Pancreatic glucagon response to an ordinary meal.

Glucagon concentrations in the portal and peripheral venous blood were measured in 3 patients after an ordinary meal. A brief increase in glucagon concentration was found in the portal blood but not in the peripheral blood. As the glucose concentrations rose, the glucagon levels fell. The secretion of pancreatic glucagon therefore seems to depend largely on the blood glucose level.


Alteration of esophageal peristalsis by pentagastrin in patients with diffuse esophageal spasm.

Although it has been shown that gastrin and gastric alkalinization affect the lower esophageal sphincter, in vivo studies have not demonstrated a measurable effect of pentagastrin on esophageal peristalsis. In 9 patients with diffuse esophageal spam and in 10 control subjects esophageal peristalsis was recorded before and after pentagastrin infections. Subcutaneous pentagastrin increased peak amplitude significantly more in patients, 31.2 +/- 8.1 mm Hg (mean +/- S.E.M.), than in controls, 12.1 +/- 5.1 mm Hg (P less than 0.02). Max. duration of contraction waves in patients showed a rise of 11.3 +/- 2.7 sec as compared to controls, 1.9 +/- 0.9 sec (P less than 0.01). The effect of pentagastrin on esophageal peristalsis in patients with diffuse esophageal spasm may be explained as denervation supersensitivity.


Increase in urinary indican excretion in pancreatic steatorrhoea following replacement therapy.

Urinary indican excretion was studied in 5 patients with steatorrhoea of pancreatic origin, 4 patients with steatorrhoea due to other causes, and 5 normal subjects. Treatment with pancreatic extract resulted in an immediate increase in indican excretion to above the normal range in patients with steatorrhoea due to pancreatic insufficiency. Administration of pancreatic extract did not result in a rise in the patients with steatorrhoea not due to pancreatic insufficiency, or in the normal subjects. In one patient with pancreatic insufficiency maintained on a low protein diet, the rise in indican excretion on replacement therapy was much slower and did not reach as high a level as in the patients on a normal protein diet. The possible mechanisms underlying these observations are discussed. It is suggested that the finding of a low indican excretion in the presence of steatorrhoea and its rise to above normal on pancreatic enzyme therapy is strongly suggestive of exocrine pancreatic insufficiency.


Anicteric liver damage during nitrofurantoin medication.

Four patients are described in whom anicteric hepatitis appeared to be related to the use of nitrofurantoin. All the patients had increased serum transaminase levels, hypergammaglobulinaemia, and liver biopsies suggestive of chronic active hepatitis. Three patients showed cirrhotic features in the biopsy and two had circulating albumin-IgG-complexes ('tailing-albumin'). The serum transaminases became normal within weeks after withdrawal of the drug whereas the hypergammaglobulinaemia and the liver biopsy findings persisted essentially unchanged during two to six months of observation. One patient was re-challenged with nitrofurantoin, which resulted in recurrence of elevated serum transaminases after nine weeks medication.


Intestinal disaccharidases in Greenland Eskimos.

Jejunal biopsies from 19 adult Greenland Eskimos were studied regarding disaccharidases, two intracellular beta-galactosidases, and morphological appearance. Fifteen of the patients (79%) had low lactase activity, and 3 of these (16%) had sucrase-isomaltase deficiency as well. Two patients had low trehalase activity. Microscopical appearance was essentially normal in all the biopsies, except for a certain stromal plasma cell infiltration. All the patients with low lactase activity had a measurable residual activity of brush border lactase, which was localized in the middle and apical parts of villi, as normally seen for digestive enzymes. Lysosomal acid beta-galactosidase and cytosol hetero beta-galactosidase were not altered. In the patients with sucrase-isomaltase deficiency there was a complete absence of active sucrase-isomaltase complex. The residual maltase, as well as the very weak residual isomaltase, was exerted exclusively by the heat stable maltases (maltase II and III). The material is the first one in which multiple, but not generalized disaccharidase deficiencies are demonstrated.


Acute pancreatitis caused by closed duodenal loop in the rat.

Closed duodenal loop was created in the rat by obstructing the duodenum on both sides of the common bile duct. Acute haemorrhagic pancreatitis developed in these animals within 24 hours. Increased serum amylase activity, pancreatic acinar cell necrosis, pancreatic oedema and haemorrhages, and intra-abdominal fat necroses, together with formation of ascites fluid containing high levels of amylase, were observed in the experimental animals. The findings support the view that reflux of the duodenal contents into the pancreatic duct is an important early pathogenetic mechanism in the development of acute pancreatitis. The closed-loop technique in the rat offers a simple and reliable experimental model for studies on acute pancreatitis.


The incidence in Copenhagen County of gastric and duodenal ulcers in the same patient.

This study represents a prospective, epidemiologic study dealing with patients from a geographically well-defined area of Denmark who had both a gastric and a duodenal ulcer diagnosed during the years 1963-1968. The average annual incidence of new cases was 1.6 per 10,000 inhabitants aged 15 years and over, which is a higher incidence than any registered so far, especially compared with the frequencies of solitary gastric and duodenal ulcers. The incidence was 20 times as high as might be expected if the occurrence of the syndrome was incidental only. In both sexes the incidence increased with age in a manner similar to that seen in solitary gastric ulcers. The male:female ratio was 2.2:1. The incidence of cases in which both ulcers appeared simultaneously at the first 'positive' diagnostic examination was 0.7 per 10,000 at risk. Certain observations indicate, however, that even in those cases, the two ulcer components have arisen at different times.


Disease activity and serum proteins in ulcerative colitis. Immunochemical quantitation.

Nine different serum proteins from 50 patients suffering from ulcerative colitis were quantitated by means of Laurell's rocket-electrophoresis. The periods of study extended for up to five years. Twenty-six patients were seen at brief intervals from days up to two months; 18 patients were seen at intervals from two to six months. As surgical intervention was urgently required in six cases, few determinations were made in these patients. The disease was classified into five phases according to its clinical activity (as assessed by temperature, blood via the rectum, and number of episodes of diarrhoea). The phases are designated: active febrile; active afebrile; unstable; remission; and restitution. The concentrations of orosomucoid and haptoglobin were found to rise in parallel with intensified clinical activity, while the concentration of pre-albumin falls, thus making these proteins particularly useful for determining changes in the clinical status of the patients. The concentration of pre-albumin during the active phase was especially useful in cases where it was to be decided whether or not surgery was indicated. Concentrations of orosomucoid and IgG were not as useful as pre-albumin in these cases. In patients who escaped operation, the concentration of pre-albumin was seen to rise from low values up to normal before clinical improvement set in.


Penicillin concentrations in abdominal operation wounds after intravenous administration.

The concentration of benzylpenicillin has been studied in serum and in homogenates of the subcutaneous tissue from abdominal operation wounds in 13 patients who underwent surgery of the colon and/or rectum. An intravenous bolus of 5 megaunits benzylpenicillin gave rise to a serum median concentration of 128.0 i.u./ml and a corresponding tissue median concentration of 29.6 i.u./ml in the operation wound. The serum concentration never fell below the tissue level in sequential periods, and a significant correlation between the concentrations in serum and tissue supports a hypothesis of penetration of penicillin into the wound tissue by diffusion. The results indicate that administration of benzylpenicillin initiated at the time of colo-rectal surgery ensures concentrations in the operation wound inhibitory to a variety of contaminating bacteria, thus being an adjunct to the tissue defences in combating the development of postoperative wound infection.


Kinetics and pool size of chenodeoxycholic acid in cholesterol gallstone patients.

The pool size, half life, and daily production rate of chenodeoxycholic acid (CDCA) was determined by the isotope dilution method upon intravenous injections of about 10 muCI OF 24-14C-CDCA in 7 patients with radiolucent gallstones in functioning gallbladders, and 9 healthy controls. Bile was obtained by duodenal intubation. The method also allowed measurement of the CDCA percentage of total bile acids (TBA) and an indirect calculation of the TBA pool size. The pool size and daily production rate of CDCA were slightly, but not significantly, diminished in the gallstone patients. The half life of CDCA was almost equal in the 2 groups. The CDCA percentage of TBA was significantly higher in the gallstone patients (0.02 less than P less than 0.05), and the TBA pool size was significantly reduced (P less than 0.01) in the gallstone patients. It is concluded that the CDCA metabolism is similar to that of cholic acid in gallstone patients. Thus the formation of gallstones is hardly due to specific alterations in CDCA metabolism, suspected on account of the specific cholelitholytic effect of CDCA ingestion. The significance of increased CDCA percentage in bile is discussed in relation to the results from other study groups, and it is pointed out that a relative increase in the bile content of dihydroxy bile acids may lead to reduced cholesterol holding capacity of bile, and thus favor the formation of gallstones.


Human fetal endothelial cells in cluture.

Human endothelial cells were isolated from the umbilical cord vein by collagenase treatment and cultured for periods up to 6 weeks. The cultured cells were identified as endothelium by cell morphology and growth pattern, the presence of Weibel-Palade bodies, and their ability to stimulate allogeneic lymphocytes (Hirschberg et al 1974). Cultured fibroblast-like cells derived from the umbilical cord were clearly different in all three respects. Approximately one third of the primary endothelial cultures showed clear evidence of proliferation during the first 3-4 days in culture as judged by cell counting. Replicating ability in a culture was correlated with cell density at the time of seeding. Autoradiography of endothelial cells after exposure to 3-H-thymidine showed a 30-fold increase in nuclear labelling from day 1 to day 3 in culture. The endothelial cells have so far been subcultured three times.


A new variant of erythrocyte pyruvate kinase - PK "maebashi".

A new case of erythrocyte pyruvate kinase deficiency was described. - A 9 year-old male patient was hospitalized because of anaemia, jaundice and splenomegaly. Diagnosis was made primarily on the basis of the erythrocyte enzyme studies. Because the pyruvate kinase of this patient demonstrated certain different characteristics from the other variants described previously, it was tentatively designated PK "Maebashi".


Splenomegaly, macrothombocytopenia and stomatocytosis in healthy Mediterranean subjects (splenomegaly in Mediterranean macrothrombocytopenia).

Spleen size, stomatocytosis, macrothrombocytopenia, haemoglobin level, white cell count, and abdominal pain episodes were assessed in a coded study of healthy Mediterranean immigrants to Australia. Spleen size was estimated from a length measurement, L, on a standardized plain abdominal radiograph and expressed both as spleen weight and as a spleen length index, L/square root BSA; the platelet count and size parameters were determined electronically and the presence of stomatocytes was evaluated in stained blood films. In relation to 16 Northern European control women 12 of 25 Mediterranean women had radiographic splenomegaly, 10 had macrothrombocytopenia, 9 had stomatocytosis, but none had episodes of abdominal pain. The median spleen weights of the two groups were estimated as 157 and 247 g with ranges from percentile 2.3 to 97.7 of 75 to 328 and 112 to 669 g. Within the Mediterranean group splenomegaly correlated with macrothrombocytopenia (P less than 0.001) but not with stomatocytosis, haemoglobin values or white cell counts. Thus, mild splenomegaly may be expected in Mediterranean macrothrombocytopenia, Mediterranean stomatocytosis appears unrelated, and all of these apparently benign anomalies may be incidental findings in patients from the Italian and Balkan peninsulas.


No effect of an N-terminal fragment of human prothrombin on blood-platelet aggregation.

An N-terminal fragment of human prothrombin (m.w. 19,600) had no detectable effect on the aggregation of platelets by ADP, collagen or thrombin.


A circulating factor V inhibitor: possible side effect of treatment with streptomycin.

A potent inhibitor of factor V was discovered in a middle aged woman shortly after streptomycin therapy. The patient suffered from severe bleeding over a period of 10 days and the inhibitor was demonstrable for 6 weeks. By use of specific antisera the anticoagulant was found to be of an IgG nature. In agar electrophoresis the inhibitor mowed with the immunoglobulin fraction and was separable from factor V activity in the pathological plasma although no factor V activity was demonstrable in untreated patient plasma. It is suggested that this method should be used to distinguish between cases of inhibitors in patients with congenital factor V deficiency and cases of transient inhibitors in patients with normal factor V production.


Isochromosome 17 in a case of eosinophilic leukaemia. An abnormality common to eosinophilic and neutrophilic cells.

In a patient with eosinophilic leukaemia, serial chromosome studies using the Giemsa banding technique revealed a similar marker chromosome, identified as an isochromosome 17, in all bone marrow metaphases analysed. There was no Ph-1-chromosome. The cytogenetic data support the view that eosinophilic leukaemia is a specific disease entity, and suggest that both eosinophilic and neutrophilic cells are involved in the leukaemic process.


Cell-mediated and humoral immunity to streptococcal cell wall antigenic extract in patients with glomerulonephritis and in healthy controls.

Cell-mediated immunity of lymphocytes to group A, type T 12, streptococcal cell wall extract was evaluated by measurement of DNA synthesis in cultures of lymphocytes from healthy controls and from glomerulonephritic patients. Cells from adult healthy persons regularly responded to this antigen, whereas cord blood lymphocytes did not. Several additional experiments suggested that the response in normal controls was due to a specific immune response and was not caused by a nonspecific mitogenic effect of the cell wall antigens. In a group of 17 patients with progressive glomerulonephritis (PGN) and 10 with nonprogressive glomerulonephritis (IRGN) the level of response was comparable to that of healthy controls. In the PGN group the response was significantly lower after 4 days, but this difference disappeared after 6 days. Thus, this method failed to differentiate between health and disease. The presence of anti-streptococcal cell wall antigen antibodies was tested using a passive hemagglutination technique. Only 1 of 6 controls had a demonstrable antibody titer, whereas 15 of 26 nephritic patients had detectable antibodies and 10 of them had titers greater than 1/64. Our findings suggest the possibility of a relationship between streptococcal bacteria and progressive glomerulonephritis.


[Supranuclear progressive paralysis (or oculo-facial-cervical dystonia)].

The authors describe 14 personal cases of progressive supranuclear palsy, 8 of them including a neuropathological study. The analysis of this material confirms the characteristics of this nosological entity, which is now well individualized amongst the apparently idiopathic degnerative diseases of the CNS. The clinical picture was characterized in all cases by a supranuclear opthalmoplegia, a pseudo-bulbar syndrome, an axial dystonia and a 'subcortical' dementia of a particular type. The average duration of the disease was 4 years for the 12 patients followed until death; the first symptoms appeared at a slightly older age than the average reported in the literature. Males are not predominantly affected in our material. Lesions are remarkably homogeneous as to their localisation in all cases but one. The nuclei of cranial curves are moderately involved, the reticular substances throughout the brain stem is more severely effected. In two cases, senile degenerative lesions of the cerebral cortex are associated with subcortical lesions of the progressive supranulcear palsy. No anamnestic or histologic feature is suggestive of any etiology of this disease. L-Dopa with or within a Dopa-decarboxylase inhibitor did after alter neither the patients condition nor the course of the disease.


[Neuropathological lesions in posttraumatic internal hydrocephalus].

The authors described the lesions associated with post-traumatic internal hydrocephalus in 4 cases who died after a prolonged post-traumatic coma. The internal hydrocephalus, quite severe in all cases, and the demyelination in the periventricular white matter in 3 cases, are thought to be produced by a chronic increase in the intraventricular pressure, probably secondary to malfunction of circulation and resorption of the cerebro-spinal fluid.


[Schizophrenic defect syndromes and drive behavior].

First the terms "impulse" (Antrieb) and "schizophrenic defect" (schizophrener Defekt) are explained and defined. 49 (= 12 per cent) of the 409 schizophrenic in-patients, treated 1970-1972, had the symptoms of a schizophrenic defect. All of them showed disturbances of impulse: more than half the patients a deficiency, nearly a third an unsettled surplus, and about ten percent an alternating impulse. The deficiency as the alternating impulse usually were accompanied with a negativ mood. The surplus of impulse was bound up as equal parts with positive and negative moods. At last any kind of disturbances of described is illustrated by an example.


[Contribution to the study of students' mental health (author's transl)].

The authors intended to study within the population of an outpatient psychiatric consultation those who are under training or education, whatever type of education it may be. These 'students', in a broad sense, have been the object of epidemiological and clinical studies. The sample they constitue has been compared first with a sample of the service's population, secondly within the sample itself comparison has been made between smaller groups, caracterized by the level of formation. This leads to a description of the typical 'student patient' of this consultation. The comparison with the other patients of the service shows some differences, specially age. Students are. as a rule, younger. We note others and more interesting differences related with origin, the proportion of strangers is much greater in the students; group. On the other hand, they are people who spontaneously come to consult for neurosis. The comparison between the two sub-groups within the group of students shows the same differences we noticed above. They showed up with a greater evidence in the University students' group, but this last group does not fundamentally diverge from the students in the professional schools in relation to the items that were the object of this study.


[Changes in vocabulary in a psychoanalytic process].

This paper at first deals with some aspects of the relationship between psychoanalysis and linguistics. Freuds theory of parapraxis is interpreted in terms of Bühlers model of speech, whereby the entire verbal output of a speaker can be understood as an act of symptomatic behavior. The investigation of the vocabulary of nouns of a patient suffering from anxiety neurosis illustrates the fertility of this model. The frequency dispersion of all nouns taken from a specific sample of the patient's and analyst's speaking shows the stability of statistical properties of speech behavior. Following, the role of content-analytic techniques for the specific demands of research in pstchotherapy is discussed. A large part of content-analytic measures is rather far removed from the clinical description of the psychotherapeutic process, thus diminishing the validating relevance of these studies for psychoanalytic concepts. The final chapter describes the process of a psychoanalytic treatment by means of the content-analytic technique. The changes of the patient's verbal content show highly specific correlation to the clinical ratings of psychoanalytic concepts like transference and anxiety. As an initial study, these results are qualified to stimulate the development of content-analytic categories for research in psychotherapy.


[Acute hemorrhagic encephalitis of Hurst. Clinical, electroencephalographic and anatomic presentation of a case from the literature and revue].

Clinical and electroencephalographic evolution, as well as the neuropathology, are described in a 25 year old man with a Hurst's acute haemorrhagic leucoencephalitis. Lesions, unusually symmetrical, coexists with those, without vascular necrosis nor haemorrhages, of the perivenous encephalomyelitis. The aspecific onset, course and results of complementary investigations appear on reviewing 44 clinical observations in the literature. Histologic examination of affected white matter is the only was to assess the diagnosis. Two features that may have been previously neglected are outlined: the predilection for 20 to 40 years old males, while the adolescent male, the most susceptible to perivenous encephalomyelitis after specific fevers, is not affected by Hurst's disease. Multiple sclerosis or a prodromal meningo-encephalitis, clinically undetected, could be not rare. Therapeutic results of surgical decompression, hyperosmolar substances and massive doses of corticosteroids (3 survivals out of 10 cases diagnosed on biopsy) cannto be evaluated at the present time. By analogy with the simple and the hyperacute forms of EAE, the myelinotoxicity may result from sensitized lymphocytes alone in the perivenous encephalomyelitis, from an association of circulating antibodies and lymphocytes in Hurst's disease. Whether the immunoglobulins enchance the cellular myelinotoxicity or induce an immune complex disease upon a perivenous encephalomyelitis is still to be determined.


[Neuroradiology of hydrocephalus in newborns and infants].

Up-to-date views on the various types of infantile hydorcephalus are exposed from a practical neurosurgical point of view. The neuroradiological procedures are divided in 3 groups: the neuroradioisotopes, the angiographies and the pneumographies. They are described and analyzed. Indicators and possibilities are outlined. Their complementary value is stressed.


[Extrapyramidal symptoms in meningiomas].

We report 2 cases of sphenoid ridge meningeomas with symptoms of a parkinsonian sydrome, one of them contralaterally, the second bilaterally. Both did not respond to specific antiparkinson treatment. The extrapyramidal symptoms disappeared in both cases promptly after removal of the tumor. In the first case they reappeared temporary in connection with a local wound-infection. The histological examination of the second case, which died on a pulmonary emboly, showed no alterations of the cerebrum in the sense of an idiopathic or postencephalitic M. Parkinson. The authors try to show possible corrlations by means of the relevant literature (total 75 cases). It is found, that extrapyramidal symptoms do not allow uniequivocal localising or specific conclusions referring the kind of tumor or lesion. Nevertheless the meningeomas preponderate, excluding the basal infiltrating tumors. Referring to the localisation, the frontal located meningeomas preponderate. The bilateral meningeomas all lead to bilateral extrapyramidal symptoms. Next it especially also the frontal meningeomas of convexity mostly cause bilateral extrapyramidal symptoms. In the majority of cases the diately after operation, the rest during weeks to months. Finally the authors discuss the possible pathophysiologic mechanism of origin according to the literature.


[Dermatomyositis and polymyositis].

In this review article the author stresses the fact that it is difficult to find a classification which fulfils all clinical, morphological and pathogenetic criteria and that is not advisable to separate the late onset myopathies of M. Shy from the group of polymyositis. Treatment with high doses of corticosteroids is useful in most cases, whereas in individual patients immunosuppressive agents may be tried.


[Bladder and rectum disturbances in multiple sclerosis].

Bladder and bowel dysfunction in multiple sclerosis. In a group of 88 unselected patients suffering from multiple sclerosis the incidence and type of neurogenic bladder and bowel dysfunctions, the reliability of subjective complaints and the relationship between these disorders and neurological signs were investigated. The bladder function was proved by a cystometry, in some cases also by an uroflowmetry. Cases with bladder neck obstructions caused by tumours were eliminated. The results demonstrate the incidence of 58% subjective bladder disorders. Urinary retention was found in 60%, pathological results in cystometry only in 46% in contrast to literature findings with a higher amount of pathological results in cystometry. It should be emphasized the dissociation between subjective complaints and proved bladder disorders in 25% of the patients. Bladder and bowel disorders appear more frequent if the neurological syndrome is characterized by perception disorders.


[Socio-psychological aspects in marriages of alcoholic women].

In a controlled study during two years we have collected psychological and sociological data on partners of chronic female alcoholics by making use of a semistandardized interview (80 items were evaluated by program Dial and the input scales of Spitzer and his decision logic), of the Freiburger-Persönlichkeits-Inventar (FPI) and of the Hawie-Dahl-test, a German abbreviated version of the Wechsler-Bellevue-Intelligence-test. Furthermore we investigated the interpersonal perception in the marriage of the female alcoholic by a semantic differential. The relatively small number of subjects and controls emphasizes the considerable problems as far to the methodial implications of such a study. Therefore we have to interpretate cautiously our results. We may plead for the hypothese, that the husband of the chronic female alcoholic already from the beginning of the marriage had fifficulties in the realisation of his male role and beyond this that the partnership of the chronic female alchoholic is evidently disturbed by distortion of the interpersonal perception. Finally the interpretation of our results is disucssed with regard to the special approach of examination.


[Social change and alcohol consumption in a mountain village].

This study is the first part of a longitudinal study. The object of this study 'Alpendorf' is the economic and socio-cultural change of Swiss mountain village. Following construction of a communication's road a village was transformed into a worldwide tourist spot; well-known and invaded by mass by mass modern tourism. The forerunners of those changes were above all the technics and the acculturations. On the one side the technical development and on the other side the boom of construction created more numerous work openings and and bay that new roles for the village inhabitants...


Need, demand, and supply of medical care in a population sample of rheumatoid arthritis.

Estimates of medical need in persons with rheumatoid arthritis (RA) are rarely based on data from population surveys. In a population survey of RA in Stockholm City, 293 RA sufferers were identified in four random samples of four age-groups in the adult population, age-range 31-74 years. The influence of age, sex, and severity of disease on the number of pervious hospital admissions was slight, indicating that diagnosis, rather than rehabilitation, is the impetus to hospital admission. Hospital patient inventories might give quite misleading information as to need. Need for hospital admission, out-atient care, reconstructive surgery, ADL-devices, physical therapy, and rehousing were all considered. 17% of the RA group accounted for 48% of the need. Steinbrocker functional classes I and II contributed to 61% of individuals in need of hospital care greatly exceeded those previously having enjoyed such care and possible availabel resources. Estimates of need for outpatient care for joint disease exceeded provided treatment by only 1.7 times. It is concluded that the psychological distance between doctor's decision to choose inpatient or outpatient treatment in the case of RA is generally fairly short. Figures are given for estimates of need based on a population of 100 000 with known age and sex distribution and prevalence of disease.


The epidemiology of hyperostosis of the spine together with its symptoms and related mortality in a general population.

The prevalence rate of hyperostosis, defined as the presence of complete bony bridges linking two vertebrae in at least two separate sites in the dorsal spine, was studied in a sample of some 9 000 persons who were 40 years of age or older and were representative of the general population of Finland. The standardized rates of hyperostosis were 3.8% for men and 2.6% for women. The prevalence rates rose sharply with age, and depending on the age group, the male-female ratio varied between 1.4 and 2.1. The adjusted rate of hyperostosis was higher in East Finland than elsewhere. There was a suggestion of hyperostosis being associated with a higher mortality rate as judged by regional variations and by analysis of matched case-controled pairs. There was no evidence that locomotor symptoms occurred in excess in subjects with hyperostosis; nor was prior traumatic experience more common.


The content of calcium, magnesium, copper, zinc, lead and chromium in the blood of patients with rheumatoid arthritis.

The blood concentrations of calcium, magnesium, copper, zinc, lead and chromium were measured in patients with rheumatoid arthritis and in a "normal" control group. The values of hemoglobin and the effect of some drugs on the metals studied were also estimated. In metal analyses the atomic absorption spectrophotometric technique was used. The mean concentration of copper in the blood of patients with rheumatoid arthritis was significantly higher than in the control group. This was not true in females taking conteceptive drugs that cause elevated serum copper concentrations. Chromium concentrations were significantly lower in patients with rheumatoid arthritis. The mean concentrations of zinc was higher in rheumatoid females than in female controls. The concentrations of calcium, magnesium and lead were not found to be different in patients with rheumatoid arthritis from those in the control group.


Measurement of the viscosity of synovial fluid.

An account is given of a viscometer which can be used for measuring the viscosity of synovial fluid when only small quantities are avaliable (0.15 ml) and taking into account the non-Newtonian character of the fluid. A technical description of the apparatus is given. A series of experiments are reported in which bovine synovial fluid was used to study whether and what changes took place in connection with storage, alterations in temperature, and post mortem. It was shown that storage at 4 degrees C for up to 2 weeks did not cause any particular changes, that alterations in temperature from room temperature to body temperature resulted in a moderate decrease in the relative viscosity, and that changes found 6 hours post mortem seemed to be insignificant. The conclusion drawn from the experiments is that the apparatus can be regarded as suitable for use in a more comprehensive study of the changes in viscosity which occur in various joint diseases.


[Diagnostic significance of serum bile acids].

The concentrations of bile acids in serum determined by a relatively simple enzymatic method ranged between 1.6 and 9.2 mumol/l in 60 normal volunteers and between 2.1 and 7.7. mumol/l in 14 patients with Gilbert's syndrome. In contrast, 48 patients with various liver diseases had - with 2 exceptions - markedly elevated serum bile acids (up to 140 mumol/l). Together with BSP retention, BSP disappearance and SGOT, the bile acid level in serum represented one of the most sensitive indices for detection of liver disease. The sensitivity of this test can be further increased by bile acid determination 2 h after a meal. Since this test is both simple and harmless its broader clinical use appears attractive.


[Alkaline phosphatase isoenzymes. Selection of the seperation methods and their diagnostic value].

Polyacrylamide gel electrophoresis (PAGE) of alkaline phosphatase (AP) was performed in 116 patients with elevated AP and in 36 controls. Results were compared with clinical data and with the heat inactivation techniques for AP isoenzyme separation. This latter method is simple but approximate; it is without value in the case of coexistent bone and liver pathology. PAGE gave a clear separation of liver, bile, bone, and intestinal AP isoenzymes. Disagreement with clinical data was rare (6 out of 86) and occurred in cases of associated bone and liver pathology (with 1 exception only), where one of these two abnormalities was not detected. Heat inactivation is useful as a screening test. If the cause of the elevated AP remains unknown after a few simple examinations, PAGE should then be utilized. Although more time-consuming, it is certainly more effective in the separation of AP isoenzymes.


[Significance of a negative inhalation test in chronic obstructive lung disease].

To assess the bronchospastic component in patients with chronic obstructive lung disease, measurement of vital capacity and forced expiratory volume (FEV) before and after inhalation of a beta-agonist is a widely used procedure. In a minority of patients this simple inhalation test yields a negative result, suggesting the possibility of unresponsive airways. The purpose of this study was to explore th significance of a negative test result by examining pulmonary mechanics in 17 patients before and after inhalation. The results permit the following conclusions: (1) A significant broncholytic action of a beta-agonist can be determined by measuring vital capacity and FEV. As a rule, a negative test cannot be attributed to the alleged insensitivity of spirometric measurements. For clinicla purposes, the more demanding determination of specific airway conductance is not necessary. (2) A negative inhalation test does not imply a pure emphysema with out peripheral airway disease, any more than it does irreversible bronchiolitis. All it proves is the unimportance of bronchiolospasm at the time of examination. The true role of a spatic component in the course of the disease, and the benefit of regular inhalations, can be assessed on the basis of repeated controls only.


[Evaluation of the quality of diagnostic examinations in ambulatory patients].

100 medical records of male and female patients seen for the first time in 1972 at the Medical Outpatients Department, University of Basel (Switzerland) were reviewed retrospectively to assess the quality of history and clinical as well as laboratory diagnostic procedures. In addition, 10 patients were selected for total re-evaluation by renewal clinical and laboratory examinations. On the basis of entries made in the medical records (format DIN A5) the medical history and the clinical examination were judged to be of good quality. A minimal program for laboratory investigation (sedimentation rate, hemoglobin, leukocyte count, serum-transaminase, BUN, urine for sugar and albumin and urine sediment) and small format chest-X-ray had been carried out according to the rules and supplement by additional investigations in 87%. The retrospective check on 10 patients showed that the first examination had been well done and without omissions. Continuous checking of diagnostic procedures was recognized as important, and changes in the forms used were admitted to be necessary for improving quality.


Lacunar brain infarction. Diagnosis and prognosis.

"Lacunar stroke" is described and 4 characteristic lacunar syndromes are presented. These small infarcts frequently occur in patients with essential hypertension. At their peak they cause a relatively minor neurologic deficit and are followed by almost complete recovery. Arterigraphic examination is not indicated as only the small arteries are involved. Treatment consists exclusively of control of hypertension. The prognosis is usually good. The small infarcts arise from pathologic changes and occlusions of penetrating arteries. Localization of the pale softenings which produce the typical lacunar syndromes is briefly discussed.


[Infestation of the ductus choledochus with Fasciola hepatica. Study of human Fasciola].

In a 66-year-old woman with suspected cholecystopathy, cholecystectomy led to the chance finding of the common liver fluke Fasciola hepatica (F.h.) in the common bile duct. Subsequent therapy with Dehydroemetin brought about regression of eosinophilia and of the pathologic immunofluorescent antibody test for F.h. The life cycle of F.h. and the clinical features of human infection are described in detail.


[Paget's deforming osteodysttophy].

The present clinical aspects of Paget's osteodystrophy are reviewed. The nosological definition, localiztion, natural course and signs are described and the recent description of "rheumatoid manifestations" in Paget's disease by FRANCK et al. is mentioned. The same authors revealed a positive correlation between the grade of extenstion of Paget's disease in the whole skeleton and the concentration values for alkaline phosphatase and uric acid in the serum. Among the complications of Paget's disease the orthopedic, neurological, haemodynamic, oncologic, hematological and dermatological are reviewed X-ray of the involved skeleton, which in most cases is diagnostic, may be supported by isotope scanning with 18F or 87mSr and bone biopsy for establishment of diagnosis. Current drug therapy is confined to diphosphonate and calcitonin. The antibiotic mithramycin, which is cytotoxic, reduces bone turnover and may improve the course in Paget's disease. However, toxic side effects on kidney, liver and hemopoiesis do not allow its further therapeutic use in this disease. A case is described which demonstrates that a spontaneous or traumatic fracture in the area of osteodystrophy exhibits almost the same potential for conso lidation as normal bone tissue following both conservative and osteosynthetic treatment of the fracture. In a further instance corrective osteotomy with osteosynthesis (plate) because of serious varisation and antecurvature of the femur due to Paget's disease were performed sucessfully without assisting drug therapy. A third patient displayed extensive osteodystrophy of the whole pelvic skeleton, which was discovered by X-ray as rehabilitation following CVA failed to progress due to severe bilateral reduction of hip joint function. In view of the age and general status of the patient and the absence of pain, no medication or surgical therapy was performed in this case.


[Plasma concentration of phenytoin in epileptics--importance for the clinician].

Plasma concentrations of diphenylhydantoin were determined by the method of Wallace (double extraction, spectrophotometry) in 150 samples taken from 121 epileptic patients. They correlated well with those determined by gas chromatography, were not dose-dependent and were often below 10 mul/ml. They were above 20 mul/ml in 6 patients with CNS intoxication. These determinations were also useful for detecting patients who did not take the drug as prescribed (14 suspected cases, 4 confirmed). However, blood levels did not seem to offer an accurate index of the effectiveness of diphenylhydantoin.


[Acute renal artery occlusion. Origin, diagnosis, possibilities of treatment].

Although acute renal artery occlusion is luckily a rare event, many cases are probably overlooked. They are caused either by emboli, accidents or iatrogenic vascular injury. The conventional wisdom holds that the kidney is irreversibly damaged by arterial obstruction lasting several hours, but clinical experience shows that there are exceptions to this rule. How this is to be explained from the pathophysiologic viewpoint is discussed in this article. Recognition of acute renal artery occlusion is easiest and fastest in iatrogenic cases. In trauma due to accidents, useful pointers are hematuria, site and intensity of the injuring force and concomitant lesions. Emboli do not give rise to specific symptoms and are most to be suspected in cases prone to embolism. It is helpful to subdivide renal artery occlusions into two groups, one with and the other without mural lesionsof the artery. The outlook is a priori considerably better in cases with intact vascular wall. Here, i.e. in the presence of fresh or recent thrombo-embolic occlusion, surgery is most likely to prove successful, but conservative management alone is known to afford good results too. A differentiated approach to treatment is outlined. Severe vascular trauma may confront the surgeon with virtually insoluble problems, but the conditions under which surgical intervention is nonetheless recommended are defined. Generally the presence of a normal conttalateral kidney will lessen the need for surgical action. Surgery is however mandatory in the none too rare case of bilateral renal artery occlusion or when a solitary kidney is affected. In these cases in-situ perfusion combined with organ cooling, explantation, reconstructive surgery extra vivum and heterotopic re-implantation (for instance into the pelvis) is a most promising procedure.


[Procedure on finding microhematuria in medical practice].

Of 2000 unselected patients consecutively examined during the first 3 months of 1972 at the Outpatient Clinic for Internal Medicine, University of Basel, 102 (5.1%) were found to have pathologic erythrocyturia on routine urinalysis. In 63 of these patients the first examination did not produce a precise diagnosis such as to explain the microhematuria symptom. 30 of the 63 patients were not rechecked. 24 of the 33 rechecked patients with microhematuria again showed a pathologic erythrocyte count in urinalysis. Further workup for hematuria in 18 of these patients produced a definite diagnosis in 11 but not in the other 7 i.e. the final diagnosis in the latter was (microhematuria of undetermined origin). Workup for microhematuria is of great importance in clinical practice, and for this reason a specific procedure for workup of ambulatory patients is proposed.


[Clinical and immunological analysis of 1,047 allergic reactions to penicillin].

Of 1047 patients who had had an allergic reaction to penicillin established by clinical and laboratory findings, 224 were given penicillin therapy again later. One third of these patients developed a second allergic reaction to penicillin. In patients experiencing a second allergic reaction the most striking feature is a dramatic increase in the immediate reactions and especially of the anaphylactic type, and less markedly, an increase in the serum-sickness type of reaction. All the patients were skin tested with penicilloyl-polylysine (PPL) and benzylpenicillin (BPO). Circulating hemagglutinating antibodies were determined and in vitro stimulation of peripheral blood lymphocytes was performed in all cases. Skin tests show little change for several years. In contrast, circulating hemagglutinating antibodies disappear in half the cases within 6 months. Finally, lymphocyte stimulation with penicillin was positive in only 50% three months after onset of the allergic reaction, whereas one year later there was a 73% positive response. The best test for prediction of an allergic reaction to penicillin appears to be determination of the (high) and (low) reactors among patients with a positive skin test to PPL and BPO.


[Respiratory insufficiency in acute lung diseases].

The diagnosis of respiratory failure is  based on pathological findings in arterial blood gas analysis. Thus, even in emergent cases with acute pulmonary disorders, rapid differentiation of the amount and nature of the respiratory impairment is possible. Furthermore, evaluation of the blood gas analysis may be an essential factor in the choice of therapeutic procedures. Hypoxia should be treated by strictly controlled oxygen administration, to avoid further respiratory depressant effects. Patients with acute and progressive respiratory acidosis usually need artificial ventilation by volume- or pressure-cycled respirator. Some important modifications of ventilation are recommended with a view to improving pulmonary gas exchange and decreasing the incidence of complications, especially during the long-term treatment with respirators.


[Defence capacities of the respiratory tract].

The defenses of the lung against inhaled gases and particles include aerodynamic filtration mechanisms of the tracheobronchial tree, mechanical clearance and local detoxification. Cough, mucociliary transport, alveolo-bronchiolar fluid flow and clearance to lymph and blood participate in the mechanical excretory mechanisms whereas phagocytosis, immunologic and secretory mechanisms, and tissue reaction represent in-situ detoxification. Impaired mucociliary transport causes obstruction of the airways, the pathophysiologic hallmark of chronic nonspecific lung diseases. The clearance of diseases airways is not easy. It may be accomplished either by changing primarily the physicochemical properties of the mucus or by stimulating ciliary activity. By means of doublebind-crossover studies in patients with stable chronic nonspecific lung diseases, it is shown how drugs which presumably improve the clearance of diseased airways do affect the various physicochemical properties of the tracheobronchial mucus.


[Therapeutic procedure in acute pulmonary and pleuropulmonary diseases].

The treatment of acute infections of the lung tissue, of noncardiogenic pulmonary edema and of large pleural effusions and pneumothorax is discused. At the onset of these acute situations, the therapeutic decision has sometimes to be made before a definite diagnosis is available. Clinical, radiological and statistical factors often condition the first steps of treatment. Once the definite diagnosis has been established it is usually possible to adapt the treatment to accepted principles, which are dwelt on in detail.


[Lung diseases due to atypical mycobacteria].

The epidemiology, symptoms, diagnosis, and treatment of mycobacterioses are reviewed. In the Canton of Vaud, Switzerland, the incidence of mycobacterioses approximates to 1% of infectious tuberculosis cases. Non-pathogenic typical mycobacteria have been identified in 2.8% of non-infectious chronic respiratory disorders, in 1.2% after culture conversion of respiratory tuberculosis, and mixed with tubercle bacilli in 4% of cases.


The Shapiro cards scale as a method of assessment of obsessional symptoms in clomipramine therapy.

One of the major problems encountered in research into the value of a new treatment for obsessional states is the small number of patients seen in any one centre. Another problem is the great diversity of symptoms which obsessional patients display. These two problems may be partly overcome by the use of the method of rating devised by Shapiro. The technique is described and its application to the treatment of obsessional disorders illustrated.


The Lynfield Obsessional/Compulsive Questionnaires.

The need for adequate methods of measuring symptoms in obsessional disorders is stressed, particularly since, owing to the comparative rarity of the condition, a multicentre approach will be necessary if controlled studies are envisaged. A new method of measurement, the Lynfield Obsessional/Compulsive Questionnaire, is described. The questionnaire is derived from the Leyton Obsessional Inventory and may be of value in showing response to treatment.


A new rating scale for obsessional and phobic states.

A brief rating scale for use in assessing patients with phobic and obsessional states is presented. The scale concentrates on the measurements of general anxiety, avoidance, interference and physiological accompaniments in phobias and an anxiety, resistance and interference in obsessions. It also includes a section on other psychiatric symptoms.


Recent advances in the behavioural measurement of obsessional illness. Difficulties common to these and other measures.

Research into the effect of treatment on phobic and obsessional disorders has been hampered by the need for agreed and acceptable criteria in clinical evaluation and therapeutic comparison. Methods of measurement now available, including two recently developed scales, are described.


Depressive reactions in the course of clomipramine therapy used in the treatment of obsessional conditions.

In a small series of patients, suffering from obsessional disorders, it was found that there seems to be a type of depression which occurs during the course of clomipramine therapy. As clomipramine is an antidepressant, this may seem to be an anomaly but it is suggested that depression is secondary to agitation and tension which are recognised side-effects of clomipramine. The patients nevertheless showed improvement in their obsessional symptomatology. The finding seems to reinforce the view that clomipramine has an antiobsessional effect which is distinct from its antidepressant property.


The role of intravenous clomipramine in the treatment of obsessional and phobic disorders.

The results of intravenous clomipramine therapy in 118 patients suffering from obsessional syndromes and phobic anxiety states are reviewed. A remarkable consistency of improvement was observed especially in those patients suffering from obsessional symptoms. Better results were obtained in patients lacking hysterical personality traits. A brief reference is made to a pilot study involving the use of the 16PF personality test in assessing the effect of clomipramine.


Science is measurement.

In the assessment of phobic and obsessional states three approaches have been adopted--self rating scales, observer rating scales and physiological measurements. A comprehensive approach utilising all methods is suggested in the evaluation of new treatment techniques.


A pilot study of anafranil in the treatment of phobic states.

A pilot study of the use of Anafranil in the treatment of phobic disorders is described. Twenty-two patients were included in the investigation, 16 receiving intravenous and oral Anafranil combined and six oral Anafranil alone. After one month, four were free of phobic symptoms and 13 only mildly disabled. At six month follow-up 10 were free of symptoms and seven only mildly disabled.


An investigation into the use of anafranil in phobic and obsessional disorders.

A multicentre clinical trial of clomipramine in the treatment of obsessional and phobic disorders in general practice is described. All phobias showed an improvement in situational anxiety, interference and autonomic side effects. With the exception of two cases of animal phobia there was also improvement in general anxiety and avoidance. Obsessional cases showed an overall improvement in all symptom areas.


A preliminary report on the use of clomipramine in general practice.

The use of clomipramine in a large suburban general practice is reviewed. Three hundred and fifty patients have been treated to date out of a total practice population of twenty-one thousand. It is argued that phobic anxiety states are much commoner than is normally supposed and that they are usually associated with a history of separation or rejection in childhood. A combined treatment regime is employed for one month thereafter clomipramine alone is used. Side-effects may initially present a problem although they may not all be truly drug induced. Some patients use side-effects to manipulate the clinical situation. However proper interpretative management of side effects can assist the clinicians in persuading patients to continue therapy. Some impressive results have been obtained with clomipramine therapy. Illustrative case histories are provided.


Physiological measurements in phobic and obsessional disorders.

The various physiological measurements which can be made in obsessional and phobic disorders are described. Useful information can be obtained about the effects of acute stress and the changes that medication can produce in anxious patients and the clinical progress of behaviour therapy can be monitored. When physiological measurements are made it is important to record the emotional state of the patient simultaneously so that the level of physiological arousal is related to the subjective experience of the patient.


Visual sensations induced by Cerenkov radiation.

Pulses of relativistic singly charged particles entering the eyeball induce a variety of visual phenomena by means of Cerenkov radiation generated during their passage through the vitreous. These phenomena are similar in appearance to many of the visual sensations experienced by Apollo astronauts exposed to the cosmic rays in deep space.


Membrane protein analysis by two-dimensional immunoelectrophoresis.

Water-soluble membrane proteins may be analyzed by a new, rapid technique that combines electrophoresis on high-resolution sodium dodecyl sulfate (SDS) polyacrylamide gels and immunoelectrophoresis. After separation in the first dimension by electrophoresis in SDS, the proteins are subjected to a second electrophoresis at right angles through a two-layered buffered agarose gel. They first pass through a layer containing Lubrol PX which forms complexes with free SDS and then into an antiserum layer where antigen-antibody precipitates form. Precipitin arcs appear at positions corresponding to the antigens separated in the first dimension. The effectiveness of the technique was demonstrated with frog and cattle opsins, human erythrocyte membrane proteins, and their rabbit antiserums and for several water soluble proteins. By this method two fundamental parameters, molecular weight and antigenicity, may be readily used for analysis of membrane proteins.


Enteropancreatic circulation of digestive enzymes.

Intact digestive enzymes can be absorbed by the intestine and resecreted by the pancreas. The pancreas, therefore, appears to be able to recycle proteins much as the liver recycles bile salts, although the magnitude of this process remains uncertain.


Tail pinch induces eating in sated rats which appears to depend on nigrostriatal dopamine.

Mild tail pinch reliably and rapidly induced eating, gnawing, or licking behavior in all animals tested. Eating was by far the predominant response. Pharmacological analysis of the involvement of the brain catecholamines in tail-pinch behavior suggests that it is critically dependent on the nigrostriatal dopamine system.


Muscle activation: effects of small length changes on calcium release in single fibers.

In single muscle fibers, small (1 percent) changes of length have a marked effect of both the calcium activation and the tension elicited by a constant current stimulus. The decrease in tension with shortening is accounted for almost entirely by a decrease in calcium release, rather than by changes in mechanical factors, such as filament geometry.


Taste aversions to sexual attractants.

The vaginal secretion of female hamsters serves as a sexual excitant or attractant for the male even in the absence of previous sexual experience, but attraction to the secretion can be altered with surprising ease by pairing ingestion of the secretion with gastrointestinal illness.


Glucoregulatory feeding by rats after intraventricular 6-hydroxydopamine or lateral hypothalamic lesions.

Rats given intravenricular injections of 6-hydroxydopamine or bilateral electrolytic lesions of the lateral hypothalamus do not show the normal increase in food intake in response to large decreases in glucose utilization or exposure to severe cold stress. However, they will eat more during chronic glucoprivation that is less intense, or during exposure to more moderate cold stress. Thus, the feeding deficits of these lesioned rats may not reflect an inability to respond to certain qualitatively different stimuli, but rather an inability to respond to quantitatively different intensities of the same stimulus.


Pitfalls in the application of digoxin determinations.

The radioimmunoassay of digoxin is one of the most important services of the nuclear medicine laboratory. Precision and accuracy in the performance of the test are especially critical. A number of commerical kits are available and reliable. Pitfalls to be avoided includelimited availability or delay in performance of the assay; failure to consider senitizing factors; drawing the blood sample too soon after a digoxin dose; failure to consider desensitizing factors; forgetting that renal function is a major determinant of blood and tissue digoxin levels; assuming patient compliance and uniform intestinal absorption (bioavailiability with all digoxin preparations in all patients; attempting to interpret digoxin levels without the necessary clinical information; and failure to deliver the result to the proper person. If one avoids these pitfalls, and important service will be rendered in the evaluation of the patient requiring digitalis therapy.


Clinical significance of gastrin radioimmunoassay.

Serum gastrin radioimmunoassay (RIA) is a sensitive and specific method suitable for measurement of circulating concentrations of this peptide hormone, which is a major regulator of gastric acid secretion. When performed under optimal conditions this RIA permits measurement of low and normal serum gastrin levels and changes that occur after physiologic stimulation. Hypergastrinemia may be secondary to atrophy of the acid-secreting gastric mucosa. This form of pypergastrinemia is appropriate and leads to no seriousequences. Hypergastrinemia associated with gastric acid hypersecretion is inappropriate. The major cause is a gastrinsecreting tumor (gastrinoma) that produces the clinical picture of the Aollinger-Ellison syndrome. The differential diagnosis of inappropraite hypergastrinemia includes antral G-cell hyperplasia and ISOLATED RETAINED ANTRUM. Accurate diagnosis of these conditions may be aided by ancillary studies including feeding, secretin, and calcium stimulation tests. Distinction among these conditions is important in planning appropriate surgical tratment.


Current status of carcinoembryonic antigen assay.

The carcinoembryonic antigen (CEA) is a glycoprotein that can be measured by radioimmunoassay and other immunologic techniques. The CEA reagent is currently commercially available in kit form and has been found to be satisfactory for laboratory use. The highest percentage of elevated plasma CEA and the highest CEA titer have been found in patients with entodermally derived tumors. CEA has also been detected in patients with other tumors and in patients with nonneoplastic disease, as well as in heavy cigarette smokers. The present CEA assay cannot be used to screen for cancer in the general population. The greatest clinical usefulness of current CEA assay is in assessing prognosis, in the detection of residual tumors and recurrent disease, and in monitoring chemotherapy and radiotherapy. The use of anti-CEA antiserum as a tumor-localizing agent may be of potential value in the future.


Solitary metastatic carcinoma of the spleen.

A care is reported in which an isolated metastatic lesion of the spleen was discovered one year after a modified radical mastectomy for carcinoma of the breast, and seven years following total hysterectomy and bilateral salpingo-oophorectomy for carcinoma of the left ovary. Splenectomy was followed by significant clinical improvement of the patient who remains alive and well four years after operation. Regular physical and roentgen examinations have revealed no evidence of recurrent disease. The factors relating to the occurrence of solitary splenic metastasis are discussed briefly. This case is apparently the fifth reported in the literature.


Cerebral cysticercosis.

Cerebral cysticercosis is a neurologic disease with myriad manifestations. Three basic types of infections occur: localized, widespread, and proliferative inflammatory reaction. A case is reported illustrating the first type of infection and one type of clinical presentation,--focal seizures. The worldwide distribution of the disease suggests that as global travel increases we will have to consider the diagnosis more often. The diagnosis is established principally through thorough examination of the CSF plus signs of parasitosis in other parts of the body. A history of living in an endemic area should strengthen suspicion. Definitive treatment is currently limited to neurosurgical intervention.


Intrathoracic chordoma presenting as a posterior mediastinal tumor.

Chordomas are tumors originating from remnants of the notochord, most commonly found in the cranial and caudal regions. This is a report of the seventh intrathoracic chordoma in the world literature and the second to be reported in a woman. Histologically the physalipherous (blister-bearing) cell is characteristic of the tumor. Complete surgical excision is rarely successful and recurrence with or without metastasis is the rule.


Hemolytic anemia and thrombocytopenia associated with penicillamine ingestion.

A case of a 52-year-old white woman who developed hemolytic anemia and thrombocytopenia after receiving D-penicillamine is presented. Although there appears to be a causative relationship, it cannot be documented at this time. No other case of hemolysis has been suggested in patients treated with penicillamine. Since penicillamine is being used more frequently and in an ever-growing list of conditions, it is advisable to be alert to the possibility of hemolytic anemia as another of the complications of therapy.


The problem-oriented medical record in a surgical practice.

I have found the POMR to be a valuable tool in both the office and hospital practice of general surgery.


Anesthesia and the porphyrias.

A simplified classification of the porphyrias is given which is thought to be advantageous to the anesthesiologist in determining those patients who are predisposed to acute attacks. These acute attacks may be precipitated by the administration of barbiturates, but may also be spontaneous. The current theory for the precipitation of the acute attack is described, with the probable mechanism being a decrease in uroporphyrinogen synthetase levels and the resultant interference in heme production. Increased formation of cytochrome  P-450 with barbiturates also produces increased levels of delta aminolevulinic acid, which may be a cause of the acute attack. The significance in anesthesia and suggested means of anesthetic management are discussed.


Papillomas of the nasal and paranasal cavities.

Intranasal papilloma is an uncommon, benign tumor of the nasal cavity and, by extension, the paranasal sinuses. It occurs only once for every 25 cases of ordinary nasal polyps. A recent case is reported, followed by a summary of the cases treated at the Emory University Hospitals in the last ten years. The histologic classification is reviewed, as well as current treatment, with an emphasis on wide surgical excision through the lateral rhinotomy approach. Because about 10% of these tumors will have associated malignancy, guidelines are given to insure that this malignant transformation is not missed.


Endoscopic retrograde choledochopancreatography.

Endoscopic retrograde choledochopancreatography (ERCP) was attempted in 77 patients. Of 33 patients suspected of having bilitary tract disease, ductograms were obtained in 21. Of 56 patients suspected of having pancreatic disease, ductograms were obtained in 35. Since 12 patients were thought to have disease of both ductal systems, the total number of suspected ducts exceeds the number of patients. It is concluded that ERCP is a valuable diagnostic tool in the evaluation of pancreatic or biliary tract disease. Additional data from a prospective study are necessary to determine its clinical relevance.


Technetium 99m sulfur colloid spleen/liver ratio and other liver tests in the diagnosis of cirrhosis.

The results of seven laboratory tests of liver function, including spleen/liver activity ratios obtained by densitometric analysis of scans, are analyzed in 50 patients with proven Laennec's cirrhosis. In this series, the liver scan not only disclosed the liver gross anatomy and structural abnormality and established the best possible site for biopsy examination, but also, the increased splenic activity served as a useful diagnostic indication of Laennec's cirrhosis. Of 50 proven cases of Laennec's cirrhosis, 41 (82%) had abnormal spleen/liver ratios. An abnormal spleen/liver ratio in combination with abnormal results from any one or two other tests was relatively effective in the detection of cirrhosis. The accuracy is improved if the other laboratory tests are chosen from among tests for serum albumin, serum bilirubin, and SGOT. (Liver abnormalities other than cirrhosis can also present an abnormal spleen/liver ratio.) This simple determination extends the value of the liver scan commonly requested in search of metastases, primary lesions, or inflammatory processes, or in preparation for needle biopsy examination.


Volvulus of the sigmoid colon.

A study of 37 patients with sigmoid volvulus is presented. Subsequent bouts of recurrent volvulus are very common after sigmoidoscopic intubation, and overall mortality rates are high. Surgical resection is the preferred method of treatment.


Pacinian corpuscle neuroma of digital nerves.

Symptoms and incapacitation due to abnormal aggregations of pacinian corpuscles are uncommon. Indeed, only three reports have been found in the scientific literature. A case is presented in which the patient's chief complaint was pain and localized tenderness in the hand which interfered with normal activity. Surgical exploration of the palm showed abnormalities of pacinian corpuscles attached to the median digital nerve in the form of a grape-like cluster and a single enlarged corpuscle beneath the epineurium; the abnormality attached to the ulnar digital nerve appeared as an offshoot of hyperplastic corpuscles lying in tandem. The abnormal corpuscles were excised. The symptoms have not recurred to date. These abnormalities in size, position, and number of pacinian corpuscles are compared to the findings of the few other reports in the literature. The neuroma formation found attached to this ulnar nerve has not been cited previously.


Mental and emotional disturbance with pentazocine (Talwin) use.

Pentazocine (Talwin) originally was believed to be a safe, nonaddictive analgesic, but further experience has shown that severe mental and emotional disturbance, as well as addiction, may occur. This survey documents the experience in the Texas Medical Center and elsewhere. The accumulated data show the following: (1) Depressive states are reported most frequently, while toxic psychoses, hallucinogenic reactions with panic, and paranoid states on withdrawal of the drug are less frequent. (2) Of the 197 cases of addiction reported to date, only six were related to oral use of the drug. The abstinence syndrome is mild, consisting usually of restlessness, nausea, cramps, and insomnia. (3) Convulsions have been reported on four occasions. Euphoria and psychotomimetic effects may relate to rapid release of noradrenaline and dopamine. Oral use of the drug is advised to avoid euphoriant effects and addiction, and physicians should alert patients to report unusual visual phenomena. Tranquilizers are of value in cases of severe reactions.


Chiari's osteotomy of the pelvis: an evaluation of early results.

An early evaluation of the Chiari pelvic osteotomy done on 19 hips in 16 patients is presented. Indications were: (1) congenital hip dysplasia, where conservative or other surgical treatment had failed or where the patient's age contraindicted conservative treatment, and (2) hypoplastic hip joints associated with neuromuscular disorders. Results were classified according to pain, limp, Trendelenburg sign, range of motion, and radiographic appearance. Follow-up, averaging 16 months, revealed the relief of pain and an increase of hip motion in many cases. However, the limp and positive Trendelenburg sign frequently persisted. The overall success rate was 69%.


Peritoneal dialysis: its potential for use in the community hospital.

Peritoneal dialysis is a treatment of proven efficiency for a variety of disorders. Experience with 53 peritoneal dialyses performed on 28 patients over a three-year period at two community hospitals without permanent house staffs is summarized. Proper adherence to a few basic principles can lead to a very low incidence of complications, especially those of an inflammatory nature. This form of dialysis has considerable potential for the small community hospital. Training programs should make the knowledge and skill of this technic available to those wishing to learn it, and especially to those considering practice in communities removed from the medical center.


Acute slipped capital femoral epiphysis.

Of 12 cases of acute slipping of the capital femoral epiphysis (representing 11 patients), results were satisfactory in nine cases and poor in three cases at follow-up (in two of the three cases with poor results, reduction was lost postoperatively). Five of nine patients with prodromal symptoms were seen by a physician but were undiagnosed or untreated before the acute slipping. An additional patient had roentgenographic evidence of an early (asymptomatic) slipping capital femoral epiphysis one year before the acute slipping. Preferred treatment is gentle manipulation and fixation with multiple threaded pins, followed by crutch walking for three to four months. Spica casting is not recommended because of an increased incidence of acute articular cartilage necrosis and the possibility of late recurrence of slipping.


Spontaneous rupture of the spleen with EMATOMA.

A case of spontaneous rupture of the spleen with hematoma is presented. The spleen presumably with ruptured while the patient was in the hospital, during a severe coughing episode secondary to viral pneumonia. The time interval between splenic rupture and operation was 31 days. Along with pertinent diagnostic acids, difficulty in making the diagnosis is stressed. Knowledge that this condition exists is a major factor in making the diagnosis.


Comparative survey of psychiatrists' prescription preferences: New York and Texas.

The present survey compares the treatment preferences of New York and Texas psychiatrists using a questionnaire report of a single psychiatric case. The characteristics of this approach enable the investigator to hold and symptoms and syndromes of the patient constant. All clinicians respond to identical stimuli. What varies naturally, then, is the judgment of the clinician in developing his treatment procedure, thereby enabling estimation of the degree of standardization in treatment preferences. Three hundred twelve psychiatrists from New York and 133 from Texas provided data for comparative purposes. On the first admission 41% of the New York respondents and 24% of the Texas psychiatrists preferred a regimen that included more than one drug. When a combination of drugs was selected, chlorpromazine-trifluoperazine was preferred. But ten other specific combinations also were selected. Most were of potent neuroleptics, but some included antidepressant-neuroleptic combinations. None of the variables included in the study provided tangible systematic variance for these treatment preferences. A year and a half after first admission, followed by treatment in and out of hospital, the patient's clinical course continued to deteriorate. At this point more than 50% of the respondents in each state selected a regimen that included a minimum of two drugs. As many as 24 different combinations were selected for this single case. Nineteen percent of the New York respondents and 13% of the Texas respondents selected a regimen that included three or more psychoactive medications. The existence of these treatment preferences requires a more basic understanding of treatment preferences, for these seems to be no basis for them.


Fluid shifts after burn injury.

Following significant burn injury, severe translocations occur in the distribution of water and solute. These result in major deficits in functional extracellular fluid and circulating water volume which may result in shock. The weight of evidence suggests that resuscitational regimens must contain large quantities of water which should be at least isotonic with respect at sodium; and some evidence suggests that current resuscitational regimens may not provide sufficient potassium to maintain the normal relationship between intracellular and extracellular solute and to prevent sodium sequestration. It is clear, however, that most of the currently used resuscitational "formulas" are effective in restoring and maintaining water balance, renal function, cardiac output, and in preventing or correcting shock.


Chronic thallitoxicosis: treatment of the choreiform sequelae.

A case of chronic thallium poisoning of 10 to 15 years' duration is presented in detail. The exact duration could not be determined. Treatment of the choreiform sequelae with levodopa is described for the first time. A system for classification of thallium poisoning is proposed.


Radial and volar perilunate transscaphoid fracture dislocation.

An unusual volar and radial perilunate transscaphoid fracture dislocation is reported. Treatment of perilunate transscaphoid fracture dislocations by closed reduction often produces a poor result. Early open reduction may be followed by a good result, but if open reduction is impossible, proximal row carpectomy is advised.


Experience with the multiple-choice paper for Part 1 M.R.C.O.G.

A critical analysis of the aims and achievements of the multiple-choice type of examination for Part 1 of Memobership of the Royal College of Obstetricians and Gynaecologists is provided. In addition to a description of the system of marking and an evaluation of the results to date, comments are offered on reciprocity between South Africa and the United Kingdom in regard to the Part 1 examination.


Thoughts on contraception and family planning clinics.

Population figures for the Republic of South Africa are given, with projected figures to the year 2000. The population status of the Municipality of Johannesburg, its birth rate and infant mortality rate, are presented. Points affecting the acceptance of contraception and family planning clinics are made and the unique situation of family planning clinics is emphasised. Figures relating to attendence at family planning clinics in Johannesburg are presented. Aspects such as consent for contraception, sex education for adolescents, abortion and sterilisation are commented on.


Social factors influencing contraceptive usage in the Black population of Rhodesia.

Adoption of family planning practices involves two decisions--acceptance or rejection of, firstly, the concept of voluntary fertility control, and secondly, of the use of contraceptives. Modern contraceptives are a medical innovation. The diffusion process is influenced by social, economic and political factors in the country.


Endometrial regeneration and adhesion formation.

The implantation of fibroblasts over the denuded endometrium in rabbit and rat uteri was followed by the inhibition of endometrial regeneration. The fibroblast  proliferation led to development of intra-uterine adhesions and endometrial fibrosis. These observations were the rationale behind a clinical trial which attempted to reduce uterine blood loss by the replacement of the endometrium by connective tissue.


Carbohydrate tolerance, plasma insulin, growth hormone and lipid levels in Indian and Black diabetics.

Glucose tolerance tests were carried out on 35 recently discovered Indian and Black maturity-onset diabetic patients. Differences were found between the two ethnic groups although they were of comparable age, body weight, and probable duration of diabetes at the time of investigation. Glucose tolerance was worse among Blacks and was associated with low plasma insulin levels. Blacks also had lower plasma triglyceride and cholesterol values than Indian diabetics. Plasma growth hormone respone was similar in both groups. The possible role of these factors in determining the relative frequency of ischaemic heart disease in the two racial groups is discussed.


Amyloidosis of the kidneys. Review of patients and literature.

The clinical findings in 49 patients (27 males) who had histologically confirmed amyloidosis of the kidney, are reviewed. In 28 patients, the diagnosis was arrived at by percutaneous renal biopsy, and in 21 patients it was made at autopsy. The youngest patient was diagnosed at the age of 16 years. In 11 patients (22,5%) no associated disease was found, in a further 11 patients the amyloidosis was of the type connected with familial Mediterranean fever, and in 27 patients (55%) the amyloidosis was of the secondary type. Forty-six patients (94%) presented with proteinuria at some stage of their disease. Twenty-one patients developed the nephrotic syndrome. Thirty-two patients died, and in 18 instances uraemia was the cause of death. In 18 patients there was evidence of renal pathology other than amyloidosis, and in some patients this may have contributed to the impairment of renal function and the appearance of proteinuria.


Cystic fibrosis in the South West African Afrikaner. An example of population drift, possibly with heterozygote advantage.

An incidence of the genetic recessive disease cystic fibrosis (mucoviscidosis) far in excess of that reported recently from other countries, has been encountered in the South West African Afrikaner. This has probably resulted from the immigration of a segment of the South African Afrikaner population rich in the gene, into South West Africa, where, for religious reasons and reasons of geographical isolation, the gene has persisted and, perhaps, increased in frequency. Malaria, which killed many of the early settlers, might have selectively spared carriers of the gene, thus enriching its occurrence in the population. Details of patients, particularly with regard to the criteria of diagnosis, are given with the relevant population and birth figures, from which an estimate of the incidence of the disease and of its carrier rate has been made. Screening of the newborn for the condition and the compiling of a register of potential and obligatory carriers are also discussed.


Review of the medically important spiders in Southern Africa.

Known and suspected medically important Southern African spiders are reviewed in terms of their distribution, identification, action of the venom and treatment of the bite. Simple diagnostic characteristics of each species are provided to assist the non-specialist in identifications.


Functionig phaeochromocytoma of the organ of Zuckerkandl. The second case treated at Edendale Hospital.

The second case of a functioning phaeochromocytoma of the organ of Zuckerkandl has been treated at Edendale Hospital. A young Black woman was admitted as a case of juvenile hypertension and a pre-operative diagnosis of a functioning phaeochromocytoma was made. The case, the importance of pre-operative preparation and the proposed follow-up are described.


Clinical and cytogenetic aspects of the 21 deletion syndrome.

The clinical, cytogenetic and dermatoglyphic findings in a patient with a ring chromosome 21 are presented. This anomaly acts as a deletion of chromosomal material and results in specific congenital defects. A comparison is made with 24 cases of deletions involving chromosome 21 described in the literature. Six of these have been studied by means of recently developed chromosome banding techniques. Cases presumably arise through somatic non-disjunction or chromosome breakage. When the chromosomes of both parents are normal the recurrence risk is negligible.


Metabolic bone disease in the elderly. Biochemical studies in three different racial groups living in South Africa.

In an attempt to detect biochemical evidence of metabolic bone disease in the aged, we measured plasma parathyroid hormone (PTH) concentrations, in addition to plasma calcium, phosphorus, alkaline phosphatase and creatinine levels, in elderly White, Black and Indian women. All three ethnic groups demonstrated raised mean PTH concentrations. The Black patients, however, showed the greatest mean PTH elevation and the lowest plasma calcium level. Increased PTH secretion in elderly females may reflect either an age-related decline in renal function or subclinical osteomalacia. Elderly Black women seem particularly susceptible to the latter disorder, probably because of dietary and environmental factors.


Orthostatic hypotension due to Shy-Drager syndrome.

A case of orthostatic hypotension is presented, as well as postmortem neuropathological findings. The features of this case are consistent with those of the Shy-Drager syndrome, which comprises primary orthostatic hypotension and neurological manifestations caused by degenerative disease of the central nervous system.


Factor viii-related antigen in the detection of the haemophilia carrier state.

The levels of factor VIII-related antigen (ERA) in normal White females, in White and Black obligatory haemorphilia carriers and in possible haemophilia carriers compared with the functional factor VIII activity. The results obtained compared favourably with those previously reported, in that the obligatory carrier group demonstrated excess antigen compared with functional factor VIII activity. The F VIII/ERA ration obtained for each obligatory carrier was compared statistically with the ratio of normal group. A ratio of 0,65 was the level below which haemophilia carrier status could be predicted within the 95% confidence limits.


[Anesthesia for patients with intestinal obstruction].

The pre- and intra-operative care of patients with acute intestinal obstruction is reviewed. The most important pre-operative problems are hypovolaemia, sepsis, electrolyte and acid-base imbalances. The evaulation and treatment of these disorders are discussed. The importance of preventing regurgitation and inhalation of stomach contents is emphasised and the methods which are used are described. The safest techniques of induction and maintenance of anaesthesia as well as muscle relaxation and intra-operative fluid therapy are indicated.


From general practitioner to family physician.

A plea for the recognition of expertise in general practice by the medical authorities of this country is made, and a scheme for the registration of a higher degree in family medicine is suggested.


[Summary of contributions to the symposium on 'the moment of death'].

In their original meaning, the terms 'life' and 'death' refer to the biotical aspect of the cosmos, although many non-original (analogical) uses of these terms exist. The concrete process of dying, however, is not incorporated in the biotical aspect because it also displays other cosmic aspects. In this contribution, we have tried to focus our attention on the biotical, sensitive-psychical, juridical and ethical aspects. It emerged that present medical practice implies different moments of death as soon as one distinguishes between death in a biotical, sensitive-psychical or juridical sense.


The physiology of exercise and its clinical implications in coronary heart disease.

Exercise conditioning is a safe, effective therapeutic weapon in coronary heart disease (CHD) if correctly applied. This correct application presupposes, as would be the case in other forms of medical or surgical management, that the prescriber has a thorough knowledge of the underlying pathophysiology, both of the disease and of the cure. The physiology of exercise in normal persons is described in some detail, since similar effects apply in CHD patients. The training phenomenon, too, is similar in CHD sufferers, although it is less extensive than in athletes. Lastly, the alterations in physiology by which the patient can expect to benefit, are discussed.


Lysosomal disruption during the development of endotoxic shock in the baboon.

Lysosomal disruption with release of lysosomal enzymes has been described in shock. Our study was designed to demonstrate the release of lysosomal enzymes in the liver and lung in addition to determining circulating serum lysosomal enzyme values. Terapeutic means of reducing or inhibiting lysosomal disruption were also investigated. Five groups of baboons were investigated: Group A: (control group) - no endotoxin or treatment administered. Group B: (endotoxin only) - liver and lung tissues showed an increase in free lysosomal enzymes, and a similar increase in curculating serum lysosomal enzymes was demonstrated. Group C: (chloroguine treatment (lysosomal stabiliser) following endotoxin administration) - the liver and lung tissues showed a smaller increase in free lysosomal enzymes and a corresponding lesser increase in circulating serum lysosomal enzymes was demonstrated. Group D: (dexamethasone treatment (lysosomal membrane stabiliser) following endotoxin administration) - the rise in lysosomal tissue and serum enzyme values was less than that in group B. Group E: (combination of chloroquine and dexamethasone treatment following endotoxin administration) - the rise in lysosomal tissue and serum values was less than that demonstrated in group B. The survival of the animals in the various groups correlated well with the lysosomal enzyme tissue and serum values, as did the monitored haemodynamic, hoematological and other parameters.


Exercise stress testing and an electromechanical S wave of the electrocardiogram.  Does the S-wave voltage change with increasing work rate?

A new view of the electrocardiogram, first proposed by Posel and arising from Craib's travelling dipole concept, predicts an electromechanical relationship between S-wave amplitude changes and cardiac mechanical function changes.  In an attempt to determine whether the S-wave voltage changes with increasing work rate, 10 male subjects were tested at rest and at maximum exercise.  A statistically significant increase in the S wave occurred with increased mechanical work.  The theoretical prediction of an electromechanical S wave is thus validated and a request is extended to other workers to verify or refute its existence.


The effects of sodium pentosan polysulphate on peripheral metabolism.

Sodium pentosan polysulphate is a polymer of beta-D-xylopyranose which possesses some of the biological properties of the endogenous acid polysaccharides such as heparin. The actions of this compound on plasma lipids, carbohydrate metabolism and fibrinolysis have been studied using the human forearm technique. Ten healthy volunteers were investigated in the fasting state, and blood flow measurements and blood samples were taken before and at 60 and 90 minutes after 100 mg sodium pentosan polysulphate by intramuscular injection. Following administration of the drug, significant changes occurred in plasma triglyceride, free fatty acid (ffa) and glycerol levels. Triglycerides fell (P less than 0,001) and glycerol and FFA rose (P less than 0,001. Changes were largely owing to activation of intravascular lipolysis, although an effect on stored triglycerides was also noted. Fibrinolytic activity also increased after drug administration, but no changes were noted in insulin exchange or glucose metabolism.


Giant cell tumour of the sacrum. A case report.

A case is reported of a giant cell tumour of the sacrum, an infrequent but well-recorded site for this tumour.  The relatively benign histology of this neoplasm was not consistent with its natural history in this patient, nor with its resistance to treatment.  An additional feature of interest and concern was the intense vascularity of the lesion.


Dyslexia.

A review of the literature indicates that the study of dyslexia has been almost exclusively confined to the higher cortical processes.  The suggestion is made that more thought should be directed to the attentional functions underlying these processes.  It is further suggested that medication should be more extensively used and that dosages higher than those usually prescribed should be considered.


Corrective surgery for transposition of the great arteries.

The results of corrective surgery in 32 patients with transposition of the great arteries (TGA) are reviewed. Patients with TGA and associated defects comprised 47% of the series. The over-all long-term mortality rate was 31%. An acceptable mortality rate of 17,5% was achieved in simple TGA by using a Mustard repair. Good results were obtained with the Rastelli operation for patients with TGA, ventricular septal defect and severe pulmonary stenosis. Results were poor in patients with TGA and unrestricted ventricular septal defects, in whom palliative pulmonary artery banding or corrective surgery under 6 months of age is advocated. The major late complication was patch contraction resulting in pulmonary or systemic venous obstruction.


Smoking and other factors affecting the conservative management of peripheral vascular disease.

Three hundred and ninety patients with peripheral vascular disease, who were neither eligible for, nor fit to undergo, surgery, have been studied in a prospective trial to assess the effectiveness of adequate active conservative therapy. These patients were followed up from 4 to 72 months, the duration of the average follow-up being 24 months. There was a 72% over-all improvement rate. The most striking feature of the trial was the correlation between smoking and failure to improve.


Plasma triglyceride measurement. A comparison of four commercial methods.

This study investigated the reliability of 4 commercially available methods for the assay of plasma triglycerides. The kit methods were those of Boehringer, Dade, Haury and Oxford. The Boehringer method showed a high degree of precision, acceptable accuracy, and consistent day-to-day reproducibility.


Childhood deafness in Cape Town.

An aetiological survey of a Cape Peninsula school for the deaf, in which 366 Cape Coloured and Asiatic children were examined, is reported. The relevant hereditary factors and the abnormal clinical findings are documented, and the more important of these are discussed. In 20% (74) of the children, the deafness was genetic; in 36% (132) it was acquired, and in 44% (160) it was cryptogenic.


The establishment of a child abuse unit in a children's hospital.

The recognition of the child abuse syndrome in the Republic of Sout Africa is briefly mentioned. The aims of setting up a Child Abuse Unit in a children's hospital are detailed; the procedure for the education of staff, details of training and the establishment of a programme are outlined, and the outcome is considered. The co-operation of the medical profession is sought in setting up programmes for the prevention of child abuse.


The Cape Town obstetric flying squad.

The number and nature of the calls received by the Cape Town Flying Squad Service during 1972 are compared with those received from 1954 to 1960. A threefold increase in the total number of calls received per year is related to a fall from 74% to 30% in calls connected with postpartum complications. Reasons for these changes are suggested.


Serological studies on human plague in Southern Africa. Part I. Plague antibody levels in a population during a quiescent and a subsequent active period in an endemic region.

Yersinia pestis fraction l passive haemagglutination studies on human sera obtained randomly during a plague epidemic showed a 10-fold increase in occurrence of antibodies compared with the results obtained on sera from the same population 11 months earlier during a quiescent phase. The pre-epidemic population antibody rate was lower than that in a comparable population tested simultaneously in another endemic region, where a recrudescence of plague was not experienced during the following year. The human plague epidemic was preceded and accompanied by a rodent die-off. A serological survey of the small mammals 2 years prior to the human survey also showed that Y. pestis was present in the environment. Otomys unisulcatus was indicated as being an important rodent in the plague cycle in the area.


The lumbar disc and its imitators.

A review of the differential diagnosis of the lumbar disc syndrome, based on patients seen and treated during the past 10 years, provides discussion of the unusual cases. A survey of 285 patients treated in a consecutive series from 1964 to 1972 was done, which showed that 253 patients had prolapsed lumbar discs, 20 were treated for spondylolisthesis and 62 (23%) required consideration because of unusual features in association with the disc lesion or because of other pathology. The need for lateral and complete exposure of the nerve root in some instances is reaffirmed.


A correlative study of serum digoxin levels and electrocardiographic measurements.

The ST-segment appearance, PR interval, corrected QU time and T-wave amplitude from standard electrocardiograms of 70 patients were correlated with serum digoxin levels done on the same day. The absence of a digtalis effect on ST segments, upright T waves and PTQ scores (a combination function of PR, QT and T) of one or less, correlated well with the absence of "toxic" serum digoxin levels (greater than 1,8 ng/ml). PTQ scores showed a significant linear correlation with serum digoxin levels, and PTQ scores of more than 3,0 were in all instances associated with "toxic" serum digoxin levels. These observations merit futher investigation and could be useful in clinical situations.


Pregnancy after the insertion of three cardiac valve prostheses.

A successful pregnancy occurring in a woman after the insertion of three cardiac valve prostheses, viz. aortic, mitral and tricuspid, is described. It appears that pregnancy in such circumstances is not an unacceptable hazard for the woman. Oral anticoagulant drugs increase the perinatal morbidity and mortality.


The clinical assessment of the intelligence of Coloured patients.

A procedure for the intellectual appraisal of Cape Coloured patients is described. This procedure may be useful in observation cases.


Pregnancy, pre-eclampsia and disseminated intravascular coagulation.

A prospective evaluation of the haemostatic mechanism was undertaken in 15 normal primigravidas and in 12 primigravidas with mild to moderately severe pre-eclampsia in order to further examine the possibility that disseminated intravascular coagulation may occur in this clinical syndrome. The only coagulation abnormality demonstrated was a prolongation of bleeding time. The data do not support the suggestion that significant disseminated intravascular coagulation is associated with pre-eclampsia. The addition of the heparinoid drug sodium pentosan polysulphate to the therapeutic regimen resulted in a significant fall in platelet factor 3 availability and in decreased aggregation against ADP but conferred no objective clinical improvement. We conclude that the drug has no place in the management of established pre-eclampsia.


Bilharzia of the Fallopian tube.

The incidence of bilharziasis of the Fallopian tube was studied in a control group of patients and in patients with ectopic pregnancies and severe salpingitis, but no significant difference was found. Two groups of 55 patients, each of which comprised 17 with ectopic pregnancies and 38 with severe pelvic sepsis, were studied for parity, symptoms and signs. Patients in one group suffered from tubal bilharziasis and those in the other did not. The findings in these two groups were similar and a typical clinical picture for bilharziasis was not found.


Obstructed labour at the University Teaching Hospital, Lusaka, Zambia - April 1972 - December 1973.

Sixty-three cases of obstructed labour encountered at the University Teaching Hospital, Lusaka, Zambia, are analysed for the period April 1972 - December 1973. For the same period there were 27 348 deliveries and 1 432 Caesarean sections. The management of choice was Caesarean section, because of a lack of experienced medical staff and the poor results obtained, together with the serious complications which follow destructive operations before vaginal deliveries. Eighty-five per cent of the babies were delivered alive. There was no maternal death. Twenty-six mothers remained in hospital for longer than 10 days. There was 1 case of a burst abdomen.


Treatment of endometrial carcinoma.

The optimal treatment for endometrial carcinoma is radical hysterectomy and hemivaginectomy with pre-operative caesium sources in the uterus and vaginal vault. Block pelvic lymphadenectomy is unsatisfactory, and gland extension is best treated by radiotherapy to the lateral pelvic and para-aortic fields. Surgery has a definite place in the treatment of advanced cases.


Folates and the fetus.

Folate metabolism is sometimes deranged in the early weeks of pregnancy at the time of placentation and organogenesis. Maternal folate deficiency may result in general impairment of fetal growth, which is reflected in low birthweight. Such women also have a high incidence of abortion, abruptio placentae and fetal malformation. Megaloblastic anaemia is the commonest and most easily recognised manifestation of folate deficiency.


Histology and histochemistry of the ovary during pregnancy and in the postpartum period.

A study of ovarian histology during pregnancy and the puerperium is presented. The relationship of the findings to both physiological and pathological situations is discussed.