Prognostic factors in rehabilitation after severe head injury. Assessment six months after trauma.

After initial neurosurgical treatment, 40 patients who regained consciousness 1 to 90 days after major cerebral trauma, were admitted for rehabilitation. Six months after their injury they were assessed in terms of: 1) Locomotor function, 2) Intellectual performance, 3) Communication disorder, and 4) behaviour disturbances. The usefulness of these parameters as prognostic factors in rehabilitation is discussed. Eight patients without significant disabilities in all 4 parameters returned to normal life. Patients who showed locomotor, communicative and behaviour impairment but no gross intellectual deficits, were considered capable of being retrained. The poorest prospects for social and vocational rehabilitation were found in 15 patients with cognitive defects.


Ergonomic studies of standardized domestic work in patients with neuromuscular handicap.

A model for ergonomic studies of domestic work in varying patient groups has been constructed. A control group of 15 healthy women, 30-59 years of age, 9 female patients with hemiplegia and 13 with multiple sclerosis (MS) were studied with exercise test on a bicycle ergometer. Recordings of time consumption, heart rate and subjectively perceived exertion were made during a 4.5-5 hour domestic work program. Four of the more strenuous work elements were restudied also with respect to oxygen uptake. The hemiplegic patients required more time and had higher perceived exertion, but lower heart rate and oxygen uptake for the same work tasks than did the controls. The MS-patients also had higher perceived exertion. There was a rather poor relationship between determined and indirectly estimated energy expenditure. Various explanations are discussed. The results demonstrate the importance of the perceived exertion in choosing the work intensity.


Treatment of cervical syndrome by acupuncture.

Sixty patients suffering from the cervical syndrome were treated with acupuncture three times at one-week intervals. No electric stimulators were used. According to the physician's evaluation, 68% of the patients displayed good primary results (complete cure or moderate improvement). According to postal inquiries made 6 months after the last treatment session, 33% of the patients still reported moderate improvement or complete cure. No improvement was reported by 10 patients. The results are well in agreement with those obtained with physical therapy or B-vitamin treatment, suggesting that the improvement might be associated with the natural course of the disease. All controlled clinical acupuncture investigations have proved difficult to conduct due to the essential differences between acupuncture and any other form of treatment.


Factors related to long-term prognosis following acute myocardial infarction. Importance of left ventricular function.

Factors related to 2-year and 4-year prognosis after acute myocardial infarction were studied in a series of 158 men. Stepwise multiple discriminant analysis was applied to findings recorded during hospital admission and to results of an exercise test carried out 6-8 weeks after the infarction. The best indicators for predicting a poor prognosis in the course of the following 2 years were a low systolic blood pressure on exercise and a palpable paradoxical cardiac pulsation. During the 4-year follow-up an abnormality of P terminal force in the ECG, which reflects left atrial overload, was the main predictor of poor prognosis.


A basic aphasia examination: description with discussion of first results.

A new basic aphasia test (Grunntest for Afasi) constructed for use with a Norwegian patient population is briefly described. This test follows the principles established by Goodglass and Kaplan in the Boston Diagnostic Aphasia Examination. Results with the first 43 patients examined are presented. Three alternative methods for utilizing the basic results in classifying types of aphasic disorder are considered. The classical method, as formalized by Goodglass and Kaplan, which emphasizes an evaluation of patients' speech characteristics was found to employ dimensions with the lowest intercorrelations. While this method provided the better dimensions, the description of disorder in terms of classical syndromes defined by impairment along these dimensions could not classify a majority of the patients. However, the dimensions on which such classification is based (Fluency, Comprehension, Naming, Repetition) form a useable descriptive system.


Recovery of children after severe head injury. Psychoreactive superimpositions.

After the regaining of consciousness and awareness in the strange environment of an intensive care unit, an injured child is exposed to a situation of extreme psychological impact. This situation, in addition to a probably organically changed reactivity, is liable to provoke a particular, abnormal psychic response. The abnormal reaction can follow the pattern of a feigned-death response and thus mimic an organic coma vigile (apallic state). The resulting psychoreactive stuporous state ("Sleeping Beauty syndrome") may lead to a misjudgement of the recovery degree and may delay early rehabilitation. With the help of a representative case, the clinical manifestation, course, and treatment of this reactive juvenile syndrome are presented. The interaction of physiogenic and psychogenic factors responsible for some psychiatric sequelae during the early period after head injury is emphasized.


The late neurological, psychological, and social aspects of severe traumatic coma.

Thirty patients who had survived a heavy head trauma and a post-traumatic coma, lasting for more than one week, were investigated 8 to 14 years after the trauma. The patients have been followed up from a social, psychological, and neurological point of view. Fifty per cent of these patients are considered to be well rehabilitated. All the investigated patients showed slight to severe reduction in mental capacity. Eighty per cent of the patients had neurological defects which were not as important with respect to social rehabilitation as was the mental capacity reduction.


Ventilatory capacity, working capacity and exercise-induced bronchoconstriction in a population sample of subjects with bronchial asthma or chronic bronchitis.

We have studied a representative population sample comprising 185 persons, aged 35-54 years, having certain respiratory symptoms and considered to have chronic bronchitis and/or bronchial asthma. There were 86 with bronchial asthma (without chronic bronchitis), 69 with chronic bronchitis (without asthma) and 30 with both chronic bronchitis and bronchial asthma. Fifty-one of the 116 asthmatics had reaginic bronchial allergy. In the groups with chronic bronchitis or bronchial asthma, the mean ventilatory capacities were slightly below the normal, being 89 and 91%, respectively, of the predicted values for FEV1 and 85 and 87% of those for MVV40. In the group of persons with both diseases, the mean FEV1 was 77% and the mean MVV40 84% of that predicted. Of the 21 persons with a mean FEV1 below 70% of that predicted 10 had both asthma and bronchitis. Exercise-induced bronchoconstriction, defined as a 15% fall of PEF after exercise, occurred in 22 of the 116 asthmatics and in one of the 69 persons with chronic bronchitis without bronchial asthma. In the asthmatics there was a significant correlation between resting PEF or the difference in PEF before and after orciprenaline inhalation on the one hand, and exercise-induced bronchoconstriction on the other hand. This was taken as an indication of increased bronchial hyperreactivity.


Evaluation of skeletal muscle tremor due to bronchodilator agents.

Two methods of measuring skeletal muscle tremor when evaluating this side-effect of treatment with bronchodilator agents are described. The first method, involving drawing a line between two sinus curves, is simple and requires no special equipment. Each time that the line crosses one of the sinus curves this is registered as an error. The large variation in results is a disadvantage but this drawing method can be used when more sophisticated devices are not available. Skeletal muscle tremor recorded with a Grass accelerometer gives accurate results provided the method is carefully standardized and the resting period adequate. The dose-response curves obtained during infusions of beta-adrenergic-stimulating drugs are linearly related to the dose given and are highly reproducible. The tremor ratio has the advantage over absolute values of smaller variations. The first of three 30-s periods registered gives the lowest tremor value and least variation, so this is the period used for analysis. Subjective experience of tremor is related to the Grass recording. In some cases, however, there is marked discrepancy between subjective and objective evaluation of tremor, which may be explained by the masking effect of concomitant heart stimulation. When tremor is related to heart rate in a single experiment a regression line is obtained. Another drug may give a different slope. The two slopes demonstrate the different selectivity of the drugs for the beta-receptors in the heart and skeletal muscle.


[Drug allergy damage to the blood ].

Drug induced blood dyscrasias, leukocytopenia, thrombocytopenia and hemolytic anemia were observed in 7% of 643 adverse drug reactions registered by drug monitoring in Bern, Switzerland, in the period 1970-1973. Life threatening reactions were consistently more frequent in hematological side effects (22%) than in the total of adverse drug reactions (6%). Blood dyscrasias induced by drug allergy are generally believed to belong to the allergic reactions of type II. Antigen-antibody reaction evolves in connection with cells of the blood, either by fixation of the drug itself or a metabolite on the cell surface, or by adsorption of primarily formed antigen-antibody complexes on the cell. In drug induced immune hemolytic anemia three types may be distinguished: 1. the innocent bystander type, caused by quinine, PAS, rifampicin and others, 2. the penicillin-type, caused by penicillins and cephalosporins, and 3. the autoimmune type caused by alpha-methyl-dopa etc. Agranulocytosis in Europe is most frequently due to pyrazolones, while phenothiazines play the leading role in the USA. In pyrazolone agranulocytosis an allergic pathogenesis is very probable, whereas phenothiazines probably induce agranulocytosis by a direct toxic effect on bone marrow cells. The clinical course in pyrazolone agranulocytosis is acute, whereas it is rather insidious in the phenothiazine type. The main drugs causing allergic thrombocytopenia are thiazide diuretics, quinine, quinidine and sulfonamides. Clinical aspects and therapy of drug induced blood dyscrasias are discussed.


[Effects of alcohol on the blood].

Acute alcohol intoxication, particularly in chronic alcohol abusers, leads to qualitative and quantitative changes in all three hemopoietic systems. In addition to a hemolytic effect through various possible mechanisms, functional abnormalities of granulocytes, immunocytes and marcophages and qualitative anomalies of platelets, alcohol exerts a toxic effect on cell production which cannot, or can only partially, be prevented by correction of the frequently demonstrable folic acid deficiency.


[Blood damage due to chloramphenicol and thiamphenicol].

Dose-related blood dyscrasias during treatment with either chloramphenicol or thiamphenicol chiefly include erythroid suppression and may be recognized at an early stage by observation of reticulocytopenia and an increased serum iron concentration. Ferrokinetic studies show the typical features of sideroblastic anemia. Whilst chloramphenicol is conjugated with glucuronic acid in the liver, thiamphenicol is predominantly eliminated by the kidney in its unmodified form. Sensitization  against both drugs has been described and may, following reexposure, lead to dangerous granulocytopenia. Potentially the most dangerous late complication after chloramphenicol treatment, i.e. aplastic anemia, has not thus far been observed in patients treated with thiamphenicol.


[Mesenteric infarct during digitalis poisoning].

So-called nonocclusive or spastic mesenteric infarction is a well-known complication of severe circulatory failure with low cardiac output and hypotension. In recent years, acute mesenteric insufficiency has been described in connection with certain drugs. Clinical and experimental evidence suggests a relationship between digitalis therapy, especially overdigitalization, and nonocclusive mesenteric infarction. Two cases are presented in support of this hypothesis. Both patients had digitalis intoxication and died from nonocclusive mesenteric infarction proven by surgery, autopsy and, in one case, arteriography. No cause other than digitalis intoxication (shock, severe cardiac failure or other drugs) could be found. Despite the frequent occurrence of digitalis intoxication, nonocclusive mesenteric infarction is a rare event. Interruption of digitalis therapy does not alter the usually fatal outcome. Experimental data with glucagon and phenoxybenzamine suggest that a therapeutic trial with these drugs might be worth while. Digitalis should be used with caution in shocked patients, since in these the splanchnic circulation is usually critical.


[Angiography in acute ischemia of the small intestine].

Diagnostic accuracy in the prediction of acute mesenteric ischemia from clinical symptoms and radiologic examinations (conventional radiography and angiography) has been analyzed in a retrospective study of 17 cases. The findings suggest that arteriography should always be performed if acute mesenteric ischemia is suspected on clinical grounds and from conventional radiography.


Speech perception by the chinchilla: voiced-voiceless distinction in alveolar plosive consonants.

Four chinchillas were trained to respond differently to /t/ and /d/ consonant-vowel syllables produced by four talkers in three vowel contexts. This training generalized to novel instances, including synthetically produced /da/ and /ta/ (voice-on-set times of 0 and +80 milliseconds, respectively). In a second experiment, synthetic stimuli with voice-onset times between 0 and +80 milliseconds were presented for identification. The form of the labeling functions and the "phonetic boundaries" for chinchillas and English-speaking adults were similar.


Ventricular obstruction: effect on drinking induced by intracranial injection of angiotensin.

Lesions of the subfornical organ (SFO) severely attenuated drinking induced by injections of angiotensin II into the lateral ventricles, but a few days (4 to 14) later a recovery of the drinking response is observed. A possible explanation for this is that other dipsogenic sites are involved which are beyond the interventricular foramen and that SFO lesions produce an obstruction by edema or debris at the foramen which blocks access of cerebrospinal fluid-borne angiotensin to those sites. This hypothesis is supported by tracer studies and by direct injection into the third ventricle of SFO-lesioned animals. Other studies reported implicate the anteroventral third ventricle as a likely site for angiotensin receptors.


Hyperbaric hydrogen therapy: a possible treatment for cancer.

Hairless albino mice with squamous cell carcinoma were exposed to a mixture of 2.5 percent oxygen and 97.5 percent hydrogen at a total pressure of 8 atmospheres for periods up to 2 weeks in order to see if a free radical decay catalyzer, such as hydrogen, would cause a regression of the skin tumors. Marked aggression of the tumors was found, leading to the possibility that hyperbaric hydrogen therapy might also prove to be of significance in the treatment of other types of cancer.


Delivery of a quaternary pyridinium salt across the blood-brain barrier by its dihydropyridine derivative.

A dihydropyridine-pyridine type redox system was successfully applied for delivering a quaternary pyridinium salt, N-methylpyridinium-2-aldoxime chloride (2-PAM), through the blood-brain barrier. The dihydropyridine derivative of 2-PAM was quickly oxidized to 2-PAM after crossing the blood-brain barrier. As a result of this approach, the brain cholinesterase blocked by organophosphates could be reactivated. The new method should be useful in delivering numerous drugs which are otherwise inaccessible to the brain because of their polar ionic character.


Genetic control of chloroform toxicity in mice.

Mouse strain differences suggest intermediate or multifactorial gentic control of chloroform-induced renal toxicity and death. The chloroform dose lethal to 50 percent of animals was four times higher in C57BL/6J males than in DBA/2J males. Twice as much chloroform accumulated in the kidneys of the sensitive as the resistant strain. First generation offspring were midway between parental strains for both parameters.


Monthly gonadotropin cycles in premenarcheal girls.

Patterns of nocturnal excretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were investigated in 11 girls. Autoregressive digital filtering of low- and high-frequency variations was used to make patterns more apparent. Coincident FSH and LH surges, separated by an interval of 20 to 40 days, were seen in specimens from three of six postmenarcheal girls and three to five premenarcheal girls. This suggests that cyclic hypothalamic-pituitary-ovarian interactions occur before menarche.


Somatostatin suppresses secretin and pancreatic exocrine secretion.

Somatostatin, a hypothalamic peptide, suppresses hydrochloric acid-stimulated release of secretin, pancreatic flow rate, and bicarbonate and protein secretion in fasted, conscious dogs. It also reduces nonstimulated pancreatic exocrine secretion but does not affect basal secretin concentrations. Suppression of HCl-stimulated secretin release is complete, whereas pancreatic flow rate and bicarbonate and protein secretions are only partially inhibited. The action of somatostatin is rapid in onset and quickly reversible.


Satiety: a graded behavioural phenomenon regulating caloric intake.

Rhesus monkeys inhibited their feeding in response to intragastric nutrient preloads, so as to maintain a constant caloric intake. There is a definite dose- response relationship to calories which does not depend on the volume, caloric concentration, or nature of the nutrient. This accurate control is accomplished even though some of the preload remains in the stomach throughout the feeding period.


Sexual inhibition is reduced by rostral midbrain lesions in the male rat.

Electrolytic lesions in a circumscribed area of the rostral midbrain of rats shortened the inhibitory period following ejaculation, thereby increasing the number of ejaculations achieved in 1-hour tests. These lesions also interrupted the dorsal norepinephrine bundle as reflected in a 63 percent reduction in telencephalic or cortical norepinephrine.


Vibrational states of the biopolymer polyglycine II: theory and experiment.

The density of vibrational states, and hence the heat capacity, has been calculated for the parallel-chain hexagonal lattice of 3(1) helical polyglycine. The agreement with experimental results in the temperature range from 1 to 20 K, including an anomaly near 8 K, is the best obtained thus far for homopolypeptides.


Tetrahymena: growth without phagocytosis.

We have succeeded in growing a Tetrahymena mutant without food vacuoles in growth media supplemented with vitamins and heavy-metal salts. This finding implies the existence of adequate alternative routes of entry for every required nutrient, and clearly indicates that the food vacuole in Tetrahymena is a dispensable cellular organelle. The growth of the mutant without food vacuoles makes available a valuable experimental tool.


Insular biogeography: of mice and mites.

The number of mite species using cricetid rodents in North America is related to the host distributional areas. The age and latitude of the distributional areas have unimportant effects on the number of mite species using a rodent species. The relation between species and areas is analogous to species equilibrium numbers of island faunas.


Leukemia virus-induced immunosuppression: scanning electron microscopy of infected spleen cells.

Spleen cells from mice infected with Friend leukemia virus were examined by scanning electron microscopy. Whereas splenocytes from normal noninfected animals showed the expected morphologic classes of lymphocytes, including those with smooth surfaces and with numerous villous projections, an alteration of cell type was evident within a few days after infection. Friend leukemia virus caused a rapid decrease in the number of villous cells, with a concomitant increase in the number of cells with smoother surfaces. By the end of the first 1 to 12 weeks after infection the majority of cells were smooth, many showing distinct morphologic changes, including "holes" and a spongy appearance. Nearly all of the splenocytes were abnormal in appearance by days 17 to 30 after infection, with most showing a spongy topography. These changes paralleled the marked immunosuppression induced by Friend leukemia virus infection, as well as the appearance of virus-associated surface antigen on individual splenocytes. Topographic changes evident by examination with scanning electron microscopy were not readily apparent by either standard histology or transmission electron microscopy.


Parathyroid hormone and 25-hydroxy vitamin D3: synergistic and antagonistic effects on renal phosphate transport.

The effect on phosphate excretion of graded doses of parathyroid hormone (PTH) and the biologically active vitamin D3 metabolite, 25-hydroxycholecalciferol (25-HCC), administered singly and in combination, were studied in the nonexpanded, vitamin D-depleted thyroparathyroidectomized rat. Infusion of 1 unit of 25-HCC per hour for 6 hours induced an antiphosphaturia only when administered with 0.2 units of PTH per hour, while neither agent alone changed phosphate excretion. A dose of 2.0 units of PTH per hour did not cause phosphaturia unless given with 1 unit of 25-HCC per hour. In pharmacologic dosage (5 units per hour), PTH produced phosphaturia in the absence of the metabolite.


Behavioral characterization of d- and l-amphetamine: neurochemical implications.

Various doses of d- and l-amphetamine affect the temporal pattern of rat behavior in the following ways: First, the patterns of activity produced by d- and l-amphetamine are similar but out of phase; that is, the response to d-amphetamine has a relatively shorter latency whereas the effects of l-amphetamine persist for longer periods of time. Second, d-amphetamine is approximately five times as potent as l-amphetamine in its effects on both the total amount of locomotor activity and the duration of stereotypy. Both amphetamine-induced locomotion and stereotypy may be mediated by the same neurochemical mechanisms.


Neural connections of sparrow pineal: role in circadian control of activity.

Surgical and chemical interference with the neural connections of the house sparrow (Passer domesticus) pineal does not abolish the free-running rhythm in constant darkness, unlike pinealectomy. Pineals transplanted to the anterior chamber of the eye are capable of restoring rhythmicity to pinealectomized birds in constant darkness. The avian pineal does not appear to be neurally coupled to other components of the circadian system.


The Müller-Lyer figure and the fly.

In the Müller-Lyer illusion two horizontal line segments of equal length are perceived by humans as unequal. The gaze of a fly presented with Müller-Lyer figures corresponds to human eye movements and human (illusionary) evaluations of the segment lengths. It is suggested that a theory similar to the phenomenological theory which accounts for the fly's gaze may account for the human eye's movement during an observation of Müller-Lyer figures.


Auditory fatigue: retrocochlear components.

Changes in auditory sensitivity were measured at the VII nerve, cochlear nucleus, and inferior colliculus after a fatiguing sound exposure. Losses in sensitivity progressively increased from peripheral to central auditory sites. The results suggest that there is a retrocochlear component to auditory fatigue when it is induced by low-level sounds of short duration.


Time-dependent effects of phenothiazines on dopamine turnover in psychiatric patients.

Psychiatric patients studied early during treatment with chlorpromazine and thioridazine demonstrated elevated probenecid-induced accumulations of homovanillic acid, a major dopamine metabolite, in cerebrospinal fluid. In those studied after longer periods of treatment with phenothiazines, homovanillic acid values were not elevated. This suggests that there are time-dependent effects of phenothiazines on dopamine turn-over that may be relevant to the time course of antipsychotic efficacy.


Experience with renal vein renin ratios in the identification of a pressor kidney.

The positive, preoperative recognition of a pressor kidney has many important ramifications, the most important being the ability to predict a reduction in blood pressure following surgical reconstruction or nephrectomy. One hundred forty hypertensive patients were selected for study for renal artery stenosis by measuring the differential plasma renin activity by either radioimmunoassay or bioassay. Bilateral renal vein renin determinations and renal arteriography were made consecutively in supine position and without stimulation of renin secretion. Unilateral or bilateral renal artery stenosis was found in 55 patients (39%). Twenty-eight of the 55 patients (51%) were treated surgically. Eighteen patients (64%) were cured of hypertension and seven (25%) were improved. All but one of the surgically treated patients had renal vein renin ratios of greater than 1.3 on the affected side over the unaffected or less-affected side. Increasing the ratio to greater than 1.5 or greater than 2.0 as a criterion for selection of patients for operation would not have decreased the failure rate. If used as the only criterion, increasing the ratios would have resulted in nonsurgical treatment of up to 50% of the patients cured or improved by surgery. Stimulation of renin secretion, although not used in this study, has been shown by others to more accurately identify a pressor kidney by increasing differential renal vein renin ratios. Although a combination of renin activity with renal plasma flow may lead to more accurate diagnosis, a careful clinical evaluation has not yet been replaced as the best method of selection of the patients for operation.


Psychiatric illness associated with systemic lupus erythematosus.

Estimates of the frequency of mental changes associated with systemic lupus erythematosus (SLE) range from 3% to 65%. Variations in classifying and reporting symptoms account for much of the difficulty in determining the true incidence. Other problems in study design also make it difficult to compare results of various studies, although it appears that psychiatric illness associated with SLE falls into two categories: organic and functional disorders. The former occur in 22% to 29% of patients having SLE and rheumatoid arthritis and are associated with a poorer prognosis and higher mortality. The latter occur in 18% to 35% of SLE patients and slightly less in patients with rheumatoid arthritis. Several possible causes for mental changes of SLE have been proposed. The case of a patient with SLE having an acute psychotic episode illustrates the possible roles of premorbid personality, mental and environmental stress, and steroid therapy in precipitating psychiatric illness in SLE.


Total urinary estrogens in complicated pregnancies.

One hundred fifty-seven pregnancies complicated by different degrees of diabetes, toxemia, and hypertension were studied with serial urinary placental estrogen determinations. A simple and fast method for total placental estrogen determination was used. The level of total estrogen excretion was related to Apgar score in cases of class B diabetes, severe toxemia, and also in moderate toxemia when estrogen excretion was falling. Mean estrogen levels did not differ as a function of severity of diabetes. Levels did differ with severity of toxemia; however, only the difference in mean estrogen excretion between mild and severe toxemia was significant. Estrogen excretion was very low in hypertension but was not related to Apgar score. This study concludes that total urinary estrogens constitute only a single parameter necessary in the management of high-risk pregnancies.


The role of interstitial sources in radiotherapy.

Interstitial sources of radiation are a useful and sometimes essential modality for achieving optimal dose distribution in radiotherapy. This paper presents examples of various applications of this technic. The essential advantage is not that survival statistics can be improved, but rather that whatever can be accomplished by ionizing radiation may be accomplished at a lesser cost in time, effort, and morbidity by judicious use of an interstitial radiation component.


Management of pancreatic ascites.

Two patients with persistent pancreatic ascites are presented. Both were managed successfully by internal drainage. A trial of nonoperative treatment with nasogastric intubation and intravenous hyperalimentation is advocated for patients with pancreatic ascites. Patients who fail to improve usually have a pancreatic duct disruption and should have internal drainage operation and/or distal pancreatic resection.


Cancer of the vagina.

Carcinoma of the vagina may be found in association with carcinoma of the vulva and cervix. Patients with neoplasms in any of these locations should have careful inspection of the entire anogenital tract. As in all malignancies, early diagnosis and prompt, adequate treatment offers the best opportunity for cure.


Delayed open reduction of isolated fractures of the femoral shaft.

Twenty-five isolated fractures of the femoral shaft treated by delayed open reduction and internal fixation are reported. On the average, operation was done 13.4 days after fracture. Several early postfracture complications, including fat embolism in 20% of the cases, were resolved before operation. There were no nonunions, refractures, or deep infections. Delaying operation until revascularization and callus formation are under way ultimately produces less tissue destruction and ischemia and may partially explain the decreased incidence of infection seen in this series.


Further observations on 85Sr scintimetry in intracapsular fracture of the hip.

Sixty-seven hip joints with intracapsular fracture and the 67 opposite, normal hip joints were studied with 85Sr scintimetry from two weeks to six years after fracture. Consistently, fractures that developed osteonecrosis showed extremely high counts at the fracture site and the femoral head; fractures that failed to unite also showed extremely high counts at the fracture site and somewhat lower counts in the femoral head; fractures that were healing normally showed counts at the fracture site that were higher than those of the normal, uninjured hip but lower than those at fracture sites where osteonecrosis or nonunion was present. Prediction of complications by 85Sr scintimetry is not reliable within the first few months on injury; thereafter, however, the procedure has definite diagnostic value, particularly for osteonecrosis.


Differential diagnosis of midline facial granulomas.

The list of differential diagnoses in the case of midline facial granulomatous lesions is long. Intensive investigation into the true origin of disease must be done before definitive treatment can be begun. Extensive and repeated biopsies are necessary. The diagnosis may narrow down to the nonspecific midline lethal granuloma. Evidence in the literature coupled with our experience strongly indicates that this disease does not exist as a pathologic entity but merely as a clinical syndrome which upon further evaluation will reveal either Wegener's granulomatosis or a reticulum cell neoplasm. Treatment of the syndrome consists of corticosteroid drugs, irradiation, and chemotherapy until a definitive diagnosis is made. Midline granulomas have been and will continue to be a challenging diagnostic and therapeutic problem for the otolaryngologist.


Serologic study of toxoplasmosis in Taiwan.

Toxoplasma gondii antibody titers as determined by either the indirect hemagglutination test or the methylene blue dye test were determined for a group of aborigines and for Chinese as well as for swine, cats, rats, dogs and one bovine, all resident on the island of Taiwan. None of the 194 aborigines and  only 3 (1.97%) of the 152 Chinese were found to be positive. Of 433 swine tested 132 (30.5%) were positive. Thirteen (27.7%) of 47 domestic pet cats were positive while none of 11 feral cats were positive. None of the 29 rats, 3 dogs or the one bovine were positive. Possible reasons for the lack of infection in Chinese is discussed.


Studies on filariasis in the Pacific. 4. The application of the membrane filter concentration technique to a survey of Wuchereria bancrofti filariasis in Kepu district, Jakarta, Indonesia.

A blood survey for filariasis was carried out in the Kepu District of Jakarta. Examination of stained 20 c.mm finger-prick blood thick films and membrane filter concentration (MFC) of 1 ml venous blood. The youngest age group examined, 5-9 years old revealed a mf rate of 17% of which 71% were of a low density character detected by MFC only. The mf rate appears to remain relatively constant from the 10-14 year old group onward, approximately 35%, but at all age groups at least half the infections were of low density. The highest mf rate and density was observed present in the 15-20 year old group.


Repeated infections of Brugia pahangi in the jird, Meriones unguiculatus.

Male jirds, Meriones unguiculatus, were subcutaneously inoculated in the groin with 1 to 5 doses of infective-stage larvae of Brugia pahangi at weekly or monthly intervals. When a dose of either 25 or 75 larvae or 4 weekly doses of 25 larvae were given, 15-16% of the larvae were recovered as adults approximately 4 to 7 months post inoculation. Only 8-10% of the larvae were recovered if 4 weekly or 5 monthly doses of 75 larvae each were given. After an inoculation of 75 larvae, 25% of the worms were recovered at 30 days. The 30 day-old population consisted of an average of 10 female and 8.8 male worms. Jirds previously inoculated with 4 weekly or 5 monthly doses were challenged with an additional 75 larvae 30 days prior to necropsy. An average of only 4.5 thirty day-old female worms were recovered in these cases, presenting a 55% decrease as compared to the single inoculation situation. There was some decrease in the mean length of female worms in multiply-inoculated jirds, but no difference in the mean lengths of the male worm population from singly or multiply-inoculated jirds was observed. No differences in prepatent periods or in patterns of microfilaraemia were observed in singly or multiply-inoculated jirds.


Studies on filariasis in the Pacific. 5. Brugia malayi filariasis in treated and untreated populations of South Borneo.

A blood survey employing membrane filter concentration (MFC) and examination of stained 20 c.mm thick blood films as diagnostic methods was carried out in Banjar Regency of South Borneo, an area of endemic B. malayi filariasis. In untreated populations the mf rate, as revealed by MFC, ranged from 23.2% for the 5-9 year old group to 43.7% for the greater than 50 year old group. For all age groups approximately one half of the microfilaraemias were of a low grade nature, diagnosed by MFC only. In a population that had been subjected to mass DEC administration 1 1/2 years prior to this survey, the MFC-diagnosed rate was 15%. Approximately two thirds of these infections were of very low density, the average density being 2.2 mf/ml.


Studies with Brugia pahangi. 11. Measurement of lymph flow in infected cats.

Rates of lymph flow in cats were measured by calculating the disappearance of radioactive colloidal gold (198Au) from the feet of (1) uninfected cats, (2) cats infected for various periods after primary infection with Brugia pahangi, and (3) cats repeatedly challenged with B. pahangi infective larvae over long periods. The results of the study showed that (1) there is great variation in gold disappearance rates in different cats in all 3 groups above, (2) the cat lymphatic system is functionally highly efficient, and (3) in a cat with lymphoedema and early elephantiasis, there was a significant impairment of gold removal from the affected foot. The study proved useful in finding lymph drainage rates in the various animals but did not, as hoped, show any pattern of lymph flow decrease which might have enabled the use of the technique as a diagnostic tool for lymphatic pathology prior to the occurrence of external clinical manifestations of filariasis.


Distribution of Oncomelania hupensis in the Napu Valley of Central Sulawesi, Indonesia.

Fifteen colonies of Oncomelania hupensis were found near trails transecting the North Lore District, Napu Valley, Central Sulawesi. Habitats were in abandoned rice fields, uncultivated grazing areas for livestock, roadside ditches and, in one case, an actively worked rice field. Marsh grasses, Ischaemum barbatum and Laersia hexandra, were the most common plants in oncomelanid habitats. Other mollusks found in association with O. hupensis were Radix sp., Melanoides sp., Gyraulus sp., Idiopoma sp., Thiara sp., Opeas sp. and Indopyrgus sp. in that order of frequency. Schistosoma japonicum cercariae, as determined by mouse exposures, were shed from snails collected at four foci. In Sulawesi, O. hupensis and S. japonicum were found in high mountain valleys near, or above, 1,000 meters in elevation. Oncomelania hupensis, however, were not found in what appeared to be suitable habitats at lower elevations in the same drainage systems.


Mekong schistosomiasis. 4. A parasitological survey of wild rodents, domestic pigs and cattle on Khong Island, Laos.

No evidence of infection with the Mekong Schistosoma was found in 12 Rattus exulans, 81 R. r. molliculus, and 10 Bandicota savilei caught in the vicinity of and downstream from the schistosomiasis transmission focus on Khong Island, South Laos, and examined by dissection and portal perfusion. Likewise, no eggs of the Mekong Schistosoma were detected in faeces of 15 domestic pigs or 43 domestic cattle examined on Khong Island both by merthiolate-iodine-formalin concentration and by the hatching technique. These results suggested that the wild rodents listed above, as well as pigs and cattle in the vicinity of Khong Town, may not contribute significantly to the transmission of the Mekong Schistosoma under present conditions.


Comparative morphology of genital cones of genus Ancylostoma Dubini, 1843.

Male worms of Ancylostoma braziliense, A. ceylanicum, A. kusimaense, A. malayanum, A. duodenale, A. caninum, A. tubaeforme, Agriostomum vryburgi and Cyclodontostomum purvisi have the external appendages beside the anogenital aperture. These anogenital structures are morphologically similar and are assumed to be homologous among the species with three pairs of teeth or more. In hookworms with two pairs of teeth, the anogenital structures are complex. Anogenital features can be used as a taxonomic character in separating the species.


Distribution and ecological consideration of Breinlia booliati infecting wild rodents in Malaysia.

Seven of the 18 species of lowland forest terrestrial and semi-arboreal murids were found naturally infected with Breinlia booliati. Of these, two species, Rattus sabanus and R. cremoriventer, were found to be the most preferred hosts. None of the murids from the highland, field or human-inhabited areas was infected. This could have been due more to the greater scarcity of the vectors in these habitats than to the susceptibility of the hosts. The absence of this parasite in the squirrels examined may be attributed either to host specificity or to the normal activity cycles or vertical stratification of the vectors, separating them in space and/or time from the squirrels. The pattern of dispersion of the parasite is influenced by the wide distribution of suitable hosts, and the hypothesis that the parasite is of forest origin is discussed.


Fluoride studies in Malaysia.

Twenty-four-hour urine samples and whole deciduous teeth from fluoridated (0.71 ppm) and non-fluoridated (0.14 ppm) areas together with some selected local food items were analysed for their fluoride content. The mean values for urinary fluoride were 0.90 ppm or 0.77 mg per day for the fluoridated area and 0.50 ppm or 0.52 mg per day for the non-fluoridated area. Assuming that half of all the fluoride ingested is excreted in the urine, this study suggests that the average daily fluoride intakes by adults in the fluoridated and non-fluoridated areas were about 1.5 mg and 1 mg respectively. The mean fluoride content of non-carious deciduous teeth from the fluoridated area was 416.89 ppm compared to 178.45 ppm in the low fluoride area.


Clinical classification of perinatal deaths.

The purpose of classifying perinatal mortality is to assist in its prevention. A clinical classification has been devised an applied to 506 perinatal deaths which occurred among 15 251 deliveries in the Peninsula Maternity Services in Cape Town during 1972. Prematurity, accidental haemorrhage and fetoplacental inadequacy are the three main causes of perinatal loss. There appears to be a lower incidence of congenital abnormalities in the Cape Cape Coloured community. Detection of the premature labour group, the aplication of prevention and the early delivery of the fetus which is unable to withstand the stress of intra-uterine life will lower the perinatal mortality rate.


Dermatitis and keratoconjunctivitis caused by a prickly pear (Opuntia microdasys).

Two patients were affected by the barbed bristles of the ornamental cactus Opuntia microdasys, a small prickly pear plant. Dermatitis occurred in both patients and consisted of itchy papules produced by implantation of the glochids. One patient developed a severe keratoconjunctivitis in the right eye, which cleared after a glochid had been located in the palpebral conjunctiva, and removed. The glochids were studied under light and scanning electron microscopes and their structral details are described.


The trace elements: A new chapter in nutrition.

Formerly reported by analysts as being present as "traces", the minute amounts of many elements present in plant and animal materials can now be detected and estimated with a remarkable degree of sensitivity and accuracy. Some of this heterogenous group of metals and nonmetals have been shown to be essential for life or for the well-being of animals, including man; others possess toxic properties, while yet others are probably there as contaminants. Although present in such extremely small quantities, those known to be essential play highly individualistic as well as astonishingly varied roles in our metabolic processes; they must, therefore, take their place with the other nutrients needed in our diet.


The irritable bowel syndrome in the urban South African Negro.

The 'irritable bowel syndrome' is a disorder of civilisation, in which a low-residue fibre-deficient diet is probably the major aetiological factor. This is illustrated by the first 2 Black patients presenting with this syndrome. They represent a population which has only recently changed from a rural to an urban way of life.


Digestibility of protein and dry matter in caecectomised and intact rats.

The dry matter digestibility (DMD) of sifted granulated maize meal and the digestibility of the protein in yellow haricot beans were determined in intact and caecectomised rats. The experiments were done to ascertain whether microbial activity in the caecum has an effect on the digestibility. Removal of the caecum resulted in a decrease of 9 percentage units in the DMD value but had no appreciable effect on the protein digestibity data.


Biological assessment of protein quality. Essential amino acid requirements of young rats in certain states of nitrogen balance.

The nutritive value of dietary proteins depends on, inter alia the degree of correspondence between the essential amino acid (EAA) content of the protein and the EAA requirements of the animal in question. In the present study the EAA requirements of the young male rat for the maintenance of nitrogen balance equal to 0; + 100; + 200; or + 300 mg N/100 g body mass/8 days were estimated. It was found that, probably because of time-dependent adaptive changes, there are differences, mainly between the EAA pattern for maintenance of N balance = 100 mg and higher. This finding is discussed with reference to its bearing on the methodology of protein evaluation and on the assessment of EAA requirements in general.


Staging laparotomy with splenectomy in Hodgkin's disease.

Staging laparotomy, consisting of splenectomy and biopsies of liver, lymph nodes, and bone marrow, is a very useful adjunct in the workup of a patient with Hodgkin's disease. In this series of 400 patients, 1 percent required reoperations for complication, 3.7 percent had major complications, and 14 percent had minor complications from the operation. Further evidence of Hodgkin's disease was discovered in 42 percent of the cases and a change from the clinical to the pathologic stage occurred in 27.5 percent of these cases. The surgeon's task in the treatment of Hodgkin's disease and other malignant diseases is to document and mark the areas of involvement so that accurate and appropriate therapy can be given, while minimizing morbidity and mortality.


Regionalization of trauma patient care: the Illinois experience.

1. A program of regionalization of critically injured trauma patients has been ongoing in Illinois since July 1, 1973. 2. The Illinois trauma system was initiated with the functional categorization of some 47 local, areawide, and regional and three special regional hospital trauma centers strategically located across the state, and established a frame-work for a statewide comprehensive emergency medical services program. 3. Program concepts, subsystems components, and trauma registry clinical data have been presented to describe the dynamics of this trauma-EMS care system. 4. Trauma patient care, because of its complex requirements, provides an excellent model from which to design a basic emergency health care delivery system, and one that can be expanded to include all types of emergency medical problems. 5. Because of the obvious demanding clinical needs of critically injured trauma patients for comprehensive care and the necessity for consolidation of medical resources for these patients at all community levels, surgeons should take a leadership role in regional and areawide trauma-EMS planning and implementation in their local communities.


Effects of anesthetics on the kidney.

All general anesthetics employed clinically have significant and reversible effects on renal hemodynamics, water, and electrolyte excretion at concentrations in which they are usually employed for surgical anesthesia. Some of the mechanisms by which these effects are produced are discussed. The minmal depressant effect on renal function of epidural anesthesia is possibly related to local anesthetic effects on the central system and/or the kidney. Methoxyflurane has been demonstrated to produce renal dysfunction when administered in high concentrations for prolonged periods of time to obese patients. Metabolites of methosyflurane including fluoride and/or oxalate appear to be the cause of this problem. Problems of anesthetic management in patients with renal failure have been briefly summarized with specific attention to the undersirable effects of some neuromuscular blocking drugs.


Primary and adjunctive therapy in carcinoma of the adrenal cortex.

The absence of a clinically useful staging system for carcinoma of the adrenal cortex has permitted undue pessimism to develop and prevented effective evaluation of postoperative adjunctive therapy. The records of 15 patients undergoing operation for carcinoma of the adrenal gland were studied, and a staging system is proposed. The correlation between the proposed clinical stages and a patient's survival time was highly significant. An aggressive surgical approach toward both the primary tumor and the isolated metastatic lesion appears warranted. In those patients with functioning tumors, determination of urinary steroid levels provides early evidence of recurrence.


Family studies of malignant melanoma and associated cancer.

This study comprises five cancer prone families with one or more occurrences of melanoma in context with a variety of other histologic types of cancer, including an excess of multiple primary malignant tumors. The genetic mode of transmission of cancer in each family was consistent with a dominant factor which has seemingly predisposed these patients to a general cancer diatheses. The tumor spectrum included malignant melanoma and cancers of the breast, gastrointestinal tract, lung and lymphoproliferative system. Recently, S1 and S2 antigens were noted to occur with malignant melanoma and the same variety of tumors which have occured in these five families.


Hemopneumothorax following blunt trauma of the thorax.

Hemopneumothorax is a frequent sequel of blunt trauma of the thorax and is easily treated if it occurs without associated injury. As an isolated injury, it is accompanied by a low mortality rate, 2 per cent in this series of 330 patients. The principal treatment for hemopneumothorax was tube thoracostomy with large bore chest tubes. Initial thoracotomy was required for 3.3 per cent of the patients, and late thoracotomy for complications was necessary only in 1.2 per cent of the patients. The over-all mortality rate of 20.3 per cent reflected the many associated injuries. Extrathoracic trauma played a significant role in 44 of the 67 deaths.


Radiothelemetric monitoring of hydrogen ion levels of the small intestine.

A radiotelemetric technique was used to document the pH level within the intact small intestine of the dog. It was found that the pH in the area of the upper part of the jejunum ranged in a neutral zone between 6 to 7 in the fasting dog. Stimulation of the Thiry-Vella loop in these dogs, with either acid or alkaline solution, always resulted in the pH rising toward a higher level, the highest pH level being recorded as 8.2. All dogs demonstrated a lowering of this pH level toward a neutral range of 6 to 7 within three hours after Thiry-Vella loop challenge.


Experimental evidence for a significant impairment of host defense for gram-negative organisms by a specific cutaneous toxin produced by severe burn injuries.

Dry heat forms a specific burn toxin in mouse and human skin from a naturally occurring precursor by a polymerization process and not by producing breakdown products. Precursor and toxin are both macromolecular lipid-protein complexes with similar chemical composition and physical structure both occurring in mouse and human skin as well as in serum of burned patients. Specific toxicity resides only in the apoprotein of the polymeric toxic form which also has new specific artificially produced antigenic site or sites. This phenomenon makes it possible to jump the species from man to mouse, shown by the success of specific immunotherapy. Neutral apolar lipids of the coat are contributing in an unspecific but significant manner to the toxic effect. Bacteria are not involved in toxin production nor in toxin activity. The target systems of the toxin are the cell wall membranes of all parenchymal cells of paractically all organs. The toxin apparently causes severe damage of the membrane verified by an increased permeability for compounds which otherwise do not penetrate. This basic cell damage itself is able to kill the animal, depending on the ratio of intact to damaged cells. Sublethal doses of toxin, however, prepare the background upon which bacteremia in burn injuries leads to a lethal sepsis. Finally, the direct toxic action as well as the enhancement of the susceptibility for gram-negative organisms both leading to the lethal outcome can be counteracted by specific passive antitoxic immunotherapy.


Treatment of carcinoma of the rectum by intracavitary irradiation.

Intracavitary direct contact irradiation can be used in the treatment of carefully selected patients with carcinoma of the rectum. The treatments last three minutes and are adminstered on an out-patient basis for three to five treatments with no limitation of activity. The treatments are given two weeks apart. In 25 patients, there has been no morbidity or mortality as a result of the treatments. In two patients, poorly differentiated carcinomas were not controlled, and subsequent abdominoperineal resection was required. This method of treatment should be available to more radiotherapists so the actual potential of this modality can be ascertained.


Symptomatic lipomas of the gastrointestinal tract.

Eleven patients with symptomatic lipomas of the gastrointestinal tract have been observed. The lipomas generally are relatively large, and the signs and symptoms consist mainly of abdominal pain and chronic blood loss. These lesions most commonly are seen in the colon and in the region of the ileocecal valve and less commonly in the small intestine, stomach and esophagus. Distinguishing thest tumors from carcinomas or sarcomas may be difficult, and patients are generally in the same age range as those with cancer. Roentgenologic contrast studies are helphful in localizing the tumors, but accurate tissue diagnosis usually is not made until the lesions are excised. Operative management by either local excision or segmental resection is required, and the prognosis is excellent.


Oophorectomy for advanced carcinoma of the breast.

From 1960 to 1972, 639 patients have undergone bilateral oophorectomy for carcinoma of the breast. The over-all regression rate was 29.5 per cent; regressions lasted on an average of 16 months, and 19 per cent of the patients who responded to surgical castration survived five years or longer. The best results were achieved when the patients were premenopausal and over 35 years of age or not more than one year menopausal, if the free interval was longer than two years or if the patient had primary advanced carcinoma and when the lesions were localized to the soft tissues, bones, lung and pleura. Attempts to demonstrate the hormone-dependence of the tumor by correlating the response rate to preoperative urinary steroid determination or by cytologic examination of the vaginal smear were inconclusive.


Evaluation of the effect of fundoplication on the incompetent lower esophageal sphincter.

The increase in tension of the gastroesophageal high pressure zone after fundoplication and hiatal hernia repair could represent either a mechanical effect or enhanced smooth muscle tone of the lower esophageal sphincter. Determination of the response of this high pressure zone to cholinergic stimulation, a protein meal and deglutition before and after Belsey Mark IV fundoplasty in seven patients with intractable reflux indicates the latter. Fundoplication resulted in a resting tension of the high pressure zone significantly greater than that found preoperatively but similar to that of controls. This normotensive postoperative high pressure zone had properties of a physiologic lower esophageal sphincter, that is, normal relaxation to deglutition, a response to a protein meal and a response to cholinergic stimulation with edrophonium. In response to edrophonium, evidence of a partial improvement in lower esophageal sphincter smooth muscle function was found postoperatively when compared with the response of controls and in patients preoperatively. The response to a protein meal postoperatively remained similar to that noted preoperatively, which was significantly less than the response of controls. Therefore, the increase in tension of the high pressure zone after fundoplication and hiatal hernia repair appears to result from improved function of the lower esophageal sphincteric smooth muscle.


A new probe for measurement of muscle pO2 and its use during cardiopulmonary bypass.

Results of recent studies have shown that skeletal muscle pO2 measurements provide an excellent index of peripheral tissue perfusion. Until recently, equipment required was large and difficult to operate. A small new disposable sensor was used upon ten patients during an open-heart bypass operation. Preliminary results clearly indicate a significant decrease in oxygen delivery to peripheral muscle tissue during nonpulsatile bypass. The miniature oxygen probe used in this study functioned well in providing continuous muscle pO2 levels. Not only can it be used to monitor muscle pO2 during total body bypass but also could be used readily in other areas, such as monitoring changes in tissue pO2 during surgical revascularization or during other clinical situations requiring critical care.


Fibrinolytic treatment of postoperative deep venous thrombosis.

Eleven patients with deep venous thrombosis were treated with streptokinase. Lysis of thrombi and prevention of pulmonay embolism were achieved in eight patients. Bleeding from the operative wound necessitated transfusions in seven patients. Fibrinolytic treatment of deep venous thrombosis lyses the floating portion of the thrombi. Protection against pulmonary embolism may be expected. The fibrinolytic effect of streptokinase is rapid; its value can be answered only by follow-up examinations.


The source and removal of microaggregates in aged human blood and human blood components.

Microaggregates are formed during the storage of human blood and are composed largely of platelets and leukocytes. These microparticles reside in the buffy coat fraction of blood. The formation of microaggregates can be successfully prevented by removal of the buffy coat or by treatment of blood with drugs which inhibit platelet function prior to storage. Once formed, the volumes of microaggregates in aged blood can be significantly reduced by washing, centrifugation or treatment with urokinase or streptokinase. Glycerol frozen red blood cells and blood components--packed red blood cells and plasma--are free of microaggregates, and they can be infused without fear of embolic consequence.


Stratification of bile in gallbladder and gallstone formation.

The essential role of the gallbladder in gallstone formation should not be underestimated, as cholesterol stones originate in the gallbladder. The possible significance of stratification of bile in the gallbladder has been studied using recently proposed lithogenic parameters, such as triangular co-ordinates, lithogenic index and cholesterol saturation index. Bile becomes less lithogenic as the concentrating process in the gallbladder progresses. The concentrating activity of the gallbladder seems to differ considerably for each bile constituent. Bile salts are most concentrated in the gallbladder, followed by phospholipids and cholesterol. The presence of a selective absorption process in the gallbladder is suggested. As the gallbladder diminishes the lithogenicity of bile during storage, its role probably lies in its ability to interrupt the enterohepatic circulation leading to the production of lithogenic bile as well as providing a recess to ensure continuous growth of stones.


Breast biopsies on outpatients.

One hundred and three excisional biopsies of breast masses were done on an outpatient basis under local anesthesia. The criteria for selecting patients were such that only two malignant tumors were found, and 101 unnecessary hospital admissions were avoided. A large majority of patients responding to our survey accepted or even preferred the outpatient, local anesthetic technique. Thirteen of 16 patients who had previous inpatient biopsies under general anesthesia preferred biopsy as an outpatient under local anesthesia. This idea is not new, but new economic and social conditions as well as developing diagnostic techniques now increase its potential value.


A technique for drainage through the bed of the twelfth rib.

Operations in the upper part of the abdomen with anticipated large postoperative collections are best drained through the most direct and dependent route. An effective method through the bed of the twelfth rib, which uses intra-abdominal resection of the rib and a wire suture for locating the drains, has proved satisfactory without compromising dependency or directness. It can be used for the insertion of Penrose drains or a sump catheter with equal effectiveness.


Levator ani as substitute puborectalis sling in treatment of anal incontinence.

For anal incontinence caused by destroyed or absent sphincter mechanism, a levator sling serving as a substitute puborectalis sling was used in five patients with incontinence of varied causes with good to excellent results. This sling was constructed bu freeing the insertion of the pubococcygeus and the ileococcygeus muscles from the coccyx. By further freeing the arcus tendineus from the lateral wall of the pelvis, the sling is made to arise from the pubis, thus theoretically giving the sling the potential of greater traction.


Topical lidocaine in treatment of cerebral vasospasm.

Relief of segmental spasm in monkeys was obtained using topical lidocaine after experimental subarachnoid hemorrhage. Dilatation of spastic vessels was also observed in patients following lidocaine application during operations. The segments of arteries approximating the clipped aneurysm were noted to be dilated angiographically in certain cases.


Epidural hematoma.

A report is given on 80 consecutive patients with epidural hematoma. The mortality was 16%. The rate of disability among the survivors was 20%. The classical clinical course with a lucid interval was seen in five patients only. The classical neurological signs of an epidural hematoma, contralateral hemiparesis, and ipsilateral third nerve palsy were seen in 15 patients, i.e., 19%. The main factors associated with increased mortality and morbidity were concomitant brain injury, rapid development of the hematoma and unconsciousness at the time of operation. In almost half of the fatal and disabled cases there was a delay in the diagnosis and operation. Consequently better results are possible with better organization of the supervision and treatment of brain injured patients.


Giant aneurysm of the middle cerebral artery: angiographic analysis of blood flow.

The authors report a giant aneurysm of the middle cerebral artery with subarachnoid hemorrhage and without intraluminal thrombosis; by serial angiography, the turbulent blood flow within the aneurysm was demonstrated. The aneurysm was clipped successfully.


Intraperitoneal pseudocyst: treatment by aspiration.

Abdominal pseudocysts have been recorded infrequently as a complication of intraperitoneal shunting and the diagnosis and treatment of this problem in the past have been made of laparotomy. The management of this complication of peritoneal bypass was successfully undertaken at the time of conversion to a vascular system in a patient where an enlarging abdominal mass was associated with the signs and symptoms of shunt malfunction. It is felt in view of past recorded cases and our present experience, that the diagnosis of this complication can be made clinically and the condition treated without resorting to a major abdominal exploratory procedure.


Electrical stimulation of the brain. I. Electrodes and electrode arrays.

Investigators engaged in studying the effects of electrical stimulation on the blood-brain barrier (BBB) and brain usually find it necessary to fabricate the electrodes and electrode arrays required in their acute and chronic experiments. Techniques for fabricating spring-mounted, concentric and salt-bridge electrodes and electrode arrays are described in this report.


Steroid treatment of brain edema.

Experimental brain edema due to extradural compression was studied in rats, and the beneficial effect of a steroid, betamethasone, on this was tested. Immediately following extradural compression, betamethasone therapy was begun by intraperitoneal injection. Three groups of animals received eight divided doses of betamethasone over 48 hours: total doses were 64 mg, 6.4 mg, and 0.64 mg/kg, respectively. Two other groups received doses at zero and 24 hours only, with total doses of 64 mg and 6.4 mg/kg. Water and sodium content of the brain were reduced depending upon dosage. Administration every 6 hours was superior to every 24 hours. Potassium content was not consistently altered. After injection of radioactive steroid, a significant increase in uptake of the drug was observed in the edematous brain.


Venous lakes in the suboccipital dura mater and falx cerebelli of infants: surgical significance.

At birth, 25% of infants have relatively large venous channels coursing in the mid-line of the suboccipital dura mater. They connect the confluence of sinuses with the marginal sinuses. These are limited to the midline suboccipital dura mater in some, whereas in others they implicate the contiguous falx cerebelli as well. These fetal channels gradually shrink, dwindle, or otherwise disappear, and are absent in adolescents and adults. When performing a bilateral suboccipital craniectomy on an infant, one usually divides these venous channels. This may present technical difficulties. Vinylite casts have been made of a series of occipital sinuses. These demonstrated the size, variations, course, and connections of the occipital sinuses and these venous pathways.


"Missing tube" of peritoneal shunt: migration of the whole system into ventricle.

Migration of the whole shunting system of a ventriculo-peritoneal shunt into the lateral ventricle  of a three-month-old male infant is presented. This is a very rare complication of ventriculo-peritoneal shunt.


Electrical neurological stimulation systems: a review of contemporary methodology.

An analysis of the essentials of both external and implantable neurologic stimulation devices is presented. Specific system requirements have been extracted from clinical experience with neurologic hardware for pain inhibition. Application of these devices includes dorsal column stimulation, transcutaneous nerve stimulation and peripheral nerve stimulation. The electrode, an essential component of any neuro-stimulation system, is examined critically, with particular attention to unanswered questions regarding the electrode tissue interface.


Papillary muscle ischemia with patent coronary arteries.

Intermittent murmurs of insufficiency (MI) associated with left atrial "V waves" often are ascribed to papillary muscle (PM) ischemia in coronary artery disease but their cause is not clear with unobstructed coronary arteries. In 49 open-chest dogs, left atrial, left ventricular, and aortic pressures and regional coronary flow (microsphere method) were measured. Subendocardial (SE) ischemia (endocardial/epicardial flow ratios less than 1.0, ischemic intracavitary electrocardiograms) was produced by lowering the SE supply/demand ratio (diastolic pressure time index times O2 content per tension time index) to below 12 with either arteriovenous fistulas, anemia, or aortic stenosis. In nonischemic hearts, O2 delivery to the PM was 20 percent more than to the SE (P less than 0.01) and rose with increasing demands. When ischemia occurred, O2 delivery per unit demand fell 35 percent (p less than 0.01) to the SE muscle, and PM O2 delivery decreased more strikingly (55 percent, p less than 0.01). This reduction in PM and SE O2 delivery often was associated with a "V wave" in the left atrium which disappeared when the intervention impairing the adequacy of O2 delivery was discontinued. We conclude that PM ischemia (1) is the probable cause of intermittent MI, and (2) can be predicted from readily obtained measurements of blood pressure and O2 content.


Postoperative metabolic alkalosis and acute renal failure: rationale for the use of hydrochloric acid.

Metabolic alkalosis secondary to chloride depletion, especially following gastrointestinal surgery and associated with acute renal failure, is a frequent clinical occurrence. Management of the resultant acid-base disturbance mandates chloride replacement. The presence of oliguria limits the choice of accompanying cation. The use of intravenous hydrochloric acid to correct and maintain proper chloride balance, secondary to external gastric fluid losses, is recommended as a straightforward approach. Two brief case synopses are presented. Both patients, florid examples of profound chloride depletion, required large amounts of intravenous hydrochloric acid. The options regarding the choice of chloride solution, hazards involved, and a simplified schema of replacement therapy are presented. Combined gastrointestinal and renal dysfunction create unusual biochemical and clinical alterations and may result in a complex management problem.


Foot vascular resistance index: a noninvasive method to assess foot vasomotor tone.

A new objective hemodynamic technique has been evaluated to assess foot vasomotor tone pre- and postoperatively in patients undergoing lumbar sympathectomy alone or as an adjunct to vascular reconstructive surgery. A foot vascular resistance index at rest (FVRIR) and after reactive hyperemia (FVRIHT) was determined with a noninvasive plethysmographic method. The ankle-to-toe systolic pressure gradient and foot blood flow were measured with strain gauge plethysmorgraphy and were combined in a ratio to provide an index of vascular resistance. The indices were measured in patients without vascular disease who were used as controls and in patients undergoing lumbar sympathectomy alone or in conjunction with aortic reconstructions. Patients who underwent reconstructive procedures alone had a mean FVRIR which approximated the control value. In contrast, those patients who, in addition, had a lumbar sympathectomy had a significant reduction in the mean postoperative FVRIR which equalled the mean preoperative FVRIHT. Three of five patients undergoing lumbar sympathectomy alone had excellent preoperative hyperemic responses and benefited from the operation, whereas two patients with poor hyperemia had no benefit and had subsequent amputations. Our studies suggest that this technique is of value in the pre- and postoperative assessment of foot vasomotor tone and also may be useful in the preoperative prediction of response to lumbar sympathectomy.


Rapid reversal of compensatory renal hypertrophy after withdrawal of the stimulus.

The permanence of the early phases of compensatory renal hypertrophy was tested by interrupting vascular parabiosis between an anephric rat and a normal rat after 48 hours. At the time of interruption, the weights and the ratio of ribonucleic acid (RNA) content to deoxyribonucleic acid (DNA) content of the kidneys were the same as those of the remaining kidney in a single rat subjected to unilateral nephrectomy, previously reported. Within 12 hours after parabiosis was stopped, renal mass and nucleic acid concentrations returned to normal. Compensatory hypertrophy could be produced again by unilateral nephrectomy. Regression of the early phase of compensatory hypertrophy appears to be faster than muscular atrophy produced by disuse or denervation. Compensatory hypertrophy can be activated at least twice.


Quantitative tracheal cultures in surgical patients requiring mechanical ventilatory assistance.

The efficacy of respiratory support devices has been compromised by respiratory infection possibly related to the support mechanism itself. Differentiation between airway contamination (tracheobronchitis) and parenchymal infection (pneumonitis) is clinically significant, as is the differentiation of respiratory infection from other foci of sepsis in the complicated surgical patient. Serial quantitative tracheal cultures provide excellent objective measures of the presence, progression, and/or resolution of respiratory infection with few false positive or negative observations. Indeed, such observations often allow earlier definitive diagnosis of infection than can be achieved with conventional clinical, chemical, or roentgenographic studies. The method represents a useful supplement to the care of the patient requiring respiratory support when infection is a realistic possibility.


Evaluation of ventilatory therapy for acid aspiration.

Aspiration of hydrochloric acid in experimental animals results in severe, progressive hypoxia which is due to intrapulmonary shunting and depressed cardiac output. This preparation is useful therefore in studying the therapy of hypoxia. Mongrel dogs were subjected to acid aspiration and the effects of several ventilatory patterns on intrapulmonary shunt fractions and lung water accumulation observed. The combination of large tidal volumes (30 c.c. per kilogram) with positive end-expiratory pressure was effective in preventing intrapulmonary shunting and other ventilatory patterns were ineffective. Pulmonary edema uniformly followed acid aspiration and was not affected by ventilatory therapy. When ventilatory therapy was delayed for 4 hours, the progression of shunting apparently was limited, but the existing shunt was not reduced.


An evaluation of segmental gastrectomy for gastric ulcer: one to ten year follow-up.

Of 61 patients with gastric ulcer subjected to an improved technique of segmental gastrectomy, 26 were available for follow-up study for 1 to 10 years; evaluations were made mainly on the postoperative reduction of gastric acid secretion and motor function of the gastric remnant. (1) x-ray observation revealed the gastric remnant to be larger than usually seen following Billroth I or II gastrectomy, with no dilatation or remarkable deformity; sphincteric function of the pylorus and peristaltic activity of the gastric remnant were satisfactory; (2) gastric emptying was usually complete in 60 to 180 minutes in 73 percent of the patients, similar to control patients; (3) no instance of dumping syndrome was recognized; (4) average rates of postoperative acid reduction were 58.3 percent for maximal acid concentration, 67.1 percent for maximal acid output, and 67.6 percent for peak acid output, indicating the reduction of gastric acid secretion to be fairly satisfactory. In none of the patients available for follow-up was identified a recurrence of ulcer. These follow-up results suggest the use of segmental gastrectomy for gastric ulcer and for other benign lesions in the mid portion of the stomach.


Pharmacologic effects of gastrointestinal hormones on intestinal oxygen consumption and blood flow.

The vasoactive effects of cholecystokinin-octapeptide (CCK-OP), pentagastrin, synthetic secretin, glucagon, and acetylcholine were assessed in the intestinal circulation of the dog. In pharmacologic doses of glucagon, CCK-OP, and, to a lesser degree, pentagastrin significantly increased blood flow and oxygen consumption. Atropine blocked the vasodilator effects of CCK-OP, pentagastrin, and acetylcholine but did not block those of glucagon. Neither the alpha-adrenergic blocker, phenoxybenzamine, nor the beta-adrenergic blocker, propranolol, blocked the vasodilator response to pentagastrin. Synthetic secretin had no significant effect on either blood flow or oxygen consumption in the intestinal segment. The vasodilator response to CCK-OP and pentagastrin appears to be mediated specifically through cholinergic receptors.


Distribution of blood flow in the intestine with hypertonic glucose in the lumen.

The effects of luminal placement of 50 percent glucose solution on distribution of blood flow within the jejunal wall were studied with radioactive microspheres. Two types of spheres, 15 +/- 5 mu in diameter, were used. One was labeled with cerium- 141 (Ce- 141) and the other with strontium-85 (Sr-85). They were injected sequentially to test for reproducibility of the results. These two types of spheres gave similar results qualitatively and quantitatively. Luminal placement of 50 percent glucose increased total blood flow to the jejunal wall but the increase occurred mainly in the mucosal layer. The flow to the submucosa or muscularis-serosa was not altered. This increased mucosal flow was attenuated by prior exposure of the mucosa to a local anesthetic, dibucaine. It is suggested that the increased intestinal blood flow that occurs in the experimental dumping syndrome is confined to the mucosa of the intestine and is mediated by mechanisms that can be inhibited by exposing the mucosa to a local anesthetic.


Surgical anatomy of the mesocaval shunt.

Having encountered wide variations in the surgical trunk of the superior mesenteric vein and its arterial relationships during the performance of mesocaval shunts, we believed it would be rewarding to evaluate this vessel in a series of 36 cadavers. In two of these 36 instances, we determined that the anatomic findings precluded the performance of a mesocaval shunt. In ten other instances, even though a shunt could be performed, a knowledge of these variations could prevent operative complications. The most common variation was a bifurcation of the superior mesenteric vein at or proximal to the site of the surgical trunk. Another variation which could cause operative difficulties was unusual positions of the superior mesenteric artery and its major branches in relation to the vein at the level of the surgical trunk. A knowledge of these variations in the surgical anatomy of the superior mesenteric vein should make mesocaval shunts easier and safer to perform.


Rate of breaking strength loss of absorbable sutures in the stomach.

Plain and chromic catgut, Dexon, and Vicryl were exposed to the acid-pepsin secretions of the stomach in vivo in dogs. No plain gut was recovered in 24 hours; chromic was found as long as 48 hours after implantation but the breaking strength was reduced markedly. Dexon and Vicryl lost strength slowly in a curve similar to the loss after implantation in other tissues.


Multifocal colonic carcinoma and Crohn's disease.

Multifocal colonic carcinoma occurred in a 65-year-old man with a 13 year history of colonic Crohn's disease. The relationship between solitary and multiple colonic cancer and Crohn's disease is discussed.


Acute post-traumatic coarctation of the abdominal aorta.

An unusual case of coarctation of the abdominal aorta following trauma in reported. The resultant supratenal aortic constriction was associated with severe hypertension and elevated plasma renin concentration. Gradual aortic dilation at the suture site was accompanied by remission of hypertension and return of plasma renin concentration to normal. Correlation of laboratory and hemodynamic changes resulting from this unusual case of abdominal coarctation is discussed.


[Fractures of the scapula in pigs intended for slaughter (author's transl)].

Fractures may be observed in the scapulae of those pigs intended for slaughter, which have undergone electrical stunning. These fractures may be classified into three types. That type in which the fracture is localized in the glenoid cavity is the most injurious one as it is accompanied by haemorrhage and therefore will result in loss of meat. This is liable to cause injuries to the employees engaged in boning out. It was concluded from an inquiry as well as from experimental exposure to stress that fractures of the shoulder are due to the marked tonic contractions of mainly antagonistic muscles, resulting in excessive strain on the shoulder blade and its joints. It is a striking fact that fractures of the shoulder were not observed in pigs stunned electrically while they were in a restraining apparatus.


[ A case of avian tuberculosis with exudative characteristics in a horse (author's transl)].

A case of avian tuberculosis in a horse, with fatal course, is reported. The animal was imported from Poland and became ill after some weeks, in the beginning showing non-specific symptoms which became more severe until death supervened. Post-mortem examination showed a generalised form of tuberculosis. The most important lesions were seen in the lungs, liver, kidneys, spleen, intestinal tract, bones, bone marrow, and the internal lymph nodes. Beside chronic proliferative tuberculosis of the organs, many exudative foci were found with remarkably abundant acid fast bacilli. Mixed lesions were seen, too. Mycobacterium avium was isolated in microbiological examination. The pathogenesis of the infection, the predisposing factors leading to this generalised and open form of tuberculosis and the increasing importance of avian tuberculosis for animals and man are discussed.


[Meningo-encephalitis in mink caused by NCD virus (author's transl)].

In 1970-1972 a great number of mink died of a meningo-encephalitis in the Netherlands. The results of the detailed microbiological and histopathological examination pointed to infection by NCD virus as the cause of the mortality. During the isolation of the NCD virus in embryonated hen eggs the haemagglutinating properties were extremely weak and incomplete; the normal haemagglutination of the NCD virus was not found until the mink isolates had been passed through chickens. Transmission experiments revealed that the pathogenicity of the NCD virus was relatively low in mink after i.c. and i.m. infection, very young mink being the most susceptible. The mink were doubtlessly infected with the NCD virus bij feeding with offal of infected poultry. There was in fact quite a high incidence of Newcastle disease on Dutch chicken farms in 1970-1972.


[Quantitative studies for the presence of Salmonellae in deep frozen broiler chickens (author's transl)].

When poultry carcasses were examined immediately prior to deep freezing those which were contaminated with salmonellae were generally found to contain about 17/100 g skin. In two instances more than 1400 salmonellae/100 g skin were found to be present. After deep freezing and thawing a 5 fold reduction had occurred in the numbers of salmonellae present. A high positive correlation was found between the number of Salmonella organisms on the skin and that in the thaw water.


[The animal in the environment of man(author's transl)].

An analysis of the content of the terms "man", "animal" and "environment" provides the framework within which the difference between animals and man is defined. Animals have their place in the environment of man. Man has the ethical duty of giving them full value. Animals also are values but they are not persons. Therefore they do not have any rights. Certain rules of conduct to be observed by man in his treatment of animals may be deduced from the above.


[Protection of animals and legislation(author's transl)].

In an introductory part, a number of aspects in the attitude of man towards animals and nature are distinguished, such as an economic, a knowledge, an emotional, a moral, a religious and an ethical aspect. Shifts in the intensity and priorities of these aspects, in the emphasis put on them during various cultural periods, are plainly perceptible and have been so particularly during the past few years: increasing exploitation of animals and nature on the one hand and an increase in sensitivity on the other. Various protective movements have emerged and become active in this sphere during the past 150 years: first, protection of animals, then conservation of nature and, more recently, environmental protection. A special aspect of the exploitation of animals consists in intensive livestock production which has grown considerably during the last few decades. Strong objections to certain features of this system have not only been raised by national and international societies for the prevention of cruelty to animals but also by ethologists. Admittedly, it is difficult to lay down exact criteria of animal welfare (which, for that matter, also is true of criteria of human welfare) but it is essential to a systeem of values which is becoming increasingly sensitive that efforts should be made to alter the current system of intensive livestock production with the aid of the various sciences closely associated with this system as well as by enlightenment of consumers. The question as to what we are allowed to do with animals and that of where the shifting limits of necessity lie are becoming increasingly relevant from the points of view of ethics and science.


[Ethics in veterinary medicine. Welfare, production and profit].

The welfare of animals does not invariably coincide with efficient agricultural production. Lack of welfare is the result of maladjustment of the animal to its environment. Maladjustment causing lack of welfare relates to physiology, veterinary medicine and/or ethology. Physiological and veterinary maladjustment may be, but does not necessarily have to be, associated with diminished welfare. Ethological maladjustment resulting in diminshed welfare prevents an action from being performed or being performed satisfactorily, although the animal is prompted to do so. Failure to perform an action or to perform it satisfactorily is due to: (1) absence of specific stimuli (deprivation), (2) obstruction of a particular activity (frustration), (3) absence of satisfaction when the action has been performed. Welfare is a relative concept. Profit is a matter related to welfare. Determining the relationship between welfare and profit is a scientific matter. The choice between welfare and profit is an ethical matter.


[Considerations of the farmer in intensive livestock husbandry on choosing his system of management(author's transl)].

Modern intensive livestock husbandry constitutes an economically inevitable development essential to stock farmers. The decreasing profit margin per unit of produce is inherent in this development. As a result, the income of pig and poultry farmers is very sensitive to fluctuations in prices and, on the other hand, it is considerably affected by seemingly slight rises in cost. The systems of management adopted are therefore designed to keep down the fixed cost of labour and premises as much as possible and reduce the risk. This accounts for intensive livestock husbandry in its current form. This is illustrated in a number of examples. In view of the wide variety of systems within the branches of stock farming and because of the marked variations from year to year and the resulting differences in the importance of measures to be adopted, thorough preliminary studies will be required.


[Do veterinarians have obligations (author's transl)].

In a brief introductory part the reasons are stated for which reflection on the ethics of livestock husbandry and veterinary medicine is necessary today. A sharp distinction should be made between facts and standards. The veterinarian has a considerable responsibility in defining the attitude of man towards animals. In addition to consultative curative work, the possibilities of prevention require and active approach. As regards the mainly surgical procedures, the opinion or attitude of the veterinarian will have to be determined by his view (a common view of possible) of his responsibility to himself, the owner of the animal and the animal as an individual or species. Because of longterm effects, equal importance should be attached to these three approaches.


[Amputation of half a tip of the tongue in cattle, to prevent sucking(author's transl)].

A surgical therapy is described for the prevention of sucking in cattle.


[Autofertilisation in the chicken (Gallus domesticus)(author's transl)].

It is a well known fact that after removal of the left ovary in the young chicken, the right gonad starts growing and assumes the structure of an immature testis. In the cases reported in the literature active spermatogenesis rarely occurred. To bring autofertilisation of the hen closer to reality, we used ten day-old female embryos, whose gonads were divided between two gonadectomized young animals of different sex. In this way the left ovary became functional in an ovariectomized hen, whereas the right ovary from the same embryo was masculinized into a fertile "testicle" in a castrated male host. If these animals, whose germ cells come from one and the same embryo, are mated one can speak of autofertilisation, and inbred lines can be bred within a few generations. A quarter of the ova (ZW chromosomal pattern) fertilised with sperm of the right ovary (with also a ZW chromosomal pattern) will produce "WW-hens". After mating of these hens with normal cocks (ZZ), the offspring will be exclusively female (ZW).


[Possible chloralose poisoning in buzzards (author's transl)].

The use of alpha-chloralose in poisoned eggs is conditionally permitted in the control of Corvidae. Chloralose does not have a selective action. Poisoning occurs in other egg-eating animals (hedgehogs) and, indirectly, in carrion-eating predators which prey on these unintended victims. A tentative diagnosis of alpha-chloralose poisoning in three buzzards (Buteo buteo) was based on the history, the clinical picture (identical with that in magpies with known chloralose poisoning), the complete recovery and the exclusion of other diseases. Other methods for the control of Corvidae are advocated.


[Some aspects of fertility following artificial insemination and natural service in dairy cattle (author's transl)].

The difference between the non-return percentage (60-90 days) following 17,086 first inseminations and that after 9,776 first matings in Dutch-Friesian cattle was studied in a random sample of the Netherlands Herd Book records in 1969. The effects of the following factors on this difference in the cases studied are discussed: -- age of bulls and cows, -- frequency of natural service and artificial insemination during each oestrus, -- use of deep-frozen semem --housing and grazing periods. The difference having been corrected for these factors, it was estimated at not more than 9 per cent of non-return 60-90 days in favour of natural service.


[Carcass composition of newborn (Dutch-Friesian and Meuse-Rhine-Yssel) bull calves (author's transl)].

The quantitative aspects of the composition of the carcases of newborn bull calves were studied. Fifty bull calves of the Dutch-Friesian and fify of the Meuse-Rhine-Yssel breed, all of which were third calves of pedigree cows, were purchased, slaughtered and anatomically dissected. Several of the muscles which are of interest to retailers have been identified both by their Dutch and by their Latin names. At an age of nearly five days, calves of the Dutch-Friesian breed weighed 39.5 kg., those of the Meuse-Rhine-Yssel breed weighing 42.5 kg. The height at withers of calves of the Dutch-Friesian breed was 70 cm. and that of calves of the Meuse-Rhine-Yssel breed was 68.7 cm. The carcass dressing percentage was identical in the two breeds, being 61.2 per cent. The composition of the muscles of the fore-quarters as well as that of the muscles of the hind-quarters showed slight significant differences between the two breeds. This is a striking feature, the more so these breeds were not separated until the early part of the present century. Coefficients of correlation are given for many of the magnitudes studied. Moreover, bilateral dissection was carried out in eighty-eight carcases. This showed that, on an average, the left half of the carcass was heavier than the right half. Those components of the weight, which were mainly involved, are stated. The literature was studied with special reference to the following subjects: aspects affecting the birth weight, the relationship between birth weight and meat production and the ratio between the weight of muscles within the carcases.


Investigations on the relations between the biochemical changes in the brain and behaviour of irradiated rats.

The behaviour of irradiated rats and biochemical changes in the brain tissue were investigated in the early period after whole-body irradiation with the dose of 800 R. It was found that after exposition to X-ray psychomotoric activity undergoes phasic modifications. Within the first day the behavioural activation was stated, which was accompanied by the increase of hydroproteolytic and MAO, activity in the brain. Simultaneously a decrease of serotonin and noradrenalin content in the brain stem was found in irradiated rats. On the second and third day of postirradiation syndrome the behavioural inhibition was observed.


[Radiological check-up examinations for the assessment of therapeutic response in malignant bone diseases].

Results of the improved treatment in radiation therapy of malignant bone lesions demand regular check-up examinations in order to assess the therapeutic response. For this purpose roentgenographic verifications are recommended before the beginning of treatment and after finishing radiation therapy and furthermore two or three months later. Follow-up by radionuclide scanning is suggested. An initially possible increase of a bone lesion in the course of radiotherapeutic treatment does not justify to stop radiation therapy.


[Differential diagnosis of struma maligue].

With reference to a case in which the scintigram showed an autonomous adenoma with a cold area that histologically, however, turned out to be a carcinoma of the thyroid gland, the diagnostical problems of thyroid cancer and the various possibilities in the differential diagnosis are demonstrated.


Leucoerythroblastic anaemia in carcinoma of ovary.

The survey of cases of ovarian carcinoma referred to the Radiotherapy Centre at Sheffield between 1956 and 1965 was undertaken, which revealed one case of leucoerythroblastic anaemia as a complication. This patient also had a demonstrable bony metastases, which appeared eight years after the apparent cure of the diasease-a most unusual feature of carcinoma of ovary.


[Dose distribution in cobalt-60 irradiation of the axillary efferent lymphatic area in breast cancer].

A method of postoperative irradiation of breast cancer is reported using high dosage in the area of the axillary and subclavicular efferent lymphatic ducts. Within opposite fixed fields it was possible to modify the dose distribution by means of wedges, thus obtaining a maximum value of axillary and clavicular doses, together with a small radiation load on the lymphatic vessels which drain the region of the arm. The dose distributions in the depth of the shoulder are discussed on the basis of measurements at a phantom using different adjustments of the wedge filter. The most favorable dose distribution was noted with 17.5 degree lead wedges whereas, however, the angular aperture in the axillary and clavicular region was reduced to 2.5 degrees. This method is now being tested clinically.


[Bone calcium metabolism following local x-irradiation. XIII. Effect of castration and estrogens on the general response of male rats].

The course of local and general deviations in osseous tissue of locally irradiated male white rats is different in hormonally not influenced and in castrated animals. By castration, both the intensity and the variations of this response are inhibited whereas especially the second osseous tissue shows a great deal more sensitivity. The male sex hormones thus lead to a certain instability and intensity of the defence reactions against local radiation damage which derail more easily than in females.


[Effect of aminopropyl-aminoethylthiphosphate on radio-iron utilization following whole-body irradiation of mice in the sublethal dose range].

The effectiveness of the thiophosphate compound WR 2721 was investigated with regard to the radiosensitivity of X-irradiated female mice in the sublethal dose range of 50 to 150 R using the radioiron test (59Fe). An increase of the radioresistance with regard to the radioiron uptake in young erythrocyte populations was obtained only beyond radiation doses of 75 R. In lower dose ranges the animals treated with thiophosphate became even more radiosensitive. At dose values of 100 R and 150 R dose reduction factors (DRF) of 1.3 and 1.5 respectively were obtained. These factors are considerably smaller than the DRF-values found for the survival rate at LD 50/30. A possible mechanism for this result may be due to the different dephosphorylation rate of the thiophosphate in various tissues, as described in literature.


[Effect of 5-fluorouracil and irradiation of the cell kinetics of Walker carcinoma and the small intestine in rats].

A therapeutic schedule of synchronizing cytostatical-radiological treatment often used in human medicine is applied to rats carrying a Walker tumor. The effect of this treatment on the kinetics of tumor cells and epithelium of small intestine is investigated. 1. 5-Fluorouracil, i.p. during 18 and 12 hours, brings about no changes in the mitotic index; however, in the curve of marked mitoses a small fraction of cells is represented which is considered to be a consequence of the synchronization of a very small portion of tumor cells. 2. If ten hours after 5-FU-injection the cells are irradiated with a single dose of 300 rd, there occurs a distinct G2-block and a lengthening of the S-phase. These changes are found both in the 5-FU ground and in the controls. 3. 5-FU-injection thrice alternated with irradiation likewise causes a G2-block. After solution of the block a delayed increase of mitoses in the controls is going on which cannot be detected in the 5-FU group. These findings are interpreted as an effect of 5-FU on the proliferation rate of tumor tissues.


Different radiosensitivity of hematopoietic cells in chick-embryos.

Embryos of different ages from 24th to 120th hour of incubation were irradiated with a dose of 700 R gamma rays at a rate of 50 R/min. After irradiation peripheral blood was taken every 24 hours in order to control proliferation dynamics of megaloblastic and normoblastic cells. The results have shown that the cells of megaloblastic strain reduce much more the mitotic activity that those of normoblastic line. Although the cells of both strains after irradiation show depression in the proliferative activity, in transfer to polychromatophilic forms, megaloblasts disappear almost completely until normoblasts recover spontaneously. The nature of different radiosensitivity in these cell strains has been discussed.