[Radiologic diagnosis of secondaries in the liver (author's transl)].

A diagnosis of secondaries in the liver carries considerable weight in prognosis and treatment, particularly pre-operatively, so that a possibly unnecessary operation may be avoided. Among techniques available for screening for metastases of the liver scintigraphy plays an important part. Besides laboratory tests and clinical examination it is relatively efficient and does not burden the patient. But they often are incapable of providing a basis for therapeutic decisions. Radiologic techniques are unsuitable (13). Knowledge and proper interpretation of indirect signs will permit guidance at the right time. In essence they serve the radiologic proof of advanced metastatic growths. Space occupying processes in the liver are the main indication for angiography. This is certainly not a routine method but makes sense when trying to identify the nature of defects shown in scintigrams (10). Where a primary tumor is known, angiography will follow scintigraphy of the liver, the search technique of choice. While the two techniques are correctly positive in 75-90% for avascular secondaries, experience of numerous investigations confirms that vascular metastases can be recognized earlier in angiograms than in scintigrams. Only angiography provides specific information differentiating metastases from a heptoma. The additional proof of primary tumors of the pancreas is important. Angiography is essential for indication and planning of partial hepatectomy. The angiographic picture does not permit conclusions from the metastases as to site and identity of the primary tumor. Critical evaluation of the radiographic techniques for early recognition of secondaries in the liver suggests humility. Only by carefully combining the various techniques will it be possible to demonstrate secondaries in the liver earlier and more frequently.


[Examination of the organs in the upper abdomen with ultra sound (author's transl)].

Ultrasonography is a harmless reproducibel technique with its own specific indications, an established part of clinical diagnosis in obstetrics, gynecology, ophthalmology, neurology and cardiology. Investigations on the organs of the upper abdomen have greatly extended the indications. Interpreting the sonograms requires experience in providing and evaluating the picture. In part I of this paper normal ultrasonic findings on liver, pancreas, spleen and kidneys are shown and explained on the basis of the physical characteristics of ultrasound techniques and the various ultrasoundtopographic data. This echographic normal anatomy of the organs mentioned enables us to understand pathologic changes shown in part II. An attempt is also made to allocate and evaluate ultrasonography among other diagnostic techniques.


Ultrasonography is a harmless reproducibel technique with its own specific indications, an established part of clinical diagnosis in obstetrics, gynecology, ophthalmology, neurology and cardiology. Investigations on the organs of the upper abdomen have greatly extended the indications. Interpreting the sonograms requires experience in providing and evaluating the picture. In part I of this paper normal ultrasonic findings on liver, pancreas, spleen and kidneys are shown and explained on thebasis of the physical characteristics of ultrasound techniques and the various ultrasoundtopographic data. This echographic normal anatomy of the organs mentioned enables us to understand pathologic changes shown in part II. An attempt is also made to allocate and evaluate ultrasonography among other diagnostic techniques.


[Radiologic diagnosis of diseases of the salivary glands (author's transl)].

Sialography of the major salivary glands is simple and without risk. Radiologic changes in their ducts permit certain differentiation between infective and malignant processes. Sialography determines further diagnostic and therapeutic action.


Familial clustering of degenerative cardiovascular diseases.

In two geographical areas; the Gurghiu Valley, in a mountain region, and the village of Jurilovca on the shores of the Razelm lagoon, investigations were performed in 390 subjects of both sexes over 20 years of age, first degree relatives of healthy index subjects (males aged 40 to 60 years) and 298 subjects of both sexes over the of 20, first degree relatives of index-subjects with coronary heart disease and/or hypertension. The prevalence of these diseases was found to be 40% higher in the families of diseased subjects. The authors assume the participation of a genetic factor in the etiology of these two degenerative cardiovascular diseases.


Coronary arteries in infants up to the age of ten years. I. Chronology of adaptive intimal changes.

In the coronary arteries of old fetuses the presence of musculo-elastic and elastic hyperplastic layers was firstly detected in the branching pads of aortic ostia and the emergence of the left anterior descending branch. These layers appeared constantly more developed in the left than in the right coronary bed. During the first six months of the extrauterine life the coalescence of pads revealed a passage from localized to diffuse adaptive changes in the main branching sites and in their immediate vicinity. Then,  in the first decade of life, a progressive extension of the musculo-elastic and elastic hyperplastic layers was observed, leading to the well known aspect of diffuse intimal thickening.


Clinical evolution, histologic type and general lymphographic picture in Hodgkin's disease.

In 88 patients with Hodgkin's disease the clinical value of the general lymphographic picture (lymphodynamic aspects plus nodal patterns) is analysed. The survival times are also reported according to the different pre- and postlymphographic evolution. Histologic types and prelymphographic therapy are correlated with the general lymphographic picture. The predominance of foamy and/or spotty lymphographic patterns of lymph nodes as well as the lymphatic blockages have a severe prognosis (mean intervals between lymphography and exitus 8.3 and respectively 6.2 months). In such cases lymphocytic depletion represents the most frequent histologic type.


Breathlessness and transfer factor for the lung in chronic obstructive lung disease.

The breath-holding CO transfer factor and transfer coefficient were correlated with the severity of dyspnea in 37 patients with moderate or severe obstructive lung disease FEV 1.0 less than 1.5 1) No correlation was evident when the whole group was considered. When the patients were subdivided into "bronchitics", "intermediate" and "emphysematous" a correlation between dyspnea severity and gas transfer appeared for the latter subgroup; this correlation was statistically significant for the transfer coefficient.


Screening tests for the enzymatic diagnosis in liver diseases and myocardial infarction.

To perform the ever increasing number of analyses with a minimum equipment the tendency all over the world is now to replace the classical tests with screening tests. The laboratory of enzymology of the Institute of Internal Medicine has achieved screening tests for the estimation of alkaline phosphatase, of total lactatedehydrogenase and of its fraction I, whose results are in agreement with the reference methods of Bessy-Lowry-Brock and of Lac-Dehystrate-Goedecke in cases of acute and chronic liver diseases, neoplasms, bone diseases (Paget's disease) and myocardial infarction.


Prolonged effects of nitrogen mustard on mouse haematopoietic and lymphoid tissues.

Groups of mice have been autopsied at regular intervals during the period of lymphomyeloid tissue regeneration which follows the phase of hypocellularity induced by the i.v. injection of 100 mug (4 mg/kg bodyweight) nitrogen mustard. The marrow cellularity recovered to levels in the normal range by the 8th day and remained in this range up to the 40th day. Subsequently, the marrow showed a slight degree of hypocellularity up to day 120. Granulocytes were predominant during the initial phase of marrow regeneration during the second week post-injection. The thymus exhibited periodic size variations such that it was substantially larger than the thymus of age-matched controls from 20-30 d, 46-73 d, and 75-100 d after injection. The lymph nodes and lymphoid tissue of the spleen regenerated only slowly to reach control values by 40-50 d. Superimposed on the recovering lymphoid tissue of the spleen was a phase of erythroid hyperplasia lasting from 10-18 d post-injection. This coincided with a shift from granulocytosis to erythroid hyperplasia in the marrow. This erythroid hyperplasia lasted until day 30 when the cellular composition of the marrow and spleen returned to normal. A possible explanation of these results is that nitrogen mustard introduces a degree of synchrony into stem cell proliferation and differentiation. Additionally, these results emphasize the role of the haematopoietic microenvironment in the control of stem cell differentiation.


Cell adherence as a serious source of error in the haemacytometer count of leucocytes in artificial suspensions.

This report demonstrates a previously disregarded source of error in the count of lymphocytes that have been fixed in Turk's dilution fluid (acetic acid and gentian violet). If the dilution fluid does not contain any serum protein or other proteins, a large proporation of the lymphocytes will stick to the walls of the mixing vessel. The use of plastic or siliconized vessels does not prevent this. The number of cells which in that way will be eliminated from the suspension is dependent on several variables, such as the type of mixing procedure and mixing vessel, the compensation of the dilution fluid and the cell density. As a consequence it is difficult to give any correction factor for such a count in a haemacytometer counting chamber. More than 30% of the cells may disappear under generally obtained conditions. This source of error is to some extent also involved in the white blood cell count, despite the presence of about 1% protein in the dilution fluid from the serum and lysed erythrocytes. To prevent this loss of cells either bone serum albumin, to a concentration of 5%, or the detergent Certrimide, to a concentration of 2-5 mM, may be added to the dilution fluid.


Iron absorption during iron supplementation in blood donors.

The total amount of iron absorbed from a total supplementation of 2000 mg of iron was studied after a blood donation. 10 regular blood donors and 10 subjects without previous blood loss were included in the study. No subject had received any iron treatment before the investigation. Both groups were given one sustained release tablet containing 100 mg of iron as Fe SO4 once daily for 20 days. The iron in these tablets was labelled with 59Fe. The total amount of iron absorbed from the tablets was measured by a whole body counting technique. Laboratory tests including haematological data, desferrioxamine tests and sternal marrow punctures were made before and after the iron treatment. The non-donors lost a mean amount of 215 mg iron by phlebotomy and the total iron absorption from the tablets was only 94 mg (4.7%). In the regular blood donors the corresponding iron loss was 276 mg and the absorption was 280 mg (14%). The iron supplementation given in this study covered the iron losses in the regular blood donors but not in the non-donors. This iron prophylaxis will present a depletion but not a reduction of the iron stores in blood donors with high donation frequency.


Integrity of the iron transport process in mice with X-linked anaemia.

The defect in iron (Fe) absorption in X linked anaemia (sla) remains an enigma; absorption of a tracer dose of Fe is impaired in mice raised on an iron-containing cube diet but not in those raised on an iron-deficient diet. Because cobalt (Co) shares a similar intestinal transport pathway with Fe, a study was made of the effect of iron deficient diet on Co absorption. The duodenum of sla and genetically normal mice was perfused for 30 min with labelled solutions containing Co or Fe. Co uptake and transfer were similar in sla and normals fed cubes whereas Fe uptake and transfer were less in sla than in normals. The iron deficient diet caused an increase in the uptake and transfer of Co and Fe in sla and normals. When Co and Fe were perfused together in sla fed deficient diet, the uptake and transfer of each metal was less than when performed alone. The distribution of Fe and Co in subcellular mucosal fractions was determined by a differential centrifugation technique. Deficient diet resulted in a directionally similar change in the subcellular distribution of Co and Fe in sla and normals. The increase in Co as well as Fe absorption in the sla on an iron deficient diet to the same high level found in genetically normal animals, and the inhibitory effect of each metal on the absorption of the other suggests that the absorption defect in sla is unlikely to be due to a primary defect in the function of the transport carrier.


Generalized proteolysis in a young woman with Weber-Christian disease (nodular nonsuppurative panniculitis).

A patient with Weber-Christian disease (syn. nodular nonsuppurative panniculitis) is reported. The generalized cellular destruction in this patient resulted in liberation of proteolytic enzymes into the circulation, which led to multiple haemostatic disturbances with haemorrhagic diathesis. The most prominent haemostatic defects were thrombocytopenia with a normal life span of isologous platelets, high levels of AHF-related antigen, hypofibronigenaemia with short fibrinogen survival, low levels of Factor XIII (fibrin stabilizing factor = FSF) and increased amounts of fibrin/fibrinogen degradation products (FDP). Proteolytic enzymes, other than thrombin and plasmin which especially degrade Factor XIII and fibrongen, derived from destroyed cells (probably leukocytes) seem to have been involved in the pathogenesis of the bleeding disorder in this patient.


Selective eradication of rat bone marrow erythroid cells by administration of cytosine arabinoside. Observations on resumption phase of erythropoiesis.

The in vivo effect of a single i.p. injection of cytosine arabinoside (250 mg/kg body weight) on the rat bone marrow is reported. Cytosine arabinoside (ara-C), a potent inhibitor of DNA-synthesis, was seen to produce selective necrosis of fast cycling bone marrow erythroblasts. The depleted erythroid marrow is replenished by stem cells which are members of the lymphoid-transitional cells compartment. An indirect correlation between the degree of erythroid cell depletion and the extent of marrow lymphocytosis was noted 6-12 h after the administration of ara-C. At 24-48 h, however, the marrow returned to its normal activity. The rat bone marrow 6-12 h following a single injection of ara-C is suggested as an experimental model for providing stem cells committed to the erythroid line.


Ultrastructural analysis of erythroid colonies in diffusion chambers in irradiated rats. Effect of cytosine arabinoside administration on donor rats.

Ultrastructural observations of erythroid colonies in diffusion chambers implanted in lethally irradiated rats are reported. The donor cells were obtained from rats treated with cytosine arabinoside (250 mg/kg body weight) 6 h prior to seeding. The marrow of donor rats contained a high proportion of stem cells committed to the erythroid line. 9 days after implantation, vast numbers of erythroid colonies developed in the diffusion chambers. The erythroid cells were observed arranged around a central macrophage resembling erythroid islands in bone marrow. Erythroid colonies most probably differentiated from committed stem cells in the inoculum. It is postulated that development of erythroid colonies in diffusion chambers is conditioned by, among other factors, the presence of a special type of macrophages. These macrophages have the same function as those of central reticular cells (CRC) in bone marrow erythroid islands.


Observations on the in vivo aging of red cells in the rat.

Aging of rat erythrocytes was studied in vivo by two experimental models. In the first, a single cohort of erythrocytes labelled with radioiron was followed; in the second, sequential hypertransfusions were employed to obtain a defined red cell population, which was continuously transferred from host to host. The results are compatible with a normal red cell life span of about 60 days and with sequestration of senescent erythrocytes in the spleen and in the liver. Red cell aging was associated with a decline in cell volume, haemoglobin, G6PD and ATP content. There were no measureable changes in osmotic fragility. Thus, changes in osmotic resistance do not appear to be critical factors limiting the life span of circulating erythrocytes in the rat.


Immunoradiometric assay for ferritin in human serum.

A sensitive, specific and precise immunoradiometric assay for ferritin has been developed. Ferritin was measured in the serum of 160 hospital controls, 101 females (118 +/- 9 mug/l) and 59 males (189 +/- 16 mug/l). This difference was statistically significant. In 28 patients with untreated iron deficiency anaemia, serum ferritin concentration (6.1 +/- 0.7 mug/l) was significantly lower than in the controls, but it was within the normal range in 14 cases of polycythaemia vera treated by repeated phlebotomy. In 4 patients with primary haemachromatosis (2884 +/- 56 mug/l), 25 with secondary iron overload states (5702 +/- 1235 mug/l) and 8 with haemolytic anaemia (1612 +/- 605 mug/l), serum ferritin levels were markedly elevated. In 14 cases of transfusional siderosis there was a highly significant correlation between serum ferritin concentration and units of blood transfused. A circadian rhythm in serum ferritin concentration was observed in 7 healthy subjects.


Detection of measles antibodies in cerebrospinal fluid and serum by a radioimmunoassay.

Evidence that different structural components of the measles virus may act as antigens has been provided by the serologic methods of hemagglutination inhibition hemolysin inhibition, and nucleocapsid complement fixation. Using radioiodinated measles viral antigens, and immune precipitation assay has been designed that is capable of discriminating among various reactivities to measles viral structural components in serum or cerebrospinal fluid (CSF) and of distinguishing whether IgG and IgM antibody is involved. This technique has been applied to the study of measles antibodies in CSF and sera of patients with multiple sclerosis (MS) and other neurologic diseases. From data presented here, it was found that both groups of patients have individual reactivity to measles proteins, present in CSF and serum, whereas three normal CSF samples were found not to have such antibodies. It appears that oligoclonal immunoglobulins in CSF of MS patients may be detected by this method, and one patient with MS was found to have CSF IgM anti-measles antibodies.


An experimental model in mink for studying the relation between amyloid fibril protein AA and the related serum protein SAA.

Experimental amyloidosis was induced in mink by repeated injections with endotoxin. Amyloid fibrils extracted from liver and spleen were fractionated by gel filtration after treatment with guanidine-hydrochloride and a reducing agent, dithiothreitol. An elution profile very similar to that of human amyloid fibrils, having protein AA as a major component, was obtained. The mink amyloid protein eluted at a position similar to that of human protein AA was by amino acid composition and partial sequence studies shown to be very similar to the latter protein and was called mink protein AA. In addition, a protein AA-related component (protein SAA) was found in increased amounts in serum of amyloidotic mink, providing further evidence of the homology with human amyloids. Experimental amyloidosis in mink represents a suitable model for studying amyloid proteins and related serum components.


Protein A reactivity of two distinct groups of human monoclonal IgM.

Fifteen human monoclonal IgM proteins could be divided into two groups based on their ability to inhibit binding of a labelled human monoclonal IgM (IgM-Se) to Staphylococcus aureus Cowan 1 (IgM-Se assay); seven were positive and eight were negative. We found complete agreement between positive reaction in the IgM-Se assay, the presence of protein A reactivity in gel diffusion experiments, and high titres in an indirect haemagglutination test detects antibodies to protein A-IgG complexes. The protein A precipitation patterns of IgM and autologous IgG were not identical.


Antibodies against nicotinic acetylcholine receptor and skeletal muscle in human and experimental myasthenia gravis.

Using rocket immunoelectrophoresis and indirect haemagglutination tests, antibodies to nicotinic acetylcholine receptor (n-AChR) from Torpedo marmorata were detected in sera from rabbits with experimental myasthenia but not in sera from patients with myasthenia gravis or in rabbit antisera to a partly purified skeletal muscle antigen. Antibodies to this antigen were demonstrated in sera from patients with myasthenia gravis but not in sera from rabbits with experimental myasthenia. The results indicate that there is no immunological cross-reaction between the muscle antigen and n-AChR from Torpedo marmorata, and little or no cross-reactivity between these n-AChR antibodies and possible muscle n-AChR antibodies in myasthenia gravis patients.


Free fascial sling to correct urinary incontinence after prostatic surgery. Results of eight operated patients.

Eight men with total urinary incontinence after prostatic surgery were operated using a free fascial sling. Four patients were continent 7-36 months postoperatively. Two patients had stress incontinence and two patients had recidivating incontinence. The latter two patients were the only ones in whom the preoperative cystometry was abnormal.


Late effects of transurethral resection of bladder tumours at the ureteric orifice.

Nineteen patients, transurethrally resected for low-grade malignant tumours of the urinary bladder at or near the ureteric orifice, were investigated with respect to the presence of distal ureteric stenosis and/or vesico-ureteric reflux. The follow-up studies were performed from 6 to 28 (mean 12) months after the resection and included intravenous pyelography, voiding cystography, cytoscopy with catheterization of the ureteric orifice on the operated side, quantitative urinary culture, and serum creatinine determination. The intravenous pyelographies showed that the ureters on the operated side were significantly wider than those on the control side. This widening was recorded regardless of whether vesico-ureteric reflux was present or not. Vesico-ureteric refluxwas found on the operated side in 9 patients. No reflux was found on the control side in any patient. Preoperatively, no difference in ureteric width was observed between the tumour side and the control side. No severe stenosis was found at the follow-up investigation-in all cases at least a 5 French catheter could be inserted. Postoperatively, the urinary cultures were positive in 4 patients, 3 of whom had a vesico-ureteric reflux. A slight increase in the serum creatinine was noticed in one patient. The absence of ureteric stenosis in this series might be caused by the fact that the resection was performed with a minimum of coagulation.


Surgical injuries of the ureter. A review of 42 cases.

A review of 42 cases of iatrogenic ureteral injuries treated at the Department of Urology in Lund is presented. A thorough knowledge of the anatomy and blood supply of the ureter is necessary to avoid damage to the ureter during surgery. If, however, such injuries occur, early diagnosis is desirable. Several surgical methods are available for reconstruction. Of great importance is proper choice of the procedures to be used in a given case. The value of diverting operations (pyelostomy, nephrostomy) is stressed. Nephrectomy cannot always be avoided especially if the injury is not detected early. In order to evaluate the results of reconstructive procedures postoperative control with intravenous pyelography is recommended to enable early diagnosis of restrictures and thereby early reoperation.


Proteinuria in patients with uroepithelial tumours with special regard to tumour size, clinical staging and grade of malignancy.

Concentrations of albumin, transferrin and immunoglobulins A, G and M were determined in both serum and urine from 59 patients with uroepithelial tumours. 51 patients had tumours in the bladder, which could be classified according to size, clinical stage and grade of malignancy, the remaining 8 had tumours in the ureter or renal pelvis. Urinary proteins were found in all the patients studied, the concentration being proportional to the tumour size. There was no correlation, however, with the grade of malignancy. The level of serum proteins and the urinary protein fraction pattern were similar in all groups of patients. Immunoglobulins were found in relatively large amounts in the urine, except for IgM which was absent in 13 patients. It is suggested that there immunoglobulins originate from the tumour surface and may represent an immune reaction by the host against the tumour. Their estimation in the urine may be a useful diagnostic help when urinary tract tumours are suspected.


Acute non-specific epididymitis in boys. A survey based on 48 consecutive cases.

A series of 48 boys with acute non-specific epididymitis is presented, indicating that this disease is probably not so rare as has been claimed. Our material consisted of two major groups: infants and boys between 10 and 15 years of age. Surgical exploration was made in 22 cases, predominantly infants. Diagnosis could be made from the clinical picture in most of the older boys. In the younger boys, wide indications for surgical exploration are necessary in order not to overlook a torsion of the testis. One third of the patients had significant growth of bacteriae in the urine. Bacteriuria was more often found in infants than in older children. The possible source of the epididymitis could be found in only a small proportion of the cases. A follow-up investigation 3-20 years after the initial attack showed that the prognosis is favourable in boys.


A comparison between urography and radioisotope renography in the follow-up of surgery for hydronephrosis.

The result of surgical correction of hydronephrosis caused by chronic obstruction at the pyeloureteral junction has been evaluated clinically as well as by urography and body background substracted renography performed preoperatively and up to 65 months postoperatively. The average follow-up period was 24 months. Twenty-eight patients (29 kidneys) were operated. Clinically 24 patients were improved. Urography showed regress of hydronephrosis and/or improved urinary pelvic drainage in 22 patients, whereas kidney function is judged from renography was improved in only 8 patients. Improvement in all parameters was generally most marked during the first postoperative months. Renographic improvement was seen much more often when the contralateral (non-operated) kidney was abnormal. Thus, kidney function in terms of effective renal plasma flow is rather uninfluenced by hydronephrosis surgery if the contralateral kidney is normal, whereas clinical improvement in urinary drainage is regularly obtained. This improvement in drainage is poorly registered by renography. It is concluded that renography is an important complementary method to urography, but the method cannot replace the radiological methods in the follow-up of hydronephrosis surgery.


Renal blood flow in acute epidemic nephritis (nephropathia epidemica of Scandinavia).

Different haemodynamic and functional parameters were studied in 5 cases of acute epidemic nephritis with uraemia using nephroangiography and dye-dilution measurements combined with determination of extraction ratio and clearance for 51Cr-EDTA and PAH. In the acute phase, with greatly reduced renal function, increased vascular resistance was noted in spite of the vasodilatation observed in the renal artery out to and including the interlobular arteries. Moreover, angiography revealed enlarged kidneys with an increase in the thickness of the cortex and reduced cortical contrast accumulation. The renal blood flow, which was normal or slightly reduced initially, increased during convalescence, and renal function returned to normal. The investigation indicated that a primary vascular lesion in glomerular to postglomerular capillaries gives rise to pronounced interstitial oedema, which, probably as a result of secondary tubular compression, may be the cause of the rapidly developing renal failure.


Rubidium redistribution after suprarenal caval ligation in the rat.

The distribution of infused 86 Rb Cl between different organs was followed for 48 hours. When SRVCL was perfused 15 hours after the 86 Rb Cl infusion, there was a redistribution with loss of Rb from the kidneys and the thigh musculature and an increase in the Rb concentration in the liver and shoulder musculature.


Segmental cortical renal infarction with spontaneous regression. A clinical and roentgenological study.

A patient with a suspected segmental aseptic renal infarction is described. Initially, the clinical picture was characterized by pain and macroscopic haematuria. An acute intravenous pyelography showed a normal roentgen anatomy. At a second intravenous pyelography one week later, an incomplete filling of the two cranial calyces was found. A subsequent renal angiography showed an avascular area within the corresponding parenchyma. The distinct demarcation of the avascular zone caused us to suspect that the disease might be ischemic. A second and a third renal angiography 6 weeks and 4 months later, respectively, both showed complete restoration with a normal vascular pattern. The necessity of performing an acute renal angiography in every case of a suspected renal infarction is stressed. The possibility of preventing hypertension by kidney resection in patients with incomplete restoration of the renal parenchyma is evaluated.


Biological age, health, and health-risk indicators among 25-57-year-old men in two parts of Finland.

Biological age, health, and health-risk indicators were examined among 460 systematically chosen men, aged 25-57 years, in two parts of Finland. Morbidity rates and the prevalence of some health-risk indicators were higher and the standard of living lower in North Karelia than in South-West Finland. The index of biological age (IBA) did not show significant differences between the districts and did not correlate with health-risk indicators. People working in physically hard occupations (industrial and mining workers) were found to have more diseases and had higher IBA values than had workers in lighter occupations. The results suggest that both ageing and morbidity are regulated by occupational status and social conditions connected with it.


Mortality among female alcoholics.

The investigation group is composed of the 83 female alcoholics who, in the period of 1961-68, were subjected to their first compulsory treatment by the Temperance Board in Malmo. Their socioeconomic status was low. In many cases the women were heavily disadvantaged, socially. By the end of 1973, 15 of them (18%) had died: 8 through accidents, 4 by suicide, 1 of liver cirrhosis, 1 of myocardial infarction, and 1 of cerebral haemorrhage. General and cause-specific mortality was calculated on the basis of age-specific risk tables for females. The ratio of observed to expected mortality was: for all causes of death fully 7:1, for accidents 70:1, for suicides 30:1, and for other causes 1.6:1. Those who died as a result of suicide were on average younger than the other female alcoholics at the first compulsory treatment, and those who died of other causes were on average older. All who died by suicide had earlier made many attempts at suicide. In fully half of all known attempts at suicide, violent methods had been employed.


The diagnostic process in outpatient endocrine care with special reference to screening. Further study of diagnostic patterns, their changes, total and diagnosis-specific resource consumption.

A screening procedure based on physical examination alone was used in the outpatient unit of a department of endocrinology and metabolism. The volume effectiveness and efficiency of this diagnostic process was evaluated by studying the case-records and by mail questionnaire. The case-records of 296 patients admitted to the clinic during 1968 were analyzed. It was found that 103 of these patients were immediately referred back after a brief physical examination only. The pattern of diagnosis, its changes during the screening procedure, and the outpatient-investigation were also studied. 50% of the patients subjected to outpatient-investigation ended up with a new diagnosis. It was also possible to construct a diagnosis-specific cost estimate for outpatient-investigation, starting from a non-confident and arriving at a confident diagnosis. The distribution of these costs was very skew. The cost for the physician performing the screening was estimated to represent only 2.6% of the costs saved by the introduction of the screening.


Comparison between participants and non-participants at a gynaecological mass screening.

Nearly 35% of the women invited to the gynaecological mass screening in Uppsala do not participate. It is therefore of importance to study the reasons for this, especially as previous research in this field is sparse. We used a mail questionnaire which included questions concerning sociological data, gynaecological background, attitude to gynaecological examinations and to mass screening, attitude to cancer and to sexual matters. 87.5% of the sample of 800 women replied. We compared the group of women who had at some time participated in the mass screening with those who had never participated. The sociological variables were found to be closely correlated, and their individual significance could consequently not be distinguished. Those who had not participated did not as a whole constitute a critical group as regards detection of cancer, since it was found that most of these women had attended a gynaecologist elsewhere and, although they had had smears taken, they appeared to be poorly informed as to the type of cancer that the smear is intended to detect. Our questioning failed to show the women's attitude to cancer or to sexual matters was of significance for participation, although there is some evidence that the latter may be of some importance. The most significant difference disclosed between the groups was that non-participants consider gynaecological examinations more unpleasant than do participants. Furthermore it was found that women's expectations of the mass screening differ from what they consider to be included in the examination. Finally, measures intended to increase participation are suggested.


Female alcoholics and public assistance.

The proband group in this investigation consisted of 71 female alcoholics subjected to compulsory treatment by the Temperance Board. Public assistance was surveyed from the calendar year when the subject reached 19 years of age to the 9th year after the first compulsory treatment. During the four-year period preceding the first compulsory treatment, the percentage of probands on public assistance per year increased from 25 to 50; this coincided with the increase in the percentage of probands having non-compulsory contact with the Temperance Board, annually. During the same period, both the percentage of probands who for the first time received public assistance and also the percentage of probands having first non-compulsory contact with the Temperance Board were doubled. After the first compulsory treatment, the dependence on public assistance remained constant at a very high level. The first instance of public assistance was a late socio-medical symptom. The first gonorrhoeal infection and also the first recorded criminal offence usually occurred considerably earlier; on the other hand, the first conviction for drunkenness occurred somewhat later in the course.


[Psychological behavior in terminal illnesses].

The physician usually identifies the diagnosis - and implicitly the prognosis - of a terminal illness by its objective signs. The patient, however, recognizes fatal disease through pain and subjective symptoms as well as the reaction of his doctor and family. The overwhelming majority of patients suffering from a fatal disease realize that they will die within a given span of time; but most physicians still believe that frank information of the patient about the fatal character of his disease is irresponsible. The response of the patient to the approach of death is in many ways comparable to the usual adaptation to a psychological stress. As in illness behaviour in general, adaptation depends on personality structure (especially defense mechanisms), the given life situation and the illness. The main goal of psychotherapy in terminal illness is to answer the patient's questions as frankly as possible, without destroying hope for those in need of it. Support for the patient through the different phases of dying will preserve him from human isolation.


[The frequency of relapse in operated and non-operated Crohn's disease. Conclusions for the indications for surgery].

162 patients with Crohn's disease were followed up for an average of 9.1 years. 91 patients underwent surgery. In our series 60% relapses were noted in patients in whom the interval between surgery and reevaluation was at least 3 years. 19.8% of the 71 patients who did not undergo surgery had relapses. The following conclusions are drawn: 1. The operation has a curative effect in only a few cases. 2. The operation is indicated only in the event of complications. 3. Relapses following appropriate surgery are not due to the operation but are a sign of activity of the disease.


[Dietary modification of a specific hormonal system of the duodenal mucosa controlling the endocrine and exocrine pancreatic secretions].

The effect of different food substrates on production by the duodenal mucosa of factors acting on the endocrine and exocrine functions of the pancreas was studied in the rat in vivo. Intragastric loads of glucose, maltose, arginine, lysine, peanut oil or a protein hydrolysate (Nesmida) were given to a first group of rats. The duodenum was removed at various times after food and extracts of duodenal mucosa were injected into the pancreatic-duodenal artery of other rats. The effect of these extracts was determined by measuring immunoreactive insulin levels in the portal vein and amylase, trypsin and lipase activities in the pancreatic juice of this second series of rats. Glucose and arginine, but not lysine, increased the activity of duodenal extracts on insulin secretion, whereas oil ingestion modified the activity of the duodenal extracts by inhibiting insulin secretion. Duodenal mucosa extracts taken 30 min after glucose and maltose ingestion stimulated amylase but not trypsin in the pancreatic juice, whereas extracts taken 45 min after ingestion of a protein hydrolysate stimulated trypsin but not amylase production. The extracts taken after oil ingestion specifically stimulated lipase secretion. These observations suggest the possibility of a hormonal system which is modulated by various food substrates and influences both endocrine and exocrine pancreas functions.


[Urinary concentration and antibacterial effect of short and long acting tetracycyline].

Forty-one hospitalized patients, of whom the majority had asymptomatic bacteriuria, were randomly divided into 4 treatment groups. They were given either tetracycline HCl 1 g, or tetracycline HCl + terpenes 100 mg, or minocycline 200 mg, or cotrimoxazole (sulfamethoxazole 1.6 g + trimethoprim 320 mg), daily for one week. A large number of bacteria were resistant to tetracyclines. The urine was sterilized in 14 out of 24 patients receiving tetracyclines and in all of the 17 patients receiving cotrimoxazole. The mean urinary concentration of tetracycline was 20 times higher than that of minocycline. The 24-h urinary excretion of tetracyclines was slightly higher in patients receiving the combination of terpenes and tetracycline, but these differences in urinary excretion did not appear to have any influence on the antibacterial effect of tetracyclines.


[The place of "monocomponent" insulins in diabetes mellitus therapy].

The chemical and biochemical properties of highly purified insulin (termed "monocomponent insulin") are discussed. The clinical indications for this mc-insulin are immunologic side effects of conventional insulin therapy such as resistance, allergy and lipoatrophy. Furthermore, highly purified insulins can be tried in high insulin requirement, in juvenile diabetes and intermittent insulin therapy. Case histories for these clinical indications are presented. It is advised that the use of mc-insulin should be restricted to precise clinical indications until enough pure pig insulin is available for treatment of all insulin-dependent diabetics.


[The effect of cholecystectomy on the lipid composition of the liver bile. Follow-up studies in 10 cholecystectomized patients with recurrent calculi in the bile ducts].

In 10 patients who had formed new stones in the common bile duct after cholecystectomy, the lipid composition of the hepatic bile was determined on three different days after relaparotomy and placing of T-tude and the cholesterol content of the stones was investigated. The cholesterol content in 9 out of 10 recurrent gallstones was between 78 and 93%. The lipid content was lithogenic in these 9 cases. In the tenth (a patient with mixed recurring gallstones) solubility for cholesterol was in the critical area. There thus seems to be no normalization of lipid composition in patients with cholesterol stones after cholescystectomy, and the conditions for recurrence of cholesterol stones remain unaltered.


[The inhalation of beta stimulators. Effect of the inhaled aerosol deposited in the oropharynx and in the bronchial tree].

Inhaled aerosols are predominatly deposited in the oropharynx and only a minor portion penetrates into the sublaryngeal airways. The effectiveness of both components of an orciprenaline aerosol was tested in 12 asthmatics. For this purpose they were given an inhalation on one day and, on the next, the entire oropharynx was sprayed with the inhalant. Evaluation of the corresponding bronchodilator effects was based on repeated measurements of specific airway conductance. The results show that the inhalation is about 6 times as effective as the spray, and thus prove the superiority of inhalation therapy over oral or peroral medication with beta-stimulants in the treatment of bronchial asthma.


["Small airway disease". A short review].

Recent research aimed at detection of early chronic obstructive lung disease has resulted in the concept of "small airway disease". The physiologic abnormalities associated with this entity, which is characterized by structural changes in peripheral airways, are too slight to be detected by conventional pulmonary function tests. A number of more sensitive methods have been found helpful in the recognition of small airway disease which, among other conditions, appears to be present in asymptomatic young smokers. Although final evidence of the suggested relationship between small airway disease and clinically manifest chronic obstructive lung disease is still lacking, this hypothesis is intriguing since it relates to a chronic disease in a potentially reversible stage.


[Pre and postoperative secretion studies in selective proximal vagotomy. Report on 50 patients].

In 50 patients with peptic ulcer (48 duodenal ulcers and 2 pyloric channel ulcers) proximal gastric vagotomy was performed. The diagnosis was confirmed by radiology and endoscopy in all cases. Pentagastrin-stimulated maximal acid output (MAO) was measured preoperatively. At 6-12 months after the operation a pentagastrin test (6 mug/kg) and an insulin test (12 units regular insulin intravenously) were carried out. The results of the insulin tests were assessed by 5 criteria. In patients with 3 or more positive criteria the vagotomy was considered incomplete. 30 patients had "complete" and 20 "incomplete" vagotomy. MAO was reduced by 56%. The mean reduction of MAO was 63% in cases of "complete" vagotomy and 46.5% in "incomplete" vagotomy. The purpose and indication of postoperative studies of gastric secretion are discussed.


[The surgical strategy in cases of arterio-venous aneurysms of the posterior fossa. A propos of 3 cases].

Three cases of strictly subtentorial arteriovenous aneurysm (out of 55 intracranial malformations of this kind) are presented, with special reference to surgical tactics and technics: the pros and cons of different positions on the operating table, search for afferent pedicles whose clipping may suffice, necessity of routine use of bipolar coagulation, use of the operating microscope, and continuous intraoperative checking of vital data by the anesthetist. These lesions are operable and should therefore be looked for.


[New aspects of inflammation prevention by means of non-steroid antiphlogistics: the effect of Voltaren].

Voltaren, a non-steroid antiinflammatory agent (NSA) of an entirely new chemical structure, is characterized by the high degree of antiinflammatory, antipyretic and analgesic activity it displays in animal experiments. Like other NSAs, the preparation inhibits prostaglandin synthesis, and various findings indicate that the spectrum of pharmacological activity of these agents is at least partly due to this inhibitory effect. Despite this common feature, however, there are quantitative and qualitative differences between Voltaren and other NSAs.


[Pseudolupus: a severe side effect of a varicose vein drug?].

Among 7 patients with "pseudolupus" (a lupus erythematodes-like syndrome with antimitochondrial antibodies) an unusual incidence of varicose veins was noted. Reexamination of their histories revealed that all had been taking the same rather uncommon drug "Venocuran" for a prolonged period before developing the typical symptoms of this disease (recurrent fever, perimyocarditis, myalgias). They appeared on average 7 months after initiation of drug therapy and lasted for weeks or months even when the drug was promptly withdrawn. It is probable, though by no means certain, that one or several components of this drug play an important role in the pathogenesis of this immunologically distinct disease.


[The value of conventional pancreas scintigraphy as a diagnostic method in pancreatic diseases].

In a retrospective study 170 pancreas scintigrams have been compared with the final clinical diagnosis. In 87% of cases the nuclear medicine and clinical diagnoses were in agreement. Given the 95% accuracy of normal pancreas scans, scintigraphy is a reliable method in ruling out pancreatic disorders. The problems of the pathologic pancreas scan are discussed and an approach is recommended for clinical clarification. Finally, a list of indications for pancreas scintigraphy is given.


[Beclomethasonedipropionate for corticoid inhalation therapy in bronchial asthma].

Beclomethasone dipropionate, a new corticosteroid for inhalation in the form of a pressurised aerosol with a daily dosage of 300-400/mug, has been given to 130 adult asthmatics. In 56% of the steroid-dependent asthmatics, oral or parenteral corticosteroids were reduced and in a further 28% discontinued entirely. In 16% of patients a reduction of systemic corticosteroids could not be achieved. 12 patients suffering from an obstructive airway disease who had not previously been on systemic corticosteroids were treated successfully with inhalation of beclomethasone dipropionate alone. The reduced dosage of systemic corticosteroids as a result of the use of beclomethasone dipropionate was 4.24 mg of prednisone daily. Side effects, in the form of mouth candidiasis, were noted in only 2 patients.


[Exhalation diagnosis with C14 tagged compounds, methods and results].

The method and results of the 14C exhalation test for metabolic studies are presented. In patients under radiotherapy for malignant diseases (we consider radiotherapy to be a well defined metabolic disturbance), studies with 14C-carboxyl triglycerides, with 14C-glycincholate, with 14C-histidine and with 14C-uridyl reveal the extent of the metabolic changes and also how long it would take to return to the normal state. It is not yet well understood why a disturbace of glycincholate absorption persists for years after radiotherapy of the pelvis. The method can also be employed in gastroenterology (absorption of bile salts) and in assessing an anabolic or catabolic state as af function of thyroid hormone. Further metabolic tests for radiobiologic evaluations are in progress.


[Surgical treatment of funnel chest. Surgical experience with 90 cases].

Funnel chest, a congenital hereditary deformity, may lead to impairment of cardio-pulmonary function. The predominant motives for operation are psychological and cosmetic. Minor deformities amenable to physiotherapy should not be operated on, but moderately severe one represent a justified surgical indication. Objective photographic documentation is essential. Because of their bearing on surgical technic and results the symmetrical, asymmetrical, localized and extensive deformities should be distinguished. 90 operations have been performed between 1951 and 1974 according to the different known technics published during that period. Results were irregular until the introduction, eight years ago, of an operation combining extensive resection, by the method of RAVITCH, and stabilization by a metal strut as recommended by ADKINS et al. 24 operations performed during the last eight years have afforded perfect long term results.


[The value of endoscopic retrograde cholangiopancreaticography for the surgery of bile duct and pancreatic diseases].

The value of endoscopic retrograde cholangiopancreaticography (ERCP) for establishing the indication for surgery and for planning surgical procedures is discussed. The two most widely practiced methods of direct cholangiography - percutaneous transhepatic and endoscopic retrograde cholangiography (PTC and ERC) - are compared: although the filling rate with ERC is slightly lower than with PTC, the endoscopic method has some important advantages as it allows endoscopic observation and biopsy of the duodenum. Furthermore, opacification of the pancreatic duct system often provides important additional information. ERCP is essentially important in post-cholecystectomy syndrome, as puncture of undilated bile ducts is difficult and persistent symptoms after cholecystectomy are not infrequently related to pancreatic disease. The importance of rapid surgical intervention after retrograde filling of the biliary tree in obstructive jaundice is stressed. In pancreatic diseases the indication for surgery is based mainly on clinical and laboratory findings. Differentiation of malignant and inflammatory changes in the pancreaticogram is still a problem. However, the contribution of ERCP to pancreatic surgery is very important, as it exactly localized lesions of the pancreas and therefore allows detailed planning of a surgical procedure. Stenosing or obstructing lesions often are an indication for surgery, even if their malignant nature is not certain, as severe pain in chronic pancreatitis may be relieved by surgery. The potential for therapeutic application of endoscopy in biliary and pancreatic diseases is briefly discussed.


[EEG-abnormalities in patients with vagovascular syncope].

In 248 patients with vagovasal syncope, EEGs recorded during a seizure free period showed abnormality in 19.3% of the cases. In 2% there were only nonspecific disturbances of background activity. 12.9% (during the resting record 9.7%) of the investigated persons showed paroxysmal slower and/or sharper transients and a further 4.4% (in the resting record 2.4%) hypersynchronous activity, which occurred significantly more often in women than in men. It also usually consisted of single fine spikes or sharp waves and only rarely did real sharp and slow-wave complexes or abortive spike-waves appear. Two patients (one with a normal and the other with an abnormal record) had spontaneous syncopal attacks during the EEG recording, showing in the EEG as generalized high voltage delta waves, which in one case changed into a transitory isoelectric trace. These EEG changes were similar to those in provoked vagovasal syncope, as described by other authors. EEG transients in patients with clinical vagovasal syncope are discussed. In the rare cases with very pronounced EEG changes, a neurological examination is advisable for complete assessment of the case. In patients with otherwise typical vagovasal syncope, long-term anticonvulsive therapy merely because of dyrhythmic transients and/or single fine spikes in the seizure-free period is, in the opinion of the author, not indicated.


[Testing of the antirheumatic agent tolmetin for its interactions with oral anticoagulants].

In 15 patients on long-term oral anticoagulation the new antirheumatic drug tolmetin (Tolectin) was administered over a period of 10 days. Based on 11 parameters of coagulation, no interaction between the drug and phenprocoumon was found. A significant though clinically irrelevant prolongation of bleeding time was observed.


[The fate of elderly patients who have been refused admission. Half-yearly catamnesis of patients not admitted to a psychiatric clinic  because of lack of space in 1973].

Six months after being refused admission to the psychiatric clinic, more than half of 128 patients over 60 years of age were found to be inadequately cared for in hospitals, homes and their families. Some were living in appalling conditions. Those admitted to other hospitals stayed there much longer than would be expected from the average hospital stay of psychiatric patients. Had these patients been admitted, the psychiatric clinic would very soon have been unable to admit emergency cases. This situation could be improved by providing better outpatient facilities, increased psychiatric supervision in homes for the elderly and more psychiatric day hospitals and homes. In this way psychiatric clinics could remain available for emergencies.


[Continent ileostomy--indication and possibilities].

Proctocolectomy with conventional ileostomy cures patients with severe ulcerative colitis but ileostomy appliances must be worn for the rest of their lives. The continent ileostomy, as devised by Kock, provides the patient with an intraabdominal ileal reservoir and a valve constructed by invaginating the efferent ileal segment into the reservoir. The patient empties his reservoir 2-3 times a day by inserting a catheter through the valve. Our experience with 14 patients is reported. The continent ileostomy was in most cases constructed as a second procedure after proctocolectomy. Minor postoperative complications, such as abscess, fistula or partial luxation of the valve were easily corrected. One patient who underwent proctocolectomy and simultaneous construction of a continent ileostomy died in acute liver failure due to a severe preexisting cirrhosis. All the other patients are continent for feces and gas and do not need external appliances. The construction of a continent ileostomy as a secondary procedure can be recommended in patients with proctocolectomy. It offers patients a life situation with differs only insignificantly from that of normal persons.


[Radioimmunological measurement of tetanus antitoxin].

A radioimmunological assay method has been developed for large-scale screening for tetanus antibodies. Its specificity is excellent and the sensitivity is in the region of 0.001 International Units per ml; it is thus comparable with the animal protective test. By this method a series of human sera was examined for which the vaccinal antitoxin titers were determined by animal protection tests. A parallel between the two tests was confirmed. Screening of 60 military recruits established that the test is usable as a mass method. Furthermore, the technique of Habermann and Wiegand was compared with ours and the results correlated well.


[Subcutaneous small heparin doses for the prevention of thrombosis in general surgery and urology].

1. The effectiveness of 3 X 5000 IU s. c. heparin daily (starting preoperatively) for the prevention of postoperative deep vein thrombosis was evaluated in a prospective, controlled, randomized study including general surgical and urological patients. 125I-fibrinogen test was performed daily in all patients. 2. 178 patients fulfilled the conditions of the protocol. 35.8% of the 95 patients in the control group developed deep vein thrombosis, but only 13.3% of 83 subjects in the heparin group did so. The difference is statistically highly significant (p less than 0.001). 3. The vast majority of all thrombi in both groups appeared before the 3rd postoperative day. 4. With 1 exception, all deep vein thrombi in the heparin group started in the mid-calf region. In the control group 5 deep thrombi originated in the popliteal vein. 5. Heparin displays a better effect in males (n = 34; p less than 0.01) than in females (n = 49; p less than 0.025). 6. In patients undergoing surgery for malignant disease heparin does not reduce the incidence of deep vein thrombosis. 7. Heparin is far more effective in patients under 60 years of age than in those over 60 (p less than 0.005). 8. Heparin is more effective in obese patients than in those of normal body build. 9. Heparin prophylaxis also reduces the incidence of deep vein thrombosis in patients who exhibit predisposing factors. In patients of the control group with preexisting disease of the venous system, there were significantly more deep vein thrombi (p less than 0.01) than in those without predisposing factors. 10. In the heparin group 29% of all thrombin time determinations show a definite prolongation of more than 26 sec (normal value 15 sec). 11. In 14 patients (=16.9%) of the heparin group, 21 side effects or complications were seen. Bleeding complications were the main problem, comprising 5 wound hematomas and hematomas at the injection site, 4 postoperative bleeding episodes and 2 reoperations. There were no complications in the control group. 12. According to the results of 10 well controlled studies, there is no doubt that in general surgery small doses of subcutaneous heparin, commencing preoperatively, do reduce the incidence of postoperative deep vein thrombosis to a significant degree. However, whether this form of prophylaxis is also effective in patients with fractures of the hip and in elective hip surgery cannot, on the evidence available, be decided. In the fields of gynecological surgery and urology as well, more data are needed before this form of heparin prophylaxis can be recommended.


[Hormonal contraceptives and myocardial infarct].

Out of a total of 36,208 admissions during the 21-year period from 1954 to 1974, 514 female patients were hospitalized for acute myocardial infarction. Only 4 of these 514 females were below 40 years of age. In addition to one of the generally accepted risk factors for coronary disease, all 4 patients had been taking hormonal oral contraceptives for a prolonged period. Although there is no direct proof of a connection between the use of oral contraceptives and myocardial infarction, there is increasing evidence that risk factors for coronary disease are potentiated by the use of oral contraceptives. In the presence of risk factors for coronary disease, therefore, oral contraceptives should be taken only on the basis of a strict indication and under regular medical supervision.


[The psychological behavior of tumor patients with agranulocytosis under conditions of isolation].

31 patients with severe leukopenia, including 27 with neoplastic diseases, were treated in a germfree isolator system for a total of 767 days. For this purpose the patients were informed of their diagnosis. Deprivation syndromes as well as aggressive and regressive behaviour patterns were the most common psychological reactions to isolation. In no instance was the isolation terminated because of psychological complications. A variety of factors are of particular importance in the guidance of isolated cancer patients: confidence in medical treatments, adequate information about the disease and therapeutic goals, firm human interrelationships and active participation of the patient in the therapeutic program. These are principles which can also be applied in the psychological approach to cancer patients in general.


[Double neoplasms in larynx and lung].

The incidence of primary malignant tumors in both the larynx and the bronchial system has been studied in the autopsy material of the Institute of Pathology, University of Zurich. In a total of 29,849 autopsies performed from 1960 to 1972, carcinomas of the bronchus were found in 1382 patients (4.6%) and carcinomas of the larynx in 214 patients (0.7%). 17 patients had primary carcinomas in both the larynx and the bronchus. The coexistence of both these carcinomas is about twice as frequent as their calculated chance combination. The importance of appropriate clinical examination of patients with lung or larynx carcinoma is accordingly stressed.


[Neuroradiologic examinations in ophthalmology].

Radiology can contribute to the solution of numerous diagnostic problems encountered in ophthalmology. Malformations, trauma, tumors and pseudotumors of the orbit and adjacent cranio-facial structures often require well ordered standard and tomographic X-ray techniques. Next in line are important and nonaggressive methods such as bone scintigraphy of the head and brain and orbit scintigraphy. More recently, computer assisted axial transverse tomography has already proved of great assistance. Finally, selective angiography of the branches of the external carotid and of the ophthalmic artery and phlebography of the orbit may be necessary. These techniques are briefly and systematically reviewed.


[Familial Wilson's disease: copper induced hemolysis, hypersplenism and hyperpigmentation as the main symptoms].

Wilson's disease was diagnosed in a 16-year-old adolescent who presented with signs of hypersplenism due to cirrhosis, with marked hyperpigmentation of both lower legs and neurological disturbances. In view of progressive thrombocytopenia and leukocytopenia, splenectomy was performed during therapy with penicillamine later in the course, and the result was good. The patient's 12-year-old sister was found to have a hepatic form of Wilson's disease with typical biochemical findings. During the initial hospitalization a severe, spontaneous copper-induced hemolysis was noted. Another sister probably has a presymptomatic form of the disease. The parents are healthy but heterozygote carriers with regard to biochemical findings. The importance is stressed of hypersplenism, hyperpigmentation of the legs and especially of acute hemolysis in infancy as pointers in the diagnosis of Wilson's disease. Further diagnostic and therapeutic aspects are discussed.


[Current elective surgery of chronic duodenal ulcers].

At present a number of different procedures are used for elective surgery of chronic duodenal ulcer. The merits and demerits of established methods such as subtotal gastrectomy, truncal vagotomy with drainage and truncal vagotomy with antrectomy are discussed from the viewpoint of operative mortality, recurrence rate and postoperative sequelae. Vagotomy techniques have been refined by the addition of selective vagotomy and proximal gastric vagotomy with and without a drainage procedure. Proximal gastric vagotomy appears to involve fewer side effects than any of the other methods. However, information about longterm recurrence rate after proximal gastric vagotomy is still scant. Methods for checking the completeness of vagotomy are still unsatisfactory. It is still not known whether the operation can or must be "tailored" to the needs of the individual patient according to the results of secretion studies. It is felt that the established procedures still have a place in the surgical treatment of chronic duodenal ulcer. Truncal vagotomy and drainage is a good operation, especially for emergency surgery and in poor risk patients. The longterm results of subtotal gastrectomy are less satisfactory than has been assumed, and it is therefore suggested that this operation should be performed less frequently in the treatment of chronic duodenal ulcer.


[The impairment of the ability to drive with blood alcohol concentrations of 0,5 per mille. A review of the literature].

As a contribution to the discussion surrounding reduction of the 0.08% limit, empirical data concerning the influence of blood alcohol levels around 0.05% on driving ability are reviewed. The papers reviewed, all of which satisfy the usual methodological standards, show that in the 500 subjects investigated there was already marked impairment of driving ability below blood alcohol levlels of 0.08%. Marked impairment is particularly apparent in those abilities which, with regard to the complexity of the perceptual and psychomotor patterns involved, are most relevant to the real driving situation: --decreased performance of simple and complex perceptual mechanisms, attention and vigilance; --decreased performance of psychomotor skills, resulting in impaired control of the vehicle in the real traffic situation. It can be concluded that even at these low blood alcohol levels an increased accident risk is to be expected.


[Proceedings: Indications and limitations of breathing gymnastics].

Chronic obstructive lung disease represents the most important field of application for respiratory physiotherapy. The technic comprises two successive stages: inhalation of a bronchospasmolytic and secretolytic aerosol (e.g. Alupent or Ventolin, diluted in tacholiquine or Bisolvon) followed by breathing exercises. These exercises are divided into three parts: respiratory movements such as diaphragmatic or abdominal breathing, drainage of bronchial secretions, and exercises to relax the muscles of the shoulders, the thorax and the skin, all these movements being executed in the rhythm of breathing. The effect of respiratory physiotherapy depends on the cooperation of the patient, the technic and the degree of severity of bronchiolar stenosis. The method is only successful in patients with slight to moderate bronchospasm; in those who suffer from dyspnea at rest it is usually ineffective. The prerequisite for success is longterm treatment. This means that the patient must continue to practice the acquired technique at home at least once a day. A description of the other indications for breathing exercises, such as bronchiectasis, chronic pneumonia, lung abscess, atelectasis, pleural fibrosis etc., is followed by a summary of the contraindications for the method.


[Proceedings: Home treatment of chronic respiratory insufficiency: carrier solutions for aerosol inhalations].

The excellent bronchodilatory effect of inhalation is widely accepted today. In order to obtain good results, correct instruction of the patient and correct choice of the nebulizer and inhalation solution are necessary. The performance requirements of the nebulizer and the most frequently used carrier solutions are critically discussed.


[Proceedings: Long-term therapy with steroids].

All glucocorticosteroids available at the present time exert a wide range of actions in every single cell of every organ. It is still not possible to dissociate the therapeutically desirable effects from the undesirable side effects, and whether this goal will ever be achieved is more than questionable. Thus, chronic treatment with steroids is invariably associated with side effects, but there are a number of therapeutic rules whose strict observance may prevent a patient in chronic need of steroid treatment from developing a second, iatrogenic disease. For example, there is strong evidence that spacing the administration or oral steroids, even without changing the 24 h dosage, may substantially decrease the steroid induced side effects without loss of therapeutic action. Another promising approach has been reported in the case of steroid dependent asthmatics, many of whom may be treated by inhalations of steroid esters with strong topical but low systemic effects.


[Proceedings: Cardiac therapy in chronic respiratory insufficiency].

The cardiac problems of patients with chronic respiratory failure are not confined to cor pulmonale. About one half of these patients also suffer from coronary heart disease with left heart failure, angina pectoris or arrhythmias. The specific difficulties surrounding cardiac therapy in these patients chiefly arise from the administration of digitalis, beta-adrenergic blocking and beta-adrenergic stimulating agents.


[Proceedings: Home treatment of chronic respiratory insufficiency: criteria of disability].

The degree of disability of a patient with chronic respiratory failure must be determined on a theoretical basis. Using a water filled spirometer, VC and FEV1 tracings are observed several times until the maximal values are clearly reproduced. The percentage deficit of the patients' ventilatory capacity is determined by the formula (see article) and represents the first approximation of the degree of disability (in %). The result must now be corrected by arterial blood gas data obtained during 5 mon exhaustive work on a bicycle or tread-mill ergometer. The percentage disability results from a correction depending on the arterial pO2 and the pCO2 found during exercise: deterioration of the arterial hypoxemia and/or hypercapnia leads to an increase and their normalization to a decrease in the disability quota found during spirometry. Patients with unstable chronic obstructive lung disease and respiratory failure should be evaluated only after adequate rehabilitation at home and at work, and after cessation of smoking. Patients under tuberculostatic treatment must also be excluded from disability evaluation. The degree of disability determined on the basis of lung function tests is a theoretical one; the tests must be performed by trained staff in a pulmonary function laboratory.


[Modified Cr51-chromium-albumin test for the differential diagnosis of exudative gastropathies and enteropathies].

A modification of the 51Cr-chromium-albumin test allows differentiation between protein-losing gastropathy and protein-losing enteropathy. After i.v. application of 51Cr-chromium-albumin, radioactivity is measured in the gastric fluid (basal after pentagastrin and after atropine, each for 1 h) and in the stools (96 h). In 9 healthy controls, radioactivity in the gastric fluid was 0.11-0.08% (x+/-SD) of the injected dose in the basal period, 0.28+/-0.04% after pentagastrin and 0.08+/-0.32% after atropine, respectively. Output of non-peptic protein in the gastric secretions paralleled the measured radioactivity. In a patient with edema due to hypoproteinemia associated with Ménétrier's disease, there was also a decrease in protein exsudation in the stomach when atropine was administered. After therapy with an anticholinergic drug, hypoproteinemia disappeared. Anticholinergic drugs may therefore be useful in the treatment of some cases of protein-losing gastropathy.


[Proteinuria in mature diabetic patients. Quantitative and qualitative analysis].

Proteinuria has been analysed in 334 maturity-onset diabetics and 80 matched controls. Proteinuria measured in the recumbent position exceeded 100 mug/min in 53% of the diabetic population. The percentage of excessive proteinuria increased with duration of the disease. Sex and age had no influence. Out of 55 first year diabetics, 49% had abnormal quantitative proteinuria; this is in contrast to 76 longterm diabetics (over 12 years) of whom 38% had proteinuria under 100 mug/min. Electrophoresis and immuno-electrophoresis showed a glomerular pattern in 40%, a tubular pattern in 15% and a mixed pattern in 8% of all the diabetics. 32% of the diabetics with quantitatively normal proteinuria were abnormal qualitatively, and this may be the first manifestation of diabetic nephropathy. Thirty-eight other patients had a normal electrophoretic pattern in spite of increased proteinuria. Proteinuria levels were significantly associated with hematuria, bacteriuria and reduced GFR, but not with leukocyturia, insulin dependence and hypertension. Upright position increased the proteinuria to a greater degree amongst the patients with normal proteinuria. We discuss the role of increased filtration pressure and glomerular permeability in modifying proteinuria in diabetes. Sensitive quantitative and qualitative proteinuria determinations are important tools both in early diagnosis of diabetic nephropathy in clinical practice and in epidemiological studies.


[Syncope in glossopharyngeal neuralgia].

The case is presented of a 51-year-old man with symptomatic glossopharyngeal neuralgia who exhibited syncope during some of the neuralgic attacks. Clinically and pathophysiologically, these syncopes differ from the "carotid sinus syndrome" by the fact that they are caused by irritation of the sensory fibers of the IXth cerebral nerve instead of the pressoreceptors in the carotid sinus. While carbamazepine (Tegretol) had only transient beneficial effects, complete relief of symptoms was obtained by intracranial section of the glossopharyngeal nerve.


[Diagnosis and therapy of liver actinomycosis].

A 47-year-old man who had undergone gastrectomy for duodenal ulcer required repeated hospitalization due to recurrent fistulas in the region of the laparotomy scar and increased cholestasis and cachexia. An intrahepatic and subphrenic abscess was diagnosed clinically and by liver scan and confirmed by laparotomy. The histologic findings revealed actinomycosis. Through early surgical drainage and administration of 20 million units penicillin G daily it proved possible to discharge the patient completely cured after 2 months. The pathogenesis of liver actinomycosis is discussed.


[Heme biosynthesis].

300--400 mg of heme is synthesized daily in the organism. Heme is the prosthetic groups of hemoglobulin, cytochromes and other hemoproteins. Major sites of heme synthesis are bone marrow and liver. At least 7 enzymes and intermediary products are involved in the sequence of reactions that lead from glycine and succinyl coenzyme A to heme. delta-Aminole-vulinic acid synthetase, the first enzyme in the sequence of reactions, is rate-limiting for heme formation and important regulatory events are directed at this enzyme.


[The complement system].

The complement system may be activated by at least two different pathways:  the clinical pathway involving C1, C4 and C2 and the alternative pathway involving properdin, C3, factor B and factor D. The classical pathway can be activated by antigen antibody complexes, while the alternative pathway can be activated by other substances such as natural polysaccharides. Both pathways lead to an activation of C3 and of the last complement components (C5 to C9). Congenital defects of the complement system have been described for several components. Some of these defects are relatively well tolerated, but others, such as C3 deficiency, lead to increased susceptibility to bacterial infections. Acquired complement defects are frequently observed in association with several diseases. Usually they are characterized by an increased level of complement components involved in the classical pathway and therefore reflect activation by antigen antibody complexes. Such changes may be systematic, as in lupus erythematodes, or localized to some biological fluids such as synovial fluid in rheumatoid arthritis. In some renal diseases the complement profile suggests activation of the complement system by the alternative pathway, and this may reflect a different pathogenesis.


[The care of the hemophiliac--our contribution to the prevention of his invalidism].

In view of the normal present-day life expectancy of the hemophiliac, our main task is to prevent disability. The chief cause of disability is joint and muscle hemorrhages, though these are not in themselves life-threatening. Their early and proper treatment serves to avoid disability through replacement of the deficient coagulation factor, careful immobilization of the affected limb and early physical therapy. Optimum treatment calls for close cooperation between the hemophilia specialist, the general practitioner or pediatrician, and the hemophiliac.


[Clinical use of factor IX concentrates].

Factor IX concentrates are of paramount importance in the treatment of hemophilia B. Growing reports of thromboembolic complications and of disseminated intravascular coagulation, coupled with the danger of hepatitis transmission, suggest that the concentrates should be primarily reserved for the treatment of hemophilia B. Concise guidelines for treatment are presented.


[Emergency transport of newborn infants. Organization and experiences in the Bern region].

Mechanisms of cardiorespiratory adaptation to extrauterine life are reviewed and the pathophysiology of impaired adaptation is discussed. An emergency transport service for sick newborns in the region of Berne, Switzerland, is described. It is manned by a specialized team consisting of a pediatric resident trained in anesthesiology and a pediatric intensive care nurse, and in 1974 emergency transport was provided for 135 newborns. Most had respiratory distress and there was a large proportion of prematures; a further large group was made up of newborns with infections and congenital cardiopathies. Mortality among the transported newborns was 25% in the first two weeks of life. Transport was by helicopter on 8 occasions and otherwise by ambulance. The financial aspects of the service are discussed, together with its advantages and disadvantages.


[The transmetacarpal oblique amputation of the index finger].

The main principles underlying amputation of the index finger are discussed. In two follow-up groups of patients the results have been compared of longest-possible finger stump versus transmetacarpal amputation of the second ray. Measurements were made of rough power (Vigorimeter) and pinch-grip power (Intrinsicmeter, Mannerfelt). Both measurements revealed higher power in the group with transmetacarpal amputation. Rehabilitation was likewise more rapid and favourable. For pinch grip the resected index finger is replaced by the midfinger without difficulty. Rough power is not impaired by narrowing of the hand. Transmetacarpal amputation of the second ray is thus a procedure to be advocated. The "small amputation of the index finger" now in more common use often provides merely a useless stump.


[Frequency of juvenile diabetes mellitus in the Canton Bern (Switzerland)].

The prevalence of juvenile diabetes in the under-20 age group was found to vary from 5.2 to 9.8 per 10 000 juvenile population in Canton of Bern (Switzerland), varying with the region. The overall prevalence was 5.9/10 000. There were twice as many juvenile diabetics in the mountain region than in the other two geographically different areas. The survey was carried out with the help of practitioners and chiefs of hospital services. Participation was close to 100%.


[Creation of an intercantonal tumor register].

A population-based Cancer Registry is a permanent system which records all the malignant tumors occurring in a particular geographical area. Its main objective is to set up the basis for the establishment of statistics, either for practical use (cancer control) or for research. More than a hundred such registries exist nowadays throughout the world, and in Switzerland a number have been recently created or are in process of organization (cantons of Geneva, Neuchâtel, Vaud, Zurich, Basel). A coordination group has accordingly been created to harmonize the data and the coding system, in order to allow the organization of an Intercantonal Registry.


[Do we have to treat non-Hodgkin's lymphomas the same as Hodgkin's disease?].

The pattern of Hodgkin's disease has changed significantly with the use of radical radiotherapy (total nodal irradiation) and chemotherapy, and with the general adoption of the histological classification of LUKES and the Ann Arbor modification of Rye staging system. Histological classification of non-Hodgkin's lymphoma is far from satisfactory, a fact which renders evaluation of the optimum treatment difficult. Spread is usually hematogenic. Bone marrow and mesenteric nodes are involved in 60% of cases, and therefore total nodal irradiation is ineffective in eradicating the disease. Chemotherapy is the treatment of choice except in some stages IE and IIE when, after careful pretherapy evaluation, local radiotherapy may be sufficient. In generalized lymphomas the role of total body irradiation is still under study.


[Hepatitis epidemiology 1974. With special reference to the canton Zurich and the Upper Country of St. Galler].

357 cases of acute hepatitis occurring in 1974 in two distinct areas of Eastern Switzerland have been analyzed. The incidence of hepatitis was 54,8 per 100 000 per year in an urban region (Winterthur, pop approx. 95 000) and 33,7 per 100 000 per year in a rural area (St. Galler-Oberland, pop 47 000). These figures are three to four times higher than those reported by the public health authorities. More than 50% of the hepatitis patients were 16-30 years old and only 3% were children below 15 years of age. Males were slightly in excess. HBSAg (Hepatis Bsurface-Antigen) was detectable by radioimmunoassay in 49% and anti-HBS alone in 8% of all patients. According to a careful anamnestic survey the mode of transmission was thought to be parenteral in 137 (39%) of the patients (68% of these being HBSAg positive), enteral in 131 (38%) (38% of these being HBSAg positive), while no anamnestic clue was found in the remaining patients (23% with 39% HBSAg positives). In 12% of the hepatitis cases, contact with other diseased individuals at the relevant time was recorded; however, no clusters of more than 2 patients occurred within the study area. The results are discussed in regard to other studies concerning hepatitis epidemiology in Switzerland. In an additional survey the medical staff of several laboratories have been repeatedly tested for HBSAg and anti-HBS at intervals of one to three months. Transitory antigenemia (up to 55% positive in one laboratory with only one hepatitis case), and transitory high incidences of anti HBS (up to 40% in one laboratory) suggest epidemic spread of hepatitis B infection. From all available data it is estimated that the ratio of hepatitis B infection to overt disease varies between 1:1 and 23:1 depending on the epidemiological situation.


[The therapy of diabetic coma: quantitative value of insulin loss on the infusion instruments].

The loss of insulin due to adsorption to glass and tubing has been quantitatively determined. The properties of albumin, plasma protein, gelatin, heparin and Rheomacrodex in the prevention of insulin adsorption have been tested. The loss of insulin given by intravenous infusion is reproducible and constant for any given situation. The loss of insulin increases as the ratio of volume to glass surface decreases and as the time of contact between insulin and glass is prolonged. There is an almost linear relationship between insulin loss and insulin concentration, as would be expected if insulin binding by glass was an unspecific phenomenon. Albumin and plasma protein almost completely prevent insulin adsorption. In most clinical situations the loss of insulin through adsorption to glass and tubing can be ignored, and hence no albumin or plasma protein needs to be added to the solution.


[Vitamin B 6 deficiency anemia].

The course of spontaneous vitamin B6 deficiency anemia in a 57-year-old woman is reported. The anemia was characterized by hypochromasia of the erythrocytes, hyperferricemia, absence of hemolysis, and hyperplastic, ineffective, sideroblastic erythropoiesis of the bone marrow. It was corrected by oral vitamin B6 therapy. On interruption of the vitamin B6 therapy the anemia relapsed. On resumption of vitamin B6 medication it responded again with normalization of the hemoglobin and erythrocytes values. The hematological remission could be maintained under longterm vitamin B6 medication. The nosological significant of this rare anemia and its differentiation from other forms of anemia are discussed.


[Hemolytic-uremic syndrome in a young woman following the use of ovulation inhibitors].

After prolonged intake of oral contraceptives a 28-year-old woman developed a hemolytic uremic syndrome with microangiopathic hemolytic anemia, renal failure, malignant hypertension and blindness due to papillary congestion. Renal biopsy revealed widespread arteriolar alterations with massive intimal thickening, narrowing of the lumina and fibrinoid necrosis. During treatment with anticoagulation, antihypertensives and hemodialysis the hemolysis disappeared and vision improved, but the renal failure persisted. The possible relation between oral contraceptives and hemolytic uremic syndrome is mentioned and the literature is reviewed.


[Study of a large family with hereditary angioneurotic edema].

A large kindred (156 members) with hereditary angioneurotic edema is reported. 44 members of the family exhibit typical symptoms of the disease: recurring edemas of the skin and episodes of abdominal pain accompanied by vomiting due to mucosal edema in the stomach and intestine. In 32 patients complement studies were performed which in  28 cases revealed decreased levels of C1-inhibitor and almost normal values for C3 concentration. Among 21 members of the family who had never had symptoms of the disease, 7 also had low levels of C1-inhibitor. In 6 of 16 women, attacks often occur in conjunction with menstruation. In 9 of 10 women the symptoms of the disease had worsened during their first pregnancy. 8 patients have been successfully treated with tranexamic acid for 7-20 months.


[Palliative treatment of metastatic breast cancer with diethyldioxystilbene diphosphate (Honvan)].

21 postmenopausal patients with skin or/and bone metastases of breast carcinoma received 100-120 mg daily diethyldioxystilbene diphosphate (Honvan) orally. 7 objective remissions were observed, 8 tumors remained unchanged, and 6 were progressive. In 3 cases, rapid tumor progression was suggestive of estrogenic stimulation. Side effects were the same as for other estrogens. Diethyldioxystilbene disphosphate is an active estrogenic compound in the treatment of breast carcinoma.


[The blunt pancreatic trauma].

A personal observation prompted study of the diagnosis and treatment of blunt trauma to pancreas. By comparison of the differing therapeutic approaches of various authors, an attempt was made to establish guidelines for optimal management of this lesion. Therapeutic considerations suggest a division of pancreas lesions into three groups: I. lesions to the left of the spine, II. lesions to the right of the spine, and III. ruptures of the neck. Each group calls for a different surgical procedure. Operative tactics involve three essential steps: 1. meticulous hemostasis, 2. management of the parenchymal lesion, and 3. efficient suction drainage.


Proceedings: Echocardiology.

Any technique which allows "a look inside the body" without being invasive, affords major diagnostic possibilities. The application of ultrasound offers this possibility now. The purpose of this paper is to review the current status of this relatively new diagnostic method for the detection and quantification of many cardiac disorders and to outline its usefulness. It may be said that echocardiology offers "the ideal diagnostic method" of the future, particularly when one considers the low cost-benefit ratio in comparison with other diagnostic methods such as angiocardiography.


[Epidemiology and clinical aspects of infectious endocarditis].

There has been a change in the epidemiological, etiological and clinical pattern of infective endocarditis. This changing pattern has been substantiated by comparison of 156 cases of infective endocarditis seen over the period 1947-1957 (period I) and 227 cases treated during the period 1961-1974 (period II). Epidemiologically the pathomorphosis consists in a slight decline in "medical" cases, contrasted with a marked increase of--predominantly acute--cases after cardiac surgery. Etiologically the change is characterized mainly by a reduction of streptococci (61%/33%) and a much higher incidence of virulent organisms, especially staphylococci (3%/21%), as the infective agent. With regard to the clinical picture of infective endocarditis, the changing pattern is apparent in an increase in atypical and misleading features and an often oligosymptomatic presentation. In period II the classical signs were more often absent. The difference in the course of infective endocarditis consists in a higher hospital mortality during period II. In this period the main cause of death was refractory heart failure, often provoked by acute rupture of the aortic valve. The factors which may be responsible for this change and the clinical implications are discussed. The difficulties in early diagnosis and the role of misleading symptoms of this still "malignant" disease are outlined. Special interest is focused on the diagnostic problems involved in recognizing acute endocarditis, right-heart endocarditis and acute rupture of the aortic valve.


[Proceedings: Chemotherapy of bacterial endocarditis].

The present concepts of antibiotic therapy in bacterial endocarditis are reviewed. Recommendations for the treatment of the most frequent pathogens -- streptococci of the viridans group, enterococci, staphylococci -- and for unknown organisms are presented. Antimicrobial therapy directed against gramnegative organisms, especially of the pseudomonas group, and against anaerobic bacteria is briefly discussed. The presence of renal impairment calls for adjustment of dosage; relevant nomograms are published in the literature. Probenecid may be added to the antibiotic therapy to increase serum levels of penicillins and some cephalosporins, though a major drawback is its side effects. Clinical experience teaches that every recrudescence of bacterial endocarditis adds permanent damage to an already impaired valve. Hence  it is of utmost importance that the aim of antimicrobial therapy should be a 100% cure.


[Proceedings: Surgical treatment of infectious endocarditis].

Surgical therapy of infective endocarditis can be undertaken as a prophylactic measure to avoid infection, e.g. in patent ductus arteriosus. In the majority of cases operations are done electively for correction of residual valvular defects ensuing on healed endocarditis. The most challenging problem is cardiac failure in the presence of active infection. While the surgical indication for life-threatening failure is generally recognized, the necessity of early operation, i.e. for acute valvular insufficiency with only mild cardiac failure, is still controverted. Valve replacement to remove a valvular form refractory to antibiotic therapy is less frequently necessary. In fungal endocarditis surgical intervention is recommended as soon as the diagnosis is established. Seven personal cases operated on in the presence of active infection are presented. All survived, but in one patient with fungal endocarditis the infected valve had to be replaced three times before healing was achieved.


[Proceedings: Right bundle-branch block without a wide split of the 2nd sound].

In a series of 38 complete right bundle branch blocks (RBBB) (17 "idiopathic" and 21 cardiopathies), auscultation and phonocardiograms disclosed a normal split second heart sound (S2 = A2-P2 less than or equal to 0.045 sec) in 27 and a wide split S2 (A2-P2 greater than or equal to 0.06 sec) in only 11 cases. Analysis of the initial and terminal vectors constructed from ECGs recorded at 250 mm/sec shows no valid correlation between a transseptal mode of depolarization of the right ventricle and the presence of either a normal or wide split of the 2nd heart sound. A review of the mechanisms generating the 2nd sound and discussion of the additional factors which may influence the duration of A2-P2 in RBBB (start of activation, length and quality of right ventricular systole, impedance of pulmonary arterial bed, possible delay of 2nd aortic sound) explain why wide splitting of the 2nd sound in RBBB is the exception rather than the rule.


[Proceedings: The evaluation of the mixed venous O2-saturation in the oxymetric determination of heart minute volume and shunt size].

An investigation has been conducted into three groups of patients without intracardiac shunt (A: 59 adults without anesthesia, B: 58 children in anesthesia, C: 53 children without anesthesia). Oxygen saturation in the pulmonary artery was plotted against saturation in both venae cavae or against saturation in only one of them. The resulting 9 equations can be used as formulas to calculate the saturation of mixed venous blood in patients with an intracardiac shunt. Furthermore, mixed venous saturation can be estimated from "subclavian catheter" blood samples in patients without shunt.


[Proceedings: Quantification of mitral valve insufficiency by means of videodensitometric measurement of the amount of contrast media in angiocardiography].

A new indicator quantity principle is presented which permits estimation of the regurgitant fraction in mitral incompetence from left heart angiocardiography by videodensitometric measurement of contrast medium content in the left heart chambers. In 90 experiments on dogs, a linear correlation of r = 0.89 was established between simultaneous determinations of mitral regurgitation by videodensitometry and electromagnetic flow measurement. Since only 1 catheter is needed for the injection of contrast medium and concomitant aortic incompetence can be computed from the same videodensitograms, this method is considered to be of special interest in clinical heart catheterization.


[Proceedings: Determination of the severity of aortic insufficiency with pulsed Doppler-ultrasound in the common carotid artery].

The severity of aortic incompetence can be assessed by quantifying the alteration of blood flow in the common carotid artery. The use of a pulsed multichannel ultrasonic Doppler device in 41 patients with aortic valve disease yielded a satisfactory correlation between the ultrasonic parameters and the maximal aortic regurgitation distance. Correlations between Doppler parameters and regurgitation (thermodilution) were less strict.


[Proceedings: The echocardiogram in the differential diagnosis of mitral valve insufficiency].

54 patients with mitral incompetence of varying origin have been studied by echocardiography. Echocardiography was usually not helpful in the diagnosis of pure mitral incompetence of mixed mitral valve lesions. However, it proved to be a sensitive method for recognition of the typical anomaly in "mid systolic click/late systolic murmur syndrome", which is ballooning of one or both leaflets toward the left atrium (17 out of 22 patients). The echo was equally useful for documentation of an abnormal systolic motion of the anterior mitral leaflet toward the septum, which was found in 7 of the 11 studied cases of hypertrophic obstructive cardiomyopathy.


[Proceedings: Erythrocyte 2,3-diphosphoglycerate during the development of myocardial infarct. Concerning 118 cases].

In four groups of patients with myocardial infarction the increase of 2.3-DPG concentration in erythrocyte was important when complications appeared during the evolution or when the patients died.


[Proceedings: Early mobilization after myocardial infarct--late results].

The longterm effects of early mobilization after myocardial infarction (MI) have been investigated. 122 patients aged under 65 years were reexamined 84.6 +/- 24 weeks after MI. The physical work capacity (PWC) of these men was 22% below the normal value. Patients with angina pectoris after MI had a PWC only 45% of normal. The overwhelming majority (88%) of MI survivors had returned to their jobs by the end of the follow-up period. Of the conventionally treated patients only 70% had returned to work. Age, PWC after MI and psychological status critically influence the rapidity and rate of return to work after MI.


[Proceedings: Cor triatriatum in an adult].

Case report on successful open heart surgery in a 21-year-old male with cor triatriatum.


[Proceedings: Results of the surgical treatment of valvulopathies and ischemic heart disease in patients older than 65 years].

53 patients aged from 65 to 76 years underwent surgery for valvulopathies (23 patients), atherosclerotic heart disease (24 patients) or both diseases combined (6 patients). All these cases were in NYHA fonctional classes III and IV except for one patient in class II. Hospital mortality after surgical treatment of these cardiopathies was 3.8% (2 deaths). The late mortality of 19% (10 deaths), though high, was of non-cardiac origin in 7 of these patients. The clinical and hemodynamic findings in the two patients who died in the postoperative period were compared with those in the others. These two patients were more severely ill and had a greater degree of cardiomegaly than the average patient in the surviving group. The satisfactory clinical improvement in these elderly cardiac patients suggests that surgery can be recommended at least up to 75 years of age if there are no obvious contraindications. Life expectancy of 13-16 years for patients aged 65 and 8-9 years for patients aged 75 is a further reason for advocating surgical intervention.