Air temperature recordings in infant incubators.

Air temperatures were continuously recorded inside four incubators with proportional heating control and six incubators with on/off heating cycles, during routine use. The air temperatures in the former were constant throughout, with a gradient between the roof and above-mattress air temperature not exceeding 1 degree C. In contrast, the recordings from the latter models showed a regular cyclical oscillation, the duration of the cycle varying from 14 to 44 minutes. Each incubator had a characteristic profile. The roof air temperature could vary by as much as 7-1 degrees C and the above-mattress air temperature by as much as 2-6 degrees C during the cycle. The oscillation persisted in the air temperatures recorded inside an open-ended hemicylindrical heat shield when used inside these incubators, but was markedly reduced inside a closed-ended heat shield, Carbon dioxide concentration did not increase significantly inside the latter.


Leucocyte function in children with kwashiorkor.

A study of leucocyte response to infection, polymorphonuclear leucocyte chemotaxis and bactericidal activity, and nitroblue tetrazolium (NBT) reduction in children with kwashiorkor was undertaken and compared with a control group. The results show that total leucocyte counts were depressed in children with kwashiorkor, and lymphopenia was not infrequent. NBT reduction was normal. Abnormal polymorphonuclear leucocyte chemotaxis and bactericidal activity, though frequently found in children with kwashiorkor, was shown to be dependent on infection and not on protein depletion per se. Therefore, apart from some impairment of leucocyte mobilization in the presence of infection, the qualtiy of polymorphonuclear function, as determined by the above techniques, appears to be normal in kwashiorkor.


Pharmacology of some oral penicillins in the newborn infant.

Serum and urine concentrations of ampicillin, amoxycillin, and flucloxacillin achieved after oral administration have been measured in 27 newborn infants. Compared with adults and children, newborn infants show a delay in achieving adequate blood concentrations, presumably due to delayed absorption. However most infants achieve therapeutic concentrations in the serum. Infected newborn infants should be given these antibiotics by intramuscular injection for the first dose, but thereafter oral therapy (25 mg/lg every 6 hours begun concomitantly) should be satisfactory. The better absorption of amoxycillin compared with ampicillin reported in adults has not been confirmed in the newborn infant.


Ascorbic acid and tyrosine metabolism in preterm and small-for-dates infants.

Ascorbic acid levels in plasma and leucocytes and urinary excretion of tyrosyl derivatives (TD) were determined in 11 normal, 18 preterm, and 4 small-for-dates infants. Concentrations of ascorbic acid in both plasma and leucocytes were found to be similar in the 3 groups. There was no difference in the basal levels of TD between normal and small-for-dates infants, but preterms showed higher basal excretion of TD than the other two groups. After protein load the excretion of TD was higher than the basal level in preterms. It was concluded that the altered metabolism of tyrosine observed in preterms is not the result of poor ascorbic acid status; and that tyrosine metabolism is influenced by the period of gestation rather than the body weight of the infant.


Tests for occult in stools of children.

Three tests for the presence of occult blood in the stools of children were examined; the orthotolidine test, the guaiacum resin test, and a modified reduced phenolphthalain test. The stools of 71 neonates, 33 normal children, and 8 children with suspected gastrointestinal pathology were examined. The 1% orthotolidine test and the guaiacum resin test produced a high number of false positive results in healthy children eating a meat-containing diet. It is concluded that a positive result by these tests is of little diagnostic value in children eating a normal diet.


Bacteroides fragilis septicaemia and meningitis in early infancy.

A case of recurrent Bacteroides fragilis septicaemia leading eventually to meningitis in a 6-week-old infant is reported. Perforation of the small bowel at the constriction ring of a strangulated inguinal hernia caused a faecal peritonitis and was the primary source of infection. Erythromycin, to which the isolate was fully sensitive in vitro, was only temporarily an effective treatment; the infection was finally eradicated with chloramphenicol, and the baby made a full recovery. Bacteroides infections in infancy and childhood are briefly reviewed.


Bile acid excretion after pull-through operation for Hirschsprung's disease.

Four children with chronic diarrhoea and perianal excoriation after a pull-through operation for Hirschsprung's disease have been shown to have increased but not markedly raised levels of faecal bile acids. Bile acid analysis of the 'bile-rich' duodenal fluid obtained after pancreozymin stimulation in 3 of the patients indicated a marked reduction in the proportion of deoxycholic acid conjugates. These findings are compatible with colonic malabsorption of secondary bile acids in these patients which is related in some way to the pull-through operation, but which is not likely to be the cause of the diarrhoea and the anal excoriation.


Serum cortisol concentrations in children with chronic renal insufficiency.

Children with chronic renal insufficiency have a normal diurnal rhythm and normal nocturnal values for serum cortisol when determined by competitive protein binding. Falsely raised values were obtained when a fluorimetric technique was used for the cortisol determination in these patients.


Micropenis associated with testicular agenesis.

This paper describes 2 male infants who were born with sever micropenis and in whom testicular tissue could not be identified at surgery. HCG stimulation in one infant was not followed by a rise in plasma testosterone. It was decided that both cases would be best raised as females, despite their male chromosomal sex.


Urinary tract in schoolgirls with covert bacteriuria.

During screening of 16,800 primary schoolgirls, aged 4-12 years, in Cardiff and Oxford, significant bacteriuria was found in 294 (1-7%). Intravenous urography and micturating cystography were performed in 246 of these girls. The urinary tract was abnormal in 47%. Pyelonephritis with or without vesicoureteric reflux was present in 26% and reflux without renal abnormality in a further 16%. The prevalence of pyelonephritis and reflux was independent of age. With few exeptions kidneys without pyelonephritic scars appeared to be normal in size, even when ureteric reflux was present.


Confirming persistence of gluten intolerance in children diagnosed as having coeliac disease in infancy.

In young infants the clinical and investigative features of coeliac disease (CD) may be mimicked by other conditions such as cow's milk intolerance or secondary disaccharidase deficiency. It is therefore especially important to confirm a diagnosis of CD by later gluten challenge in such infants. Sixteen children in whom the diagnosis of CD had been made before the age of 12 months had an oral gluten challenge, after being treated with a gluten-free diet for periods of one month to 5 years. In 15 we showed intestinal xylose malabsorption by the one-hour blood xylose level within 1-28 days of starting ingestion of gluten. One child, with a persistently normal one-hour blood xylose test after gluten challenge for 3 months, had normal absorption and normal jejunal histology after 18 months on a gluten-containing diet; she is considered not to have CD. The one-hour blood xylose test before and after gluten challenge can help to confirm the diagnosis in coeliac patients diagnosed in infancy.


Screening for inherited metabolic disease in Wales using urine-impregnated filter paper.

Urine specimens from 135 295 infants have been collected on filter papers and tested for 7 abnormal urinary constituents using spot tests and paper chromatography. The method has detected 5 infants with phenylketonuria, 4 with histidinaemia, 5 with cystinuria, 5 with diabetes mellitus, and one with alcaptonuria. Transient abnormalities such as tyrosyluria, generalized aminoaciduria, cystinuria, and glycosuria have been noted. 2 phenylketonuric infants failed to excrete a detectable quantity of o-hydroxyphenlacetic acid at the time of testing. The findings show that the detection of this compound in urine is an unreliable method of screening for phenylketonuria.


Intestinal enterokinase deficiency. Occurrence in two sibs and age dependency of clinical expression.

Intestinal enterokinase deficiency in 2 sibs in described. A boy failed to gain weight and had vomiting, diarrhoea, oedema, hypoproteinaemia, and anaemia in early infancy. His duodenal juice contained very low or absent proteolytic enzyme activity, which increased markedly after addition of enterokinase. He was treated with pancreatic extract and gained weight rapidly. At 44 months of age he is normal, apart from some development delay, and no longer needs pancreatic extract. His older sister, who had had similar symptoms in early infancy but then grew normally, had the same abnormality in her duodenal juice when seen at 4 years of age. Enterokinase activity was virtually absent in the duodenal mucosa of both patients. Mucosal morphology was normal. The findings suggest that enterokinase deficiency is an inherited congenital defect and not the result of mucosal damage. Affected patients may show spontaneous improvement and normal growth after the age of 6 to 12 months. This phenomenon may be related to the decreasing growth volocity during the first 2 years of life and the concimitant decrease in protein requirements per unit bodyweight.


Vitamin D status after resection of ileum in childhood.

Serum 25-hydroxycholecaliciferol levels and x-rays of the wrist were normal in children who had had extensive resections of ileum and no supplementary vitamin D for considerable periods. These results suggest that normal vitamin D status occurs in the absence of the ileum and that supplementary vitamin D is unnecessary.


Serum levels of lysozyme in term and preterm newborns.

Serum lysozyme levels were studied in term babies at the time of delivery and again between 7th and 30th postnatal days, and in preterm babies on the 1st, 3rd, and 5th postnatal days. Levels in term babies at delivery (mean 2.28 mug/ml) were similar to those found in adults, but they fell between the 7th and 30th postnatal days. In premature babies lysozyme levels on the first day of live (mean (0.82 mug/ml) were lower than in term babies. They tended to rise during the first 5 days, by which time they had reached levels found in term babies between the 7th and 30th days. The low lysozyme levels in preterm and in term babies after the first few days of life may contribute to the poor ability of the newborn baby to localize infection and to kill bacteria extracellularly.


Disseminated intravascular clotting in kwashiorkor.

The role of disseminated intravascular clotting (DIC) in the pathogenesis of the bleeding diathesis kwashiorkor was investigated in 22 patients. According to the severity of the clinical and haematological findings, two grades of DIC were observed. A severe grade of DIC was  shown in 6 cases (5 fatal) presenting with thrombocytopenia, hypofibinogenaemia, and multiple coagulation defects, and with abnormally prolonged partial thromboplastin,prothombin, and thrombin times]. A second goups of 16 patients (7 fatal) showed a less severe grade of DIC manifested by thrombocytopenia, low fibringoen level, and a clotting factor defect shown by rpolonged prothrombin and thrombin times.


Fanconi's aplastic anaemia with short stature. Absence of response to human growth hormone.

A patient with idiopathic marrow hypoplasia associated with short stature and other anomalies (Fanconi's anaemia) is described: treatment with human growth hormone for one year did not accelerate his growth rate or significantly affect his anaemia: androgen treatment considerably improved both features. Endocrine studies suggest that though he had poor and insufficient production of endogenous growth hormone to insulin-induced hypoglycaemia, the major defect in this syndrome is determined more at the end-organ than at the pituitary or gonadal level.


Gestational age assessment in infants of very low birthweight.

The accuracy of gestational age assessment (Dubowitz et al., 1970) was tested for infants weighing 1500 g or less. There was good correlation with known dates. This system is applicable to and accurate for infants delivered very prematurely.


Desquamative fibrosing alveolitis unresponsive to steroid or cytotoxic therapy.

A case of desquamative fibrosing alveolitis beginning in early infancy is described. The disease was characterized by tachypnoea, hypoxia relieved by O2, absence of signs in the chest or clubbing, and radiological and physiological evidence of hyperinflation. The diagnosis was made by needle biopsy of the lung. Treatment with steroids and immunosuppression was without effect and the infant died at 9 months. The disease has a high mortality in infancy, only 2 out of 9 reported cases having survived. The difference from the usual course in adults and older children is noted.


Pancreatitis in children. A study in the North of England.

Cases of pancreatitis in children in the Newcastle Regional Board area were studied over approximately 6 years. There were 9 cases aged between 6 weeks and 15 years. In 5 children (all under 7 years of age) likely aetiological factors were found (2 cases of mumps and 1 case wach due to trauma, measles, and hereditary pancreatitis). In 4 children all over 13 years of age no likely aetiological factor was found. It is speculated that they may represent one end of the age spectrum of idiopathic pancreatitis as it occurs in adults. Hereditary pancreatis was definitely found in only one child and possibly in one other. Therefore, it probably does not represent the major cause of pancreatitis in children as has been previously thought. One child died, but all the other children have thrived since their illness.


Effect of maternal education and ethnic background on infant development.

We examined the influence of maternal education and ethnic background on the four main areas of development (as measured by the Brunet-Lezine adaptation of Gesell's developmental schedule) of their infants. 173 babies were examined at the ages 0f 3, 6, 9, and 12 months in the Kiryat Yovel area of Jerusalem, an area where Jew from North Africa, Asia, Europe, and Israel are represented at different educational levels but all share the saem maternal and child care services. The mean development quotients (dqs) of the infants of highly educated mothers were higher in all four areas of development that those of infants whose motherw were of low education. Further, North African infants of middle educated mothers had higher DQs than those of middle education European mothers, especially in motor and adaptive areas. It was concluded from this study that higher education of mothers will be expressed in higher DQs of their babies. This was true in all ethnic groups. However, where educational groups were comparable, North African babies have shown better development than all other groups, while European babies were the least developed.


Negative sweat tests and cystic fibrosis.

Two brothers are described with chronic suppurative pulmonary disease. One has classical cystic fibrosis with complete pancreatic involvement and abnormal sweat test. The other had incomplete pancreatic disease with repeatedly normal sweat tests. The implications of a negative sweat test in patients with cystic fibrosis are discussed.


Pathogenetic aspects of bromocarbamide intoxication.

In bromocarbamide intoxication in humans, as in rabbits, the predominant feature is the endothelial damage characterized by desquamation and vacuolisation, followed by interstitial oedema. Consumption coagulopathy, as observed in some cases of human bromocarbamide intoxication and also in our experimental model, can be prevented by anti-coagulant therapy with heparin and also, as could be shown in rabbits, with aggregation-inhibiting agents. These findings strongly suggest that consumption coagulopathy is only a secondary phenomenon which develops in the course of primary endothelial damage. Similarities in the histological findings of endothelial damage between bromocarbamide intoxication in humans and in rabbits and the so-called "Adalin purpura", which can be observed after chronic use of bromocarbamide, are discussed.


Thiamine pyrophosphatase and acid phosphatase. Their ultrastructural localization in rat skin.

The ultrastructural localization of TPPase and AcPase in rat skin was studied. AcPase appeared localized in the lysosomes of the basal layer and in the keratinosomes of spinous, granulous and corneum layers. A diffuse reaction was also present in the granulous cells cytoplasm. Only the keratinosomes in the superficial layer were TPPase positive, specially those of the intercellular spaces of the proximal horny cells. The Golgi apparatus of all skin cells reacted strongly towards TPP. Membranous structures with TPPase and AcPase activity were evident within horny cells and seem to be infolded portions of the cell membrane which keep their enzymatic activity.


[Kinetics of refatting of human hair (author's transl)].

The sensitivity of the ground glass method for measurement of lipids can be considerably increased by a more sensitive polish of the glass plates. Therefore lipid measurements are possible in areas with only few sebaceous glands and even on scalp hairs. The hair lipids are continuously measureable without disturbance by sebum from the skin of the head and without extracting the hair of the test person; the time needed for measurement is only short. The curve for the refatting of the hair can be quantitatively recorded. Beside the measurement of the dynamics of hair fatting, we now have a method to prove the cosmetical treatment of hair which also allows experiments to be carried out on a larger scale.


[Effect of high dosis of D-penicillamine and paramethasone on mechanical properties of rat connective tissue (author's transl)].

Male albino rats are treated with high doses of D-penicillamine (2000 mg/kg/day orally), paramethasone (50 mu-g/kg/day orally), and with a combination of equal doses of D-penicillamine and paramethasone for a period of 4 weeks. At the end of treatment the mechanical properties of dorsal skin and aorta of the experimental animals are determined. 4 weeks of treatment with D-penicillamine or paramethasone, respectively, leads to a decrease in the skin thickness of the experimental animals. With simultaneous administration of both substances the decrease in skin thickness is about the same. Load resulting in rupture is considerably reduced by D-penicillamine, while only a slight decrease is seen with paramethasone. Simultaneous administration of both substances results in considerable decrease in load resulting in rupture, similar to the effect produced by D-penicillamine. Tensile strength which is not influenced by paramethasone treatment, decreases after treatment with D-penicillamine as well as after simultaneous administration of D-penicillamin and paramethasone. Load resulting in rupture of the aorta remains uninfluenced under the experimental conditions. Comparison of the groups shows that simultaneous administration of D-penicillamine and paramethasone leads to the same results as those which may be obtained with sole administration of D-penicillamine. This suggests that the effect of D-penicillamine on the mechanical properties of the rat skin is not influenced by an additional high dose of paramethasone under the experimental conditions chosen.


Variation of cadmium concentration in Swedish wheat and barley. An indicator of changes in daily cadmium intake during the 20th century.

In order to evaluate whether or not an increase in daily cadmium intake may be taking place, 75 wheat samples (spring wheat and fall wheat) harvested from the same "nonpolluted'' farm fields between the years 1916 and 1972 were analyzed. The individual scatter was large but a significant (Psmaller than.05) tendency toward increasing concentration with time was evident for fall wheat. A similar tendency was found for spring wheat, through not a statistical significance. This increase may be explained by general air contamination or the cumulative effect of fertilizers. There was a clear covariation in cadmium concentrations of differenc genotypes of wheat and barley harvested in the same year despite yearly variations in average concentration.


Neurotoxicity of methylmercury in squirrel monkeys. Cerebral cortical pathology, interference with scotopic vision, and changes in operant behavior.

Blood mercury was raised to levels exceeding 1,000 ng/gm by weekly oral doses of methylmercury hydroxide to squirrel monkeys. Operant behavior tests were employed and neurological signs were recorded on film. Sudden visual disturbance occured with subacute exposure. Prolonged exposure resulted in impaired coordination with impairment of scotopic vision and possibly also sensory disturbances. Scotopic vision was tested by determining the critical fusion intensity (cfi) at 10 cps. An increase in cfi was the earliest neurological sign appearing in some monkeys months before other signs could be detected. Poisoned monkeys exhibited typical cerebral cortical lesions. The visual cortex was invariably involved. Extension to adjacent cortical areas increased with increasing duration of exposure and increasing brain mercury. The microgram per gram brain tissue was the lowest concentration of methylmercury seen wiht morphological lesions.


Cardias arrhythmias in hypoxic rabbits during aerosol propellant inhalation.

Rabbits were exposed for four minutes to combinations of oxygen (21%, 11%, or 7%) and fluorocarbon-11 (0%, 5%, or 15%). Exposure to 7% oxygen-15% fluorocarbon-11 caused cardiac arrhythmias in all rabbits exposed. These bradyarrhythmias developed at levels of arterial hypoxemia that did not cause arrhythmias in rabbits exposed to 7% oxygen alone. In contrast with recent reports, hypoxia and this aerosol propellant do appear to have an interactive effect on cardiac rhythm.


Concentrations of fluoroalkanes associated with cardiac conduction system toxicity.

When respiratory alterations associated with the inhalation of aerosol propellants were eliminated, it was demonstrated that a ten-minute exposure to trichloromonofluoromethane (Freon 11) at concentrations below 15% never caused death. Rarely, at a concentration of exactly 15% minimal sinus slowing occurred (change less than 10% the base line rate). At concentrations between 15% and 17%, nine animals survived while seven succumbed. Ranges between 17.5% and 21% resulted in seven survivors of 19 animals, while no animal survived a ten-minute exposure to a concentration in excess of 21%. The mode of death was most commonly and ultimate asystole. Concentrations of dichlorodifluoromethane (Freon 12) greater than 95% were necessary to produce death in ten minutes, and severe oxygen deficit was evident.


Short-term effects of cigarette smoking on bronchial clearance in humans.

The short-term effects of cigarette smoking on the bronchial clearance of inhaled monodisperse radioactive insoluble particles was studied in nine nonsmokers and six smokers. Each subject inhaled two aerosols of the same particle size, tagged with a different isotope, with an interval of several hours between aerosol exposures. Simultaneous measurements were made of the clearance of both aerosols. Smoking of from two to seven cigarettes was started shortly after the second tagged aerosol. Comparison of the bronchial clearance times of the two tagged aerosols gave a minimum estimate of a twofold transient speedup in deep bronchial clearance caused by the cigarette smoking in both smokers and nonsmokers.


Spontaneous gastric rupture in the newborn: a clinical review of nineteen cases.

The term "spontaneous gastric rupture" is used to describe our cases of neonatal gastric perforation. Nineteen such neonates are reviewed. Current opinions regarding the possible etiology is included in the discussion. Neonatal asphyxia was the most commonly seen predisposing cause in our series (63%). Roentgenograms of the abdomen are most helpful in making a positive diagnosis. Surgical repair is the treatment of choice. All the surviving patients in our series underwent surgical repair. The need for gastrostomy during surgery should be individualized. The mortality was 27% in the cases operated since 1970; a significant improvement as compared to a mortality rate of 62% for the cases operated before 1970.


Quality of life: the continent ileostomy.

Ten patients are presented in whom a continent ileostomy (internal ileal reservoir or Kock Pouch) was constructed. The series is unique in that it includes the first such ileostomy successfully constructed in this country. The other 9 patients, for a variety of reasons, sought conversion from a standard ileostomy with an external appliance, to a continent ileostomy. Eight of 9 were successfully converted. Subsequent loss of continence has occurred in 2 of the patients due to reduction or intususception of the nipple valve. In one of the two, a satisfactory level of continence appears related to adequate pouch size. The second patient is seriously inconvenienced by a varying level of continence in part related to slow development of pouch size. Seven of the 10 attest to a dramatic improvement in life style, and illustrate the high level of patient satisfaction with a continent ileostomy.


False aneurysm of the abdominal aorta due to blunt trauma.

Nonpenetrating trauma to the abdominal aorta is uncommon and the development of a traumatic abdominal aortic aneurysm is even more rare. The victims of blunt trauma to the abdomen should be examined for diminution or absence of femoral pulses, especially if numbness, diminished sensations, or motor weakness appear following trauma. If pulse abnormalities are present, aortography should be performed promptly to exclude aortic disruption or dissection. Immediate surgery should be performed once the diagnosis of aortic disruption is made. To our knowledge, this is the second reported case of successful surgical treatment of a false aneurysm of the abdominal aorta following nonpenetrating trauma.


Postoperative chronic renal failure: a new syndrome?

Of 125 patients with postsurgical acute tubular necrosis, 87 died, 34 regained clinical normal renal function, and 4 survivors (9.5%) were left with severe permanent renal failure, two of whom required chronic dialysis and transplantation. Preoperatively these 4 patients had normal renal function. The 4 patients were above age 60, two had undergone methoxyflurane anesthesia, and nephrotoxic antibiotics were used in all. The incidence of permanent renal failure is much higher than ever reported and may reflect the survival of patients who previously died because of less ideal dialysis. We believe that the cause of this permanent lesion is multifactorial, including age (over 60 years), nephrotoxic antibiotics (particularly cephalothin and gentamicin sulfate), and nephrotoxic anesthetic (methoxyflurane) agents. This combination of factors should be avoided whenever possible.


Solitary bony metastasis as the first sign of malignant gastric tumor or of its recurrence.

Symptomatic solitary bony metastasis as the First sign of asymptomatic gastric carcinoma is very infrequent. Only 8 cases reported by 7 authors have been found in the literature. Furthermore, solitary bony metastasis as the sole sign of recurrence after hopefully curative resections are so rare that none has been previously reported in the literature. Three additional instances of solitary and histologically proven osseous metastasis of malignant gastric neoplasms have been observed and treated at Memorial Hospital during the years 1949 through 1969, and are herewith reported.


Effect of low dose intra-arterial reserpine on vascular wall norepinephrine content.

A number of reports in recent years have indicated that the administration of low dose intra-arterial reserpine has resulted in significant clinical improvement in patients with symptomatic vasospasm, with the benefits presumably resulting from regional vascular wall norepinephrine depletion with resultant vasodilatation. However, to date, there has been no evidence that such low dose reserpine actually alters vascular wall norepinephrine content. This study was performed to determine both regional and systemic effects of low dose intra-arterial reserpine on vascular-wall norepinephrine content, and the duration of any alterations. Twenty-four mongrel dogs had vascular segments excised and assayed for norepinephrine content, before and for up to 4 weeks following a single injection of reserpine, 0.01 mgm/kg, into one femoral artery. The results indicate a pronounced norepinephrine depletion in the injected femoral arterial system, with the reduction persisting for 2-4 weeks, at which time complete norepinephrine recovery occurred. The visceral vessels sampled also showed considerable norepinephrine depletion, indicating systemic spill-over of the drug from the injected peripheral arterial tree. The visceral vessels, however, showed maximal depletion at 24 hours, with recovery by 7 days.


Pulmonary microembolism associated with massive transfusion: II. The basic pathophysiology of its pulmonary effects.

In animals pulmonary hypertension, a decrease in total body O2 consumption and metabolic acidosis occur after transfusion of blood with an elevated screen filtration pressure (SFP) through standard blood transfusion filters. The purpose of this study was to define in detail the pulmonary abnormalities that develop following transfusion of blood with an elevated SFP through standard blood transfusion filters. Exchange transfusions of approximately twice blood volume were administered through standard commercially available blood transfusion filters (measured pore size--200 microns) to 6 animals. SFP measurements verified the presence of large numbers of aggregates in the transfusions. Although filters reduced SFP of the stored blood somewhat, numerous microaggregates passed the filters, and post-filtration SFP remained high. After transfusion average O2 consumption decreased to 77% of normal and metabolic acidosis developed. Pulmonary arterial hypertension was associated with an increase in pulmonary shunting of blood and a decrease in pulmonary diffusing capacity. The presence of extensive numbers of microemboli in the pulmonary arteriolar and capillary bed was confirmed by microscopic examination of lung tissue.


Appraisal of arteriography for assessment of operability in periampullary cancer.

The preoperative arteriograms in 87 periampullary cancers were analyzed in relation to the extension of tumor as explored in surgery, the resectability and the survival time. Most of the patients in whom the pancreaticoduodenal arcades were intact (Group I-O) showed no extension of the lesion into the surroundings and survived more than two years after pancreatoduodenectomy. Those in which the invasion was confined to the anterior pancreaticoduodenal arcade (Group I-A) could also be resected with much anticipation of long survival. About a third of the patients, in whom either the posterior arcade (Group I-P) or both anterior and posterior arcades were invaded (Group I-AP), were resectable. Only a few patients with the involved gastroduodenal artery (Group 2-A) or with the involved superior mesenteric artery (Group 2-P) were treated by extended pancreatoduodenectomy, but they died of recurrence shortly after resection. Further extension of the lesion was explored in surgery when preoperative angiography showed invasion of both the gastroduodenal and superior mesenteric arteries (Group 2-AP) or of the extrapancreatic vessels such as the hepatic artery (Group 3-C), intestinal arteries (Group 3-M) and both (Group 3-CM). Survival in these cases was only a few months after by-pass operation.


Inhibition of serum and urine amylase activity in pancreatitis with hyperlipemia.

In 6 of 7 patients with acute pancreatitis and hyperlipemia, inhibition of serum amylase activity was detected by dilution of the serum before assaying for amylase and by correcting for tthe dilution factor. In 4 patients the inhibition phenomenon disappeared within the first few days of hospitalization as the elevated serum triglycerides fell. However, in 2 others there was no relation between triglyceride level and amylase inhibition. Removal of the excess serum lipids by ultracentrifugation did not eliminate the inhibition of amylase activity. Inhibition of amylase activity also occurred in the urine of these patients. No amylase inhibition was demonstrable in lipemic serum from patients without pancreatitis or in pancreatitis serum to which excess lipids were added. The data suggest the presence of a circulating inhibitor of amylase, distinct from the elevated serum lipids, in the serum and urine of patients with acute pancreatitis associated with hyperlipemia. The diagnosis of acute pancreatitis in the patient with abdominal pain and lactescent serum can be facilitated by correcting the serum amylase activity by dilution.


Melanoma of the head and neck.

A series of 94 patients with cutaneous malignant melanoma of the head and neck region has been studied. Fifty-three of the patients had regional lymph node dissections performed and the results in 37 performed more than 5 years ago are presented. The policy of elective lymph node dissection for invasive melanoma of the head and neck is strongly endorsed, although not proven by the data presented in this limited series. Whenever possible, a total excisional biopsy should be performed to establish the diagnosis. It is recommended that all melanomas be classified by the method of Clark and Mihm and that the level of invasion also be determined. There is an appreciable error in the clinical evaluation of lymph nodes for metastases. In general, it is suggested that elective regional lymph node dissections be performed for invasive melanoma (levels III, IV and V). The literature pertaining to cutaneous melanoma of the head and neck has been reviewed and surgical and pathological problems peculiar to lesions of this region are emphasized.


Human skeletal muscle energy metabolism during and after complete tourniquet ischemia.

The extent of cellular metabolic deterioration and its reversibility was studied on human skeletal muscle needle biopsies during operations in bloodless field. The tissue levels of high energy phosphates and glycolytic metabolites were analyzed after various times of tourniquet ischemia and compared to contralateral control extremity levels. In the ischemic extremity the phosphocreatine (CrP) levels decreased by 40% within 30-60 min and after 60-90 min a 60% reduction was found. No significant ATP changes occurred. Lactate levels increased by 225% after 30-60 min and by 300% after 60-90 min. The glucose and G-6-P levels increased slightly and indicated glycogenolysis. The rate of the metabolic changes decreased with ischemia time. In the control leg no significant metabolic changes could be seen. After the release of the tourniquet there was a rapid restoration of the phosphagen content and clearance of lactate in the ischemic leg. Near control levels of these substances were seen already after 5 min. The present results show that clinical tourniquet ischemia of up to 90 min duration produces less pronounced metabolic alterations than those seen in working muscle.


Acute effects of furosemide on left ventricular contractility in dogs.

The acute effects of the intravenous administration of large doses of furosemide on the left ventricle were studied in a controlled open-chest dog preparation. The data revealed that there was no direct effect of furosemide on the ventricular myocardium. This suggests that any acute cardiovascular effects seen clinically after the use of furosemide would most likely be due to changes in the effective circulating blood volume, direct effects upon certain vascular beds, electrolyte alterations, and possible secondary reflex cardiovascular effects rather than to any direct cardiac effects.


Effect of ouabain on cerebrospinal fluid formation after carbonic anhydrase inhibition.

The effect of ventriculo-cisternal perfusion of ouabain was determined on CSF production after inhibition of carbonic anhydrase by benzolamide in cats. An additional decrease in CSF formation was observed by combination of i.v. benzolamide and intraventricular ouabain. However, the effect of the combined drugs was less than the sum of the effects of the drugs given individually. It is concluded that the reduction of the CSF production by ouabain is probably partly due to its effect on Na-K exchange (through inhibition of Na-K-activated ATPase) and partly due to its effects on Na+ transport coupled to anion transport mediated by carbonic anhydrase.


An evaluation of the analgesia induced by morphine gamma-hydroxybutyrate.

Experiments were performed to determine 1) whether synergism existed between morphine and gamma-hydroxybutyrate in the production of analgesia and 2) the effect of each of these agents on pain-induced changes in brain amino acid content in mice. The analgetic ED50 for both agents was determined using hot plate and tail-flick procedures. The combination of one-half the ED50 of each agent produced an effect equivalent to the ED50 of either agent administered alone in the hot plate but not in the tail-flick test. Although both agents produced an unresponsiveness to noxious stimulation, only morphine prevented pain-induced alterations in brain GABA and glutamate levels.


Influence of extrahepatic cholestasis on metabolism and biliary excretion of imipramine.

Seven days after bile duct ligation, rat receiving 80 mg of 14-C-imipramine/kg i.p. excrete less than 2 per cent of the dose as total drug (imipramine plus metabolites) within 2h through a bile fistula. In rats without cholestasis, the biliary excretion accounts for 15 per cent of the dose. The percentage of the dose found in liver, lung, brain, and blood does not differ from that found in bile fistula rats without prior bile duct ligation. The conjugates of the hydroxylated imipramine metabolites account for 33 per cent of the total drug excreted through bile after bile duct ligation as compared with 88 per cent in rats without bile duct ligation. The remaining 67 per cent of total drug are excreted as desmethylimipramine, imipramine-N-oxide and imipramine at about equal parts. Hepatic microsomal N-demethylating enzyme activity after bile duct ligation is decreased as well as the content of microsoma cytochrome P-450. A concomittant complentary appearance of the metabolically inactive cytochrome P-420 is observed.


The effects of ouabain and phenytoin on myocardial noradrenaline.

In guinea pigs, 160 mug kg-1 of ouabain decreased noradrenaline content of the right atrium and left ventricle by 44% and 68%, respectively, 2 hr after intraperitoneal injection. In rats, 20 mg kg-1 decreased noradrenaline content of the right atrium and left ventricle by 35% and 55%, respectively, at 1 hr. In mice, 10 mg kg-1 decreased myocardial noradrenaline by 33% and 20 mg kg-1 by 45% at 15 min. Phenytoin, 10 mg kg-1 in the guinea pig, 80 mg-1 in the rat, and 40 mg kg-1, in the mouse suppressed the effect of ouabain. Hexamethonium did not suppress the effect. In isolated, perfused guinea pig and rat hearts, 5.5 + 10-8 M and 6.8 + 10-6 M, respectively, caused an increase in noradrenaline output, which was usually followed by oscillatory fluxes; the initial increase in output was obtunded and the oscillations were entirely prevented by premedication with phenytoin but not by the addition of the drug to the perfusion medium.


Application of polyvinylpyrrolidone as a carrier for kallikrein.

Kallikrein covalently attached to polyvinylpyrrolidone was prepared. The kinetic parameters, the molecular weight and the blood pressure depressor effect of kallikrein and kallikrein bound to polyvinylpyrrolidone are compared. Analytical ultracentrifugation showed a mean molecular weight of 110 000 dalton for kallikrein bound to polyvinylpyrrolidone. The specific activity of kallikrein-PVP was 4.6 times lower when compared with native kallikrein, however K-M was only slightly different. The maximal reduction and the duration of the decrease of mean arterial blood pressure were statistically not different from each other when kallikrein and kallikrein-PVP were injected in amounts of the same esterolytic activity.


Hyperthermic and hypothermic effects of morphine in mice: interactions with apomorphine and pilocarpine and changes in sensitivity after caudate nucleus lesions.

In mice, both apomorphine and pilocarpine either potentiated a hypothermic effect of a high dose of morphine or reversed a hyperthermic effect of a low dose of morphine to a hypothermic effect. Haloperidol paritally blocked the hypothermic effect but not the  hyperthermic effect of morphine. Scopolamine partially blocked the hyperthermic but not the hypothermic effect of morphine. Bilateral lesions of the caudate nuclei produced no changes in sensitivity to  either the acute hyperthermic or hypothermic effect of morphine but did selectively facilitate the developement of tolerance to morphine-induced hypothermia. The results suggest that morphine's temperature effects are determined by the interaction of several mechanisms and that the caudate nucleus may have a specific role in drug tolerance.


Role of noradrenaline and serotonin in the central control of blood pressure in normotensive and spontaneously hypertensive rats.

Noradrenaline and alpha-methylnoradrenaline applied to the area of the nucleus tractus solitarii of the medulla oblongata decreased arterial blood pressure and heart rate of anesthetized normotensive rats. Alpha-Methylnoradrenaline was more effective than noradrenaline. Prior administration of the alpha-adrenergic blocking agent phentolamine at the same site prevented the central inhibitory action of the two catecholamines and even reversed the effect on blood pressure. The hypotensive responses evoked by electrical stimulation or alpha-methylnoradrenaline application were found to have a common distribution of the most effective site, comprising the middle-caudal part of the nucleus tractus solitarii at the obex level. Bilateral electrolytic lesions of this area caused an immediate and severe hypertension. The data suggest that the area of the nucleus tractus solitarii is a site of action of hypotensive drugs which may act by noradrenergic receptor stimulation in the brain. In addition brain serotonin may also play an inhibitory role as indicated by the association of elevated blood pressure and brainstem serotonin depletion during treatment with para-chorophenylalanine of normotensive and genetic hypertensive rats.


[Comparative study on the action of some substituted benzamides on the isolated ileum of the guinea pig].

Metoclopramide [(Mcp)-N-diethylaminoethyl-2-methoxy-4-amino-5-chloro-benzamide] was shown by the authors (This Journal 1973, 204, 239) to stimulate the isolated guinea-pig ileum, mainly by an indirecr cholinergic mechanism, to increase responses to acetylcholine (Ac) and transmural stimulation, and to inhibit responses to serotonin (5 HT) and histamine (H). Four structuraly related benzamide derivative (1211, 1265, 1308 and 1347) also stimutated the ileum, 1211 being the most active, and 1347  the least active, and resembled Mcp  with regard to the responses to Ac, transmural stimulation and histamine. However, serotonin contractions were enhance by 1265 and 1347, while 1308 and 1211 were inhibitory. These observations suggest that a 4-amino group does not seem to be essential for the stimulant effect or the interference with Ac responses (1211, 1265, 1347), whereas a methylsulfonyl group (1347) and, to a lesser degree, a flour in 5 position (1265) sensitize the ileum towards 5 HT contractions.


Coxsackievirus infection in mice.

White mice of the NYA: NYLAR strain were infected with coxsackie B1 or B4 virus and studied for persistence of virus, antibody conversion, histologic changes, and glucose tolerance during periods up to 13 months. Pancreatitis was observed during the acute phase of infection. Suggestions of subclinical diabetes were found during the first six months after virus inoculation. A normal glucose tolerance at 10 to 13 months suggestes that the functional lesion is temporary.


Enhanced tubular reabsorption of phosphate.

Individual kidney functions were studied during water diuresis in eight patients, following the relief of unilateral ureteral obstruction. Fractional excretion of phosphate was diminished in four of the patients, presumably due to enhanced tubular reabsorption of phosphate in the diseased side. Glomerular underperfusion may be the main factor responsible for the hypophosphaturia in the postobstructive kidney. Fractional excretion of sodium and water was increased in the obstructed side in six of the eight patients. In two of the four patients with hypophosphaturia, there was enhanced fractional sodium excretion, suggesting a dissociation of renal handling of sodium and phosphate in some patients with this condition.


Participation by internists in primary care; Results of a survey of Mayo clinical alumni.

In late 1972, a survey of Mayo Graduate School alumni was undertaken to determine if changes were needed to make the internal medicine residency program more relevant to such medical practice in the 1970s. Responses were obtained from 783 of the 1,109 former residents in internal medicine to whom questionnaries were sent. Althought nearly half of the responders indicated a subspecialty component to their practice,73% indicated they spend more than half of their time in the delivery of parimary car; and additional 15% reported that primary care occupied from 20% to 50% of their professional time. There was agreement that more general internists are needed and that better geographic distribution of physicians would improve health care delivery.


Low-renin hypertension. Occurrence in vascular complications.

Two hundred one patients with essential hypertension, who had studies of their renin-aldosterone system performed between April 1967 and December 1972, were surveyed for myocardial infraction or cerebrovascular accident. Of the patients, 42% had low plasma renin activity. Myocardial infractions or cerebrovascular accidents were documented in 15% of those with low plasms renin activity and in 5% of those with normal plasma renin activity. When adjustments were made for differences in afe and blood pressure , a protective effect in low-renin hypertension was evident. When black patients were considered separately,there was no difference in diastolic blood pressure; however, vascular complications were not less frequent in low-renin hypertensives. The results suggest that low plasma renin activity does not protect against the development of vascular complications in essential hypertension.


Pseudomyeloma. Is association of severe osteoporosis with serum monoclonal gammopathy an entity or a coincidence?

The designation "pseudomyeloma'' is used to describe three patients who had a clinical picture that closely resembled multiple myeloma and was characterized by severe osteoporosis and a serum monoclonal paraprotein peak. The diagnosis of myeloma could not be made histologically, initally or after three, four, or ten years of observation. The protein abnormalities and the bone marrow picture remained stable. It is not known if this association has pathophysiologic importance or if it represents a chance phenomenon.


Prognosis of chronic renal failure. II. Factors affecting survival.

After serum creatinine levels exceeded 10mg/100ml, median survival was 55 days (to death or dialysis) in a group of 112 patients with chronic renal disease. Renal failure was partially reversible in 29 patients, partially accounting for prolonged survival. Those with polycystic kidneys, pyelonephritis, or obstructive nephropathy survived longer,partially because of more frequent reversibility and a slower increase in serum creatinine concentration. Kiabetic nephropathy, myelomatous kidneys, and amyloidosis were associated with shorter survival, less frequent reversibility, and more rapid progression. Urinary infection and extracellular volume depletion often accounted for partially reversible renal failure and prolonged survival. Blood pressure and age were not prognostic variables, while coexistent heart failure shortened survival. Survival correlated significantly with sodium excretion.


Polyarthritis associated with type IV hyperlipoproteinemia.

Twelve patients had undiagnosed articular disease associated with type IV hyperlipoproteinemia. Objective joint findings involved both large and small joints. Disease was bilateral but asymmetrical and oligoarticular. Synovitis was midly inflammatory and persistent rather than episodic in natrue, and disability was minimal. Serial slinical, laboratory, and radiographic assessment excluded other currently recognized forms of rheumatic disease. Joint radiographs demonstrated large metaphyseal and epiphyseal cysts in five patients. Synovioanalysis and synovial biopsy results are reported in two patients. These cases appear to constitute a clinically homogeneous group. The concurrence of a distinctive articular syndrome and type IV hyperlipoproteinemia suggests a possible causal relationship.


Hyperphosphatemia and hypocalcemia in Burkitt lymophoma. Complications of chemotherapy.

In two patients, metabolic complications, previously unreported to our knowledge, of severe hyperphosphatemia and hypocalcemia in addition to hyperkalemia nad hyperuricemia were demonstrated after treatment with cyclophosphamide. In one patient, elevated blood and ascites lactate levels were measured. The levels decreased rapidly to normal following chemotherapy. The hyperphosphatemia and hyperkalemia may have been due to rapid tumor lysis and the hypocalcemia may have been caused by the hyperphosphatemia. The reduction in blood and aseties lactate levels may reflect the lysis of anaerobically metabolising tumor cells. Renal dialysis was required in the management of both cases. Because of the potential for cardiac arrythmias related to electrolyte imbalance, it is recommended that whenever possible reanl dialysis be available before treating cases of Burkitt lymphoma with large tumor burden.


Liver disease caused by propylthiouracil.

This report presents the clinical, laboratory, and light and electron microscopic observations on a patient with chronic active (aggressive) hepatitis caused by the administration of propylthiouracil. This is an addition to the list of drugs that must be considered in the evaluation of chronic liver disease.


Lymphopenic infectious mononucleosis.

Lymphopenic IM is a real phenomenon. It is likely to appear as a more severe clinical illness and, in contrast to the benign course to typical IM, may have a poorer prognosis. The clinical spectrum of IM should be extended to included to include lymphopenic patients if their diagnosis is supported by appropriate heterophil and EBV antibody titers.


The Jewish Hospital of St. Louis therapeutic grand rounds no. 9. Diagnosis and therapy of acromegaly.

Acromegaly, the clinical expression of chronic hypersecretion of growth hormone, develops insidiously and is too often not recognized until the disease is advanced. However, a useful screening procedure, the measurement of serum growth hormone after an oral glucose load, is available. Though evidence suggesting that acromegaly may be a disorder of defective hypothalamic regulation of pituitary growth hormone secretion has accumulated, the pathogenesis of the diease is not sufficiently understood to permit consistently effective medical therapy. Current therapy, therefore, is directed toward destruction of growth hormone producing pituitary tissue. Patients with major suprasellar extension and chiasmal compression usually require transfrontal surgery. Patients without major suprasellar extension can be treated with external irradiation or with transsphenoidal surgery. It is our current practice to limit the former to young patients withe relatively modest elevation of the serum growth hormone concentration.


Effect of growth substrates on morphology of Nocardia corallina.

Cells of Nocardia corallina ATCC 4273 form multiply branched coenocytic mycelia and subsequent fragment to spherical cells when grown on solidified complex media. In liquid shake cultures using complex media the organisms grow into pleomorphic but seldomly branched rods, divide as rods and then the rods fragment to spheres as the stationary phase is reached. In a defined liquid medium with glucose as carbon source, the organisms divide entively as spheres at a doubling time of 44 hrs. The addition of L-tyrosine, some fatty acids and tricarboxylic acid cycle intermediates or fructose to the glucose medium caused the cells to grow at considerably faster growth rates (2.8-8.5 hrs doubling times) and to undergo the shphre-rod-shpere growth cycle. Other amino acids, fatty acids or surgars added singly to the glucose medium did not produce the sphere to rod morphology change. Some amino acids when added to the medium in pairs effected sphere to rod morphopoiesis. None of these amino acids alone were effectors. Some of the culture grew as rods and the remainder as spheres when isoleucine and valine were added to the glucose medium. No other amino acid combination tested gave this result. The reason for the mixed growth response was traced to inhomogeneity of the parent culture. The life cycle of N. corallina is illustrated in a series of photomicrographs of two slide cultures.


The regreening of nitrogen-deficient Chlorella fusca II. Structural changes during synchronous regreening.

Chlorella fusca, strain 211-15, cells degreened in a nitrogen-deficient mineral growth medium in the light for 4-6 weeks were regreened for up to 24 hrs in a nitrogen rich medium that leads to synchronous cell division at 24-26 hrs. Structural changes in the plastid membranes during the regreening period were observed by thin section and freeze-fracture electron microscopy. Nitrogen-deficient plastids were found to have non-appressed lamellae, prolamellar body-like membrane aggregations, and only 2 types of freeze-fracture face. At this time no photosynthetic oxygen evolution could be demonstrated. After 6 hrs regreening the plastid lamellae had fused to form bands of appressed lamellae and the four types of freeze-fracture face, described previously, were visible. At this time photosynthetic oxygen evolution could be demonstrated. After 24 hrs regreening the plastids had an appearance typical of normally grown Chlorella and had commenced to divide. Supporting evidence for these developmental stages is presented from isolated chloroplast particle fractions. An unusual type of cell wall proliferation was observed in the nitrogen-deficient Chlorella cells that resulted in the laying down of several walls, each with a trilaminar component.


Myocarditis induced by coxsackie B3 virus in mature mice.

Forty female mice during breast-feeding were infected intraperitoneally with coxackie B3 virus. Gross and microscopic examination of the hearts of the mice 7, 20, 44 and 120 days after infection revealed myocarditis typical of the acute stage of the disease, not reported previously, and gradually increasing intensity of immunologic changes in the chronic stage.


Phagocytic properties of exudative microphages from animals with alloxan diabetes and insulin-induced hypoglycemia.

Phagocytosis was studied in exudative microphages from white mice with alloxan diabetes and insulin-induced hypoglycemia. Peritoneal exudates were induced to obtain exudative forms of microphages, which were used to phagocytize Staphylococcus aureus 209 P Oxford. Phagocytic indices were calculated by the method of Davies. The liver and pancreas were studied morphologically and histochemically, and serum glucose levels were assayed. The experiments showed that: 1) lowered phagocytic indices in animals with alloxan diabetes and insulin-induced hypoglycemia indicate lower phagocytic capability of exudative microphages; 2) normal phagocytosis depends on: a) normal blood levels of glucose as energetic material, and b) adequate concentration of insulin in tissues as enzymatic "transporter" of glucose.


Effect of thyroid hormones on activity of nonspecific phosphohydrolases in blood serum, tissues and liver mitochondrial fraction of white rat.

Activity of alkaline and acid phosphatase was determined by the method of Bodansky in blood serum, homogenates of liver, kidney, lung, brain, liver mitochondrial fraction of normal, methylthiouracil-induced hypothyroid, and Thyroideum-induced hyperthyroid rats. The following results were obtained: an increase in both enzymes in all studied materials in hyperthyroidism, and a decrease in most of the studied materials in hypothyroidism.


Comparison of results of isolating lymphocytes with Ficoll plus Ronpacon and with gelatin.

White blood cells were isolated from peripheral venous blood with gelatin and with a combination of Ronpacon and Ficoll. Gelatin gave greater concentration of white blood cells, whereas Ronpacon plus Ficoll yielded less concentrated preparations but with significantly higher percentage of lymphocytes, as well as a larger proportion of viable cells in comparison with gelatin.


Slowing of nerve conduction velocity in hemiplegia: possible factors.

A study of nerve conduction velocities in ulnar and peroneal nerves bilaterally in 27 hemiplegic patients revealed a statistically significant slowing in the affected limbs compared with the unaffected limbs, and a slowing of both compared with the standards for completely normal subjects. These results suggest that the upper motor lesion affects the function of the lower motor neuron. Proposed causes include a demonstrated lower skin temperature, a possible atrophic thinning of the fibers and other less plausible factors.


Grip strength and grip endurance in physical therapy students.

A hand-grip dynamometer was used to test the maximal grip strength and endurance index of 15 male and 15 female physical therapy students. The results showed that there was no apparent correlation between maximal grip strength and endurance index in the male subjects, but there was a tendency for endurance index to decrease as maximal grip strength increases in the female subjects. Maximal grip strength and body weight were positively correlated in both the males and the females. There was no significant difference in endurance index between the males and the females.


Vocational status of multiple sclerosis patients in Israel.

In a research study, the vocational status of 172 patients with multiple sclerosis who were from 20 to 50 years of age was evaluated. These patients constituted 35% of the total population having multiple sclerosis in Israel. Ninety-four are working and 78 are unemployed. In the unemployed group, 41 are severely disabled but 37 have working potential. No rational explanation could be found in the demographic, vocational or educational backgrounds for the unemployment of the 37 patients. It is suggested that a vocational rehabilitation program at the onset of the patient's disability may prevent eventual unemployment.


Orthotics research evaluation framework.

The evaluation framework presented here defines a three-tier hierarchy of the functional goals of rehabilitation, using the tenodesis splint as an example of an orthosis designed to improve limb function. These goals are combined with five categories of evaluative criteria to create a matrix. Based upon the key validity assumptions underlying the goals, conjoint criteria are suggested. Directions of development and inquiry are indicated. The matrix illustrates the separation as well as the integration of goal levels and evaluative categories; it sets the stage for the proper context and relative importance of specific splinting. This framework will increase the validity of criteria for orthotics evaluation in the design of future clinical studies.


Rehabilitation after bilateral lower extremity amputation.

Fourty-four men (average age, 61.5 years) who had undergone amputation of both lower extremities were studied at a Veterans Administration hospital. Vascular insufficiency was the most frequent reason for amputation. In 26 of the patients bilateral below-knee amputations had been performed. Although diabetes mellitus was present in 26 of the patients, it severely hampered rehabilitation in only four. Twenty-nine (nearly 65%) of the 44 patients became totally independent in daily functions. However, the average time required for maximum rehabilitation was almost 30 weeks.


Biliobiliary fistula. A trap in the surgery of cholelithiasis.

Of 24 cases of abnormal communication between gallbladder and main bile duct occurring in a service specializing in hepatobiliary surgery, jaundice was present in all, but variable in degree and persistence. No particular clinical picture suggested this complication of cholelithiasis, and preoperative diagnosis is rare. At operation, adhesions were strikingly dense, often first suggesting a diagnosis of cancer. The gallbladder, fused to the main bile duct, should not be dissected from it because of the risk of ductal injury. Under these conditions, the gallbladder should be opened peripherally, stones extracted, and a cholangiogram performed to assess the situation. Treatment consists of partial cholecystectomy and closure of a cuff of gallbladder wall over a T tube placed into the main bile duct through the fistula.


Radiation-induced brachial plexus paralysis.

Fifteen patients with radiation-induced brachial plexus paralysis were studied. Thirteen women had been treated for breast cancer. Two men developed symptoms and signs following radiation therapy for lung cancer. The brachial plexus paralysis initially was not static and progressed, but spontaneous arrest with permanent residual paralysis was seen in three patients. Three were noted to have intractable pain, but the major complaint of the remaining 12 was the inability to use their hand. The ten patients on whom an earlier operation directed at the brachial plexus had been performed were not relieved. Two of these were later considered excellent candidates for a tendon transfer in the hand. One did not desire surgery. The other underwent operation and showed marked improvement of her grasp and general hand function.


Left carotid steal. A new observation.

A patient had an occlusion of the left subclavian artery just proximal to the takeoff of a previously placed subclavian-carotid graft. This caused reversal of flow in the graft and a symptomatic steal of blood via to the intracranial arteries. An axilloaxillary graft restored forward flow. In a second patient, a steal occurred from the right carotid and vertebral systems into the distal carotid system of the left side that has been isolated by a proximal carotide artery occlusion from arteriosclerosis. A saphenous vein, used as a bypass from the subclavian to the carotid artery, restored normal flow. Thus, the carotide system may be the low-pressure area responsible for the steal, although this is rarer than the subclavian.


Sterility of intestinal transudate during aortic reconstructive procedures.

In 119 patients undergoing intra-abdominal arterial reconstructions, the small intestines were retained in plastic bags and the fluid that passed from the small intestine into the intestinal bag was cultured for bacteria to search for enteric organisms as a source of prosthesis infection. No enteric organisms were recovered from these 119 cultures. Three cultures did yield bacterial growth; in two cases Staphylococcus epidermidis was found and in one instance S aureus was cultured. Under the conditions of this study, which included intravenous administration of cephalothin sodium preoperatively, intraoperatively, and postoperatively, the small intestinal transudate did not harbor enteric bacteria.


Late thrombosis affecting one limb of aortic bifurcation graft.

Late unilateral limb thrombosis was encountered in 45 of 601 patients discharged from the hospital with functioning aortic bifurcation grafts, an incidence of 7.5%. It was invariably associated with clinical manifestations of arterial insufficiency to the affected limb more serious than those of the extremity prior to the initial operation. Although the specific cause could not be determined, it was usually due to either progression of the disease distal to the reconstructed segment or to certain compromises at the time of the first operation or both. Among several procedures employed, unilateral reconstruction of the thrombosed limb is the procedure of choice. The reoperation was successful in 75% of the patients.


Serendipitous passage of a common duct stone following ampullary cannulation.

A transduodenal endoscopic pancreatocholangiography dislodged a distal common duct stone. The conclusion that the stone was disimpacted by the manipulation was reached by (1) demonstration of a negative shadow representing a stone in the distal part of the common duct on roentgenograms following injection of contrast material after successful ampullary cannulation, (2) the clinical sequence of events that followed ampullary cannulation, and (3) the operative finding of a grossly dilated common duct without the presence of a stone and normal intraoperative and postoperative T-tube cholangiograms.


Wound botulism.

Botulism occurring in patients with wounds has been thought of as a rare disease. A patient with a lacerating wound of his hand and wrist and an avulsion of his fourth finger developed diplopia, dizziness, and slurred speech one week later, followed by generalized weakness and difficulty in swallowing. Repetitive nerve stimulation studies showed signs of neuromuscular block consistent with the diagnosis of botulism. Results of bacteriologic and immunologic tests were not revealing, but the subsequent course of progressing, and retrogressing, bulbar signs and symptoms with eventual nearcomplete recovery confirmed the diagnosis. Increasing awareness and employment of electrophysiologic studies are uncovering increasing numbers of cases.


The split rib technique. An approach to the thoracic cavity.

The technique involves resecting a 1-cm section of rib posteriorly and then splitting the rib longitudinally with the Stryker saw or the neuroaerotome to the desired point anteriorly, where the rib is again divided. Blood loss on entering is minimized, reapproximation during closure is simpler and more secure than by other methods, and the patients experience little postoperative pain.


Trauma to the appendix. A report of two cases.

Only two cases of trauma to the vermiform appendix are recorded in the English literature. This report adds two more cases: one due to a penetrating bullet wound of the abdomen where tangential laceration of the appendix was the only intra-abdominal injury, the other an avulsion of the appendix from the mesoappendix resulting from blunt abdominal trauma. Preoperative diagnosis of this specific lesion could not be made. Both patients were successfully managed by appendectomy.


Concurrent and consecutive infection and immunisation with yellow fever and UGMP-359 viruses.

Concurrent and consecutive infection and immunisation with yellow fever virus and UGMP-359 virus was investigated in mice, using identical doses of both viruses. In double infection it was shown that both viruses could multiply independently of one another, when both were inoculated simultaneously by the intracerebral route. On the other hand, there was mutual exclusion between them when the inoculation of one antedated the other, by the same intracerebral route. Both viruses multiplied to similar titres, in single infection, in the target organ (brain). By the intraperitoneal route, the outcome was influenced byhe relative sensitivity of this route of inoculation to support and sustain the replication of either virus. Thus, because yellow fever virus replicated more than UGMP-359 after intraperitoneal inoculation, the latter is always excluded, even when the inoculation ofUGMP-359 preceded that of yellow fever. In the double immunization studies it was shown that comparative specific antibody titres to both viruses were obtained either when both viruses, as immunogens, were given simultaneously, or when the inoculation of one was alternated, at weekly intervals, with the other.


[Multiplication of sindbis virus in Drosophila cells cultivated in vitro (author's transl)].

Sindbis virus replicates in Drosophila cell cultures without any cytopathic effect. In continuous cell lines the virus is able to establish a persistent infection similar to other arboviruses in insect cell lines. The growth curve of Sindbis virus in Drosophila cells shows a maximum virus yield at around 24 hours postinfection, thereafter the virus production decreases and then remains fairly constant during a number of cell divisions. The average virus yield per cell has been estimated to be small, i.e. at best 5 PFU per day.


Type I primary neuropathic amyloidosis (Andrade, portuguese).

The authors present a review of 21 cases with the diagnosis of type I amyloid neuropathy based on epidemiological data, clinical evolution and histopathological findings. They call attention to the possibility of cranial nerves involvement (hyposmia, diplopia, masseterian hypotrophy, peripheral facial paralysis, hypoacusis, dysphonia, laryngeal paralysis, dysphagia, and trapezium muscle hypotrophy), to the severeness of the digestive symptoms, to the precocity of the autonomic disorders, and to the rather high incidence (6 cases) of heart involvement. The electromyography showed anterior horn involvement in 3 cases. The electrocardiography showed repolarization disorders in 11 cases, left ventricular overload in 6 cases and atrioventricular block in 5 cases. The serum proteins electrophoresis showed frequent abnormalities, but no typical curve could be obtained. The barium-contrasted X-rays of the gastrointestinal tract showed no anatomical lesions, but functional abnormalities (hypo or hypermotility) were found in 14 examination. The Schilling test showed impairment of vitamin B12 absorption in 50% of the cases. However, with the concomitant administration of intrinsic factor (3 cases) there was improvement of it absorption. This proves that the gastric mucosa plays an important role in the disease malabsorption. The test with labeled-triolein showed slow absorption in 2 cases and steatorrhea in 3 (6 tests). For the confirmation of the amyloid deposits, the best histopathological procedure was nerve biopsy. In men, when the nerve biopsy was negative, testicular biopsy has shown to be a good option.


Neuropathy in myotubular or centronuclear myopathy.

A detailed electrophysiological study has been made of the extensor digitorum brevis, thenar, hypothenar and soleus muscles in one patient with myotubular or centronuclear myopathy. The main finding was a noticeable reduction in the population of active motor units in all the investigated muscles. The remainer units showed normal sizes. The experimental observations have been interpreted in terms of a neuropathic process.


[Evolutive examination and learning difficulties].

A comparative study between two groups of fifty children, whose ages ranged from 7 to 10 years old and presented, respectively, good and poor development in class in 1973, is reported. The scholars were evaluated by the evolutive neurological examination, WISC and Bender Test. By statistical analysis it is emphasized the importance of the neurological and neuropsychological evaluation and management of scholar difficulties.


[Frontobasal cranio-encephalic injuries].

The authors deal with the results accomplished by surgical procedure on 10 cases of fronto-basal trauma. X-Rays taken from the skull disclosed an involvement of bone structures of the fronto-basal region in all cases examined. The most outstanding clinical findings in these cases were: lesion of the olfactory nerve (7cases), bacterial meningitis (3 cases), cerebrospinal fluid cranio-nasal fistula (3 cases). The surgical technic was accomplished according to the procedure devised by Dietz and consisted of plastics of the anterior floor of the skull accompanied by galea-periosteal junction taken out from the scalp. The authors did not find any post-operative complications in the cases registered.


[Involvement of nonhypothalamic encephalic structures in the Hand-Schüller-Christian disease. Report of a case and review of the literature].

A case of Hand-Schüller-Christian disease which presented a pyramidal syndrome besides elements of the classical triad and concentric retraction of the visual field is reported. The rare involvement of non-hypothalamic encephalic structures in that disease is emphasized together with the favourable effect of corticotherapy and radiotherapy.


[Descending ocular myopathy].

The case of a 23 years old female patient, with primary involvement of the extraocular and faringeal muscles without familiar history is reported. Electromyographic and muscular biopsy studies proved the myogenic nature of the process. A clinical comparison between the ocular myopathy and the descending ocular myopathy is made, the authors thinking that both of them would be variants of the same muscle disease.


[Eosinophilic granuloma of the cervical spine with atypical neurological, cerebrospinal fluid and radiological manifestations].

A case of eosinophilic granuloma of the cervical spine in a ten year-old white boy is reported. The patient complained of posterior cervical pain at the level of C5-C6 and right hemiparesis that progressed to mixed tetraparesis (lower motor neuron in upper limbs and upper motor neuron in lower limbs). Examination of the cerebrospinal fluid (CSF) disclosed an inflammatory reaction; radiologic studies of the cervical spine showed an irregular aspect with demineralization at the base of spinous process of C6. The patient was treatet intermitently with corticosteriods (prednisone); there was an improvement of neurologic symptoms and the examination of the CSF was normal within a few days, each time he took the drug. Neurologic symptons and abnormalities of the CSF recurred after discontinuation of corticotherapy. Examination of a fragment of the spinous process and neighboring tissues of C6, taken by biopsy, disclosed eosinophilic granuloma. Radiotherapy was then indicated, plus corticosteroids. There was remission of all neurologic symptoms and signs. The unusual features of the case are discussed in relation to others reported in the literature.


[A method for the continuos recording of intracraneal pressure].

91 patients with acute head injuries, hydrocephalus, cerebral infarction, subarachnoid hemorrhage, encephalitis, intracerebral hemorrhage, or carbon monoxide intoxication have been so monitored by using the Numoto pressure switch by a method herein described. The main advantage has been the knowledge of the level of intracranial pressure at any given time and the early detection of a rising pressure when this phenomenon occurred. There were no complications except for 3 cases of infection. Two of these cases were minor purulent collections only at the site of exit of the tube in the scalp. One patient with a compound wound, cerebral laceration, and intracerebral hematoma developed a wound infection and brain abscess which required drainage.


[Recording of the intracranial pressure].

A revision of the methodology for recording intracranial pressure and its use in man is made. Experience is presented with animal embolism followed by recording the extradural pressure. Preliminary report is made about the extradural and intraventricular pressure in patients with signs of involvement of the brain stem.


Intraocular surgery with general anesthesia.

A specialized technique developed specifically for ophthalmic surgery has led surgeons at the Manhattan Eye, Ear and Throat Hospital to perform most private cataract extractions-more than 1,000 per year-with patients under general anesthsia. Because this practice is followed by so few ophthalmic surgeons elsewhere, an evaluation of the relative safety and benefits of local vs. general anesthesia was undertaken. A retrospective study comparing 2,217 consecutive patients operated on under general anesthesia with 561 patients operated on under local analgesia leads us to believe that general anesthesia providess the surgeon with optimum operating conditions. General anaessthesia has proved to be a safe procedure, with a minimum of complications. The ophthalmic surgeon is assured of absolute patient immobility, with safety equilvalent to that seen with procedures performed with local analgesia, despite the advanced age and resulting physiological degeneration of the patient population.


Pseudoentrapment of ointment in the cornea.

A previously unrecognized characteristic clinical entity, "pseudoentrapment of ointment in the cornea" may occur in corneal lesions that have (1) topical application of ointments to the corneal lesion, (2) application of a firm pressure dressing, and (3) stromal loss or distortion of its normal architecture that allows for ointment globules to lie below the corneal surface. The clinical picture is that of a cluster of large ointment globules lodged within the corneal defect. Experimental data suggest that the ointment globules are entrapped within the wound exudates and lodged below the plane of the corneal surface. No treatment is necessary since the globules are extruded within the next 24 to 48 hours even if the pressure dressing is continued. Pseudoentrapment of ointment inthe cornea is compared with and differentiated from corneal ointment entrapment and corneal spheroidal degeneration.


Aneurysmal bone cyst of the orbit.

A 16-year-old girl presented with progressive, painless proptosis of the left eye. X-ray studies revealed an extensive lesion involving the left orbit, antrum, and middle cranial fossa. A biopsy confirmed the diagnosis of aneurysmal bone cyst, and the lesion was surgically excised. There has been no evidence of recurrence after three years. In a review of the literature, we were able to find only seven other cases of aneurysmal bone cyst involving the orbit.


Expandable silicone implants for scleral buckling. III. Experiments in vivo.

Experimental scleral buckling was obtained in rabbits by using expanded silicone rubber implants under scleral trap doors. Buckle heights ranged from 2.3 to 4mm after injection of 0.05 to 0.15 ml of fluid into the implants. Therate of decrease in buckle height followed up opthalmoscopically for five months, was found to be slow and continous and was caused mainly by loosening by the scleral flaps rather than by the diffusion of fluid from the implants. Implants expanded with chorampenicol solutions provided sustained release of the antibiotic in the area of the operation. This was confirmed in agar plantes by inhibition of the growth of Sarcina lutea around subimplant tissues and the expanded implants that were recovered post mortem. These implants provided an opportunity of modify the buckle height easily, either during the procedure or postoperatively.


Casts of chorodial vasculature at physiologic pressures. A new technique.

A method for making latex rubber casts of the ocular vasculature while maintaining physiologic vascular relations has been developed. A series of short-haired domestic ctas, Rhesus monkeys, and albino rabbits were anesthetized and cannulated in the common carotid arteries. The jugular veins were severed, and heparinized saline was infused into the carotid arterial circulation of the animals for complete exsanguination of the head. Throughout the infusion procedure, normal physiologic pressure was maintained. After exsanguination was complete, a solution of latex rubber in distilled water was infused bilaterally and continued until the flow from the jugular veins ceased. The eyes were enucleated and placed in a curing solution. After fixation, the eyes were selectively trimmed and placed into a solution of sodium hydroxide for digestion. The digested tissue was transferred to distilled water for dissection. After dissection, the cast was closely inspected for completeness of capillary filling. Casts such as these are intended for use in observations of ocular vascular anatomy.


Ocular penetration of topically applied gentamicin.

The biologically available concentration of gentamicine sulfate in eight ocular tissues of 140 rabbits and 96 humans was measured by a modified disc diffusion technique. If enough topically administered gentamicine was applied, this bioassay detected it in all ocular tissues tested except the lens nucleus. The decay of antibiotic activity was faster in some tissues, eg, aqueous, than in others. A higher level of antibiotic was found in corneas altered by sutures than in virgin tissue. The degree of inflammation, the frequency of application, and the interval between the drops are directly proportional to the  antibiotic level in the tissues. The antibiotic free vehicle of commercial 0.3 per cent gentamicin drops possesses an antibacterial potential.


Malignant glaucoma" in an eye with no antecedent operation or miotics.

The diagnosis of malignant glaucoma was entertained preoperatively in a patient with no previous history of glaucoma surgery or use of miotics. The marked asymmetry in the anterior chamber depth and angle configuration between the two eyes was the significant clue. The findings at operation confirmed the diagnosis. The closure of the angle appeared to be due to retrovitreal fluid displacing the vitreous and the iris-lens diaphram forward.


Delayed trochlear nerve palsy in a case of zoster oticus.

A 57-year-old man with herpes zoster oticus developed a delayed fourth nerve palsy followed by transient intermittent sixth nerve weakness. Trochlear nerve lesions occur rarely with zoster, particularly in the absence of zoster ophthalmicus. A knowledge of the wide range of motor manifestations and the chronicity of meningitis with zoster will afford earlier diagnosis without resort to arteriography.


Retinal periarteritis secondary to syphilis.

A 43-year-old black woman showed ophthalmoscopic evidence of retinal arteriolitis two weeks after being treated for uniocular panuveitis. Angiographic examination suggested that these deposits were not intraluminal or endothelial atherosclerotic emboli or plaques, but were deposits in the outer walls of retinal arterioles. Sequential ophthalmoscopic and angiographic examinations at one-month intervals for 12 months showed no progression or change in location of these deposits. Results of clinical and laboratory investigations suggested the diagnosis of syphilis. We believe it is rare for syphilitic infection to be implicated in the diagnosis of isolated retinal arteriolitis without periphlebitis.


[Total joint surfact replacement in the hip joint. Preliminary communication].

A method of joint surface replacement for the operative correction of severe osteoarthrosis of the hip joint is described. This type of surface replacement has obvious advantages especially in the younger age group. From experience with homogenous carilage transplants in which only the joint cartilage surfaces are transplanted, the method described offers hope of good results. The important advantage of surface replacement is the fact that the substance of the neck and head of femur are not removed. Therefore all alternative future procedures remain available if necessary. Accurate assessment of this method will require more prolonged follow up.


[Surgical management treatment of dislocation fractures of the hip. Classification--indications--results].

30 fracture-dislocations of the hip were operated in the years 1967-1973. Indication, operative approach, X-ray diagnostic and complications are discussed. Postoperatively continuous traction is applied for some weeks, 26 patients were followed up with 11 very good, 10 good, 3 fair and 2 poor results. It is pointed out, that open reduction with interfragmentar compression - osteosynthesis is a real progress in the treatment of irreducable fracture-dislocations of the hip.


[Histological and Histomorphometric Changes after Osteotomies of Rabbit Tibiae Treated with Plate Osteosynthesis (author's transl)].

In all specimens the cross-sections of bone taken at 4 marked points showed atrophy of the cortical bone which had occured in a typical manner. In the 1-week specimens no qualitative changes could be observed by normal light microscopy. In the 2nd week, however, a vivacious bone remodelling with wide Haversian canals and vessels starts from the medial cortex as could be seen identically in every series of our experiments. In the 4th week and especially in the 6th week it becomes also apparent on the lateral, dorsal and ventral wall. In the 12th week bone remodelling is still active but obvious diminishing of the osteons can be observed between internal and external lamellae. In the 24th week only solitary enlarged sinus and few osteons are found medially and laterally. Alltogether the cortical bone has become very thin. The bone remodelling has stopped and this state is characterized by loss of osteons and abundance of intermediate lamellae. Already in the 1st week polarisation microscopy shows a certain demascating of the collagenous fibres opposite to the plate. The control specimens do not show changes of the collagenous structure in this area. In addition to these results histomorphometric investigations of 1-week specimens revealed a quantitative increase of Haversian canals which are located closer to the medullary space as well as to the side opposite the plate. This result is due to the fact that the bone remodelling starts from the cortex opposite to the metal implant.


[Electromyographic studies over the influence of surgical procedures of the vertebral column on muscle function (author's transl)].

Electromyographic examinations of the paravertebral muscles were performed on patients after operation of the spine. It was demonstrated that injuries of the paravertebral muscles ocurred in relation to the different grade of intra-operative damage of the dorsal spinal nerves.


[An X-ray approach to differentiate benign and malignant bone tumors (author's transl)].

A critical analysis of X-ray signs induced by the interaction of a bone tumor with bone itself is presented. These enables the physician to recognise a pattern of characteristic findings for each particular tumor. Clinical examples are demonstrated illustrating at the same time a schematic classification of those signs on a roentgenogramm which in many cases facilitate the prediction of the specific diagnosis and in consequence the prognosis of the lesion. The need for an effective cooperation between the involved specialties is stressed.


[Fracture movement and fracture healing in plaster case fixation (author's transl)].

The fixation of a fracture in a plaster cast, or in traction is not absolutely rigid. Experiments were carried out on adaver tibial fractures placed in long leg plaster casts. It was observed that the possible deformity ranged between 4-8 degrees in a well-padded cast and 2-5 degrees in a nonpadded cast. Further observation were conducted while hip osteotomies were compressed by external fixator. These osteotomies are further protected by hip spicas. It was demonstrated that increasing the length of the cast did not increase the degree of fixation. It is suggested that fracture healing in conservatively treated cases is optimal if movement of the fragments remains within the physiological elastic limits of the not fractured bone. Fracture healing can be disturbed not only by extensively denudation and soft tissue disturbance, but also by under-or overstressing the bone and by unphysiological immobilisation.


[The venous drainage of the long bone after reaming and intra medullary nailing. An experimental study of the dog tibia (author's transl)].

Following the destruction of the medullary vascular system the venous drainage takes place exclusively in a centrifugal direction through vessels leading transcortically to the periost. This is in accordance with the described observations made on the arterial vascular system under the respective conditions of destruction.


A simplified tone decay test.

This report describes a simplified suprathreshold tone decay test procedure (STAT).  The sustained test signal is presented for 60 seconds at 110 dB sound pressure level.  The patient is asked to respond as long as he hears the sound.  If the patient responds for the full 60-second test period, the result is negative.  If, however, he fails to respond for the full 60 seconds, the result is considered positive for eighth-nerve site.  Clinical experience with the new test procedure suggests that it minimizes false alarms without sacrificing accuracy of identification of eighth-nerve site.


Stomal recurrence following laryngectomy.

The extent of subglottic involvement and preoperative tracheostomy, appear to be the most important causative factors in peristomal carcinoma.  Our case histories have demonstrated tumor foci in a tracheopstomy tract and in pretracheal lymphatics.  Once established, the prognosis of the lesion is grave.  Radiation and chemotherapy offer only limited palliation, and extensive resection offers the best chance of cure at the present time.  Prophylactic measures such as avoiding a preliminary tracheostomy, meticulous paratracheal dissection, and microscopic control of the resected margins of the surgical specimen may reduce the incidence of peristomal carcinoma.


Effect of electronic filters on electronystagmographic recordings.

With the advent of digital computer measurement techniques for nystagmus parameter determinations, the need has arisen for careful quality control of nystagmus recording methods.  For this study, electronic filter distortion of nystagmus waveforms was quantified, and the results were used to formulate guidelines for selection of appropiate band-widths depending on the user's requirements.  For minimum distortion, a lower time constant of at least three seconds and an upper frequency cutoff of at least 60 hertz are recommended.


Is the vidian nerve cholinergic?

Electrical stimulation of the parasympathetic nerve (vidian) to nasal mucosa induces a nasal secretion and a nasal vasodilation.  We have provided additional evidence that, in the dog and cat, the secretory mechanism can be blocked with low doses of atropine sulfate (0.01 mg/kg), but the dilation mechanism is not blocked by high doses (1 mg/kg) of atropine sulfate.  By some definitions therefore, the vasodilation is not a cholinergic effect.  There appears to be a basic difference in the composition of the vidian nerve in the dog and cat.  In the cat, the vidian appears to have a strong sympathetic component.  In the dog it does not.  The human vidian nerve, according to anatomists, is more like the dog's.


Pathogenesis of hearing loss in head injury.  Studies in man and experimental animals.

This study reports on the histopathologic findings in the temporal bones and brain of a patient who died of head injury.  A common type of head injury in man was simulated in guinea pigs by shaking them.  A hearing loss was demonstrated with Preyer reflex audiometry although the cochlear potential thresholds remained normal.  Only minor pathologic changes were found in the membranous labyrinths.  Laceration and hemorrhage in and around the cerebrum, rhombencephalon, and eighth nerves were noted in most of the experimental animals.  Auditory manifestations following head injury may very frequently be due to damage to the central auditory pathways rather than to the end organ.


Labyrinthine otosclerosis and sensorineural deafness.  Pathologic findings of the spiral ligament.

In severe labyrinthine otosclerosis, spiral ligament changes occur predominantly adjacent to the stria vascularis, and consist of a decrease or loss of the capillary-perilymph system. It is suggested that this results in increased concentrations of metabolic products in the cochlear fluids that can no longer be absorbed effectively. If vascular shunts form they might represent collateral channels, with the flow of blood from the cochlea into the otosclerotic focus, bypassing the deficient capillary network in the spiral ligament. The zone of dense collagenization is described as a widening of the soft tissues endosteum of the cochlear capsule due to erosion of the bone, with the bone surface now set further back. This may result in greater mobility or loosening of the suspension mechanism of the basilar membrane.


Primary adenocarcinoma of the middle ear.

Two patients with primary adenocarcinoma of the middle ear displayed symptoms in the affected ear many years before their condition was diagnosed as adenocarcinoma.  Treatment included simple extirpation of the tumor, radical mastoidectomy with or without radiation.  A review of the literature shows 11 cases reported previously.  Follow-up of the patients for more than four years revealed four deaths in the reported cases-one from causes unrelated to the tumor and the others showing only local invasion without distant metastases.  These tumors grow slowly and have a low-grade of malignancy.


Production of parathyroid hormone by laryngeal cancer.  Report of a case.

Nonparathyroid humoral hypercalcemia is becoming an increasingly more common problem associated with carcinoma. Carcinomas of the head and neck may elaborate parathormone or parathormone-like humors that in the absence of bone metastases, renal disease, parathytoid tumors, or secondary hyperparathyroidism may produce hypercalcemia, which if unrecognized, complicates and prevents the appropriate management of the patient. This report deals with the production of parathyroid hormone and the first reported case, to our knowledge, of carcinoma of the larynx associated with nonparathyroid hypercalcemia.


Cholesterol fatty liver. Morphological changes in the course of its development in rabbits.

Livers from 90 rabbits used in a factorial experiment relating cholesterol contents of various tissues to their serum cholesterol levels and duration of exposure were observed under light microscope. Livers from eight additional rabbits fed a 2% cholesterol diet for various periods up to 90 days were fixed in an aldehyde fixative containing 0.2% digitonin and observed under electron microscope. Digitonin-induced laminar and microtubular structures appeared five hours after cholesterol feeding. Fat vacuoles in both hepatocytes and Kupffer cells were first noted on the third day and increased in number and size to the 60th day but decreased on the 90th day. Adaptation of the liver to such excessive fat accumulation was evidenced by the gradual decrease of fat vacuoles and increase of binucleated cells.


Myxoma-like features of organizing thrombi in arteries and veins.

Evidence for the development of the cardiac myxoma from organizing thrombi has been presented previously. In this study, many of the features of the myxoma were observed in organizing thrombi in arteries and veins. Individual undifferentiated mesenchymal cells, cords of similar cells, vascular bud-like cellular aggregates, fibroblasts, well-formed vessels, and multiwalled vessels set within a loose, mucoid ground substance were present in the thrombi. These areas resembled the basilar layer of the cardiac myxoma. Cartilage-like cells, like those in the superficial zone of myxomas, were noted in some thrombi, and ossification had occurred rarely. These observations support a thrombogenic origin of the myxoma. Local physical factors may provide the stimulus for varying differentiation of mesenchymal cells in both the peripheral thrombi and the myxoma.


Postnatal persistence of spongy myocardium with embryonic blood supply.

Focal presence of the embryonic pattern of myoarchitecture and of a lacunary blood supply was found in the left ventricular wall of five infant hearts. Four of these hearts showed various malformations; one was a case of cardiac fibroma. The persisting intertrabecular spaces and sinusoids communicated with the ventricular lumen; there appeared to be some communication with the coronary branches. The intertrabecular spaces of the spongy myocardium were lined with a continuous layer of endothelial cells, thus resembling the microscopical appearance of myocardium of adult cold-blooded vertebrates rather than the embryonic phase of myocardial development of warm-blooded animals.


Hairlessness in Mus musculus. A pathologic study.

The homozygous albino hairless mice at birth have hair bulbs and follicles the same as normal mice. Hairs develop and grow the same as in normal mice. However, about the sixth to eighth day hairs in the skin around the nose begin to disappear. This depletion of hairs continues over the  head, neck, back, and abdomen of all mice in the same pattern. Essentially every hair over the entire body is absent macroscopically by the 30th to 40th day except for the vibrissae. A progressive atrophy of the hair bulbs and follicles is the basis for the absence of hairs after the first pelage. Only a rare follicle with a hair is present histologically in the adult mice. There are a few cysts in the dermis resulting from dilated residual hair follicles.


Identification of Duchenne muscular dystrophy carriers. Electron microscopical investigation of skeletal muscle.

In order to identify a subclinical dystrophy, muscle biopsy specimens from 15 mothers of boys with Duchenne muscular dystrophy were studied by electron microscopy. Genetic investigations and biochemical determinations were not conclusive for a diagnosis of the carrier state. The fine structural lesions were sufficient to vertify the diagnosis of a subclinical dystrophy, and our findings were in agreement with other investigators. However, original intranuclear filamentous formations were noted in one case.


Teratoma of the spinal cord. Report of a case and review of the literature.

A 6-week-old infant had a teratoma that involved the entire spinal cord. No reports of another such extensive teratoma of the spinal cord can be found in the literature. We postulate that an embryonic rest was incorporated into the spinal canal and, when removed from its normal inducer tissue, grew haphazardly throughout the spinal cord.