subcutaneous emphysema, pneumomediastinum, and pneumothorax during respirator therapy.

Pulmonary barotrauma developed in 18/430 patients receiving respirator support for longer than 12 hours. Pneumothorax occurred in 15 of these patients and was treated with tube thoracostomy and 15-20 cm H2O pleural suction. Full reexpansion of the lungs were achieved in all but three patients, two of whom had bronchopleural fistulae. Major complications occurred in 8/15 patients developing pneumothorax. We recommend extreme conservatism in clamping or removing tube thoracostomy. There should be no air leak and full lung expansion for 48 hours, followed by a trial of underwater seal drainage without recurrence of pneumothorax. Removal should be preceded by an additional trial of tube clamping.


Disagreements in chest roentgen interpretation.

Each of 100 chest radiographs selected randomly from a hospital population were read by five experienced radiologists. The films were rich in abnormal findings. Disagreement analysis was performed considering the entire content of the interpretation. The disagreements were graded by a panel as to type (false negative, false positive, and indeterminate) and significance. The overall repeatability of the panel's performance was 75 percent. Forty-one percent of the reports contained potentially significant errors and 56 percent indeterminate disagreements. Among all errors 78 percent were false negatives and 22 percent were false positives. The error rate varied among readers. An average of 25 percent of important findings were omitted by an individual reader. An association between specific abnormalities and the types of disagreement was found.


The effects of phlebotomy, hemodilution and autologous transfusion on systemic oxygenation and whole blood utilization in open heart surgery.

Blood utilization in 400 consecutive adult patients undergoing a wide variety of cardiovascular operations requiring cardiopulmonary bypass was documented following institution of: 1) complete oxygenator hemodilution; 2) intraoperative phlebotomy and autologous transfusion; 3) infusion of residual oxygenator red cells; and 4) use of reconstituted frozen cells in patients whose blood type was uncommon. These techniques have resulted in an average utilization of 4.8 units of blood per adult patient. Fourteen patients required no blood at all and a total of 259 patients required less than 5 units of blood during their entire hospital course. Physiologic effects of this blood program and hemodilution were evaluated in ten patients and the results indicate that marked reduction of red cell mass by hemodilution with hypothermia and low flow perfusion is not detrimental to satisfactory whole blood oxygenation during open heart surgery.


Regional pulmonary function before and after pneumonectomy using 133xenon.

Regional pulmonary function studies using 133xenon gas, spirometry, and arterial blood gas levels were performed before and 1 to 47 months after pneumonectomy for bronchogenic carcinoma in 27 patients. The mean loss in forced vital capacity was more after right pneumonectomy (44.9 percent of preoperative value) than after left lung resection (41.4 percent). There was no significant change in regional pulmonary function distribution within the remaining lung in 24 patients. Two patients developed significant changes in regional pulmonary blood flow; one had hepatic cirrhosis, and the other sustained a myocardial infarction after pneumonectomy. The third patient with significant apical hyperperfusion before pneumonectomy gradually developed abnormal distribution of ventilation concomitant with electrocardiographic evidence of cor pulmonale within two years after pneumonectomy. The mean ventilation of the apical zones was significantly lower than the mean of 14 healthy subjects. This finding and the higher incidence of ventilatory defects were related to old age and heavy smoking. Seven patients with marked reduction of pulmonary blood flow to the tumor-bearing lung (9 to 33 percent of cardiac output) had technically successful pneumonectomy. A formula and nomogram were developed to estimate the prognostically significant forced expiratory volume in one second after pneumonectomy from the preoperative studies.


Cardiac involvement and prognosis in acute mucocutaneous lymph node syndrome.

Cardiac involvement and prognosis were studied in the acute febrile mucocutaneous lymph node syndrome which recently has been found among Japanese infants and younger children. The reason for its particular predilection for the main coronary arteries and the pathologic process are discussed in relation to the pathogenesis and nutrient of the main coronary arteries.


Occult atrial septal defect in adults.

Two patients are described who presented with congestive heart failure and were found to have an atrial septal defect with a pulmonary blood flow approximately twice the systemic blood flow. Most of the usual clinical signs of atrial septal defect were absent, and the diagnosis was established by right heart catheterization and radioisotopic angiography. Both patients had hypertension and coronary artery disease. Atrial septal defect in the adult patient may not be recognized because of associated cardiac disease, including coronary artery disease and hypertension, or pulmonary disease which may obscure the usual clinical signs of a septal defect. Radioisotopic angiography and right heart catheterization should be considered in any patients with heart disease or congestive failure of obscure cause even if the usual diagnostic signs of atrial septal defect are absent.


Electrocardiographic criteria for the diagnosis of left anterior fascicular block. Left axis deviation and delayed intraventricular conduction.

The two current criteria for diagnosis of left anterior fascicular block (LAFB) were evaluated; they are marked left axis deviation (LAD) and a delay in the time of inscription of the intrinsicoid deflection (ID) in lead aVL asynchronous to V6. From 400 electrocardiograms with a LAD of --30 degrees or greater, 62 percent showed asynchronous activation of the left ventricle. There was only a general relationship between the degree of LAD and delayed ID in aVL. The incidence of delayed ID in aVL was as follows: 2 percent with mean frontal QRS axis at 0 degrees; 9 percent at --15 degrees; 41 percent at --30 degrees; 69 percent at --45 degrees; 82 percent at --60 degrees; and 100 percent at --75 degrees or greater. The lack of correlation between both criteria in many instances questions their validity. The LAD alone should not be considered synonymous with LAFB. Recognition of delayed inscription of the ID in aVL is a useful supplemental criterion for diagnosis.


Atrioventricular nodal reentry in the Wolff-Parkinson-White syndrome.

Wolff, Parkinson, and White, in their initial description of the syndrome that bears their names, emphasized the association of tachycardias with the electrocardiographic abnormality. Subsequent investigations have identified, both anatomically and electrophysiologically, that dual pathways of atrioventricular (AV) conduction exist. Furthermore, experimental and clinical evidence has stressed that the mechanism of tachycardia production in the syndrome appears to reentry utilizing these dual pathways. However, recent studies have emphasized that other mechanisms of tachycardia production may be responsible for the arrhythmias seen in this syndrome. The present report identifies that AV nodal reentry may be the sole mechanism for tachycardia induction in the Wolff-Parkinson-White (WPW) syndrome. This finding may be of great clinical significance in light of the availability of surgical therapy for WPW patients with intractable arrhythmias.


A preliminary study of elevated alkaline phosphatase and cathepsin in bronchial aspirates of patients with lung cancer and bronchitis.

The measurement of acid and alkaline phosphatase and cathepsin activities in bronchial aspirates obtained through bronchoscopy from a series of 75 patients suggests a procedure that may have value as a routine diagnostic examination. Using this approach, seven patients with neoplasms in the lung showed elevated levels of alkaline phosphatase and cathepsin in bronchial aspirates without elevation in acid phosphatase activity.


Prediction of maximal oxygen consumption. Comparison of the Bruce and Balke treadmill protocols.

This study investigated the hypothesis that an individual's maximal oxygen consumption can be realistically predicted by the maximal time achieved in the Balke or Bruce treadmill protocols. The range of maximal oxygen consumption that can be expected for healthy individuals of any given age and activity was also evaluated. The maximal oxygen consumptions achieved by 79 men exercised using the Balke protocol and 77 men using the Bruce protocol were linearly regressed by a least-squares fit technique on maximal treadmill time and on age with activity status classified. Statistical analysis demonstrated an inadequate relationship for predicting maximal oxygen consumption from maximal treadmill time using either protocol. Also, maximal oxygen consumption correlated poorly with age even though activity status was considered. These findings make the nomogram for predicting an individual's functional aerobic impairment a clinical technique of questionable value. Since maximal oxygen consumption can only be grossly estimated from the maximal time performed in the Bruce or Balke protocols, there is no necessity to use them in preference to other clinically acceptable protocols.


Unusual hemodynamic response during exercise-induced angina pectoris.

A patient with coronary artery disease exhibited reduction in systemic arterial pressure and striking changes in pulmonary artery wedge pressure and pulse contour during an episode of exercise-associated angina pectoris. There is suggestive evidence that these phenomena were secondary to marked but reversible exacerbation of mitral regurgitation.


Prolonged Q-T interval syndrome. Successful treatment with combined ventricular pacing and propanolol.

A case of the sporadic variety of the prolonged Q-T interval syndrome without deafness is presented. The patient is unusual because of a long survival to age 13, despite progressive worsening of her disease, and the presence of marked atrioventricular conduction abnormalities in addition to the usual ventricular trachyarrhythmias. Successful therapy was finally achieved with a combination of permanent pervenous ventricular pacing and propranolol.


Cardiac rupture complicating acute myocardial infarction in presence of normal electrocardiogram.

Cardiac rupture following acute myocardial infarction occurs most frequently in patients with electrocardiographic evidence of transmural infarction. Unusual presentations of cardiac rupture need immediate recognition to enable successful surgical treatment. An unusual case is presented of cardiac rupture complicating acute myocardial infarction despite a normal electrocardiogram prior to the rupture.


Pulmonary interstitial fibrosis following near-drowning and exposure to short-term high oxygen concentrations.

Following near-drowning in fresh water, a 19-year-old man experienced severe adult respiratory distress syndrome, necessitating ventilatory support with positive end-expiratory pressure and high oxygen concentrations. Post-extubation, his course was highlighted by persistent hypoxemia and interrupted by a lung abscess which responded promptly to antibiotics. Pulmonary function tests were consistent with severe restrictive disease and chest radiograph revealed persistent bilateral alveolar and interstitial infiltrates. An open lung biopsy on the 26th hospital day showed interstitial fibrosis. Over the ensuing two months, the chest radiograph and pulmonary function tests returned towards normal. We attribute the pulmonary fibrosis to incomplete resolution of the alveolar interstitial pathology secondary to the near-drowning and exposure to high oxygen mixtures.


Dextran 40: another cause of drug-induced noncardiogenic pulmonary edema.

Drug-induced noncardiogenic pulmonary edema occurred in a previously patient receiving dextran 40. Dextran 40 should be considered another etiologic factor of drug-induced noncardiogenic pulmonary edema when this syndrome occurs in the absence of known precipitating causes such as shock, aspiration, and overwhelming pneumonia.


Double outlet right ventricle with absent aortic valve.

A case of double outlet right ventricle with multiple associated cardiovascular anomalies, including total absence of the aortic valve, is reported.


Volume-controlled lung lavage in a woman with cystic fibrosis.

A 22-year-old woman with cystic fibrosis was treated by volume-controlled lavage of each of her lungs on two occasions. Following the first lavages, the patient's vital capacity increased by 1.03 liters and her 1-sec forced expiratory volume increased by 0.70 liters/second. Similar improvements, although less pronounced, were noted after both lungs has been lavaged a second time. It is concluded that volume-controlled lung lavage can be of benefit as an adjunct in the treatment of patients with cystic fibrosis.


Hypoplasia of the coronary sinus with coronary venous drainage into the left ventricle by way of the Thebesian system.

A 60-year-old woman with recent onset of exertional chest pain, left anterior hemiblock and negative stress electrocardiogram was found to have hypoplasia of the coronary sinus with drainage of the major coronary venous blood by way of the Thebesian system into the left ventricle. This abnormality appeared to be of no great functional significance.


Echocardiographic identification of a pericardial cyst.

The echocardiogram of a woman with an anterior mediastinal mass showed an echo-free space between the chest wall and the right ventricle. The interface of mass with pericardium was outlined by a narrow echo. These findings suggested a homogeneous fluid-filled, thin-walled sac. Postoperation, echocardiography was normal.


In vitro study on the effects of silver sulfadiazine on bilirubin binding.

Silver sulfadiazine is a new topical antimicrobial agent with a broad spectrum of activity against most bacterial (both gram-positive and gram-negative) and many fungal species. This broad spectrum of activity suggests that silver sulfiazine may be useful in clinical situations which require the inhibition of cutaneous bacterial and/or fungal colonization. The present study was undertaken to determine the effect of this agent on a bilirubin-protein binding. Using chromatographic procedures on artificially jaundiced sera and human serum albumin solutions, we were unable to detect any releast of protein-bound bilirubin by a saturated suspension of silver sulfadiazine.


Preventive effects of trimethoprim/sulphamethoxazole on experimental staphylococcic pyelonephritis in rats.

108 white rats weighing 170-250 G were given trimethoprim, sulphamethoxazole and the combination trimethoprim 1/sulphamethoxazole orally and parenterally in order to test the preventive effect of these substances on experimental hematogenous pyelonephritis due to Staphylococcus aureus. Oral applications of 48 mg/kg/24h of trimethoprim/sulphamethoxazole prevented abscess formation. Intraperitoneal applications of 48mg/24h of the combination did not seem as effective as the oral applications. On the other hand, there was no difference between the effects of oral and parenteral applications when the doses were 96 mg/kg/24h. The preventive effects of trimethoprim and sulphamethoxazole alone were much less than those observed when the combination trimethoprim/sulphamethoxazole was given. No peritoneal or other tissue damage was observed after intraperitoneal injections of trimethoprim/sulphamethoxazole in rats.


Fosfomycin in treatment of chronic urinary tract infection.

A study was made of fosfomycin in the treatment of chronic urinary infection in 51 patients. 72% of the 67 bacteria isolated and tested in the laboratory with discs containing 50 mug of fosfomycin were found to be sensitive to the antibiotic. The majority of E. coli, Klebsiella, P. mirabilis and Ps. aeruginosa strains were sensitive to the antibiotic. Generally, 60 mg of fosfomycin/kgbody weight was administered intramuscularly 6-hourly for 7-15 days. A clinical and bacteriological cure was obtained in 39 patients (76%), and after 4-6 weeks in 31 patients (61%). Blood and urine fosfomycin levels were determined in seven patients, three with normal renal function, three with moderate renal insufficiency, and one with severe renal insufficiency. The antibiotic levels and elimination time maintained a clear relation with the degree of renal insufficiency.


Pharmacokinetic studies with mecillinam and pivmecillinam.

Mecillinam (FL 1060) is a new beta-lactam antibiotic particularly active against gram-negative organisms. When given intravenously, very high serum levels were maintained for a short period of time. Lower peak levels but comparable bioavailability were obtained after intramuscular administration. Gastrointestinal absorption of mecillinam is poor, and for effective oral therapy the drug must be given in the form of its pivaloyl-oxymethyl ester pivmecillinam (FL 1039) which is well absorbed and rapidly transformed to mecillinam by enzymatic hydrolysis in the body. Urinary recovery of mecillinam after orally administered pivmecillinam was 45% in the first 6 h compared with 55 and 59% after mecillinam given by the intravenous and intramuscular routes, respectively. By increasing the dose the orally active ester produced proportionally higher levels of mecillinam, and the area under the serum curve was doubled with the dose. Higher peak levels and prolonged maintenance of high serum concentrations were seen after administration of pivmecillinam with probenecid. The presence of food in the stomach did not influence the absorption of pivmecillinam to any great extent.


Penetration of parenterally administered gentamicin into the cerebrospinal fluid in experimental meningitis.

The penetration of parenterally administered gentamicin into the CSF was examined in dogs. The experiments were carried out in three stages: (1) in healthy dogs, (2) in dogs with meningitis, and (3) during recovery from the acute inflammation. Gentamicin was found to penetrate poorly into the CSF, reaching mean peak levels of 0.7 mug/ml in healthy dogs. During the height of the meningeal inflammation the mean peak gentamicin level in the CSF was 0.9 mug/ml. The ratio of mean maximum CSF to mean maximum serum levels of gentamicin was 5.8% in healthy dogs, and 11.3% in dogs with meningitis. Thus, inflammation increases the penetration of parenterally administered gentamicin into the CSF, but therapeutically adequate levels for gram-negative bacillary meningitis are not achieved.


Electron microscopic appearance of silver sulfadiazine-treated Enterobacter cloacae.

Upon exposure of Enterobacter cloacae silver sulfadiazine, a number of ultrastructural changes involving the cell envelope take place. Foremost among these is a modification of the cell wall from an undulating structure to one which is smooth and has become enlarged. Strains of E. cloacae resistant to silver sulfadiazine do not exhibit these changes.


Mebendazole (R 17635) in enterobiasis. A clinical trial in mental retardates.

The efficacy of mebendazole against enterobiasis was tested on 150 institutionalized mental retardates (range 5-25 years). At the start of the trial all patients swallowed on tablet containing 100 mg mebendazole. Another tablet was administered to all patients 2 weeks and 1, 2 and 3 months later. 19 patients were further treated with one tablet 4 and 5 months after the start of the trial. The presence of E. vermicularis was checked with cellophane adhesive tapes from the anal skin and from the right-hand finger-tips before the trial and after 1, 3 and 6 months. 94 subjects were positive before the trial. At the first post-treatment examination, all patients were found negative. However, 12% were reinfected. No side effects were observed or reported.


Clinical and laboratory evaluation of the effect of cephradine on patients with ear, nose and throat infections.

27 patients with ear, nose and throat infections have been treated with cephradine orally. Ten patients received 250 mg and 17 patients 500 mg every 6 h during 10 days. 26 patients were cured. One patient failed to respond to treatment but reinfection could not be excluded. Determination of plasma concentrations showed that cephradine was well absorbed. The drug showed no severe adverse effects. Cephradine is a good replacement in patients with allergy to penicillins. It is also suitable when broad-spectrum therapy is needed.


Antibiotic concentrations in maxillary sinus secretions and in the sinus mucosa.

In maxillary sinusitis, the blood circulation is supposed to be impaired in the oedematous sinus mucosa, and in such cases the transport of antibiotics into the maxillary sinus should be reduced. To prove the accuracy of this assumption a comparison has been made between the concentrations of penicillin and doxycycline (Vibramycin, Pfizer) in sinus mucosa and secretions and the serum concentrations in patients under treatment with these antibiotics. Measureable concentrations of penicillin (greater than 0.2 mug/ml) were reached in the secretions only if the serum concentration was high (greater than 4-5 mug/ml). In contrast, measurable concentrations of doxycycline were achieved in both mucosa and secretions in all patients treated with this antibiotic. This must depend on the fact that doxycycline, due to its optimal lipid solubility, was able to penetrate poorly vascularized tissue. In most cases, the concentrations of doxycycline far exceeded the minimum inhibitory concentrations of the isolated organisms, and in some cases the local concentrations were higher than those found in the serum. The clinical response to doxycycline was good and correlated well to the laboratory data.


Vibramycin programme in the United Kingdom. Winter 1973-1974.

A total of 204 patients between the ages of 20 and 80 and suffering from respiratory tract infections were treated by general practitioners with doxycycline. The infections were representative of those usually encountered in practice except that there were only three cases of pneumonia. The response to treatment, both subjectively and objectively, was good; by the third day, 84% of patients were improved. 89% of patients were cured by the tenth day. Failure to improve was noted in only 5% and failure of cure in 11% of patients. The participating physicians assessed the result of treatment as good or very good in 87% of patients and as moderate in 8%, only 5% of the patients had a poor or negative result.


Doxycycline concentrations in lung tissue, bronchial wall, and bronchial secretions.

Doxycycline levels were measured in 44 patients undergoing lung surgery; 44 determinations were made on serum, 37 on resected lung tissue, 11 on bronchial wall, and 8 on bronchial secretions. The concentrations in lung tissue were, with few exceptions, higher than the serum concentrations, while those in homogenized bronchial wall specimens were slightly lower than the serum readings. All these concentrations were on average considerably higher than the minimum inhibitory concentrations for the pneumococcus and Haemophilus influenzae. The comparatively low bronchial secretion concentrations were accounted for by the surgical circumstances. All patients had been intensively trated pre-operatively, and showed no florid mucosal inflammation at the time of the operation: as inflammation subsides, so the antibiotic concentration in the bronchial secretion declines rapidly. The lung and bronchial wall tissue levels indicate that doxycycline has great promise in the treatment of pulmonary and bronchial disorders.


Visualization of doxycycline in lung tissue and sinus secretions by fluorescent techniques.

The two studies which are reviewed in this paper demonstrate the value of fluorescent microscopic observations in the studying of the distribution of antibiotics in lung tissue and in sinus secretions. In the lung tissue study, the standard microbiologic assay data on doxycycline concentrations in respiratory tissue take on greater meaning when one is able to visualize the relative distribution of doxycycline-derived fluorescence among bronchiolar, vascular and parenchymal sites. In the sinus secretions study, doxycycline was shown to pass into the sinus secretions in concentrations, in most instances, which are significantly greater than the relevant MICs. These therapeutic levels were achieved and assayed in sinus secretions, even though a corresponding fluorescence was not always demonstrated. When fluorescence was shown, the wide homogeneous distribution of doxycycline throughout the aspirate of purulent maxillary sinus mucus was striking. Fluorescent microscopy can provide a dynamic visualization of doxycycline's presence in human tissue and secretions. Fluorescent microscopy, together with standard microbiological assay methods, affords both qualitative and quantitive data on the drug's biologic activity.


Human respiratory tract infections with mycoplasmas and their in vitro susceptibility to tetracyclines and some other antibiotics.

The role played by Mycoplasma pneumoniae and possibly by other species of mycoplasma in respiratory tract infections in man is considered. The in vitro sensitivity of human mycoplasmas, that is, M. hominis, M. fermentans, M. orale type 1, M. pneumoniae, M. salivarium and T-mycoplasmas to different tetracycline analogues and some other antibiotics was determined. The strains tested were often somewhat more susceptible to doxycycline than to methacycline, minocycline and tetracycline, while oxytetracycline, per unit of weight, was in most instances 8-16 times less effective than doxycycline. The difference between the minimum concentrations of the above-mentioned tetracyclines, that inhibited metabolism of M. pneumoniae in liquid medium, and the minimum lethal concentrations of these antibiotics was small. Variation of the inoculum size of this organism had comparatively little effect on the result of the susceptibility tests with doxycycline. The study indicates a cidal rather than static action of doxycycline on M. pneumoniae. This organism as well as T-mycoplasmas were sensitive to low concentrations of erythromycin, while the strains of the other species studied were resistant to even 100 mug/ml of this antibiotic. M. pneumoniae and T-mycoplasmas were resistant to 20-80 mg/ml lincomycin, while the other human mycoplasmas were moderately sensitive. Chloramphenicol and gentamycin were generally less effective, per unit of weight, than the tetracyclines against most of the strains of mycoplasma tested. Some known effects of antibiotic treatment of mycoplasma infections in man are also discussed.


Somatic changes during human prenatal life.

A twofold synopsis is presented on human developmental anatomy prior to birth. The first portion of the paper focuses on conceptual perspective and the second part on factual understanding. Section 1 gives an overview of the wide assortment of somatic changes manifested in the prenatal segment of human ontogeny; it illustrates alterations occurring in number, kind, location, size, and shape of body components. Section 2 presents a chronological panorama of human anatomical modifications during prenatal life; it traces somatic changes from "zygote to embryo", from "embryo to fetus", and during "the fetal period".


The effect of stimulus complexity on infant visual attention and habituation.

Infant visual attention and habituation were examined with a procedure providing independent assessment of an infant's latency of orienting to a pattern (attention getting) and his subsequent fixation of that pattern (attention holding). 18 male and 18 female, 17-week-old infants were given 2 trials with a red circle, 16 trials with either a 2 times 2, 8 times 8, or 24 times 24 checkerboard pattern, then 2 more red-circle trials. The major results were that habituation occurred in fixation time with males habituating more than females, and that a general decrease occurred in latency with females selectively increasing or decreasing their latency depending upon the pattern they had previously seen. These results indicated the necessity of separating attention-getting from attention-holding measures and that both sexes remembered something about the visual patterns but demonstrated that memory differently.


Generalization and persistence of effects of exposure to self-reinforcement models.

2 experiments examined the persistence and generalization of effects of exposure to modeled self-reinforcement standards. Children observed a peer model exhibiting either a high or low standard for self-reward at a novel game or saw no model. Subjects then played the game, either with or without specific instructions to follow the model's example. 2 weeks later, in a new situation, subjects played either the same game or a different game. In these subsequent sessions, substantial persistence of the effects of exposure to the model and generalization of these effects to a new game were demonstrated. Initial differences between the 2 modeling conditions and between instructed and noninstructed subjects, however, generally did not persist in this later test.


Effects of increased teacher support on young children's learning.

6 groups of middle-class children (N = 116) received training in a motor skill, skipping, and a cognitive task, conservation of substance, under 2 conditions of teacher supportive behavior. Children in 3 treatment groups received instruction under the condition of increased teacher support, while instruction was given with nonvaried teacher support to 3 control groups. Experimental and control group gain scores on the 2 learning tasks were compared. Findings suggested that preschool children, especially girls, benefit significantly by increased teacher support in learning a motor skill, but greater gain was made in the cognitive area when receiving training under the condition of nonvaried teacher support.


Logical operations and role-taking abilities in two cultures: Norway and Hungary.

9 Piagetian measures of conservation, classification, and role taking, and a task designed to test verbal egocentrism were administered to children in 3 social settings in rural Hungary. The work is an extension of research carried out by Hollos and Cowan in Norway. In each setting 45 male and female children with equal numbers of 7-, 8-, and 9-year-olds were tested. Factor analysis yielded a logical-operations factor and a role-taking factor. Age and setting effects were significant for both factors. The socially isolated children performed less well on role-taking tasks but did significantly better on logical operations at all ages than village and town children. The results are almost identical with the findings of the Norwegian study, further supporting a threshold hypothesis regarding the amount of social interaction needed for the development of logical operations. Language stimulation and the effect of linguistic role marking in Hungarian do not seem to be significant factors, nor is schooling.


A longitudinal study of relations between outer-directedness and IQ changes in preschoolers.

The study was designed to determine whether outer-directedness, measured by glances at E during object assembly tasks administered according to the Turnure and Zigler (1964) procedure, predicts changes in preschoolers' Binet IQs over 6 months. With MA as a covariate to control for the small but significant relationship betweeen glances and developmental level, an ANOCOVA showed a significant interaction resulting from increases in the IQs of non-outer-directed Ss and declines in the IQs of outer-directed Ss. Glances at E's puzzle while S assembled his own were unrelated to glances at E or to IQ changes, but, unlike glances at E, were significantly related to improvements in performance from puzzle 1 to puzzle 2.


Hemispheric processing and cognitive styles in learning-disabled and normal children.

A paradigm of specialized brain hemisphere processing abilities was used to test cognitive skills and cognitive style in "learning-disabled" (LD) and "normal" children. Results indicate that (1) verbal ability is not a unitary factor, and LD children are deficient in only some aspects of verbal ability; (2) the LD group perform as well as the control group on right-hemisphere tests; (3) LD boys are more field sensitive (field dependent) than the control boys; (4) LD children may be attempting to use a nonverbal information processing mode to deal with academic tasks. The need for information on nonverbal processing skills in order to aid verbal processing is discussed.


Visual orientation and self-perceptions of children in an external-cue-relevant or cue-irrelevant task situation.

On the basis of visual orientation on a block design task, 180 kindergarten through fifth-grade children were assigned to 3 categories of task approaches: (a) inner directed or task oriented (TO), (b) information seeking (IS), and (c) approval seeking or cue dependent (CD). The performance and self-perceptions of the children were then examined as they worked on a concept-identification task in which an external cue was either relevant or irrelevant. The results showed that performance of the children in the 3 categories on the task was differentially affected by the manipulated cue conditions, though not consistently across grade levels. The relationship between task-approach categories and self-perceptions also differed over grade levels.


Interactions of black inner-city mothers with their newborn infants.

Interactions of 45 black inner-city mothers with their healthy full-term newborn infants were observed during a bottle-feeding on the third day after birth. An exhaustive catalog of some 100 mother and infant behaviors was used to describe objectively the interactions of mothers and infants. In addition to being observed with their mothers, infants were examined with the Rosenblith scale. The infants' birth weights, birth order, and sex and maternal medication were found to affect the infants' behaviors and/or the patterns of mother-infant interactions.


Effects of sorting on subsequent recall of unrelated items: a developmental study.

Second graders, fifth graders, and adults participated in 2 experiments designed to study the effects of sorting on subsequent recall of unrelated words. 1 group sorted the items freely, while a second group was constrained to learn the sorting schemes generated by free subjects. In the first experiment, subjects sorted until they reached a criterion of organizational stability. In Experiment 2, sorting was terminated prior to reaching a stable criterion. Recall and output clustering were reduced in Experiment 2, relative to Experiment 1, because of organizational instability. No meaningful differences were found in either experiment in the sorting schemes generated by free subjects in the 3 age groups, nor was there an effect of age of yoking partner on performance of constrained subjects. This result differed from previous research, and it was concluded that the sorting technique diminished differences in organizational behavior usually found between older and younger subjects.


Relationship of Apgar scores and Bayley mental and motor scores.

Infants with 0-3 Apgar scores at 1 minute had significantly lower 8-month mental and motor scores than infants with 7-10 scores and significantly lower mental but not motor scores than infants with 4-6 Apgar scores. Correlations indicated significant relationships (independent of birth weight) between Apgar scores and Bayley mental and motor scores for random, Colored Portuguese, and total samples but not for Negroes and whites. Results demonstrated a significant difference in Apgar scores by 8-month classifications with significantly lower scores for children classified as abnormal, and by longevity with significantly lower scores for neonates who died within 2 days.


The relationship of single words to two-word sentences.

The relationship between the single-word utterances and 2-word sentences of 12 children was examined as part of a longitudinal study of language development. Children whose single-word utterances usually named objects produced sentences which named many objects. Children whose single words were frequently interjections produced sentences which expressed desire for an object. 2-word sentences seem to have some of their structural and functional roots in the single-word phase.


Parental manipulation of the behavior of normal and deviant children.

The present study examined the ability of parents to bias home-observation data by influencing their child's behavior in socially desirable and undesirable directions. Parents of 12 deviant and 12 non-deviant boys, aged 4-8, were given the response set to present their child as "good", "bad", and usual (normal) during 6 45-minute observations of family interaction. Deviant and non-deviant children showed significantly more deviant behavior under the bad condition as compared with normal, whereas their good and normal conditions did not differ. Parent positive and negative behaviors were related to changes in child deviant behavior for the deviant sample; parent positive and commanding behaviors were related to changes in child deviant behavior for the nondeviant sample. Parent self-report of behavior change was generally consistent with the observation data. The results suggested implications for naturalistic observations of families and for child behavior change interventions.


The influences of methylphenidate on heart rate and behavioral measures of attention in hyperactive children.

Reaction-time performance and heart-rate responses associated with attention were used to assess the hyperactive child's attentional deficit and his response to methylphenidate. Attentional deficits shown by long response latencies were reflected in heart-rate responses theoretically incompatible with sustained attention. Subjects exhibiting the greatest attentional deficit displayed the most favorable response to methylphenidate in both reaction-time performance and physiological measures. However, subjects who showed the greatest improvement in social behavior were those who showed the least improvement in reaction-time performance.


The search for structural principles in children's manipulative play: a parallel with linguistic development.

Our study investigated the role of 3 structural principles--hierarchical complexity, interruption, and role change--in the development of children's construction play. The 3 principles are formally parallel to dimensions of language structure. Children from 2 to 6 were required to use varying combinations of structural features in order to build a series of modeled constructions. Predictions about the order of difficulty of our constructions, formulated on the basis of their constituent structural features, were confirmed by the results. Hierarchical complexity and role change, features of "deep structure", added significantly to the difficulty of a construction strategy. Interruption, a "surface-structure" feature, had, in contrast, a minimal effect. The results lend further support to the notion of a cognitive organization common to language and other modes of behavior.


Nonassertive expression of parental approval and disapproval and its relationship to child disturbance.

Assertiveness and affective quality of voice intonation were compared for approving, neutral, and disapproving statements made by 20 sets of parents of elementary-aged children who demonstrated emotional or behavioral disturbances in school and 20 sets of parents of "normal" control children. For mothers, a significant interaction (p = .01) was found between parental group and verbal affect: mothers of "normal" control children demonstrated more assertive voice intonation when expressing affective verbal content (approval or disapproval) than when making neutral statements; mothers of "disturbed" children demonstrated less assertive voice intonation when expressing affective verbal content than when making neutral statements. Differences between mothers on affective quality of voice did not reach statistical significance. No significant differences were found for fathers.


Father absence, perceived, maternal behavior, and moral development in boys.

The rated and observed moral behavior, judgment, and affect of 120 preadolescent, predominantly lower-class boys from early-divorced (before the boys were 6), late-divorced (between 6 and 10), and parentally intact homes were investigated. In addition, the mothers' discipline (power assertive, inductive, and love withdrawal) and affection were examined by asking subjects about their mothers' methods of dealing with their transgressions. Moral behavior was assessed with resistance-to-temptation, self-criticism, altruism, reparation, and teacher-rating measures, while moral judgment was evaluated with 3 Kohlberg items and moral affect was investigated with 2 story-completion items maximizing guilt. The major findings were: (1) when relevant variables (IQ, SES, age, sibling status) were controlled, few differences were found between father-absent and father-present boys; (2) however, father-absent boys were reported by their teachers as less advanced in moral development than father-present boys; (3) the sons of the divorced women showed more "social deviation", according to their teachers, but were more advanced in level of moral judgment than were the sons of widows; (4) divorced women disciplined with more power assertion than widows, according to their sons' reports.


Effects of perceptual salience on the matrix task performance of four- and six-year-old children.

The effects of salience on 4- and 6-year-old children's ability to classify multiplicatively was investigated. A rank-ordered salience hierachy consisting of 3 dimensions was first assessed for each S. Several weeks later half the Ss of each age group were presented with a series of 9 3 times 3 matrix problems consisting of values from 2 dimensions ranked high in salience. The remaining half received identically structured matrices consisting of values from 1 highly salient dimension and of others from a dimension ranked low in salience. The goal in each problem was to select that compound stimulus from a set of alternatives that appropriately filled an empty cell in the matrix. Prior to the matrix problems, half the Ss in each matrix condition received sensitization training designed to increase the salience of the relevant dimensions in the matrix problems. The results showed that the pre-assessed salience of the relevant dimensions affected matrix solution in that more accurate performance was associated with those problems with both relevant dimensions relatively high in salience than those with one high and one low. Although the older Ss solved more problems, the evidence for coordination in the younger Ss was clear. No effects of sensitization training were found.


The distinction between perceiving and memorizing in the presence of category cues.

The study proposed and tested 2 hypotheses to account for the claim by Appel, Cooper, Knight, McCarrell, Yussen, and Flavell (1972) that "memorizing and perceiving are functionally undifferentiated for the young child" by presenting preschool, second-, and fifth-grade children a "memory" and a "look" problem under several treatments in which semantic category cues were present. Surprisingly, preschoolers showed functional differentiation even in the absence of semantic cues--a finding interpreted as evidence for a functional differentiation in the young child's deployment of attention. Second and fifth graders also exhibited functional differentiation in the absence of semantic cues, and there were age changes in the facilitating effects of input and retrieval cues on children's memory.


The ubiquity of big brother.

Teachers from grades K through 6 nominated the most physically active and most physically passive students from each sex. Half the schools were attended mainly by low-SES Mexican-American students and half upper-middle-SES Caucasian students. The main finding was that physically active students were more likely to have an older brother than were physically passive students. This effect was independent of sex, grade level, race, SES, and other-sibling combinations. A second study confirmed this relationship when college students rated themselves on the same active-passive dimension.


Developmental changes in the understanding of implied motion in two-dimensional pictures.

The power of various pictorial movement cues in eliciting a reading of movement was studied to determine the relationship between the ease with which a picture is interpreted and the degree to which the picture retains the structure of reality. Movement was indicated in 2 ways: pictorial conventions indicated movement by lines, blurs, and vibration marks; and pictorial postures indicated movement by figures which were isomorphic with the postures involved in real movement. Preschoolers, first graders, sixth graders, and college students were asked to label and sort pictures of human figures as "moving" or "still". Members of the 2 young groups did not classify pictures with conventional cues as "moving" as often as they did pictures with postural cues. Members of the 2 older groups classified both types of pictures as "moving". Since postural cues for movement are recognized at an earlier age than conventional cues, those that are more similar to reality may be easier to understand.


An investigation of the relationship between cognitive tempo and creativity in preschool-age children.

70 preschool-age children were administered a modified version of the Matching Familiar Figures test as well as a modified version of the picture completion task from the Torrance Tests of Creative Thinking. Sex of subject and cognitive tempo were combined factorially with type of creativity measure in a 2 times 2 times 4 repeated-measures design. A significant effect for cognitive tempo was found showing reflective subjects scoring higher than impulsive subjects on each measure of creativity.


Pictographs and prereading skills.

This paper draws upon data collected in conjunction with the Schools Council (Great Britain) Research and Development Project in Compensatory Education to demonstrate that a picture reading task can provide a fairly good prediction of the later reading performance of 100 5-year-olds and that it is a sufficiently interesting clinical tool to merit further consideration from nursery and infant school teachers. The test's success seems to relate to its ability to measure differences in children's understanding of the nature and purpose of reading.


The effects of continuous nurturance and nurturance withdrawal on children's behavior: a partial replication.

This research replicates and extends a study by Hartrup (1958) of the effects of continuous nurturance and nurturance withdrawal on children's behavior. Kindergarten and second-grade children interacted with either a continuously nurturant adult or an adult who was initially nurturant and then withdrew nurturance. A questionnaire was administered to assess children's perceptions of thier experiences and their perceptions of the reasons for the adult's withdrawal. Sessions ended after an assessment of the adult's social reinforcer effectiveness. The results indicated that the adult's social reinforcer effectiveness was an interaction of the effects of sex, children's frequency of verbalization, and nurturance condition. The results partially replicated Hartrup's (1958) and are discussed in terms of suggestions for future research on less complex contrasts between adult interaction patterns.


The efficacy of peer modeling and social conflict in the acquisition of conservation.

Significant gains in conservation of number, amount, mass, and weight were made by 53 nonconservers (age 6-9) who either simply observed conserver's performance on mass and weight problems or argued with conservers in a social conflict situation about these problems. There were no significant differences in conservation performance between the modeling and social conflict treatments. It was suggested that the social conflict effect could be attributed to modeling effects.


[A successful blood vessel reconstruction following inadvertent exeresis of arteries during varicose vein surgery].

A case of inadvertent stripping of the arterial system of the left leg during an operation of varicose veins is reported. By use of the unchanged saphenous vein the limb was able to be saved and the patient is without any complaint three years afterwards. Conclusions are made to the lege artis carrying out of Babcock's operation.


[Hazards of electrosurgery].

Burn accidents due to the use of electrosurgical instruments (electrotomy, electrocoagulation) are uncommon but generally serious: explosion of inflammable anaesthetics or antiseptics, local tissue necrosis by an uncontrollable current or coagulation necrosis by a high current. An appropriate use of electrosurgical instruments based on the correct range of indications is the basis for the prevention of accidents.


[Complications following colostomy closure --resection or extraperitoneal closure?].

At the Surgical Clinic of the University Erlangen-Nürnberg 213 colostomies in the period between 1961 and 1971 have been closed. In 88 patients an extraperitoneal procedure and in 125 patients a resection was performed. We recommend resection, because complications (first of all leakage) have been observed less often than in the extraperitoneal method.


[Bursa omentalis hernia through Winslow's foramen].

The case of a 61 year old female patient suffering from an incarerated hernia through the foramen of Winslow into the lesser sac is discussed. The hernia contained the terminal ileum (20 cm) with caecum, part of the appendix, the ascending colon, hepatic flexure and the first third of the transverse colon. This type of hernia is one of the rarer forms which may occur. After surgical reposition of the hernia contents and closure of the foramen of Winslow, the patient recovered completely and was discharged.


Stercoraceous perforation of the cecum: report of two cases.

Two cases of stercoraceous perforation of the cecum with adjacent mass formation simulating a neoplasm are described. The predisposing factors for the formation of fecalomas and the mechanisms of perforation are discussed and a review of the literature on this subject is presented. There were no demonstrable predisposing colonic lesions to account for the fecaloma formation in these casesmboth patients recovered completely after surgical treatment of the lesions.


[On the question of drug-induced pseudo-LE syndrome: preliminary results in 58 cases (author's transl)].

Drug intake had been checked in 58 patients with pseudo-LE-syndrome. In view of the findings of the Zürich group a connection between the intake of Venopyronum¿ coated tablets and a pseudo-LE syndrome was strongly suspected in 45. In a further seven patients who also had taken the drug no definite connection could be shown because there was no temporal relationship between drug and disease. Three patients had taken Venopyronum-triplex capsules. Only three patients categorically denied ever having taken the drug in any form.


Carcinoma arising in a perianal sinus tract: report of a case.

The case of a woman who had had a perianal sinus tract for nine years, in whom squamous-cell carcinoma arose in the sinus tract, is presented. We believe that long-standing perianal sinus tracts should be examined carefully for tumor development. In suspected cases, a biopsy specimen should be obtained from the central part of the lesion.


Giant air cyst of the sigmoid complicating diverticulitis: report of a case.

A giant gas cyst of the sigmoid is reported, and the relevant medical literature is discussed. The vast majority of these lesions are pseudocysts and are a complication of diverticulitis that has not been emphasized in previous reports. The diagnosis should be able to be established by various roentgenographic procedures.


[Septicaemic-endotoxic shock: problems of early diagnosis and treatment (author's transl)].

At least in its early stage, the syndrome of septicaemic-endotoxic shock gives rise to a heterogeneous clinical picture which often lacks definite clinical, haemodynamic and biochemical features. But even if this form of shock is merely suspected, adequate fluid supply and administration of appropriate antibiotics should be started, in addition to general supportive measures. The administration of vasoactive drugs and corticosteroids has provided favourable results. The low early mortality (10 among 50 patients) is probably due to the medical causes which precipitate shock in this group, and the early onset of treatment.