An evaluation of the management of hypertensive patients.

The medical work-ups received by hypertensive patients at Charity Hospital, New Orleans, during a three-month period in 1972 were evaluated. One hundred charts were reviewed using a questionnaire which covered aspects of history, physical examination, and laboratory tests important to the clinical evaluation of hypertension. The frequency with which these ideal parameters appeared in the charts reviewed is given in percentage form.


Prosthetic fitting immediately after below-knee amputation.

Frequently surgical amputation of a lower extremity is required when gangrene develops as a result of peripheral vascular disease. This is particularly true in geriatric patients. A below-knee amputation, with refinements in the surgical procedure, and immediate rigid-cast prosthetic fitting are strongly advocated by our group. The progress of two patients treated in this manner is described. Preservation of the knee joint improves the amputee's prognosis for ambulation with a below-knee prosthesis. The rigid-cast dressing on the below-knee amputation reduces edema and postoperative pain, is of psychologic value to the patient, and permits him to stand at from one to two days postoperatively.


Tuberculosis without fever.

Fever is usually thought to accompany tuberculosis. However, a review of 103 cases of tuberculosis presenting to a general hospital showed that 53% of the patients did not have fever when they first came to the outpatient clinic, and 10% did not have fever at any time while under observation. Absence of fever in a patient with pulmonary disease should not be used as evidence against the presence of tuberculosis.


Xanthomatous inflammatory pseudotumor of the lung.

A case of xanthomatous inflammatory pseudotumor of the lung is reported. Large lipid-laden macrophages were the most prominent microscopic feature of thelesion. Within the lung parenchyma three possible sources of alveolar lipids are serum lipids that pass into the alveolar spaces after injury to alveolar capillary walls, lipoproteins secreted by type 2 alveolar epithelial cells, and lipoproteins formed within alveolar macrophages. Phagocytosis and retention of such lipids by alveolar macrophages are proposed as important factors in the pathogenesis of the xanthomatous inflammatory pseudotumor of the lung.


Sugar intake and dental caries in pupils in four South African ethnic groups.

In virtually all populations, the prevalence of dental caries is increasing. To elucidate the local situation, especially as regards the influence of sugar intake, appropriate studies, In association with dental research workers, were made on 16-17-year-old pupils in four South African ethnic groups-Back, Coloured, Indian and White. As expected, the caries situation in Whites was poor, and in rural Blacks, excellent; data on Coloureds and Indians were intermediate. The most outstanding finding was that urban Blacks still have very good teeth despite relatively high sugar intake and an increasing consumption of refined cereal products. Discussion of these results, as well as those reported in numerous similar investigations, leads to the view that sugar is neither the sole nor the principal cariogenic component of modern dietaries.


Carbon tetrachloride overdosage. A case report.

A case is described of a 30-year-old White male who drank 120 ml carbon tetrachloride (CCI4). The patient suffered severe liver damage and oliguria, he developed atrial fibrillation and become confused and irritable. During recovery, his bone marrow became depressed. He was discharged 29 days after admission.


Tyramine content of South African cheeses.

The tyramine content of certain South African cheeses has been determined by gas chromatographic analysis. Aged (mature) cheese such as cheddar and Roquefort contain relatively large concentrations of tyramine as compared with other cheese, especially cottage cheese. Foods containing pressor amines must be avoided by certain patients.


Lynestrenol as a contraceptive preparation. Experience with a micro-dosage formulation.

Lynestrenol 0,5 mg was administered daily for a total of 1 082 cycles to 143 women of proven fertility and natural sexual activity. Twenty-three women withdrew from the trial for various reasons, the commonest of which were menstrual distrubances. No unplanned or accidental pregnancies occured. The menstrual disturbances tended to become less troublesome with continuation of treatment, and this was noted in relation to other side-effects, of which headache and loss of libido were initially the most troublesome.


Malignant melanoma of the skin in Black Africans.

Malignant melanoma of the skin in Blacks in formidable and sinister tumour. This study is concerned with the epidemiology of malignant melanoma, as seen in both urban and rural Black Africans. A smaller series in which follow-up on the patients was available is included. To our knowledge, this is the first study of its kind in which follow-up, and hence survival figures, can be quoted. Although the numbers are relatively small, they provide a valuable indication of the behaviour of melanomas in this group. The difficulties of follow-up cannot be overemphasised, and follow-up on 79 cases out of 100 could be obtained only by the employment of an able and enthusiastic Black social worker for 3 years. The first recorded survival figures in a Black population show a 3-year survival rate of only 28,4%. Prognosis is related to the size and extent of the tumour with larger and more widespread tumours faring worse than others. The incidence of malignant melanoma in Johannesburg Black was 1,2 per 100 000 and accounted for 2% of all cancers. The largest number of cases occurred in the 50- 70-year age group and there was a female preponderance. As in previous studies, the sites predominantly affected were the foot and the hand, mainly on the plantar and palmar surfaces.


Plasma renin levels in Zulu hypertensives.

Plasma renin was measured by immunoassay in 10 normal Zulu controls and 72 hypertensive Zulu patients. Plasma renin values were similar in controls and patients with benign essential hypertension (1,6 plus or minus 0,83 and 1,7 plus or minus 0,21 ng/ml).


Incidence of Crohn's disease at Groote Schuur Hospital during 1970-1974.

In the period 1970-1974, 45 patients with Crohn's disease were seen. The incidence of the disease seems to be increasing. Twenty-nine of the patients were White, and 16 Coloured. The disease involved the small bowel alone in 9 patients, the ileocaecal region in 17, the large bowel alone in 4 and both the small and the large bowel in 15. Alone or in combination, abdominal cramps and diarrhoea were the commonest modes of presentation. The type of therapy used is discussed. Only 10 patients in this study have not as yet required surgery. Salazopyrin, steroids, antibiotics and azathioprine have been used with varying success in the treatment of most of the patients. Crohn's disease has a high degree of morbidity, but a low mortality rate.


Comparative determination of total serum thyroxine. Radio-immunoassay and protein-binding assay.

The precision, accuracy, sensitivity and clinical results of a radio-immunological method for the determination of total serum thyroxine are compared with similar criteria of a competitive protein-binding assay. Application of both methods in the assay of thyroxine in 150 serum samples gave good agreement between the two techniques. The radio-immunoassay offers certain methodological advantages and is considerably less costly than thyroxine determinations in which commercially available kits are used.


Dogbite injuries in children.

An analysis of 50 children suffering from severe dogbites showed that the face was the anatomical site of predilection (75%(, and that the breed of dog most commonly involved was the Alsatian (German Shepherd). Primary debridement and suture under general anaesthesia is the treatment of choice. Ampicillin has been shown to be the antibiotic giving the widest over-all prophylactic chemotherapeutic cover.


Radiology of the autosomal dominant form of craniometaphyseal dysplasia.

The autosomal dominant variety of craniometaphyseal dysplasia was diagnosed in 8 members of three generations of a White family living in the Cape Province and in Natal. Radiographic investigations of these individuals permitted assessment of the spectrum of involvement and of the age relationship of the abnormalities. Characteristic radiographic features included cranial hyperostosis and sclerosis, in association with metaphyseal splaying. Diagnostic precision in this order permits accurate prognostication and rational genetic counseling.


Leiomyosarcoma of the stomach.

Leiomyosarcomas comprise only 1-3 percent of malignant growths of the stomach. In the case presented, the correct diagnosis was not made pre-operatively. This article emphasises that, although they are rare, these tumours have certain characteristics which make possible a correct pre-operative diagnosis. Only 1 Black African patient has hitherto been described.


The administration of drugs and tranquillisers where it can lead to dependence on the part of the patient in hospital.

Prevention of the development of dependence on drugs and tranquillizers in hospital is a task which requires constant vigilance on the part of the hospital authorities as well as the right attitude on the part of prescribing doctors, administrating nurses and receiving public.


The air transport of patients.

Air transport of patients by light aircraft and air ambulance is safe, fast and comfortable, and it is becoming increasingly popular. There are, however, specific problems, shortcomings and other details which must be dealt with effectively at various levels to ensure the best service for the patient.


Virus particles and gastro-enteritis in Black and White Children in Rhodesia.

Stools from Black and White children with gastroenteritis and from controls were investigated for potentially pathogenic agents by conventional virological and bacteriological methods and by electron microscopy. Isolations were obtained in 30 percent of cases but electron microscopy more than doubled the number of agents found. Orbiviruses were present in 40 percent of all cases, often in combination with other organisms. There was no difference between the Black and White groups.


[The moment of death].

With the development of medical science, especially the advances made in the transplantation of human tissues and organs, members of the medical and legal professions are taking a renewed interest in the diagnosis of the exact moment of death. The object of this symposium is to combine the views and suggestions of the medical, legal and other professions in an attempt to form a medico-legal definition of the moment of death.


Tuberculous osteomyelitis of the rib. A case report.

Tuberculous osteomyelitis of the ribs is a rare condition. This report describes a circumscribed tuberculous lesion of the rib shaft which presented as an abscess of the chest wall. The management is described and the literature is briefly reviewed.


The changing pattern of cancer mortality in South Africa, 1949-1969.

Cancer mortality rates for Whites, Coloureds and Asians for the period of 1949 - 1969 have been analysed, and a changing pattern has been found. Some comparisons with other countries have been made, and the risk for each race group has been delineated for cancers at the commonest sites.


Cardiac disease in Malawi.

A prospective clinical study of 114 Malawian patients with cardiac disease seen at Queen Elizabeth Central Hospital, Blantyre, is presented. Rheumatic and hypertensive heart disease, cardiorenal failure and severe anaemia were the most common causes. Pericardial disease, mainly due to tuberculosis, was an important treatable cause of cardiac disease. Endomyocardial fibrosis was not diagnosed with certainty and cardiomyopathy was relatively uncommon. Ischaemic heart disease was not seen.


Haemophilia home infusions with dried fresh plasma.

A group of 26 haemophilic patients was successfully managed on a home infusion programme over a one-year period. Single donor units of dried fresh plasma, the coagulant activity of which was adequate to ensure haemostasis of most of the haemorrhagic episodes treated, were used. The transmission of hepatitis was kept to a minimum by careful selection of regular, known donors and by the utilisation of single donor units of plasma in preference to plasma pools. Although the programme was costly, it was less expensive than it would have been had alternate antihaemophilic products been used. The advantages and disadvantages of self-administration are discussed. No serious mishaps occurred, and the programme was considered an outstanding success by both laymen and medical personnel. Minor alterations in liver function tests were demonstrated in several of the recipients. No factor VIII inhibitors were detected.


Congenital rhabdomyoma of the heart.

A case of rhabdomyoma of the heart found in a Black female infant at postmortem examination, as well as the clinical data, necropsy and histopathological findings, are presented. The characteristics of cardiac rhabdomyomata are discussed.


[Determining when a person is dead].

The man-in-the-street's idea of death is centred around the cessation of respiratory and cardiac function. Both these functions can be artificially maintained and the question may then arise as to whether a patient is dead or alive. Certain criteria of death are discussed, and stress is laid on the fact that doctors concerned with declaration of death must never be concerned or involved in organ transplantation.


Use of balloon flotation catheters in critically ill patients.

In summary, balloon flotation catheterization of the central circulation provides data in patient management which are meaningful and important. It has allowed the application of sound physiologic principles to the understanding of the circulatory abnormalities characterizing an illness in an individual patient, and provides a rational basis for selection of therapy with objective, quantitative assessment of patient response. The procedures are simple, the complication rate is low, and the information highly relevant to clinical care.


External counterpulsation in low cardiac output states.

External counterpulsation represents a rational extension of the basic principles of counterpulsation as developed over the past 20 years. Its unique properties of being totally noninvasive, free of significant morbidity, and easily and quickly instituted clinically suggest that it may have a significant therapeutic role in the prevention and treatment of cardiogenic shock following acute myocardial infarction as well as being helpful in other cardiac disorders. Continuing evaluation is necessary, and it should be thought of as one of several useful mechanical circulatory assist devices now available to the internist, cardiologist, and surgeon caring for the critically ill patient.


Cardiac tamponade.

Cardiac tamponade is an insidious and often fatal complication which can occur on any service, in many diseases, and at any age. The increasing pressure within the pericardium prevents ventricular filling and depresses cardiac output, coronary and systemic perfusion, and venous return. Compensatory mechanisms may protect the patient for some time, but prompt diagnosis and rapid decompression are usually required and must be followed by meticulous evaluation and treatment of the underlying disease.


Hemodilution.

The dilution of whole blood leads to a significant improvement of its rheologic properties based on a decrease in hematocrit and, hence, blood viscosity. Under conditions of normovolemia and an adequate response of the cardiorespiratory system, the acute dilution of blood will enhance the venous return to the heart and thereby improve total and capillary blood flow significantly. In the hematocrit range of 25 to 30 per cent (limited hemodilution), this increase in flow rate is able to compensate fully for the diminished oxygen content of the blood. Changes in oxygen extraction or in oxygenhemoglobin affinity are only encountered at hematocrits below 20 per cent or if hemodilution is associated with hypovolemia. Since normovolemia is the condition sine qua non for the heart to increase its output compensatorily, intentional hemodilution should preferably be performed with colloid solutions which are capable of maintaining the colloid osmotic pressure of plasma and the circulating volume in normal limits. Limited normovolemic hemodilution with its beneficial effects on microcirculatory flow and tissue nutrition is emphasized for the treatment of impaired microcirculation as occurring in shock and low flow states, polycythemia, and high viscosity syndromes. Acute preoperative hemodilution is a means of reducing the use of bank blood and of avoiding the risks of blld transfusions in patients undergoing major elective surgery. Extreme hemodilution and total body washout in hypothermia appear to be effective clinical tools.


Momitoring the patient in shock: what, when, and how.

In critically ill patients there is frequently more than one problem, which may not be obvious, contributing to the shock state. The history, physical exam, and monitoring devices may not be reliable individually, but must be considered together and interpreted in the light of the pathophysiologic mechanisms involved. A plan for monitoring and treating critically ill patients is outlined. The advantages and limitations of various monitoring techniques are discussed.


Use of vasoactive drugs in the treatment of shock.

The effective use of vasoactive drugs in shock requires an understanding of the pathophysiologic mechanisms involved in the various types and stages of shock and knowledge of the specific pharmacologic effects of each drug in the abnormal state. Vasoactive drugs should be used after the primary and secondary causes of shock have been corrected. Specific vasoactive drugs should be selected on the basis of measured hemodynamic abnormalities.


Histocompatibility testing in dogs. I. A semi-micro mixed lymphocyte culture (MLC) technique for histocompatibility matching in dogs.

A semi-micro method for the mixed lymphocyte culture (MLC) test in dogs is described. Optimization of various factors influencing the test were invistigated. Discrimination between allogeneic and isogeneic cell mixtures was possible after 90 h or culture but a culture period of 144 h was found to be optimal. The method measures MLC identity or non-identity and can be used as a tool for histocompatibility testing of lymphocyte defined (LD) Antigens.


Histocompatibility testing in dogs. II. Leukocyte typing in relation to the mixed lymphocyte culture (MLC) reactivity.

The correlation between MLC reactivity (LD) and serological leukocyte typing (SD) was studied in a beagle colony. Disparity for a serologically defined non-DL-A lymphocyte antigen did not correlate with MLC reactivity. Lymphocytes of colony members with common ancestors and SD identical DL-A haplotypes did not stimulate each other in the MLC. This implies that LD typing in the beagle coolony can be generally predicted by DL-A SD typing. Consequently, lymphocytes of sibs homozygous for a given DL-A SD haplotype could be shown, with few exceptions, to be also homozygous for MLC determinants. Cells of these homozygous sibs can be used in MLC typing as reference cells for DL-A LD specificities. Two exceptions to the expected linkage between DL-A SD typing and MLC reactivity were found. These findings could not be explained by recombination with the DL-A region assuming a single major LD locus coding for MLC. Thus, suggestive evidence for more than one single LD locus has been obtained.


Serotyping for MLC gene products:  I. Presumptive evidence that ABCIL may detect MLC factors.

Serum from a grand multiparous Inuit (Eskimo) woman, who is HL-A identical but stimulatory in MLC with cells of her husband, contains strong ABCIL reactivity. This serum is operationally monospecific against a cell membrane determinant on lymphocytes, but not platelets, of some unrelated persons. Cells of those who are ABCIL positive with this serum always give a lower MLC stimulation index compared with their MLC responsiveness to cells that are ABCIL negative. This serum also contains good MLC inhibitory activity but only in those one way MLC reactions in which it reacts, by ABCIL, with the stimulating cells. It is postulated that the ABCIL activity is directed against a common MLC factor on lymphocytes.


A new alloantigenic system on human lymphocytes.

Certain otherwise well-definedHL-Atyping sera contain extra antibodies which do not appear to be closely related to known HL-A specificites and which react in the cytotoxic test with chronic lymphaticleukemia lymphocytes but not with normal lymphocytes. Despite nonreactivity in thecytotoxic test, absorption studies show that the antigenic factors are well represented onnormal lymphocytes. Based on cross-absorption experiments using both normal andleukemic cells, followed by back-testing with the cytotoxic test against a leukemiccell panel, evidence is presented suggesting the existence of a complex, probablymultiple allelic system on human lymphoid cells which appears distinct from the, HL-Asystem, and is definable by serologic techniques.


Ankylosing spondylitis in a large kindred: clinical and genetic studies.

In a kindred of 66 members spanning four generations, seven cases of ankylosing spondylitis (AS) HAVE BEEN FOUND. Four of these were in a single sibship of 13. AS was associated with HL-A27 in three of the four involved siblings, but close linkage was shown to be unlikely. Knowledge of HL-A genotype has made possible informed counseling for younger members of the sibship of 13, some of whom, as teenagers, already have back pain.


[Problems of cancer therapy in the hairy part of the head].

Biological assumptions concerning carcinogenesis at the hairy part of the head were discussed.  At the Research Institute of Oncology in Sofia, 71 patients suffering from a carcinoma at the hairy part of the head were treated until 1967.--47.2 percent of them were in the first stage, and 34.7 percent in the second stage.  The temporal region was affected most (39.3 percent).  Contact therapy was done preferably.  Three years after treatment, all persons treated (100 percent) were cured--after five years 82.2 percent, and after ten years 58.0 percent.  Four patients were affected by regional lymph metastases; in two of these persons, biologically verified metastases of basicellular cancer became evident.


[Three-dimensional isodoses for radiotherapy in stereoscopic demonstration].

Three-dimensional isodoses can be calculated with the aid of computers, and recorded stereoscopically in a relatively inexpensive manner.  A critical judgement is given concerning the clinical practical as well as the instructional value of stereoscopic representations of isodoses.


[Changes of peripheral leukenic lymphocytes during radiotherapy and clinical symptoms of indirect radiation effect].

Leukaemic lymphocytes are much more sensitive even to local irradiation than non-leukaemic ones.  The substantial drop in the number of lymphocytes id partly due to indirect radio-biological effects.  It appears likely that the antigens liberated by the damaged tumour cells under the action of radiation augment immunoreaction thus causing additional pathological cells to be destroyed (radioinduced immune processes).


Dose distributions and mean doses in cylindrical cavities of bone marrow on X-ray irradiation.

Dose distributions as well as mean doses to cylindrical cavities of bone marrow on X-ray irradiation have been calculated using (a) Monte Carlo method and (b) a simplified straight line approximation method.  The results are compared with earlier published ones.  Point doses differ appreciably from the earlier results by as much as 40 percent at some points, whereas mean doses agree to within 10 percent for all the three methods.


Histological studies after experimental grid irradiation vi. Findings on Guérin-tumours irradiated by high doses.

Author demonstrated subsequent to high-dose grid irradiation in Guérin-tumours of the rat the histological grid pattern corresponding to inhomogeneous dose distribution.  Two to four days after irradiation through the grid of narrow openings in some sites certain phenomena could be observed, which seem to refer to the severe damage acquiring a diffuse character, but after 7 days the histological grid pattern has been clearly defined and the severely damaged stripes were about 50 percent narrower than the relatively intact ones.  On the basis of the results on the actual tumour and among the applied experimental conditions the existence of a specific grid-tumour effect could not be justified by histological methods.


Further aspects of the radioprotective mechanism of thiourea.

Thiourea in three different concentrations ranging from 10-4-M to 10-2-M was employed in pre- and post-treatments to test whether it decreases the chromosomal fragment frequency induced by 1000 R of X-rays in the growing root tips of Hordeum vulgare.  In pre-treatment experiments thiourea in 10-2-M concentration yielded the maximal protection of 28.9 percent against radiation- induced chromosomal fragments.  In post-treatment approximately a similar rate of protection is secured.  It is discussed that the test-chemical protected the chromosomes against X-rays by two different mechanisms.  The recovery process by restitution of the broken chromosomal fragments and the protection against initial radiation damage were the possible protective mechanisms displayed by thiourea in this plant material.


Radiation-induced chromosome aberrations in human peripheral lymphocytes.  Exposure to X-rays or protons.

A quantitative analysis was carried out of structural chromosome aberrations in human perpheral lymphocytes exposed in vitro to 180 kV X-rays or 50 MeV protons. Statistical treatment of experimental findings by least-squares technique showed a regressional relationship between dose administered and yields of various chromosome aberration types. Fitting of the data to four mathematical models indicated, for both radiation types, that two-break aberrations, total number of aberrations and total of breaks are best fitted by the polinomial of second degree Y equals bD + CD-2, while one-break aberrations and number of aberrant cells are best fitted by the model Y equals a + bD. For all chromosome aberration types numerical values of the coefficients in these models are presented.


Simultaneous application of pulsed high frequency currents and gamma-rays to cultured melanoma cells.

Cells differentiated from a human metastasizing melanoma have been irradiated simultaneously with pulsed high frequency currents (27.12 MHz, 400--600 pulses/s, pulse duration 65mus, average power 25--38 Watt) (Diapulse), and gamma radiation from a Co-60 source.  Simultaneous pulsed high frequency field and gamma radiation acted in a way resembling a cell-protecting mechanism, enhancing the number of surviving cells to the extent of about 15 percent as compared with the cell number scored after pure Co-60 gamma-radiation treatment.  Irradiation with pure high frequency currents resulted in increasing cell death for a period of up 4 minutes; subsequently, this seemed to be almost independent of time.  The number of cells which survived, as compared with the controls, was found to be approximately 80 percent, near a distance of 6.5 cm from the symmetry axis, perpendicular to the plane of the radiating element.


Urine excretion of nucleosides in Hodgkin's disease treated by combined chemotherapy.

The authors have followed the excretion of pyrimidine doexyribonucleosides in the urine of patients with generalized stages of Hodgkin's disease.  They proved an increased excretion of deoxyuridine and thymidine in these patients compared to healthy persons.  In the course of 14-days of combined chemotherapy a statistically significant increase in the excretion of DNA catabolites followed was found.


Investigation of immunoglobulin (IgG, IgA, IgM) levels in the blood serum of uranium miners after higher and lower exposure to ionizing radiation.

The levels of IgG, IgA and IgM were measured in the blood serum of uranium miners in a minin-district, where after a geological disturbance exposure to a high level of ionizing radiation took place. The mean exposure to 222-Rn daughters after first year was 7.35 WLM, after the second year 0.13 WLM only. Serum was sampled before miners started their occupation, for the second time after the first year and for the third time after the second year. The levels of IgG and IgM significantly decreased after one year of exposure, while the IgA changed only slightly. After the second year the levels of IgG and IgM significantly rose. IgG exceeded the initial levels: a regenerative hypercompensation took place. On the other hand IgA at the same time decreased. The IgG levels are only slightly correlated with radiation dose rate; for IgA and IgM the correlation is lacking. Individual Ig levels appear to be very variable. The reduction of IgG reached hypogammaglobulinemic levels in some miners after the first year and was followed by a propensity to infections of the respiratory tract. The significance of these observations is discussed from the immunological, radiological and radiohygienical point of view.


[Influence of biophysical factors on redox processes and biological oxidation.  20. Tissue temperatures under ultrasonic administration].

The temperature differences obtaining in the subcutaneous tissues directly below the zone exposed to ultrasonic irradiation, the liver an the myocardium of white rats were measured during and after ultrasonic treatment.  The only rise in temperature was observed in the tissues located below the field of ultrasonic irradiation after the second minute.  The temperature drop in each of the three types of tissue examined is a characteristic feature.  This paradoxical effect produced by ultrasonic intensities of 0.2, 0.6, 1.0, and 1.6 watt/cm-2, which has not as yet been described in the literature, may be explained by the control mechanisms keeping the internal body temperature relatively constant and, in particular, by those mechanisms of temperature regulation which are controlled by the biogenic amines.


[Sacrococcygeal chordoma in childhood].

A extremely rare case of sacrococcygeal chordoma in the infancy is communicated and it is discussed about the diagnose, therapy and clinic of these tumors with regard to the literature.


[Kidney stress in percutaneous abdominal radiotherapy].

Percutaneous abdominal radiotherapy leads to an obligatory simultaneous stress of the kidneys. This partial stress of the kidneys can be reduced to a bearable minimum if the medicophysical irradiation planning methods, already developed nowadays. are used. The improved irradiation technique basing on these methods was examined, by administering abdominal irradiation, in a corresponding collective of patients. Clinical, laboratory-chemical, roentgenologic, and nucleo-medical examinations were carried out in different intervals. The significant control results certified the kidney protecting method of our radiotherapy.


Nuclear magnetic relaxation in the cell.

The authors have measured proton relaxation times of gynecological cancer. T1 and T2 of human tumours are longer than proton relaxation times of corresponding normal tissues. Radiotherapy changes also proton relaxation times T1 and T2 in tissue.


[Simultaneous effect of 5-bromodeoxyuridine and cysteamine on x-irradiated diploid cells of Chinese hamster, Cricetulus griseus, in vitro].

Cells of the Chinese hamster line B 14 FAF 28 were treated with BUdR and irradiated with X-rays under the presence of cysteamine. The dose-dependent inactivation rates could be determined rather precisely by marking single cells. Daily cell counts in the growing colonies made it possible to establish individual colony growth curves. The results of both analyses show for untreated and treated cells a nearly equal factor with respect to the protecting effect of cysteamine. Also in the "macrocolonies" this effect is clearly measurable even five days after irradiation indicating a still existing very different vitality of the cells at that time. The results are discussed with concern to following irradiations.


[Effect of acute irradiation on the exocrine secretion of pancreas in pig].

Six fistulated pigs have been used in this experiment to study the effect, on the exocrine pancreatic secretion, of a partial acute irradiation, at 600 rd and 800 rd. Whatever the dose, the irradiation provoked an immediate and temporary decrease of the pancreatic secretion. The normal values were reached after the 8th day post-irradiation. Furthermore, a direct effect on the synthesis of amylase and lipase was shown. The synthesis of trypsin and chymotrypsin was not modified by irradiation.


Effects of 400 R whole-body x-irradiation on 5-hydroxytryptamine content of the rat gastrointestinal tract.

The effects of a single 400 R whole-body dose of X-irradiation on the regional 5HT content of the gastrointestinal (G. I.) tract were studied from four hours to 40 days after irradiation. The total 5HT content of various G.I. tissues was determined and 5HT was also determined per unit of body weight, wet weight of tissue and tissue protein. Irradiation caused an immediate decrease of the amine content of various G.I. regions in adult rats. This was followed by recovery, the degree of which varied in different regions. Some minor morphological changes were seen in enterochromaffin cells one and two days after irradiation but not later. The effects of irradiation on the G.I. tissues were stronger in young rats, in whom no complete recovery of 5HT occurred within 45 days. The present results support the view that irradiation exerts a direct damaging effect on the gastrointestinal 5HT storage, which is associated with liberation of 5HT from amine-containing cells. The duration of the effect varies with age and intestinal segment concerned.


Microwaves in radiotherapy of tumors - alternative to heavy particles?

An increase of the radiosensitivity can be obtained by means of microwave use in combination with sparsely ionizing radiation. Comparing the therapeutic effect on the model of an euoxic tumor (mice testicles) with a tumor that contains important parts of hypoxic cells (solid tumor of Ehrlich) it appears that the sensitization evidentely is seen in the hypoxic tumor first of all. No sensitization can be obtained on the euoxic profileration tissue on the testicles. The temperature enhancement ratio (equal TER) does not increase linearly with increasing temperature, but is the greatest within the scope of 41 degrees C. The mere heat effect appears in the foreground with high temperatures (43 degrees C and more). The high frequency application lets hope a solution of the oxygen problem in radiotherapy and could substitute the use of heavy particles (high LET) in the combination with sparsely ionizing radiation as far as a concentration of high frequency and heat on the tumor succeeds in.


[Retention of 241Am in the rat and the Syrian hamster].

The retention of 241-Am during the first three months after injection as well as its microdistribution on the 2nd day were investigated in the rat and the Syrian hamster. Deposition, retention and microdistribution in the skeleton of both species are virtually identical; the same holds for kidneys, except for a higher initial deposition in the hamster. The microdistribution of 241-Am in kidneys and liver of both species is homogenous with a distinct accumulation in the cortical zone of the kidneys. A pronounced difference was observed with regard to the elimination of 241-Am from the liver: Most of the 241-Am is excreted by the rat liver with a half time of 7 days whereas this value is about 150 days for the Syrian hamster. The consequences of the species differences are discussed.


[Metabolism and toxicity of therapeutic chelating agents. 14. Effect of DTPA on hematopoiesis].

By use of 3-H-thymidine it is shown that toxic doses of Ca-DTPA lead to a reversible inhibition of DNA-synthesis in the lymphocytes, erythro- and myelopoietic cells of the rat. The incorporation of 59-Fe into the erythrocytes is markedly imparied. The hematological reaction, i. e. granulocytosis, lympho- and eosinopenia, is ascribed to the general adaptation syndrom. Zn-DTPA proved to be ineffective in all respects.


[Some patterns of RNA synthesis in the proliferation induction process in a stationary culture of Chinese hamster cells].

An increase in the incorporation of eH-uridine into RNA and in the cell membrane permeability for 3H-uridine in stationary culture cells after medium replenishment were found to be parallel. Increase in the RNA synthesis occurs practically in all cells stimulated to proliferate and is not accompanied by swelling nucleii, as demonstrated by measuring the projected areas of nucle on fixed cells. The rise in RNA synthesis as a response to proliferative stimulus is pronounced at every cell density but with increasing cell density fall in the magnitude of the response occurs.


[Study of RNA and protein synthesis in mollusc epithelial tissues adapting to changes in the salinity of the medium].

RNA and protein synthesis in the epithelial tissues of White Sea snails Mytilus edulis was investigated autoradiographically with H-3-uridine and S-35-methionine during adaptation to various salinities (10 0/00, 14 0/00, 18 0/00, 35 0/00); normal salinity being 25 0/00. The incorporation of labelled precursors into the epithelial tissues of M. edulis was shown first to change abruptly, the return to the normal condition occurring after a prolonged adaptation. The reaction of different tissues shows specific features. The role of compensatory processes during the adaptation to changed salinities, is discussed.


[Quantitative description of the process of radiation inactivation of cells. VI. Calculation of the modifications in the dose survival relationship of eukaryotic cells].

The parameters of dose-survival relation in terms of cytogenetic action of radiation are directly connected with real characteristics of experimental survival curves: initial slope, final slope, and threshold. A system for estimation of the elementary modification is suggested. 9 elementary modifications are interpreted in terms of the suggested model which enables to analyse complex kinds of modification. Intermolecular DNA links are considered responsible for non-zero initial slope of survival curve. The final slope of survival curve is determined by double-strand DNA breaks which are due to both the size of target and the efficiency of repair at the hit -- primary lesion stage (on molecular level). Threshold of the sruvival curves is determined by the competition of recovery after primary lesion and the fixation of lethals (assymmetrical chromosome exchanges -- cytogenetic level).


[Cytoplasmic RNA content in the brain and spinal cord neurons of red-cheeked susliks during the hibernation period and on arousal].

By means of scanning cytospectrophotometry of gallocyanin chrome alum stained sections, cytoplasmic RNA content per cell in the neurons of the ground squirrel hippocampus, hypothalamic supraoptic nucleus, and spinal cord anterior horns, was shown to decrease as far as the hibernation went on. Before the arousal the RNA amount increased, the increase being the greatest in the hypothalamic neurons. First days after the arousal, the cytoplasmic RNA content in all the neurons was significantly higher than in the same neurons before the hibernation. Changes of RNA content in the neurons and in the homogenates of corresponding brain areas were compared; important role of the hypothalamus in metabolic reconstruction of the nervous system at various stages of hibernation, was outlined.


[Use of an ultramicroelectrophoretic method for separating blood serum cellular and isoenzymes].

Methods for staining of ultramicroenzymelectrophoregrams are described. Sharp and well reproducible bands of isozymes of LDH, MDH, G-6-PD, AcP, AlP, alpha-NAE were obtained from homogenates of cultivated human fibroblasts, of rat's liver, kidney and brain, of human embryonic liver, and in blood serum of man and frog. An extract from the rat brain containing only 3.4 ng of proteins or a quantity of 70-80 fibroblasts were sufficient for obtaining a well differentiated spectrum of LDH isozymes. The ultramicromethod significantly lowers the need in deficit reagents, reduces the cost and time of analysis.


Ultrastructural characteristics of "aging" of human prostate cells in monolayer cell culture.

Monolayer tissue culture cells from benign nodular hyperplasia of the prostate transferred at 1-2 weeks intervals were examined under the electron microscope after the 3rd, 9th, and 10th transfers. Changes seen after 9 to 10 transfers were interpreted as an "aging process" and consisted of the presence of lysosomes of various types and variations in the mitochondria profile. These changes were described in detail and illustrated and compared to the ultrastructural appearance of monolayer cell cultures in the early transfer stage.


The diagnostic value of enzymuria, cell excretion, and proteinuria in experimental renal diseases.

Enzymuria, urinary cell excretion and proteinuria were simultaneously determined in renal diseases of female Wistar rats in order to investigate the diagnostic value of urinary enzymes. Investigations were carried out on rats with E. coli-pyelonephritis facilitated by oestradiolundecylate, aminonucleoside nephrosis, aminoglycoside induced renal lesions and pyelonephritic animals treated with therapeutic and toxic doses of tobramycin. --From the results of these studies it was concluded that the main diagnostic value of urinary enzymes is detection of drug induced tubular lesions in individuals with preexisting renal diseases.


Studies on urinary isozymes of lactic dehydrogenase and beta-glucuronidase in patients with bladder tumors.

Isozymes of urinary lactic dehydrogenase (LDH) were studied in 55 subjects, including 17 patients with bladder tumors. Normal clear urine from healthy persons showed little activity of LDH5, but in 11 out of 17 patients with bladder tumors LDH5 was increased sufficiently to invert the ratio of LDH5/LDH1, although the urine was not contaminated appreciably with leucocytes. Studies on tissue LDH isozymes in 16 tumors specimens strongly suggested that increased LDH5 in the urine of patients with bladder tumors originated from the tumors themselves. beta-Glucuronidase (B-G) isozymes were studied in urine specimens from 10 normal subjects, and 10 patients with bladder tumors and in 5 specimens of normal epithelium and 5 of tumor tissue. Two or three distinct bands of beta-G were separated from specimens of urine and tumor tissue from patients with bladder tumors, but only a single band was found in specimens from normal subjects.


Congenital neuropathic bladder: practicalities and possibilities of conservational management.

Upper urinary tract and renal deterioration in the child with congenital neuropathy is due to high intravesical pressure associated with urinary retention. Preservation of kidney function often can be achieved when bladder emptying is improved by lowering the urethral resistance, when reflux is cured, and when infection is controlled. Since incontinence is most often of the overflow type, complete bladder evacuation can allow the child to remain dry for a socially acceptable period of time between voidings. Success depends greatly on the child's motivation and on his cooperation in a bladder training regimen. Diversion is sometimes unavoidable but should be considered only when conservational methods have failed.


Cystinuria: a surgical challenge.

A case is reported in which cystinuria was unresponsive to medical treatment. Replacement of both ureters with small intestine gave a satisfactory result.


Nortriptyline hydrochloride in urology.

Forty female patients suffering for long periods from frequency, urgency, and dysuria without any definite organic cause received nortriptyline chloride for three weeks. In 75 percent there was either considerable improvement or total disappearance of urinary complaints. At the same time the in vitro effects of the drug were tested using the isometric muscle contraction technique. Nortriptyline was found to have anticholinergic properties. The importance of this effect in the clinical study and the possible mode of action of the drug are discussed.


Use of Boari flap in lower ureteral injuries.

We review our experience with the Boari flap to correct distal ureteral injuries. Satisfactory results were obtained in 15 of 21 patients. We believe this procedure should be considered as an alternative to transureteroureterostomy, autotransplantation, and ileal interposition for short or long distal ureteral defects.


Secondary bladder neck obstruction in patients with urethral valves: Treatment with phenoxybenzamine

Two cases are reported of functionally significant bladder neck obstruction following urethral valve fulguration which resulted in inability to void. Both patients responded to the administration of phenoxybenzamine, an alpha-adrenergic blocking agent. Treatment of patients with suspected bladder neck obstruction with this agent provides a reversible method of decreasing urethral resistance without the potentially harmful effects of surgical bladder neck revision.


Anterior bladder tube for continence in neurogenic bladder. Experimental study.

Experimental studies designed to evaluate the anterior bladder tube as a method of maintaining continence in the neurologically deprived bladded achieved a 50 to 60 per cent success rate. This success rate is not sufficient to warrant its clinical use.


Effect of muscle length on adrenergic stimulation of canine detrusor.

The effect of muscle length on adrenergic stimulation of canine detrusor was studied in an vitro muscle bath. The commonly reported response of muscle relaxation with norepinephrine stimulation was seen in muscle strips at or near the resting length. When the muscle strips were stretched, however, an alpha receptor mediated contraction was noted. Length, rather than norepinephrine dose or tension, was the predominant factor determining whether a given strip would respond in an alpha or beta fashion. Sympathetic stimulation may enhance accommodation (beta effect) during bladder filling at low muscle length and potentiate bladder emptying (alpha effect) at increased muscle length.


Calcified adrenal cysts.

Two case of calcified adrenal cysts are reported. Previously proposed diagnostic criteria for the recognition of a parenchymatous cyst was identified in our first case. Pain has been the main feature in our two cases.


Phenacetin-induced renal papillary necrosis: pyonephros, anuria, and bilateral ureteral obstruction.

A fifty-five-year-old man was seen with anuria. Retrograde pyelograms demonstrated bilateral ureteral obstruction subsequently shown to have resulted from sloughed renal papillae. A twenty-year history of phenacetin was obtained. Treatment included bilateral ureteral intubation, then ureterotomy on one side.


Nonduplication of upper urinary tract associated with horseshoe kidney and bilateral ureteral ectopia.

A three-month-old white baby girl was found to have marked hydroureteronephrosis associated with ectopic, nonduplicated ureters and horseshoe kidney. Her clinical and radiographic course are discussed.


Total unilateral renal destruction caused by irradiation for Hodgkin's disease.

Total unilateral renal destruction has been observed in a patient who previously received irradiation for Hodgkin's disease. The clinical features, after a six-year asymptomatic interval, included recurrent calculi and infection in what was subsequently demonstrated radiographically to be a nonfunctioning kidney. The gross and microscopic characteristics of the nephrectomy specimen have been described and correlated with the magnitude of irradiation and the clinical course.


Penile horn.

A case of penile horn is reported. Its occurrence is uncommon, and treatment consists of excision.


Metastatic carcinoma of prostate masquerading as abdominal aortic aneurysm.

A case is reported in which the patient had classic findings of an abdominal aortic aneurysm, including a pulsatile abdominal mass, curvilinear aortic calcification, and anterolateral deviation of the left ureter. These findings were subsequently demonstrated at surgery to be due to metastatic nodes from prostatic carcinoma. Data presented indicate that further diagnostic studies may be in order in unusual cases in which patients are suspected of having abdominal aortic aneurysm. This is especially true if the patient is known to have another condition such as carcinoma which may mimic aneurysm with metastatic periaortic lymph nodes. Aortography and/or lymphangiography occasionally have their place in selected patients, and this is discussed.


Endoscopy of intestinal urinary conduit.

Using flexible gastrointestinal endoscopes, we have examined the urinary intestinal conduits of 15 patients. We have found this to be a reliable, easily performed endoscopic procedure that allows ureteral catheterization when needed. The instrument, technique, and results are described.


Effect of estramustine phosphate on plasma testosterone during treatment of carcinoma of prostate.

Estramustine phosphate administered orally at 900 mg. daily depressed plasma testosterone levels in 10 consecutive patients who had previously been treated with estrogen hormones and/or orchiectomy and who were all in relapse from carcinoma of the prostate. Approximately one half of the patients responded to the treatment clinically. The decrease in plasma testosterone did not correlate with the clinical response. The clinical effect of estramustine phosphate may be due to decreased plasma testosterone levels, inhibiton of 5-alpha reductase activity, and a local cytotoxic effect.


Staging of localized prostatic carcinoma by pelvic lymphadenectomy: technique using sequential, unilateral extraperitoneal incisions.

A technique for sequential, unilateral, extraperitoneal pelvic lymphadenectomy is described. The procedure is advocated for staging patients with localized prostatic carcinoma in whom all laboratory test results for metastases are negative and in whom definitive radiation therapy or radical prostatectomy is contemplated. This procedure allows complete excision of the regional lymphatic drainage of the prostate with minimal surgical morbidity.


Susceptibility of urothelium to neoplastic cellular implantation.

This study sought to determine whether or not transitional carcinoma cells can adhere and progressively grow on normal or inflamed bladder urothelium. Inflammation was produced by intravesical N-methyl-N-nitrosourea. Tumor cell implantation occurred in only 13 per cent of mice with normal bladder, whereas in the presence of an altered urothelial surface ther was a 60 per cent incidence of tumors. This study not only has clinical implications but also offers a model to investigate modalities to prevent tumor cell implantation.


New fine structural observations in testicular malakoplakia: role of the Sertoli cell.

A case of testicular malakoplakia is described in which cells other than histiocytes were involved in the tissue response. The abundant cell junctions, some closely related to mitochondria, and the peripheral displacement of rough endoplasmic reticulum by abundant phagolysosomes, suggest involvement of Sertoli cells, in addition to histiocytes. It is suggested that, perhaps, some forms of granulomatous orchitis and malakoplakia represent a single disease process observed at a different stage in its evolution.


Cystometry: III. Cystometers.

Cystometers may employ either fluid (water) or gas (air or carbon dioxide) as the distending medium. The operation of air and carbon dioxide cystometers is described, and a comparison is given of the various systems currently in use.


Production disease control: three dairy herd case studies in NE Scotland.

Three cases of dairy herds affected by production disease (infertility, calf scours and low milk yield) were carried out.  The value of blood analysis in establishing a diagnosis and a dietary supplement of molasses in correcting the production problems is illustrated.


Management of deer for experimental studies with foor-and-mouth disease virus.

Red, sika, fallow, roe and muntjac deer adapted to captivity in experimental units designed for working with foot-and-mouth disease.  The red, sika and fallow deer readily accepted rolled oats and hay as their staple diet.  This diet was replaced for the roe and muntjac deer with flaked maize, calf starter pellets and green browse.  Etorphine/acepromazine ans xylazine were found to be suitable sedatives for detailed examination of the tongue and oral cavity of the various species of deer and gave adequate analgesia for the inoculation and collection of virus samples.


Atrophic rhinitis of pigs: abattoir studies.

The snouts of 2701 pork, bacon and heavy pigs killed at five abattoirs in England and Scotland during March to July 1974 were examined for evidence of atrophic rhinitis.  Lesions were graded 1 to 5 according to severity.  Suspicious lesions were present in 75-7 per cent of the sample.  There was obvious atrophy of the turbinates in 44-7 per cent (grade 2 to 5) and severe atrophy in 17-5 per cent (grades 3 to 5).  Foreign bodies were found in or between the posterior cheek teeth of 5-3 per cent of the sample.  There was frequently an associated gingivitis.  Other lesions seen included black discolouration of the teeth, severe tooth wear and osteoarthrosis of the temporomandibular joint.  It was concluded that the incidence of atrophic rhinitis could have increased markedly since the last survey of the United Kingdom was undertaken in 1956/57 and some form of disease-monitoring service was urgently needed.


An immune hemagglutination procedure with very high sensitivity applied to the detection of hepatitis B antibody and antigen and immune complex.

An immune agglutination procedure is described in which red cells are coated with antigen and agglutination is observed after a short incubation with antibody in reagent serum. Conversely, the cells may be coated with antibody and used to test for the presence of antigen. Treatment of the reagent serum with cobra venom factor results in inhibition, and there is a marked lo-s of sensitivity with cells pretreated with formalin or chromic chloride, suggesting that C3 and some type of reactive sites on the cells are required. The distinctive features of the new procedure are that incubation time is very short, sensitivity is several orders of magnitude higher than with other related tests, and, within some limitations, bovine (steer) red cells with bovine serum can be used as an alternative to human red cells with human serum. It is necessary to remove an inhibitor from the reagent serum, human or steer. While the mechanism of the procedure needs further elucidation, the findings reported here suggest that it ought to be sufficiently sensitive to detect hepatitus B antigen if present in virtually any blood sample. With appropriate modifications it should be useful for blood donor screening, diagnosis, and for studying many other antigen-antibody systems.


S--s--U-- phenotype in South African Negroes.

A Negro woman of the Xhosa tribe of Port Elizabeth in the Eastern Cape was found to be S--s--U--with anti-U in her serum.  She had two S--s--U-- children, and her husband, father and other children all had single doses of S or s antigen.  Three furhter S--s--U-- Negroes were found in a random sample of 1,000 Negro antenatal patients at Port Elizabeth.


ADA-7--a new allele.

A new ADA phenotype which is particularly susceptible to phenotypic changes following storage was observed.  Family studies indicate that this type may be due to a new allele, ADA-7.  The phenotype observed was classified as ADA 7-1.


Is the determination of AHF activity feasible for individual cryoprecipitates?

A method is described in which the factor VIII (AHF) activity of 40 individual cryoprecipitates can be determined within 4 h.  The reagents employed do not require plasma congenitally deficient in factor VIII.  The preparation of cryoprecipitates with known biological activity should result in a more rational use of this type of factor VIII concentrate.


Acute heroin fatalities in San Francisco. Demographic and toxicologic characteristics.

The mortality rate due to heroin overdosage in San Francisco has increased dramatically since 1968 and now stands as one of the highest in the United States. While the numbers of heroin fatalities in many eastern United States cities have declined substantially in the past few years, the figures for San Francisco and the other West Coast areas continue to increase. The group of heroin overdose victims from the 1970 through 1973 period is more predominantly Caucasian and younger than from the 1963 through 1965 period. In nearly all of the victims, the presence of morphine (a heroin metabolite) was noted in bile or urine, and in about half the results of blood alcohol tests were positive. Measurement of blood morphine concentrations in the victims showed no significant difference from the concentrations noted in a control group of heroin addicts dying from causes other than overdosage.


Medical oncology. Clinical experience over one year.

Over a one-year period, 167 patients with cancer were seen in a total of 1,931 clinic visits. Of these patients, 59 percent responded to therapy, with 20 percent achieving a complete response. The median duration of response was eight months (12+ months for complete responders, 7 months for partial responders), with only a two-month average survival for nonresponders. Seventy-seven deaths in clinic patients occurred for a death rate of 46 percent. Hospital tumor registry referrals rose 46 percent. The effect of early referrals, sources of referral, metastatic sites, chemotherapeutic drugs used, morbidity and type of therapy are also reviewed.


Cystic fibrosis complicated by heart failure.

Survival studies were done on 36 children with cystic fibrosis and heart failure. Thirty percent did not survive the first four weeks, and the median survival for the group was between two and three months. By the end of the first year from the onset of failure, 74 percent had died and at 30 months, 87 percent had died.


[The value of cytogenetic investigations in the differential diagnosis of abnormalities in sex differentation (author's transl)].

This report is concerned with the scope of cytogenetic investigations in the diagnosis of sex abnormalities. In the majority of cases the karyotype leads to correct diagnosis only when the clinical picture and the histology of the gonads are known. It is only rarely possible to identify the phenotype from the chromosome picture, as for instance in the case of XO or XXY karotypes. Cytogenetic investigations can be considered advisable in the diagnosis of sex differentiation disorders in the following cases: a) in the case of ambiguous external sex organs; b) in primary amenorrhoea; c) in secondary amenorrhoea, above all in the case of early menopause; d) in male hypogonadism and in certain cases of gynaecomastia.


[Diagnostic and therapeutic problems in malignant chorionepithelioma (author's transl)].

2 cases of malignant chorionepithelioma are reported on account of their interesting symptomatology and the procedure by which a correct diagnosis was made. Chemotherapy must now be considered superior to surgical treatment and the most important chemotherapeutic drug is methotrexate. The therapeutic efficacy of this preparation is offset by severe side effects, which may even have a lethal outcome.


[Ultrasound measurements in early pregnancy (author's transl)].

With the aid of the ultrasound scan technique the amniotic sac was measured on more than 700 occasions between the 8th and 20th week of gestation. In each examination the greatest transverse, anterior-posterior and longitudinal diameters were determined. The statistical mean and the double standard deviation were calculated from these data. The areas of the transverse diameter and of the longitudinal diameter show a distinct and continuous increase, whilst the area of the anterior-posterior diameter displays a small and uncharacteristic increase during pregnancy. The values of 12 patients were registered in the region of the transverse and of the longitudinal diameter. The clinical findings, as well as the ultrasonic values, had shown no abnormalities at that time. The data show a decrease in these diameters during the following examinations; the last measurement was carried out when the fetal heart beat was absent for the first time. The increase in size of the amniotic sac during pregnancy can be observed by means of these examinations. Repeated examinations enable the detection of disturbances in the developement of the pregnancy at an early stage.


[Malformations and abnormality of the sex ration after hormone treatment in mice (author's transl)].

Ovulation was induced in 90 randomly-bred virgin mice (Swiss albino) by the i.p. injection of 5 I.U. pregant mare's serum and human chorionic gonadotropin, respectively, with an interval of 48 hours between injections. Pregnancy occurred in 32 animals following normal fertilization. Caesarian section was generally performed on account of blocked delivery and the progeny placed with foster mothers. A statistically-significant shift in the sex ration (to the disadvantage of the males) was observed. The incidence of malformations of the extremities was significantly higher than in a control group. In comparison with control embryos which were also born by Caesarian section, the chance of survival of the progeny of hormone-injected females appeared distinctly reduced. A possible correlation between hormone-induced ovulation and abnormalities in the progeny is discussed in this paper.


[Haemolysis after heart valve replacement (author's transl)].

Intravascular haemolysis is frequently seen in patients after heart valve replacement, but is often compensated. The cause of the haemolysis is traumatic damage of the red cells. It is more often seen after aortic, than after mitral replacement, because the transvalvular pressure gradient is higher and is more severe in ball valves than in disc valves. If substitution therapy with iron, folic acid, or even red cells fails, re-operation should be seriously considered.


[Indirect calorimetry by means of displacement spirometry of the respiratory minute volume (author's transl)].

One factor limiting the accuracy of indirect calorimetry is the measurement of the respiratory minute volume. The precision of available gasometers can scarcely ever be reduced beyond plus or minus 1% of the volume which is to be measured. A new method is presented which enables the metabolic rate to be determined with far greater accuracy by increasing the precision of respiratory volume measurements. Expired air is collected in a metal cylinder and its volume is determined by forcing it under water and measuring the weight necessary to accomplish this. This force is equivalent to the buoyancy force of the measured volume. The lower limit of accuracy in measurement of compensatory weights is 1 g, which is equivalent to an accuracy of 1 ml gas volume, independent of the size of the spirometer. Losses caused by mechanical friction reduce the factual accuracy to plus or minus 0.1%. After volume determination, the O2 and CO2 content of the collected air is determined in analysers connected to the displacement spirometer.


[Specific weight loss in hyper- and hypothyroidism (author's transl)].

By means of a new method of extremely precise weight measurement (buoyancy scale) it is possible to measure the continuous weight loss of the human body. This weight loss is made up of three components, viz. the weight difference between produced CO2 and consumed O2, water loss through the lungs and transpiration through the skin. In relation to body weight it is called "specific weight loss." This parameter was measured in healthy human subjects and found to be within a relatively narrow range (16.42 plus or minus 2.55 mg/min/kp body weight). In four patients with hypothyroidism the values were very low (5.5 to 8.5 mg/min/kp). An increased specific weight loss was found in patients with hyperthyroidism (38 to 102 mg/min/kp in clinically severe cases). The applicability of this method to examination of thyroid function is discussed. It is compared to the classical method of basal metabolic rate measurement and its advantages are enumerated.


[In vitro investigations on the influence of various antirheumatic drugs on the enzymes of the purine salvage pathway (author's transl)].

On testing the effect of 5 drugs (azapropazone, flufenamic acid, indomethacin, oxyphenbutazone and prednisolone) commonly used in the therapy of rheumatic diseases on 3 enzymes of the purine salvage pathway (adenine-phosphoribosyltransferase, guanine-phosphoribosyltransferase and hypoxanthine-phosphoribosyltransferase) a distinct inhibitory effect of oxyphenbutazone and flufenamic acid was noted. A particularly marked effect was observed on adenine-phosphoribosyltransferase at the applied concentration (50 mug%) by both drugs but also guanine-phosphoribosyltransferase and hypoxanthine-phosphoribosyltransferase indicated reduced activities.


[Dermatologlyphic investigations in a kindred manifesting familial atrial septal defect (ostium secundum). A contribution to the problem of genetic counselling in multifactorial inheritance (author's transl)].

In order to improve the possibilities of genetic counselling in multifactorial inheritance, dermatoglyphic investigations were performed in a family with atrial septal defect (ostium secundum) - ASD II - affecting two out of six children of a married couple and a maternal aunt. The frequency of finger-print patterns differed widely between the husband and his father on the one hand and the wife and her relatives on the other hand. Assuming some partial effect of the ASD II genes on the total gene influence on dermatoglyphics, it seemed possible that the finger-prints of the two affected siblings and of those brothers who were fairly near the threshold of ASD manifestation might resemble more closely the finger-prints of their mother and their mother's relatives than the finger-prints of their father and their paternal grandfather. This assumption was, however, disproven.


[The conservative treatment of phosphate calculi by citrate buffer (author's transl)].

3 patients with U-tube pyelonephrostomy were treated conservatively for multiple struvite (triple phosphate) stones in the kidney by means of constant irrigation with citrate buffer (pH 4.8). Complete dissolution of the stones was achieved in 2 patients. Conservative therapy was unsuccessful in the third case in view of narrowing of the renal calyces. Combined therapy by means of direct irrigation and oral chemotherapy is recommended.


[The post partum administration of quingestanolacetate 0.3 mg as oral contraceptive (author's transl)].

Quingestanolacetate (0.3 mg daily), as from the second week post partum was given to 13 women for a total of 111 therapeutic cycles of 28 days. In addition to clinical follow up, 8 women were subjected to serial pregnanediol determinations in the night urine every other day for a total of 45 cycles. One woman became pregnant in the 5th therapeutic cycle, demonstrating an insufficient contraceptive effect of this minipill. The only major side effect was the occurrence of irregular episodes of bleeding during the first 3 therapeutic cycles. With increasing duration of the administration of this drug, the vaginal bleeding settled down to approximately 7 days per 28 days. When pregnanediol serial determinations were started in the 4th to 6th therapeutic cycle post partum, 6 out of 8 women showed ovulatory cycles. In the two remaining patients ovulatory cycles were observed in the 7th and 10th therapeutic cycle, respectively. Of 45 cycles in which control pregnanediol serial determinations had been undertaken, 11 (25%) were anovulatory, 21 (46%) showed a normal ovulatory excretion pattern and 13 (29%) showed severe luteal insufficiency. An insufficiency of luteal function appears to be partially responsible for the contraceptive effect of this minipill.


[Therapy of the bronchitic syndrome (author's transl)].

The bronchitic syndrome necessitates chemotherapeutic management, especially in view of the secondary complications arising in this condition. Chemotherapy must be consistently adhered to, not only during acute exacerbations, but also during the relatively symptom-free intervals between exacerbations and also in those cases displaying minimal symptomatology. A useful criterion of the necessity for chemotherapy is the presence of a purulent sputum and with the appearance of this feature, specific chemotherapy should be initiated without delay (W. T. Ulmer). Appropriate investigations in 41 patients showed that Lidaprim, a combined preparation of trimethoprim and sulfametrol, can be recommended on the basis of its beneficial chemotherapeutic effect, good tolerability and simplicity of administration. Purulence of the sputum disappeared within 10 days of commencement of treatment with 2 times 2 tablets Lidaprim daliy in 38 out of the 41 patients. The clinical symptoms, including respiratory difficulties, improved simultaneously with the decrease in quantity of expectorated sputum. Lidaprim represents a useful and effective chemotherapeutic agent in the hands of both the hospital specialist and the general practitioner for treatment of the bronchitic syndrome in all its diverse forms.


[Fluorescence diagnosis of a lengthened Y-chromosome in father and son].

Two cases with long Y chromosome in a father and his son have been described.  The chromosomes were analysed routinely using the peripheral blood leukocyte culture according to Moorhead et al. (1960) and of the slightly modified fluorescence method of Caspersson (1970, 1971) after QM-staing.  In both patients the size of the Y resembled that of the pair 17--18 of autosomes.  A brightly fluorescent heterochromatic region of the Y showed normal patterns and size.  In one of the patients the analysis of solar and palmar dermatoglyphics, the testicular biopsy, EEG, glucose loading test, as well as laboratory tests evaluating the hormonal function of adrenal cortex and of thyroid gland were performed.  The second patient did not agree to any tests.


[Non-delirious toxic psychoses in children (author's transl)].

There is an increasing occurrence of drug-intoxications in infancy, thus psychopathological changes due to intoxication also occur more frequently in children. 6 children were described with cases of acute and reversible toxic psychoses whose--mainly visual--hallucinations together with conditions of excitation and hyperactivity were the most striking features of the psychopathological picture; in contrast to the more frequent delirious confusion (delirium) disturbances of consciousness and orientation were missing. The phenomenological characteristics of halucinosis in children-a condition so far not specified in the case of infants and children-have been elaborated with regard to other psychotic phenomena during infancy and adult age. Relevant neurophysiological and psychodevelopmental findings lead to the following four theorems: 1. Drugs with hallucinotic effects facilitate the occurrence of "internal" pictures independent of external perceptions which are described phenomenologically as hallucinations. This theory is based on the fact that hallucinogenic drugs intensify the electrical potentials which are evoked by optic stimulation in the visual area, while an intracortical impulse propagation is inhibited. 2. A change in emotion either caused by situation or by exogenous or endogenous factors facilitates the development of hallucinations, especially if emotions dominate to such a degree that rational control of reality is being suppressed. Since hallucinogenic drugs exert their effects not only on the sensory system but also on brain structures which influence directly or indirectly emotional functions, hallucinations might also be evoked via this mechanism. 3. Brain stem has-apart from its importance in emotional processes-a filter effect and a controlling function of sensoric stimuli originating in the periphery. Hallucinogenic drugs can influence this screening function and have a disinhibitory effect which cause an inundation of the brain cortex by sensoric stimuli which again facilitate hallucinations. 4. The neurophysiological actions discussed above which are caused by intoxications have a synergistic effect together with the psycho-developmental facts relevant to infancy. This synergism can explain the frequent occurrence of fever hallucinoses as well as the fact that agents primarily not hallucinogenic as e.g. benzydamine can also cause hallucinations in infancy.


Morphological and morphometric studies of the skeletal muscles of rachitic rats.

The question of "myopathia rachitica" was pursued in a disease progress study using rachitic rats. The length of the study was 18 weeks. During this time a discrete dystrophic myopathy formed. The morphometric examination showed muscle fibre diameters 8--24 mu  less than those of healthy control rats in correlation with the degree of rachitis. The absence of fiber growth in the C fibres was conspicuous. The question of the relation of these findings to the inactivity, osteomalacia and changes in metabolism in rachitis was discussed. The myopathic changes can not be solely interpreted as a result of inactivity, but the cause of myopathia rachitica remains unclear.


Studies of malformation syndromes in man XXXVI: the Pfeiffer syndrome, association with Kleeblattschädel and multiple visceral anomalies. Case report and review.

This paper reports sporadic occurrence of the Pfeiffer syndrome with Kleeblattschädel (KS) in a male infant who died at 6 months of pneumonia with signs of increased intracranial pressure and who was found to have hydrocephalus, polymicrogyria, cerebellar herniation, bicuspid aortic valve, a common mesentery, absence of lesser omentum, hypoplasia of gallbladder, a single umbilical artery, and multiple eye defects. This case is presumed to represent a new mutation: in other families the Pfeiffer syndrome has been dominantly inherited. The Pfeiffer syndrome is a form of acrocephalosyndactyly and impresses clinically as a mild form of the Apert syndrome. The Kleeblattschädel is an etiologically non-specific developmental field defect (DFC); about two fifths of 51 known cases have apparent thanatophoric dwarfism and about one fifth are probable or possible examples of the Pfeiffer syndrome. The KS-DFC has also been seen in the syndromes of Carpenter, Apert and Crouzon.


[Intestinal amino acid absorption in vitamin D dependent rickets].

Since structure and specifity of amino acid transport systems are basically similar in kidney and intestines it was suspected that rickets associated with hyperaminoaciduria was linked with defective intestinal amino acid uptake. Therefore amino acid absorption from everted sacs of small intestines was studied in 2 piglets suffering from vitamin D dependent rickets, and 7 healthy piglets using 14-C labelled amino acids. The experiments revealed an unaffected intestinal absorption in the rachitic animals, whereas the uptake decreased significantly with increasing age of the experimental animals. The results from these studies suggest that regulatory factors in the blood system, e.g. increased level of PTH or lack of specific vitamin D metabolites, do not directly affect amino acid transport systems in kidney and intestines. It is concluded that hyperaminoaciduria has to be mediated through specific and thus far unidentified effects at the tubular cell level.


Isoenzymes of alkaline phosphatase in the serum of patients with cystic fibrosis.

In 36 children with cystic fibrosis (CF) the isoenzymes of alkaline phosphatase (AP) were determined microelectrophoretically in polyacrylamide- and starch-gel. The study was done to evaluate the clinical significance of these additional data for the diagnosis of liver involvement in DF. The results led to the following conclusions: 1. Serum activity of total AP is comparatively unsensitive "masking" alterations in the isoenzyme pattern contributing to the AP serum activity. 2. In 17 children resp. 47% bile-duct phosphatase was increased indicating a secretostasis while other marker enzymes of cholestasis were normal in part. 3. The activity of bone phosphatase in the serum showed a significant correlation to the degree of growth retardation in these patients. 4. Intestinal phosphatase was present in the serum of only one child with cirrhosis of the liver being an indicator for liver insufficiency. 5. Determination of AP isoenzymes in the serum may provide additional information about the organs involved for the physician in handling CF patients.


[Serum concentrations of vitamin A, carotene, retinol-binding protein and prealbumin in patients with cystic fibrosis (author's transl)].

Vitamin A, carotene, retinol-binding protein (RBP), and prealbumin (PA) have been measured in 42 children and adolescents with cystic fibrosis (CF) and in 92 normal controls. All patients with CF were on vitamin A palmitate in twice the dose for normals. For statistical analysis U- test of Wilcoxon, Mann and Whitney, parametric correlation coefficient and Spearman's rank correlation coefficient were used. Compared with those in normal controls mean serum concentrations of vitamin A, carotene and RBP were depressed in patients with CF (P smaller than 0.001), whereas PA levels did not differ significantly from those of normal individuals. In normal controls there was only in serum concentration of PA an elevation with age (r=0.455, P smaller than 0.001). In patients with CF, serum concentration of vitamin A decreased in correlation with age (r=--0.423, P smaller than 0.01). PA and RBP as well as RBP and vitamin A were positively related in both groups (P smaller than 0.001). In normal individuals  there was a highly significant correlation between serum concentrations of vitamin A and carotene (rs=0.606, P smaller than 0.001), whereas in patients with CF this relationship was less significant (rs=0.311, P smaller than 0.02).


[Origin and treatment of the socalled "cast syndrome" following operations for scoliosis (author's transl)].

Discussion of the causes and treatment of the syndrome called in the literature misleadingly "cast syndrome". Observation of 9 cases who had surgery for scoliosis suggests that the syndrome is largely due to disturbances of function of the innervation of stomach and duodenum.


[Results of surgical correction of flexion contractures of the knee joint in CP children (author's transl)].

Follow-up of 78 CP children with elongation of the tendons of knee flexors. In addition further operations were done in a large number of cases, frequently shortening of the patellar ligament, lengthening of hip flexors and correction of pes equinus. The further motor development shows worsening in 8, no improvement in 28 and improvement in 42 children. Analysis according to age showed better results in children under 9 years: Of the 48 younger children 33 showed progress, 13 free walking. Of the 30 older children only 9 showed progress and only 2 learned to walk freely. This difference was significant. Investigation of the causes for not walking showed the importance of motor preconditioning. Only children who had knee-standing before operation learned free walking. Major lack of motor development was most frequently preventing walking. Further causes were mental retardation, athetosis, pes calcaneus and general flexion patterns. While results in gaining extension at the knee were quite good, outward rotation at the hip averaged an improvement of 9.7 degrees. A favorable influence of combined elongation of knee flexors and adductor tenotomy at the hip in the CE angle was also clear. It diminished on average by 6.9 degrees. Special pre-operative conditions and the technique of examination are discussed in detail.


[Distraction epiphyseolysis. An experimental study for bone lengthening. Part I (author's transl)].

Distraction epiphyseolysis is an operation for bone lengthening in children and adolescent which is often performed in Russia. Our experimental examination in rabbits has shown a lot of problems with this method. With distraction epiphyseolysis it is possible to get a primary lengthening of bone and a soon consolidation of the distraction-cleft. During further growth this primary lengthening is going lost. After the end of growth there was no significant difference between operated and non operated bone. The cause of the growth-disturbance is discussed in a further publication guided by histological findings.


[Distraction epiphyseolysis. An experimental study for bone lengthening. Part II (author's transl)].

Histological findings of rabbit's tibia after distraction epiphyseolysis within the first days and weeks shown severe disturbances of growth. There is a transformation zone between epiphyseal bone plate and resting cells with early ossification. Furthermore there was a lasting interruption of the perichondral ring, especially with growth disturbance in longitudinal direction of the epiphyseal plate. Comparison to the traumatic epiphyseolysis in children and adolescents are discussed, also the reaction of lasting tension power on epiphyseal plates.


[Biomechanical investigations on the parry fracture of the ulna (author's transl)].

108 ulnae from the cadavers of 50 men and 6 women were fractured in four positions with a tension testing machine with electronic measurement of force. Stress-strain-diagrams were registered, and the values of breaking load, breaking energy, breaking stress and ultimate deflection were correlated to the areas of cross sections of compacta and medulla. Breaking load and breaking energy decrease distally: medium breaking load in the upper portion of the ulna about 320 kp, in the lower portion about 100 kp; breaking energy in the upper portion about 65 kpcm, in the lower about 20 kpcm. Breaking stress is greatest in the middle portion of the ulna (19 kp/mm-2 in contrast to 11-14 kp/mm-2 near the joints). With increasing age the cross sections of the medulla increase significantly, but breaking load, breaking energy, breaking stress and area of cross section of the compacta decrease significantly. Ulnae from females are less resistant than those from males. Intact periosteum rises resistance to breaking and ultimate deflection. Experimental data agree with clinical observations.


[Overlooked and unappreciated anatomical facts with regard to the development of pes planus].

Based on careful anatomical praeparations and analyse of fibres the incorrect and incomplet descriptions and illustrations of the calcaneonavicular ligaments are corrected and the deductions for the normal and the pes planus producing processes are concluded. The significance of the "Fibrocartilago navicularis" (BNA) and the manysided efficiency of a vigorous but as yet unnoticed ligaments is discussed.


[Torque load and types of fractures of threaded holes in cortical bone by lag screw. Mechanic and histological studies (author's transl)].

For the better understanding of fracture fixation by means of screws the torque load and types of fractures from threaded screw holes in cortical bone were studied. The experiments were performed on sheep tibia and femora in vitro and in vivo. We applied the 4.5 mm cortical bone screw (AISF) as lag screw. The screw was threaded in until total destruction of the thread occurred. The process of torque load was registered as a torque-angle of twist curve with 4 typical parts. Histologically in most cases shear fractures with different geometry occurred. In some cases we found conical geometric, and in others cylindrical geometric fragments in the threaded screw holes. The value of the torque at which destruction of a threaded hole occurs is a linear function of the thickness of the cortical bone. The gradient of this linear function is 6.6 kpcm/mm. In practical case, the insertional torque may be estimated by multiplying the cortical bone thickness in mm (if known) by a factor 4.


[Fractures of the leg and modern skiing equipment (author's transl)].

Raising the top of the ski-boot does not prevent the feared fractures of the ankle, only changing the angle does. The modern ski-boot with advance and a hight of shaft of about 28 cm produces torsion-wedge fractures in the middle third of the tibia, if the binding does not give away.


[Subcutaneous rupture of the tibialis anterior-tendon. (Report of 3 cases) (author's transl)].

In 1966 we saw 1, in 1973 2 cases of spontaneous rupture of the tibialis anterior-tendon. 2 patients were treated by operation, 1 declined it. A follow-up the operated patients had no symptoms and normal function. The non-operated patient also had no symptoms, but slight limitation of dorsiflexion and uncertain gait. One female and one male had been treated with local injections of cortisone before rupture. One can neither prove nor disprove a connection.


[Allergic cobalt reaction (metallosis) following knee arthroplasty with vitallium endoprosthesis ad modum Walldius (author's transl)].

A case report is given on a woman with rheumatoid arthritis and deformed knee joints. She got a knee arthroplasty with a metal-to-metal Vitallium endoprosthesis ad modum Walldius. About one year after the arthroplasty she showed both a sterile fistulation from the knee joint and an eczema of the skin of the operated knee. An epicutaneous test for cobalt was positive. It is suggested that the metal-to-metal contact in the prosthesis and the proximity of the prosthesis to the skin is a possible explanation to the allergic reaction.


[The influence of kyphosis on lung function in young scoliotic patients (author's transl)].

By assessment of partial correlation in the field of lung function in kypho-scoliosis, the direct influence of kyphosis on the upward-shift of the mid-respiratory level (FRC% TLC) can be documented. It is shown that several other lung function parameters are dependent more or less on a change of volume balance in the deformed chest and, thus, indirectly on the degree of kyphosis. The degree of scoliosis which was the presenting symptom in our series, shows, of course, a highly significant direct correlation to vital capacity, which in itself is the source of changes in several other lung function parameters. The role of kyphosis in the development of lung function during therapy is being discussed.


[A case of Maffucci-Kast syndrome (author's transl)].

A 40-year-old man showed the typical cardinal signs of Maffucci-Kast syndrome: largely one-sided bony chondromatosis and tuberous dermal angiomata. In addition there were pigmented spots in the skin, moderate hypertrophy of the extremities most involved (left hand and foot) and hypoplasia of the skeleton in these parts.


[Metabolic stress by guanosin in healthy persons and in patients suffering from gouty arthritis].

The oral administration of 2 g guanosine resulted in both normal and gouty patients in a significant increase of serum uric acid levels, remaining for 24 hours above the initial values. There was no difference in the response of both groups investigated, indicating that a "purine-tolerance test" has no significance in the diagnosis of arthritis urica. The 24-hour-rhythm of serum aicd was studied in 20 normal persons, showing no statistical significant differences. The results of this investigation demonstrate that blood-sampling for uric acid determination can be performed at any time of the day, provided a provided a purine-poor diet is given 24 hours before.


[Antistreptolysin-o latex test. A simple screening method for the determination of antistreptolysin-o antibodies].

Experiences with a rapid latex slide test to distinguish elevated fron normal antistreptolysin-O titers are reported. A series of 1000 randomly selected sera were tested in parallel with the ASO latex test and the classical antistreptolysin-O titration test. All sera with an ASO titer of more than 200 I.U. produced a positive agglutination with the ASO latex test. No false negative results were recorded. 6,2% of the sera with a positive ASO latex test exhibited less than 200 I.U. in the titration test. A further advantage of the ASO latex test, apart from its easy practicability, is that it is not inhibited by serum lipids like the hemolytic titration test. The dextransulphate precipitation method combined with the ASO titration showed no advantaged when compared with the ASO latex test combined with the ASO titration without dextransulphate. When patients in our series with ASO TITERS OF 500 AND MORE I.U. were considered in relation to their clinical diagnosis it as found that infections with beta-hemolytic streptococci would not be overlooked, when the ASO latex test is used as a screening procedure. The ASO latex test therefore all  s a considerable reduction of personnel and working time. It is however, essential that industry should keep the quality of latex reagents strictly standardized.


[Is gonarthrosis with varus deformity a clinical entity].

Studies were conducted in a group of patients with varose deformity. The present paper gives the results of indicidual bone metabolism studies conducted on 663 healthy controls and patients with articular disease without genu varum or with varose deformity. In subjects with genu varum intravenous administration of calcium causes the urinary elimination of hydroxyproline and nitrogen to fall. Among the groups under investigation this group of patients excretes the least amount of urine, has a relatively low calciuria and shows the highest retention rate of intravenously administered calcium. Patients with gonarthrosis associated to varose deformity excrete, a day after intravenous administration of calcium, the relatively least amounts of phosphorus, as compared to the healthy controls and other degenerative joint diseases without genu varum. Although the retention of intravenous calcium in the studied group resembles that seen in the process of generalized osteomalacia, no coinciding signs of osteomalacia c ould be found in subjects with gonarthrosis and varose deformity. X-ray examination of patients with genu varum revealed more marked changes in the bone structure, namely sclerosis, necrosis and osteophytes of shapes and sizes other than in gonarthrosis without varose deformity. Epidemiological analysis of 30 patients showed 83.3% of patients to have overweight type I to III according to the Broca formula. Pains in the knee joints started appearing at the mean age of 50 years. A large part of the patients showed the presence of serious varicose syndrome and relapsing phlebitis of the lower limbs. Although the clinical and X-ray pictures make it possible to conisder a larger amount of disease types, we assume that gonarthrosis with varose deformity may be regarded as an isolated clinical entity which refers primarily to a localized bone process.


[Peroxidase activity in the paw of animals in adjuvant arthritis and its changes by antiphlogistics in vitro].

The peroxidase activity is increased in the inflamed paw of rats with adjuvant arthritis. The increase is biphasic like for other enzymes. The higher peak occurs during primary inflammation in the injected paw according to the behaviour of polymorphonuclear leucocytes. Of 32 substances tested in vitro, among them 19 antiphlogistics and derivatives, especially the antiphlogistics inhibited the peroxidase reaction. Therfore it seems not unlikely that inhibition of the peroxidase reaction is involved in the mechanism of activity of anti-inflammatory agents.


Cyclic peptides of sarcosine. Syntheses and conformation.

A series of cyclic peptides of sarcosine with the general formula c-Sar-n, n=2-8, has been synthesized and conformational studies carried out both in solution and in the solid. The rings are conformationally very homogeneous and contain both cis and trans amide bonds. Their barriers to ring inversion are high; in the smaller rings this is attributed to steric hindrance, caused by the N-methyl-groups, whilst in the larger rings the folding of the chain in helical segments plays an important role.


The crystal and molecular structure of (2-Hydroxyphenyl) alanine (o-Tyrosine).

The crystal structure of D,L-(2-hydroxyphenyl)-alanine has been determined by X-ray methods using 1971 observed reflections. The crystals are monoclinic, space group P2-1, with four molecules in the unit cell of dimensions a=6.32-5 A; b=26.48-9 A; c=5.36-7 A, and beta=98.1-8 degrees. The structure was solved by direct methods and refined to a conventional R-factor of 0.048; estimated standard deviations in bond lengths not involving hydrogen are 0.002-0.004 A and in angles 0.1-0.2 degrees. Bond lengths and angles are in accordance with those found in tyrosine. Owing to an intra-molecular hydrogen bond between the ammonium group and the ring hydroxyl oxygen atom, however, the conformational angles differ from those found in several other phenylalanine derivatives. There are non-crystallographic centres of symmetry between pairs of enantiomeric molecules.


Structural studies of metabolic products of dopamine. III. Crystal and molecular structure of (--)-adrenaline.

The crystal structure of (--)-adrenaline has been determined by X-ray methods, using 831 observed reflections collected by counter methods. The crystals are monoclinic, space group P2-1 with a=7.873(2), b=6.790(2), c=8.638(2) A and beta=98.01(2) degrees. Least-squares refinements yielded a conventional R-factor of 0.053. Standard deviations in bond lengths are 0.005-0.006 A and in bond lengths aree 0.005-0.006 A and in bond angles 0.4 degrees. The adrenaline molecules were found to exist as zwitterions in the crystals. The conformation of the adrenaline molecule corresponds closely to that usually encountered among the salts of the sympathomimetic amines. The crystals consist of molecular double layers parallel to (100). The molecules within a layer are linked through hydrogen bonds of the types N--H...O and O--H...O, whereas the layers are connected by van der Waals interactions.


[Unusual isotope scanning aspects of hot thyroid nodules: diagnostic problems].

The classical picture of development of the "hot" nodule, which takes into account at the same time fixing or non-fixing nature of healthy perinodular tissue and the clinical condition of the patient fails to explain certain biological and scintigraphic findings. The authors discuss problems related to scintigraphy which they encounter in the course of the examination. In 174 stimulation tests carried out, 12 resulted in hypofixation of the isotope in the nodule, scintigraphy being carried out in three patients using 99-mTcO4 spontaneous reactivation of healthy tissue was seen in 5 patients. In the light of the cases reported, it would appear that the scintigraphic picture of the "hot" nodule is more in favor of a duality between the latter and healthy tissue with respect to iodine than of a hypersensitivity to TSH. In the 12 inhibition studies carried out, 3 showed the persistence of a contralateral shadow. Finally, on five occasions histological examination of  the operative specimen showed the presence of neoplastic change, in two cases within the "hot/ nodule.


[Fasting with muscular exercise: change in body weight and nitrogen balance].

Amongst a group of 27 obese patients subjected to a 10 day fast (250 cal. with 22 Gms protein), 11 picked at random also followed a muscular exercise programme- the others serving as controls. This physical activity was well accepted and tolerated without problems. Weight loss was similar in both groups but the daily nitrogen balance in those patients performing muscular activity was less negative and tended to become positive more rapidly than in the control group. The loss of active muscle mass by protein catabolism as a result of fating was significantly less in the muscular activity group. This may indicate that muscular activity is useful in aiding adaptation to fasting and may orient weight loss preferentially towards fat mass.


[Unilateral congenital pulmonary lymphangiectasis].

The authors report the anatomo-clinical description of a case of a complex malformation of the Ivemark type with asplenism. They draw attention to the presence of a left-sided unilateral congenital pulmonary lymphangectasia due to the absence of the left pulmonary venous trunk. This observation confirms the role of total blockage of pulmonary venous circulation in the aetiology of these very rare cases of congenital pulmonary lymphangectasia.


Effects on breathing mechanics and gas exchange of different inspiratory gas flow patterns in patients undergoing respirator treatment.

In order to investigate the importance of different inspiratory gas flow patterns in respirator treatment, eight intensive care patients were studied with breathing mechanics and five patients also with gas exchange studies. Three different inspiratory gas flow patterns were tested in randomized sequences namely, accelerating, constant and decelerating flow. All three flow patterns were generated by the same respirator. No end-inspiratory pause was used. The results point to a favourable effect on breathing mechanics of a decelerating and a constant flow when compared with an accelerating flow type. However, when the total effects on gas distribution and lung perfusion were evaluated in the gas exchange studies, no significant differences were seen between the three flow patterns.